Reference no: EM133350296

Case Study for the Parker Family:

Sara Parker is a 72-year-old widowed Caucasian female who lives in a two-bedroom apartment with her 48-year-old daughter, Stephanie, and six cats. Sara and her daughter have lived together for the past 10 years since Stephanie returned home after a failed relationship and was unable to live independently. Stephanie has a diagnosis of bipolar disorder, and her overall physical health is good. Stephanie has no history of treatment for alcohol or substance use; during her teens she drank and smoked marijuana but no longer uses these substances. When she was 16 years old, Stephanie was hospitalized after her first bipolar episode. She had attempted suicide by swallowing a handful of Tylenol® and drinking half a bottle of vodka after her first boyfriend broke up with her. She has been hospitalized three times in the past 4 years when she stopped taking her medications and experienced suicidal ideation. Stephanie's current medications are Lithium, Paxil®, Abilify®, and Klonopin®. Stephanie recently had a brief hospitalization as a result of depressive symptoms. She attends a mental health drop-in center twice a week to socialize with friends and receives outpatient psychiatric treatment at a local mental health clinic for medication management and weekly therapy. She is maintaining a part-time job at a local supermarket where she bags groceries and is currently being trained to become a cashier. Stephanie has active Medicare and receives Social Security Disability (SSD). Sara has recently been hospitalized for depression and has some physical issues. She has documented high blood pressure and hyperthyroidism, she is slightly underweight, and she is displaying signs of dementia. Sara has no history of alcohol or substance use. Her current medications are Lexapro® and Zyprexa®. Sara has Medicare and receives Social Security benefits and a small pension. She attends a day treatment program for seniors that is affiliated with a local hospital in her neighborhood. Sara attends the program 3 days a week from 9:00 a.m. to 2:00 p.m., and van service is provided free of charge. A telephone call was made to Adult Protective Services (APS) by the senior day treatment social worker when Sara presented with increased confusion, poor attention to daily living skills, and statements made about Stephanie's behavior. Sara told the social worker at the senior day treatment program that, "My daughter is very argumentative and is throwing all of my things out." She reported, "We are fighting like cats and dogs; I'm afraid of her and of losing all my stuff." Home Visit During the home visit, the APS worker observed that the living room was very cluttered, but that the kitchen was fairly clean, with food in the refrigerator and cabinets. Despite the clutter, all of the doorways, including the front door, had clear egress. The family lives on the first floor of the apartment building and could exit the building without difficulty in case of emergency. The litter boxes were also fairly clean, and there was no sign of vermin in the home. Upon questioning by the APS worker, Sara denied that she was afraid of her daughter or that her daughter had been physically abusive. In fact, the worker observed that Stephanie had a noticeable bruise on her forearm, which appeared defensive in nature. When asked about the bruise, Stephanie reported that she had gotten it when her mother tried to grab some items out of her arms that she was about to throw out. Stephanie admitted to throwing things out to clean up the apartment, telling the APS worker, "I'm tired of my mother's hoarding." Sara agreed with the description of the incident. Both Sara and Stephanie admitted to an increase in arguing but denied physical violence. Sara stated, "I didn't mean to hurt Stephanie. I was just trying to get my things back." The APS worker observed that Sara's appearance was unkempt and disheveled, but her overall hygiene was adequate (i.e., clean hair and clothes). Stephanie was neatly groomed with good hygiene. The APS worker determined that no one was in immediate danger to warrant removal from the home but that the family needed a referral for Intensive Case Management (ICM) services. It was clear there was some conflict in the home that had led to physical confrontations. Further, the house had hygiene issues, including trash and items stacked in the living room and Sara's room, which needed to be addressed. The APS worker indicated in her report that if not adequately addressed, the hoarding might continue to escalate and create an unsafe and unhygienic environment, thus leading to a possible eviction or recommendation for separation and relocation for both women.

Video transcript:

Parker Family Episode 1 Program Transcript MISS PARKER: I can't believe you did this. MRS. PARKER: Shut up! You had it coming. MISS PARKER: Got what coming? FEMALE SPEAKER: Please, Ms. Parker. I was telling your mother here that I was referred by the social worker in her day program. MISS PARKER: What did you say? What lies did you tell? MRS. PARKER: Not lies, the truth. You're always yelling at me and throwing out my stuff. MISS PARKER: Like you can tell! All this mess! You're choking me with it! I am not the one with the problem. She is. Just look! MRS. PARKER: That's right. Go to your room and sulk baby girl and leave my cats alone. FEMALE SPEAKER: How many cats do you have, Mrs. Parker? MRS. PARKER: Six. One big family. FEMALE SPEAKER: Can you explain what's happening here? I can see that you're very angry with your daughter. Her name's Stephanie, right? MRS. PARKER: Yes. Princess Stephanie. You want to help me? Tell the princess to stop throwing out my stuff. FEMALE SPEAKER: Well that's not something I am able to do. I think the best course is for me to assign an intensive case manager to help work with you on your home situation. MRS. PARKER: What do you mean? FEMALE SPEAKER: You'll work together, set up goals for your relationship with Stephanie, how to deal with the two of you living here. Mrs. Parker? MRS. PARKER: Maybe. All this fighting has to stop. FEMALE SPEAKER: I want to go talk to Stephanie, Mrs. Parker. But first, I want to ask you some general questions. May I? MRS. PARKER: OK. FEMALE SPEAKER: OK. How long have you and Stephanie lived in this apartment? [KNOCKING] Hello, Miss. Parker? MISS PARKER: Come on in out of that garbage dump. I knew you'd want to talk. It's quite a difference, isn't it? It's the only place I can feel like I can breathe around here. FEMALE SPEAKER: May I sit down? I understand that you're very angry with your mother. I heard you say earlier that you want your home to be clean. MISS PARKER: Wouldn't you? You saw it. FEMALE SPEAKER: How long has it been like this? MISS PARKER: Since my dad died about three years ago. It's gotten worse lately. Every time I try to clean anywhere outside of this room, throw something away, she freaks out. I have to keep this in here. The last time I tried cleaning up, she chased me with it, swinging it like some crazy woman. I don't know how much more of this I can take. I just want to hit her with it. FEMALE SPEAKER: I understand that this is very difficult for you because your mother gets so angry when you try to clean house. That's why I'm making a referral for an intensive case manager. I've already spoken with your mother about this. MISS PARKER: Do you really think that you and your case manager are going to make a difference? My mother is getting dementia and the princess is bipolar. She and I, we're like gasoline and fire. You really think you can fix that?

Answer questions partaining to all above and apply references:

1. Describe your preparation and plan for a family session with Sara and Stephanie Parker.

2. Specifically, what questions would you ask the family and why? How would you engage them?

3. What kind of conflict or dynamic might you anticipate based on the case?