Helping a Family Suffering from Problematic Emotional Tension - Case Study Example

1 Action Summary on the EBL Scenario: Helping a Family Suffering from Problematic Emotional Tension Introduction The EBL scenario presented in this essay demonstrates a serious condition for a family passing through emotional tension owning to some factors that will be highlighted, discussed and properly handled in this essay. The main child at the centre of the storm is the 7-year-old Damien whose behavioural difficulties may have arisen owning to the prevailing situations around him. This essay looks at Damien’s problems by considering two interesting parts of Child Mental Health: namely, bio-psychosocial and environmental aspects. Using the appropriate assessment procedures, it is possible to design the right therapeutic cares for the boy in question (Damien) in the light of bio-psychosocial and environmental factors that have led him into his present behavioural problems. The action of each character in the EBL scenario will be analyzed to indicate how they the individual action has negatively impacted Damien’s problematic behaviour and possible solutions/care approaches are offered to help the whole family recover from their current dangerous circumstances. Bio-psychosocial and environmental aspects of child mental health are chosen because those are the areas where Damien’s problems are emerging from. 2 Facts obtained from CAMHS Assessments The following undeniable facts are garnered from the assessments carried out in the EBL scenario. Giving an outline of them in this essay will clearly reveal who needs what treatment of mental health care in order for the family to be helped out of their present predicament. 1. Damien: a 7-year-old at the centre of this storm; he exhibits dangerous violent behaviours at school and home; he misses his dead grandparents; he hates being separated from his elder brother Gary; he hates the constant argument between his dad, mum and Gary. 2. Gary: The first child of Damien’s mother born to another man; he suddenly turns to playing truant and drinking alcohol; he leaves the home he shares with Damien and his mother and step-father; he stops taking his alcoholic therapy. 3. Mrs Calvert: Damien’s mother; she has suffered depression several times-during postnatal and the lost of her parents; she is sometimes bullied by husband; she is distraught about the behaviors of her two sons. 4. Mr Calvert: A quiet man but he sometimes becomes violent and harass Damien’s mother and argues hotly with Damien’s half-brother when he didn’t go to school or drank alcohol. 5. Emily: Damien’s 3-year-old younger sister who neglects playing with Damien but only ticks to her dolls. 3 Some Drastic Actions Necessary to Help Calvert Family It has now become prevalent in the United Kingdom that children have been forced to show asocial violent behaviours due to their unlucky exposure to violence within their households. The research carried out by National Society for the Protection of Cruelty to Children, 78% of the violent attitudes that often make children to grow violent and exhibit behavioural problem often occur at home; hence, mothers are responsible for 49% of these cases while fathers account for 40% of the circumstances (Cawson, et al., 2000). It is clear that Damien’s emotional stress would have emanated from the uncomfortable situations caused by the constant outbursts and expressions of anger or tension he perceived between his father and mother or elder brother Gary. This observation points to the fact that Damien’s troubles did not arise from school bullies or other sources, but right from his home. Professionals and experts on Child Mental Health and Children Nursing believe that this consequently leads bio-psychosocial and family environmental problems that produce inconvenienced feelings in children and make them lose their bearings emotionally as they confront situations that seem to be bigger than what they could personally handle. This family cause-and-effect model is generally believed to produce constant emotional trauma in the affected child or children as long as he or they continue to live in such environments where the situations have not improved, or their expectations for normalized relationships have been perpetually dashed (Stern, 2008). 4 Many homes are becoming emotionally traumatized day by day parents find themselves in a dire situation that they could not control their own feelings based on the loss of their loved ones, as in the case of Damien’s mother grieving over her deceased parents; or Mr. Calvert’s worry about his automatic mechanic business as well as his inability to control his anger whenever his step-son, Gary messed up by running from school or consuming too much alcohol. In the light of the above explanations, the Calvert family members should undergo the following therapies in accordance with the recommendations of Child and Adolescent Mental Health Services CAMHS: (i) Psychotherapy: Being the main character in this scenario, Damien needs to pass through some psychotherapy procedures (CAMHS, 2010: Stern, 2008). Damien is expected to have sessions with experienced psychotherapists that would painstaking observe him and watch for any signs of troubled emotion in him. This session could take in a couple of months or for several weeks in a situation whereby serious emotional problem has been detected in him. The approaches usually taken by the psychotherapists include giving Damien something to play with, like a box of toys, drawing materials, and other things that could make him concentrate or talk or express his feeling. In the course of this treatment some emotionally troubled children cannot hide their true nature; 5 hence, their