SOC 386 Week 5 Assignment – Case Study 2-4
SOC 386 Week 5 Assignment – Case Study 2-4
Details:
Read and evaluate “Case Study 2-4” from Case Studies in Social Work Practice, “Using a Family Systems Approach with the Adoptive Family of a Child With Special Needs.” Listed below.
Write a 500-750-word reflection about the case that includes a discussion of the child and family subsystems, boundaries, social systems, and cultural influences of the family described in the case. Make a list of the micro, mezzo, and macro systems. (Ecomap Example: See Figure 2.1 in Applying theory to Generalist Social Work Practice, 2014 by Langer & Lietz). 
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
Prepare this assignment according to the guidelines found in the APA Style Guide. Please include a introductory paragraph with thesis statement and a conclusion paragraph.
Case Study 2-4 Using a Family Systems Approach With the Adoptive Family of a Child With Special Needs
This case study illustrates the use of a family systems approach to working with a new family constellation that has been created out of tragedy. This therapeutic intervention, informed by family systems theory and practice, incorporates elements of attachment theory and the dynamics of kinship adoption, an understanding of the effects of complex trauma on individual and family functioning, recognition of the impact of culture, class, and immigration status, as well as contextual social factors such as racism and sexism, on the functioning of the family system in relation to its individual members, as well as on the functioning of the family in a larger context of community and the dominant culture.
Questions
1. How can family systems therapy help a family newly formed through adoption learn how to meet the emotional and social needs of each of its members?
2. Can a family system that has been formed as a result of grievous loss create a new, more positive identity for the future?
3. What is the best way to help adoptive parents of a child with serious emotional and behavioral challenges manage their child’s needs while still attending to their own?
4. What are the special concerns, if any, when working with a family from a different culture than one’s own?
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Even though I have been a social worker for nearly 40 years and a family systems therapist for almost that long, every time I explore a case using a family systems lens, I feel a kinship with the very first professional social workers— like Mary Richmond— who understood well the importance of the family system in interpreting the psychosocial dynamics of the individual. Although in the 21st century we know a great deal more than our professional foremothers and forefathers did about the biological basis of human behavior, these early professionals recognized the importance of observing family members together “acting and reacting upon one another” (Richmond, 1944/1917, p. 137).
The family in all of its dimensions has historically been the purview of social workers (Carr, 2009; Dore, 2012; Walsh, 2011). Whether working in child protection, adoption, child guidance, family services, eldercare, or in a specific setting like a hospital, school, or community mental health clinic, social workers have recognized that the individual could only be truly understood in interaction with his or her environment, the most essential element of which is the family. The Family The particular case I have chosen to use to illustrate family systems therapy is that of the Laurent family. The family consists of the father, André, age 36; mother, Marie Clothilde, age 32; and their adopted son, Michel, age 10, who is also Marie Clothilde’s nephew. André Laurent immigrated to the United States as a young teenager when his parents fled Haiti after the first overthrow of President Jean-Bertrand Aristide in the early 1990s.
They settled in the greater Boston area, where André attended school and learned to speak English fluently. He graduated from a technical high school, where he studied information technology, and since graduation he has been consistently employed in IT services in the pharmaceutical industry. Marie Clothilde immigrated more recently, coming to the United States in 2005 to stay with an older sister in the hopes of finding work to help support her family back in Haiti. Because Marie Clothilde spoke very little English, her employment options here were limited. She worked primarily on a cleaning crew that maintains office buildings at night. Shortly after she arrived in this country, she met André through a cousin. They married in 2007. Even though André had a goodpaying job, Marie Clothilde continued to work after their marriage so that she could send money back to her poverty-stricken family in Port-au-Prince.
The Presenting Situation: Everything changed for André and Marie Clothilde on January 12, 2010, the date of the devastating earthquake in Haiti. Marie Clothilde spent frantic days after the disaster trying to find out what had happened to her family. Eventually, through a family friend, she learned that her entire family in Port-au-Prince had been killed, with the exception of her sister’s son, Michel, who was dug out of the rubble of the extended family home still alive two days after the earthquake. With the aid of her priest, who is also Haitian, she was able to locate Michel in a makeshift orphanage in Port-au-Prince and arrange for him to come to this country. Michel, who lost his only parent and grandparents in the earthquake, along with his uncle, aunt, and two young cousins, was still in shock when he arrived at Logan Airport in Boston in April 2010, to begin a new life in a strange country with adoptive parents he hardly knew. Marie Clothilde was struggling emotionally as well. Her family had been decimated in the earthquake, and she barely had time to process the loss when she was confronted with an emotionally distraught child to care for.
