ISSN: 0976-3759

ISSN: 0976-3759

Journal of SCHOOL SOCIAL WORK April 2013

Journal of SCHOOL SOCIAL WORK April 2013

ISSN: 0976-3759

ISSN: 0976-3759

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Volume IX Issue 11

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Editorial Prof Visvesvaran P K Patterns of Power Struggle and Remedy at Hand Dr Vijayalakshmi V Pattern Recognition: A Challenge before Parents Prof Visvesvaran P K Typical Relationship Patterns in Families Naidu P J Concept Paper on Control Vs. Autunomy Casework Intervention for the Hearing Impaired Dr Sinu E Changing Patterns in Daily Routine among Urban Commuters Sandhya Rani P J Nafisa Khan and Dr Charumathi P J

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Honorary Special Editor: Dr Rajendrakumar, Chairperson, Department of Social Work, Bangalore University, Jnana Bharathi Campus, Bangalore

Focus: Pattern Recognition

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Journal of SCHOOL SOCIAL WORK April 2013

Journal of SCHOOL SOCIAL WORK April 2013

ISSN: 0976-3759

ISSN: 0976-3759

Pattern? Yes! Rigidity ? No! Editorial Identification is, however, only the Ruth Benedict in her anthropological masterpiece first step and is not a solution by itself. Patterns of Culture identifies the Also, any diagnosis is only tentative modal personalities in different and the therapist should have an societies. The typical Dobuan open mind to revise his views as he suffers from chronic anxiety, hostility goes along and as new facts come and paranoia. His gods are hostile up. A corollary to this is the fact that beings and all social relationships are characterized by deliberate fraud, symptoms are a mixed bag and not treachery and double-dealings. On a holdall. For example, a person the other hand, the average Zuni is may exhibit symptoms of anxiety, friendly, co-operative and peace- depression and obsessiveloving. That is because his deities compulsion all rolled into one. Any are benevolent and his culture attempt to put it in anyone particular encourages peaceful resolution of all pigeon hole may fail. More important than this is the conflicts. Erich Fromm refers to the Manus who are highly competitive need to avoid labeling, either the and drive themselves to despair and symptom or the client. For example, death pushed to the brink by intense the childs enuresis may belong to rivalry towards one another. the revenge type (punishing the Identification of patterns is, thus, very parents) or regressive type (arising important for human beings to from sibling rivalry) or may represent understand one another. To adapt both, usually the last. Let not the Swithun Bowers (who uses the therapist label a boy permanently as following phraseology to define a mother-hater or an exhibitionist social work) pattern detection is an though he manifests these art, based on the knowledge of the tendencies alternatingly. For labeling science of human relations. One may prove to be a self-fulfilling should have some knowledge of the prophecy and turn an one-time Freudian theory, the behavioural offender into an incorrigibly chronic approach and the modern schools of antisocial character. Identification of treatment such as the client-centered patterns is a handy therapeutic tool Rogerian therapy to discern typical but let us guard against its fall patterns of behaviour in our clients. out,namely role inflexibility. Journal of SCHOOL SOCIAL WORK April 2013 02

Casework Intervention for the Hearing Impaired

Sinu E*
*Dr Sinu E, Assistant Professor in Psychiatric Social Work, Department of Psychiatry, Kasturba Medical College, Manipal University, Udupi, Karnataka.

