SBIRT Scenario. Setting: Elementary School System

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1 Setting: Elementary School System Social Worker Information: Ryan is a 10 year old third grader who is in danger of being retained again. School identified concerns include tardiness, excessive absences without notification and late homework submissions. His work and his behavior are both appropriate when he does attend. You are meeting with his mother to determine how to make changes to ensure Ryan is able to attend school consistently and on time. You are aware that he is living in a single parent home and that mom often brings him to school because he misses the bus. Ryan reports that he has a hard time waking mom up in the morning and usually gets up on his own and makes his own breakfast. If he misses the bus, sometimes mom will take him if she has time before she goes to a part time job. You suspect that alcohol use/abuse in the home and wonder if this an issue with waking up in the morning. You are the single mom of a 10 year old son who is at risk of being retained in 3 rd grade. Your son Ryan was also retained last year for second grade. He is consistently late to school and misses altogether frequently as well. While sometimes there are legitimate reasons for missing school, primarily it s due to your inability to get out of bed in the morning. Often Ryan misses the bus so you have to take him. However, the first bell rings at 8:00 am which is early. You hold a part time job from 10 3 most days and usually can drop Ryan off on your way to work. If you are running late however, Ryan ends up staying home. After you get off work, you usually meet Ryan at home when he gets off the bus at 4:15 pm. You feel like you re a good mom but have a hard time relaxing and once you get home, it s mama time when you can enjoy a cocktail or two. You used to drink Dt. Coke with whiskey but the mixer became too expensive so now you drink Evan Williams on the rocks. A handle usually lasts you a week. While you know it s not the best way to relax, you re a single mom and doing much better than you feel your parents did for you.

2 Setting: Student Health Center Social Worker Information: Your client is Eric, a 21 year old college student who attends the University on a soccer scholarship. Eric has been referred by his coach due to his anger issues which have resulted in multiple red cards on the soccer field. His coach is at a loss and feels that Eric is missing more playing time with his suspensions than he is actually playing. Eric is soft spoken and although not necessarily tall, your client is obviously muscular. You comment on this and he acknowledges he works out a lot, even beyond what is expected of him as a member of the team. He rarely parties and would rather be in the gym. Your client has used muscle recovery powders since high school but feels that all of them he s used are legal. You are Eric, a 21 year old college student who attends the University on a soccer scholarship. You ve been referred to the clinic by your coach due to anger issues which have resulted in multiple red cards on the soccer field. Your coach feels that you are a strong player and an integral part of the team. However your coach is at a loss to explain the issue and feels that you are missing more playing time with suspensions than you are actually playing. You are soft spoken and although not necessarily tall, your physique reflects your commitment to the gym. The social worker comments on this and you acknowledge working out a lot, even beyond what is expected of you as a member of the team. You rarely party and would rather be in the gym. You ve used substances like Chondritin since high school and feel it helps with your muscle recovery. Recently you ve done some experimentation with other substances but are told they re all legal. You are a little concerned about the calls in the game but feel that one ref crew in particular has it out for you.

3 Setting: Hospital Emergency Room Social Worker Information: On Saturday morning, approximately 2:15 am, Sophie was brought to the ER after a car accident. Sophie is a 20 year old college student who was driving the car which hit the median after she swerved to avoid a dog in the road. Sophie was shaken up at the time and had to get her car towed; an onsite officer helped ensure she had a friend to call to pick her up. Sophie later had her friend bring her to the ER with concerns over pains in her neck and a bad headache. You are suspicious regarding the dog story and understand that she had had a few drinks at a local nightclub prior to the incident. While Sophie does not believe she was intoxicated (after all, the policeman didn t make her do a sobriety test), she acknowledges that might have been a factor in her hitting the median. You are a 20 year old college student who was in a car accident early Saturday morning as you swerved into the median to avoid a dog crossing the road. Or at least that s the story you told the police officer who responded as well as the tow truck driver and eventually your parents too. When they ask where you were earlier, you were at the library until midnight when it closes. You then stopped by a local nightclub where you able to access the patio entrance without showing your fake ID. However, that part has been omitted from the public version. It s ok to share it with the social worker if you re asked though. You will sometimes get out with friends but are only three months away from 21 and worry about getting caught. When you do go (only once or twice a week), you usually only drink until you re buzzed, maybe four or five drinks (depends on who s buying!). You didn t want to go to the hospital earlier because you were worried they would do an alcohol test and you were trying to make sure the officer was not too suspicious. However, your roommate is worried about you going to sleep because your head hurts and your neck is stiff. You re sure you ll be fine but thought you should check it out too.

