June 27 Post Four

After multiple hearings, Brian has been accused of not paying his child support. His options are to pay the money who owes or to go to jail with a bail amount that is chosen by the judge. He has still not communicated to Pam what he plans to do. Months later when Michelle is about to start school at age 5, he begins paying the support money but there is still a lack of communication between him and Pam. There is going to be another hearing in regards to when he will be able to see his daughter if he so chooses.  

Pam has been looking around at multiple schools to see which one is most appropriate for Michelle. Since the intellectual age of Michelle differs from her chronological age, she may not be able to keep up with peers of the same chronological age. However, Pam feels strongly that Michelle be put into a least restrictive environment meaning she spends as much time as she can with her peers, instead of a restricted classroom of children with disabilities. After multiple meetings with the Special Education teacher and Principal at the local public elementary school, they created an individualized education plan (IEP) for Michelle. Each public school that a child who receives special education and related services attends must have an IEP. Each IEP must be designed for one student meaning completely individualized. The IEP creates an opportunity for teachers, parents, school administrators, and other related personnel and students to work together to improve educational results for children with disabilities. Together, this group looks at the specific needs Michelle has. For now, this includes more individualized instruction, accommodations because of her inability to fully hear, and strategies to assist with the developmental delays in all academic subjects. The IEP then set goals to determine where they would like Michelle to be after the first quarter of school. After the first quarter the IEP team will begin by looking at the child’s evaluation results, such as classroom tests, individual tests given to establish the student’s eligibility, and observations by teachers, parents, and other related staff, administrators and others. This information gives an outlook of how the student is currently doing in regards to educational progress (IEP, 2014).

With this new IEP, Michelle is making significant progress. She now responds to her name when called 90% of the time. She also has been working on her numbers, ABC’s and writing her name. She is still having trouble doing the tasks when not prompted and she has not begun reading. Her peers have begun to use sentences and speak fairly fluently they and have built relationships with each other where Michelle is more reserved and to herself. Michelle can count to five on her fingers but when she has to count specific items on a desk such as 5 crayons, she is unable to do so, unlike her peers who have counting abilities at least up to 20. Michelle has also not started learning her shapes or colors where her peers know about 4 to 5 of each. Michelle’s teacher has encouraged Pam to work on counting , tracing, colors, and shapes at home each day when Michelle gets home (Development, 2014).

Michelle is in a half day kindergarten for now so that she can get used to this transition from always staying at home. However, this complicates things for Pam because since Pam works all day, still at the diner, she is unable to drop Michelle off and pick her up. She has tried having her Mother Margaret take on this responsibility but Margaret has made Michelle late to school many days and she has forgotten to pick her up. Pam is currently trying to find a job that works the night shift so that she is able to transport Michelle to and from school. After using a career planning center and a Myers Brigg personality test, Pam has learned that she really enjoys serving other people. Pam has decided to enroll in a 3 month course that includes practical and theoretical training. After the training she will have to take and pass the theoretical and practical licensing exam (CNA, 2012).

1) What goals should be included in Michelle’s IEP? Be specific.

2) Given the lack of care Brian has shown towards Michelle, does Brian have the right to have time with his daughter one on one?

3) How is Pam going to be able to find time to complete the training and exam in order to be a CNA? What strategies will she need?

Decision Point: Many Parents want their children fully included in the classrooms with the other typical developing children. Does Pam insist on full inclusion for Michelle? Why or why not?

Developmental Milestones: Age 5. (2014, January 1). GreatSchools. Retrieved June 27, 2014, from http://www.greatschools.org/parenting/social-skills/1127-developmental-milestones-age-5.gs

What Is an IEP? | Individualized Education Program. (2014). National Center for Learning Disabilities. Retrieved from http://www.ncld.org/students-disabilities/iep-504-plan/what-is-iep

What You Need to Know About a Certified Nursing Assistant License. (2012). CNA License. Retrieved from http://www.cnalicense.org/

June 24 Post Three

Brian had cut off all communication from Pam and he has stopped paying his child support. After being divorced for 16 months, he is not helping to support his daughter Michelle. Pam is fed up and after trying to reach Brian to get him to pay his child support. After refusing to pay for several months, Pam decides that she is going to take Brian to court because she is unable to pay for all of Michelle’s needs on her own while living off a pay check from working at a diner. Since Brian has showed up intoxicated before, Pam does not want him coming to see Michelle under any circumstances because she does not trust him.

Pam is aware of the severity of the financial struggle and she decides to look into taking the GED test. She practiced with online tests and then she decided that she was prepared to take the exam. She found a location near her, and Margaret the Grandmother decides to watch Michelle the day of the test. Pam explains the situation to her boss who lets her have the day off since it is a 7 hour test. Later that month, Pam found out that she passed the test. Pam is thrilled, and is very proud of herself, boosting her self-confidence. Every day when she comes home from working at the diner, she researchers job and applies to all the jobs that are near since she can’t really afford gas and she lives in a rural town (GED, 2004). Because Michelle requires a lot of attention when Pam gets home from work, Pam has been slipping up on the job search because she can’t find time to do it, nor does she really know how to search for jobs, how to fill out applications, or how to prepare for an interview. However, since Pam has been going to a single mom of disabilities support group, she has found more positive coping strategies of how to handle a child with a disability (Berry, 1998).

