Case Study – ASYE’s involvement with individual with burns injuries

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The following case study from Birmingham City Council relates to the successful interaction of a newly qualified Social Worker (during her Assessed Supported Year of Employment) with an 18 year old girl who sustained serious burn injuries which she feared had brought an end to her future career aspirations and, at times, blighted her perception of any future life.  

Such feelings were exacerbated by the fact that the fire which caused her life limiting injuries and had resulted in the death of her mother had been deliberately set by her father, who was subsequently imprisoned for his actions.

 

CASEWORK

One of the first cases Liz was assigned as an ASYE related to “Sunita”, an 18 year old girl with mobility needs, whose circumstances needed to be reviewed on her transition from Children to Adult Services, in order to determine whether support was still needed and Direct Payment arrangements were still appropriate.

The presenting circumstances were, however, much more complex, in that Sunita had been involved in a house fire at the age of 16, in which her mother had died and her father was subsequently convicted of her murder and sentenced to life imprisonment. Sunita herself sustained serious injuries and spent several months in intensive care, as a result of severe burns to the lower half of her body, which severely interrupted her educational aspirations and took away her independence.

Since discharge from hospital, she had been cared for by her sister and brother-in-law, who were naturally also struggling in their sudden new roles as “enforced” carers, at a time when the sisters were grieving for the “loss” of both of their parents.

Realising there were inter-dependency issues to be addressed when considering Sunita’s current and future needs, promoting her independence and assisting her to regain self-confidence and motivation, Liz was also mindful of the potential psychological effect on Sunita of having experienced the dual trauma of having to come to terms with the physical disabilities she experienced, whilst at the same time “losing” both parents at a significant formative point in her life.

By adopting a task-centred approach and a strengths-based model, Liz was able to focus on Sunita’s strengths and resilience in terms of what she personally, and the family collectively, had to overcome since the unfortunate circumstances which led to the “loss” of both parents.

When engaging with Sunita, Liz ascertained she was desperate to complete her College course, but was concerned to have fallen behind with her work, due to reduced attendance, and feared this would impact upon her ambition to pursue a degree in I.T./Business Studies.  Although Sunita was required to attend College four times per week, at that point in time, she only managed to attend twice a week due to mobility issues and, not being able to travel independently, relied on her sister to transport her to/from College. An initial attempt to travel independently by bus resulted in Sunita having a fall, which greatly affected her confidence and resulted in the temporary retrograde step of having to resort to again using a wheelchair, rather than the crutches she had progressed to using.

Najma had temporarily reduced her working hours to support Sunita, but needed to seriously consider returning to work, yet was concerned about Sunita’s ability to adequately manage the dressing of her wounds and the potential for these to become infected.

Liz recognised from the outset that the presenting circumstances were defined by two distinct sets of personal needs – those of Sunita, as the main focus of her assessment/ review, and those of her sister Najma, who was evidently under a great deal of pressure herself, having had to suddenly “assume” the role of carer for her younger sister.

Having asked a Health colleague to undertake a joint home visit with her and was disappointed when Tissue Viability/District Nurses were unable to provide support, Liz resolved the situation by obtaining a Direct Payment for Sunita to employ a Personal Assistant to assist with personal care needs, as well as attending to her dressings/applying the required medicated cream 3 times a day.

As this was one of the first cases assigned to Liz, she acknowledged that, with a protected workload, she was able to devote time to building trust/establishing a rapport with Sunita and Najma, demonstrating sensitivity in respect of faith/culture, whilst exploring residual feelings there might be in terms of their parental loss and the knowledge that, whilst one parent had “offered protection”, the other had potentially “put Sunita’s life at risk”. There was also the shared knowledge that, whilst Sunita had expressed the view that she wanted no further contact with her father, Najma felt there were questions she needed answered in order to provide closure for her.

Sunita also did not want her peers to know anything about the circumstances of her acquired disability and had chosen to explain her mobility difficulties as the result of a car   accident. As a consequence, Liz considered potential psychological implications and was able to invest in stronger communication, exchanging e-mails and undertaking extra home visits to build Sunita’s self-confidence/esteem, encouraging her to focus on the goals she wanted to achieve.

 

 

SERVICE USER BENEFITS

Adhering to anti-discriminatory practice, Liz was also mindful/sensitive to Sunita’s cultural/ religious needs, and felt it important for her to also have a Direct Payment so that she could “employ” a Personal Assistant, of a similar age and culture, who would have an understanding of her requirements.

Liz similarly ensured that Sunita’s sister received a Carers Assessment, which highlighted for Najma that she also had needs and being able to return to work without the understandable anxiety/associated feelings of “guilt” and “abandonment” was a natural aspiration to have. The engagement of a Personal Assistant of Sunita’s choice significantly lessened such feelings for her.

Working in an anti-oppressive manner, Liz considered the impact their father’s actions had on both sisters and offered Sunita the opportunity to explore her feelings on the matter and to positively focus on what she wanted to achieve, rather than dwell on presenting limitations. This enabled Liz to support Sunita to change her own situation, rather than assuming the “power” to bestow change upon her. As a consequence, Sunita was able to obtain an extended deadline to update her course work and subsequently managed to maintain the level of input required by the College.

Having developed a strong rapport/trust with Sunita, Liz, recognising the commonality of having recently undertaken a University course, was able to support and encourage her in completing a UCAS application and exploring additional support options available from Universities.

Acknowledging that Sunita was lacking in confidence and had low self-esteem following her sustained injuries, Liz helped her to address such issues, to the point where she is now considering working with the Katie Piper Burns Awareness Project.

 

OUTCOME SUMMARY

The sensitive handling of this case, acknowledgement that having a reduced workload at the time enabled Liz to invest time and energy in building a rapport with both sisters, and being entirely person-centred focussed, enabled the aspirations of both sisters to be achieved.

For Sunita, the ability to resume her academic studies and to pursue with greater optimism her previous career aspirations, was greatly enhanced by having a Personal Assistant to reduce her reliance upon her sister and give her greater control over her personal care needs and increased independence. Providing the opportunity for Sunita’s sister to have a Carers Assessment made her more confident about acknowledging her own needs and right to resume her career without guilt or any other reservations, confident that her sister’s needs were being met in accordance with her own wishes and aspirations.

Sunita, when provided with the opportunity to provide feedback on the support she had received, responded as follows:-

Liz would come and visit me and my sister on the days that were suitable for us, as well as herself, which made it convenient, as I was at College and my sister was at work.

Whilst I used to have “ups and downs” at College, Liz was always there to support me when I needed her.   She helped me get my needs met, not just at home, but for College too.

Liz has been a great support to me and my sister throughout the whole time she has worked with me. She gave me and my sister good advice on what we could do regarding my own day-to-day needs and what I prefer and feel most comfortable with. Having a Direct Payment helped me, because I am now getting my daily care needs undertaken by someone I know and am comfortable with.

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