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Archive for the ‘
How Social Workers Help ’ Category
Introduction
“To care for him who shall have borne the battle and for his widow and his orphan" were the words spoken by President Lincoln in his Second Inaugural Address that serve as the foundation for the primary mission of the Department of Veteran Affairs ("Mission, Vision, Core Values & Goals", 1996). They are a reminder of our government's privileged responsibility to provide the highest quality medical and psychosocial care for our nation's veterans and their families.
Today, the Veteran's Health Administration (VHA) is the largest integrated healthcare system in the nation and serves as the largest single employer of master's prepared social workers ("VHA Programs & Organizations", 1996 & "Social Work Awards", 2006). VA social workers proudly serve veterans in every veteran hospital, community based clinic and vet center. "The mission of Social Work is to eliminate psychosocial complications as significant barriers to healthcare interventions for veterans and families. This is accomplished by developing and maintaining integrated quality programs in patient care, research, education and prevention." ("VA Social Work Mission, Vision and Values", 2006).
Quality health care is one of the major benefits among many made available to our nation's heroes through the Department of Veteran Affairs. According to VHA eligibility guidelines, any honorably discharged armed services member is potentially eligible for VA health care. A standard medical benefits package is accessible to all veterans who enroll to include preventative care, outpatient diagnostics and treatment services, in-patient diagnostics and treatment services, as well as medications and medical supplies. Although there is no monthly premium required for VA health care services, veterans are subject to a co- pay. However, depending on their unique eligibility and income level many veterans are eligible to receive cost-free medical care. The VA utilizes a priority system to ensure veterans with service connected disabilities and those with low income are able to enroll and receive medical attention ("VA Health Care Eligibility", 2006).
Every veteran who receives his or her care through a VHA facility is assigned to a primary care team that typically includes a physician or physician assistant, a registered nurse, a pharmacist and a social worker. Social workers play a critical role as interdisciplinary treatment team members in the delivery of clinical services to disabled veterans. VA social workers assist in the identification and treatment of the complex needs and problems faced by disabled veterans and their families. As noted by the U.S. Department of Health and Human Services, eligible disabled veterans have access to a wide-ranging variety of specialty care services including state-of-the-art treatment and services for spinal cord injury, blind rehabilitation, chronic mental illness, traumatic brain injury, amputations, brain dysfunction, post-traumatic stress disorder (PTSD), and substance abuse treatment programs as well as geriatric medicine and hospice care ("Delivering on the Promise", 2002). Social workers are often the gatekeepers to these specialty programs through education and referrals.
Social workers also serve outside of primary care specializing in various treatment areas such as oncology, military sexual trauma, substance abuse, psychosocial rehabilitation, and other specialties. Medical social work interventions are largely focused on helping patients and their families to achieve more adequate, satisfying and productive emotional and social functioning as it relates to their medical problems. Social workers treat and counsel patients to cope with acute illness, chronic illness, mental illness, disabilities, community placements, addictions, home care, homelessness, and transitional adjustment periods among varying levels of care. Social workers coordinate VA and non-VA resources to ensure that veterans have access and choice among programs and services. Social workers provide professional clinical services to disabled veterans across all patient settings and ensure continuity of care.
Social workers strive to provide "Seamless Transition" services to eligible returning veterans of Operation Enduring Freedom and Operation Iraqi Freedom by providing education, resources and case management services to assist with the transition to civilian life and to ensure medical and mental health care services are made available to them in a timely manner. Social workers seek to educate and empower all enrolled disabled veterans and their family members so that they can make informed choices about their medical care and the many benefits available to them. Social workers build trusting relationships with their patients and often serve as liaisons between the VHA facility and outside community agencies by advocating for supportive programming with the least restrictive measures to maximize the veteran's independence.
VHA social workers can be found assisting veterans and their families in and outside of the VA in their communities. Many VHA social workers have received disaster relief training by agencies such as the American Red Cross and voluntarily deploy to serve as first responders to local and national crises such as the Oklahoma City bombing, September 11th, and Hurricane Katrina (Manske, 2006). Some VHA social workers serve as adjunct professors at universities, several have written professional articles and authored books and many volunteer for community agencies such as the United Way of America or Boys and Girls Clubs of America. Many social workers serve on professional boards and community agency councils. Moreover, some VHA social workers are veterans themselves or actively serve in the military reserves.
VHA social workers have the opportunity to obtain clinical licensure supervision, mentor social work students, participate in national social work committees, attend leadership trainings, conduct clinical research, and attend national educational trainings. There are also national mobility and executive career advancement opportunities. Competitive salary and excellent benefits are also provided to attract graduate prepared and experienced social work clinicians. Above all, VHA provides social workers with the distinct opportunity of public service.
