case study

Case 2

Buddy Returns Home

Part 1

Nam Tran is a practitioner at a satellite Community Mental Health Center. He is a 32-year-old short, slender Vietnamese-American, with short, black hair. He received the following intake form on a client to be seen next week:

Intake Information

The household consists of Tammy Herman (the mother, age 33), her son Buddy (age 16), her daughter Lori (age 13), her son Billy (age 9) and her daughter Vanessa (age 7). Tammy’s boyfriend Johnny Green, age 35, also lives with them. Tammy has another daughter, Annie, age 18. Annie and her boyfriend live in the same town, with the boyfriend’s parents.

The family lives in an apartment in a public housing community in a small town. The Herman family is European American. The public housing community in which they live is predominantly African American.

Annie and Buddy have the same father; he is deceased. Lori’s father is in another state and has no contact with her. Billy and Vanessa have the same father who is incarcerated in a facility about two hours away from where they live.

Tammy did not graduate from high school and is not employed outside the home. She is exempt from welfare-to-work regulations under TANF under the categories of being “hard to serve” and also because she has a child with physical disabilities. (Billy has Muscular Dystrophy.)

Johnny has lived with Tammy for 2 years and has never been married. Prior to moving in with Tammy, he lived with his widowed mother who died shortly before Johnny met Tammy. Johnny does day labor work, primarily in construction.

Reason for referral:

Buddy has been in and out of home placements for almost 5 years and is being returned to his mother’s physical (not legal) custody next week. Buddy initially was removed from the home for fire-starting and other delinquent behaviors. Due to behavioral problems in residential treatment and foster homes, as well as other family issues, he has had limited contact with family members for the past few years. The county Department of Social Services, upon hearing that Buddy would be discharged from residential treatment, insisted on home based services for the entire family for a minimum of 6 months.

Part 2 Chapter 8

Nam meets Tammy in her apartment. Nam dresses casually when he visits new clients in their homes as he thinks that makes them more comfortable. Tammy is a slightly overweight, nervous woman who doesn’t meet his eye as he introduces himself. After Tammy invites Nam in, he introduces himself and asks if she would prefer to be called “Mrs. Herman” or “Tammy.” She says she prefers to be called Tammy, and Nam invites her to call him “Nam.” Tammy’s clothes are worn and not very clean. As Nam enters the living room, he notes that it is typical of public housing in the area: cinderblock walls, old linoleum that is peeling in some areas and stained in others, a single window air conditioning unit. There is a couch and upholstered chair in the living room, in addition to a couple of metal folding chairs. There aren’t many “knick-knacks” around, and it seems to be sparsely furnished overall. There is a big pile of clothes on the floor in the living room that are either dirty or have not been put away.

Since Nam can tell Tammy is nervous about having him there, he looks around to see what he might point out to begin their conversation on a casual note. Nam sees a framed picture of Jesus and the disciples at the Last Supper. Nam asks Tammy about it, and in a soft voice Tammy tells Nam that it belonged to her mother who died several years ago. As they continue to talk, Nam notices there is a stale cooking odor, perhaps from recent meals cooked in the kitchen. Nam is a bit distracted through the session by yelling from the apartment next door, which is audible despite the fact that Tammy’s apartment windows are closed.

NAM: I like to start the first session telling you what to expect during our time together. As you know, our agency was asked to help your family when Buddy returns home. I am wondering how you feel about working with us?

TAMMY: I don’t know if I can talk to someone like you.

NAM: Maybe we can start off just talking about what usually happens in sessions like this. How does that sound?

TAMMY: Well, you know, I’ve had a lot of caseworkers before, but they were all white women. Some were okay, some didn’t understand me at all. And now they send a man, who isn’t even old enough to have a boy like Buddy and who isn’t even American.

NAM: I can understand your reluctance to talk to someone so different from you. I appreciate you being so honest with me from the beginning. I hope you will continue to tell me about your concerns and help me understand your situation. As I am working with you and your family, it is important for me to understand how you feel.

Nam goes on to talk about his role with the family and confidentiality. Tammy has some experience with agencies, so she seems to understand everything he is telling her.

NAM: Tell me how you feel about having Buddy come back to your family.

