The following case study illustrates several concepts you have read about in this chapter. It presents four possible clients who are experiencing problems and who have different perspectives on their problems. This situation also illustrates both the individual and the family as clients. Let us focus first on the human service model of service delivery.
Consider yourself the human service professional who has received the following case. As you read it, think about these questions:
How have Susan, Ted, Justin, and Matthew solved problems in the past?
How do you think each person in the case study will define the problems?
As you consider problem solving as a systematic way of thinking, how would you as a human service professional approach the problems Susan faces?
Identify any strengths of any of the four individuals that might be helpful in addressing problems.
Describe the cultural considerations that are important when working with the individuals in the family and with the family unit.
How will the themes and characteristics of human services guide your work with this case?
SUSAN AND TED
· Susan and Ted met in college, where she was studying to be a teacher and he was studying to be an engineer. Ted was from an upper-middle-class family; Susan, from a religious, working-class family. Even while they were dating, Ted was a heavy “social drinker,” but Susan ignored his drinking. She wanted to marry a man with a college education and have a large family. She came from a small, close-knit family and had only one sister. She remembered her family as having few luxuries while she was growing up, but much love and nurturance. Ted’s family was also small, but not close. Ted had little contact with his family, even though they lived in the same town as the university.
Ted and Susan decided to marry during Ted’s senior and Susan’s sophomore year. They were living together and talked about a life together. When Susan became pregnant, they talked with both of their families about the pregnancy. Both families saw marriage as the “right thing to do.” Susan’s family promised to help care for the baby. Ted’s family agreed to pay tuition and basic living expenses until Ted graduated. Ted continued in school; Susan dropped out to concentrate on building their home. Her religious tradition placed value on her responsibilities as a wife and mother.
Ted felt he was leaving behind a happy, carefree life without responsibility. He was now beholden to his parents for financial support. He was determined to graduate so he could take his place in the world and earn a decent salary. His dreams did not include children; he saw college and career as a way to enhance his social status and pay for an exciting lifestyle that included fast cars and an active social life. He now faced an uncertain future.
Susan tried to be the “perfect wife” her mother had been. She was determined to work before the baby was born. After the baby was born, she would assume the role of homemaker and mother. Susan and Ted did not discuss their finances together. Susan felt that Ted should assume the role of the financial planner. She was happy to have an allowance for food and other expenses. She deposited her check from work into their account. Ted felt that Susan had no business in the financial affairs. That was a husband’s role. In addition, Ted’s parents were paying many of their expenses. Susan’s small financial contribution did not merit her involvement.
Ted began drinking heavily after they married. His grades were slipping. He did not spend much time at home. When Ted came home he seemed angry. He did not resemble the man Susan married. He threatened to hit her several times. Susan was sure that she must be doing something wrong. She thought her mother was a good wife and she followed her mother’s example, so she was lost about what else she could do. She was scared that she might lose Ted if she complained. Ted turned to drugs, and the relationship deteriorated further. Susan was alone and depressed but did not confide in her family, because she did not want to upset them.
Susan knew that Ted was intent on completing school. He was often away for days. As Susan’s pregnancy progressed, Ted would come home after class frustrated and angry. He began to hit her. Once, he beat her so badly that he cracked two of her ribs and broke her nose. He also attempted to strangle her. She told no one and lied to her doctor, coworker, and friends about the injuries. Ted “came to his senses” and tried to make amends, but he began drinking heavily once again and in a fit of rage kicked her in the stomach, bringing on labor. Susan delivered a son in the sixth month of her pregnancy. Justin weighed 3 pounds, 2 ounces, and had difficulty breathing. He was placed in an intensive-care nursery for six weeks before his parents could take him home. During this time, Susan worked and Justin continued to be sickly, suffering from chronic ear infections and colic. Ted had trouble adjusting to his new son and refused to help, so Susan quit her job and took care of Justin alone.
Susan worried about the medical bills related to Justin’s premature birth and subsequent medical treatments. Anytime she brought up questions about finances, Ted yelled at her, saying she did not trust him to manage that part of their lives. He forbad her to open the mail. She complied; she still could see the stack of letters or bills stacking up on the living room desk. Justin was so sick that she could not go back to work. After Ted graduated Susan hoped that their relationship would improve. Ted took a job at a local company; Susan believed that the job would be less stressful than school and Ted would have fewer pressures.
