Author: Andre Coleman

A mental health nurses perspective of the issues surrounding the treatment of patients with a dual diagnosis of psychiatric disorder and learning disabilities in mainstream mental health units. This essay is going to explore from a mental health nurses perspective the issues surrounding the treatment of patients with a dual diagnosis of psychiatric disorder and learning disabilities in mainstream mental health units. Including a discussion around prevalence, provision of services, access to services, government policy and whether staff in mainstream mental health units have the knowledge and skills necessary to provide effective care for this potentially vulnerable service user group.

The contemporary concept of learning disabilities focuses on the physical and social difficulties that can occur as a consequence of being labelled a person with a learning disability and how any impairments a person may have affect them (Swain et al, 2004) however it neglects to identify the mental health issues people with learning disabilities regularly and more commonly face

If people who meet the diagnostic criteria for borderline learning disability are included the prevalence of learning disabilities in the UK equates to 12 % of the population or around 8 million people (Hassiotis et al, 2008)

It is generally recognised that people with a learning disability have a higher rate of psychiatric disorder compared with the general population with the prevalence estimated at 40 – 50 % (Raghavan and Patel, 2005). In comparison to 10 – 20 % of the general population (The Office for National Statistics, 2000) Various factors have been cited as being contributory towards this vulnerability including brain damage, sensory impairment, chronic physical ill health, epilepsy, repeated loss or separation issues, poor self-image, coping mechanisms and social skills, communication difficulties and family problems (Fraser & Nolan 1995, Hardy et al, 2007)

Mental health nurses are specifically trained to treat a diverse group of people including children and young people, working age adults, the elderly and new mothers all with mental health problems. Experiences from clinical practice demonstrate an increase in the number of people with learning disabilities admitted to general acute mental health hospitals and the increasing incidence of complications that can often come along with the care of this group of people. These include problems with assessment and treatment, usually stemming from communication difficulties, behavioural issues and barriers to collaborative working between the learning disabilities and mental health teams. They can often lead to an increase in length of stay in hospital and inappropriate or inadequate care being delivered.

Problems arise for the most part when a person with a learning disability develops a psychiatric disorder to the extent that requires acute psychiatric admission. It is now more common to find that they are being admitted to general psychiatric beds under the care of general adult psychiatrists and mental health nurses, many of whom have had little training in the assessment and treatment of mental illness in this group. The communication difficulties people with a learning disability may face can make assessment extremely complex. People with learning disabilities often require a longer stay and may also be vulnerable (i.e. Abuse and exploitation) without additional support on the ward. People with a learning disability may also have unusual presentations of common mental disorders due to brain injury or other long standing conditions such as epilepsy leading to difficulty in diagnosis and an idiosyncratic response to treatment.

Furthermore, people with learning disabilities represent a diverse group with a varied range of complex mental health needs, which mainstream staff may feel ill-equipped to meet. Boundary disputes between general adult and learning disability services frequently lead to a reduced quality of care for people with complex needs

Death by Indifference (Mencap, 2007) highlighted alleged care failings in general hospitals and primary care settings It led to the establishment of an independent government inquiry in England. The inquiry unfortunately did not extend to mental health services It found that there is little evidence concerning the quality of care received by people with learning disabilities in these settings but anecdotal evidence from practice has indicated that it is reasonable to believe mental health services face the same kind of problems as general medical care.

It seems pertinent to tackle these issues head on in order to meet the needs of this client group who have a diverse range of needs that can span across all branches of nursing and whose care can suffer as they seem to be regularly forgotten or pushed to the bottom of the pile

Until 20 years ago, people with learning disabilities did not normally come into contact with mainstream services. Most people with a learning disability who had complex needs including mental illness, were cared for in specialist mental handicap hospitals, and all medical and psychiatric care was provided on site. Deinstitutionalisation has transformed their care and now this group can live in the community and access mainstream health services, regardless of the degree of their disabilities. This process has been guided by the principle of normalisation since the early 1970s, which is a philosophy that remains influential today. Normalisation represents a fundamental statement of human rights stating that patterns of life and everyday living which are as close as possible to the regular circumstances of society should be made available to all mentally ill and learning disabled people (Nirje, 1976).

Closely associated with the principal of normalisation is the concept of mainstreaming, which advocates the use of standard rather than specialised services, for example, schools,

Employment and health care it is now a firmly established principle and features heavily in government policy which supports the use of mainstream services and the interrogation of the learning disabled population back into society but also recognises the need in some cases for specialist services. (The Department of Health, 1992) stated that: “wherever possible people with learning disabilities should be enabled to use ordinary health services as well as specialist assessment and treatment services”.

Advocates of normalisation generally support the mainstream approach; they may argue that specialised services lead to labelling, stigmatisation and negative professional attitudes. The argument for this approach at first glance appears sound and is supported widely by literature. It is, for example, current policy in the UK and USA. However, in practice mainstream community mental health and inpatient teams have found it increasingly difficult to meet the needs of people with learning disabilities and psychiatric disorders (US Public Health Service, 2002).

Each of the four UK countries has its own policy structure addressing how the needs of people with learning disabilities should be met in a mental health environment. England’s policy is set out in the following reports. Valuing People: A new strategy for learning disability in the 21st century (Department of health, 2001), Health Services for People with Learning Disabilities (Department of Health, 1992) and Mental Health: National Service Framework, (Department of Health, 1999), The common themes and issues that underpin this policy structure, include: promoting collaborative working between mainstream mental health services and specialist learning disability services; allowing people with learning disabilities to access mainstream mental health services wherever possible but creating small specialist inpatient services for those whose needs cannot be met by mainstream services, implementing a changing role for specialist learning disability services to providing support and facilitation for mainstream services including providing mainstream mental health and care staff with adequate training on the needs of people with learning disability; applying a care programme approach for people with learning disability and mental health problems and creating mental health promotion materials which are made accessible for people with a learning disability.

Advice is available to help care providers and staff support people with learning disabilities in accessing mainstream mental health care settings (Hardy et al, 2006). The Green light toolkit (Foundation for People with learning disabilities et al, 2004) is one example of a guidance document that demonstrates how policy structure and specific policies are being implemented in practice. It is used throughout England as an audit tool to measure how the National Service Framework for mental health (Department of Health, 1999) is being implemented for people with learning disabilities. The toolkit provides a gold standard that can be used by local mainstream mental health services to measure services against. It offers a traffic light scoring system and provides guidance on how services can be improved, covering areas such as local partnerships, planning, accessing services, care planning and workforce planning. After a green light toolkit assessment, each local area should develop an improvement plan from the action points identified and have a time frame to implement the necessary changes. Anecdotal evidence from observations in practice suggest that the green light tool kit is still being used in practice today but similar areas for improvement are identified time and time again such as access to health promotional materials in understandable formats. This would suggest that although assessments of services are being undertaken the outcomes of these assessments and action points are not being carried forward into practice. The Disability Rights Commission (Disability rights commission, 2006) supports this view by saying that previous guidance documents intended to help people with learning disabilities gain access to mainstream health services have had limited effect.

A working group from the royal collage of psychiatrists (Royal College of Psychiatrists, 1996) acknowledged that enabling people with learning disabilities to access mainstream mental health services can be a complex and demanding task requiring input from specialists in the psychiatry of learning disability. To respond to this statement they have advocated two principles for the mental health nursing of people with learning disabilities: joint working between mental health and learning disability teams with the use of Mainstream psychiatric facilities at every possible opportunity as well as stressing that provisions for specialist services are still to be available if needed.

The independent government inquiry instigated by Death by Indifference (Mencap, 2007), while not extending to mental health services, promoted research into the experiences reported by people with learning disabilities of acute mental health units. This provides a mixed picture. The negative experiences are similar to concerns expressed by other patients. These include: lack of control and information; theft of property; intimidating multi disciplinary meetings; poor food and poor care. However the presence of learning disabilities may alter their significance for example, service users with learning disabilities may find it harder to understand information about their admission and treatment, unless it is shared in a format which is appropriate to their cognitive and communication skills. Psychotropic medication may further impair already poor cognitive functioning and may represent an additional limitation on individuals’ capacity to understand and take an active part in their treatment. Relatives and paid carers are likely to have a much more significant and long-standing role in supporting the service user than would be the case with other adults with mental health problems, Often a person with a learning disability has specific routines that only someone close like a carer would know and following these routines can make nursing them much easier. this is something to which mainstream services in particular seem to pay little attention. Not stressing involvement with carers in particular with a client from this group can lead to either a lack of support for carers or carers feeling pushed away by services and left without a role which in itself can lead to the presentation of depression and low mood in the carer. (Scior and Longo, 2005) Finally, the risk that signs and symptoms of mental health problems will be misattributed to a person’s learning disability (diagnostic overshadowing) is specific to this group. These issues need to be considered by practitioners however, evidence indicates that healthcare professionals often lack the knowledge, skills and experience necessary to meet the healthcare needs of people with learning disabilities. (Fraser, 1999)

The Royal College of Nursing (Royal College of Nursing, 2008) commented that the recent development of an expectation of the mainstream mental health services to respond to the needs of the majority of people with learning disabilities and co-morbid mental illness has often proved an unrealistic goal for the mental health nurse.

It has been proven that special expertise and training as well as the use of specialist mental health teams are required for the assessment, diagnosis and treatment of mental illness in the learning disabled population. Although it is theoretically possible to train staff in mainstream settings, the small number of cases gives little opportunity for staff in the various disciplines to gain the necessary skills. Additionally, mainstream mental health staff often feel that caring for this group of vulnerable people is not part of their role, and the resources of adult mental health services are already stretched (Day, 1988). The funding implications that arose from such a massive shift in service responsibility that came out of the implementation of the mainstreaming approach never seem to have been adequately addressed (Bouras et al, 1995)

Collaborative working between professional groups in healthcare is vital across the board for improving standards of care for patients and their carers (Pollard,2004). In relation to this professional rivalries between mental health and learning disabilities teams are common and the understanding of each other’s role is poor leading to mainly ineffective collaborative working (Bouras et al, 1995) There has also been no apparent or definitive negotiation between the two service teams in the UK to develop clear local operational policies or service agreements and only vague definitions of who is entitled to access which service exist, which can sometimes lead to a patient receiving inappropriate treatment, being bounced between services or, in rare cases, even being denied care altogether as neither team is willing to take responsibility for that patients care.

Distinguishing between psychiatric disorders and behavioural issues in people with learning disabilities is not always a straightforward process. Both empirical and conceptual issues relating to the nature of such behavioural disorders question both the validity and reliability of a diagnosis of mental illness in a person who has a learning disability (Krose et al, 2000) This raises the question what does a nurse treat first? As with dual diagnosis of a drug addiction and mental illness, in many cases the drug problem needs to be tackled first before the full extent of the mental illness can be seen (Drake,2007).However, with a learning disability this is not a possibility as a learning disability is a long standing condition that cannot be treated. The question is therefore, is the behaviour being exhibited by a patient due to their mental health problems or the learning disability?

When a person with a learning disability requires admission to hospital due to a psychiatric illness, the first objective is to agree on whether the general or learning disability psychiatrist acts as the responsible clinician. The admission of a person with learning disability often happens as a last resort in response to an emergency that cannot be managed elsewhere such as in the community or via the use or respite services. The community learning disability team should be able to offer some training to nursing staff or even carry out specific pieces of work directly with the patient.

The allocation of a named nurse is extremely important and, if available, someone with special skills or interest should be appointed in order to develop a more effective therapeutic alliance with the patient. The increased vulnerability of people with learning disabilities to abuse even during admission should be considered and protection from this potential risk given. This may need to be in the form of separation from ‘high-risk’ patients or an increased level of nursing observation such as is policy with under 18s admitted to adult acute psychiatric units. In all cases, the importance of collaboration with the learning disability team should be stressed. This becomes particularly important during discharge planning. In the scenario of an admission under a Mental Health Section, people with learning disability and mental health problems are entitled to all the provisions of the Care Programme Approach and Section 117 after-care.

It is also essential that mental health nurses have a good working knowledge of mental health law and legislation. Experiences from clinical practice have demonstrated that often mental health legislation is misused or disregarded for people with co morbid learning disabilities which denies them the safeguards and protection of the law that legislation such as the mental health act was designed to put in place (Mental Health Act, 1983). The relevant legislation should be applied to this group of people if and when it is appropriate to do so and the same categories of detention used as for other individuals experiencing mental ill health. Although it is important to note that a person with a learning disability can still be sectioned if it is deemed they behave abnormally aggressively or seriously irresponsibly, without any signs of mental illness it is therefore important to determine that that there be actual mental health problems present if a person is admitted under section to a mainstream mental health hospital.

