Jose is a 13 year-old male who lives with his mother, father and 9 year-old brother. The family is fluent in English and Spanish and lives in the Bronx. A counselor refers Jose to the neighborhood clinic because he is concerned about his weight.
Jose is unclear why he was referred but offers three possibilities: his weight, his asthma, or his difficulty getting along with his schoolmates.
Jose has a history of school-related problems. He does not raise his hand or participate in class activities, does not complete his schoolwork and often complains of being bored. He prefers to be home with his mother and does not have many friends.
The pediatrician elicits a history that a year ago, Jose saw his grandmother murdered and since then has wanted to stay at home with his mother. He also knows students who lost parents in the events of 9/11 and seems to think about it a lot. Previous visits to a counselor were not successful.
The pediatrician encourages them to meet again with a counselor, and also schedules a follow-up visit in two weeks.
Jose and his parents miss the follow-up visit. Three months later, Jose's father calls the clinic to request a same day appointment for his son who is very upset and refuses to go to school. At the visit, the father reports that the other kids bully Jose, and that Jose has threatened to jump out of the first floor window.
The use of the PSC-17 internalizing score followed by the PHQ-9 diagnostic aid may further elucidate Jose's mental health problems.