Case study: Jack

Jack’s Story

Our partnership with UNICEF is helping to change the lives of children like Jack. 

Jack* is 10 years old and lives with his family in a small town on the South Coast. Jack has an older brother James aged 12, and a younger sister Emily aged 6. He is in Year 5 at the local primary school, and outside school he enjoys playing with his pet cats, designing new Lego pieces, making cubby houses and riding his scooter. Jack is very caring towards others and he always wants to make sure that everyone else is OK.

Jack was referred to Royal Far West for support from the Paediatric Developmental Program a couple of years ago because of difficulties with anxiety, low mood and the impact of developmental trauma. After comprehensive assessment to understand how best to help Jack, a detailed care plan of support was agreed with the family. Since then Jack had made great progress and there was just one final review visit planned for mid-2020.

During the summer of 2020 the bushfires burned very close to Jack’s home and he had to evacuate several times.

In fact, the fires got so close that they burnt right up to their neighbour’s back yard. Jack’s mum, Katie, had to act quickly, and she arranged for Jack and James to stay with their Grandmother up the coast. Unfortunately, the fires spread close to that town too. Jack and James had to escape for a second time and shelter at the local surf club evacuation centre. This was very frightening for the boys, especially because Jack was worried about his mum and Emily who were staying at another town.  Jack was also very worried about his pet cats, he hoped they were keeping safe. When the family were finally reunited the journey home which should be 2 hours took 11 hours! They had to travel through thick smoke, and all the way Jack was worried about the fires returning as they listened to reports on the radio. Once home they were relieved to see that their house hadn’t been burnt but it was full of smoke and ash, and they had no electricity for several days. The thick smoke stayed for weeks and they couldn’t play outside.

During this time the RFW Clinical team were working hard to try to contact the families of all the children living in the bushfire affected areas that were known to the service. Social Worker, Lee Purches, called Jack’s mum to see how the family was coping and to find out how she could help. Katie said that the children seemed fine initially but as time went on she was becoming increasingly worried about them. Jack’s younger sister had become very “clingy” and was refusing to sleep in her own bed.  Emily was also very scared whenever she heard or saw a fire truck.  Katie was also worried about Jack, he seemed very quiet and withdrawn, he was nervous and would startle easily. She would often find him playing alone and he had started sucking his thumb, something he hadn’t done for many years.  Jack’s Teacher said he was struggling to concentrate, and he was quiet with his friends.

Katie said she felt overwhelmed and nervous for much of the time herself and she knew that this would also be impacting the children.

The RFW Social Worker provided information on resources and services that could help, including Social stories to read with the children.  Katie asked if the review visit for Jack and Emily planned for May could be brought forward and the family travelled to Manly in February. Everybody enjoyed the change of scenery and being able to relax by the beach.  Jack saw his familiar care team: Psychiatrist, Paediatrician, Dietician, Occupational Therapist, and Social Worker. In between appointments he enjoyed fun activities at school and the recreation program. His favourite was playing dodgeball and boxing, Emily loved the crafts and getting messy with the shaving foam. A week of play therapy sessions were arranged for Emily and Jack funded by the RFW Bushfire fund. Because of the UNICEF Australia funding we could add an extra Psychology session with Dr Amanda Maxwell to support Katie with information about the impact of natural disaster trauma on children, and resources and ideas regarding how to best support them. For example, the importance of re-establishing and maintaining routines, opportunities for special time together and child led play, shared reading, emotion coaching and the vital importance of also taking care of herself.

Just as the family were slowly recovering from the fires the COVID-19 restrictions hit which brought more fear and uncertainty.

Home schooling has been hard for Jack he misses his Teacher and he needs his mum to supervise all his lessons. Jack hasn’t been able to see his Grandmother and he worries about her because she is not well.

The Bushfire Recovery Program will be visiting the local school to offer support to Jack’s Teachers and his friends when we are able to visit communities in term 4. In the meantime, the UNICEF Australia funding has meant that we can support Jack and his family remotely by telecare.

Katie says, “The community feels forgotten with COVID-19 and we can no longer access supports, the bush is sprouting again but the mental scars remain” 

In May the RFW Psychiatrist reviewed Jack by Telecare and recommended further Psychology support. The UNICEF Australia funding meant that this was possible. Dr Amanda Maxwell continued the support she had offered in Manly. Amanda and Katie were able to normalise some of Jack’s behaviours and emotional responses in the context of his earlier family history and alongside the recent bushfire trauma. They discussed ways to support Jack with regulating his emotions and reconnecting with Katie as his safe carer. Amanda also talked to Katie about the importance of stories, and children leading opportunities to retell experiences in any form (written, drawing, play). Adults can play an important role in supporting children to complete the story and end with messages of safety and hope.

In addition to direct therapy and support, the Bushfire Recovery project team helps families to access other resources they may need. For Jack we could refer him for ongoing Telecare Psychology sessions through the Connect for Kids Program. With both OT and Psychology support in place Katie is feeling more hopeful about Jack’s recovery.

RFW Occupational Therapist Emily explains how her Telecare sessions are making a difference for Jack:

“Due to a number of factors, including the recent bushfires, family disruptions and home relocations, Jack has experienced increased regulation difficulties. This has resulted in increased internalising of emotions, elevated stress levels and low overall confidence in abilities. Jack has been on a waitlist to access local Occupational Therapy (OT) services locally for over 12 months, however extensive waitlists have prevented Jack from accessing regular OT. Weekly 30-minute Telehealth OT services have been provided to support Jack’s self-regulation abilities. Sessions have been a combination of trialling body-based strategies such as heavy muscle work, deep pressure and respiration and checking in to understand the impact of these on Jack’s mind and body. Additionally, psychoeducation has been provided to Jack and carer during sessions surrounding the purpose of activities. Jack and OT will continue to develop a ‘tool box’ of tools that Jack can use independently to support regulation across a range of settings including home, school and community. Based on Jack’s response to activities within sessions to date, resources including therapy ball, weighted balls and a lycra tunnel have been provided to continue to support Jack’s therapeutic progress”.

Katie said that Jack loves the sessions with OT Emily, he often shows her his 3 pet cats, holding the camera to their faces!

The timing of the OT sessions is planned so that Jack can feel regulated and calm before he sees RFW Clinical Psychologist Alex for the “talk therapy” funded through the Connect for Kids Program. Alex is also the Psychology lead for the Bushfire Project and has found the UNICEF Australia funded training opportunities invaluable for developing her practice in this area:

“Thanks to the additional funding provided by UNICEF Australia, it has been possible for my client to participate in weekly OT sessions alongside his Psychology sessions, to provide him with concrete tools to help him regulate his emotions, and so that his body can feel calmer before we begin our talk therapy. I have been able to collaborate with his OT along the way so that our approach is well-integrated and optimised to support him. It was also possible for me to access additional professional development from Emerging Minds and Dr Louise Hayes (the DNA-v growth model for youth), both of which I have drawn on when planning my therapy work with this client – it is so important that we have the skills and knowledge to work with clients who have experienced trauma from natural disasters so that they can access the most appropriate interventions, and so that we feel confident in the work we are doing. Thanks to UNICEF Australia, it has been possible for the clinicians on our team to access this training so we can provide the best care for our clients. Although I am still in the early stages of my work with this client, I can already feel that this training has positively transformed the way I am approaching the sessions and I feel more confident in the work I am doing with him.”

 

*Names and image changed to protect the privacy of the family

 

Find out more about our Bushfire Recovery Program

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