interpersonal problems between his Introduction: An 18 year old girl, a known case daughter and his wife. Casework assessment: of hearing loss in both ears, studied During family casework intake it up to 12th standard, unmarried, went on for graduate course in B.Com. was reported that her hearing in both But, she discontinued in II year ears was apparently normal till the age because of difficulty in following and of seven years. Later, she gradually understanding the class and loss of developed hearing loss after the interest in studies as a result of tonsillectomy. Presently she is able hearing loss and poor interpersonal to speak a few words but could not relationship with teachers and other speak in complete sentence. She students. Presently, she is staying did not get any formal training in sign at home for the last one year and half. language. She understands her She belongs to middle socio- parents through lip-reading. She economic nuclear family living in a wishes to have many friends and semi-urban domicile in Kundapura relatives to talk with her. Because of her hearing loss relatives and Taluk, Udupi District, Karnataka. neighbours did not show interest in Source of referral: She was referred to Social Worker talking to her. In her village houses by a Psychiatrist for family casework were not situated close to each other intervention to address the and are far apart. Hence her only interpersonal problems between social world is restricted to mother child brought by her parents and and father. Her house is very close mother. Social Worker was briefed to national highway and she has to that the mother was over-involved and cross national highway to go to critical towards patient, not letting her market and shops. She could not go out alone and patient also did not travel alone and could not walk in want to stay away from mother even road because she cannot hear for a few minutes. Father used to drink vehicles passing by or coming from alcohol regularly to cope with the behind. So she avoids going outside 19 Journal of SCHOOL SOCIAL WORK April 2013

ISSN: 0976-3759

of the house due to fear of accidents. gets angry and tries to hit them. She Due to hearing loss, she has to be used to break furniture and had accompanied by others; she cannot broken a table fan too. When parents go to any place independently. exclude her from their conversation Family history: she develops suspicion and thinks Patient is born out of non- that her mother is planning to harm consanguineous marriage. Father, 54 her. She had pervasive sadness of years old, is reported to have mood, death wish, a suicidal attempt dependence pattern of drinking for by jumping into nearby well and often the past 25 years. He said that he threatened her family members that drinks alcohol to forget about her she would die by taking tablets. daughters problems; to sleep and Whenever she goes outside she for relaxation. On an average he gets referential ideas that others are consumes 180 ml of alcohol daily. talking about her and referring to her. Patients mother aged 45 years and Her self-care is better; she had a housewife is suffering from impairment in communication, depression and on regular treatment. maintaining interpersonal relationship, There is a family history of suicide in family and social functioning. A maternal uncle. Patients younger diagnosis of moderate depressive brother is studying in 10th standard. episode without somatic symptoms Past history: and impulse control disorder was Patient was brought to psychiatry made department on January 2013 with Referrals: complaints of angry outbursts and During the course of aggressive behaviour for two years hospitalization she was referred to and episode of abnormal voluntary Department of ENT and Department movements of hands with history of Speech Pathology and Audiology. suggestive of possession syndrome She had bilateral hearing loss from (possessed by ghost). She thinks the age of 11 years and was using that if she goes out people would talk hearing aid from the age of 12 years. about her hearing problem and is On examination she was found to also worried that she would not get have recurrent bilateral nasal married. During the course of illness discharge. She underwent her speech became unclear and tonsillectomy at the age of eight years when parents asked to repeat she in Mumbai. Audiometry assessment 20 Journal of SCHOOL SOCIAL WORK April 2013

revealed that she has bilateral profound hearing loss and patient can benefit from the hearing aid. After Audiologists evaluation and advice patient was using behind-the-ear (BTE) digital hearing aid for a few days. She had broken the digital hearing aid twice when she threw the aid in anger. Parents did not get a new digital hearing aid due to the cost involved in it. Patient did not prefer analog hearing aid because others can easily know that she has hearing impairment. Due to the stigma attached to that she preferred to wear the hearing aid inside the canal (ITC) type. But it costs around 1.85 lacs; parents could not afford it. For initial years of hearing loss she was taken to Indian Institute of Speech and Hearing (IISH), Mysore in 2000. She was given free analog hearing aid. Since patient is a female she was not comfortable with analog hearing aid which has to be hung in front. Patient was counselled by speech therapist to use hearing aid and suggested regarding cochlear implant. Patient also underwent trial testing for behindthe-ear Siemens model digital hearing aid. Past psychiatric history: Two years ago patient had history of getting angry very easily, showing her anger to parents and getting

irritated often. Because of these complaints she was taken to a private psychiatrist in 2011 and a diagnosis of Paranoid Schizophrenia was made and was put on antipsychotics. She was taking treatment on out-patient basis. Patients family members were not happy about the treatment because she did not show improvement and her irritable, aggressive and violent behaviour continued. Personal history: There was no problem during pregnancy such as viral infection, drug, physical and emotional trauma. There was no information on Rh compatibility, immunization and health of the mother during pregnancy. Patient was a planned child. She was full term baby and normally delivered in hospital. There was no delay in cry. There was no blueness. There was no information on birth weight. Gender of the child was accepted by both the parents. Gross motor and fine motor activity were normal. Social interaction decreased due to non-availability of members other than family. She wished to have many friends to listen to her and share her problems. Patient is able to read, write, manage money and help her mother in household chores. She prefers to 21 Journal of SCHOOL SOCIAL WORK April 2013

