Social Work Intervention - Case Study Example

Social Work Intervention The treatment of paediatric cerebral palsy is an evolving and developing area. Although most forms of treatment have been in place for some time, existing methods are being modified and new methods introduced. In particular, advances have been made in pharmacological and surgical treatments, as well as therapy programs. The purpose of this paper is to comprehensively evaluate these trends as applied to the specified case. Case studies as well as developmental and family theory are used to determine an effective, holistic plan of care for the patient. Given that there is some concern about the child at birth, an argument for early intervention is made. Treatment is examined from birth to early childhood, in both the general hospital and home care settings. This topic has been chosen because it clearly illustrates trends in the treatment of paediatric developmental delays and cerebral palsy, from a holistic perspective using the multidisciplinary health care team approach. A critique of the writer's practice is not included in this analysis, as the writer does not have a medical background. "Cerebral palsy represents a broad range of static non-progressive motor disabilities that present from birth to early childhood, as a result of nervous system insults of congenital, hypoxic, ischemic, or traumatic origin. Motor involvement is always present, but additional neurological, sensory, and mental deficits often occur as well. The clinical manifestations vary depending on the nature and extent of the original injury. Characteristically, they are chronic throughout life and involve abnormalities in normal physical growth and mobility, as well as intellectual, social and emotional development" (Dzienkowski, et al. 1996: 45). Increased understanding and awareness about cerebral palsy, have led to improved techniques for early identification and implementation of treatment. Apgar scores provide a method for documenting the newborn's cardiopulmonary and neuromotor status in the first minutes following birth. The scoring system is based on observations of colour, respiratory effort, heart rate, tone, and reflex activity. An exclusive test for the treatment of cerebral palsy however, does not exist. Therefore diagnosis is generally based on a thorough history, physical examination, comprehensive neurologic assessment, and exclusion of differential diagnoses. The child in the case study has low Apgar scores at birth and a diagnosis of cerebral palsy; subsequently developing significant developmental delay and health problems. Scherzer (2001: 53) notes that clinical evidence consistently supports the case for very early initiation of assistance in daily management, and the provision of a treatment regime for infants with low Apgar scores. Although a diagnosis of cerebral palsy may not be apparent until between six and 12 months of age; if the child's developmental problems are confronted as they arise, larger gains are ultimately made. He goes on to state that the traditional, primary orthopedic approach in cerebral palsy has now expanded to include multiple professionals who must deal with the array of needs of the child. Best results for the child in the case study can be achieved by taking full advantage of this multidisciplinary approach and by tailoring treatment to his/her unique situation. At the same time, choice of treatment needs to be goal directed and take into account stages of the child's physical, neurological, mental and emotional development. A long term multidisciplinary approach to treatment will assist the patient to achieve the three major goals of therapy, as outlined by Wong (1995: 1874): (1) improve motor function and ability; (2) develop effective compensatory strategies; and (3) maintain maximum level of independence. The major components of holistic treatment include: pharmacologic intervention, surgical intervention, therapy programs, and access to support services. Treatment trends in each of these disciplines mean that today the goals of treatment for this child can more readily be met. The last several years have seen the emergence of new pharmacological approaches, such as the use of intrathecal baclofen and botulinum toxin A as options in the multidisciplinary treatment of cerebral palsy. Their use on our subject would not generally be recommended until at least the later preschool years. Indications for use in the actively growing infant under this age are yet to be well established, and clearly require broad clinical standards of uniformity and consistency. Baclofen administered intrathecally means smaller doses are used without the cerebral side effects seen with oral baclofen. According to Vitztum and Olney (2000: 43) "Until recently, treatment usually focused on the effects of the spasticity rather than the spasticity itself. Intrathecal Baclofen Therapy (ITB) administers a muscle relaxing agent directly into the intrathecal space; thereby decreasing the amount of spasticity the child exhibits". Many case studies have documented the benefits of ITB. Armstrong et al (1997: 409-414) outlines the study of a cross section of 25 patients aged between five and 20 who received the treatment for up to two years. Results were positive for most patients including improvements in upper extremity function, hamstring motion, and measures of daily function, and motor skills. The use of intramuscular botulinum toxin to block neuromuscular transmission in the spastic muscles of young children with cerebral palsy, has become commonplace