Intensive In-Home Services Program Offers a Helping Hand to Stroke Survivor

When Tara experienced her first stroke in March 2022, she was in her 17th year of teaching young children how to read. As a literacy specialist for K-6th graders, she drew on her love of writing to help kids overcome their challenges in the classroom – and she loved her job.  

Fortunately, the stroke was just a mild interruption in her life, and she had no residual effects. Tara was able to return to the classroom within a few days.

The hard truth is that when one stroke occurs, it’s statistically more likely that a second one is on its way. Whether it was because of a brain injury from a car accident that Tara experienced in her 20s or built-up stress from her recent divorce, Tara’s second stroke arrived with a vengeance just four months later.

She spent sixteen days in the hospital before being released.

The impact of the strokes on Tara’s functioning was devastating. Basic movements like getting out of bed, bending down, or walking up and down the stairs were accompanied by constant pain.

She tried to maintain her teaching job, but the bright lights and loud noises were wildly overstimulating and caused constant headaches and nausea.

“There were certain areas at school that would make me physically sick,” said Tara. “I had to retire after the school year ended. My brain just could not do it.”

At home, she found it increasingly difficult to keep up with basic house chores like cooking, cleaning, and caring for herself. She developed a debilitating fear of going outside – even the sound of people outside her front door caused her to run and hide.

Over the weeks and months that followed, Tara’s house and life fell into disarray. Her 16-year-old child, *Avery, was profoundly impacted by this series of life events and needed specialized mental health support.

And that’s where Cornerstones of Care and the Intensive In-Home Services (IIS) program entered the picture.

Briar Strunk, an IIS/IFRS Specialist in the Warrensburg, Missouri area, was assigned Tara’s case after a referral from Missouri Children’s Division for an unsanitary home.

The IIS program is a 4-6-week crisis intervention program for families at immediate risk of being separated due to mental illness, emotional disturbances, juvenile delinquency, family violence, abuse, or neglect. It aims to keep children safely at home by improving family functioning through safety planning, increasing life skills, and linking to community supports.

Its sister program, Intensive Family Reunification Services (IFRS), is for families already separated by these factors and aids in helping children return home.

In this referral for services, Briar was tasked with helping Tara and the family make changes in their home for the safety and well-being of Avery so she could stay at home with her mother.

An important aspect of IIS is that it’s entirely voluntary for families to participate; therefore, success in the program depends heavily on buy-in and engagement from family members.

“If they do utilize our services, it shows that they can be motivated and goal-driven and can do it on their own,” said Briar. “I like that saying that we don’t just pull people out of the river but go upstream and find out why they are falling in. I feel like that’s what this service does for people.”

Luckily, Tara was ready for what was ahead.

“I wanted help, and I know I needed help,” said Tara. “It wasn’t a safe place to live.”

The intervention began on June 14, 2023 – almost one full year after Tara’s second stroke – and started with a collaborative treatment planning process to define goals.

Goal #1: The family will work to establish and maintain a household routine.

To meet this goal, Briar worked with Tara and Avery to help them understand the importance of keeping each other accountable for maintaining a household routine. They worked together to map out a daily schedule, broken down into individual tasks, that stayed on the front of the refrigerator.

“After having a stroke, we take for granted the things we naturally are able to do,” said Briar. “I don’t realize I have to check my trash and take it out or check the mailbox. The schedule helps remind Tara of things she needs to pay attention to during the day, including cleaning, cooking, and personal hygiene.”

Briar helped Tara understand that it’s okay if she is unable to accomplish a task and that sometimes doing a task “half-assed” was better than not doing it at all. 

Briar also emphasized the importance of building in time for rest.

“I used the cup analogy a lot because you can’t pour from an empty cup,” said Briar. She also used other types of psychoeducation to teach the family about the importance of structure, accountability, and safety.

At the end of each day, Briar had Tara and Avery engage in a “nightly bonding routine” to rebuild trust and finish the day with a moment of positive connection.

Goal #2: The IIS Specialist will assist Tara in connecting her with mental health services.

When Briar first got involved with the family, it quickly became apparent that addressing Tara and Avery’s mental health needed to occur in conjunction with other interventions.

Right away, Briar connected Tara with an online support group for stroke survivors. She helped Tara enroll in early disability retirement and find health insurance before her Medicaid expired.

Briar also helped Avery establish a regular sleep routine and find support to address their undiagnosed mental health struggles.

“One thing I loved doing with this case is identifying Tara’s love languages,” said Briar. This introspective work allowed Tara to understand how she uniquely needed to give and receive love to feel happy, which helped her better communicate her needs and ask for help.

Most of all, Briar’s work focused on helping Tara and Avery navigate whatever physical or mental barriers got in the way of meeting their goals and encouraging them to make small steps towards better overall functioning.

“When I first met her, she wouldn’t open the door for people or let people in her home,” said Briar. “When I left, we met at the Family Support Division Office, and she got lost twice but was smiling and happy when she showed up.”

At the end of the six weeks, Tara was making huge improvements; she was consistently sticking to her routine and understanding the critical lesson of learning to ask for help.

“I might need a little help and support, but I can do it,” said Tara. “It might be hard, but I’ve learned that I can do hard things.”

Avery has also experienced growth by changing their habits, keeping their space clean, and getting the help they need. 

Tara hopes that this experience is only the beginning of Avery’s growth and development and that this opens the door to more treatment and less hardship ahead. She has similar hopes for her 20-year-old daughter, *Gina, who has been living with Tara’s ex-husband and is starting her first year of college this fall.

As for herself, Tara is eager to get into a handicapped-accessible apartment and make it her own. Part of the IIS treatment plan included Briar’s support in finding furniture for the new apartment.

“I’d also really like to start writing,” said Tara. “I’d like to write about my stroke. I think that will help me process it and tell my story.”

The beauty of the IIS program is that it has the potential to create real change in a short period of time, driven by a strong, trusting relationship between the specialist and the family. And for some families, the end of this relationship can come quite quickly.

“My entire family loves her,” said Tara, speaking of Briar. “It has been amazing. It’s a lifeline almost. The hardest part of this process has been saying goodbye.”

Despite this reality, Tara is grateful for the impact that the IIS program has had on her life and knows that there are many others, like her, who need the help.

“Please keep this program going,” said Tara. “It’s unfortunate that some people aren’t ready to accept help because it can do really good things in your life. Help as many people as you can because you’re doing good.”

*names changed to protect privacy