Last weeks ‘Case-of-the-Week’ brought up many issues related to the interface between mental health and child protective services. This weeks case illustrates what is at stake when mental health and child welfare services are not integrated in a trauma-informed way. We present a true and tragic case of a girl who almost died related to child abuse and whose care provoked a Governor’s commission to examine mental health and child welfare services in Massachusetts.
Disseminating TST December 4, 2009
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The development of effective treatments is only a first step (albeit an important one) in ultimately helping children and their families in the ‘real world’. Another step that is equally important is to disseminate the treatments to providers and provider organizations. Part of this process is to communicate to potential constituents the value that the treatments can deliver. One important venue for such communication is at a conference.
Accordingly, TST had a significant presence at this year’s annual meeting of the International Society for Traumatic Stress Studies (ISTSS) held in Atlanta, GA in November 2009. As stated on its website, ISTSS is “an international multidisciplinary, professional membership organization that promotes advancement and exchange of knowledge about severe stress and trauma. This knowledge includes understanding the scope and consequences of traumatic exposure, preventing traumatic events and ameliorating their consequences, and advocating for the field of traumatic stress.”
Coincidentally, the meeting occurred simultaneous with the shooting at Ft. Hood TX. This tragic event is unfortunately a stark reminder that trauma exposure in the form of interpersonal violence still exists today and that the work we conduct on a daily basis is so essential for our society.
In addition to the regular meeting, Pre-Meeting Institutes were held the day prior. Two in particular included several presentations by members of our ‘TST Family’. The first Institute, ‘Building Effective, Self Sustaining Programs for Traumatized Children and Families’, highlighted an innovative program of the Latin American Health Institute (LHI) for unaccompanied minors. An unaccompanied minor is a child “who has no lawful immigration status in the United States; has not attained 18 years of age, and with respect to whom; 1) there is no parent or legal guardian in the United States; or 2) no parent of legal guardian in the United States is available to provide care and physical custody” (Office of Refugee Resettlement, U.S. Department of Health and Human Services). The services provided are trauma-informed and melds TST with Project Joy – a model whereby playfulness in the staff and the children they serve is the highest priority and an end in itself; that is, playful engagement is essential in building therapeutic relationships and can serve as a powerful antidote to trauma. During Project Joy’s exuberant physical play activities, staff and children safely connect, problem-solve, practice effective action, and discover innate capacities for joy and creativity – factors that promote positive outcomes in the face of adversity and that foster the inherent abilities to heal. Dr. José Hidalgo of LHI (Massachusetts) is its Project Director and who chaired the Institute. Other presenters included Steven Gross, MSW from Project Joy (Massachusetts) as well as Drs. Heidi Ellis and Glenn Saxe from Children’s Hospital Boston (Massachusetts).
The second Institute, ‘The Importance of Organizational-Level Factors in the Delivery of Trauma-Informed Interventions’, expounded on TST’s utility as an organizational model of service delivery over and above its function as a clinical model of trauma-focused treatment. Specifically, the various presentations focused on several organizational factors that have been identified by the services and intervention research field as key constructs for effectiveness, including an organization’s mission, structure, culture, work attitudes, and climate as well as the notion of an interorganizational domain (i.e., organizations in a given geographical location that are engaged with a particular societal problem or set of problems – in this case, children exposed to trauma and their families). Members of our ‘TST Family’ who gave presentations represented an array of organizations (i.e., academic health center, county mental health department, residential facility, school-based agency) and discussed how unique aspects of their organizations influenced (positively and negatively) the adoption, implementation, maintenance, and ultimate long-term sustainability of a TST program. The presenters included Dr. Adam Brown from The Children’s Village (New York); Dr. Bob Kilkenny from Alliance for Inclusion and Prevention (Massachusetts); Susan Hansen, LCSW-R, RPT-S from Ulster County Mental Health Department (New York); and Drs. Heidi Ellis, Glenn Saxe, and Carryl Navalta from Children’s Hospital Boston (Massachusetts). The take-home message of the Institute was that any trauma-informed intervention is effective only if the intersection of the treatment itself and the organization that provides the treatment is successfully navigated (go to ‘MY SHARED…box’ on the right-hand column of this webpage to upload the presenters’ PowerPoint slides).
