Case B
I have chosen to work on case B because it is necessary to address psychological and psychiatric disorders that are involved with Down syndrome victims. Depressive and obsessive-compulsive disorders often lead to psychological and emotional distress therefore it is important to develop interventions beyond the scope of psychotropic medication (Dykens 2007, p. 273).
Case study C is important for this report because it offers insight into the factors that contribute towards childhood emotional and mental instability such as domestic abuse and its negative impact on children (Howe 2005, p. 90). Interventions are formulated with consideration for children’s needs rather than focusing on the perspective of adults.
Case Study B
Assessment Plan
The goal is to determine the issues experienced by Lucy Denver in order to formulate effective interventions to improve the well-being of both Lucy and her mother. According to information provided, Lucy’s mother is a loving and caring parent who does her best to ensure that her daughter receives quality health and mental care. Because her living conditions with Lucy were argumentative and stressful, she decided to take her daughter to a residential home where she will be well taken care of. After she noticed that Lucy was unhappy and stressed in the first home, she transferred her to a second residential home. In addition, she became very concerned when she discovered that Lucy was dating and felt that her daughter was not psychologically prepared for that big step.
The reason for Lucy’s behavior is that she is mentally stressed due to various reasons such as being unable to cope easily with other mates in the residential home (Silverman 2007, p. 230). Her inability to make friends may probably be the reason why she is in haste to get married to Joseph, so that she could obtain emotional stability. According to the psychodynamic theory, the mind is made up of multiple parts including irrational/impulsive, judgmental and rational ego, which can be categorized into two groups, namely conscious and unconscious parts. Both the conscious and unconscious constantly conflict each other thus causing repression, which leads to mental tension that accounts for mental illness. Mental repression can be addressed by restoring repressive thoughts or ideas into the conscious. Victims of mental repression adopt different strategies and defense mechanisms to cope with stressful situations for example Lucy has trouble waking up or practicing proper grooming. She also overfeeds, does not like eating healthy diets involving vegetables and does not exercise thus she has become overweight (Melville, Cooper, McGrother, Thorp and Collacott 2005, p. 126).
The object relations theory, which is a branch of modern psychodynamic theory, explains a victim’s relationship with other people based on one’s representation and experience. People who experience healthy early relationships often experience healthy later relationships but individuals who are abused or neglected during their early childhood often have difficulty establishing later relationships (Glaser 2002, p. 699). Despite Lucy’s mother being supportive, she did not establish a strong relationship with her daughter during her childhood and currently she is not visiting her regularly, which is why Lucy is finding it difficult to make friends.
The residential home has created a comfortable environment for Lucy and she is settling well, however there are certain concerns about Lucy’s care plan for example the plan emphasizes on independent living but in the job Lucy was assigned, she is not allowed to operate any machinery. Moreover, she is not granted her own privacy but rather treated as a child, for instance Lisa does not knock on her door during breakfast calls. Lisa also addresses Lucy using harsh words such as ‘lazy girl’ and ‘little cherub’. The duty manager demonstrates responsibility by ordering the nurses to monitor Lucy’s relationship with Joseph however, he did not involve Lucy’s mother in decision-making about her daughter’s relationship. As a result, Lucy’s mother feels left out in an important and sensitive issue and does not know the platform to use to make a complaint in a manner that will not upset her daughter. Though the manager demonstrates unwillingness to conduct an intervention regarding Lucy’s relationship, I believe an intervention is needed to prevent Lucy from making irrational decisions.
I plan to conduct my assessment within a period of 7 days whereby I will gather data through interviews with the duty manager, Lisa, Mary Jones, Lucy and her mother. Furthermore, I will use the questionnaire method to obtain additional information from Lucy on how she perceives her treatment at the residential home and her relationship with her mother. From the data collected, I will be able to formulate an effective intervention strategy that is guaranteed to improve both Lucy and her mother’s wellbeing.
Intervention
The first intervention is to strategize an effective care plan for Lucy that incorporates diet and exercise schedules. Lucy should also be granted her own privacy however under strict supervision until she proves that she is trustworthy enough to be able to make independent decisions like getting married. She should also be treated with respect for instance knocking on her door before entering and avoiding harsh words. Another important aspect is involving Lucy’s mother in decision-making especially on sensitive issues so that she would not have to make a complaint or feel the need to transfer her daughter to another residential home (Abbeduto et al. 2004, p. 240). In this case concerning Lucy’s relationship, I find it necessary to conduct an intervention whereby her mother and Lisa are able to discuss with Lucy about sex, dating and marriage in a manner that will not upset her in order to prevent her from making hasty decisions.
