|
The family: a stimulating environment for the development and growth of the child
Focus: Early Intervention
Topic: Families
Marķa Rosa Mayo Tagarro
Support Teacher
ONCE's (Spanish National Organisation of the Blind) Education Team
Campomanes, 5
33008 Oviedo
Spain
E-Mail: rmayo@inicia.es
This paper is a reflection, based on my professional experience, on the role of the family environment in the personal development and growth of the child. This reflection is supported by the two practical cases that follow.
Our Action Model has as reference basic elements from:
§ The Social Theory of Child Development
§ The Transitional Model
§ The Ecological Model.
These theories confirm that human development is of an interactive nature. Therefore, we see family as a fundamental environment where all care and relationships that determine the child's personal development and growth take place. However, these relationships are also affected by the child's own personal background and this helps us to understand the difficulties that arise during the process of establishment of the relationship when a handicap is present (in our case: blindness and extremely premature birth).
In light of the above, our Intervention Model considers the child and his social and family environment as its key elements.
To intervene in the child's closest environment implies the introduction of "the handicap" in a wider context: the nuclear family and the relationships that are established within it.
The link between parents and child is affected by the difficulties presented by the child's handicap and by the degree of acceptance of this handicap by the family. The goal of supporting the family is to facilitate more interactive communication with their child and does in fact facilitate it. It is here where we understand that prevention can be implemented, because the child develops to their full potential if the surrounding environment is favourable and, also, if the child is given by the mother (or whoever is filling the role of primary caregiver) the basic care and support, containment, acknowledgement and love necessary for the growth of the child's individual identity and their continued development.
Stimulation of the child in order to facilitate the child's response to the proposed objectives goes beyond "what and how to do it" questions. We consider it to be an enriching part of the child's everyday environment; by diversifying contacts and experiences on a daily basis, making the most of all daily life situations (nourishment, hygiene, walks, games, etc.). Our Action Model has a preventive, empowering, global and inter-disciplinary approach.
The goal of our Intervention is to boost the capacity for development and welfare of the child, as well as to give support to the education, social and family environments in order to facilitate the child's insertion into those environments.
Carlos is a very premature child born after just 26 weeks gestation and weighting 875 grams. He spent three months in the incubator and, during this period, he suffered sepsis, anaemia (three transfusions made) and patent ductus arteriosus (PDA).
During the hospitalisation period, the mother detected "something strange in his eyes" and told this to the professionals in charge of Carlos. The ophthalmologic exploration did not detect any symptoms of visual pathology.
In spite of this response, the mother insisted and a further ophthalmologic exploration was carried out. After this exploration, the ophthalmologist diagnosed a severe hypothalamia, and referred Carlos to another hospital for surgical operation.
The outcome of the surgical operation was not successful, due to a detachment of the retina. The final outcome was total blindness of the left eye and some perception of light in the right eye.
Carlos' family - of low education and socio-economic level - is composed of the young parents (28-29 years of age) and a 5-year old sister. The father is employed permanently in his town of residence, and the mother stays at home and does the housekeeping.
The family history highlights are:
§ The grandparents on the father's side were deaf-mute,
§ The grandfather on the mother's side was an alcoholic and abusive.
§ The grandmother on the mother's side died suddenly while Carlos was in hospital. This event, which occurred at Carlos' family home, was experienced by the child's mother as a traumatic and unexpected one. This brought about intense emotional experiences which, along with the stress caused by the child's difficulties, would come to compromise Carlos' situation.
FIRST INTERVIEW
The same day that Carlos was discharged from hospital, the parents brought him to the ONCE (Spanish National Organisation of the Blind) referred by the Neonatology Department.
Carlos' mother was holding him in her arms and hardly any eye contact could be noticed. She told the story of her child in a monotonous manner and showing no emotions whatsoever. The father remained silent and displayed with this attitude his agreement with what the mother's was saying.
We highlighted the need for Carlos to enjoy some time to get to know and be known by his relatives and to familiarise himself with the environments and objects he is going to meet in his everyday life.
Information was also given in response to the enquiries made by the parents in relation to the Early Care Program. We set up a place, day and time for meeting with the family. The next intervention was to take place when Carlos' parents were certain that "the meeting of their child with his closest environment" had been accomplished.
§ Gathering of information about Carlos' everyday life.
