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?
*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.
ReplyDeleteAccording to the American Academy of Pediatrics (2011) and the Centers for Disease Control and Prevention (2011), the typical developmental milestones for a 2-½ year old would include the following:
Movement/Physical milestones
• Walks alone
• Pulls toys behind her while walking
• Carries large toy or several toys while walking
• Begins to run
• Stands on tiptoe
• Kicks a ball
• Climbs onto and down from furniture unassisted
• Walks up and down stairs holding on to support
• Throws ball overhand
• Makes or copies straight lines and circles
Milestones in hand and finger skills
• Scribbles spontaneously
• Turns over container to pour out contents
• Builds tower of four blocks or more
• Might use one hand more frequently than the other
Language milestones
• Points to things or pictures when they are named
• Recognizes names of familiar people, objects, and body parts
• Says several single words (by fifteen to eighteen months)
• Uses simple phrases (by eighteen to twenty-four months)
• Uses two- to four-word sentences
• Follows simple instructions
• Repeats words overheard in conversation
• Points to things in a book
Cognitive milestones
• Finds objects even when hidden under two or three covers
• Begins to sort by shapes and colors
• Completes sentences and rhymes in familiar books
• Plays simple make-believe games
• Builds towers of 4 or more blocks
• Might use one hand more than the other
• Follows two-step instructions such as "Pick up your shoes and put them in the closet."
• Names items in a picture book such as a cat, bird, or dog
Social and emotional milestones
• Imitates behavior of others, especially adults and older children
• Increasingly aware of herself as separate from others
• Increasingly enthusiastic about company of other children
• Demonstrates increasing independence
• Shows defiant behavior (doing what he has been told not to)
• Increasing episodes of separation anxiety toward midyear, then they fade
• Plays mainly beside other children, but is beginning to include other children, such as in chase games
Terrance is significantly delayed in all area of development. Although he can walk and climb he continues to be unsteady and can easily lose his balance, hence his recent fall and sub sequential trip to the ER. Additionally he has trouble throwing, catching and kicking a ball. Terrance does not play with toys as they are intended instead he tends to line up blocks, cars, etc. and does not play or interact well with other children or adults. Terrance sometimes wanders aimlessly around the house or stares at seemingly nothing. He seldom follows directions and his defiant behavior has escalated past the point that is typical for his age. Terrance’s temper tantrums have increased in both frequency and intensity. This quite possibly is a direct result of his inability to properly communicate. Vasha needs to get to the root of the tantrums. She should pay close attention to the antecedents or triggers of the tantrums/disruptive behavior and note what happened, what happened just before the incident and what was the function of the behavior (what it was trying to convey). Vasha should also ensure that she is following up with recommendations from the services Terrance is receiving through IDEA. The services that Terrance receives through IDEA will be of little effectiveness if the practices and recommendations are not followed at home. Vasha’s inability to manage Terrance in the home has lead to chaos and stress. The household is unregimented and unorganized. Vasha has come to the point where it is easier for her to let Terrance do what he pleases instead of dealing with his behavior.
*What are the possible outcomes of a CPS investigation? What options are typically available to social workers in situations like the one described above?
ReplyDeleteWe know that Terrance’s doctor called CPS because of the suspicion of his care with Vasha. According to the Department of Human Services, the CPS has 30 days to complete an investigation unless extenuating circumstances require an extension. The investigation usually includes:
• “Face-to-face interviews with the alleged child victim(s), the child's caretaker(s), the alleged perpetrator(s).
• Viewing the family's home.
• Reviewing any necessary documents, such as police reports, criminal history, medical reports, school reports, CPS case file, etc.
• Interviewing neighbors, friends, relatives or professionals that have had contact with the family.
• An assessment of the child's safety.
• An assessment of the child's future risk of abuse and/or neglect.
• An assessment of the family's needs and strengths (Child Protective Services, 2011).”
The CPS investigator also considers important factors during the investigation such as “alternative explanations to the allegations, the family dynamics, evidence, medical examination, condition of the home and child, supervision and whether or not the caretakers seem to be emotionally/mentally abusing the child (Child Protection Services, 2011).” After completing the assessment the CPS deciphers whether the circumstances of the child are related to, maltreatment, child neglect, physical abuse, sexual abuse and psychological maltreatment (Child Protection Services, 2003).