Social work as a profession is founded on a unique set of core values that guide the practice today for more than 100 years: social justice, dignity and worth of the person, importance of human relationships, integrity and competence (2002, NASW Inc.) Everyday more than 4,400 competent and compassionate VHA social workers strive to provide hope, help and opportunities for change and healing to the brave men, women and their families of the armed services. VHA social workers are truly "The Human Touch in Healthcare".
References
Department of Veteran Affairs. (February, 1996). Mission, Vision, Core Values & Goals.
Retrieved May 8, 2006, from http://www.va.gov/about_va/mission.asp
Department of Veteran Affairs. (March, 2006). Social Work Awards.
Retrieved May 8, 2006, from http://www1.va.gov/socialwork/page.cfm?pg=11
Department of Veteran Affairs. (April, 2006). VA Health Care Eligibility.
Retrieved May 8, 2006 from http://www.va.gov/healtheligibility/HECHome.htm
Department of Veteran Affairs. (March, 2006). VA Social Work Mission, Vision and Values.
Retrieved May 8th 2006 from http://www1.va.gov/socialwork/page.cfm?pg=1
Department of Veteran Affairs. (April, 2006). VHA Programs & Organizations. Retrieved May 8th 2006 from http://www1.va.gov/health/gateway.html
Manske, Jill (2006, January). Social Workers Meeting the Challenge. (Synergy).
The Power of Social Work. (2002). National Association of Social Workers Inc
U.S. Department of Health & Human Services (April, 2002). Delivering on the Promise.
Retrieved May 8, 2006 from http://www.hhs.gov/newfreedom/final/vavha.html
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Introduction
Dr. Bernard J. Baca is a marital/couple therapist and educator with over 21 years of psychotherapy experience. He is a certified Couples Imago Therapist and Couple’s Imago Workshop Presenter. Dr. Baca specializes in marital and couple’s therapy, has conducted national workshops on marital therapy, is licensed in clinical social work, and holds a doctorate in clinical psychology. His psychotherapy practice is located in Indianapolis, IN.
Q. What is envy and are some people more susceptible to it than others?
Envy is is the feeling of displeasure and ill will at the (perceived) superiority of another in happiness, success, reputation, or the possession of anything desirable. Envy contains feelings of inferiority as well as spite — a wish to destroy the coveted assets. Scarcity and comparison exist in all people. It is based on our old brain stem automatic response of kill or be killed. Therefore, envy which is based on a comparison resulting in perceived insufficiency is present in all people.
Q. What are ways in which envy is played in family dynamics?
When anyone in the family, be it father, mother, siblings feel that they are perceived as less than another (due to gender, age, family order, profession, etc.) then envy is present. Ultimately, one tries to redistribute this perceived inequity, and spite is the method used to redistribute. This can be accomplished by making the other "better", "worse than", the self better than, or worse than, and other methods. The end result is that ultimately when one destroys the desired object, the self is injured. So all envy is ultimately self envy.
Q. How can a therapist help a couple/family that is being negatively affected by envy?
The therapist must recognize that by definition, "helping another" even therapeutically is an intrinsic disparity between the client and the therapist (usually the latter is somehow "better" than the former as they are the therapist and not the client). This sets up envy for both the client(s) and the therapist.
For example, if the couples’ therapist favors one person over the other, this sets up and reinforces envy. Whether or not either is "better than their partner—even in a pathological way", this simply isn't true from any objective sources (and there are no objective sources anywhere), people feel this and then react by either making themselves better or the other worse. Then the therapist can intervene successfully but either interpreting their client(s)' own envy toward themselves or the therapist.
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The professional mission of school social worker is to help parents with their family concerns, students with their personal issues, and teachers with their instruction. The school social worker helps by listening closely to students and adults who may have experienced very troubling circumstances at home or in school. The work of the school social worker also includes policy and program development.
The school social worker is professionally prepared to understand and respond to the many problems which people may have. These problems are typically related to life experiences that were or are emotionally very hurtful events. Intensely-felt guilt, shame, embarrassment, frustration, or anger can lead anyone to intensely-felt emotions of insecurity, fearfulness, depression, helplessness, hopelessness, or even futurelessness.
These feelings and emotional states within school children can be expressed in a variety of ways that interfere with learning and cause inappropriate behavior in school. Such children may appear to be very active, highly distractible or impulsive. They may also have difficulty with paying attention, concentrating, and controlling their behavior in the classroom or anywhere else in school.
Students rebuild their self-worth, self-control, and self-confidence by speaking with the school social worker. With unique clinical expertise, the school social worker provides the type of counseling that helps students feel trust, hope, and empathy while learning coping skills. Such counseling will yield students who have deeper awareness of their own feelings and those of other's to feel emotionally secure and safe at school.
The day begins when the school social worker awakens and is preparing to go to work. Ever mindful of each case's unique demands, the preparation is one of thinking about problem-solving, and being solution-oriented. It's a rare day when a parent isn't in the parking lot or a teacher outside the classroom door, waiting for the school social worker to arrive.
