School of Social Work Andrea R. Case Study

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Borough: Queens
Type of Report: Initial
Date of Intake: 9/15/07
Source of Report: Hospital psychiatrist
Date of Initial Visit: 9/15/07
Date Source Contacted: 9/15/07

Current Allegation: Inadequate Guardianship

Household:
Mother, Andrea R., age 27
Son, Vincent, age 9
Other Family Members:
Father, John S., age 33
Sister, Elizabeth, age 29

Allegation: Psychiatrist from Elmhurst Hospital called saying the mother overdosed on Zoloft last night and was brought to the hospital at 6:30 A.M. She was accompanied by her 9 year old son, Vincent. She was admitted to the hospital, but refused to give any information to assist in making a plan for Vincent.

Family Background

Andrea is a 27year old Caucasian woman who lives with her 9 year old son, Vincent in a one bedroom apartment in Queens that is described as spacious and clean. She is unemployed and receives $23 daily in food stamps, $68.50 biweekly in cash, and $624 monthly for SSI due to Vincent’s autism/chronic asthma. Vincent’s father is 33 year old, and is unemployed. He receives SSI due to an accident that occurred when he was 14 and left him unable to use his arm. John provides Andrea with occasional financial support and is involved with Vincent, visiting him 3 times a month. Both Andrea and John report having positive experiences with each other.

Andrea has been hospitalized at least 3-4 times according to her sister. She has been diagnosed at different times with schizophrenia, bi-polar disorder, major depression, and epilepsy. She currently takes Zoloft and seizure medication.

Prior Investigations

There have been five prior reports dating from 2001 to January 2007 against this family. In January 2001 an anonymous source reported Andrea for corporal punishment, inadequate guardianship, and drug and alcohol misuse. It was noted that Vincent communicated by crying, yelling, and making loud noises. After investigation and evaluation of the boy by an early intervention program, he was referred to a specialized hospital program and the case was closed, unfounded.

In November of the same year allegations of inadequate guardianship, lacerations, welts and bruises were made against Vincent’s father John. The allegation was first made by a police officer to whom Andrea complained after her son returned home from a visit with his father with a black and blue mark under his eye. A social worker at the hospital where his mother took him for treatment made the same allegation. The father claimed that the bruise resulted from Vincent falling off a bed and onto a toy. Andrea said that he had returned from other visits with bruises so she became suspicious. The doctor who saw Vincent at the hospital did not think the bruise could have occurred as a result of an accident, and that it had to be deliberately inflicted. However, after an extensive investigation including several home visits, and interviews with the boy, his father, his paternal grandmother, with whom John lives, the doctor, and Andrea, the worker concluded that he “did not obtain any evidence to confirm the allegations.” The case was closed, unfounded.

In 2002 a social worker at the preschool Vincent was attending made allegations of inadequate guardianship and inadequate food, clothing, and shelter against Andrea. It was alleged that Vincent often seemed uncared for, goes to school without extra diapers, in clothes that are often dirty or stained, and misses a day of school a week. Also, Andrea has usually failed to call the school when he was ill. The precipitating event for the report to the State Central Registry was that a teacher had to put another child’s pamper on Vincent because his mother had not sent any extras, and he was wearing the same diaper for 36 hours. Andrea claimed that the diaper incident resulted from miscommunication with a friend who assists her so she can attend school. She forgot to ask her friend to change her child, and she does not change his pamper when he returns from school. The worker concluded that Andrea lacked knowledge of the child’s developmental needs and referred her to a preventive service agency for services. The case was indicated.

The next report was made in 2006 by Andrea’s ex-boyfriend’s mother, who alleged parental drug and alcohol misuse and inadequate food, clothing, and shelter. Andrea denied the allegations, but said she knew who made the report. She had been assaulted by her ex-boyfriend, he was arrested, and she obtained a full order of protection against him. The CPS worker spoke with the district attorney, a friend who corroborated the assault against her, and the AHRC where Vincent was receiving services. All supported Andrea’s story so the case was closed, unfounded.

