Work Sheet for the Johnson and Harrison Cases Case

Work Sheet for the Johnson and Harrison Cases Case # 1 - The Johnson Family Presenting Problem at Intake Family has four children, ages 6, 8, 10, and 11. The family was referred by the elementary school teacher because the 11-year old had collapsed on the school playground complaining of chest pains. The teacher indicated that there had been multiple signs of problems during the past year, and that things had become much worse during the past few months. The teacher indicated: * The 11-year old has had a chronic, low-grade fever, wheeze, and bad cough. She claims she has not seen the doctor. The school nurse examined the child after she complained of chest pains and is concerned about possible pneumonia. The children were often absent from school. The children were poorly clothed for the weather; they had no boots, wore light sweaters in severe winter weather. The 7-year old stayed on the school grounds long after school was out, without supervision. The 10-year old had developed severe behavior problems, and referral to an SBH classroom was being considered. The 6-year old cried all the time. The teacher had called the mother many times, and often got no answer. The one time the teacher did reach the mother, the mother agreed to come to the school, but never did. The children often came to school hungry. * * * * * * * Investigation The Pennsylvania Child Welfare Training Program CORE 102 Casework Process and Case Planning in Child Protective Services Handout #6, Page 1 of 8 The investigation confirmed the school report. The intake Child Welfare Professional woke the mother at 2:30 PM. The children stated their mother sleeps much of the time. The 10 and 11 year olds were responsible to feed and dress the younger children. The mother was subdued and withdrawn, but she answered the Child Welfare Professional's questions. She supports herself on ADC and limited child support from her ex-husband. She claims her income is adequate to "get by." The food in the home was limited to crackers, cereal, and a few canned goods. The mother claimed she "hadn't gotten to the store" and stated she did receive food stamps. She claimed she knew the 11-year old had a cold. When she was asked why she hadn't taken her daughter to the doctor, the mother shrugged and said "I was hoping it would go away by itself." The home was marginally adequate. It was dirty and cluttered, but generally safe. A trip to the hospital clinic indicated the 11-year old had severe pneumonia, and she was hospitalized for treatment and observation and released three days later to her mother. The intake Child Welfare Professional opened the case for medical neglect of one child, and general neglect of all the children. The 11-year old was at moderate risk from the medical condition; the younger children were at low risk of immediate harm, but at risk of longer-term effects of neglect. Assessment Data The ongoing Child Welfare Professional made phone call set the appointment, and got no answer. The Child Welfare Professional made an unannounced visit at noon and woke the mother. Initially, the mother would not talk with the Child Welfare Professional. The Child Welfare Professional used supportive, openended questioning to engage the mother. Through this interview, the Child Welfare Professional determined the following. * The mother's second husband, the father of her two younger children, had left her for another woman one year earlier. The mother has never worked. She has managed to "get by" on ADC and some child support. The mother has no family and few friends in the area. She talks to the neighbor at times, but they are not close. She is "ashamed" to call her family, who live in another state. This is the second time she has had a husband leave her. * * * The Pennsylvania Child Welfare Training Program CORE 102 Casework Process and Case Planning in Child Protective Services Handout #6, Page 2 of 8 * The mother claims that all her children have been sick on and off throughout the winter, but she hasn't taken them to the doctor because "it's such an exhausting trip to spend the whole-day at the clinic." The mother has no car. She claims she used to do everything herself by taking the bus, including grocery shopping, laundry, paying bills, and other errands, and she knows her way around the city on public transportation. When asked about her own health, the mother indicated it wasn't good. She reported chronic headaches, and stated she was without energy. She claimed she was "tired all the time . . . all I want to do is sleep." She had lost her appetite, and sometimes couldn't think about food. She fed her children "Whatever was easy - it's too much effort to cook." She had seen a doctor 6 months earlier for a possible broken finger. She did not want to go back to the doctor, stating "they'll think I'm crazy." After gentle questioning by the Child Welfare Professional, she admitted to crying bouts that lasted for hours at a time. She was afraid that "they'll lock me up, and then who will care for my children?" She has had these symptoms for about a year. They began shortly after her husband left. * * Assessment Conclusions: (use back for additional space) The Pennsylvania Child Welfare Training Program CORE 102 Casework Process and Case Planning in Child Protective Services Handout #6, Page 3 of 8 Case Goal: Objectives and Activities (use back for additional space) The Pennsylvania Child Welfare Training Program CORE 102 Casework Process and Case Planning in Child Protective Services Handout #6, Page 4 of 8 Case # 2 - The Harrison Family Presenting Problem at Intake The hospital called children's services to refer a two-year old boy, who was brought to the emergency room by his 24-year old mother. She claimed he had fallen off his tricycle and bruised himself. The hospital took x-rays of his leg, suspecting a fracture. The doctor also noted bruises in various stages of healing on the child's face, back, legs, and abdomen. Relatively new bruises on the lower back were noted. The hospital indicated a strong suspicion