Assessing Children in the Urban Community

Barbara L Mercer, Tricia Fong, Erin Rosenblatt, Barbara L Mercer, Tricia Fong, Erin Rosenblatt

• Publisher: Routledge
• Year: 2015
• Print ISBN:
  9781138776258
• eBook ISBN:
  9781317681076
• Topic: Psychology
• Subtopic: Clinical Psychology
• Index: Psychology

This book illuminates the process of child psychological assessment in community psychology through discussion, theory, and case studies of collaborative, systemic treatment of children and their parents. "Assessing Children in the Urban Community" presents a semi-structured form of collaborative psychological assessment, designed to help clients gain new insights and make changes in their lives. Traditional psychological assessment focuses on diagnosis and treatment but has been slow to include contextual elements, particularly social and cultural contexts into the assessment process and psychological report.

Clients receiving services in a community psychology clinic pay for their treatment through state welfare coverage. They cannot choose their providers, they cannot always determine the length and course of their mental health care, they often do not have access to transportation to begin services, to continue them, or to take advantage of follow-up recommendations. The Therapeutic Assessment model is particularly adaptable to community psychology because it allows maximum interaction in the assessment process and promotes participation and collaboration in an often dis-empowering system.

This book will be relevant to clinical psychologists, community psychologists, social workers, family therapists, graduate students in psychology, social work, marriage and family therapists, and counseling programs.

Section III
Case Studies in Community-Based Psychological Assessment

13
Why Did She Put Nail Polish in My Drink?

Applying the Therapeutic Assessment Model with an African-American Foster Child in a Community Mental Health Setting

Brooke Guerrero, Jessica Lipkind, and Audrey Rosenberg

Finn and colleagues have developed a semi-structured assessment approach, Therapeutic Assessment (TA), which brings together skills from assessment and psychotherapy models and from multiple theoretical frameworks. The resulting approach considers assessment to be a therapeutic intervention in and of itself (Finn, 2007; Finn & Tonsager, 1992, 1997). TA is a form of collaborative assessment that is related to the work of Fischer (1985/1994), Handler (2006), and Purves (1997). Much has been written regarding its effectiveness with adults (Finn, 2003; Finn & Kamphuis, 2006; Finn & Tonsanger, 1992, 1997; Newman & Greenway, 1997; Peters, 2008), as well as with children and families (Hamilton et al., 2009; Handler, 2006; Smith & Handler, 2009; Tharinger et al., 2009; Tharinger, Finn, Wilkinson, & Schaber, 2007). While much of this work has been done in private practice or university research settings, a few articles have encouraged the use of this model in school-based settings (Tharinger et al., 2007) and with foster children and their families (Purves, 2002). There has been little research regarding using this model in community mental health settings and within culturally and racially diverse communities. This article focuses on the application of TA in a community psychology setting with an African American child living in foster care.

Fischer (1985/1994) has illustrated the usefulness of therapeutic techniques in a variety of settings, and our clinic has been influenced by her work, as well as by the teachings and writings of Purves (1997, 2002). Consequently, our clinic has utilized collaborative therapeutic techniques, including gathering questions from caregivers and clients and writing fairy-tale feedback stories to children since the mid- to late-1990s. We have been fortunate enough to have Dr. Purves and Dr. Mercer on staff and have received multiple trainings from Dr. Finn.

This case presentation illustrates one of the first cases our clinicians completed utilizing Finn and colleagues’ comprehensive TA model with children (Finn, 2007; Tharinger et al., 2009). The case we present was part of a week-long intensive training with Dr. Finn. The one-week time frame is unusual for TA assessments and was based on the training needs of the staff and scheduling factors. Dr. Finn served as the consultant on this case. Dr. Guerrero conducted the testing with the client, Lanice, and the testing sessions were viewed via live video feed in a separate room by Lanice’s aunt and mother. Dr. Rosenberg supervised the case and worked on a team with Dr. Lipkind. They observed each assessment session with the aunt and mother. Despite some alterations in timeframe and clinician configuration, we followed Dr. Finn’s suggestions regarding TA steps and procedures. We found it to be a highly effective method with our client and her family. This case illustrates how the TA model had a significant impact on our clients. However, the crisis that occurred during the assessment process and the clinicians’ response to and use of this crisis underscores several important considerations and modifications in our application of this model. This case also highlights the necessity of integrating race and class in the application of TA. Additionally, this case emphasizes the need to extend the interventions beyond the family to larger systems and adopt Boyd-Franklin’s (2003) approach to joining African American families around “real life” problems, such as engaging extended families and outside agencies in the process.

