In Whose Best Interest?

     The cool of the fall morning was just beginning to change into the warmth of an Indian Ssummer afternoon when Becky and Aldo found themselves once again at the front door of the Lowell's mobile home. Their knocks at the door were followed by quick, resonant footsteps along the length of the trailer. Then quiet. A few more knocks and, as always, it was Carol who opened the door. Although it was 11:00 A.M. it appeared that Steve and Carol had just awakened. Carol was still in her robe. Across the narrow, darkly paneled room they could see Steve, sitting in his customary slumped position on a tattered couch. Steve made no eye contact when Becky and Aldo greeted him and Carol. Carol returned their greeting with her usual timid hello, all the time watching Steve.

      Stepping in from the crisp country air, Becky and Aldo showed no reaction to the stale and clammy smell of propane heat that carried a faint scent of garbage throughout the kitchen and living area. The subflooring beneath the chipped kitchen linoleum creaked as the two early interventionists stepped carefully, working their way between a nearly empty pizza box and small piles of clean diapers mixed with dirty laundry on the floor. Peering across the width of the dark trailer, Becky could see that Aaron was awake in his pumpkin seat beneath the rickety formica table that Becky and Aldo had helped the Lowells transport from the thrift shop.

Progress and Problems

      "How's Aaron?" Becky asked as she lifted the pumpkin seat from under the table and placed it on the couch beside Steve, "I think he's grown."

      "He has been growin'," said Carol with a look of satisfaction and relief. "Doctor said he weighs eight pounds and two and a half ounces now."

      "Eight pounds, two and a half ounces! That's great. He's really getting up there," Aldo chimed in to support Carol's feeling of accomplishment.

      From the couch, Steve, who still had not looked directly at Becky or Aldo grunted, "Uhmm."

      Sensing that no further social amenities were called for, Becky got to work. "Well, we've got a lot to cover today. We're going to work on teaching you how to sterilize bottles and watch you feed Aaron. While I'm doing that, Aldo will check the baby's room to see if the electrical outlets have been covered and to see if the toilet, counter, and tub are clean. Just like we talked about doing last week, okay?" Carol gave an accepting nod. Steve was sullen.

      "If those areas are taken care of," continued Becky, "and if you have a meal planned, then you will move up to an extra 15 minutes of unsupervised time with Crystal when she comes from the foster home for her visit today." Carol nodded again.

      "If your visits increase by 15 minutes today, that will bring the total time to 3 hours that you spend alone with Crystal," Becky said to remind the couple that they were making progress at gradually regaining custody of Crystal. "Soon we will ask the child welfare department to let her stay overnight with you. Won't that be great?"

      "Let me ask you somethin'," Steve said. "Can child welfare make us take Aaron to that Early Start place?" Early Start was a birth-to-3 program for children with developmental delays or children who are at risk for such delays. Crystal had been served by the program last year.

      "Well I...," Becky stammered.

      " 'Cause we got a letter from them and I don't think that's right! How did those Early Start people get Aaron's name? We never said nothin' about him. The child welfare worker's name is on here.Nancy. She probably said somethin' to them about Aaron and that ain't right! That goes against my constitutional law!"

      "I don't know but maybe..."

      "I'll tell you somethin' else," Steve exploded. I don't like them comin' over here without askin'! They're tryin' to take Aaron away and I ain't gonna' stand for it! Cause I gotta' knife what's sharp and I'll gut 'em!"

      This wasn't the first time Steve had shown his temper. More than once his gruff manner had intimidated personnel from several human service agencies. Some had refused to return to the family's home after such outbursts. Some also had pointed to Steve's temper as the primary reason for continuing Crystal's foster placement and for continuing to provide services in the home when such services were not always embraced by the parents themselves.  Becky reflected on yesterday afternoon's case staffing when these issues had been foremost on the agenda.

