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(BQ) Part 1 book “Case studies in child, adolescent , and family treatment” has contents: Case studies in individual treatment and assessment 1 case study 1‐1 from childhood to young adulthood with ADHD, case studies in group treatment.
Case Studies in Child, Adolescent, and Family Treatment Craig Winston LeCroy and Elizabeth K Anthony editors Case Studies in Child, Adolescent, and Family Treatment Second Edition Cover design: Wiley Cover image: © Shutterstock.com/LFor This book is printed on acid-free paper Copyright © 2015 by John Wiley & Sons, Inc All rights reserved Published by John Wiley & Sons, Inc., Hoboken, New Jersey Published simultaneously in Canada No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, scanning, or otherwise, except as permitted under Section 107 or 108 of the 1976 United States Copyright Act, without either the prior written permission of the Publisher, or authorization through payment of the appropriate per-copy fee to the Copyright Clearance Center, Inc., 222 Rosewood Drive, Danvers, MA 01923, (978) 750-8400, fax (978) 646-8600, or on the web at www.copyright.com Requests 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with standard print versions of this book may not be included in e-books or in print-on-demand If this book refers to media such as a CD or DVD that is not included in the version you purchased, you may download this material at http://booksupport.wiley.com For more information about Wiley products, visit www.wiley.com Library of Congress Cataloging-in-Publication Data: LeCroy, Craig W Case studies in child, adolescent, and family treatment / Craig Winston LeCroy, Elizabeth K Anthony.— Second edition online resource ISBN 978-1-118-12835-0 (pbk) ISBN 978-1-118-41897-0 (epdf ) ISBN 978-1-118-41644-0 (epub) Child psychotherapy—Case studies Adolescent psychotherapy—Case studies Family psychotherapy—Case studies I Anthony, Elizabeth K II Title RJ504.L43 2015 618.92′8914—dc23 2014017654 Printed in the United States of America 10 Contents EPAS standards ix Matrix for chapter content Preface xvii xiii Case Studies in Individual Treatment and Assessment Case Study 1‐1 From Childhood to Young Adulthood with ADHD Susan Bogas Case Study 1‐2 Solution‐Focused Therapy with Child Behavior Problems Jacqueline Corcoran Case Study 1‐3 Crisis Intervention with a Depressed African American Adolescent Jewelle Taylor Gibbs Case Study 1‐4 What a Few CBT Sessions Can Do: The Case of a Motivated Young Adult Kathy Crowley Case Study 1‐5 The Case of Aundria: Treating Substance Abuse During Adolescence Using CBT and Motivational Interviewing Paul Sacco Charlotte Lyn Bright Janai Springer v 29 45 64 72 vii CONTENTS Case Study 1‐6 A Developmental Approach to Working with Sexually Abusive Youth George Stuart Leibowitz Susan L Robinson Case Study 1‐7 Effective Interventions for Adolescent Conduct Disorder in Residential Treatment Jamie L Glick 86 110 Case Studies in Group Treatment 130 Case Study 2‐1 A Social Skills Group for Children Craig Winston LeCroy Case Study 2‐2 A Culturally Grounded Empowerment Group for Mexican American Girls Lori K Holleran Steiker Eden Hernandez Robles Case Study 2‐3 Developmental Play Groups with Kindergartners in a School Social Work Setting Timothy A Musty Case Study 2‐4 Gay Youth and Safe Spaces Nora Gustavsson Ann MacEachron 133 Case Studies in Family Treatment and Parent Training Case Study 3‐1 HOMEBUILDERS®: Helping Families Stay Together Nancy Wells Gladow Peter J Pecora Charlotte Booth Case Study 3‐2 Evidence‐Based Approach to Parent Training Randy Magen Case Study 3‐3 Promoting Positive Parenting: Infant Mental Health Intervention with High‐Risk Families Brenda Jones Harden Elena Aguilar Cindy Cruz Elizabeth Aparicio 145 162 174 182 184 203 219 Contents Case Studies in Child Welfare and Adoption Case Study 4‐1 A Case Study of the Application of NTU Psychotherapy for Treatment Foster Care and Emotional Trauma Frederick B Phillips Peter Fitts Case Study 4‐2 Helping Families with Reunification: Returning a Child to a Less‐Than‐Perfect Family Lindsay Bicknell-Hentges John Lynch Case Study 4‐3 Nothing Left to Lose: Growing Up in Foster Care Debbie Hunt Case Study 4‐4 Deciding What Is Best for Savannah: The Grief and Joy in a Successful Adoption Melissa Evans Case Studies in School and Community Settings Case Study 5‐1 Zai: A Hmong Adolescent Creates His Own Way Harriet Cobb A Renee Staton Krystal Studivant Case Study 5‐2 Understanding Bullying and Peer Victimization: The Important Roles of Peers, Parents, and School Personnel in Prevention and Intervention Anne Williford Case Study 5‐3 Finding a Voice and Making It Heard: A Case Study of Low‐Income Urban Youth Nicole Nicotera Case Study 5‐4 Living in Survival Mode: A Young Woman’s Experience of Homelessness Richard Geasland Rachelle Wayne Author Index 363 Subject Index 371 vii 236 239 263 277 289 296 299 312 328 346 Case Studies in Group Treatment 167 group, and he needed lots of verbal encouragement to participate in the activities He was extremely brief during the feelings check‐in group, even though his verbal expression