For the Abe Family

Created on: 05/20/19

Review Due: 11/20/19

Created by: Deja Witte, Brenna Bushman, Karoly Despain, Megan Smith

FAMILY INTRODUCTION

The Abe Family lives in Spokane, Washington. Fa Lin is a 25-year-old who married Yao who is

28 years old. The Abe family lives with the husband’s parents who own a Japanese Restaurant.

Yao’s family immigrated from Yokohama, Japan to Spokane, Washington when Yao was 15

years old. Yao has worked with his family restaurant for 8 years. Although Yao has cooked for

many years he does not particularly like it, he enjoys fixing things and using his hands. His wife

grew up in Seattle, Washington. Her grandparents immigrated from Kobe, Japan. Her family

owns a flower shop. She enjoys working and caring for plants and flowers. They like to garden

together and cook with their own food. They do not currently practice a religion. Their first child,

Mulan was born at the Sacred Heart Children's Hospital in Spokane, Washington. She was born

with a cleft lip and heart defects. Mulan was diagnosed with Down Syndrome. The family is

concerned about her development as she has not met developmental milestones. She

contracted RSV (Respiratory Syncytial Virus) which weakened her heart, and her parents are

concerned about the long term effects of her heart condition. They are unsure how Down

Syndrome will affect their child and are concerned about how much she will be able to do for

herself.
FAMILY STRENGTHS

The parents are affectionate and supportive of their child and her needs. The mother stays at

home to care for Mulan, while the father works full time for a construction company. Mulan is a

happy, energetic child who is very curious about her environment. The family enjoys going to

the park together. The family lives close to supportive parents on both the mother and father’s

side. The Abe family has the ability to effectively communicate with one another which helps

resolve conflict when issues arise.

Formal

The parents are worried about Mulan’s functions pertaining to her mouth. They are worried that

the baby will not be able to develop communication and swallowing at the correct rate. Since

this is an important life function they want to address how to help there daughter develop with

swallowing and breathing.

The parents are worried about Mulan's motor skills they are worried Mulan will not be able to

develop at the normal rate. They are mainly concerned Mulan will not be able to care for herself

or perform important life movements when she gets older.

Informal

The family is concerned about how Mulan’s disabilities will affect her and their family. They are

unsure how Down Syndrome will affect her ability to care for herself, and how much care the

family will need to provide as she grows older. The family is worried about meeting their

emotional and childcare needs, they’d like support from others that can relate to their situation.
 ● The family may benefit from support groups related to parenting children with Down

Syndrome. Connecting with other parents in similar situations may give the family

opportunities to discuss concerns and receive support.

● The family may benefit from having additional child care options. Since they do not have

familial support in Seattle, additional child care may ease concerns about providing care.

Informational

The parents are concerned that they do not have enough information about Down Syndrome.

They would like to learn more so they can better help their child. The family may benefit from an

informational text about babies with Down Syndrome for example, ​Babies with Down Syndrome:

A New Parents' Guide ​by, Susan Skallerup​.

The parents are concerned that they will not have the information to know if Mulan is developing

at the rate that she should. They are concerned that they will not know the areas of concern for

their child to work on with professionals. The family may benefit from the CDC’s milestone app

on their phones.

Material

The parents are concerned about the cost of all the treatments and needs that Mulan will need

after she is born. Where they do not have a large income they are worried that they may not be

able to pay for all the care that she will need.
 ● The parents apply for Medicaid to assist with medical bills that are accruing for the

pregnancy and as well as the ones to come after Mulan is born.

The parents are concerned that Mulan’s legs will not have enough leg strength to help her walk

later. They want to be able to find something that they can use at home to help her.

● They want to purchase a device or toy that they can use at home that help her gain leg

strength.

INFORMAL SUPPORT

First Family Concern/Priority:​ The family is concerned about how Down Syndrome will affect

Mulan’s development and what the family will need to do as she grows older. The family is

worried about meeting their emotional and would like support from others that can relate to their

situation.

