Bio-Psycho-Social Assessment

Assessing a client’s biological, psychological, and social history is a holistic approach that is an essential aspect of social work practice. Since one area often affects the other two, it is important to get as accurate an assessment as possible when working with a client. Social workers use the bio-psycho-social tool to communicate specific information, and possible conclusions, about a client to other professionals. It is, at once, a summary of current issues and problems; a listing of past factors that may be relevant to the current situation; and a description of potential issues that may have an effect on the client in the future. In addition to describing the client’s challenges and problems, the assessment identifies strengths and assets that are available to provide support. For this Project you create a bio-psycho-social assessment.

By Day 7

Submit a 6- to 9-page paper that focuses on an adolescent from one of the case studies presented in this course. For this Project, complete a bio-psycho-social assessment and provide an analysis of the assessment. This Project is divided into two parts:

Part A: Bio-Psycho-Social Assessment: The assessment should be written in professional language and include sections on each of the following:

  • Presenting issue (including referral source)
  • Demographic information
  • Current living situation
  • Birth and developmental history
  • School and social relationships
  • Family members and relationships
  • Health and medical issues (including psychological and psychiatric functioning, substance abuse)
  • Spiritual development
  • Social, community, and recreational activities
  • Client strengths, capacities, and resources

Part B: Analysis of Assessment. Address each of the following:

  • Explain the challenges faced by the client(s)—for example, drug addiction, lack of basic needs, victim of abuse, new school environment, etc.
  • Analyze how the social environment affects the client.
  • Identify which human behavior or social theories may guide your practice with this individual and explain how these theories inform your assessment.
  • Explain how you would use this assessment to develop mutually agreed-upon goals to be met in order to address the presenting issue and challenges face by the client.
  • Explain how you would use the identified strengths of the client(s) in a treatment plan.
  • Explain how you would use evidence-based practice when working with this client and recommend specific intervention strategies (skills, knowledge, etc.) to address the presenting issue.
  • Analyze the ethical issues present in the case. Explain how will you address them.
  • Describe the issues will you need to address around cultural competence.

CASE STUDY:

Working With Survivors of Human Trafficking: The Case of Veronica

Veronica is a 13-year-old, heterosexual, Hispanic female. She attends high school and is in the ninth grade. She currently lives in an apartment with her biological mother and her sister, age 9. She came to this country 7 months ago from Guatemala. Veronica is a sex trafficking survivor and was referred to me for individual therapy by a human trafficking agency in the United States.

Veronica’s biological mother and father separated when Veronica was 3 years old. She lived with her maternal aunt and biological mother until she was 6 years old, and her mother left Guatemala to come to the United States. At that time, Veronica stayed in the care of her maternal aunt and kept in touch with her biological mother via phone and through the visits that her mother made to Guatemala. Veronica would visit with her father, who lived nearby, on occasion, although she stated they did not have much of a connection. When Veronica was 12 years old, her maternal aunt forced her into prostitution, using the money from the sex acts as her main source of income. Veronica reported that her maternal aunt began treating her “like a slave” and would make her smoke an unknown substance before obligating her to perform sexual acts on countless men for money. This took place for close to a year before Veronica was able to sneak a phone call to her mother and explain what had been happening to her. Her mother quickly arranged for Veronica to be picked up by a “coyote” (a person who smuggles people into the United States). The coyote successfully smuggled Veronica into the United States within 2 months of that phone call. However, while crossing the border from Mexico to the United States, Veronica once again became the victim of sex trafficking crimes. The coyote was also a pimp who arranged for men crossing the border in the same truck as Veronica to engage in sexual acts with her for which the coyote collected money. U.S. immigration officers caught most of the people traveling in the truck, including Veronica, and placed them in a detention center. However, the coyote got away. Three weeks after Veronica was detained, after much questioning and investigation, she was reunited with her mother.

I met with Veronica weekly for individual therapy in my role as a social worker at an agency serving individuals who have experienced human trafficking. Veronica reported having occasional flashbacks and fear that “it will all happen again,” and she was diagnosed with post-traumatic stress disorder (PTSD). The goals agreed upon in therapy included building Veronica’s support system, building her self-esteem, and managing her symptoms of trauma. Building rapport with Veronica in therapy took several weeks as she reported not trusting anyone and not wanting to think about what happened to her. After about 9 weeks of relationship building and safety planning, I was able to engage her through education on the dynamics of human trafficking. She reported that it was especially hard for her to trust men and that she often had a hard time speaking up. I worked with her on these issues by teaching her how to be more assertive and by modeling assertive behaviors. We worked on self-affirmations to help build her self-esteem. Because Veronica is very self-conscious, practicing self-affirmations was challenging for her. I often utilized a trauma-informed curriculum for adolescents called S.E.L.F. (Safety, Emotions, Loss, and Future) to facilitate healing and trauma reduction. Veronica reported that grounding techniques taught via this curriculum helped take her out of her thoughts and bring her back to the present moment. Some of the grounding techniques she continues to engage in on a daily basis include tapping her feet, stretching, writing, walking, and washing her face when she feels she is becoming numb or getting lost in thoughts of what happened to her.

Veronica has demonstrated great resiliency. She is attending a church close to her home and reports having faith in God. She recently enrolled in swimming and volleyball and has made several friends in the community. I continue to meet with Veronica on a weekly basis and will be stepping down with her to biweekly sessions now that she is stable and connected to her community. Because Veronica does not speak English and is a child, there are no support groups available in her area for human trafficking survivors. I am presently working on connecting her with a mentor.

Veronica is currently working with the human trafficking agency that referred her, Immigrations and Customs Enforcement (ICE), and an attorney to obtain a visa specific to human trafficking (T-Visa). A T-Visa grants survivors of human trafficking a visa in the United States. In 2000, Congress passed the Victims of Trafficking and Violence Protection Act (VTVPA), which strengthens the ability of law enforcement agencies to investigate and prosecute human trafficking and also offers protection to victims via a T-Visa. The T-Visa is for those who are or have been victims of human trafficking. It protects victims of human trafficking and allows victims to remain in the United States to assist in an investigation or prosecution of human trafficking.

Veronica’s mother is also attending weekly individual therapy. She has been working through the heavy guilt and trauma of this experience. Veronica and her mother continue to heal, and with each passing day, they grow stronger.

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