Trauma Case Study Essay

Background Information:

Bill is a nine-year-old Caucasian male. Bill is currently living with his biological mother (Crystal age 32), sister (Sage age 3), aunt, cousin, and grandmother (Jessica). Jessica owns the house and Bill’s family and grandmother live on the second level and his aunt and cousin live in the basement. The home environment appears to be safe and stable with adequate space for everyone currently there. Bill hasn’t had any contact with his biological father since he was one-year-old. Crystal is currently single. Crystal is employed full-time and Jessica provides childcare for Bill and Sage while Crystal is at work.

Approximately 9 months ago, Bill injured Sage’s eye with a pencil when they were left unattended at home. Once

Bill realized the severity of the injury, he called 911. Police and DCFS workers arrived at the home and an investigation was opened. Bill said he injured Sage because she was a dragon that he needed to kill. Bill was removed by DCFS due to suspected parental neglect since he and his sister were left at home alone. Following Bill’s placement in a foster home, his behavior escalated and he became increasingly violent towards his foster families and property, which resulted in being moved to five different foster families in six months.
In 2017, following placement with the second foster family, he spent a month at a psychiatric hospital due to extreme behavior reported as aggressive actions towards the foster family and property, orally describing himself living in an alternative reality, and being non-compliant to his foster parents’ requests and was admitted for suspected psychosis. Crystal moved in with her mother and regained custody of Bill following his six months in foster care.
Bill was also admitted to a psychiatric hospital in 2015 for possible psychosis. There is a family history of developmental delays and possible Autism Spectrum Disorder on Bill’s maternal side (uncle, aunt). There is a history of parent/child relationship difficulties between Crystal and Bill and academic problems. Crystal reports that Bill met all his developmental milestones. Bill is smart, hyper-verbal, aggressive, and experiences paranoia that could be related to domestic violence and past emotional and physical abuse, and possibly has PTSD. Bill has difficulty with transitions. He has experienced intense fears since the age of three. He has a tendency to retreat into his imaginary world. Bill was diagnosed in 2015 with ADHD, Mood Disorder NOS, severe family, Autism Spectrum Disorder, school, and peer problems.
Presenting Problem:
Bill was referred for treatment with the school social worker due to his disruptive classroom behavior. Bill yells, throws objects, hits, hides in the corner, or refuses to comply with teacher requests or when the class transitions to various activities. Since he was admitted to the psychiatric hospital for suspected psychosis in 2017 during foster care placement, he has continually struggled to manage his behavior. Bill’s mother and teachers are having difficulty with behavior management to limit his outbursts that sometimes threaten others around him.
Currently at home and in the classroom Bill has the following symptoms; inattention, irritability, aggression, lack of social skills, difficulty regulating his emotions, and is non-compliant to requests.

He has difficulty making and maintaining peer relationships. His teacher reports Bill has a couple friends in his class but struggles to maintain friendships outside of the classroom. Bill lives with his mother, sister, aunt, cousin, and maternal grandmother in a two-level single home. Bill has a difficult relationship with his mother and acts defiant towards her, doesn’t get along with his cousin, and sometimes acts aggressively towards his

sister.
Trauma:
Bill experienced physical abuse as a newborn by his father until he was one-year-old. Bill was emotionally abused at age three by his mother’s boyfriend for a period of 6 months. Bill has also experienced emotional abuse from his step-grandfather from birth until age seven. His step-grandfather and grandmother are no longer married and he does not have any contact with Bill currently. Bill has trauma related to his removal by DCFS and from being placed in five different foster homes in six months. He also has trauma related to his two stays at a psychiatric hospital.
These traumatic experiences have caused Bill to feel that he can’t control what happens to him, which makes school especially difficult because of the frequent transitions and lack of control over his environment.

The emotional and physical abuse and multiple foster care placements cause him to feel as though no one likes or cares about him. He also fears being removed from his family again. Bill is frightened by hospitals, medical professionals, and authority figures. Bill hides in the corner, is violent (throws objects, hits, acts out aggressively), or screams when he is triggered. Triggers include being ignored, transitioning to different activities, and when he’s told he can’t do something (feels like he isn’t in

control).
Engagement Strategies:
Bill is eager to attend sessions with the school social worker and has a cheerful affect, and answers most of the social worker’s questions, although he has difficulty focusing. He appears to be willing to work on reducing his emotional outbursts. He avoids talking about his traumatic experiences at UNI, in foster care, and abuse. Bill meets with the school social worker alone and sometimes with his mother. Crystal is willing to attend sessions with the social worker when her schedule allows, and has agreed to meet with the school social worker once a week. Crystal believes that Bill’s participation in sessions with the school social worker will be helpful. Crystal is willing to learn parenting skills. The sessions with Crystal will include time alone and time with Bill.
To engage Bill, the social worker will identify activities he enjoys doing, such as art (drawing, clay, collage, painting, etc), games, sports, and activities. To ensure his mom is engaged, she will be involved in sessions, treatment planning, and implementation. Activities that Bill enjoys such as reading and computer games will be used during sessions or as rewards for participating in sessions. Bill’s interests will be incorporated into the therapy sessions, which may increase his compliance and enjoyment in therapy.
Bill may be more likely to engage in therapy if he is able to use kinesthetic activity since he has difficulty sitting still for long periods of time. Bill could be allowed to bounce on a ball, play with playdough, or softly kick or toss a ball back and forth between the social worker. Bill’s engagement in therapy could increase if he is rewarded at the end of a session with a sticker, or 10 minutes of playing a game with the therapist. The effectiveness of engagement can be measured by asking Bill and Crystal to complete short surveys about their relationship with the therapist.