Current Resource/Information:​ Down Syndrome Community of Puget Sound

https://downsyndromecommunity.org/

Outcome:​ The family could receive support from other parents of children with Down

Syndrome, who are in a unique position to understand and meet their needs for information and

support.

Suggested Action:​ Fa Lin and Yao can contact the support group by either email or phone to

receive more information on meeting times for the First Call Program.
Resource Type and Name:​ Community, Parental Support Group

Contact Information:

4616 25th Ave. NE, Box 321, Seattle, WA 98105

DSC Helpline: (206) 257-7191

Fax: (206) 257-7191

contact@downsyndromecommunity.org

Program information: ​The First Call Outreach Program is designed for parents who have just

received a Down Syndrome diagnosis. They provide up-to-date information about Down

Syndrome and connect parents with resources, including a parent mentor if desired. The

opportunity to speak with other parents who have experienced what similar situations can be

invaluable.

Policy Information: ​An annual family membership is $25.00 or an individual membership is

$15.00

Applications and Handouts:

● To receive a New Parent Packet, please call 206-257-7191 or email

newparent@downsyndromecommunity.org​.

● To join, complete the application at

https://interland3.donorperfect.net/weblink/weblink.aspx?name=E204316&id=49​.
Rationale: ​The Down Syndrome Community of Pungent Sound is located in Seattle, WA. They

have several programs including The First Call Outreach Program. The First Call program is for

new parents who just learned their child has Down Syndrome. You can receive more

information, support from other parents, speak with a parent mentor, and meet with other

families.

Second Family Concern/Priority:​ The family is concerned about how much care they will need

to provide for Mulan, as she grows older. The family is worried about meeting their childcare

needs, as they may need additional help caring for Mulan and they do not have familial support

in the Seattle area.

Current Resource/Information:​ The Northwest Center: Kids at Chinook.

https://www.nwcenter.org/kids.html

Outcome:​ The family can receive childcare services in Seattle when Mulan is at least 6 weeks

of age.

Suggested Action:​ Fa Lin and Yao can contact Lavina McClam at The Northwest Center by

phone to enroll Mulan in childcare services.

Resource Type and Name:​ Community, Child Care Services

Contact Information:

401 5th Avenue​, Seattle, WA 98104

Lavina McClam: 206-286-2390 (phone)

206-764-8971 (fax)

Program information: ​The Northwest Center: Kids at Chinook is an inclusive childcare

program that cares for children who have disabilities from 6 weeks to 5 years of age. Their

curriculum is play-based and founded on research. Mulan would interact with her peers who do

and do not have disabilities and explore an engaging environment.

Policy Information:

● Initial Enrollment Fee: $100 per child

● Annual Registration Fee: $50 per child

Applications and Handouts:

● To enroll:​ ​https://www.nwcenter.org/enrollment-chinook-early-learning.html

● Childcare Tuition:

https://www.nwcenter.org/uploads/5/7/8/7/5787469/chtuition_rates_9_2018__1_.pdf

Rationale: ​The Northwest Center: Kids at Chinook is a childcare center in Seattle, WA. They

care for children who have disabilities from 6 weeks to 5 years of age. Their curriculum is

play-based and founded on research. Mulan would interact with her peers who do and do not

have disabilities and explore an engaging environment.

FORMAL SUPPORT
First Family Concern/Priority:

The parents are concerned about Mulan's motor development and her future adaptive skills.

They would like information on how to work on these skills with Mulan

Current Resource/Information:​ The parents know about occupational therapy since the wife

has a grandmother current attending occupational therapy for her fine motor hand movements.

She has sat in on a few of her sessions and had the opportunity to watch what occupational

therapists do. The parents spoke to him about possibly giving services to their daughter but he

said he specializes in older adults. The parents want an occupational therapist which

specializes in children.