TST Updates October 13, 2009
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We haven’t posted a ‘case-of-the-week’ or other information here in awhile. The summer’s over and its time to get back to work! It has been a busy few months for TST programs. Highlights have included:
1. The TST Development Team, with input from many others, has completed revisions of our Evaluation and Training packages. I’m very happy with the improvements that have been made and I think it will make our program more accessible and effective.
2. Earlier this month we conducted a large training for programs in Boston who are integrating Trauma Systems Therapy into the services provided by their agencies. Organizations represented included Martha Elliott Health Center, the Alliance for Inclusion and Prevention, the Latin American Health Institute, the Frederick Middle School, Children’s Hospital Neighborhood Partnership, Family Services of Greater Boston, Shriners Burns Hospitals, and special outside guest Sharon Hirsch from University of Chicago Comer Hospital. Its great to see so many programs inside (and outside) Boston using TST.
3. A couple of weeks ago we conducted a large training for our newest TST project centered at Hillside Family of Services in Rochester, NY. This exciting program integrates mental health and child welfare services in two counties, Monroe and Yates, around Rochester. Maria Cristalli the leader of this program has done a terrific job assembling two TST teams with key strategic partners in the county. Their organizational plan and Balanced Scorecard evaluation approach could be a model for other programs. This program also has a key partnership with University of Buffalo who will lead a randomized clinical trial on TST.
4. Programs that included Trauma Systems Therapy did quite well in the recent round of SAMHSA/National Child Traumatic Stress Network funding. Importantly, two new Category II Treatment and Service Adaptation Centers featured TST. These respective awards went to two longstanding TST trainers, researchers, and program leaders. Liza Suarez from the Institute for Juvenile Research at the University of Illinois at Chicago, and the leader of the TST Adaptation for substance Abuse, won a grant to develop and implement interventions, including TST for the complex needs of inner city children. Bob Abramovitz at Hunter College School of Social Work and colleague Ginny Strand at Fordham University School of Social Service won the grant to develop The National Center for Social Work Trauma Education and Workforce Development. Bob established the TST Foster Care Service Project (FCSP) in New York City and is taking the lead with former colleague Mary Dino from the Jewish Board of Family and Children’s Services to develop the adaptation of TST for child welfare/foster care. Mary, as most people know now leads the FCSP.
5. Please see our new featured TST program called Project Nexis from Ulster County, New York. This incredibly innovative program lead by Susan Hansen of the Ulster County Department of Mental Health is the first and longest standing TST dissemination program. The Nexis program is unique in mental health/child welfare collaborations as its core is the twinning of a mental health clinician and a child welfare worker to provide care to children who receive prevention services in their county DSS office. Project Nexis has been in business for over five years and has really changed the culture of mental health/child welfare collaboration in their county.
I guess a lot has happened since we last posted…
Case-of-the-Week:Survival-in-the-Moment August 18, 2009
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Last weeks case involved the tragic and true story about a girl who almost died related to child abuse and neglect. The case illustrated the problems that occur when the assessment process is not integrated across the services system and , as a number of commentators noted, when the TST Principle “Align with Reality” is not vigorously adhered to.
This weeks case illustrates a number of important principles in the assessment process, particularly how we gather data around “Survival-in-the-Moment” states. Please think about the case of Nelson. What pieces of information are most important in the assessment process? How may this information guide his care? What are the likely consequences for Nelson and his family if these critical facts are missed?
This case takes place in a residential treatment setting. I am particularly interested in comments from people who work in structured settings (residential programs, inpatient units, schools, shelters). I’m of course interested in any comment, question, or argument. The more responses the better for our building of this TST Virtual Community.
Nelson
You are working with Nelson, an 11 year old boy admitted to the Residential program where you work. Nelson has a history of physical and sexual abuse from his babysitter for about one year, beginning when he was 7 years old. The abuse stopped after his mother came home early and heard the abuse occurring in Nelson’s bedroom. Criminal charges were pressed. The babysitter was recently sent to prison after a trial that involved Nelson’s testimony. Over the last year, Nelson’s behavior has been increasingly out of control. He has physically assaulted classmates and his 7 year old sister. A neighbor’s pet cat was found dead in the woods near Nelson’s home and his mother presumes that Nelson killed the animal. Nelson vehemently denies harming the cat. Nelson’s mother has reported decreasing ability to control Nelson’s behavior. He has been suspended for more than 15 days this school year because of his agitated and aggressive behavior in class. He will fail the sixth grade this year as he has not completed assigned work. Nelson has always been described as a very bright child. Nelson has been receiving weekly psychotherapy in the last year for ‘anger and aggression’. He has also been treated for Attention Deficit Hyperactivity Disorder with Ritalin. His mother does not believe the therapy or the medications have helped.
