Running head: bIO-pSYCHO-sOCIAL

Bio-Psycho-Social
Katie Brogan
Wayne State University, SW 4997

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Abstract

The bio-pyscho-social assessment, and interventions for a two year old African American female
entering into child protective services for the first time. This girl was brought to the attention of
child protective services that has led to here receiving the necessary interventions to help her
succeed in life.
Keywords: Assessment, Intervention

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Bio-Psycho-Social

Ellie Lee (pseudonym) is a two year old African American female residing in Detroit, MI
in a single family home with her Maternal Great Aunt Sally Jones (pseudonym). Ellie was born
full term without complications, and no known prenatal drug or alcohol exposure. Sally reports
that she does not know Ellies weight at birth, stating that she was an average weight for a baby.
Ellie was born to a single African American woman, Jean Lee (pseudonym). Jean was 28 years
old when Ellie was born. Child protective services removed Ellie from her mother and placed
her into Sallys home approximately three weeks ago. Child protective services became involved
when Ellie was dropped off at Jeans prior foster parents home by an unknown male. It is
reported this man had recently met Jean before Ellie was left in his care. While Ellie was in this
mans care, Jean was arrested making no mention of Ellie to the authorities. The man had Ellie
for three days prior to locating Jeans previous foster parents. Jeans parental rights have not
been terminated at this time. Jean is being offered several resources to improve her parental
skills in order to reunite Jean and Ellie. Jean is being encourage to actively participate in Early
On, Infant Mental Health, Child Protective Services, along with supervised visits with Ellie. At
the time of assessment Jean was not participating in services being offered and not attending
scheduled appointments with Ellies doctor, Child Protective Services, or Infant Mental Health.
When meeting Jean to sign the consent forms, she displayed no concerns with Ellies
development or what services Early On would be providing her daughter. According to the child
protective service worker, Jean was not comprehending the seriousness of the charges be brought
up against her. Since the time child protective services has became involved the charges against
Jean have grown to include medical neglect for not showing up to Ellies doctors appointment

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along with child maltreatment. The investigation is still on going as much of Ellies life is
unknown.
Ellie was referred to Early On by child protective services with concerns with the number
of words Ellie uses. During the assessment Ellie engaged with the interviewer, appearing to
enjoy the attention from the interviewer. Ellie appeared happy, comfortable, and relaxed in
Sallys home. It was apparent that Ellie was forming a strong attachment to Sally. The Early
Intervention Developmental Profile was used to access Ellie in perception/fine motor, cognition,
language, social emotional, feeding, toileting skills, dressing/hygiene skills, and gross motor.
This assessment was created by a multidisciplinary team to be a screening tool for six
development areas. The Early Intervention Developmental Profile breaks developmental
milestones into age ranges when typical children can complete certain tasks. Children are
considered to have a delay when there is a 20% delay in any area or any delay within the first 3
months of life. The Early Intervention Developmental Profile was last revised in 1981 and is still
used as a reliable measurement of children achieving their developmental milestones.
When there is a severe deficiency or further concern is present other forms of evaluation will be
used by other disciplines including speech pathologist and occupational therapists. If the
assessment revealed that a child has a 50% delay in any category they are referred to the local
school district for more intense services. If a speech delay was observed at the age of 25 months
or older the child is referred to speech services automatically. During the assessment Sally
answered the questions regarding Ellie to the best of her ability. Due to Ellies young age and
Sally only being the primary care giver of Ellie for a short period of time, some questions in the
assessment relied upon clinical judgement. Ellie has gaps in her life that cannot be accounted
for.

