Christie Walker was born premature. She spent the first three months of her life in the hospital and was ready to come home. But a public health nurse assigned to the case was worried about what Christie would face at home.
Christie’s brother Billy, three years old, was diagnosed as hyperactive with some brain damage. Both the public health nurse and the Child Protective Services (CPS) caseworker were concerned about three concussions that Billy had suffered over the past year. Another infant in the family had died from Sudden Infant Death Syndrome. CPS was suspicious of the injuries sustained by the 3-year-old, and about the former infant death.
The family had had an open CPS case in another state, but left that state when the mother became pregnant with the current infant. CPS decided that Christie and Billy would both be placed in foster care, unless the family agreed to intensive services.
The public health nurse and the CPS caseworker discussed their concerns with the parents and the CPS caseworker referred the parents to Intensive Family Preservation Services (IFPS). The parents, William and Judy, agreed to IFPS services.
The First Visit
For the first visit, the IFPS therapist went to the home unannounced because the family had no phone. The first thing the worker noticed was the smell of gas from a furnace. Judy said she too had noticed the smell but had not done anything since they had no phone. The therapist suggested that Judy dress herself and the children warmly, open the window, and turn down the furnace while the worker phoned the landlord.
After, Judy began to talk about herself and her family. By age 22, she had been married for five years, suffered four miscarriages, and given birth to three children. Judy was very thin and pale and had decayed front teeth due to poor health.She said she was lonely with her husband gone for long hours trying unsuccessfully to sell insurance. Every previous counselor had told her that William was rotten and encouraged her to leave him. But Judy said she loved him and he was not mean to her. Judy explained that she had been very depressed since Christie’s birth and often felt the baby did not belong to her. She was extremely upset about Billy’s wild behavior and believed it came through a “bad seed” from an uncle who was in prison.
During this visit, the therapist focused on Judy’s interactions with the baby, and determined that Judy was bonding well with the infant. They discussed the infant care and SIDS prevention techniques taught to Judy by public health.
The Second Visit
On the second visit the next day, the therapist worker took Judy to a local charity where they received a donation to get the family a cell phone. They also got bed sheets for curtains. Judy was fearful because she had been raped as a teen, so a phone and curtains helped her feel more secure. The therapist scheduled an appointment with a dentist to begin work on Judy’s teeth.
On this day, Judy and the worker spent a lot of time talking about Billy. Judy said she did not love Billy and described his behaviors: Billy would throw himself backward off furniture, touch a hot stove and laugh, bang his head against the wall, and bite, scratch, and hit other people. His parents locked Billy into his room at night because he only slept a few hours at a time and would go into the kitchen and eat until he vomited. Billy would not kiss or show any affection towards his parents. Judy felt she could not cope with Billy and wanted to have him placed elsewhere.
The IFPS therapist talked to Judy about options for coping with Billy’s behavior including timeouts. The worker gave Judy her phone number and told Judy to call any time day or night if Billy’s behavior was unbearable. The worker scheduled an appointment for Billy with a special pre-school program. The therapist also volunteered to babysit later in the week.
During the five hours she spent with the children alone, the worker watched Billy engage in some of the behaviors Judy had described. By the end of the day, however, Billy was responding to positive reinforcement and timeouts. The therapist worker taught Billy to play a kissing game and Judy cried the first time that she and Billy played the game together. The therapist’s time spent teaching Billy new behaviors proved to his parents that Billy could change.
Further Intervention
As the intervention continued, Judy talked about her discontent with her marriage. She said she knew that William wasn’t working during all the time he spent away from home. She resented the fact that he had good clothes while she had only one nice outfit; that he was out playing while she sat in the apartment with the children; that he wouldn’t let her get a driver’s license but refused to take her places.
The therapist saw a “teachable moment” and began talking about how Judy could assert herself in a positive way to get her needs met. William became curious about what was happening with his family and decided to stay home one day. While Judy was at the dentist, William and the worker talked. William shared his frustrations about not being able to support his family and agreed to participate in the intervention.
During the final weeks, the therapist counseled both Judy and William on behavior management skills. Billy had begun attending the pre-school program. Judy reported more positive feelings toward Billy and no longer wanted to send him away. Christie was doing well, and the public health nurse was pleased with her progress. Judy now had caps on her teeth and smiled more often. She was beginning to gain weight.
Outcome
As the intervention ended, the therapist helped Judy obtain a counseling appointment at a local mental health center. The family moved to a better apartment in a safer neighborhood. After they moved out, they found out that the school bus wouldn’t pick up Billy. At first Judy was very upset but then she began to problem solve and found another school program for him.
A follow-up phone call several months after the intervention revealed that the family was still together. Judy was seeing a counselor regularly and she and William had started marital counseling. William quit his job selling insurance and enrolled in a job training program. Billy was beginning to talk and his behavior had improved. Christie, the infant daughter, continued to thrive.
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Source: Kinney, J., Haapala, D., & Booth, C. (1991) Keeping families together. The Homebuilders® Model. New York: Walter de Gruyter.
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