TAMMY: I am not sure Buddy should come home. He might not be ready, but I guess no one listens to the mother in this. How do they expect me to keep him under control now that he is bigger than me?

NAM: It sounds like you are very concerned about how you will manage with Buddy. What has it been like for you in the past with Buddy?

TAMMY: Well, Buddy hasn’t lived with us for years, and I have 3 other children to take care of, and none of their fathers’ are here to help. I do have a boyfriend who lives with us, but he isn’t happy about Buddy coming back home. Buddy just likes to run wild, and he skipped school and got into trouble all the time. I haven’t seen that much of him because he was far away, and I couldn’t get there very often to visit. I can hardly keep up with things around here now. (pauses) What it will be like when he comes home again?

NAM: It must be really scary to think about having Buddy come back home. Tell me more about your concerns about his running wild.

Nam summarizes what they talked about towards the end of their first session together.

NAM: From what we talked about, you are somewhat surprised that Buddy was coming back to live with you and have several concerns about this. You are nervous about keeping him “under control” and also that if he misbehaves, you might lose your HUD apartment. You are worried that you couldn’t find another apartment that you could afford. You are also worried about how the kids and Johnny will handle having him living with the family.

TAMMY: That’s right. I couldn’t make him behave when he was 10. How can I now that he is bigger? I don’t know how the other kids will do with him back. Lori remembers him hitting her and messing up her toys, and the other two kids don’t remember him at all. I don’t know if hitting him will work anymore…he’s bigger than I am! I don’t know what they expect. My other kids get in trouble too, especially Lori now that she is “developed.”

NAM: It must be scary for you to think about having him come back home and having DSFS watching what is happening.

TAMMY: Yeah, I am really nervous. (pauses) I don’t know how Johnny will do either, ‘cause he already argues with the other kids and tells them to do more around the apartment and to keep quiet. He also wants them to wait on him when he is here and to run out and get him cigarettes from the store down the street. He doesn’t even know Buddy, and he is already talking about the trouble he will be when he moves in.

NAM: You really have a lot of people to worry about, don’t you!

TAMMY: Yeah, and my nerves aren’t so good either.

NAM: I notice you need some help with reading some of the papers I brought. Do you have some trouble reading other things too?

TAMMY: Well, Johnny has to help me with notes from the kids’ school and my welfare letters. I never did too good in school and dropped out when I was 15 years old and pregnant with Annie. I never did go back after that. Nobody cared because I was already two grades behind ‘cause I missed so much school when I was a little girl. We moved around a lot.

After asking Tammy if it is okay for him to return for their next session in 2 days, Nam closes the session by telling Tammy they would spend time in the next session talking about how she could prepare for Buddy to come home and how to help the kids get ready.

Part 3 Chapter 10

Session 3

At the second session with Tammy, Nam and Tammy discuss her concerns about Johnny, the other kids, and what it will be like to have Buddy home again. She expresses her concerns about Buddy not wanting to be home with them. Their next meeting will be with the whole family 2 days before Buddy comes home.

Nam notices that Tammy has clean clothes on this time and that the living room seems a little neater than the last time. With the exception of Billy, the other children are somewhat overweight, somewhat unkempt, and didn’t say anything when he greeted them. Johnny is a large man with the ruddy complexion of one who works outside most of the time. He is sprawled on the couch when Nam walks in and doesn’t acknowledge Nam when he is introduced by Tammy. Besides helping Tammy read the paperwork for Buddy to return home, he answered several times for Tammy before she could speak up. He also stated emphatically that he wasn’t going to put up with any trouble from Buddy and that Tammy might have to choose between them. He said it was bad enough he had to put up with the other brats with their “smart mouths.” He also stated the kids never help Tammy with household chores or do what he tells them.

NAM: I am very glad to be here with everyone. I guess Tammy has told you about our meeting to get ready for Buddy to come home to the family. I’d like to hear from each of you at this meeting. Why don’t we start with you, Johnny, since you are the man of the house. Tell me what you are most concerned about when Buddy comes home.

JOHNNY: I don’t want any more mess around here than we have with three kids. I like my peace and quiet when I come home after work, and these kids already make a lot of noise. Then we have to have all that yelling coming from next door. I think it is stupid to have that kid come back after all this time.