of abuse, and asked the mother to admit the child for "observation." The mother refused treatment, would not allow the hospital to admit the child, and left the hospital with the child. Investigation The x-ray reports confirmed a spiral fracture of the lower leg. The hospital report also documented multiple bruises on non-bony parts of the body. X-ray also revealed old fractures on the same leg. Neighbors were unable to report any problems, other than the mother occasionally screaming and the child crying. As far as the neighbors knew, no one other than the mother and her son lived in the home. The Child Welfare Professional filed an Emergency Court Order with temporary placement of the child in the hospital for further assessment and treatment of injuries. The child was at high risk of harm if he remained in the home. The investigation Child Welfare Professional made an unannounced visit to the home, accompanied by the police. The mother and her son were present. The son's leg was badly swollen, and very black and blue. The mother denied abuse, and refused to talk to the investigation Child Welfare Professional. The Child Welfare Professional explained the need for placement to protect the child, and asked if the mother wanted to accompany her to the hospital. The mother refused. The Child Welfare Professional transferred the case immediately to the ongoing services unit for follow-up. Assessment Data The Pennsylvania Child Welfare Training Program CORE 102 Casework Process and Case Planning in Child Protective Services Handout #6, Page 5 of 8 The ongoing services Child Welfare Professional visited the home. The mother was extremely angry that the Child Welfare Professional came, and at first refused to let him in. "You can't even take your kid to the doctor any more without the authorities taking him away from you. You have no right, and I don't have to talk to you." The Child Welfare Professional firmly but gentle acknowledged that it probably did seem unfair, but that the agency was glad she sought help for her son, that it showed she really cared about him, and that the Child Welfare Professional wanted to talk with her to see if they could figure out the problems which led to her child's being hurt. He said he wanted to help her have her son home again, and to protect him in the future. She angrily denied touching the child, said he had fallen off his bike, and stated that nobody ever believed her. She accused the Child Welfare Professional of being just like everyone else she knew; he wasn't to be trusted. The Child Welfare Professional gently told the client that the injuries were not consistent with a fall off a bike, and that the hospital believed them to have been "inflicted." The Child Welfare Professional then indicated he had worked with many parents whose children had similar injuries, and that none of them were bad parents. The Child Welfare Professional explained that her son would be placed in a foster home for a while, not to punish her, but to protect the child, until it could be determined how he was injured and what needed to be done to protect him in the future. Over the next two contracts, the Child Welfare Professional used supportive process interviewing to determine the following information. * The mother had never married the baby's father. She had dated him for two years, and they broke up. She had wanted the baby, he didn't. She had refused an abortion. Her mother lives nearby. The client claimed they were "really close," but open-ended questions about their relationship revealed significant conflict, fights, and an apparent attempt by the daughter to please her mother. "My mother is never satisfied." She would not ask her mother for help because "all she'll do is criticize me." The client lived in a small, modestly furnished apartment. The child's room was very attractively decorated with brightly colored curtains, and there were many age-appropriate toys in the room. The client's father was an alcoholic and reportedly beat the client's mother. The client denied having been beaten herself as a child. CORE 102 Casework Process and Case Planning in Child Protective Services * * * * The Pennsylvania Child Welfare Training Program Handout #6, Page 6 of 8 * The client claims her son is incorrigible. She believes him to be just like his father. He listens to no one, and "does whatever he damn well pleases." She said he is sneaky, does things behind her back. She asks him if he needs to go potty, and he says no. He then "goes and poops his pants, just to spite me." The son was an 8-month preemie with high bilirubin at birth. He was in the hospital for a week. He was intermittently colicky. The mother thinks that the "light did something to his brain . . . he's just not right." In response to an open-ended question, the mother stated she thinks her son loves her some of the time. He brings her toys and sometimes he puts his arms around her neck and hugs her. But, he's not to be trusted. The next minute he won't stay on her lap, kicks her to get off, and wants nothing to do with her. "He likes that damn truck better than he likes me." The mother has one girlfriend whom she sees on occasion, but has no other close friends. She claims she hasn't met too many people she wants to be friendly with. She has a sister she never sees. They had a fight three years earlier and have not talked since then. She survives on ADC and claims to have no financial problems. “I’ve never had much of anything. I’ve learned to live with what I’ve got.” She is home all the time with her child. She claims she wants to “live some kind of life that’s different from what I have.” She’s “bored to tears” at home. * * * * Assessment Conclusions: (use back for additional space) The Pennsylvania Child Welfare Training Program CORE 102 Casework Process and Case Planning in Child Protective Services Handout #6, Page 7 of 8 Case Goal: Objectives and Activities (use back for additional space) The Pennsylvania Child Welfare Training Program CORE 102 Casework Process and Case Planning in Child Protective Services Handout #6, Page 8 of 8