CASE STUDY 10:  John is an eleven-year-old male who was diagnosed with Attention Deficit Disorder/Hyperactivity Disorder (ADHD), Predominantly Hyperactive-Impulsive Type at the age of 6. He currently receives 15 mg. of Ritalin per day. John was placed in group home care for six months after his mother, who is a single parent, reported significant difficulties in coping with the demands of caring for John and his sister Gloria, who was recently diagnosed with Leukemia. His mother, Ms. Anita Smith, is involved in her own personal struggle with depression. Ms. Smith’s emotional problems are suspected to have been a contributing factor in her inability to simultaneously cope with the demands associated with parenting two children with special needs. The group home setting where John spent six months generally houses six latency-aged boys and girls. The group home offers a structured environment with activities that teach life/social skills. The program also offers movie night, and arts and crafts on site.  The group home staff members were able to maintain John’s school placement, by transporting him back and forth. Initially, John found it difficult to adjust. However, over time, he settled into the new environment.  John was active in activities offered at the group home. Over the first three months of entering the group home, John averaged about three restraints per day.  Most of the physical interventions stemmed from John placing himself and others at risk, attempting to leave the residence without permission, self-abuse, and hurting others.  By the fourth month, John had settled into the routine of his new environment.  His restraints dropped to three per week. In order to encourage positive interactions with peers, John was given the chore of asking his peers what they wanted placed on the shopping list. This improved John’s status among his peers, which he relished.  By John’s discharge date, he was “attached” to one of the senior staff, Ms. Deer. This was evident by his insistence that Ms. Deer read with him nightly, maintaining close proximity of her, requesting that Ms. Deer assist him in choosing clothing for the next day and sharing his feelings with her, which he found difficult to do with other staff members.  In order to maintain John’s gains and assist with reunification, visits with his family were slowly integrated.  Visits began Saturday mornings from 8:00 am to noon, and then were extended to 7:00 pm. Later, overnight visits from Friday 6:00 pm to Sunday at noon were introduced. During this tiered reunification process, Ms. Smith called the group home for support when she found it difficult to manage John’s behavior.  At the time of John’s return home, a Family Support Worker was engaged to provide additional support. John and Gloria share a three-bedroom apartment with their mom.  Their dad, Mr. Smith, does not reside with the family; however, he visits twice a week for approximately four hours each time.  Mr. Smith is unemployed and shares a one-bedroom apartment with his younger brother.  Due to a lack of financial resources, Mr. Smith is unable to permanently parent John as Ms. Smith has requested. Ms. Smith receives public assistance. She was diagnosed with depression and anxiety disorder approximately 10 years ago and is currently on medication for both illnesses. She has seen a psychiatrist for the past ten years. She continues to manifest signs of depression at the current time and states that she has had more “good” days in recent months than a year or so ago. Ms. Smith reports feeling overwhelmed and exhausted, by her illness, and the children’s needs.  She spends most of her day on the couch or in bed and only ventures into the community to purchase groceries or for doctors’ appointments. She tends to overlook John’s misbehaviors to avoid power struggles and confrontations. It does not appear that there is any consistency in Ms. Smith’s ability to enforce rules, routines, and expectations in the home. John has displayed independence such as an ability to make his own lunch and get himself to the school bus on time.  Ms. Smith reports that John has more good days in school compared to at home. Specifically, John tends to have fewer peer conflicts at school and is able to more closely follow the rules and routines at school. His mother reports that John often talks about Ms. Deer and seems to depend on her a lot for guidance.

43. Physical interventions with John were reduced from three times per day to three times per week over the first four months of his placement.  Given John’s unique circumstances, which of the following would be the most appropriate response for debriefing/counseling following physical intervention?

31. Kitchen and dining areas in residential spaces should have an atmosphere of comfort, acceptance, and importance. Which of the following is not consistent with this type of atmosphere?

32. The facility has an isolation room.  Which one of the following statements is not consistent with the appropriate use of isolation rooms? 

45. The priority focus for the CYC practitioner to help Mom develop insight so that she can facilitate problem solving with John is to _____.

CASE STUDY 16:  The Centerville Emergency Shelter is situated in a commercial neighborhood near the center of the city, in an area that includes many abandoned storefronts and a few parks. The building includes two dormitories, a common living room, a kitchen/dining room, and two communal bathrooms. The shelter’s part of the building is a relatively small space.    There are eight teens living at the shelter.  Most of them have been involved, on and off, with child protective services and/or the juvenile court system for years. Six have been living on the streets prior to entering the emergency shelter. All eight of the residents and two CYC practitioners were returning from spending an hour playing basketball at an area park.  Two youth, who were friends in their community prior to their residence at the shelter, were playfully “trash talking” with each other on the trip back.  Jerome, one of the CYC practitioners, commented that friendly affectionate banter is okay as long as it contains no put-downs or gang slang. Sandra, the other CYC practitioner in the van, remained silent. As the boys exited the van, several of them playfully pushed each other and were loud.  Jerome stayed with the van to clean and lock it up.  Meanwhile, Sandra unlocked the door of the building and reminded the youth that they needed to calm down and put away their gym clothes. Continuing their horse-play, one youth pushed another youth hard enough for him to fall onto the couch. Bill, another CYC practitioner who had not gone with them on the outing, entered the room as this happened.  He immediately called a group session with a loud, commanding voice and presence.  The group meeting was focused on ‘personal boundaries.’  Bill and Sandra addressed when to stop playing around, how to stop before getting into someone else’s personal space, and why self-control is important. The discussion centered on “rough housing” and “horseplay,” which are not safe or allowed inside the program building.  Bill explained to the youth, “The room was not big enough for any kind of rough housing.”

13. It is the first day of camp. The best plan is to provide activities that will _____.

30. Significant renovations created an addition with a meeting room upstairs and a game room on the main floor. Which of the following characteristics of good environmental design for residential care are evident in this decision?

22. The best way to accomplish getting the snack made in this situation is to _____.

75. A good time to discuss cleanliness, health and hygiene is during snack preparation because _____.