She assumed the role of mother, a new one for her, and relinquished the role of wage earner because Michel required all of her time and attention at home. André, feeling he needed to make up financially for Marie Clothilde’s lost income and not a little displaced in his wife’s attentions by his new son, began to spend more time at work. Marie Clothilde enrolled Michel in the neighborhood elementary school, but her inability to speak much English prevented her from fully communicating what had happened to Michel with school personnel. Thus, school personnel, who placed Michel in a mixed class of children who were nonEnglish speaking, were totally unprepared for the problems he began to manifest. For one thing, Michel was unable to sit quietly at a desk for any length of time. He would begin to pace the classroom and, if requested to return to his seat, would begin screaming and thrashing about, pulling at his hair and babbling in Haitian Creole.
If a teacher attempted to touch him to guide him back to his seat, Michel would shrink away, sobbing and crying, flailing his arms and shouting about petro loas (evil spirits) who were possessing him. At these times, Marie Clothilde would be summoned to the school and told to calm Michel down or take him home until he gained better control of himself. One day Michel became so out-of-control, alternatively cowering under his desk, crying and shaking uncontrollably, and striking out aggressively, cursing at anyone who tried to come near him, that the school contacted the mobile crisis team from the child and adolescent inpatient psychiatric unit at the local hospital. In consultation with André, who had rushed to the school from his job, and Marie Clothilde, the mobile crisis team recommended that Michel should be hospitalized briefly for further evaluation.
Although many Haitian people believe that the kind of serious emotional and behavioral disturbances that Michel was exhibiting are caused by a curse from a loa (sometimes spelled lwa ) or evil spirit who is upset at being disobeyed, André and Marie Clothilde recognized that Michel’s problems were likely related to the severe trauma and multiple losses he had experienced back in Haiti. Fortunately, because the greater Boston area has the fourth largest Haitian population of any city, including those in the country of Haiti, the community hospital where Michel was admitted belongs to a behavioral health network that supports a mental health team of Haitian Creole– speaking professionals. The child psychiatrist on this team, Dr. Odette Jean-Baptist, evaluated Michel in the hospital and diagnosed posttraumatic stress disorder suffered as a result of the complex trauma he experienced during and after the earthquake in Haiti exacerbated by the process of immigrating to the United States and adjusting to a radically different life in a strange new family, school, and community.
Dr. Jean-Baptist prescribed a short course of a mood stabilizer to help Michel manage his explosive outbursts and scheduled regular follow-ups to monitor his response to the medication. She also made a referral to the local children’s mental health agency, where I am employed, for ongoing family treatment to help Michel integrate into his new family and to help his adoptive parents learn ways to support their son as he mourns his former life and embraces his new one.
Joining the Family System: Through contracts with the state Department of Mental Health designed to prevent long-term out-of-home placement of children and adolescents with serious emotional disturbances, my agency offers family-based services to children and their parents in their own homes, in community settings, or in our offices, depending on the family’s preference. If a child is already in a psychiatric placement, as was Michel, then we meet with the family in the placement setting and include in our first session the mental health professionals working with the child there. In this case, Dr. Jean-Baptist joined us to offer her insights regarding Michel’s diagnosis, his current psychosocial functioning, and her team’s recommendations for his further treatment.
As if sensing my unspoken concerns about the Haitian culture’s belief regarding disability, especially mental disability, as something the individual has brought on himself, a punishment for offending the spirits or God in the case of Haitian Christians, and how this belief might affect Michel’s parents’ response to his illness, Dr. Jean-Baptist explained to them in lay terms in both Haitian-Creole and English how experiencing profound trauma can alter the functioning of a person’s brain, particularly in children whose brains are still developing and thus are uniquely vulnerable to the physiologic changes that take place in response to high levels of traumatic stress. This explanation helped alleviate André and Marie Clothilde’s expressed concerns about their ability to parent Michel, particularly when I explained how I would be working closely with them to figure out the best ways to help Michel manage his own emotions and behavior. I added that I would also be connecting them with community resources that could offer them support with Michel into the future.
Assessing Family System Dynamics: As a therapist working from a family systems perspective, it was important at this point to join with the parents to support their capacity to adequately meet their new son’s needs by becoming part of the family caregiving system so that they did not feel so alone and overburdened. Although Marie Clothilde had extended family ties to Michel that would help sustain her commitment to him during the challenging work ahead, André had no such ties, and I was concerned that his emotional investment in Michel might be more limited, particularly if he experiences Michel as coming between him and his wife. This dynamic is frequently seen in family systems when one parent, usually the mother, becomes so invested in caring for a child with special needs that other family members, often the father and the child’s other siblings, feel shunted aside with their emotional needs going unmet.
