Case Study

Zoe

Zoe is the only child of Sarah and Martha. Zoe is 8 months old and has Down Syndrome. This was discovered at birth as neither parent wanted prenatal testing. Martha was very upset with this news and has had a very difficult time interacting and engaging with Zoe. Martha tends to leave most of the parenting to Sarah. Martha is an engineer and is often required to travel for her work and Sarah is an occupational therapist in an elder care complex. Sarah is at home with Zoe for now but plans to return to work as soon as Zoe is one year old. The family has not decided on what care arrangement will be made once Sarah returns to work.

This family lives in Vancouver and have a very extensive family and friend network. Sarah’s parents and siblings live in Vancouver as well and are often at the home when you, the Infant Development Consultant, visit the home.

Sarah demonstrates a strong attachment to Zoe and is very involved in not only caregiving tasks for Zoe but is also keen to implement as many therapeutic interventions as possible. She researchers extensively on the internet and asks you many questions and has lots of suggestions during the visits.

While the parents differ in their attachment and care with Zoe, they feel very strongly that they want all correspondence and meetings concerning Zoe to retain a gender- neutral stance as well as the language used in home visit reports and all documentation to be gender neutral.

Zoe had a very healthy birthweight but has not been gaining weight as anticipated. Zoe has a heart murmur so that is being monitored very closely. Zoe’s hearing is fine but visual acuity and field is not yet determined.

You have had several visits with Sarah and Zoe (and various extended family members) but Martha has not been able attend any visits. Sarah has told you that Martha thinks that Zoe should just be left alone and will develop at whatever rate and pace they need to.

1.

Before answering the question, reflect on your personal experience in a situation you were working collaboratively with someone or a group/ team. How did you and the other person/people contribute? What occurred that was helpful/effective? How were you engaged/supported in the process? Think about what you valued and learned and apply it to the following case and question.

Using the case study you have been given, as part of the early intervention services another professional has been engaged by the family. This could be a speech therapist, an occupational therapist, physiotherapist or behavior consultant depending on your case study.

After visiting with the family for a few weeks, the therapist approaches you and states that they do not agree with the course of action you or the family are taking, they are concerned the child is not meeting developmental goals and that they want to suggest stopping the intervention all together. 

Stand in the shoes of each role:  

·
As the parents/caregivers in your case study: What are the issues/concerns from your point of view? 

·
As the therapist: What are the issues from their point of view?

2.

Using the same scenario as question 1:

Using the case study you have been given, as part of the early intervention services another professional has been engaged by the family. This could be a speech therapist, an occupational therapist, physiotherapist or behavior consultant depending on your case study.

After visiting with the family for a few weeks, the therapist approaches you and states that they do not agree with the course of action you or the family are taking, they are concerned the child is not meeting developmental goals and that they want to suggest stopping the intervention all together. 

Reflect and think about your experience and reaction taking both roles. Discuss what you noticed about your thoughts or feelings in each role? How did taking both roles/viewpoints effect how you might approach challenging or difficult situations in the future?

3.

Watch the video 
Resolving Differences: Engaging all LearnersLinks to an external site.   (Video 7- Resolving Differences through Collaboration)  and use the information from the readings and lesson 8 regarding collaborative goal setting and resolving differences. Before answering the question, put yourself in the parents’ shoes and think about what you would want to hear or have happen so you were included and part of the solutions.

What aspects of collaboration/resolution in the video were not effective for the parents and why? Discuss collaborative and resolution skills you might use in this situation to include/engage them.

4.

Based on the video 

Resolving Differences: Engaging all LearnersLinks to an external site.
  (Video 7- Resolving differences through Collaboration) and using the information from the readings and lesson 8 regarding collaborative goal setting and resolving differences, answer the following question. Remember to put yourself in the parents’ shoes and think about what you would want to hear or have happen so you were included and part of the solutions.

Provide a specific 
participatory family-centred example of the key understandings listed in the video that demonstrate what you might do for each in practice with this family.

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5.

In ‘Service Delivery to Parents With Intellectual Disabilities’, key parents shared their experiences regarding helpful and unhelpful aspects of service delivery.

What aspects are important to consider/include when supporting a parent with their child to ensure it is helpful, and what do you need to avoid being unhelpful?

6.

The reading about adults with intellectual disabilities and decision-making in lesson 9 highlighted points about respect for persons, as well as the issues of asymmetrical power and outer-directedness. Taking these into account, read the following scenario:

Mary is a mother with an intellectual challenge. The prescription drug she took for seizures during pregnancy affected her child Joseph who also suffers from seizures and cognitive and mild motor delays. You have been supporting Mary and Joseph for a few months at home and at a local daycare to give Mary a break and Joseph time with other children. You are concerned because lately Mary has not brought Joseph, and he seems less active and alert than usual. You decide to call Mary to see if she is open to a visit at home to check in. She is willing to see you the next day.