Once the school social worker arrives in the office, it's expected that messages will be received from the secretary, all marked "urgent." It is common for the school social worker arriving at the office, to find a teacher or parent waiting to consult without an appointment. A quick glance at the appointment calendar may reveal a fully scheduled day.
The school social worker must listen and make a swift decision as how to respond most efficaciously to the parent and/or teacher. Appointments have a way of expanding beyond the limited time scheduled which requires the school social worker to decide if and when to schedule a follow-up appointment. Time is always the most precious resource for a school social worker.
Emergencies arise which can disrupt a schedule and consume a tremendous amount of time such as when, responding to a suicidal situation or to a crisis intervention. These situations typically involve parental notification and the development of a plan of action. The school social worker is responsible to follow protocol, hurdle over bureaucratic obstacles, and have emergency resource made available.
The school social worker has an ethical obligation to document all such activities, citing date, presenting problem, parties participating, and immediate outcomes with specific recommendations. Schedules need to be revised, albeit, an irritating source of annoyance for parents who perceive own their situations as equally important and no less critical.
As the day proceeds, student problems may be related to problems in school policy, practices or procedures. The school social worker needs to be sufficiently familiar with them to advise administration how some modification or revision of them is required. This type of advising-giving typifies the advocacy role that school social workers have and act upon to improve the learning opportunity for students.
At departmental or faculty meetings, the school social worker reaffirms the advocacy role to improve the school's responsiveness to parent, student and teacher needs. The school social worker must be able to speak persuasively to gain the staff's and administration's support. Being able to field questions with convincing rationale and substantive research data is paramount to establishing credibility as a change agent.
The school social worker is a member of the interdisciplinary child study team, along with learning disabilities-teacher consultants and school psychologists. They work together to evaluate students who may be educationally disabled and develop special individualized education programs for them. The better functioning teams have a genuine respect and positive regard for each other and their respective expertise.
The school social worker's assessment provides an appreciation of the student's life as viewed by the parents and the student, and, evaluates the student's mental health status. Educational assessment focuses primarily on the student's academic level of performance relative to the student's age and grade placement. The school psychologist provides an assessment of the student's cognitive functioning and abilities.
The role of the school social worker is also to establish a working relationship between school and family. This, at times, requires conflict resolutions skills and the ability to promote open communication among student, parent and educator. In maintaining a working relationship with parents, school social worker makes sure that the parent understands and is understood when participating at meetings school staff.
As the school day ends, the school social worker is typically writing reports and case notes, making phone calls, and reviewing the following day's schedule. These end-of-day responsibilities may extend into the late afternoon or early evenings with no compensation other than knowing that the needs of others have been met.
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Introduction
Lynn Hagan, PsyD, CTRS, LCSW has masters degrees in social work and recreation and taught camp counseling and management at the university level. She can be reached at lynn_hagan@yahoo.com.
Q. My daughter is preparing to go to camp this summer and I am having a lot of anxiety over it. On one hand I want her to go; on the other I am having lots of doubts. She is not apprehensive at all. Is this normal?
It is not unusual at all to feel a bit of "kid-sickness". As you send your daughter off to camp, you are sending her out into the world – without your protection – and this is making you feel somewhat powerless. The reality is that going to camp is a growing experience for everyone – parents and children alike. Feeling apprehension is normal and most parents experience it! It takes a great deal of trust to hand your daughter over to the care of other adults – sometimes those you have never met. Finding this trust and letting your daughter go off on her one to experience new adventures takes courage. Just remember, that in doing so, you will also grow from the experience and have learned new parenting skills – just as your daughter will have learned new skills at the camp.
Q. How can I make sure that the camp I select is really going to take care of her?
The American Camp Association (www.aca.org) is a national association that accredits youth camps. This accreditation means that the camp is conscientious enough to meet up to 300 national standards from staff qualifications to emergency management. In selecting a summer camp, it would behoove parents to actually interview the camp director and physically visit the camp. The ACA Web site has a searchable database of nationally accredited camps, links to state regulations, and resources for parents from what to look for in camp visits to how to pack for camp. Good preparation on the parent will alleviate a good bit of the anxiety knowing that you have made an informed and intelligent decision on where to send your child for camp.
Q. How can I prepare myself for her leaving for the summer?
You said the right word – prepare. As with any adventure, adequate preparation is of utmost importance. This is something you and your daughter can do together. First, as mentioned before, consider this a learning experience – for both of you. This will give you and your daughter experience in "letting go" – enabling both of you to experience greater autonomy and sense of self. Secondly, discuss the selection of camp together. Give her some say in the selection, but remember that you are the parent and make the final selection. Thirdly, discuss your concerns openly. Chances are that your daughter is feeling some of the same things. Expressing them will help both of you reach a fuller understanding of each other – as well as validate each others' feelings. Finally, have realistic expectations of what to expect from your daughter's camp experience. Talk to other parents and utilize the camp's orientation and communication methods (such as email) while she is gone. You are not the only parent to have these feelings – and you certainly are not going to be the last.
