Case Example 1
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Brittany*, Caucasian girl, age 13
*All names and identifying information have been changed on case examples on this site.
Background: Brittany lives in a staffed group home with another youth. She has lived in a number of different foster placements and staffed homes since coming into foster care at age 8. Brittany’s early life was characterized by much chaos and domestic violence. Her mother also struggled with addictions and mental health issues which left her unable to care for or protect her daughter. Brittany and her mother had a huge amount of instability, moving from place to place, and occasionally living in her car.
Once in foster care, Brittany was often unmanageable by caregivers with moody and unpredictable behaviour. She was seen as always “controlling and manipulative”. She was seen as self-sabotaging once things began to settle or improve and often created such a scene that police had to be called to the various homes or she would be taken by ambulance to the local emergency room. Brittany refused to attend counselling. She was diagnosed with a number of mental health disorders and was on multiple medications with little improvement. Behavioural plans hadn’t helped as she would lose more and more privileges and would seem to give up.
Strengths: Brittany can show a wry sense of humour. There is a vulnerability about her that seems to draw her caregivers to her, and people can see lots of potential in her. Brittany seems particularly able to show empathy and compassion to others. After her blow-ups she is often regretful and will show some remorse without giving an outright apology. She can be generous and often will buy the home staff a small treat on their outings.
Challenges: Brittany has a deep sense of helplessness and hopelessness. She has low self-esteem and can’t identify much about herself which is positive. The need to maintain the safety of the home environment, including the other youth and the staff, have led to protocols which involve calling the police. The staff are on edge as is the care team.
Assessment and Intervention Plan: As we completed our Functional Developmental Assessment we learned that Brittany’s development had been delayed across a number of the developmental domains. She had significant issues with stress response, with identity, and with emotional and behavioural regulation. One aspect which we decided to focus on initially was her sense of failure and hopelessness, and her sense that her life was out of control. Our initial plan included:
- Decreasing stress by utilizing “bottom-up” calming strategies and regular stress breaks during the day.
- Decreasing external stressors such as the frequency of unpredictable and unstructured visits with her mother.
- Coaching the house staff in attuned and empathic caregiving.
- A shift to a positively focused program which noted any and all small steps toward some behavioural goals (e.g. Learning to accept “No” for an answer, learning to wait, respecting boundaries).
- We added some immediate tangible items (coupons) which she could use to purchase privileges in a Level system and kept the timelines short.
- We coached the staff in responding to any outbursts in a safe but predictable way with the goal of avoiding calling police and ambulance which added to her shame experience.
- We coached the staff in a form of collaborative negotiation or problem-solving in which Brittany was given a much larger voice in setting up her program. This including setting a menu of privileges which could be earned.
Outcomes: Brittany responded almost immediately to the shift in focus. Her behaviour began to improve almost immediately and each small positive step was noted and encouraged by the house staff. At first she was shy about this and dismissive of the positive attention. She felt the coupons were a little juvenile. At the same time, she was proud of earning the coupons and planned how she could spend them. When she had her inevitable meltdowns, the staff responded in a calm way and emphasized the things she was doing well even in a difficult situation. Brittany said, “This is the first time I haven’t been in trouble all the time”. She began to learn to negotiate and to compromise and would prepare a good argument to support her views instead of flying off the handle. The number of critical incidents which would have involved outside authorities has dropped from almost weekly to none over the first 8 months.
Brittany’s mood has improved and most days are described as positive ones with the house staff. She has increased her time in school and is experiencing academic success for the first time in years.
*DISCLAIMER – At CCI, we respect everyone who comes to us for help – and many are working toward a process of integration and change in order to help those under their care. So while their stories are true, client names, ethnicity, location, images, and variable factors may have been changed to protect their privacy. Thank you for your understanding.