Appendix V -- Case Studies

Family Case Studies

Considering Suzie Age 4

I am considering the well being of the character Suzie in the case study family. She is four years old and is within the age parameters of the developmental stage labeled infancy/ childhood (Birth to 10). She is the only child in this family that falls into this category of the developmental stages. In reading the case study and conducting research on her developmental stage according to her age, I have decided to address two major factors in Suzie’s life that could use considerable attention. I will explore the areas in which I feel needs attention, as well as offer solutions or ideas in beginning the process in improving her life in these areas. The first factor is Suzie’s sleep situation including bed wetting and the second is her need for creative play and stimulation.
At 4 years old, she is creating a pattern that may end up being very hard to break. If she continues down the path of not getting enough of the right kind of sleep, there will likely be concerns and potential struggles in the future. School age children who do not receive adequate sleep show lower performance in school (Sigelman & Rider, 2006). Further down the road as a teen, inadequate sleep can manifest into lowered emotional control (p123). Problems like these do not go away on their own and often times are a catalyst to other problems and struggles in their lives.
The good news is that Suzie is in the right age group to respond well to “scripts”, or mini routines (p210). Using this developmental tendency to the advantage in getting her to sleep on more of a set routine can be a huge benefit for the whole family. The idea is that with a little bit of work, she will thrive off of the idea of having a “script” to go by and is old enough to follow it nearly on her own. Maybe she can move to the bedroom with the grandma, so she won’t be out in the main living area. She can have a dark and (somewhat) quiet area to sleep. If she goes to bed the same time as grandma every night, or say, when grandma gets her evening medication, she could respond well to the routine of it.
Sometimes, nighttime bedwetting is a sign of an underlying health problem or emotional concern. Finding a place where she can see a doctor for a check up to determine any obvious causes of the bedwetting. Ruling out any health concerns is the first step in helping her control her nighttime bladder. After the doctor visit, and the changes in her routine and sleeping area, she may improve tremendously. If not, there may be even deeper emotional concerns, at which point we’d be considering some counseling to try and help. At this point, beginning with a trip to the family doctor is in line. This could pose a challenge for the family being that they have a full schedule and limited funding. However, the DSHS office in Mount Vernon will have the resources available to help receive a doctor visit for her and they are there to work with the families’ availability as much as possible. The address for this office is 900 E. College Way #200. The phone number is 360 416 7200.
In further conversations about Suzie’s health, it would be wise to make sure she is up to date on immunizations. The immunization office has free shots for families with no funds available. It would be smart to check into her status and get her up to date with those. The immunizations office is located in the Skagit county Health Department building located in downtown Mount Vernon, 700 S. 2nd Street #301. The phone number to the office is 360 336 9477.
The other major factor that I would like to help address is Suzie’s creative life. She would do well with a good healthy creative outlet, in light of her daydreaming about the drapes in the case study story. She is at the age where play is very important and “pretend play flourishes between the ages of 2 and 7” (p178). Finding a place for Suzie to dive in to being creative and utilizing her imagination will help her tremendously in development and coping of life. “Play contributes to virtually all areas of children’s development… play fosters cognitive, motor, and social skills and helps children cope with emotional problems” (p 405). More specifically, “play contributes to healthy emotional development by providing opportunities to express bothersome feelings, resolve emotional conflicts, and master challenges” (p 405). Given the stress that her family is feeling all around her, it is all the more important for Suzie to have a healthy way to release and make sense of the world around her.
One option available for Suzie is the YMCA. They provide a preschool curriculum that has funding options available through DSHS as well as other scholarship opportunities. The YMCA can be found at 215 E. Fulton Street, Mount Vernon. Another idea is the Children’s Museum of Skagit County. They are open often and at least once a month they have a community free day where everyone can visit free of charge. They have a huge amount of activities for imagination, learning, and development. There is a room for art projects with all supplies available as well as endless opportunities for imaginative play, as well as the opportunity for Suzie to play with children her own age. The museum can be found at 419 S. 1st Street, Mount Vernon. The phone number is 360 419 7474. Most challenges associated with providing these creative outlets for Suzie have to do with transportation and availability of family members to accompany and/or transport her. The possibility of car pooling with other families should be considered. One last thought to consider in regard to Suzie’s mental/creative development is her knowledge of the television. She loves The Little Mermaid. A trip to the local library to check out some more diverse videos may give her another option for her time spent with the television. There are many children’s videos available that encourage imagination and teach a spectrum of lessons to their young viewers.
