فصلنامه مددکاری اجتماعی
سال یازدهم شماره 40 (تابستان 1401)

The parent-child relationship is one of the most important relationships a person experiences throughout the life. This period has a crucial role in determining the personality of an adult. For this reason, interventions to educate parents in order to have a better relationship and prevente of possible adulthood trauma are necessary. This study was aimed to report a social work interventions with an attention-deficit/hyperactivity disorder child to reduce the child's destructive behaviors and indirectly teach his parents to improve how to interact with him and have a secure attachment.

Case Description: 

Parsa (pseudonym) is a six-year-old boy diagnosed with attention-deficit/hyperactivity disorder. Despite frequent hospitalizations, he is no longer responde to pharmacotherapy, and his parents are helpless in dealing with him. Social work interventions by emphasizing the theory of attachment and using the Person-in-Environment approach reduced the symptoms in the child.

In this case, the social worker worked based on the attachment theory and tried to train the mother and teacher. Given the effectiveness of this approach, it can be suggested as an effective approach to other specialists in the field. Of course, in this way, there were obstacles such as mere attention to pharmacotherapy, not being participated parents in the treatment process, lack of systematic view of the treatment team and their lack of awareness of the role of social worker, which fixing them will lead to better results.

Schizophrenia is the most severe chronic psychiatric disorder that associated with impaired social and occupational abilities. In addition to the patient this disorder also affects the entire family system. The care burden is the psychological, physical and social stress that comes to caregivers as a result of long-term care. Therefore it causes many problems such as burnout, anxiety, and depression for caregivers. The aim of this study was to investigate the effect of resilience training on reducing the care burden of families with schizophrenia.

This study was semi-experimental with a pre-test-post-test and a randomized controlled group. The statistical population includes all caregivers of schizophrenia patients referred to Roozbeh psychiatric hospital in Tehran in 2019. After obtaining written consent, thirty-six people who like to participate in the study were divided into experimental and control groups by random sampling method. After deducting the drops, fifteen people were in the experimental group and eighteen people in the control group. The research instrument was the Zarit burden interview and intervention protocol, then Henderson and Milleston resilience components training program was applied to the experimental group. The control group received no intervention. Data were analyzed by SPSS software using ANCOVA.

The results showed that the social group intervention in the experimental group with the approach of resilience training was statistically significantly different from the control group and it was able to significantly increase the total resilience score compared to the control group.(P<0/05)

Group social work interventions aimed at increasing resilience in caregivers of psychiatric disorders can be effective in increasing resilience and provide a basis for improving the quality of life of these people. The results of this study help social workers to use the resilience model to promote health, increase social, economic, and welfare performance and improve the level of tolerance of caregivers; leading to educating and working with families of schizophrenia patients.

Psychiatric social work is one of the most important areas in which social workers as a member of the treatment team provide specialized services in providing a supportive environment for people with mental disorders and their families to meet their needs and return to society. Because one of the factors influencing the quality of social services provided to social work target groups is burnout, this study compares the rate of burnout between psychiatric social work and other areas of social work.

The statistical population was all social workers working in four areas of social harm, justice, health, and treatment, including general and psychiatric hospitals in Tehran, whose number was eight hundred and the sample was three hundred nineteen people. The research method was descriptive-comparative and the data collection tool was Geldard's standard burnout questionnaire. To analyze the findings, descriptive and inferential statistics (F-variance) were used through SPSS software.

The rate of burnout among psychiatric social workers with an average score of one hundred one and nine-tenths was higher than the three areas of social harm, justice, and public health with averages of eighty-eight and thirty-four hundredths, eighty-five and ninety-three hundredths, and eighty-eight and twenty-three hundredths, respectively, and this difference was significant. On the other hand, among the three dimensions of burnout among psychiatric social workers, the atmosphere in the workplace had the highest score, followed by mental fatigue, and workload respectively.

Considering the results of this study and the high rate of burnout in the field of psychiatric social work and its effects on personal and professional life and especially the provision of social services to target groups, the need for special attention and care by relevant organizations and the adoption of supportive policies is obvious. In this regard, it is one of the most important issues that should be considered by health policymakers.

Despite the significant prevalence of psychiatric disorders and the high global burden of these, a large proportion of people with severe psychiatric disorders do not receive the services they need, which is called the care gap, and one of the goals of world health organizations is to reduce this gap. The purpose of this study is to review the most important global and regional strategies to reduce the care gap.

This was a review method study. The search had done in following databases in the period 2010-2020: pubmed, science direct, proquest in English as well as sid, magiran, and noormags in Persian with the following keyword: mental health services, treatment gap, and accessibility, care gap, remote care, and long-distance intervention in English and also mental health services, remote care, treatment gap and access to services in Persian. A total of thirty-seven documents were studied and the findings of the strategies were summarized.

These studies pointed four general strategies to reduce the care gap. Includes integration of mental health services in primary health care; distance care; capacity building and useing trained non-specialists; and community-based care. These strategies are especially recommended for low and middle income countries, and various studies have examined their effectiveness.

Integrating mental health care into the primary health care is the most important macro strategy in mental health system. Limiting psychiatric treatment to medication neglects other aspects that affect the incidence, relapse, and exacerbation. Psychiatric social workers need new approaches in working with these people. Psychosocial support and social workers are the missing link in the mental health care system.

Psychiatric social work (PSW) is one of the most important areas of social work practice. So far, no protocol has been designed for these interventions in Iran. In this study, for the first time PSW protocol has been designed and presented.

This study was conducted in three phases: desk review, directed content analysis and group discussion for receiving experts' comments on the protocol. In the first phase, studies about PSW and psychosocial interventions in Iran and other countries were reviewed. In the second phase, semi-structured interviews were conducted with fifteen experts, three patients and five family members and they were asked about needs and interventions that should be provided by the PSW. Data were coded and interventions were classified. In the third phase, the draft protocol was prepared based on the previous two phases and shared with experts. The final version of the protocol was prepared based on the comments of the experts.

A total of seventy eight articles were reviewed in the first phase of this study. The most important approaches and models used for PSW interventions were ecological approach, case management and teamwork. Data were categorized as assessment, motivational interventions, response to basic needs, psychoeducational interventions, counseling, family and group interventions, peer education and support, follow-up, community-based interventions, home-based and outreach services, long-distance services, destigmatization, occupational rehabilitation.
Also in the qualitative phase, psychosocial training, activation of patient and family support network, case work, family social work, relapse prevention, advocacy, occupational rehabilitation, after discharge follow-up and community work interventions were classified. The panel designed the protocol based on case management, and ecological, contingency management and teamwork approaches. This protocol describes multidimensional assessment, planning for social work interventions at the individual, family, group and community levels. Requirements for monitoring and evaluation, documentation and termination of intervention are also included in the protocol.

The protocol of PSW interventions based the ecological approach, suggested specific services at different levels of individual, family, group and community. The use of case management approach and ICM model in this protocol ensures a comprehensive approach to the treatment and empowerment of patients with psychiatric disorders from admission to discharge and especially post-discharge services. It is recommended that policy makers and social workers use this protocol in decision making and service providing related to mental disorder patients.