case study

Case Study
Sam is in his 40s and has Marfan Syndrome. This is a genetic condition which adversely
affects connecting tissue (long limbs and long,thin fingers). Sam has defects of the heart
from the condition which can create a racing heart and/or aortic problems. In addition it
can cause spontaneous lung problems and dislocation of the lens of the eyes. Sam has an
IQ between the mild and moderate range. He has a history of seizures but none noted for
years. He currently takes Celexa for anxiety, Levothyroxine for hypothyroidism and
Lisinopril and Metoprolol for symptoms of Marfan Syndrome. He sees doctors frequently
to monitor his symptoms. He needs information concretely given and gets very confused
at times forgetting information especially when he does not like it. He in the past (2009)
touched a 6 year old boy in a store bathroom. He also touched a teenage boy who was
lower functioning when he was in his teens. Sam has no major mental health problems
but in the past had a problem with drinking beer to excess when stressed.
Sam grew up with an abusive father and attended special schools until he was 22 not
living in the home. He has always resented his parents for taking him out of the home.
His parents are now divorced. He loves his mother but at times tries to bully her. He sees
mom as his primary support but mistreats her verbally at times. He can be very
argumentative and pushy.
Sam is a Tier II sex offender and needs to register every 6 months. He has gone through 2
years of sexual offending counseling both group and individual where he has learned to
admit what he has done and to back off when angry at his mom or others. He admits that
both male and female children are triggers for him and a risk assessment puts his risk to
re-offend in the moderate range. Sam has received substance abuse education and has not
drank in years. Sam has difficulty understanding the age of consent. Sam has been dating
another developmentally disabled girl from his hometown for 4 years. She can be very
bossy at times and upset Sam. He will hang up with her but later calls back to apologize.
He has strict religious beliefs and wants to wait until married to have sex.
Sam is very active in the community taking trips to Cat Welfare, Library, Book Club and
area festivals. He does his own shopping and attends the workshop. He takes very good
care of his room. He has an interest in arts and crafts and puzzles. His independence has
increased and at times he wonders why he is being supervised. When staff explain his
risk issues he usually agrees but can not tell you his risk factors without prompts.
Sam is independent in all self care skills. He is just learning to cook and do chores routinely. He has a poor understanding of money and time. He presents self well verbally but easily gets off topic. He has poor listening and understanding of directions. He is overly dependent on others and is overly nervous. He is very impulsive and at times has temper tantrums where he will curse at others. He occasionally will try and gouge his skin with objects when upset. Sam is soon to graduate from Alvis House from a very structured program which provided him with counseling and social supports. Sam did well in the program. He will soon graduate. He will be going to a Supported Living site which is less structured and is in the community. He wants to live with his mother but she is moving without him to another state. She will keep in touch with him but does not want the responsibility of caring for him. He wants to go back to his home county and live with his mother and date his girlfriend. He also wants to ride his bike around the community as he has done in the past. Based on Sam’s case answer the following advise the staff who will soon have Sam as a new resident: What are Sam’s protective factors ( skills and abilities which can protect
Sam from offending)
What are Sam’s top risk factors ( specific issues which could lead to
offending)
What restrictive measures are needed to protect Sam?
What services does Sam need?

Source: http://www.opra.org/clientuploads/Education/2012/2012%20Fall%20Conference/session%20materials/34,%2039%20-%20handout%202.pdf