Case Stories

     A brief summary of each case story is provided to assist instructors in selecting case materials that address specific content areas and teaching objectives. Each story is accompanied by related Discussion Questions that may be used by students to prepare for case discussion or by instructors to facilitate group discussion.

     Names and certain aspects of the situations have been changed to mask the true identities of those whose lives are described. The stories, however, reflect the true nature of early intervention in the United States. Resources for additional case stories and case-related teaching materials are found on the Links page.

Section One: Unsolved Stories
     These stories are unsolved and invite the reader to decide what the professional(s) featured in each story should do next to improve the situation. Unsolved stories are the type traditionally used in conducting CMI.

The Team Meeting
This case describes a conflict among members of an interdisciplinary early intervention team. The conflict arises over the case of Adam Goodman and his family. Adam is a 2-year-old who has significant developmental delays in all areas. His behavior is a problem for his parents, Stan and Tracy. The family is also concerned about Adam's speech, motor development, and poor eating habits and has asked for additional assistance from the team. Marilyn is the member of the team who provides regular visits to the Goodmans' home. She relates the family's requests to the other team members at a meeting, but the other team members disagree about Adam's need for additional services. Marilyn is infuriated with them and their airs of superiority.

Close to Home
The last few months have often seemed like a nightmare for Bill and Carla Johnson. Ryan Johnson, age 2½, has also felt the effects of the recent changes in family life. Bill's and Carla's 5-month-old daughter, Elizabeth, was born with a chromosomal abnormality that usually results in death before a child is 2 years old. Elizabeth has severe developmental delays and has spent the better part of her short life going in and out of the hospital. Linda Cummings has worked with the family since Elizabeth was 4 days old. The case describes a visit Linda makes to the hospital the day before Elizabeth is scheduled for another surgery. On this visit, Linda is made aware that Carla's feelings about the child are not necessarily shared by her husband, Bill. This case also touches upon the sometimes inevitable effects of the professionals' personal lives on their work with children and families and vice versa.

A Matter of Policy
Susan Berkowitz is a single parent who works full time and tries to do her best to meet the needs of her 10-month-old daughter, Jennifer. Jennifer was born with multiple congenital anomalies which included a tracheoesophageal fistula, a heart defect, hearing impairment, and facial paralysis. She has frequent ear infections and has been hospitalized for pneumonia several times. Jennifer attends a half-day classroom program for infants with developmental disabilities. The case describes an instance of parent-professional conflict between the mother and the classroom teacher, Kathy. The conflict arises over the program's policy of not allowing children to return to class until they are fever-free for 24 hours. The teacher doesn't understand this mother's strong emotional response when she tries to enforce the policy and sends Jennifer home because she had been running a fever the previous day.

Supermom
Wilson Jordan is a 10-month-old who has Down syndrome. With the exception of frequent ear infections and a milk heart defect, Wilson is doing quite well. His developmental progress has been promising. In this case, Wilson's mother, Ellen Jordan, concerns the early intervention professional more than Wilson himself. Ellen seems so intent on making Wilson "normal" that she doesn't appear to enjoy the little boy behind the Down syndrome. Ellen knows everything there is to know about Down syndrome and all that goes with it. She has therapists coming to their home as often as possible to work with Wilson so he doesn't fall behind in his development. And now, she is talking about cosmetic surgery, weight control, and computers.

April Must Wait April
Banks is four years old. She has cerebral palsy, resulting in very limited use of her arms and legs, and no speech. Although April does not perform well on standardized assessments, she seems reasonably bright and has a charismatic personality. Overall, she has a lot of potential, but she also needs a lot of help to realize her potential. April was enrolled in a classroom program, but her mother withdrew her from the program and placed her in a dubious child care situation. The staff are concerned about April's welfare and the effect this situation may have on her public school placement in the next year or so. Margaret Banks, a single parent, knows the importance of intervention for her daughter but she is having a difficult time balancing all of her family's needs. The case describes a visit to the Banks's home by one of the professionals who works with the family.

Piecing Together the Community Puzzle
The complicated issues faced in working with the Williams family have often taxed the abilities of Carol, a home-based early interventionist. Bobby Williams, who is almost 3 years old, has multiple and severe disabilities with associated medical needs. He lives with his mother, Joy, who is a single parent and experiences difficulties beyond those related specifically to her son's special needs. Unemployment, limited social support, conflicts with professionals, financial difficulties, and her own medical needs are just a few of the barriers that Joy Williams faces in meeting her family's needs. Common to many cases in early intervention, several agencies and professionals are involved with the family, thus calling for interagency coordination and collaboration. Finally, the early interventionist featured in this case is faced with planning for the transition of the family into another service as Bobby ages out of the program by which he is currently served.