This dynamic could be complicated by the patriarchal tradition in Haitian culture that lays the burden of caring for a child with a disability solely at the feet of the mother. There is a great deal of shame and stigma associated with having a disabled child in Haiti. If a child is born with a visible disability, the father may leave the home and take up with another woman, who will become pregnant and bear a child without a disability, thus proving that the father is not the cause of the child’s impairment. As a result, disabled children in Haiti are often raised by single mothers. Knowing this, it will be important for me to assess the degree to which André and Marie Clothilde ascribe to these beliefs and determine how to keep André engaged with his new son so that Michel’s care is not left entirely to his wife. SOC 386 Week 5 Assignment – Case Study 2-4.
Strengthening the Adult Partner Subsystem: I knew I must also find ways to help André and Marie Clothilde communicate openly about their own needs and feelings so that Marie Clothilde does not begin to feel overburdened by Michel’s care and André doesn’t feel closed out of the mother-child subsystem in the family. A common strategy in practice informed by family systems theory is working to strengthen and develop what is called the marital subsystem in the traditional family therapy literature, but what could more accurately be termed the adult partner relationship , as it can also refer to unmarried same-sex or opposite-sex partners. This strategy is also important in a single-parent household, especially when the parent has formed a co-parenting alliance with one of the children, usually the oldest girl. The idea here is to establish and support a family hierarchy in which the adults are in charge, and to ensure that the adults have a relationship with one another that is separate from their roles as parents. Developing such a relationship requires open, clear communication of needs and feelings, as well as mutual understanding and support. Family systems therapists believe that a solid adult partner relationship is the key to a family system that responds adequately to the needs of all of its members.
The Impact of Adoption on the Family System: In addition to cultural and adult relationship considerations, there are issues around adoption, particularly the adoption of an older child with special needs, which I must be aware of in working with the Laurent family. At the point that I met with the family in the hospital, I knew nothing about the couple’s desire to have children of their own, whether this was something that they had wished for but had been unable to conceive, or whether they had decided not to have children, which I thought was rather unlikely given the high value placed on children in Haitian culture. In family systems practice in adoption, it is essential to understand a couple’s intentions regarding childbearing and what their efforts have been to have a child of their own. For some people, the inability to conceive and/or carry a child to term is viewed as a personal failing with accompanying self-blame and depression, making the emotional investment in an adopted child more challenging. When a kinship adoption is thrust on a couple unexpectedly, as was the case with André and Marie Clothilde, there is little or no time for them to consider what the addition of a new member will mean to their family system and to prepare for likely changes.
If one partner is more eager to adopt a child than the other, particularly if the lessinvested partner is simply going along with the adoption to please the other person or to salvage their relationship, then the addition of a child to the family system through adoption can result in a significant shift in the partner relationship. Adoption of an older child also brings its own challenges to the family system. Although Michel is a member of Marie Clothilde’s extended family, she has not seen him since he was a toddler and can only surmise about his prior upbringing in an extended family household that included not only her sister, Michel’s mother and a single parent, but also her mother and her father who was an alcoholic, as well as her older brother, the only wage earner in the family, his wife, and their two young children. Like approximately 80% of Haitians, the family was very poor and lived in the section of Port-au-Prince known as Cité Soliel, an infamous urban slum.
Marie Clothilde knows from her own experience that the primary school that served Cité Soliel children before the earthquake was a ramshackle building lacking in basic resources such as electricity and running water. The cost of uniforms and textbooks made sending any but the eldest male child prohibitive for families like hers. She isn’t sure just how much schooling Michel actually had back home but, like many Haitian immigrant parents, she is anxious that he should be placed in a classroom based on his age rather than his prior educational experience or ability. She is unfamiliar with the special resources available to children with Michel’s challenges in the Boston-area community in which the Laurent family lives and, again like many immigrant parents, relies on school personnel to make the best decisions for Michel. SOC 386 Week 5 Assignment – Case Study 2-4.