Assessment is a specific part of the nursing process where mental health nurses can struggle when dealing with people with learning disabilities For example, The Mental State Examination, which constitutes an essential component of the formulation process and is essential for assessing risk and formulating a treatment plan, may be problematic. This could be for a number of reasons, including high rates of compliance or an eagerness to please in certain interview situations (Sigelman et al, 1982). Moss argues that people with learning disabilities are also less likely to complain or approach members of staff to ask for help which may further complicate the Assessment and risk management process. (Moss,1999) Simple language and direct questioning including communication and in depth discussion with carers could be a way to overcome this difficulty. Higher levels of nursing observation may also be useful, not only in ensuring a person’s safety on the ward but also in giving vital information regarding a person’s mental state (Appleby,1999)

(Gibson, 2007) highlighted some key factors that nurses without specialist training may find complicate effective assessment and intervention The two main factors that affect mental health nurses are: intellectual distortion, which may result from cognitive deficits in areas such as memory and concentration which can make comprehension and communication of thoughts and feelings difficult; and Cognitive disintegration, which can occur in situations where the person is overwhelmed by the anxiety of the demands being placed on them, resulting in an inability to martial thoughts and bizarre behaviour

Communication is central to making a sound and accurate assessment. It is estimated that upwards of 50% of people with learning disabilities have significant communication difficulties (Matson, 1998) A nurse needs to address the particular communication needs of each individual as each will vary in their abilities, This is another point in which collaborative working becomes very important as if the person is involved with a learning disabilities team, that team may be able to provide the nurse with accurate information about the levels of a person’s communication and how best to manage these issues.

Many of the problems in relation to management of people with learning disability by mental health nurses relate to the lack of knowledge skills and training (Lennox & Chaplin, 1995). Evidence suggests that qualified nurses regularly feel out of their depth and unsupported when dealing with this client group and observations in practice indicate a certain amount of avoidance tactics from mental health nurses when it comes to volunteering for the named nurse roll which could be due to a lack of confidence in this area.

The current pre-registration nurse education programme for mental health nurses was originally validated by the English National Board (English National Board ,2000), and the curriculum follows the Nursing and Midwifery Councils’ Fitness For Practice Guidelines (United Kingdom Central Council for Nursing, Midwifery and Health Visiting ,1999), which states that students undertaking pre-registration programmes must have certain other specialities included. However, learning disability, as either a practical or theoretical component of the branch programme, is not one of them. With government policy (Department of Health, 2001) stating that people with learning disabilities should wherever possible access generic services, there would appear to be the need for a more specific and in-depth approach to learning disability education for all students throughout their pre-registration education.

Experiences from local preregistration nurse education show that currently nursing education provides a 12- month common foundation programme for nurses who intend to train in all areas of nursing including Adult, Mental health, Midwifery, child and learning disability nursing. Although not required by the NM, Learning disability theory is taught but placements in this area are not common. After common foundation period of training, student nurse education in mental health has little or no further opportunities to gain learning disability experience.

Comparisons with learning disabilities mental health can be made to both child and adolescent mental health, as well as to older people’s psychiatry in that they are both specialist groups with their own issues and mental health nurses are expected to study these client groups in detail during their branch training in order to become familiar with the complexities of this type of mental health nursing. As these areas are mandatory specialities in order to meet the requirements of qualification as a mental health nurse (English National Board, 2000) and, coupled with the government’s policy for people with learning disabilities to access generic mental health services, it would appear essential that mental health nurses address the speciality of people who have learning disabilities and additional mental health problems during their pre-registration education as they do with other specific patient groups.

Many senior mental health nurses have received no learning disability training at all. This lack of training may result in problems with communication and understanding, as well as negative attitudes toward people with learning disability. On the flip side, nurses in learning disability have similarly limited training in the area of mental health, although there are newly available post-registration courses. One such course gives an experienced nurse from either branch a six month secondment to the other nursing discipline which is backed up by 2 modules of theory. Anecdotal evidence gained from speaking to a mental health nurse who has recently completed this course has shown that general nursing skills that every nurse should be competent in upon qualification can be transferred across the board to other branches of nursing. The feeling of this nurse is that currently, mental health mainstream services see only those with mild or borderline learning disabilities coming into the service and the assessment and treatment process for these people is not much different to that of non learning disabled people. Currently specialist services provide the majority of care for the patients with more complex needs. (Scior and Longo, 2005)

In conclusion the evidence presented in this essay suggests a number of issues that need to be addressed if mental health nurses are to meet the needs of their clients with a co morbid learning disability effectively. There are: pre and Post registration training for mental health nurses, collaborative working between the mental health and learning disability teams and provision and access to services.

It seems that specialist learning disability in-patient units with a mental health focus offer a more positive experience for the patient than mainstream mental health units, and therefore should be developed further(Scior and Longo, 2005). However, realistically mainstream services are highly likely to continue to provide care for this group, if only because of the resource limitations in specialist services and the fact that 30% of NHS trusts provide no specialist admission facilities (Bailey & Cooper, 1997). There seems a need now for major changes to be made to the structures and day-to-day practices in these services. Such changes should include initiatives to promote more positive attitudes and behaviour towards individuals with learning disabilities through training and regular input from specialist learning disabilities services. Closer attention must be paid to the need to make information about diagnosis and treatments accessible, in media such as leaflets using simple language videos and audio information (Forster et al, 2001) and the need for stronger involvement of and co-operation with service users’ regular carers.

Current practice experience has shown however that in the most part mental health services in this area only seem to come into contact with patients who have a borderline or mild learning disability as there is a bountiful supply of specialist beds. Currently only in rare cases would mainstream mental health units be admitting a person with severe or profound learning disabilities whereby small alterations to practice and transferable nursing skills would not be enough to give that patient the best care available.

Referances

Appleby L (1999) National Confidential Inquiry into Suicide and Homicide by People with Mental Illness. Department of Health

Bailey NM & Cooper SA (1997) The current provision of specialist health services to people with learning disabilities in England and Wales. Journal of Intellectual Disability Research 41 52-9.

Bouras,N., Holt,G. & Gravestock,S. (1995) Community care for people with learning disabilities : deficits and future plans. Psychiatric bulletin, 19, 134-137.

Day, K. (1988) Services for psychiatrically disordered mentally handicapped adults. Australia and New Zealand Journal of Developmental Disabilities, 14,19-25.

Department of Health (2001) Valuing People: A New Strategy for Learning Disability for the 21st Century. The Stationery Office, London.

Department of Health (1999) mental health: national service framework, The Stationery Office, London.

Department of Health (1992) Health Services for People with Learning Disabilities (Mental Handicap). HSG(92)42. London: Department of Health.

Disability Rights Commission (2006) Equal Treatment: Closing the Gap. Final Report of a Formal Investigation into Health Inequalities. DRC, London.

Drake, R E, 2007. Dual diagnosis of major mental illness and substance disorder: An overview. New Directions for Mental Health Services, [Online]. 50, 3-12. Available at: http://onlinelibrary.wiley.com/doi/10.1002/yd.23319915003/abstract [Accessed 20 November 2010].

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Forster M, Wilkie B, Strydom A, Edwards C & Hall I (2001) Medication Information Leaflets. London: Elfrida Press.

Foundation for people with learning disabilities, valuing people support team and national institute for mental health in England (2004) Green light: how good are your mental health services for people with learning disabilities? A service improvement toolkit, London: Foundation for people with learning disabilities

Fraser, B. (1999) Psychopharmacology and people with learning disability. Advances in Psychiatric Treatment, 5, 471-477.

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Gibson, T, 2007. People with learning disabilities in mental health settings. Mental Health Practice, 12/7, 30-33.

Hardy S, Chaplin E, Woodward P (2007) Mental Health Nursing of Adults with Learning Disabilities. Royal College of Nursing, London.

Hardy S, Woodward P, Woolard P et al (2006) Meeting the Health Needs of People with Learning Disabilities. Royal College of Nursing, London.

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Krose B., Dewhurst D. & Holmes G. (2000) Diagnosis and drugs: help or hinderance when people with learning disabilities have psychological problems? British Journal of Learning Disabilities 29, 26-33.

Lennox, N. & Chaplin, R. H. (1995). Intellectual disability: the views of psychiatric trainees. Australian and New Zealand Journal of Psychiatry, 29, 632-637.

Matson,JL. and Bamburg,J. reliability of the assessment of dual diagnosis (ADD), research in developmental disabilities 20,89-95

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Nirje, B. (1976) The normalisation principle and its human management implications. In Normalisation, Social Integration and Community Services (eds R. J. Flynn & K. E. Nitsch). Baltimore, MD: University Park Press.

Pollard, KC, 2004. Collaborative learning for collaborative working? Initial findings from a longitudinal study of health and social care students. Health & Social Care in the Community, 12,4, 346-358.

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Sigelman C.K., Budd E.C., Winer J.L., et al. (1

Tony is a 14 year old boy who is out going and boisterous adolescent. June His mother describes him as “out of control” and says he never does as he is told June say’s “he is going to end up like his father terry” who is currently serving a prison sentence for a violent assault.

Discuss how an understanding of human development from a life course perspective assists you in understanding this child’s situation
Consider how your understanding will influence your work with the child and family social worker.

Human development from a life course perspective is a way of considering all contributing factors of an individual life and incorporating them with growth, development and change. It is often referred to as the lifespan or cycle, theorists use the different perspectives in order to understand and interpret different experiences and how these impact on an individual. The biggest debate throughout the centuries has been the nature nurture debate. There has been differing perspectives for example the

psychological and sociological perspectives to define exactly how much of personality, characteristics, behaviour and feelings derives from nurture or how much is in our genes and therefore innate. I will look at some theories in order to explain the case of Tony, a fourteen year old boy, who is described as an outgoing and boisterous adolescent.

Tony’s mother describes him as “out of control” she feels that he is unruly and states “he is going to end up like his father Terry” who is incarcerated for a violent assault. In order to fully understand Tony’s situation you must look further than the facts. There is likely to be various underlying issues within parental relationships, his environment, poverty and education, which will contribute considerably to his situation, therefore as a social worker I would consider a holistic approach in order to obtain a full and accurate understanding of his situation. To do this I will be incorporating theories on various aspects of his Tony’s life from a psychological, biological and psychosocial perspective.

Obstructions vary and can be hereditary such as a disability or health problems or environmental such as education unemployment and living conditions. According to the Behavioural Perspective, the individual may mimic or learn behaviours through: their environment, their peers, television, internet and media but more importantly role models. These behaviour patterns are underpinned by positive or negative rewards for the behaviour which in turn determine which behaviours are chosen to mimic Gross (20??). Tony’s father may have been a strong role model for him within a disadvantaged area where he may not have felt safe or secure. (Elaborate from violent night book).

There is a pattern throughout many perspectives which link the importance of stages in determining human development, like the lifecourse, such as; Piage’s stages of moral development, Freud’s psychosexual stages and Erikson’s eight stages of man. Erikson considered the developing stages of the life span as eight individual tasks and suggested these, depending on how successful the completion, would result in a positive or negative outcome. The eight stages of man is considered to be a Freudian based model of the psychosexual stages, as both see the relevant stages and the importance of completing them in order to successfully move on to the next. However Freud was not as flexible as Erikson, as he did not consider the ability to repair uncompleted tasks, where as Erikson suggests that more often than not there will be unresolved issues, but which may be overcome in later life. In Erikson’s adolescent stage, where the individual is thought to go through a process of identity v role confusion, searching for a coherent personal and vocational identity. The desired result of this would be for the individual to consider themselves as a consistent and integrated person.

However in Tony’s case there may have been an interruption of the stages, for example if his father has had an inconsistent relationship with Tony through a number of prison sentences from reoffending, then there may be confusion as to ‘what or who he is’. This outcome is considered to be a pattern for any individual who does not successfully complete this stage within the psychosocial model. Beckett (20??). Vitaro et al derived a theory based on Erikson’s eight stages that an individual who has a best friend or role model who is a delinquent, has a higher chance of them too developing such behaviour. However this model tends to take a somewhat individualistic approach and does not consider free will or the humanistic approach which would say that human beings have the ability to overcome adversities and choose the path in which they want to take. Gross Psychology (2008).