Over the past two weeks in the residential program, Nelson has not settled in well. He continues to appear agitated and angry in the milieu, repeating that he does not belong “in this prison’. At times he can be quite engagable. He is clearly very verbal, smart, and imaginative. He loves chess and basketball and is talented at both. He is a fierce competitor. You have had two or three sessions with Nelson where you really enjoyed his talent and charm and imagined a great future for him.
Nelson has had four or five episodes of extreme aggression since his admission. During one of these episodes he struck a male staff member in the head with a chair. The staff member developed a concussion from this assault. Nelson threw a lamp at another staff member a few days ago that barely missed his head. These episodes appear ‘out of the blue’. They don’t seem to have any precipitants. When asked, staff members report that the episodes may follow times where “He doesn’t get what he wants”. One staff member reported at a team meeting “You can’t set a limit on this kid, he has to have his way all the time or else he loses it”. He is perceived by most staff members as angry, entitled, unpredictable, and very hostile.
Nelson lives with his mother and his seven year old sister. His father has been in prison for the last four years for armed robbery. Nelson was very close to his father and was extremely upset when he was imprisoned. His mother reported that he hardly talked for a month after his father “was taken away”. Whenever you ask Nelson about his father, he says that he does not ‘want to talk about it’.
What do you do?
Case-of-the-Week August 10, 2009
Posted by glsaxe in Uncategorized.3 comments
How Trauma-informed Care Can Save Lives
The police officers had seen it all, but never anything like this.
Who did you feel safe with?
Haleigh pointed to a series of letters: M-O-M
The detectives pressed on. Could she have meant her biological mom?
Haleigh pointed to five letters on her board: H-O-L-L-I
The answer was unexpected, but that, perhaps, should have come as no surprise. The case of Haleigh Poutre has involved one stunning turn after another.
A Globe examination of hundreds of pages of medical, social service, and court documents – many never before made public – as well as interviews with dozens of relatives, friends, investigators, and child abuse specialists, suggest that authorities failed repeatedly to understand the heartbreaking complexity of Haleigh’s life. Time and again, they relied on assumptions about her that now seem dangerously wrong. What they didn’t see would almost kill her.
Throughout Haleigh’s childhood, doctors and social workers often treated unproven assumptions as accepted facts: Haleigh was a sex abuse victim. Haleigh had a self-destructive response to the sexual abuse, a kind of “post-traumatic stress disorder.” Haleigh somehow gave herself every one of the bruises and cuts on her body that clinicians meticulously documented over the years.
And repeatedly, those who examined her assumed Haleigh was telling the truth when she said that Holli Strickland was a kind woman, truly the devoted adoptive mother and loving day-care operator that she seemed to be.
These days, Haleigh remains in the Brighton rehabilitation center, probably unaware of the swirl of legal activity that is focused on her diminished life. A criminal trial is set to begin this fall in Springfield. A medical malpractice case is proceeding in Boston, where a civil rights case filed by Haleigh’s biological mother, accusing the state of wrongfully removing the girl from her home, is also pending. And lawmakers on Beacon Hill are considering a bill revamping end-of-life decisions for children in state custody.
But beyond all the public action there is this: The private, haunting story of a young girl, Haleigh, and her aunt, Holli, a relationship that began in love and ended in mystery, with one of them dead and the other nearly so. Theirs was an intimate, complicated bond that no doctor, no social worker, no investigator has ever come close to understanding.
***
Haleigh and her Aunt Holli came from a large family in Western Massachusetts dominated by Holli’s warm but tough grandmother, Constance Young. Family and friends remember one especially notable thing about Young: She kept a gun in her bedroom.
She was known to discipline through a stern look or a sharp tone, not a slap. She valued family loyalty and education. An avid reader who grew up poor, she desperately wanted the next generation to achieve middle-class respectability.
When Young’s teenage daughter, Sandra, gave birth on May 28, 1972, to a girl named Holli, Young worried. She didn’t approve of the baby’s father and was convinced Sandra wasn’t up to caring for a newborn. The strong-willed grandmother declared that she would raise baby Holli – and eventually she adopted her.