According to research, Down syndrome victims are rarely involved in sport and exercise activities, which contribute towards overweight and obesity (Melville et al. 2005, p. 128). Lucy is overweight because she hardly exercises and is allowed the freedom to eat whatever she wants including starchy foods and pudding rather than vegetables and fruits. The management should implement a strict diet and exercise plan, for example 30 minutes of daily exercise every morning from 7-7:30 a.m. Apart from losing weight, regular exercise increases mental alertness and reduces depression rates therefore, daily jogging/walking exercises will be very effective in improving Lucy’s cognitive condition (Heller, Hsieh and Rimmer 2004, p. 177). Lucy’s diet also needs to be effectively managed and the amount of starch reduced. She needs to be educated on the importance of maintaining a healthy diet to prevent overweight issues. She also requires strict supervision to ensure that she incorporates vegetables in her diet and refrains from overeating particularly during evening meals. Rather than consuming more during supper, she should be taught the importance of taking a heavier breakfast and a light meal during supper because during the day the body requires more energy.
Depressive or obsessive-compulsive disorders are common among young adults with Down syndrome and unfortunately, there are limited treatment options and interventions to address this issue (Dykens 2007, p. 274). I would therefore recommend that Lucy’s caregivers adopt the Dohsa-hou psychological treatment method. Dohsa-hou applies relaxation, bodily feeling and body movement to enhance communication and therapeutic intervention thus improving behavioral and emotional issues (Silverman 2007, p. 233). A short-term Dohsa-hou treatment plan can be incorporated into Lucy’s daily schedule for example 40 minutes every evening before bedtime from Monday to Friday for a whole month and the results obtained after 20 complete sessions. The Dohsa-hou treatment method is projected to reduce anxiety levels thus easing psychological and physical tension (Heller et al. 2004, p. 180). As a result, Lucy will be emotionally stable thus making logical decisions. Walking and balancing exercises enables the victim to gain more control over one’s own body movements therefore increasing a sense of self-dependency (Melville et al. 2005, p. 131). A daily group therapy should be included in this intervention whereby self-expression and playful activities are incorporated in order to assist Lucy in making self-judgments and expressing her opinions.
Case C
Assessment Plan
In this case, Fiona and Steve seem like caring parents because they provide for their children’s basic needs and education, however there are various areas of concerns that need to be addressed to prevent the family from breaking apart.
My first observation is that the children Liam, Shireen and Lewis are victims of domestic abuse due to ill parental health and parental substance abuse (Glaser 2002, p. 699). Fiona has a negative perspective of her family because of the bad experience she had when growing up. Therefore she does not put much effort into her parental skills nor consider her children’s emotional needs. For instance, she sees Liam as a problem rather than focusing on supporting him through love and care. Additionally, she neglects her children’s hygiene and does not even clean the house because according to her, everything about her family is wrong, therefore she does not see the need of fixing things. Steve also considers Liam as a troublemaker hence; both he and his wife have neglected him. The extra cash that Steve makes goes into alcohol drinking rather than supporting his family’s needs. Fiona and Steve constantly fight especially when they are drunk, which contributes towards the emotional instability of the children (Finkelhor, Ormrod and Turner 2007, p. 8).
Children have a right to a stable childhood and be loved and protected not only by their parents but also by the community. In this case, Liam, Shireen and Lewis are not receiving proper love and care from their parents, the school and neighbors. Their childhoods are not stable because of a number of factors such as financial instability, social exclusion, mental health issues, unemployment and poor parental-child relationship (Cook et al. 2017, p. 393). The local authority is striving to rehabilitate Liam by taking him through the youth offending program. The team is willing to help Liam, for instance offering to pay for his bus fare to the facility however, Liam does not see the importance of the program because he does not receive any support from his parents particularly his mother. In fact, Fiona told him not to disclose any information about their family if asked, which I think is a great hindrance to getting to the root cause of Liam’s social problems. According to the psychodynamic theory, older representations of relationships are used to base understandings of new relationships (Howe 2005, p. 112). Therefore, because Liam does not relate well with Steve, he has developed feelings of anger and resentment which makes him fight with other boys in school.
