Final Week

Vasha continued to struggle in her life. In her early 40s, Mental Health Support services helped quite a bit. Vasha seemed to be finding a "new lease on life" at that time. At age 49, Vasha was walking in the park and was physically assaulted by two teenagers who beat her up and took her wallet. She found herself in a deep depression. She was able to hang on until her 52nd birthday when she swallowed a bottle of Tylenol and was found dead in her apartment by maintenance personnel.

Week 9

Vasha has found herself at "rock bottom" -- again. Now 42, she hasn't seen her son in some time, and her daughter was removed from her by the Department of Social Services. She has been living in a homeless shelter for the last several months, and she can't seem to get herself together. Vasha has been using on and off -- when she can find some money to buy alcohol or drugs, she often does. Sadly, she has sometimes even sold her very body in order to get money.

The shelter recently had a group of people come in and do a short presentation on services that they offer. They say that if you have a diagnosable mental health condition, you can get assistance in the form of a worker to help with activities of daily living. Vasha, in one of her more lucid moments, made the decision to invite a person from the agency come to talk with her to see if she would be eligible.

Vasha found that she was indeed eligible for "Mental Health Support" services through the agency, and she was assigned a person to work with her.

* What are the typical developmental milestones for middle adulthood?

* What is "Mental Health Support?" What agencies in Harrisonburg provide this service? (Hint: contact Crossroads Counseling Center [801-0885] and talk with Dwayne Martin). How is it that someone can qualify for MHS services? Who is likely to be assigned as a worker, and what are their qualifications?

* What would be some goals for Vasha and her MHS worker at this point? How could someone help her given her current situation? What other services might she need?

Week 8

It has been a tough road for Vasha. Ever since the birth of her son, she has been off of her meds for ADHD - it's just as well since she really didn't need them laying around anyhow. Her mother took the baby for a while when Vasha went to get some help for her substance abuse and her ever-changing moods. She still doesn't know how she escaped Chad without becoming HIV+ herself, and she is ever so thankful that she didn't have to worry about her son contracting the condition. Still, she entrusted her mother with the care of her son, and she went "away" for 9 months.

When Vasha returned home, her son was two, and she had to adjust to being a full-time mom. Luckily for her, her mother was able to provide for the two financially, and a few years passed.

Now at age 28, Vasha seems stuck again. She has few employment prospects, and the pressure to get out of her mother's house is mounting. She doesn't know what to do, and she's thought about using again. Her mother has some gold jewelry hidden away that she knows she could sell for...and as soon as she has such a thought, she tries desperately to turn it aside, like she learned to do back at "the Ranch," the treatment facility she spent time at several years ago. She couldn't go back to those ways - she couldn't do that to her boy who seems really happy in his school. She really has to find a way to get to be on her own. She really has very little in the way of marketable skills, and she has a high school diploma (an IEP diploma).

* At minimum wage working 40 hours a week, where would it be possible in the United States for Vasha to rent an apartment, pay for utilities, have enough food for she and her son, perhaps own a car? Don't forget about medical care and car insurance as monthly expenses.

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

* What employment options are there for someone with a high school education? If Vasha were to work 40 hours a week, who would care for her son when he came home from school (assume that Vasha lives some distance from her mother)?

* How is Vasha's history of substance abuse likely to affect her prospects for employment? What about her ADHD? Is her ADHD a disability that will qualify her for any kind of public assistance?

* Where can Vasha go for help at this point?    

Week 7

Now 19, Vasha still remembers the first time she snorted Adderall. She narrowly escaped being kicked out of school completely and pleaded to be given another chance. Although she had to meet with a counselor on a regular basis and stay out of school for a few days, she knows it could have been worse. Still, she wishes that she never listened to that bratty kid Spence who talked her into trying. Even though they got caught in the act, she remembers going home that night and feeling so out of control that she tried it on her own. Then, she was hooked. From there, it was a gradual progression of things to try to help her deal with her emotions and impulse control -- first, she tried some Xanax that she got from Spence -- she was so "out of it" that she can barely remember what he tried to do to her. She thinks that they didn't have sex, but she's never been sure. She just knows that she made the decision right there and then not to hang around him anymore.

She found plenty of other kids, though, who kept her supplied with downers and amphetamines. She would alternate these to try to manage her moods. School became a blur, and her grades dropped substantially in a short time. She was seen as a "bad kid" -- beyond reaching, beyond help. Her "choice" to try snorting Adderall was something she wishes she could go back and change. She got suspended again when, in another state of mind, she threw a punch at a teacher. At that point, the school placed her in "alternative school" and essentially washed its hands of her. She managed to graduate and has been living with her mother, working odd jobs and generally wondering what comes next.

