Practicum Experience Time Log and Journal Template
Student Name:
E-mail Address:
Practicum Placement Agency’s Name:
Preceptor’s Name:
Preceptor’s Telephone:
Preceptor’s E-mail Address:
(Continued next page)
Time Log
List the objective(s) met and briefly describe the activities you completed during each time period. If you are not on-site for a specific week, enter “Not on site” for that week in the Total Hours for This Time Frame column. Journal entries are due in Weeks 4, 8, and 11; include your Time Log with all hours logged (for current and previous weeks) each time you submit a journal entry.
You are encouraged to complete your practicum hours on a regular schedule, so you will complete the required hours by the END of WEEK 11.
Time Log
Week
Dates
Times
Total Hours for This Time Frame
Activities/Comments
Learning Objective(s) Addressed
Total Hours Completed:
Journal Entries
· Include references immediately following the content.
· Use APA style for your journal entry and references.
Practicum Experience Time Log and Journal Template-Student Name:
E-mail Address:
Practicum Placement
Preceptor’s Name:
Preceptor’s Telephone:
Preceptor’s E-mail Address:
Demographics Information:
The client is 18-year-old black male, living with the parents in Smithfield, NC. He speaks English as his first language and attends high. His family is a middle-class family, with the parents working in white-collar jobs in various different organizations in Raleigh, NC. The client is covered by the health insurance of the parents, in which they are subscribed to Blue Cross Blueshield.
Presenting Problem:
The client described himself as being easily aggravated by small things and has a short temper. The teacher of the client, commented that the client was frequently involved in fights during the school times. The mother of the client also mentioned that the child sometimes refuses to act on her requests, such as doing house chores and constantly bullies her small sister and brother.
History of Present Illness:
The client mainly comes to the clinic, with the parents, with regards to the above problems. The main concerns of his parents, is the behavior of the client while at home, and the various complaints by the teachers and the disciplinary board in the school, about his aggressive behavior. The parents are also concerned about the poor academic performance of their child. The parents of the client, have reported for about over a year, the client has constantly been bullying his siblings, and sometimes even fighting them. The client has also, on several occasions, ignored request from the parents, to wash his clothes or perform other common house chores. The parents admit that even they noticed the behavior as early as when he was aged 7, they initially brushed it off, and though that he would grow out of it, and learn to live in harmony, with the friends or siblings. When he reached adolescence, the parents thought the behavior was largely a characteristic of people reaching this stage of life. As such, the thought that the problem will slowly go away as he matured.
The report from the school is very similar to the report offered by the parents. At school, the client is describing as being troublesome, with little regards to following orders or school rules. On the other hand, the client has been easily irritable and gets into fights easily. On several occasions, the child has been transferred to other schools, as well as getting suspended, due to the problem of following rules and not heeding to authorities. In one instance, the client has been accused of causing major physical harm to some of his classmates, in one of his fights. The teachers describe that his irritability, make him to have little concentration in class, which further makes him to perform poorly in school work. The poor performance in school is majorly attributed to his behavior, which makes him to have trouble concentrating in class or undertaking any activities, especially those that require the formation of groups, due to the fact that he has trouble forging good relationships with others.
Past Psychiatric History:
From the accounts of the parents, the client does not have incidents, relating to visits to the psychiatrists. Furthermore, the patient has never been hospitalized, due to mental illness or disorders. However, he was taken as outpatient at the age 12, in a psychiatric clinic. In this, the teachers noted how he had difficulties in forging peaceful relationships with other students, as well as disobeying some of the school rules and people in authority. The client was reported to be easily irritable and as such, engage in arguments or fights, with anyone, regardless of the age or authority. On the other, while at home, the client would easily get into fights and quarrels with his siblings, regardless of the issue at hand. Furthermore, the client was noted to result fighting as the only method of resolving conflicts. The parents also noted that the client would at times ignore their calls or requests and orders. His bedroom was highly unorganized, with little attention given to tidiness, which was part of his chores in the house.
At the time the client was brought to the office by the parents, he was evaluated, but there was no official diagnosis given to him or the parents. As a result of this, the provider mainly referred him to undertake a family therapy or psychoeducation. The intervention was highly successful as the parents were able to have some little information, on what was the problem with their child. Furthermore, through the family therapy and psychoeducation, it was noted that there was some significant improvement in the behavior of the child, both at school and home, until the current episode, which necessitated the parents to bring him to the clinic.