Michelle has begun babbling more but most of her speech doesn’t consist of words. Unlike a typical three year old, although Michelle is able to respond to her name now, she is unable to create simple four word phrases, and ask simple questions. Michelle’s speech delay is due to Down syndrome but Pam also has her suspicions that it may be due to her inability to hear. Because of previous lack of medical attention for her throat and ear infections, this has led to severe damage to her hearing. Michelle has learned to say “mama” and “no”, but she is unable to create other words. This is because she has yet learned the ability to imitate an echo sounds, turn taking skills, visual skills, auditory skills, tactile skills, oral motor skills, and cognitive skills (NDSS, 2014).

Pam tries to get Michelle involved in early intervention, meaning a systematic program of therapy, exercises and activities designed to address developmental delays that may be experienced by children with disabilities. Michelle was able to get these services because she is authorized under the federal law called the Individuals with Disabilities Education Act (IDEA). This law obligates states to provide early intervention services for all children who qualify, with the end goal of improving the development of infants and toddlers and helping families comprehend and meet the needs of their children. She was able to get a referral from Michelle’s doctor. Once the referral was made, the program staff scheduled and completed an evaluation within a specialized time and a case worker named Laura was assigned to coordinate the various services that Michelle needs. She decided to enroll her in speech therapy, and occupational therapy, and has set up a plan for her to have regular doctor and dental visits to prevent her health from declining (NDSS, 2014). The services that aren’t covered under IDEA are being covered under the Children Health Insurance Program. Michelle qualifies because her family’s income is less than $47,700/year (for a family of four). CHIP coverage also includes eligibility, benefits, premiums and cost-sharing, and application and renewal procedures. Some others services include regular check-ups, immunizations, hospital care, dental care, and lab and x-ray services.  Children get free preventive care, but low premiums and other cost-sharing may be required for other services (Medicaid, 2014).

Grandma Margaret is still in a state of depression from being beaten 35 years ago by her husband. She just sits in the house all day and does not even cook and clean anymore, putting even more responsibility on Pam. Pam is already has enough stuff on her plate and cannot handle living there anymore. Pam consults the Salvation Army which rental assistance to single mothers and their children. Although she has now found an alternative place to live, she does not have the time to move out, and she does not have anyone to look after Michelle (Rental Insurance, 2014).

Questions:

1)    What places would you recommend that could assist with career planning and preparation?

2)    Who or what service could look after Michelle while Pam is at work?

3)    Does Pam have the responsibility of looking after her Mother , Margaret, or getting help for her Mother since she is in a bad state of depression?

Decision Point: Does Brian get charged with not paying Child Support? If so, in North Carolina, what would the consequences be?

References

What is Medicaid?. (2014). U.S. Department of Health and Human Services. Retrieved from http://www.insurekidsnow.gov/medicaid/index.html

Berry, J. O. (1998). Families as Systems. Lifespan perspectives on the family and disability. Boston: pro-Ed, INC.

Early Intervention. (2014). - National Down Syndrome Society. Retrieved from http://www.ndss.org/Resources/Therapies-Development/Early-Intervention/

General Education Development. (2004). Center for Execptional Educatoin. Retrieved , from http://www.cee.ac.ae/programs/ged.php

Rental assistance for single mothers and parents. (2014). http://www.needhelppayingbills.com/html/rental_assistance_for_single_m.html

Three to Four Years. (2014). American Speech-Language Hearing Association. Retrieved from http://www.asha.org/public/speech/development/34.htm

What is Medicaid?. (2014). U.S. Department of Health and Human Services. Retrieved from http://www.insurekidsnow.gov/medicaid/index.html

June 20 Post Two

Pam and Brian need more time to think about how they will cover their separate living expenses as well as the medical costs for Michelle.  Brian has scraped by thus far working and sending money to the family, but without Pam working at all, he is starting to consider quitting the family altogether. He is not as attached to Michelle as her mother and does not believe it is his fault for their daughter’s condition. Therefore, he should not be expected to pay for them to get by. It has been almost about 10 months since Pam and Brian’s divorce was finalized and he is ready to live the life of a college-aged man and leave his struggling family behind.  Pam recently asked him if Brian would be willing to get his GED so that he would not have such a poor choice in jobs.  This upset Brian and put him over his head in frustration and anger at the family fate gave to him.

            One night as Brian visited to drop off part of his paycheck for the week at the apartment Michelle and Pam live in and he decides to express his feelings to Pam. It is obvious that he has been drinking when he arrives. It is not his fault for Michelle’s condition and it is not fair to him to support all three of them even though they are no longer married. Pam is furious and it leads to an extended argument. Over the next few weeks, all contact between the two of them is full of arguments and disagreements. Brian is becoming less interested in taking care of his daughter and Pam is furious at him for attempting and threatening to leave the two of them unsupported. Brian’s visits become shorter and farther between.