skills were adequate He was reticent during the “checkup for hurts” at first, not wanting to accept any lotion The physical activities, such as Follow the Leader, the Soda Chant, and the Hokey Pokey, were challenging for James because his gross motor coordination was lower than average for a kindergarten student Theresa was referred by her teacher because of her quick mood shifts, in which she would pout and refuse to her schoolwork When she was really upset, Theresa would crawl under tables in the classroom and sulk for 20 to 30 minutes She had difficulty relating to peers because of her moodiness, and she was not often included in group activities or games Her teacher found ignoring her moodiness and sulking to be the best strategy, and she would usually return to the class activities on her own In the group, she was very shy during “feelings check” and gave very brief responses She did accept the nurturing activity of “checkup for hurts” quite readily When she felt that one of the group activities was too hard, such as Follow the Leader or Beanbag Toss, she would retreat from the group and sit on the cement steps of the stage Fortunately, she never tried to leave the stage entirely Mary was referred by her teacher because of frequent temper tantrums and screaming out in the classroom, particularly if she didn’t get her way She was a very capable child academically, and she could finish her work quickly when she was focused Mary also was quite athletic and excelled at physical education and outdoor activities Mary was very cooperative in the group, and she enjoyed the “feelings check” and the “checkup for hurts.” She was the most verbal group member in expressing her feelings, and she often digressed into lengthy stories about her family that were always presented in a very positive context Because of her athletic ability, she excelled at all of the activities requiring movement When she was the leader in Follow the Leader, she wanted to cartwheels on the mat, but she had to be redirected because her peers were not capable of such an activity PRETEST Several weeks after the group had begun, the teachers of the children participating in the developmental play group were asked to fill out the Preschool and Kindergarten Behavior Scales (PKBS‐2; PRO‐ED, 2002) This 1688 CASE STUDIES IN CHILD, ADOLESCENT, AND FAMILY TREATMENT Table 2.1 Group Members’ PKBS-2 Pretest Scores Robert Peter James Theresa Mary SOCIAL SKILLS SUBSCALE: Standard Score Social Cooperation 91 88 67 109 88 Social Interaction 93 91 67 103 96 Social Independence 101 91 48 115 103 Externalizing Problems 118 125 132 115 132 Internalizing Problems 126 98 103 91 128 PROBLEM BEHAVIOR SUBSCALE behavioral observation instrument has two scales, one for social skills and one for problem behavior Higher social skills scores indicate greater levels of social adjustment Higher problem behavior scores indicate greater levels of problem behavior The pretest scores for the group members are shown in Table 2.1 TREATMENT GROUP: MIDDLE PHASE All of the group members were eager to attend the group each week, and they were disappointed when the group didn’t meet because of vacation periods, classroom group testing, or field trips During the middle phase of the group, as noted previously, the testing behavior began Robert began his testing behavior by touching peers during some of the activities His touching was not aggressive but was more of a way that he liked to needle peers and aggravate them Interestingly, he touched the boys much more than the girls He was given a green magnet when I observed him touching other group members or invading their space by standing or sitting too close to them When verbally corrected, Robert made an effort to not touch peers or to invade their personal space Peter continued to have difficulty with his hyperactivity and poor impulse control He continued to tap people on the head too hard during Duck, Duck, Goose, but he did usually respond to verbal reminders about this behavior During the Beanbag Toss activity, he threw his beanbag in impulsive and careless ways that showed he was not responding to my verbal redirection In several successive group sessions, he got two magnets for throwing his beanbag Case Studies in Group Treatment 169 impulsively so that it hit other children Fortunately, he did not hurt any of his peers with the beanbag, but there were moments when several peers showed displeasure in their facial expression Because this repetitive behavior was not improving with verbal redirection, I shared with Peter’s teacher that he would likely be sent back to class in an upcoming group session After the third week in a row of throwing his beanbag impulsively, I gave Peter a red magnet and sent him back to his classroom Subsequently, Peter was much calmer during the beanbag activity, and he responded better to verbal reminders to calm his highly overactive activity level during some of the group games He did get a second magnet in subsequent sessions, however, and lost his sticker on several occasions James did not really test the limits during group His participation in group activities