§ Carrying out the assessment of Carlos' physiological aspects: breathing, quality of sleep patterns, level of alertness, tone, movements, etc.
§ Gathering of information on the most relevant aspects of the family context: physical conditions, lifestyle, work schedules, marital relationship, family and social interactions, etc.
§ Assessment of the experiences offered to Carlos through family interaction.
§ The creation of an atmosphere that enables the family to express feelings and emotions caused by the extremely premature birth, the time spent in the hospital, the surgical operation and Carlos' blindness, in order to be able to define and contain them.
§ Listening to what they had to say and their concerns about their son.
§ Empathising with Carlos and his family.
The implementation of these actions facilitates the approach to Carlos' reality and his family environment, which has allowed us to gather the following facts:
§ Carlos has respiratory difficulties due to his pulmonary hypoplasia, resulting from his premature birth.
§ Carlos sleeps deeply and there are days where his sleep patterns are irregular.
§ He has good skin colour and tone but hardly any movements are noticed.
§ The physical environment is friendly and well organised.
§ The couple's relationship is good. The mother, who is the one who takes the initiatives, feels emotionally supported by her husband.
§ The families of Carlos' parents show their disposition to help and they frequently visit them in this first stage.
§ Carlos' parents main preoccupation centres around their son's blindness, due to it being such an unexpected turn of events which, they say, has destroyed the idea they held of their son. They were so shocked by their child's blindness that they barely spent any time talking about the circumstances of the premature birth and the consequences that this event had for Carlos and themselves.
§ When the mother talks to her son, she uses a descriptive language in relation to everyday events. Neither signs of rejection nor angst can be detected in her speech, but resignation.
§ Carlos regularly receives basic care from his mother, however she does not use this opportunity for the purposes of interaction with the child. Contact between mother and child was shockingly distant and mechanical. We interpret the way she holds and feeds him (with his back to her) as a way of avoiding eye contact with him, whether it is because of not being able to or not wanting to.
The analysis of the information gathered in these first interventions has an important significance in the formulation of the plan of action. The most important aspects of the case are:
§ The mother has difficulties verbally expressing feelings and emotions and when relating to her son.
§ Carlos has irregular sleep patterns, he is very passive and has a very week response level, due to the immaturity of premature babies and to his blindness.
§ The father is absent for a large portion of the day due to the demands of his job.
§ Carlos' sister does not engage in any interaction with the baby and seldom utters any opinion on the new family situation.
§ If this style of interaction between Carlos and his family persists, this may lead to difficulties in his future development.
The objectives of this plan of action were:
§ To boost Carlos' global development.
§ To promote situations to make interaction and communication with close relatives easier.
§ To help Carlos' family to better understand his reality.
§ To establish safe links between Carlos and his family.
The actions carried out were:
Intervention with Carlos is always based on his activity in order to make him aware of its meaning and, starting from this point, to complement and/or form it until the objective sought is attained. The activities are carried out by means of:
§ Psychomotive skills play (to get to know himself).
§ Interactive play (to boost his social skills).
Activities with the family were focused on:
§ Signalling behaviour or clues in relation to:
o The need for physical proximity showed by Carlos to perceive and experiment the other and with the other.
o The importance of making the child know that his activities are noticed, in order to raise his awareness of the fact of being observed and recognised by others.
o The importance of routines, which along with points of reference, facilitate the organisation of space and time, as well as the development of anticipatory conducts that will help the child gain control over his everyday life.
o The "routes" Carlos must take to discover the surrounding environment and interact in it (adult touch, sound and mediation).
o The importance of the parents correctly interpreting the "signs" received by their child and being able to give him coherent answers. This will allow Carlos to feel understood and discover the effect the environment has over him.
§ The collection of comments made in relation to Carlos: worries, feelings, needs, etc.
§ The transmission to the parents of Carlos' progress and development.
Between the age of 6 to 15 months, Carlos showed a normal development within the expectancy parameters marked by his circumstances, except to when it comes to relationships and communication. Three important events occurred during this period: the child recognised me, the father was beginning to give the child a sense of security and to share experiences with him, and the mother was beginning to have expectations about Carlos' development.
However, some things also concerned us: no fear of strangers, the lack of initiative in the relationships and the rejection of solid food.
