Background
Angela Butler is a 26 year old African American female living in the inner city of St. Louis, MO. She is the mother of three children ranging in aged 3, 7, and 10. She has expressed concerns regarding her stress levels and ways to alleviate the stress so she does not lash out at her children. Her primary care physician offered her a referral to our organization. Being a single mother, she does not have the support of a spouse, and in her particular case, she does not maintain a relationship with the fathers of her children. According to Angela, her mother put her out after she had her first child, so she has been on her own for ten years. When questioned about high school, Angela states she was an honor roll student, so she moved forward and got her G.E.D. once her oldest was born. She has been working as a homecare aide for the last seven years. Ms. Butler’s children attend school during the year, along with the youngest being in a pre-K program. After hours and during the summer, Angela tries to enroll them in programs, but is not always successful because of financial reasons. Not having the support of her mother, the fathers of her children, or other family, Angela has turned to our services for support.

Potential for Progress Angela appears to have wonderful ability to progress with brief counseling techniques. Because of her initiative to move forward and sincerity, I believe she will reach her goals quickly. She will be re-evaluated monthly for progress reports. These evaluations will be conducted by her primary therapist, therefore they have a clear understanding of her progress, and their rapport is true. Upon conclusion of the re-evaluation, Ms. Butler will be given a progress score within a week. This score will range from 1 to 10. 1 being little or no progress has been made and 10 being there has been complete change and improvement. With the score, she will be provided recommendations to assist her in reaching her goals.

Financial Responsibility Angela’s financial obligation in this area is free. Because she has MO HealthNet as her insurance carrier and was referred by her physician, she is expected to pay $0 out of pocket. Ms. Butler has been presented this information at our intake meeting, and has signed the HIPAA forms. She has been made aware of her rights as well.

The Plan [60 min session bi-weekly] Initially, we will look to see what triggers Angela has upon getting home from work that causes her to be short with her children. We want to provide Ms. Butler the tools to handle her stress, while also teaching her children how to handle theirs appropriately. Giving each child specific duties to do around the house will teach them responsibility and help Ms. Butler with small things. Rewards will range from an extra 30 minutes up past bedtime, to scheduled alone time with Angela or without being bothered by siblings. Angela will be able to increase their responsibility as they grow older, and rewards will be equal to their duties. Knowing Ms. Butler’s financial situation, we are currently staying away from monetary rewards to not aide in the financial stresses she is facing. As Ms. Butler progresses through our program, we expect her to be able to utilize techniques and express herself without lashing out at her children. Progress for her will be rewarded by her taking time for herself. She will understand that though she is a mother, she still has to have downtime to gather her thoughts. We will introduce journal writing for self-reflection and as an option for her to recognize what is pushing her over the edge.

Other Options
Though our short term counseling plan is going to be the initial area of focus, if referrals to other programs are necessary, with the appropriate approval, Ms. Butler will be given the opportunity to explore other counseling techniques. She has been informed not all techniques work the same nor is each client the same. We are starting with cognitive-behavior brief counseling because it appears that she is wanting more help at home, and to relieve basic stresses. If a referral is deemed necessary, Ms. Butler will find out through communication with her therapist and by written correspondence that will also be supplied to her primary care physician as well as MO Health Net.

Potential of Training to Prepare
Because the techniques we are offering Angela are reward based, we believe they have the potential to work wonderfully for her and her family. Angela’s work schedule, though primarily set, can change at any many if one of her clients are hospitalized or changes their desired shift. Angela does not make a lot, financially, so she is always trying to ensure her children have what they need and make ends meet. Though her children are young, she says they understand that “mommy works hard.” This brought tears to Angela’s eyes because she wants them to have everything she did not have growing up.
Angela will be provided with small tasks and rewards for her children to do. The rewards will not be financial, but just quality time with either her or alone. Her oldest, though only 10, has the ability to do more around the home. Angela wants to learn how to motivate her children to help when she comes home. Angela works shifts upwards to 12 hours a day, 6 days a week. She says that her clients that have longer shifts require more assistance and care than the short shifts, so when she comes home she is tired and has the capability to be short with her children. So not only will we be working on motivating the children, there will be techniques for her to take away to deal with her temper. The techniques will be ones that can be taken home for her particular situation, and she can instill them in her children for their future. Ms. Butler can utilize these same techniques in the workplace as well. Additional techniques will be given to her at the conclusion of her sessions that she can look into on her own time.

Conclusion of Services Once the initial care plan has been executed, there will be periods of checkup. During the care plan, re-evaluations are monthly, and afterwards, they will go to quarterly. If after the second quarterly visit, everything remains in a positive area for Angela, we will discontinue our services, otherwise we will continue with quarterly evaluations. The decision of whether or not to continue will be discussed by the approval board at a monthly meeting. Angela, her primary physician, and insurance company will be made aware of our recommendations via phone call and written letter, and with the appropriate approval, we will move forward.