Helping the Family System Incorporate a New Member: Marie Clothilde’s unfamiliarity with the local education system provided me with the opening I needed to engage André, who, as a result of having gone to high school in the area, was more familiar with the system and at ease with school personnel. Appealing to André’s authority on the local education system not only increased his involvement with Michel and his special learning challenges but also brought him back into an alliance with Marie Clothilde on behalf of their child, as together, with my coaching and support, they worked with the special education staff at Michel’s school to obtain a full educational evaluation and design an Individualized Education Program (IEP) to meet his learning needs. Under the Individuals with Disabilities Education Act (IDEA), parents are entitled to be considered full partners with special education personnel in contributing to planning the IEP.
Strategies to Strengthen the Parental Subsystem: My experience in working with immigrant parents, many of whom come from cultures that place educators on a pedestal, is that they are often hesitant to question the decisions of school staff or to advocate for their child if they feel his or her learning needs are not being met. This seems to happen more often when the child’s learning is impacted by serious emotional and behavior disorders. As is true in most states across the country, we are fortunate to have a very effective educational advocacy group in Massachusetts, the Professional/Parent Advocacy League (P/PAL), for families whose children have mental health challenges. P/PAL can arrange for a legal advocate who is thoroughly familiar with education law to accompany parents to an IEP planning meeting if they are at all concerned that their child will not receive appropriate or adequate educational services from the school.
If I am working with a family with a child with a serious emotional and/or behavior disorder, I routinely put them in touch with a P/PAL representative, who is usually an experienced parent of a child with similar challenges who offers support and information about local resources. P/PAL also sponsors psychoeducation groups that meet weekly in specific locations throughout the state for parents whose children are struggling with mental health concerns. In addition, the organization holds picnics and other fun events for families who may feel more comfortable socializing with other families with similar childrearing challenges. One of the most significant changes in family systems practice in recent years is the recognition that the families we work with are embedded in networks of community supports and services that can be tapped to strengthen the family system in myriad ways. Family systems work used to focus almost completely on the nuclear family system, the constellation of dad, mom, and kids.
As this constellation changed markedly over the past several decades to encompass a variety of family forms, family therapists recognized the need to broaden their purview, first to include extended family members and close friends in their therapeutic interventions, then to add to the family’s network in more creative ways. Nowadays, rather than expecting the family to meet one another’s emotional and social needs exclusively, family therapists assess a family’s life cycle stage and locate resources that can support the family in their current developmental process. For example, in working with the Laurent family, which has suddenly moved from the couple stage, with its focus on the adjustment of the marital subsystem, to the addition of a new family member, a child with special needs, I looked for community resources that could support them in this process. In addition to introducing them to P/PAL to help them navigate the education system, I also put them in touch with Adoptive Families Together (AFT), which, as the name suggests, is a grassroots organization of adoptive families, many of whom have adopted children with special needs and challenges.
AFT not only offers parent support groups throughout the greater Boston area, but also sponsors an online discussion group, which adoptive parents can access for information, advice, and general support. Families who join AFT receive a free copy of In Their Own Words . . . Reflections on Parenting Children With Mental Health Issues: The Effect on Families , a book written and published by members of this organization. Because this book is available only in English, which Marie Clothilde is unable to read comfortably, we agreed that André would read a chapter to her each evening after Michel had gone to bed, and they would discuss issues the material raised, noting any concerns they wanted to bring to our by-then weekly meetings together.
Addressing Individual Member Concerns From a Family Systems Perspective: As I noted previously, there is a large Haitian population in the greater Boston area, which luckily means that many resources are aimed specifically at the Haitian community in the area where the Laurents live. Because I had concerns about Marie Clothilde’s response to the deaths of nearly her entire family in the earthquake, which I felt she had delayed facing because of her need to attend to Michel’s mental health issues, I hoped to locate a support group for Haitian women who had experienced similar losses in that tragedy. The Association of Haitian Women in Boston, an advocacy organization for Haitian women, was able to refer Marie Clothilde to a women’s group that met locally through the auspices of the Cambridge Haitian Services Collaborative.
I also learned of an extensive women’s literacy program offered by this organization, which could help Marie Clothilde become more fluent in English, enabling her to better negotiate the various service systems on behalf of her son. In making these inquiries and referrals, it was essential that I actively engage André in the process in order to maintain balance in the family system and to honor the role of the husband and father in Haitian culture. My agency runs an ongoing father-son group in our community for fathers of boys, ages 10 to 15, who are struggling with emotional and behavior challenges. Most, though not all, of the dads in the group live apart from their sons and are seeking ways to strengthen the attachment with their boys. It is primarily an activities-recreation-adventure group that draws heavily on the many arts, education, and sports-related resources in the greater Boston area. I thought since parent-child attachment is one of the ever-present themes in this group, it might also be appropriate for André as an adoptive father seeking to build a relationship with his new son. One of the two male leaders of this group is a Haitian American social worker, Emile Richard; the other is an African American psychologist, Ed Gaines.
