Thank You for Your Time

      Jessie's reputation preceded her. Her next door neighbor described Jessie as "out of control," noting that she frequently entertained male friends and called out to young men on the street. The neighbor expressed concern about Jessie's two boys, saying that they often ran around unsupervised. It wasn't too long before our social worker received a telephone call. As a result of that call, a new family was referred to our birth-to-three program; a 15-year-old, single mother with two sons, ages 14 months and 24 months. Both children appeared to be delayed enough to warrant early intervention services. Several weeks later, I was climbing the broken stairs to their inner-city home.

      As the only early intervention teacher working in this 7-year-old program for teenage mothers and their infants and toddlers with developmental delays, I have faced many challenges. The population we serve is almost exclusively from our midwestern city's north side, the area referred to as our inner-city. Most of the families we serve live in impoverished conditions, and the majority are on welfare. The problems these families face are numerous and complex. Solutions are rarely simple. My philosophy has been to focus on the child and family and to deal with the problems of the environment only as they interfere with the parent-child relationship. When I begin to work with a teenage mother, I attempt to remain nonjudgmental, fitting myself into the home environment as comfortably as I can, even if doing this means pretending to ignore my surroundings. This is important because I have frequently seen well-meaning professionals turn a family off when they first visit a home. I remember a speech-language therapist who stared at cockroaches as they scurried up and down a bedroom wall and a social worker who gasped in disbelief as a mother of three children said that she and her children slept in the living room because her tiny apartment had no bedroom. These professionals tended to be poorly received by the families. The first visit is critical to the establishment of rapport with the family and laying the foundation for future contacts.
 

A Dark Challenge

      When I knocked on Jessie's door for the first time, it opened by itself. Peering into the darkness, I called out to Jessie, who I hoped had gotten my letter and was expecting me. I identified myself as the "baby teacher," a nonthreatening title that has gotten me through doors which might otherwise not have opened. After a minute or two, a voice called "Come in." I found that the front door only opened about half way, so I had to squeeze through with my test kit. My test kit is a big red basket, filled to the top with the necessary materials and a few colorful toys just for play. Its appearance has also helped to get me in doors. It looks like something fun, instead of something threatening, is about to take place.

      The voice turned out to be that of Jessie's mother, a woman in her 30s, wearing a robe and carrying a can of beer. "Come in and sit down," she said, gesturing to the cushionless chair in the corner of the room. I did, and then saw Jerome and Lamont standing by the two mattresses on the other side of the room. I smiled at them, but they ran out of the room, heading toward the back of the house. My eyes had become accustomed to the dim lighting in the room. The shades were pulled down, allowing little sunlight into the room. The only real light was from a bare bulb that hung from a ceiling fixture in the adjacent hall.

      Jessie's mother, Maxine, said she knew I was there to check on how the boys were doing and that she knew they were behind most other children their ages. She said that Jessie didn't spend enough time teaching them things. Maxine walked over to the mattresses and shook the figure under the sheets saying: "Jessie, get up. There's a baby nurse here to check on the boys." Jessie rolled over but did not get up.

      A child was crying in a back room and Maxine went to check on the boys. Jessie rolled over, opened her eyes, and said "Hi." I introduced myself as she sat up on the edge of the mattress. Jessie looked about 7 months pregnant, and I asked her when the baby was due.

      "In a month or two," she answered, "and it better be a girl 'cause I don't want no more boys. Boys get into too much trouble." At that moment Jerome and Lamont came back into the room, climbed up on the mattress, and sat beside Jessie.

      I began to get a brief developmental history from Jessie and found she was quite willing to fill me in on the details she could remember about the boys. Both boys had been low birth weight babies and had been sickly as infants. Jerome, at 24 months, was still not talking. Lamont's vocabulary, at 14 months, consisted of "Stop it" and "No."  Lamont had been hospitalized when he was 10 months because Jerome had stuck a hairpin in his ear, puncturing the eardrum.