in recent years. The primary objectives of the treatment are to maintain or regain range of motion, to prevent or reduce contracture, and to maximize functional mobility. At the present time, its use with individually affected muscle groups is being refined in relation to other non surgical treatment components including physical therapy, occupational therapy, use of orthotics, and serial casting. Boyd & Hays (2001: 167-177) state that the procedure is often used on young children between the ages of four and six to "buy time" during rapid growth, and before the use of permanent procedures such as selective dorsal rhizotomy or orthopedic surgery. Surgical intervention is usually reserved for the child who does not respond to the more conservative measures, but it is also indicated for the child whose spasticity causes progressive deformities. Its primary purpose is to improve function rather than cosmetic purposes and it needs to be followed by physical therapy. A comparatively recent technique is selective dorsal rhizotomy (SDR) which attempts to identify and divide out nerve rootlets that are associated with an abnormal motor response, leaving intact those that function normally. The result is a reduction in the amount of stimulation that the injured upper motor neurons must inhibit and a subsequent decrease in tone and spasticity. Intensive postoperative physical therapy is generally employed to achieve and maintain maximum benefit. The option of SDR would not be considered appropriate for our subject until preschool age at the earliest. Before this age, very rapid growth is occurring and the procedure could prove unnecessary and detrimental. Clinical studies such as that conducted by Vaughan et al (1998: 43-59) report a definite reduction in spasticity when compared to the use of physical therapy alone. This study noted improved function at 12 months after surgery followed by physical and occupational therapy. However, sustained or long term effects are yet to be consistently achieved or results regularly replicated. Although the procedure shows great promise for individuals suffering from spastic diplegia it is still considered to be experimental due to the lack of information on its long term effects. For the young child such as the subject outlined in this analysis, the most frequently utilized treatment up to the preschool years is a therapy program. Therapy is now seen as the earliest approach to habilitative treatment. Moreover, emphasis has shifted from a concentration on individual systems of treatment modalities to widespread programs of early intervention that incorporate physical, occupational and speech therapy with childhood development and early education methods. "This approach focuses on improving function and maintaining physiological conditioning in the initial stages, rather than attempting to change abnormal neurological motor patterns..." Patrick, Roberts, & Cole (2001: 275). In the actual management/treatment situation, the trend is now that the therapist should primarily act as advisor or coach to caregivers, thus emphasizing daily carryover at home. Physical therapy for the young patient should start early and aims to promote good skeletal alignment, normal posture and movement, and prevent contracture deformity. Techniques include positioning to reduce primitive reflexes, use of vibration with spastic muscles, and stretching exercises. Occupational therapy targets oral motor functions, visual perceptual problems and activities of daily living (ADLs). Training in manual skills and ADLs proceed along developmental lines and according to the child's functional level. Sitting, balance, crawling, and walking are encouraged at appropriate ages, accompanied by stimulation of protective extension and equilibrium reactions. Speech training under the supervision of a speech therapist is begun early, before the child learns poor habits of communication. Primary care givers can help by following the directions of the speech therapist. The therapy program should where possible involve the primary care giver, and be integrated into early educational methods enabling contact with other infants and families. This contact can greatly influence early learning and social maturity of the child, and provide support and direction for families. In treating the affected child up to the preschool years - like the one covered in this analysis several trends in support services have emerged. Services have generally been expanded and improved; the child's family is becoming more involved, and the focus is on integration into the wider community. Support resources include a wide range of services such as counselling for individual clients and their families, respite care for the caregiver, educational and job programs, and transportation services. Social services are essential for assessment and management of family dynamics, financial status, and special disability needs. "professionals should not lose sight of the fact that early appropriate supportive care for the family is a major ingredient reported by older patients, in long term follow up studies, to have influenced their functioning and development" (Petersen & Palmer 2001: 37). Current universal media attention, easy access to unlimited Internet information, and aggressive commercial interests all add to increasing demand for more immediate gratifying treatment results in cases such as the patient here. There are always new treatments appearing for the child with cerebral palsy, for example hyperbaric oxygen therapy, neuromuscular electrical