A case study on a domestic violence intervention

Working with Individuals

AGENCY PROFILE

The student social worker is placed with Bharatiya Mahila Federation (BMF). Bharatiya Mahila Federation (BMF) is an all-India organization women’s mass organization, working with the victims of Domestic Violence. BMF was established by many leaders including Aruna Asaf Ali. Mahila Samasya Nivaaran Kendras (Family Counseling Centers for Women) are located in Thane, Kalyan, and Bhiwandi. In the purview of socially relevant issues, it also takes care of the education of the slum children through a non-formal approach towards education, under the name of ‘Disha Classes’. BMF has vigorously campaigned against female foeticide. It is also working in tandem with Malati Vaidya Trust to start a Resource Center in Ganeshwadi, Badlapur.

The student works with the Family Counselling Center in Thane. The center is run by para-professionals, some of whom were themselves victims at some point in time.

CASE

For the purpose of explanation of the various aspects of working with individuals, the student will like to mention the case of a 30 year old women named Sanaa (name changed). Sanaa is Muslim by religion and was married off at the age of 26 as her husband’s second wife. He remarried after giving divorce to his first wife. Sanaa is residing with her parents, brother and sister-in-law in Mumbra. She has four children. The first two are twin daughters and one of them named Aalia(name changed) is intellectually challenged because of the injuries inflicted on Sanaa during pregnancy. The other daughter named Nazia was forcefully taken away by her father Khalid with him since unlike the first daughter she is normal. Clearly, the father has left the entire responsibility of the child who is intellectually- challenged on the mother, without giving any maintenance from his side. The third child, who is a boy, Naseer (name changed), is physically challenged and can’t walk normally. The fourth child, Ali, is 7 months and is chronically ill has been hospitalized many times.

Sanaa approached the agency’s Family Counselling Centre. She complained of being beaten up by her husband, brother-in-law and sister-in-law and the atrocities committed against her at the time of her pregnancy. Due to the injuries, she had a miscarriage the first time she got pregnant.

The agency wanted the trainee to do a home-visit and verify the facts. The home visit revealed that the client is staying in a chawl in unhygienic conditions. The trainee interviewed the client and her mother. Her husband has refused to accept her and the children back and wants a divorce, but Sanaa wants to stay with him. Her husband has put a condition that he will let her come back only if she and her family give in writing that they will not file a police complaint against him and will not approach any NGO/agency for further help as they did earlier. Sanaa wants to be with him despite all the physical and mental tortures that her husband makes her go through. She does not wish to burden her parents with her and her children’s responsibility. As far as her education his concerned, she has obtained education till the secondary level. Before marriage, she used to teach kids of the primary level. The trainee tried to counsel her that staying with her husband would not change her conditions. Instead she should file a case on him demanding maintenance for herself and her kids. The trainee also suggested that she takes up a job. Before a case could be filed, the trainee paid a visit to her husband to come for a meeting at the agency but he refused to all efforts of negotiation and said that he will confront her directly in the court.

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Later on, when the student called her up to know her decision about filing the case, she said she was ready to go ahead with it. Hence, she was asked to come for the meeting with the agency’s advocate on the given date. The advocate asked the trainee to submit Sanaa’s case history so that the petition could be filed in the court.

The student social worker also figured out that Sanaa’s case has a lot of scope of medical intervention apart from assistance at the legal level. While the trainee was planning the further course of action for the case, the client took up a teaching job in a neighbourhood school in her locality. This indeed came as a happy news for the trainee as it reflected that mere triggering an idea can actually motivate the client to help herself. The client was also encouraged to further continue her studies.

For the medical help for Sanaa’s kids, the trainee decided to take them to a BMC Hospital. After waiting in the queue for two-and-half hours outside the OPD for Skin Diseases, Naseer was diagnosed, medicines were prescribed and the doctor asked to bring him in the coming week for follow-up. The prescribed medicines were not available in the hospital’s pharmacy. So, the medicines were bought from outside. Naseer was also examined for his swollen abdomen. The doctor told that there is a doubt of him suffering from Langerhans cell Histiocytosis (LCH) and hence he needs to be admitted. Sanaa was apprehensive about admitting Naseer, since she would not be able to afford it. The trainee could observe an expression of fear on her face. It was time for the trainee to counsel her about the urgent need to get her son admitted. On the way back home, while talking to the client, the trainee found out that Sanaa’s mother wants her to quit the teaching job since its taking a lot of her time and it becomes difficult for her mother to handle three kids when Sanaa’s is out for work in the afternoon school. As an alternative, her mother had suggested her to take up tailoring work. For the same, she expressed the need for a sewing machine.

So now, there was a need to look for a donor for Naseer’s treatment and for the machine. The supervisor suggested that Sanaa’s case can be referred to another organization who is involved into such kind of work. After brainstorming, the trainee decided to refer Sanaa’s case to MESCO – an organization in Mumbra.