On arrival at the house at noon, it takes awhile for Mary to answer the door. Once inside, it appears that Joseph may still be in his crib, Mary isn’t dressed and it looks like they haven’t been up yet. There are numerous dishes and household items lying around, and Mary does not seem as vibrant as usual. She is often excited to talk about Joseph and his progress of things he does. He typically brings a smile to her face. Mary seems low energy, and Joseph appears to have low affect and energy and is very lethargic.

This is concerning given his seizure/medical situation. You ask Mary how he has been and she mentions he has had a few seizure episodes that have lasted longer than usual and then he falls asleep. She did not want to disturb him so left him in bed. It appears that Mary has not been playing/doing much with Joseph based on what she shares and that his seizure activity has increased lately and lasts longer. You are concerned that this situation could or is becoming non-stimulating and less social and active for them both. 

Discuss what you need to consider when working with Mary given the issues of
 asymmetrical power and outer-directedness.

7.

Based on Mary’s scenario, answer the following question.

Mary is a mother with an intellectual challenge. The prescription drug she took for seizures during pregnancy affected her child Joseph who also suffers from seizures and cognitive and mild motor delays. You have been supporting Mary and Joseph for a few months at home and at a local daycare to give Mary a break and Joseph time with other children. You are concerned because lately Mary has not brought Joseph, and he seems less active and alert than usual. You decide to call Mary to see if she is open to a visit at home to check in. She is willing to see you the next day.

On arrival at the house at noon, it takes awhile for Mary to answer the door. Once inside, it appears that Joseph may still be in his crib, Mary isn’t dressed and it looks like they haven’t been up yet. There are numerous dishes and household items lying around, and Mary does not seem as vibrant as usual. She is often excited to talk about Joseph and his progress of things he does. He typically brings a smile to her face. Mary seems low energy, and Joseph appears to have low affect and energy and is very lethargic.

This is concerning given his seizure/medical situation. You ask Mary how he has been and she mentions he has had a few seizure episodes that have lasted longer than usual and then he falls asleep. She did not want to disturb him so left him in bed. It appears that Mary has not been playing/doing much with Joseph based on what she shares and that his seizure activity has increased lately and lasts longer. You are concerned that this situation could or is becoming non-stimulating and less social and active for them both.  

Describe what you need to consider and do to 
help Mary make decisions and get supports to manage Joseph, and to respond to the potential crisis/change in his care.

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8.

Lesson 10 and the readings focused on ethical issues confronting us in relation to our work with children and families. Do no harm and having their best interests in mind is key to ethical decision-making. Ethical issues require us to explore a variety of perspectives in order to make an objective, ethical decision on behalf of another person. This involves weighing multiple options/viewpoints, and their potential consequence and impact on others before making the decision.  

Continuing to use the case scenario of Mary, and the following steps modified from “7 Steps to Making Decisions”, discuss your process of how you will work through an ethical issue and make a decision through each step. You are encouraged to incorporate any content from the readings/lesson that relate and help you to work through the issues to make your decision.

1.
What is the dilemma: Pose the issues in this case.

2.
Ethical perspectives: Pose some of your own questions based on each of the 4 perspectives: your personal beliefs/values; justice; critique, care; and professionalism.

3.
Possible 2-3 solutions: Pose some solutions for the issues and state why you chose them.

4.
Consequences: Discuss/weigh the effect of each solution and who is affected by them.

5.
Rank/Prioritize: Rank your solutions in order of choice and who should be involved. Now m
ake your decision and state the reason you chose it.

6.
Monitor/Modify:  State how you will monitor the decision.

Mary is a mother with an intellectual challenge. The prescription drug she took for seizures during pregnancy affected her child Joseph who also suffers from seizures and cognitive and mild motor delays. You have been supporting Mary and Joseph for a few months at home and at a local daycare to give Mary a break and Joseph time with other children. You are concerned because lately Mary has not brought Joseph, and he seems less active and alert than usual. You decide to call Mary to see if she is open to a visit at home to check in. She is willing to see you the next day.

On arrival at the house at noon, it takes awhile for Mary to answer the door. Once inside, it appears that Joseph may still be in his crib, Mary isn’t dressed and it looks like they haven’t been up yet. There are numerous dishes and household items lying around, and Mary does not seem as vibrant as usual. She is often excited to talk about Joseph and his progress of things he does. He typically brings a smile to her face. Mary seems low energy, and Joseph appears to have low affect and energy and is very lethargic.

This is concerning given his seizure/medical situation. You ask Mary how he has been and she mentions he has had a few seizure episodes that have lasted longer than usual and then he falls asleep. She did not want to disturb him so left him in bed. It appears that Mary has not been playing/doing much with Joseph based on what she shares and that his seizure activity has increased lately and lasts longer. You are concerned that this situation could or is becoming non-stimulating and less social and active for them both.

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