PRACTICE13 Working With Childrenand Adolescents:

The Case of Claudia 

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Claudia  is  a  6-year-old,  Hispanic  female  residing  with  her  biological mother and father in an urban area. Claudia was born in the United States 6 months after her mother and father moved to  the  country  from  Nicaragua.  There  is  currently  no  extended  family living in the area, but Claudia’s parents have made friends in the neighborhood. Claudia’s family struggles economically and has  also  struggled  to  obtain  legal  residency  in  this  country.  Her  father inconsistently finds work in manual labor, and her mother recently began working three nights a week at a nail salon. While Claudia  is  bilingual  in  Spanish  and  English,  Spanish  is  the  sole  language spoken in her household. She is currently enrolled in a large public school, attending kindergarten.Claudia’s family lives in an impoverished urban neighborhood with a rising crime rate. After Claudia witnessed a mugging in her neighborhood, her mother reported that she became very anxious and  “needy.”  She  cried  frequently  and  refused  to  be  in  a  room  alone without a parent. Claudia made her parents lock the doors after returning home and would ask her parents to check the locks repeatedly.  When  walking  in  the  neighborhood,  Claudia  would  ask her parents if people passing are “bad” or if an approaching person is going to hurt them. Claudia had difficulty going to bed on nights when her mother worked, often crying when her mother left. Although she was frequently nervous, Claudia was comforted by her parents and has a good relationship with them. Claudia’s nervousness was exhibited throughout the school day as well. She asked her teachers to lock doors and spoke with staff and peers about potential intruders on a daily basis.Claudia’s mother, Paula, was initially hesitant to seek therapy services  for  her  daughter  due  to  the  family’s  undocumented  status  in  the  country.  I  met  with  Claudia’s  mother  and  utilized  the  initial  meeting  to  explain  the  nature  of  services  offered  at  the agency, as well as the policies of confidentiality. Prior to the 

SOCIAL WORK CASE STUDIES: CONCENTRATION YEAR14meeting,  I  translated  all  relevant  forms  to  Spanish  to  increase  Paula’s comfort. Within several minutes of talking, Paula notice-ably relaxed, openly sharing the family’s history and her concerns regarding Claudia’s “nervousness.” Goals set for Claudia included increasing Claudia’s ability to cope with anxiety and increasing her ability to maintain attention throughout her school day.Using  child-centered  and  directed  play  therapy  approaches,  I began working with Claudia to explore her world. Claudia was intrigued  by  the  sand  tray  in  my  office  and  selected  a  variety  of  figures,  informing  me  that  each  figure  was  either  “good”  or  “bad.” She would then construct scenes in the sand tray in which she  would  create  protective  barriers  around  the  good  figures,  protecting them from the bad. I reflected upon this theme of good versus  bad,  and  Claudia  developed  the  ability  to  verbalize  her  desire to protect good people.I  continued  meeting  with  Claudia  once  a  week,  and  Claudia  continued exploring the theme of good versus bad in the sand tray for 2 months. Utilizing a daily feelings check-in, Claudia developed the ability to engage in affect identification, verbalizing her feelings and often sharing relevant stories. Claudia slowly began asking me questions about people in the building and office, inquiring if they were  bad  or  good,  and  I  supported  Claudia  in  exploring  these  inquiries. Claudia would frequently discuss her fears about school with me, asking why security guards were present at schools. We would  discuss  the  purpose  of  security  guards  in  detail,  allowing  her  to  ask  questions  repeatedly,  as  needed.  Claudia  and  I  also  practiced  a  calming  song  to  sing  when  she  experienced  fear  or  anxiety during the school day.During this time, I regularly met with Paula to track Claudia’s progress  through  parent  reporting.  I  also  utilized  psychoeduca-tional  techniques  during  these  meetings  to  review  appropriate  methods Paula could use to discuss personal safety with Claudia without creating additional anxiety.By  the  third  month  of  treatment,  Claudia  began  determining  that more and more people in the environment were good. This was  reflected  in  her  sand  tray  scenes  as  well:  the  protection  of  good figures decreased, and Claudia began placing good and bad 

PRACTICE15figures  next  to  one  another,  stating,  “They’re  okay  now.”  Paula  reported that Claudia no longer questioned her about each indi-vidual that passed them on the street. Claudia began telling her friends in school about good security guards and stopped asking teachers to lock doors during the day. At home, Claudia became more comfortable staying in her bedroom alone, and she signifi-cantly decreased the frequency of asking for doors to be locked. 


To prepare for this Discussion,  review this week’s resources including the assigned case study. Then,  consider the NASW Code of Ethics and Diversity & Cultural Competence  statements. Think about your personal multicultural awareness, cultural  tolerance, and cultural competence.

Post a description of the  cultural factors that you might consider in providing service to the  individual and family described in the case. Explain the course of  action a medical social worker should take to address the cultural  issues illustrated in the case. Be sure to support your statement by  referring to the National Association of Social Workers standards or  recommendations. Explain two cultural factors that  might challenge you when working with a patient and his or her family  who belong to a different culture than yours. Explain measures you might  consider to enhance your cultural competence.

  Gehlert, S., & Browne, T. (Eds.). (2012). Handbook of health social work (2nd ed.). Hoboken, NJ: Wiley.
Chapter 11, “Religion, Spirituality, Health, and Social Work” (pp. 263–290)
  Hodge, D. R., & Limb, G. E. (2010). Conducting spiritual assessments with Native Americans: Enhancing cultural competency in social work practice courses. Journal of Social Work Education, 46(2), 265–284.
Note: Retrieved from Walden Library databases.

Office of Minority Health, U.S. Department of Health & Human Services. (n.d.). National standards for culturally and linguistically appropriate services (CLAS) in health and healthcare. Retrieved July 19, 2019, from https://thinkculturalhealth.hhs.gov/assets/pdfs/EnhancedNationalCLASStandards.pdf

Seipel, A., & Way, I. (2013). Culturally competent social work practice with Latino clients [Online]. The New Social Worker. Retrieved from http://www.socialworker.com/home/Feature_Articles/Ethics/Culturally_Competent_Social_Work_Practice_With_Latino_Clients/ Acevedo, V. (2008). Cultural competence in a group intervention designed for Latino patients living with HIV/AIDS. Health Social Work, 33(2), 111–120.
Note: Retrieved from Walden Library databases.
  Diamond, D., Sytsma, S., Dreger, A., & Wilson, B. (2003). Case study: Culture clash involving intersex. The Hastings Center Report, 33(4), 12–14.
Note: Retrieved from Walden Library databases.

Working with children and adolescents: The case of Claudia. (2014). In Plummer, S.-B., Makris, S., & Brocksen S. M. (Eds.). Social work case studies: Concentration year (pp. 13–15, 99–101). Baltimore, MD: Laureate Publishing. [VitalSource e-reader]