Textbook Case Studies

A Homeless Family

Crystal is a 16-year-old girl with a 3-month-old baby boy. She has been referred for community health nursing services by her teacher at a special program for adolescents with children. In this program, the girls attend school while childcare services are provided for the children. During the day, the girls participate in the care of their infants and learn about childcare as well as the usual high school subject material. Crystal has been referred because she has not been coming to school and her teacher is concerned. The school does not have a home address or phone number for Crystal, but the teacher gives you the phone number of Crystal’s grandmother. After several attempts, you finally contact the grandmother, who agrees to give Crystal a message to get in touch with you. The grandmother says that Crystal does not live with her and that she sees her only occasionally.

The following week you receive a call from Crystal. She is reluctant to give you an address but agrees to come to the health department with the baby. When she arrives, she tells you that she has not been going to school because the baby was ill and cannot return to the childcare center without a doctor’s note that the baby is well. Crystal says she cannot afford to see a doctor. She has no health insurance and no money for health care. She began the application process for Medicaid but never followed through because it was “too much hassle.” She lives with her mother and stepfather in a camper shell at a construction site where her stepfather is temporarily employed. She refuses to give you the location of this construction site, saying that they will probably move to a new site soon. Crystal says her parents provide her with food and formula for the baby, who appears clean and well nourished. The baby has not begun his immunizations, again because of lack of funds for health services.

Crystal says she is in good health but has not had a postpartum checkup. Although not currently sexually active, she has a steady boyfriend and is contemplating sexual intimacy with him. She asks about various types of contraceptives.

The father of her baby is no longer in the area and is not aware that Crystal had a baby. Crystal’s own father is also removed from the picture and Crystal does not know where he is. When asked about her grandmother, Crystal says that they do not get along well and that her grandmother hardly speaks to her since she got pregnant.

Crystal is anxious to complete high school and enroll in a program to become a beautician. She tried recently to get a parttime job in a fast-food restaurant, but was told they wanted someone with experience. She socializes somewhat with the girls at school and goes with several of them to take their babies to the park and similar outings.