Assignment: Children and Adolescents

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Assignment: Children and Adolescents

Assignment: Children and Adolescents


Working With Children and Adolescents: The Case of Noah Noah is a 10-year-old, multiracial male who is currently in foster care. Prior to the foster care placement, he was hospitalized three times in 3 months as a result of increased aggression, disruptive outbursts, and self-harm behaviors. Noah has a long history of dangerous behaviors, including twice jumping out of a moving vehicle, breaking a peer’s leg, making suicidal and homicidal threats, and killing a dog. Noah was living with his mother, stepfather, full brother (Edgar), and three half-siblings in his home state before his dangerous behaviors increased in severity 2 years ago. At that point, Noah’s mother’s marriage ended, and she left Noah and his brother Edgar in the care of his paternal grandfather in another state. Noah’s behavior during this period included cutting himself, fighting, and threatening to burn the school down. The latter two incidents resulted in Noah’s suspension from school. His grandfather sought assistance from the county, and social services began working with the family. However, Noah continued to exhibit behavioral problems, including those that resulted in his hospitalizations. After his last hospitalization, Noah’s mother took him and Edgar to live with her in a different county. The hospital made a referral for a children’s mental health caseworker to work with the family. Within a month of reuniting, Noah’s mother called law enforcement in response to Noah’s out-of-control behavior. Noah had been running down the highway and screaming that his mother had put bleach in his eyes. His mother explained her concerns to the case manager, saying that she was overwhelmed with Noah’s behavior and felt she could not handle him any longer. The county had been receiving child protection reports regarding Noah’s out-of-control behavior as well as concerns that his mother was not taking Noah to medical appointments or giving him medication as prescribed. Noah was then placed in his current foster home where he has been for the last 9 months. Child Protective Services developed a reunification plan upon his placement in the foster home. Services provided for Noah include individual and family counseling, medication management, and weekly supervised visitation with his mother. Noah’s most current diagnosis is mood disorder, not otherwise specified (NOS); attention deficit hyperactivity disorder (ADHD), combined type; and learning disorder, NOS. His current medications include Abilify® and Concerta®. His full scale IQ is 72 and he receives special education services. I began working with Noah after he was placed in his foster home. During my initial intake with his mother, she stated that Noah met all of his developmental milestones on time. She denied any alcohol or drug use during her pregnancy but admitted to smoking cigarettes. She described Noah as active and having a temper from an early age. She said his kindergarten teacher had voiced concerns about his inattention and behavior, and it had been recommended that he be evaluated for ADHD. After Noah had set a fire in his home’s bathroom, his mother had him examined, and he was diagnosed with ADHD and prescribed medication. There is no known history of sexual abuse, and Noah’s mother reports that while she and her ex-husband had frequent verbal fights, there was no physical abuse in the home. Within his current foster home there have been some difficult moments, but Noah has acclimated to the family. He attends their church and is involved in the church’s youth program. Noah and his foster brother get along and enjoy each other’s company. Noah’s foster parents are active participants in working with Noah’s plan and maintain good communication with his providers. At our first session, Noah explained he was in foster care because “my mother can’t take care of me.” I asked if there was anything he would like to change about himself, and he said to “act better” so he could live with his mother again. My assessment made clear that although Noah is 10 years old, his developmental level is younger. I began working with him using cognitive behavioral play therapy. Noah’s play was very aggressive, and he struggled with appropriately expressing himself and working through different play-based scenarios. I focused on improving Noah’s coping skills. Noah has begun to identify his feelings, and he has learned about triggers related to his anger and the impact on his thoughts and feelings. Noah has continued to have scheduled supervised visitations with his mother; however, she has failed to keep many of her scheduled visits. On the days she misses appointments, Noah exhibits increased negative behaviors at school and at the foster home. As part of my role, I am in contact with his foster mother and CPS social worker. It became clear that Noah’s mother had not been following through with the reunification plan, and social services is pursing termination of her parental rights. Noah’s foster mother reported that she and her husband would like to adopt Noah. They are unsure of how to talk to him about the upcoming termination hearing and their interest in adoption. I offered to facilitate this discussion with Noah and his foster parents. In preparation for the upcoming court hearing to terminate parental rights, the social worker discovered Noah’s maternal grandmother was full-blooded Native American and has tribal registration. This information had not been in any of Noah’s prior records. According to the Indian Children Welfare Act (ICWA), the registered tribe needs to be included in Noah’s placement plan. ICWA sets federal requirements that apply to state child custody proceedings involving an Indian child who is a member of or eligible for membership in a federally recognized tribe. The CPS social worker states Noah will need to be placed in a Native American foster home.


Assignment: Children and Adolescents

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