1. Jordyn
Jordyn’s Mom ed me, concerned about her 13 year old daughter who was having panic attacks. I ed back and asked her to book an end-of-the day counselling appointment in the next couple of days and sent a message to the front desk to let them know that her Mom would be arranging this.
Jordyn was a 13 year old Grade 8, straight A student. She was the oldest of two children in a stable family. Mom has had problems with depression, for which she takes an SSRI. She is doing well. Kaylee has a wide circle of friends in a religious private school; her classmates are quite competitive.

2. At the first visit, Jordyn described that she was having significant problems with anxiety attacks, about 12 in the last 18 months but these are getting worse in the last month, where she has had three (two in the last week).
These are almost always related to school and usually in situations where she has to do a group project, where she feels she hasn't grasped a concept or just felt more behind.
Her attacks generally start with feeling anxious, palpitations, slightly sweaty but no dry mouth. She notes that these episodes are starting about 30 minutes before school and last minutes relieved with time and talking to her mother. Her last attack two days ago was precipitated by a group presentation where she felt that she had no control over how the other students would present and that this would affect her mark.
After asking the three screening questions and determining that there were no mood problems or difficulties with behaviour or attention but that anxiety was obviously an issue and having a brief discussion about this with them, I asked Jordyn and her Mom to do the child and parent SCARED assessments separately at home. I ed the auto-scoring SCARED forms and gave them printed copies and asked them to fill in whichever form they were more comfortable with. I also gave Jordyn a TeFA questionnaire to be done on the day of her next appointment, in one week.
**** Can discuss using , when to use TeFA, auto-scoring SCARED form ****

3. SCARED 26 38
Jordyn and her Mom both ed back their electronic forms two days later and came back to see me in one week.
**** show audience Jordyn’s score and ask them whether they thought that Mom’s score was higher, lower or about the same ****
**** Discuss about parents’ scores usually being lower ****

4. After asking Jordyn’s preference about her Mom staying in the room, I asked Jordyn the questions from the CRAFFT substance abuse questionnaire, reviewed her TeFA, neither of which reviled anything of concern, and discussed the results of the SCARED questionnaire.
**** Question to the audience – “How else might this visit have played out?” “What workflow processes might be an issue here?” “Would you ask the three screening questions again? Would you do CGI assessment at each visit? ****
Jordyn scored highest in the Generalized Anxiety and Panic Disorder sections of the SCARED questionnaire, so as a first step I went to the anxiety section of the module.
Anxiety

5. And decided to focus on teaching some CBIS skills.
**** What other approaches might be taken? ****

6. CBIS Skills
To start with I chose to focus on relaxation skills and taught Jordyn and her Mom abdominal and box breathing techniques, negotiated how often Jordyn would practice these and gave she and her Mom information about anxiety. I asked them when they wanted to return and they preferred to return in two weeks.
Over the next two months, I continued to work with Jordyn, with her relaxation. I ed her Mom an MP3 relaxation file for them to download onto their iPhones to use.

7. CGI – Clinical Global Improvement
Over the next two months, I continued to work with Jordyn, with her relaxation. I ed her Mom an MP3 relaxation file for them to download onto their iPhones to use. Jordyn’s CGI was minimally improved at the second visit after the SCARED assessment was done, just having acknowledged her problem. There was a slight blip just before Christmas exams but she continued to do well and stopped coming in for visits.