Pink Slip
"What is it about children's biting that pushes people's buttons so?," wonders Stacy, as she contemplates the current situation in her classroom of two-year-olds. One of the toddlers in her class, Carly, started biting the other children about two months ago. At one point, Stacy had thought the problem was resolved but, then, Carly started biting again. And yesterday, Carly bit the wrong child—Michael. Michael's mother was outraged about the incident. She blames Stacy for not protecting her son from Carly's assaults and now she is out for blood. She has told Stacy that Carly should be dismissed from the child care and has threatened to sue Carly's parents if she ever bites Michael again. Michael's mother isn't the only parent who feels this way. Another mother has also voiced her concerns to Stacy and suggested that Carly be dismissed. Stacy thinks the parents are overreacting and doesn't feel as though it's right that she, alone, be held responsible. After all, wasn't she already doing everything she could to stop Carly's biting? It just wasn't easy. Carly's biting was simply too quick and too unpredictable to prevent it from happening completely.

Big Business
Ann Bradshaw made her way through the freezing rain to the New Generation child care center for her second unannounced follow-up inspection since the initial complaint about a month ago. An anonymous caller had informed her department that the center's adult to child ratios were too high and out-of-compliance. The caller had also said the children had not been receiving milk at lunch. When Ann visited the center for the first time a month ago she did find the adult to child ratios out-of-compliance. But with the receipts for milk the director had provided, she had found the milk complaint unsubstantiated. Today she expected to see the center had corrected their ratios. Instead when she finds the center's ratios still out-of-compliance and also learns that the children may not be receiving milk, and that she may have been purposefully duped, she faces difficult decisions that require immediate action. In the midst of handling this situation she wonders how she is going to follow-through on instructions from her department to provide technical assistance to the very same centers and family day care homes she inspects.

Family Profiles
Optimizing the development of all young children (birth to age 5) requires the joint effort of a number of agencies at the state and community levels. The Family Profiles was developed primarily to assist communities in assessing the extent to which policies and resources are in place to support the development of infants, toddlers, and preschoolers. These include policies and resources related to a) ensuring that quality child care is available and accessible to families who need it, and b) ensuring that other types of family support services are also in place. The Family Profiles feature a brief description of 4 different families and the needs they have related to their children's care and development. The families vary along a number of dimensions such as marital status, financial needs, employment, and the number and ages of children in the household. A series of thought-provoking questions are found at the end of each family's story. These ask readers to identify the needs of the child and family and to determine the extent to which policies or resources in their own community would adequately address child and family needs. Family Profiles is an excellent tool for policymakers or multi-agency groups to use in examining the adequacy of their current system of services for young children and families and in planning together to improve the availability, accessibility, or quality of services. Worksheets for analyzing the Family Profiles are also available and may be used in addition to or as an alternative to the discussion questions found at the end of each family story. The Family Profiles may also be used with preservice or inservice audiences to increase their awareness of community resources and how policies influence the quality of young children's experiences prior to school entry.

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Section Two: Solved Stories
    These case stories provide exmples of early interventionists struggling to apply recommended practices. Many of the stories describe professionals in confusing situations, and the "right" thing to do is anything but clear-cut. Despite their uncertainty, these professionals are willing to try. Even when they feel confident about what should be done, they often face barriers that circumvent the execution of their plans. Although not always completely satisfied with the outcomes of their work, these professionals show a willingness to adhere to principles of recommended practices and to learn from their mistakes. Perhaps most inspiring are the stories of professionals who become aware of the incluence their own personal values can have on the decisions they make in their work with children and families.

Little Things That Count
Dana and Barry envisioned a joyous arrival of their firstborn child, but their dreams were abruptly shattered by the premature onset of labor at 26 weeks gestation. Their newborn daughter, Megan, spends the first weeks of her life in the neonatal intensive care unit (NICU). She wins her fight for life, but does not escape brain injury in the process. The residual effects of Megan's early trauma remain unknown as the parents prepare to take their little girl home. This story describes the parents' reactions to the unexpected crisis of a premature birth and beginning parenthood in the world of the NICU. The story also describes the sensitive approach of a psychologist and physical therapist as they conduct a newborn assessment, communicate assessment information to the family, and restore the parents' confidence in their child and themselves.