The most recent complaint was filed by a police officer in January 2007. He reported that Andrea had become irrational, displaying extremely abnormal and erratic behavior, walking in circles, running from room to room, and calling 911 while officers were still in the home. He thought Vincent was also displaying abnormal behaviors similar to his mother. They were both transported to a major hospital where Andrea remained for about 2 weeks. During that time his maternal aunt, Elizabeth, cared for Vincent. Andrea was released with a diagnosis of major depression with psychotic features and prescribed several medications. She was to be seen by a therapist at the hospital so the case was closed, unfounded.

In addition to these reports, Andrea lived with her mother when at least 2 reports were made naming her and her siblings as maltreated. The allegations were educational neglect, lack of supervision, and inadequate guardianship. These complaints were filed when Andrea was 14 and 16. In both cases the sources complained Andrea’s mother smoked crack, left the family alone when she went to buy drugs, and let Andrea and her sister be out on the street until late. In the later complaint it was also noted that different men were frequently seen going in and out of the house. Although both cases were indicated, it is unknown what services were provided.

Current Investigation

On 9/15 the source, Dr. H., a psychiatrist, told CPS that Andrea was brought to the hospital by EMS at 6:30 am that morning because she overdosed on Zoloft the night before.  Andrea’s son Vincent accompanied her to the hospital.  Andrea took the medication in an attempt to kill herself because she was depressed, lonely, and overwhelmed, along with having conflict with both internal and external family members.  Dr. H. also reported that Andrea was hospitalized for schizophrenia in January 2007 at another hospital. Andrea was described  as being “alert, quiet, guarded and uncooperative,”  the latter because she failed to give the hospital staff any legitimate telephone numbers of resources for her son while she was being treated at the hospital.  He asked that ACS make immediate plans for care of Vincent. The worker talked with Dr. H. about respite care as an alternative to foster care, but after consultation with a hospital administrator, it was decided that ACS should assume responsibility for Vincent.

The worker held a face-to-face interview that day at the hospital with the child, Vincent, a fourth-grader, who reported that he does well in school. During the interview, Vincent told the CPS that his mother was “nice and taking good care of him.” He denied that his mother hit him and said that his mother would talk with him when he would do something bad. Vincent added that he had been helping his mother to clean the home since she was not feeling well. In reference to the suicide attempt, Vincent said that he saw his mother take medication, but did not know the reason. The interview concluded by Vincent telling the CPS that he helped his mother a lot and hoped that she would be better soon. The worker also attempted to interview Andrea, however, she did not appear coherent.

During the hospital visit, the worker again spoke with Dr. H., the source. He said that Andrea was admitted to the Emergency Unit for evaluation. He also told the worker that Vincent’s maternal aunt, Elizabeth said that Andrea had been hospitalized over five times for psychiatric problems and that the family is concerned about Vincent’s safety. According to Dr. H., the aunt did not feel that Vincent would be safe returning home to his mother until there was remarkable improvement in her mental condition.

On 9/16, Vincent was observed at the hospital and found to have no bruises or marks; he was removed to the Children’s Center awaiting placement with a relative after the completion of an expedited home study. He was later placed with a voluntary foster care agency.

The CPS worker had a face-to-face interview with Vincent at the Children’s Center on 9/17, during which Vincent said that he was home with his mother at the time of the incident. He said that he saw his mother drinking “black water”, but he later said that it was “black pills.” Vincent said that he was afraid his mother was going to turn into a monster, but he did not elaborate as to what he meant, even after the worker questioned him. After being asked how he is punished at home, Vincent said that his mother tells him not to do whatever he did again, and she has also told him that “I’m going to punch you in the face.” Vincent denied his mother ever followed through. He did admit to being hit by his mother 4 times with a belt on his arms and legs. When asked by the CPS whether he has ever seen his mother acting “weird or out of place,” Vincent denied that his mother heard voices or talked to herself. He did however, say that his mother feels better when he takes care of her when she gets sick, and he clarified his mother’s sickness as when she “gets a cold or when she doesn’t feel good.”

Vincent also explained that he makes his mother feel better by listening to her, watching television and being quiet. Asked about his father, Vincent said he sees his father on a regular basis. He likes to see his father because they go to the movies and the park.

The CPS observed an old scratch mark on Vincent’s forehead and an old circular quarter-sized mark on his right arm. Vincent explained the mark on his forehead came from a fall while playing, but he did not have an explanation for the mark on his arm; he denied that it was the result of being hit. Vincent receives speech, counseling, and occupational therapy at his public school, where he is in special education.

