Final Week

Lisa found her way into a group home in her later years and lived out her days with others who struggled in similar ways. She was able to make several friends and contributed to her community. Lisa died at the age of 72.

Week 9

Lisa is now 55 years old. She has been living with Marsha and Cindy for the past several years. Lisa enjoys her part-time job at a local grocery store, and she has been working there for 12 years. Lisa is content. She has an understanding that there is something wrong with Cindy, and she knows that her Marsha is sad a lot of the time. She vaguely remembers attending her father's funeral many years ago, but she does remember that she hasn't seen him in so long - she's almost forgotten what he looked like.

Marsha tells Lisa that Cindy has cancer, and she is preparing for the two to deal with Cindy's death. Cindy's cancer is non-Hodgkin's lymphoma, a form of the disease that has a low rate of cure. The doctors detected the cancer at a fairly late stage. For Cindy, she knows that Marsha and Lisa will be OK in the house, and that is at least some comfort for her. Marsha is getting up in years as well, and she worries about Lisa if something should happen to her.

Lisa started to notice that she cannot see things as clearly as she used to, and she recently got a pair of eyeglasses to aid her reading.

Lisa doesn't know how she will live without Cindy, a woman she has known for most of her life as a caregiver and parent. She is scared and has no idea what will happen.

* If Marsha were to die, what options are there for Lisa? Is it legally possible for Marsha to determine what she would like to happen if Lisa is unable to live on her own (which is unlikely)?

* Describe the developmental milestones of middle adulthood. What kinds of changes is Lisa likely to have experienced? How are these typical developmental changes mediated by her disability?

* When is Lisa eligible for Medicare? What is the difference between Medicare and Medicaid?

Week 8

Lisa is now 29 years of age and has been participating in programs through the Department of Rehabilitative Services for several years. She works at a local store through a program which helps supervise her employment there. She has come to be well-liked by the staff and owners even if she often has "idiosyncratic" relationships with customers from time to time.

Lisa lives with her mother and her mother's partner. The two decided that it would be best for their relationship and Lisa if they were all one family. Although Lisa was unsure at first, she now welcomes Cindy as a parent. The death of Lisa's brother in Afghanistan was a shock to Cindy and Marsha, but Lisa had a difficult time understanding exactly what happened. She still asks about him.

Lisa rarely talks about her dad and sees him even less. There are rumors about him getting involved in drugs and being a part of some nefarious activities in the next town. Marsha doesn't know and doesn't want to know. Lisa has been able to maintain appropriate boundaries with men after alot of coaching and careful monitoring by those around her. She will likely continue to live at home.

* What is the time period for early adulthood? What are the physical, cognitive, and socio-emotional changes that typically take placed during this period?

* How might someone like Lisa understand and cope with loss? She has lost both her brother and her father. What effect might this have on her given her limitations?

* Given Marsha and Cindy's development as middle adults (the period of middle adulthood), what are the stresses that might result from having Lisa at home? 

Week 7

Lisa is a 19 year old young woman who has been diagnosed with Autism Spectrum Disorder for a number of years. Her transition goals in her IEP have helped her to be more socially independent, and she is able to make some forays outside of the home without supervision.

Lisa's parents finally divorced last year, and Lisa's brother went into the Army, and it seemed Scott and Marsha could not find anything outside of the kids the keep them together. Lisa misses seeing her dad and often asked when she will get to see him again. It is hard for her to understand why her parents don't live together any longer. It makes her sad and sometimes angry.

Lisa is able to have some supported employment at a local hardware store, and she continues to attend the local school close to Marsha's house. When Scott moved out, he moved to a town nearby and is said to be working odd jobs to pay the bills. Marsha is now working in a local pediatrician's office. The hours are somewhat flexible, and the practice has given her the ability to be with Lisa when needed. It is good that Marsha has close friends who are also able to help with Lisa. She's particularly close to Cindy and has been for the last several years. Cindy is always around, picking up Lisa at her job, taking her home and making sure she has eaten. Cindy would really like to be with Marsha and can see a future for them. Marsha really never thought of herself as bisexual, but not that Scott is finally gone, she has begun to be attracted to Cindy. They have even talked about moving in together.

Lisa loves to be with other young adults at the Clubhouse, a community-based space where people with special needs "hang out." There is a man, Raymond, at the Clubhouse who is a few years older than she, and he keeps trying to get her to do things that make her uncomfortable. He's always touching her on her shoulder and back, and he is often "in her space." She's not sure how to say it or who to say it to, but there's just something especially strange about him. Lisa doesn't like the way the man treats her.


* Find out information about Summit House in Harrisonburg. Who goes there?  Why? What are the requirements for attendance?

* Describe typical developmental milestones for a 19 year old. 

* Given Lisa's need for adult supervision most of the time, what are the future possibilities for employment for her? Assume that her IQ is 74.

