Our department was referred to provide Therapeutic Behavioral Services (TBS) services to a young boy (6 years old) who was living with his 71-year-old paternal grandmother. This young boy had a history of neglect and abuse by his biological parents and also had 11 other siblings all from different fathers. This young boy was in jeopardy of being removed from his home and placed in a higher level of care due to his behaviors, which included tantrumming, assaulting, kicking, spitting, throwing objects, property destruction, ignoring directives and biting his grandmother. On the first home visit, our clinician arrived at their home and witnessed his 71-year-old grandmother restrain the young boy, on the floor, for 1 hour and 40 minutes! The grandmother was clearly overwhelmed and didn’t have the “tools” to raise her oppositional/defiant grandchild.

Our clinician collaborated and worked closely with the grandmother and child 3 days a week, 3 hours at a time for a period of 1 year. During the time spent together, the clinician was able to teach, model and support the grandmother in using behavioral modification techniques to reduce the child’s behavior. These techniques included communication skills, planned disengagement, incentive rewards and appropriate consequences. The clinician also worked closely with the child and helped him learn and practice self-soothing techniques and alternative coping skills. TBS services were extremely beneficial and successful in helping reduce the child’s behavior, which enabled him to remain in his grandmother’s care. All tantrums were significantly reduced in severity, frequency and duration and the child responded to verbal prompts (ie: take a 2 minute “time out”, used deep breathing techniques to calm his body down) rather than having to be physically restrained or act out in order to get his needs met.