On 09/17 the worker also had a face-to-face meeting with Andrea in the hospital, where she seemed heavily sedated. When the worker asked her about the incident that led to her hospitalization, Andrea reported that she took too many Zoloft, but did not know how many. She went on to explain that she took the pills because she was lonely and depressed. She said she called 911 after taking the pills so that EMS could take her and Vincent to a “different location.”

Andrea said that she was seeing a psychiatrist named Dr. B., but she did not know how long or what his telephone number was. She denied hearing voices and past suicide attempts. She admitted she was hospitalized in Virginia while visiting a relative in May or June, but she refused to talk about it. Andrea said she takes Zoloft and Dilantin for her past diagnoses of depression and seizures, but she has not taken the medications on a regular basis. When asked how long ago it had been since she took the medication, Andrea responded by repeating herself. She asked to have Vincent placed with her sister, Elizabeth who reside in Brooklyn. She reported that she does not get along well with her mother or sister; and she hadn’t seen them in over a month. She also stated that Vincent’s father is involved because he brings her money.

An interview was held with Vincent’s father John S., on 09/17 after the worker received a phone call from him. Mr. S. said that heard from Andrea that morning advising him that Vincent was placed in foster care. The worker explained that Vincent was at ECS because his mother overdosed on pills. Mr. S. said he was aware that Andrea had mental problems, but did not know how bad. He said that he had never lived with Andrea, and she appeared “fine” when he would see her. He said he only became aware of her mental problems recently, and Vincent never told him about any problems he was having at home or about any of his mother’s unusual behaviors. Mr. S. was not aware of Andrea’s prior hospitalizations. Mr. S. Said Vincent is his only child, and they have a close relationship. He visits his son three times a month, and he has always found him well groomed. He denied ever seeing marks on Vincent. When asked by the worker whether he was willing to care for Vincent, he refused because of his living conditions, which he would not further explain. He thought it would be best for Vincent to be placed with his aunt, Elizabeth.

The worker interviewed this maternal aunt, Elizabeth on 09/17 by telephone. She disclosed that Andrea was diagnosed a few years ago with schizophrenia, bipolar disorder, depression and epilepsy. Andrea was reportedly under the care of a psychiatrist at that time, but Elizabeth did not have any contact information. She said Andrea attempted suicide and was in the hospital for at least a month in May or June. At that time, Elizabeth said she cared for Vincent. Elizabeth further reported that Andrea had three or four more hospitalizations for the same reason, all occurring within a year. She could not give details of those hospitalizations. Elizabeth described Andrea as being unstable because of her mental health problems. She said the last time she saw Andrea was in July ’07, and she had seen her crying and laughing at the same time. She also saw her talking to herself and hearing voices; however, she did not know what Andrea was saying. Elizabeth said that she has witnessed this behavior before. Vincent was described by Elizabeth as being very protective of his mother, saying nothing negative about her. Although Elizabeth disclosed that she is not close to her sister and hardly talks to her, she wants to be a resource for Vincent.

In exploring this possibility, the worker found that Elizabeth lives in a two-bedroom apartment with her husband and two children. She told Elizabeth that a visit would have to be made to her home to conduct a home study prior to Vincent’s placement there. At that point, Elizabeth told the worker of prior ACS investigations, all of which were unfounded. She explained that these unfair reports were made by a woman in her building.

The worker also contacted Vincent’s maternal grandmother, who said that she visits Andrea and Vincent on a regular basis. The worker discovered that this grandmother is not a placement resource because she currently lives in a rented single room. The grandmother said she witnessed Andrea “acting weird” only once when she was laughing and crying all at the same time, but she never questioned her about her behavior. She denied that Andrea talked to herself and was hearing voices, or that she abused drugs and alcohol. She described Andrea as being very loving towards Vincent so she never considered him in danger while in his mother’s care. When asked whether Vincent ever talked to her about his mother’s behavior, she denied this. She too described Vincent as being “very protective” of his mother. She said she never felt Vincent was in any danger with his mother.

On 9/18 the worker contacted Vincent’s school and spoke with his teacher for the past two years. She said that Vincent had been attending the school for the past three or four years and is in a special education program under District 75. She added that Vincent does have an IEP on file from about three years ago, which states that Vincent is diagnosed with autism. He has not displayed behavioral problems and is in a regular education, but he receives speech therapy, counseling and occupational therapy. She also stated that there was no prior suspicion of abuse or neglect and that he has good grades and attendance.

