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?