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La profesin del trabajador social permite a personas, familias, grupos y comunidades mejorar o recuperar su capacidad para una ptima salud psíquica, afectiva, espiritual, social y física. Los trabajadores sociales prestan un servicio central en los equipos de cuidados paliativos. Sus valores y aptitudes profesionales son un complemento perfecto para los programas de cuidados paliativos, cuyo objetivo es tratar a la persona en su conjunto de manera interdisciplinaria para mejorar la calidad de vida en caso de enfermedad grave.
Los trabajadores sociales defienden vivamente la autodeterminacin y la atencin culturalmente adecuada. Se han capacitado en la evaluacin de las fortalezas de las personas y familias y comprenden que la buena atencin médica exige la satisfaccin y el respeto de los deseos y las necesidades de las personas. Cuando la cura ya no es posible, aparecen muchísimos factores de tensin psíquica, física y espiritual que la persona y su familia deben enfrentar y tratar, y los trabajadores sociales cuentan con capacitacin especializada para proporcionar asistencia a tal efecto.
Los trabajadores sociales asisten a las personas y familias en las siguientes áreas:
- Tratamiento de síntomas. Tratamiento de síntomas físicos, como los ejercicios de relajacin para aliviar la nausea o el dolor, es slo un ejemplo de los servicios que prestan los trabajadores sociales.
- Tensin psíquica y espiritual. Los factores de tensin psíquica y spiritual, como la ansiedad, la culpa y la depresin, se abordan y tratan mediante orientacin psicolgica (incluido el apoyo afectivo), educacin y técnicas psicolgicas de corto plazo.
- Dilemas éticos. Puede que también surjan dilemas éticos (como el retiro o la omisin del tratamiento), y los trabajadores sociales son hábiles en la solucin de problemas, la defensa y la coordinacin de los recursos adecuados para buscar soluciones que sean útiles para cada familia.
- Apuros econmicos. Los apuros econmicos generalmente son un problema al final de la vida, y ésta es otra área en la que los trabajadores sociales tienen gran conocimiento y éxito para ayudar a obtener recursos como la cobertura de seguro médico, el pago de gastos y facturas de salud y la obtencin del ingreso por incapacidad.
- Planeamiento anticipado de atencin. La asistencia en el planeamiento anticipado de atencin para garantizar que todos los tratamientos cumplan los deseos del paciente también se encuentra dentro del ámbito de la intervencin del trabajo social. El planeamiento anticipado de atencin implica tomar decisiones acerca del tratamiento al final de la atencin médica y la planificacin del sepelio, y comunicacin de dichas decisiones a los seres queridos y en documentacin jurídica.
- Pérdida y duelo. Enfrentar la pérdida y la posterior elaboracin del duelo es otra área en la que los trabajadores sociales están muy versados. Manejar las intensas emociones relacionadas con el duelo puede ser abrumador sin el apoyo y la informacin adecuados. Los trabajadores sociales tienen conocimientos y habilidades que permiten facilitar el duelo y ayudar a evitar obstáculos que conduzcan a reacciones más complicadas, como la depresin.
Los trabajadores sociales que integran equipos de cuidados paliativos realizan una evaluacin psicosocial inicial que es esencial para que la atencin médica resulte eficaz y adecuada para cada una de las familias. En dicha evaluacin, se incluyen preguntas sobre creencias espirituales y culturales para que los trabajadores sociales que sirven para concienciar a los demás integrantes del equipo y a sí mismos acerca de las necesidades de los familiares y, lo que es más importante, lo que no desearían.
Los antecedentes también son esenciales, ya que el trabajo social tiene en cuenta las fortalezas de la familia en el pasado, e identifica la capacidad y la fortaleza de superacin que las personas ya hubieran utilizado. Dichas capacidad y fortaleza se aprovechan y aumentan para ayudar a las personas en estos momentos difíciles. Si no se presentan dificultades especiales, como una gran cantidad de pérdidas o apuros econmicos, los trabajadores sociales ayudan a planificar mayor cantidad de intervencin, apoyo y recursos.
Como parte del equipo interdisciplinario, los trabajadores sociales representan los deseos de la persona y su familia en cada reunin del equipo, y defienden sus necesidades dentro de otros sistemas para mejorar la respuesta de los mismos y garantizar que cada familia reciba la atencin disponible que se ajuste a sus necesidades. Luego de la muerte del paciente, los trabajadores sociales proporcionan informacin, educacin y apoyo sobre el duelo para ayudar a los deudos a superar la muerte y la posterior adaptacin (“nueva normalidad”) a una vida sin su ser querido.