varied from week to week Sometimes he was focused and could participate pretty well in the group activities Because of his poor gross motor coordination, he continued to have difficulty with some of the activities, such as Beanbag Toss, the Hokey Pokey, and Follow the Leader He did try on many occasions, but his coordination was far below that of his peers I gave him lots of verbal praise for his participation at the level he could achieve Theresa continued to be avoidant in participating in many of the activities because of her moodiness and lack of self‐confidence She frequently received one magnet for not participating in group activities, but she always sat on the steps of the stage until the group was close to finished She often would return to the group for the story and the food share activity She usually listened well to the story, and was decent with giving a snack to a peer and also receiving a snack from a peer Depending on her mood, Theresa sometimes was eager to accept a sticker for her participation in group, but at other times she was disinterested in taking a sticker Mary tended to test the limits by her overly lengthy stories during “feelings check.” She had to be verbally redirected on several occasions to shorten her story, because it would become tedious to her peers She also would want to dominate some of the activities, such as Beanbag Toss and Follow the Leader, with her athletic prowess, and she frequently had to be verbally redirected to not try cartwheels or flips on the mat She received a second magnet on a couple of occasions for not listening to the first verbal redirection and lost her sticker for that day 170 CASE STUDIES IN CHILD, ADOLESCENT, AND FAMILY TREATMENT TREATMENT GROUP: ENDING PHASE During the last couple months of the school year, group activities are introduced that require more patience, cooperation, and social skills Examples of games used in the ending phase of treatment include Mother May I?, Simon Says, Drawing a Letter on the Back, Where Is My Monkey?, various games with the CoOper Band, and Blowing Ping‐Pong Balls to each other across the mat Drawing a Letter on the Back has all group members sitting in a circle and taking turns outlining a capital letter on the back of the peer sitting next to them with their finger This game challenges each group member to recognize the shape of the letter as it is outlined on their back Some children pick up the outlined letter very quickly, but others not Where Is My Monkey? is a game of hide‐and‐seek in which one child is the monkey Another child is chosen as the owner of the monkey and counts to 10 with his or her eyes closed while the monkey hides somewhere The owner then has to describe the monkey to the rest of the group members, who then assist the owner in looking for the monkey The game continues until each child in the group has had a turn being both the monkey and the owner The CoOper Band is a large, fabric‐covered rubber band that is used for having the children run into, jump over, and jump through, taking turns one at a time In addition, the entire group can form a circle inside the CoOper Band, and slowly walk in a circle around the mat without touching the band with their hands or fingers These advanced activities are saved until the ending phase of the group (about the last three months of group) Robert was able to make considerable progress by the last several months of group He stopped touching peers, and he did not receive any magnets during the last six weeks of the group He was focused and much less impulsive during the ending phase He actually took some leadership in some of the games, such as Mother May I? and Simon Says He also encouraged James to participate in the activities that were slightly more complex, and he modeled being patient with James when he didn’t understand He enjoyed the physical challenge of jumping over and through the CoOper Band Peter continued to have problems with impulsivity in the group On a positive note, he did learn to tap other group members on the head gently during Duck, Duck, Goose Peter got wound up during the activities, and he would sometimes run into his peers unintentionally when doing the CoOper Band activities He received a magnet for these behaviors, with a verbal reminder Case Studies in Group Treatment 171 to respect the boundaries of his peers Fortunately, he would make a concerted effort to slow down after receiving his second magnet He needed lots of verbal reminders from me about slowing down, and he received verbal praise when he was making an effort to watch his boundaries with others James did his best to keep up with the more complex activities, but he didn’t have the physical coordination to some of the activities with the CoOper Band It was also difficult for him to understand the rules for Mother May I? and Simon Says, so I stood next to him during these activities to guide him along Also, James did not really socialize much with his peers during most of the activities He was able to play the part of the monkey during Where Is My Monkey?, but he wasn’t able to be the owner because he couldn’t verbalize a description