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Case Study
Jaquasia C. Vandross
Department of Counselor Education and Family Studies, Liberty University
Author Note
I have no known conflict of interest to disclose.
Correspondence concerning this article should be addressed to Jaquasia C.
Vandross.
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ABSTRACT
Trauma, including singular, multiple, or long-lasting repetitive events, affects everyone
differently. Some individuals may display symptomology per post-traumatic stress
disorder (PTSD). Still, many individuals will exhibit resilient responses or brief
subclinical symptoms or symptomology outside diagnostic criteria. The impact of trauma
can be subtle, insidious, or catastrophic. How an event affects an individual depends on
many factors, including individual characteristics, the type and characteristics of the
event(s), developmental processes, the meaning of the trauma, and sociocultural
factors. This case study begins with a personal account of experienced trauma,
highlighting the specific level of trauma and techniques used to cope with the effects.
Key Words: trauma, posttraumatic stress disorder, foster care, sexual abuse
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Introduction
Globally, the COVID-19 pandemic has profoundly affected how we connect and
socialize. Due to recommendations for social distancing, video platforms have become
increasingly popular. This interview was conducted via ZOOM to uphold agency policy
and maintain safety for both parties. ZOOM is a cloud-based video communications app
that allows you to set up virtual video and audio conferencing, webinars, live chats,
screen-sharing, and other collaborative capabilities. On Thursday, November 9th, 2023, I
was granted the opportunity to engage in a 50-minute interview with an extraordinary
young woman who experienced a series of traumatic events that were meant to leave
her depressed, discouraged, and defeated.
Before the interview began, the interviewee and interviewer discussed the
interview's purpose, the interviewee's role in this assignment, and confidentiality. The
interviewer also took a few moments to evaluate the interviewee’s immediate level of
safety, psychological stability, and readiness for the interview (Briere & Scott, 2015,
p.67). The interview began once the interviewer was convinced that the interviewee was
safe and reasonably stable.
The interviewee is sixteen-year-old “Jasmine Wells,” an African-American female
residing in the Bronx, New York, with her one-year-old son, Jayden Wells, and Foster
Mother, Ms. Evergreen. Jasmine entered the foster care system when she was twelve
years old. Since then, Jasmine has experienced several foster homes, group homes,
case workers, counselors, and physicians. Jasmine is one of the 391,000 children in the
foster care system (An Office of the Administration for Children & Families, 2022). At the
time of this interview, Jasmine is still refusing to seek mental health treatment but has
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acknowledged that she has experienced an event that has had a traumatic impact on
her life, impeding her daily functioning.
Interview findings
Jasmine answered the seven questions provided per the case study assignment.
These questions led to answers that recounted Jasmine’s experiences, trauma, short
and long-term effects, and the utilization of coping techniques. (Briere & Scott, 2015)
Stated:
Although one might assume that traumatized individuals easily disclose the
events that bring them to therapy, this is not always the case. In fact, several
studies indicate that trauma survivors are often reluctant to volunteer detailed (or
any) information in this area unless directly asked due to embarrassment, a
desire to avoid reactivating traumatic memories, or the clinician’s own avoidance
of such information (p. 66).
For the above reasons, the interviewer shared with Jasmine that this was her story and
that she could tell as much or as little of her story as she wanted; there was no
pressure. The interviewer explained that there would be check-in points throughout the
interview where the interviewer would ask Jasmine if she was good to continue or
needed a break. The interviewee acknowledged that she understood the information
relayed to her and agreed to share her story.
The interview began with the interviewer asking Jasmine to describe the
traumatic event she experienced. Jasmine was removed from the home of her Natural
Mother (NM), Ms. Wells, after Ms. Wells called the Administration for Children Services
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(ACS), stating that she was unable and unwilling to care for Jasmine and her behavioral
and mental health needs. It was reported and documented that Jasmine was acting out,
running away from home, sexually active, and abusing substances. Ms. Wells feared
Jasmine was becoming a danger to her and the younger children in the home, so
removal was necessary. However, what wasn’t reported or documented was the cause
for the drastic change in Jasmine's behavior and the decline of her mental health.
