Final Week

All was going well for Terrance. His job was going well and he was getting along with many of the members of in his group home. Unfortunately, one day Terrance had a tantrum at work when some teenagers came in to the restaurant and were making fun of the way he spoke. His employers tried to work with him but with the outburst following the incident, he felt that Terrance could not handle the job and was fired. Terrance could not understand why he was fired, he believed it was the customer’s fault and he did not understand why he was at fault. His behaviors at the group home also began to escalade causing issues. Terrance went back to his job coach and worked on his social skills once again. He was also sent to behavior management therapy to work on managing his temper tantrums and his anger. As his skills began to develop, Terrance was able to go back to work again getting a job stocking shelves at a local grocery store. Although Terrance has a lower IQ of about 75 he learned to match items and was able to lift heavy items due to his large size.

            As the years went on, Terrance’s body began to fall apart. He was forgetting things more easily and picking up heavier items was taking a toll on his body. He began to walk with a slight hunch and eventually needed the use of a cane to get around. He no longer was able to lift heavy things in the grocery store and was placed at a new job. He was assigned to wash windows and other maintenance tasks at a local office building. Terrance was good at doing these tasks, especially after training. He liked being around people, but he did not really have to initiate interactions. Many of the people working at the business were older, more accepting. Terrance really enjoyed being at work and everyone got to know him and loved his help.

            Terrance worked at his job for ten years until he lost most of his hearing and was unable to communicate properly at his job. He was told to “retire” and just spend some time at the group home. While at the home, he helped daily with tasks around the home which kept him busy but his lack of employment and communication problems really limited him. He began to get angry again and did not understand why he could not hear what anyone was saying and why they would not speak up. Fortunately, one of the caretakers at the facility noticed that he was having trouble hearing and referred him to hearing specialist. Medicaid paid for his hearing aid and he was able to become social again.

            Once Terrance reached 65, the caretakers of his current group home felt that his needs were getting to be a little more severe. Terrance was having difficulties bathing himself daily as well as other day to day tasks. It was decided through his social workers that it was time to move to another group home more suited for elderly individuals with mental disabilities. Terrance felt abandoned and became depressed. Why did they not like him? Once he reached his new group home he settled in after a few months. Eventually his health began to deteriorate and he began to have heart issues. Fortunately, Terrance lived happily until just a week after his 80^th birthday when he suffered from a heart attack and passed away. His mother would have been proud to see him living a happy life with friends and being well taken care of.

Week Thirteen

At the time of Terrance’s arrested, his mother, Vasha, was starting to get her life on track with help through Mental Health Support services.  Vasha’s "new lease on life” left her with a clearer mind and her counselor was able to provide her with great resources to help get Terrance the services he so desperately needed.  Terrance and Vasha meet with a case manager from the Community Services Board (CSB) who began the process to acquire a Mental Retardation/Intellectual Disabilities (MR/ID) Waiver for Terrance. 

In order to qualify for the MR/ID Waiver, Terrance must meet three categories of eligibility:  Diagnostic Eligibility (i.e. mental retardation diagnosis); Functional Eligibility (i.e. significant needs in at least two of the following categories of the Level of Functioning (LOF) survey: Health Status, Communication, Task Learning Skills, Personal/Self Care, Mobility, Behavior, or Community Living Skills); and Financial Eligibility (i.e. financially eligible for Medicaid).  The availability of waiver services or “slots” as they are more commonly known is very limited.  Even if Terrance was found eligible, he would need to go on one of three waiting lists:  the urgent, non-urgent or planning.  Terrance was found eligible for the MR/ID Waiver.  Since he met the following criteria:

§  has a diagnosis of mental retardation,

§  meets the ICF-MR criteria,

§  needs services within 30 days,

§  is considered to be at significant risk and

§  would accept services immediately if they are offered.

And additionally, even though Vasha was no longer living in the homeless shelter and was making progress with her own life, she was in no condition to care for Terrance.  Vasha, being Terrance’s primary caregiver, falls under the following criteria:  “one primary caregiver, or both caregivers, has a chronic or long-term physical or psychiatric condition or conditions which significantly limits the abilities of the primary caregiver or caregivers to care for the individual with mental retardation” (Office of Mental Retardation Services, 2008).  Due to this additional criterion, Terrance was placed on the Urgent Waiting List. 

