Posted: March 21st, 2022

Cassell case study SOWK 321

Cassell case study SOWK 321

The original source for this case study comes from Cases for intervention planning: A source book (1993) by Molly R. Hamcock and Kenneth Miller. It has been revised for SOWK 321 use at Metropolitan State University by Dr. Monica Roth Day.

Agency: Children’s Hospital and Clinics, St. Paul, Minnesota

Referral date: March 1, 2021

Referral source: Pat R, nursing staff in the Diabetes and Endocrinology Clinic

Client: Joanne Cassell, age 13 (birthdate 2/28/2008)

1234 Tree Lane, St. Paul, Minnesota

218-111-9876 (home phone)

Family members:

Father: John Cassell, died in 2009

Mother: Jean Cassell, age 49, lives with the client, works as a driver with Amazon


Marvin, age 33, married and lives and works in Onamia, Minnesota

Lorraine, age 32, single, lives with the client and works as a cook in a local retirement home

Frances, age 29, single parent of Lucy (6-months old), lives with the client and works part-time at a local youth shelter

Presenting problem

Joanne requires dialysis three times a week. She was diagnosed as a Type I diabetic at age seven. Her mother states that at that time, the doctor told her Joanne had very little time to live, and that the family should make that time as easy and pleasant for her as possible.

Joanne needs dialysis because she is in kidney failure. It was brought on by her persistent non- compliance with the dietary and insulin regimen prescribed as necessary to control the diabetes. In the past year, she has begun to experience some very gradual vision loss caused by the non-compliance. Mrs. Cassell shared that she encouraged her to take her insulin by promising her rewards when she did. Joanne was inconsistent and the reward system diminished because of Joanne’s lack of follow-through.


Joanne sees this as her only problem as the family doesn’t have a consistent or reliable source of transportation and it is difficult to get to the hospital by bus for her dialysis. The family has one car which Lorraine and Frances use for work. It is old and needs significant repair.

The family lives about 3 miles from the hospital. While there is a bus line nearby the family’s home, it takes several transfers and over an hour to get to the hospital. After Joanne was discharged from the hospital and began dialysis, a neighbor drove Joanne and her mother to Children’s Hospital. The

Cassell case study SOWK 321

neighbor had been laid off from his job because of the pandemic. This transportation is no longer possible because the neighbor has been called back to work. On those few days when Joanne has tried to take the bus on her own, she has missed her transfers and arrives too late for her dialysis appointment.

For some patients where transportation is a problem, a system of continuous dialysis which occurs in the home is possible. This requires a sterile environment. For Joanne, it is not recommended because of her very low standard of personal hygiene.

Patient care issues

At home, Joanne is inconsistent and slovenly in her self-care and personal grooming. Joanne does not bathe regularly, sometimes going a week or more to take a bath. When Joanne agrees, her older sister and mother will help bathe her in the bathtub. There is no physical reason why she cannot bathe herself. Her sister and mother do not have the strength to insist that Joanne keep herself clean. They cannot handle Joanne’s tantrums and give up the struggle if she resists their suggestions.

When hospitalized, Joanne is a very difficult patient. She demands the nurses give her immediate attention for minor needs and becomes quickly frustrated if they do not respond. She cries and goes into tantrums when they try to help her take a shower or wash her face. She has shouted in the patient unit and the hospital lobby that no one cares about her and no one would care if she died.

Other background information

Mrs. Cassell is a woman who is currently on anxiety medication provided by her physician. Mr. Cassell died in 2009 of a massive heart attack. The Cassell family moved to St. Paul in June 2020 during the pandemic. Mrs. Cassell was laid off from her job in Mora (where the family used to live) after the pandemic shutdown and was hired on as a driver with Amazon. She works long hours and shares that she struggles balancing her work and family responsibilities. She feels responsible for all of her children.

Family income is moderate. Mrs. Cassell earns regular pay through Amazon and Lorraine’s earnings help the family. Frances receives child support for Lucy and works part-time at the youth shelter. The family received COVID relief payments which increased their resources for a short time, but that money has been spent. They are hoping for an additional COVID payment to help them catch up with rent.

Joanne is at risk of truancy. She was hospitalized for two weeks in December and was provided resources for virtual learning. She did not attend her classes and did not submit homework, but spent a great deal of time watching shows/movies. The St. Paul school district is now offering in-person classes, but the family has opted for Joanne to continue learning at home. During her hospital visit, Joanne shared that internet was unreliable in the home and she could not watch her favorite Netflix shows.

Mrs. Cassell stated that Joanne remains in her pajamas and hates to participate in classes. She will sit in front of the tv and insists that her meals be brought to her.

Joanne has no meaningful contact with the world. She states that she does not have friends and that the kids at school hate her. The only people she is in regular contact with are family members and medical professionals (at those times that she does come in for dialysis or when hospitalized).


Case Study of Cassell 321 SOWK

The original source for this case study is Molly R. Hamcock and Kenneth Miller’s Cases for Intervention Planning: A Source Book (1993). Dr. Monica Roth Day adapted it for SOWK 321 use at Metropolitan State University.

Children’s Hospital and Clinics in St. Paul, Minnesota, is the agency.

Date of referral: March 1, 2021

Pat R, a member of the Diabetes and Endocrinology Clinic’s nursing team, referred the patient.

Joanne Cassell (born 2/28/2008) is the client.

1234 Tree Lane, St. Paul, Minnesota

218-111-9876 (home phone)

Family members:

Father: John Cassell, died in 2009

Mother: Jean Cassell, age 49, lives with the client, works as a driver with Amazon


Marvin, age 33, married and lives and works in Onamia, Minnesota

Lorraine, age 32

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