Background of Case

Reason for Referral

At the time of the assessment, Lanice¹ was an 11-year-old African American girl in the fifth grade. She was referred to our clinic by her aunt, with whom she lived, to evaluate her cognitive and emotional functioning, as well as to determine possible causes for her oppositional behaviors and angry outbursts. Lanice often refused to do schoolwork and exhibited acting-out behaviors with her teachers. She reportedly spaced out in class for extended lengths of time and had trouble paying attention. At home, Lanice was generally respectful to her aunt, but she displayed some concerning behaviors that left her aunt feeling confused and angry. On one occasion, Lanice poured nail polish into her older cousin’s drink when she wasn’t looking and sat quietly while she waited for her cousin to ingest it. Additionally, Lanice left shavings of wax from a candle in the carpet and on furniture in the home. Her aunt also reported that Lanice tore up pieces of paper and left them in random places around the house. Lanice did not verbalize why she had so frequently engaged in these behaviors. Her aunt also stated that Lanice was often disrespectful and physically aggressive toward her developmentally delayed mother.

Relevant History

Lanice lived with her aunt, Paula, and her aunt’s adult daughter. Lanice’s mother, Jakara, was diagnosed with Mild Mental Retardation and left Lanice with relatives when Lanice was a baby. Jakara continued to be a part of her life, as she visited with Lanice and occasionally had overnight visits, but her role was closer to that of a cousin than of a parent. Lanice never had a relationship with her biological father. Lanice lived with several different family members, but spent the majority of her life with her grandparents until they passed away in 2007. After their death, she moved in with Paula and Paula’s daughter. Lanice attended her grandfather’s funeral, as he passed away first, but Paula felt it would be too difficult for Lanice to attend her grandmother’s funeral. Paula stated that Lanice had never spoken about her losses. Lanice’s grandparents were elderly and reportedly in poor health, which left Lanice without close supervision and limit setting. Paula stated that Lanice was “spoiled” during her time with her grandparents due to the lack of discipline and explained that she was permitted to do as she pleased without consequences.

For many years, Lanice struggled with her academic performance and behavior in school. Paula wondered if Lanice had a learning disability due to her difficulties with reading and completing homework. Her third and fourth grade teachers urged Paula to request testing for Lanice due to their suspicions of a learning disability. These teachers reported that, despite intensive tutoring and extra attention during class, Lanice was far behind the other students in her grade. Due to unknown reasons, a year and a half passed from the time Paula initially requested the Individualized Education Program (IEP) to the time an actual IEP meeting was held. The school asserted that Lanice did not qualify for services because no significant discrepancy between her cognitive and achievement scores was found. Regardless of their assertion, her reading achievement scores were assessed to be at the kindergarten level.

Participants in the Testing Process

Paula agreed to participate in the TA process and we asked if Jakara could also take part. We encouraged Paula to engage Jakara in the process and welcomed any other important people in Lanice’s life to attend, including Paula’s adult daughter. Paula’s daughter declined the invitation; thus the individuals who participated in the TA were Paula, Jakara, and Lanice. We also engaged the school system, which included Lanice’s teacher, her previous year’s teacher, and the Resource Specialist in the Special Education Program.

We began the assessment by meeting with Paula and Jakara together, gathered background information, and developed their questions for the assessment. During this meeting, some of the obstacles to the TA model became apparent. Although Jakara was diagnosed with Mild Mental Retardation, we hypothesized that her functioning was somewhat lower. For example, we struggled with her tendency to derail the discussion by introducing off-topic facts and her difficulty understanding questions. In addition, although Paula wanted to know why Lanice had angry outbursts at school, she firmly stated that she did not see Lanice’s anger and had virtually no problems with her at home, aside from the few previously mentioned behavioral incidents.