André was hesitant about joining the group with Michel given the boy’s emotional and behavior challenges, but he agreed to meet with Emile and Ed to see if the group was a fit for him and his son. As it turned out, André and Emile were distantly related through their mothers, which cemented André’s willingness to try the group. From the group leaders’ modeling, André learned some effective strategies for managing his son’s behavior in public situations, as well as attunement skills to help Michel build capacity for self-regulation. André connected with several of the other fathers in the group, and a small group of them with their sons, all around Michel’s age, began meeting in a local park on Saturday mornings to play pickup soccer. Through the fathers’ group, which occasionally met at a local sound recording studio, André and Michel discovered a mutual love of Kompa (in English called compas ), the traditional music of Haiti. They often listen together to old LPs made by Kompa artists like Nemours Jean-Baptist and Rene Saint-Andre that were given to André by his father. Michel wistfully remembers his grandfather playing the same records back in Haiti. SOC 386 Week 5 Assignment – Case Study 2-4.
Finally, as the theme of trauma runs through this family system, I used the strategy of storytelling to aid healing among its members (Kiser et al., 2012). Storytelling is also an important technique in adoptive families to help members co-construct a narrative that binds their lives together. The goal of this strategy is for each member to move from owning an individual story to collaborating on a shared narrative of their evolving family system. This technique was particularly useful in working with this family because Michel was initially unable to talk about his experiences during and after the earthquake in Haiti, expressing his feelings and fears through night terrors and overwhelming anxiety attacks during the day. As he listened intently to his adoptive parents tell the stories of their own childhood experiences, particularly their individual immigration stories, each of which involved emotionally painful loss and renewal, Michel gradually became able to put his own experiences into words, which described an ordeal so terrifying that it was difficult for the adults in his life to hear.
My role was to help André and Marie Clothilde manage their own affective responses to this difficult material and to learn how to use reflective listening skills to accurately and empathically respond to Michel’s efforts to communicate his needs and feelings to them. In one of our most significant family sessions, Marie Clothilde sat with tears streaming down her face as Michel described being able to hear his grandfather’s weakening voice in the rubble, urging Michel to be strong until searchers could find him. By the time rescuers came, no one except Michel was left alive in the debris. Marie Clothilde opened her arms and Michel, who had been sitting by himself on a small chair somewhat outside of the family circle, hesitated only momentarily before flinging himself into her arms, sobbing noisily. André got up from the couch where he had been sitting and, pulling another chair close to his wife’s, embraced his wife and son as they cried together, mourning their mutual losses. It was shortly after this that the family, with my guidance and support, began to co-construct a narrative of their emerging life together as a new family system. This story included the routines, rituals, and traditions they were developing, as well as some of the obstacles they had faced and overcome as a family.
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Conclusion : I recognize in presenting this somewhat complex case of family systems work that the contemporary approach to this type of practice is heavily dependent on viewing the family in the context of larger systems and on using available resources outside of the family to strengthen the functioning of both individuals and family subsystems. The kinds of resources I was able to draw on in working with the Laurent family as Haitian-born immigrants are not available in many parts of the country, particularly in poorer and more rural communities. Clinicians are often surprised, however, at what is actually available when they are seriously committed to connecting family members to resources that can enhance resilience in the family system. SOC 386 Week 5 Assignment – Case Study 2-4.
Mentors can be found almost everywhere with a little effort, as can activity groups. Support groups for parents who have adopted special needs children or whose own children have serious emotional or behavior challenges are as close as the Internet, although the clinician must be vigilant in ensuring that the client’s online privacy is protected and that the website is sponsored by a recognized legitimate entity before recommending this resource. In summary, my work with the Laurent family, although informed throughout by a family systems perspective, was also dependent on my knowledge of adoption dynamics (Reitz & Watson, 1992), particularly the unplanned adoption of an older child and its impact on an existing family system; of complex trauma and its bio psychosocial impact on a latency age child as well as an adult; and of the public education system and how to manage its response to a child with serious emotional and behavior challenges, all with an overlay of Haitian culture and the immigrant experience. Although the specific issues in each family that presents for treatment are different, or as Leo Tolstoy put it so well, “Every unhappy family is unhappy in its own way,” a family systems approach easily accommodates these unique factors, giving structure and overall direction to the work.