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

Week Seven

Individual assignment

Week Six

Vasha was at the end of her rope. After CPS found that she was being neglectful of Terrance, she didn't know what to do. On the one hand, she felt anger at "the system" -- what did they know about her son? What did they know about her? She resented such interference into her life, and she had half a mind to take Terrance and leave the state - but she knew that would put her in much more trouble than she was already in. 

Vasha had limited social support - her friend Sarah was still a close confidant - and she wasn't sure how she was going to deal with the pressure she perceived from the social worker. It was like she was the enemy of this person, even though all she was doing was trying her best to care for her son. Sarah was the only one who understood. 

Terrance continued to be a challenge, even after the mandated counseling. The counselor even came to the home. Vasha was both skeptical of this person and rather annoyed. The counselor was a young girl who didn't even have kids of her own! What did she know? How could she help? For Vasha, such a presumption that someone so unlike her could provide assistance was another slap in the face. Terrance seemed to like the counselor, but he didn't do anything differently - in fact, he really threw a tantrum after each time the counselor left the house. 

Terrance was able to enjoy himself sometimes - usually when he had some kind of video device nearby. He would sit for hours in front of the TV - and Vasha would let him - and watch reruns of old shows. It wasn't the content that captured him as much as the movement, the colors, and the sounds. He loved it when the TV would just go to static.

Vasha learned from the counselor that Terrance ceased to qualify for the intensive in-home service under which he was being served, so the counselor would have to stop coming to the home after only 6 months. Vasha didn't care - it's not like it was helping anyhow. The social worker set up regular meetings with Vasha to check in on her, and Vasha kept going to see her counselor. 

Vasha continued on this way until Terrance was 4. He was old enough to get around, and he was tall enough to get into heaps of trouble around the house. It was one sleepy Sunday morning that proved to be the last straw for Vasha - and for CPS. Terrance got hold of a book of matches and set some paper on fire. By the time Vasha smelled the smoke and ran into the room when Terrance was, the fire was slowly spreading. She grabbed Terrance and got out of the house. 

The fire department came and was able to save most of the home. Vasha still had a place to live even though it was in need of great repair. For his part, Terrance didn't seem affected by the incident whatsoever. CPS was called again, and the social worker gave Vasha the choice to place Terrance with a relative or to have him go into the care of the state. Vasha made contact with her mother who begrudgingly agreed to care for Terrance.  

* Describe typical developmental milestones for a four year old.

* What is "intensive in-home" as a Medicaid-provided service? Who typically provides this service? What is the level of training required? How ethical is it to cease serving someone because their insurance runs out?  

* Hypothesize as to Vasha's various negative responses to her involvement in the child welfare system.  

* Describe the manner in which a family transitions from Part B of IDEA to Part C. What are the major differences between the services provided under Part B vs Part C?

In addition to the questions above, please also answer the following questions posed to you by the other groups (not all questions are included from all groups) :::

From the Lisa Yoo group :::

1) Where can Vasha go/who can she talk to about her concern about the services Terrance is receiving? Are there any other services that are available for Terrance, other than those offered in IDEA and if so what are they?

From the Thomas Mahoney group :::

1) What is Vasha’s relationship with her parents like? With the babies’ father? Can any of these relationships be affecting the way that she is raising Terrance or the way she is reacting to motherhood?

From the Ahmad Nassar group :::

1) Is there any information available about the success rates of community services overall? Have they actually been proven to be effective?

2)  If CPS suspects that the child is being abused or neglected, why was he not taken out of the home?

Week Five

Individual assignments.

Week Four

Now 2 1/2 years of age, Terrance is a handful. He continues to struggle to meet developmental milestones and is significantly delayed in all areas. Terrance has very little tolerance for being held in spite of the fact that he often throws incredible temper tantrums that seem to call out for physical and emotional containment.  Services through IDEA have been somewhat helpful, but Vasha doesn't think they are intense enough to meet Terrance's needs.

Terrance is more or less "out of control" in the home, and Vasha is unable to manage him, even at 2 1/2. Terrance fell off of a chair in the home and had to go to the ER for a bad laceration on his forehead. There was something about Vasha's presentation in the ER that made the doctor suspicious, and Child Protective Services (CPS) was called.

Vasha has continued to receive services, but she is less and less certain that her therapy is helping her. In spite of her work, she continues to be depressed.

* "Tantrums" are an aspect of typical development. How does Vasha tell whether or not Terrance's tantrums are typical? How would she know if they were overly intense and therefore atypical?

* Describe the typical developmental milestones for a 2 1/2 year old. Be sure to include physical, cognitive and socio-emotional domains. Describe Terrance in light of these milestones, and write a comprehensive description of what we might see if we were to observe Terrance in the home.

* What are the possible outcomes of a CPS investigation? What options are typically available to social workers in situations like the one described above?

DECISION POINT ::: What is the outcome of the CPS investigation?

Week Three

At 18 months of age, Terrance didn't meet many of the developmental milestones typically associated with children his age. He was able to talk, but the manner in which his mouth seemed to hang open a bit made articulation difficult. Terrance was a challenge overall and had been since birth. He simply could not sit still and had a very difficult time soothing in general. It was like he could never quite get comfortable in his mother's arms.  Terrance didn't walk until 17 months and was still very unsteady on his feet. He would meet his mother's gaze and was able to look at things she looked at, but his language was almost impossible to understand. He did seem to have many words that he was able to attempt to form, and his level of frustration when he couldn't speak in the way he wanted to was evident.