Outcome: ​Mulan will be provided with services that allow her to start working important motor

skills such as crawling and gripping.

Suggested Action: ​The parents need to speak with Mulan’s pediatrician and have them refer

them to occupational therapy. Once referred the child will be given appointments to come to the

hospital and attended therapy session that will work on gripping and staring at objects..

Resource Type and Name:​ This is a State (since the family is on Medicaid the state will be

funding the expenses) / Seattle Children’s Hospital

Contact Information:

o ​ ​206-987-2113

o ​4800 Sand Point Way NE, Seattle, WA 98105

Program information: ​This is a state resource funded by the state and donors that provides

health care to the children. Ranked as one of the top ten children's hospitals it provides top

quality care for children with a variety of health concerns. It has a department that focuses

solely on Speech Pathology for children.

Policy Information: ​Scheduling Center hours are Monday through Friday, 7 a.m. to 6 p.m., and

Saturday, 9 a.m. to 1 p.m. Urgent Care offers online or phone scheduling. Occupational

Therapy must have a referral before they will be allowed to set an appointment.

Applications/Forms: ​There is no application or form to fill out. This will be done through there

pediatrician, who can go to this website for instructions to the referral process

https://www.seattlechildrens.org/healthcare-professionals/access-services/ambulatory-s

ervices/clinic-referrals/clinic-referral-information/​.

Pamphlets/Handouts: ​A handout could not be found online but this webpage is a visitor’s

guide to the Hospital and this website contains any need information.

https://www.seattlechildrens.org/utility/search-results/?q=japanese&Search=Search

Rationale: ​The Seattle’s Children Hospital is focused on children and will be able to meet the

needs of young Mulan with top quality care. This hospital is not only located in Seattle but also a

variety of location in the city. Not only do they offer top quality services like occupational therapy

but also they offer a wide variety of services. For example, they offer a speech therapist, which

is another service that Mulan will benefit from.

Second Family Concern/Priority:

Current Resource/Information: ​The parents know about Speech Therapy since the husband

met with a speech pathologist at the high school once a week since he was struggling to speak

English correctly. The parents want to find these services again to help their daughter with

swallowing and eating.

Outcome:​ Mulan will be provided with services that allow her to start working important mouth

function such as swallowing.

Suggested Action:​ Speak with Mulan’s pediatrician and speak with them to have them refer

them to speech therapy. From there the child will be given appointments to come to the hospital

and attended therapy session that will work on swallowing and important mouth movements.

Resource Type and Name: ​This is a State (since the family is on Medicaid the state will be

funding the expenses) / Seattle Children’s Hospital

Contact Information:

o ​206-987-2104 (Speech Therapy Admissions)

o ​4800 Sand Point Way NE, Seattle, WA 98105

Program information: ​This is a state resource funded by the state and donors that provides

health care to the children. Ranked as one of the top ten children's hospitals it provides top
quality care for children with a variety of health concerns. It has a department that focuses

solely on Speech Pathology for children.

Policy Information: ​Scheduling Center hours are Monday through Friday, 7 a.m. to 6 p.m., and

Saturday, 9 a.m. to 1 p.m. Urgent Care offers online or phone scheduling. Speech Therapy

must have a referral before they will be allowed to set an appointment.

Applications/Forms: ​There is no application or form to fill out. This will be done through there

pediatrician, who can go to this website for instructions to the referral process

https://www.seattlechildrens.org/healthcare-professionals/access-services/ambulatory-services/

clinic-referrals/clinic-referral-information/​.

Pamphlets/Handouts:​ A handout could not be found online but this webpage is a visitor’s

guide to the Hospital and this website contains any need information.

https://www.seattlechildrens.org/utility/search-results/?q=japanese&Search=Search

Rationale: ​The Seattle’s Children Hospital is focused on children and will be able to meet the

needs of young Mulan with top quality care. Being ranked as one of the top ten children’s

hospital. This hospital is not only located in Seattle but also a variety of locations in the city

making the hospital very accessible. Not only do they offer top quality services like speech

therapy but also they offer a wide variety of services. For example, they offer occupational

therapy that is another service that Mulan will benefit from.