It was not long after Terrance was placed on the waiting list that someone moved out of the area, freeing a spot for him.  Fortunately for Terrance, it was determined that he was the most in need and was consequently offered the waiver.  Accepting the waiver, he thereby “waived” his right to be placed into an institutional setting.  A Consumer Service Plan (CSP) which is “the document that addresses needs and desires in all life areas of individuals who receive Mental Retardation Waiver services.  It is comprised of Individual Service Plans, as dictated by the individual’s health care and support needs” (Office of Mental Retardation Services, 2008) was developed for Terrance.  He moved into a group home with 3 other individuals where he was able to live and work with the level of supports necessary to keep him on track and productive.

Vasha would visit Terrance periodically, however as the years when on the visits became fewer and far between.  After Vasha was assaulted and robbed she struggled with increasing depression. When Terrance was 32, Vasha swallowed a bottle of Tylenol with a bottle of her old favorite: Vodka, and was found dead in her apartment by maintenance personnel. It was her 52nd birthday.  Terrance could not fully comprehend exactly what it meant that Vasha was dead and essentially went on with his life like nothing had happened.

Every once in a while Terrance would have serious behavioral issues the exact cause of which eluded the staff at his group home.  On several occasions Terrance’s behavior escalated to the point in which he risked being removed from his group home.  In cases such as this Terrance was able to use the Crisis Stabilization service of his MR/ID waiver.  “Crisis Stabilization is a time-limited service designed to temporarily increase the level of supports to the individual at his time of need to prevent hospitalization or loss of community services. It can be approved in 15-day increments, up to a maximum of 60 days per CSP” (Office of Mental Retardation Services, 2008).

Terrance continues to do well for the most part.  He continues to receive residential support services to help him with daily living, financial issues, etc.  Due to the limitations of Terrance’s condition, he receives multiple federal aids and financial benefits. After contacting the Federal Rehabilitation Services Administration, Terrance was also assigned a local job coach. Terrance’s new coach helped him refine his interpersonal communication skills as well as his hands-on employment skills. After months of training, Terrance finally had the opportunity to employ his new skills at a local restaurant as a busboy. This job provided structure and routine. Although transitioning into the workforce was hard, Terrance found an “employer who was understanding of FASD, had reasonable expectations, and provided a supportive work environment” (Streissguth & Kanter, 1997). Although Terrance’s job does not provide him with the highest salary, he has received something more valuable in return. Terrance now has a supportive group of people surrounding him at all times, even though his peer and social interactions remained fairly poor even with the support that was offered.  He liked having people around but did not initiate the social interaction. 

Week Twelve

Terrance has been through a lot. He finished high school with an 'IEP' diploma and intended to go into the Air Force. He had been talking to a recruiter who came to his school, and the individual led Terrance to believe that it was really possible for him. Little did he know that such a possibility was far out of reach. Terrance almost broke down when he went to the recruiter's office in his community and was turned away. He couldn't understand why the nice man in the lunchroom kept telling him to apply. For Terrance, it was just another thing he didn't understand about the world. 

Now at age 22, Terrance had little to look forward to and even less to do on a daily basis. He spent a lot of his time walking around his small town and quickly gained a reputation as a kind, if quirky, person. On occasion, he would walk a little too quickly toward someone or be a little too forward with his conversation, and the person would get scared and half run away from him. In reality, Terrance just wanted to get to know people and wasn't always sure how to do that. 

Terrance still lives with his mother for the most part. His wayward nature and lack of relationship with her means that he more or less comes and goes as he pleases. Sometimes, he won't be home for several days, something that has ceased to worry Vasha. Terrance is drifting in life with no real plan and, truthfully, no real options. He has found his way in, though, with a group of people who seem to like him. They welcome him into their home and are always patting him on the back. It feels good to be liked like that. Besides the fact that they are always asking him to take little bags places (which he doesn't mind even though it's kind of strange), he likes being around them. There are always different people coming and going, and he can get food from the fridge whenever he wants. 

