The Wates Family Case Study

You are a licensed clinical Social Worker. You have full diagnostic and psychotherapy privileges. You work in a primary care clinic, Hoffington Medical Associates, as part of an interprofessional healthcare team. The professional team is comprised of 3 Family Practice physicians, 1 NP, 1 RN, 3 LPNs, a part-time dietician, a BSW working as the care coordinator, and an MSW (you). All providers racially identify as White. You provide behavioral health services to individuals and families in the clinic. There are 4 pharmacies in the local area that clinic patients use to fill prescriptions. The dietician is available Monday, Wednesday, and Thursday mornings. Physical therapy is provided through the local hospital system, which is approximately 17 miles from the clinic. All services are located on the bus line.

The Wates Family
Segment 1

Todd is an 8 year old male diagnosed with cystic fibrosis. He is a patient in the primary care clinic at Hoffington Medical Associates. The parents identify his race as blended.

Family History

Todd lives with his parents, Anthony and Sarah Wates. Anthony identifies as African American. Sarah identifies as Native American. Sarah and Anthony lived on a reservation during their pregnancy. A tribal midwife attended Todd’s birth. Sarah breastfed and socialized with other young mothers and children on the reservation.

Todd was raised on the reservation for the first six years of his life. The family moved off the reservation to a town approximately an hour from the reservation for better work opportunities.

Todd’s father works for a local produce delivery company. He is at work by 4:30 a.m. each morning. He works Monday through Friday, and has mandatory overtime on most Saturdays. He generally finishes work at by 11:30 a.m. Todd’s father spends the afternoon with his co-workers. They eat at the Five and Dine, a local diner, and then go to Mac’s Saloon. Todd’s mother is a waitress at the Five and Dine. She drops Todd off at school in the morning and then works until the end of the dinner shift. An older neighbor, a woman form their own reservation, watches Todd and another seven-year old Native American boy while their parents are working.

Todd’s family lives in a first floor apartment in a former industrial area of town. Most of the industries have relocated to other regions, leaving most of the warehouses and production facilities vacant. The family’s apartment has a kitchen, living room, dining space, and one bedroom. Todd sleeps in a playpen in the living room. He often wakes when his father is getting ready for work. Todd’s mother brings Todd into bed with her for the remainder of the night. The apartment is affordable for the family; the monthly rent includes utilities. They have a single vehicle. Todd’s father is picked up by co-workers in the morning and usually drives home with his wife in the evenings.

Todd’s health insurance in provided through Child Primary Health (CPH), a state-based Medicaid program for children under 21 years of age. Todd’s medical expenses are fully covered by CPH.
Presentation of Symptoms
From birth through age 6 years, Todd received medical care on the reservation. At that time, services were provided by midwives, tribal doctors, and a visiting Nurse Practitioner. Todd showed signs of poor growth beginning in infancy. This was blamed upon the mother not having appropriate milk volume during breast-feeding. The infant was converted from breast-feeding to bottle-feeding. As the symptoms continued and Todd had difficulty ingesting the milk, he was diagnosed with acid reflex. At 4 years of age, his problems breathing were diagnosed as asthma.

At the age of 7 years old, Todd was first seen in the clinic for symptoms of respiratory distress. The diagnosis of asthma continued to be a consideration, although the treatment team constructed a broader differential.

At age 8, he was diagnosed with cystic fibrosis. His treatment regimen currently includes:
• Antibiotics
• Daily nebulizer
• Chest physiotherapy
• Inhalant therapies: bronchodilators; mucolytic; antibiotics; corticosteroids.
• Ibuprofen (as an anti-inflammatory)
Several factors contributed to the delay in diagnosing Todd’s condition. Todd was born on a Native American reservation with a midwife; therefore, he did not receive the same health screening that other children do in the United States, including screening for cystic fibrosis. The differential diagnosis developed for Todd during infancy and toddlerhood did not consider cystic fibrosis due to his racial heritage. Cystic Fibrosis is rare in both Native Americans and African Americans.
In the professional team’s morning meeting, the physician raised a concern with the patient’s history. Cystic fibrosis is generally associated with persons of European decent. There is very low prevalence among Native Americans, African American, and Asians. The current literature also suggests that both parents need to have the cystic fibrosis gene (dominant or recessive) in order for a child to inherit the condition.

The family’s history does not provide a clear understanding of how Todd inherited the condition. The team speculated that there is racial blending somewhere in both families’ histories prior to Anthony and Sarah’s marriage.

1.Develop an ECOMAP for Todd based upon the information provided (This is separate from the maximum page limit for the assignment). NOTE: Please do 10 full written pages, but 1 PAGE SLIDE of an ECOMAP.
2. Develop 10 QUESTIONS I would like to ask the family to help clarify information for the ECOMAP. NOTE: Please elaborate on these 10 questions.
3. What is the potential CULTURAL COMPETENCE ISSUES in this scenario? How would I resolve these?