Justin continued to have many health problems and was constantly under the care of physicians. He was often hospitalized with pneumonia and severe dehydration. When Justin was 14 months old, Ted deserted them. Susan had no money, no job, and no car. She turned to her parents for a small loan and took a job in a department store making minimum wage. She had to work, but it distressed her to leave Justin with her mom. She felt that she should be able to care for her own son. Being a single parent was difficult. By the time she paid the rent, the bills, and the babysitter, there was no money left. She was desperately unhappy but determined to make the best of things.
Several months later, Ted returned. He had a new job making good money and was ready to “work things out.” He continued to drink and he still beat her, but she now wanted him at any cost. He soon learned this fact. One year later, Susan had another son, Matthew. At this point, Ted and Susan bought a house and proceeded to raise their family. For Ted, this consisted of nightly bouts with the bottle in front of a television set, long sessions on the computer, and forcing himself sexually on Susan. Whenever Susan thought about leaving, she concluded that her life included two very important aspects: she was financially secure and she was not raising her children alone.
Since Justin and Mathew both needed special services, financial stability was critical. Justin was diagnosed with Asperger’s syndrome when he was three. He attended a special day care for two years and now attends elementary school. Justin continues to be in ill health. Just last year he was diagnosed with severe allergies. He has had pneumonia twice in the past year; he was hospitalized three times for various illnesses. Mathew is visually and hearing impaired. Each was diagnosed at his two-year-old pediatric exam. Mathew responded poorly to developmental and physical tests; after subsequent visits to specialists, doctors recommended therapeutic intervention. Every day Susan was grateful for Ted’s insurance coverage. Even with the coverage, their medical expenses were about $1,500 a month.
Susan’s stability ended the day that Ted announced he had lost his job. He was to pack up his office by the end of the week. He received one month’s severance pay. Susan had feared this would be the result of the recent downsizing in many of the local industries. The entire community was feeling the effects of the economic downturn; all she had to do was drive to the neighborhood grocery store to see the devastating effects. Along this route, five houses were for sale on their street; several restaurants, the hardware store, one dress store, and two beauty shops had closed their doors in the last six months. Susan hoped that Ted would be spared. Susan was afraid that Ted would not be able to handle the layoff. She tried to talk with him about next steps in looking for alternate employment and applying for unemployment benefits. Ted’s answer was escalating violence and drink. He left a week later.
Susan knows that she needs help. In fact, she is overwhelmed by her problems. She tries to make a list of what issues she faces, but despairs 10 minutes into the activity. She applied for a part-time job and has asked her mom and dad if they could take care of the boys when she is working. She worries about Ted’s whereabouts and health. Her connection with him survived such hard times, and, for her, it is difficult to imagine a world without him. And then there are the day-to-day financial pressures that confound her. How will she pay the rent, utility bills, and medical bills? What about food and transportation expenses? Susan wonders who she can turn to for help. What can she do? Where can she go?
As you think about these clients’ needs from the human service perspective, you quickly realize that a part-time job and child-care support from Susan’s parents solve only immediate problems. The larger problems that Susan, Ted, Justin, and Matthew face are much more complex and will require comprehensive, coordinated service delivery.
You have learned in this chapter that human service professionals use three primary models of service delivery. In taking charge of this case, you will function within the context of the human service model. To promote the well-being of the whole person and to provide the comprehensive services necessary to that end, you may rely on professionals whose service delivery is guided by the public health model or by the medical model. To minimize duplication of services and to promote coordinated service delivery, you need to maintain active links with other professionals who may work with the same clients as you do.
Now that you are familiar with the history of Susan, Ted, Matthew, and Justin, review the problem-solving process. Select one of the individuals in the case study as your client and ask yourself the following questions:
What is the mindset of this client now?
What problems and subproblems does the client face?
How does culture influence the issues?
What alternatives are possible to solve these problems?
How would you as the helping professional use the human service model in this case? How would you blend the three models?
What services might be provided by professionals who practice the medical model, the public health model, or both?
How can a human service professional facilitate the interaction of all three models in resolving client problems?
Using models is a helpful way of identifying the different approaches to clients’ problems. The distinctions among the models are not arbitrary, for each has a separate history and has developed in response to different social needs. From the human service perspective, however, each model has a part in the problem-solving process. The worker is responsible for blending the models, and the treatments or services they represent, in response to client needs. Indeed, one strength of human services is the focus on clients’ needs and the flexibility to use approaches from various models to meet those needs.