The Role Of The Social Service Worker In The Rehabilitation Of The Juvenile Amputee

Claire Janelle, M.S.W.


During the past two years, the Medical Social Service Section of the Rehabilitation Institute of Montreal has developed rapidly and has played an increasingly active role in the rehabilitation of children and adult patients. This activity has been fostered by the administration, which facilitated the reorganization of the section, and by the physiatrists and other members of the treatment team, who expected the social workers to fulfill their real professional role as caseworkers and group workers. Participation in the children's rehabilitation program represented an important percentage increase in the referrals made to our section. This paper will comment briefly on a few aspects of this participation.

Policy of Referrals

Patients newly accepted for a rehabilitation program are not referred routinely to our Social Service Section. Instead, the treating physiatrist selects the patient and/or the family he wishes to have seen by the social worker on the basis of various considerations. Of 206 amputees under 20 years of age treated at the Rehabilitation Institute during 1966, Social Service had contact with 119, or 57 percent of the total case load. In this group of referrals, 71 percent were below the age of 11 years. This special interest in younger children reflects points of emphasis in our approach to the rehabilitation of the juvenile amputee which have previously been described by Dr. Maurice Mongeaul. These points are the importance of being concerned with the physical, social, and psychological needs of the child amputee, and the necessity of active participation by the parents in the rehabilitation program.

Role of the Social Worker

It was deemed necessary to broaden and improve the quality of our participation in the rehabilitation of handicapped children. A senior caseworker was assigned to the child amputee clinic, with the following specific objectives:

  1. To evaluate with the parents the social and emotional problems created by the handicap, and to analyze their expectations of the rehabilitation program, their perception of their role, and their motivation to participate in the work of the rehabilitation team.

  2. To establish quickly a meaningful and productive relationship with the parents and to maintain this relationship during the prolonged program of rehabilitation. Parents were encouraged to participate actively in regular follow-up visits and to consult with the social worker whenever they felt the need to discuss a problem. The follow-up visit took on a special meaning in our setting, since a high percentage of our clientele live far from Montreal.

  3. To maintain a dynamic participation in the work of the team.

Social Treatment

Parents have reacted positively to our new approach. In general they were able to involve themselves in various forms of social treatment. Special efforts were made with the parents, especially those living outside of Montreal, to utilize and adapt new concepts of short-term casework in a crisis period 2. Our short-term treatment program included parents with whom only a few interviews were possible, as well as those with whom a daily interview over a period of three to four weeks was an element of the rehabilitation program. Experience has proved that meaningful services can be offered to clients even when the time available is limited.

Conclusion

The policy of selective referrals has now been modified. All parents of newly admitted juvenile amputees are now referred routinely to our Section of Social Service. Parental group meetings are in the process of being developed as adjuncts to our casework program, and a group worker is working on the definition and methods of approach to our first groups of parents. Constant exchange and communication with all the members of the team has become a necessity. As a result, a more effective interagency working relationship has developed.

Claire Janelle, M.S.W. is Head of Section of Medical Social Service Rehabilitation Institute of Montreal Montreal, Quebec, Canada

References:
1. Mongeau, Maurice, "An Approach to the Rehabilitation of the Child Amputee," ICIB, VI:1, January 1967. 
2. Parad, Howard J., Crisis Intervention: Selected Readings, Family Association of America, 1965.