behaviours help the psychotherapists to fully understand their conditions and offer the right approach to solving their problems (Stern, 2008). Therefore, Damien should have about 20-40 sessions with the experienced psychotherapist in order to be able to completely understand how deteriorated his condition has been. Some of these sessions could be carried out in the presence of each member of Calvert family: this will give the psychotherapists the chance of seeing how Damien is going to behave in the presence of his entire family members. This model is in agreement with Tavistock Model of child observation, which emphasizes on the significance of putting the child in the natural condition he lives in so as to detect his reactions to the different members of his household (Reid & Tavistock Clinic, 1997). This will be quite helpful in deciding which solutions to offer by the psychotherapist to the family in trouble. Close and detailed observation of this nature will help the psychotherapist discover the attachment disorder Damien has to Gary; it will reveal the level of his trauma and emotional depression; it will show his extent of anger, fear and stress within his own household (CAMSH, 2010). This is the very first step in determining how best to help Damien change his emotional problem and become a friendly child to everyone at home and school. According to Tavistocck Model, the distressed child will reveal more if he or she has been given enough attention that he or she has not been able to get in a long time. Damien will have the chance to even confront any member of his family who he may have hated because of one reason or the other. By doing this, this will help the 6 psychotherapist to find a way to resolving whatever grievances Damien may have had about the person. (ii) Family Therapy: The second aspect of Damien’s problem that requires solution is his environment. Who is he living with? How do the people in his home make him happy or sad? Who among them is basically responsible for his emotional trouble? How can the people in his household help him to change his violent behaviour? These and many other questions will be asked in other to detect the exact environment Damien is residing in. Some families have broken down due to a number of factors. For example, poor communication among family members may cause uncomfortable relationships in the family; negative parenting may result in children picking up violent behaviours; disaffection may come from uncontrollable hatred that arises from inadequate show of love from family members—for instance, Damien’s parents always quarrel with one another, his elder brother left home for some time, his younger sister cling to her dolls and does not play with him. All these events can make a 7-year-old go crazy and begin to show unexpected violent behaviour (Reid & Tavistock, 1997). Therefore, in a condition like this, it is important that all the family members that are directly linked with the distressed child be made to appear before a family therapist. A family therapist can help the family to achieve so many things that they had not thought of before: these include: 7 (a) Information: The family therapist can let the family members know what constitute child abuse that could cause child mental problem. Most families, unfortunately, do not realize that their actions are indeed contrary to the laws and declarations that support children against physical, mental, and other forms of abuse. Laws like Legal and Ethical frameworks in CAMHS Mental Health Act 1989, UN Convention on the Rights of the Child 1990, and so on, give details of what people (family members or not) should not do so that they won’t break all these laws that give children their own rights within societies. But, sadly enough, in UK one child in every five is suffering from mental health issue (Department of Health, 2003). This indicates that family members across UK do not recognize the harm they do to the children around them as a result of their own asocial behaviours. (b) Positive parenting: It is the duty of family therapists to explain how parents could positively raise their kids. This may entail changing their own bad behaviours of quarreling in the presence of their kids or throwing tantrums to everyone at home (Stern, 2008). By being positive, they invariably create a comfortable atmosphere for their children to grow up naturally and happily (c) Creating a comfortable environment: Parents can learn from family therapy to learn how to create a comfortable atmosphere for their children. They could do so by showing more affection to their children or playing more with them in their free time. They definitely need to stop bickering in the 8 front of their children, so that they won’t send a wrong message to them that violent behaviour is an acceptable way of life. This is why all members of a household suffering from emotional trauma should approach a family therapist together. Damien could learn how to control his anger. His younger sister, Emily could learn how to play more with her older brother. Mr and Mrs Calvert could understand that fighting while their children are there is a totally asocial deed. Conclusion Having been subjected to observation or assessment, Damien and his family members could be revive through psychotherapy and family therapy. These will help to create a conducive atmosphere for him at home. And he will definitely change from his current violent behaviour to a better way of life if the therapies are not discontinued within a very short time. Most parents do not realize the danger they cause by quarreling in the presence of their children; they don’t even know that they are mentally abusing their children and breaking all the laws that