SOCW 6051 Week 9 Discussion 1 And 2
SOCW 6051: Diversity, Human Rights, and Social Justice
Discussion 1 due 07/28/2021 $5.00 and Discussion 2 / Analysis due 07/29/2021 $10.00
Discussion 1: Ability, Disability, and Erasure
Consider the notion that an individual with a disability may feel primarily defined by his or her ability status. Also, consider the historical treatment of people with disabilities and the number of individuals who were euthanized and sterilized in the U.S. and across the globe due to having a disability.
For decades, individuals with disabilities were left in institutions, hidden away from the rest of society. Parents were told if their child was born with a disability, they should have them locked away. Consider in today’s society how people with disabilities are still “hidden.” Think about how many people you see each day that have a visible disability. While there are many hidden disabilities that should not be ignored, it is significant to recognize the limited number of people you see each day with disabilities. Also, consider how others react toward a person with a disability in public. Do they stare? Do they move away? Do they invade the person’s space and ask inappropriate questions? What experiences have you seen in public with a person with a disability? Why do you think society has marginalized this group for so long? Why are those with disabilities limited or eliminated from full participation in society today? Who has the right to decide what makes a “good life” and how is that decision made?
To prepare: Read the case “Working With Individuals With Disabilities: Valerie.”
By Day 07/28/2021
Post an explanation of why our society has marginalized those with varying abilities historically. Then, explain the role of social workers in supporting clients with varying abilities (not limited to physical and mental) while recognizing and honoring those clients’ other identity characteristics. Use specific examples from the case study in your explanation.
Plummer, S.-B., Makris, S., & Brocksen S. M. (Eds.). (2014). Social work case studies: Foundation year. Baltimore, MD: Laureate International Universities Publishing. [Vital Source e-reader].
- “Working With Clients With Disabilities: Valerie”
Young, S. (2014, April). I’m not your inspiration, thank you very much [Video File]. Retrieved from https://www.ted.com/talks/stella_young_i_m_not_your_inspiration_thank_you_very_much?language=en
Zayid, M. (2013, December). I got 99 problems…palsy is just one [Video file]. Retrieved from http://www.ted.com/talks/maysoon_zayid_i_got_99_problems_palsy_is_just_one.html
Working With Clients With Disabilities: The Case of Valerie
Valerie is a 56-year-old, heterosexual, African American female. She receives Social Security Disability Insurance (SSDI) and works part time at a credit card company as a telemarketer. She currently lives in an apartment alone but receives home attendant services for 5 hours a day. She lost her left leg when she was hit by a car and has a prosthesis. She uses a walker or an electric scooter to be ambulatory but generally prefers the scooter. She is slightly overweight, which makes using the walker more painful. She has been prescribed Zoloft® (100 mg per day) for general anxiety and has been taking it for almost 3 years. Valerie has a history of drug and alcohol abuse, although she has been drug free for 15 years. She has a core group of friends she has maintained a relationship with over the course of her lifetime, and although she does not see them as often as she would like, she keeps in touch over the phone and through email. She has no criminal background.
Valerie came for services to address unresolved feelings related to an abusive marriage. She continued to be in contact with her ex-husband, John, although they had been divorced for almost 13 years. Valerie said that she and John had remained intimate since the separation and divorce and that John texted and called her to meet for sex. She felt torn because she believed no one else would want to date her due to her disability but also felt John was using her. She also stated that although he had stopped hitting her, he continued to be verbally abusive. She remained anxious and depressed and felt hopeless about the situation.
Valerie said John abused alcohol and began using drugs in the first few years of their marriage. Unaware of his illicit drug use, Valerie arrived home from work early one day to surprise him and found him using cocaine. John attacked her and forced her to use cocaine as well. She relented due to her fear of continued assault. An ongoing pattern of drug use and physical assault persisted throughout their marriage.
Valerie lost her left leg when she was walking across the street and was hit by a car, and she spent close to 9 months in the hospital and a rehabilitation program. She was fitted for a prosthetic leg and given an electric scooter through her insurance company, which allowed her to begin working part time at a credit card company when she returned home. John’s abusive behavior and drug use continued, so Valerie hid her paychecks, slowly saving her money until she had enough to leave. Eventually, she was able to rent a room. In addition, she was able to secure the assistance of a home health aide.