NAM: So you are concerned most about having more of a mess and more noise in the apartment. I can understand why you want peace and quiet when you come home from a long day at work. How about you, Lori?

LORI: (in a very quiet voice) Buddy used to hit me all the time and he made Mama cry. But sometimes he was nice and gave me candy. I don’t really remember much about when he lived here.

NAM: So it sounds like you are mostly concerned about Buddy hitting you or causing trouble for your Mama. I can see you must be worried about having him home with those memories.

LORI: Well, he is my brother, so I guess he should come home.

JOHNNY: Yeah, we really need another kid around here!

NAM: How about you, Billy? What are you worried about?

BILLY: I don’t like yelling. I don’t want more yelling because Buddy is home.

NAM: So you have the same concerns as Johnny about having it quiet around here.

(Billy nods.) What about you, Vanessa? I wonder if you even remember Buddy living here with you.

VANESSA: I went with Mama one time to see Buddy when I was in kindergarten. He seemed okay to me. Can I go play in my room?

NAM: I’d like to make sure you have a chance to talk with all of us. I think it is important for you to stay and talk with us.

VANESSA: Okay.

NAM: So it seems like everyone is concerned about trouble when Buddy comes back home, although it has been a long time, and we can’t really know how it will be to have him in the family. Why don’t you tell us your concerns, Tammy?

TAMMY: I think we need for things to be different around here with Buddy coming home. I need more help and I would like less fighting, too. Billy might need to use a wheelchair since he is getting too tired using his crutches, and I will need more help taking care of him. I think…

JOHNNY: Well, if you want less fighting, don’t bring Buddy here. You know he will make trouble, and I don’t want to put up with any more brats and their “smart mouths.” Maybe I will just leave if there is more trouble here.

NAM: Johnny, I’d really like everyone to take their turns talking. Could we agree to let each person finish and then the others can talk? (Johnny snorts and looks away.)

TAMMY: (Looking worried) It’s okay, I was done talking. Johnny is right; maybe we don’t need Buddy to come home and cause more trouble.

NAM: So what I hear you all saying is that you don’t want any more trouble here, and you would even like things to get better than they are right now. Tell me more about what it would be like with less trouble around here

JOHNNY: No fighting.

TAMMY: More help for me and not so much fighting and arguing.

LORI: Everyone being nicer to each other.

BILLY: Peace and quiet and maybe people talking to each other more nice.

NAM: Well, I think everyone has an idea of how they would like the family to be. We’ll talk more about this next time. Since we can’t talk to Buddy until he comes home, let’s plan to talk more in 2 days after he comes back home. At that meeting, we can work together on some plans to have less trouble and more peace and quiet. Is that okay with everyone?

Tammy walks to the door with Nam.

TAMMY: You know, I think you understand my concerns.

NAM: Thanks, Tammy. I really appreciate your honesty. That is a great characteristic to have. I like working with you and your family. I think we can make some changes with everyone’s help.

Part 4 Chapter 12

Here is the transcript of the session with Nam, Buddy, Tammy, Vanessa, and Johnny on Buddy’s return. Billy has been sick and is sleeping.

Buddy comes into the apartment with Tammy and Nam. He is a thin, pale boy who has said little to either Tammy or Nam since they picked him up at his residential school. Johnny is watching television and finally gets up and turns it off at Tammy’s prodding.

NAM: I am so pleased we could meet together with Buddy on the day he has returned to live with his family. We are meeting today to talk about what it will be like for all of you now that Buddy is back home. Your mother is very happy to have you home, Buddy, but wanted us to talk about how to make things go better for all of you.

NAM: (turning to Buddy) Buddy, this is first time we’ve had much of a chance to talk. I know I introduced myself at your school, but there was a lot going on there so let me reintroduce myself. I am Nam Tran. You can call me Nam. How are you feeling about being back home?

BUDDY: (shrugs his shoulders and mumbles something.)

JOHNNY: (in a loud voice) Speak up, Buddy. Don’t be rude.

BUDDY: (a bit louder) I’m not sure.

NAM: It’s a big move. (pauses) Well, I’ve met with your mom, Tammy, and with Johnny and the other kids. So this will be you joining in with what’s been going on for awhile. So let me summarize a little. Tammy, you’re concerned about the fighting and arguing in the family.