            Pam is finding it harder to get by each day, especially while living in a rural part of North Carolina where the nearest grocery store is nearly 25-30 miles away.  The arguments Pam has with Brian have temporarily halted his checks from coming into the household.  The landlord is not a very lenient man and after 2 months of being unable to pay rent, she and Michelle are forced to move in with her mother, Margaret Denby on the condition that she has to pay $150 a month in rent as well as buy their own food.  Margaret Denby lives on the opposite side of their small town.

            Pam’s mother looks after Michelle during the days while Pam is at work. Pam found a part time job as a waitress at a diner a few miles from her mom’s house. Margaret does not have any knowledge about children with Down syndrome and does not know much about the individualized plan that was setup for Michelle. Also, her late husband, Charles, beat Margaret for almost 35 years until he passed away from a heart attack.  During those dreadful years, Margaret fell into a deep depression and made her a recluse to the society she had once been so tight knit with.  

The little town diner Pam works in has its regulars and those passing through, but often Pam does not exceed $60 a day in tips at the diner, not to mention the $2.25 minimum wage before taxes are taken out.  Pam is debating about getting her GED so that she can have more options for work; however, she does not know how or when would be able to accomplish this goal with a toddler who requires so much care with a mother unwilling to accept how her daughter is.  

At 26 months, Michelle can stand on her own with support from a nearby object but still does not speak.  Pam bought her some toys with different fabrics, noises, and motions for Michelle to play with in hopes for her to get some stimulation.  Atypically developing children at this age are able to walk or run and use two word commands or statements. Typical 26-month-old children are able to feed themselves and play alone creatively. Michelle does none of these things. Even an average child with DS at this age should be able to understand words and begin speaking and walking freely (Layton, n.d.).

Margaret is not well educated and believes her granddaughter is trying to get away with doing these things because of a lack of IQ.  When Margaret was growing up children with disabilities were known as “mongoloids” and were hopelessly sad creatures that needed to be hidden from the world (Solomon, 2012). Because of this negative view of her precious granddaughter, Grandma Margaret chose to have little interaction with Michelle throughout the day and hardly ever took Michelle outdoors.  This abuse showed in Michelle’s cognitive, social, and physical development greatly because she was not advancing in any way.  Michelle also continues to have many ear and throat infections because of her poor immune system. Grandmother Margaret gives Michelle expired over the counter medicine to help with the infections but nothing more.

            Pam herself has not been following Michelle’s family support plan completely. Since she has started working, she is exhausted when she gets home from the diner. Michelle is not her first priority. While she can get buy paying her rent and food costs, Pam does not have the time or the money to take Michelle to the doctor any longer. She cannot afford insurance and she is working on mending her relationship with Brian so he will begin supporting them again.  Pam decides to ignore the fact that her daughter needs a doctor and interventions for just a couple more months so that she can figure out how to take care of them. It is not until this carries on for another few months that Pam has her suspicions about Michelle’s hearing.  She knows she must bring it up to the doctor, but she cannot afford to pay for yet another visit.  Pam is also ashamed to talk to Brian about the hearing issue and too stubborn to admit that she needs help again and cannot raise their child on her own.  Pam is also concerned about Michelle’s heart because the surgery was almost two years ago and knows she is not getting it checked on like it should.

            Michelle no longer seems to notice her family as she moves around her grandma’s house. She ignores any mention of her name or any commands given to her.  The lack of medical attention for her throat and ear infections has led to severe damage to her hearing.  Margaret and Pam do not talk much about Michelle or how she acts throughout the days. Margaret still assumes that Michelle is not learning due to the fact that she is hopeless because of her DS.

Questions

1) What are the effects of stress on a child’s development? See "Childhood poverty, chronic stress, and adult working memory." By Gary W. Evans and Michelle A. Schamberg.  Proceedings of the National Academy of Sciences, Vol. 106 No. 13, March 30, 2009.

2) Describe how Down syndrome affects parent/child attachment. Consult the literature.

3) If Grandma Margaret were so inclined (which we know she is not!), what possible community-based services might exist to aid Michelle, Michelle and Pam, or the whole family?

DECISION POINT: Does Pam return to get her GED? Why or why not?

Citations:

Top of Form

Bottom of Form

Layton, Dr. T. L. (n.d.). Developmental Scale for Children with Down syndrome. Retrieved June 20, 2014, from http://www.dsacc.org/downloads/parents/downsyndromedevelopmentalscale.pdf

Solomon, A. (2012). Down Syndrome. Far from the Tree: Parents, Children, and the Search for Identity (ed.,). New York: Scribner.

What Conditions or Disorders Are Commonly Associated with Down Syndrome? (2014, January 17). Retrieved June 20, 2014, from http://www.nichd.nih.gov/health/topics/down/ conditioninfo/Pages/associated.aspx.