Wright Family Case Study1

Wright Family Case Study

Tammy R. Grant
Department of Education
Webster University

Wright Family Case Study2

Abstract
The information shared in this case study is based upon an actual case that I worked
when employed with the Missouri Department of Social Services Children's Division.
The events are real however the names of individuals and places involved have
been changed to protect the confidentiality of the family. The primary objective of
this case study is not just to look at the procedures that were taken in addressing
the problems, but to examine the resiliency of Lisa Wright by explaining it through
the developmental stages of Dr. Erick Erikson and others in the field.

Problem Presented
The Wright family was referred for services with our agency to assist the family with
obtaining mental health services for Lisa Wright whom was defecating on herself at
school. The family was involved with Truancy Court because of the childrens
behavior. Allegations were also made that Mr. Holt was a drug user and was
consistently high.

Family Case History

Wright Family
NAME
Cierra Wright
Lisa Wright
Leah Wright
Lester Holt
Crystal Wright

AGE
25
5
11
26
58

GENDER
Female
Female
Female
Male
Female

Kyle Wright
Kevin Wright

30
19

Male
Male

RELATION
Mother
Child
Child
Father
Maternal Grandmother
of Lisa and Leah
Brother of Cierra
Nephew of Cierra

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The Wright/Holt family household consist of the members listed above. Mr. Holt does
not live in the home but due to his active participation in the lives of his children, I
have included him in the household. There were roughly four members that were
not listed and requested not to be a part of the assessment process. The Wright
familys social economic status is: low income; poverty. Cierra Wright and Lester
Holt lived together roughly six years prior, but Lester lost his job and was unable to
maintain housing for the family. Cierra Wright and her children now reside in the
home of her mother, Mrs. Crystal Wright. This was due to Cierras inability to find
low income housing, however she has applied for low income housing and was on
several low income housing waiting list. The primary source of income for Cierra
Wright and her children was Temporary Cash Assistance for Needy Families (TANF),
Food Stamps and Social Security Income (SSI). The family reported that Cierra
Wright was diagnosed as Mild Mentally Retarded as a child. Kyle and two other
siblings (not living in the home) are learning disabled. Other than the diagnoses of
mental retardation and learning disabilities, there were no other mental health
issues reported by the family. As a result of a work related accident, Lester is blind
in his left eye. Lester receives Social Security Disability Income (SSDI). Mr. Holt
resides with is paternal aunt. Mr. Holt also works odd jobs to supplement his income
but most of all to keep himself busy. Both, Cierra and Lester graduated from high
school and have a strong belief in education. There are no known health problems
with either Cierra or Lester. There are no reported health problems with the children
or other family members with exception of Mrs. Wright. Mrs. Crystal Wright has been
diagnosed with COPD and a bad back. Mrs. Wright retired from Proctor Gamble
several years prior (Note: Mrs. Wright could not exactly when she retired because

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she was off of her job for more than seven months prior to her actual retirement.) .
Lisa and Leah are currently current with all of their vaccinations. They see Dr. Helen
Athens at Florence Hill clinic. Dr. Athens has only been seeing the children for two
years but the children have always been seen at the clinic.
The family reported no major problems with Lisa in the home. Cierra stated that she
had no problems during her pregnancy with Lisa; and Lisa was full term. The family
reported that Lisa sleeps through the night, loves playing outside, loves helping
around the house and has a healthy appetite. The family reported that Lisa loves
eating vegetables. The family reported that Lisa does get aggrieved when she
cannot get something right but, she just keeps trying. An example of this is making
up the bed. The children are taught to fix their beds in the morning. Lisa gets upset
when she cannot get her bed to look like her sisters or Mrs. Wrights. Mrs. Wright
stated that she has explained to Lisa that it is ok, that her bed does not look like
theirs. Mrs. Wright stated that she tells Lisa that the more she practices the better
she will get. Lisa will do the task repeatedly without asking for help. Lisa and her
sister Leah have gotten into fights because Leah attempted to help Lisa. The family
reported that Lisa attended preschool prior to entering kindergarten. The family
stated that Lisa loved attending school. From the school work samples that the
family shared with me, I could see no problem with the structure of the writing.
There was however an accident two years ago. Lisa was hit by a car when she was
about three years old. It appears that Mr. Holt was arriving home from work and
parked on the opposite side of the street. It was reported that the child darted out
into the street after her father. Lisa was in the hospital for roughly two months. The
family reported that Lisas arm was broken, head and other injuries. Upon release,