We quickly discovered that Paula’s expectations were inconsistent regarding Lanice’s ability to tolerate emotions, which resulted in her sending mixed messages. For example, Paula reported that Lanice avoided her painful feelings, but Paula did not take Lanice to her grandmother’s funeral because she felt it would be too difficult for Lanice. It seemed that her aunt could objectively see that Lanice’s denial of negative feelings was not healthy, yet there was no space for Lanice’s negative affect to come out, other than at school. As a team, we wondered how to handle this issue during the discussion/summary session, as Paula seemed to have difficulty tolerating painful feelings.

Our team worked with Paula and Jakara to develop and refine their questions for the assessment and they identified six questions (see Table 13.1). Their primary questions regarded Lanice’s reading difficulties and oppositional behavior.

Table 13.1 Paula and Jakara’s Assessment Questions

1. Does Lanice really not have a learning disability?

2. Why is she so angry?

3. Why does she space out? Does she have problems with attention?

4. How can I get her more excited about reading?

5. How can I get her to be more responsible about cleaning up after herself?

6. Why does she push limits with people who are helpless or can’t stand up for themselves?

Testing Process and Themes Revealed

Dr. Guerrero² met with Lanice to conduct the testing, while Drs. Rosenberg and Lipkind met with Paula and Jakara in another room where they observed the testing sessions via a live feed displayed on a flat-screen television. In the first testing session, Dr. Guerrero began with projective drawings to establish rapport, which included Draw-A-Person (D-A-P; Harris, 1963), House-Tree-Person (H-T-P; Buck, 1966), and Draw-A-Person-In-The-Rain (D-A-P-R; Verinis, Lichtenberg, & Henrich, 1974). Dr. Guerrero also administered the Conners’ Continuous Performance Test (CPT-II; Conners & MHS Staff, 2000), the Childhood Depression Inventory (CDI; Kovacs & Beck, 1977), the Revised Children’s Manifest Anxiety Scale (RCMAS; Reynolds & Richmond, 1979), and a series of incomplete sentence stems constructed by the assessment team based on the presenting issues. Dr. Guerrero also conducted a play interview with Lanice, where a nondirective approach was utilized and imaginative play was encouraged.

As the administration began, Lanice’s tendency to minimize her feelings and deny negative affect immediately became apparent. For example, Lanice stated that she always felt happy. When tasks obviously frustrated her, Dr. Guerrero reflected her frustration, but Lanice actively denied feeling any negative emotions. Her projective drawings provided additional information. While her Person-in-the-Rain (Figure 13.1) was protected by an adequately sized umbrella, the rain was abundant and formed a puddle larger than the person just outside of the umbrella’s reach. While protection such as an umbrella symbolized the presence of emotional defenses, the puddle represented Lanice’s perceived external stress, which she narrowly escaped (Oster & Crone, 2004). Her tree was filled with apples, which represented high dependency needs (Ogden, 1975). We hypothesized that this could be related to emotional deprivation early in Lanice’s childhood.

A play interview was conducted to better understand Lanice’s inner world and observe the reported behaviors. During the play interview, Lanice engaged in symbolic dollhouse play and invited Dr. Guerrero to join her for a picnic, where they worked together to prepare and enjoy a meal. Lanice became frustrated at various points during the play, but when asked, she denied negative feelings. Soon after becoming frustrated, she engaged in oppositional behavior that necessitated limit setting. She intrusively held objects directly in Dr. Guerrero’s face and intentionally knocked items onto the floor. During this initial session, Dr. Guerrero set few limits in order to test how far Lanice would push the boundaries. However, when Dr. Guerrero intervened, Lanice responded positively and quickly stopped the undesirable behavior. We decided as a team that it would be important to set more limits with Lanice in the subsequent testing sessions.

