TRAINEE ACTIVITY PACKET:
MENTAL HEALTH & MENTAL DISORDERS, V2.1
(Image from prc.dartmouth.edu)
SCENARIOS FOR TRAINING DAY
California Common Core for Child Welfare Workers
SMALL GROUP ACTIVITY: CULTURE, CHILD WELFARE and INTERVENTIONS
“LIA LEE”
CHILD: Lia Lee, age 3 months
PARENTS: Foua Lee (mom) and Nao Kao Lee (dad)
CULTURAL BACKGROUND: Hmong
SPOKEN LANGUAGES: Monolingual Hmong speakers
CULTURAL PERSPECTIVE:
The Hmong religious belief in shamanistic animism asserts that malevolent spirits are constantly seeking human
souls, especially those of vulnerable or unloved children. In Hmong culture, epilepsy is referred to as qaug dab
peg (pronounced “kow da pay”, translated in English: "the spirit catches you and you fall down"), in which epileptic
attacks are perceived as evidence of the epileptic's ability to enter and journey momentarily into the spirit realm. In
Hmong society, this ability must be used to help others. Qaug dab peg is often considered an honorable condition
and many Hmong shamans are epileptics, believed to have been chosen as the host to a healing spirit, which allows
them to communicate and negotiate with the spirit realm in order to act as public healers to the physically and
emotionally sick. (Source: http://en.wikipedia.org/wiki/The_Spirit_Catches_You_and_You_Fall_Down, retrieved
7/15/14.)
LIA’S SITUATION:
“When Lia was about three months old, her older sister Yer slammed the front door of the Lees’ apartment. A few
moments later, Lia’s eyes rolled up, her arms jerked over her head, and she fainted. The Lees had little doubt…that
her soul had fled her body and become lost. They recognized the resulting symptoms as qaug dab peg (The Spirit
Catches You and You Fall Down, p. 20).
Despite their cultural beliefs that Lia was special, her parents were also concerned and took her to the hospital.
Lia’s symptoms of seizure stopped by the time they arrived at their first visit to the hospital, and there was no one on
staff who could speak Hmong with the family to determine what they had come in for. The parents could not relay
their daughter’s symptoms verbally or in writing, since they did not speak, read or write in the English language. A
resident completed some scans and misdiagnosed Lia’s condition as a form of pneumonia and prescribed
antibiotics.
The parents left and returned a second time a few weeks later; the seizure had again stopped by the time they
reached the hospital and the same misdiagnosis occurred. When Lia was eight months old, she had another seizure
– and this time, the seizure was still happening when they arrived for their third visit to the hospital. The attending
physician made the correct diagnosis of epilepsy at this visit. This physician prescribed medication to treat Lia’s
epilepsy; prevention of further grand mal seizures via use of the medication was considered essential for Lia’s longterm health.
Lia's parents did not give her epilepsy medication as it was prescribed because they believed that Lia's state showed
a sense of spiritual giftedness, and they did not want to take that away. Lia’s parents used their own traditional
remedies. American doctors did not understand the Hmong traditional remedies that the Lee family used; the
doctors treating Lia made a report to Child Welfare Services.
Answer the following questions with your table group:
1. What are this family’s strengths?
2. Does the meaning Lia’s parents give to the epilepsy an indicator of mental illness? Which mental
illness(es)? Why or why not?
3. What are your thoughts on how the parents are treating Lia’s epilepsy?
4. Is there a safety issue in this scenario? If so, what is it?
5. How might your own cultural/ethnic background affect how you perceive this family?
6. What advocacy needs might there be for this family?
7. As the worker who is asked to respond to this family after the physician made the report, what would you do?
Training Scenarios for Mental Health & Mental Disorders (Version 2.1, Updated February 2015)
2
KAREN & SAM’S STORY: PART I
(Part I adapted from 2013 Child Welfare Trauma Training Toolkit, NCTSN.org)
Karen has two children, Crystal (age 5) and Jonathan (age 10). Jonathan’s biological father died several years prior,
and Crystal’s biological father is Sam, Karen’s boyfriend. Karen was reported to child welfare authorities by Crystal’s
teacher, who was concerned about Jonathan’s excessive absences from school. Additionally, at the time of the CPS
report, the teacher mentioned that Jonathan had been having problems at school. Upon interview, Jonathan
disclosed to the Child Welfare Worker that although he was born a boy, he feels he was born in the wrong body and
feels like he is really a girl inside - and that he doesn’t feel safe returning home after having told his mom this. The
investigation revealed that Karen’s boyfriend, Sam, physically abused her and her children, and evidence emerged
that she had physically abused the children as well. There were several attempts to engage her in services, but
because of her lack of follow-through and the ongoing safety concerns, her children were removed from her home
and have been in foster care for 6 months.