stimulation, acupuncture, and cranial osteopathy. Many of these fail to stand both the test of time and scientific scrutiny. While these 'trends' are at their height, however, professionals need to be well informed about them so that we can properly advise vulnerable parents or primary care givers. It is important to keep an open mind on these issues as some do appear to provide some help, although the scientific premises for their use is not always clear. Although there is no cure for cerebral palsy, it can be effectively managed through coordinated efforts of multiple disciplines and long term follow up therapy. In analysing trends in the treatment of a child who has low Apgar scores at birth and a diagnosis of cerebral palsy, the plethora of options is revealed. Pharmacological and surgical interventions are successful in partially controlling symptoms of cerebral palsy and such associated disorders as seizures and contractures. Additional interventions of occupational, physical, and speech therapy as well as social work services can further assist patients and their families in adapting to the limitations of their disorder and their environment. The full range of treatments available for use are not discussed here. Instead some of the comparatively newer treatments are outlined to illustrate treatment trends and modifications. Ultimately choices need to be weighed up against the age and developmental stage of the child, whether the cost/benefit/harm ratio is favourable, and whether the treatment is appropriate in the child's multidisciplinary treatment plan. By focusing on the treatment of the child up to the preschool years, the importance of early diagnosis and intervention is revealed, as well as some of the possibilities available for this age group. When a management option is being considered, its impact on cost, time demands of the family, social limitations and psychological issues all need to be considered. The goals that are selected need to be realistic, understood by patient, family and provider, and assessed on a frequent basis. Because the writer is not from a medical background, a critique of his own practice is not provided. However from his analysis, conclusions can be drawn about application of treatment trends in the general hospital and home care settings. In essence, the choice of the most effective safe treatments for the individual child, and a professionally objective evaluation of functional outcome, must be the primary goals. Defining selection criteria in respect of the multiple treatment options available for the child with developmental delay and cerebral palsy is paramount. Part 2 We are yet children, the seeds that have been planted and hoped to grow into that one tall and sturdy tree, but the moment we try to break away from our roots and follow the paths of others not only will we fail to become that tree but also that we will never be recognised as the seeds we are! From a child's first breath to their first word, from their first step to their very first tooth, parents have always been there to protect and cherish that every moment. We are the part of them, our relation to them is the relation of the body and the blood that runs in it to keep it alive, whereby the child is the body and blood that runs through it is our parents love, wishes and prayers that are always with us. Regardless of how far we may be from them one day we cannot break this tie as we were engaged to it from the very first second of our existence. Life is a long ride that will eventually lead us to our own paths and scatter us in our different directions but no matter where this ride may lead it will follow the reflection of our parents footsteps. The happy and loving home they provided us with, the advice they have given to us have moulded our tiny brains and hearts to think and feel the way we do. Nobody has as much as influence as our parents do in our lives, even if we may not be very close to them what they do and how they are around us develops the same kind of reaction inside us. If others influence us and we tend to follow them hence getting at a difference with our own parents we will split into many different ways because every other person sees a different vision and insight to our lives. Besides if we try to break away and isolate our selves from the lives of our loved ones then what a failure we are trying to fit within the life of others! We cannot escape the fact that parents are the most important people in a child's life and become the conscience that lives within them. We cannot question our selves of the significance and love that we have for our parents with that of any other. It is very true that we need not only our parents but also our environment and our community to build up the people we become then again our parents are the only ones that can truly see who we are and without them we would wander ourselves into all kinds of failures and difficulties before reaching any success. People around us can help us but even though cannot help us in the best ways because we are a different person in every other's eye. Meanwhile our parents understand what's most important for us, they understand our strengths, and our weaknesses and can create in us the determination that we need. It is only when we ask those who may have lost their parents and orphans who have never had parents the importance and value of having them near us today. For those who are blessed with a father and a mother may not realise it but their parents hold a very special place within our hearts because of which what ever