We can assume that there is a problem with finances which may suggest that there are some aspects of poverty. According to Perry (2004), children largely reflect their upbringing; positive and negative life experiences will determine behaviour. Therefore an understanding of early experiences and how they impact on the human brain is vital in order to understand the individual. The more enriched the early experiences of the child, the better the outcome and chance to reach their full potential is thought to be.

Du Plessis suggests, DATE the only innate features human beings are born with is reflexes such as blinking, breathing and sucking. Everything else is thought to be learned through the environment in which they live which then in turn will then determine the adult they become. She gives an example of a person given the wrong directions would never reach the desired destination, just as a child not given the necessary emotional support, love and affection will never reach their full potential, therefore the parents as the primary educators.

“The destiny of children’s lives lies in the hands of their parents”. Du Plessis (19..)

Mills suggests that people develop differently depending on the culture and environment in which they live as this affects the opportunities which they may have, or lack, through their life span. REFERENCE Income has a direct effect on children’s development for example; poor housing conditions such as: damp, cold and poorly nourished have a direct emotional and physical effect. There is also an indirect effect through the parent’s suffering hardships, parents and caregivers may not fully accomplish their parenting tasks unless living within ‘permitted circumstance’. Children’s development and well being is said to suffer through inequality as financial deprivation is probably the most common and wide spread stress factor faced by families within society. Algate, etal (19??).

“Poverty means staying at home, often bored, not seeing friends, not going to the cinema, not going out for a drink and not being able to take the children out for a trip or a treat or a holiday. It means coping with the stresses of managing on very little money, often for months or even years. It means having to withstand the onslaught of society’s pressures to consume. It impinges on relationships with others and with yourself. Above all poverty takes away the tools to create the building blocks of the future-your ‘life chances’. It steals away the opportunity to have a life unmarked by sickness, a decent education, a secure home and a long retirement. It stops people being able to plan ahead. It stops people being able to take control of their own lives. Taken from Aldgate – (Oppenheim and Halker 19996 p5)

Behaviour which is collectively considered unacceptable or maladaptive behaviour is thought to derive from distorted thought cognitions. These can often be self defeating thought processes not feeling good enough or in Tony’s case being constantly told he will never amount to anything positive. Gross Psychology (200??). Piaget’s theory of cognitive development emphasises the understanding of how a child’s cognitive ability varies by age, this too is a stage theory of cognitive ability. Such theories have given an insight into how a child is able to understand, or make sense of, their environment or a given situation and enabling professionals to consider such factors to guide their approach. (advanced psychology reference)

It may be argued that Tony is merely a product of his environment (look at book on environmental issues)…

However environmental factors, although have a vast impact, do not consider the individual will or the ability of human resilience to overcome obstacles, for example: the Humanistic Approach which emphasises individual choice. There is the thought that a person chooses whether or not to submit to oppressive circumstances and, has the ability, to overcome disruptions in order to reach full potential Gross (2008). Psychosocial is considering both individual psychology and social context of people’s lives on their individual development Walker (2008). It focuses on the importance of illiminating obstructions which may be preventing self actualisation, like the Humanistic Approach, emphasis on the will of a person and their ability to overcome adversities.

(Look at Darwin for biological explanations)…

Sociological explanations on deprivation- Bronfenbrenner (1979) influenced social work practice as he derived a series of systems to explain deprivation in depth which were: The microsystem which is the immediate environment such as people and events in the home, this is said to have the largest impact as it is direct, the mesosystem, which is a social and cultural factor and the way in which two or more Microsystems interact, the chronosystem which is the history of growth and development of time, the Ecosystem is beyond the immediate environment, for example the neighbourhood in which the child lives, and finally the macrosystem which is social factors, economic conditions and cultural values. Each of these systems interacts with each other to form the complexity of each individual’s life. Crawford and Walker (2008)

Look up examples of psychosocial theories-psychological theories is developmental psychology, cognitive and behavioural approaches which are already in essay but need to relate to eachother and state as such.

Conclusion To gain an understanding of each individual, as an individual, there must be an understanding of the interaction between various factors such as: the genes we inherit, physical characteristics, environmental factors, the impact of culture and response of others for example social class, the way we are brought up and choices made, random or unexpected events, opportunities and the impact of others on and in our lives Crawford and Walker (2008). As a social worker I would take a life course perspective, in order to ensure that I could incorporate this theory into practice, I would take a narrative approach. This is a way of working with individuals that focuses on the importance of their experiences and the meaning they attach to them, how the individual may have interpreted experiences within their lifespan to get to this point and therefore possible approaches or interventions to fit.

For ADP being careful of discriminatory language like youth culture which is linked to hoodies culture, talking about anti social behaviour is again linking the individual to a label based on age and assumptions. Also not using jargon therefore ensuring language is clear and targets are clearly understood, not abusing power by ensuring the individual has a right to input on how they feel and what they want despite them being a minor. Not making assumptions based on class or the environment in which they live that may be linked to high drug and crime rate. Not assuming the behaviour is innate and therefore there is genetics which will determine the behaviour of Tony to be exactly like his father. Ensuring all legislation and procedures are met as he is a minor with regards to objectives and choices given. Making sure you’re using resources available to the best of ability as you will more than likely be working within a budget. Assessing time scale trying to improve the situation before there is a crime committed, therefore assessing whose needs are to be addressed first. Looking at what agency you are working with and the approach that they take therefore being accountable for any choices you make within this restriction and having awareness of poverty, adolescence, the effects of incarcerated parents on their children and local agencies that you may incorporate to deal with practical problems.

Children’s whose parents are incarcerated are often overlooked when considering adversities faced by families and support structures which are put in place after such an event. According to Barnardo’s report, children of those in prison are more likely to experience mental health difficulties, poor housing conditions and poverty, yet are less likely to offered help and support for these. There is said to be over two hundred and eight local authorities and health boards spread across the United Kingdom and yet only twenty make reference to children whose parents are imprisoned in their children’s plan. (According to Linda Wilson director of bernardo’s Northern Island).

In today fast-paced society, finding a perfect balance between work and daily living is a very challenging task that every worker must face. Particularly, it is most affected to families lives, as some couples may prefer having more children, yet cannot see how they would afford to working lesser or stop working in order to look after their kids; while some other families satisfy with the number of kids they have, but still prefer working more to support their life styles. This typical problem somehow raises difficulty to the government in a sense that if parents could not achieve their desired work-life balance, it could affect their welfare and so directly impacts on the development of the country as a whole. As a matter of fact, it is said there is no such thing called ” perfectionism ” in this world.

Even so, Work life balance is still very important for the healthiness of everyone – employees and employers, so as for the good sake of the organization; presently it has also received attention from researchers, governments, management teams and employee representatives (Pocock, Van Wanrooy, Strazzari & Bridge, 2001; Russel & Bowman, 2000). In fact, most of us have all heard the term and simply complain that we do not have enough of it in our lives; so what is work-life balance, exactly? According to Kathleen Gerson, Sociologist, young people are searching for new ways to define Work-life balance that do not force them to choose between spending time with their children and earning an income. Yet, it is generally believed that parents should make more time to support their kids both economically and emotionally, as well as sharing labor equally, at the same time. Indeed, Work-life balance is not simply about working less or starting a family; it is also about learning how to truly live and enjoy our lives. In this paper, I would like to address the importance of work-life balance in the workplace; also, the challenges and solutions upon work-life balance.

II. Body
2. a. Benefits

Work-life balance describes an individual’s work and personal life. It tries to prioritize between work (career and ambition) and life styles (health, pleasure, leisure, family and spiritual meditation), so that people can maintain their leisure times with families and friends, and at the same time improving their potential performance at work. On that account, three main benefits are given to both employers and employees when organizations agree to adopt Work-life balance; firstly, embracing Work-Life balance helps attracting and retaining top talent staffs. Otherwise, negatively changing work environment like increasing working hours or lack of support and guidance from new employers are likely to force them to leave the place. Due to the fact that Work-life balance is compulsory toward the growth of company, The Yamaha Group, for example, is known to actively cooperate with labor for many years in its efforts to promote Work-life balance – shortening total work hours and providing support for both work and family. The company then started introducing employee benefit programs and systems ahead of statutory requirements. Besides, The Yamaha also introduced childcare leave followed by a system of nursing care leave, hopefully eliminating the negative outside forces of their staffs while working for the company (” Initiatives for a Better Work-Life Balance ”, 2011).

Secondly, work-life initiatives helps employees to reducing absenteeism, health costs, and stress even though they may have some distractions by family issues at work; it is known that people who are free of worry about what is going on at home can be more productive at work. According to the Australian data from the 2010 National Work/Life Benchmarking Study (Barbara Holmes, Work/life Balance International) found that thirty-seven percent (37%) stated that their work-life balancing strategy contributed to a reduction in absenteeism, while seventy-nine percent (79%) reported a positive impact on work productivity.

Thirdly, work-life balance also allows changes in working flexibility. New research from Families and Work Institute (FWI) has found out that employers and employees benefit, when both partner in finding flexible ways to work. Working flexibly means due to shortages of talent and skills, many knowledge workers have the bargaining power to negotiate their working conditions, including working hours preferences and space available, as long as they can ensure the job will be done. That is to say, working flexibly can not only help employees to manage their work and personal responsibilities, but it can also enhance an employees’ effectiveness on the job, and thus benefiting employers as much as employees themselves.

b. Challenges

We live in stressful times, and each of us has to deal with stress everyday. In a society that filled with conflicting commitments and responsibilities, work-life balance is known to be a predominant issue in the workplace; thus, having better understanding the interface between work and family relation, it directly and indirectly affects the daily living and performance in the workplace. Regardless of above benefits, three major challenges of work-life balance are described here. Firstly, global competition describes the outside forces that bring about the work-life balance tensions. These days, due to the various demand of the national and international workplaces, employment experience is changing – to get the jobs within today’s business environment, workers need to obtain higher skills to compete with overseas workers, it is somewhat weaken the relationship between work and family life. Also, in this new global trend, in order to decrease the company’s cost, most employers are searching for lower costs workers, resulting in pushing the wages lower and income insecurity higher for the individual workers. According to A Work-Life balance survey in 2009, it was stated that seventy percent (70%) of more than one thousand and five hundred (1500) respondents said they do not have a healthy work-life balance.

Ageing population, secondly, impacts the staffs’ benefits directly. According to Joseph Rowntree Foundation, Older workers are those men and women who continue their employment after reaching age 50, or who during their fifties or sixties are seeking to re-enter the labor market. Therefore, to stabilize their job in old age, an individual has to work longer hours, thus forgoing personal leisure time as well as neglecting their health, to meet the excessive demands of work and life. In the United States, for example, healthcare does not provide to all citizens. Statistically, Berg disclosed that 15.7 percent out of a population of 46 million is said to have no access to healthcare, because it is mainly covered by their employers and for the expenditures on this healthcare have just rose by 40 percent. Likewise, since their society takes it as a private matter, there is no federal assistance for this child rearing and sickness, causing it to be very expensive for most workers to afford. Additionally, Berg also added that starting from 1997 until today, dual-earner couples has been increasing in US – causing them to work by 10 hours per week and thus personal time has been dramatically reduced to an hour or less for men and women respectively.

Thirdly, technology is said to have facilitated employees from pressuring and keeping themselves at work more than home; however, the increased technology allows individuals to work anywhere and at anytime. Berg again raises that men nowadays have less time off but working more, which pushing them to face higher levels of intensity at workplace. An increasing in ill health, both mental and physical, and stress then have become troublesome problem in the modern workplace as much for office staff, managers, and even shop floor workers, due to over-work.

c. Solutions

Since work life balance is rising to the top of many employers’ and employees’ consciousness, in today high-tech society, human resource personnel seek alternatives to positively impact the bottom line of their companies – improve employee morale, retain employees with valuable company knowledge, and at the same time to keep pace with workplace trends. There is no particular strategy of one size fits all; yet three possible solutions are given to deal with above challenges. To begin with, On-the-Job Training should be provided. Being able to take part in lots of seminars and training might allow employees to challenge themselves in a global market. Besides, it is also enabling them to learn how to better manage their workloads, eliminate unproductive work habits, get enough exercise and bargain for more flexible work conditions, which meet their needs.