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ISSN: 0976-3759

watch TV and send short messages dependence in father in mobile were her leisure activities. Z91.5 Personal history of self-harm She attained puberty at the age (by jumping in to well) of 13 years. Her menstrual care was Social work treatment: adequate. She reported that her 1. Psychosocial need periods were irregular and weak. assessment revealed that felt She was diagnosed to have need of patient was to continue Oligomenorrhea. her education since she was the Temperament history revealed that topper in her class. She wants patient is timid and irritable. She had hearing aid (ITC type) so that attention-seeking behaviour, attention others cannot identify her as deficits and bedwetting during her hearing impaired. She wants to childhood. Her temperament have friends to communicate at assessment revealed history least over telephone. Patient also suggestive of temperamentally felt that parents avoided her in difficult child. their conversation. Mothers felt Social diagnosis: need was treatment of father for Profound hearing loss in patient alcohol dependence. Parents felt has led to the following psychosocial need was reducing patients problems: irritability and aggressive Z55. Problems related to behaviour. education and literacy 2. Family casework intervention Z56. Problems related to focused on reducing the overunemployment involvement and criticality towards Z60.Target of perceived adverse patient by mother. Education was discrimination and persecution given to mother and father that 24 Z61.3 Events resulting in loss of hours of continuous contact self-esteem in childhood between patient and caregiver Z62.1 Problems related to proved to cause expressed upbringing in terms of parental emotion (EE). Reduction in the over-protection and over contact between caregiver and involvement and criticality patient (separation for six hours Z73.4 Inadequate social skills a day) would help reduce EE. It Z73.5 Social role conflict was not possible with her and so Z81.1 Family history of alcohol the social worker advised to 22 Journal of SCHOOL SOCIAL WORK April 2013

patient to be away from mother for three hours a day by going to market, purchasing groceries, going for a walk in the evening for not less than 30 minutes. 3. Referral service : Father was assessed for alcohol dependence and referred back to psychiatrist for de-addiction treatment. Initially patients father showed resistance to get treated and also said that his body does not accept higher intake. He had already decreased his alcohol but was unable to totally stop. Social Worker motivated the patient by providing personalized feedback for treatment. He was suggested to try out-patient treatment and if it helps in quitting he can continue the treatment. Option was given to him decide. Finally he agreed to try out-patient treatment. Brief motivational techniques were used to motivate the patients father. Before referral affordability of the treatment was ensured. Patients mother said her husband spends daily Rs.100 for drinking and so he can afford Rs.20 daily for tablets to quit. 4.Continuing education through distance mode 5. Family members were advised to include patient in decision

making with regard to the matters concerning her and home and to inform whatever is happening around them so that she may feel wanted. 6. Social worker gave his contact number to contact him in case of emergency of any help. Next follow-up was scheduled after two weeks 7. Telephone follow-up: Social worker followed up the fasther over the phone who reported a decrease in patients irritable and aggressive behaviour and they were giving all the information to patient whatever is happening in their surroundings. All the family members spent time with patient and talked with her. Patients father had not yet started taking deaddiction medicines. 8. Reviewed the awareness and knowledge regarding social welfare measures for persons with hearing impairment with respect to reservation in employment and educational facilities given as social welfare schemes below: Social welfare schemes: Free education is being provided to CWHD till 18 years of age. Three % reservation of seats in favour of the disabled in all normal educational institutions. 23 Journal of SCHOOL SOCIAL WORK April 2013