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Early Intervention Developmental Profile

In the area of perception/fine motor Ellie was capable of completing three out of six
tasks in the 12 to 15 months range. Ellie was able to turn pages of a cardboard book, use pincer
grasp to drop a small item into a small opening and build a two cube tower. Ellies was able to
complete three out of three tasks in the 12 to 15 months range for cognition. Ellie plays with a
doll, can pick up small objects, and can put items into a small container. Ellie has not master
object permanence yet and once she puts an item into a small bottle does not know how to
retrieve the object. Language assessment was completed with the assistance of Sally, Ellie did
not speak a word during the assessment. Ellie fell into the 16 to 19 month range for language,
being able to complete four out of seven tasks. Sally reported that Ellie can name one object
upon request, point to objects, and select two of three familiar objects. Ellie does not use more
than one word communicating and is unable to point to a body part upon request. Social
emotional development appears to be on target with Ellie being able to complete two out of four
tasks within her age range. Ellie will occasionally play near other children and shows periods of
strong independence. Feeding skills are developmentally behind falling into the 12-15 months
range. Ellie can drink from a cup with several spills along with chews and swallows her food
without problems. Ellie cannot use utensils to eat her meals and makes a mess while eating,
requiring adult assistance. Toileting skills Ellis is in the 12-15 months range, she has not begun
toilet training yet and does not communicate the need to use the toilet. In dressing/hygiene skills
Ellie is in the 12-15 months range she cooperates with dressing and diaper changing. Ellis does
not remove or put on articles of clothing upon request or perform hygiene tasks on request. In

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gross motor skills Ellie is in the 16-19 months range being able to run, jump, and crawl up stairs.
Ellie in unable to walk up or down stairs.
Ellie was developmentally delayed in five of the six areas accessed, perception/fine
motor, cognition, language, feeding, self-help, and gross motor. It was observed that Ellie was
not exposed to many experiences to help her reach her developmental milestones. When handing
Ellie a crayon she looked at the crayon, not knowing what to do with the crayon. Partial physical
prompting was used to assist Ellie color on paper, even with prompting Ellie struggled to grip the
crayon. Ellie was given a sticker book, again with partial physical prompting she was assisted in
pulling a sticker off and showing her that the sticker is sticking on one side along with what to do
with a sticker. Ellie brought with her no toys when she came to live with Sally. According to
Sally she had very few ago appropriate toys to play with when living with her mother. When
completing the assessment, repeatedly questions needed to be rephrased due to Ellie was never
exposed to the material.

Family Intervention
A childs first teachers are the individuals in their life that care for them, learning starts
from the day they are born. A childs brain is like a sponge during the first few years of life as
connections in the brain are formed. (Ashford & Lecrory, 2013) Care takers set the stage for their
child to start learning beginning with forming an attachment with their care taker. (Santrock,
2014) In forming a positive attachment parents interact with their children, respond to their
childs needs and wants while being a positive role model for their children. These interactions
with their children teach children language and literacy skills, thinking skills, self-control, and
self-confidence. (Lerner & Ciervo, 2004) When a child is born a parents often use the same

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parental style that their parents used with them. (Ashford & Lecrory, 2013) Unfortunately not all
parents received the attention and encouragement from their own parents growing up along with
the media, friends, and family providing advice that is not appropriate. New parents are bound
to be told advice that would not be recommended today. Advice that has been suggested to new
parents include putting their baby on their back will give them a flat spot on their head, use
alcohol for teething, or children should sleep in their parents bed with their parents. Working
with families on their existing strengths allows parents to increase the bond they have with their
child while keeping their child safe. Walking into a home a family has already taken a step that
shows their dedication to their childs future, allowing someone to come into their home to work
with the family. Building on the strengths of the family fosters courage and self-esteem within
the parent to give them the courage to be the best parent they can be.

Teaching Methods
Working with children, parents, caretakers, and siblings requires the need to be flexible in
the techniques used to educate family members. Techniques are taught using active-reflective
styles, sensing-intuitive styles, visual-verbal, inductive-deductive, and sequential-global styles
(Cournoyer & Stanley, 2002). When working with each client a determination must be made to
access how does a family learn best and which learning style to use. Family members are given
both written documents including written words and pictures along with verbal explanations.
Techniques are also demonstrated for families with a chance for the family to practice the skill
with the social worker still present. Families are encouraged to ask questions and the social
worker asks open ended question to ensure family members understand the technique. The
benefits behind each technique are explained along with the ultimate goal of the technique. It is

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essential that families understand these techniques if they are going to utilize these techniques
with their child. A social worker only makes one monthly visit a month, without family support
the interventions will not work. During these training sessions families are praised for their
interactions with their child and asked questions that parents enjoy answering. Questions are
asked to let the parent know that we are a team and they are the expert of their child, routine, and
environment. As a social worker coming into their home I only offer suggestions and it is up to
the parents to comply with the suggestions to help their child develop.