The visit to MESCO turned out to be quite fruitful. In the meeting with its representatives, it was planned that the after submitting required documents the financial assistance would be provided for Naseer’s treatment. However, one constraint was that MESCO provides help only on first three days of every month so the trainee had to really pace up the process of arranging all the documents. For Sanaa’s tailoring venture, the representative mentioned that she will have to appear for a skill test after which she would be given a sewing machine.

The documentation process can actually kill a lot of time and the trainee already had limited one in hand, since the end of the field work for the year was approaching. After running from post-to-post for one signature from the doctor at the hospital, trainee had a cost certificate in hand which turned out to be of no use since the social worker at the hospital asked to get another one for the total estimated cost of treatment, running around for which was postponed to another week by the doctor. In the meantime, the student was struggling with herself as to find a way to convince the client to get her son admitted. Every week he was falling ill and the medicine for the skin disease seemed to have an effect only in the first week. Follow-ups to the doctor after that did not make much of a difference. This led the trainee to ponder as to why this was happening and the speculation was that it is possible that the skin disease could be a symptom of LCH. After reading up on LCH, the doubt was confirmed. For weeks, Naseer was being treated for the symptom! But now the field work year was over! So what should one do in such a situation? The client cannot be left midway in the helping process. It raises a lot of ethical issues.

STAGES IN WORKING WITH INDIVIDUALS

1. Social Study 2. Social Assessment 3. Intervention 4. Termination 5. Evaluation

The initial description of the case is clearly a Social Study of Sanaa’s case. Social Study is a systematic study of the client and her/his circumstances in relation to her/his problem Information is collected and organised with regard to the following: Problems (the initially stated problem and associated problems if any), Age, sex, marital status, Educational qualification, Nature of employment, income, Health conditions, Personality features, Home and neighbourhood, Family constellation, Family history (significant events, attitudes,relationships, etc.). Sanaa’s case was constantly assessed for the purpose of necessary intervention. Each course of action had to be simultaneously evaluated to check for loopholes. However, the case cannot be called to have reached the termination. But the intervention done so far has proved to be be fruitful to the extent that Sanaa took up a job on her when encouraged and motivated. The trainee could locate an organization who could provide her with a machine for starting tailoring work and fund the treatment of her child. Naseer did receive some OPD treatment, which revealed the need for a long term treatment. The trainee was also able to facilitate the process of providing legal assistance to the client.

TOOLS & TECHNIQUES

Tools can be defined as the ways through which a particular profession, occupation or form of trade is practiced. In social casework, tools are the means of establishing and developing contact with the clients. Through casework tools, one can have access to the information about the client, her concerns, her family, her environment. The student made use of all the five casework tools, namely, Listening, Observation, Relationship, Home-Visit and Interview. According to Grace Mathew, the last three tools mentioned here, are the channels to make the casework techniques operative. Mathew has defined casework techniques as the systematic procedures of helping. These are- Acceptance, Assurance, Facilitation of Expression of Feelings, ,Allaying overpowering feelings, Accrediting and Building Self-Confidence, Encouragement and Reassurance, Being with the Client, Emotional Support, Action-Oriented Support. Then Grace Mathew listed down certain other techniques for the purpose of enhancing resources. These are – Providing or Procuring Material Help, Change of Physical Environment, Enhancing Information and Knowledge. There are also techniques for changing the internal processes- Counselling techniques (Reflective Discussion, Advice, Motivation, Clarification, and Correcting Perception), Anticipatory Guidance, Modelling, Role Playing, Reality Orientation, Remove Guilt Feelings and using them constructively, Interpretation, Partialisation, Universalisation, Setting Limits, Confrontation, Reaching Out, Renewing Family Links, Improving Communication Patterns, Changing Attitudes.

Listening as a tool is effective only if it is active and attentive to understand the client’s emotions and to know what she/he is conveying. Effective listening is facilitated by maintaining an eye contact with the client. Distractions, wool gathering and selective listening obstruct the listening process.

Observation is used in casework to note the client’s facial expression, body language and signs of uneasiness in the process of interaction with the client.

Relationship between the worker an the client is a professional one and is positive in nature. The positivity of the relationship is manifest in the rapport the caseworker has with the client.

Home Visit is an instrument, which enables the social worker to verify the facts of the case being handled. It also conveys a message to the client about the social worker’s interest in his/her welfare. Sometimes home-visits can be be highly revealing and at times, may change the shape of the course. The facts me be turned upside down.

Interview facilitates face-to-face interaction between the caseworker and the client. The objectives in such an interaction are to obtain information from the client or to impart some to the client, to study and assess the situation of the client’s problem unique to her/him and to give assistance.