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ISSN: 0976-3759

Integrated schools for normal and children with special needs under Sarva Siksha Abhiyan (Rajiv Vidya Mission). Hearing impaired candidates studying Intermediate are exempted from Payment of examination fee, 30 minutes extra time at Intermediate Public Examination (I and II Year) and exemption of one language. The qualifying criteria and pass marks in final examinations, VII and X classes are reduced from 35 to 20 (Twenty) marks for all subjects. Residential schools for Children with Hearing Disability (CWHD) under Department of Social Welfare in respective states. Residential Colleges for hearing impairment. Hostel facilities : Residential facilities for students through 40 hostels under disabled Welfare Department and special schools for hearing impairment under Department of school education. Pre-Matric Scholarships : Disabled students studying classes from I to X and whose parents/guardians income is less than Rs.1,00,000/- per annum are sanctioned scholarships and other allowances like transport allowances. Note books to hearing impaired hostel boarders

at a cost of Rs.150/- per boarder per annum. Post-Matric Scholarships : Disabled students studying Intermediate and above classes and whose parental income is less than Rs.1,00.000/- are eligible this scholarship. Books and instruments are supplied to I.T.I and Polytechnic students, whose Parents/guardians income is less than Rs1,00,000/- per annum. Total reimbursement of tuition fees and special fees is provided to the students studying Professional courses like M.B.B.S., B.E., B.Tech, M.B.A., Computer, B.Ed., for A category seats whose parents/guardians income is less than Rs.1,00,000/- per annum. International day of disabled: On third day of December every year games, sports and competitions in skill and talent for disabled are conducted to bring them into the main stream of public life. KGBV Schools for Hearing Impaired girls provide educational benefits at the elementary level to the disabled girls. Hearing Aids are being supplied to the needy. The scheme of Cochlear Implant Surgery has been included in Aarogyasri-I for the benefit of the

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Journal of SCHOOL SOCIAL WORK April 2013

hearing handicapped person This scheme is being sanctioned below six years. in order to enhance employment *Travel: free bus passes to all the opportunities for disabled persons disabled persons irrespective of whose parents/guardians income age to travel within the cty and sub is less than Rs.1,00,000/- per urban areas and 50% annum. concessional pass in all rural * Purchase of petrol/diesel: areas. Disabled persons who are owners *Employment: Reservations of of motorized vehicles and having posts in services and age income up to Rs.24.000/- per relaxation. annum are sanctioned 50% *Economic rehabilitation: Under subsidy on actual expenditure on this scheme, the disabled purchase of petrol / diesel to an persons whose parents/ extent of 15 ltrs for 2 horse power guardians income is less than vehicle and 25 ltrs for more than 2 Rs.11,000/- per annum are horse power vehicle to go to the sanctioned subsidy not place of duty and back to their exceeding Rs.3.000/- per residence. candidate to enable them to make *Pension: Pensions are being a living. sanctioned to persons with *Incentive awards for marriages disabilities irrespective of age between disabled and normal who come under below poverty persons: To promote social line. integration, a sum of Rs.10.000/Conclusion: as cash incentive award is A systematic analysis of the sanctioned to a normal person problem followed by professional marrying a disabled person whose intervention resulted in improvement disability is atleast 40%. of the patients overall wellbeing and *Coaching for typewriting and information about schemes available shorthand examinations and for the hearing impoaired had other competitive examinations: empowered her. Focus for Future May 2013 HSE: Dr Amali Megala CONTROL Vs. AUTONOMY Contributors are requested send a e-copy to jssw.india@gmail.com and post two hard copies and CD on or before 21st April 2013. ~Ed. 25 Journal of SCHOOL SOCIAL WORK April 2013

ISSN: 0976-3759

ISSN: 0976-3759

ISSN: 0976-3759

This article can be quoted as: Dr Sinu E (2013): Casework Intervention for the Hearing Impaired. Journal of School Social Work, IX-11 pp19-26.

If any text is taken verbatim in the article it can be quoted as ....... (Sinu E, 2013)

Journal of SCHOOL SOCIAL WORK April 2013

Journal of SCHOOL SOCIAL WORK April 2013