As a result of the condition, there was really no need for the psychoactive or stimulant medication as some of the pharmacological intervention to the problem facing the client, owing to the main reason that the psychotherapy, mainly seemed to be effective. However, it should be noted that there is no a one-size-fits-all treatment option, for the children as well as the teenagers that suffer from ODD. Despite all this, the most effective treatment plan for the disorder, are mainly tailored towards the behavioral symptoms as well as the needs of the client. It should also be noted that some of the treatment options are majorly determined, based on a number of different things.
These include the age of the client, the nature and severity of the behaviors and whether the client has another mental health condition, which exists at the moment. Due to the nature of the behavior of the child, as it touched on both school and home life, it was largely agreed that he be enrolled in a social skills programs as well as some school based programs. These programs mainly teach the adolescents as well as the children, how to relate positively with other peers and also help them improve they’re on their school studies. Furthermore, the therapy is usually considered to be very successful, especially when done in a natural environment.
Medical History:
At the time of the presentation, the client had no fever. He was weighing 165lbs, with a height of 6 ft. and 3 inches. His BMI index, was thus 21.18. From the BMI, it is seen that the client is healthy, as it falls within the acceptable range of 17.1 to 24.2 for this age, weight and height. The client has no known allergies, to any drugs or food. Furthermore, there is no history of head or head or trauma injuries, which have led to the loss of consciousness. Furthermore, the client has no major physical injuries, except for scars on his face, which are majorly attributed to the fights that he has engaged in, while at school and at home.
Developmental History:
Developmental Stages: The mother acknowledged that she had some good prenatal, while pregnant with the client. The mother admitted that she always took care of herself and watched her nutrition as well as exercise, while she was pregnant. However, the mother admitted that it was a stressful period, owing to the fact that they were jobless and had little money to support themselves. It should be noted that stress and anxiety, especially in pregnant women, increase the chances and risks of the infants, to develop ADHD and ODD, as well as other complications (Burke & Loeber, 2010). From various literatures, one of the factors that increase the risk of getting ODD is the participation of smoking during pregnancy. However, the mother denied engaging in any substance abuse, during the pregnancy (Sadock, Saddock, & Ruiz, 2015).
Developmental Milestones in Toddlers
The mother stated that the client started walking when he was about 20 months old. Furthermore, in most her visits to the doctors, the client was never diagnosed with having some problems with his cognitive development. The mother stated that he grew up normally, just like his siblings. The mother also acknowledged that the client started uttering words when he was 2-years-old. He also started his toilet training at the age of 3, and before the end of the pre-school period, the client had gained perfect control of his bowel. The cognitive abilities of the client were also well developed during this period.
Substance Use/Abuse History:
Substance 1st use/amount Period of heaviest use/amount Method of use Last/current use/amount
Amphetamines He denied None None None
Bath salts He denied None None None
Benzodiazepines He denied None None None
Caffeine Pa He denied None None None
Crystal Meth He denied None None None
Ecstasy He denied None None None
Energy drinks He denied None None None
Heroin He denied None None None
Marijuana He denied None None None
Methadone He denied None None None
Narcotics He denied None None None
Nicotine He denied None None None
PCP/Acid He denied None None None
Spice He denied None None None
Other (specify) NA None None None
The client denied ever engaging in substance abuse. Furthermore, the parents also admitted that they had never smoked but occasional ingested alcohol.
Psychosocial History:
One of the main things that is very relevant to the clinicians, in planning for the treatment of their clients, is the social and personal history of the client (Sadock, Sadock, & Ruiz, 2015). The client is current in his 12th grade, however, he is not behaving like normal teenagers of his age. The client does not have romantic relationships, but likes to play football. The client is the first born in a family of three. His siblings are twin girls, who are in their 7th grade. The family has never separated, and the client has lived with his parents the entire time.
On the other hand, the client has been suspended and transferred to other schools, due to various disciplinary problems. He has been described as being short-tempered and high-headed, as he rarely follows instructions. He frequently engages in arguments as well as fights with most people that he disagrees with on some issues. The client comes from a middle-class family, which is able to provide most of his necessities.
amily Psychiatric History: Family Genogram
History of Abuse/trauma:
The client has no trauma or abuse history.