On top of that, it is important for line manager to be aware of overwork, because only managers are able to manage the error rates, absenteeism and stress-related burnout of their employees, by simply offering employee-assistance programs. Moreover, a manager should also guide them on how to prioritize their works in case lower level workers do not have related-knowledge; otherwise workload and stress are likely to exist amongst them.

Next, both men and women in ageing society mainly like in US, are found to be very crucial for the development of organization in terms of the knowledge they have, the role they can play in mentoring or coaching younger colleagues, and for the experiences they offer; so organization should consider creating strains on retirement pension budgets and education on retirement healthcare, prompting governments to encourage older employees to remain in the workplace with flexible time contracts. Otherwise, those young talented staffs will urge to retire more and enjoy early retirement stage, while other older and experiential senior workers insisting on retirement due to the need of spending more time with family and friends. Plus, government also plays important role in eliminating age discrimination in the workplace either upon promotion or recruitment. According to Margaret Collins from Bloomberg.com/news, once they lost their jobs, older workers in the age of 55 years old tend to stay out of work longer about 41 weeks on average in 2010, compared to 35 weeks of those age 25 – 54 years old.

Last but not least, with unlimited access to information and technological advances, it seems to serve both of our personal and business matter at the same time, faster than expected. However, when technology could be accessed everywhere people seem to be busier than they used to; it is suggested that if one is really addicted to web surfing, so to better balance this typical work-life, an individual should limit their working time (checking email, and work on it) and start focusing on family life, while getting some other times for leisure, as well. Besides, it is suggested that all workaholic should adopt the single idea of ” work will never be finished ”. It is true that there are some certain people, who try to please everyone (boss, customers, family) by holding multi-tasking at the same time, but they may forget that it could make them less productive and inefficient if they still continue with their workloads. People are not computer, there are times to be productive and times to be not, so entertainment is a must in this sense, to help them relax or re-focus on their job after a short while.

III. Conclusion

To sum up, in today’s sophisticated life, although money is not everything, people have to work harder to support their infinite demands. Meanwhile, they have to distinguish between working and family time while earning money. So it is the responsibility of all the managerial levels of organizations to ensure that they provide positive working environment for their employees by taking Work-Life Balance into consideration. Employees tend to feel more motivated when they feel appreciated and respected, thus boosting up their morale and productivity levels. In my opinion, efforts should be made to balance personal life and professional life, for the reason that if employees tend to pay more attention on personal life, then professional life will be more disturbed which resulting in losing the job and income. Nonetheless, if employees would give more importance to professional life, it is more likely to affect their nerve causing higher stress levels and thus negatively affecting their work performance.

As the population continues to age, it is becoming increasingly important to focus on policies and practices that support and enhance the wellbeing of the older population in later life. One sad reality for many seniors in later life and an increasing cause for concern is elder abuse. Elder abuse is one of the most disturbing and rapidly growing areas of crime throughout the global. It is extremely difficult to exactly quantify the extent of elder abuse because many such cases go undetected and under-reported.

The World Health Organization reported that it is generally agreed that abuse of older people is either an act of commission or of omission or neglect, and it may either be intentional or unintentional (Krug et al., 2002). It results in unnecessary suffering, injury, the loss of violation of human rights, and a decreased quality of life for the older person. Like any other form of domestic violence, abuse of the elderly initially remained as a private matter hidden from public view. It was initially seen as a social welfare issue and latter on a problem of ageing, but now has developed into a significant public health and criminal justice concern. The value of loving family institution has been tarnished by greed, position-struggle and impatience.

Despite elder abuse is not entirely a new issue; it is time to find out the prevention ways to be implemented and effective interventions to emerge. There are a few welfare needs that will be highlighted after so that the young generation have a strong sense of love and care towards the senior citizen.

Elderly

Nowadays, Malaysians are living longer; they are on an average of 74 years for men and 78 years for women. In others words, their life expectancy has increase. With the advances in medical care and better nutrition, older people are living longer, they are more visible, more active and more independent than ever before and they are in better health. Therefore there is a growing concern regarding the global phenomenon of aging. A decline in the birth as well as death rates has resulted in an increase in the elderly population. Given that the elderly population is on the rise, it is of paramount importance to examine the care of the older persons.

2005
(%)
2010
(%)

Total Population

26.75 m

28.96 m

65 and above

1.15 m

4.3%

1.36 m

4.7 %

This table shows that the total population and the aged of 65 years or above in Malaysia between the year of 2005 and 2010. In 2005, the total population of Malaysia was 26.75 million, and which 1.15 million or 4.3% was aged 65 years and above. Moreover, in 2010, Malaysia currently has a population of approximately 29 million, and aged 65 years and above has increased to 1.36 million or 4.7%. With the projected population growth of 2% annually, it expected that the total population in 2020 will rise to 34 million, of which 3.2 million or 9.5% will be the age of 65 years and above. In the year 2035, the country is expected to have a total population of about 46 million of which 6.9 million or 15% will be the aged 65 years and above. This is evident that Malaysia’s demographic ageing pattern is emerging. Based on the figure showed in this table, the real numbers of older person have increased lately, which also means that the number of elderly will continue to grow over the coming year. As the populations of older Malaysian grows, so there has a hidden problem of elder abuse. Further, the number of elderly with chronic illness is likely to increase. This can pose an increased burden on their caregivers such as family members, and it could lead to a higher risk of elderly abuse.

Elder abuse

Elder abuse is a single or repeated act or lack of appropriate action occurring within any relationship where there is an expectation of trust which causes harm or distress to an older person (Action on Elder Abuse 1995). The “wilful infliction of injury, unreasonable confinement, intimidation or cruel punishment with resulting physical harm or pain or mental anguish, or the wilful deprivation by a caretaker of goods or services which are necessary to avoid physical harm, mental anguish or mental illness” (1985 Elder Abuse Prevention, Identification & Treatment Act). According to the Swanson (1999), elder abuse refers to the mistreatment of older people by those in a position of trust, power or responsibility for their care. This is a global problem that is likely to intensify in view of the increasing number of older people and the changing socio-economic and environmental conditions worldwide (Randel et al. 1999). Further, Hazzard (1995) described elder abuse as cruel and inhumane treatment of the elderly. Kapur (1997) defines it as a kind of harassment or an injustice done to the elderly by the family members themselves. In fact, there is too many definition of elder abuse but despite this, most would agree with this definition “an action or inaction by someone in a position of trust; often a family member or unrelated caregiver”. Normally, more than two-thirds of the abusers are their family members and are typically giving their basic needs or care support such as food, shelter, personal care or transportation. In others word, someone who commits elder abuse usually has control or influence over the older person. The older persons often know and trust the abusers. Some victims of elder abuse depend on the people who hurt them, sometimes for food, shelter, personal care, or transportation. Therefore, the abusers could be their family members, friend; someone the older people relies on for basic needs or staff in group residential settings such as care homes or in long term health care facilities.

The Prevalence of Elderly Abuse in Five Developed Countries
Country
Prevalence (%)

USA

3.2

Canada

4.0

Finland

5.4

Netherlands

5.6

United Kingdom

5.0

The accepted prevalence rates of abuse of older people are drawn from five community surveys carried out in developed countries, which are USA, Canada, Finland, Netherlands and United Kingdom. The prevalence of the elderly abuse in USA with percentage is 3.2%, in Canada is 4.0%, in Finland is 5.4%, in Netherlands is 5.6% and United Kingdom is 5.0%.

But in Malaysia, the information and data of elderly abuse is scarce. There are no reported cases of elder abuse to the Department of Social Welfare as well as no agency keeps proper records of the incidence of elder abuse in this country. Although this ‘epidemic’ is virtually unheard of in Malaysia, we are challenged to be aware of the many faces of elder abuse in our own society and this issue is much more common than societies admit.

Types of elder abuse

Elder abuse referred to an inappropriate action that causes harms or distress to an elderly which the older person has expectation trust onto the person. Elder abuse can take in several forms. Elder abuse may take form in physical, psychological, financial, sexual abuse, neglect and abandonment that cause distress to a person who is past retirement age.

Physical Abuse

Physical elder abuse is non-accidental use of force against an elderly person that results in physical pain, injuries, or impairment (Ellen, Tina, Jeanne, 2008). This abuse includes not only physical assaults such as hitting or shoving but the inappropriate use of drugs, restraints, or confinement. The physical acts of violence commonly include slapping, hitting, and striking with objects. Indicators of potential physical abuse are broken bones, sprains, or dislocations, unexplained signs of injury such as bruises, welts, or scars, especially if they appear symmetrically on two side of the body, signs of being restrained, such as rope marks on wrists (Elder Abuse.com, 2009). Diagnosis may be difficult even at autopsy as findings may be subtle and invariably some chronic or debilitating disease would be present. The case of an elderly lady from a nursing home referred to the police for suspected physical abuse. Investigations showed that osteomalacia and spontaneous fractures could have accounted for her injuries. However, recognition of physical abuse may not be straightforward, as injuries may be secondary to falls to which the frail elderly are more prone.

Emotional abuse

Emotional abuse is defined as the infliction of anguish, pain, or distress of elderly. Emotional abuse also referred as an act with the intention that causing emotional pain or injury which often accompanies physical abuse. This abuse may be happens in verbal or nonverbal acts. Verbal forms are included humiliation and ridicule, intimidation through yelling or threats and habitual blaming or scapegoating. Nonverbal emotional elder abuse can take the form of ignoring the elderly person, isolating an elder from friends or activities and terrorizing or menacing the elderly person (Ellen, Tina, Jeanne, 2008). Therefore, an elderly person who shows fear, passive, withdrawn, low self esteem, reluctance to talk openly, insomnia, fatigue and listlessness or behave mimics dementia, such as rocking, sucking, or mumbling to oneself may be abused in the form of emotional abuse.

Financial Abuse

Exploitation of the elderly is also considered as an abuse which includes acts of material or financial exploitation. Financial or material exploitation is defined as the illegal or improper use of an elder’s funds, property, or assets (Elder Abuse.com, 2009). Elder financial abuse is one of the most difficult types of elder abuse to recognize due to its lack of obvious symptoms. Some of these include misuse an elder’s personal checks, credit cards, or accounts, steal elder’s cash, income checks, or household goods. Most common example case is the announcements of a “prize” that the elderly person has won but they need to pay money to claim (Ellen, Tina, Jeanne, 2008). Besides that, theft of pension checks, threats to enforce the signing or changing of wills or other legal documents, and coercion involving any financial matters also consider as the example of the financial abuse. Indicators of potential financial abuse may include unusual bank account activity, sudden changes in the elder’s financial condition, or worsening medical conditions due to lack of follow up or unfilled drug prescriptions. Exploitation may also occur in the form of fraud schemes; someone may persuade the elderly person to withdraw their life savings in a “get rich quick” scheme, or ‘contractors’ convincing the elderly that the house needs repairs which in reality might be unnecessary. Financial abuse is one of the most difficult types of elder abuse to diagnose as the victim may not be aware of its occurrence or may not know how to seek help.

Abandonment and Neglect

Abandonment is defined as the desertion of an elderly person by an individual who had physical custody or otherwise had assumed responsibility for providing care for an elder. It also referred to the action of withdrawing a person or a thing entirely; putting aside all care for him or it. Neglect of the elderly is also a form of abuse and is often referred to the refusal or failure to fulfil any part of a person’s obligations or duties to an elder. This may be intentional or unintentional neglect. Active neglect is the intentional withholding of basic necessities or care, while passive neglect is not providing basic necessities and care because of a lack of experience, information or ability. Another area to consider is self-neglect where older adults, by choice or ignorance, live in ways that disregard health or safety needs, sometimes to the extent that the disregard also poses a hazard to others. For example, the caregiver may be unable to perform care giving duties such as bathing or changing an incontinent elderly person. Therefore, an elderly person with unusual poor hygiene, loss in weight, poor nutrition, skin breakdown, unsuitable clothing, unsafe and unclean living conditions such as no heat or running water, faulty electrical wiring, other fire hazards and smelling of urine may be neglected either intentionally or unintentionally.

Sexual Abuse

Sexual abuse is defined as non-consensual and unwilling sexual contact of any kind. This includes all unwanted sexual activity, such as verbal or suggestive behaviour, fondling, sexual intercourse or a lack of personal privacy. Besides that, activities such as showing an elderly person pornographic material, forcing the person to watch sex acts, or forcing the elder to undress are also considered sexual elder abuse. Indicators of potential physical abuse are unexplained venereal disease or genital infections, bruises around breasts or genitals, unexplained vaginal or anal bleeding and torn, stained, or bloody underclothing (Ellen, Tina, Jeanne, 2008). Sexual abuse usually implies a physical sexual relationship with an elderly person without that person’s informed consent, though this is not restricted to sexual intercourse but includes other forms of intimate sexual contact. It is often difficult to establish whether sexual abuse has occurred, unless the individual has cognitive impairment.