* Given Lisa's atypical development, how might she understand inappropriate physical contact such as that that comes from Raymond?

DECISION POINTS:

Does Lisa find a way to communicate her needs to someone "in charge" at the Clubhouse?

Do Marsha and Cindy move in together?

Week 6

Lisa is now 15 years old, and the last several years have continued to be a rollercoaster for her family. They have had some intensive in-home therapy which they found marginally helpful, and Scott and Marsha have been attending couples therapy with a local therapist who charges on a sliding scale. They scarcely have the money to support the family, but they feel they need the support.

Lisa is in high school, and she is in Special Education classes for most of the day. While it is challenging to get an exact number owing to Lisa's difficulty with testing environments, it is thought that her FSIQ is around 70. Sometimes, however, Lisa demonstrates incredible insight and thought, but then, quick as that, it seems to disappear into her usual moodiness. Now that she is a teenager, her medications that had been helpful in the past have not been as helpful. Her parents have struggled to get her on medications that will benefit her with the changes brought on by puberty.

Scott and Marsha understand that there is a special school in a nearby town that offers to work with children like Lisa. They have considered selling their house to go live in a trailer in order to pay to send her there. They have heard that kids can be "turned around" at the facility and, while they have accepted Lisa's disability, there is a part of them both that wonders if Lisa could grow out of her autism.  Even if they could send her for a year, they feel like it would be worth it.

* What is the Faison School for Autism? How much does it cost to attend and who typically pays the tuition? What kind of program does the school have for children with Autism?

* Describe the typical developmental milestones for a 15 year old girl.

* Write a narrative of how Scott and Marsha might have explained menstruation to Lisa.   
* Describe three goals that might be found on Lisa's IEP at this point in her life. What transition goals might also be there?

DECISION POINT: Do the Penningtons sell their house and send Lisa to the school?

Week 5

Lisa is now 9 years of age and has been diagnosed as a student with an Autism Spectrum Disorder and/or a student who is Intellectually Disabled. Her parents, with the assistance of a local child psychiatrist, placed her on medications two years ago. 

* What medications was Lisa likely prescribed given her diagnoses Have the medications you indicate been approved by the FDA for use in children?

* Write a narrative “interview” in which you communicate with Lisa in an effort to get to know her.

* Write a narrative “interview” in which you talk with Lisa’s parents about her.

* Who is Lisa? What kind of child is she? What might someone expect upon meeting her for the first time? Base Lisa’s imagined personality on what you know about she and her family so far.

Week 4

Lisa Pennington – Week Four

Lisa is now 6 ½ years of age and has been attending her local public school as a first-grader. The schools in this part of the state are good – that’s part of why the Pennington’s wanted to live here – but they are increasingly worried as to how they are going to keep the house. Scott and Marsha went to couples counseling and individual counseling, and Scott has been able to change most of his patterns of relating to Marsha. Still, they have their moments, and Marsha has not yet been able to forgive Scott for the way he treated her. She is not sure that she will ever be able to do so. Yet they stay together “for the kids” and, on occasion, for the care they are somewhat able to show to one another.

Scott and Marsha met in college and graduated the same year. Scott was trying to start his own business, and Marsha was working in retail while she tried to find work in the marketing field. They had been able to buy a house because of money Scott had inherited from his uncle – it wasn’t a huge amount, but enough to give them a nice down payment and a bit of a financial cushion. Until, of course, the market tanked, and they lost “everything” as Scott was often heard saying. Marsha knew it wasn’t that bad, but Scott took it terribly. His business was just beginning to turn a profit, and it seemed like there was no hope. In the midst of the turmoil, the Pennington’s welcomed their first child into the world – a healthy baby boy. Without insurance, the Penningtons still have medical bills they are paying on the birth of their children, and this debt contributes to the stress. Scott and Marsha’s house is small, but they could possibly sub-let the basement to someone. It might help Scott’s high blood pressure to ease just a bit.  

Lisa’s brother is now 9 y/o. He is doing well in school. Lisa, however, is another story. She was identified as a student needing intervention last year while in Kindergarten. She was simply unable to sit still. When teachers would attempt to work with her, she would scream and throw a tantrum, kicking and flailing on the floor. One time, she picked up a stapler and threw it at the teacher’s aide. Incredibly, the school did not carry out a full scale evaluation for Special Education but instead implemented pre-referral interventions. These have proved to be useless in the face of Lisa’s increasingly “out-of-control” behavior.

* Describe some pre-referral interventions that a school might implement with a student like Lisa. Consider her age, cognitive development and socio-emotional development.

* Describe typical developmental milestones for a 6 ½ year-old.

* What is the next step in the process of Special Education assuming that pre-referral interventions have failed?

DECISION POINT

* Do Scott and Marsha decide to sub-let their basement?