case study 5: abbie
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DESCRIPTIONCase Study 5: Abbie. Janna Presley, Holly Koster, Samantha Newcomb, and Ryan Elsea . Description of Setting. Abbie’s foster family resides in rural Lamar County , Alabama. Services will be provided in the spacious home of her foster family. Service Delivery Model:. - PowerPoint PPT Presentation
Case Study : Abbie
Case Study 5: AbbieJanna Presley, Holly Koster, Samantha Newcomb, and Ryan Elsea Description of SettingAbbies foster family resides in rural Lamar County, Alabama.Services will be provided in the spacious home of her foster family.
Service Delivery Model:Services will be delivered via a transdisciplinary model. This is a team model which consists of professionals from multiple disciplines and family members who will pool their knowledge and skills to support Abbies development.Abbies Team (Human Resources)Foster mother and fatherBiological motherPhysical Therapistwho serves as the Primary Service ProviderSpecial Educatorwho also serves as Service Coordinator and a consultative resourceOccupational Therapists (2)who serve as consultative resourcesAll are involved in evaluation procedures.
BackgroundHistory and Description of Abbies Disability12 month old female, 9 months correctedBorn premature to a single mother with history of drug useVentilator support and supplemental oxygen while in the hospitalDisability: Grade III IVH, current respiratory infections, and possible vision and hearing impairmentsFamily and Social HistoryPlaced in foster care in Lamar County at 3 months oldBirth mother has supervised visits with Abbie every 2 weeks, but she has missed the last 5 visits.Foster parents want to provide the best care.
Grade III IVH:
Abbie was placed in foster care by DHR due to concerns of the lack of ability of Abbies birth mother to care for her needs.
Mom stays at home since her mother-in-law had a stroke.4Background cont.StrengthsCared by a loving family with a mom, dad, and grandmotherNice homeFather has a good job.Physical strengthsRoll overGrasp toys and bring them to midlineBalance momentarily in seated positionCommunity and Support ServicesCommunity Service Programs of West Alabama, IncARC of Fayette/Lamar/Marengo Counties, Inc.TOTS Early InterventionEI, Head Start, and Early Head Start Programs
The family does not get to choose the agency from which they receive services. Where they receive services will depend on either how this particular county is divided, territorially speaking, or on where the referral was sent.
5Background cont.Ethical and Cultural AdaptationsFoster parents are devout Roman Catholics, who want Abbie to grow up sharing their faith.However, Abbies birth mother wants her to be raised as a Protestant.As a result, this has raised controversy.
Well discuss this issue in further detail later and discuss how it can be resolved.6Formal AssessmentsDevelopmental Assessment of Young Children (DAYC) Standard scores on the DAYC were: Adaptive 66, Social Emotional 78, Communication 67, Cognitive 63, Physical Development 60, and the General Development Quotient score is 69.Qualifies for EI services
Abbie was given the Developmental Assessment of Young Children (DAYC) to formally assess her level of development. Abbies standard scores on the DAYC were as follows: Adaptive 66, Social Emotional 78, Communication 67, Cognitive 63, Physical Development 60, and the General Development Quotient score is 69. The scores on this assessment indicate significant delays in the physical, adaptive, communication, and cognitive areas. This test indicates a general delay in development that is significant enough to qualify Abbie to receive an Individual Family Service Plan through Early Intervention services in the state of Alabama. After a thorough physical therapy evaluation, Abbie presented with increased tone in her upper and lower extremities, as well as hyperactive reflexes. She did not display any sensory deficits and had full range of motion in her upper and lower extremities. Although she was able to be placed into end ranges of motion by the physical therapist, she voluntarily kept her arms and legs close into her body in a flexed or bent position.
7Informal AssessmentsRoutines-Based Assessment WorksheetRealistic weekly routineFunctional activitiesFamily activitiesECO MapStrong connectionsStrained connectionsFamily ConcernsFoster parents feelings of inadequacyAbbies frequent respiratory infections, feeding difficulties during mealtime, and delayed development (i.e., not being able to sit and interact with toys)
WeekdaysWeekendsMorning:-Abbie wakes up at 7:00 AM and drinks formula from her bottle. Mom also tries to feed her baby cereal and fruits.-Mom gets herself ready for the day and eats breakfast
Morning:-Everyone eats breakfast together after everyone wakes up.-Each one takes turns watching Abbie while everyone is getting ready for the day.