Un estudio reciente (Reese y Raymer, "Relationships Between Social Work Involvement and Hospice Outcomes: Results of the National Hospice Social Work Survey", Social Work, 2004) señal, entre otras cuestiones, que hubo mayor satisfaccin de los usuarios y menos noches de atencin hospitalaria cuando hubo mayor frecuencia de la intervencin de los trabajadores sociales en los equipos de cuidados paliativos. Al fallecer aproximadamente 2.4 millones de personas por año en Estados Unidos, resulta esperanzador saber que cada vez más trabajadores sociales de campo reciben aún más capacitacin especializada para ayudar a las personas a vivir la última parte de la vida con la mayor plenitud posible y ayudar a los deudos a buscar una "nueva normalidad" que tenga sentido.
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Las opiniones expresadas en este artículo son las del autor, y no reflejan necesariamente las de la Asociación Nacional de Trabajadores Sociales de Estados Unidos ni las de sus miembros.
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La adolescencia resulta un período muy difícil para ciertos jvenes y su familia. Si bien la adolescencia puede ser una etapa emocionalmente intensa y tormentosa para prácticamente todos los jvenes, en ocasiones los conflictos adolescentes necesitan intervencin especial. Muchos adolescentes tienen conflictos de salud mental, relaciones familiares, amistades, rendimiento escolar, adicciones, sexualidad y otras conductas de alto riesgo.
Los adolescentes conflictivos generalmente muestran signos de sufrimiento. Entre los signos de advertencia comunes se encuentran los siguientes:
- Baja autoestima
- Fracaso y ausentismo escolares
- Actitud desafiante hacia la autoridad (por ejemplo, padres, docentes, policía)
- Huir del hogar
- Elegir las amistades "equivocadas"
- Comportamiento impulsivo (por ejemplo, conducir a velocidad excesiva y realizar otras actividades riesgosas)
- Cometer actos ilícitos
- Depresin
- Alcoholismo o drogadiccin
- Aislamiento social
- Trastornos alimentarios (comer en exceso, no comer, provocar el vmito)
- Automutilacin (por ejemplo, cortarse)
Existe ayuda para estos adolescentes y su familia a través de muchos medios.
Existen muchos medios para buscar y obtener programas y servicios para adolescentes conflictivos. Como primera medida, los padres deben buscar ayuda comunicándose con el personal de la escuela (orientadores, trabajadores sociales, administradores), entidades de servicios familiares, centros comunitarios de salud mental, otros programas de servicios sociales comunitarios orientados concretamente a jvenes en riesgo y su familia, organismos públicos de bienestar infantil, tribunales de familia y menores y tribunales especiales (por ejemplo, tribunales de ausentismo escolar y drogadiccin).
Los trabajadores sociales ayudan a los padres y los adolescentes conflictivos a identificar y analizar cuestiones familiares difíciles y problemáticas. La orientacin individual, familiar y grupal que proporcionan los trabajadores sociales clínicos puede server para que padres e hijos mejoren su comunicacin y relacin, resuelvan conflictos y aborden importantes problemas de salud mental.
Los profesionales denominados "defensores educativos" y "asesores educativos" ayudan a padres e hijos a obtener los servicios necesarios. Los defensores educativos, que generalmente son abogados, ayudan a las personas a obtener servicios educativos especializados. Los defensores educativos cobran honorarios por sus servicios a los padres y trabajan con funcionarios educativos municipales, estatales y federales para garantizar que los estudiantes reciban los servicios y las "adaptaciones especiales" a que tienen derecho por ley. Los defensores también hacen presentaciones judiciales para obligar a los distritos escolares a proporcionar o pagar servicios y programas de necesidades especiales fuere del distrito.
Los asesores educativos ayudan a los padres a buscar programas y servicios orientados a satisfacer las necesidades de su hijo. Los asesores educativos cobran honorarios a los padres, evalúan las fortalezas y necesidades exclusivas de cada adolescente y ayudan a la familia a buscar las escuelas o los programas más adecuados para su hijo. Muchos asesores educativos supervisan la evolucin de los estudiantes en el programa o la escuela nuevos y, cuando fuera necesario, defienden al adolescente en el programa o la escuela cuando surgen inconvenientes.
Los programas y servicios para los adolescentes conflictivos pueden ser muy costosos. Algunas familias pueden pagar dichos programas y servicios "de su propio bolsillo". Otras familias cuentan con seguro médico que cubre todo o parte del programa; o bien, el costo puede cubrirse por parte del sistema educativo público.
