Week 6 Assignment 1: Motivational Interviewing Mini-Case Study
NU-646-04-24PCSP
Instructions
For this assignment, you will review the case study and complete a comprehensive
case study write up in paper format using the NU646 Comprehensive Case Study
Template provided as a guide for paper format. Address specific questions posed
for each section of the case study in your paper as well.
Complete this assignment after reviewing the weekly learning materials, reviewing
the additional learning materials below, and completing the MI certificate module.
Learning Materials
The attached files are resources to help you prepare for your visit. You will need to be
familiar with them, and they will already be familiar if you have completed the MI training
required for this module. You should print or save the AUDIT instruments for reference and
add them to your desk guide for the final module of the course.
AUDIT 10 and AUDIT-c Instruments (PDF)
Motivational Interviewing Resources
Motivational Interviewing Reminder Card
Readiness Ruler.
The Spirit of MI Audio Files
Modalities to Consider
You work for an integrated primary care office as a new PMHNP. The office has one
other PMHNP provider, with a defined role to strictly do initial visits intakes as they
rotate through different clinics. This integrated model allows a more efficient
workflow and increased access for new patients into the healthcare system for
treatment.
You are a new graduate from Regis College and therefore begin in this position with
the additional training certificates as follows; MAT, SBIRT, and MI. For this reason,
any substance use disorders are added to your client list. Review the case study and
questions to determine best practice and treatment options for Clark.
Motivational Interviewing Comprehensive Case Study
Introduction to the Case
Clark is a 42-year-old Caucasian- Hispanic biracial male. He uses pronouns he, him,
and his. He presents to the outpatient primary care office at the request of a follow-
up by another provider in the office who only completes initial appointments. This
follow-up was requested for secondary diagnosis with concerns for substance use
disorder and depression. On initial screening at his primary care visit he endorsed
that he drank 4x/week and that his consumption often was three 40 oz beers.
Additionally, he endorses drinking six or more drinks in social situations at a
minimum of 2x/ month.
He endorses mood changes that started 4-6 weeks ago. He has had increased
sadness and irritability since hurting his back at a barbeque. He endorses he was
intoxicated and fell, twisting his back. He rates his pain at a 3/10 daily and
occasionally a 6/10 if he moves anything heavy. Since the injury, he has missed work
several days, has been placed on light duty and therefore has lost compensation. He
works in the construction industry and notes “I have very few options when I can’t
carry the shingles up the ladder or twist and turn all day; so I try to work a few days
then I’m down for a couple and have to take time off again.”
1. Complete and score the AUDIT-C (Alcohol Use Disorders Identification Test (AUDIT)
using the information provided. Based on Clark’s score, what is your next step?
2. Briefly, what are pros and cons of using AUDIT-C vs. full AUDIT instrument?
Differential Diagnosis, Rationale, Pertinent Positive, Negatives, DSM-5 Criteria
On your initial interview you explore factors associated to his alcohol
consumption. The discussion of substance use was introduced in a respectful and
collaborative way. As his provider you start with the following: “I wonder if we might
talk about your drinking today? I do review these questions with all my patients as
part of the initial appointment with me. I need to gain as much information as
possible to best assist you.”
Clark endorses the drinking has increased and is interfering with his relationships.
He adds that he has been suffering from “awful lower back pain after falling down
some stairs one evening at a friend’s barbeque after “drinking more than usual.” He
reports having a hard time going to work as the pain has increased and has not gone
away on its own as anticipated. “I thought I would be sore for a few days then be
fine.” He states, “It has become somewhat better but it’s still pretty bad.” “It has
gotten to the point that I don’t really get out of the house as much and like I said I am
missing a lot more work than ever before. I really am just laying around a lot and
watching TV.”
What are your preliminary differential diagnoses? (Minimum of three)
Provide rationale based on DSM-5 diagnostic criteria.
What additional questions would you like to ask Clark to rule in or out the diagnoses you
chose.
Mental Status Exam
General: A and O x4. Appearance, behavior speech appropriate. Thoughts coherent. Remote and
recent memories intact. Appears stated age and of good health. Dressed appropriately for
weather and situation.
Movement: Wringing hands while talking, bounding leg at times, normal gait and stance, no
involuntary movements.
Speech: Speech was clear, organized, abundant.
Mood: Notes recent changes in regular mood to irritable, depressed.
Affect: Full ranging affect, correlates to mood described.
Language: No language abnormalities; speech fluent; no dysphonia; no stuttering.
Cognition: Patient-oriented x 4, no disorientation, short term memory impairment, reduced
abstraction ability, diminished cognitive functioning, endorses concentration problems at work
and at home due to chronic pain.
