Case Study CAF 1
Family:
John Brown8 years old
Jane Brown4 years old
Susan Brown2 years old
Amy Brown(mother – works as a practice nurse for her GP)
Ian JamesAmy’s partner and father to Jane and Susan
Simon GreenFather to John
John is known to his local Hospital and children’s services since birth. Has global developmental delay, and a seizure disorder. He has had spinal rods put in to prevent further scoliosis. Ian James does not work and stays at home to care for the 3 children whilst Amy works. He has problems with anxiety and saw his GP a few months ago who referred him to a specialist. Ian did not attend, saying that he should be able to deal with the problem himself. He is a very proud man and prior to his children being born had a responsible and senior job as an engineer with British Airways. He took voluntary redundancy with a good financial package to take care of the children, including the care of John. The finances now though are running thin and the family need some advice.
Family live in private accommodation with 2 bedrooms, hence all three children sleep in one room – the 2 younger children in bunk beds. The living area downstairs has been adapted for John’s wheelchair.
John is admitted to your ward following concerns about his weight loss and now infected spinal rods. He has sore infected areas on his back where metal work is just visible under the skin, and almost exposed.
Mother refuses to see a social worker saying that in the past they have not been any help. You are surprised to learn that mother has not seen a social worker about John’s needs for over a year now, and really feel that they must care for John themselves. He takes most of their time.
On the ward the two younger children spend a lot of time seeking attention from the nurses. Both find it hard to settle in the playroom.
How will you encourage Amy and Ian to allow a CAF to be carried out?
What would you be asking in a CAF?
Does Simon Green need to be involved? He is John’s father and lives with another family, seeing John on alternate weekends for 2 hours on a Saturday afternoon only.
Case Study CAF 2
You are the health visitor for a 6 month old baby. Mum is 19 years old and lives with her partner Tommy, who is 26. Mum has mild learning difficulties and received extra help at school. Her reading level is at age 11. She left school at 16 with no qualifications. Tommy has a job in an office and his job appears to be stable, and Tommy works hard. He also helps with the baby at home. He does not earn a lot of money and the couple live in a council flat.
You have the opportunity to talk to Mum at the local health clinic and she and the baby receive additional home visits. She seems to like to talk to you and loves to tell you about her little daughter. She doesn’t go the mother and baby group organised by your health visiting team as most of the Mums are older than she is.
Mum is on benefits and seems to have a limited amount of cash. She also appears rather thin and pale and you wonder if she is feeding herself properly. The baby appears to be putting on enormous amounts of weight and despite having talked with mother about nutrition and diet and practical things such as how to give solids, encouraging healthy eating etc. the baby is mainly fed puddings and baby rice, with little variation. Also she spends large amounts of time in her cot. The baby always appears clean and appropriately dressed, in fact mum is obsessive about clean clothes and keeping warm. Tommy takes charge of the washing.
One day she tells you that her partner has left her. Her Mum helps her sometimes, but most of the time she manages by herself as the two don’t get on. Her mum has always been critical of her not being clever, not getting a job, and being lazy.
Mum says she does not want social services interfering and taking the baby away, she is terrified that this will happen. However, you can foresee problems as the baby gets older and the stresses on Mum become greater.
What are the immediate issues for this baby and Mum?
How could you encourage Mum to agree to a CAF being completed? Who needs to be involved? How would you evidence your concerns to frame a referral? What would you expect to happen?
Case Study CAF 3
Kuda11 years
Mother38 years
BrotherAsante 19 years
Ethnicity – Somali (Black African)
The family came to the UK from Somalia 5 years ago, after Kuda’s father was murdered. Her mother won’t talk about his death and it’s not clear whether Kuda knows what happened to him. Kuda speaks English. Her mother needs help from an interpreter. The family live in a one-bedroom flat. They have no friends or family nearby.
The police recently arrested Kuda’s mother because a neighbour alleged that she had assaulted and tried to kill her after an argument. The flat is in a poor state of repair, with holes in the bare floorboards. The curtains are drawn so no natural light comes in. The kitchen has mouldy food in it, it’s hard to sit down in the living room because there is stuff all over the furniture, and the beds are piled with clothes and other belongings.
Kuda’s mother gets very cross and aggressive with professionals. She thinks they want to take Kuda away from her and won’t let anyone speak to the child on her own. Last year Asante had a psychotic breakdown and was admitted to hospital. He seems much better now.
Kuda’s school attendance is poor. She has been off for a while and says this is because she fell and hurt her hip. Her attendance at school is poor. When she does go, teachers say she is pleasant and cooperative. She finds it hard to make friends.
How would you assess this child (Kuda) using the CAF? With the CAF in mind, what are the immediate issues for Kuda, and who needs to be involved? How would you evidence your concerns to frame a referral? What would you expect to happen?
Case Study CAF 4
A 5 year old boy, Darren, is admitted for investigation of facial palsy. Unbeknown to you his parents are separated. Mother lives with her partner in ‘bed and breakfast’ accommodation that is due for dereliction. There are not supposed to be children in the home but the couple have nowhere else to live. You, the professional, have no idea that Darren is living here – according to your records Darren still lives at home with his parents and mother confirms that address. She is also 3 months pregnant.
The little boy is allowed home for a weekend. On return Darren seems very quiet. Mother leaves him quickly, telling you that she has to go shopping. You join him in the playroom where he is looking at a picture book of animals. You encourage him to talk and talk about the pictures with him. He is very quiet and barely says yes and no. Whilst you are there your colleague takes a call from the school administrator. The school are concerned because Darren has not been at school for over a week. They are phoning the ward to see if he is there. Mother informed them that he was coming into hospital for tests, but have heard nothing since. There are concerns about his learning abilities.
Mother returns to the ward later and you inform her that the school has phoned. Initially she is very angry; you have to explain that they did that because they could not contact her, and they were concerned for Darren’s welfare. Mother then bursts into tears and says that she is in great difficulty with things and needs help.
With the CAF in mind, what are the immediate issues for Darren (and family), and who needs to be involved? How would you evidence your concerns to frame a referral? What would you expect to happen?
Case Study CAF 5
A pregnant mother (38 weeks) is admitted to an A&E department. She gives birth to a baby girl who has a below average birth weight. There has been very little ante-natal involvement. It transpires that mother only met with the midwife and GP on one occasion during the pregnancy (only 1 scan completed). Further information from the GP reveals that the mother came to see him as a ‘temporary resident’; she is part of a large family of travellers, having recently travelled through Europe from Romania. Her understanding of English is fair, but she converses well in French.
She has not engaged with the GP, Midwife or HV since that time. This baby is the third – her first child is now 6, and she has a 3 yr old. In conversation with the midwife following delivery the mother talks about her 3 yr old at home (home is a mobile home on a designated site). She says that he doesn’t walk, he is carried everywhere and her relatives are saying that there is something wrong with him. The 6 yr old boy is apparently attending a local school, but it is now the summer holidays and you don’t know how to check this information out. The father is a young man of 23 and mother says that he is on ante-depressants and doesn’t work. The home that they are in is very cramped, both sets of grandparents are also living in this 2 bed roomed home.
Blood tests taken on the baby reveal traces of amphetamines and cocaine but the baby shows no sign of withdrawal. The father and older boy arrive at the Hospital following the birth, both appear unkempt and the 6 year old appears completely disinterested in the baby, he wanders off into the Hospital corridors. When you call him he does not appear to hear you.
With the CAF in mind, what are the immediate issues for this baby (and family), and who needs to be involved? How would you evidence your concerns to frame a referral? What would you expect to happen?