of his monkey He also couldn’t recognize the letter during the Letter on the Back Activity James wasn’t really pushed to things he wasn’t able to, and his fellow group members did not point out or pay attention to his limitations Theresa showed substantial progress in the last couple months of group She didn’t retreat from the group as frequently, and with encouragement from me, she tried to participate in most of the activities She made quite a bit of progress in managing her mood and not sulking as often She did well during the CoOper Band activities, as she actually was quite physically well‐coordinated She particularly enjoyed playing the monkey during Where Is My Monkey? She was unable to take a leadership role in Mother May I? or Simon Says, but she often got frustrated with a peer if he or she was leading the activity and Theresa thought she was being unfairly treated by the peer She had a couple of temper flare‐ups, where she yelled at the peer leading the activity, and she was given a magnet Once she retreated from the group after being given her first magnet Overall, however, Theresa showed good progress in group Mary gained the most of all of the group members in terms of being able to interact positively with her peers She seemed to enjoy the activities greatly, particularly the physical movement in the CoOper Band activities She was very adept at providing lengthy descriptions of the monkey when she played the owner in Where Is My Monkey? She was also skilled at leading other group members in Mother May I? and Simon Says She quickly got the letter during the Letter on the Back Activity Of all the group members, Mary required the least verbal redirection, and she got the fewest magnets of any group member (other than James, who really didn’t get any magnets because he did not misbehave in any way) 172 CASE STUDIES IN CHILD, ADOLESCENT, AND FAMILY TREATMENT Table 2.2 Group Members’ PKBS-2 Posttest scores Robert Peter James Theresa Mary SOCIAL SKILLS SUBSCALE: Standard Score Social Cooperation 101 83 83 109 112 Social Interaction 105 96 41 113 117 Social Independence 76 82 54 115 115 Externalizing Problems 117 127 112 82 114 Internalizing Problems 120 119 111 78 102 PROBLEM BEHAVIOR SUBSCALE POSTTEST About six weeks before the group was to end for the school year, the teachers were asked to fill out another PKBS‐2 (PRO‐ED, 2002) The post test scores for the group members are shown in Table 2.2 DISCUSSION The post‐test results of the PKBS‐2 surveys that were completed by the teachers for the children participating in the developmental play group were highly variable The boys showed less improvement than the girls in their scores On the social skills subscales, Robert showed an increase in the subscales of social cooperation and social interaction but a decrease in social independence He showed a slight decrease on the problem behavior subscale on externalizing problems and on internalizing problems Peter showed a decrease in social cooperation and social independence, but a slight increase in social interaction He showed a slight increase in externalizing problems and a substantial increase in internalizing problems James improved his score in social cooperation, declined in social interaction, and increased in social independence He showed a substantial decrease in externalizing problems and a slight increase in internalizing problems Theresa showed a significant increase in social cooperation and social interaction, and no change in social independence She showed a decrease in externalizing and internalizing problems Of all the students in the group, Mary showed the most improvement on her standard scores She increased substantially in social cooperation and social interaction, and slightly in social independence She showed a substantial decrease in externalizing problems and internalizing problems Case Studies in Group Treatment 173 Based on the standard scores only, it did not appear from the teacher’s observations that their children made tremendous progress In addition, there is no way to ascertain specifically how the group activities might have contributed to an improvement in the children’s social skills or a decline in their problem behaviors My observations of the group members showed a definite improvement in the social skills of the members Testing or negative behavior had markedly declined by the end of the group The group was more cohesive overall and accepting of each member’s unique personality And most important of all, we had lots of fun together CONCLUSION Although there is no definitive way to ascertain the benefit children may derive from the developmental play group, anecdotal reports from kindergarten teachers during my 18‐year history of conducting the groups has been quite positive And teachers have always been eager to refer children to the groups year after year Also, I have been approached in all of the elementary schools where I have worked by many of the students who participated in the developmental play group when they entered first grade, commenting on how much they enjoyed the group Some of these students asked if they could participate