Muchas familias no pueden costear los programas y servicios necesarios, no cuentan con suficiente cobertura de seguro y no pueden obtener el financiamiento del departamento de educacin pública. En ciertos casos, las familias que no pueden costear los servicios necesarios acuerdan otorgar la custodia de su hijo al organismo público de bienestar infantil local, que a su vez financia los servicios o programas (en varios estados el organismo público de bienestar infantil financia los servicios sin exigir a los padres la entrega de la custodia). En casos más graves, los padres desesperados recurren al tribunal de menores o de familia y solicitan formalmente que se declare a su hijo "rebelde", lo que permite al tribunal exigir al menor que acepte la intervencin. En estos casos, el estado generalmente paga los servicios y programas necesarios. Ciertos padres se muestran reacios a usar esta vía para acceder a los servicios, porque es el tribunal, y no ellos, quien determina donde debe ir su hijo para obtener ayuda.
Existe una amplia gama de servicios y programas administrados por organismos privados y públicos para adolescentes conflictivos y su familia. Algunos programas se ofrecen en la propia localidad; sin embargo, ciertos programas se desarrollan en otras localidades o estados, lo que implica que el adolescente debe vivir lejos del hogar para recibir los servicios necesarios.
Una amplia gama de profesionales y entidades ofrecen servicios de intervencin en crisis y orientacin complementaria a adolescentes y familias. Dichos servicios se ofrecen a través de entidades de servicios familiares, centros comunitarios de salud mental, consultorios externos hospitalarios, organismos públicos de bienestar infantil y psicoterapeutas privados (como trabajadores sociales clínicos, psiclogos clínicos y orientadores, asesores de salud mental, asesores pastorales, enfermeras psiquiátricas y psiquiatras).
Muchas localidades ofrecen programas integrales de orientacin e intervencin familiar específicamente para adolescentes y familias en crisis. Dichos programas (denominados "servicios integrales de urgencia" o "servicios intensivos integrales") proporcionan evaluacin domiciliaria, orientacin de urgencia, informacin y derivaciones para ayuda de más largo plazo.
Una variedad de escuelas alternativas, escuelas terapéuticas y programas de tratamiento atienden a adolescentes que tienen problemas importantes de conducta, afectivos, de salud mental y adicciones. Algunos programas, como las preparatorias alternativas, se concentran principalmente en la educacin al tiempo que tratan los problemas de salud mental y conducta de los estudiantes. Otros programas, como los programas de tratamiento residencial, internados terapéuticos y programas de tratamiento al aire libre, se concentran principalmente en problemas de salud mental, afectivos y de conducta, al tiempo que incluyen un componente educativo. Los internados de "crecimiento emocional" abordan simultáneamente problemas de salud mental, afectivos, de conducta y educativos. Otros internados se concentran en incapacidades de aprendizaje concretas al tiempo que prestan atencin al estudiante en su conjunto. En una palabra, distintos programas enfatizan en distinto grado las cuestiones personales y académicas.
Los padres de adolescentes conflictivos (particularmente adolescentes que son hostiles y desafiantes) pueden verse tentados a colocar a su hijo en una escuela o un programa que promete imponer la disciplina y la estructura necesarias. Con frecuencia, tales escuelas y programas (como los internados militares y los que publicitan su misin como "educacin del carácter") no prestan los servicios de salud mental que muchos adolescentes conflictivos necesitan. Tales escuelas y programas pueden ocasionar más daños que beneficios para adolescentes conflictivos que tienen problemas personales y de salud mental que agravan sus problemas.
Las siguientes son las principales opciones de programas:
- Las escuelas preparatorias alternativas proporcionan educacin, incluidos servicios de educacin especial a adolescentes que han fracasado académica o socialmente en escuelas preparatorias tradicionales. Dichas escuelas pueden ser autnomas o contar con el apoyo de un centro comunitario de salud mental, una entidad de servicios familiares, un distrito escolar o un emprendimiento de colaboracin compuesto de varios programas de servicio social y educativos.
- Los programas de suspensin del proceso a prueba para menores de generalmente intentan ayudar a adolescentes conflictivos que han tenido contacto con la policía a evitar un involucramiento más formal en la justicia de menores (tribunales de menores e instituciones penitenciarias). Dichos programas ofrecen a los delincuentes sin antecedentes orientacin individual y familiar, vínculos con otros servicios necesarios (como la medicacin psiquiátrica) y educacin.
- Los programas de vida independiente tienen por objeto ayudar a los adolescentes a desarrollar la capacidad que necesitan para vivir de manera independiente. Dichos programas atienden principalmente a adolescentes que no tiene familia estable y que se encuentran en custodia estatal. Ciertos programas de vida independiente también atienden a adolescentes cuya familia puede pagar dichos servicios de manera particular. Generalmente los servicios incluyen práctica en habilidades de la vida cotidiana, administracin del dinero, planificacin profesional y educativa, servicios de salud mental, asistencia de vivienda, esparcimiento y actividades sociales y gestin de casos.