Holli fulfilled many of her grandmother’s goals. Growing up in Agawam, she received good grades and was the first in the extended family to go to college. In the autumn of 1990, 18-year-old Holli Young went off to Bay Path College in Longmeadow, where she earned a two-year degree in early childhood education.
In her college yearbook, she wrote, “Gram, I hope to always make you proud. . . . Watch out world here I come!”
All the while, Holli was worshiped by a younger half sister, Allison, a second daughter of Sandra’s. On Feb. 24, 1994, Allison, 17, gave birth to a baby girl, Haleigh, a name derived from an acronym of Holli’s full name – Holli Anne Laurin Young – H-A-L-Y.
“I idolized her,” said Allison Avrett, Holli’s only sibling, in recalling their childhood relationship. “My sister was always there for me.”
And Holli was always there for her niece, Haleigh, as well, often taking her on shopping excursions and for weekend sleepovers.
In the summer of 1998, Holli’s already exalted role in her extended family grew when she agreed to care temporarily for Haleigh, then 4.
Allison, 22 and single, had joined her boyfriend, Jason Valles, on an extended visit to Virginia. Allison had brought Haleigh along, but word got back to her relatives that Allison had gotten involved with drugs and alcohol, and that Haleigh’s care was suffering because of it.
When some relatives drove down to Virginia to bring Haleigh back, they found a little girl looking disheveled – and too thin. Back in Massachusetts, Haleigh jumped into the arms of her adored Aunt Holli.
Holli was now married to Jonathan Poutre, a factory worker, with whom she had a 2-year-old girl. When Haleigh joined them, they all lived in Constance Young’s mobile home in West Springfield. It was a snug arrangement, said one relative, but they liked being a family that “always watched out for each other.”
Shortly after Haleigh moved in, Holli allegedly overheard her make a strange comment while taking a bath with Holli’s 2-year-old daughter.
“Can I be your special girl, I’ll lie on the bed,” Haleigh said, according to a medical record.
Based at least partly on this comment, Holli became convinced that Haleigh had been sexually abused by Allison’s boyfriend in Virginia. Holli contacted the Massachusetts Department of Social Services, which subsequently contacted Virginia’s child protection agency.
Spokesmen from both agencies declined to discuss the investigation, but officials and relatives familiar with the probe said there was no conclusive evidence of a sexual assault.
Valles, who currently lives in Holyoke, denied that he ever sexually abused Haleigh. He said Massachusetts authorities never questioned him, and Virginia officials, after investigating him, dropped the case and never criminally charged him.
“They didn’t find anything,” he said. “There was nothing to find.”
Still, social workers recommended that Holli assume temporary physical custody of Haleigh, apparently convinced that Allison had seriously neglected her daughter. DSS initially kept open the possibility of reuniting Haleigh with Allison, who has said she was trying to turn around her life.
However, about a year later, for reasons that DSS has not fully disclosed, the agency gave up on plans to return Haleigh to Allison. It recommended that the child be adopted by her aunt.
***
As the country awaited the new millennium in December of 1999, Holli was looking ahead to a series of exciting and stressful changes in her life.
She was close to achieving her dream of suburban stability. Six months earlier, she and her husband had bought a modest Cape on a quiet cul-de-sac in Westfield for $121,000, with financial help from her grandmother. She opened up a family day-care center, which quickly became popular with local families. In her state license application, Holli specified to her discipline methods.
“Time out only if behavior doesn’t change after many warnings,” she wrote. “The minutes of a time out will coincide with the child’s age. Ex . . . a 3 yr old in time-out sits for 3 minutes.”
To help with her busy day-care center, Holli hired a teenager who lived next door to work as an aide. Alicia Weiss soon began spending off-duty hours at Holli’s house as well. Weiss seemingly “lived there,” said one neighbor.
Holli needed extra help. Around the time the family moved to Westfield, Haleigh began exhibiting some behavioral problems, such as banging her head and faking seizure-like spasms for no apparent reason, records show. Holli began taking Haleigh to see therapists, who attributed the girl’s behavior to a history of sexual abuse and neglect.
To care for Haleigh, Holli received roughly $500 a month from DSS. The girl was considered a “special needs” child because of her psychological issues, and her caretaker qualified for a state stipend.
Holli kept her two girls busy, enrolling them in dance classes and sports programs. She often dressed them alike. Neighbors admired Holli as diligent and disarmingly honest, openly telling them about her struggles raising Haleigh and difficulties in her marriage.