      I allowed the boys to explore the toys in my test kit and observed their play skills. I observed a lot of manipulation, but little functional play. Jessie was interested in the toys herself, but fairly punitive toward the boys' attempts to handle them. She made comments like, "That's not how you do it," but did not provide them with appropriate alternatives. Based on what I heard and saw, I decided to recommend a visit by our transdisciplinary team. Because Jessie was attending school only sporadically, she readily agreed to a follow-up visit the next week. I suggested that, if she did go to school and the boys were left in the care of another trusted adult, the evaluations could still take place.

      A week later, three of us arrived at the designated time. We knocked on the door and Jerome opened it. Peering inside, we could see a man sleeping on the floor. We called out, identifying ourselves, but the man didn't move and no other adult appeared. We have learned to be cautious in such situations, so we waited at the door as Jerome and Lamont pounced on the sleeping man. The boys eventually persuaded him to wake up. Upon seeing us at the door, he stood and we immediately offered an explanation, "We're here to test the boys to see if they can get into our program." He motioned for us to come inside.

      "Jessie told me you would be coming," he said, "I'm Jessie's stepfather and I'm watching the boys while she's at school."

      We went in and got comfortable on the floor where the boys were already sitting in anticipation. Jessie's stepfather pulled one of the mattresses over to a corner of the room where he stayed for the remainder of our hour-long visit. For the most part, he appeared to be sleeping, but he opened his eyes periodically and glanced in the direction of the boys. Jerome and Lamont were reasonably cooperative, appearing comfortable with the idea that three strangers were asking them to play with a lot of new toys.

      By the end of the hour, our psychologist had obtained enough information to determine some specific areas of delay. I had been able to score two developmental checklists. Our speech-language pathologist gained enough information to report significant expressive and receptive language delays and a case of ringworm! This is one of the hazards of the job and doesn't stop us from holding children on our laps.

Off to School

      An offer was extended for the boys to be enrolled in our program, and Jessie accepted. "Can you take them to school every day, all day?" she asked.

      I explained that our program was both home-based and center-based, with children attending our classroom one, two, or three mornings a week and with home visits scheduled once a week whenever possible. Jessie opted for three mornings a week and said that weekly home visits were fine as well.

      Jessie's input into our goal-setting procedure was clear-cut. "I want them toilet trained so I don't have to keep buying them Pampers, especially after the baby comes. And I want them to stop fighting with each other." 

      I helped Jessie to translate her concerns into a goal of toilet training 2-year-old Jerome, a goal of awareness of a wet diaper for Lamont, and several goals of sharing and improved play skills for both boys. We then suggested a few additional goals in areas that were explained to Jessie as "getting ready to talk," "understanding what you say," "learning to think while playing," and "learning to dress and eat by themselves." She agreed to these as well, but made it clear that her priorities were getting the boys out of diapers and stopping the fights they had with each other.

      The boys' first day to attend our program was the first Tuesday of December. In our state, December is cold regardless of whether the sun is shining. With the temperature hovering at approximately 32 degrees, Jerome and Lamont stepped off our bus in winter jackets and shorts. We got the boys into the classroom as quickly as possible, removed their jackets and there they stood in matching, tropical print, short-sleeved shirts and shorts.

      We settled into a routine of weekly home visits on the same day each week after school. Jessie was usually there and showed at least some interest in activities I brought for the boys. She rarely participated in the activities, but her interest was enough to sustain my efforts. Then the baby was born. Jessie had her girl, healthy and full term. She and the baby became inseparable. As Jessie became very attached to her new daughter, Sara, her interest in the boys seemed to wane. We tried various approaches to helping Jessie strike a balance between her three children's needs for attention.

      Jessie dropped out of school. How do you convince a 15-year-old mother of three that going back to school is important? We tried, but soon realized that we had little chance of persuading her. Jessie's mother tried as well, but eventually laughed off her failure to get her daughter to stay in school. Rather than continuing to pressure Jessie about school, we decided to take advantage of the time she had at home and invited her to come to school with Jerome and Lamont. We encouraged Jessie to ride along on our bus with them in the mornings. We saw this as an opportunity for Jessie to spend some quality time with her sons. Jessie must have seen it differently, because, on her first visit to the program, she got off the bus with Sara in her arms. We tried to make the best of the situation, but the baby was not only Jessie's focus, but also the children's. I asked Jessie if there was anyone who could watch Sara at home so she could help us out in the classroom when she came.

