Case Formulation

Predisposing factors
Personal: difficult temperament of the child
and learning disability.
Contextual: disruption of basic needs: sleep
patterns, food, etc; family isolation: family
and village ostracisation; family background:
role models: both parents come from
conflictive families and poor relationships.

Maintaining factors
Personal: school absence in relation to his
learning disability, anger management issues.
Contextual: bullying from peers in school,
disruption of basic needs, ostracisation of the
village, inconsistent affective relations with
family members.

Precipitating factors
Father entering prison, subsequently
leaving the duty to raise the kids to
Rita.
The inability of the latter to engage
in adequate parenting, missing
essential parental duties, engaging in
coercive patterns of behavior
subsequently leaving the children
unattended.

Protective factors
Personal: feelings of loyalty towards his brothers
and normal intelligence in fields excluding
arithmetic, spelling and reading.
Contextual: commitment from the principal of
the school to help him and the family overcome
their problems and mothers desire to keep the
family together.

Conduct disorder
Robbery, as he stole money and goods from neighbors on
several occasions.
Misconduct which includes aggressive and violent behavior,
drinking, smoking, etc.

Goals and recommendations for Rita:

-

Improve the parenting skills: Rita needs to acknowledge that the token economy must be arbitrary. That is, despite the mood shes
in or how she feels in that moment, points should be awarded for each behavior performed.
Positive interactions with her sons should be encouraged to improve family environment at home. Conversations must be calm and
quiet and restrict the use of bad words. She is advised to spend time with her kids, while encouraging their strengths and promote
positive relations between them.
Also, Rita needs to keep in mind the importance of fulfilling the basic needs of her sons: the house must be kept clean, food is to be
available and the children have to go to school everyday, no exceptions made.

Work on her depression: we would advise Rita to go to psychotherapy to manage the way she feels and faces life. One way of
improving her well-being would be to join a support group and commiting to attend it.

Goals and treatment for Billy

School objetives
-Establishment of a good and healthy relationship with his peers and teachers
-Paying attention in class
- Adequate behaviour in class
-Participative behaviour
-Daily attendance
Home objectives
-No fighting

-Homework completion
-Collaborating in home chores (e.g.: setting the table, keeping bedroom tidy)
-Appropiate behaviour in the family context and community
Most of these goals will be adressed with the application of the TOKEN ECONOMY

Token Economy System

Inmediate Tokens:
-Small IT: lollipop/Sugus
-Medium IT: piece of cake/biscuit
-Large IT: free choice food prize

Long-term Tokens: According to point system, every 5 points acquired, Billy will be granted with choosing what film/book/TV-show he
wants to watch or read with his family. When 10 points are gathered, Billy will be allowed to select an activity to be done with family
company outside the family home; thus: going to the park, going to the cinema, going for a picnic, etc.

One point will be acquired by the completion of each task:

-Mantaining his bedroom tidy (toys picked up, bed made)
-Behaving adequately at school (monitored by teachers and headmaster)
-Being participative in the classroom when he isnt understanding something or has dificulty with completing a task. Staying after school
time has finished to resolve doubts.
-Showing his completed homework to his mother.
-Setting or cleaning up the dinner table
-Playing/Interacting with his brothers in a non-aggressive way (Cards/catch/hide-and-seek)
-Playing sports or physical activities with family/friends/classmates, with the purpose of avoiding disruptive behaviours once school hours
have finished (Rugby, Football, Workout, Capoira)

Points can be either acquired or lost, depending on the success of the task/activity.