Arnie Grape: Case Study

I received a call from a Deputy Sherriff in Endora reporting the repeated dangerous activities involving the minor child, Arnie Grape. In my role, I must assess not only the actions of the minor, but I must also assess the living conditions (i.e. family , home, siblings, etc.) and make a recommendation for the child’s future supervision and appropriate sustained support for the family in-residence with the minor.
Client: Arnie Grape (Primary) – Caucasian, 17 years old soon to be 18 years old and developmentally delayed.
Sub-Client: Bonnie Grape - Mother/Widow, 47years old (approx), Caucasian, morbidly obese, severely depressed, unknown spiritual identification (assumed Christian), SES – low to lower-middle class, heterosexual, rural
dwelling, head of household (all children live in residence), there was a total of seven members in the Grape family.
A. Grape - Father, Caucasian, deceased 17 years ago.
Larry Grape - Brother/sibling, Caucasian, location unknown; subject does not live in the family dwelling. Larry left the family home immediately after graduating from high school.
Amy Grape - Sister/sibling, 23 years old (approx), Caucasian, high-school graduate, unmarried, unknown spiritual identification (assumed Christian), SES – low to lower middle class, heterosexual, rural dwelling, currently unemployed outside the home, lives with Mother and siblings in family home, Amy has taken over the majority of the family’s responsibilities especially domestic chores.
Gilbert Grape - Brother/sibling, 21 years old (approx), Caucasian, high-school graduate, unmarried, unknown spiritual identification (assumed Christian), SES – low to lower middle class, heterosexual, rural dwelling, primary breadwinner (has job outside of home), lives with Mother and siblings in family home, Gilbert is also responsible for fixing his family home, and the primary caretaker of Arnie his younger brother,
Ellen Grape - Sister/sibling, 16 years old (approx), Caucasian, high-school graduate, unmarried, unknown spiritual identification (assumed Christian), SES – low to lower middle class, heterosexual, rural dwelling, has job outside of home, lives with Mother and siblings in family home. Ellen helps Amy out with some of the family’s house chores (Please see Appendix A). Presenting problem(s)
The Grape family system lacks major resources and support. Even though their main client system is within each other, the family roles have changed dramatically due to their father committing suicide. Bonnie’s morbid obesity and Arnie’s mental health condition has left Amy and Gilbert as the primary caretakers of the whole family. The current conditions in the family structure are causing major parenting and disciplining issues for the children in the family. When Mr. Grape suddenly took his own life, it really affected every family member. In addition, no one in the family has ever received any form of counseling or given any type of outlet to mourn the death of their father’s death. Lastly, the condition of the family home that they all reside in is extremely destitute and in need of major repairs and maintenance.
Assessment and Dynamic Formulation
In reviewing the evidence and current circumstances, we can assume that the Grape family’s support system is very limited. Luckily, they are a very close-knit family and will support one another. However, Bonnie has continually gained weight at an unhealthy rate since the father's death. Bonnie's current obesity interferes with her role as primary caretaker of Arnie and many of her would be duties as a parent to her other children. Because of this, Amy and Gilbert have had to fill in as surrogate parents. In return, neither of them had much time for themselves, opportunity of pursuing an higher education, meaningful relationships, or acquiring good paying jobs. While Amy and Gilbert are the two primary caretakers, Bonnie established a serious codependency that is not necessarily based in true dependency. The adult children are manipulated into remaining homebound and in caretaking roles for Arnie and ailing/obese Bonnie.
Arnie’s dependency on older brother Gilbert is clearly expected behavior on the part of siblings and Bonnie. Arnie accompanies Gilbert, who is one of two breadwinners outside the home, to his place of employment daily. Arnie, who is mentally challenged, depends on Gilbert almost all the time. Arnie has developed a habit of repeated dangerous behavior. Arnie repeatedly scales the exterior of an elevated water tower without regard for his personal safety, and in fact, appears oblivious to the danger due to observed mental incapacities. Therefore, Ellen and Gilbert are constantly getting into arguments with each other over the care or lack of for Arnie. The current coping skills being used within the family are to stay away from issues that exist within the family. Their lack of communication skills and self-expression of how each other are really feeling has affected their family tremendously. For instance, the children know that their home is in need of significant repairs but they will not bring these issues up to their mother. The children fear that if they bring the repair issues to Bonnie's attention it will only make her feel more depressed and hopeless as a provider for her family. Another instance when asked about the father's death no one would talk about it. The family tries to act as if it did not happen or that they are just fine. The whole family needs to learn how to seat down as a family and talk about their individual feelings and express their concerns. The Grape family cannot continue to communicate in this manner. They need help in addressing and recognizing the issues that they are facing as a family. Once the family is able to communicate, then they will know how to address issues as they arise. As a result, this can also encourage them to seek family counseling and appropriate coping skills in regards to their father's death. Additionally, the Grape family needs to apply for financial assistance to help fix their house.