Linda, Karen’s caseworker, has referred Karen to parenting classes, domestic violence services, and for a mental
health evaluation. Karen has not followed through on the referrals, is often not home when Linda has a scheduled
visit, and when the foster parent last brought the children for visitation, Karen was alternately angry and defensive
towards Linda and the foster parent and disengaged from her children. Linda is concerned because of the amount
of time Crystal and Jonathan have been in foster care. A decision will be made shortly about their permanency plan,
and Linda believes that she hasn’t been able to engage Karen in either addressing her family’s issues or identifying
her strengths, much less come up with a plan that builds on them.
Linda’s supervisor asked Karen why she has made no progress and noted that the last visit between Karen and her
children got “out of control”, but did not offer any concrete suggestions to Linda as to how she could have handled it
differently. When Linda tries to talk with Karen about the urgency of the situation, Karen minimizes her concerns
and appears increasingly angry towards Linda and the system.
Refer to the following content to help you answer the questions below:
§ Katie A. content, pp. 18-19
§ 7 Essential Elements of a Trauma-Informed CW System
§ Trauma and the Child Welfare Population
§ Birth Parents with Trauma Histories and the Child Welfare System: A Guide for Child Welfare Staff
Questions:
1. What are the strengths present in this family?
2. What might be some of the reasons that Karen appears increasingly angry towards Linda and the system?
3. From a Trauma-Informed perspective, what do you need to consider when engaging with Karen? With
Crystal and Jonathan?
4. What if Karen and/or Sam are from minority ethnic groups? How, if at all, might your work be different as a
result?
5. What steps might you take to engage Karen? To engage Sam?
6. From a Katie A/Pathways to Well-Being perspective, what are your responsibilities to these children?
7. What other referrals might you consider making for this family?
Training Scenarios for Mental Health & Mental Disorders (Version 2.1, Updated February 2015)
3
KAREN & SAM’S STORY: PART II
Sam, Karen’s boyfriend, asks to meet with you (child welfare worker), stating concerns that Crystal and Jonathan
have been away too long from their mom and need to come home. He says he wants to know what he can do to
support them coming home. You express appreciation for his concern, and agree to meet with him and Karen at
your county’s offices at 10am the following day to hear them out. (In the interim, you call Karen to see if she feels
safe meeting with Sam at your county offices. Karen says she doesn’t feel comfortable attending this meeting with
Sam, and it will just be Sam attending the meeting.)
The meeting starts out cordially, with Sam saying that he and Karen love their kids and really want them home. You
ask him if he understands the reason Crystal and Jonathan were placed in foster care. Sam says, “I guess you’re
concerned about parents spanking their kids, right?” You talk with him about having received reports that physical
interactions between him and Karen and the children exceeded ‘spanking’, and there were multiple visible bruises
on both children. You also discuss that in those reports, witnesses mentioned having seen him hit Karen, too, in
front of the children. Sam’s demeanor quickly changes; he raises his voice and says, “You destroyed my family by
removing Crystal and Jonathan from their home and placing them in Foster Care. I tell you, I did not come home
from war to have my kids taken away from me. What the hell is that about? Who do you think you are? You need to
bring them home NOW. They belong to us. Plus, Jonathan’s dad died, and he needs a father figure to teach him
how to be a man.”
As part of de-escalation strategies, you engage him in a discussion about having made the sacrifice to serve his
country. Sam says after the 9/11 attacks on the World Trade Center towers, he volunteered with the Army. As part
of Operation Enduring Freedom in Afghanistan, he served three tours of duty with combat units. He left with an
Honorable Discharge in early 2007 after injury to his right leg on his third tour of duty.