they may say, good or bad, gets to us, it touches our hearts and we react the way we do. Parents guide their children with what may seem as small advice but has a big meaning. They teach us with their failures and guide us with their success. Wisdom comes with the walk of life and so what they have learnt from their lives is what they want to teach us, they do not want us to fall the same way they did, they do not want us to fear what they feared, to face the troubles they faced. All these feelings and thoughts cannot be felt for any child by anyone else except for his/her parents. Look inside your self, and you will find they live in every corner of you, in your every breath and there is no way that you can take this away because you will always remain a part of them. The term Domestic Violence did not come into use until the 1970s. Having first been used to address the problem of wife battering, it now encompasses much more. Other terms commonly used are, for example, spousal abuse and intimate partner abuse. There are four major types of domestic violence. Firstly, there is physical violence, which includes pushing, slapping, beating, and assault with a weapon. Secondly, sexual abuse, which covers a wide range of assaults including forced sexual intercourse, penetration with a foreign object, grabbing and fondling, verbal sexual threats, and any other unwanted completed or attempted sexual contact. Thirdly, economic abuse, whereas the abuser denies the victim access to resources to which the victim is entitled such as education and employment. Lastly, psychological abuse, which includes acts such as isolating the victim from contact with others, humiliating the victim, degrading the victim, and threatening to harm the victim or those close to the victim (Encyclopaedia of Social Work, 1998). Definitions of domestic violence in a legal context vary from state to state. Some states limit domestic violence to violence between a man and a woman living together, while others include ex-partners or family members, regardless of gender. Other States also include the destruction of property into their domestic violence laws. Causes for Domestic Violence Three primary models try to explain why a person abuses those he or she professes to love. The first, the Feminist model, believes that men use violence to uphold their traditional dominant role in the family and to assert the patriarchal organization of society. The feminist model further believes that the conduct of men who abuse is the product of sexism and culturally learned mores (customs) and norms. The second model, the Family Conflict model, on the other hand explains domestic violence with resulting from stresses a family may experience. Additionally, conflict may also be a family's accepted way of resolving conflicts. Also, abusers aim to play a leading role in the household; therefore, any household member may potentially contribute in the escalation of violence. Third, the Psychotherapeutic model, assumes that personality disorders, traumatic life experiences in early childhood, or other personal dysfunctions draw a person to exercise violence in family relationships (Davis, n.d.). No matter what the reasons for domestic violence are, it is commonly agreed upon that domestic violence is a major societal problem. This research provides an overview of domestic violence during the last century, describes the demographic characteristics of the client population, raises major issues and concerns important to this field, and discusses services available and needs these services fill for the clients. The History of Domestic Violence During the Last Century According to Gelles, (as cited in Encyclopaedia of Social Work, 1998) until recently a woman could not legally accuse her husband of rape, because the law defined rape as a forced sexual intercourse on someone other than the wife of the person accused. As of 1988 only Alabama still prohibited men from being charged with raping their wives. Which stands in stark contrast to the 1871 ruling in Fulgham v. State, that made Alabama the first state to deny a husband the right to abuse his wife (Facts On File News Services, 2000). Not only marital rape but also domestic violence used to be widely accepted as a husband's right. Before 1970, police department training manuals stated that domestic violence was not serious and marital privacy should be respected (Encyclopaedia of Social Work, 1998). Until the late 1970s, restraining orders were only issued if, when filing for the order of protection, women also filed for divorce. These orders were not only hard to obtain, they were also not sufficiently enforced (Facts On File News Services, 2000). The feminist movement during the 1970s fundamentally changed society's attitude towards domestic violence. Women who formerly had been battered and abused developed services for domestic violence victims. They also lobbied for government support of these services and raised awareness of domestic violence (Encyclopaedia of Social Work, 1998). Since then, numerous changes have taken place to address the problem of domestic violence. Class action lawsuits and civil-damage suits forced law enforcement agencies to revise their policies and adapt processes to better address domestic violence. Domestic violence incidents were, in many states, established as crimes against the state, resulting in the victim no longer having to press charges. Law enforcement officers today are often trained on how to respond to domestic violence incidents (Facts On File News Services, 2000). The medical