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Family Case Study

ETE 324
Jones Family

Marie Berlinger
Margaret O’Mahony
Samantha Safran
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I. Background Information

Our case study was done on the Jones family. For the sake of this study, we will name the

child, Mark. Mark was born in China in 2013 with a cleft lip and palate. After he was born,

Mark lived in an orphanage until his new parents adopted him at twenty two months. Mrs. Jones

explained that his cleft lip was incorrectly repaired in China when he was five months. The

Jones family wanted to bring Mark home right away; however, he had a hernia in his scrotum

area, causing his intestines to poke downward. This was not something placed in any of his

records. The Jones family had to wait until this operation was completed before bringing him to

their home in America. Mr. and Mrs. Jones have three other children: a 17 year old girl, a 12

year old girl, and an 8 year old boy. Mark’s transition into the family was “difficult but well

prepared for”. He was officially brought home February of 2015.

By June of 2015, Mark had his first cleft palate surgery to correct the damage done by the

doctors in China. This surgery normally would take place when a baby is still in the hospital

after birth. However, Mrs. Jones explained that it is not unheard of to fix a cleft palate at the age

of two in China. By the fall of 2015, Mark started early intervention. Mrs. Jones realized that

Mark would go into a coughing fit for five minutes after each swallow of his bottle. This

terrified her, so she immediately began speech therapy to try and find the problem. He was way

behind on eating solid food and refused to talk at all by the age of three. Mark’s speech therapist

reassured Mrs. Jones that this was merely a matter of “catching him up” since Mark was

malnourished and had the added difficulty of the cleft palate. The speech therapist did not end up

doing a swallow study because Mark ending up catching up on his own by the age of three.
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Mark’s Early Intervention began with developmental screening, and he qualified for once

a month developmental therapy where they came to his house. Mrs. Jones explained that she

was very impressed with the Early Intervention since they continuously prepared Mark for the

age of three when he would “age out” of the program. He transitioned really well into his new,

preschool system, but continued to get speech therapy. In 2016, Mark went to Riverview where

he received an hour of speech therapy twice a week. Mrs. Jones did not like this therapist since

he would never communicate with her about Mark’s progress. In the summer, Mrs. Jones did

not want to completely stop Mark’s speech therapy for three months since it was still very

difficult to understand him. So, the school gave him summer speech therapy half hour a week for

six weeks. It was not a lot, but it was better than nothing. By the end of 2016, Mark was doing

much better. However, Mark has had ear tubes ever since he was a child to help him hear and

understand people. In 2016, he had his tubes replaced for the first time, and then it happened

again this past September. Mrs. Jones was just told that the average ear tube length is six to

eight months. A child with a cleft palate tends to need them changed more often than most kids

since there is so much the palate is involved with in the body.

Currently, Mark is four and a half and just started school at Germantown Hills Early

Childhood Preschool. Mrs. Jones likes that speech therapist much better even though Mark is

only the second or third child with a cleft palate he has ever worked with. Mark rides the bus to

and from school on his own. He is very independent, strong, coordinated, and athletic. When

Mark plays, imagination is a new concept to him. He still refuses to play with other children, but

he really enjoys playing with adults. He is growing at a rapid rate and is a very sweet little boy.
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II. Data, Analysis, Interpretation, Conclusion

Our team struggled the most in this area because it was difficult to successfully collect a

significant amount of data without actually being present for observations. Most of our data was

collected during a two hour meeting Marie was able to have with Mark and his mother. During

the meeting, she was able to observe and participate in two activities with Mark. However,

because of Mark’s behavior during their visit time, his mother requested that no more visits take

place. Therefore, we had to respect her wishes and receive any additional information as best we

could via email. His mother said that due to the fact that he transitioned so quickly from Early

Intervention they never filled out an IEP because it was already done for them when he moved

on to the next program. Therefore, Dr. Lee and Marie worked together on filling out an IEP

document during our last class. The most interesting form of data we collected was from the

activities done during the visit. Mark was extremely difficult to understand and it was very clear

why he was in speech therapy. However, it was also very clear to Marie that he is a very

intelligent boy. Mark’s mother said that he plays very well with adults and on his own, but has

great difficulty socially interacting with other children including his siblings.