support the rights of children in the societies. References Child and Adolescent Mental Health Services, 2010. How we help. [Online]. Available at: http://www.camhscares.nhs.uk/v/bexley_help [Accessed 5 May 2010]. Cawson, P., Wattam, C., Brooker, S. & Kelly, G., 2000. Child maltreatment in the United Kingdom: a study of the prevalence of child abuse and neglect. London: NSPCC. Reid, S. & Tavistock Clinic, 1997. Developments in infant observation: Tavistock Model. London: Routledge. Stern, B., 2008. Child-friendly therapy: biopsychosocial Innovations for Children and families. New York: W.W. Norton & Company. Appendix Dr R Feltwell  Parvington Surgery  Treadingshire  Ref: 565558/CB  14/07/2008  Dear Sir/Madam  RE: Darren Calvert. D.O.B- 15/10/2001 - 15 Elm Drive, Parvington, Treadingshire. Tel. 0755 68996  The primary health care team would like to refer the above named child to the Child and Adolescent Mental Health Services team for assessment, as this young 7 year old appears to be suffering with some severe emotional and behavioural difficulties, which over recent months have become very concerning to his mother, health visitor and teachers.  Darren’s mother reports that he has always been an active child and she has had problems in the past trying to control his relatively minor behavioural problems (temper tantrums and defiant behaviour). Our health visitor; Vera Feelgood did some work with Darren and his mother looking at positive parenting and methods of managing his behavioural difficulties and in the short term this intervention appeared to help. However over the last five months Darren’s behaviour has progressively got worse, he spits at his mother, has hit his younger sister very hard over the head with a toy car and has sometimes refused to go to school. His behaviour is also causing difficulties at school, in that he is bullying other children, unable to settle and concentrate in class, and on three occasions has worked himself up into a very agitated state and has tried to run off the school premises saying over and over again ‘I need to go home’.  For your information, attached to this letter, is Health Visitor Mrs V Feelgoods report that provides further details on the Calverts present family situation.  Yours faithfully  Dr R Feltwell  Health Visitor Report 12/07/2008  Dear Dr Feltwell  RE: Darren Calvert. D.O.B- 15/10/2001 - 15 Elm Drive, Parvington, Treadingshire. Tel. 0755 68996  As you are aware the above named 7 year old is presently experiencing some emotional upset and his mother is struggling to deal with some severe behavioural problems. Darren’s mother is eager for Darren to receive specialist help therefore I would support a referral to CAMHS as the brief summary below details the present complex family situation.  The Calvert’s are a family of five.  Stacey Calvert (30yrs) Mother and wife of Stephen Calvert  Stephen Calvert (26 yrs), Stacey’s husband and father to Darren and Emily  Mr Edward Hill –Stacey’s ex-partner and Gary’s father (lives in Firshire)  Gary Hill (14 yrs) son of Stacey and Edward Hill.  Darren Calvert (7yrs) son of Stacey and Stephen Calvert  Emily (3yrs) Daughter of Stacey and Stephen Calvert.  Darren’s mother informs me that there have been many family tensions of late. Her son Gary has recently left home to live with his father as there has been many arguments between Gary and his step father, Stephen, over Gary’s poor school attendance, truanting, smoking and alcohol use. It was Gary who felt he could not live in the same house as Stephen and five months ago he moved out to live with his Dad. Notably Darren was very close to Gary and found Gary’s moving away very difficult, especially as visits are likely to be infrequent as he is some distance away.  Stacey has informed me that with Gary’s difficulties and now Darren’s difficulties she has found things very stressful of late, she and Stephen are rowing continually; she is finding she is experiencing severe agitation and stress and will often shout at Emily and Darren for no real reason. Stacey has said very clearly ‘I feel at the end of my tether and do not know if I can go on, as for my marriage that is unlikely to last’. I have concerns that Stacey might be moderately depressed and therefore with her permission have referred her to the primary care mental health team for assessment. Of note is that Stacey says she is also worried about her husband Stephen, a car mechanic, who she knows is finding things difficult at present and because of this has had some severe angry outbursts, however because he does not talk about things and is reluctant to speak to professionals about the family difficulties Stacey feels the situation with her marriage is unlikely to get any better. When asked if she finds Stephen aggression threatening, Stacey was keen to point how he was a good father and husband and was not normally a violent man.  The youngest child Emily does not appear to have behavioural problems however she has had some eating difficulties and her weight is monitored closely by our team as some times she refuses to eat (food refusal).  None of the children or parents have any physical illness or difficulties. They live in mortgaged property in the centre of town and as I am led to believe live comfortably with no financial difficulties. Stacey has a number of friends she says she can depend on; however she misses her parents who passed away two years ago. She says they were the people who supported her and were very loving towards her and the children. Stacey describes her relationship with Stephens’s parents as difficult and says that they have very little contact with her in laws despite them living very close.  