Thought Process: No deficiency on evaluation of connectedness, organized.
Thought Content: No thought content impairment; denies; suicidal ideation, homicidal ideations,
paranoid ideations, poverty of thought, thought insertions, obsessions, irrational fears, delusions,
hallucinations.
Insight and Judgment: Slightly impaired insight and judgment-indecisive on treatment options.
Primary Diagnosis(es)
Now that you have completed your assessment what is your primary diagnosis?
Nonpharmacological Intervention Details: Motivational Interviewing
As his PMHNP provider, you continue with the assessment process by inquiring
about more details of the drinking. “Please tell me a bit more about what your
drinking has been like over the past few years. Describe how you have increased in
consumption amounts.” Clark states that he had been a “regular drinker” since he
was a teen. He was able to drink less early in his marriage and when his children
were young, initially by request of his wife.
He endorses an increase in drinking since the two oldest daughters went to college
and are no longer living at home.
He quickly adds that he “has” tried to cut back but old habits die hard.”
Next you inquire about withdrawal symptoms during times he tried to cut back.
Clark denies any s/sx of withdrawal and reports “I never get shaky when I don’t drink”
He denies history of seizures, or complicated withdrawal and reports that he “can
see the benefit of cutting back” he just isn’t sure he “wants to stop drinking all
together. It’s just always been my go-to- to calm down from stress.”
You ask the following: Tell me more about what your pain is like? How have you
been dealing with it? How has it affected you and your family?
Clark indicated that he has been feeling more discouraged by his back problems and
wondered if he would ever feel like his old self again. In addition to general feelings
of hopelessness, Clark reports problems with sleep, poor concentration, irritability
with his wife, and loss of appetite.
He is also worried about finances. He said “unless my back starts to get better
soon, I don’t seek how I’m going to be able to support my family. Thus far he had
attempted to relieve his pain by increasing his alcohol consumption now using 5–6
beers per night and occasionally using Vicodin that he had obtained from a friend
who had sustained an injury last year.
Clark has mixed feelings about asking for help.
He is also sensitive to the issue of his drinking and given the renewed request from
his wife that he drink less, he is inquisitive about options.
He reports that he has enjoyed drinking and felt it helped him manage the pain at
night. However, he also said he had been falling asleep in front of the TV and
waking up feeling stiff and unrested with his back hurting even more some
mornings.
1. Using the motivational interviewing technique of developing discrepancy, how would
you assist Clark to develop discrepancy between his desire to drink and the
detrimental effects drinking has on his life?
2. Include a general description of the technique you chose and, an example of how
you would use it in the interview with Clark.
As his PMHNP provider, you ask Clark “Is it ok if I give you some information about
the ways that alcohol can affect sleep.?” Clark nods and consents, and you gently
explain how alcohol can affect sleep quality. You continue to build rapport by asking
about Clark’s values and goals while remaining mindful of his social context, saying
“I wonder if you could tell me a little more about your family and what plans you have
in the next year or two?” Clark endorses the importance for him to be a positive role
model for his adult children and that he wants to provide financially for his family by
continuing to work. He reports that he has been worried about his relationship with
his wife and the amount of money he is spending on alcohol.
1. How would you use the motivational interviewing technique of rolling with resistance
to assist Clark in increasing his readiness for change?
Additional Components for Plan of Treatment
At the end of the appointment, Clark agreed to have no more than two drinks per night and
not to drink at all if his pain level was especially bad or worse than a 3/10 and he needed to
take pain medication. He plans to follow through with an evaluation for physical therapy
referred by the provider from the initial assessment on previous clinic visit for primary care
of the pain. The previous provider also called in a script for Meloxicam 7.5 mg (may take
one to two tabs daily as needed for pain).
1. What is your initial treatment plan?
2. You may include pharmacological and/or non-pharmacological interventions that
you feel are appropriate.
3. Please be specific about your recommendations.
Assignment Checklist:
1. Review the case study.
2. Review the 646 Comprehensive case study Content Exemplar (Word) to understand
what is needed within your paper.
3. Use the 646 Comprehensive Case Study Paper Template (Word) to write the
assignment in the proper format.
4. Follow the requirements on the rubric and within the content exemplar.
5. Interactive comprehensive case studies should be 3-5-pages in length, excluding the
title and reference pages.
6. Interactive case studies should include a minimum of three evidence-based practice
guidelines or articles.
7. All papers should conform to the most recent APA standards.
Please refer to the Grading Rubric for details on how this activity will be graded.
To Submit Your Assignment:
