Synopsis of the Case
The case under analysis relates to a young girl named Geraldine Brown, who is an America-African girl aged nine years. The history of Geraldine shows that she has grown up in one of the towns in the United States all her years. She has a sister three weeks old named Jasmine.
Their mother, Tanya is the sole breadwinner in the family who works in one of the Information Technologies firm while their father is a local driver with one of the truck companies in the city. Geraldine was very close with her mother and maternal grandmother. Her mother’s relatives would frequently visit. Through an interview, it is revealed that Geraldine is staunch Christian since she was an active member of the local church when her mother was alive.
Unlike the mother, her father is an alcoholic and an abuser of various drugs. This condition made him violent towards Geraldine’s mother, who was frequently abused. However, her father was never violent to her since he provided the needed care. An interview with Geraldine proved that the family has been moving from one place to the other. Whenever settled in one place, her father would always abuse the mother.
Reports from the police proved that 911 calls had been received from each house that the family lived meaning that her father’s violent behavior has been consistent. Geraldine’s mother refused to file charges against her husband whenever the police arrived in response to the 911 calls. The father’s behaviour was extremely dangerous to the family since he would even assault the mother when she was pregnant.
Three weeks after the mother delivered Jasmine, she was seriously beaten and succumbed to injuries. Geraldine was taken to the care centre specializing in trauma diagnosis for further examination. Before this, a forensic interviewer had extracted some critical information from Geraldine. At the fateful night, Geraldine was sleeping in her room while Jasmine was in a bassinet when she heard a sound of utensils breaking.
When she woke up, her parents were fighting while yelling at each other. Geraldine was helpless and she could not control anything, as the yelling went on for hours. At one time, she could not hear any noise and she was optimistic that the fight was over. After a few moments of silence, the screaming went on, but this time it was different since a scary sound was heard. She never attempted to check what was going on since she knew that everything would be fine as usual.
Soon after, her parents went in their room and locked the door. While in their room, her parents started quarrelling once more, something that forced her to check what exactly was going on. She was terrified since she feared that her father would see her peeping in the door hole. When her parents were quarrelling and fighting, Jasmine was crying. The mother was trying to calm Jasmine while threatening to call the police.
At this moment, Geraldine thought of calling the police, but she feared her father would notice. She also contemplated notifying the neighbours, but she could not reach them without opening the main door. She convinced herself that the fight would be over and everything would go back to normal. Before she could even return to her bed, she heard a strange yelling from the mother, something that she had never heard before.
She was now scared since the mother was crying for help while shouting that she was not ready to die. Her father opened the door she was leaning on. The father seemed tired as if she had done a heavy work. When she opened the door to see where her mother was, she only saw her father, but her mother was nowhere. She never confronted the father since she knew that she could be injured or even killed.
Her father instructed her to go to her bedroom and claimed that a tragic accident had just occurred. The father moved towards the kitchen to wash his bloodied shirt. Geraldine went back to her bedroom, but she returned soon after since she could not hear any noise, apart from that of Jasmine crying. She heard her father talking over the phone saying that something terrible had just happened in the room.
Geraldine rushed to her mother’s room to see what had taken place, but she was ordered back to her room. She obeyed her father’s instructions and went back to sleep. After a few minutes, she heard an ambulance siren, with some paramedics. The medics wrapped Jasmine in a blanket and handed her over to Geraldine. The body of her mother was taken away to the morgue, but Geraldine was convinced that her mother would be fine. The police while in handcuffs whisked her father.
Geraldine never believed that her mother would be dead since she was hopeful that God had heard her prayer. She was taken to the neighbour’s house whereby the social worker and one police officer asked her whether they had a relative. She gave them her grandmother’s number, who was called soon after.
Geraldine and her young sister were later taken away to the grandmother’s house whereby she was taken to the CAC centre the following day for an interview regarding what she saw that fateful night. She explained that her mother could have been injured accidently or her father could have caused the injury. She not convinced that her mother dead. Geraldine attended her mother’s burial service, but she was not emotional. Her grandmother and godmother are the two legal custodians of the two sisters.
