Conceptualizing a Case Makala

Conceptualizing a Case: Makala
Conceptualizing a Case: Makala
Case description
Identification of the Problem: Makala is a 15-year-old African American girl in ninth
grade. She attends Euclid Heights High School. She was referred to our agency by her math
teacher and family physician for skipping school and excessive weight loss.
Individual and Background Information
Academic: Makala is friendly and outgoing, and is the president of the student council at her
high school. Her active role in the school is visible in her participation in the student council. She
has skipped school recently.
Family and Culture: Makala has four sisters and a brother. She is the youngest of her siblings.
She lives with her aunt following her grandmother’s death six months ago. Makala’s mother is in
a rehabilitation institution and her father lives in another state. Makala’s brother attends college
far away. Her other siblings are much older and live with their own families. She is a Christian
and has made many friends from her church. Christianity, therefore, has a significant bearing on
her life.
Physical: Medical records show that Makala was a plus-size girl, weighing 201 three months
ago. She now weighs 142 pounds. She has started working out more intensively recently, leading
her trainer to notice the unusual change.
Social: Makala has many friends at her school and church. She has an outgoing personality and
enjoys singing and dancing. Her wide social network indicates her willingness to share her life
experiences with others. She has, however, skipped school and student council meetings
recently. This recent behavior is a notable change from her past.
Developmental Analysis
Developmentally, Makala’s progress is mixed. The environment around her is playing a
role in her cognitive development. At her age, according to Piaget’s theory of cognitive
development, Makala is at the formal operational stage (Ribaupierre, 2001). This stage is the
final stage in cognitive development as per Piaget’s theory and is shaped by experience and the
environment. An individual’s development at this stage involves accumulating knowledge which
is constantly informing and drawing upon their experiences and surrounding. Makala is
conscious of the role of her surrounding on her own life. Her decisions draw upon complex
interrelated issues affecting her school, family, and personality. This observation points to
rationality in her thinking, a phenomenon that is a central element of the formal operational stage
in Piaget’s theory. She has grown uncomfortable with her plus-size weight as seen in her desire
to lose excessive weight. Moreover, her increased level of intensity and frequency as regards
physical exercise resonates with her recent excessive weight loss.
Cultural Analysis
Makala’s African American and American identity at large suggest some unique
experiences underpinning her life. Her active lifestyle as indicated by her role in the student
council and her work out routine suggests her desire to stay fit. This objective is particularly
common in the United States amid concerns over high levels of obesity in the country.
According to Wang, Beydoun, Liang, Caballero, and Kumanyik, (2008), obesity in the US has
raised alarm across various domains of the society, driving many Americans to adjust their
lifestyles in attempts to address this burden. Such adjustments often place unnecessary burdens
on people’s lives as they strive to obtain unrealistic targets. Makala’s role as leader of the student
council is reminiscent of the spirit of the wider American society grounded in individualism.
Williams (2006) noted that in individualistic societies like America, people tend to put loyalty to
themselves first (p. 183). This attribute is visible in Makala’s recent behavior involving skipping
school and leadership meetings. Her culture is also defined by her church activities. She has
many friends in church, pointing to her active involvement in religious gatherings. Her
involvement in the church also indicates that she is a Christian. Makala seems to have also
deviated from her Christian values as her deviant behavior involves disregarding her
responsibilities and the expectations of her community and the society.
Assessment of Stressors and Supports
The main stressors for Makala arise from her family, community, as well as the American
culture and society. Her father lives in another state, reducing the likelihood that he performs his
parental responsibilities effectively. She is also detached from her siblings and has recently faced
her grandmother’s death. The leadership responsibility implies that she is expected to be a role
model for others in her school and the wider community. Her plus-size appearance is also a
stressor keeping in mind the portrayals of the desired appearance in the American society.
According to Voelker, Reel, and Greenleaf (2015), one’s weight status ad media portrayals of the
supposed ideal image represents a major stress factor in adolescents. This observation is
consistent with the descriptions defining her stage in Piaget’s model. She is at a point where she
operationalizes the knowledge acquired from her environment and life experiences, including the
media and society.
There are also several supports in Makala’s life. Her aunt is currently her guardian and
gives her both material and other support. Her school is also another important support for the
student as she has been elevated to a leadership position. The fact that the school has not
removed her from this position despite her recent behavior indicates the confidence the school
community has in Makala. Her teacher and physical trainer are also life supports as they are keen
to help her keep her development on the right track. Despite the support offered to Makala, she
misses out on important interventions such as counseling that specifically aim to address her
recent behavior. As a Christian, the church serves as an important support factor in Makala’s life.
According to Battey (2009), spirituality is important for the overall well-being of an individual.
The church represents an important dimension for Makala’s spiritual development, boosting her
development. It is, therefore, important to establish whether she has been skipping church
recently as has been the case for school. This information would help towards developing a
comprehensive treatment for Makala.
Legal and Ethical Issues
One of the key legal issues surrounding Makala’s case is the absence of her father amid
her change in behavior. Her father has the legal obligation to perform his parental obligations.
He has instead left Makala’s aunt to perform all the parental duties, raising the ethical issue of
whether his actions are in conformity with the expectations of the American society. Although
the health information about Makala was obtained in accordance with the legal requirements of
the HIPAA Privacy Rule code, the important ethical question of whether Makala should have
been involved in the process remains unsolved (English & Ford, 2004). Another ethical issue is
whether the school has been fair to Makala by failing to offer her more support in the form of
counseling. Recent events, including the death of her grandmother, suggest that the girl is
undergoing a troubled period and needs personal attention. Makala’s aunt also seems to ignore
the emotional needs of her niece as it is the teachers who reported the change in behavior.
Careful consideration should be given to the possibility that both Makala’s father and aunt are
negligence as regards taking good care of the adolescent girl.
Treatment Plan
Problem Identification
Makala, a 15-year-old African American high school student is experiencing a behavioral
disorder that has seen her behavior change drastically to the alarm of those around her.
Problem Definition
Makala is an adolescent minor currently living with her aunt while her father lives in
another state. Her weight is a source of concern for her and has seen her undertake physical
exercise with unusual intensity and frequency. Her breakdown in behavior has also undermined
her education and social life as she skips school and student council meetings.
Goal Development
To develop an intervention that restores good behavior in Makala
Measurable Outcomes
- Makala will attend all her classes
- Makala will attend all her student council meetings
- She will normalize her intense workout regime
- She will learn life skills and gain coping skills, motivation, and a positive view of life that
does not focus on achieving unrealistic physical appearances often depicted in the
American media
- She will become confident in her appearance
Creating Interventions
- Makala will attend one therapy session per week
- She will attend one family therapy session every fortnight.
The therapist will monitor progress and receive reports from Makala’s teacher, fitness
trainer, and aunt.
English, A., & Ford, C. (2004). The HIPAA Privacy Rule and Adolescents: Legal Questions and
36(2), 80 - 86.
Ribaupierre, A. (2001). Piaget's Theory of Child Development. International Encyclopedia of the
Social & Behavioral Sciences, 2001, 1143411437.
Voelker, D. K., Reel, J., & Greenleaf, C. (2015). Weight status and body image perceptions in
adolescents: current perspectives. Adolesc Health Medicine and Therapeutics, 2015(6),
Wang, Y., Beydoun, M. A., Liang, L., Caballero, B., & Kumanyika, S. K. (2008). Will All
Americans Become Overweight or Obese? Estimating the Progression and Cost of the US
Obesity Epidemic. Obesity 16(10), 2323-2330.
Williams, C. (2006). Effective Management. New York: Thomson/South-Western.

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