It is completely conceivable that given a healthy outlet for creative play, coupled with an improved nighttime environment, her bedwetting may disappear altogether and the need for counseling may never actualize. It is guaranteed that a child provided with creative outlets and opportunities for imaginative play is better adjusted and more developmentally healthy than a child with no such opportunities.
Considering Barton Adolescents

There are three adolescents in the Barton family. All three of these individuals have some very good ideas and potential to truly thrive if they are provided the support and guidance needed to help them make some important decisions. Peter is preparing to make a decision about whether to participate in a sport for school, while April is faced with a decision about whether to continue attending high school or drop it for a career path. Tracie is about to become a young mother and is challenged with a number of decisions regarding the upcoming birth.
Peter should be encouraged to take the offer from Mr. Kemper. This man is a good (and needed) male role model. With Peter’s dad struggling to manage his health and alcoholism he is not as available as he could be. Peter is at the age in which puberty is in full swing. He will thrive off of guidance in the time where his autonomy is emerging. According to the authors Sigelman and Rider “Parents- mothers and fathers alike- can help adolescent adjust successfully to puberty by maintaining close relationships and helping adolescent accept themselves” (p133). It would be helpful if Phyllis could make a point in connecting with Peter regularly, as well as supporting his consideration of joining the wrestling team and inevitable relationship with the coach. There is a high potential for Peter to learn a healthy outlet for his aggression in addition to being immersed in an entirely new environment that will provide him a new set of friends and priorities. When Peter was having a hard time concentrating in class, it made me think that the stress of his families situation is affecting him and an activity like sports may give him something more age appropriate to focus his thoughts on. Peter also seemed to harbor some shame about the help his family was receiving when he feels embarrassed to use the food coupons. This may be why he was hesitant to accept Mr. Kemper’s offer to “waive” the registration fee. Sometimes, though, families that qualify for public assistance such as food stamps, also qualify for help in areas like this one. He and his family should ask if they can get some help with the registration fee for him to play and he would not have to feel embarrassed or singled out when he is on the team.
April will largely benefit from some encouragement and guidance in making decisions as well. April has some very real and valid ambitions with her interest in helping people in a professional setting. However, her expectations about perusing the jobs without completing school (or equivalent) may be unrealistic. Given her age, she will likely need some pointed guidance in helping her to formulate a plan for arriving at her goals. “[Those in April’s adolescent] age group, more readily accept evidence consistent with their preexisting beliefs than evidence inconsistent with those beliefs” (p186). Because she does not enjoy school and she so thoroughly enjoys helping people it is understandably difficult for her to truly see the value in finishing school because she is hearing more clearly the arguments in favor of what she wants to do than viewpoints that go against what her feelings are. I think she should make one last appointment with the school counselor, or a different one if she prefers, with the purpose of exploring the possibility of her job interests. In this meeting it would be helpful for that person to offer some avenue in visiting the places where she could see herself working. Given the opportunity to meet people in the field she could ask advice about finishing school from those she already looks up to. In order to help her make a decision, while taking into account her developmental abilities to weigh decision, and help her truly see the argument against her preexisting beliefs, “teachers [, counselors, parents etc], may need to give [her] extra assistance by using specific examples and demonstrations to help clarify general principals” (p.186). A visit to some possible places of employment for information and insight gathering may be just what she needs to formulate a good, structural plan in actualizing her well founded ambitions.
