dr e sinu: casework intervention for the hearing impaired

7/28/2019 Dr E Sinu: Casework Intervention for the Hearing Impaired

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Journal of SCHOOL SOCIAL WORK April 2013Journal of SCHOOL SOCIAL WORK April 2013

ISSN: 0976-3759 ISSN: 0976-3759


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ISSN: 0976-3759 ISSN: 0976-3759

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A National School Social Work monthly dedicated to networking of parents and teachers.

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Journal of School Social Work,8 (New 14), Sridevi Colony,

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Focus: Pattern Recognition

Honorary Special Editor:

Dr Rajendrakumar, Chairperson,

Department of Social Work,

Bangalore University, Jnana Bharathi Campus,

Bangalore

C o n t e n t sVolume IX Issue 11 A p r i l 2 0 1 3 Page

Editorial Prof Visvesvaran P K 02

Patterns of Power Struggle and

Remedy at Hand Dr Vijayalakshmi V 03

Pattern Recognition: A Challenge before

Parents Prof Visvesvaran P K 11

Typical Relationship Patterns in Families Naidu P J 13

Concept Paper on Control Vs. Autunomy 17

Casework Intervention for the Hearing ImpairedDr Sinu E 19

Changing Patterns in Daily Routine among

Urban Commuters Sandhya Rani P J

Nafisa Khan and Dr Charumathi P J 27

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Introduction:

An 18 year old girl, a known case

of hearing loss in both ears, studiedup to 12th standard, unmarried, went

on for graduate course in B.Com.

But, she discontinued in II year

because of difficulty in following and

understanding the class and loss of

interest in studies as a result of

hearing loss and poor interpersonal

relationship with teachers and other

students. Presently, she is staying

at home for the last one year and half.She belongs to middle socio-

economic nuclear family living in a

semi-urban domicile in Kundapura

Taluk, Udupi District, Karnataka.

Source of referral:

She was referred to Social Worker

by a Psychiatrist for family casework

intervention to address the

interpersonal problems between

child brought by her parents andmother. Social Worker was briefed

that the mother was over-involved and

critical towards patient, not letting her

go out alone and patient also did not

want to stay away from mother even

for a few minutes. Father used to dr ink

alcohol regularly to cope with the

interpersonal problems between his

daughter and his wife.

Casework assessment:During family casework intake it

was reported that her hearing in both

ears was apparently normal till the age

of seven years. Later, she gradually

developed hearing loss after the

tonsillectomy. Presently she is able

to speak a few words but could not

speak in complete sentence. She

did not get any formal training in sign

language. She understands herparents through lip-reading. She

wishes to have many friends and

relatives to talk with her. Because of

her hearing loss relatives and

neighbours did not show interest in

talking to her. In her village houses

were not situated close to each other

and are far apart. Hence her only

social world is restricted to mother

and father. Her house is very closeto national highway and she has to

cross national highway to go to

market and shops. She could not

travel alone and could not walk in

road because she cannot hear

vehicles passing by or coming from

behind. So she avoids going outside

Casework Intervention for

the Hearing ImpairedSinu E*

*Dr Sinu E, Assistant Professor in Psychiatric Social Work, Department of

Psychiatry, Kasturba Medical College, Manipal University, Udupi, Karnataka.

02

Editorial

Ruth Benedict in her

anthropological masterpiece

Patterns of Culture identifies the

modal personalities in different

societies. The typical Dobuan

suffers from chronic anxiety, hostility

and paranoia. His gods are hostile

beings and all social relationships are

characterized by deliberate fraud,

treachery and double-dealings. On

the other hand, the average Zuni is

friendly, co-operative and peace-

loving. That is because his deities

are benevolent and his culture

encourages peaceful resolution of all

conflicts. Erich Fromm refers to the

Manus who are highly competitiveand drive themselves to despair and

death pushed to the brink by intense

rivalry towards one another.

Identification of patterns is, thus, very

important for human beings to

understand one another. To adapt

Swithun Bowers (who uses the

following phraseology to define

social work) pattern detection is an

art, based on the knowledge of thescience of human relations. One

should have some knowledge of the

Freudian theory, the behavioural

approach and the modern schools of

treatment such as the client-centered

Rogerian therapy to discern typical

patterns of behaviour in our clients.

Identification is, however, only the

first step and is not a solution by itself.

Also, any diagnosis is only tentative

and the therapist should have an

open mind to revise his views as he

goes along and as new facts come

up.

A corollary to this is the fact that

symptoms are a mixed bag and not

a holdall. For example, a person

may exhibit symptoms of anxiety,

depression and obsessive-

compulsion all rolled into one. Any

attempt to put it in anyone particular

pigeon hole may fail.

More important than this is the

need to avoid labeling, either thesymptom or the client. For example,

the childs enuresis may belong to

the revenge type (punishing the

parents) or regressive type (arising

from sibling rivalry) or may represent

both, usually the last. Let not the

therapist label a boy permanently as

a mother-hater or an exhibitionist

though he manifests these

tendencies alternatingly. For labelingmay prove to be a self-fulfilling

prophecy and turn an one-time

offender into an incorrigibly chronic

antisocial character. Identification of

patterns is a handy therapeutic tool

but let us guard against its fall

out,namely role inflexibility.

Pattern? Yes! Rigidity ? No!


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o

f the house due to fear of accidents.

Due to hearing loss, she has to be

accompanied by others; she cannot

go to any place independently.

Family history:

Patient is born out of non-

consanguineous marriage. Father, 54

years old, is reported to havedependence pattern of drinking for

the past 25 years. He said that he

drinks alcohol to forget about her

daughters problems; to sleep and

for relaxation. On an average he

consumes 180 ml of alcohol daily.

Patients mother aged 45 years and

a housewife is suffering from

depression and on regular treatment.

