Michelle Belanger

April 25, 2014

SEI 513
Case Study

Child and Family Background:
Jason is 5.4 year old male child currently enrolled in Portland Public Pre-K at Youth and Family
Outreach. He attends the program Monday through Friday from 8:30am until 12:00pm. Jason lives at
home with his dad, a retired diesel mechanic and his mom, a construction worker. He has a step brother
who is about 25 years older than him and lives in a different state. Jason was born at 43 weeks by a
cesarean section and received surgery to correct his club feet. Recently the pediatrician said that he
has no concerns with his gross motor stemming from the surgery. Jason also has two heart mummers,
which mom and dad were told is normal. No major illnesses or injuries were reported. Mom reports
that Jason met motor milestones on time, although believe there may have been some delay with some
of the milestones. Mom and dad have reported that Jason has had challenging behavior since
toddlerhood and does not have much early childhood history, as he stayed home with dad until being
referred to Youth and Family Outreach in November of 2013, after initially starting in a local, public
Kindergarten classroom and being told that he was not old enough to stay in Kindergarten.
The family has recently moved to Maine from the south so mom can find work. There is no extended
family supports for the family. The family recently got involved with Opportunity Alliance Child/Parent
Psychotherapy (CPP), which is a trauma based therapy working with the child and the parents, and also
childrens case management. Both are proving to be a great support for the family.
Initial child status/ functioning:
Based on direct observations Jason has strong gross motor skills and is very bright. He
demonstrates both sensory seeking and avoiding. When things are loud he covers his ears yet will over
react to the slightest bump from friends. Jasons biggest challenge is social interactions and behavior.
He is very inflexible when it comes to play with peers. He has one way to play and gets upset when
things are not done in that way. For example it was observed in the block area that Jason wanted the
blocks lined up a certain way and the children to jump from one block to another in a certain order. One
of his friends wanted to move them closer together and Jason got very upset and started to get worked
up. He also tends to get very upset when he is not picked for the center he wants to play in and has a
difficult time waiting his turn. His play is very directive with his friends when he does interact with
them. A lot of his play tends to revolve around violence and he can get almost obsessive about the
violence part of the play.
The behavior in the classroom is also a concern at home where mom reports he has a hard
time when his schedule is disrupted or when there is an expectation of a certain behavior. Jason has
trouble with complying with common social situations and mom has reported that he has bolted away
from her on more than one occasion.
Jason has many strengths among them is he is a very independent little guy who has a very
curious mind and always wants to know how things work and why things are like they are. He has a very
strong trusting relationship with his teachers and enjoys being at school. Jason also has a genuine
concern for the well being of his peers and loved ones. He has a great interest in gross motor as well as
sensory play. He also loves to be the teachers helper and thrives when he has jobs to do.
Jason is in the process of a CDS evaluation where a psychologist and occupational therapist have
assessed him. The OT screening came back with no concerns other than the need for more exposure to
fine motor activities such as cutting and writing. The school psychologists report is based on
observation, discussions with the family and teachers as well as evaluations. The report had come back
that there are severe concerns for his social interactions and behavior. It was recommended that
further tests be done to explore the possibility of Autism Spectrum Disorder. It was also recommended
that he receive a speech and language evaluation for pragmatic language skills.
Family Concerns, priorities, needs, and resources:
Mom reports that the main concern is Jasons behavior. She states he can get very emotional
and angry. At times she has witnessed violent, self-harming behaviors. She reports that Jason has a hard
time occupying himself and has a very limited attention span. Also safety is a huge concern with mom.
Mom reports that they have needed to lock the door and windows in the apartment because Jason has
fled the apartment and tried to open the windows.
Mom is also concerned that Jason may have anxiety over kids not wanting to play with him and
she worries that he maybe vulnerable when he goes to Kindergarten. She also wants to help him
become safe in the choices he makes but does not know how to help him.
Newly in place supports have been a real help in helping mom find supports and strategies that
help Jason. The CPP is aimed at helping the relationship between mom and Jason, giving mom
strategies in helping manage his behavior. It has also helped with managing moms expectations of
Jason, what he can and cannot do. The case manager has been really helpful in helping mom advocate
for Jason through the CDS process. At the IEP meeting mom said she felt intimidated and was afraid to
ask questions, the case manager has stepped up and helped her get those questions answered and
helped in finding programs and support groups for Jason and herself.
Goals for Intervention:
The main goals for Jason are that he receives the supports necessary to be successful in a
regular education setting. Success would look like being able to play in a cooperative way with peers.
Being able to verbalize what his needs are and understanding that others may not think or feel the same
way he feels. This would also include Jason being patient around waiting his turn with a certain toy or
activity and attending to the different aspects of the day. Another goal is that Jason maintains safe
practices at school and at home. This includes staying with mom or dad or the teachers at school, not
engaging in self harm talk or behavior and following safety rules.
Intervention Process:
The classroom teachers set the current intervention model in place. No outside supports have
been available. Jason has had a modified schedule since his start at Youth and Family Outreach. He
started off coming 1 hour a day and has increased from 9:00am-10:00am to 8:30am-12:00pm. Starting
April 28
th
he will be attending the full day program of 8:30am-1:00pm. Currently a teacher in the
classroom shadows Jason and intervenes when things start to get escalated with Jason, either with
peers or himself. While shadowing him, the interventions would be stepping in to give him the social
language or reminding him about not taking a toy or offering suggestions around play. For example,
reminding Jason to ask before he gives a hug to someone. Also, the teacher is responsible for engaging
Jason in play with the environment and with his peers. Also the interventions are set with highly
motivating activities that Jason likes; this makes it easier for Jason to participate in the classroom
routines. Jason was also made a personal picture schedule so he knows what is coming. He is also given
ample warning for any transition. These supports have made great improvements in Jasons overall
behavior and success in the classroom. Jason still needs a shadow but the interventions are less that
when he first started in the room. It also takes less time to calm him down and he has not bolted out of
the classroom or school in quite a while.
At home mom reports that they are starting to set limits with consequences when he does
something that is not safe. Mom states that having him school has been very helpful at home and Jason
has been able to carry over some of his learned strategies from school at home.
The recommendation from the psychologist was for 5 days a week of specially designed
instruction or a one on one developmental therapist for in classroom support. CDS has stated that they
will not be providing services for Jason but will have a transitional meeting with the public schools to
ensure he will have supports entering kindergarten. This is something that mom is not comfortable
with and feels that Jason should start receiving services immediately and throughout the summer. Mom
is following through with further diagnostic testing at Maine Pediatrics to see where or if Jason falls on
the Autism Spectrum. With the help of the classroom teacher (myself) and the case manager, we have
encouraged mom to call CDS and ask why Jason cannot receive any services currently. The hopeful
outcome is that Jason will be able to receive the specially designed instruction for the rest of the year
and throughout the summer.
Recommendations for addressing continuing/future needs:
It is my recommendation that Jason continues at the school where he is for the rest of the
school year preferably with assistance from a developmental therapist who can help with social thinking
and monitoring his behaviors and social interactions with peers.
Even more so I would strongly recommend that Jason enroll into a summer program so as not to
loose any of his strategies that he has learned and been able to apply. This could be done by either
getting into a CDS special purpose program for the summer, either at Northstar or Childrens Odyssey in
Portland. If this is not possible then it would be best that Jason and his mom find a play or support
group for children on the spectrum so he can maintain and practice his social behaviors. The case
manager and CPP will continue throughout the summer until school starts.