Between the ages of ten and twelve, Jasmine experienced physical and sexual abuse at
the hands of Ms. Well’s paramour, Mr. Evans.
While alarming, there is an overwhelming amount of research that children living
in step-families or families with a nonbiological parent are more likely to
experience some form of abuse. A study completed by Berger et al. (2009) found that
families living with a man who was not the biological father of all the children in the
home and families living without a man in the home were significantly more likely to be
contacted by CPS compared to families in which the biological father of all the children
lived with the mother. Another study completed by D'Alessio and Stolzenberg (2012)
reported that children living with unmarried parents are also at risk for abuse,
including physical, sexual, and emotional abuse.
“Why didn’t you immediately tell an adult about this incident?” A question that
Jasmine has been tasked with answering countless times. Jasmine had been
threatened into silence. Mr. Evans had convinced Jasmine that no one would believe
her if she told and that if she ever did tell, he would hurt her, and no one would care, nor
would they miss her. As a young and impressionable child, she believed this and kept
quiet about the abuse, fearing the consequences. Despite the constant threats, Jasmine
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told someone about what was happening a few weeks before being removed from the
home. “I was young, but I knew what was happening to me; what he was doing to me
wasn’t right. I knew that and needed to tell someone,” says Jasmine.
Jasmine stated that though she feared the outcome, she had finally worked up
the courage to confide in her mother, and that’s where Jasmine said, “Things just went
downhill from there.” She was labeled a liar, homewrecker, problematic, and dangerous.
“Before I realized what was happening, I was being removed from my home and taken
to the Children’s Village. I didn’t even have the opportunity to tell my story,” says
Jasmine. For the reader’s knowledge, The Children’s Village (CV) is a nonprofit
organization working with underserved children and their families. The CV provides a
wide array of services, including but not limited to Immigration services, foster care,
family preservation, short-term shelters, and housing and community outreach
programs (childrensvilliage.org, 2023). While Jasmine and her NM never quite saw eye
to eye, she never would have imagined that she would choose Mr. Evans over her
daughter. “I was young, so I couldn’t fully grasp what was going on, nor could I put
words to what or how I was feeling, but I knew from that day on things would never be
same between my mother and me,” says Jasmine. Being physically and sexually
abused by Mr. Evans was devasting. Being removed from her home at such a young
age was terrible. But having her NM choose her spouse’s side broke Jasmine in
unimaginable ways. “I am my mother’s oldest child and her only daughter. We are
supposed to be close, but she turned her back on me,” says Jasmine.
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The interviewer gave Jasmine a few minutes to attend to her son and collect
herself. As you can imagine, digging up such a traumatic-induced event can also bring
up some unwanted feelings. The interview reconvened with the interviewer asking
Jasmine how she responded immediately following this traumatic event. “I completely
shut down. Again, I was a child, only twelve years old. I didn’t know how to feel or what I
was even feeling”, says Jasmine. Jasmine confirmed that during the time she was in her
NM’s home, she had fallen in with a group of individuals who introduced her to vaping,
marijuana, and alcohol. Jasmine went on to say that she was constantly distracted,
unable to focus on anything. “I was a distracted mess. I even stopped going to school
fully, and when I did go, I would either pick a fight with a teacher or another student,”
says Jasmine. Jasmine said she ran away twice but realized she had nowhere to go, so
she always returned home. Jasmine also reported that while her NM stated that she
was sexually active while under her care, it was a lie. She confirmed that she did not
start willingly having sex until she was removed from the home. Jasmine denied having
multiple partners. “It was weird, you know, being a pre-teen and not being interested in
the things that I should be or used to be interested in, like fashion, music, and art. I lost
interest in all of those things,” says Jasmine.