“She came across as absolutely authentic,” said Mitchell Salnick, who sent his three daughters to Holli’s day care for more than a year.
Holli’s marriage to Poutre finally fell apart. In bitter divorce proceedings, she accused him of having an explosive temper and being physically abusive to her and the two girls. DSS investigated these allegations, which Poutre has denied to authorities. (Poutre declined to be interviewed by the Globe.)
Soon after Poutre moved out, Holli began dating Jason Strickland, a quiet, hard-working auto mechanic from North Carolina, and within months, he moved into her Westfield home. On Sept. 28, 2001, before a gathering of relatives, day-care parents, and friends in their backyard, the couple were married.
***
Just as Holli Strickland’s life had a new promising beginning, Haleigh’s mood dimmed.
Starting in late 2002, when Haleigh was 8, she began missing school for days at a time. She was seen more frequently by local doctors and nurses for burns, bruises, and cuts. Haleigh was treated in psychiatric hospitals at least three times in 2003 and 2004. According to hospital records, doctors concluded that her wounds were self-inflicted, that she hurt herself because of “post-traumatic stress disorder” brought on by past sexual abuse.
Haleigh’s troubling behavior included mutilating her lower lip, self-induced vomiting, and defecating on the floor, records show. She allegedly threw herself down stairwells in her home, which notes in her files describe as “stair surfing” stunts.
Haleigh sometimes suggested to doctors that she misbehaved to get more attention from Holli, who by the summer of 2002 was pregnant. She also often made oblique references to earlier troubles.
“I was having problems at home,” she said, according to a medical document from Providence Behavioral Health Hospital in Holyoke. “I was not behaving. I was mad because of what happened in the past.”
A doctor’s summary of Haleigh’s two-week stay at MetroWest Medical Center in Natick reads: “The patient herself was eventually able to say that her self-injurious behaviors seemed to be most closely associated to what she calls flashbacks.”
One psychiatrist described Haleigh as an 8-year-old girl who was tearful and holding a “teddy bear in her arms” with “a scab of clotted blood on her nose.”
During Haleigh’s hospital stays, which totaled more than 30 days, doctors had ample opportunity to question the young girl alone about possible abuse. Written summaries of her hospitalizations make no mention of that sort of questioning.
So convinced were psychiatrists that Haleigh was hurting herself that they recommended that she receive a genetic test for Smith-Magenis syndrome, a developmental disorder that occasionally manifests through self-harming behaviors. One hospital record said the results were negative, though a DSS record suggested the test was never done. Meanwhile, doctors put Haleigh on several drugs to try to curb her aggressive behaviors.
Several people in Westfield told the Globe they saw Haleigh hurt herself.
“She just sort of jumped, head first, down the steps,” said Stephanie Adams, a former day-care parent. “Then she got up and it was as if it was a normal thing.”
One close relative described watching Haleigh jab the inside of her mouth with eating utensils. Several neighbors said they observed Haleigh continually picking at a scab on her nose over many months, to the point that her nose looked deformed.
***
As new wounds appeared on Haleigh’s body, many neighbors, parents, and teachers in Westfield continued to see Strickland as a compassionate caretaker of a troubled child. But others quietly speculated that the adoptive mother and her husband might actually be responsible for Haleigh’s injuries.
Starting in September 2002, the Department of Social Services received more than a dozen anonymous complaints about Haleigh’s bruises and unkempt appearance. One former day-care parent said she called DSS several times. This parent suspected Jason Strickland was a bad influence because Haleigh’s life “changed after he became more active in the picture.”
But DSS found no basis to accuse Holli or Jason of abuse, apparently relying heavily on doctors’ and Holli’s statements, as well as on Haleigh’s own accounts of hurting herself or getting into accidents.
Yet Haleigh had numerous suspicious injuries, according to medical records and interviews with child abuse specialists. Among them were severe bruises in the middle of her back and cuts between her shoulder blades, atypical locations for self-injury.
She also suffered first-degree burns on her legs, allegedly from scalding bath water, which is a rare self-harming scenario, Dr. Eli Newberger, a Boston child abuse specialist, said in his report in a malpractice case filed against some of Haleigh’s medical providers. The suit, filed by a court-appointed lawyer for Haleigh, alleges that the providers should have suspected abuse.
The explanations for some of the injuries were inconsistent. In April 2004, Haleigh’s pediatrician saw her for a swollen eye, an injury Strickland said was from an errant softball. But Haleigh said she hit herself.
