Robbie J., a 19-year-old white male and first-year college student, suffered a significant brain injury 6 months ago as a result of a car accident. Robbie had been partying at a friend's house and left about 1:00 a. m. Driving home, he missed a curve in the road and rolled his car. Robbie's parents knew that their son drank "occasionally," but they never thought he had a "problem." They had purchased a car for him and warned him of the dangers of drinking and driving.
Prior to the accident, Robbie had been a gregarious young man. In high school he had been a good student, popular, and played on the football team. Robbie loved skiing, skin diving, and riding dirt bikes. Robbie's rehabilitation has been arduous. His parents are still in disbelief. Robbie's father is a prominent corporate attorney, and Robbie had always expressed a desire to follow the same career path. Robbie's mother divided her time between caring for her husband and son and her volunteer work on behalf of abused and neglected children in the community. Since his injury, Robbie's mother has spent most of her time caring for him and participating in his rehabilitation. His father is spending longer hours at work and misses the time he spent hunting, fishing, and playing golf with his son. Though supportive at first, his friends are calling less and less and rarely come around.
Both parents were stunned to learn that Robbie and some of his friends got drunk nearly every weekend. This information surfaced during a family counseling session conducted by a social worker on the rehabilitation team who had recently attended a seminar on screening and brief intervention for alcohol and other drug problems. Robbie's parents had a hard time believing it was true, but after questioning Robbie's friends, they learned that this was indeed the situation.
The brain damage Robert sustained has affected his impulse control and decreased his short-term memory and ability to concentrate. Robbie's emotional affect is labile. At times he laughs out loud; the next moment he may be crying. He has limited insight into his own behavior and how he has changed, so it is difficult for him to understand why his friends and family react to him differently now. Very few things sustain Robbie's attention; even watching TV is not pleasurable. The muscle weakness on his right side limits his ability to participate in many of the athletic activities he enjoyed previously.
Robbie is on an emotional roller coaster. At one level he knows that his plans for the future have to change. At another level, he cannot accept these limitations. He wants things to be the way they were. His condition makes it impossible for him to return to a successful college experience. He resents his parents' constant supervision, and feels that they are "treating him like a baby." He says no girl will want to date him with this kind of interference. Most of his friends are back at college, so he has begun to hang out with a younger group and drink again. Robbie is frustrated with the difficulty he has in remembering, expressing himself, and concentrating. He is restless and agitated sometimes, both as a result of his frustration and the organic aspect of his injuries. Robbie's parents can afford high quality treatment, but Robbie does not always comply with the treatment regimen.
What are the relevant facts in Robbie's case (e.g., "What is actually happening here")?
Identify the problems and issues that are arising in Robbie's case (e.g., What has gone wrong in this situation?" and "What needs to be addressed in order to improve the situation?")
Identify the positive and strengths aspects of the situation (e.g., "What has gone right so far?" and "What positive elements exist in this situation?")
Analyze the issues in terms of knowledge presented in the training modules (e.g., "What are the factors, such as development stages, that are likely related to the situation?" and, "How do these factors influence the situation?")
Use training materials to develop a list of options and an initial plan of action (e.g., "What has been shown to work in these kinds of situations where substance abuse and a traumatic brain injury are involved?" and "What options are available?" and "What are the likely results of each option?")
Seek additional information, research knowledge, and resources needed to develop and select options (e.g., What else do we need to find out to make a viable plan for Robbie and his parents?" and "Where can we go to get this information?" and "What did you find out when out when you sought this information? Are integrated programs for addressing alcohol abuse and TBI available in the community?")
Develop a concrete strategy for Robbie and his parents (e.g., "What can be tried over the next weeks/months? How can you help the parents come to terms with the situation? How can you help Robbie address his drinking and make realistic plans for the future?")
Identify methods for evaluating the outcomes and revising the plan (e.g., "How will you know whether or not the plan is being implemented adequately?" and "How will you know if the plan is working?" and "How will you revise the plan based on different possible outcomes?")