Drawing from the above case, first of all the caseworker had to evoke the confidence of the client since the constant victimization to the domestic violence had made her doubt her own capabilities. The client had to be told that she can regain her lost confidence by keeping herself busy and taking up a job. She was encouraged and motivated enough to take up the teaching job again. The caseworker has been working towards making provision for material help for the treatment of kids and for the required equipment so that she can take up tailoring work at home. The caseworker did a lot of advocacy work in Sanaa’s case such as visiting the hospital for procuring the certificate, meeting with the referral organization’s representatives for seeking financial assistance for the client. Many counseling techniques as Correcting Perception, Advice, Removing Guilt Feelings, Universalisation were made use of. In the beginning, when the Home-Visit was made the caseworker advised Sanaa on the way to come out of her situation, how the agency would facilitate the process. When her son was taken for treatment, so due to waiting in the long queues and the whole documentation process of OPD treatment, Sanaa started feeling

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guilty that why did she marry in the first place, had she not married she would not have had to face such problems. In such a situation, she had to be told that marriage was not the fault and she does not need to be guilty about something for which she is not responsible. She was married off to a man, the background and other details of whom were not at all confirmed by her family. As it came to the caseworker’s amazement while talking to the client’s mother, the latter used to see a girl frequently in the locality and got acquainted with her and on her proposal, married off her daughter to her brother. When the caseworker asked the client to get an income proof from her school, without which she would not have received financial assistance from the referral organization, she did not do so for weeks despite repeated reminders. The social worker had to then step in and find out what the matter was and what came out was that she had a misconception about it. The client thought that if she would submit an income proof, then she would not be provided any help since, according to her, they may think if she is earning then she does not need help. The caseworker then had to correct her perception that the income proof is a formality and because her income is meager to afford the treatment of her son she would definitely be provided with financial assistance. Once the client was very thwarted with herself. At that time, the caseworker brought to light the examples of many other woman who have been and who are in worse situation than hers.

THEORETICAL APPROACHES USED

The student trainee made use of the Empowerment and Advocacy Approach. It has been said that empowerment seeks to help clients gain power of decision and action over their own lives by reducing the effect of social or personal blocks to existing power, by increasing capacity and self-confidence to use power and by transferring power from the environment to clients. Advocacy seeks to represent the interests of the powerless clients to powerful individuals and structures. For Furlong, empowerment is an essential objective of casework because it avoids a crude polarization of social action and individualized perspectives, placing work with individuals and families in a context of concern for social objectives. In 1994, Anderson et al, presented a model of empowerment for social development in Africa concerned with the five dimensions of practice: personal, social, educational, economic and political. These dimensions are intertwined with each other and looking at them so allows people to meet individual needs (personal power), improve their capacity to influence others (interpersonal power), which in turn creates an ability to influence the power distribution more widely (political power). Rees came up with a set of ideas with regard to empowerment, viz., a) biography b) power c) Political understanding d) Skills e) Interdependence of Policy and Practice. For Rees, the basic aim of empowerment is social justice, greater security, political and social equality to people, through mutual support and shared learning. Kondrat emphasized upon the value of local knowledge, specifically the one coming from the clients. One intricacy of advocacy lies in the duality of its interrelated meanings of ‘representation’. The representation in advocacy is in term of the acting and arguing for the interests of the clients. However, for Phillip (1979), advocacy entails ‘representation’ in terms of interpreting and displaying the value of clients to the powerful groups in the society. Advocacy, in part, is said to be an aspect of empowerment, since it can be used to argue for resources, or change the interpretation which powerful groups make of clients. Anderson’s model of empowerment was crucial for application in Sanaa’s case, since socio-economic, personal and educational aspects were focused upon at the level of assessment as well as intervention.

The caseworker also made use of Rees’s understanding of empowerment in terms of the Skill enhancement. The client’s tailoring skills was tapped on to enable her choose a suitable livelihood option. Advocacy work was also done by initiating the process of legal assistance and facilitating the process of financial assistance by MESCO.

CHALLENGES, DILEMMAS & RESISTANCE

One of the challenges encountered was that not all three kids could be taken for consultation together since no one from the client’s family could accompany her to the hospital. So there was a lack in terms of human resources. Social Case Work Practice is a huge responsibility, especially when any form of medical intervention is involved, especially, when one’s target system involves infants. Another challenge was the unavailability of the prescribed medicines in municipal hospital’s pharmacy. Those who cannot afford to buy the expensive medicines from outside are not even able to start the treatment. At the macro level, this remains a big loophole in the health care sector of the country. It is an obstacle for the low-income group in accessing health care services. This also paralyses the government health care sector at a very basic level. Looking for a donor or an organisation where Sanaa’s case could be referred for another challenge.

The biggest ethical dilemma was about the leaving the treatment process midway. The follow-up in the case is being planned to overcome the dilemma.

The client has been very resistant to the idea of admitting the child in the hospital despite repeated reassurance that the financial assistance would be taken care of.