DSS social workers, who began having suspicions, occasionally questioned Haleigh alone. She would blame herself for her wounds and once wept about the prospect of being removed from her home. She allegedly told clinicians she wrote about some of her behaviors in a “worry journal” that she kept in her bedroom.
When a social worker in May 2005 asked 11-year-old Haleigh how she was punished if she did “something really wrong,” Haleigh stated “she is sent to her room or can’t watch TV.” She denied ever being “spanked or hit” and expressed only fondness for her adoptive mother.
Haleigh’s younger sister, who shared a room with Haleigh, also told investigators that neither Holli nor Jason ever struck her or Haleigh.
DSS was unable to find medical clinicians who would back up the idea that Haleigh was being abused.
Instead Haleigh’s medical providers, as well as many in the Westfield community, consistently portrayed Holli as a loving mother, doing her best for a child who increasingly showed up with chipped teeth, swollen eyes, and split lips.
Suzanne Malloy, a Westfield nurse practitioner who had begun to examine Haleigh nearly weekly for “body checks” based on a DSS recommendation, described Haleigh as a mentally ill attention-seeker who is “very talented in getting into situations” where she hurts herself, according to a DSS record.
Carol Field, a social worker at the Carson Center for Human Services in Westfield, said that Haleigh is “one of the most disturbed children she has ever dealt with” and that Holli has “done a remarkable job with the child.”
Haleigh’s two other regular clinicians, Dr. Rukmini Kenia, a pediatrician, and Dr. Frank Gatti, a child psychiatrist, also viewed Holli as a caring mother. (Through their attorneys, Malloy, Field, Kenia, and Gatti have declined comment. All four are named in the malpractice suit.)
Meanwhile, some neighbors began noticing that Holli gave Haleigh’s younger sister more dance lessons and privileges than Haleigh. One neighbor described Haleigh, often busy with chores, as the “Cinderella,” and the younger sister as the “princess.”
Theories arose about what was happening in Haleigh’s home. Some neighbors speculated that Strickland had Munchausen Syndrome by Proxy, a psychological disorder in which a caretaker creates injuries or illnesses in children to get attention from doctors. The younger daughter never seemed injured, leading some to speculate that Strickland had hostility toward Haleigh – perhaps based on deep-rooted resentments over having to take in her niece and lingering anger that she, too, was not raised by her biological mother.
As the summer of 2005 was ending, Strickland appeared overwhelmed. She had closed her day care. She had a new baby boy. Bills were piling up, creditors were demanding payment, and she borrowed $75,000against her house.
As all of this was unfolding, DSS recommended that Haleigh live for 90 days at a residential facility for troubled children, saying this would keep the girl safe from injury. But some of Haleigh’s medical clinicians opposed the move, saying Haleigh had recently shown improvement.
“Her parents continue to do a good job with her, given Haleigh’s mental illness,” wrote nurse practitioner Malloy in a letter to DSS on Aug. 31, 2005.
Haleigh insisted she did not want to leave Holli’s side. And Holli, after some wavering, ultimately said she wanted Haleigh to stay at home, telling a relative she was committed to her grandmother’s vision of family unity.
***
On Sept. 10, 2005, the weekend after Labor Day, the Strickland calendar included two soccer games for Haleigh’s younger sister. On this balmy day, Holli, 33, and Jason, 31, and the three children were seen on the field, court records show. Haleigh helped carry a chair to the lawn.
That night, Holli called Weiss, asking whether she could mind Haleigh the next day. Holli said Haleigh had the flu and needed to be watched while the family went to the weekend’s second soccer game.
Around 12:30 p.m. on Sunday, Weiss came over to baby-sit. According to Weiss’s testimony in a court hearing, Holli said Haleigh was sleeping in her bedroom. Over the next two hours, while Weiss watched over Haleigh, Holli called several times from the soccer field, inquiring about Haleigh. Weiss told her that she had checked on Haleigh, and that the girl was sleeping.
She did not notice any obvious signs of injury, Weiss testified.
The family returned home around 2:30 p.m. While Jason watched over their son downstairs, Holli raced upstairs to check on Haleigh. Screams erupted in the bedroom. “Wake up! Wake up!” Holli shouted.