community also felt the need to act in response to domestic violence. In Delaware, for example, the Delaware Coalition against Domestic Violence together with Delaware's medical community and the Domestic Violence Coordinating Council (DVCC) developed a manual for healthcare providers addressing how to respond to domestic violence. The DVCC also trains hospitals and clinics, police officers, prosecutors, judicial officers, court personnel, executives, faith-based personnel, social workers, advocates, probation officers, and therapists throughout the First State on domestic violence (DVCC, 2003). While most laws pertaining to domestic violence are on the state level, the federal government also responded to domestic violence. For example, it is a federal offence to travel from one state to another to commit domestic violence or to force an intimate partner to cross state lines in an attempt to commit domestic violence (18 U.S.C. & 2261). Additionally, the federal government passed interstate stalking legislation (18 U.S.C. & 2261A) making it a federal offence to cross state lines in an attempt to stalk a victim, and also barred offenders from carrying and owning weapons (18 U.S.C. 922(d)(8), 922(g)(8), 922(d)(9), and 922(g)(9)). The Violence Against Women Act (VAWA) further protects victims of domestic violence and provides funding for services. VAWA also requires that the victim, if so desired, be heard at a bail hearing with regard to the danger posed by the defendant. VAWA also stipulates that the victim be reimbursed for costs occurred to the victim in obtaining a restraining order and other costs connected to a domestic violence conviction. Another important aspect of VAWA is the ability for battered and abused spouses and children of citizens and lawful permanent residents to self-petition for independent legal residency (8 U.S.C. & 1154). Before VAWA, immigrant victims had to fear deportation when leaving an abusive relationship. Since the late 1970s, states took an active role in domestic violence prevention. About a third of domestic violence outreach and services are funded from state level (Encyclopaedia of Social Work, 1998). Most states have laws that allow prosecutors to charge abusers without having to involve the victim. Many times victims are no longer are required to testify against their abusers. In 1997, a total of seven states and the nation's capital had mandatory arrest laws on the books that required law enforcement to make an arrest if there is evidence of an assault. Even more states encouraged such arrests. A 1984 study showed, that arresting abusers lowered the re-arrest rate within the next 6 months for domestic violence to 10%. However, more studies are needed to replicate these findings (Facts On File News Service, 2000). Demographic Characteristics While wife battering happens throughout all sectors of society, certain socio-economic factors indicate higher incidents of wife battering. These are, for example, poverty, underemployment or unemployment, and employment in blue-collar jobs (Dibble & Straus, 1990; Gelles & Cornell, 19990; as cited in Encyclopaedia of Social Work, 1998). According to Suitor, Pillemer, and Straus it also appears that youth increases a person's probability of being abused or being an abuser (Encyclopaedia of Social Work, 1998). Straus, Gelles, and Steinmetz report that unmarried couples living together are twice as likely to experience domestic violence than married couples. Additionally, abused girls are more vulnerable to becoming abused and battered women, while boys that witness domestic abuse are three times more likely to become abusers themselves (as cited in Encyclopaedia of Social Work, 1998). On the surface, race also seems to play an important role in domestic violence incidents, however, when comparing socio-economic factors, these differences vanish. In 2000 the U.S. Department of Justice issued a special report on intimate partner violence. The report tracks isolated incidents as well as a series of incidents. Therefore the data does not exclusively track domestic violence, however, is still useful in assessing who is most at risk of experiencing domestic violence. The report showed that women between the ages of 20 and 24 experience the highest incidence of intimate partner violence. Also, the report highlighted that regardless of demographics, women were 5 times more likely to experience intimate partner violence than men. Characteristics such as being black, young, divorced or separated, earning lower income, living in rental housing, and living in urban areas is all associated with higher rates of intimate partner victimization. Research Data The Center for Disease Control and Prevention (CDC) conducted a telephone survey of 8,000 men and 8,000 women on intimate partner abuse. Examination of the data collected showed that nearly 25% of women and 7.6% of men were raped or physically abused by a current or former intimate partner. 