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?
The ‘Open Method of Coordination and ist Effects:’ Policy Learning or Harmonisation? Stefan Okruch Edited by the Professors and Readers of Andrássy Gyula University, Budapest. This series presents ongoing research in a preliminary form. The authors bear the entire responsibility for papers in this series. The views expressed therein are the authors’, and may not reflec
http://www.fda.gov/AnimalVeterinary/NewsEvents/CVMUpdates/ucm054434.htm Cephalosporin Order of Prohibition Questions and Answers On January 4, 2012, the Food and Drug Administration’s (FDA) Center for Veterinary Medicine (CVM) issued an order prohibiting certain uses of the cephalosporin class of antimicrobial drugs in food-producing animals. A copy of the Federal Register document is av