Valerie began individual and group sessions to address her feelings of depression and anxiety. I worked with her to set manageable goals to increase her independence in physical functioning and from her ex-husband’s controlling and abusive behaviors. Valerie and I agreed to use cognitive behavioral therapy to address her continued negative thought patterns that affected her behavior. Valerie shared many insights into her disability to help me understand how she felt in a world that was not very accessible. Through our meetings, I learned about the Americans with Disabilities Act (ADA) and how inaccessible buildings and programs affected her quality of life. We met once a week for 3 months, and I monitored Valerie’s depression through a baseline and then periodic administrations of a depression screen using the Beck Depression Inventory.
After 12 weeks, we decided together it was time for termination. She reported fewer episodes of anxiety and expressed feelings of hope for the future. She continued to attend the group sessions and found new friends who had become a support network for her. She had stopped seeing her ex-husband and changed her phone number to prevent him from contacting her.
Discussion 2: Ability and Disability in the Parker Case
To prepare: View this week’s media, Parker (Episode 30).
Think of the many names and labels you may have heard to describe persons with disabilities and those that are currently socially acceptable. The changing monikers given to those with disabilities are evidence of the continual negotiation of the society who labels and those who are so labeled to define what disability is and who is disabled. What do these shifting labels suggest about the social construction of disability?
Society is inconsistent in its treatment and protection of the rights of individuals with disabilities, creating a situation that contributes to marginalization that can complicate other forms of marginalization and oppression. Consider that being labeled with a disability can be simultaneously something to be fought against because of the stigma it entails and fought for because of the access that it grants to social services that meet basic medical needs, aid economic survival, and improve access to education that society can otherwise deny.
Post an analysis of the implications of the social construction of disability. Describe how disability can be defined as a social construct. Explain how that relates to the perception of disability. Be specific and draw on examples from the Parker case to illustrate your thoughts. Also, describe the intersection of Stephanie’s mental illness with other characteristics of her identity. Explain how those intersections could serve to further marginalize Stephanie’s place and experiences in society. Finally, explain how such marginalization impacts her ability to make choices, use self-determination, and be an active agent with equitable status in her interactions with other professionals.
Plummer, S.-B., Makris, S., & Brocksen S. M. (Eds.). (2014). Sessions: Case histories. Baltimore, MD: Laureate International Universities Publishing. [Vital Source e-reader].
- “The Parker Family”
The Parker Family
Sara is a 72-year-old widowed Caucasian female who lives in a two-bedroom apartment with her 48-year-old daughter, Stephanie, and six cats. Sara and her daughter have lived together for the past 10 years, since Stephanie returned home after a failed relationship and was unable to live independently. Stephanie has a diagnosis of bipolar disorder, and her overall physical health is good. Stephanie has no history of treatment for alcohol or substance abuse; during her teens she drank and smoked marijuana but no longer uses these substances. When she was 16 years old, Stephanie was hospitalized after her first bipolar episode. She had attempted suicide by swallowing a handful of Tylenol® and drinking half a bottle of vodka after her first boyfriend broke up with her. She has been hospitalized three times in the past 4 years when she stopped taking her medications and experienced suicidal ideation. Stephanie’s current medications are Lithium, Paxil®, Abilify®, and Klonopin®.
Stephanie recently had a brief hospitalization as a result of depressive symptoms. She attends a mental health drop-in center twice a week to socialize with friends and receives outpatient psychiatric treatment at a local mental health clinic for medication management and weekly therapy. She is maintaining a part-time job at a local supermarket where she bags groceries and is currently being trained to become a cashier. Stephanie currently has active Medicare and receives Social Security Disability (SSD).
Sara has recently been hospitalized for depression and has some physical issues. She has documented high blood pressure and hyperthyroidism, she is slightly underweight, and she is displaying signs of dementia. Sara has no history of alcohol or substance abuse. Her current medications are Lexapro® and Zyprexa®. Sara has Medicare and receives Social Security benefits and a small pension. She attends a day treatment program for seniors that is affiliated with a local hospital in her neighborhood. Sara attends the program 3 days a week from 9:00 a.m. to 2:00 p.m., and van service is provided free of charge.
