Project: Healthy Generations
Organization: Children's National Medical Center
Washington, DC
Story submitted by Kathleen Soloway, Clinical Director of Generations Home Visitation Program of Children's National Medical Center.

Possibilities

Trevon’s pediatrician called me to ask how quickly we could enroll Renata, Trevon’s fifteen-year-old mother into the home visiting arm of our program. The pediatrician was concerned because Renata had said that she was feeding her two month old Carnation Instant Coffee Creamer instead of Formula. She said it was all they had in the house.

After helping Renata re-enroll in the WIC Program and determining that she was indeed interested in home visitation services we scheduled our first home visit.

During that visit I marveled at the many facets of this young woman; smart, funny, lost, wondering if anybody loved her. Her shining brown eyes and impish smile vied mightily with her dirty clothes and unkempt hair. She told me way too much the first time we met; all about her disappointment in her mother who couldn’t care for her because she was a drug addict, her obsessive adoration of her boyfriend who was hiding from the police, and her bitter fights with her grandmother, with whom she lived. I explained our program, which includes weekly home visits to offer support and parenting information, but mostly I just listened. Apparently this was a mistake.

Maybe I heard too much, and Renata felt too vulnerable or embarrassed, but in any case she would not reschedule with me for many months. I kept tabs on her through the pediatrician who saw both Trevon and Renata for their medical care. She was consistently concerned about Renata’s home life and possible risk of becoming pregnant again. I repeatedly called Renata and sent an occasional note, stopped in to see her when she was in clinic, but could not interest her in scheduling home visits.

About six months after our one and only visit I stopped in to talk with her sister who also receives medical care from our program. I asked how her family was doing and was met with a barrage of information and a request to help get Renata into Foster Care. I called Renata’s grandmother to ask if there was some way I could be helpful to the family. After several hour long telephone conversations with Ms. Washington she agreed to try a couple of family meetings and we scheduled for a time she thought Renata would be home. Renata was not home for the first visit or the second one. Her grandmother and I talked at length about her hopes for Renata and her frustrations with her granddaughter’s disrespectful behavior. I left Renata long notes emphasizing the positive pieces of our conversations. I was careful to say that we did not want to make any decisions without hearing her side of the story. With her grandmother’s permission, I contacted Renata’s case manager from her parenting group. She agreed to encourage Renata to join in the family meetings. Finally, Renata was home on my third attempt.

That first meeting was tough on all of us; lots of recriminations blame and pent up disappointment. Renata sat stiff and silent while her grandmother recited a litany of “shoulds”

“You should go to school every day”
“You should put a hat on that boy, its cold out there”
“You should be home when it’s dark outside, who knows what might happen to you outside on those streets.”
“You should… You should… You should…”

Watching Renata’s shoulders hunch tighter and tighter into a self-protective slump my stomach began to knot. I was not at all sure if I could transform this angry advice into an expression of love. I summoned the courage to interrupt and asked Ms. Washington about her hopes and dreams for her granddaughter.

Haltingly, in between bursts of advice she began to talk about her belief in Renata’s ability to go to college. She acknowledged Renata’s wish to be a good mother. Tears rolled down Renata’s cheeks, she straightened her shoulders and found her voice. I crossed my fingers when I proposed another session and breathed a sigh of relief when they agreed. At our next meeting Renata respectfully asked if she and I could meet alone. Her grandmother concurred and we began a series of meetings in which Renata began to explore her feelings about her family, her son, and her relationships. Often we were able to focus on our home-visiting curriculum. Almost as often we veered off the planned topic to discuss her more personal issues.

Over the summer Renata got a summer job which kept her very busy. She had originally planned to send her son, then 18 months old, to live with her Aunt for the summer. I was very concerned over the impact this long a separation could have on their relationship and used our session on “Attachment” to provide Renata with some information about this phenomenon. Using these ideas she revised her plan, to include keeping her son on the weekends. She came up with the idea of giving Trevon her school ID so that he could wear her picture around his neck while they were apart.

Renata has started off the school year in style. I saw her on the first day of school when she came in to get her depo shot. She was wearing a hot pink tee shirt and new pink converse sneakers. Her hair was done in beautiful braids, which she told me, had been done by her sister. She was proud of herself for being responsible about her birth control and for starting school again. She looks like a young woman who has decided to take action in her life and she is excited about the possibilities.

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