Before being prompted, Jasmine explained that drinking, smoking, and having
sex were her coping methods; it was her escape from reality. “I was angry all the time
and just needed to feel any other emotion besides anger,” says Jasmine. While Jasmine
is fully aware now that those coping skills were not conducive or healthy, at the time,
they felt like her only option. It wasn’t until Jasmine attempted to take her own life that
she considered getting professional help. Jasmine was hospitalized for a week,
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undergoing medical and mental health observation. After being discharged from the
hospital, she was connected with a therapist, whom she met with weekly until she
decided to terminate the sessions. “I knew I needed help, and I knew I needed better
coping skills, but at the age of fourteen, I didn’t feel like sitting in a room speaking with a
therapist who could never understand what I was going through or how I was feeling.
She couldn’t help me, so I just stopped going and kept coping the best way I knew how,”
says Jasmine. Jasmine went on to say that while this was her first suicide attempt, it
was not her last. Jasmine had a total of 3 suicide attempts. “I felt worthless; I did not
think I deserved anything good,” says Jasmine.
According to Kaewkiattikun (2017), “Being a victim of rape at a young age is
associated with more long-term and severe consequences, like mental disorders.”
Similarly, Eastman et al. (2019) reported that “Children who have been maltreated are
at increased risk for adolescent pregnancy.” Katz et al. (2011) reported that
children and adolescents in care were at greater risk of suicide and attempting suicide
than those who were not in care. The research seems to hold particularly true for
Jasmine, who, as previously mentioned, had three suicide attempts and was diagnosed
with Major Depressive Disorder (MDD) and Post Traumatic Stress Disorder (PTSD).
Jasmine also disclosed that she has been treated for STDs a total of three times. In
addition to the previously mentioned, Jasmine became pregnant at the age of fifteen
with twins and unfortunately lost one during the pregnancy. Giving birth to her first child
in October of 2022, Jasmine finally found a reason to keep living. “having a child gave
me hope; it wasn’t about me anymore. I had to get up, dust myself off, and keep
fighting. I had a little boy to look after,” says Jasmine.
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“Learning to be a mother when you do not have any positive motherly role
models is difficult. I thought I’d have to read books, watch TikTok videos, or scroll on
Instagram to learn how to be a mother. But then I was placed in the home of Ms.
Evergreen, and she has been the biggest source of support for me and my son this past
year,” says Jasmine. Jasmine was placed into the home of Ms. Evergreen in September
of 2022. While the connection was not instant, the two have grown close in the past
year. “I went from having a family to losing my family to gaining an even better family,”
says Jasmine. Though Jasmine is only sixteen, she has grown immensely since she
was removed from her home in 2019. The event that was meant to break her only made
her stronger. “I have grown from the things meant to break me,” says Jasmine. The
interviewer ended the interview by thanking Jasmine for her time and praising her for
her resilience and vulnerability, as it takes someone strong to be willing to be
vulnerable.
As mentioned in the introductory portion of this interview, Jasmine is still refusing
to seek mental health treatment. However, Jasmine has joined a mommy-and-me class
and attends weekly support groups at a local church for young mothers. Jasmine is also
receiving a series of services via Graham Windham. Graham Windham is a nonprofit
agency that provides a full range of programs to empower children and their families to
succeed. Graham’s services include after-school programs, mental and behavioral
health services, education, career coaching, internship programs, and a range of
parenting supports; when necessary, Graham provides foster care and adoption
services (Graham Windham, 2023).