Her latest boyfriend, Chad, was her supplier. Chad and Vasha would have huge fights and then collapse into a mish-mash of marijuana smoke and sex. Chad never told Vasha that he was HIV+, and she didn't find out until long after she learned that she was pregnant. 

* Given Vasha's diagnosis of ADHD, why would the school have been able to do what they did? What is the problem with that course of action?

* What could Vasha's mother have done when the school was not meeting her Special Education needs regarding her disability? Why do you think her mother did not advocate for her daughter? Provide some hypotheses.  

* What do you think accounts for Vasha's choice of partners? Why doesn't she just make better choices?

* If she were willing to participate, what services would you recommend for Vasha? Where could she go to get these services? How would she pay? Is she eligible for Medicaid or other public assistance regarding medical care?

DECISION POINT:

What does Vasha do now that she is pregnant?

Week 6

Vasha is now a 15 year-old girl who has found a way to "fit in" with a small group of friends. The four of them have much in common - Vasha is Hindu, Tamil is from Afghanistan, Jake claims to be a practitioner of Wicca (which he refers to as 'Wicker' thinking that it's the correct term for the religion), and Spence just got out of a residential treatment center for kids with emotional problems. An unlikely group, to be sure, but one with whom Vasha has found something of a second home. Of course, there is nowhere Vasha would rather be than at her real home, but these friends she's made are a wonderful substitute when she's not at home.

Vasha is still close to her mother, and the family has been through alot since Arup died. Most of the siblings are off living their lives, but they come back quite a bit to visit. 

One day, Vasha and her friends are talking at lunch. Somehow, the conversation rolls around to ADHD, Spence's stay at the facility and the kinds of medications he had while he was there. It comes up that Vasha is on a medication for her ADHD. Spence wants to know if she's ever tried snorting it, and she is horrified - "of course not" she says. Spence, however, having been around lots of kids with lots of problems, has a way of being convincing and sly when he wants to be. He manages to turn Vasha's initial reluctance into a promise for her to bring some of her meds to school with her tomorrow. Spence is going to show everybody how to "get high" on Adderall.

The next day comes, and Vasha brings her meds with her, unaware of the potential ramifications of such an act. The four go outside after lunch, and Spence starts to tell them how it's done...

It is about at that moment that the Assistant Principal walks around the corner, catching all of them in the act of snorting a controlled substance on school property.

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

* What are the intrapersonal dynamics that might lead an otherwise kindly 15 year-old girl to experiment in such a way? How about the interpersonal dynamics?

* What do you suspect will be the reaction of Vasha's mother to the news? Write a developmentally and culturally appropriate narrative of the dialogue that Vasha and her mother have regarding this event. 

DECISION POINT:

Does Vasha get kicked out of school? If so, for how long? If not, what are her consequences?

Week 5

Vasha is now 9 years of age. Her mother, with the assistance of a local child psychiatrist, placed her on medications two years ago. 

* What medications was Vasha likely prescribed given her diagnosis of ADHD? Have the medications you indicate been approved by the FDA for use in children?

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

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

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

Week 4

Vasha Singh – Week Four

Vasha is now 7 years of age and in the second grade. Shura has been able to make ends meet thanks to a large life insurance policy that Arup had. In addition, Shura’s family has provided financial assistance when she has needed it. She is feeling better and is able to support all of her children both in the home and as they keep going to college – there are now two children in college, and another will go this year. Education has always been hugely important for the Singh family, and Arup made sure that if anything ever happened to him, money would not be a barrier for the family’s educational aspirations.

In school, Vasha has been having a better year since she was identified as a student with a slight learning disability. She also has an “Other Health Impairment” in that her pediatrician diagnosed her with Attention-Deficit /Hyperactivity Disorder.

An added complication is that Vasha is the only Hindu student in her school, and other kids sometimes laugh at her, calling her names. They have seen her mother come to pick her up wearing traditional Indian dress, and they don’t understand. What’s more, many of the children come from families whose experiences with those who are different from the perceived “norm” is limited.

* Describe the developmental milestones for a typically developing 7 year old.

* What is the prevalence of ADHD in the population of Indian –Americans? Is it more or less prevalent than in the general population? Why do you think this is?

* What kinds of things can the school do to address bullying and diversity?

* Assuming that Vasha has an IEP for a reading disorder, what has already taken place with regard to interventions prior to the Special Education process? (Hint: Find RTI strategies for reading). What are some goals that you might find on Vasha’s IEP given the interaction of LD and ADHD?