Type of data Date collected How and Where Who

Interview 10/17/17 via email Between Marie and

Mark’s mother

Original meeting with 11/15/17 Mark’s house Marie

child and mother

Observation 11/15/17 Mark’s house Marie

IEP information 11/17, 11/21 via email Between Marie and

Mark’s mother

IEP document 11/28/17 In class Marie and Dr. Lee

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III. Analysis of the data by developmental domains

Mark needs the most work in his social emotional development, language linguistic, and

behavior. He has difficulty interacting with others his age and while he can form an idea he

cannot clearly articulate it. He does not respond well to new people or environments which was

the main reason we were unable to continue visiting with him to complete this project. During

the visit, he acted out even so much as climbing on top of the stove, ripping Marie’s keyboard

cover, and nearly ripping her earrings right out from her ears. He is not yet aware of how to act

appropriately in his environment and it is clear that the mother has a hard time controlling him.

He seems to have no motor development delays except for speaking because it is extremely

difficult to understand the words he is saying. Overall, he is extremely intelligent but needs

further development as he is a little behind social-emotionally and physically when speaking.

I believe based on our studies that his behavior will improve over time as he becomes exposed to

more and more discipline.

IV. Description of Interventions

Mark received speech therapy both in school and during the summer. The only

interventions we became aware of are the therapy he receives but we were unable to get specifics

on materials or techniques used during therapy. He currently receives therapy at his new

preschool and they are working on his social skills with other classmates as well. They are

currently struggling with several professionals that Mark is supposed to see as they have not

returned her phone calls or refuse to meet more than once a year. Mark is currently struggling

with his speech we believe due to the fact that his ear tubes need to be changed. Hearing is a
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crucial part to Mark’s speech success and without being able to hear properly the speech therapy

and interventions will not benefit him. At home, Mark needs a lot of behavioral intervention.

From our observations, it is clear that Mark does not know how to control his behavior, words, or

actions in any way and when disciplined, he often acts out more.

V. Procedure for the first activity

1. Mark was asked to play “Doctor” with Marie. His language was observed as well as his

ability to communicate in other aspects.

2. Mark was expected to talk, use his hands, ask questions, and speak well enough to hold a

conversation.

3. Mark was able to say words such as: doctor, hurt, help, fix, band aid, and ear. He also,

surprisingly, used very large vocabulary in incomplete sentences such as: CT, infection,

ear tube, skeleton, X-ray, reaction, medicine, appointment, and “overnight stay”.

Procedure for the second activity

1. Mark was expected to sit still in a chair.

2. He was asked to use his hand coordination to take stickers off a sheet and place them on a

blank piece of paper.

3. Mark correctly pealed the stickers off, although he refused to use big stickers. He found

it comforting to peal the smallest stickers possible off the sheet so there was a challenge.

4. In the end, Mark completed a beautiful picture of stickers which we put on his fridge.
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VI. Progress the child has made

Mark’s mother told us that she is very pleased with her child’s progress since he began

receiving intervention services. She sees progress and is happy with his transition from early

intervention to school. Mark used to be behind on eating solid food and has had difficulty

swallowing. Today, he has caught up and can eat solid food without a problem. Mark

transitioned really well into the school system. Every sound to him is brand new, however, he

figured out how to say vowel sounds on his own and he is able to do nasal sounds like “n” and

“m”. All of the other sounds, like p and b, are too hard for him since they have to build up air

pressure. Since the air pressure goes out the nose, he cannot do that with his cleft palate. They

think he is functioning well enough because they can get him to make a pretty good p sound.

This school year, Mark’s mother had a meeting to update his IEP goals. He is usually able to

meet one or two of them. Mark also rides the bus to and from school on his own and is starting to

use his imagination during play. Although it seems to be going rather slow, Mark is continuing to

make progress and has transitioned out of the early intervention program.