Jack and Jill--and Sam?
This situation had already reached crisis proportions when Barbara, director of the Jack and Jill Child Care Center, decided to call for assistance. Sam's mother, desperate for summer child care, had enrolled him at Jack and Jill without explaining the extent of his special needs. His persistent misbehavior was infuriating to the staff, and serious consideration was being given to dismissing him from the program. The telephone call for help was Sam's last chance to remain at Jack and Jill. This story describes the efforts of a consultant, Monica, to assist the child care staff and support Sam's inclusion in this less-than-perfect integrated setting.

Thank You for Your Time
Jessie was fifteen years old and already the mother of two young boys, Jerome and Lamont. She was also pregnant, expecting her third child in a matter of weeks. Jessie's questionable parenting skills resulted in the family's referral to a combination home-based and center-based intervention program. This case describes the efforts of the interventionist who visited Jessie and her two sons in their inner-city home. Under less than ideal circumstances, the interventionist attempts to foster Jessie's interest and involvement in the boys' development. Potentially sensitive issues such as birth control and completing high school are also addressed through the interventionist's work with this young mother.

The First Year Together
Born 10 weeks early, Evan spent the first weeks of his life in the intensive care nursery. It was a struggle for both him and his parents, Carolyn and Terry, but all survived and Evan went home. This case describes the emotional and physical stress that his mother faces in caring for her premature infant who has gastroesophageal reflux. The case also describes the efforts of professional, Bonnie, who visited the family's home throughout the first year of Evan's life. Bonnie attempts to provide support as the family adjusts to the demands of an infant with special needs and, as Evan's need for special care subsides, she is supportive of Carolyn's attempts to recoup a part of her own life that had been temporarily abandoned.

An Orange Raincoat
Pearl and her 9-month-old son, Robert, attend an infant development program only to avoid Robert's removal from the home. Pearl makes it obvious that she does not want to be there and the staff feel dumped on and unable to gain her trust. Over time, the staff come to understand Pearl better and find meaningful ways to provide assistance to the family. This case describes the forging of a relationship between the program staff and this mother with mental retardation as they work together to overcome barriers and establish a network of support for Pearl and her family.

Kindergarten's Not for Another 2 Years
Maureen and Jerry had been very pleased with the services they and their son, Marcus, had received for more than 2 years at the Geary street Infant Development Program. The private program had been extremely supportive of the family through some very difficult times including Marcus's diagnosis of agenesis of the corpus callosum. Soon, Marcus would be 3 years old, and it was time for him to make the transition from the infant program to the community's school-based preschool services. Andi has been assigned to work with the family to plan Marcus's transition. Theirs is the first family she has worked with in her new job. This case describes the anxiety experienced by both Maureen and Andi as they take on the challenge of ensuring a smooth transition and quality services for Marcus.

No Place to Call Home
Jessica, Eric, and Josephine are toddlers with developmental delays and, although they have lived under similar circumstances, they are not related. All three were former residents of welfare hotels in New York City which were designed to provide temporary housing for homeless families. This case describes a child care program for children living in this once famous hotel. The issues for staff members faced are told through the stories of their work with these three young children and their families. The dismal environment surrounding the classroom and the challenges the children present pale in comparison to the difficulties the parents have encountered and their tentative futures.

The Disney Connection
Tommy Minh Pham was born with Larsen syndrome, a rare genetic syndrome that made him particularly vulnerable to the typical bumps and bruises of early childhood. When Tommy was 3 years old, that vulnerability was realized when he became paralyzed and completely dependent on a ventilator. This case is about the efforts of a home-based preschool teacher, Isabel Morris, to have Tommy integrated in the district's regular education program. It describes the enormous effort necessary and barriers encountered in coordinating the many people and agencies involved in making such a goal a reality. It also describes Isabel's attempts to insure that Tommy's parents are actively involved in the decisionmaking that takes place, which is made somewhat difficult because Mr. & Mrs. Pham do not speak English.