in the group again, and I had to clarify that the group is for kindergarten students only Conducting developmental play groups has been challenging at times during my time as a school social worker, but the joy of playing with kindergarten children has been very fulfilling and rewarding REFERENCES Ginsburg, K., & The Committee on Psychosocial Aspects of Child and Family Health (2007) The importance of play in promoting healthy child development and maintaining strong parent‐child bonds Pediatricss, 119, 182–191 Musty, T (2003) Developmental play groups with at‐risk kindergarteners SSWAA Belll, September, 2–3 PRO‐ED (2002) PKBS‐2, preschool and kindergarten behavior scaless (2nd ed.) Austin, TX: PRO‐ED Rubin, P., & Tregay, J (1989) Play with them: Theraplay groups in the classroom Springfield, IL: Charles C Thomas The Theraplay Institute (2005) Theraplay group activities flip book k Evanston, IL: Theraplay Institute 174 CASE STUDIES IN CHILD, ADOLESCENT, AND FAMILY TREATMENT CASE STUDY 2‐4 GAY YOUTH AND SAFE SPACES Nora Gustavsson Ann MacEachron Social isolation and other shared experiences can make group work an effective treatment approach for sexual minority youth Using the simple yet powerful goals of support and creating a safe space, this case study follows a young man’s involvement in a drop‐in youth center and a particularly supportive group Questions for Discussion Why is group work the preferred modality for sexual minority youth? Why the authors take a more “direct approach” with gay, lesbian, bisexual, and transgendered (GLBT) youth, answering questions rather than redirecting as they would with other clients? The authors describe their primary intervention with the client as “environmental manipulation and support.” How does this approach lend respect to the client? “Is he out there?” Tim was the first adult advisor of the drop‐in center to ask the inevitable question There are usually five advisors at each meeting, including a coordinator The Reverend Smear had been protesting the GLBT youth meetings for the last month “Yep, he’s there, and his new sign says ‘God Hates Fags.’ This will upset some of the youth,” said Tim We adult advisors have become accustomed to or, more accurately, resigned to the protesters since the drop‐in youth program at the Gay and Lesbian Center opened a few years ago The protesters added to our workload, because we had to be concerned with our participants’ safety Some of our young program participants were willing to engage the protesters in heated verbal exchanges, and we worried about escalation As we watched the parking lot, we noticed a new youth He hurried past the reverend and burst through the door, looking anxious He was about feet tall, 160 pounds, with sandy blonde hair and blue eyes He introduced himself as Zack He lived in the northwest part of the city and had to take Case Studies in Group Treatment 175 two buses to get to the center He was a junior at one of the larger public high schools, which is known for frequent arrests for drugs and weapons He had learned about the center and the drop‐in youth program on the Internet We had a web page that listed activities, as well as telephone numbers for community resources The youth group meeting was about to start, so we invited Zack to join us USE OF GROUP WORK WITH SEXUAL MINORITY YOUTH Zack was quiet his first night in group, but this is typical For youth who fear they are the only GLBT young person in the world, it can be both a relief and a little overwhelming to be in a group of 30 to 70 GLBT youth When we run educational programs (e.g., information on scholarships, health screening, job skills, etc.), we address the entire group On other weeks, we have breakout sessions The topics for breakouts are often suggested by the youth and usually include dating, family, racism, sexism, homophobia, drug use, safe sex, and religion Group work is our preferred modality with sexual minority youth Many of the difficulties experienced by GLBT youth are a result of trying to live in hostile environments Peers are especially important to GLBT youth, because they often feel isolated Finding a reference group is one of the challenges that GLBT youth face The format for group work has evolved over the years We divide the session into sections The beginning always consists of introductions and greetings of all group members The middle section is focused on a topic that was usually suggested by the youth the week before The last section is open discussion Youth can bring up a topic or can anonymously submit ideas by writing a note and putting it in a basket that is passed around at meetings We also offer art projects, field trips, and movie nights The developmental tasks of adolescents guide the programming Helping youth with their decision‐ making skills, exploring career options, working toward self‐sufficiency, becoming socially responsible, exploring what marriage and family can mean for them, and learning how to appreciate the diversity that is America are topics covered regularly in programming The youth are informally screened during each meeting Some young people are not appropriate