The very first thing that Tracie needs to do is get into a prenatal doctor’s appointment. “Once a woman is pregnant she should seek good prenatal care as quickly as possible so that she will learn how to optimize the well being of both herself and her unborn child and so that any problems during the pregnancy can be managed appropriately” (p98). It is understandable that she would be feeling apprehensive to see a doctor about her pregnancy, for so many reasons. In this case it is far more important to assure the health of the baby than indulge in apprehension or anxiousness. At her doctor’s appointment, they will address the important topic of nutrition and pregnancy. My concern here is that this family, while trying hard, is not maintaining a consistently well rounded diet. Tracie should know that “offspring of a malnourished mother sometimes show cognitive deficits as infants and children. Poor prenatal nutrition may also put some children at risk for certain diseases in adulthood” (p99). One idea to address this need, is for her to contact a representative from the WIC program. The Women Infant Children program will provide her, as an expectant mother, with much needed nutritional foods to help maintain a healthy pregnancy and newborn baby. Another good idea for Tracie to consider is an organization called Hannah’s House. This is a non-profit organization that will provide a full spectrum of help for her including pregnancy health, room and board, educational avenues, job search help and techniques for life skills, they will also be a resource for support and assistance in deciding to raise the baby or offer it for adoption. In either case they will help her prepare for her decided journey in myriad of ways. All of these interventions are offered free of charge, but Tracie would be expected to live at the house with the staff and other young mothers living there. This would be a challenging decision in itself, but could potentially be the best thing for her, and the family. Hannah’s House is located in Mt. Vernon. The phone number to call for an application or appointment is 360 424 6797.
Being faced with a decision to make is difficult for anyone. These young people are trying to make decisions at a time when their family is not completely equipped to help them and they themselves, as adolescents, truly need the guidance and help. These situations are also manageable. Even with the little amount of resources available to them, it is within their reach to travel on a path that will most benefit themselves and their futures.
Considering Parents
The parents in the Barton family are Phyllis and Paul. They are 41 and 42 years, respectfully, and both fall into the category of early/middle adulthood. This family’s health and livelihood fall almost completely on the shoulders of these two individuals. They, in conjunction with trying to maintain themselves, are working to maintain the family. “The lives of adults are dominated by work –paid or unpaid, outside the home or within the home” (Sigelman & Rider, p 281). This statement is so true in the case of the Bartons. Phyllis’s reality is that she is, at times, the sole monetary provider for their large family, as well as mother, niece, and now a grandmother. Paul’s reality is that, with failing health, he continues to struggle with alcoholism and old injuries that contribute to the already intermittent nature of his job. The situation is that they are struggling, but still surviving. They are doing many things right for their family, and with a little perspective and encouragement; they could be doing even better in some areas.
It is good that Phyllis and Paul are already utilizing the federal benefits that provide them with food stamps. They are also using creative ways to bring food into the house and preparing meals that will last a few days at a time. If they aren’t already getting help with health care costs through the same avenues, that would be a good idea for them to look into.Paul is struggling to find work in his handyman line of work that will not exacerbate his injuries. He would be a good candidate for a vocational rehabilitation program, in which he could be trained to do a job that is respectful of his physical abilities and limitations. He could contact the Washington State Department of Labor and Industries for information on a vocational rehabilitation program. The number for the department is 1-800-547-8367. Going to school or new training, for him, could stand to be a huge challenge and could also be very helpful for him and for the family. He should not feel uncomfortable about considering a new line of work in his 40’s. Sigelman and Rider explore tendencies of adults in finding a vocation. “Even in their mid-30’s about a third of adults were still exploring what they wanted to do when they grew up.... After their relatively unsettled 20’s and decision making 30’s, adults often reach the peaks of their career decisions in their 40’s” (p 315). If he does decide to pursue new training it could be a great source of distraction while he continues his efforts in staying sober. While taking classes he could continue to accept handyman jobs that are flexible with his schedule, and eventually, after he completes training be in a job that has potential for a higher income and will not irritate his existing injuries. If he does not consider the possibility of a new line of work, he will likely notice a decline in his abilities to keep up to the work pace he was once accustomed to. “As people age, their nervous systems, reaction times, and motor behavior slow; their capacity for vigorous activity is also reduced” (p 141). He must also take into account the amount of decline that his alcoholism likely had on his system. “Excessive alcohol consumption… [is a ] clear example of abuse of the body that contributes to declines in functioning” (p 140). Especially after his hospital stay, he should be continually aware of the dangers of consuming any amount of alcohol. In light of this, and his proven diminished will power at the birthday party, he should seriously consider sincere involvement in the local Alcoholics Anonymous program. The 24 hour number for the local AA office is 360-734-1688. This could be something that he and Phyllis pursue together, as she may learn a lot about helping him as well. If Phyllis becomes part of a changing environment with knowledge of how to best support him, it will benefit everyone. “Change [in people] is more likely when there is a poor fit between person and environment” (p 311). If Phyllis can learn how to facilitate a loving environment that is not conducive for him to continue to abuse alcohol, he is more likely to embrace the change within himself. With Phyllis being the main help in Paul’s recovery, it will add yet another demanding title to her load.