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Lisa received treatment for her arm that was still in a cast. There was no additional
services provide for the family. They were told that the child was fine.
According to the information gathered, Mrs. Crystal Wright is the primary support
system for Cierra. The family expressed their belief in God but stated that they do
not attend any specific church. The only social relationships established are those
that the children have at school, with their physician, and the other children in the
neighborhood. The families strength is their willingness to stick together. For
recreation it is reported that the family enjoys going to the park. Mr. Holt drinks
occasionally but there is no reported history of drug or alcohol abuse and no history
of domestic violence. Ms. Cierra Wright does not appear to have good coping skills,
she stated that she always tries to address situations concerning the children but
cannot handle the way that she is treated by school officials and others
professionals. Cierra even admitted to not understanding the information that was
being shared with her by professionals that she comes in contact with.
Lisa and Leah appear to be very happy children. The children did not report any
form of abuse or maltreatment. Lisa and Leah reported that when they get in
trouble, they are punished. They cannot go outside and play or watch television.
Both of the girls stated that they rather be outside playing than watching television.
Leah expressed her interest in bike riding, when she is outside.
The four bedroom cottage style home is very cluttered but clean. While, I observed
roaches I could not say that it was an infestation. The family reported having just
sprayed the day prior to our meeting. The family; Cierra, Leah, Lisa and sometimes
Lester reside on the second floor of the home. It is cluttered but there are beds for
everyone to sleep. The children do their homework at either the kitchen or the
dining room table.

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Method
To assist the family in addressing the issues with Lisa, I had to first gain the
confidence of the family because, I was not in a position to make a diagnosis. I
accomplished this by listening to the family. I repeated back to them information
that they shared to assure that I had the correct understanding. I was also able to
explain to the family the position of the school and the legal obligation that they
had to all of their students. This made the assessment process even easier because
the family understood that my primary objective was Lisas wellbeing and prepared
them for other questions that I had to ask. It was reported by the family that Lisa
had never been sexually abused nor complained of her private parts hurting. The
family also reported that they had brought this issue to the attention of the
childrens pediatrician. The pediatrician stated that there was nothing wrong with
Lisa and suggested that maybe she was not being allowed to go to the restroom.
The family reported to staying at the school with Lisa to learn why the child was
having accidents but saw nothing out of the normal that would cause concerns. I
received a release from the parents to speak with school officials and the childrens
pediatrician.
The purpose of speaking with school officials was to obtain insight on what was
happening at school. I was looking for patterns of behavior. I spoke with the schools
social worker Ms. Tate. In my conversation with Ms. Tate, I posed simple question
such as, how many days of the week was this occurring? Was there a specific time
of the school day that this happened? Has Lisa been doing this since school started?
What is the reaction of Lisa when this occurs? Ms. Tate was not able to provide me
with answers to these questions. Ms. Tate informed me that she would have to
speak with the classroom teacher to obtain that information. However, Ms. Tate

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invited me to a Recommendation Individualized Education Program (IEP) meeting. I
was informed that the meeting was to review the steps that had thus far been taken
and then recommend that the child be tested. Ms. Tate stated that the school was
really unequipped to handle such behavior and needed the child tested. Ms. Tate
also expressed her concerns with the presence of the children. Ms. Tate stated that
the childrens clothes were dingy and that they smelled. Ms. Tate reported that Ms.
Wright and Mr. Holt do come to the school when they are called but feel as if they
come at their leisure. Ms. Tate also reported that they too stink. I accepted the
invitation and while waiting for this meeting (which was the following week), I
contacted Lisas pediatrician.
I sent the release for information to the clinic and received the medical history of
both the children. Lisa and Leah were current with all of their vaccinations. I saw
nothing in the information sent by the clinic that would denote any developmental
problems. Dr. Helen Athens confirmed the information that I received in a telephone
conversation. Dr. Athens expressed that she really did not have any concerns for the
child and if she was defecating on herself that it was due to lack of training by the
parents. Dr. Athens expressed her detain with the manner in which the children
looked and acted. Dr. Athens stated that the behavior was not out of the norm for a
child but felt that Ms. Cierra Wright was not living up to her parenting duties.
I consulted with Mr. Jerome Anthony a colleague at a local therapeutic day
treatment preschool in the area that I had worked with in the past. Without sharing
private information I expressed my concerns about the case. Mr. Anthony agreed to
and with the permission of the parents I invited him to the Recommendation IEP
meeting.