The godmother reports that Geraldine is always scared of any noise and seems troubled since she wakes up in the middle of the night while sweating and shaking. Any time an ambulance passes by, she is anxious. She wants to respond to any phone call hoping that it is her father calling. The grandmother and the godmother are optimistic that Geraldine would be fine in case she is transferred to a different school.
Trauma-Informed Assessment
Practitioners in the field of counselling employ a number of trauma treatment models. Trauma-informed assessment means that the role of each actor is important. Therefore, a critical review should be conducted to determine the role of each person as far as managing a traumatic event or situation is concerned. Based on this, it is true that each person has a role to play in initiating trauma-informed practices. To support traumatized children, such as Geraldine, certain terms should be evaluated in detail.
Caregivers and specialized psychologists should change their approach in terms of addressing the problems that traumatized children, such as what Geraldine, went through. For a social worker to execute his or her duty excellently, he or she should understand basic terms such as trauma focused-cognitive behavioural therapy, survival brain, resilience, developmental trauma disorder, and trauma integration.
The social worker cannot employ all treatment models in addressing the problems facing the child, but instead he or she should first identify the thing that matters most. This would help him or her deliver the much needed help to a child going through a trauma, such as Geraldine.
For the client described in this case, the social worker would have to identify what matters most and go a notch higher to determine the coping abilities of the child. In this case, what Geraldine was exposed to was the source of trauma (Lehmann, 2000). Her current surrounding matters so much since it determine her ability to cope. The information gathered through an interview with the client is what would be relied upon in assessing her situation.
Violence is the main cause of trauma in children and adolescents because reports from juvenile justice system and child welfare confirm this. Trauma could also be caused by other factors, such as fire and accidents, but violence is the leading cause, particularly in children.
When children are exposed to non-violent incidents, such as house fire and car accidents, trauma is not usually screened in them (Openshaw, 2008). Therefore, it is true to argue that experiences matter so much since it affects an individual’s coping ability. For the social worker to identify what Geraldine is going through, the way in which she experiences the event ought to be understood.
Resilience research and developmental trauma disorder research are some of the conceptions that support the idea that the way an event or situation is experienced induces trauma to the child. Furthermore, only the child going through trauma is in a position to explain what would be employed effectively to resolve the situation.
Studies focusing on resilience claim that not all events or situations believed be to be traumatizing would usually affect individuals (Saxe, 2007). For a relevant treatment plan to be applied in the case, the client must give her views as regards to how she experiences what she is exposed to in her daily life. Research shows that a treatment plan could turn out to be traumatizing in case it is not applied effectively (Osofsky, 2003).
Every traumatizing event or situation would have unique conditions that would call for an extra-ordinary treatment plan. A social worker would not assume that all children are traumatized by what they are exposed to in their environment. In case a trauma occurs, the intervention techniques or the treatment plan is not usually similar.
In 2005, one of the organizations specializing in child welfare concluded that all efforts channelled towards minimizing trauma in children should be based on certain ideas, strategies and processes, which are meant to offer security, tone of voice and alternatives to the child. Such treatment plans must always be individualized meaning that the solution should be reached after an extensive consultation with the client.
The client should be involved in any process by incorporating his or her views in the development of the plan. The report from the child welfare advised further that trauma services should focus on guaranteeing physical security and emotional safety (Vickerman, & Margolin, 2007). These treatment plans should be resilient meaning that they have to be supple and individualized, ethnically competent, and advocate for reverence and dignity.
Resilience studies reveal that evaluating the presence of posttraumatic stress disorder is very easy, but the assessment of coping abilities and the processes involved in dealing with trauma is very difficult in children. The ability of a child to cope with the traumatizing event is important in designing a treatment plan. For the case of Geraldine, the situation ought to be approached from an experience-diagnostic perspective. The treatment plan would be aiming at altering the experience and reducing diagnostic symptoms.
Geraldine ought to be given enough time to respond to specific questions that would be very important to designing a treatment plan. Form the interview, only a single statement would be enough to design the plan. Therefore, allowing her to give her views freely would be productive as far as developing a powerful treatment plan is concerned.
