This paper will look at the case study of Ruth, Joseph and their family. They are Humanitarian Entrants in Australia and face many issues. Their past life in Southern Sudan was fraught with war, violence and displacement. As a social worker assessing their case there are several factors which need to be taken into account which can impact greatly on their future. These include the dominant discourse which as a social worker we will choose to work from. The biomedical discourse deals with many factors which are evident in the work with Ruth and Joseph. Factors such as torture and trauma and the repercussions psychologically which this has had and how it continues to impact on the family. This paper will also look at how the western biomedical model may limit mental illness as just a brain disease and not look at all the factors which are related. When working with trying to resettle a refugee family in a new country which is so far removed from what they know, a social worker needs to deal with broad range of tasks. Selecting the right theory is crucial. The theory which would best work for Ruth and Joseph would be Anti-oppressive. Looking at the anti-oppressive theory when working with new migrants can help us to understand their history and help them overcome the oppression which they have felt for so long. It is our role as social workers to help integrate refugee people into local communities and adjust to a new culture. I will need to evaluate my own values and attitudes when working with my CALD (Culturally and Linguistically Diverse) clients. My focus will be on how these differences may impact or inhibit my work with Ruth and Joseph namely our cultural differences.
Assessing clients and intervening as a Social Work practitioner it is essential that we choose the best discourse relevant to our clients needs. As Healy (2008) states ‘ the biomedical discourse is one of the most powerful discourses shaping practice contexts, particularly in health services such as hospitals, rehabilitation services and mental health services’ (p20).
Healy discusses how social work practitioners need to ‘learn to understand’ some form of the biomedical terminology (2005,p22). When working with clients such as Ruth and Joseph whom both have post-traumatic symptoms in varying degrees the biomedical discourse seeks to address the complexity of their problems. Both Ruth and Joseph appear to suffer from some form of mental illness related to their post-traumatic experiences. Penhale and Parker (2008) say that difficulties with mental illness can be deepened if the person/s comes from black or minority ethnic community (p103).
The symptoms which Ruth and Joseph are experiencing are in the form of flashbacks, anxiety and fear. The National Centre for PTSD state that ‘refugees frequently experience recurring losses, challenges, and changes during the exile/acculturation and resettlement/repatriation periods’ (Bolton,2010).
When assessing Ruth and Joseph, we have to be careful not to objectify them as just their illness. As a social worker we need to look at a client from varying degrees not just one. We need to look at a client and their past history in a holistic biopsychosocial way. With Ruth and Joseph, addressing their mental illness is just one of the multidimensional factors which they are experiencing. Looking at them as people rather than as an illness can help with assessing their case. STARTTS elaborate saying that ‘It is necessary for social workers in this field to develop an understanding of organised violence and its effects on individuals, families and societies, and also of the refugee experience of escape and surviving in refugee camps’ (Bowles, n.d.).
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The biomedical discourse can also have limitations. Healy discusses how there is potential for biomedical knowledge to contribute to social oppression (2005,p26). When working with Ruth and Joseph our practice must be about empowering them and help them overcome any oppression which they have experienced. The implications which we as practitioners may face when working with refugees from the biomedical model is as Healy (2008,p.25) suggests ‘in conflict with the holistic approach’. As social workers it is our role to look at a client in a social context. Ruth and Joseph present with a range of problems that stem from the trauma which they have encountered. This branches into areas of social, economic and emotional needs that need to be addressed. Ruth faces trying to navigate her way around the bureaucracy of Centrelink, Medicare and other agencies just to get their simplest needs met. We will need to work with Ruth to overcome her fear of authority which stems from her trauma which she experienced in Southern Sudan. In the case study it mentions that Ruth appears afraid of all the questions regarding getting a job and the fear of authority coupled with the language/cultural barrier which she experienced has led to her self-doubting. We need to look at the case of Ruth and Joseph from more of social level rather than a medical level. ‘This model does not consider the role, such as family and community play in development of illness; thus, diagnosis and treatment are narrowly defined ‘ (Pardeck and Yuen,2001, as cited in Pardeck,2002,p.4).
Assessing clients whom have trauma related symptoms such as Joseph, being aware of his condition and all aspects appear to be from physical to emotional to psychological will help us to make decisions of referrals to other agencies which may need to be done. It appears as though Joseph will need to see a physiotherapist, dentist and a GP to help overcome his physical pain. His emotional and psychological problems range from trouble concentrating to becoming violent towards his family. The safety of Ruth and the children will be made in the initial assessment. It will need to be decided whether Ruth feels safe enough to have Joseph in the house with her and her children if he continues with his violent behaviour. Referrals may need also to be made to a psychologist or a mental health agency for Joseph.
Healy places anti-oppressive practice between strengths perspective and the postmodern practices to reflect the common historical lineage of theories for practice, all which have emerged as significant influences in the formal base of social work since 1990’s (2005,p173). Adopting an anti-oppressive framework whilst working with Ruth and Joseph, tribute must be paid to the past struggles and sacrifices which they have faced. Ruth and Joseph have suffered great oppression in Southern Sudan. This oppression included imprisonment, relatives killed, being taken from their home, hunger, and lack of safety. O’Hara and Weber (2006) maintain that an anti-oppressive or radical framework encourages practitioners to understand the structural context of their assessment practice (p,141). Some critical components of the anti-oppressive framework are the ‘isms’. These are anti-racism, anti-sexism, anti-heterosexism, anti-ablism, and anti-ageism (Moore,2003,n.d). Addressing these components of the anti-oppressive framework when assessing Ruth and Joseph will allow practice to empower and enable and support them to gain more control over their lives. As Milner and O’Bryne mention ‘…..social work should make a difference so that those oppressed may regain control of their lives and re-establish their right to be full and active members of society’ (2009,p.23).
