Case Study – Human Service Intervention

Case Study – Human Service Intervention

You are a social worker/human service worker/psychologist  working in a rural setting in SA who is employed at the local community health centre. You are working closely with another worker  from Disability SA.

A  family has been referred to you for assistance and support, in particular the eldest son, Stellios who has a mild disability and is 20  years of age. 

The mother, Isabella is a  second generation Australian born Italian woman who is 45 years of age and a single parent since divorcing her husband 10 years ago due to the Domestic Violence she endured  during her marriage to Costa. Costa constantly put her down, for all things – her ‘bad’ parenting skills, her ‘inability’ to manage the household, ‘inability’ to cook  or  clean according to his standards.  Costa  never took responsibility for these  tasks either. He always told her she was useless and stupid.

At times Costa would threaten to hit her, would also push and shove her and was always verbally aggressive towards her. On A number of occasions  Costa would upturn a bowl of spaghetti over Isabella’s head so it would slowly and painstakingly run down her hair , forehead and face to punish her for what he described as an unsatisfactory meal. Isabella always felt like she had to walk tentatively around the house. For  Isabella  it was  like walking  on “egg shells” as she never knew when his next abusive episode was coming so she always lived in constant fear. Isabella always  felt unsafe for herself and her children in her own home.

Her oldest son, Stellios, 20 yrs of age has Asperger’s  Syndrome ( a mild form of autism) and her younger son  Alex is 17 and studying  Year 12. Stellios is currently studying at TAFE  but has not been employed in any job since finishing  Year  11 about  4  years ago.   Stellios  lacks confidence in his abilities and has a very limited support network or social friends.  He often links in with his mother’s social activities.  He is fairly estranged from his father Costa, as his father has never really been able to cope with his son’s mild disability.

Stellios has a few difficulties in socialising due to  his disability and prefers the company of  adults as his peers are often lacking in understanding of the fairly mild social faux pas he sometimes  makes. Due to Stellios having   Asperger’s Syndrome he is socially inept and will often use humour inappropriately. Stellios also struggles to interact appropriately as he does not know how to ask questions or provide responses according to the progression of the conversation. As such his interactions are very stilted or focus on the same topics which generally includes cars or sport. These topics are the limitations of his interactions with people. He also does not have the skills to gauge others’ responses to him so he is always missing the social cues. This results in his peers rejecting him and socially isolating him from social groups  in his age group.

Stellios has never had a girlfriend, but would like to be in a relationship. He would also like to have  some  of his own friends so that he can go out to do things on the weekend. Stellios would like to get a job and even though he loves his mum and really is very attached to her,   he would like to live independently of his mother.   Stellios believes being able to live independently of his mother will be a sign that he has matured and may be able to cope with independent living. Whilst he is generally, able to look after himself daily, he lacks motivation and is unable to set goals for himself or stick to a plan to work towards achievable goals .   Stellios suffers from depression and anxiety and his mental health state  appears to be deteriorating on a daily basis. He feels frustrated that when  he sees other young adults his age going out and having a good time and being able to earn their own money through employment because  he is not able to do this.  He has always been told there is nothing wrong with him so he and the rest of the family are in constant denial about the mild disability.

He never went to kindy or pre – school as his parents tried to protect him from being bullied or ridiculed by other kids due to his mild disability. Stellios went to a local public school for a few months when he started school. However, he could not cope and he was teased and bullied  by the other children. He began to refuse to go to school. As a result, Stellios was home schooled  by his mother Isabella, so never was able to make friends as a child. Stellios was assessed by a psychologist when he was around 10 years old, but there has never been any professional assistance or support or intervention put into place.

Stellios has always been socially inept and has struggled with interpersonal communication with his peers. He is a likeable young man with a pleasant respectful demeanour, yet often presents as being a square peg in a round hole.   This is particularly so due to his limited social skills , his inability to read the reaction of his listeners ( ie when they get bored or think he is a “ Nerd”, because  his sole  interest in cars  then becomes the focus of his very limited discussion topics at all times). Stellios  lacks skills and abilities to hold an extended conversation with others  on topics that do not focus on cars.