A telephone call was made to Adult Protective Services (APS) by the senior day treatment social worker when Sara presented with increased confusion, poor attention to daily living skills, and statements made about Stephanie’s behavior. Sara told the social worker at the senior day treatment program that, “My daughter is very argumentative and is throwing all of my things out.” She reported, “We are fighting like cats and dogs; I’m afraid of her and of losing all my stuff.”
During the home visit, the APS worker observed that the living room was very cluttered, but that the kitchen was fairly clean, with food in the refrigerator and cabinets. Despite the clutter, all of the doorways, including the front door, had clear egress. The family lives on the first floor of the apartment building and could exit the building without difficulty in case of emergency. The litter boxes were also fairly clean, and there was no sign of vermin in the home.
Upon questioning by the APS worker, Sara denied that she was afraid of her daughter or that her daughter had been physically abusive. In fact, the worker observed that Stephanie had a noticeable bruise on her forearm, which appeared defensive in nature. When asked about the bruise, Stephanie reported that she had gotten it when her mother tried to grab some items out of her arms that she was about to throw out. Stephanie admitted to throwing things out to clean up the apartment, telling the APS worker, “I’m tired of my mother’s hoarding.” Sara agreed with the description of the incident. Both Sara and Stephanie admitted to an increase in arguing, but denied physical violence. Sara stated, “I didn’t mean to hurt Stephanie. I was just trying to get my things back.”
The APS worker observed that Sara’s appearance was unkempt and disheveled, but her overall hygiene was adequate (i.e., clean hair and clothes). Stephanie was neatly groomed with good hygiene. The APS worker determined that no one was in immediate danger to warrant removal from the home but that the family was in need of a referral for Intensive Case Management (ICM) services. It was clear there was some conflict in the home that had led to physical confrontations. Further, the house had hygiene issues, including trash and items stacked in the living room and Sara’s room, which needed to be addressed. The APS worker indicated in her report that if not adequately addressed, the hoarding might continue to escalate and create an unsafe and unhygienic environment, thus leading to a possible eviction or recommendation for separation and relocation for both women.
As the ICM worker, I visited the family to assess the situation and the needs of the clients. Stephanie said she was very angry with her mother and sick of her compulsive shopping and hoarding. Stephanie complained that they did not have any visitors and she was ashamed to invite friends to the home due to the condition of the apartment. When I asked Sara if she saw a problem with so many items littering the apartment, Sara replied, “I need all of these things.” Stephanie complained that when she tried to clean up and throw things out, her mother went outside and brought it all back in again. We discussed the need to clean up the apartment and make it habitable for them to remain in their home, based on the recommendations of the APS worker. I also discussed possible housing alternatives, such as senior housing for Sara and a supportive apartment complex for Stephanie. Sara and Stephanie both stated they wanted to remain in their apartment together, although Stephanie questioned whether her mother would cooperate with cleaning up the apartment. Sara was adamant that she did not want to be removed from their apartment and would try to accept what needed to be done so they would not be forced to move.
The Parker Family
Sara Parker: mother, 72
Stephanie Parker: daughter, 48
Jane Rodgers: daughter, 45
Stephanie reported her mother is estranged from her younger sister, Jane, because of the hoarding. Stephanie also mentioned she was dissatisfied with her mother’s psychiatric treatment and felt she was not getting the help she needed. She reported that her mother was very anxious and was having difficulty sleeping, staying up until all hours of the night, and buying items from a televised shopping network. Sara’s psychiatrist had recently increased her Zyprexa prescription dosage to help reduce her agitation and possible bipolar disorder (as evidenced by the compulsive shopping), but Stephanie did not feel this had been helpful and actually wondered if it was contributing to her mother’s confusion. I asked for permission to contact Jane and both of their outpatient treatment teams, and both requests were granted.
I immediately contacted Jane, who initially was uncooperative and stated she was unwilling to assist. Jane is married, with three children, and lives 3 hours away. At the beginning of our phone call, Jane said, “I’ve been through this before and I’m not helping this time.” When I asked if I could at least keep in touch with her to keep her informed of the situation and any decisions that might need to be made, Jane agreed. After a few more minutes of discussion around my role and responsibilities, I was able to establish a bit of rapport with Jane. She then started to ask me questions and share some insight into what was going on in her mother and sister’s home.
