Family Centered Social Work in Clinical Social Work

Family Centered Social Work in Clinical Social Work Dr Sojan Antony​1​, Dr A Thirumoorthy​2​, Dr D Muralidhar​3 Assistant Professor, Department of Psychiatric Social Work, NIMHANS, Bengaluru 2​ Professor, Department of Psychiatric Social Work, NIMHANS, Bengaluru 3​ Professor and Head, Department of Psychiatric Social Work, NIMHANS, Bengaluru & The President, Indian Society of Professional Social Work Introduction 1​ Professional social workers work in clinical settings to mitigate the sufferings of persons and to promote the welfare of families with illness. Social workers use social case work and group work to address the needs of patients and their families. Family is the primary unit of society across various cultures. In India, people give more importance to the family in key decision making. Family members are the main social support for person with illness or disabilities. They provide emotional, physical and financial support to person to survive the illness. In this context social workers need to reflect how to work with the families in hospitals. In the absence of universal health insurance coverage, family has to be prepared to meet the socio-economic difficulties associated with caretaking. Families expect emotional support, information and skills from treating team to empower themselves to be a caretaker. Social workers by training are eligible to help families in this regard. Social workers have already recognized the family as the ‘best natural’ rehabilitation centre (​Hughes, Cummings, Weaver, Manheim, Braun, & Conrad, 1992)​. In following sections, this article will present some key areas, in which social work interventions would enhance the confidence of family members in care taking. Support in crisis Though family members have their own mechanism to cope with emotions and problems, most of the families are disrupted with the onset of chronic physical illness. As observed in hospitals, cardiac arrests, stroke, chronic kidney disease, emergencies during pregnancies, accidents and suicide attempts lead families to crisis. Crisis by definition is a state of sudden helplessness and hopelessness. They need a hand to hold and guidance to pass the situation. Sometimes family members have adequate resources to deal the situations; still they need support from an expert who can guide them to cross the river. Social workers use their scientific knowledge and skills to support families to face the crises. Many times families reach a state, in which they wonder themselves ‘what to do further’. It is worth to note that during this crisis, some families may become victims of exploitations. Especially during the end stage of cancer, many families keep changing the hospitals for some ‘miracle healing’. An active social work team with proper counseling skills may prevent this phenomenon in oncology settings. Information for Informed Decision Making Informed decision making is a right of persons with illness and their family members. They need adequate information to proceed with decision making. Doctors and nurses do give information during the course of treatment. Sometimes such information may not be registered in their mind due to their distress. Hence reviewing their understanding about the causes, nature, course, treatment and outcomes of illness would enable social workers to identify the need for further information. Skills Training for Care Taking Social workers can train family members to follow instructions from treating team during the stay in hospital and after the discharge from hospital through home visits. Many families keep ask the following questions in Hospitals: “What to do while patient complain pain?” “Which kind of diet is appropriate for patient?” “How can we convince a patient who denies the dialysis care?” “How can we help him to control his anger?” “How can family members recognize the need for urgent medical care?” These questions indicate that patients’ families look forward to skills training to help or care the person ​(Cooper, Eslinger, & Stolley, 2006)​. Social workers can develop appropriate programme to equip families with care taking skills. Along with doctors and nurses, social workers can educate and prepare patient and family members during the stay in hospital to address the above mentioned issues. Windows to Welfare Measures Popularly people and treating team believe social workers are windows to know and avail welfare measures. There are many schemes such as farmers’ health insurance, disability benefits and relief funds from state and central governments which would ease care takers burden. Professional social workers may maintain a repertoire of welfare measures in the department. Such list would help even a new social worker to provide this information to deserving patients. Build Partnership for Prevention, Treatment and Rehabilitation Though many upcoming corporate hospitals treat patients and family members as customers, building partnership with families are essential to establish trust among them. Such trust is catalyst in prevention, treatment and rehabilitation. The partnership mode of care will enhance the credibility of the institute in society. Trained social workers may act as an expert to establish this partnership between families and treating team (​Cowles, & Lefcowitz, 1992)​. Promote Resilience to Address the Burden Social, emotional, physical and economic burden are common among care takers of persons with chronic or terminal illness. In this context caring the care takers programme may alleviate the care taking burden. Regular support groups, facilitating social supports and welfare measures, informed decision making and empathy of treatment team would promote the resilience among family members. Clinical Social Workers have to examine and manage the care takers’ burden using professional strategies with the support of the medical team. Conclusion Hence Clinical Social Workers have to understand that family members are not passive care takers, they do involve in deciding the outcome of treatment. Empowering family members using social work methods would ease the struggles in treatment process including handling the financial difficulties arising out of treatment cost. References Cooper, C., Eslinger, D. M., & Stolley, P. D. (2006). 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