Throughout the process, culture would be given priority since the designed treatment plan should be responsive to the traditional set of beliefs of the client. Cultural consideration in designing the treatment plays means that the social worker should actually have the capacity to offer trauma-informed assessment effectively. This implies that any treatment plan aimed at resolving the issues facing Geraldine should acknowledge, respect, and integrate the traditions, principles, and social practices of Geraldine’s current family.
The term culture in this context is used to mean the classification of the family’s race and traditions. In the case, it is eminent that Geraldine is from the African race meaning that the designed treatment plan should be consistent with the African culture (Osofsky, 2003). Apart from the race, the processes of designing the plan should comply with the religious beliefs of the client. In the case, Geraldine was a Christian before the traumatizing event occurred meaning that the treatment plan should adhere to this.
The family living with the client is not superior in terms of socio-economic status. Moreover, the current family seems to be semi-illiterate hence the treatment plan should be cost-effective and easy to understand. The family should afford it and understand it in detail in case it is to be applied clearly. Culturally competent treatment plan would demand that the values of the grandmother and the godmother be respected and be incorporated into the treatment designing process.
The cause of trauma should be interpreted from a cultural perspective since not all cultures have a similar definition of traumatizing event. In some cultures, children are informed right away if a traumatizing event takes place. For the case of Geraldine, no one was willing to inform her mainly because of cultural beliefs. In African-American culture, it is usually assumed that traumatizing events, such as death of the loved one, are not revealed to children instantly.
Research supports the idea that cultural factors have enormous influence on bio-psychological experiences regarding trauma in children. This implies that the reactions of Geraldine to traumatic stress could be a result of cultural factors. This shows that ethno-cultural aspects, such as religion and family values, play a critical role as far as vulnerability of an individual to traumatic events is concerned. Geraldine could be experiencing and expressing trauma mainly because of her religious beliefs.
The way she would respond to the treatment plan depends on cultural factors. In this regard, the social worker will have a number of roles to play as far as the influence of cultural factors is concerned. The first thing the social worker would do is to recognize cultural disparities in the biased insight of trauma and response. Moreover, the caregiver would need to comprehend the role of values in the understanding of shock and revitalization process.
Through this understanding, the social worker would be in a position to assist Geraldine to bring back a sense of security through trust building. To do this effectively, the caregiver is expected to interpret the problem from Geraldine’s cultural perspective. Finally, the social worker will have to work within and through Geraldine’s present family structure in order to encourage expressive and social support.
Immediate Treatment Issues for Geraldine
The first concept claiming that traumatic experiences are inherently complex applies to the case under study because Geraldine’s case is unique and cannot be compared to that of any other child.
The concept suggests that each traumatic event has a different moment, which may vary from threats human life, the physical assault to the witnessing of death. Depending on the type of trauma that the child would be exposed to, he or she may portray different characteristics, ranging from changes in the belief system, reasoning, emotional response and the concern over safety.
Based on this, a child would develop a different protective action, depending on the type of the traumatizing event. The views of the child might result to the internal conflicts whereby a child feels confused and helpless. Some would even regret witnessing or going through the traumatizing situation or event while others would simply be angry and guilty.
The concept suggests further that previous experiences and developmental levels influence the response of each child to trauma. For Geraldine, she grew up knowing that the father would always batter her mother. When the traumatizing situation occurred, she could not believe that the simple fight between her parents could cause her mother’s death. The occurrence of other events complicates the trauma since they introduce other layers.
The loss of the mother exposed Geraldine to a precarious situation whereby she was forced to depend on other people, even though she was used to them. The fourth concept argues that trauma makes children exhibit certain forms of behaviour that vary in nature, commencement, intensity, regularity, and time.
The concept suggests that the pattern and the course of response would definitely depend on the traumatic experience and effects. For Geraldine, social environments made her suffer more because she was used to her father’s violent behaviour.
In the case, it is reported that she was always afraid of noise and phone calls thinking that her father was around. Moreover, she became nervous of the siren sound since it was involved in the transfer of her mother’s remains. It is noted that this type of behaviour can degenerate to a serious problem known as posttraumatic stress disorder or depression. These disorders have the ability of disrupting the normal growth of a child.