Signs and symptoms of elder abuse

Signs and symptoms of elder abuse should be taken seriously. It is vital that we are alert to the possible indicators of abuse. In assessing any situation, it is important to realize that an indicator may be present for reasons other than abuse or neglect. However, if a combination of the following indicators is present there is a need to further explore why those indicators are present. Increase awareness of abuse signs and symptoms as well as monitor the progress in suspected cases of abuse. Home care community nurses can play a critical role in detecting suspected cases of elder abuse. However, in Malaysia, we do not as yet have a health care system in place for such purposes, although these types of services are only now slowly emerging. Hence the only opportunity for detecting abuse is when the older adult visits a primary care setting or an emergency department.

Characteristics of the Abused Elder

Most victims of elder abuse are mentally competent and able to make decisions for them. Most of them able to taking care of their own health needs and do not need constant care. Although some victims of elder abuse are generally dependent on their abuser in some way, their dependency is not necessarily because they are mentally incapable or physically frail (Al Loney, 2006). However, if the older people who having mental or physical disability, they may be more vulnerable to be abused. Those at risk are most likely to be female, widowed, frail, cognitively impaired, and chronically ill. The older adults who poor in physical health, highly dependence on the abuser, functional or cognitive impairment and a living arrangement shared with the abuser are consider as risk factors for elder abuse. Normally, older women are more vulnerable to abuse than older men and are burdened with a lifetime of experiences and beliefs that may increase their susceptibility. In most instances, violence and abuse against older women can be sexual, physical or psychological and also can include material or financial abuse and neglect. It can occur in the home, in institutions or as a result of harmful cultural practices that specifically target older women (Breatheinspirit, 2006).

There are various studies have looked at factors associated with elder abuse. In the NEAIS report, females and those aged 80 and above were more likely to suffer abuse, family members were the most likely perpetrators and victims of self-neglect were usually depressed, confused or extremely frail. Other studies have similarly reported vulnerable elderly as those with physical and mental weaknesses, advanced age, women, those with previous abusive relationships in the family, financial strain and caregiver stress and burnt out.

Characteristics of the Abuser

The abuser is most likely the person with whom the elderly person stays with. More often, the abuser is a close relative; 80% being spouses and children of the victims, or a close relative. In some cases, elder abuse may be caused to abusers’ over use of drug or alcohol, history of anti-social behaviour, or mental illness problems. Abuse is more likely to happen when the abuser is going through a period of high stress. It may be the stress of looking after the older person due to old age is a time of weak health, low income, meaningless role, or the death of loved ones (Al Loney, 2006). These problems may be creating great unhappiness for older people and then damage the relationships with their family. In extreme cases, this may lead to abuse.

Elder abuse often happens because of the abuser’s power and fully control over an older person. Family members who depend on the elder for financial, housing, or other necessities have a higher risk of become an abuser. A caregiver’s inexperience, a history of family violence, economic dependence on the elder or a blaming personality and unrealistic expectations often contribute to elderly abuse. The abuser may be lack involved in community activities, social services, and even contact with other family members. Besides that, they may lack of family support, facing marital conflict, overcrowding and the high burden of care placed on the caregiver. In most of elder abuse cases, the abuser may not allow people to visit or talk to the older person alone.

On the other hands, staff in long-term care homes, such as homes for the aged and charitable institutions, might involved in abuse the older people in physically or mentally. Abusers are more likely to be staff members who are not able to do their jobs properly (Al Loney, 2006). This may due to poor of training, low salary, over-work without pay, or under-staffing. Besides that, it also could be the staffs have personal problems that influence their services to older people which under their care. But, there is no excuse for abuse. The personal circumstances or problems of the caregiver can’t be an excuse of elder abuse. These problems may be factors in the abuse, but they do not try to recognize it. It is unmoral because the older people are fully trusted and relies on the caregiver, but the caregiver misuse the trust of the older people to do something that threaten to the older people.

Common Reasons Elder Abuse Is Not Reported

The actual and prevalence of elder abuse is unknown and difficult to measure. Elderly abuse exists in our society but it is seldom reported, and perhaps even less so in an Asian society where filial piety and respect for the elderly is traditionally highly regarded. This problem often remains undetected because of poor public awareness and lack of knowledge among health care personnel. This is because it can cause some adverse effects on the health and quality of life of the elderly. Due to their mental capacity, they are unaware of the help available to them. Therefore, elder abuse is seldom reported. In most situations, elderly are unlikely to report that they are abused as they are fear of embarrassment and fear of losing care support. They are mostly completely under the control of the abuser and depend on the abusers for food, shelter, clothing and health care. Furthermore, they also fear of harm by the abuser. Some of them are lack of awareness; they are only suspect but uncertain that is abuse, therefore, the cases of elder abuse is hardly to report and also seldom reported.

Risk Factors for elder abuse

Abuse of older adults is such a complex issue with no single explanation. However, there are many factors seem to contribute to these critical issues and each case has its own unique mix of factors.

One of the most obvious factors is the family dynamics. The habits, values, emotional and coping skills are learned early in life and largely through family interaction. In other words, if unhealthy or violent behaviours go unchecked, abuse may continue when roles are reversed. Therefore, if a child who was previously abused becomes a primary caregiver, there is a probability that the cycle of abuse will continue and be inflicted on a dependent parent.

Besides that, inability to cope with stress especially for those non professional caregiver such as spouses, adult children, other relatives and friends find taking care of an elder would caused many responsibilities. This may be extremely stressful to cope with the demands of elder care giving. As a result, the stress of elder care can lead to mental and physical heaths problems that caused caregivers impatient, burned out, and sometimes are unable to keep from lashing out against elders in their care.

Next, problem of elderly abuse may also happen in the nursing home when the staffs who worked are those lacks of experience and training. This is because even caregivers in institutional settings can experience stress at levels that can lead to elder abuse. The nursing home staff may be prone to elder abuse if they lack training, have too many responsibilities and are unsuited to care giving, or they are work under poor conditions.

Social isolation can also conceal and perpetuate abuse or neglect. An older person may become isolated due to physical or mental illness, or through the loss of friends and family members. Therefore, isolation does not just conceal abuse and neglect; it perpetuates the problem. The result of this isolation can make it easier for an abuser to exploit, neglect or abuse an older person. There is a significantly higher risk for elder abuse if without a caring support network. In addition, if a caregiver imposes isolation to avoid uncovering the abuse, this is also a form of abuse.

In addition, sometimes caregivers who are unable to cope with the long term care giving may react to the stress of too many responsibilities in appropriate ways. These unusual releases way are such as abusing, neglecting the older adults in their care. Also, most of the caregiver’s perception is that taking care of the elder is burdensome and without psychological reward. Thus, many of them choose to neglect the older adults.

The society’s acceptance towards violence can also be a form of factors in contributing the elderly abuse. For example the Canadians see violence in the news, movie and television shows. This wide exposure often leads to a general acceptance or tolerance of violence as an acceptable way of venting frustration or anger. Thus, this tolerance creates an environment which can contribute to abuse and neglect of older adults.

The welfare needs of elderly

Welfare needs are necessary for elderly in order to stop the growing elder abuse issue. The government, law and legislation, mass media, school education, health care providers, family and also elderly have the responsibility to give support the rights of old persons.

The government

The National Service Program or Program Latihan Khidmat Negara (PLKN) was established since started in 2004 as a response to the Malaysian Government’s desire to inculcate the spirit of patriotism in the hearts and minds of Malaysian youths. Besides to develop the spirit of patriotism, it instils a spirit of caring and volunteerism among members of society as well as to develop positive characteristics among younger generation through good values. The three-month program is aimed at shaping young people into disciplined, independent and resilient citizens capable of advancing the nation.

From this programme, the young generations could learn how to respect the elderly.

Welfare pension should be introduced in Malaysia. If elderly do not have the ability to claim maintenance from their financially-able children, they have the pension as a security. It is seen as a way to eradicate poverty. The senior citizens are still able to take care of themselves in spite of they are abandoned by their merciless children.

Abuse prevention programme could be introduced by Malaysian government as well. Its purpose is to provide and arrange for services to protect adults who are unable to protect themselves from abuse and provide older adults with information about their rights. For example, Abuse Prevention Programme (APP) in Australia which supports older adults who are being abused, or who are at risk of being abused, by someone with whom they are in a relationship of trust, such as family and friends. APP advocates work in consultation with the older adult, either directly, or with someone else the older person has chosen (their representative). APP can assist them to identify and understand the issues related to abuse of their rights as well as discuss information about options which they can implement to assert their rights. Besides, it suggests action they can take to stop abuse of their rights and give them with appropriate advocacy support that enables them to have their rights met.

In addition, the government can launch adult day care programme, which it enables the caregivers to get time off during the day. Adult day care is a planned program of activities designed to promote well-being though social and health related services. Adult day care centres operate during daytime hours, Monday through Friday, in a safe, supportive, cheerful environment. It not just provides older persons an opportunity to get out of the house and receive both mental and social stimulation but also gives caregivers a much-needed break in which to attend to personal needs, or simply rest and relax.

Law and legislation

Malaysia law and legislation also play a vital role in overcoming the elderly abuse problem. Malaysia law can establish a legislative “Elder Protective Act” which is warranted to protect our vulnerable elderly from untold suffering. They have the right to live with dignity and security. For example in all 50 US states have specific adult protection legislation within which issues related to elder abuse and/or neglect are addressed. This legislation is influenced by child welfare models, and is characterised by legal powers of investigation, intervention and mandatory reporting. In the absence of federal mandates, states have been developing their own responses to adult abuse, neglect and exploitation. Legislative “Elder Protective Act” should be implemented by the government to safeguard the rights of our vulnerable elderly.

Suggestion has been made for the government of Malaysia to adopt a law which allowing the elderly parents to claim maintenance from their financially-able children. This can be learned from the country of Singapore where the Maintenance of Parents Act enables parents above 60 years old who cannot support themselves to seek legal action forcing their children to provide maintenance for them.

The government of Malaysia should also tighten the law and can used country of India as an example. In India, children could be imprisoned or fined or be subjected to both if they abandon their elderly parents. The Tamil Nadu government is set to notify rules for the Maintenance and Welfare of Parents and Senior Citizens Act, 2007, to help tribunals in each district decide on the order of maintenance for elderly citizens, who complain about being neglected by their children. Therefore, the government is committed to develop such services and formulate policies against elder abuse in Malaysia.

Malaysia, being one of a few countries that uphold Syariah Law has Islamic Law that governs the welfare of family matters including the ageing parents, following the case in which a couple sued their daughter for not providing sufficient maintenance as what they have agreed.

Elder abuse is a national problem with far reaching consequences for individuals, families, communities, and institutions. The state courts must play a critical role in addressing the needs of victims of elder abuse. The court’s ability to assist older persons essentially determines whether individuals live their remaining years with respect and dignity, or are further alienated from the justice system with personal safety.

Mass Media

Mass media also plays a quite significant role in minimizing the problem of elderly abuse in Malaysia. The media was often blamed as one of the sources of the negative images of older adults in society. It was seen as important to work with the media to change these negative images, to raise awareness and to educate the population about elder abuse. They are able to inspire the public to be aware of this social issue by utilizing mass media such as televisions, radio networks, internet, newspaper, magazines, etc.

Nevertheless the problem often remains undetected because of poor public awareness and lack of knowledge among healthcare personnel. Therefore, the print as well as electronic media are to play active roles to increase the society’s awareness of the elderly.

Media coverage of elder abuse cases can make the public knowledgeable about-and outraged against-abusive treatment in those settings. Due to most abuse occurs in the home by family members or caregivers, there needs to be a concerted effort to educate the public about the special needs and problems of the elderly and about the risk factors for abuse. Within mass media cultures, social issues such as elder abuse, have key reference points which can attract concentrated coverage of the topic and carry influential associations in public perceptions. For example, in USA, the Indochina Sino-American Community Centre formed a coalition called “Chinese Americans Restoring Elders”, they used mass media to encourage the public to contact the Community Centre for matters related to elder abuse; provided some individual counselling sessions; and conducted a press conference and distributed brochures and flyers in Chinatown to commemorate World Elder Abuse Awareness Day.