Analysis and Discussion
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Post-Traumatic Stress Disorder
Child abuse and neglect is a severe and pervasive public health problem, with
approximately 3.4 million children in the United States reported to Child Protective
Services (CPS) in 2022 alone (Administration for Children and Families, 2022). Child
victims of maltreatment commonly experience severe and lasting effects, such as
impairments in brain functioning, problems with physical growth and development,
difficulty forming attachments, chronic health problems, and mental health conditions
such as posttraumatic stress disorder (PTSD) (Bartlett & Rushovich, p.30,2018). PTSD
is a significant mental health concern among foster youth; researchers have reported
that 20 percent of abused children in foster care experienced symptoms of PTSD
versus the 11 percent that remained in their original home (Bartlett & Rushovich,
2018). When speaking with Jasmine, we learned that she did receive multiple mental
health diagnoses, one being PTSD, which, based on the above research, is very
common among foster children.
Major Depressive Disorder (MDD)
Youth placed in foster and residential care show a heightened risk for depressive
and anxiety disorders compared to the general youth population (Bronsard,2016). A
point prevalence of 37.0% for depressive disorder and 34.0% for anxiety disorders has
been found among youth placed in residential care (Jozefiak, 2016). We see that the
above statistic holds true for Jasmine, who was diagnosed with MDD after meeting with
a licensed mental health professional.
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Moreover, The Diagnostic and Statistical Manual of Mental Disorders, 5th edition
(DSM-5, American Psychiatric Association, 2013) lists the following as the criteria to
receive a diagnosis of MDD: Five (or more) of the following symptoms have been
present during the same 2-week period and represent a change from previous
functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of
interest or pleasure. Note: Do not include symptoms clearly attributable to another
medical condition. Jasmine displayed the following symptoms as per the information
given in the interview:
Depressed most of the day, nearly every day, as indicated by subjective report
(e.g., feels sad, empty, hopeless) or observation made by others (e.g., appears
tearful): Jasmine stated: “I was angry all the time and just needed to feel any
other emotion besides anger.”
Markedly diminished interest or pleasure in all, or almost all, activities most of the
day, nearly every day (as indicated by subjective account or observation):
Jasmine stated: “It was weird, you know, being a pre-teen and not being
interested in the things that I should be or used to be interested in, like fashion,
music, and art. I lost interest in all of those things.”
Feelings of worthlessness or excessive or inappropriate guilt (which may be
delusional) nearly every day (not merely self-reproach or guilt about being sick):
Jasmine stated: “I felt worthless; I did not think I deserved anything good.”
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Diminished ability to think or concentrate, or indecisiveness, nearly every day
(either by subjective account or as observed by others): Jasmine mentioned that
she could not concentrate while in school, which caused her to leave temporarily.
Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation
without a specific plan, or a suicide attempt or a specific plan for committing
suicide: We learned through Jasmine's recounts that she did attempt to take her
life and was hospitalized for this attempt. She also mentioned that she had made
two more attempts to end her life.
Trauma.
The Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5,
American Psychiatric Association, 2013) defines trauma as:
Exposure to actual or threatened death, serious injury, or sexual violence in one
(or more) of the following ways: (1) Directly experiencing the traumatic event(s);
(2) witnessing, in person, the event(s) as it occurred to others; (3) learning that
the traumatic event(s) occurred to a close family member or close friend – in
cases of actual or threatened death of a family member or friend, the event(s)
must have been violent or accidental; (4) experiencing repeated or extreme
exposure to aversive details of the traumatic event(s).
Jasmine experienced repeated acts of physical and sexual violence firsthand for an
extended period. It is also worth mentioning that the adverse effects of maltreatment on
children in foster care are frequently exacerbated by family disruption and placement in
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multiple-resource parent homes, resulting in further traumatic experiences of separation
and loss that affect children's mental health and well-being (Bartlett & Rushovich, 2018).
Jasmine faced such heinous acts of violence at such a young age, yet she
persevered. The road was not easy, and there were some bumps and hiccups along the
way, but she got up, dusted herself off, and kept going. While hearing her story, Isiah
41:10 came to mind, "Fear not, for I am with you; be not dismayed, for I am your God; I
will strengthen you, I will help you, I will uphold you with my righteous right hand” (New
International Version, 2011). Romans 8:28 states, “And we know that all things
work together for good. To them that love God, to them who are the called.