For Geraldine, her growth could be impeded in case a treatment plan is not designed in time. Her functioning in the family, school, and in the community is already disrupted because she does not pay attention to what others tell her. The social worker will have to understand the response of Geraldine to the trauma if a suitable treatment plan is to be generated. This would entail competent assessment of the event, conducting an accurate diagnosis, and intervening effectively.
Lastly, the fifth concept discussed would also emerge as an important area of focus when designing a treatment plan for Geraldine. The concept underscores the fact that trauma could perhaps affect a child’s sense of protection and safety. Moreover, it can amplify the child’s concerns regarding his or her safety.
For the treatment plan to be successful, restoration of confidence and a sense of protection are critical. The plan should aim at making the Geraldine feel at home, accept the past events, and move. The grandmother and the godmother in the case suggest that transferring the Geraldine to a safe place would resolve the issues surrounding her, but the fifth concept suggests that this would simply serve to worsen the situation.
Geraldine’s condition is complex since she cannot even differentiate between safe and unsafe place. In fact, this has readjusted her risk-behaviour since she always feels that the father is calling. However, Geraldine would recover fast because the environment she lives in is safe. The situation could be different in case she was living in an unsafe environment.
Phase of Treatment
According Saxe’s analysis, Geraldine’s case is at the first phase of treatment surviving is the major issue facing the client. Geraldine should be given specific skills that would help her cope with the new environment.
The first phase, according to Saxe, aspires to protect Geraldine from intimidating surroundings and hazardous desires that would result to serious disorders, such as posttraumatic stress disorder and depression. The treatment plan in the first phase would be seeking to set the stage for interventions in subsequent phases, particularly the second and the third stages, which are concerned with stabilizing the mind of the client and encouraging him or her to endure the pain or loss.
Behaviour of Geraldine in the first phase is irregular and highly threatening. In this regard, the best treatment plan should be home-based, as well as community-based. This would help in understanding the home environment in which the child is exposed in while at the same evaluating the degree of danger. The social worker will therefore work with other human services delivery agencies, such as psychiatric units.
In this phase, the behaviour of the child is usually impulsive meaning that he or she would do something that is extremely dangerous to her and other members of society. The treatment plan would focus on emotional regulation whereby Geraldine would be given adequate skills on behaviour regulation. The social worker would recommend psychopharmacological intervention whereby the use of drugs would be recommended.
Working with Treatment Teams
The condition of Geraldine is very complex meaning that a number of professionals would be involved in managing her traumatic condition. The social worker will focus on helping the patient go back to her initial status in terms of behaviour.
This means that the caregiver would simply be concerned with the social aspects, such as the behaviour of the child at home, her interaction in school and her relationship with other peers (Crenshaw, 2006). Therefore, the social worker would have the major task of designing a treatment plan that focuses on engaging the behaviour of the client positively.
Moreover, the social worker will be trying to stabilize the behaviour of the client, which is currently irregular and unpredictable. This would be accomplished through system advocacy and instilling meaning making skills to the client. The social worker will work with a team of psychologists whose major role would be to develop the emotional skills of the client and build cognitive processes.
The psychologist will be concerned with ensuring that the brain of the client functions properly. The doctor on the other hand would be playing a major role of administering drugs on the patient, which would constitute pharmacological treatment. Any defects to the brain or any other central nervous organ would be rectified by the doctor. The social worker will advise the psychologist on the best cultural practices to employ when counselling the client (Lehmann, 2000).
Summary of the Treatment Modules
Engagement
This treatment plan suggests that many families usually experience problems with the introduction of treatment strategies because of the mistrust. This could be due to cultural barriers or lack of proper time keeping, which discourages the client to continue attending the sessions. This form of treatment is relevant to all families and clients starting the processes of healing. It entails evaluating the capability of the family and dealing with barriers that would interfere with the resolution of the problem.
It forms a partnership with the affected family in order to resolve the problem from the family’s perspective (Margolin, & Vickerman, 2007). In engaged families or organized families, the treatment plan takes a shorter period while it takes over a month for a disorganized family. For Geraldine’s family, it would take a shorter period since family members are organized and highly concerned.
