Key Issues
Discuss About The Empowerment Approach To Social Work Treatment.
This case study is concerned with Frank who is 78 years age and recently shifted to nursing home following the fall from the in front of his house. It led to severe consequence for him as he suffered a bad fracture. Frank has Parkinson’s disease. Before this tragedy, Frank was leading an independent life living on the small ground floor unit. It was only after the due pressure from the nephew, and the elder sister and Frank agreed to be discharged to a nursing home for further rehabilitation and the assessment of the ability to live in an independent manner. Frank was aware and he could understand that he was recovering as his hip was getting well. However, he found it difficult to manage his walking frame. Frank was getting irritated easily as he was nt staying in his own unit. Due to this irritation, he started arguing with the residents and staff over food. Franks informed hi s family that he was not interested to stay in the nursing home but wished to return home. He was of the view that with support from family along with additional assistance from Home Care Service and Meals on Wheels, it would be easier for him to accommodate. However the family is in dilemma and they approach the Aged Care Assessment Team for further consultation. The Geriatrician My Shah strongly objects to this as he finds that Frank is still in poor health condition and the Parkinson’s disease would lead to further deterioration of the mental and the physical health of the person. However, the social worker in the team, Jeremy has other views. He feels that Frank should return home and home care would prove to be beneficial for Frank and the entire family.
The key issues that have emerged in this scenario are the loss of power and autonomy of Frank. Firstly, due to his old age he experiences a sense of loss of power. Secondly, post the Parkinson’s disease there is helplessness in him. He has recently had a severe injury and shifted to the nursing home owing to an accident. Despite the Parkinson’s disease, before the accident he was leading an independent life that he felt has been encroached upon owing to the shift he had to make to the hospital. Another issue that surfaces in this context is that Frank became irritated because he was not living in his unit. For him, this is a kind of displacement and he was overpowered by a sense of homelessness, as he was not present in his usual location. It maybe assumed that since he was sharing the space of the unit with dementia patients he did not like the atmosphere. Another assumption that can make in this context is that living different patients may make him feel sicker; therefore, he wanted to shift back to his home. Another possibility for this behavior is that inhabiting with dementia patients is difficult and it may make him feel suffocated. Another key issue that has been identified her is the conflict between Frank (client) and the professional team of the Aged Care Assessment Team and the conflict in their values. Frank finds himself fit and competent to return to his own unit and feels that the Home Care Service and the Meals on Wheels would be helpful in making him comfortable, cope with the situation and make him an important part in his recovery journey. The next issue that emerges in this context is the divergent opinion shared by Dr Shah, the geriatrician of the Aged Care Assessment Team and Jeremy, the social worker in the team that Frank would be able to manage on his own given the necessary support. Meals on wheels is known for producing 5,000 nutritious meals five days a week. It is run by the volunteers who participates in the preparation of the meal and thereafter delivering the meal to the respective clients.
Explanation through theoretical framework/How both these theories inform the social work response
The systems and ecological perspective in social work was developed drawing its inspiration from the biological science of ecology. According to this view, all human beings are adapted from the social and physical environments in which they are located. Ecological systems theory and the models of practice area associated with a long history of social work (Zastrow, 2016). Systems, theory maybe traced to the diverse and intellectual sources that are specific to organismic biological ecology, the social survey movement in social survey movement in social work, the human ecology in sociology, cybernetics and the information theory. From the outset of the profession in social work, there has been a concern for the character and the circumstance, the environment and the people (Colarusso & Nemiroff, 2013). Therefore, there has been a concern with the interrelations and the entire unit that encompasses them. Mary Richmond pioneered the ecological method of community research in sociology to the notion of the charitable cooperation that integrated and made use of the resources and forces that are internal to the client and his family. Ada Sheffield suggested the concept of the total situation in which the people and the dynamic field of experience that involves the sub-institutions that emphasizes on the inter-relation between the physical-social settings. During the period of the 1950s, the trend was to put social into social work and develop a more realistic and profession-wide perception of the practice. This has marked a new paradigm shift in the field of social work. There has led to the preference of the social system theory (Birren et al, 2013). It has served key purpose in supporting the model of family therapy and the community health movement and the contextual systems for the treatment and the care of the elderly. There has been an extension in the form of ecological systems theory. This theory became more popular in social work compared to other disciplines that may be attributed to the socialization of the social workers. They feel more obliged towards their clients and discipline, and therefore exhibit a down to earth attitude. This theoretical framework of social work is related to the ecological consciousness of the social workers and it is compatible with the self-image of the social workers as earth mothers (Parrot, 2014). The ecological model of social work emphasizes on the relationship between the man and the society. It is understood that the mind-body-environment in the transactional relationship. People in the physical-social-cultural environment are understood in terms of the complementary exchanges of resources and the mutual reciprocity through the systematic functional requirements of the individual is not supplemented. Ecological theory comprises of the humanistic and dynamic dimensions. This is further concerned with people who are responding to the real lifetime and space within the territorial habitats so that there is a new emphasis on social work on the concepts of reciprocal complimentarity of the exchange of resource and the adaptive fit between the situation and the sub-systems of the person and the situation of the client (Reamer, 2013). Therefore, there is a functionalist understanding associated with the social systems and ecological theory.
