Case Study 5: Abbie

1. Case Study 5: Abbie Janna Presley, Holly Koster, Samantha Newcomb, and Ryan Elsea

2. Description of Setting • Abbie’s foster family resides in rural Lamar County, Alabama. • Services will be provided in the spacious home of her foster family. Service Delivery Model: • Services will be delivered via a transdisciplinarymodel. • This is a team model which consists of professionals from multiple disciplines and family members who will pool their knowledge and skills to support Abbie’s development.

3. Abbie’s Team (Human Resources) • Foster mother and father • Biological mother • Physical Therapist—who serves as the Primary Service Provider • Special Educator—who also serves as Service Coordinator and a consultative resource • Occupational Therapists (2)—who serve as consultative resources • All are involved in evaluation procedures.

4. Background • History and Description of Abbie’s Disability • 12 month old female, 9 months corrected • Born premature to a single mother with history of drug use • Ventilator support and supplemental oxygen while in the hospital • Disability: Grade III IVH, current respiratory infections, and possible vision and hearing impairments • Family and Social History • Placed in foster care in Lamar County at 3 months old • Birth mother has supervised visits with Abbie every 2 weeks, but she has missed the last 5 visits. • Foster parents want to provide the best care.

5. Background cont.’ • Strengths • Cared by a loving family with a mom, dad, and grandmother • Nice home • Father has a good job. • Physical strengths • Roll over • Grasp toys and bring them to midline • Balance momentarily in seated position • Community and Support Services • Community Service Programs of West Alabama, Inc • ARC of Fayette/Lamar/Marengo Counties, Inc. • TOTS Early Intervention

6. Background cont.’ • Ethical and Cultural Adaptations • Foster parents are devout Roman Catholics, who want Abbie to grow up sharing their faith. • However, Abbie’s birth mother wants her to be raised as a Protestant. • As a result, this has raised controversy.

7. Formal Assessments • Developmental Assessment of Young Children (DAYC) • Standard scores on the DAYC were: Adaptive 66, Social Emotional 78, Communication 67, Cognitive 63, Physical Development 60, and the General Development Quotient score is 69. • Qualifies for EI services

8. Informal Assessments • Routines-Based Assessment Worksheet • Realistic weekly routine • Functional activities • Family activities • ECO Map • Strong connections • Strained connections • Family Concerns • Foster parents feelings of inadequacy • Abbie’s frequent respiratory infections, feeding difficulties during mealtime, and delayed development (i.e., not being able to sit and interact with toys)

9. Overview of outcomes • Outcomes are focused on Abbie’s needs and her caregiver’s concerns: • Difficulty sitting independently to play • Lack of interest in toys • Inconsistent when responding to toys, keeps toys in midline, not reaching for toys • General delays in physical development • Not weight bearing through legs, not catching herself when loses balance, prefers to lay on back, minimal transitions • Problems with feeding • Frequently chokes/gags on food • Worried they are not doing everything needed to help Abbie due to being inexperienced parents

10. Overview of outcomes • Examples: • While sitting in boppy pillow, Abbie will reach for toys on her own and then hold them on her own during play 3 out of 5 trials each day during the week. • Abbie will reach arm out to catch herself when tilted to the side four out of five times while playing, four days of the week. • Abbie will independently transition in and out of sitting four out of five attempts while playing, three days of the week. • While playing, Abbie will bear weight through her lower extremities when placed in supportive standing three out of five attempts, three days of the week.

11. Overview of outcomes • Examples (continued): • Abbiewill sit in a supportive seat with the family during evening mealtimes for up to fifteen minutes four days of the week • Abbie will eat one meal a day consisting of baby cereal with decreased choking or gagging on 5 days of the week. • Foster family will express increased confidence in positioning Abbie during play. • Foster family will follow up on an ophthalmology and audiology screening. • Biological mother will learn and gain confidence in childcare skills with Abbie

12. Intervention Strategies • Assistive devices: • Boppy pillow • Supportive chair/seat • Bath seat • Help Abbie engage in play with toys: • Incorporating toys with different textures, lights, and sounds • Increase Abbie’s stability: • Reaching and grasping activities • Tilting reactions • Transitioning and weight bearing activities • Instructing parents to hold at Abbie’s hips • Improve Abbie’s feeding: • Changing the textures of foods • Pacing of feeding • Altering utensils • Changing the alignment of the head, neck, and body when feeding

13. Specific issues: religion • Foster parents are devout Roman Catholics. • Birth mother prefers Abbie be raised according to a protestant religion. • What variables may influence this decision? • Who do you think gets the final say?

14. Where to look! • State of Alabama Department of Human Resources. (2001). The foster parent handbook: A guide for Alabama’s foster parents.

15. The answer: • “The child needs the opportunity for spiritual development; however, the foster parent must keep in mind the child’s and his family’s religious preference. At no time should the foster parent require or push the child to accept the foster parent’s religious beliefs or rituals. It is the role of the foster parent to provide transportation to social and religious activities”(State of Alabama Department of Human Resources,2001).

16. Specific Issue: Foster vs. birth Parents • Abbie is currently in the care of foster parents as mandated by DHR nine months ago. • Abbie’s foster parents are also almost solely involved in her daily routines—which is where our team hopes to embed intervention strategies. • Abbie’s biological mother is allowed visits (supervised by DHR) every two weeks—although she has missed 5 of these appointments. • Which set of parents gets to choose the goals in Abbie’s IFSP? Biological? Foster?

17. Where to Look! • In the October 2009 edition of Interdisciplinary Report on At Risk Children and Families, Sheryl Dicker and the Permanent Judicial Commission on Justice for Children published a report titled The Promise of Early Intervention to Foster Children and Their Families.

18. The answer: • Until parental rights are surrendered or terminated, biological parents still have rights under Early Intervention law. • The IFSP is a model that allows for all of those involved in a child’s life to be involved in their plan as well. • A good transdisciplinary team should be able to find a way to address each person’s goals and concerns—AND can foster the success of multiple caregivers. • In order to accomplish this, our team arranged to align one therapy visit a month with one of Abbie’s biological mother’s visits.

19. references • Kramer, P., Hinojosa, J., & Royeen, C.B. (2003). Perspectives in human occupation: Participation in life. Baltimore, MD: Lippincott Williams & Wilkins. • Law, M., Cooper, B., Strong, S., Stewart, D., Rigby, P., & Letts, L. (1996). The person-environment-occupation model: A transactive approach to occupational performance, Canadian Journal of Occupational Therapy, 63, 9-23. • Rudolph, C.D., Link, D.T. (2002). Feeding disorders in infants and young children. Pediatric Gastroenterology and Nutrition, 49(1), 97-112. • State of Alabama Department of Human Resources. (2001). The foster parent handbook: A guide for Alabama’s foster parents. Retrieved from http://www.dhr.state.al.us/large_docs/fphandbook.pdf. • Washington K., Deitz, J.C., White, O.R., Schwartz, H.S. (2002). The effects of a contoured foam seat on postural alignment and upper-extremity function in infants with neuromotor impairments. Journal of The American Physical Therapy Association ,82(11),1064-1076. • Dicker, S. and The Judicial Commission on Justice for Children(1999). The promise of early intervention to foster children and their families. Interdisciplinary Report on At Risk Children and Families.