Motor Skills Early Intervention

Motor development intervention is used to address children that have disabilities and also
children that are at risk for motor development delays. (Case-Smith, Frolek, & Shlabach, 2013)
Families are provided with techniques to improve both gross and fine motor skills. Gross motor
skills include activities that utilize large muscles, walking, crawling, jumping, and sitting up to
name a few. Fine motor skills are activities involving small muscle such as holding a crayon,
cutting, or tying shoes. Activities are customized to each child, focusing on their strengths and
abilities. Children that have poor fine motor skills are encouraged to manipulate play-doh, string
beads, manipulate small objects such as cereal or raisins. Activities are to promote gross motor
development include placing a rolled up towel or pillow under a childs chest during tummy
time, placing toys out of a childs reach to motivate the child to move for the toy, or helping a
child surf a couch when learning to walk to name a few. These activities must be utilized daily
to build muscle strength and coordination. These activities should be done with both the parent
and child having fun and stopped once the child or parent or no longer having fun completing the
activity.

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Cognition Skills Early Intervention

Parents are encouraged to emerge their child in visual stimuli, letting them explore this
stimuli both with their eyes and through physical manipulation. Infants as young as 2 days old
have been found to discriminate between 2 visual stimuli. (Moll & Tomasello, 2010) Infants
need to be exposed to stimuli as their brain continues to create connections. Infants should be
exposed to smiling faces, bright colors, and items with different shapes and sizes. Stimuli
presented to infants and children should change to keep the infant and childs attention. Parents
are taught how to expose their infant and child to help develop their cognitive skills at an early
age at no or low cost. Parents are encouraged to have their children be in different parts of the
house during awake time, go for walks, read books, make silly faces at your child, and play with
their child or infant. Demonstrate and allow a child to play with toys appropriately, such as
playing with cars, dolls, Mr. Potato Head or shape sorter. Children can also learn problem
solving skills by stacking cans in the kitchen, building a fort from pillows or couch cushions, or
sorting objections in the house by size, color, or shape. Children need to be allowed to explore
their world and encouraged to solve problems on their own.

Language Skills Early Intervention

Techniques that are presented to parents include self-talk and parallel talk. Benefits of
self-talk and parallel talk include increasing a childs vocabulary, thinking skills, self-control,
and self-confidence. Self-talk and parallel talk can accomplishments these benefits by parents
talking about what they are doing or their child is doing. When parents talk about feelings, how
to do a task, or describe an item expands a childs knowledge base and gives them the confidence

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to try new tasks. Parallel talk involves parents narrating what their child is doing adding
descriptive words. When a parent sees a child playing with a ball they would talk to their child
about the shape, color, size, and what they are doing with the ball. This technique can be used
for any and all activities that a child is engaged in. Parents are also taught how to teach their
children through songs and poems. Parents are provided with examples of songs to sing along
with the benefits of songs. Some of the benefits from songs and rhymes include reading skills,
number recognition, letter recognition, shape recognition, body part recognition, along with
bonding. Parents are taught that they can provide a wealth of information to their child without
costing anything. Examples of songs are head, shoulders, knees, and toes, ABCs, where is
thumpkin, the body parts song, rub-a-dub dub, nursery rhymes and so many more. Children are
drawn to music, enabling the songs to be an excellent way to learn. Songs can be sung
throughout the day being incorporated into daily routines.