Jane informed me that she was very angry with her mother and had not brought her children to the apartment in years because of its condition. She said that her mother started compulsively shopping and hoarding when she and Stephanie were in high school, and while her father had tried to contain it as best he could, the apartment was always cluttered. She said this had been a source of conflict and embarrassment for her and Stephanie all of their lives. She said that after her father died of a heart attack, the hoarding got worse, and neither she nor Stephanie could control it. Jane also told me she felt her mother was responsible for Stephanie’s relapses. Jane reported that Stephanie had been compliant with her medication and treatment in the past, and that up until a few years ago, had not been hospitalized for several years. Jane had told Stephanie in the past to move out.
Jane also told me that she “is angry with the mental health system.” Sara had been recently hospitalized for depression, and Jane took pictures of the apartment to show the inpatient treatment team what her mother was going home to. Jane felt they did not treat the situation seriously because they discharged her mother back to the apartment. Stephanie had been hospitalized at the same time as her mother, but in a different hospital, and Jane had shown the pictures to her sister’s treatment team as well. Initially the social worker recommended that Stephanie not return to the apartment because of the state of the home, but when that social worker was replaced with someone new, Stephanie was also sent back home.
When I inquired if there were any friends or family members who might be available and willing to assist in clearing out the apartment, Jane said her mother had few friends and was not affiliated with a church group or congregation. However, she acknowledged that there were two cousins who might help, and she offered to contact them and possibly help herself. She said that she would ask her husband to help as well, but she wanted assurance that her mother would cooperate. I explained that while I could not promise that her mother would cooperate completely, her mother had stated that she was willing to do whatever it took to keep living in her home. Jane seemed satisfied with this response and pleased with the plan.
I then arranged to meet with Sara and her psychiatrist to discuss her increased anxiety and confusion and the compulsive shopping. I requested a referral for neuropsychiatric testing to assess possible cognitive changes or decline in functioning. A test was scheduled, and it indicated some cognitive deficits, but at the end of testing, Sara told the psychologist who administered the tests she had stopped taking her medications for depression. It was determined Sara’s depression and discontinuation of medication could have affected her test performance and it was recommended she be retested in 6 months. I suggested a referral to a geriatric psychiatrist for Sara, as she appeared to need more specialized treatment. Sara’s psychologist was in agreement.
Because they had both stated that they did not want to be removed from their home, I worked with Sara and Stephanie as a team to address cleaning the apartment. All agreed that they would begin working together to clean the house for 1 hour a day until arrangements were made for additional help from family members. In an attempt to alleviate Sara’s anxiety around throwing out the items, I suggested using three bags for the initial cleanup: one bag was for items she could throw out, the second bag was for “maybes,” and the third was for “not ready yet.” I scheduled home visits at the designated cleanup time to provide support and encouragement and to intervene in disputes. I also contacted Sara’s treatment team to inform them of the cleanup plans and suggested that Sara might need additional support and observation as it progressed. Jane notified me that her two cousins were willing to assist with the cleanup, make minor repairs, and paint the apartment. Jane offered to schedule a date that would be convenient for her and her cousins to come and help out.
Key to Acronyms
APS: Adult Protective Services
ICM: Intensive Case Management services
SSD: Social Security Disability
We then discussed placement for at least some of the cats, because six seemed too many for a small apartment. Sara and Stephanie were at first adamant that they could not give up their cats, but with further discussion admitted it had become extremely difficult to manage caring for them all. They both eventually agreed to each keep their favorite cat and find homes for the other four. Sara and Stephanie made fliers and brought them to their respective treatment programs to hand out. Stephanie also brought fliers about the cats to her place of employment. Three of the four cats were adopted within a week.
During one home visit, Stephanie pulled me aside and said she had changed her mind—she did not want to continue to live with her mother. She requested that I complete a housing application for supportive housing stating, “I want to get on with my life.” Stephanie had successfully completed cashier training, and the manager of the supermarket was pleased with her performance and was prepared to hire her as a part-time cashier soon. She expressed concern about how her mother would react to this decision and asked me for assistance telling her.
We all met together to discuss Stephanie’s decision to apply for an apartment. Sara was initially upset and had some difficulty accepting this decision. Sara said she had fears about living alone, but when we discussed senior living alternatives, Sara was adamant she wanted to remain in her apartment. Sara said she had lived alone for a number of years after her husband died and felt she could adjust again. I offered to help her stay in her apartment and explore home care services and programs available that will meet her current needs to remain at home.
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