Problem:
Ruben is an 18-year old youth admitted to a residential treatment facility two days ago after his parents called 911 due to his violent behavior towards them and he was assessed to need a structured level of care for his own mental health and behavioral needs. During the intake, it was discovered that he had received harsh and bizarre physical punishments from his parents and protective services was called to investigate. His parents admitted that since Ruben's behavior has escalated, they have become scared and overwhelmed leading to poor choices in discipline. They are glad that he is receiving services because the stress of trying to manage his aggressive behavior was impacting their ability to provide effective care. Ruben's parents have been actively trying to access resources to teach them how to better handle his outbursts. Still, knowledge of and access to help are proving difficult in their small community, and they have not been successful. They say they want their son to get help and return home.
Ruben has 2 older brothers that he generally gets along with, and both of his parents are active in his life. Ruben enjoys gardening because he can easily see the positive results of his work; when working in the yard, he becomes focused on the task and time flies by pleasantly. He is proud of his vegetables and flowers and shows the garden to anyone who visits the house. The family resides in a small rural community where they are all active in the church.
While Ruben was diagnosed with Autism Spectrum Disorder at a young age, he only became violent towards his parents in the last two years. Before then, his anger was often directed at windows and mirrors. One time he couldn't break a window with his hand so he put his head through it resulting in a trip to the ER and multiple stitches. Ruben also admits to trying to choke his mother and "attacking dad." His violent behavior towards people and objects has always been impulsive.
Ruben had not been receiving mental health services but was prescribed medication by his primary care doctor to manage his aggression. His mother stopped the medication when she felt it was not helping, and he has not been taking it for 6 months. Now that he is in a supervised care setting, staff makes sure he takes his medication regularly. He completes chores with reminders and independently manages his hygiene and other daily living tasks.
Because of Ruben's aggression, he has participated in online schooling for the last two years. Due to his ASD symptoms, he lacks appropriate social skills and boundaries with peers which results in him unintentionally crossing the line and making them feel uncomfortable or angry. He will need to be assessed before starting school on campus; the online school has evaluated him educationally at the 5th-grade level but he is making progress quickly towards the next level. Ruben has not yet held a job or volunteered. When asked what he wants to do for a job, his response is simplistic and disorganized: he thinks he could be an altar boy at the church because someone needs to take care of all the plants or he could become an accountant like his father (though he admits that he's not very good with math). He knows how to use his computer to do schoolwork and other essential functions and to play online games. Since Ruben is new to the facility, staff has told him that if he stays on for two weeks and continues to maintain his daily routine, he can be considered for employment in their community garden.
In the 2 days that Ruben has been at the residential facility, he has twice required physical holds for brief periods due to physical aggression (trying to put his head and hands through a window). In addition, he often becomes upset when his mom calls. Ruben struggles to control his anger and cannot explain what makes him angry. Ruben displays obvious symptoms of post-traumatic stress disorder such as flashbacks (i.e., memories of his punishment) and rapid breathing. Ruben has been referred for routine medical and mental health assessments, with a further trauma assessment requested. Need Assignment Help?