BACKGROUND INFORMATION

The following information was obtained from Robert, who was a restless and dubious
historian, from his hospital chart, and from a March 12, 2000, telephone conversation
with Dr. Smith.
Robert was born and raised in San Francisco County and his biological parents remain
married.
The father, approximately age 40, is a career Air Force person with a rank unknown to
Robert.
He said his father teaches machine maintenance and attends college.
He described his father as a mean, violent, cruel person. (How does he show this?) He
used to hit me. (What would cause him to do that?) Sometimes when I did something
wrong. (Like what?) Anything, any little thing, sometimes.
He said he was hit with objects such as a belt, sticks, spoons, forks, knives. Any object a lot
of times.
He said the most significant injuries he suffered during such beatings were
large blood blisters on my hand. He said he never suffered an injury that required
medical attention but that he did ask his fathers permission to remain out of school to
conceal the marks from his peers. He said his father refused the request.
Roberts mother is approximately age 35 and a business secretary. Asked to describe
her, he said, I dont know. I guess shes mean. Thats what I think. Is it my opinion?
(Yes. Mean in what way?) Verbal abuse, yelling, screaming. (What causes her to do
this?) Anything, like my father. Frustration. (How does she react when your father
hits you?) She doesnt do anything. She lets him.
Robert is the oldest of three siblings with a brother, age 13, and a sister, age 10.
Both siblings live in the home and attend school. My brothers a little strange. Very
silly and inappropriate for his age. He said his brother shows these characteristics
when he runs around naked, talks real strange like hes on an acid trip when hes not.
He said his brother excels in school and has never received counseling or psychotherapy.
Regarding the sister, Shes fine.
Medically, Robert believes he experienced an uneventful gestation and delivery. Regarding
unusual illnesses or accidents, he said that at age 10 or 11 he broke either his
wrist or his thumb during horseplay with friends and that the break healed without
limitation. He said that at a later age he could not recall he broke his finger and wrist
in horseplay and that he had broken such bones approximately four or five times. He
said that otherwise his health has been good.
Asked about unusual events in his life before starting school, Robert said, I cant
remember that far back. He said he enrolled at Rutledge Elementary School at the
usual age where he remained in regular classes through the sixth grade. He earned primarily
Cs, and related to his peers well. He said he also related to his teachers
well. He said he had no behavioral problems in elementary school and that his life
was uneventful.
For the seventh grade, Robert was placed in a Roman Catholic school because during
the sixth grade they felt I was failing, not doing my work, taking too much leisure
time. He said he remained at the Catholic school until the last month of the school
year when he was expelled because of frequent misbehavior. Initially, he said he could
not remember what act led to the expulsion but later said, I lit a firecracker in class.
(In your opinion, why did you do that?) Rebelling. (Against?) Parents. It was also
for fun. (Why were you rebelling against them?) Cause I didnt want to go to that

school. I wanted to go to public school. (Why?) Because I had gone to a public school
for six years, and all my friends were going there.
Robert said he remained home without attending school until the following fall, September
1999, when he enrolled in the eighth grade at Franklin Junior High School to
remain in regular classes until entering Monte Hospital. In the eighth grade, his marks
were failing, no, below standard. (Why were they so low?) Because I had started
using alcohol, drugs. I dont know. I dont know if thats the reason. (Why did you
start using drugs?) I dont know that, the reason why. He said he was introduced to
alcohol and other drugs by his age peers. He estimated that he was intoxicated
approximately
30 times during the eighth grade, usually at home with friends while his parents
were out. The only street drug used was marijuana. He said his parents did not
know about his substance misuse but complained about his grades. They wanted me to
bring them up, but I started failing even more. He said otherwise there were no unusual
events during the eighth grade.
Last September, Robert enrolled in the ninth grade. Then, I started hanging out
with more friends that drank and used more drugs, but he misused only alcohol and
marijuana. He said he was intoxicated a few times a week and misused marijuana
maybe four or five times a week. He said that otherwise his life was uneventful until
he entered Monte Hospital for the first time during Christmas vacation because I was
dead drunk. He said he remained hospitalized three days, until the doctor thought I
should be discharged. A week later, he returned to Monte Hospital for his current
hospitalization.
Asked about his future plans in life, Robert said, I havent made any. I want to live
with my grandparents, but theyre not going to let me. He said his mother and his
treating psychiatrist were against this plan because they think Im running away from
my problems.
BACKGROUND INFORMATION
Information obtained from family court documents, consultation with Annas therapist,
her social worker, her current foster parents, and interview with Anna indicates
that Anna has experienced multiple disruptions in her home life events throughout her
childhood. These events include physical/emotional abuse, neglect, and abandonment.
Anna lived with her biological mother, Lupe S., until she was approximately 6 years
old. At that time, Anna and Ms. S. moved in with Juan F., whom Anna refers to as her
stepfather. Anna continued to reside primarily with her mother, stepfather, and their
two children, Roberto and Juanita, until March 2001.
After moving in with her stepfather, Anna reported that her mother repeatedly
stated, I wish you [Anna] were never born, and that her parents frequently yelled at
her, hit her, and did not provide adequate clothing or care for her. Furthermore, Anna
reported that she and her mother frequently left her stepfathers home to live with other
relatives or in homeless shelters because of her stepfathers mean behaviors but that
her mother always returned to him. Family court documents indicate that there were
five substantiated reports of physical/emotional abuse and neglect of Anna and/or her
siblings by both her mother and stepfather. Annas parents reportedly did not comply
with family supervision plans as mandated by Child Protective Services. Additionally,
Anna explained that over the past several years her mother exhibited weird behaviors
such as rummaging through garbage cans, forgetting to wash clothes, and most pertinent
to the child, witnessing her mothers attempt to choke herself. Anna also reported that
her mother has been hospitalized at least 4 to 5 times for attempting to kill herself. In
the past year, Anna was temporarily placed at the local childrens shelter after running
away from her home and when her stepfather attempted to abandon her at this facility.

Subsequently, Anna resided with a maternal aunt for an undetermined amount of time
before returning to her mothers care in the spring of this year.
During the spring of 2001, Anna and Ms. S. resided intermittently with relatives,
Ms. S.s employer, and then in a homeless shelter. Ms. S. then requested that acquaintances
from church care for Anna. The acquaintances agreed to this on a temporary
basis. However, they reported that Anna began having significant problems at school
(e.g., suspended for fighting). Furthermore, these caretakers stated that Anna appeared
to have significant emotional problems and were, therefore, unwilling to care for her
any longer. They contacted Social Services and explained Annas situation, clarifying
that her mother was not available to care for her. As a result, Anna has been a ward of
the state since May 2001, and has been placed in the foster home of Mr. and Mrs. G.
Annas social worker referred Anna for mental health services given her history of
neglect and abuse, physical aggression in school, and her excessive irritability. On
placement in her current foster home, Anna initially appeared very sad and had difficulties
interacting with her foster siblings. Annas foster parents indicated that Anna
has not exhibited overt behavioral problems but does appear to be immature (e.g.,
excessive
teasing, difficulty sharing), needs a considerable amount of individual attention,
and displays excessive moodiness.