This is because the environment of the person is considered important in shaping the person. In the given scenario, it can be seen that although Frank had Parkinson’ diseases yet he was contended with his life. However, post the hip injury that may be attributed to the difficulty in mobility faced by the patients with Parkinson’s disease, Frank had to shift to a different unit in the nursing home. In case of Parkinson’s disease, it has been found that at the later stage, patients have the tendency to fall down quite easily. The thrust of ecological theory is that deals with the web of life that the interface between the sub-systems and the systems so that it relates to the self-organizing, open, self-regulating and the adaptive complexes of the interdependent and interacting sub-systems. The ecological systems theory is considered to be the most appropriate theory for social work that aims to enhance the quality of transactions taking place between the people and the environment. The ecosystem in social work comprises of the people, life situations and the well-functioning or the dysfunctioning behavior patterns that emerge from the interaction. This theory focuses on assessment and comprehensive approach to social work. The term social functioning in this context refers to the systems integrated and coordinated application for the well-developed, well-working capacities in the everyday social relationships (Turner 2017). This is done through the incorporation of the internal and the external resources. The ecological model to social work is applicable to a wide range of situations in which the client may be the individual or the group or the family (Lee & Hudson, 2017). The second aspect related to the ecological model is that the attributes of the person-client relationship during the course of interaction and the situation that needs to be internally consistent, complementary and coherent. These two principles indicate that the individual, family, community or the organization demands access to and the utilization of the adequate and the compatible resource for the efficiency and the self-fulfillment (Smith & Shaw 2017). Studies have shown that an individual person will only be able to function well given the person has the internal abilities and the requisite competencies. The third aspect of the ecological model is the dialectical principle of change. This is concerned with the systematic change and the transformation of the structure. Drawing from the life model approach intrinsic to the ecological perspective, it can be understood that Frank is undergoing stress during this particular life transition, suffering from the hip injury and displacement to a different environment (Pulla, 2011). He is feeling stressed out living in this kind of environment as he feels that he does not have the adequate resource to deal with the situation. Jeremy would apply this approach to social work as he has understood the actual source of irritation behind Frank’s behaviour. The life model approach of the ecological environment can be accomplished through the four following phases.
- Initial: Getting started- This phases is marked by the identification and definition of the life stressors present in the life of the client. The client needs to be encouraged about identifying the life stressors that they are experiencing and then recognize the one that is causing them the most trouble (Banks, 2012).In this stage, Frank would be encouraged to identify the life stressor. This would be followed by recognizing the strength, resources and the coping skills of Frank. Once the life stressor is selected there needs to be collaboration between the client and the social worker to establish an initial agreement that would identify the goals, responsibilities and the roles (Gitterman & Germain, 2008). It is important to understand addressing one life stressor would automatically lead to the alleviation of another life stressor.
- Ongoing: Working towards goals: In this phase, the task would be to work with the clients and the environment to strengthen their relationship with the environment. This step is characterized by addressing the life stressors through appropriate interventions that may include cognitive behavioral therapy or motivational interviewing or solution focused events (McLaughlin et al, 2011) There may be interventions to address the interpersonal and dysfunctional processes that would include the couple or the family systems or mediation or advocacy. Considering the situation of Frank, motivational interviewing seems to be the most appropriate technique.
- Ending: Bringing the Shared Work and the Relationship to a close- This phase is characterized by the formal closure where the social worker and Frank would end the work, evaluate the work and recognize the accomplishments, and develop for the future.
