When the nurse and family case manager first began visiting with Mindy and her children Steven (now 6 years old) and Sarah (now 2 ½ years) in November 2010, they identified that both children would benefit from health care coordination and family strengthening services. Both children were diagnosed with asthma and began receiving asthma case management immediately . Sarah in particular, had a history of numerous ER visits related to breathing problems. Mindy proved to be a determined listener, and learner. Asthma triggers identified early on for both children included: weather changes, cigarette smoke, dust, perfumes, and fumes from cleaning products. Mindy worked conscientiously on decreasing clutter, dusting and cleaning frequently, reducing the use of commercial cleaning products, asking grandma to smoke outside when she visited them, and scheduling their outdoor activities for the cooler part of the days in the summer. With assistance, she was able to secure an air conditioner to use on the hottest days. Over the last 6-7 months with trigger reduction and medication adjustment by Sarah’s Carilion Pediatrician, Sarah is now demonstrating a current symptom assessment reflecting “well-controlled” disease status.
With Steven, Mindy’s concerns were focused on speech development, asthma, dental needs and his growing weight. After developmental assessment on a home visit, Steven was referred to the developmental clinic for evaluation and also to REACH for educational support and subsequently has been diagnosed with autism. Mindy had also expressed concerns about Steven’s growing weight. At his last WCV in the fall he had a BMI exceeding the 99th % for his age. She responded in positive ways to the many suggestions offered by her FCM Elizabeth and nurse Carol. She shared that she has restructured the family’s meal plans and that the children now eat three meals with two snacks daily. She has replaced the sweets with fruits and provides water rather than juice or sweetened drinks. During a recent visit when Steven requested a snack, Mindy brought out a vegetable tray from the refrigerator and both children snacked on a variety of vegetables without dip. Despite being on a fixed income the mother is committed to improving the family’s nutritional status. The restructured meal planning was partnered with more consistent exercise opportunities for both children and for Mindy. As their asthma status improved, both children were able to physically accomplish more. Both Mindy and Steven have lost a significant amount of weight and Mindy said Steven had changed from a size 14 to a size 7.
Steven’s dental needs are being addressed presently as he has been referred to Carilion Pediatric Dental Office for follow-up of multiple caries noted when he was first enrolled. Fortunately, Sarah is of the age where she can still benefit from our Begin with a Grin Program and is receiving oral hygiene education and fluoride varnish.
Mindy was also able to respond positively to suggestions for behavior management, especially with Sarah. Sarah was observed to be a very active toddler and frequently would not listen to her mom’s communication about controlling some of her inappropriate behaviors. Mindy listened to her CHIP nurse and case manager and tried a few strategies regarding behavior management. Despite fervent protests from Sarah demonstrated by such loud screaming that the neighbors came over to see what the matter was, Mindy persisted in enforcing Sarah sitting on the stairs during time out. In addition, for both of the children she created a star chart with stars being awarded for positive, desired behaviors. As the children’s behaviors improved, she rewarded them with play money and took them to the dollar store every once in a while to purchase a little something they wanted.
CHIP will be establishing a Parent Advisory Board soon and Mindy will be asked to participate and her strengths would be valuable for other parents to emulate.