Around the age of 18 months, Carlos took his first solo physical explorations of his surroundings. During this stage, the child asked for "more" (experiences, game-sharing, new spaces, etc.). However, his mother gave no response: she suffered fits of gastroenteritis and felt a sharp overcoming pain in her chest. Faced with this situation, the child withdrew, rejected physical contact and turned into a sullen and unpredictable child who made contact difficult. For these reasons, we referred Carlos to the Mental Health Service.
The containment, the role of connecting their son to his environment, the transmission of language, play, etc., was upset and, as a consequence of this, Carlos showed a significant delay in his maturing process and had difficulty relating to others.
The mother felt permanently frustrated due to the low level of response from her son. Her concerns revolved around blindness, and she delegated the responsibility for her son's development to the professionals.
This was the beginning of a process of alienation that still persists today, when the child is two years old.
EXPOSITION OF THE SECOND CASE
Even when the same plan of action implemented with Carlos was used, a brief look at the history of Marķa shows how different her development was, not only due to other physical and personal conditions which were in place, but because of a more positive family environment.
Marķa was a full-term baby who was diagnosed congenital glaucoma at birth. She was the first daughter of a young couple, mid to lower class, with nothing exceptional to point out in their personal lives except the sudden death of the mother on the mother's side when she was 15 years old.
We took on the case when Marķa was 5 months old. Up to that moment, she had two surgical operations: implantation of a valve in the left eye for the control of intra-ocular pressure and the unsuccessful cornea transplant in the right eye.
When we started the intervention we noticed that Marķa appeared to be a fragile and not particularly expressive child, giving weak and slow responses. Her life was organised on the basis of her basic necessities and, although weak, a mother-child relationship could be observed.
Our attention was primarily drawn toward the strengthening of this relationship and the satisfaction of the parents' demands: support and guidance.
Once they received this support, everything developed spontaneously. The mother, who now felt safer, played down the limitations posed by her child's handicap and drew from her own childhood experiences to be shared in her daughter's life.
The father approached her and she enjoyed him. Marķa gave them pleasure and then, it was from this point, that her development progressed: Marķa, aged three years old, was enrolled in her neighbourhood's Kindergarten. Above all though, she is a very expressive child who has great interest in getting acquainted with the world around her and with everything she finds interesting.
It is necessary to point out that the mother needs Marķa to "act" as a way to compensate for her blindness. This is, as of today, one of the objectives of our intervention.
CONCLUSIONS
The cases exposed above give us an indication of the role performed by the family environment in the construction of the child's individual and social identity and, in consequence, of the need to focus the Intervention on the strengthening of this environment, so it can become a space that facilitates the development and growth of blind and/or visually handicapped children.
Our country opens the 21st Century with great social changes of different kinds: demographic, legislative and technological, of organisational methods and social co-existence. These changes are the cause and effect of the emergence of new values and ways of life that will be reshaping our society. A large part of these changes affect the structure and the running of our family system.
If, as children development theories affirm, "family is the environment where a person's individual and social identity is built", Early Care, as a dynamic form of Intervention in relation to social and family reality, cannot be separated from these changes. It needs to be utilised in professional circles for reflection, with the aim of re-drawing the Frameworks of Action in order to reconcile them with the new social realities.
BIOGRAPHICAL DATA SHEET
Title of the document / poster: The family: A stimulating environment for the development and growth of the child.
HS Reference number: 3787
Support area: Early Intervention
Subject: Families.
Name: Marķa Rosa Mayo Tagarro. Support Teacher for the integration of the blind and the visually handicapped, ONCE (Spanish National Organisation of the Blind).
She has focused all her professional life mainly on the attention and support to handicapped children.
She has been working for the ONCE since 1985.
Coordinator of the Early Care Unit of the Asturian Principality's 3rd Health Area.
Co-author of the Early Care White Book Spanish edition.
Member of the research group: Outlook of the national Early Care services: layout, organisation and coordination.
AUDIOVISUAL FORM
Name: Rosa Mª Mayo Tagarro
Paper / poster: Evaluation of the Braille reading comprehension
Focus Area: Early Intervention
Topic: Families
I will require the following audio-visual equipment form my session. I understand it is my duty to check that the equipment is in place and is in working order before my session begins.
3. Video Projector (PAL system)
|
Please send comments or questions to webmaster@icevi.org.