Another theoretical framework that needs to be discussed in this situation is the psychodynamic theory. In this theory, the key focus is that the mind comprises of the conscious and the unconscious processes that inform the human behavior. It is further said that the humans have the inborn need to associate and attach to the others. Defence mechanism of the human beings protects them from the anxiety and the unacceptable impulses. The external world has implications on the internal body and adjustment to the social world. Human beings have the tendency to adapt to their environment (AUSTIN 2011). The therapeutic relationship that exists between the human beings serves as the focus for the change. The type if interventions that is intrinsic to the psychodynamic model is paying attention to the developmental processes, placing emphasis n the therapeutic relationship especially through the transference and the countertransferance, focusing on the affect and the aspects of the emotions of the client. Psychodynamic theoretical framework is concerned with the exploration of the interpersonal experiences, whishes, fantasies and the dreams (Kruske, Belton, Wardaguga & Narjic, 2012). The most important feature of the psychodynamic process is the avoidance of topics or the engagement in activities that obstruct the progress of the therapy. Drawing from the contentions of this paradigm, human beings exhibit the tendency to associate with others and attach to the people around him (Connor, 2006). The view of Dr Shah regarding the capability of Frank emerges from this theory. He believes that Frank would be in a better position and recover faster if he stays in the unit along with the other patients. The home care health delivery is not deemed fit for Frank considering his delicate condition. There is a belief that humans adapt to their environment. Therefore, the geriatrician is overlooking the problems faced by Frank and believes that eventually he will adapt to the environment and would not face any problem staying with the dementia patients. As can be perceived, this theoretical framework functions with authority of the person rather than the client. It lacks a client-focused dimension.
The strength of both the systems ecological theory and the psychodynamic theory have been discussed in the previous sections. Therefore, in this section there would be discussion on the limitations. The limitation of the systems ecological model is that system analysts assume that all the systems are similar without identifying the differences between the person and the work organization (Banks, 2012). There is a tendency among the systems theorists to overestimate the rationality of the human kind pertaining to decision-making and the problem-solving of the organizational behaviour. There is an assumption that the system components are interdependent that sustainable interventions at different points would affect the different elements. There are no points of entry or levels of interventions (Garbarino, 2017). It is further criticized for its inability to deal with the subjective experiences of the patients and understand their aspirations, meanings and their values. Since it lacks a value system it lacks a constructive direction.
The limitation of the psychodynamic process is that there is limited focus on the ethnic identity, culture or the racial identity of the person. It has been vehemently criticized for being heterosexist, anti-feminist and embedded in homophobia (Germain, 2011). There is limited evaluation research on the treatment outcomes. This long-term treatment model is incompatible for managing the care environments and the low-income of the patients. Another criticism pertaining to the psychodynamic theories is that although there is focus on the individual behaviour and the treatment, there is inadequate attention paid to the environmental context. The psychodynamic theories lack concrete techniques and have abstract principles.
References
AUSTIN, B. (2011). Technology, Art Therapy, and Psychodynamic Theory. Materials and media in art therapy: Critical understandings of diverse artistic vocabularies, 199.
Banks, S. (2012). Ethics and values in social work. Palgrave Macmillan.
Birren, J. E., Cohen, G. D., Sloane, R. B., Lebowitz, B. D., Deutchman, D. E., Wykle, M., & Hooyman, N. R. (Eds.). (2013). Handbook of mental health and aging. Academic Press.
Colarusso, C. A., & Nemiroff, R. A. (2013). Adult development: A new dimension in psychodynamic theory and practice. Springer Science & Business Media.
Connor, S. (2006). Grandparents raising grandchildren: Formation, disruption and intergenerational transmission of attachment. Australian Social Work, 59(2), 172-184.
Garbarino, J. (2017). Children and Families in the Social Environment: Modern Applications of Social Work. Routledge.
Germain, C. B. (2010). Social work practice. Columbia University Press.
Gitterman, A., & Germain, C. B. (2008). The life model of social work practice: Advances in theory and practice. Columbia University Press.
Kruske, S., Belton, S., Wardaguga, M., & Narjic, C. (2012). Growing up our way: the first year of life in remote Aboriginal Australia. Qualitative Health Research, 22(6), 777-787.
Lee, J. A., & Hudson, R. E. (2017). Empowerment Approach to Social Work Treatment. Social work treatment: Interlocking theoretical approaches, 142.
McLaughlin, D., Hasson, F., Kernohan, W. G., Waldron, M., McLaughlin, M., Cochrane, B., & Chambers, H. (2011). Living and coping with Parkinson’s disease: perceptions of informal carers. Palliative Medicine, 25(2), 177-182.
Parrott, L. (2014). Values and ethics in social work practice. Learning Matters.
Pulla, V. (2014). Towards the greening of social work practice.International Journal of Innovation, Creativity and Change,1(3).
Reamer, F. G. (2013). Social work values and ethics. Columbia University Press.
Smith, L. J., & Shaw, R. L. (2017). Learning to live with Parkinson’s disease in the family unit: an interpretative phenomenological analysis of well-being. Medicine, Health Care and Philosophy, 20(1), 13-21.
Turner, F. J. (2017). Social work treatment: Interlocking theoretical approaches. Oxford University Press.
Zastrow, C. (2016). Empowerment Series: Introduction to Social Work and Social Welfare: Empowering People. Cengage Learning.
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