to participate in the group, namely those who are actively psychotic, impaired by alcohol or other drugs, or sexually or 1766 CASE STUDIES IN CHILD, ADOLESCENT, AND FAMILY TREATMENT physically aggressive These young people are referred to other agencies for specialized help The group provides a safe space for GLBT youth Participants learn that other young people are struggling with similar issues, and they learn new strategies for negotiating their environments The group encourages peers to support each other The youth most of the talking, which is unusual in their lives GLBT youth report that there are always adults willing to talk at them, but that they have rarely experienced interactions in which they felt listened to and understoodd The group is able to universalize the unique experiences of GLBT youth Younger adolescents, ages 15 and 16, report that they like to hear the “older kids” talk about how they cope The older kids are the 17‐ and 18‐year‐olds Group participants are also offered the opportunity to speak privately with any of the adult advisors This combination appears to be effective Many of the adolescents have experienced individual counseling as a result of conflict in school or the home that is directly or indirectly related to their sexuality Those counseling interactions are described as generally unhelpful by the youth LISTENING TO ZACK Zack returned the next week, and the reverend was also there with his sign We made a point of asking Zack how things were going They were not going well His family was becoming increasingly unhappy with his homosexuality, he felt alone at school, and he was worried about God He asked us if we thought it was true: Does God hate him? How you answer a question like this? If this was a clinical setting, and Zack was in the client role, we might have one type of answer Depending on the casework model, we could ask Zack what he thought, or why this was important, or “Is this a problem?” We reject these conventional casework models for youth like Zack because they are stigmatizing and focus attention on the person, assuming a systems theory notion that if you change the person, then there will be other changes throughout the system System theory ignores the unequal distribution of power in a system Zack was not “the problem”; he did not need to change Zack was living in a noxious environment that was undermining his confidence and competence His needs and tasks were typical of anyone his age He did not have unresolved issues requiring extensive one‐on‐one counseling, but he could profit from support and environmental work That Case Studies in Group Treatment 177 is what we set about doing with Zack We are aware that GLBT youth are at an elevated risk for several negative outcomes We are ever‐vigilant for suicidal ideation We encourage the youth to get a formal education, either in alternative schools or at community colleges We often see how public schools try to dissuade GLBT youth from attending We have also seen the results of community‐sanctioned physical violence A few GLBT youth have been murdered There have not been any arrests In most therapeutic models, the therapist might be reluctant to answer such a direct question, especially one about religion However, when working with vulnerable GLBT youth who regularly receive negative messages from an oppressive society, direct answers can be helpful We answered that we did not believe in a hating God We asked Zack about his view of God His response indicated that he had been thinking about this topic extensively, and that he was bright, sensitive, and thoughtful During the discussion, Zack asked questions that were beyond our competence At the advisors’ meeting, we suggested a religion panel for the next group We were assigned the task of finding the presenters This proved to be a challenge Although many of the religious leaders were willing to talk to the youth, very few were gay affirming They would tolerate GLBT people but did not embrace them Thanks to Zack, we now have a semiannual religion/spirituality meeting in which leaders answer the youths’ questions about their relationship with God and how to be a spiritual GLBT person The religion panel is one of the best‐received groups Zack continued to attend group meetings regularly and assumed a leadership role Other youth found it easy to talk with Zack, and he was seen as a friend He would alert us if another youth was in trouble (e.g., physically ill, homeless, or suicidal) Zack shared with the group his struggles at home and in school In many ways, his struggles were not unique He lived in a single‐parent home with an overextended mother and a few younger siblings The family was one paycheck away from eviction Zack hoped to go to college, but his family needed money and encouraged him to work full‐time Because he was bright and physically strong, he was rarely subject to the physical assaults that many of the other youth had to deal with regularly This is especially true for young males who are small in stature or have a developmental disability Zack was fortunate in another way—there was a teacher at his school who liked him