A fictional account of MST-CAN in practice
Jane and her husband, Greg , have three children, the youngest, only two months old. Six weeks prior to treatment, the police were called when a neighbour heard glass breaking and screaming coming from the house. A fight had broken out between Greg and their eldest child, Jacob. Jane was standing in the back of the room, while the baby, Gail, was crying in an upstairs room. The middle child, 10-year old, Gillian, was crouched under the table in the kitchen. Greg yelled at Jacob, blaming him for upsetting his mother and the baby, and yelled at Jane to go calm the baby.
Community Services had already received a number of reports about the family, particularly from Gillian and Jacob’s school. They had been truant without reason on several occasions, and one report stated that Jane may be the victim of abuse from her husband. After several visits with the family, more concerns emerged. Jane did not appear to be able to look after her children, especially while there were more than two people in the house. With the violent behaviour, potential abuse and truancy, the children were at risk of being removed. Community Services suggested a referral to MST-CAN, which could teach the family skills to keep the children and each other safe, keeping the family together.
Goals of treatment were developed after an extensive assessment process with the family. All family members wanted the fighting to stop, and for Jacob and Gillian to go to school. They also wanted better relationships with each other, and to keep Community Services and police out of their lives. The therapist prompted the family about the concerns that the children may not be getting adequate care, and the parents agreed that they wanted to be there for their children more. Using these initial goals, the therapist created several short-term goals for each week.
Treatment focused on reducing violence in the household, which included sessions with the whole family. Jane and Greg also met with the therapist and worked on building their skills to maintain the structure and rules in the house that they decided upon. Greg admitted he didn’t like Jacob’s new friends and didn’t know how to get Jacob to realise they were bad news. Each family member agreed the move to the neighbourhood had left Jacob without his good friends, and they had been too preoccupied with Gail to take much notice of who he was spending time with. Together, they developed a plan, with rewards and consequences, tied to school attendance and spending time with approved friends. Jacob was not happy with the new rules, but was happy with the reward he would get at the end of the school year.
The family came up with a plan, coinciding with Greg’s busy work schedule. This meant that Jacob and Gillian would help out more when Jane is occupied with Gail. There were some setbacks, especially when Jacob had more interesting things to do. The therapist and the family worked together to tie-in rewards and consequences for helping out at home. One of the rewards included regular house parties, with Jane or Greg supervising. This was a strong reward for Jacob, who had been finding it difficult to make friends in the new neighbourhood. Even though he was only allowed a small number of friends over, and there were a lot of rules, he enjoyed every part of it. It also showed the therapist that Jacob had the skills to make positive friendships, though Gillian struggled.
It seemed that Gillian had problems with social interactions at school as well, and her teachers were so used to it they didn’t notice anymore. The therapist worked with Greg and Jane to develop a plan for communicating with the school about problems and they eventually took the lead. The parents were taught social skills, how they can teach, model and reinforce them with Gillian, and work with the school to provide the best care and support she can get.
During sessions, the therapist noticed that Jane was vocal and able to speak her mind, and questioned the initial suggestion of emotional abuse as a factor in her parenting ability. It was only after many successful sessions in reaching goals that Jane told the therapist she had been abused as a child. She didn’t want her children to think that she wasn’t there for them, and was finally determined that she would work through her past. The therapist gathered more information from Jane, and reviewed her case with the MST-CAN team. The MST-CAN psychiatrist confirmed a diagnosis of post-traumatic stress disorder, but didn’t think medication was necessary. The therapist started individual treatment with Jane, ensuring she had adequate supports in place. Greg, Jacob, and Gillian were great for Jane, as were the new neighbourhood friends, and some family members who were available by phone. The therapist congratulated them for developing a rich network of supports, which would be useful once the MST-CAN program was finished.
Jane continued to work through her individual treatment, seeing successes with her family, reaching most of their initial goals. Greg and Jane felt like they were the parents again, and knew what responsibilities they had to keep their children safe and healthy. Jacob received several ‘A’ grades, and got his big camping trip as a reward. He changed the friends he had originally wanted to go with, which was also an achievement for his parents. Gillian had a steady group of friends, and the school reported less incidents.
Jane struggled during her treatment with dealing with her traumatic past, but memories had stopped popping into her mind, and she didn’t seem to zone out as often as she did before. Greg had an understanding of what happened to her, and knew how he could help, particularly to look after Gail during those tough moments. Community Services agreed the parents were able to keep their children safe and cared for, and closed their case with them. The MST-CAN team threw a congratulatory party for the family, who now knew that if they ever came across troubles again, like moving towns or the inevitable trials of adolescence, they had ways to deal with them which would be beneficial for everyone.
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