It was during this (IEP) referral meeting that I learned that the school

officials were perplexed with the situation, they felt that the family was simply not

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doing enough. The school did make documented notes about the child defecating
on herself and the producers that they followed to address the issues. Of the efforts
reported, the primary effort made was to contact the parents. It would appear that
the family would be called every ten minutes after the initial call. If the parents
could not be reached because they were on their way and had no cell phone; the
school would then begin to call the emergency contacts listed. Not only were the
school officials pointing fingers at the parents but also at each other. The family was
aggravated with the school and their calling several times a day. The family
reported that they had spoken with Lisas pediatrician whom stated that there was
nothing wrong with the child.
With no real data obtained from the school or the pediatrician that could help me in
assisting the family, I suggested to the IEP team (which included the family) that the
child be placed in the therapeutic day school for the remaining school term.
Because the therapeutic day treatment preschool only worked with children till the
age of six, Lisa would have to return to the school for the next school term. Mr.
Anthony stated that because of its small class sizes, it would be better equipped to
monitor Lisas behavior and obtain a better understanding of why she is defecating
on herself. Mr. Anthony explained that the family would also obtain family therapy
within the home to teach the parents how to better address behavioral problems
with Lisa in the future. Arrangements would thus be made for Lisa to be tested for
Special Education while she is attending the therapeutic day treatment preschool.
The school was pleased with this option.
After the meeting I spoke with the family privately. I stated that a child Lisas age
does not normally defecate on themselves. I pointed out to the family that when I
spoke to the child about why she did this, I denoted shame. I explained that I had

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did some research and learned that with their insurance coverage they did not need
a referral to see a specialist. I went on to state that I learned that the childrens
primary physician was associated with Childrens Hospital and considering that in
past conversation that they had expressed their preference for Childrens Hospital, I
thus sought out children gastroenterologist at the hospital. I provided the family
with the name of several physicians within the Gastroenterology & Nutrition clinic. I
suggested that they call and make an appointment for Lisa as quickly as possible.
Mrs. Wright made the appointment for Lisa and requested that the medical records
from the clinic be sent to the hospital. I also suggested that the family contact St.
Louis Regional Services. I stated that depending upon the diagnoses from the
school, Lisa could possibly be eligible for services. I explained to the family that this
would mean someone with expertise in Special Education could attend all of the
school meetings with them.

Thus assuring that Lisas needs would be met. The

family agreed, contacting the agency and getting all needed documentation.

Results
Lisas attending the therapeutic day treatment preschool provided the needed data
for the family and I. It had been reported by the pervious school that Lisa was
defecating on herself daily. While, in the four month time span in which Lisa
attending the school, she only had two accidents. One of the accidents was due to
Lisa being ill and she was sent home. In one situation, the therapist and Lisa were
sitting on the floor. They were playing a word game to enhance speech and site
word recognition. The therapist stated that she thought that Lisa had just passed
gas. When the odor did not subside within a few moments, the therapist asked Lisa
if she had did something. The therapists reported that it took a moment for Lisa to