Following the investigation the CPS will put the case into a category, I thru V:
• “Category V-Cases in which CPS is unable to locate the family, no evidence of child abuse or neglect is found or the court declines to issue an order requiring family cooperation during the investigation.
• Category IV-Cases in which a preponderance of evidence of child abuse or neglect is not found. The department must assist the child's family in voluntarily participating in community-based services commensurate with risk level determined by the risk assessment (structured decision making tool).
• Category III-Cases in which the department determines that there is a preponderance of evidence of child abuse or neglect and the risk assessment indicates a low or moderate risk. A referral to community-based services must be made by CPS.
• Category II-Cases in which the department determines that there is a preponderance of evidence of child abuse or neglect and the risk assessment indicates a high or intensive risk. Services must be provided by CPS, in conjunction with community-based services.
• Category I-Cases in which the department determines that there is a preponderance of evidence of child abuse or neglect and a court petition is needed and/or required. Services must be provided by CPS (or foster care), in conjunction with community-based services (Child Protective Services, 2011).”
Then if necessary to ensure the child’s safety the CPS may file a petition with the court system. (Child Protection Services, 2011).
For Terrance’s situation typically the options would be to investigate the interactions of him and his mother in their home setting. By doing so the social worker would get a better understanding of the household dynamic that the two of them share. The social worker also might go to the hospital where Terrance was brought when he needed treatment and speak to the nurses and doctors who saw the suspicious appearance that Vasha presented while caring for her son.
Decision Point continued...
ReplyDeleteWith all of this information that was collected, and the assessments regarding Terrance’s safety, future risk of abuse and/or neglect and the family’s needs and strengths were completed, the social worker determined that the case was a “Category III-Cases in which the department determines that there is a preponderance of evidence of child abuse or neglect and the risk assessment indicates a low or moderate risk. A referral to community-based services must be made by CPS (Child Protective Services, 2011).”
The social worker did see evidence of neglect on Vasha’s part of being a mother due to her overwhelming depression that consumed every ounce of energy that she had. Energy that could better be used to follow Terrance around, play with him, and make their living conditions safer. The neglect was also seen through Vasha’s constant battle against her alcoholism. She was drained of all emotion, and therefore has little to none left for her child.
A CPS service plan must be constructed and followed now in order to create a safe environment for Terrance to live in at home. It will include:
• “The specific needs identified with the family and the services to be provided to the family to address those specific needs, including the family’s perception of those needs.
• Who will provide the services.
• The frequency of these services.
• A specific time to review the service plan.
• The goal or expected outcome of the service (Virginia Department of Social services, 2011).”
The service plan must be reviewed with the family at least once every 90 days to ensue that it is being followed and things are looking up. The services that are included in Vasha and Terrance’s service plan and require the involvement in are: family training/counseling to be the most important, physical therapy for Terrance, speech therapy for Terrance, psychological services for both Vasha and Terrance who is showing signs of a potential emotional and behavior disturbance which could be a result of the neglect he has experienced through his first 2 and a half years of life. These services are going to be more frequent and intense than the ones provided by IDEA, as well as more specific to the strengths and weaknesses that have been identified within the home. Hopefully with this new, more intense and invasive array of services offered through CPS, and a close watch on both Vasha and Terrance, it will be enough to see a change.
References:
ReplyDeleteHealthwise. (2010). Temper Tantrums – Topic Overview. Retrieved February 08, 2012,
from http://children.webmd.com/tc/temper-tantrums-topic-overview
Berry, J.O., Hardman, M.L. (1998). Family Systems. In J.O. Berry,Lifespan Perspectives
on the Family and Disability (pp. 24-44). Boston: Allyn & Bacon.
Children's protective services investigation process. (2011). Retrieved
fromhttp://www.michigan.gov/dhs/0,1607,7-124-5452_7119_7194-159484--,00.html
Child protective services: A guide for caseworkers. 2003. (2003). Retrieved
from http://www.childwelfare.gov/pubs/usermanuals/cps/cpsf.cfm
American Academy of Pediatrics. (2011). Ages & stages. Retrieved February 7, 2012
fromhttp://www.healthychildren.org/english/ages-stages/
Centers for Disease Control and Prevention. (2011). Developmental
Milestones. Retrieved February 7, 2012 from http://www.cdc.gov/ncbddd/actearly/milestones/