Reference no: EM133867554

Case Study

You are doing an undergraduate internship at a free clinic for the summer. Even though it is not strictly in the field of psychiatric or mental health, you feel that the experience is invaluable, and you are appreciative of the fact that you still have a chance to work with varied and interesting mental health issues.

Today brings you a particularly unusual family, one that does not really seem to fit in. Mindy Harper is a mother of three children under the age of 5. Mindy, a petite, pretty woman with very carefully done hair and nails, her clothing and her children's clothing perfect, has come to the clinic with all three children today. She asks to have one of the children, an 18-month-old boy named Charlie, examined for a possible inguinal hernia.

Mindy and her children are very well dressed, standing out among others in the free clinic's waiting room. However, something strikes you as odd: it's a hot summer day, yet Mindy and her 5-year-old daughter are both in long sleeves. When you smile and comment on this, escorting them back to an exam room, Mindy smiles and says, "Oh, I know! It's hot! But Ella and I don't like air conditioning, do we, Ella? So we wear our sleeves!" She smiles a little excessively at Ella, who nods, her face serious. The family sits down in the exam room.

"I like to go in the pool," Ella says quietly, looking at you and pulling on her long sleeves.

"Well, yes," says Mindy, shifting uncomfortably, "but not today. We need to get Charlie looked at today, don't we?"

Ella nods and looks up at you again. Mindy quickly hands Ella a book.

As the examination of Charlie's possible inguinal hernia begins, you see no signs of bruising or other injuries, but there is an enlarged testicle suggesting the possible beginning of an inguinal hernia. Mindy says suddenly, "I apologize for coming to the free clinic, when we obviously don't fit in. I hope we're not taking your time away from someone more needy and deserving!"

Before you can say anything, Mindy says, "It's just that, well, even though he's an attorney, my husband doesn't like me to make frivolous use of the doctor's office. He thinks our copay is too high as it is, and it's because I'm the one who wanted kids, you know? So we pay more because of me. So if I come here, he won't see a check carbon for a copay."

She's watching you anxiously.

"I'm sorry!" she says. "That's selfish, isn't it? I'm so stupid!" She has tears in her eyes and, as she raises her hand to stop them, you see a bruise on her wrist where her sleeve rides up.

"Listen," she says, "I can pay you in cash! I have the money, see? But my pediatrician's office said they have to record copays, so I couldn't do it there. Please let me pay you to check Charlie? Please?"

_{What clues do you have to possible abuse in this family? List all possible types you see, providing rationales.}