and encouraged him We have been impressed over the years with what a difference a supportive teacher or aide can make 1788 CASE STUDIES IN CHILD, ADOLESCENT, AND FAMILY TREATMENT in a young person’s life The youth who leave high school are those who are harassed by both students and teachers Most of the youth have stories about the response or lack of response from school officials to reports of abuse The youth are advised to forget about it, to not be so “obviously gay,” or to go to an alternative high school One of the projects that Zack actively participated in was helping other youth to establish gay‐straight alliances in their high schools Allies provide much‐needed support for GLBT youth Our groups are open to supporters of GLBT youth We usually have a handful of heterosexual youth who accompany their GLBT friends They are an asset and help to reassure GLBT youth that not everyone hates or fears them Zack also participated in our writing workshops He wanted to be part of the acting group, but transportation and time were insurmountable obstacles He wrote about God, hate, love, acceptance, dating, and hope He submitted his material to citywide high school competitions and had pieces selected for publication Zack seemed to be doing well, but we were still concerned His living situation was precarious We asked Zack to call the center if he found himself in trouble UNRESPONSIVE ENVIRONMENTS By the time Zack was in his senior year, his living situation began to deteriorate rapidly His mother was having trouble coping with three children in adolescence She lost her job Her sister moved into the small family home The youngest child was caught with drugs at school Conflict in the home was escalating, and Zack was wondering how long he was going to be able to stay at home We offered to refer the family for counseling Zack thanked us for the offer, but he feared that his mother would only be angrier if she knew he was talking about family problems with outsiders We had several family events (picnics and holiday dinners) to which GLBT youth are encouraged to invite their family Family is defined as anyone the youth views as emotionally important Most of the other youth bring a parent or another adult relative to these events, but Zack never brought anyone We usually had Zack sit with us at a table of supportive parents We asked Zack if we could ask Parents and Friends of Lesbians and Gays (PFLAG) to send a couple of representatives to these family events for him He declined the offer, adding that he appreciated the fact that we always made a place for him at meetings and events Case Studies in Group Treatment 179 Zack often referred to us as Grandma Ann and Grandma Nora We were not sure about the grandmother part We are aware that to a 16‐year‐old, we do, indeed, seem ancient We are also aware that the professional literature often describes GLBT people as having problems with boundaries and intimacy However, we have not observed this and wonder if this view is a result of heterosexist assumptions about a normative model This has become more perniciously virulent as politicians endeavor to define “legitimate” relationships The only relationship that the federal government and many states are willing to accept as worthy of legitimacy and respect is heterosexual marriage However, GLBT persons are denied the right to marry, thus illegitimizing and destabilizing their relationships We understood that Zack needed a context in which to understand our concern for him He had no grandparents, but he had a fantasy about how a grandmother might have treated him At this point in his life, a grandmother fit quite nicely We knew that in time we would lose the grandma title That would be okay as long as it was on his timetable Things went downhill during the Christmas break of his senior year, and Zack was now homeless Friends took him in on a temporary basis He desperately wanted to finish high school He had applied to the local college and had been accepted with a tuition scholarship and the promise of work‐study funds He just needed to survive the next six months, but those six months were painful Zack stopped coming to group meetings We did not have a telephone number or address for him We asked the other youth to keep an eye out for him One youth reported seeing Zack, or someone who looked like him, at the infamous pick‐up park where married men go to solicit young males We were worried We discuss HIV and other sexually transmitted infections (STIs) extensively with the youth, encouraging abstinence and safer sex practices, and the center runs a support group for young men who are HIV positive The size of this group continues to increase Tim called us one night to say that he had received a call from the police Zack had been found standing on a freeway overpass He had climbed over the fence The police got him down and then took him to the center Tim was on duty We decided to get Zack into a transitional living program He might be the only openly gay youth in the program, but we would build in supports We got Zack in a crisis bed for the night, began making calls the next morning, and found a