Review of System & Assessment
ROS
The Review of the system, is very critical in the coming up with a treatment plan, as it helps to determine the complications that could result from treatment, which can further have negative effects to the client during treatment (Wheeler, 2014). The physical exam on the client was done on August 2018, while his dental care examination was done on June 2018.
Constitution: The client sleeps an average of 8 hours every day, and denies sweating at night.
Eyes: Denies any problems with vision.
Ears: Denies any problems with hearing.
Nose: He denies problems with a sense of smell, unusual nasal congestion, or nose bleeds.
Throat and Mouth: He does not have any part or functionalities of his throat and mouth.
Head and Neck: Denies history of losing consciousness or injury to his head. The head is symmetrical and no bumps on his scalp.
Respiratory: There was no adventitious sound heard. All breath sounds were normal.
Cardiovascular: Denies chest discomfort and tachycardia. S1 and S2 sounds were normal.
Gastrointestinal: He goes to the bathroom every day. He denies problems with his appetite. Although he may not finish his food at a sitting, he eats very well. His gastrointestinal function was unremarkable.
Genitourinary: The individual denies diurnal or nocturnal enuresis. His gastrourinary system was without problem.
Musculoskeletal: The client able to move all extremities with full range of motion.
Psychiatric and Neurologic: The client denies history of mental illness. The client could not recall history of brain injury.
Mental Status Examination:
Appearance: The individual’s appearance matches his age. His dressing was neat and he looks well fed.
Attitude and Behavior: The individual shows cooperation during the interview though he rocks himself in the chair. He also asks for restroom breaks while he was having the interview; he looks directly in the eye of the clinician. He makes eye contact though not sustained during the interview.
Speech: The client is talkative. He talks a lot with normal rate, volume, and tone. Though, he blurts out the answer even before the questions are asked. There was a fast latency of response in his speech. His speech is coherent.
Motor Activity: The client has sat up straight in his chair, and there was no hand tremor, lip smacking or head rocking noted.
Affect and mood: The client reports that his mood was good. And his affect is congruent with mood. His affect too was broad and expansive. He denied suicidal ideations or plan or intention.
Temperament: The client has a short temper, and is easily irritated by various small things.
Perception: He denies hallucination or illusion.
Thought process: The client’s thought process was organized and logical. He frequently answers questions rather too instantaneously.
Thought content: The client denies delusions, and there were no obsessions or preoccupations.
Sensorium and Cognition: He is alert and oriented to person, place, time, and situation.
Memory: His short-term memory is okay and long-term memory intact.
Abstract thought: He was able to explain “an apple a day keeps the doctor away,” he said “if a person undertakes to look out for themselves, through nutrition and exercise, they are capable of keeping most illnesses at bay,” That means abstract thinking was okay.
Intelligence: The client’s knowledge seems normal for his age and educational level.
Insight: His insight was difficult to assess at the moment.
Judgment: His impulsivity greatly affects his sense of judgment.
Physical Assessment and Neurological Examination
Vital Signs: BP: 106/62, HR: 67; R-18, T- 98.2
Pain: The individual rated pain 0/10.
Height/Weight: Ht= 6’ 2”, Wt= 160 pounds
Body mass index percentile was 21.
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Neurological exam
Mental status: The client is alert and oriented to person, place, time, and situation. He was very calm and cooperative during the interview.
Assessment of Cranial Nerves:
Olfactory nerve (I): the client could smell vanilla and had intact olfactory nerve, which is CN1.
Optic nerve (II): On the Snellen Chart, the client’s visual acuity was 20/20 which indicated optic nerve was intact.
Oculomotor nerve (III), trochlear nerve (IV), and abducens nerve (VI): the client’s ability to control his eyes movement in every direction both horizontally and vertically portrayed intact CN III, IV and VI. The eye nystagmus was absent.
Trigeminal nerve (V): the client had an intact blink reflex, and he could feel the sense of touch of both sharp and dull with eyes closed. His trigeminal nerve is intact.
Facial nerve (VII): The client’s facial muscles are well innervated as evident by his ability to lift his eyebrows, grimace, and smile.
Acoustic (VIII): It is the cranial nerve employed to listen to sound and hear. He demonstrated ability to hear without any difficulty.