INFORMATION SUPPORT
First Family Concern/Priority:​ The parents are concerned that they do not have enough

information about Down syndrome. They would like to learn more so they can better help their

child. The family may benefit from an informational text about babies with Down syndrome

Current Resource/Information:​ The family currently has the information that the doctors have

given them. They have looked up Down Syndrome on the internet but they are not sure if it is a

reliable resource.

Outcome:​ The family will learn vital information about their child's disability. They will learn how

to best prepare for the arrival of their daughter, and for the challenges that face them during her

infancy.

Suggested Action: ​The parents will sign up for an Amazon subscription or go to Barnes and

Nobles to by the book Babies with Down Syndrome: A New Parents’ Guide by Susan Skallerup.

The link is provided below.

Resource Type and Name:​ Private, Informational Books, ​Babies with Down Syndrome: A New

Parents' Guide ​by, Susan Skallerup​.

Contact Information:​ The parents can find this book on Amazon, at Barnes and Nobles, and

on the Kindle.

https://www.amazon.com/Babies-Down-Syndrome-Parents-Guide-ebook/dp/B00A8LMCUW

Book information:

2009 IPPY Award Winner: Silver Medalist, Parenting/Family category

BABIES WITH DOWN SYNDROME, the trustworthy guide which has benefited thousands of

families since it was first published in 1985, is completely revised and updated in a new, third

edition. Covering the best practices for raising and caring for children with Down Syndrome

through age five, this book is invaluable to new parents who have welcomed a baby with Down

Syndrome into their lives.

This new edition incorporates the latest scientific, medical, educational research, and practical

information available, as well as parents’ suggestions and feedback. Existing chapters have

been revised, some completely rewritten by new authors, and in keeping with its parent-friendly

reputation, most of the book’s contributors are parents of children with Down Syndrome.

Policy Information:

The book is 11.22 on the kindle and hard copy paperback book. The book is more money at

Barnes and Nobles. The family will need an account on Amazon to by this book. If they do not

have one, it just asks for their name, email and password it does not cost money as long as it is

not Amazon Prime.

Applications and Handouts:

There is no application the family will just have to order the book or buy it. The family can use

this link to order the book,

https://www.barnesandnoble.com/w/babies-with-down-syndrome-susan-skallerup/1013616090

Rationale: ​This book will help the parents learn more Information about Down syndrome. They

will get the information they need to help Mulan and what they should expect from her. This best
is a great resource for new parents and will help them through the hard times and the good

times of their child's infancy.

Second Family Concern/Priority:​ The parents are concerned that they will not have the

information to know if Mulan is developing at the rate that she should. They are concerned that

they will not know the areas of concern for their child to work on with professionals.

Current Resource/Information:​ The parents have the child's doctor but they do not visit him

enough to get the information they want of the development of their child. They do not have a

ton of information on the typical development of a child.

Outcome:​ The parents will be able to independently assess their child's development. Using

this app will help parents decipher what Mulan needs to work on or what her next step is in her

development.

Suggested Action:​ The parents should download the CDC app on their smartphone and fill out

the milestones that Mulan has hit.

Resource Type and Name:​ Federal, CDC’s Milestone Tracker.

Contact Information:​ This is the Website for the app,

https://www.cdc.gov/mobile/mobileapp.html​.

The parents can also look it up on their phones by typing in the name, CDC milestone tracker.
Program information:

“Download CDC’s new parent-friendly app,​ ​Milestone Tracker​, to track your child’s

developmental milestones from age 2 months to 5 years! Photos and videos in this app illustrate

each milestone and make tracking them for your child easy and fun. Get a summary of your

child’s milestones; view tips and activities to support your child’s development; and find out what

to do if you ever have a developmental concern.”