Lewis looks up to his father and sees him as his role model, however Steve is not instilling the right values and qualities in his son for example he tells Lewis to always stand up for himself, which makes him fight with other boys in school. Moreover, he does not teach his son the importance of education but goes with him to work instead of taking him to school. The social learning theory which is made up of the cognitive learning theory states that learning is impacted by numerous psychological factors. The behavioral theory also stipulates that learning is influenced by stimuli factors from the environment hence; learning is divided into observation, retention, reproduction and motivation (Iwaniec 2006, p. 34). Because Steve is a role model for his son, Lewis is most likely to learn a lot from his father through observation, retaining and reproducing the same skills that Steve portrays. The long-term effect of this situation is that Lewis will portray the same behavior that Steve portrays for example alcohol abuse.
The community has also neglected its duty to ensure that the children are well taken care of, for example the neighbors exclude Liam because they see him as a criminal and troublemaker. Shireen and Lewis are socially excluded in school because of being untidy and queer; moreover, the teachers constantly accuse Shireen of ill behavior and negatively influencing other children. It may however be difficult for the school and probation facility to help the children because Fiona does not want them to share their personal home issues. As a result, the community misunderstands the Evans family and considers them socially unacceptable. According to section 11 of the 2004 Children Act, it is the responsibility of local agencies such as health services to promote the wellbeing of children and ensure they are safeguarded (Howe 2005, p. 122). Additionally, the Children and Social Work Act of 2017 requires local agencies and local authorities to collaborate to improve the welfare of children in their local area (Iwaniec 2006, p. 41). So far local bodies have neglected their social obligations, for example addressing Liam’s cold and coughs and as a result, Liam’s health could deteriorate leading to adverse health effects or death.
My self-assessment plan will run for a period of two weeks whereby I will collect data through questionnaires issued to the children’s teachers and the school administration, neighbors of the family, the manager of the anti-social team and the head of the local youth offending team regarding the anti-social behaviors of Liam and his siblings at school and in the neighborhood. It is also mandatory to conduct interviews with Fiona and Steve regarding their parenting experience and how they perceive the community. Some drawbacks likely to be experienced include prejudice and negative judgments that can impair the quality of my assessment results and analysis.
Intervention
The first intervention is parental rehabilitation to address parental mental health issues and substance abuse that contribute towards domestic abuse (Glaser 2002, p. 700). Both Steve and Fiona need to be rehabilitated on successful parenthood that involves offering love, care and security for their children. Furthermore, I recommend that Fiona seeks employment to supplement her husband’s income rather than blaming him for not being able to meet all the family’s needs for example paying for school trips, buying school uniforms and paying for healthcare and hairdressing. Both parents need to be taught the importance of being ideal role models for their children for example reducing alcohol abuse, hence positive change should begin first and foremost with the parents. When the children begin to see a positive outlook in their parents, they will also display acceptable social behavior such as keeping away from fights (Iwaniec 2006, p. 45). For instance, both parents should change their approach of solving conflicts from fighting and issuing blame to peaceful talks and discussions involving negotiations in the presence of a mediator or a counselor if need be (Finkelhor et al. 2007, p. 10).
The relationship between Liam and Steve should be recreated because Liam is in dire need of fatherly love and care. Firstly, Steve needs to address his alcohol problems and demonstrate more concern for his step-son’s wellbeing rather than leaving the entire burden with Fiona. Liam does not feel like he has a home because he does not relate well with Steve, therefore if their relationship is restructured, it will lead to effective results in helping him regain emotional and mental stability (Cook et al. 2017, p. 395).
The second intervention involves implementing effective child-based safeguarding systems in the community. Many safeguarding systems fail because they are based on the perspective of adults rather than putting the needs of children first. Children need their grievances and opinions to be heard and valued. They also require respect and a stable relationship with their caregiver that is based on trust and consistent support (Howe 2005, p. 133). I recommend that that school and members of the estate also participate in Liam’s rehabilitation alongside the local youth offending and anti-social behavior teams rather than pointing fingers and blaming the family. Fiona should be open to discussions about their family issues to arrive at the root cause of Liam’s problems and formulate effective strategies for his rehabilitation. Healthcare groups in the local area also have a responsibility to attend to Liam’s health issues that have been neglected.
Conclusion
The Dohsa-hou psychological intervention method has been noted to produce effective results in improving emotional and behavioral problems associated with Down syndrome victims. Lucy’s intervention program will improve her self-efficacy levels while maintaining self-perceptions and being able to express her opinions.
Parental care revolves around creating emotional stability alongside providing basic necessities. In the case of Fiona and Steve, parental rehabilitation is required to improve parenting skills based on social behavior and psychodynamic theories. Apart from the parents, local authorities and agencies have a duty to ensure that children are protected thus promoting their wellbeing.
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