Occupational Therapy Street Reality: Early Intervention

Here is a quick clinical scenario, in case anyone is out there glamorizing pediatric occupational therapy practice.

This one is more "dirt road" reality as opposed to "street" reality.

I have been in squatter's homes before that have amounted to little more than foundation-less sheds and shacks tucked away on corners of land that other people have abandoned or forgotten. These are sad stories, but they are realities nonetheless, and these people make up a certain underclass of society that require a lot of support. As I drove up a country road toward my destination I saw rows of dilapidated trailer homes with lots of bare plywood, litter-strewn 'yards', and many roaming cats. There must be good hunting for the kitties around here.

The saddest part, I considered, is that this is an organized trailer park. Someone is actually charging these people for the electric and water hookups. I wondered what kind of person would want to make a business of supplying water and electric to such run-down buildings, or how in good conscience they can charge for the 'trailer space' where people construct or park their home-shacks.

There wasn't much sound made when I rapped my knuckles on the water-rotted hollow-core front door. "Come on in," I heard through the door, and as I opened it up I was overwhelmed with a strong odor of kerosene gas.

I was there to see Amanda, a two year old with very chubby cheeks and a pointy elven chin. Grown-up perspective exaggerates her facial features, but as she stared straight up at me all I saw were uneven bangs partially covering very large eyes and even larger cheeks. She was cute.

Amanda stumbled around the floor and I wondered if she was stumbling on the debris or if she was stumbling because of some partially diagnosed neurological problem. The mom knew that Amanda had some kind of seizure disorder but they haven't followed up because pragmatically she heard the doctor say that 'they weren't going to do nothing for it anyway.' I am not certain that this is the message the doctor meant to convey.

Anyway, all this was kind of lost because I couldn't get over the very strong smell of kerosene. Turns out that they don't have kerosene space heaters, but that they were burning kerosene in their furnace that had a leak in it. I asked the mom if we could open windows for ventilation and she said, "I don't have no screens - Amanda might be falling out the windows if I did." It was a concern: with all the rusted and twisted metal, and all the rotting boards with exposed nails there was real possibility of injury if she tumbled eighteen inches out of the window into the yard.

In true deus ex machina form, at that moment a car pulled up to the shack which prompted the mother to yell, "Fxxx! It's CPS again!" Amanda just smiled and tripped around the room, unfazed by the mother's outburst.

The CPS (Child Protective Services) worker thought the odor was cat urine, but I educated her on the source of the kerosene gas smell. She called in the kerosene provider and the toothless owner of the trailer park and they all began debating about the faulty vent on the furnace and how no one wanted to crawl up onto the roof because it would collapse. I left, praying for St. Nicholas to watch over the children if the CPS worker didn't. I didn't know what else to do, and I figured that is what my grandmother would have done.

Fast forward one week and CPS is satisfied that as long as the family doesn't turn on the furnace again there is no risk of the shack blowing into orbit. That is comforting. From the CPS worker's perspective, opening the door to dissipate the fumes is adequate, and after all, 'the carbon monoxide detector hasn't gone off.' I am still scratching my head and trying to figure out why they didn't understand when I said that the carbon monoxide detector is not designed to measure combustible kerosene vapor. The kerosene company states that the shack is "unhealthy, but not dangerous." Can anyone help me decipher that?

The early intervention program accepts the determination of CPS. That means that I can either resume the case or they will assign another provider. Ethics dictates that I will remain on this case until they remove me. In the meantime, I intend to make a few waves with CPS, and maybe a county legislator or two.

Our systems are very broken. I can not fix these problems, but I can point them out.


Anonymous said…
What will CPS do? Removing the child will simply punish the whole family for their poverty. They might be able to refer the family to public housing, if it's available, but there might be a long waiting list or the family might not qualify for other reasons (perhaps someone has a drug or violence conviction or they've been kicked out of public housing before). It would be nice to see the child get more consistent medical attention, but then again maybe mom needs help with logistics such as transportation. But as for the kerosene, that's a housing issue, not a neglect issue. I've worked with homeless families who've been involved with CPS--with the ones I knew, at least, once they became involved in the system, they never seemed to get out.
Anonymous, you are partially correct. Poverty or other financial inability to provide basic care is not maltreatment.

I don't know what things are like where you live, but in NY State in the United States of America, there are ample public programs that allow people who are poor to have adequate shelter, clothing, and food.

Anyone (mostly) can reproduce in this country, and that freedom comes with a certain responsibility. That responsibility includes a willingness to take advantage of those social programs that are in place to protect the basic health and safety of children who are not able to make independent decisions.

In this country you are free to be as poor as you want, to live in any shack you want, and to expose yourself to any degree of danger or depravity that you want. However, that freedom does not include the right to expose your children to it.

Parens patriae, and similar basic legal constructs are explicitly included in US laws. That doesn't mean that they systems work well all the time, as I indicated - but that the parens patriae function of the state is certainly not designed to 'punish' families. It is there to protect children, and it's just the law, and it is indeed that simple.

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