Single Mother and Child Case Study

¶ … client is a 28-year-old, recently divorced single mother with a six-year-old daughter. She is the primary caregiver, as the father lives out of state and visits every 6-8 weeks. The father pays no child support. The divorce was due to drug abuse and infidelity on the father's part. The client is limited in social support resources; her parents are restricted from babysitting the child because of a child molestation accusation that has yet to be resolved. The inability to rely on her family for babysitting creates difficulties for the client, who attends school in addition to working. The child is also experiencing some stressors, which have manifested as an obsession with the weather and a focus on death. The client feels extreme stress due to the ongoing legal issues, financial issues, lack of paternal involvement, and inability to access her normal support network. The client is seeking help and has a generally positive opinion of the healthcare system, though she does not seem certain that the system will provide her the necessary assistance. She is also conflicted about the dual role that healthcare providers are playing in her daughter's ongoing molestation allegations, which may impair her ability to rely upon healthcare providers.

Encounters and Family Assessment

The overall impression of the family, which consists of a mother-daughter dyad, is one of insufficient resources to meet the family's needs. The client is an attentive and nurturing mother to the child, but is not able to devote as much time to the child as may be required. The client has no downtime to herself at all, and, as a result, is under persistent and significant levels of stress. This results in her being somewhat short-tempered and not always able to focus on the child. The child is focused on things that are beyond her control, such as the weather and death, which adds more stress to the client because of her perceptions that she cannot fix the child's problems. The client was raised in a Christian background and self-identifies as Christian, but does not currently spend time in a church or other religious organization. It is difficult to define the family roles; the client has made an effort to ensure that the child will be able to be a child and has resisted the temptation to put adult responsibilities on the child. However, the client has informed the child of the father's substance abuse problems because of concerns that the father might become intoxicated while with the child. The communication in the family is compromised by the fact that there are molestation allegations against the mother's family. The mother does not seem to believe the allegations because she is protective of her child, yet still talks about not being allowed to use her parents as babysitters. The allegations put the client and the child in an adversarial position, which may compromise their ability to communicate about what is probably the central issue in the child's life, at this time: the molestation allegations. Whether or not the molestation occurred, the fact that allegations have been made is important and can be expected to impact the child's life for a significant period of time; given her age, the probability is that molestation either occurred or that the child is being manipulated into making allegations, either of which can damage the child.

Their home is well-kept, with none of the obvious safety hazards that often accompany financial struggles. The home is small and clean, though not tidy. There are no guns in the home. Medications are kept in an upper cabinet in the kitchen. The home has smoke detectors. The home has a small fenced back yard, but the fence is a dilapidated condition. The home next door has a large unneutered male outside dog that is kept chained, and the chain is long enough to allow the dog to enter into the fenced yard. All of those conditions are associated with a high risk of dog bites, which the client does not seem to recognize (ASPCA, 2015). She considers the dog next door to be sweet, which he may be, and did not seem to take the suggestion that he is a high risk for dog bites because of his living conditions very seriously. The neighborhood environment is what one would expect in a lower-middle class area in a town. There is a small grocery store in town with a moderate selection of food, but nicer grocery stores are located at a distance. Emergency healthcare is easily accessed; there is a small hospital within 2 miles of their home. However, non-emergency medical professionals, such as pediatricians, are located in the wealthier parts of town and require a commute. The town's public transportation system is non-existent and the family relies upon an old car for transportation, but the car is reliable and well-maintained.

The encounters with the family have been semi-productive. The client seems open to most suggestions and concerns, but is also defensive about some of the choices that are linked to a lack of resources instead of being open to exploring potential alternatives that might be affordable or otherwise offer financial relief. The child is timid and does not interact with the healthcare professional unless required to do so, but is relaxing enough to play in front of, but not with, the professional. The client describes a change in the child's behavior, which could be linked to molestation or could be linked to the stressors the child is experiencing because of pressure to make or maintain false allegations (Wakefield & Underwager, 1989).

Problem Identification

The family is experiencing a number of non-health problems that are manifesting as health conditions. The mother's constant stress has left her physically tired, which increases her vulnerability to illnesses and injuries. The lack of sufficient financial resources makes it more difficult for the family to eat a healthy diet, which places them at-risk for becoming overweight with its attendant health issues. The child is in the midst of a psychological health crises, as she has either been molested or has been coached to make false molestation allegations against her grandparents. Either scenario requires a significant intervention.

Goals/Objectives/Plans