There is a family history of suicide inmaternal uncle. Patients younger

brother is studying in 10th standard.

Past history:

Patient was brought to psychiatry

department on January 2013 with

complaints of angry outbursts and

aggressive behaviour for two years

and episode of abnormal voluntary

movements of hands with history

suggestive of possession syndrome

(possessed by ghost). She thinks

that if she goes out people would talk

about her hearing problem and is

also worried that she would not get

married. During the course of illness

her speech became unclear and

when parents asked to repeat she

gets angry and tries to hit them. She

used to break furniture and had

broken a table fan too. When parents

exclude her from their conversation

she develops suspicion and thinks

that her mother is planning to harm

her. She had pervasive sadness of

mood, death wish, a suicidal attemptby jumping into nearby well and often

threatened her family members that

she would die by taking tablets.

Whenever she goes outside she

gets referential ideas that others are

talking about her and referring to her.

Her self-care is better; she had

impairment in communication,

maintaining interpersonal relationship,

family and social functioning. Adiagnosis of moderate depressive

episode without somatic symptoms

and impulse control disorder was

made

Referrals:

During the course of

hospitalization she was referred to

Department of ENT and Department

of Speech Pathology and Audiology.

She had bilateral hearing loss from

the age of 11 years and was using

hearing aid from the age of 12 years.

On examination she was found to

have recurrent bilateral nasal

discharge. She underwent

tonsillectomy at the age of eight years

in Mumbai. Audiometry assessment

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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 theaid 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 initialyears 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 behind-

the-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 anti-

psychotics. She was taking treatment

on out-patient basis. Patients family

members were not happy about thetreatment 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 healthof 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


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watc

h TV and send short messages

in mobile were her leisure activities.

She attained puberty at the age

of 13 years. Her menstrual care was

adequate. She reported that her

periods were irregular and weak.

She was diagnosed to have

Oligomenorrhea.Temperament history revealed that

patient is timid and irritable. She had

attention-seeking behaviour, attention

deficits and bedwetting during her

childhood. Her temperament

assessment revealed history

suggestive of temperamentally

difficult child.

Social diagnosis:

Profound hearing loss in patienthas led to the following psychosocial

problems:

Z55. Problems related to

education and literacy

Z56. Problems related to

unemployment

Z60.Target of perceived adverse

discrimination and persecution

Z61.3 Events resulting in loss of

self-esteem in childhood

Z62.1 Problems related to

upbringing in terms of parental

over-protection and over

involvement and criticality

Z73.4 Inadequate social skills

Z73.5 Social role conflict

Z81.1 Family history of alcohol

dependence in father

Z91.5 Personal history of self-harm

(by jumping in to well)

Social work treatment:

1. Psychosocial need

assessment revealed that felt

need of patient was to continue

her education since she was thetopper in her class. She wants

hearing aid (ITC type) so that

others cannot identify her as

hearing impaired. She wants to

have friends to communicate at

least over telephone. Patient also

felt that parents avoided her in

their conversation. Mothers felt

need was treatment of father for

alcohol dependence. Parents feltneed was reducing patients

irritability and aggressive

behaviour.

2. Family casework intervention

focused on reducing the over-

involvement and criticality towards

patient by mother. Education was

given to mother and father that 24

hours of continuous contact

between patient and caregiver

proved to cause expressed

emotion (EE). Reduction in the

contact between caregiver and

patient (separation for six hours

a day) would help reduce EE. It

was not possible with her and so

the social worker advised to

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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 topsychiatrist 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 suggestedto 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. Nextfollow-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 familymembers spent time with patient

and talked with her. Patients father

had not yet started taking de-

addiction 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.


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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 PublicExamination (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 andinstruments 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 whoseparents/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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hearing handicapped person

below six years.

*Travel: free bus passes to all the

disabled persons irrespective of

age to travel within the cty and sub

urban areas and 50%

concessional pass in all rural

areas.*Employment: Reservations of

posts in services and age

relaxation.

*Economic rehabilitation: Under

this scheme, the disabled

persons whose parents/

guardians income is less than

Rs.11,000/- per annum are

sanctioned subsidy not

exceeding Rs.3.000/- percandidate to enable them to make

a living.

*Incentive awards for marriages

between disabled and normal

persons: To promote social

integration, a sum of Rs.10.000/-

as cash incentive award is

sanctioned to a normal person

marrying a disabled person whose

disability is atleast 40%.

*Coaching for typewriting and

shorthand examinations and

other competitive examinations:

This scheme is being sanctioned

in order to enhance employment

opportunities for disabled persons

whose parents/guardians income

is less than Rs.1,00,000/- per

annum.

*Purchase of petrol/diesel:

Disabled persons who are ownersof motorized vehicles and having

income up to Rs.24.000/- per

annum are sanctioned 50%

subsidy on actual expenditure on

purchase of petrol / diesel to an

extent of 15 ltrs for 2 horse power

vehicle and 25 ltrs for more than 2

horse power vehicle to go to the

place of duty and back to their

residence.*Pension: Pensions are being

sanctioned to persons with

disabilities irrespective of age

who come under below poverty

line.

Conclusion:

A systemati c ana lysi s of the

problem followed by professional

intervention resulted in improvement

of the patients overall wellbeing and

information about schemes available

for the hearing impoaired had

empowered her.

Focus for Future

May 2013 HSE: Dr Amali Megala CONTROL Vs. AUTONOMY

Contributors are requested send a e-copy to [email protected] and

post two hard copies and CD on or before 21st April 2013. ~Ed.


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ISSN: 0976-3759 ISSN: 0976-3759

This article can be quoted as:

Dr Sinu E (2013): Casework Intervention for theHearing 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)

dr e sinu: casework intervention for the hearing impaired

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