Terrance was out walking one day on his way to a house across town - doing an "errand" for his friends. He didn't know why, but a police car pulled up next to him and started asking him questions. Terrance remembered police from earlier in his life, and he knew he didn't like them. He started to run. Right away, the officer got out of his car and ran after Terrance. Terrance ran faster and dodged his way through an alley. The officer was close behind as Terrance climbed a gate - over he went, failing to notice the three officers on the other side. He was thrown to the ground, a plastic tie wrapped tightly around his hands. Terrance's life was about to change significantly...

* What community supports are available for people with disabilities similar to Terrance's? Research Friendship Industries in Harrisonburg. 

* Is the military an option for someone like Terrance? Why or why not? 

* Would Terrance qualify for Mental Health Support services under Medicaid (assuming he had Medicaid)? 

* Does Terrance receive any public assistance? 

DECISION POINT ::: What happens next for Terrance? 

Week Eleven

Now at age 16, Terrance's relationship with his mother continues to be strained and difficult. Significantly different from other children his age, Terrance is well aware of how he is perceived by other children, and school has proven to be quite challenging for him. Two years ago, Terrance was placed in a specialized day school for children with multiple disabilities after having a particularly bad tantrum at his local public school. A manifestation determination indicated that his behavior was a result of his disability, so off to another placement he went. Since then, he has done slightly better, but his behavior is mostly managed within the behavioral point/level system at the school. 


Another aspect of Terrance's experience in school has been his bi-racial identity. While Terrance has a difficult time understanding why kids sometimes call him all sorts of names, he really doesn't understand why some children call him certain names. Terrance thinks of himself as black; after all, his dad was black. Terrance has support from many of the teachers at his school, and, most of the time, nasty episodes between he and peers are dealt with quickly. Indeed, a stated purpose of the school Terrance attends is the purposeful integration of cross-cultural tolerance into the curriculum. 


At home, Terrance and his mother still struggle. The social worker who had been visiting weekly stopped doing so, and there have been few services provided since Terrance went to his new school. Terrance is physically much larger than his mother, and she thinks she has little influence on him in the home. In fact, he more or less does what he pleases without much consideration for what his mother says or thinks. 




* If a specialized day school is indicated in the IEP, who pays for the placement? What if it is not? What has likely taken place in this scenario?  


* What is a point/level system? Is this common in the type of school that Terrance now attends? 


* From the standpoint of the school and the IEP, what is transition? Describe at least 3 transition goals for Terrance. When would the IEP team have started to consider and include these?


* How is Terrance likely to understand his racial identity given his low level of cognitive functioning?

* What is a manifestation determination meeting? Why does it occur? What are the possible ramifications of the meeting?

* What happens when Terrance turns 18? For which services will he still be eligible? What kind of public assistance can he receive? How will he support himself? Be sure to look into SSI and disability – is he eligible when he turns 18? Is he eligible now, at 16?    

Week Ten

The following installment is courtesy of the Lisa Yoo group:

After working hard to clean herself up, Vasha regained custody of Terrance when he was 10 years old. Once Terrance returned home, things went well between him and Vasha for the first 2 weeks. However, things began to go downhill after that. Because of Vasha’s drinking problem when Terrance was a child, as well as Terrance’s emotional instability, there was never an appropriate attachment formed between the two. This made things difficult once Terrance was under the care of his mother again. The two could not seem to get along or communicate well with one another. The communication difficulties also had to do with the malformations in Terrance’s oral cavity, so in order to try and help the situation, Vasha looked further into the surgery Terrance would need.  Vasha found that the surgery would be covered by insurance so they went ahead and got it done. The surgery was a success and it helped Terrance better communicate with others-including his peers and his mother.

Although the surgery was a success, Terrance’s speech was not appropriate for his age; he needed some help from professionals to learn how to appropriately articulate his speech. Vasha decided to enroll Terrance in speech therapy. She ran into some difficulties when she found that the insurance would not fully cover these services. Because she saw how much Terrance was improving just because he was able to communicate, she wanted him to improve even more and decided to pay out of pocket for the services. She picked up an extra job and was doing everything she could to help her son and improve their relationship. After 3 months, Vasha could no longer afford to pay for Terrance’s therapy and had to pull him out. Terrance grew very upset about this because he enjoyed going to therapy and really liked his therapist. It was at this point that things took a turn for the worst. The whole ride home from Terrance’s last therapy session consisted of crying and screaming horrible things to his mother. They got home and Terrance continued to lash out at his mother; she couldn’t take it anymore and began to yell back. This caused Terrance’s emotions to rise to the point that he grabbed the chair behind him and threw it across the room in Vasha’s direction. The chair ended up hitting Vasha on the forehead leaving a gash. Vasha had to go the hospital where she once again encountered social workers and had to answer their questions.