A Question of Custody

      The child welfare department had called the staffing to review the Lowell case with each service provider. After this review the department would begin to formulate a recommendation to the juvenile court about whether to continue Crystal's foster placement and whether the parents should be ordered to cooperate with services for Aaron.

      Attending the staffing were persons from the public assistance office and the public health department, the foster parents, and the family's homemakers (i.e., paraprofessionals involved in providing assistance with transportation and other basic family needs). Becky and Aldo represented Project 12-Ways, an in-home intervention program serving a variety of families including families with histories of child abuse and neglect. In the course of serving these families, the staff often identified family members, both parents and children, as having disabilities.

      The caseworker, Nancy, had started by reviewing the original reasons for becoming involved in the family's life. Crystal, at 3 years of age, had been taken into foster care following substantiated reports of physical abuse by her father, who was Carol's first husband, Bob. Carol herself had not abused Crystal and, in fact, she too had been badly beaten by Bob. Even so, the court ruled that Carol had failed to provide adequate protection for Crystal and that the conditions in the home were hazardous and unsanitary. As part of Crystal's plan to return home, Carol received weekly supervised visits with Crystal in her home. Staff members from Project 12-Ways supervised these visits. These never involved Bob, whom Carol divorced and who was sentenced to prison shortly thereafter on charges of check fraud.

      From all reports, Carol had been cooperative and successful in learning appropriate parenting skills during visits with Crystal. Then Steve entered the picture and began to live with Carol.  At the time they met, Steve was 25 and Carol was 31. Both were receiving public assistance as a result of their developmental disabilities. Steve had a reputation for making verbal outbursts and intimidating people with his size (i.e., 235 pounds) and angry demeanor. Although never physically violent against another adult, local law enforcement officials had been called by neighbors to quiet Steve during late night shouting matches at his sister's house. His temper surfaced occasionally in public and had made him less than welcome at the offices of several human service agencies.

      For the team, Nancy reviewed how she had enlisted the public health department's outreach program when Carol became pregnant with Aaron. When he was born, Aaron weighed 5 pounds 6 ounces. After Carol and Aaron were discharged from the hospital, a nurse from the health department began making regular home visits to provide the family with infant formula and to weigh Aaron. At 3 weeks, Aaron weighed only 5 pounds 9 ounces. He was protruding his tongue from his mouth, spitting up large amounts of formula after every feeding, and often startled whenever Steve spoke.

      On one home visit, it appeared to the health nurse that Aaron was dehydrated. She urged Steve and Carol to have Aaron hospitalized, but they both feared that this would lead to their loss of custody. The nurse felt legally obliged to report the matter to the child welfare abuse hotline. Within hours the welfare department conducted an investigation and arranged for Aaron's hospitalization. After 2 days at the hospital, Aaron gained 7 ounces and was discharged. Carol and Steve were ordered by the court to cooperate with the public health nurse in maintaining Aaron's feeding regimen. They had done so, and Aaron had grown steadily.

      Nancy concluded her review of the case by saying, "The real question for me is whether Crystal can ever be returned to the home, particularly as long as Steve is there. He is so volatile. Last week he was removed from the WIC office for causing an uproar. It seems he accused the nurse of holding back on some of Carol's food stamps. Also, you all know that when he was going to the sheltered workshop, folks there said he'd killed his sister's dog with a rubber mallet. I just wonder how much longer it will be before we have a report that something serious has happened to Aaron--something more serious than this last episode."

      The homemaker, Bess, quickly responded to Nancy's concluding remarks, "Well all I know is I won't go back to that home alone. The last time I was there, Steve stood up, stuck his face in mine, and yelled, 'You got no right to be in my home tellin' me what to do with my kid. I don't want you back here no more! I guess he forgot that the only way he can get to the store or to a doctor's appointment or wherever he needs to go is if we take him."