      On her next visit, Jessie did not bring the baby, and we treated her as a parent volunteer. We gave her specific activities to carry out with individual children, including Jerome and Lamont. We were surprised at her enthusiasm in working with the children and the effectiveness of her interactions with them. In fact, we were so impressed that we made up a parent volunteer award, personalized with her name on it, and presented it to her during our end of the morning group time. Jessie beamed with pride and pointed out her name to Jerome and Lamont, who sat on either side of her in the circle. "Look," she said, "it has Momma's name on it. It says your Momma did a good job." Her response to our praises was a lesson we have never forgotten in dealing with Jessie, or other teenage parents.
 

Pride and Progress

      As the weeks passed, we began to see progress in Jerome and Lamont. A few functional words were emerging, and they were developing basic cognitive, social, and adaptive skills. To Jessie's delight, Jerome was making some progress in becoming toilet trained.

      One day the boys were absent with no explanation. A visit to thier home revealed that the family was packing and would be moving the next day. Luckily, we caught Jessie and her mother still at home and were able to get the new address, which was about 20 blocks away. Visits to the new home, an apartment in a six-family building, were often chaotic and confusing. Numerous family members and visitors came and went during our visits. The living room, where Jessie preferred to meet, was between a kitchen and two bedrooms and was the major pathway through the home. I wanted to draw Jessie into the visits more, but she was as distracted by all the activity as Jerome and Lamont were. Then, one week I brought my camera.

      I told Jessie that I was taking pictures of mothers playing with their children to demonstrate to other professionals that parents in our program really learn how to interact with their children and help them to progress. Quite unexpectedly, Jessie firmly reprimanded the first passerby for interrupting. She announced to all the members of the household that they were not to bother us when Jerome and Lamont were having their "learning time." The camera became a catalyst for Jessie to attend to what the boys were doing. For the camera, she began to implement suggestions that she had been aware of for months. She used simple, clear directions, got down on her children's level, interacted face-to-face, and elicited beautiful cooperation as she and the boys put pieces in a puzzle and played an object-matching game. I praised her lavishly as she continued her role as parent-teacher for the camera. The following week I showed Jessie the pictures and gave her a set of pictures to keep. From that time, she was much more focused during activities with the boys, and they were less distracted as well.

      The months passed with Jerome and Lamont making steady progress. Jessie remained generally enthusiastic about what they were learning. She stayed out of school another semester despite our encouragement to return. The motivation and family support to do so simply was not there. We find this to be a pattern with many of our parents, especially after several children are born. We still felt that for Jessie, maintaining a supportive interest in all three children was an accomplishment in itself.
 

Handling a Threat

      That spring, we got news that a teenage mother we were working with was expecting her fourth child, and my thoughts turned immediately to Jessie. Jessie's boyfriend had recently moved into the house with her family's approval, and it was entirely possible that she would become pregnant again. Some positive things were happening in her life, and the possibility of another baby seemed to threaten this progress. I wondered what preventative role I could or should play. My teacher assistant and I discussed the issue and decided that I could bring up the topic with Jessie and then let her decide whether my involvement was appropriate.

      On my next visit, I told Jessie that we really cared about her and her children and knew how difficult it could be for her if she were to have another baby. Jessie agreed that another baby would be difficult to handle and accepted my offer to help her avoid another pregnancy. Jessie had a means of birth control, but she wasn't consistent in using it. My assistant and I decided that we would try designing a simple, catchy phrase, printed on colorful paper to encourage her. Our "Hang tough-you can avoid another pregnancy" message was printed on florescent pink and orange paper, and I took one of these on each visit to Jessie. At first, Jessie laughed. I brought them for four or five weeks and then one week I forgot. Jessie asked, "Where's my pregnancy reminder?" almost as soon as I sat down. Jessie had noticed that I was consistently demonstrating to her that someone did care whether she got pregnant again, and, so far, the caring was working. The weekly reminders have continued, and, as this is being written, Jessie has not had any "baby news." It is the longest she has gone without carrying a child in three years.

