Case Study: Jen and Maura

Maura is an occupational therapist working for an early intervention (EI) program. She
received a referral on a 2 1⁄2 year old girl named Jen Stone who was recently
discharged from the hospital. Jen is the youngest of five children, and the reason for
her referral to EI was a recent hospital admission following a home accident. Jen was
injured when the Stones were moving. During the move, they removed a door from its
hinges to move several large pieces of furniture. The door fell on Jen, resulting in
head trauma.

Maura's initial evaluation noted that Jen was profoundly delayed in all developmental
milestones. Her vocabulary was limited to about 10 words, and she demonstrated a
mild left hand weakness and significant delays in fine motor skills. Jen rarely smiled
and demonstrated significant stranger anxiety during the evaluation. Ms. Stone
reported that all her children were “slow talkers.” Ms. Stone thinks that Jen needs
medication because of the way she hit her head. In subsequent conversation with Ms.
Stone, Maura realized that Ms. Stone was talking about phenobarbital, an
anticonvulsant medication that is prescribed to prevent seizures and not designed to
foster development.

Maura explained the purpose of the medicine and that Jen needs extensive therapy to
assist with her neurological recovery. Ms. Stone told Maura that everyone in the
hospital wanted Jen to go to a rehabilitation facility but that she really wanted to take
Jen home. Maura concluded that Ms. Stone had a poor understanding of typical child
development and how this head injury would affect Jen.

Maura left the Stones troubled by the case and with serious questions about Jen and
her family. In her monthly meeting with the EI team, Maura brought up her concerns.
Shoshona, the caseworker assigned to Jen's case, reported that “this is a high-risk
family” and that other siblings had been admitted to the hospital in the past only to be
taken home against medical advice. After that meeting, Maura and some of her
coworkers went for a quick cup of coffee. As Maura waited in the line at the coffee
shop, Shoshona said, “Stick with that Stone case. Make sure you do whatever you
need to stay involved. Remember this is a high-risk family.” Maura was shocked at
this breach of confidentiality and said, “Remember, we are not at the office anymore.”

The following week when Maura went to see Jen, Ms. Stone would not let her in,
saying that her husband had overheard some people talking about them in a coffee
shop. Mr. Stone had told his wife, “If you let them in the house again, you will regret
it.” Maura quickly apologized and left, embarrassed, upset, and concerned about Jen
and her family.