As he is telling this story, you notice he has the faint smell of alcohol on his breath. You ask how recently has he had
something to drink today, and Sam gets agitated. Sam said sometimes he drinks to take the edge off, because he
all of a sudden gets nervous and his heart starts racing and he doesn’t know why. Sam said he also has memories
pop up at random times from when his unit encountered an IED (Improvised Explosive Device), and several in his
unit died. Sam said sometimes he yells at the kids and forgets where he is when this happens. He said he hasn’t
talked to a doctor about this yet, because he doesn’t want someone saying he’s crazy.
When you ask what he feels he does well in being part of the family, Sam says he has a job as a security guard in an
office building during the afternoon and evening shift on weekdays, and contributes financially to the household.
Sam says he likes cooking for the kids, and that they like his food. Sam said he likes doing the laundry at home, and
folding laundry helps him calm down.
Answer the questions for Part II of this story on the chart on the next page.
Training Scenarios for Mental Health & Mental Disorders (Version 2.1, Updated February 2015)
4
KAREN & SAM ’S STORY, PART II: PROVIDE ANSW ERS IN CHART BELOW
Strengths
present?
Hypotheses
about what
could be
going on?
Appears
Chronic
or
Acute?
Implications and
Considerations for
Parenting &
Meeting Children’s
Needs?
Decision
given
current
available
facts?
Possible Case Plan
Objectives?
Possible Planned
Child/Family
Services?
(The expression of what
success will look like for
the family, a specific
behavioral change to
achieve.)
(The activities intended to
provide new skills or
knowledge to allow
participants to achieve the
case plan objective.)
CWW Case Mgmt
Tasks?
(Hint: See Diagnoses Job
Aides in this packet, which
incl. warning signs for
escalation, risk factors, and
implications for case
planning)
KAREN & SAM’S STORY: PART III
As the lead child welfare worker working with Karen and Sam, you attempt another home visit. It is late afternoon,
and the door is open to their home. You see a 4 year old in the living area, and ask where an adult is; the child says,
“my Auntie is laying down. She is tired and sleeps a lot.” You ask the child to go and get her Auntie.
You see dirty bowls with bits of cereal and milk in the living room. You look into the kitchen and see stacks of plates
and bowls on the counter with food drying on them. You also see empty cans of spaghetti-o’s on the table and an
open loaf of white bread.
You take a seat in the living room as Karen shuffles into the room in a nightgown and slippers. She is unkempt, with
greasy hair, and bleary eyed. You mention that you came by because you have tried to set up meeting times with
Karen, and really want to talk with her about Crystal and Jonathan, because there is a timeline and you want to try
and talk about what is needed for Crystal and Jonathan to return home.
Karen sits down on the couch and the 4 year old immediately climbs into her lap and watches with wide eyes. Karen
immediately begins to cry, telling you that she is tired all of the time and she doesn’t know why. She said she
sometimes has ups and downs, and used to be able to stay up for days at a time and get a lot done - but nowadays
she just can’t seem to get going. She also states she shouldn’t be tired because she doesn’t do anything since she
lost her job 4 weeks ago, except to take care of her 4 year old niece (her sister’s child) in the afternoons after
morning preschool is over. Her sister works at the local hospital and picks up her niece at dinnertime. Karen goes
on to say that she makes sure her niece eats lunch but that Karen has had no appetite for several weeks.
Karen cries harder; she says she wants Crystal and Jonathan back with her but is afraid she is “losing it again”.
When you ask her what she means, Karen reports she had a nervous breakdown about 5 years ago after she gave
birth to Crystal and “they put me away”.
Answer the questions for Part III of Karen and Sam’s story on the chart on the next page.
KAREN & SAM ’S STORY, PART III: PROVIDE ANSW ERS IN CHART BELOW
Strengths
present?
Hypotheses
about what
could be
going on?
Appears
Chronic
or
Acute?
Implications and
Considerations for
Parenting &
Meeting Children’s
Needs?
Decision
given
current
available
facts?
Possible Case Plan
Objectives?
Possible Planned
Child/Family
Services?
(The expression of what
success will look like for
the family, a specific
behavioral change to
achieve.)
(The activities intended to
provide new skills or
knowledge to allow
participants to achieve the
case plan objective.)
CWW Case Mgmt
Tasks?
(Hint: See Diagnoses Job
Aides in this trainee packet,
which includes warning
signs for escalation, risk
factors, and implications for
case planning)