It appears that if Stacey is not offered some specialist support this family’s situation is likely to be exacerbated so an urgent referral to CAMHS is recommended.  Yours sincerely  Vera Feelgood (Health Visitor)  Parvington Surgery  Assessment Letter back to the refer  Dear Mr and Mrs Calvert  RE: Darren Calvert. D.O.B - 15/10/2001 - 15 Elm Drive, Parvington, Treadingshire. Tel. 0755 68996  You and your family attended the assessment at Over the Moon clinic on the 15/08/2007 following a referral from your GP Dr Feltwell and Health Visitor V Feelgood. Below, is an outline of the assessment and a summary of how we as a team can help Darren and support you as a family. Notably since we received a referral to our service your family circumstances have changed in that Darren’s older brother Gary has returned to live at your own home.  All of the assessment team agreed that Darren appears to be suffering from some emotional difficulties at present and this has consequently led to some severe behavioural problems that both his school teachers and the family are finding difficult to manage. A summary of our assessment is outlined below.  Family Assessment  All the family members attended the assessment and all family members were keen to address Darren’s problems and had the opinion that Darren’s bad behaviour was the cause of much of the disharmony in the house. Stacey Calvert answered many of the questions, Stephen Calvert was quieter. Gary (Darren’s eldest brother) said very little and when asked any questions answered in clipped sentences. Emily a small thin child appeared to be happy and inquisitive.  Stacey Calvert spoke about Darren’s early years; he was a premature baby, who was nursed in specialist care baby unit for five weeks following his birth. Stacey experienced post natal depression following the birth of Gary but said that she did not experience post natal depression following the birth of Darren, she did say that she was very busy at that time in her life because she was not only looking after a young baby and a young child but also caring for her sick elderly father and frail mother so that put her under a lot of stain. Stacey informed the MDT team that life had never really been straight forward, fortunately the children, Stephen or herself had never had any physical health problems, however things had been tough for the family in an emotional way. Stacey told the team that she had her eldest child Gary when she was only 16 years of age, Gary’s father was also young, they never married and subsequently drifted apart, however Gary’s father does have some contact with Gary now. Stacey married Stephen when she was 19 yrs of age. Gary she said was always a handful, but Stephen was a good dad to Gary and tried his best. (Notably Gary and Stephen looked uncomfortable during this part of the interview). Stacey said that family problems had become very difficult following the death of her father and mother. Gary was close to her grandparents and found their death difficult and consequently developed severe mood swings that Stephen found difficult to deal with. Gary began truanting from school and at one point was drinking a lot of alcohol. Gary had a social worker Samantha Better who had been a great support through some difficult times, but Gary had lost touch with the social worker when he moved out of the family home to live with his dad.  Stacey stated that like Gary, Darren’s behaviour has always been difficult to manage. The support of the health visitor was helpful but things have deteriorated over recent months and Darren’s severe behavioural difficulties at school were concerning. Stacey stated that she did not feel Darren had any learning problems; she described him as a bright child who just lacked concentration and could be very frustrating because he would lose all of his school equipment and would not complete his homework. Stacey stated that Darren’s behaviour appeared to get steadily worse following the death of her father and mother and then very bad when Gary left the family home. However even though Gary was back at home Stephen and Stacey felt Darren’s behaviour has not getting any better.  Gary when asked his opinion about the family situation felt that his parents did not make the situation any better, they would often argue and he felt that both Emily and Darren would deal with the arguing in different ways, in that Darren would be naughty and Emily would cling to her mother and cry.  Child Assessment  Darren’s was happy to speak to our clinical nurse specialist and also confident enough to ask us some questions. We asked Darren about school, he said he liked school, however was always getting in trouble with his teachers and would sometimes upset other children. We asked Darren about the times he wants to leave the school and return home. Darren said on these occasions he wanted to return to his mum to make sure she was ok. When asked what was worrying him, he spoke about how his mum had tried to swallow some tablet one weekend and how his dad had to take her to the hospital. It appeared that this episode was playing on his mind and causing some distress. We asked Darren about home life, he told us he enjoyed playing football with his Dad and was now really happy that his older brother Gary had returned home because he had missed him so much. He said his sister was ok but she only liked playing with dolls. Darren however did say that what he did not like about home was the arguments between his Mum and Dad and Dad and Gary.  Summary of Action  This has purposefully been left blank for the student group to consider and discuss.  Yours sincerely  B Thinkpostive (Clinical Nurse Specialist) on behalf of the MDT Team CAMHS  C.C Dr R Feltwell  V Feelgood (Health Visitor)  S Better (Social Worker)  Read More