Stabilization
Stabilization is a treatment strategy that entails offering an extensive home-based and school-based treatment, with the main aim of reducing stress and eliminating elements of trauma. This form of treatment is appropriate for Geraldine since she faces a serious risk of posttraumatic stress disorder.
The client faces behaviour regularity and environmental instability meaning that stability should be sought first before proceeding to the next level. The treatment plan is usually employed during the initial stages of curing process. However, it can be employed even when the treatment plan is ongoing in case a new crisis that threatens the plan emerges.
Services Advocacy
This form of treatment entails offering resources to the client, which could help in emotional regulation. This aims at stabilizing the social environment in which the client lives in. The treatment plan aims at finding solutions to the stressors that affect the behaviour of a client. It is usually utilized jointly with other plans, particularly the stabilizing and surviving plans. Core services offered to the client include schooling, fitness, social services, shelter, and migration.
Psychopharmacology
This treatment plan is applied to children whose traumatic conditions force them to engage in dangerous behaviours that could be harmful to other members of society. It may also include the services of the psychiatrist since the child might sometime be uncontrollable. The use of drugs to control the behaviour of children is usually employed during surviving and stabilizing phases, but is usually discontinued once the client is in a stable condition.
Emotional Regulation
This form of treatment module is the most important as far as recovery is concerned. It is an office based treatment plan, which assists the parent and the child in mastering strategies of emotional regulation. It is employed at the enduring phase of treatment, even though it might as well be employed in the earlier stages. The module is appropriate to children who are unwilling to talk about the traumatizing event.
Cognitive processing
This module is usually utilized in conjunction with the emotional regulation module. It is applied once the client accepts to discuss the problem without getting emotional. The child is given specific skills that would help him or her talk about the traumatizing event without being distracted (Kaplow, Saxe, Putnam, Pynoos, & Lieberman, 2006). The treatment plan is only applicable when the client is in a stable condition emotionally.
Meaning Making
This module focuses on the future implying that the social worker encourages the family to move on and make some meaning from the traumatizing event. For instance, the family is encouraged to learn a lesson from the event and try as much as possible to prevent the occurrence of the event in the future. The role of the social worker in this plan is minimal since the family learns to live without the help of the caregiver.
Summary of the Work with the Client
An experience with Geraldine was very productive since she was cooperative and willing to share critical information with the social worker. However, the client needed some time to recover from the event before being subjected to the interview. The treatment plan to be developed had to focus on the experiences of the client since the traumatizing event affected her so much.
Emotional regulation would be the first treatment plan to be utilized since the client was unable to share information regarding the event without shading tears. Even the grandmother and the godmother were affected too since they could not give any information without crying. Cognitive processing would be the second treatment since the family accepted the situation and was ready to move on.
References
Crenshaw, A. D. (2006). An interpersonal neurobiological-informed treatment model for childhood traumatic grief. Omega: Journal of Death and Dying, 54(1), 319-335.
Kaplow, B. J., Saxe, N. G., Putnam, W. F., Pynoos, S. R., & Lieberman, F. A. (2006). The long-term consequences of early childhood trauma: a case study and discussion. Psychiatry: Interpersonal and Biological Processes, 69(2), 362-375.
Lehmann, P. (2000). Posttraumatic stress disorder (PTSD) and child witness to mother assault: A summary and review. Children and Youth Services Review, 22(4), 275-306.
Margolin, G., & Vickerman, A. K. (2007). Posttraumatic stress in children and adolescents exposed to family violence. Professional Psychology, Research and Practice, 38(5), 620-628.
Openshaw, L. (2008). Social work in schools: Principles and practice. New York: Guilford Press.
Osofsky, J. D. (2003). Prevalence of children’s exposure to domestic violence and child maltreatment: Implications for prevention and intervention. Clinical Child and Family Psychology Review, 6(1), 161-170
Saxe, R. (2007). Theory of Mind. New York: Taylor & Francis Group.
Vickerman, A. K., & Margolin, G. (2007). Posttraumatic stress in children and adolescents exposed to family violence. Professional Psychology, Research and Practice, 38(1), 620-628.