Policy Information:

The app is free all the parents will need is a smart phone to get this app.

Applications and Handouts:

There is no application to get the app.

Rationale:

The parents will gain independence when they know how well Mulan is developing. The App

give them tips on how to help Mulan, and they will know the areas that Mulan needs help. This

app will help the parents feel more comfortable to advocate for their child because they will

know exactly what she needs.

MATERIAL SUPPORT

First Family Concern/Priority:

The Abe family is concerned about the cost of all the services and hospital bills and their small

income. They are worried that they will not have enough income to cover the needs of their

daughter after she was born.

Current Resource/Information:

We suggested to the family that with their income level they need to apply for Apple Health.

https://www.hca.wa.gov

Outcome:

The Abe family will be able to have the proper medical support and needs for Mulan.

Suggested Action:

File for medical assistance.

Resource Type and Name:

Federal, Apple Health; Medicaid

Contact Information:

Medical Eligibility Determination Services (MEDS)

(MAGI Medicaid program)

Phone: 1-800-562-3022

Email: ​askmagi@hca.wa.gov

Mailing address:

PO Box 45531

Olympia WA 98504

Program information:
This program provides coverage to pregnant women with countable income at or below the

Medicaid standard, without regard to citizenship or immigration status.

Once enrolled in Apple Health for Pregnant Women, you'll be covered for 60 days after your

pregnancy end date, plus whatever days are left during the month in which the 60-day period

ends. (So, for example, if your pregnancy ended June 10, your health care coverage would

continue through August 31).

This coverage will be in effect regardless of any change in your income, and you receive this

postpartum coverage regardless of how your pregnancy ends.

Your child may be eligible for Apple Health for Kids free or low-cost coverage (with a low

premium) if your income is at or below the Medicaid standard.

Policy Information:

For a two person family with a pregnant woman the income level is $2,790 monthly. For a three

person family income level is $3,822 for a child to have free coverage. For a $20 premium,

income level is $4,710, and $30 premium income level is $5,635.

Applications/Forms:

Online form​ ​https://www.wahealthplanfinder.org/

One provided in folder.

Pamphlets/Handouts:

About Washington Apple Health (Medicaid)

https://www.hca.wa.gov/assets/free-or-low-cost/about-Apple-Health.pdf

Rationale:

With the medical assistance from Washington Apple Health, they will be able to afford the

hospital/doctor bills throughout the pregnancy. It will also help cover the medical expenses and

aids/therapies the baby will need after she is born knowing she has Down Syndrome. Knowing

that Mulan already has a heart problem and Down Syndrome the cost of her care will be

expensive. With the coverage from Apple Health she will get all of the care she will need with a

smaller cost on the family.

Second Family Concern/Priority:

The family is concerned with the leg strength that Mulan currently has. She does not have the

strength that she will need in them to be able to walk later.

Current Resource/Information:

The family does not have any information on what a bouncer is.

Outcome:

Mulan should be able to gain leg strength that could be beneficial for her later in life.

Suggested Action:

Purchase a baby bouncer saucer.

Resource Type and Name:

Private, Craigslist;

https://seattle.craigslist.org/see/bab/d/renton-baby-bouncer-saucer/6877904520.html

Contact Information:

email through Craigslist ​233d9869925d3f16894d39062c99458d@sale.craigslist.org

Program information:

An online website where individuals can sell or purchase items.