Glossopharyngeal nerve (IX) and Vagus (X) nerve: the cranial nerves IX and X are intact as evident by the client’s ability to verbalize “ah” without any deformities noted in his soft palate. His gag reflex is intact as shown with his ease of swallowing effortlessly.
Spinal accessory nerve (XI): The client demonstrated intact CN XI as evident by his ability to lift his shoulders up against resistance and move his head in all direction within normal range of motion. Hypoglossal nerve (XII): The client’s hypoglossal was within normal functioning as evident by his tongue movement in every direction.
Lab/Diagnostic testing
Test Patient’s Value Normal Range
Urine Opiate Screen negative negative
Urine Buprenorphine negative negative
Urine Oxycodone negative negative
Urine Methadone negative negative
Urine Propoxyphene negative negative
Urine Barbiturates negative negative
Ur Tricyclics negative negative
Phencyclidine Screen negative negative
Urine Amphetamines negative negative
Urine Methamphetamines negative negative
Urine Benzodiazepines negative negative
Urine Cocaine Screen negative negative
Urine Carboxyl THC Screen negative negative
The client tested negative to using the street drugs.
Assessment tools:
Differential Diagnoses (Diff. Dx.):
The differential diagnosis must be ruled out for a client to get proper treatment and better outcome of care. So, clinicians must be versatile to the condition that may present as the actual diagnosis but are not (Carlat, 2017). For this case study, the DSM-V has the following differential diagnosis for a client for an eventual diagnosis of ODD.
1. Oppositional Defiant Disorder (ODD). ODD is different from ADHD in that children with ODD are more or resisting order or instruction from higher authority in the form of negativity, defiance, and hostile as against a child with ADHD who action is characterized behaviorally as being inattentive, hyperactive and impulsive. Therefore, since this boy did not present with the symptoms of being hyperactive, inattentive and impulsive, ADHD as a possible diagnosis is eliminated (APA, 2013).
DSM-V Diagnosis:
Oppositional Defiant Disorder
Case Formulation:
In school, teachers have always described the client as being difficult to work with others and cannot join group works effectively. Teachers have also said that he completely disregards and flaunts various school rules. He also ignores orders from authority. At home, the parents claim that he bullies his younger siblings and even beats them up, whenever an adult is absent. Furthermore, the parents claim that the client sometimes disregards the rules or requests.
Treatment Plan:
The client being a 18-year-old, with ODD, will need the cooperation of both the teachers and the parent, as part of the treatment plan. The parents will be enrolled to a family therapy, which will teach them how to manage the behavior of their child. On the other hand, the client will be enrolled in a social skills program that is school based, to ensure that he learns appropriate socialization skills with the teachers. Since the client does not posses’ severe symptoms of the disorder, no medical intervention will be needed.
Medication/medication adjustment:
Medical intervention will not be needed.
Assessment Tools with Rationale:
For the condition, the assessment tool that was used was the Diagnostic Interview Schedule for Children. According to Galanter and Jensen (2009), parts of the questionnaires can be very helpful in determining the extent of the problems caused by ODD. From the assessment, the information from the patient, corroborated with the manual for the questionnaire.
Referrals and Rationale:
The patient will return to the clinic after two weeks, to check on his progress and response to the therapy.
Therapy with Rationale:
Since the problem is prevalent at both school and home, the family and the teachers at school, will be collectively needed to be approached in the therapy options of the client
Legal Issues:
The parents gave consent for the treatment
Patient Education:
The ODD is one of the mental disorders that is commonly diagnosed in the school going children. The disorder mainly occurs to about 2% to 16% of the entire population in U.S. Some of the common symptoms of the disorder include being short tempered, arguing with adults and easily irritable.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Burke, J., & Loeber, R. (2010). Oppositional Defiant Disorder and the Explanation of the Comorbidity Between Behavioral Disorders and Depression. Clinical Psychology: Science And Practice, 17(4), 319-326. doi: 10.1111/j.1468-2850.2010.01223.x
Galanter, C. A. & Jensen, P. S. (2009). DSM-IV-TR-IV-TR casebook and treatment guide for child mental health. Washington, DC: APA
Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock’s synopsis of psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Philadelphia: Wolters Kluwer.
Wheeler, K. (Ed.). (2014). Psychotherapy for the advanced practice psychiatric nurse: A how-to guide for evidence-based practice (2nd ed.). New York, NY: Springer Publishing Company.