As the couple raced to the car, holding Haleigh’s limp body, Holli suggested that Weiss go upstairs to check for evidence that Haleigh overdosed on some medicine or left a note, according to Weiss’ testimony. Haleigh’s younger sister joined Weiss. The sister found a note that Weiss quickly grabbed away from her. Weiss said she read only the first line of the note, which said: “I did it again.”
Weiss testified that she assumed Haleigh had written the note, but that she was not sure.
As doctors examined Haleigh’s battered and unconscious body over the next few days, they diagnosed her as suffering from a severe brain-stem injury, the kind that happens in a high-speed crash. Her brain trauma was also of the type seen in babies who are shaken violently, they said. According to records, doctors said they did not think Haleigh’s injury came from a stairway fall or from any self-inflicted acts.
As doctors put her on life support, police officers began their hunt for Haleigh’s assailant.
Holli insisted to police that Haleigh, inexplicably, lost consciousness after suffering a stomach ailment the night before. That night, she said, Haleigh also had a bowel movement accident in the bathtub. Jason said he played no major role in caring for Haleigh that weekend. Haleigh’s younger sister told police that Haleigh may have hurt herself in the basement by attempting “a back flip with no hands,” then hitting her head on the concrete floor as a result.
Police questioned the babysitter. Weiss initially described Holli and Jason as model parents. But about a week later, as the severity of Haleigh’s injuries became clear, Weiss returned to the police station. She said that, over the previous summer, the couple more than once threw Haleigh down the stairs – and often struck her with an open hand or other objects, including a spoon or a plastic wand. She said she had never told anyone because Holli had convinced her that this was appropriate punishment for Haleigh’s behavior.
Weiss also admitted in court that she once struck Haleigh with an open hand.
On Sept. 20, based on Weiss’s testimony, police officers arrested the couple on child abuse charges. They were taken to a Ludlow correctional facility. The family’s two other children were placed in foster care.
News of the arrests stunned, and angered, many in Westfield. Numerous parents who knew the Stricklands were convinced Holli and Jason were being scapegoated by police, who didn’t understand the depths of Haleigh’s disturbed behavior. They still admired Holli, who insisted on the right to see Haleigh in the hospital even when staff glared at her with suspicion. As DSS petitioned a judge to allow the removal of Haleigh’s life support, declaring her to be in an “irreversible vegetative state,” friends and family prepared themselves for word of a funeral.
What came next was beyond their imagining.
On Sept. 22, just hours after being released on bail, Holli went to her beloved grandmother’s apartment in a senior-citizen housing complex in West Springfield. Holli and Constance Young talked, wrote notes, and made a plan.
Around 6 the next morning, gunshots went off.
Young shot Holli, who was sedated with sleep medication, records show. The 71-year-old woman then called her former husband, saying she had killed Holli to end her misery. She had one thing left to do to complete the murder-suicide pact.
She shot herself. Both women died that day.
One suicide note, allegedly written by Holli, spoke of her feelings toward Haleigh: “Please know that I loved her. I could never have harmed her.”
In that note, she also referred to her reasons for ending her life.
“This is going to be the hardest thing I’ve ever had to do. I need to do this for my kids. All 3 of them.” she wrote. “This way, I can be with Haleigh, and [the two other children] won’t have to live through this mess. I love my kids, you guys, without them, I have nothing.”
***
Holli may have thought she was joining Haleigh in death. But as so often before, Haleigh would defy the assumptions about her.
In the months that followed, DSS went before the state’s highest court for approval to withdraw Haleigh’s life support. One of Haleigh’s two doctors agreed with the request, the other did not. Another dissenter was Jason Strickland, who would face murder charges if Haleigh died. On Jan. 17, 2006, the judges authorized the removal of Haleigh’s ventilator and feeding tube to let her “die with dignity.”
But a day after the ruling, doctors at Baystate Medical Center in Springfield announced that the girl was breathing on her own and responding to commands. Doctors and DSS officials have not disclosed whether medical staff detected Haleigh’s improved condition only after the court ruling, or days earlier but failed to report this to judges. On Jan. 24, the DSS commissioner, Harry Spence, visited Haleigh in her hospital room, observing her pick up a Curious George doll and a yellow duck on command.
Her recovery has continued, to the point that last Tuesday in Springfield, a prosecutor told a judge that she plans to call Haleigh as a witness in the criminal case against Jason Strickland, whom authorities consider culpable for Haleigh’s injuries -though they believe Holli was the mastermind. Defense attorneys say they will seek to block Haleigh’s testimony, by raising questions about her competency and credibility.