Policy Information:

none

Applications/Forms:

none

Pamphlets/Handouts:

none

Rationale:

With the bouncer, Mulan could gain leg strength that will help her progress further in life. With

the bouncer Mulan will have a safe place to play and interact with some toys while she is able to

use her legs in a different way then she would be able to if she was just playing on the floor.
Please check one and sign below:

______​ I agree to the above stated plan

______​ I agree to the above stated plan with the following changes (see attached addendum

sheet)

______​ I do not agree to the above stated plan and refuse all services and supports

_________________________ __________________________

Parent/Legal Guardian print name Parent/Legal Guardian print name

_________________________ __________________________

Parent/Legal Guardian signature Date Parent/Legal Guardian signature Date

_________________________

Service Coordinator Signature Date

 Table of Contents

Page 1

● Family Introduction

● Family Strengths

● Concerns: Formal

Page 2

● Concerns: Informal

● Concerns: Informational

● Concerns: Material

Page 3 and 4

● Support: Informal

Parental Support Group

First Call Outreach Program

4616 25th Ave. NE, Box 321, Seattle, WA 98105

DSC Helpline: (206) 257-7191

contact@downsyndromecommunity.org

Childcare Services

The Northwest Center

401 5th Avenue, Seattle, WA 98104

Lavina McClam: 206-286-2390 (phone)

Page 5 to 7

● Support: Formal

Pages 8-10

● Support: Informational

○ https://www.amazon.com/Babies-Down-Syndrome-Parents-Guide-ebook/dp/B00

A8LMCUW

○ https://www.cdc.gov/mobile/mobileapp.html​.

● Support: Material

Medical Eligibility Determination Services (MEDS)

(MAGI Medicaid program)

Phone: 1-800-562-3022

Email: ​askmagi@hca.wa.gov

Mailing address:

PO Box 45531

Olympia WA 98504

Pages 10-13

● Support: Material

Craigslist ​233d9869925d3f16894d39062c99458d@sale.craigslist.org

● Agreement
Young Children (Elementary)

Mulan may be eligible for an IFSP (Individual Family Service Plan) until she is three years of

age. The service plan would identify the priorities that the Abe family has and resources that

Mulan could benefit from. Early childhood interventions and other services may then be

provided. When Mulan turns three, the Abe family may choose to continue her IFSP until she is

five years of age. At three, she may be eligible for an IEP (Individual Education Program)

instead that will outline academic goals and services that may benefit her. Mulan may attend a

preschool program that is designed for children who have special needs alongside peers who

do or not have special needs as well. When she enters Kindergarten, she may receive special

services or special education to help meet the goals outlined in her IEP.

Families with adolescents:

Mulan may be eligible for an IEP throughout middle school and high school. She will have the

opportunity to work with typical peers and other children with special needs. She could have the

opportunity to have an extended school year which means she could go to school for a couple

days a week during the summer. Most schools have after school programs for children with

special needs where they do fun activities with their typical peers. She can go to high school

until she is 21 years of age.

Launching Children
Mulan will be able to go into work programs after she finishes high school. There are programs

that work with those with disabilities that will help them enter into the workforce and some

assistance and supervision in some cases where there is a person job shadowing. When she is

able to hold a job she will be able to accomplish more goals for her. Depending on her abilities

and what she is able to do Mulan could live on her own or with some assistance.

Families in Late Middle Age

As Mulan ages she will be able to become more independent. It is important to remember that

every person is different, her family will need to evaluate Mulan to decide how dependant she

needs to be. She may need support from adults to help her in her every day adaptive skill and

she will need support to continue to teach her. Malun may be able to be married, this case she

can have children but she will have a higher rate for a miscarrige. If she does have children she

will need extra support in caring for the child. It is important Mulan continues to attend social

groups and perfect her skills. She should participate in activities that put her with those with and

without syndrome.

Families nearing the end of life

Over the years, the life expectancy has increased for adults with Down Syndrome. Just like any

adult, good nutrition, exercise, educational, and social opportunities are key for a lengthened

life. This is even more important for adults with down syndrome since are more prone to health

problems.. It will be important to monitor Mulan for Aleztimers since it can be harder to track

these diseases with those that have downs syndrome. Adults with down syndrome are at a

higher risk of depression, especially after the death of a parent. Mulan needs social supports to

help her understand the grieving process. There are support groups for parents of children with
Down Syndrome. These support groups can help the parents cope with their child nearing the

end of their life.