Phyllis is managing a physical and emotionally draining schedule. She is juggling many roles and seems to be fairing well considering the stressors that are on her during these times. She is mother to three children all with vastly different needs, monetary provider for this large family, elderly care provider for her aging aunt, wife to one with health struggles. “Middle-aged adults who must foster their children’s (and possibly their grandchildren’s) development while tending to their own development and caring for aging parents sometimes find their situation overwhelming” (p 441). As far as her financial stressors, those struggles are well founded. Attempting to provide for such a large family with one income is near impossible. With the birth of her new grandson they have a very full and extended family household. “Extended family households are common in many cultures of the world” (p 422). So Phyllis should not be discouraged in her living arrangement. There are many benefits to be had with living so close with her family. They have the potential to create a very special bond with the newborn and can likewise benefit from a close relationship with her aunt. Families working together to live is potentially much more rewarding than living separated. Families are diverse and dynamic. Its success depends on all of the parts and what each gives and takes from the system. They are not, however, independent of the world around them. Many of the Barton’s struggles are well founded because “family…does not exist in a vacuum…[it is] a system embedded in larger social systems” (p 422). The journey out of financial ruins is a tough one that is not easy even with the help that is available to them. The presence of health care costs for Paul and Grandma, and the age of her children can only compound the problem. One perspective that I think would be helpful for Phyllis is what effect her financial stress could be having on her children.
“Parents experiencing financial problems tend to become depressed, which increases
conflict between them. Marital conflict, in turn disrupts each partner’s ability to be supportive, involved and effective parent…this breakdown in parenting them contributes
to negative child outcomes such as low self esteem, poor school performance, poor peer relations, and adjustment problems such as depression and aggression”(p 428).This perspective confirms the potential benefits of becoming involved in Paul’s healing process through AA. Maintaining a strong marital relationship through struggles will positively affect their children. As part of considering this perspective, it would be beneficial for Phyllis to recognize April’s poor school performance as of late, Peter’s tendency for aggression, and Tracie’s teen pregnancy as possible products of the stressors apparent in the home that may have stemmed from financial stress and effects of alcoholism. She may also consider some ways to bond with her children on an individual basis and with positive atmosphere. This can help alleviate some of the effects of the stressful environment on the children as well as provide an opportunity for her to positively influence some of the things her children are facing at their respective ages and developmental stages. At this point, supporting Paul to stay sober, and possibly gain new skills that will bring in a regular paycheck without pain to his injuries should be considered as a viable plan in pulling this family out of financial and behavioral strain.
Both Phyllis and Paul have their work cut out for them and are in a decidedly difficult life situation right now. The hope is that with these encouragements and perspectives, they can embrace their strengths and continue doing the things they know they are doing right, as well as attempt to improve in some other areas as well.
Considering Grandmother
This last paper brings the 4 part series to a close. It is appropriate that I am writing about the last stage of life for the Grandmother. In the year long Barton family story summer is the end. So to with Grandmothers long 90 years of life. I found that the Barton family did many very positive things in making her last months as fulfilling and comfortable as possible. In order to find some things that could have also been done, I will highlight the many things that were done that I believe to be extremely helpful. I will offer some additional ideas that may have helped the Barton family in those months leading up to and directly following her passing.
First of all, the Barton family worked together as a team in taking care of their grandmother. For any family that is going through emotionally taxing times, it is a positive accomplishment to stay connected working for the same goal. In this case it was about someone always being available for grandmother, around the house, for food and health assistance, and emotional support, holding hands etc. When the times called for someone to be continually near her, they took shifts. While the stress of the situation surely became apparent, the system they’d set up of teamwork did not fail. A notable example of this shift, teamwork system was during the spring when Tracie was home with Max and helped with grandmother through the week while Phyllis was working. Then when Phyllis was home on the weekends it gave Tracie a break. Another example was near the end when family members took turns in shifts holding her hand through the night so she would not be alone. This is so loving and helpful and without a doubt something that would have been impossible had she been in a nursing home.