Terrance’s bad behavior caused Vasha to turn back to alcohol even after being clean for 5 years. Although he was no longer going to live with her after her report to the social worker, she still couldn’t handle the stress and pain he had caused her. Terrance was placed in an emotional and behavioral facility an hour away from Vasha’s home; he was 10 ½ years old when placed in this state funded facility. When he arrived at the facility, numerous tests and evaluations were done. The doctors found that Terrance suffers from multiple disabilities. He was diagnosed with depression and anxiety, which helps to explain many of the outbursts that Terrance had. After a hearing screening, it was also found that Terrance suffered from some hearing difficulties that contributed to communication difficulties. It was found that his right ear did not develop properly while in the womb due to Vasha drinking while pregnant. The emotional and behavioral facility provided Terrance with the appropriate therapy and services needed for him to get better.

 Although Terrance still had difficulty forming positive relationships with the other kids in the facility, he was able to develop a healthy relationship with his mother. The hospital had family therapy sessions in which Vasha and Terrance attended to work through their problems. Aside from the therapy session, Vasha visited Terrance weekly to see how he was doing. He continued to make significant progress and after 17 months, Terrance was released from the facility and able to go home. While Terrance was in the hospital working on improving himself, Vasha also returned to classes to forever give up alcohol, allowing Terrance to remain in her custody. While at home, Terrance and Vasha currently receive weekly consultation from a social worker just to make sure that everything is going smoothly. Terrance is attending the public school in his district. With the diagnosis received when at the hospital, he is able to receive services under IDEA at school. Although Terrance’s FSIQ continues to remain at 65, which is significantly below the requirements for normal intelligence, he continues to make progress in his learning as well as his ability to form positive healthy relationships. 

Week Nine

Terrance has spent the last few years with his grandmother, and things have not gone well for him during that time. Now a 7 year-old, Terrance is quickly getting bigger and stronger - making his tantrums even more difficult to handle. Terrance attends public school, and his teachers work with him daily to help him to manage his social and emotional responses. Terrance is a child identified with multiple disabilities. His FSIQ is 65 with performance and verbal areas being roughly equal. His speech continues to become somewhat more discernible with time, but those working with him in that area have indicated that he will require surgery to attempt to correct the physiological obstacles to clearer speech. Still, the biggest concern is Terrance's explosive temper that seems to come out of nowhere. Given his differing physical appearance, it is hard for him to make friends, and this fact seems to have created a situation where he will attempt to push other kids away before they can reject him. This sometimes leads to physical altercations, and several parents have contacted the school out of concern for the safety of their own children. School administrators wonder if this school is the best placement option for Terrance, but recent budget cuts have left precious little for sending children like Terrance to specialized schools. Still, the school may be one more incident away from having to explore the issue in greater depth.

Vasha went into treatment during this time, and she has moved back to the area. She gets to see Terrance several times a week, and she is in contact with the Department of Social Services to determine how she can regain custody of Terrance so the two can live together. Vasha has managed to hold down a job at a local convenience store and has saved up a small amount of money. She seems to have dealt with her addiction and has been clean for over two years.  

* What alternatives are there that might meet Terrance's educational needs? What considerations might a school make before recommending that a change of placement be made? What document needs to be amended in order to change his placement to something more restrictive? 

* How is it that Vasha still has contact with Terrance even though she was responsible for his FASD? Why was he not removed at birth given the severity of his condition? Should DSS require some kind of "parental fitness" evaluation of Vasha if she is to regain custody? How is this done? 

* What does it mean that Terrance has a full-scale IQ of 65? What implications does this have for his treatment in general? 

* Write 2-3 goals one might find in Terrance's current IEP. Under each goal, include at least 3 objectives. 

DECISION POINT ::: Is there a change in Terrance's placement? In other words, does he stay at his current school or go to a more restrictive environment? If so, where (simply indicate the type of placement)?

  

Week Eight

Spring Break