April 1, 2004

Adequate social services have yet to arrive in Karachi, writes Sheila Ali

In car rides during the daylight hours, quite frequently I see the sign for a social services agency and/or educational institution I have yet to discover. This also occurs when I am in session with a client, in conversation or while researching organizations to make client referrals. While this is an indication that the social services sector is creating a presence in our society, it also becomes apparent that adequate social services have yet to arrive in Karachi.

The earlier statement is based upon observations of signs for organizations that intend to provide services for disenfranchised populations, yet bear words with negative connotations such as “retarded”, “handicapped” or “addict” in their titles. Furthermore, a minimal amount of research into these organizations often reveals a bare minimum to no qualified professionals, a lack of organizational structure and more importantly either a clientele medley or a misdiagnosed nightmare.

The local social services and/or educational set-ups jump about nine steps ahead of themselves and begin to provide the community with much needed services: education, healthcare, mental health provision, etc. However, this occurs without an agency mission, programme guidelines and, often enough, even without qualified staff.

While the willingness to get your hands dirty is noble, nobility alone cannot sustain an organization (and in the long run, a society’s at-risk populations) without a conceptual framework.

Clinical social worker, Dr Judith Lee (1994) explained that adequate service provision requires the service provider to be well equipped in the areas of professional purpose, a strong value base, knowledge, theoretical foundations and a programme method that consists of principles, processes and skills.

Contrary to the literature, Karachi’s social services and/or educational organizations begin to provide services prior to meeting structural demands. The idea is understandable and will generate sympathy. It is a moral dilemma. The need exists and the thought pattern is that some service provision is far better than none. While this thought process too, is noble, it can in fact impart far more harm than good.

It appears that as a result of the lack of qualified staff, agency philosophies and structure, the usage of words such as “learning disability”, “emotional issues”, “mildly mentally retarded”, “slow”, “delayed”, “downs child”, etc., has become fashionable in the current mental health and/or education provider’s arena.

Terms of the discipline are so casually utilized and yet organizations appear to panic when in the company of a client/student who exhibits signs of behaviour that is set apart from the norm. Agencies either provide inappropriate services during these times or find the client unfit for their organization and refer him/her out for services. Immediately, the child, client or student is either rushed out for an assessment and/or behavioural evaluation or parents are rushed in for a “discussion” of what has by now been termed dysfunctional behaviour by the agency staff.

Last month, my client Faiza (name changed) sobbed through her session with me as she relayed a parent-teacher conference regarding her seven-year-old daughter. The school staff had recommended an assessment for a learning disability, as the staff felt quite certain that her child was a slow learner. Like most parents, Faiza did not have knowledge of learning disabilities or their impact on a child, nor had she noticed an impairment in her daughter’s ability to grasp learning concepts.

After two assessments at different agencies, Faiza’s child showed no signs of a learning disability. In the following session, Faiza reflected on the three sleepless nights her husband and she had experienced prior to the assessments. More importantly, my client felt a sense of relief after hearing about such encounters from other parents.

The problem with this case’s example is not merely the unofficial misdiagnosis. It is primarily the manner in which Faiza was informed about her child’s possible learning disability. Additionally, it is also the lack of awareness and empathy the staff appears to exhibit regarding the crucial issues of labelling a child.

Once a child is deemed a slow learner or any such term/label that differentiates the child from others in a group, the child’s self esteem has been tampered with. Rebuilding the damage that one insensitive comment may cause can simply take years.

Imagine you are a seven-year-old girl. Now imagine that your teacher has told your mother that you are not smart. Yet, in your reality, you do not experience difficulty learning, you did not even know you were not smart. Now someone you do not know confirms you are in fact not smart.

How safe or confident will you feel when returning to school on Monday morning? How much will you trust your class teacher? Do you think that maybe, you may even stop to doubt your own intelligence or ability to learn? How comfortable should Faiza feel with the school her child attends? (This case example has been utilized per client’s consent.)

Parents rely on institutions to not only provide their child with the appropriate services, but to also provide parental guidance. Perhaps parents must begin to develop a stronger sense of parental competency.

Attachment theorist John Bowlby (1982) stated that the attachment behaviour that formulates within a child is regarded as what occurs when certain behavioural systems are activated. The behavioural systems themselves are believed to develop within the infant as a result of his interaction with his environment of evolutionary adaptedness, and especially of his interaction with the principle figure in that environment, namely his mother.

In order to avoid feelings of fragility upon hearing of your child’s possible disability or behavioural issue, care givers must possess an unfaltering knowledge of their child’s strengths and weaknesses. The child’s place of learning or acquiring services must not be used to define the child or his ability, but be seen for just what it is: service provision.

Regardless of any forms of intervention a child may receive, it is the child’s parents who know him best. Parents must train themselves to acknowledge their child’s educators aptitude yet trust their own judgment when the educator’s/service provider’s level of professional capability raises questions.

It is a service provider’s ethical obligation to provide services in substantive areas or use intervention techniques or approaches that are new to them only after engaging in appropriate study, training, consultation, and supervision from people who are competent in those interventions or techniques (National Association of Social Workers, 1999).

Social workers and/or educators must be certain of and well versed in their approach to the work, prior to deliverance of services. Service providers must collaborate with other professionals within or outside of their own agencies in an effort to gain a deeper knowledge and understanding of the field.

Agencies must provide continuous staff training, strong supervision and a safe environment that encourages staff to raise questions. Additionally, administrators must begin to do their homework. The expertise and the funding to hire the staff are out there, the motivation to find them must be brought to the table.

An unclear agency mission impacts staff, clientele, activity formation, etc., and results in ambiguous service delivery. A haphazard approach to service provision is not only indicative in the actual service that is provided to clients, but also in an organization’s own environment. While on the job training may be a valuable asset to both employers and employees, prior to employees gaining that training, it is simply unqualified staff that is providing very crucial services.

Working with individuals in the capacity of educators and/or social workers is a privilege. Workers must invest in education, supervision, and experience to earn this privilege.

The writer is a psychotherapist

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