Another great idea that was utilized was April’s relationship with grandmother and her need for extra school work. April used the stories she heard from grandmother to write short essays and get extra-credit. This helps the family by having some free time while the two of them were visiting, it helped grandmother because she was feeling socialable and had company, and helped April to find something she could do for school that did not take her away from the needs of her family, a challenge she’d been facing before.
When Paul thought of a food option for grandmother, it was very thoughtful and contributing to helping her maintain sustenance when it was hard for her to eat. In this family help, creativity, and thoughtfulness all came together to create an environment that surely did not go unnoticed by their ailing member.
They utilized the volunteer help of the Hospice worker. This was a very smart decision given the information and support they received from this avenue. This was not only help for the health and welfare of grandmother, but a welcomed avenue for the family and opportunity to gain knowledge and perspective about what they were experiencing in the last months. In regard to grandmothers emotional well being in her last months, the decision on hospice care was a good one according to “one study [where], a third of individuals cared for by a home health care agency, nursing home or hospital felt they received too little emotional support, whereas, only about 20% of those receiving home hospice services felt this way” (Sigelman &Rider p.508).
The family also did practical appropriate things like talking about what would happen to the house after her passing. Something that would stand to be an added challenge if left until after her passing and time of grief for the family. Another practical thing the family did was to have a plan with the hospice worker and neighbors in the final moments. Everyone knew what to do even though the actuality of the emotional experience could not be planned for.
I truly feel that many of my ideas and input for these last few months in the Barton family were already achieved. They had options, but it would have only changed the experience and not necessarily made it easier. First, in response to their understandably high level of stress, they may have benefited from family meetings where each person had a chance to share what they were feeling, or even just sit with one another and acknowledge each individuals experience through the days and weeks. This may have helped to bring perspective to their live is it was, and alleviate some of the stress, if only momentarily. They may have also benefited with even more information about what their grandmother was going through in the dying process and what the family was going through in experiencing it as well. They could have found this information through Caretakers support groups or resources through Northwest Regional Council. They could have used these same resources to find out other nutritional ideas to help her receive nutrition and not have to eat the same thing each day.
In the months and years after grandmothers passing, the family will be dealing with a whole new set of emotions and stressors. Grief and mourning. Sigelman and Rider’s concise overview of this process is that grief and mourning are “expressed in overlapping phases of numbness, yearning, disorganization and despair; and finally, after a year or more, reorganization” (S &R, p.497). In reality, “[it] is a complex and multidimensional process that varies from person to person and often takes a long time. Many emotional reactions are involved and their course and intensity differ from person to person”( S & R, p.497). The Barton family would benefit from a continued close relationship with one another and frequent communication about each of their experiences. Also in their experiences, and at the right time, to remember that “psychologists are coming to appreciate that bereavement and other life crises also have positive consequences and sometimes foster personal growth…Many bereaved individuals believe that they have become stronger, wiser, more loving and more religious people with a greater appreciation of life”(S & R, p507). This communication and forward thinking may be a challenge for the family because each individual will process the death in their own way, but without the continued closeness and teamwork, some members of the family may be left feeling depressed. “Some Individuals are better equipped to deal with the stages of bereavement” (S & R, p506) than others and this knowledge will help the Barton family to move through their mourning with sensitivity. “Finally, grief reactions are influenced positively by the presence of a strong social support system and negatively by additional life stressors” (S & R p.506). This statement is working for and against the Barton family, while they have a fairly strong family and support system, they also have a lot of stress unrelated to this death in the family. As they begin to heal, they should stay open to the option of seeking counseling to help them further cope with life alongside their grief.
Overall, the Barton family has come together to make it through this difficult time of the last few months of grandmothers life. If they continue to utilize their collective strengths and creativity in difficult times, they will continue to grow together and survive.


References
Sigelman, C. K., & Rider, E. A. (2006). Lifespan Human Development (5th Ed.). NY: Thomson/Wadsworth.