- Los programas de tratamiento al aire libre ofrecen un tratamiento muy estructurado intensivo de corto plazo (de tres a seis semanas) en lugares alejados para quitar a los adolescentes de las distracciones existentes en el lugar donde viven (por ejemplo, televisin, música, computadoras, automviles, drogas y alcohol, películas, grupos de delincuentes juveniles). Las dificultades de la vida completamente al aire libre y el desarrollo de habilidades de supervivencia en la naturaleza ayudan a los adolescentes a generar autoconfianza y conductas sociales. Con frecuencia, se aconseja a las familias enviar a su hijo primero a un programas de tratamiento al aire libre y, luego, a un internado terapéutico o de crecimiento emocional, y no hacer regresar al adolescente al ambiente del lugar donde vive.
- Los internados para adolescentes con incapacidades de aprendizaje importantes ofrecen programas académicos estructurados que se concentran en la educacin y el aprendizaje al tiempo que abordan cuestiones pertinentes afectivas y de conducta.
- Los internados de crecimiento emocional ofrecen programas académicos estructurados y se concentran en el desarrollo emocional y el crecimiento personal pero no prestan los servicios de tratamiento intensivo que ofrecen los internados terapéuticos.
- Los internados terapéuticos se concentran intensamente en la salud mental, las adicciones y los problemas de conducta de los estudiantes al tiempo que también proporcionan un programa educativo académico.
- Los centros de tratamiento residencial ofrecen tratamiento muy estructurado que aborda adicciones, problemas familiares y otras cuestiones de salud mental. Al contrario de los internados terapéuticos, los centros de tratamiento residencial se asemejan más a un hospital psiquiátrico que a una escuela, si bien pueden que tengan un componente académico/educativo en su programa.
En muchas localidades existen tribunales de adicciones (en ocasiones denominados tribunales de drogadiccin) y tribunales de ausentismo escolar. Dichos tribunales especiales emplean un enfoque de apoyo y fomento en vez del enfoque punitivo para ayudar a los adolescentes conflictivos. Mediante la gestin de casos, orientacin, enseñanza particular, asesoría y educacin de padres, el objetivo de los tribunales es evitar futuros problemas e involucramiento más formal en la justicia de menores.
Los trabajadores sociales proporcionan a los adolescentes conflictivos y su familia lo siguiente:
- Evaluacin de las necesidades y fortalezas del adolescente y la familia
- Informacin acerca de los programas y servicios necesarios y derivacin hacia los mismos
- Informacin acerca de cuestiones y recursos econmicos y jurídicos
- Nombre de defensores y asesores educativos de confianza
- Servicios de orientacin de intervencin en crisis
- Psicoterapia continua para adolescentes, padres y toda la familia
- Gestin de casos (para ayudar al personal de diversas entidades a coordinar y comunicarse en nombre del adolescente, y para defender a la familia ante quienes prestan estos servicios)
- Informacin acerca de "signos de advertencia" importantes de los adolescente que encuentran en una espiral descendente y los pasos necesarios para obtener ayuda
Recursos
Para obtener informacin acerca de servicios y programas para adolescentes conflictivos y familias, consultar a trabajadores sociales, escuelas, organismos públicos de bienestar infantil, tribunales de menores y de familia, entidades de servicios familiares, centros comunitarios de salud mental, defensores educativos, asesores educativos y abogados. A continuacin se enumeran sitios Web útiles:
El doctor Reamer y la doctora Siegel son los autores de Finding Help for Struggling Teens, A Guide for Parents and the Professsionals Who Work for Them, en venta a través de la Imprenta de NASW. El doctor Reamer también ha escrito The Pocket Guide to Essential Human Services, que compila diversos recursos en una guía fácil de usar adecuada para profesionales, voluntarios y usuarios.
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Las opiniones expresadas en este artículo son las de los autores, y no reflejan necesariamente las de la Asociación Nacional de Trabajadores Sociales de Estados Unidos ni las de sus miembros.
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A typical day for the high school social worker is unpredictable, yet always interesting. Before the first bell rings, a student walks into the office to report that the police were at his house last night to raid his apartment for possible drugs. Fortunately, no drugs were found, but the stress of the incident means today will be a rough day for this student; homework did not get done, and emotions are on edge. The social worker processes the incident with the student and helps him come up with a plan to cope with the day.
A teacher stops in during first period to report concerns that one of her students wrote a paper with a suicidal theme and wants the social worker to explore this further; after meeting with the student and talking to parents, a decision is made to refer the student for further evaluation. While regularly scheduled appointments with other students have to be rescheduled due to the incident, this kind of collaboration and response may very well have saved the life of a teenager.
A moment later, a sophomore girl in tears comes by to report she just broke up with her boyfriend and wants to go home. After a brief period of discussion and listening, the girl says she feels better and agrees to return to class.