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acknowledge what she had done. As soon as she did, Lisas physical gestures and/or
body movement was that of both remorse and shame. The staff at the therapeutic
day school reported that Lisa was constantly passing gas. It was determined that
Lisa passed gas most often when she would become excited or stimulated by the
activity that the class was about to do.
This information was shared with the gastroenterologist at Childrens Hospital. The
family reported that Lisa was seem by Dr. Ray Dawn Chong. Dr Chong explained
that Lisas large intestine was full of bowel, which I learned later was Encopresis.
The family explained that Lisa was never having a complete bowel moment even
though it felt like she had. Dr. Chong prescribed a stool softener that was to be
given to the child two times a day for sixty days, after which the family would return
with Lisa to further assess the issue.
The test result for the development of the IEP revealed that Lisa was Mentally
Retarded. The examiner, Mrs. Macyola Cole, reported that it was difficult to conduct
the exams due to Lisas lack of focus. However on the RIAS and the PTONI
intelligent test Lisa scored a 69. On the YCAT achievement test, she scored a 55.
Mrs. Cole explained to the team that any score under 69 is details of mental
retardation. This meeting was concluded with another meeting being scheduled to
develop the actually IEP.
The family submitted all information from this meeting to the St. Louis Regional
Center. Lisa was assessed with the agency and obtained a Regional Case manager.
It was determined at the IEP meeting that Lisas needs would be best meet at
Mubarak Academy Therapeutic School.
Discussion

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Initially, I thought that Lisa had been a victim of sexual abuse. But, when the family
assured me that there had been no complaints by Lisa when using the restroom, no
urinary tract infection and Lisa confirmed that no one had touched her in a manner
that made her feel uncomfortable; I dropped that notion. It was the conversations
and the interaction with Lisa that let me know that this was something not as
complex, as it was being made to appear but complex enough to ruin a little girls
very existence. Lisa knew that she was loved by her parents, her grandparents and
the other relatives in the home that she came in contact with. Lisa also conveyed
within our conversations, that as long as she did her very best that was all that her
family was asking her to do. According to Dr. Ann Masten, families contribute to the
resilience of their children. They do this by simply providing the physical, emotional
and spiritual substance needed for growth. In conjunction with a safe environment
the family is providing the opportunity for the child to gain experience and
confidence in their own skills (Masten, 2014).The Wright/Holt family had created for
Lisa a foundation of love, trust and empowerment; that she drew upon daily.
I then began to understand Eriksons Psychosocial Development and even Piagets
Four Stages of Cognitive Development and the role that they play in Lisas
resiliency. The first two stages of Eriksons Psychosocial Development are that of
Trust vs. Mistrust; then Autonomy vs. Shame and Doubt (Cherry, 2013) (Santock,
2014). Preoperational Stage is the second stage of Piagets Cognitive Development
Theory (Santock, 2014). Again, from my observation and information that I gathered
from both the family and Lisa; there was a clear bond of trust that was established
between Lisa and her parents. Lisa also loved helping out in the home by doing
chores. However, it was during the Autonomy vs. Shame and Doubt stage and the
Preoperational stage that Lisa received physical trauma to her head when hit by

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that car.

I speculate that it is here that Lisas psychosocial and cognitive

development slowed down.

According to information that I gathered from

WebMd.com, Intellectual Disability (ID), once called mental retardation can occur
when any condition impairs the development of the brain before birth, during birth
or childhood illness/injuries.

While the first IEP consisted of the school official

pointing fingers at the parents and each other. It was Lisas teacher whom stated
that it was very difficult to redirect her but once redirected she assumed the
positions of the leader; not as much to lead the other students but to assert control
and power over what she had learned. Which reflects the earlier characteristics of
the Preoperational Stage of Piagets Cognitive Development Theory.
Lisa began to learn to cope with her environment, once at the therapeutic day
treatment preschool. She had not mastered the skill before leaving the school but
she never stopped trying, which was her strength.

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References
Cherry, K. (2013, January). Erikson's Theory of Psychosocial Development. Retrieved
from About.com Psychology: http://about.com
Intellectual Disability(Mental Retardation). (2013, March 16). Retrieved from WebMd
: http://www.webmd.com
Masten, A. S. (2014). Ordinary Magic: Resilience in Development. New York, New
York: The Gulford Press.
Santock, J. W. (2014). Child Development 14th Edition. New York, New York: McGraw
Hill Education.