Afternoon:-Mom does work around the house while Grandma watches and plays with Abbie.-Mom, Grandma, and Abbie eat lunch together. .Afternoon:-Dad takes Abbie to the park/playground.-When they get back, everyone just relaxes and watches TV.Evening:-Dad comes home at 5:00 PM.-Dad and mom take Abbie to the park/playground for 30 minutes after Dad gets home from work.
Evening:-Dad takes everyone out to dinner on Friday nights. -Anne watches Abbie, so Mom and Dad can go see a movie once a month on a Friday night.
By completing the routines-based assessment worksheet, we were able to decipher what were the most difficult times for Mom during the week, which were play time, dinner time, and bath time.
ECO Map: I just wanted to mention a few important relationship connections from the ECO map.
Strong connections: Foster mother and father, Foster parents and grandmotherStrained connections: Foster parents and the biological mother of Abbie
We were able to develop goals/outcomes based off these informal assessments.8Overview of outcomesOutcomes are focused on Abbies needs and her caregivers concerns:Difficulty sitting independently to play Lack of interest in toysInconsistent when responding to toys, keeps toys in midline, not reaching for toysGeneral delays in physical development Not weight bearing through legs, not catching herself when loses balance, prefers to lay on back, minimal transitionsProblems with feedingFrequently chokes/gags on foodWorried they are not doing everything needed to help Abbie due to being inexperienced parentsOverview of outcomesExamples:While sitting in boppy pillow, Abbie will reach for toys on her own and then hold them on her own during play 3 out of 5 trials each day during the week. Abbie will reach arm out to catch herself when tilted to the side four out of five times while playing, four days of the week. Abbie will independently transition in and out of sitting four out of five attempts while playing, three days of the week.While playing, Abbie will bear weight through her lower extremities when placed in supportive standing three out of five attempts, three days of the week.
10Overview of outcomes Examples (continued):Abbie will sit in a supportive seat with the family during evening mealtimes for up to fifteen minutes four days of the weekAbbie will eat one meal a day consisting of baby cereal with decreased choking or gagging on 5 days of the week. Foster family will express increased confidence in positioning Abbie during play.Foster family will follow up on an ophthalmology and audiology screening.Biological mother will learn and gain confidence in childcare skills with Abbie
Intervention StrategiesAssistive devices:Boppy pillowSupportive chair/seatBath seatHelp Abbie engage in play with toys:Incorporating toys with different textures, lights, and soundsIncrease Abbies stability:Reaching and grasping activitiesTilting reactionsTransitioning and weight bearing activities Instructing parents to hold at Abbies hipsImprove Abbies feeding:Changing the textures of foods Pacing of feedingAltering utensilsChanging the alignment of the head, neck, and body when feeding
12Specific issues: religionFoster parents are devout Roman Catholics.Birth mother prefers Abbie be raised according to a protestant religion.What variables may influence this decision?Who do you think gets the final say?
A specific issue related to this case is what religion Abbie should be raised as. Her foster parents are devout Roman Catholics who attend mass on a regular basis every Sunday and are involved in many of the Catholic churches events and social functions. However, in their last meeting with the case manager and Abbies birth mother, Abbies birth mother became upset when she learned that the foster family had been taking abbie to the Catholic Church and that they would like her to be raised as a practicing Catholic. The birth mother wants Abbie to be raised according to her protestant religion. When considering this issue, we first considered many of the case variables. First, Abbies birth mother has not attended the past few meetings, does that have a influence in her say? Abbie is also being cared for primarily by her foster parents and they are extremely involved in their Catholoic practices. So, should they have to sacrifice some of their practices and social involvement so they will not upset the birth mother? Abbie is also very young, so she cant currently participate in many religious activities13Where to look!State of Alabama Department of Human Resources. (2001). The foster parent handbook: A guide for Alabamas foster parents.
After considering all the different variables influencing this decision, we decided to do a little investigating into state laws and regulations. In searching for information, we went to the state of alabamas dhr webpage. Here is where we found the State of Alabama Department of Human Resources book available in a pdf form : the foster parent handbook, a guide for Alabamas foster parents. This book was last updated in June 2001 under Governor Don Siegleman and Bill Fuller, Commissioner State of Alabama Department of Human Resources. This resource book incorporates state laws into family friendly lang