It's midday and the school social worker's presence is needed at a meeting for a student with an emotional disability. The parent is distressed and in need of some supports in order to more effectively address their child's issues. The social worker meets with the parent alone after the meeting for almost an hour and then follows up with referrals to some community agencies that may help stabilize the family's living situation.
The social worker then meets with her regularly scheduled appointment; a parenting teenager in need of child care in order to be able to stay in school. Further discussion reveals that the teenager also needs health insurance for herself and her child, as well as possible housing.
The student, who has no phone of her own at her current residence, makes calls from the School Social Worker’s office to request insurance eligibility forms, and to call community resources to find out about housing availability. This process is time consuming; the Social Worker encourages the student to advocate for herself as much as possible, but sits with her to help. Ultimately, a lot of information is gathered and the process for obtaining tangible help has begun. An appointment is scheduled for the next day to follow up.
The Social Worker understands that success in school extends beyond academics. The role of the School Social Worker is to look at the big picture; understanding the obstacles to learning often mean assisting students with many different aspects of their lives. In this way, School Social Workers have a unique view of school or learning issues. School Social Workers are most often the ones who reach out to parents and other community agencies, and act as a liaison among all the support systems in a student’s life.
The day continues with phone calls to various agencies and community resources; during this time a student with behavioral issues comes by to report s/he has just stormed out of class and is very angry; after working with the student to calm down, and consulting with the teacher and administrators, the student returns to class.
The final bell of the day rings and it has been an action packed day. A tentative schedule is planned out for tomorrow- but who knows what the day will actually bring!
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Many times older relatives experience a slowing of some aspect of their lives – be it in the functional, or social, or mental realms. Perhaps they are having a hard time making it up the steps everyday, getting out of the house more than once a week, or being confused about the simple data facts of the day (such as date, day of the week).
Not knowing the resources for elderly persons can be worrisome. Development of a plan is not interfering, but rather proactive and necessary. Communicating concerns is vital to the health and welfare of elderly family members.
A geriatric care manager can be of great service. According to the National Institute on Aging, geriatric care managers are professionals who have multidisciplinary insight into key medical, functional and social issues important to the care of older individuals with complex medical and social problems. Just as one might go to a lawyer to draw up a will, or an accountant to prepare taxes, there are professionals who are skilled in the art of comprehensive assessment of seniors in their diversity of circumstances, have a broad knowledge of the range and variety of resources locally, are trained in counseling and crisis intervention skills, and are able to make all this information practical in action.
When seeking support from a geriatric care manager, find someone who belongs to the Association of Professional Geriatric Care Managers, as well as the National Association of Social Workers. Not all geriatric care managers are social workers, but as they are trained in support, resource development, advocacy and counseling, they are the ideal professionals to be providing geriatric care services. When looking for a geriatric care manager, find someone who knows the area in which the elderly person lives.
As the job of the geriatric care manager is not just to support the "senior", but to also give familial and friend support, meet with the care manager to discuss the next steps to take. A good geriatric care manager will make sure there is support, education, and advocacy. A good geriatric care manager will be available when needed, meaning they are schooled in crisis intervention. A good geriatric care manager will bring tools and strategies on how to deal with the situation. And a good geriatric care manager is compassionate.
Be aware though that hiring a geriatric care manager can be expensive. Occasionally, a long term insurance plan may help pay for geriatric care services, but generally, payment will be out of pocket. Many times, however, only one or two sessions may be needed to resolve a situation.
Geriatric care managers can be especially helpful in situations where an aging loved one lives far away. They can be your eyes and ears, and most helpfully, they can be the planner when it comes time to either get help in the home, or when relocating a loved one to a facility where the he or she will receive more support.
The Association of Professional Geriatric Care Managers maintains a Web site where one can identify a geriatric care manager by zip code. Geriatric care managers are familiar with working with each other to accomplish tasks for their clients.
The Association of Professional Geriatric Care Managers recommends asking specific questions when hiring a geriatric care manager.
- What are your professional credentials?
- Are you licensed in your profession?
- Are you a member of the National Association of Professional Geriatric Care Managers?
- How long have you been providing care management services?
- Are you available for emergencies?
- Does your company also provide home care services?
- How do you communicate information to me?
- What are your fees? (These should be provided to the consumer/responsible party in writing prior to rendering services)
- Can you provide me with references?
Some geriatric care managers provide written information, make recommendations of books to read, or groups in which to get involved, and advise on agencies or companies that can give support. The key is the provision of comprehensive services. On all levels – physically, mentally, emotionally, and spiritually, utilizing a geriatric care manager can bring peace of mind to all parties concerned.
Sometimes, in order to have tranquility, attend to those practical matters in life. Allow a professional geriatric care manager to assist on that journey.
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