The Smith Family

Amanda has been the health visitor for the family for a number of years. Her contact with the Smith family started in the months before Ryan, now aged 9 was born.  Once Ryan started school, Amanda’s professional contact with the family came to an end.  Amanda, then, had no direct contact with the family until just over 3 years ago, when Dawn was pregnant with Tonia, at which point Amanda once again became the family’s health visitor. 

Amanda is concerned that things are not going as well for the family as they were when she first became involved with them. 

Her main concerns are the health and wellbeing needs of Tonia, aged 3. Tonia is small for her age, lacks confidence, becomes extremely upset when separated from her mother, and is developmentally behind for her age.  She usually has a dummy in when Amanda visits.

Because of Tonia’s separation anxiety, Dawn sometimes decides not to take Tonia to Nursery, finding the daily tears and crying at the nursery door difficult to cope with.  On days when Dawn is working, though, she feels she HAS to take Tonia to nursery, as her husband, Tom, seems incapable of taking ‘proper’ care of Tonia.

Tom has suggested many times that he can manage ‘just fine’, and it is a bone of contention between them that Dawn appears to think otherwise.  This can sometimes lead to heated exchanges as Dawn is leaving to go to the nursery with Tonia.

Tonia also wears glasses, and has delayed speech.  Amanda has referred Tonia to SALT (Speech and Language Therapy), and sessions have been scheduled to begin working on her speech in the next few weeks.

She is also working with Dawn to try to alleviate her fears about Tom’s ‘inability’ to care for Tonia.  Amanda is concerned that Dawn is being unreasonable, as there appears to be no reason for her thinking Tom cannot cope.  Amanda’s main concern is that this is impacting Tom and Tonia’s relationship, and that this may be a factor in Tonia’s separation anxiety.

Amanda, though, is also concerned about the lack of money coming into the family, and has discussed this with Tom and Dawn, as she suspects that they may not be in receipt of their full entitlement of benefits.  She has suggested they allow her to refer them to the Welfare benefits Advisor to ascertain what may be available to help them out financially. 

She recognises that Tom would like to go to college to retrain, and that he is worried about money.  Amanda is hopeful that sorting out their benefits might put his mind at ease, however Amanda suspects that there is more to Tom’s reluctance to enrol in college, and has concerns about Tom’s self confidence and self esteem. 

Amanda also has concerns about Tom’s parents, in particular his father, Joe.  Joe is a heavy smoker and drinker, and, frequently, he and his wife Anna come to visit, and help themselves to food.  Amanda’s concerns are that, with Tom and Dawn already struggling financially, they can’t afford to feed their children properly if the contents of their kitchen cupboards are repeatedly under attack !

Amanda is also concerned that Joe visits when under the influence of drink, and that the children are subjected to passive smoking as Joe is rarely seen without a lit cigarette.  As a health visitor, these potential health risks cannot be ignored, however Amanda has not yet raised this issue with Tom and Dawn and she is aware that there are already tensions within the family around these issues.  To raise the issue at this time may just exacerbate those tensions, potentially even damaging the good working relationship Amanda has with the family.  She is, though, exploring a number of options, and, when the time is right, she will broach the issue.