According to his purpose.” (New International Version, 2011). Everything we go
through while in the moment may bring up trauma, crisis, or stress, will work out for our
good; God does not set us up to fail.
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References
Adoption and Foster Care Analysis and Reporting System (AFCARS) FY 2021 data.
Children’s Bureau An Office of the Administration for Children & Families. (2022,
June 28). https://www.acf.hhs.gov/sites/default/files/documents/cb/afcars-report-
29.pdf
Bartlett, J., & Rushovich, B. (2018). Implementation of trauma systems therapy foster
care in child welfare. Children in Youth Services Review, 91, 30-38. Retrieved
from www.elsevier.com/locate/childyouth
Berger LM, Paxson C, Waldfogel J. Mothers, Men, and Child Protective Services
Involvement. Child Maltreatment. 2009;14(3):263-276.
Briere, J., & Scott, C. (2015). Principles of Trauma Therapy: A Guide to
Symptoms, Evaluation, and Treatments (2nd ed.).
Bronsard, G., Alessandrini, M., Fond, G., Loundou, A., Auquier, P., Tordjman,
S., & Boyer, L. (2016). The Prevalence of Mental Disorders Among
Children and Adolescents in the Child Welfare System: A Systematic
Review and Meta-Analysis. Medicine, 95(7), e2622.
https://doi.org/10.1097/MD.0000000000002622
Child fatalities due to abuse and neglect decreased in FY 2020, report finds.
Administration for Children & Families. (2022, January 21).
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https://www.acf.hhs.gov/media/press/2022/child-fatalities-due-abuse-and-
neglect-decreased-fy-2020-report-finds
D'Alessio, S. J., & Stolzenberg, L. (2012). Stepchildren, community
disadvantage, and physical injury in a child abuse incident: a
preliminary investigation. Violence and Victims, 27(6), 860–870.
https://doi.org/10.1891/0886-6708.27.6.860
Eastman, A. L., Palmer, L., & Eunhye, A. (2019). Pregnant and Parenting Youth
in Care and Their Children: A Literature Review: C & A. Child &
Adolescent Social Work Journal, 36(6), 571-581.
https://doi.org/10.1007/s10560-019-00598-8
Graham Windham. (2023, May 30). https://www.graham-windham.org/
Jozefiak, T., Kayed, N. S., Rimehaug, T., Wormdal, A. K., Brubakk, A. M., & Wichstrøm,
L. (2016). Prevalence and comorbidity of mental disorders among adolescents
living in residential youth care. European child & adolescent psychiatry, 25(1),
33–47. https://doi.org/10.1007/s00787-015-0700-x
Kaewkiattikun K. (2017). Effects of immediate postpartum contraceptive
counseling on long-acting reversible contraceptive use in
adolescents. Adolescent health, medicine and therapeutics, 8, 115–
123. https://doi.org/10.2147/AHMT.S148434
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Katz, L. Y., Au, W., Singal, D., Brownell, M., Roos, N., Martens, P. J., Chateau,
D., Enns, M. W., Kozyrskyj, A. L., & Sareen, J. (2011). Suicide and
suicide attempts in children and adolescents in the child welfare
system. CMAJ : Canadian Medical Association journal = journal de
l'Association medicale canadienne, 183(17), 1977–1981.
https://doi.org/10.1503/cmaj.110749
Levers, L. (2012). Trauma counseling: theories and interventions. Springer
Pub.
The Children’s Village. (2023, April 25). https://childrensvillage.org/
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Can you describe the traumatic event you experienced?
How did you respond immediately following the event?
What coping strategies did you use? What longer-term symptoms or effects did you
experience?
Did you receive a formal diagnosis?
What counseling services and treatment have you received, and how did these help?
How has your life changed as a result of this trauma?