VII. Summarization of Report

Overall, Mark has had a bit of a rough start to life but we have learned that he is a strong

intelligent boy who through therapy and continued learning will be just fine. He is very lucky to

have a mother who is very eager to stay involved in the services he is receiving. Speech therapy

has helped Mark a great deal already and with continued therapy he will do well in school. The

data we collected, mostly through interviewing Mrs. Jones shows that Mark has made great

progress and that therapy has been greatly beneficial to his development. Even though she is not
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pleased with many of the professionals, she is pleased with the progress she has recently seen in

her son. Based off of Marie’s observations, Mark was really hard to understand and it was clear

as to why he was in speech therapy. Mark needs improvement most on his social emotional

development and based on what we have learned in class, we have concluded that these

improvements take time but should certainly happen now that he is in school. From the

interview with Mark’s mother, we were able to analyze our data and have our questions

answered. The most interesting parts to this study was connecting what we learned in class to

the data we collected from Mrs. Jones about Mark’s development.

VIII. Recommendation and Planning Matrix

Objective 1: Clarity of Objective 2: Objective 3: Classroom

Speech Developmental Achievement
Behaviors

Arrival Acknowledgement and Polite manners Hang up coat

audible greeting ● Mark will Interact Sit on the carpet
● Mark will say hello and greet his ● Teacher will tell
to the teacher fellow students Mark to hang up
● Teacher will prompt ● Teacher will his coat and sit on
Mark to greet others prompt Mark to the carpet
greet other
students

Free play Choice of game Ability to play with Mark will play the games
● Mark will use words someone set out for the students
to participate ● Communication ● Follow the rules
● Explain to teachers ● Sharing ● Get along
where he wants to ● Understanding ● Teacher will
play ● Teacher will tell explain the rules of
● Teacher will ask Mark the rules of the game to Mark
Mark where he communication
would like to play and sharing when
playing.

Clean Up Mark will ask where items ● Following Working efficiently

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belong directions ● Teacher will

● Mark will sing the ● Team cooperation observe Mark to
clean up song with and positive assess if he is
the other students attitude working efficiently
● Teacher will prompt ● Teacher will
Mark to help clean instruct Mark to
up follow the
directions

Outside Play Interactive speech Understanding right vs. Active play

Teacher will encourage wrong Teacher will arrange the
Mark to play with his peers Teacher will observe to environment in a way that
see that Mark is doing the is inviting.
right thing.

Closing Circle Clear choice of words Clapping Mark will learn how to
● Mark will properly Stomping transition well to and from
say goodbye Singing the school setting
● Sing the goodbye Teacher will make sure Teacher will create a
song with peers that Mark is clapping, transition observe Mark
● Teacher will tell stomping, and singing throughout the school year
Mark to say
goodbye to his peers

We created this matrix based on Mark’s IEP goals and objectives to be embedded at a school

setting. The goals are as follows:

1. Classroom behavior

2. Developmental behavior and milestones

3. Academic Behavior

4. Specific Speech sounds

Description:​In the classroom, the teacher will prompt Mark in order to get him to interact with

the other students. This is important because collaboration is a vital part of learning in the early

years. We also explained in this matrix that the teacher will demonstrate to Mark the ways in

which he should behave inside and outside of the classroom. The teacher prompting Mark is
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especially important for him because he is behind in socio-emotional development and does not

naturally interact with others inside the classroom. This is especially important in Mark’s case,

since this is something that he has trouble with. Mark will be told the procedures that he must

follow and the ways in which he should participate in the classroom. It is important for children

to be given clear instructions so that they know what is being asked of them. The teacher will

observe Mark in order to see if he is following the rules and behaving in an appropriate way.

Behavior management and rule following are both things that are crucial to his development.

Recommendations:​When looking at Mark’s IEP goals, we constructed the best matrix possible

to try and fit his individual needs and the wants of his mother. From our interview, we

discovered that Mrs. Jones was not as involved in the therapy sessions and writing Mark’s IEP as

she should have been. Mrs. Jones’ personal worries were not being met, and she did not even

feel like she contributed to her son’s IEP document or goals at first. Through this matrix, we

constructed (with Mrs. Jones) a set schedule and plan for seeing improvement in Mark’s

behavior, academic achievement, and speech. In the future, we would recommend involving

Mrs. Jones and more regular updates on Mark’s progress.