TAMMY: I think we all want less trouble in the family. I also want to be sure the chores get done. With this many people in the house, I just don’t know how we’re ever going to keep anything straight.

NAM: Right, it’s a lot to do with this many people. (pause) You also mentioned, with Buddy back home, that’s kind of new and you want everything to go as smoothly as possible.

TAMMY: Right, I want him to be able to stay. I want him to be happy, and the younger kids don’t know him very well and… (Tammy stops talking)

NAM: So Tammy, you are hoping to work things out between Buddy and the other kids. Johnny, you’re kind of concerned because sometimes the kids don’t obey you, and they fight and that gets on your nerves. It seems to me that you were saying you thought the kids should help their mom more.

JOHNNY: Absolutely. I mean, she does so much for them. They really need someone to crack down on them. They don’t always listen to me. I get a lot of (in a high falsetto voice) “You’re not my dad!” You know, that kind of stuff. I’m living in the house, and I should get respect.

NAM: It must be hard for you because you’re not their dad, but you’re here.

JOHNNY: But I pay their bills. I’m not their dad, but when they need a pair of jeans, guess who they come and talk to?

NAM: I can understand that. I think it’s terrific that you’ve made so many contributions to this family. Of course, you never have gotten acquainted with Buddy at all, so that’s going to be new for you. So…

TAMMY: Already he makes the kids go out and buy him cigarettes and stuff. I’m afraid he’s going to start doing the same thing with Buddy. Buddy’s already been in trouble, he doesn’t need to get into any more trouble. I don’t want him down there buying cigarettes. He’ll be down there buying cigarettes and the next thing you know he’ll be buying alcohol and other kinds of drugs. So I’m real concerned about … You know I’m glad Johnny is here, but you know, sometimes….(Tammy stops talking and sighs)

NAM: Since we’ve been talking so much about Buddy, I wonder if he might have something to say about what he is hearing.

BUDDY: This is a little like the group we had at the group home. Do I get to say what I think?

NAM: Yes, we would really like to hear from you. Your mom is very concerned that you can stay here and not get into trouble. She would like less fighting and more help. Johnny seems to want the same things, too, even if he didn’t say it in the same way. Does that sound like I have it right? (Looking at Tammy and Johnny)

Tammy nods and Johnny looks away, but doesn’t say anything.

NAM: With a new person in the family, it seems like a great time to make some changes in the family. What do you think about that, Buddy?

BUDDY: I really don’t want to get in trouble and have to go back to a foster home or the group home. I don’t know about the other stuff.

JOHNNY: Well, it is a lot of trouble just having you come here and make more work for your mother.

NAM: You know, Johnny, you say you want less trouble around here and more help for Tammy, but some of the things you say seem to mean the opposite. I know it must be hard to have another person come to live here, but I think all of you have a chance to make this work. Are you willing to try to do something to make that happen to help Tammy?

JOHNNY: Maybe, if I don’t have to do all the work.

NAM: So we have talked about several problems so far. We all want Buddy to stay out of trouble, we want less fighting in the family, and Tammy needs more help around here to get things done. That is quite a list of things to work on. It is usually helpful to pick one thing to start with. I am wondering if we might start with more help for Tammy since that involves everyone. Can we all agree on that goal to start with?

Everyone nods.

NAM: Tell me more about the things you think you need more help with.

TAMMY: Well, I guess the kids could help with the dishes, laundry, and the cleaning. They could help with Billy’s care and the cooking and…

NAM: Whoa! That is quite a list. Maybe you could start to make a list of things you need help with and we could start to sort out what will work to start with. Can we make that a goal for next week? Tammy will make a list together of the chores she needs help with. How about if we keep it at no more than 10 things just to start with?

TAMMY: I don’t know if I can write down the things since I don’t spell too good.

BUDDY: Maybe I could help you, mom. We used to do chores at the group home, but we got rewards for doing them, too.

NAM: What a great idea, Buddy. Maybe you can also think of some kind of reward for doing the chores. So we have agreed Tammy and Buddy will make a list of 10 chores and a list of suggested rewards for our next meeting. How does that sound?