Chapter 19: Other Conditions That May Be a Focus of Clinical Attention

Relational Problems

• Problems Related to Family Upbringing

• Other Problems Related to Primary Support Group

Problems Related to Family Upbringing

• Z62.820 Parent-Child Relational Problem.

• Z62.891 Sibling Relational Problem.

• Z62.29 Upbringing Away From Parents.

• Z 89.8 Child Affected by Parental Relationship Distress.

Z 89.8 Child Affected by Parental Relationship Distress.

• apply to situations in which children witness, or are otherwise impacted by, conflict between their parents

• These children may experience medical and psychological changes because of conflict between their parent

Z62.29 Upbringing Away From Parents.

• in which a child is, for a variety of reasons, not being reared by his or her parents

• These situations may include court-sanctioned placement (e.g., foster care or placement with a relative), non–court-sanctioned placement (e.g., living with family or friends), or state custody (e.g., group home or orphanage)

Z62.891 Sibling Relational Problem.

• a sibling is considered any person who is related to the client through full genetic relation, half genetic relation, the blending of families, foster parenting, and adoption

• (a) “significant impairment” within the client or family unit, (b) the emergence of symptoms within the client or a sibling, or (c) interference with the course, prognosis, or treatment of a medical or psychological disorder within the client or a sibling

Z62.820 Parent-Child Relational Problem.

• Problems within the parental relationship may impair cognitive, behavioral, or affective functioning within both the child and parent

• Specifically among parents, behavioral impairment may take the form of ineffective parenting practices, such as strict authoritarianism, overprotection, insufficient supervision, and lack of structure

Other Problems Related to Primary Support Group

• Z63.5 Disruption of Family by Separation or Divorce

• Z63.8 High Expressed Emotion Level within Family

• Z63.4 Uncomplicated Bereavement.

Z63.4 Uncomplicated Bereavement.

This code may apply to situations in which a client experiences a “normal reaction to the death of a loved one,” which serves as the primary treatment focus

Z63.8 High Expressed Emotion Level within Family

• in which a couple’s or family unit’s high level of expressed emotion either serves as the primary treatment focus or impacts the course, prognosis, or treatment of a medical or psychological disorder

Z63.5 Disruption of Family by Separation or Divorce

• This code may apply to situations in which adult intimate partners are either separated or in the process of obtaining a divorce

• Parental conflict during separation or divorce can have a significant impact on children.

Child Maltreatment and Neglect Problems

• Child Physical Abuse

• Child Sexual Abuse

• Child Neglect

• Child Psychological Abuse

Housing and Economic Problems

• Housing Problems

• Economic Problems

• Occupational Problems

• Other Problems Related to the Social Environment

Other Problems Related to the Social Environment

• Z60.0 Phase of Life Problem.

• Z60.3 Acculturation Difficulty.

• Z60.4 Social Exclusion or Rejection

• Z60.5 Target of (Perceived) Adverse Discrimination or Persecution

• Z60.9 Unspecified Problem Related to Social Environment.

Z60.9 Unspecified Problem Related to Social Environment.

This code may apply to situations in which the client experiences a problem related to the social environment that is not otherwise better accounted for by the above-mentioned Z codes of Other Problems Related to the Social Environment.

Z60.5 Target of (Perceived) Adverse Discrimination or Persecution

apply in situations in which a client either experiences or perceives discrimination or persecution because of the client’s membership to a specific group or people

Z60.4 Social Exclusion or Rejection

• apply in situations in which a client experiences persistent social exclusion or rejection

• Examples include intentional exclusion from activities, bullying, mocking, intimidation, humiliation, and verbal battering

Z60.3 Acculturation Difficulty.

apply to situations in which a client experiences difficulty acclimating to a new culture and this is the primary treatment focus

Z60.0 Phase of Life Problem.

code may apply to both children and adults and can be used when a client experiences difficulty adjusting to a normal developmental life change, such as starting or graduating from school and individuating from one’s parents

Occupational Problems

Z56.9 Other Problem Related to Employment

Housing Problems

• Z59.0 Homelessness

• Z59.1 Inadequate Housing

• Z59.3 Problem Related to Living in a Residential Institution

Z59.3 Problem Related to Living in a Residential Institution

• directly related to any issues the child or adolescent may have living in an institutional setting.

• This can include children who are in a permanent residential situation via the foster care system or children who are receiving mental health or drug and alcohol treatment in a residential setting.

Z59.1 Inadequate Housing

will be used when the client has housing, but there are serious dangers or deficits in the home.

Z59.0 Homelessness

• One in 45 children in the United States is homeless, and they often experience a multitude of mental and physical problems as result

• homelessness is an aspect that must be addressed before the client will be able to focus on any other aspects of counseling

Economic Problems

• Z59.4 Lack of Adequate Food or Safe Drinking Water

• Z59.5 Extreme Poverty and Z59.6 Low Income

• Z59.7 Insufficient Social Insurance or Welfare Support

Z59.7 Insufficient Social Insurance or Welfare Support

who might qualify for health insurance or social support but does not have this coverage due to lack of resources or documentation

Z59.5 Extreme Poverty and Z59.6 Low Income

may be a focus of treatment for a child or adolescent in the event that the clinician wishes to link the client with community resources or case management services to assist the family in their current situation

Problems Related to Crime or Interaction with the Legal System

• Z65.4 Victim of Crime.