The television networks always played the advertisements that have the influence on the public over the caring of the elderly. Like the PESTRONAS during religious or cultural holidays (namely Aidilfitri, Chinese New Year, Deepavali) are often accompanied by touching advertisement that convey the message to show love and care to our parents.

School Education

Education is the cornerstone of preventing elder abuse. This education needs to start very early, in primary school.

The students need to be educated to perceive to older adults more favourably as positive contributors to society. The elderly do not necessary mean burden to the family or society. With their wealth of knowledge and experience, they can still contribute to economic development and wealth creation. They have contributed to the development of the nation in their earlier years and they can still continue to be productive in their golden years. The students should consider senior citizens are an important and integral part of our society.

Students need to understand the interpersonal dynamic of care-giving. For example, they need to be award of the value placed on the dependency and inter-dependency in care-giving; role reversals in care-giving; and how unresolved emotions between the elderly and the care-giver influence the care-giving process.

The school curriculum is to include education on the family to enable the younger generation to understand and appreciate the elderly. They need to be encouraged to form closer relationships with older adults. The general population also needs to be aware that elder abuse happens and is a problem. Students need to understand the subtle difference between abuse, neglect and abandonment theoretically as well as operationally. The moral education teachers not just teach theoretically but also operationally. What is more, the schools should organise a numbers of the activities like visiting old

The rationale behind this assignment is to highlight restorative justice and the aspects of it, in terms of how it differs from the traditional legal justice system. This will include a critical analysis of restorative justice while evaluating its strengths and weaknesses as a different approach to crime control. I will identify underlying theory, legislation and policy that brought restorative justice to the forefront of opinion, and specifically relate it to the Northern Ireland criminal justice system. The aim is to identify if it is a meaningful system to all parties involved and why/if it is necessary in the present criminal justice system.

Introduction

In an age of “hoodie culture” and prison overcrowding, questions are being asked over the efficacy of the criminal justice system and how much of a deterrent from crime it really is. Following a long period of differing regimes, such as retribution, rehabilitation and restructure, all competing to be the dominant influence in the criminal justice system, there has emerged a ‘new’ approach to crime control, that of restorative justice (Hughes, 2001, p247). The aim of this approach is to provide an opportunity for the rehabilitation of the offender, as well as punishment of the criminal behaviour, with a central role in regards to the rights of, and provision of justice for the victim (Hughes, 2001, p248). The commonly accepted definition of restorative justice is; ‘Restorative justice is a process whereby parties with a stake in a specific offence collectively resolve how to deal with the aftermath of the offence and its implications for the future’ (Marshall, 1999, p5). According to Hughes (2001) Restorative justice aims to bring the process of criminality back into the ‘community’, enabling all parties affected by criminal behaviour to be involved in working towards resolution and future planning (Hughes, 2001, p248). This is a new concept, as traditionally criminal justice was retributive and aimed only to address the offence by punishing the offender.

In recent years, restorative justice has been a process that has been adopted by an international audience, particularly the USA, Australia and New Zealand, each employing it to address some of the traditional concerns of the formal justice system (O’Mahony and Doak, 2004, p484) i.e. the effectiveness of prison acting as a deterrent for crime, or victims lack of inclusion in the criminal justice process. The ‘new’ restorative justice system aims to move away from the traditional notions of retribution into a new context of restoration. Most international practices are supported by Braithwaite’s (1989) theory of reintegrative shaming, which exerts the idea that the offender should be encouraged to experience shame for their actions and work towards absolution (O’Mahony and Doak, 2004, p484). The process attempts to ‘repair the relationship’ between the victim and the offender and begin a ‘healing process designed to meet the needs of the victims, whilst also reintegrating the offender into society’ (O’Mahony and Doak, 2004, p484). Braithwaite’s theory is based on the proposal that the process of restorative justice will address the needs of the victim materially, emotionally and psychologically, whilst also helping them emerge from the process with more respect for the system (O’Mahony and Doak, 2004, p484).

Another theory of restorative justice was first introduced by the New Zealand Maori and their principles of collective responsibility, where restorative justice seeks to decentre the state’s status as the responsibility of dealing with crime (Tauri and Morris, 2003, p44). Instead, operating by drawing together all those involved in an offence to an environment, promoting equal power relations, while discussing the harm caused, and jointly agreeing on how reformation can be made (Tauri and Morris, 2003, p44). A central component to restorative justice is that the community is seen to be a key stakeholder in the offence (Zehr and Mika, 2003, p41). This can take a variety of forms, from the vicinity in which the offender and victim live, or their wider social networks of family, friends and colleagues (Zehr and Mika, 2003, p41). This allows for comprehensive information sharing beyond that of only the offender and victim, so that the scale of the harm caused by the offender can be explored. This is the main difference between the formal justice system and that of restorative justice, where all parties can contribute information of the offence and the harm caused, while also having an involvement into meaningful reparation.

Restorative Justice in practice

Restorative justice in practice is a relatively new concept in the UK, having elements such as reparation orders in the Crime and Disorder Act (1998), and referral orders in the Youth Justice and Criminal Evidence Act (1999) (Crawford and Newburn, 2002, pp476-478). Within Northern Ireland it was the Criminal Justice Review (CJR) (2000) which provided recommendations to involve victims in the criminal justice process and develop restorative justice approaches for juvenile offenders. The review concluded that restorative practices for adult offenders and young adult offenders (aged 18-21) be piloted and evaluated before whole schemes are introduced (Criminal Justice Review, 2000, p203).

Since then, within the UK and indeed internationally, there are the three common practices of restorative justice used within the criminal justice system, these are; 1) Victim-Offender Mediation (VOM) – a face-to-face meeting with a trained mediator, the offender and the victim to discuss the offence and reparation. VOM is predominantly offered to incarcerated offenders. 2) Family Group Conferencing (FGC) in Youth Justice – is open to a wider number of participants including the offender, victim, victim’s family and professionals who are linked to either party, where the aim is to resolve conflict or behaviour, and discuss reparation. Specifically used within youth justice as an alternative to formal prosecution, encouraging offenders to achieve empathy towards their victim, while also assuming responsibility for their behaviour. 3) Restorative/Community Conferencing – Open to a wider circle of participants including the offender, victim, both families and members of the community who discuss the offence and how to repair the harm caused. Conferences hold the offender accountable, but also offer reintegration into the community.

(Extracted from www.restorativejustice.org.uk)

FGC in youth justice is seen as one of the most successful models of restorative justice, widely used internationally in New Zealand, Australia and parts of the USA, and gaining momentum in the UK (O’Mahony and Doak, 2004, p485). FGC aims to be an alternative to formal prosecution, providing the offender, victim and families with an opportunity to understand the offence and the implications of it. The main aim of FGC as a form of restorative justice seems to exist to prevent younger people becoming implicated in the adult criminal justice system, having countless disadvantages for their future. FGC specifically seems to be effective as it uses a holistic understanding of the offence. It incorporates collaboration between the offender, victim and community i.e. friends and family, to find suitable resolution to the offence. This perhaps creates a more ‘person centred’ justice system realising each person’s needs are different but equally important. A reflection of this on a wider scale is that – should the reparation fit the people rather than the crime? Restorative justice practice shows that it is necessary to meet all parties’ needs, and not just the offenders. This relates to changes in policy which recognises the victim as a central aspect of the criminal justice process.

In other areas of the criminal justice system, such as with adult offenders and serious crimes, restorative justice only operates within the already established systems of punishment. Restorative justice is not used to substitute traditional measures, i.e. retribution, but to work alongside them. Restorative justice for serious crimes is not used unaccompanied without formal justice, as legislation and policy do not currently permit it. Marshall (1999, p7) claims restorative justice should be used with serious offences as there is more to gain in regards to victim benefits, and also crime prevention. However, it remains to be seen if this could be functional as the only form of justice, and without punitive measures would the behaviour be negatively reinforced?

Within Northern Ireland restorative justice is a relatively new concept which has been introduced under different circumstances and will be discussed below.

Restorative Justice in Northern Ireland

As mentioned earlier restorative justice in Northern Ireland was a result of the recommendations made from the Criminal Justice Review (2000), and the Justice (NI) Act (2002); each identifying that the victim should be central in the criminal justice process. This became the state led restorative justice approach, but a community based restorative programme was unique to Northern Ireland and the ‘Troubles’ at that time. Restorative justice and theory became prominent during the Northern Ireland peace process as an alternative to paramilitary violence (McEvoy and Mika, 2002, p2). First introduced from the Good Friday Agreement (1999), community projects were established, in part, to remove ‘paramilitary policing’, while reflecting the desire for community-based justice (Gormally, 2006). Projects were established in both communities – Northern Ireland Alternatives on the Loyalist side and Community Restorative Justice Ireland on the Republican side (Gormally, 2006). Both projects now operate successfully throughout Northern Ireland, each having numerous locations. The main agenda for the projects are to provide victim-offender mediation and reparation of the communities, with the community playing a significant role in each. It is also indicated that beyond the non-violent alternatives to paramilitaries, the projects now extend into ‘broader mediation and conflict work’ (McEvoy and Mika, 2002, p7). Critics of the community-based projects claim that paramilitary violence still occurs, only under the ‘respectable cover’ of these schemes (www.mediationnorthernIreland.org) leading to questions being asked about its legitimacy. However, evaluation of the projects show punishment violence related to crime and anti-social behaviour has decreased dramatically within each community (McEvoy and Mika, 2002, p8).

As well as the strengths of restorative justice and the benefits it provides it is also necessary to discuss possible draw-backs in order to be fully aware of the system. This will be discussed below.

Critical Analysis of Restorative Justice

Restorative justice, as mentioned earlier, has a strong theoretical basis and practical application. However, as it is a relatively new concept it is imperative to discuss potential shortcomings as well as benefits in relation to retributive forms of justice. The four main criticisms that will be discussed below will relate to the offender, community, victim and retribution in relation to restorative justice.

Offender:

The principles of restorative justice are about redefining crime as harm and giving stakeholders a share of power (Marshall, 1999, p6). The benefits of this are well documented in practice, especially within youth justice, with the young offender more likely to complete reparation plans if they themselves have helped construct them. However, it remains to be seen if this practice is completely ethical. When facing a victim, in a room full of strangers and perhaps their own parents, a young person is likely to comply to any measures, without dispute, in order to hasten proceedings (Daly, 2002). The victim may also be revengeful or unforgiving and want a harsher punishment with pressure on the young person to agree, creating a power imbalance similar to punitive measures. The young person may then regret volunteering for the restorative process, aiding the break down of restorative plans, making the process ineffective and meaningless.

Community:

Possibly one of the biggest critiques of restorative justice is its reliance on community relationships, with the community playing a large role in the reintegration of the offender back into society. Marshall (1999) claims that communities are not as integrated as they once were, with many individuals wanting greater privacy and self-sufficiency. Leading to questions; who are the community and how can they play a significant role in the rehabilitation of the offender? According to Zehr and Mika (2003) the community can take a variety of forms, for example, the neighbourhood where the offender and victim live, or their closer social networks of family, friends and colleagues. Braithwaite’s (1989) theory of reintegrative shaming claims that strong relationships within the community helps limit wrong-doing because of conscience and anxiety. For those offenders that commit crime ‘shaming’ then is an integral part, not only for reintegration, but for crime prevention. Restorative justice then needs community and family relationships to be effective, if the offender does not take responsibility for their crime or feel shame, then they cannot be rehabilitated correctly or reintegrated into society. Does restorative justice then have its downfall if there is no bond to society?

Victim:

Another criticism of restorative justice is that it is open to offender manipulation and other symbolic implications. Is it seen as an easy option? Perhaps it is all too easy for an offender to say sorry and ask for forgiveness, without actually being punished appropriately for their actions. Daly and Stubbs (2006) claim that without treating offences seriously, the wrong message can be conveyed to the offender e.g. that their behaviour is acceptable, and therefore reinforced, leading the victim to feel injustice and therefore re-victimised. This is one of the major downfalls when it comes to adult restorative justice; if it was the only form of justice it is open to manipulation and coercion of the offender.

