Family Centered Social Work in Clinical Social Work 
 
Dr Sojan Antony
 
1
, Dr A Thirumoorthy
 
2
, Dr D Muralidhar
3
 1
Assistant Professor, Department of Psychiatric Social Work, NIMHANS, Bengaluru
2
Professor, Department of Psychiatric Social Work, NIMHANS, Bengaluru
3
Professor and Head, Department of Psychiatric Social Work, NIMHANS, Bengaluru & The President, Indian Society of Professional Social Work
Introduction
 Professionalsocialworkersworkinclinicalsettingstomitigatethesufferingsofpersonsandto  promotethewelfareoffamilieswithillness.Socialworkersusesocialcaseworkandgroupwork  toaddresstheneedsofpatientsandtheirfamilies.Familyistheprimaryunitofsocietyacross variouscultures.InIndia,peoplegivemoreimportancetothefamilyinkeydecisionmaking. Familymembersarethemainsocialsupportforpersonwithillnessordisabilities.Theyprovide emotional,physicalandfinancialsupporttopersontosurvivetheillness.Inthiscontextsocial workersneedtoreflecthowtoworkwiththefamiliesinhospitals.Intheabsenceofuniversal healthinsurancecoverage,familyhastobepreparedtomeetthesocio-economicdifficulties associatedwithcaretaking.Familiesexpectemotionalsupport,informationandskillsfrom treatingteamtoempowerthemselvestobeacaretaker.Socialworkersbytrainingareeligibleto helpfamiliesinthisregard.Socialworkershavealreadyrecognizedthefamilyasthebest naturalrehabilitationcentre(
 
Hughes,Cummings,Weaver,Manheim,Braun,&Conrad,1992)
 
. Infollowingsections,thisarticlewillpresentsomekeyareas,inwhichsocialwor interventions would enhance the confidence of family members in care taking.
Support in crisis
 Thoughfamilymembershavetheirownmechanismtocopewithemotionsandproblems,most ofthefamiliesaredisruptedwiththeonsetofchronicphysicalillness.Asobservedinhospitals, cardiacarrests,stroke,chronickidneydisease,emergenciesduringpregnancies,accidentsand suicideattemptsleadfamiliestocrisis.Crisisbydefinitionisastateofsuddenhelplessnessand hopelessness.Theyneedahandtoholdandguidancetopassthesituation.Sometimesfamily membershaveadequateresourcestodealthesituations;stilltheyneedsupportfromanexpert whocanguidethemtocrosstheriver.Socialworkersusetheirscientificknowledgeandskillsto 
 
supportfamiliestofacethecrises.Manytimesfamiliesreachastate,inwhichtheywonde themselveswhattodofurther.Itisworthtonotethatduringthiscrisis,somefamiliesmay  becomevictimsofexploitations.Especiallyduringtheendstageofcancer,manyfamilieskeep changingthehospitalsforsomemiraclehealing.Anactivesocialworkteamwithprope counseling skills may prevent this phenomenon in oncology settings.
Information for Informed Decision Making
 Informeddecisionmakingisarightofpersonswithillnessandtheirfamilymembers.Theyneed adequateinformationtoproceedwithdecisionmaking.Doctorsandnursesdogiveinformation duringthecourseoftreatment.Sometimessuchinformationmaynotberegisteredintheirmind duetotheirdistress.Hencereviewingtheirunderstandingaboutthecauses,nature,course, treatmentandoutcomesofillnesswouldenablesocialworkerstoidentifytheneedforfurthe information.
Skills Training for Care Taking
 Socialworkerscantrainfamilymemberstofollowinstructionsfromtreatingteamduringthe stayinhospitalandafterthedischargefromhospitalthroughhomevisits.Manyfamilieskeep ask the following questions in Hospitals: “What to do while patient complain pain?” “Which kind of diet is appropriate for patient?” “How can we convince a patient who denies the dialysis care?” “How can we help him to control his anger?” “How can family members recognize the need for urgent medical care?” Thesequestionsindicatethatpatientsfamilieslookforwardtoskillstrainingtohelporcarethe  person
 
(Cooper,Eslinger,&Stolley,2006)
 
.Socialworkerscandevelopappropriateprogramme toequipfamilieswithcaretakingskills.Alongwithdoctorsandnurses,socialworkerscan educateandpreparepatientandfamilymembersduringthestayinhospitaltoaddresstheabove mentioned issues.
Windows to Welfare Measures
 
 
Popularlypeopleandtreatingteambelievesocialworkersarewindowstoknowandavail welfaremeasures.Therearemanyschemessuchasfarmers’healthinsurance,disabilitybenefits andrelieffundsfromstateandcentralgovernmentswhichwouldeasecaretakersburden. Professionalsocialworkersmaymaintainarepertoireofwelfaremeasuresinthedepartment. Such list would help even a new social worker to provide this information to deserving patients.
Build Partnership for Prevention, Treatment and Rehabilitation
Thoughmanyupcomingcorporatehospitalstreatpatientsandfamilymembersascustomers,  buildingpartnershipwithfamiliesareessentialtoestablishtrustamongthem.Suchtrustis catalystinprevention,treatmentandrehabilitation.Thepartnershipmodeofcarewillenhance thecredibilityoftheinstituteinsociety.Trainedsocialworkersmayactasanexperttoestablish this partnership between families and treating team (Cowles, & Lefcowitz, 1992).
Promote Resilience to Address the Burden
Social,emotional,physicalandeconomicburdenarecommonamongcaretakersofpersonswith chronicorterminalillness.Inthiscontextcaringthecaretakersprogrammemayalleviatethe caretakingburden.Regularsupportgroups,facilitatingsocialsupportsandwelfaremeasures, informeddecisionmakingandempathyoftreatmentteamwouldpromotetheresilienceamong familymembers.ClinicalSocialWorkershavetoexamineandmanagethecaretakersburden using professional strategies with the support of the medical team.
Conclusion
HenceClinicalSocialWorkershavetounderstandthatfamilymembersarenotpassivecare takers,theydoinvolveindecidingtheoutcomeoftreatment.Empoweringfamilymembersusing socialworkmethodswouldeasethestrugglesintreatmentprocessincludinghandlingthe financial difficulties arising out of treatment cost.
References
 Cooper,C.,Eslinger,D.M.,&Stolley,P.D.(2006).Hospital-basedviolenceintervention  programs work.
 Journal of Trauma and Acute Care Surgery
,
 
61
(3), 534-540. 
 
Hughes,S.L.,Cummings,J.,Weaver,F.,Manheim,L.,Braun,B.,&Conrad,K.(1992).A randomizedtrialofthecosteffectivenessofVAhospital-basedhomecareforthe terminally ill.
 Health services research
,
26 
(6), 801 Cowles,L.A.,&Lefcowitz,M.J.(1992).Interdisciplinaryexpectationsofthemedicalsocial worker in the hospital setting.
 Health & Social Work 
,
17 
(1), 57-65..
of 4