On 09/18 the CPS worker filed an Article X petition against Andrea and a remand was granted. Vincent’s father did not appear in court as he had previously promised. The case was adjourned to 10/11.

On 09/20, the CPS called Vincent’s father to ascertain why he had not gone to court and to inform him about the next court date. Mr. S. said he had gone to court but he was late. He said he would show on 10/11. He was then asked if he could provide the names of any relatives that could be a resource for Vincent if maternal relatives should not be accepted. He said he did not have any in mind, but he would call back if he thought of any.

On 09/26, the CPS worker received a phone call from the psychiatrist, Dr. H, at the hospital where Andrea had been admitted. He said Andrea was discharged from inpatient psychiatric unit on 9/25 and was diagnosed with major depressive disorder and prescribed Zoloft. Andrea was also diagnosed with a seizure disorder and was prescribed medication for this condition as well. The doctor recommended that Andrea continue to see the psychiatrist she had seen previously as an outpatient.

On 10/1 a 72-Hour conference was held at the foster care agency with the child evaluation specialist (CES), the unit supervisor, the supervisor and a worker from the foster care program, a worker from Association for Help of Retarded Children (AHRC), and Vincent’s parents. During the conference Andrea produced her discharge form from the hospital recommending that she follow up at the other hospital with her psychiatrist, Dr. D. She said she had been seeing the psychiatrist for about a year. It was reported that Vincent was doing well in his program at AHRC where he was learning daily living skills and receiving after school care, and community integration services. In discussing plans for Vincent, Andrea could name only her sister, Elizabeth, and her mother as possible resources for Vincent, but she requested that neither be allowed to have contact with him without going through her. John said he thought Vincent should return to his mother’s care. The conference ended with Andrea being advised that she must attend therapy weekly and also attend a parenting skills class.

On 10/11 both parents went to court where Andrea requested a 1028 hearing for Vincent. She produced a letter from her therapist, Dr. D., stating that she is being treated for major depressive disorder and has been compliant with therapy. Dr D. recommended that Vincent be reunited with his mother, writing that Andrea is capable of caring for her son.

On 10/12 the CPS worker made a home visit and met with Andrea. She noted that they lived in a clean, spacious one-bedroom apartment.

Andrea visited Vincent at the foster care agency on 10/13. Both were happy to see each other, and Vincent asked when he could go home with his mother. She explained to him that she couldn’t make any promises. The foster care worker described them as having a strong positive bond and relating well to each other.

In another court hearing on 10/15 Andrea withdrew her 1028 request and asked for unsupervised visits with Vincent based on Dr. D’s letter of recommendation. The foster care worker said the visit at the agency had gone well. The judge ordered the CPS worker to contact Andrea’s psychiatrist, saying the case would be recalled.

That same day the worker called Dr D. who confirmed that he had been seeing Andrea for 2 years, found her to be generally compliant, taking her medications as prescribed. Noting that the doctor had not seen Andrea for several months prior to 9/28 when he wrote the letter for her, the CPS worker asked if he was aware that Andrea had a “mental breakdown” and was hospitalized for this on 1/7, 5/7 and 9/15. The doctor said he was aware and still recommended reunification.

The worker then asked if the doctor was aware that when Andrea took the handful of Zoloft, she did this in the presence of her son. The doctor was unaware of this, but did not change his position. He informed the worker that Andrea’s condition would worsen if Vincent remained in care, saying she would become more depressed without him. He did not believe Andrea posed a risk to the safety of Vincent. He had seen her several times since her hospitalization and reported that she had been compliant with her 30 minute sessions. When the worker asked why he thought Andrea had not shown up for treatment for several months before this recent hospitalization, the doctor responded, “she just stopped coming.” He added that when he saw her on 9/28, Andrea just said she was on “some sort of a trip.” The doctor then ended the call, saying he was extremely busy, and disconnected.

When the case was recalled in court later that month, the CPS worker informed the judge that Andrea’s psychiatrist had not seen her for several months prior to writing the letter. The judge then adjourned the case until 2/6/08 and ordered that all visits be supervised.