      "I just don't take Steve too seriously," said the nurse. " He huffs and puffs but he's never really scared me. The main problem we have is that they take things very literally. We told them to give Aaron 5 ounces of formula every four hours. They do this without fail, even to the point of waking the baby up to feed him. But as far as we are concerned, it's better to be a little too fat than underfed. We don't see the need to continue going to the family's home every week. We'll just furnish them with a large supply of the formula so they'll have what they need for the next few months".

      "What about Crystal?" asked Nancy. "How is she getting along in the foster home?"

      Dianah, the foster mother, replied, "Well, sometimes she'll act like she's sick so she don't have to go visit at Carol's and Steve's. I just tell her, 'Look, you got to go. Your mother wants to see you. So don't be makin' like you're sick'. Usually she'll quit her actin' then. When she comes home, though, she sometimes will tell me that Steve yelled a lot. She really likes seein' her mama but don't like him too much. I tell her, 'They're married now and you have to try to get along,' but she can be a little manipulator. If she could figure out how to be with Mom without him being there, she would do it."

      "Okay," accepted Nancy, "What is Project 12-Ways seeing"?

      Becky began, "When we initially began serving the family, Carol was in the process of divorcing Bob. Steve was just moving in, and Crystal came to the home for supervised visits for an hour one day each week. The home was filthy at that time. Garbage was piled up in and outside of the house. The plumbing was clogged, the toilet backed up, and piles of dirty clothes and boxes were everywhere. Plus, the baby was due in a few months. We were not optimistic."

      "We began by making a contract with the parents -- literally a contract to gain longer visiting periods with Crystal and, ultimately to regain custody of her. As you know, cases like this are tough. One or more family members have a disability and would truly benefit from services but, because of their involvement with the legal system due to child abuse or neglect, they're not necessarily all that enthusiastic about us, especially when we first start. Anyway, our approach has always been to put the cards on the table -- to let the parents know that we are happy to provide services but that they can refuse these services. We want them to know, however, that unless some specific changes are made in the household, it is unlikely that the court will allow a child to go home. So, with Carol and Steve all this information was put in a contract."

      "Each week we renew the contract. We negotiate some aspect of change that they can achieve within a week's time. For example, a week's objective might be to have the dishes in the sink clean, or the toilet unclogged, and so forth. If they can do that in time for Crystal's visit the following week, then we agree to add 10 or 15 minutes to the length of that visit. If they do not make the changes we agree upon, the visit remains the same length as the week before. More visiting time is added, some of it unsupervised time, as more changes are made and maintained. Right now, the family is spending nearly 3 hours with Crystal, and most of that time they are alone with her."

      Becky passed around a graph that showed an ascending set of bar graphs representing the amount of time the family spent together during weekly visits for the last few months. Superimposed upon that were ascending plots with such labels as "Percent of Diapering Steps Performed," "Percent of Kitchen Areas Clean," "Percent of Praise Statements to Children."

      The group took a moment to study it all. Becky interpreted the technical details for them.  Then Nancy asked, "So what's your plan for the future?"

      "Well," responded Becky, "we'll try to continue to stretch out the amount of time the family spends together and to increase the changes the parents make to receive visiting time with Crystal. We would like to fade Crystal back into the home in this gradual manner".

      Nancy furrowed her brow, "I guess the only problem I have is with the unexpected. You've taught the parents to handle specific situations the way that I train a dog to follow specific commands. I don't mean to sound like I'm putting you or them down. It's just that my concern is with what happens when a situation comes up that you simply haven't trained the family to handle. How can you be sure that Steve won't haul off and hurt someone when you're not there? Even if you could teach them to handle every possible situation now, won't you have to retrain the parents over and over for the new situations that come up when the children grow older? Is Project 12-Ways or any other agency prepared to serve this family for a lifetime? And, even if you were, would that be in the family's best interest if it always meant having some involvement with us or the court?"
 

Continued Uncertainty

      Nancy's questions from the staffing echoed in Becky's head as she struggled for the right way to handle Steve's outbursts. "I see you are upset," she began calmly. "If you want, we can talk about that more at the end of the session. Right now, we've got the bottles to take care of." Becky rose and walked toward the kitchen.