Letters of Support

      Last year, our program was put in the situation of having to find out whether the teen parents we served appreciated the services we provided. We were notified in May that, due to severe budget cuts, there would be no funds to continue our program. The program would be dissolved in September. We launched a desperate attempt to save the program through letters and telephone calls of parent and professional support. Professional support was fairly easy to obtain. Teachers, therapists, social workers, and others, both inside and outside of our school system, wrote to or called the school board on behalf of the program.

      I also asked teenage mothers, including those we had served previously and those we were currently serving, to consider writing a letter of support to prevent our program's closing. I provided paper and an envelope for each mother and asked only that they think of what the program had offered them that they though was worthwhile. Many of our teenage parents are school dropouts with reading and writing skills at a grade-school level. Even so, letters did come back to us. Some were very well written, and some were barely readable. Jessie's stood out among all of the others.
 

  Dear Birth to Three Program,

   This Program has really helped my children alot. When they got there neither one of them was talking and they are really talking and very good. And they home visits are very nice to. They come in and teach they how to match thing and all kinds of thing. When they pick them up Sara come to the door and gets them. TheBirth to 3 Program is one of the best Programs that I have heard of, and the teachers are very nice and I know that I can trust them with anything and I really think that it should say.
                                  Thank You for Your Time,
                                          Jessie
 

      I read this letter in my empty classroom, and it brought tears to my eyes. It was the most articulate parent letter we received and, of all the letters people were so kind to write, this one said it all. Jessie had written the perfect letter of support. She covered all of the important points -- how the program helps her children, the importance of our combined classroom and home visit approach, our door-to-door transportation, and trust. Jessie had chosen to mention trust, and it touched all of us who worked with her family.

      I was equally impressed with the way she chose to end her letter--with "Thank You for Your Time." Other parents had simply signed their names, but Jessie had appreciated that someone on the school board would take the time to read what a 15-year-old mother of three would have to say about how the district's money should be spent. We decided to put copies of Jessie's letter on the top of the packets containing 45 other support letters. Every school board member and administrator received copies. Our letters, telephone calls, and other efforts finally paid off on June 26th. The school board voted 8 to 1 in favor of continuing the funding of our program for one more year. We took Jessie and another mother out to lunch to celebrate our victory. It was a tangible way to express our appreciation for their support.
 

An Unexpected Ending

      If there is oe thing that I have learned in my years of working with teenage mothers, it is to expect the unexpected. On a routine home visit to Jessie's house a few weeks ago, she interrupted my report of her sons' recent progress with, "In five days I'm going to be moving." I told her that would not be a problem because we had enough time to arrange for the bus to pick up Jerome and Lamont at their new address next week.

      "No," she said, "we're moving to Oklahoma." I stared at her in disbelief, and she proceeded to explain that her mother was throwing her, the children, and Jessie's boyfriend out of the house. Jessie said things had gotten really bad. There were allegations of sexual assaults taking place in the home, public assistance checks being stolen, and other accusations being made. The situation sounded serious and too complex for my counseling abilities. Jessie had decided to move with her boyfriend to his family's home in Oklahoma. The bus tickets had been purchased already!

      I didn't know what to say to Jessie. When I asked her if she had really thought out what such a drastic move would be like, she told me she had discussed the move with her social worker and that he had supported it. A telephone call to the social worker later confirmed that Oklahoma was the best option -- maybe the only option -- for Jessie at this time. I told Jessie how much she and the children would be missed.

      When I mentioned continuing the boys in some type of early intervention at their new home, Jessie again surprised me. She told me that she had talked to her boyfriend's mother and his mother, who had already telephoned the appropriate Oklahoma school district to find out how to enroll the boys in the local program.

      I returned on the day of the big move to have Jessie sign a permission form to forward the boys' records. Her bag was packed and Jerome and Lamont sat expressionless on the front steps, not really understanding what was about to happen. Jessie told the boys to give me kisses for helping them to learn so much. Then I gave Jessie a hug, and she said, "Thank you for caring about me and my kids."

      What more could I say?  Working with Jessie had been a challenge and I felt we both had benefited from the experiences we shared. I had learned some valuable strategies that I could apply to other challenging family situations. The time Jessie had spent with me would continue to be beneficial long after she was gone. And so, I turned to her and said, "Good luck, Jessie, and thank you for your time."

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.

Thank You for Your Time
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