IX. IEP (Document Attached to the Case Study)

Regular IEP was completed by IEP team, which normally includes parents, at least two

teachers, doctors, and professionals. In Mark’s case, his mother did not even know she was

supposed to be involved in the process when we talked to her. She said, “since he was

transitioning from early intervention, I assumed they got all the paperwork for that instead. So I
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didn’t fill anything out. Was I supposed to?” Seeing all the work our team put into creating our

own version of Mark’s IEP, I cannot imagine why Mrs. Jones was not involved.

Mrs. Jones explained that for this school year she is preparing for her first meeting to

update Mark’s IEP and update his goals. Some goals they are going to focus more on are his

behavior and his specific speech goals. He needs to be a certain percent understandable and

focus on certain sounds which he cannot pronounce. Overall, Mrs. Jones thinks the school could

do more therapy but she is generally happy with Mark’s current programs. She says that she sees

significant progress.

X. Record of Observations

Introductory Meeting and Observations (November 15, 2017)

For the first meeting, Marie went to Mrs. Jones’ house for the initial interview. She met with

Mark and observed his behavior. Mark became extremely energetic and began to run around the

room in a crazy manner due to all the excitement. During the interview, Mark climbed onto the

stove and began to open all the cabinets in the kitchen. He grabbed Marie’s computer cover and

ripped it in half. Then, Mark began to run around the room asking for someone to play with him.

This behavior caused the interview to take over an hour and a half.

Discussion of Therapy (November 16, 2017)

In an email, Mrs. Jones explained that Mark’s speech therapy is going well, but she does not like

the professionals since they do not include her in the discussions. When it comes to his cleft

palate specialists, Mrs. Jones does not appreciate the fact that they will only meet with him once

a year to see the plastic surgeon. She explained that they were supposed to call two months ago
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and they have not responded. Mark has recently been pointing to his left ear and saying, “my ear

my ear”. This is normally what happens when Mark needs his ear tubes replaced, but her regular

specialist will not see him. Mrs. Jones is about to take Mark to Chicago to see a different

specialist. “If he cannot hear correctly, his speech therapy is pointless.”

2 Activities Observed (November 15, 2017)

For the first activity where Mark was asked to play “make believe doctor”, he was able to

communicate with Marie, use interactive speech and active play, focus his thoughts to the one

activity, and respond with a large vocabulary even though it was unclear. Mark asked Marie if

her ear tubes hurt and if she needed a CT scan. The fact that Mark knows large words such as

this is proof that he is not developmentally behind. He simply has difficulty with certain speech

sounds. For the second activity, Mark was given tiny stickers to place on a piece of white paper.

He used his fine motor skills to carefully peel the small stickers and create his own masterpiece.

By the end of the activity, Mark was able to completely calm his nerves and focus on the project.

XI. Interview

Question: “Could you tell us about your child?”

● born in china with a cleft lip and palate

● lived in an orphanage for one month

● they adopted him at twenty two months

● they repaired his lip at five months in china

● he had has a hernia in the scrotum area intestines were poking down

● they didn’t put it in his record anywhere

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● brought him home February 2015

● in June 2015 was his first palate surgery in America

Question: How old is he?

● 4 and a half

​Question: physical characteristics?

● Brown eyes

● Chinese

● Male

Question: how many siblings does he have?

● 3 siblings

● 17 year old girl

● 12 year old girl

● 8 year old boy

Question: Special need?

● Cleft lip and palate, reading disability, speech disability, ear tubes

Question: “Could you tell us about how you felt as a family when you found out about Mark’s

special need?”

● We knew when we adopted him. We were very confused about the faulty surgery on his

lip and about the speech problem.