1.5% of women and 0.9% of men experienced physical or sexual abuse during the past year. According to these findings, there are 1.5 million women and almost 840,000 men abused by an intimate partner annually in the US. The study also showed that women who were battered were commonly also emotionally abused. These results hold up the belief that the abuse of women happens as part of a dominance and control pattern. Women also tended to experience injuries at a much higher level than men, at 41.5% compared to 19.9 percent. Lesbians tended to be abused less then heterosexual women by their intimate partners, at a rate of 11 percent. However, gay men experienced with 15 percent a higher rate of abuse then heterosexual men. However, other studies show that abuse in same-sex relationships happens as much as in heterosexual relationships. More studies are needed to come to reliable results. Domestic Violence in Delaware As reported by Delaware's Domestic Violence Coordinating Council (DVCC), founded in 1993 to address domestic violence in the First State, in its 2003 Annual Report, there are only 5 years of data available on domestic violence in Delaware. Since the council was founded domestic violence has gained in attention in the First State. Nonetheless, it is almost impossible to obtain current domestic violence statistics. Neither the DVCC and the Delaware Coalition Against Domestic Violence nor the Delaware Statistical Analysis Center, which evaluates data from the State Police's incident-based reporting system, have up-to-date in-depth reports available. Delaware's legislation defines domestic violence in a variety of ways, therefore omitting groups of people from obtaining help in domestic violence incidents. For example, the Protection from Abuse Act defines domestic violence as abuse between spouses or former spouses, a man and a woman cohabitating with or without having a child together, or a woman and a man who have a child in common but do not live together. This definition excludes Delaware's numerous gay and lesbian couples from obtaining protection under the Protection from Abuse Act (DVCC, 2003). During the last 5 years, Delaware has experienced an increase in domestic violence incidents, however the number of incidents resulting in injuries in relation to the total incident rate has consistently decreased. Delaware was the last state to establish protection from abuse order, however the number of orders granted has continually risen. In 2002 Delaware's courts finalized a total of 1505 protection from abuse orders. Delaware's domestic violence hotline also saw an increase in incoming calls, totalling 4216 calls in 2002 (DVCC, 2003). During 2003, over 9,400 cases of criminal and non-criminal domestic incidents were investigated by the Delaware State Police (Domestic Violence Unit, n.d.). Behaviour exhibited by clients Battered women often are overwhelmed by multiple traumas. For example, stress form years of abuse, fear of losing children, and fear that the abuser will abuse the children. These victims often appear angry, fearful, confused, and distraught. Walker (as cited in Encyclopaedia of Social Work, 1998) described the behaviour of battered women as battered women's syndrome, a subset to posttraumatic stress disorder that includes depression, anxiety and cognitive distortion of reality. She further concludes that these behaviours, while necessary for women to survive the abuse, also block women from changing their situation. Major Issues and Areas of Concern Availability of Services. A major concern is the availability of services to all members of society. Accessing mainstream services can be frustrating to women with disabilities, because services may not be able to cater to their disability, such as hearing impairment, or shelters may not be able to accommodate their needs, for example, being inaccessible or unable to administrate mediation (Nosek & Howland, 1998). Also, victims of same-sex domestic violence may not be able to access shelters, especially if these victims are male or transgender. Filling Positions of Retiring Workers Additionally, as many human services workers are getting older and are looking at retiring, their positions need to be filled with new, trained workers. While this means that plenty of employment opportunities will be available in the future, poor working conditions such as long working hours and emotionally draining work, and relatively low pay may make it difficult to fill these positions. The median annual earnings of social and human service assistants in 2002 was $23.370, while Social workers earned $33,150 annually, and government employed mental health counsellors had median annual earnings of $29,940. Many of the positions are also part-time. Therefore, while many employment opportunities will open up within the next years, it will be difficult to attract college graduates to these positions. Especially, since many positions require a Bachelors degree or higher (Bureau of Labour Statistics, 2002). Batterer Intervention Programs and their Effectiveness From great concern is the effectiveness of batterer treatment programs. Research by the Department of Justice in 2003 studied the effectiveness of batterer intervention programs. The study showed that batterer intervention programs do not change behaviours of those attending. Twenty-four percent of men in both the experimental and control groups were, during their one-year probation period, rearrested. Thus, no significant differences were found between batterers who received treatment and those who did not receive any treatment. However, the study did show a difference in the reoccurrence of domestic violence between batterers who had steady employment and/or who owned a house and those who were unemployed and/or lived in unstable housing. It appears that batterers who have little to loose are more likely to become repeat offenders. Also, it appears that those who received longer treatment, twenty-six weeks versus 8 weeks, were less likely to re-offend. Nevertheless, neither group had changed their views o women or domestic violence. While various circumstances, such as high dropout rates from treatment programs