      "Well I just don't like they way they treat us!" continued Steve.

      "Okay, Carol, do you want to do the bottles first or should Steve go first?'' asked Becky.

      From the corner of her eye Becky could see that Steve was looking away.

      "I guess I'll start," said Carol.

      In the back of the trailer, Aldo had begun to check the children's room for hazards that Steve and Carol had agreed to eliminate. Things had improved so much, he thought, from the first time he had come to the home. It was filthy then, infested with cockroaches, and without heat except for what was put out by the burners on the stove. Maybe Steve and Carol could manage to regain custody. Maybe it would be all right.

      Meanwhile, in the kitchen, Carol was busy at the stove. "How'd I do?" she asked hopefully.

      Becky began on a positive note, "You did real well in bringing the water to a boil. You also kept the bottles in the water for a long enough time to be sterilized. Remember, though, you have to use a very clean cloth to drain the nipples on after you wash them. If you set them on the side of the sink or in the dish rack, they will pick up germs again."

      "Oh yeah, that's right," said Carol with obvious pleasure at having only missed a simple step. "Your turn, Steve."

      Steve appeared disinterested. "I'll get Aldo to go over sterilizing the bottles with you, Steve," said Becky.

      Aldo entered the kitchen and, shaking his head, said, "Uh-oh. I'm not sure I can remember all the steps".

      "Oh you remember them," Steve livened up. "You're just saying that to see if you can trip me up!" Then with a broad grin Steve chimed, "I really love you folks-'preciate all you are doin' to help us."

      Becky and Aldo shared an uneasy moment of eye contact at this sudden change of mood. They then worked through the task with Steve.

      Before leaving that day, Becky reviewed the family's contract. They had kept their part of the bargain. The house was acceptably clean. They had a meal planned for Crystal. They both had been able to sterilize the bottles and feed Aaron. Becky reassured herself that these were tangible indications that the parents could take care of the children. At least the family would be able to manage the three hours they would be alone with one another.

      There was a knock at the door. Carol opened it and there stood Crystal, grinning.

      "Hi baby!" said Carol.

      Crystal just grinned and walked in. She went to the table and picked up an orange. "Baalll," she said, holding it for Aldo to see.

      "It's like a ball. It's an orange. O-r-r-a-a-n-n-ge," enunciated Aldo while bending low for Crystal to see his mouth.

      Crystal smiled and put it back on the table.

      "Well, you have three hours alone together with your family," said Becky. When she walked over to Aaron to say good bye, she caught a whiff of urine. "Looks like the baby's diapers are wet."

      "Yeah, but those are large Pampers, not like the littler ones you taught us with", Steve said confidently. "They hold a lot more."

      "Yes, but wet diapers cause a rash." Becky sighed. "Let's go over diaper changing before we go."

      Becky and Aldo said good-bye, squinted in the sunlight, and stepped onto the makeshift steps at the trailer door. They looked at each other hesitantly. What were the options? The child welfare agency could consider terminating parental rights to Crystal, but the agency's case would not be a strong one. After all, neither Carol nor Steve had perpetrated any abuse. Termination and adoption proceedings also take time. Meanwhile, Crystal's delays were already apparent and Becky suspected that Aaron's development would follow a similar course.  Would either or both children be in great demand and would someone want to adopt both to keep them together? If not, Becky knew that the children would probably drift from one foster home to the next.

      But why agonize over such questions? For all Steve's roaring, he had shown no bite. Becky and Aldo walked to the car reassured that they were doing the right thing.

      They paused as they heard the sound of Steve's raised voiced, the slamming of a door, and the baby's cry muffled by the tin siding of the mobile home.

This case story originally appeared in McWilliam, P.J., & Bailey, D., (Eds.). Working Together with Children & Families, Case Studies in Early Intervention. (1993). Baltimore: Paul H. Brookes Publishing Co.

In Whose Best Interest Discussion Questions