Vasha, for her part, continued to feel incredibly guilty, and she struggled with her depression. Going to AA was helpful for a time, and she was able to befriend Sarah, someone with whom she was able to share her joys and sorrows. Surely their friendship was a welcome bright spot in what otherwise was an ongoing struggle for Vasha. She often thought about giving up, but she really didn't know what that would mean. She loved Terrance, to be sure, but that sense of love was crowded with other feelings of helplessness, hopelessness, grief and sorrow.  

* Describe typical developmental milestones for an 18 month old child. Be sure to include physical, cognitive, social and emotional domains. 

* How does Vasha go about getting services through Part C of IDEA? Assume that Vasha does not have access to the Internet. What might a IFSP for Terrance include? Propose goals for Terrance. What are Vasha's responsibilities with regard to IDEA Part C?  

* Create an M-CHAT for Terrance that might exist at his 18 month pediatric visit. How will diagnosticians be able to distinguish between FASD and Autism Spectrum Disorder? 

* Given Terrance's significant challenges, what other services are available in the community for him? Check into PACE at the Community Services Board.  What other services are available for Vasha? Check into Medicaid-funded Mental Health Support.

DECISION POINT ::: Does Vasha obtain other services in addition to IDEA Part C? If so, which ones?

Week Two

Vasha was ready for her child to be born. She had picked a name – Terrance. It was a name she had always liked, and pre-natal ultrasounds had revealed that her child was a boy. Vasha went into the hospital for a relatively easy delivery.

It became apparent that Terrance was not like most babies. In fact, what Terrance’s birth revealed was that she had been wrong about her lack of alcohol consumption during the first weeks of pregnancy. First, Terrance’s delivery was relatively easy because his birth weight was low. Additionally, he presented with some facial abnormalities that were a clear indication of FASD.

Vasha was at once overjoyed at the birth of her son and also had a sense of incredible guilt with regard to Terrance’s challenges. Vasha could feel herself spiraling downward into a depression as the reality of the situation sunk in. She wasn’t sure she could do back to AA – it was too much a reminder of her past and of her responsibility for having done this to her child. She didn’t know what to do.

* What happens when a child is born with FASD? Is there anything unique about the postpartum process given the observable disabilities that were apparent with Terrance? Are further tests typically done to ensure that there are no other issues with internal organs, etc.?

* Outline the typical developmental milestones for newborns and infants in their first year. How are babies born with FASD likely to approach those milestones?

* What are the recommended immunizations for newborns? What immunizations are typically provided just after birth? Which ones in the first year? How frequently should the newborn visit the pediatrician in terms of what is recommended? What is the M-CHAT and when is it given to parents? Outline Terrance’s first year in terms of doctor visits. Provide rough information as to the fees associated with these visits. How does Terrance’s FASD affect these visits and the associated costs?

* What is postpartum depression? What is the prevalence of the disorder? How is it typically treated? What resources might be available to Vasha in terms of self-care? What is the effect of postpartum depression on parent-child attachment?

* With regard to FASD, what publically available services are there to support a newborn with FASD?

DECISION POINTS :::

Does Vasha return to AA? How does Vasha decide to manage her depression? 

Week One

Vasha Singh didn’t want a child at her age. In fact, her life was supposed to be completely different. If only she hadn’t listened to her “friends,” if only she hadn’t have been so impressionable. What was a 20 year old like her supposed to do? She hadn’t finished high school and had no prospects at all for employment or anything. She had no idea how she was going to raise a child. She worries about the drugs and alcohol that she was into before she knew about the pregnancy. Would any of that hurt the baby? She really had no idea. She thought that maybe she learned about the pregnancy in time…When was the last time she got really drunk? She couldn’t exactly remember, and that fogginess allowed her to pretend that the last several incidents were further in the past than another part of her knew that they were. Still, she would love this child no matter what.

Vasha had been talking to a pastor that she met during one of her bouts of despair – for some reason, the two struck up a conversation as she was buying cigarettes, and they wound up talking for over an hour. Vasha’s Hindu past was just that – well in the past, and she struggled to find meaning in her life. This person seemed to provide an open door when all other such doors were locked and dark. Vasha started going to a Christian church, and it seemed to help her just a little. The pastor talked with Vasha about AA, and she was really considering going, even while she was 8 months pregnant.        

·   

     1) What are the typical developmental milestones for the child in utero? Outline the stages of pregnancy and the threats to optimal development at each stage. When are teratogens most dangerous for the developing child?

·    2) Describe the various conditions that can result when someone uses alcohol at various stages of development. Is Terrance at-risk for any of these conditions given Vasha’s history of substance use and her “fogginess” with regard to knowing whether or not she “stopped in time?”

·    3) Given Vasha’s substance abuse and its possible effect on her child, what kinds of treatment options could she explore? Describe how Alcoholics Anonymous (AA) purports to work (and/or Narcotics Anonymous, Al-Anon, etc.).  

 
DECISION POINT ::: Does Vasha decide to attend AA? Why or why not?