All housing would be conveniently located; be wheelchair accessible, spacious and safe if a social model approach was adopted by builders and councils. This would mean no adaptations would ever be necessary. Unfortunately, in reality a referral for medical assessment is made when a person with impairment applies for housing. This assessment focuses on bathing facilities, access in and out of the home and to the essential rooms (Oliver and Sapey, 2006).
I believe one must employ both the medical and social model approaches when working with someone who has spinal cord injury. This is because initially medical intervention will be required and occupational therapists will need to assess the service user’s home so adaptations can be made (Royle and Walsh, 1992). Once these adjustments have been made the service user will require a social model approach which a medical model approach does not holistically address. A solution focused approach would be appropriate once the service user has made a successful transition from hospital to home. This approach builds on strengths and solutions rather than problems and labels (O’Connell and Palmer, 2003). Psychological support can also be integrated using this therapy.
Core Professional Skills
Social workers must have both a comprehensive knowledge and skill base in order to be effective practitioners (Thompson, 2005). There are many core professional skills which are particularly important when working with people who have spinal cord injury. Effective communication skills are central to our role as social workers and communication is of the utmost importance to someone who is undergoing great changes in life. Communicating effectively is a mandatory requirement of the General Social Care Council (2002). Communication is multi-faceted it does not mean just conversing but incorporates listening, empathy, verbal and non-verbal interaction too (Egan, 2002). This is supported by Trevithick (2005) who said although it may not be in words, we are always communicating.
Egan (2002) explains that listening fully to service users means listening accurately, actively and listening for meaning. Tschudin (1995) ascertained that listening requires one to respond, thus making listening and therefore helping an active not a passive skill.
Ineffective communication skills can be apparent within the health and social care fields because there is a pervasive sense of time and resource pressure (Brown, Carter and Crawford, 2006). With this in mind when one is communicating with service users it must not be obvious to them that there is a time limit as this will contribute to people feeling like they are not being listened to or not being given the opportunity to speak because they feel under pressure. It is essential that one is effective with time management in order to prevent shorter visits with service users or carers (Thompson, 2005). Repeating what service users have said demonstrates listening skills. Inskipp (1996) agrees that active listening involves paraphrasing, reflecting feelings and summarising. Asking questions is a way to extract information from service users. The types of questions are significant in various settings. Hogston and Simpson, 2004 claim that, closed questions are appropriate if someone is in pain or depressed, answering a simple yes or no is much easier for them. Alternatively, open questions allow the service user to expand on the question posed. Giving explanations is important when communicating with service users because it is essential they understand what is being discussed; this may require repeating what was said or clarifying a point.
Empathy is another crucial skill when working with people with spinal cord injury as Hockenberry (1996) points out there are different types of paralysis amongst people with spinal cord injury. Each person’s injury will be completely unique to them as this impairment varies greatly. Empathy allows one to recognise the service user’s emotions and respond accordingly, but one will not experience the same emotions (Thompson and Thompson, 2008). Egan (2002) explained that if the needs, broad characteristics and behaviours of the people with whom we work are understood, in this case spinal injured people, the better positioned one is to adapt to the individual needs of the client group.
Working in partnership has to be recognised as being a highly skilled attribute which is an amalgamation of many skills (Thompson, 2005). Neville (2004) opined that working in partnership is beneficial to service user’s whose confidence is lacking or their knowledge is limited. This should help service user’s recognise their potential and meet their specific needs. A way to combine a social model approach with essential core professional skills would be to adopt the values of the integrated living team. This is based on the philosophy of removing barriers in the environment and enabling disabled people to live a secure and integrated life as possible (Finkelstein et al., 2002).
Empowerment and Advocacy
Stigma is common amongst people with a physical impairment so much so that the term disablism now exists. Assumptions, generalisations and exaggerations are made by people who have little or no understanding of different impairments (Marks, 1999).
Being an advocate and empowering service users to fight prejudice, discrimination and oppression is essential to good social work practice.
Trevithick (2005) sees empowerment as, seeking to maximise the power of service users and to give them as much control as possible over their circumstances. This basically is the opposite of dependency which, if incorporating the medical model would conflict with this essential principle. This is supported by Thompson (2006) who highlighted that traditional approaches disempower people with impairment. Therefore, empowerment must be the central concept in the development of anti-disablist practice. The personal and political empowerment of disabled people is promoted by the social model of disability (French and Swain, 2008).
Oliver and Sapey (2006) wrote that social workers should work as allies and as people who are prepared to give up and share their power, if they have a role to play in the process of empowering disabled people.
Parsloe and Ramon (1996) argue that empowering service users could be used to protect professionals own power and status. In contrast to this Kemshall and Littlechild (2002) say empowerment allows people to have more control and enhances the power that people have over their lives. Thompson (2005) opines that social workers must be sensitive to and aware of the power issues involved in the working relationship with service users. It is important to contribute to empowering service users rather than reinforcing a sense of powerlessness that they may be feeling. Being an advocate to service users is a way to balance the power imbalance. A practical measure which could be taken to address this issue is for the social worker to be open, honest and ask the service user what they want and seek their opinion during at all times.
Advocacy defined by Thompson and Thompson (2008) means to represent or speak up for those who are unable to do this for themselves. As a student social worker this is a National Occupational Standard (2004) which needs to be demonstrated to qualify successfully in social work. To become an advocate for another person requires both professional knowledge and confidence in order to confront fellow authority figures (Trevithick, 2006). Marks (1999) offers a useful solution to reducing stigma and being an effective advocate, she says if people become more involved politically with the social experiences of people with impairments, then it would improve our work and help one to understand the inner world of the people with whom they work.
Normalisation is a concept within advocacy work which is relevant when working with people with impairments. This is basically committing to providing equality in relation to the rights and needs of people so they can have the same lifestyle as others. Person-centred support encapsulates both empowerment and advocacy because this includes personalisation, self-directed support and individual budgets. The government have made a commitment to these approaches. The implementation of these increases choice and control for people with impairments (Beresford et al., 2008).
Conclusion
This assignment has discussed the pros and cons of using both the medical and social model. Having examined both approaches to disability it was concluded that a dual approach must be implemented. Despite the medical model being the approach traditionally used, I believe it would be an injustice to service users to only apply this due to its one dimensional approach. I have discovered that the definition of disability will remain an ambiguous term due to the medical and social definitions conflicting and society only being familiar with the traditional meaning.
The core professional skills mentioned are not extensive but are invaluable for a social worker to be supportive, proactive and positive. In order to be an effective communicator one must be sensitive to the service users needs. It is essential that the types of questions and language used are appropriate because someone with spinal cord injury will undergo many psychological changes. Being empathic, an effective listener and employing partnership skills are all fundamental interpersonal skills which are crucial to social work.
Empowerment, advocacy and the importance of service users meeting their potential so they can live as independently is highlighted. This is made possible with the introduction of initiatives such as normalisation, personalisation, self-directed support and individual budgets.
Finally, Oliver and Sapey (2006) make a sensible suggestion to improve the negative societal view of those with impairments and are viewed as being dependent. They proposed to incorporate disability training and studies into social work education. This certainly appears to be a valid suggestion and one which could be achievable in order to change the views of today’s society and of the next generation.
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