Intro to Research Proposals

Social Work Research: Using Multiple

Assessments

Lucille is a 68-year-old, Caucasian female. Her husband of 43 years passed away 4 years ago

after a long and debilitating illness during which Lucille was his primary caregiver. During their

marriage, he worked at the sanitation department, and she was a homemaker. She continues to live

in the house where she and her husband raised their three children. Lucille receives a limited

income of approximately $2,100/month from her husband’s retirement pension

and Social Security; she owns her home and has no major outstanding debts. She receives

Medicare to cover her major medical expenses and a small supplemental health plan to cover any

outstanding medical costs. Her physical health is good, and she has not had any major illnesses or

surgeries, although she has not had a complete physical in over two years. Her favorite hobbies

are gardening and cooking. Lucille has two sons and one daughter, each living away from home

with their own families. Lucille’s daughter and one son reside in the local area; her other son lives

in another state.

Lucille’s major concern is about her daughter, Alice (33), who has battled substance abuse and

alcoholism since adolescence. At present, Alice is not employed and has had several encounters

with law enforcement for drug possession and intent to sell illegal substances. Alice has admitted

that she has used cocaine as well as other substances in the past. She has made several attempts to

go into drug rehabilitation, but she has never completed a program. Her siblings have essentially

disowned her. Alice has three children, Michael (6), Rachael (4), and Randy (18 months), who

was recently diagnosed with fetal alcohol effects (FAE). Lucille is not certain who is the father of

her grandchildren; it is a subject Alice refuses to discuss. Alice has repeatedly left her children

alone for several hours in their tiny apartment, and once she was gone for several days. Child

Welfare has interceded, but Alice continues to have custody of her children. Whenever Lucille

visits her daughter and grandchildren, the living conditions are filthy, there is little food in the

house, and there is talk of constant “visitors” to the house well into the night. Because of Alice’s

instability, Lucille has taken physical custody of her grandchildren without any redress from Alice.

Lucille’s family members are not aware of the stress Lucille is feeling about possibly having to

spend the rest of her life raising her grandchildren, including one with a disability. This causes

Lucille to often feel “down in the dumps,” resulting in overeating because, as she stated, “comfort

food makes me feel better.” Within 2 months, she gained 15 pounds.

Lucille heard about a counseling program at the local community center for grandparents

raising grandchildren. The program provides support, group meetings, parenting classes,

individual counseling sessions with a social worker, and referrals for other supporting services. At

first, Lucille was skeptical about attending the program. She was embarrassed to tell others about

her family circumstances; she was particularly fearful that others would blame her for her

daughter’s lifestyle and wonder how she could now care for her grandchildren if she could not

raise her daughter properly. She already blamed herself for her daughter’s actions, which made

her bouts of depression more frequent and difficult to overcome.

Eventually, Lucille came to the community center after some encouragement from her

neighbor. Lucille is quite concerned about the fate of her daughter. Fearing the worst, she is

constantly worried she will get a late night phone call that her daughter was found dead somewhere

from a drug overdose or something related to her drug life. She once believed caring for her

grandchildren was a temporary arrangement but more recently believes this will become

permanent. Although Lucille loves her grandchildren, she is afraid that she will have to raise them

alone and is angry with her daughter for putting her in this position. She does not know if she can

do it at her age. Her youngest grandchild will need many resources over the years, and she does

not even know where to begin to access them. She admits feeling overwhelmed and depressed

frequently, but she does not have a wide circle of family or friends to talk to about her concerns.

She spoke to her church minister once about her family circumstances but did not feel she got

much out of it. “He just did not seem to understand what I was talking about,” she stated, “so I

never went back.” She stated she was feeling unable to manage her family needs and that “I just

want to get control of the ship again.”

After a thorough psychological assessment, the agency psychiatrist determined that medication

was not necessary for her bouts of depression. After our initial talk, I administered a series of

baseline measures on her emotional and physical functioning, specifically the Center for

Epidemiologic Studies—Depressed Mood Scale (CES-D), Family Resource Scale, Family

Support Scale, and the Medical Outcome Survey, SF-12v2. Our plan is to administer these

measures at 3-month intervals for 1 year to assess her emotional functioning and social progress.

Using a strengths-based approach to problem solving, I collaborated with Lucille on a biweekly

basis to define personal goals that focused on helping her address feelings of depression and

broaden her support network for managing family challenges. She attended monthly support group

meetings with other grandparents who discussed their challenges and celebrated their triumphs.

Lucille never missed a meeting. I made two home visits per month to observe Lucille in her home

environment. Our individual sessions included assessing strengths, defining/redefining needs,

targeting problems and goals, identifying resources to address needs, and monitoring goal

progress. A nutritionist also conducted two home visits to help her with food options for herself

and her grandchildren. Lucille is an excellent cook, and the nutritionist showed her how to reduce

calories without sacrificing taste. Within four weeks, Lucille was able to make small changes in

her everyday life. She began walking her grandchildren to the local park for playtime, preparing

her front yard for spring flowers, and preparing Sunday dinners to reengage her family. She also

visited her family physician and learned that she has high blood pressure, which can be controlled

with proper diet and exercise, and she has asked her son and daughter-in-law for respite once per

month so she can have some “down time.”

After 6 months, I facilitated a family group conference with Lucille and her sons and their

wives. The focus of the meeting was to plan how the family would support Lucille as the

primary caregiver for her grandchildren and to define the role other family members would play

in assisting in raising Alice’s children. There was family agreement that it was in the children’s

best interest for Lucille to seek legal counsel so she could establish temporary custody for her

grandchildren, as well as learn the options for a more permanent relationship, such as adoption.

She also applied for disability benefits for her youngest grandchild. Later, the family would meet

to conduct permanency planning for the grandchildren. After 9 months, Lucille’s emotional health

improved, and we decided to suspend individual counseling, but she continues to participate in the

weekly support group meetings where she can have her blood pressure checked by the program

nurse. After 12 months in the program, Lucille has a positive perception of her support network,

including her family; familiarity with community resources and how to access them; a positive

emotional state; and she has lost 10 pounds and her blood pressure is normal. Lucille has even

initiated a grandparent mentoring service for new custodial grandparents who want to partner with

a “seasoned” grandparent caregiver. Last week, Lucille found out her daughter Alice, who she has

not seen in nearly a year, is 6 months pregnant.