Goals for Intervention
The Grape family will need to set some goals for improvement. Therefore, as their social worker I have worked with them on coming up with several realistic goals for them to work on. We discussed several options and this is what the Grape family agreed to work on the following issues. The first goal is for them to gain better communication skills as a family. Second, they need to obtain grieve counseling for their father's death. Lastly, they need to search for available financial support and resources for their home repair. The first goal, communication is the main goal and the answer to a successful outcome for this family. Realization of this goal will allow each family member to have more confidence talking and addressing current issues as well as new ones. Relationship building also comes from the work that the Grape family is putting into increasing their communication skills. I hope that they will seek out agencies in their community that can provide them with local home repair companies. That might have employees that will volunteer their help to the Grape family for repairs to their home. The Grape family can use this as an opportunity to meet and make friends in their neighborhood and community. These steps will assist the Grape family in accomplishing their goals and growing stronger as a family unit.
Plan for Intervention
While working with the Grape family I have gained their confidence, trust and communicate well with them on a constructive level that will promote them to participate and complete the goals of intervention.
First, I would like to improve the family’s communication skills. I would give daily activities that require everyone to participate in communicating with each other and as a family. This activity would require them to share how they are feeling, and share something interesting that happened in their day. They would continue this activity for eight weeks, with all family members participating. I would highlight that family relationships and understanding for one another is extremely important in helping their family heal and move forward. I would acknowledge all the hard work the family is doing as a whole unit and encourage them to work on themselves individually also. This is why I would engage Bonnie in understanding the importance of her role as the mother and decision
maker.
In order to evaluate the Grape’s progress I would use self-reporting and have them give feedback to me on each other. This will cause them to engage in conversation with each other daily, and several times a day. Members of the Grape family usually communicate with each other out of frustration or when asking one another to do house chores. This is why learning to communicate in a healthy more productive manner is so important, also learning about each other’s role and frustrations. My hope as their social worker is that these activities will allow them to develop the much-needed social skills that they lacked as a family. A skill that they can then use to build relationships with neighbors, peers, friends, and community. For the next eight weeks, everyone in the family should take part in building new positive relationships in the community on a daily basis. They can evaluate their progress by seeing whom they have built a relationship with and how many of these new friends they can get to volunteers to help with the repairs of their home. I would explain to the family that with any new skill it takes time. For example, when a baby starts to walk they will fall many, many, times before they perfect it. Strong communication skills take time as well, so once accomplished, the Grape family should start to address their father’s death. However, if the Grape family would like I could make the referral to a family therapist who would start the process of helping the family openly mourn the death of their father together as a family. The Grape family would need to agree to go for at least six month no less than three times a week. Progress can be tracked in the manner in which the family has become used to, they can self-report, evaluate their attendance to the sessions, and what effect counseling has had on the whole family. In most cases, it is hard for the family to start another relationship with a therapist, given the relationship they have established with me. It is my job to make sure the Grape family understands the importance of family therapy, and the need for them to cope with happened to the whole family when the father/husband died.
Self-awareness and ethical issues I am an African American woman; my beliefs and values are not that different from the Grape’s beliefs and values. For starters, I grow up with a stay at home mom and my dad was a longshoreman, he was the sole breadwinner in the house. I cannot imagine how life would have been without a father or a mother who was morbidly obese and incapable of caring for her own children. I was adopted and grew up as an only child, I had everything I needed financially and emotionally. In most cultures, the role of the mother is to cook and keep the house clean for her family, while the father is the breadwinner. I would guess other cultures like Caucasians have similar roles to play in the family. However, in the Grape family, the breadwinner is dead and the mother mentally and physically cannot take on the role of the primary caretaker. I have come to understand my strength is being accepting to different individuals and families. I understand that you have to be patient and take your time when dealing with cultural differences. Although, I worked with the Grape family for quite a while there were still limitations in working with them because I was not the same race as they were. I do not feel that impacted the service that they received it is still fact. Being culturally sensitive and competent is very important in this work. Social workers advocate for populations that are culturally diverse, we need to be aware of all the different cultures that are present in our society. For example, if I were to exchange the Grape family with a Chinese American family, there is some additional information I would need to include. Like Level of English proficiency and accessibility to healthcare facilities in their area – Endora, rural, etc. Their views on accepting advice from people outside their family circle mainly women in position to offer advice versus men. I would need to pay close attention to their social relationships.
First, I would offer language translation/access to native language speakers for purposes of sharing information.
Based on superficial cultural awareness research, I would ask more in-depth questions about family views with regard to mental illness, grief, nutrition, and sustained family therapy. I would work on their interdependency issues with keen attention to cultural practices and maintaining respect and deference to family/cultural traditions. Second, I would try to communicate the significance, and importance of having outside help, while still being culturally sensitive to their views. Last, I would try to expand their social relationships being that their mindset is in the form of hierarchy instead of equality. This could open many more doors for the family because depending on their economic and social status they may have certain views that are not necessarily "proper" in today's society. As social workers, we need to ourselves to be more culturally aware and be positively open to the different values and beliefs of the people we work to
help.