In an initial assessment with Ruth and Joseph factors to be considered include whether an interpreter is needed as translation will play a vital role in the assessment process. Ruth and Joseph have obviously sought freedom from persecution because of war, assault and torture and/or other degrading treatment. STARTTS state that ‘Social workers in this field are exposed to stories of gross human rights violations, and cannot maintain neutral opinions concerning the actions of various groups and regimes. Conversely, one is also exposed to the complexities of civil and international conflicts; one’s own political ideologies, stereotypes and beliefs are all challenged in this work’.
Culture plays a significant part in anti-oppressive practice when working with Ruth and Joseph. Penhale and Parker (2008, p.197) points out:
Cultural competence stems from an anti-oppressive approach to practice and concerns the competence and understandings to work with diverse groups, respecting and acknowledging difference whilst working with people to effect changes that have been agreed and negotiated together.
There is no need to be a cultural expert as such but awareness of cultural differences and how this may impact on communicating effectively with Ruth and Joseph is important. By doing some research if possible of Ruth and Joseph’s Dinka culture will help when working with assessing their needs. For example the WYDA states that Dinka family members provides an essential support network (2008, para 5). This is important when talking to Ruth and Joseph about their family life and roles in the family etc. Another consideration to make would be to ask them what some of their expectations may be and ask them how things were done in their country. Breaking down this cross-cultural barrier in the initial assessment can lead to a more positive outcome for both the social worker and Ruth and Joseph. . Thompson’s PCS interactive model of oppression (Penhale and Parker, 2008, p.155) shows oppression to be the constructor of personal, cultural and societal views and that the personal prejudice alone does not explain racism. Furthermore it is important that a social worker understands how these aspects of life interact can create and recreate patterns of oppression and discrimination. It is important also to note that Ruth and Joseph’s children appear to be acculturating faster therefore may have to take over the role of translators in official realms. This reversal of roles can create stress in both parents and children and can sometimes lead to intergenerational conflict. Parents can feel like their children have lost respect for them and that that their authority may have been undermined.
Social work practice must address a myriad of issues when dealing with asylum seekers and refugees. In establishing themselves in the community Ruth and Joseph they will require a number of services with which to access which will play a vital role in providing a safe community. Offering ongoing support and adopting an anti-oppressive practice
Working with CALD (Culturally and Linguistically Diverse) clients as a social work practitioner this can raise several issues with values and attitudes which I may have. I am white, Australian and a social work student. I have a different cultural identity and am from a different country which holds different views and ideas to Ruth, Joseph and their family. Being a female and a mother I can empathise with Ruth in regards to running a household and caring for children. Ruth has had to take over as ‘head’ of the family as Joseph appears to be mentally unwell and not fit to lead his family for the time being. She also has a large family and caring for seven children can be a struggle let alone being in a new country and trying to navigate our welfare and schooling systems. Having different cultural identities could limit my capacity when working with Ruth and Joseph. I need to recognise that refugees have similar social, emotional, spiritual and financial needs to everyone else and be work in a culturally sensitive way. As I am from the Australian culture this is another subgroup which I have membership. With all the negative media attention surrounding ‘asylum seekers’ or ‘boat people’ it has been hard not to form an attitude. My attitude is that I believe that I don’t understand, and I never will, the desperation that asylum seekers must feel to have to put themselves and their family in such unsafe environments such as a rickety boat from Indonesia just to escape the persecution and fear which they must experience in their own country to have to flee. I know that Ruth and Joseph are Humanitarian Entrants meaning that Ruth’s sister sponsored them to come and live here but they still were in fear of persecution and subjected to torture and trauma in their own country. As I am citizen of a country that lives in democracy I will never fully understand but my values of respect, honesty and
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Another subgroup I am part of is that of a family. I have two children of my own and I know personally that my family is my initial support network. As mentioned, the Dinka culture regards their immediate family as their initial support network also. When working with Ruth and Joseph my values and attitudes towards family support can enhance my capacity with addressing their needs. I feel that it is important to work with the positives of Ruth and Joseph’s situation and in this case it is their family is together in the one place. Offering some family counselling would allow a safe space for the family to address any issues which have arisen, such as Joseph’s lack of connectedness with the family. Along with Joseph receiving some therapy in regards to his mental health this would put the family on the path to healing together.
Oommen, Brian, Stephen and Komersee (2008, p.6) state that ‘An equally important concept when working in culturally diverse settings is the need for a health professional to suspend their personal biases and judgements about those for whom he or she may be planning health programs’. As with so many areas involving values, reflective practice and self-awareness
are central. I need to examine and question the sources and nature of my own power and the ways in which this is exercised in my relations with children and my family. By using reflective practice when working with Ruth and Joseph can help me maintain a level of self-awareness so as to apply my attitudes in an appropriate manner. As there is a domestic violence issue this could be one of the areas where my value of respect could limit my capacity when working with Ruth and Joseph. I could overcome this limitation by looking at the all the factors and understanding that the domestic violence is something that is perpetuated from their history as displaced persons and the trauma and torture which they have experienced. Working with a non-judgmental attitude will also help with conflicts such as domestic violence.
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