Early Intervention Strategies for Success

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  • A Bug Infestation in the Home…What Do You Do?(current)

Scenario #1: Each time you visit with Mehki’s family, you notice cockroaches crawling around the floor and on the walls. You’ve had to swat them off of Mehki and awayCockroach from yourself many times and are becoming increasing concerned. Mehki’s mother says that there’s nothing they can do about the bugs because the neighbor has roaches too and won’t treat his apartment. Besides, she says, they’ve learned to live with it. Working in the home with the roaches, however, makes you very uncomfortable. What do you do?

Scenario #2: Sofia’s mother tells you that she thinks the family has bed bugs because they have itchy welts all over them. She found a bug in her daughter’s bedding and shows it to you. You do some research and find out that it does appear to be a bed bug. You’re nervous about continuing to visit the home because bed bugs spread so easily and you don’t want to bring them back to the office or your own home. Sofia’s mother asks for help with treating the problem but is unsure if they have the money to have the home professionally treated. What do you do?

A Challenging and Sensitive Issue

Providing EI in the midst of a bug infestation is challenging, even for the most experienced service provider. It is typically complicated by concerns for the child and family as well as for oneself. It can be a sensitive issue to address and a difficult one to solve. Some families, like Mehki’s, will have learned to live with the situation and might not want help treating it. Others, like Sofia’s mother,  might be more eager for help but need support to manage the problem. Still others might be actively treating the problem themselves. Whenever a family is in this situation, we have a requirement to continue to provide services so must think creatively about how we work together. Here are a few thoughts about how to approach the two scenarios above:

  • Talk with your supervisor and document your concerns.
  • Talk with family, expressing your observations and concerns in a sensitive, nonjudgmental manner. If you have specific concerns related to the child’s health, share those. For instance, if a child has a history of breathing problems, sharing information about the detrimental link between cockroach dander and asthma might be beneficial.
  • Ask the parent if he or she would like assistance with the infestation.

If YES: Have a conversation about what the parent has tried to do to deal with the infestation and what she thinks needs to happen. (Try using your coaching skills to gather information.) If you are the service provider, enlist the assistance of the family’s service coordinator if additional resources are needed to help the family treat the problem.

If NO: The service coordinator can also be a great help here too. He or she can talk with the family separately about the problem and offer assistance and more information. This can be helpful if a family is embarrassed or uncomfortable talking about the problem with the provider whom they see more frequently. (The opposite can also be true.) If the family does not want assistance, and the infestation is severe enough to be a health hazard to the child, it is possible that a referral to child protective services could be warranted. Not every infestation requires a CPS referral so share your concerns with your supervisor if you are in doubt.

In EITHER case: There’s still the issue of the service provider’s comfort with working in the home. Since we cannot refuse to provide a service because of a bug infestation, and we also cannot require a family to relocate services, we really have to work collaboratively with them to solve this problem. Perhaps services can occur at a relative’s home or another community location where the family spends time until the infestation is under control. Maybe the provider can explore other activities the family would like to do with the child or places they would like to go. These locations would be determined together rather than solely by the provider or program. Exploring multiple settings and activities the family does or would like to do is good practice anyway, and might be really helpful in a challenging situation such as this.

How would you handle either of these scenarios? What have you done when you’ve worked with families who have had similar issues in their homes?

If you are local system manager or supervisor, how do you support your staff when they are uncomfortable visiting homes where there are bug infestations?

9 comments on “A Bug Infestation in the Home…What Do You Do?

  • Janet Hammond says:

    Thank you for addressing one of our challenges in working with some of our more marginalized families. Some of the things we see are really tough. I have done some trainings on “challenging families” and only heard my easier families described. We see all kinds of things and need to know what response will help this family and which would only further marginalize them.

    • Yes, I agree, the most appropriate response to these situations really can’t be prescribed across families. It needs to be very individualized to the family’s needs and situation, just like all of early intervention. It IS a very real and challenging topic and needs to be dealt with in a compassionate manner that won’t offend the family. Since an infestation problem can happen with families at any end of the SES spectrum, different supports might be needed but sensitivity is always required. Thanks for joining the conversation Janet!

  • Cori Hill says:

    Well, I have to confess that I felt a bit itchy after reading this one! I think the tips, suggestions, and strategies are “spot on!” I do think the critical part is how to manage these situations respectfully. I’ve never met a family yet who wanted a pest infestation!

  • Leigh Anne Ross, RN says:

    I tried to help a family once and it kind of backfired. An apartment complex was infested with roaches and the family asked for help. They had complained to management repeatedly, but were told spraying was too expensive. The family was trying bug bombs, but of course treating only one apartment doesn’t do any good. The family was tired of wasting money. With their permission, I offered to look into it. I explained the situation to a friend of mine who works for the city, and he said not to worry that he would speak to management about it. I was feeling very proud of myself until my next visit. The family let me in the door and as I closed it I noticed a big sign on the back of the door announcing a $25.00 per month fee to cover exterminator costs. You can imagine how badly I felt. Long story short, we had to get the Health Department involved and eventually the complex management was held responsible for spraying. Luckily, the family understood that I was only trying to help and they knew that I certainly didn’t mean to cause additional financial hardship. Sometimes taking the bull by the horns doesn’t give us the end result we are hoping for. Another reason that coaching is the way to go!!

    • Hi Leigh Anne! Wow, this is a powerful story. I agree, sometimes it’s hard to tell how a situation will work out until you are in the midst of it. I’m glad you were able to work with the family and the Health Dept to resolve the infestation, to the benefit of the family and probably the other apartment residents as well! Since you mention it, if you think back, how might you have handled the situation differently if you were using coaching?

      • Leigh Anne Ross, RN says:

        I think I would have tried to get more information about what the family had already tried other than buying their own bug bombs. I would have tried to find out more details about how their previous encounters with management had been. Based on the new information, I could have explored whether or not any of their neighbors were concerned and encouraged the family to approach the management as a group. Perhaps a role play would have helped the family feel more confident complaining again. I definitely should have let the family have more control in the situation. I am open to suggestions…..

  • Janet says:

    I just got in from a training with CPS. This infestation topic came up. CPS claimed that this topic falls under our mandated responsibility to file a complaint with CPS.

    • That’s really interesting, Janet. I’ve also worked with CPS workers that said that “it depends” on whether the infestation is truly a safety or health hazard (or is just a bug problem that can be managed). As with any situation where the provider is concerned about possible neglect, calling CPS and talking with them about the situation can be very helpful in determining whether or not a report is warranted.


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