Peter and the Watermelon Seeds
Peter loves to play with blocks, swing with his friends, and slide down the sliding board. While not remarkable for most four-year-olds, his ability to enjoy these activities along with the other children in his preschool is a real accomplishment for Peter. Peter is blind. At 1 year of age, he was diagnosed with retinoblastoma—tumors in both eyes. Chemotherapy was unsuccessful and both of Peter's eyes were surgically removed by the time he was 2 years old. This case study describes a rather typical day for Peter at preschool. On this particular day, Miss Murray, the consultant for children with visual disabilities, is visiting the classroom. She has worked along with the regular preschool teacher to make the adaptations necessary for Peter's full inclusion. These adaptations are described in the case as well as other helpful hints for enabling children like Peter to handle the challenges of everyday activities independently and with confidence.

Only Time Will Tell
Jonah was born bearing the burden of his mother's history of drug abuse. The mother, Karen, had succeeded in freeing herself of her addiction to heroin but the methadone that had helped her for so long was now a source of bondage for her newborn son. This is a story about the struggle of the newborn, Jonah, as he goes through withdrawal from methadone. It is also the story of Janet Cruz, a professional who provides support to Karen throughout this traumatic ordeal and who tries to ensure a smooth transition from hospital to home when Jonah is discharged.

The Blooming of Rose
Rose was limited in many respects, but not in all. Viewed from the right perspective and under circumstances that provided opportunities, Rose's strengths shone through. This case describes the support provided to Rose and her family by a primarily center-based preschool program. In particular, it is the story of one professional's repeated contacts with the family over a 7-year period as she provided services to two of Rose's three children. Rose's limitations, multiple family crises, and the transition of the children into new services pose challenges for this professional and others in the community.

The Eye of the Beholder
Jessica's disabilities were the result of her encounter with cytomegalovirus while still in her mother's womb. Now, almost three years old, she still was fed through a gastrostomy tube in her stomach and required a ventilator to breathe. Looking beyond the obvious challenges she faced, Jessica was a curious and delightful toddler. A desire to provide their daughter with an opportunity to be with other children led Jessica's parents, Sharon and Douglas, to enroll her in an inclusive model preschool at the university. Jessica, however, had far more severe disabilities than the other children who attended the model classroom. This case describes the difficulties encountered in attempting to integrate Jessica into the daily activities of the program and the program director's efforts to help the child care staff overcome their anxiety and reluctance. This case also touches on the more general issue of forging alliances between child care staff and professional support staff.

Shaping Ben's Future
It's seldom easy to go against established practices. Sam and Amy learned this firsthand when they decided that they wanted their son, Ben, enrolled in a regular kindergarten class in their local elementary school. In their community, children with disabilities routinely went to a separate school designed to meet the special needs of these students. This was not what Sam and Amy wanted, and they were willing to fight the system on behalf of their son. The staff of the local elementary school are up in arms at the prospect of Ben's placement there and not at all satisfied that Ben's best interests have been considered. This case focuses on the decisions and actions of Ben's current preschool teacher, Kate, as well as those of Jackie, the director of the preschool, in handling the tense situation. They, too, are uncertain of what is best for Ben and must come to terms with their torn allegiance between the parents and the educational system of which they are a part.

In Whose Best Interest?
Carol and Steve would probably prefer not to have the weekly home visits they receive. Although they could refuse these services, they would stand a good chance of losing custody of their two young children, Crystal and Aaron. Both Carol and Steve have limited intellectual abilities. Their lack of basic child care skills, as well as the unsanitary and often unsafe home environment, concerns many professionals who have come into contact with the family. To add to these difficulties, Steve has recurrent outbursts of anger and has threatened several professionals in the community. This case describes one of the many home visits to this family of four as well as the overall strategy that has been taken in helping the parents to learn basic parenting and homemaking skills. Despite the progress that Carol and Steve have made, questions still remain regarding their ability to provide a safe and nurturing environment for their young children.

The Go-Between
No one knew the extent of Luisa Ramirez's drug use. A urine test had revealed that her son, Ramon, was exposed to cocaine shortly before his birth. Ramon was at risk for developmental delays and, therefore, eligible for early intervention services. Elaine York was assigned as the Service Coordinator for Ramon and his family. This assignment was fortunate because Elaine spoke fluent Spanish, Luisa's only language. This case study describes a situation in which the mother, Luisa, is motivated to work for change that will benefit both herself and her children. It is soon discovered, however, that the services she desires to make the changes in her life are unavailable for a variety of reasons. Agency policies and procedures prevent access, "turf" issues among agencies impede their effective collaboration, and complex questions about the financing of services cannot be easily resolved. Elaine York tries to be supportive of Luisa and respect her role as decision-maker in matters that affect her family, especially development of the individualized family service plan but other service providers in the community do not necessarily share this respect.

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