program for Zack Tim took Zack to the facility, where he received a safe place to stay, medication, and counseling After 180 CASE STUDIES IN CHILD, ADOLESCENT, AND FAMILY TREATMENT a month in the program, Zack came to a group meeting We had not seen him in a long time We told Zack we had missed him and were worried about him We developed a harm contract We asked Zack to promise that he would call the center if he ever felt that despondent again We told him that we had been working with the center’s adult support groups and had been able to get a computer system for him as well as a gift certificate to a youth‐oriented clothing store We also solicited movie passes and promises of summer employment Despondent may not be an accurate description of Zack In talking with him, we were struck by how often the themes of discouragement and defeat emerged Describing Zack as depressed or despondent misses the environmental context of his affective state If he was depressed or despondent, it seemed to be in reaction to how his attempts at agency were being defeated and how his striving to establish autonomy was being discouraged These are important distinctions because they direct intervention If Zack is defined as depressed, then he is likely to get a mix of medicines and cognitive‐behavioral therapy If Zack is seen as discouraged by environmental forces, then efforts can be directed at minimizing these discouraging factors or developing supports to counteract the negatives of defeat Zack invited us to visit his placement We set up the visit for the following week We packed the car with the computer, printer, monitor, food (Rice Krispies with marshmallows are always well received), T‐shirts, socks, sweaters, and a stuffed bear Zack introduced us to the staff and other youth His housemates asked if we were the grandmothers that Zack talked about so much While Zack appreciated the material goods we brought, he seemed much more pleased that he could say to those in his immediate living environment, “Hey, look everybody, there are people who care about me I have not been abandoned.” He walked us to the car, gave us a hug, and said, “Goodnight, Ann Goodnight, Nora Thanks for coming.” It was the first time he had not called us Grandma We have watched Zack struggle and grow into a capable and caring young man We continue to worry about him He has fewer supports than most of his peers Our primary intervention with Zack was environmental manipulation and support The Diagnostic and Statistical Manual of Mental Disorderss (DSM) has little utility for a youth like Zack There are no codes for homophobia or heterosexism GLBT young people can profit from safe places to socialize with other youth where caring adults can keep an Case Studies in Group Treatment 181 interested eye on them It is a privilege to know these youth They are so very brave They battle fear and intolerance every day They resist being labeled as “sick” and in need of therapy They are adept at identifying their needs Acceptance is usually number one on their list They ask for so little Like much social work intervention, the goal was to improve the fit between Zack and his environment Interventions, however, often focus on changing individuals so they can “fit in” to noxious environments Zack knew he did not fit in to the systems that mattered most to him—family, friends, religion, and school Other systems failed him as well He had been seen at a health facility for a school physical When asked about sexual activity, he said he was gay He was then told he would get AIDS and die if he did not change Upon the reversal of Don’t Ask, Don’t Tell, Zack began thinking about the military as a career option Zack hoped to be able to marry someday He was concerned that his partner might not be able to visit him in a hospital The Defense of Marriage Act added to his concerns Zack does not know how much he helped the center to improve its services Because of Zack and youth like him, the center now offers an online high school We have a contract with a local behavioral health agency to provide screening and services for youth with mental health issues We have a summer jobs program provided by supportive small business owners that offer training in service industries We have had some success in offering transitional housing for young adults (18 through 22) but continue to battle to get a group home for youth under the age of 18 The task of transforming the environment is ongoing but essential if we are ever to help GLBT youth become happy and productive adults ... Case Studies in Child, Adolescent, and Family Treatment Craig Winston LeCroy and Elizabeth K Anthony editors Case Studies in Child, Adolescent, and Family Treatment Second Edition... LeCroy, Craig W Case studies in child, adolescent, and family treatment / Craig Winston LeCroy, Elizabeth K Anthony.— Second edition online resource ISBN 978 -1- 118 -12 835-0 (pbk) ISBN 978 -1- 118 - 418 97-0... Permissions Department, John Wiley & Sons, Inc ., 11 1 River Street, Hoboken, NJ 0703 0, (2 01) 748-6 01 1, fax (2 01) 748-6008 Limit of Liability/Disclaimer of Warranty: While the publisher and author