In this case study we will be exploring the childhood stage. Specifically I will be looking at Suzie Barton who is four years old. Suzie is what Piaget defined to be in the Preoperational Stage (from two years to seven years old). Preoperational Stage is defined as when the use of symbols, intelligence, and language is developed. Our social service agency became involve with the Barton family as a result of Suzie’s siblings’ truancy. In this case study we will be directly recommend specific service recommendations with a developmental perspective.
I met Suzie Barton during our initial interview at her house. The first thing I notice was the house: leaks in the roof, and a strong cold draft. It became apparent that the house has a rodent infestation. The psychologist Abraham Maslow theorized that humans must meet their physical safety needs (safe shelter from the environment/rodents) before they can develop into their personal potential (Wagner, n. d). Maslow’s Hierarchy of Needs states that humans must have their physical and safety needs met before developing proper esteems to become “self-actualizing individuals” (Wagner, n. d.).
It is imperative to have the home fix not just for the obvious health reasons but for Suzie’s development. My first referral would be to Weatherization and Home Repair programs offered by the Opportunity Council. The weatherization services program goal is to improve comfort and safety of low income families. They provide professional energy audits, diagnostic services and other repairs. The result of weatherization is a decrease of energy bill by thirty percent according to http://www.oppco.org/services_ehr.html. The program does provide a professional home repair. The cost of the home repair program depends on the value of the house and income of the Barton household. The Opportunity Council may provide non-interest loans or grants. The Opportunity Council is located at 1111 Cornwall Ave. Suite C, Bellingham, WA 98225. I would make sure that Mrs. Barton knew the location, application process and hours of operation.
The Older Barton children reported “dumpster-diving” for food. Mrs. Barton cans the savaged vegetables. Suzie’s dietary needs are not currently getting met. The United States Department of Agriculture states “children over the age of two need to eat a daily diet that consists of whole grains, fruits, vegetables, lean protein, calcium rich diary products, and some oils” (Oswalt, Reiss & Dombeck, 2008). There is strong scientific evidence that diet influences cognitive development. “Rapid growth of the brain and its high metabolic rate… may influence the cognitive development of children” (Benton, 2008, p. 1). Suzie may learn unhealthy eating habits. Children establish healthy or unhealthy eating by their parents (Oswalt et. al, 2008).
I would check to see if the household is currently enrolled in Washington State’s Basic Food program. Basic Food program provides monthly food benefits, free school lunches and low-cost phone services. Mrs. Barton works two part-time jobs and cannot get time off to apply in the Basic Food office. I gave her the number which she can apply through the mail (1-877-514-FOOD). Suzie also qualifies for Women, Infants, and Children program. WIC provides “nutrition education and counseling, nutritious foods, and assistance with access to health care” for children under the age of five. WIC will give vouchers to staple foods like cheese, milk, bread, beans, and juice for Suzie. Suzie’s mother must apply for WIC benefits at Whatcom County Health Department.
The Basic Food program, WIC, and Barton’s private funds most likely would not feed a family of seven for a month. Food Banks provide another option. Whatcom County has various food bank options: Bellingham Food Bank, Christ The King Church, Southside Food Bank, Hope House-Emergency Food Pantry, Salvation Army and other area specific food banks throughout Whatcom County. I gave a detail list of food bank locations, hours, and requirements. I also gave the family the number of Whatcom Food Hotline (788-7EAT). The hotline tells the caller what food banks are open that day, and where they can access a hot meal.
Sleep like nutrition is very important for a child’s development. Suzie told me that she sleeps on the couch while her dad watches late night TV shows. April makes sure Suzie sleeps on plastic sheet so she does not wet the couch. Suzie needs to sleep between ten to twelve hours of sleep (Oswalt et. al, 2008). Sleep “influences one of the body’s functions and helps the body to heal, grow, and stay on track” (Oswalt et. al, 2008). I do recognize that seven people sleeping in a three bedroom house makes sleeping arrangements tight. Suzie however needs to sleep in her own bed away from TV.
The House 2 Home Network run by the Volunteer Center (http://www.whatcomvolunteer.org/programs/house-2-home-network/) will provide furniture for individuals or families who just left homelessness. House 2 Home Network requires the case manager to fill out the application paperwork. A volunteer would then deliver a child size bed to the Barton household. Bed wetting may be normal for her developmental stage or a system of stress. In any case, I advised the family to seek an opinion from a physician at Interfaith Community Health Center. Interfaith accepts medical coupons and has a sliding scale for low income people. The office is located at 220 Unity St, Bellingham, WA 98225.
It is reported by family members that Mr. Barton is an alcoholic. He is known to go on alcoholic “tares”. Mr. Barton’s alcoholism effects every family member including little Suzie. “Many [children of alcoholics] have common symptoms such as low self-esteem, loneliness, guilt, feelings of helplessness, fears of abandonment and chronic depressions” (Berger, 1993). Children of alcoholics may “develop a poor self-image in which they closely resemble their alcoholic parents” (Silverstein, 1990, p. 75). Research implies that children of alcoholics experience a higher level of stress and tension. Parsons (2003) states that it is common for young children of alcoholics to wet their bed or experience nightmares. Issues of intimacy may develop in adult children of alcoholic because “previous experiences have taught them not to trust people” (Parsons, 2003, 4).
I would make a referral for Mr. Barton to receive an alcoholic assessment at Catholic Community Services. CCS provides chemical dependency counseling services. I made a recommendation for Mrs. Barton and the children to seek family therapy services also at CST Treatment program. I would also suggest to Mrs. Barton to attend Al-Anon meetings—a support group for partners of alcoholics. Mr. Barton alcoholism harms all family members. He may not comply with recommended services. Mrs. Barton and the children can learn skills that may help them cope with the Mr. Batron’s drinking induced behavior. Therapy and self-help groups are often beneficial for alcoholic families to improve their wellbeing (Parsons, 2003). Children of alcoholics will carry their problems into later life if not treated.