Question: If the parent doesn’t volunteer information freely, ask them to tell you about the

services they received, and to what extent they participated in the decision-making of the

program services. “How were you involved in the early intervention program?”
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● they started early intervention right when he got home from China

● they started speech therapy immediately and worried about his swallowing cause he

would cough for five minutes after each bottle

● so they started speech therapy

● he was way behind on eating solid food

● it was a matter of catching him up

● they didn’t do a swallow study because he caught up on his own

● he was malnourished so that’s why

● early intervention followed him for feeding therapy and developmental screening

● he qualified for once a month developmental therapy where they came to the house

● once he had the palate surgery in june the doctor wanted to give him time to heal before

speech

● March 2016, when he turned 3, he aged out of early intervention

● He transitioned really well into the school system

Question: “Were there other families involved and if so how?”

● No. They just came to our house so no one else was involved.

Question: “Could you tell us about the program Johnny is in right now and what types of

services he is receiving at that?”

● 2016 he went to Riverview where he kept getting speech twice a week

● a total of an hour a week
● she didn’t hear anything from that speech therapist
● independence he was ahead on and other things he was behind on
● he’s very strong, coordinated and athletic
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● the school gave him summer speech therapy half hour a week for six weeks and then
you’re done
● with his surgery he didn’t have time for anything else
● fall of 2016 he started at Germantown hills early childhood preschool
● that speech therapist is a lot better
● Mark is only the second or third cleft palate child the teacher has ever had
● He rides the bus too and from school
​Question: “How is he doing with his specialists?”
● For his cleft palate the specialists want to see him once a year Dr. allowed a plastic
surgeon
● but they haven’t called her yet so she is about to give up on them
● Mrs. Jones is going to take him to Chicago
● every sound to him is brand new
● the vowels he figured out on his own
● any nasal sounds like n and m he can do
● but all the other sounds are too hard like p and b since they have to build up air pressure
since it goes out the nose and with his cleft palate he can’t do that
● they think his is function well enough because they can get him to make a pretty good p
sound
● he’s recently been pointing to his left ear and saying my ear my ear
● She thinks it hurts him
● so she called the specialist and they wouldn’t see him
● so if he doesn’t hear right then his speech therapy won’t work
Question: What other surgeries has he had?
● He had his ear tubes replaced in 2016
● They have to do it again this past September
● Average ear tube length is six to eight months
● A child with a cleft palate tends to need them more often than most kids
Question: Does he have an IEP filed out?
● Yes. But I was not involved. Should i have been?
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Question:What are some of Kai’s IEP goals?

● general classroom behavior goals

● developmental and academic goals

● specific speech goals a certain percent understandable and certain sound she is working
on
● he usually meets one or two of them
● the process is really super slow
Question: What would you say are Kai’s strengths?

● Energetic

● Enthusiastic

● Uses Imagination

● Loves doctors

Question: So in all, do you think there is real progress with his current program and the

activities he is doing?

● she thinks the school could do more therapy but overall she is happy with his current
programs
● She sees progress and she was super happy with the transition from early intervention to
school

XII. Meeting Log

Date Where What Who

9/19/17 In class Interview questions, Marie, Maggie,

researched cleft Samantha
palate, distributed
roles of the group

9/24 via email Contacted family Marie

9/26 In class Went over emails, set Marie, Maggie, and

up interview time Samantha
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with family

10/13-11/15/17 via email Introductions, Marie

meeting dates

10/24 In class Went over interview Maggie, Dr. Lee

questions, continued
creating a plan based
on circumstances of
situation

11/7/17 In class Decided on emailing Marie, Maggie,

interview as Samantha
scheduling a meeting
was becoming too
difficult and running
out of time

11/15/17 Jones house Original meeting with Marie

child and mother

11/15/17 Jones house Observation Marie

11/17, 11/21 via email IEP information Between Marie and

Mrs. Jones

11/28/17 In class IEP document Marie and Dr. Lee

11/30/17 via google doc Report Marie and Maggie

12/3/17 via google doc Report Marie and Maggie

12/4/17 Outside of class Report Marie and Maggie

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