and inadequate assessment of batterer's attitudes towards women and domestic violence may make this research unreliable, it still questions the effectiveness of the batterer treatment programs commonly offered. Reporting of Domestic Violence According to the CDC (2000), most intimate partner abuse is not reported to law enforcement, making it difficult to know exactly how many men and women are abused. Only about 20 percent of all rapes, 25 percent of physical assaults, and 50% of stalking incidents against women were reported to law enforcement. The number of victimizations of men by intimate partners reported to police is even smaller. A general belief that the police cannot help or would not do anything keeps victims from reporting abuse or stalking incidents. Services in the field There are a variety of services available to victims of domestic violence as well as abusers. 24-Hour Hotlines. Hotlines provide around the clock contact for victims of domestic violence. They assist by either having someone talk to the victim, or by referring those seeking services to appropriate service provider. Part 3 Providing accommodation to Darren is a big problem as homelessness is a growing social injustice. The degradation that these people face every day is terrifying. It is a crisis that we too often ignore, hoping it will restore itself. That assumption delivers a widespread lack of understanding about the facts that lead to homelessness. Homelessness exists as a problem that we should acknowledge and treat. Homeless children often depend on the highest-cost public service systems. They need emergency room care, hospital psychiatric beds, detoxification centres, and residential treatment programs, due to the fact that one-third of the children who are homeless have serious mental illnesses, and more than one-half of them also have substance use disorders. Many children who are homeless and have addictive disorders want treatment, but the service system is ill-equipped to respond to their needs, leaving them with no access to treatment services and recovery supports. Studies show that supported housing is an effective option for communities working to meet the needs of people who are homeless with mental health disorders. Supported housing offers stable homes and services such as mental and physical health treatment, supported education and employment, peer support, daily living skill training, and money management instruction. These unfortunate people are citizens of our country, and it is our duty to help them get the treatment they need for their illnesses and addictions. References Armstrong, R., Steinbok, P., Cochrane, D., Kube, S., Fife, S., Farrell, K. 1997, 'Intrathecally administered baclofen for treatment of children with spasticity of cerebral origin' Journal of Neurological Surgery, 87: 409-414 Boyd, R. & Hays, R., 2001, 'Outcome measurement of effectiveness of botulinum toxin type A in children with cerebral palsy' European Journal of Neurology, 8(5): 167-177 Bureau of Labour and Statistics, & U.S. Department of Labour. Occupational outlook handbook, 2004-05 Edition. Retrieved April 1, 2004, from http://www.bls.gov/oco Davis, R.(n.d.). The many faces of domestic violence Delaware State Police (n.d.). Domestic Violence Unit. Retrieved April 20, 2004 from http://www.state.de.us/dsp/domestic.htm Department of Justice (2003). Do batterer programs work? Two studies. Washington, D.C. Domestic Violence (2000). Retrieved April 27, 2004 from Facts On File News Services: http://www.facts.com Domestic Violence Coordinating Council. 2003 annual report. Retrieved April 2, 2004, from http://www.dvcc.state.de.us/documents/ar2003.pdf Dzienkowski, R., Smith, K., Dillow, K. & Yucha, C. 1998, 'Cerebral palsy: a comprehensive review' The Nurse Practitioner, 21(13): 45-60 Intimate partner violence. Retrieved March 30, 2004, from National Center for Injury Prevention and Control: http://www.cdc.gov/ncipc/factsheets/ipvfacts.htm Korpela, R. & Seppanen, R. 2002 'Technical aids for daily activities: a survey of 204 disabled children' Developmental Child Neurology, 34: 985-998 National Association of Social Workers. (1995). Encyclopedia of Social Work (19th ed.) New York: NASW Press. National Institute of Justice, Centers for Disease Control and Prevention (2000). Extend, nature, and consequences of intimate partner violence. Washington, D.C. Nosek, M.A. & Howland, C.A (1998). Abuse and women with disabilities. Retrieved April 1, 2004 from http://www.vawnet.org Patrick, J., Roberts, A. & Cole, G. 2001, 'Therapeutic choices in the management of the child with cerebral palsy' Archives of Disease in Childhood, 85(4): 275-281 Petersen, M. & Palmer, F. 2001 'Advances in Prevention and Treatment of Cerebral Palsy' Mental Retardation and Developmental Disabilities Research Reviews, 7: 30-37 Scherzer, A. 2001, Early Diagnosis and Intervention Therapy in Cerebral Palsy. An Interdisciplinary Age-Focused Approach, New York: Marcel Dekker The Family Violence Prevention Fund (2001) State by state legislative report card on health care laws and domestic violence. San Francisco. U.S. Department of Justice (2000). Bureau of Justice statistics Special report: Intimate partner violence. Vaughan, C., Subramanian, N. & Busse, M. 1998 'Selective dorsal rhizotomy as a treatment option for children with spastic cerebral palsy' Gait Posture, 8: 43-59 Vitztum, C. & Olney, B. 2000, 'Intrathecal Baclofen Therapy and the Child with Cerebral Palsy' Orthopaedic Nursing, 19: 43-51 Wong, D. 1995, Nursing Care of Infants and Children, St Louis: Mosby Read More