I was under the impression that Suzie Batron has yet entered preschool or a head start program. Preschool usually begins when a child is between the toddler and school age (around three to five). Preschool helps with personal, social and emotional development. It also helps with verbal, creative, physical and mathematical development. High quality preschools have lasting affect on children development. Children “were five times more likely to be chronic law breakers by age twenty-seven than those who were assigned to… Perry Preschool program” (http://www.highscope.org/Content.asp?ContentId=260).
My final referral would to the Head Start program. Head start was created by President Johnson in 1965 to provide early childhood education for low-income children. The children may also receive health assessments, nutrition education, mental health services, social services, home visits and family support services. Suzie’s mother would need to fill out an application form, show verification of Suzie’s age, and income proof to qualify for benefits.
Suzie Barton and her family do have strengths. Suzie has a caring and nurturing relationship with her sister April. She has a bright imagination. Her mother has pickling and canning skills that will be useful for the family diet. Suzie is not currently homeless. Suzie situation can improve with access to appropriate services.
Betty, a ninety year old woman, had been referred to my agency this summer. I am a Healthcare Social Worker at Whatcom Hospice Foundation. The Whatcom Hospice Foundation mission is to provide services
for people who have a prognosis of six months or less to live. With pain relief and symptom control, hospice patients can live their final days to the fullest, surrounded by loved ones and the things they cherish (“what is hospice”, para. 1)
Volunteers and professionals provide patients and their family with emotional, spiritual, medical and social supports. Hospice goes straight to the individual’s home or facility to provide direct care services. The services provided rang from nursing care to pain management, personal care, spiritual support, respite care and grief/loss support (“the hospice care team”, para 3). Medicare and Medicaid pay for the complete services (“what is hospice”, para. 5).
I am one part of the interdisciplinary hospice care team: nurses, home health aides, chaplains, speech therapist, dieticians, physical therapists, occupational therapist, doctors and volunteers. It became clear while working directly with Betty that she could have benefit from various social service referrals. Betty had strong family support: four generations lived under Betty’s roof. It is typical for people in Betty’s generation to be isolated from community support services and family. This case study will highlight social service referrals which would be beneficial for seniors like Betty. In additional, I will provide service recommendation for her family after Betty death.
The first thing I do with all new clients to see if they have an advance directive. Advance directive is a legal document which communicates your wishes regarding the level of medical intervention (what are advance directive, para. 1). For example a person may not want to be force feed or kept on a breathing machine. Anyone may gain an advance directive from their doctor’s office. This may be a difficult discussion for majority of people. It is important for the family, emergency staff and health staff to understand the individual’s wishes. Professionals may be held liable if they do not follow the directive. It is a good idea to post the directive in area which has easy access (like a fridge). Simply planning can prevent tragedy.
Betty’s teenage granddaughters and daughter had been her primary caregivers. I gave the family contact information about support services for family caretakers. Northwest Regional Services for the Aging website (http://www.nwrcwa.org/we_serve.htm) is a good resource. From the website we found a support group for the family to discuss the pressure of care giving her grandmother. In addition, provide a list of Medicaid supported home health aide agencies. Home health aides can provide companionship, housekeeping and safety services.
The Bellingham Senior Center is place which provides enrichment to seniors’ lives. Social interaction is a basic requirement for anyone regardless of age. Betty may enjoy making new friends, and be with people from her generation. Bingo, meals, and card games are examples of activities offered at the Senior Center. Studies have shown a link between learning new activities and the prevention of dementia. Occasionally free healthcare screenings (such as toe-nail care, blood pressure etc) and services are offered. The Whatcom Transit Authority can pick-up Betty at no cost.
The Meals on Wheels could provide delivered daily food to Betty. The program can also provide free liquid meal replacement shakes. Meals on Wheels organization provides meals to home bound seniors. Six million seniors face hunger on a daily basis according to Meals on Wheels website (“Our Vision”, para 1). It is commonly known that nutrion influence general health. Seniors need a specific kind of diet; especially if they are having difficulties swallowing or are diabetics. It would reduce the finical burden to the Barton Family.
In a sensitive manner, I asked Betty if she had any religious connections. Many people find comfort with clergy members or church leaders. It is important as a social worker to be cultural competent with societal norms and customs around death. Some people may require last rites ceremonies. I would encourage the family members to discuss the will, and her plans after her death.
The second half of the case study will be focused on the surviving family members. The Barton family was active in witnessing Betty’s health decline and eventual death. The Hospice staff gave a lot of information to the family on what to expect during the dying process. The family members typically often describe themselves as lost. The dying process and death is rarely discussed in our culture.
Grief is a normal process of loss. It may look different on every individual depending on their age and personality. People often feel sad, numb, and wonder about their regrets. Others may react in anger. There is also no set amount of time for grief. It depends once again on the individual. Hospice often refers family members to clergy members. If they family is not religious, sometimes a skilled therapist session may provide relief.
The finical burden of planning Betty’s funeral service may be a stress for the family. Burial arrangements are expensive. Hopefully Betty has a will that contain her last wishes and money set aside. If not, Whatcom County Coroner may cover the cost of a cremation. I would Phyllis Barton to apply for indigent benefits before cremation takes place (Heida, 2009). If cremation is against their religious beliefs; referrals to their house of worship may be of benefit.
People like Betty have various community resources: food services, heath services, household core assistance, companionship services and hospice program. It is vital for helping professionals to educate seniors on available services. The Barton family like any family will need grieving support services. It is important for the family member’s development to properly grieve the loss of Betty.