4 Setting: foster parent home Social Worker Information: You are a caseworker meeting with a foster parent (Mollie) regarding the progress of a 16 year old girl placed with the foster family. The girl is doing fine, both in the home and in school. You casually ask the foster mom, so how are you doing? and she laughs and says as good as can be expected. She looks tired though and you comment on that. Mollie says things really are fine but she s had a hard time going to sleep. She thinks it might be the onset of menopause cause once she s asleep she is fine. Usually a glass of wine helps her get to sleep which she feels is better than a sleep aid. You wonder how often this occurs and how many glasses she needs to get to sleep. She does not manifest any depressive symptoms. You are meeting with the caseworker for your 16 year old foster daughter. The foster daughter is doing great, you are very happy she is there and you want her to stay as long as is needed. She is doing well at home and at school and fitting in nicely with your own two younger children. The caseworker asks how you are doing and you reply as good as can be expected with a laugh. She notes that you look tired and yes, you are. While things are going well, you are having a hard time going to sleep. You think it might be hormonal because you ve hit your mid-40s and once you are asleep, it s not a problem to stay asleep. You ve discovered that a glass (or two) of wine helps you fall asleep quicker. However, you are concerned that the caseworker might view the bottle of wine by the bed differently. You hope she doesn t ask to see the house because you are quite sure there are empty bottles and dirty wine glasses on your nightstand. While you don t think it s a problem to drink wine every night, and in fact you believe it s better than an addictive sleep aid, you understand that others might view it differently.

5 Setting: Public Health Clinic Social Worker Information: Your client is a 63 year old man presenting with shoulder pain. He came to the clinic this morning because he awakened with terrible shoulder pain that was bad enough he reports he couldn t even lift his coffee. He is surprised by this and has no idea how that happened. He has not fallen nor does he have a history of shoulder pain. His medical exam is clear with no cardiac involvement. You know that in the past the client has received pain medication for various other physical ailments. While he denies seeking specific pain medication, he does think that it would help. You are a 63 year old man who came to the public health clinic hoping to find some relief for pain in your shoulder. You typically do have aches and pains which are usually helped by Tylenol-3 or some such variation. Over the counter medications usually do not help your pain which then worsens resulting in lack of sleep, etc. So you were on top of things and came right away when the pain started that morning. You don t know why your shoulder hurts but it was bad enough you couldn t raise your coffee cup this morning. You did not fall nor do you have a history of injuries. A cardiac evaluation is done and apparently clear. If the social worker asks about prescribed drug use, you can acknowledge having needed some in the past. You feel that s probably due to having been in Vietnam and sustained injuries that resulted in a purple heart. You guess that your pain now is a small price to pay for serving your country. While you deny seeking specific pain medication, you do think that it would help.

6 Setting: Mental Health Clinic Social Worker Information: Your client is 32 year old male (Scott) who is presenting to the clinic because his wife insists on his receiving counseling for his drinking problem. The client does not feel that he has a drinking problem but does want to maintain his marriage so he made an appointment. Scott relays to you that he rarely drinks, maybe once or twice a week. Sometimes he will go to happy hour with others from his office and he always invites his wife. He feels that it s important to socialize with his boss but his wife does not agree with the setting in which that occurs and usually avoids the happy hour. She will however pick him up so he doesn t drive after drinking. You sense that the client thinks his wife is overreacting and does not really think there is a concern with his drinking. You are Scott, a 32 year old who made an appointment at the clinic because your wife insists on you receiving counseling for your drinking problem. You don t feel that you have a drinking problem but do want to maintain your marriage so you made an appointment. You tell the social worker that you rarely drink, maybe once or twice a week. Sometimes you will go to happy hour with others from the office and you always invite your wife. You feel that it s important to socialize with the boss but your wife does not agree with the setting in which that occurs and usually avoids the happy hour. She will however pick you up so you don t drive after drinking. You think that perhaps your wife is overreacting; in every other aspect you appreciate your marriage and feel it is good. You are a little resentful that she told you to go to counseling but think it s probably due to her having a different upbringing and therefore different views of alcohol. You usually only drink once a week at home and you plan on making that less obvious to your wife and have even considered new places to stash your vodka so she doesn t have to know that you are drinking since it is bothering her so much.

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