Retribution vs. Restoration:

The main question that needs to be addressed is ‘can restorative justice exist without retribution and the formal justice system?’ In regards to juvenile court it is possible to exist alone, if the offence is minor. But for adult offenders, with major offences, the process is not so simple. According to Mead’s ‘psychology of punitive justice’ (cited in Daly, 2002, p59) there are two contrasting methods responding to crime. 1) ‘The attitude and hostility toward the law breaker, which brings attitudes of retribution, repression, and exclusion’ which identifies the offender as the ‘enemy’, and 2) Outlined in youth justice, is the ‘reconstructive attitude’, which tries to ‘understand the causes of social and individual breakdown’ & ‘not to place punishment, but to obtain future results’. It is a contrasting method which identifies differing views, which is fundamentally what restorative and retributive justice represent. The question that needs to be addressed is ‘can restorative justice exist alone as a justice system for all crimes?’ According to Morris (2002, p601) it shouldn’t have to meet the standards of conventional criminal justice, but just consider what it has already achieved, and what it can still achieve.

It is now accepted that restorative justice should be used to integrate with traditional forms of justice, to provide an effective service to all those involved & to offer a ‘whole’ justice (Marshall, 1999, p8). Marshall (1999, p8) claims both forms of justice should now support each other to become a single system in which the community and formal resources can work in partnership. Nevertheless, without current legislation or policy that governs restorative justice practice, this leaves the projects that do exist in Northern Ireland, and the rest of the UK, operating in an informal basis with a lack of safeguards, resources and support to gain proper momentum.

The criticisms of restorative justice practice are negative, but research nationally and internationally can show us just how successful it can be, with victims and offenders experiencing greater satisfaction with the processes and outcomes of restorative justice compared with attending court (Ashworth, 2003, p175 and Daly, 2002, p208). Properly done, restorative justice can have many benefits to not only the offender, but to the victim and community as well, providing a balance that is surely the way forward for the criminal justice system.

Conclusion

The question for this assignment was ‘restorative justice aims to address the consequences of offending for victims, offenders and communities in a meaningful way’? Evidence shows that restorative justice works within the youth justice system, but due to restraints on policy and legislation it is limited in the adult justice service. When restorative justice is implemented properly, it is effective at meeting the needs of offenders and victims, but to decide if this is meaningful is based on an individual experience, which I do not possess.

On the theory of restoration vs. retribution – to combine them, rather than separate them provides all stakeholders with a ‘whole’ justice, capable of meeting physical, emotional and social needs, while also considering all parties as equal.

There are many criticisms of restorative justice, but evidence shows that it is effective and provides reformation far beyond that of retribution. It provides explanation of behaviour, which in itself is meaningful, and is more than traditional methods provide. Restorative justice is an internationally respected system, and identified as a person centred form of justice, representing all parties equally, while balancing reformation with understanding.

References:
Ashworth, A. (2003) ‘Is Restorative Justice the Way Forward for Criminal Justice?’ in McLaughlin, E., Fergusson, R., Hughes, G. and Westmarland (eds) (2003) ‘Restorative Justice: Critical Issues’, London. Sage Publications. The Open University
Braithwaite, J. (1989) ‘Crime, Shaming and Reintegration’, Cambridge, Cambridge University Press
Crawford, A and Newburn, T (2002) ‘Recent Developments in Restorative Justice for Young People in England and Wales’. British Journal of Criminology, 42:3
Daly, K. (2002) ‘Restorative Justice: the real story’, Punishment and Society, 4:1, 5-79
Daly, K. & Stubbs, J. (2006) ‘Feminist engagement with restorative justice’. Theoretical Criminology, 10:1, 9-28.
Gormally, B (2006) ‘Community Restorative Justice in Northern Ireland – An Overview’: http://www.restorativejustice.org/editions/2006/april06/gormallyarticle – Accessed 22/10/09
Hughes, G (2001). ‘The competing logics of community sanctions: welfare, rehabilitation and restorative justice’. In E McLaughlin and J Muncie, ‘Controlling Crime’, London. Sage Publications. The Open University.
Marshall, T. (1999) ‘Restorative Justice: An Overview’. London. HMSO
McEvoy, K & Mika, H. (2002) ‘Restorative justice and the critique of informalism in Northern Ireland’. British Journal of Criminology. 43:3, 534-563
Morris, A. (2002) ‘Critiquing the Critics: A brief response to critics of restorative justice’. British Journal of Criminology, 42:3, 596-615.
O’Mahony, D. & Doak, J. (2004) ‘Restorative justice – is more better? The experience of police-led restorative cautioning pilots in Northern Ireland’, The Howard Journal, 43: 5, 484-505
Tauri, J., & Morris, A. (1997). ‘Reforming justice: The potential of Maori Processes’. Australian and New Zealand Journal of Criminology, 30:2, 149-167.
Zehr, H and Mika, H (2003). ‘Fundamental concepts of restorative justice’
In E McLaughlin, R Fergusson, G Hughes and L Westmarland (Eds). ‘Restorative Justice: Critical Issues’. London. Sage Publications. The Open University.

Web sources:

http://www.mediationnorthernireland.org/documents/BrendanMcAllisterEuropeanRestorativeJusticeConferenceJune2006.pdf – Accessed 22/10/09
http://www.psni.police.uk/index/updates/index/updates/consultation_zone/eqia_of_youth_diversion_scheme.pdf – Accessed 19/10/09
http://www.restorativejustice.org.uk/index.php?What_is_Restorative_Justice%3F –

In his statement to the House of Commons when presenting Lord Laming’s Inquiry Report into the death of Victoria Climbie, on 28 January 2003, the Secretary of State for Health, Alan Milburn, said:

“It is an all too familiar cry. In the past few decades there have been dozens of inquiries into awful cases of child abuse and neglect. Each has called on us to learn the lesson of what went wrong. Indeed, there is a remarkable consistency in both what went wrong and what is advocated to put it right. Lord Laming’s Report goes further. It recognises that the search for a simple solution or a quick fix will not do. It is not just national standards, or proper training, or adequate resources, or local leadership, or new structures that are needed.”

I will give an overview of the inquiry. I will also give an overview of the themes, lack of accountability right through the organizations to the most senior level and staff not adequately trained in child protection. I will analyse and critique these themes in relation to agency policy, legal requirements, research, practitioner knowledge and the voice of the service user. Previous inquiries and there link to this inquiry will be discussed along with have we learned any lessons from this. The failure to implement a legal, ethical and political framework to inform current best practice will be utilized. I will reflect on the implications of evidence informed practice and how this will inform future social work practice.

This paragraph will provide a summary of the events leading to the death of Victoria Climbie, and establish why there was a need for the inquiry. From the report (Lord Laming, 2003) we know that Victoria Climbie came to England with her great-aunt, Marie-Therese Kouao in April 1999. Within a year, she was dead. On 25th February 2000, Victoria died of hyperthermia at St Mary’s Hospital, Paddington. She was just eight years old and had 128 separate injuries to her body. On 12th January 2001, her great-aunt Kouao and her boyfriend, Carl Manning, were convicted of murder. The level of cruelty experienced by Victoria was truly horrific, with daily beatings using several different implements. Her final days were spent living and sleeping in an unheated bathroom in the middle of winter, where she was bound hand and foot, lying in her own urine and faeces in a bin bag in the bath. The secretary of State set up the independent statutory inquiry into her death, under the Chairmanship of Lord Laming, in April 2001, to establish under section 81 of the Children Act 89 the concerns with the functions of the local authority social services committees and the way they relate to children. The inquiry wanted to examine the way in which local authorities in respect of their social services functions and identify the services sought or required by, or in respect of Victoria, Marie-Therese and Carl.

This section will now aim to analyse and critique the key theme I have identified that emerged from the inquiry report which is lack of accountability right through the organizations to the most senior level and staff not adequately trained in child protection. Lord Laming (2003) points out ‘There were at least 12 key occasions when the relevant services had opportunities to successfully intervene to help Victoria, but had failed to do so.’ Within the Report Lord laming (2003) states ‘That not one of these interventions would have required great skill or made heavy demands on staff, sometimes it needed nothing more than a manager doing their job by asking pertinent questions or taking the trouble to look in a case file.’ He continues to states Lord Laming (2003) ‘There can be no excuse for such sloppy and unprofessional performance.’ As Lord Laming (2003) commented ‘Not one of the agencies empowered by Parliament to protect children in positions such as Victoria’s emerged from the Inquiry with much credit, what happened to Victoria, and her ultimate death, resulted from an inexcusable “gross failure of the system.’ Lord Laming’s (2003) expressed ‘His amazement that nobody in the agencies had the presence of mind to follow what are relatively straightforward procedures on how to respond to a child about whom there is concern of deliberate harm.’

The Inquiry Report (Lord Laming, 2003) highlighted “widespread lack of accountability through the organisations” as the principal reason for the lack of protection afforded to Victoria. Who should be held responsible for these failures? As Webb (2002) states: ‘Lord Laming was clear that it is not the hapless and sometimes inexperienced front-line staff to whom he directs most criticism, but to those in positions of management, including hospital consultants, I think that the performance of people in leadership positions should be judged on how well services are delivered at the front door’. Professor Nigel Parton (2003) points out that ‘Too often in the Inquiry people justify their positions around bureaucratic activities rather than around outcomes for children. Frankly, I would be the very last person to say that good administration is not essential to good practice. Professor Nigel Parton (2003) continues to state that ‘Good administration-and we did not see a lot of it, I have to say-is a means to an end. I cannot imagine in any other walk of life if a senior manager was in charge of an organisation and that organisation was going down the pan-to put it crudely-in terms of sales and performance that someone would say ‘My role is entirely strategic, do not hold me to account for what happens in the organisation’. People who occupy senior positions have to stand or fall by what service is delivered at the front door. The Inquiry Report Lord Laming (2003) highlighted the apparent failure of those in senior positions to understand, or accept, that they were responsible for the quality, efficiency and effectiveness of local services. As Rustin (2010) states Lord Laming pointed to the ‘yawning gap’ in the differing perceptions of the organisation held by front line staff and senior managers. Lord Laming was unequivocal that the failure was the fault of managers whose job it should have been to understand what was happening at their ‘front door.’ As the Report Lord Laming (2003) pointed out, some of those in the most senior positions used the defence “no one ever told me” to distance themselves from responsibility, and to argue that there was nothing they could have done. Rustin (2004) states this was not a view shared by Lord Laming. Rustin (2004) also continues to state that Lord Laming went even further in evidence to us, telling us forcefully that, in his view, accountability of managers was paramount, and that the front line staff were generally doing their utmost. In addition to the fundamental problems of a lack of accountability and managerial control, it was also apparent in the course of the Inquiry Lord Laming (2003) that other failings existed in all aspects of practice. This section will evaluate previous inquiries and how they link to this inquiry and have any lessons been learned from them. As Rustin (2004) states: ‘As with many previous inquiries into child protection failures, Maria Colwell (1973), Jasmine Beckford (1984), Tyra Henry (1984) and Kimberley Carlile (1986) it was clear that the quality of information exchange was often poor, systems were crude and information failed to be passed between hospitals in close proximity to each other. As the Report commented Lord Laming (2003) ‘Information systems that depend on the random passing of slips of paper have no place in modern services’.

The evidence from another report, Maria Colwell, who had died in January of 1973 pointed to similar weaknesses, which were found in Victoria’s report these weaknesses were, lack of accountability and staff not adequately trained (Corby et al, 2001).

Inquiry reports are sources of evidence to inform social work practice and even though they have many weaknesses within them as illustrated. Professor Nigel Parton (2004) points out that ‘In many respects public inquiries have proved to be the key vehicle through which changes in policy and practice have been brought about over the last thirty years in relation to child protection policy and practice in this country.’ Professor Nigel Parton (2004) continues to point out that ‘Rather than public inquiries being ignored, they have been fundamental to the way child protection operates. In this respect, they are as much a part of the problem as they are the solution.’

Have lessons been learned from the many public inquiries over the previous thirty years. It was as if states Professor Nigel Parton (2004) ‘The frontline professionals, and the key organisations and agencies who have responsibility for children and families were quite incapable of learning the lessons and, crucially, putting these into practice in such a way that such horrendous tragedies could be avoided. It is hoped by many, therefore, that the report by Lord Laming, and the changes brought about as a result, will mean that this will be the last report of its type.’

