Client: A.S., 34-year-old male Setting: Outpatient Veterans Affairs Mental Health Clinic Presenting Complaint: "I can't sleep and I keep reliving what happened." History: A.S. is a recently discharged military veteran who survived an improvised explosive device (IED) attack during deployment. He reports persistent nightmares, emotional numbing, and avoiding crowded environments. His spouse notes increased irritability and detachment from family members. A.S. denies substance use and suicidal ideation but expresses "hopelessness about things ever changing." Exhibits Select the assessment findings that require immediate follow-up

Assessment Finding Requires Immediate Follow-Up? Sleep disturbance No Avoids group interaction No Verbalized hopelessness Yes Startled by loud noise No Preoccupation with trauma No • Sleep disturbance: Although poor sleep (2–3 hours/night) is concerning and affects functioning, it is a common symptom in PTSD and does not represent an acute safety risk. Sleep issues should be addressed in therapy and medication management but do not require immediate intervention. • Avoids group interaction: Social avoidance and minimal participation in group sessions reflect PTSD symptoms such as emotional numbing and avoidance. While important to address therapeutically, this behavior does not indicate imminent danger and does not require immediate follow-up. • Verbalized hopelessness: Expressing hopelessness signals emotional distress that can escalate if unaddressed. Even in the absence of suicidal ideation, feelings of hopelessness are a strong risk factor for worsening mental health and may indicate the need for closer monitoring, therapeutic intervention, and potential safety planning. Immediate follow-up ensures timely support and intervention. • Startled by loud noise: Being easily startled is a typical hyperarousal symptom of PTSD. It is expected given the client’s trauma history and does not present an immediate safety concern requiring urgent follow-up. • Preoccupation with trauma: Trauma-related preoccupation is consistent with PTSD and is expected in a newly admitted client. While this symptom requires ongoing therapeutic attention, it does not necessitate immediate intervention for safety.