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HoNOSCA case study written vignette - Hohepa

Hohepa is a 13-year-old boy who lives with his mother (Mere) during the week and goes to his father's (Willy) place on the weekend. Six months ago he started his first year at the local mainstream college. His parents are concerned because yesterday the Year 9 Dean rang them to say Hohepa’s behaviour is of concern and he is not settling down in class.

Prior to starting college Hohepa attended the local Kohanga and Kura Kaupapa where he achieved well in his academic schooling and was actively involved in both school and Marae based sports both at lunchtime and after school. Hohepa had two close friends at Kura Kaupapa but they have both gone to Māori boarding schools elsewhere.

The Dean reported that Hohepa seems to have difficulty fitting in and socialising at college and is often seen on his own. In the last two weeks he has been caught on several occasions roaming the locker rooms when he should have been in class. One time when confronted Hohepa retaliated by swearing at the teacher, thumping a wall with his knuckles and pushing a chair over, saying he would rather be dead than at school. Hohepa’s academic performance has slipped due to incomplete assignments and increasing non-attendance at school.

He has been told by his parents not to associate with one of the boys at college. Last week school staff caught Hohepa and the boy on the top field smoking cigarettes and drinking RTDs (Ready to Drink) the boy had taken from home. Hohepa strongly denies smoking or drinking with this boy.

Hohepa’s parents separated three months ago and despite collaborating and having similar rules in both homes they are finding it extremely difficult to deal with his behaviour. Since the beginning of the New Year Hohepa has seemed restless and irritable most of the time. There have been several emotional outbursts targeted at his mother, especially at hand over times (between parents). The outbursts mostly relate to accessing resources he feels he needs, such as phone top up money or money for clothes. Last weekend, Willie returned Hohepa to his mother on the Saturday morning saying he was ‘fed up’ with him not talking and not playing sports. Hohepa was upset and although his mother tried to talk with him he refused and spent the day in his room.

Over the past four weeks his mother Mere has continued to notice changes in his behaviour at home and describes him as unhappy and distracted. On two occasions she has found him in his room crying. Hohepa no longer talks or jokes with his parents and younger siblings, which he used to do, and refuses to respond to questions from his family in te reo. Mere says that Hohepa has been less concerned with his appearance and is not showering daily as he used to. She said Hohepa always prided himself in looking ‘cool’ but now does not seem to care how he dresses. Hohepa has always had a good appetite but in the past three weeks she has noticed he is eating very little at home.

Hohepa has always had a good appetite but in the past three weeks she has noticed he is eating very little at home.

Hohepa has never been a good sleeper but both Mere and Willy have recently found him in the lounge watching DVDs at various hours of the night or early morning. At weekends Willy notes Hohepa never gets up before noon, but says he expects this from a 13-year-old boy.

Willy believes Hohepa has always had too much testosterone and has therefore encouraged him to play sports. Willy tries to be supportive of his son and thinks he should just join a sports team.

The Dean suggested that Mere and Willy meet with the school counsellor, which they did the next day. Hohepa was invited to attend but refused. They talked with the counsellor about their concerns regarding Hohepa’s increasing unhappiness, seeing him crying in his bedroom, the changes in his behaviour and engagement with both them and his siblings.

Mere told the counsellor that last week one of her whānau had said that Hohepa’s cousin Hine, who attends the same college, had seen Hohepa being pushed and teased by some boys. The boys were laughing about texts they had sent him.

Mere said she had noticed that on Sundays, especially in the afternoon and evening, Hohepa seemed to be anxious and fidgety and talked about his old school and friends. Mere recognised that this seemed to precede “the times he stays home from school with stomach pains” which has been weekly over the past four weeks. She noted that he complains of a sore stomach and feeling sick but by late morning appears to be well and relaxed, but still refuses to go to school. Both parents report they have asked him what is wrong but Hohepa says there is nothing wrong.

The counsellor suggests a referral to CAMHS to assess Hohepa’s anxiety and changes in behaviour. Willy and Mere agree to this once they realise they do not have to pay to use this service. When they are also informed that they are able to see a Māori Mental Health clinician, they agree to try and get Hohepa to attend with them as they feel this would make it much easier for Hohepa to participate as he is much more comfortable expressing himself in te reo.

An appointment was made with a CAMHS Māori Mental health clinician and Mere and Willy chose a home setting for the meeting supported by their whānau.