Figure 13.1 Lanice’s Person-in-the-Rain

During the second testing session, Dr. Guerrero administered the Rorschach Inkblot Method (Exner & Weiner, 1995), Roberts Apperception Test (Roberts, 1994), Children’s Apperception Test (CAT; Bellak & Bellak, 1949), and the Early Memories Procedure (EMP; Bruhn, 1992). In addition, two subtests of the Woodcock-Johnson III Test of Achievement (Woodcock, McGrew, & Mather, 2001) were given to supplement the testing obtained from Lanice’s school. Specifically, the subtests Auditory Attention and Understanding Directions were administered to better understand Lanice’s problems with attention. She performed well on these measures, but the data suggested that she learns better when visual cues are paired with auditory cues (Auditory Attention standard score = 81; Understanding Directions standard score = 102). The treatment team also reviewed the school’s test results and found that Lanice scored in the Low Functioning and Borderline range on the cognitive measures and was achieving academically between the equivalent of a kindergartener and a second grader. The school argued that there was not a large enough discrepancy (1.5 standard deviations) between her cognitive and achievement scores, thus she did not qualify for special education services as a learning disabled student. However, her school did not address the findings that Lanice read at the kindergarten level and performed in math at the second-grade level. The school staff expected her to work at the fifth-grade level and complete fifth-grade homework. We could not find any justification as to why Lanice did not receive any assistance and support for her significantly below grade level reading.

With regard to emotional functioning, we learned that while Lanice had difficulty putting words to her own feelings and experiences, she could use projective materials to express herself quite well. We immediately saw her difficulties with school emerge on the projective measures. In her responses to the Roberts’ Apperception Cards, Lanice creatively linked the cards to produce one entire story. This story depicted a young girl who struggled with her schoolwork and reading and became angry as a result. In her story, the young girl also missed out on opportunities for fun because of her poor academic performance.

Table 13.2 Lanice’s Structural Summary

The last part of the story described the girl at home and painting on the wall because she continued to feel angry about what happened at school. It was as if Lanice had directly answered the question about her strange behaviors at home and showed the assessment team, as well as Paula and Jakara, who watched, what led her to rip up pieces of paper, pour nail polish in drinks, and destroy candles. Fortunately, because Paula and Jakara had the opportunity to observe the testing throughout the administration with Drs. Lipkind and Rosenberg, they more readily understood what this sequence of stories represented. We observed a story about a girl who felt incompetent, missed out on activities with her peers, and tried to remain hopeful, but became disappointed. Such experiences resulted in her feeling angry and displaying strange behaviors. Paula appeared to feel relief from understanding Lanice’s struggles and she began to cry as she heard the story.

Lanice’s Rorschach responses (Exner, 2001) (Table 13.2) revealed low self esteem (Egocentricity Ratio (3r+2/R)=.37; MOR = 2), minimization of needs (FM = 0), and constricted affect (Afr = 46). Her minimization of affect was also evident on the Early Memories Procedure. For example, when prompted to identify a time when she felt angry, Lanice responded, “I never got angry.” However, her responses on the Rorschach had an elevated Aggressive Content score (AgC = 5) (Gacono & Meloy, 1994). Lanice’s early memories were somewhat superficial and, while she observed, Paula commented that these memories appeared to be from photographs in the home, rather than actual experiences. Our team wondered about the possible paucity of early meaningful experiences, but were concerned that Paula would have difficulty accepting this, as it was her parents who cared for Lanice when she was young. During the session where projective material was administered, Lanice engaged in behavior that pulled for limit-setting as she spun the Rorschach cards on her finger like a basketball, laid the top half of her body across the table, and put her feet on the table. In this session, however, Dr. Guerrero set firm limits throughout the testing and these behaviors vanished by the end of the session.

Family Intervention and Crisis

This section focuses on the family intervention se...

Table of contents

• Cover Page
• Half Title page
• Title Page
• Copyright Page
• Dedication
• Contents
• Illustrations
• About the Editors
• Contributors
• Acknowledgements
• Introduction Assessing Children in the Urban Community
• Section I Introduction to Community Psychology
• Section II The Cultural Environment Theory and Practice
• Section III Case Studies in Community-Based Psychological Assessment
• Appendix A Stories About Feelings
• Appendix B Stories About Identity
• Appendix C Stories About Learning
• Appendix D Stories About Past Hurts
• Appendix E Letters
• Index