And what might Haleigh say? During her interview with police last winter, she apparently did not shed light on what led to her brain injury, but she did say that she was physically disciplined, sometimes harshly, by Holli and Jason when she misbehaved.
Haleigh’s younger sister, now 12 and living with her father, Jonathan Poutre, has since given police a revised statement. She now says that Haleigh lost consciousness after being thrown down the stairs by Holli and Jason. The couple’s 5-year-old son, who is living with foster parents, has not made any disclosures about abuse in the Strickland home, records show.
Haleigh, now 14, has stayed for more than two years at Franciscan Hospital for Children in Brighton, where she is described as a friendly child who routinely smiles and waves at staff. Haleigh can speak some words and attends a day school in a wheelchair. A juvenile court judge has declared that Haleigh is functioning at a level “too high” for placement in a nursing home, and she is likely to go into an adoptive home with a personal assistant or a group home.
Haleigh apparently has adjusted to the fact that Holli Strickland is gone. News of the death of this important person in her life once caused her overwhelming anguish and grief. Now, however, Haleigh quietly refers to her adoptive mother as being in “heaven.”
Patricia Wen can be reached at wen@globe.com![]()
TST Updates August 9, 2009
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Since this TST website was launched a little over 2 weeks ago, it has generated tremendous interest, including 1400 ‘hits’! We are interested in your comments on our site. We’ve had a lot of comments on the look of our ‘header’. Many of you like the header and have used words such as ‘intriguing”, “calming”, “thought provoking”. Others have said it looks “gloomy”, “depressing” and reminds them of the “Blair Witch Project” and “Lord of the Rings”.
What do you think??
On a more content-related topic. Our TST Development Team has been working hard revising our measures and our training approach. We held a day long meeting last week to review and make decisions about these important issues. This meeting included guests Mary Dino from the Foster Care Services Project in New York City; Adam Brown from Children’s Village in Dobbs Ferry, NY; and Liza Suarez from the Institute for Juvenile Research, University of Illinois. It was a very productive meeting and we plan to post more detail about the changes in our evaluation and training approach soon.
Our new “Case-of-the-Week” has generated a lot of interest and is our most visited page. Look for a new “Case of the Week” tomorrow which we think will really engage your thoughts (and feelings).
Welcome to Trauma Systems Therapy! July 30, 2009
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We’re glad you have joined us! This site is assembled and managed by the TST Development Team, a group of mental health clinicians and researchers affiliated with Children’s Hospital Boston, Harvard Medical School, and the National Child Traumatic Stress Network. We have been developing and evaluating TST for about 10 years based on our belief that available interventions and services for traumatized children and families were not addressing the most important problems driving the child’s need for care. Over these years we’ve innovated the integration of community and home-based intervention and legal services in the care of traumatized children. We’ve developed organizational, financial, and evaluation approaches to assist agencies to implement TST. We’ve also conducted a series of studies to evaluate TST’s impact on children and families and the
organizations that serve them. We are so glad that our work developing TST has resulted in the improved care of traumatized children across the United States.
The demand for TST has been enormous. Agencies have worked closely with us to adapt TST for such diverse groups of traumatized children as refugees, children with co-morbid substance abuse, children who receive care in foster homes, residential programs, schools, outpatient clinics, shelters for unaccompanied minors, and hospital intensive care units.
We’ve developed this website to provide information about TST to those unfamiliar with it, and to provide a vehicle of information sharing for our many partnering agencies implementing TST Programs. This website contains pages that will let you know about our program model, our team, and about other teams that are adapting and using TST. Information about how you might get TST set up at your organization is found on our ‘TST Basics’ page.
The TST Manual
Detail about the TST model can be found in our book: Collaborative Treatment of Traumatized Children and Teens: The Trauma Systems Therapy Approach published by Guilford Press. We provide the link to the Amazon page if you are interested in purchasing this book (click the image on the left).
Please don’t miss the ‘Case-of-the-Week’ page. We will post both clinical and organizational dilemmas, about weekly. We hope to use this page to engage anyone interested in the care of traumatized children in interesting, informative, and even controversial discussions about how such difficult issues may be addressed, and how TST may be used to help.
We hope that you will find this website interesting and informative. Please let us know what you think,
The TST Development Team
Glenn, Heidi, Carryl, Amanda, and Jenny
might have delivered a near-fatal blow to her head nearly three years ago.
The TST Book