• Z65.0 Conviction in Civil or Criminal Proceedings without Imprisonment

• Z65.1 Imprisonment or Other Incarceration

Z65.1 Imprisonment or Other Incarceration

This code may apply to situations in which a client has been convicted of a crime and, as a result, has been incarcerated. Children convicted of a crime may be incarcerated in a juvenile detention facility.

Z65.0 Conviction in Civil or Criminal Proceedings without Imprisonment

This code may apply to situations in which a client has been convicted of a crime, regardless of whether the client was imprisoned for that crime.

Z65.4 Victim of Crime.

• client is the victim of a crime.

• An alarming number of children are victims of nonsexual crime.

• These may include, for example, physical assault, intimidation, emotional victimization, property crime, and exposure to violence

Other Health Service Encounters for Counseling and Medical Advice

• Z70.9 Sex Counseling

Z70.9 Sex Counseling

when an individual seeks counseling for sexual orientation, which may be a presenting concern for gay, lesbian, bisexual, transgender, questioning, and intersex

Problems Related to Other Psychological, Personal, and Environmental Circumstances

• Z65.8 Religious or Spiritual Problem

• Z64.0 Problem Related to Unwanted Pregnancy

• Z64.1 Problems with Multiparity

• Z65.4 Victim of Terrorism or Torture and Z65.5 Exposure to Disaster, War, or Other Hostilities

Z65.4 Victim of Terrorism or Torture and Z65.5 Exposure to Disaster, War, or Other Hostilities

will likely accompany an acute stress disorder or posttraumatic stress disorder diagnosis, and therefore the treatment focus will be similar.

Z64.1 Problems with Multiparity

Multiparity occurs when a woman is pregnant with more than one fetus at a single tim

Z64.0 Problem Related to Unwanted Pregnancy

will be used for an adolescent female when the pregnancy will be a focus of treatment.

Z65.8 Religious or Spiritual Problem

relates to any issues the adolescent may have related to his or her spiritual beliefs and practices

Other Circumstances of Personal History

• Z91.49 Other Personal History of Psychological Trauma

• Z91.5 Personal History of Self-Harm

• Z72.9 Problem Related to Lifestyle

• Z72.810 Child or Adolescent Antisocial Behavior

Z72.810 Child or Adolescent Antisocial Behavior

is to be included when the client is engaging in antisocial behavior that is not attributable to a diagnosable disorder, such as conduct disorder.

Z72.9 Problem Related to Lifestyle

include aspects of the child’s or adolescent’s activities of daily living that may have an impact on any current mental health and physical diagnoses.

Z91.5 Personal History of Self-Harm

Nonsuicidal self-injury can be defined as any action where the child or adolescent engages in bodily harm that is not intended as an attempt to take his or her life or is done for the purposes of body modification

Z91.49 Other Personal History of Psychological Trauma

may be used if the client has experienced a psychological trauma other than those delineated in the psychological abuse category; however, treatment and diagnosis strategies will be similar.

Nonadherence to Medical Treatment

• Z91.19 Nonadherence to Medical Treatment

• Z66.9 Overweight or Obesity

• Z76.5 Malingering

• Z91.83 Wandering Associated with a Mental Disorder

• R41.83 Borderline Intellectual Functioning

R41.83 Borderline Intellectual Functioning

the clinician should include assessment of the conceptual, social, and practical domains in addition to standardized testing.

Z91.83 Wandering Associated with a Mental Disorder

should be included only if the wandering is specific to a diagnosed disorder, as opposed to an intent to remove oneself from an unwanted situation

Z76.5 Malingering

defined as “the intentional production of false or grossly exaggerated physical or psychological symptoms, motivated by external incentives”

Z66.9 Overweight or Obesity

should be used when the client’s weight will be a focus of treatment, regardless of diagnosis with an eating disorder

Z91.19 Nonadherence to Medical Treatmen

can include noncompliance with medication or any other treatment for medical or mental disorders that would be a focus of attention in counseling.

Treatment

• Cognitive Behavioral Therapy (CBT)

• Dialectical Behavior Therapy (DBT)

• Psychoeducation

• Behaviorism

• Play Therapy

• Expressive Therapy

Expressive Therapy

approaches include art, music, drama, dance or movement, poetry, sandplay or sandtray, and integrated arts therapies

Play Therapy

is way of “communicating therapeutically with clients” through play media and within the context of a safe relationship, through which clients can explore and learn more about themselves and the ways they engage in the world

Behaviorism

can be an important tool when working with children and adolescents specifically to decrease problem behaviors and increase positive behaviors.

Psychoeducation

• a blend of both psychological approaches and educational approaches to increase the functioning of a client struggling with mental illness

• For children and adolescents, this will often include the involvement of parents and family members.

Dialectical Behavior Therapy (DBT)

• considered a third-wave CBT approach

• research has found it to be effective in reducing hospitalizations and nonsuicidal self-injury (NSSI) through several randomized controlled trials

Cognitive Behavioral Therapy (CBT)

• has been around for decades and is by far the most researched therapeutic approach in the mental health field

• An approach that focuses on identifying maladaptive thoughts, reframing those thoughts, and generalizing new skills to all situations in the clients’ lives