Summary of Interventions
All of the interventions are designed to promote developmental growth that are easy to
practice without the need to spend money. Interventions that are taught during family training
sessions are designed to be carried out by the care giver in between family training sessions. All
of the interventions require that care givers are willing, capable, and understand the techniques
for the interventions to work. All interventions are practiced between the child and care giver
before the end of the family training session. Interventions are designed to be fun for both
caregiver and child and to not only work on the developmental delay but also on bonding.
Interventions are encouraged to be used by all family members recognizing the strengths within
the family to help the infant or child reach their developmental milestones. Families through the

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use of the interventions performed gain confidence in their ability to shape their childs world.
As confidence continues to grow families become closer, family routines increase, and families
look forward to their next family training visit to show off the new skills their child has.

Dilemmas in service delivery

Working with families that live in poverty raises the problem of having age appropriate
material available for the child to explore. Walking into Ellies home it was quickly discovered
that the home did not have age appropriate materials. Once the assessment began it was clear
that Ellie was never exposed to the materials used within the assessment. The dilemma becomes
how to create interventions to promote motor and cognitive development without the materials
that are recommended. During the assessment Sally apologized and looked embarrassed that she
did not have the money to purchase age appropriate toys. Before creating the intervention Sally
needed to be reassure that she was doing an amazing job with Ellie and that she not feel guilty
for not have toys for Ellie. Once Sally was reassured interventions had to be created in a home
that did not have age appropriate material without making Sally feel uncomfortable. This was
accomplished by suggesting to have Ellie color on junk mail, have her put small objects into a
pop bottle using the pincher grasp, allow Ellie to stack cans, and take Ellie to the playground for
her to work on her gross motor skills.
The second dilemma encountered was the lack of parental involvement. Jeans parental
rights have not been terminated, yet she is not participating in services with Ellie. The
interventions provided do not work unless a caregiver is supportive and willing to practice the
interventions. Family training sessions are being provided to Sally and Ellie, with the possibility
of Ellie going back to her mother. Ellie is developmentally behind her age peers and without

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intervention will fall farther behind putting her at more risk in the future. If Jean is not the client
and cannot be forced to participate which has a direct negative consequence on Ellie. As long as
Sally is caring for Ellie interventions will be followed, but if Ellie goes back to living with Jean a
new intervention would need to be created requiring more intense outside services.

Ellies progress
Ellie has progressed greatly in the short few months since living with the Sally. Sally is
able and committed to providing a safe, loving environment filled with enrichment to help Ellie
grow. Sally has started increasing the gap in here development. Ellie now has the fine motor
strength to hold a crayon and knows what a sticker is. Ellie has started imitating tasks that she
has watched Sally complete, including domestic activities and activities that are part of a routine.
Ellie is now accustom to her routine and looks forward to the activities that she participates in
with Sally and extended family members. Ellie is using more words to appropriately
communicate her needs without the need to tantrum. Sally and extended family members have
purchased Ellie age appropriate toys. While Ellie is still developmentally delay she has made
huge strides, showing resiliency. Toilet training still has not begun yet, but with the
improvements that Ellie has made should be started within the next few months. As of today
Jean still is being unresponsive to her parental duties, still not understanding what is at stack.
Sally continues to improve and alter her life for Ellie with great joy.

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Bibliography

Ashford, J. B., & Lecrory, C. W. (2013). Human Behavior in the Social Environment A
Multidemensional Perspective Fifth edition. Belmont: Brooks/Cole.
Case-Smith, J., Frolek, G. J., & Shlabach, T. L. (2013). Systematic Reiew of Inverentions Used
in Occupational Therapy to Promote Motor Performance for Children ages Birth-5 Years.
The American Jouranl of Occupational Therapy, 413-424.
Cournoyer, B. R., & Stanley, M. J. (2002). The Social Work Portfolio. Belmont: Brooks/Cole.
Lerner, C., & Ciervo, L. A. (2004). Zero to Three. Retrieved from Getting Ready for School
Begins at Birth: http://www.zerotothree.org/child-development/social-emotionaldevelopment/gettingreadyforschoolbeginsatbirth.pdf
Moll, H., & Tomasello, M. (2010). Infant Cognition. Current Biology Col 20 No 20 .
Santrock, J. W. (2014). Essentials of Life-Span Development third edition. New York: McGraw
Hill.