Case Study:  Tom* aged six years at application for HCN

At the age of five, Tom was placed with Child, Youth and Family caregivers after police removed him from his home after it was destroyed by his mother’s partner. Since starting school, Tom had not spoken to anyone and displayed oppositional, violent and antisocial behaviours, frequently absconding from school. A paediatric appointment noted selective mutism and an ‘unusual presentation’ of behaviours. He was considered to have an extremely complicated combination of presentations because of his lack of communication skills, lack of attachment, and lack of understanding about his early childhood experiences.

Despite multiple agency involvement, gaps in service provision (including a lack of permanent placement, unsustainable assistance from special education, and awaiting involvement from disability services), a lack of intensity in current services available, and a lack of shared understanding as to the cause of Tom’s issues meant he wasn’t making sustainable progress.

Tom’s case was referred to the local Interagency Management Group, and when Tom was six an application was submitted for HCN funding. Tom received a HCN-funded neuropsychological assessment completed which highlighted the needs Tom had that were going to require ongoing support. He was diagnosed with an attachment disorder, anxiety, and disruptive behaviour disorder. He also displayed many symptoms of attention deficit hyperactivity disorder, and was found to be within the intellectually deficient range for his age, meaning he would require programmes to be set at his level. With the result of the assessment, an interagency plan was developed.

“The report was a huge turning point. It informed everyone as to what had to happen next,” said the Services Coordinator for the interagency team. “Finding permanent caregivers was also a huge turning point.”

Grace* and James* (who have two young daughters) responded to an ad seeking permanent caregivers for Tom, and visited him during one of his therapy sessions. When they agreed to take Tom on, they received a lot of support from the interagency team. A clear, stepped transition plan was developed.

Tom is making improvements at school. “We met with the school and the speech language therapist prior to Tom starting school to get the school situation set up before he showed up,” said his Special Education caseworker. “The neuropsychological report was really helpful for the school – it just opened up a whole world and gave us direction.”

Prior to receiving HCN funding, Tom could only attend school for two hours per day for safety reasons. Now, Tom is settling into class and is doing better than anticipated. “We work to keep Tom in the classroom as much as possible, and most of the time he is included in class activities,” said his teacher. “It’s about coming up with solutions.”

Tom’s teacher aide sends through a weekly report to the interagency team, and Tom’s teacher attends team meetings as often as possible. “The team dynamic allows everyone to compare their experiences with Tom and address behaviours quickly across all settings before they escalate,” said the Services Coordinator. “If a new behaviour develops, such as over-eating, we are able to deal with it as a team.”

“I feel incredibly supported,” said Grace. “This is harder than I ever imagined, but the team is always there to support me. And every now and again Tom’s face, which is usually like a mask, will just light up and that’s what keeps us going.”

“It’s not really about the money – it is sharing the workload and not working in isolation,” said Tom’s CYF caseworker. “HCN has been fabulous and without [it] there is not such a commitment to working together. The funding allows for some innovation and this was needed for Tom.”

We will keep you updated about Tom’s progress.

(*names have been changed) 

For the original article read HCN Newsletter Issue 12 December 2009.