Whilst he generally gets on with his younger brother Alex, Alex is resentful of his brother Stellios, because he believes  he will have to support and look after Stellios once their parents are deceased.   Alex has lots of friends and also has an active social life. However, he does not include his brother Stellios in any of these activities as he is embarrassed by his older brother and does not want to be seen with him unless it is at a family gathering.

Stellios was always put down as a child by his father who often yelled at him, calling  him a “spastic”, “dumb” or “stupid” as Stellios has always struggled to comprehend instructions unless they are very simple and straightforward.  This experience throughout his childhood and early adult life  has left Stellios  with very low self esteem and confidence in his social interactions and his ability to try and secure some form of employment. Stellios is so fearful of failing that he never takes any risks in changing his mental attitude or trying to change any of his behaviours.

Stellios is exceptionally scared of taking risks such as seeking employment or attending classes to assist him to gain some skills in developing a CV or assisting him with developing social skills or improving his communication skills. Stellios is also very slow in whatever task he undertakes and therefore is too scared to try and seek employment. When Stellios is challenged about his lack of motivation and his procrastination on all things he becomes quite defensive , agitated and angry.

Unrealistically, Stellios aspires to have his own small business yet does not really understand the complexities of small business management or how to get started in his own business.  This is the reason he is studying for a Certificate IV in Small Business Management through the local TAFE College. He is enrolled in this program as an external /online student as he is too shy and lacking in confidence to participate in classes. His mother also does most of his assignments to help him get through the course.  Isabella will also be heavily involved in any small business they may try to start as Stellios will  not be able to take leadership of a business venture.

His mother Isabella has always over compensated and used to do most of his assignments  whilst he was at high school  and at TAFE as Stellios could not really write academically or comprehend the academic requirements.  Stellios has always had difficulties in comprehension and processing of things he reads and his understanding of things is very limited.  Isabella is beside herself as she has constantly encouraged Stellios to try and get a job or to join groups so he can meet some people his own age and hopefully make some friends etc. .

However, Stellios constantly puts up major barriers and obstacles to any of these suggestions. Stellios is too scared to venture out of his safe comfort zone. All he does all day is watch TV , surf the internet, tries to sell small items on e-bay, and go to the local shopping centre for a coffee and to have a look around. He has his driver’s license and so is mobile and he uses his mother’s car as she works locally and Stellios can drop her off in the morning and then is free to collect his mother at the end of the day.  Stellios does not like to drive long distances or at times when there is likely to be heavy traffic. He also maintains a general speed of around  55 – 60 kms even on the freeway or in zones where the speed limit is 100 kms .

Stellios ‘ depression and anxiety appears to be an ongoing problem. As he gets older and it becomes clearer he does not have the capacity to work he feels increasingly anxious and depressed about his future.  Approximately 3-4  months ago, Stellios had a series of seizures and has recently been diagnosed as Epileptic. This means now he will probably not be able to work in a mainstream job. Stellios is currently exploring the possibility of getting a permanent disability benefit through Centrelink.

Stellios’ father is Turkish and of Muslim belief system. His own upbringing was very socially isolating as his family did not mix with other Australians or any other race for that matter.  They migrated to Australia in the early 70’s and were ostracised by mainstream society. Stellios’ father, Costa always was aggressive as a child and teenager and still is, as an adult. As a child, Costa also had a learning disability and many suspect also has Asperger’s Syndrome however he was never formally assessed either as his family was also in denial. Costa was yelled at whilst at school by his teachers and also labelled as a difficult student because of his learning difficulties and aggression. This left Costa with low self-esteem and an inability to relate to others as a peer. He therefore cannot cope with his son Stellios  being  “ slow and unable to get a job or to mingle in society “.

They have very little family support because most of their close family members live interstate.