This section will address the other theme I have highlighted adequate training. The question of adequate training and supervision for staff working in all the relevant agencies were also an issue identified in the Inquiry. Professor Nigel Parton (2004) points out that In Haringey, for example, it was observed that the provision of supervision may have looked good on paper but in practice it was woefully inadequate for many of the front line staff. Professor Nigel Barton (2004) also points out that nowhere was this more evident than in the fact that in the final weeks of Victoria’s life a social worker called several times at the flat where she had been living. There was no reply to her knocks and the social worker assumed, quite wrongly, that Victoria and Kouao had moved away, and took no further action. As the Laming Report (Lord Laming, 2003) commented, ‘It was entirely possible that at the time Victoria was in fact lying just a few yards away, in the prison of the bath, desperately hoping someone might find her and come to her rescue before her life ebbed away’.

This section will now look at the failure to implement the legal and political framework within the inquiry report. Lord Laming within the report (Lord Laming 2003) told us that he continued to believe that the Children Act 1989 was “basically sound legislation”. His recommendations do not argue for a major new legislative framework. However, Lord Laming (2003) states he did not believe that the Act was being implemented in the way that had been envisaged for it, and, in his view, there was “a yawning gap at the present time between the aspirations and expectations of Parliament and the certainty of what is delivered at the front door”. Rustin (2004) states ‘In the absence of adequate managerial accountability, front line workers were obliged to make crucial strategic decisions, for example about the use of the Children Act, and between using sections 17 and 47 (relating respectively to a child in need, and a child in need of protection)’. The sections of the Act had been developed with the intention of as pointed out by Rustin (2004) ‘Of recognising the different needs of children’. How the sections were being applied on the ground however as stated by Lord Laming (2003) is ‘Quite different, far from employing the section of the Act that would best meet the needs of the particular child and their circumstances, what they were actually doing was using these sections to restrict access to services and to limit the availability of services to people’. The Children Act, Lord Laming (2003) argued to us ‘Should be about promoting the well-being of children, not about putting labels around people’s neck’. Lord Laming (2003) went on to suggest that ‘Front line workers were being forced into making decisions that should properly have rested with management and policy decisions’. This raised major questions about the role of public services and the basic principles that should underpin them, as (Lord Laming 2003) stated ‘We need to stand back and say that we need to discover the basic principle that the public services are there to serve the public, not just some of the public and not just some people who can get through eligibility criteria, or who are sufficiently persistent’. Therefore services must be more accessible and they must be more in tune with their local communities. If, as Lord Laming believes Kirton (2009, p.17) states ‘The Victoria Climbie case was not unique, but highlighted widespread and major deficiencies in the implementation of the Children Act, this raises issues that Government should address.’ I believe that the Children Act 1989 remains essentially sound legislation. However, there is concern as pointed out by Professor Nigel Parton (2004) ‘That the provisions of the Act which sought to ensure an appropriate response to the differing needs of children are being applied inappropriately, used as a means of rationing access to services, and have led to section 17 cases being regarded as having low priority.’ The Laming Inquiry (Lord Laming 2003) recommended that consideration should be given to unifying the Working Together guidance and the National Assessment Framework guidance into a single document, setting out clearly how the sections of the Act should be applied, and giving clear direction on action to be taken under sections 17 and 47.

Within this section I will discuss the ethical framework. It is important to include the issues of social class and gender, which were not evident in the Victoria Climbie inquiry. However, it is issues around ethnicity and race that are more evident. However, the diversity referred to is incredibly complex. This is illustrated at various points states Webb (2002) For example: ‘At the time Victoria’s case was handled in Brent, all the duty social workers had received their training abroad and were on temporary contracts. (In Brent) at least 50 per cent of social workers time was spent working on cases of unaccompanied minors.’ As Webb (2002) states ‘There was evidence that Haringey has one of the most diverse populations in the country, with 160 different languages spoken locally, a long tradition of travellers settling in the borough and a high proportion of asylum-seeking families (9 percent of the total population).’

Within the report Lord Laming (2003) points out that ‘In relation to all the London boroughs involved there were high levels of poverty and deprivation, diverse ethnic, cultural, linguistic backgrounds, as well as the diverse backgrounds of the workers themselves.’ In many respects, it seems Victoria’s situation was not unique in these respective boroughs. Webb (2002) indicated ‘The impact of increased global mobility, more specifically the rapid increase in asylum-seeking families, together with the diverse backgrounds of the workers themselves increasingly seems to characterise work in many metropolitan areas.’ This has a particular impact states Webb (2002) ‘On the nature, stability and cohesion of local communities.’ It is worth noting that, compared to the Maria Colwell case, no referrals are noted in the Victoria Climbie case from neighbours or other members of the community apart from the ‘child minder’ Mrs Cameron. We are not simply talking about diversity here but incredible complexity. Kirton (2009) argues that ‘Not only does it pose major linguistic challenges but also it poses major challenges for statutory departments in relation to the familial and cultural identities of those with whom they work and to whom they have responsibility.’ Issues around racism are clearly important here, however they cannot be reduced to a simple black and white community and cultural divide.

This section will reflect on the implications of evidence-informed practice (EIP) and the usefulness of the inquiry to inform the development of future social work practice. Often, in hindsight, those who put people at risk are blamed for the misfortune and harm they cause. (Kirton, 2009) This is arguably the most signi¬?cant professional context in which EIP has emerged. According to Munro (1998) ‘Social workers rely on vague assessments and predictions, rather than considering what is more or less probable. In everyday life decisions have to be made on a limited evidence base and professional decisions are also at best problematic’. There are numerous unexpected and complex outcomes in social work, many of which rest on having to make judgments under conditions of uncertainty. (Kirton, 2009) The main problems associated with making effective decisions in social work as stated by Kirton (2009) include: risk and uncertainty, intangibles, long-term implications, interdisciplinary input and the politics of different vested interests pooled decision making and value judgments. Decision analysis has developed as a statistical technique to help overcome these kinds of problems. Decision analysis is closely related to risk assessment and actuarial practices. Evidence-informed practice and policy are self-explanatory. They involve the adoption of evidence-based protocols and use local standards for conducting social work practice and developing organizationally speci¬?c policies. (Webb, 2002) It has been suggested that evidence-informed protocols feed directly into the practitioner context to provide guidelines for carrying out EIP. Essentially evidence-informed practice and policy in social work will entail the explicit and judicious use of current best evidence in making decisions about the social care of service users. This de¬?nition is widely used and derived from Sackett et al.’s ‘Evidence-based Medicine’ (1996). A pragmatic approach as stated by Sackett (1996) ‘Has been adopted here, which regards the practice of evidence as integrating practitioner expertise with the best available external evidence from systematic but multiple research methods.’ The implementation model outlined is the idea that the practice-based process begins with the evidence rather than the individual or groups of clients.

Clearly the application of evidence-informed practice and policies will be governed by the economic scope of social work agencies in terms of resources and the development of an evidence-informed infrastructure. (Kirton, 2009) Sackett (1996) points out that ‘At a local level it will also be dependent on incremental learning and accumulative professional development which are likely to be facilitated by the practice research networks and evidence-based brie¬?ngs discussed above.’

In this essay I have analysed and critiqued two key themes from the inquiry, lack of accountability right through the organizations to the most senior level and staff not, adequately trained in child protection. I have also analysed and critique these themes in relation to agency policy, legal requirements, research, practitioner knowledge and the voice of the service user. I have linked previous inquiries and discussed have we learned any lessons from these inquiries. I identified the failure to implement a legal, ethical and political framework to inform current best practice will. I also reflected on the implications of evidence informed practice and how this will inform future social work practice.

A closing quote to finish from the Secretary of State, Alan Milburn (2003)

“It has felt as if Victoria has attended every step of this inquiry, and it has been my good fortune to have had the assistance of colleagues whose abilities have been matched by their commitment to the task of doing justice to Victoria’s memory and her enduring spirit, and to creating something positive from her suffering and ultimate death.”

Ministry of Community Development, Youth and Services (MCYS, 2005) states that, “Child abuse is defined as any act of omission or commission by a parent or guardian which would endanger or impair the child’s physical or emotional well-being, or that is judged by a mixture of community values and professionals to in inappropriate.”

Different types of abuse

MCYS (2005) recognised four different types of abuse, namely physical abuse, sexual abuse, emotional abuse as well as neglect. In addition, neglect can be broken down into 4 segments; physical, medical, education and emotional (Child Welfare Information Gateway, 2006)

Therefore, what actually comprises in each of the different types of abuse?

Physical Abuse

In accordance to Child Welfare Information Gateway (2005), physical abuse is physical injury caused by punching, beating, kicking, stabbing, burning or using a foreign object to hit the other party. The severity of injury may vary from minor bruises to fractures or death. Furthermore, physical abuse does not take into consideration if perpetrators accidentally or intentionally harm the child.

Sexual Abuse

Sexual abuse is known as inappropriate activities performed by the perpetrators. The Federal Child Abuse Prevention and Treatment Act (CAPTA) further defined sexual abuse as “the employment, use, persuasion, inducement, enticement, or coercion of any child to engage in, or assist any other person to engage in, any sexually explicit conduct or simulation of such conduct for the purpose of producing a visual depiction of such conduct; or the rape, and in cases or caretaking or inter-familial relationships, statutory rape, molestation, prostitution, or other form of sexual exploitation of children, or incest with children.” (Child Welfare Information Gateway, 2006)

Emotional Abuse

Child Welfare Information Gateway (2006) states, child can be emotional abused if perpetrators conduct behaviours that affects child’s emotional development or sense of self-worth. However, MCYS (2005) added, emotional abuse not only affects child’s emotionally development, it also weakens child’s social and intellectually development. Additionally, such abuse exists with adult’s continual hostility, ignoring, blaming, threats, discrimination or blatant rejection of the child (MCYS, 2005).

Moreover, based on research, both sources agreed that other types of abuse are also present if emotional abuse is being identified.

Neglect

In relation to Chan, Chow & Elliot (2000), neglect was redefined as either omission or commission of any act that impairs the child’s physical, psychological, intellectual or social development.

As mentioned above, neglect can be categorised into 4 different segments. First, physical neglect may be the inability of providing food and shelter as well as the lack of supervision (Child Welfare Information Gateway, 2006). Second, adult may failed in the provision of essential medical care or mental health treatment which is known as medical neglect (Child Welfare Information Gateway, 2006). Next, adults may commit to education neglect if they are not capable of giving child an education as well as the lack of attention to special education needs (Child Welfare Information Gateway, 2006). Last but not least, if adults do not attend to child’s emotional needs, failure to give child adequate love and care and allowing child to have easy access to alcohol and drugs, adults are at high risk in executing emotional neglect (Child Welfare Information Gateway, 2006).

However, it is important for further investigations to be done if any of the neglect is present. There might be other contributing factors such as poverty or different culture practices that might surface parents are being negligent.

Why is Child Abuse a topic of interest

As an advocator, it is important to know that children are safe, being respected and are treated appropriately. With the raising numbers of cases of child abuse in Singapore, it shows that any children may be at risk of being a victim.

According to the statistics on child abuse investigations from Year 2009 to Year 2010 (MCYS, 2011), apart from physical neglect, the rest of the types of abuse cases had increased. The numbers shown were the cases with evidence of cases. For example, the number of physical abuse cases had a jump from 82 to 133, which is about 38%. As for sexual abuse, it raised from 28 to 46 numbers of cases, which is equivalent to 39%. Emotional abuse cases had increased by 2, summing up to 6 cases in Year 2010. Although there was a drop of 4 cases for physical neglect, it may show that people may be more aware of such wrong behaviours. However, these numbers stated above only showed the reported cases with evidence. What about the other cases that had been reported but inadequate evidence were gathered?

In addition, children from the United States (U.S) were victims of abuse and neglect as well. Statistics for Year 2006 shows that 54% are victims of child maltreatment of age up to 7 years. To add on, statistics reported an estimated number of 1,530 children died due to abuse or neglect. Out of 1,530 children, 78% were children under the age of 4 (Shaw & Goode, 2006). This shows that children of the preschool years are very vulnerable to abuse.

Maine State Dept. of Behavioral and Developmental Services (2001) mentioned that childhood abuse may lead to adult experience of shame, repeated flashbacks and nightmares may be traumatic for the victim. In addition, it may cause victim to be severely anxious over matters, depression as well as developing feelings of humiliation and unworthiness.

Therefore, it is also important to educate parents about the raising numbers of child abuse cases. In addition, to create awareness that no one should deprive a child to have a healthy childhood experience.

Hence, in this present paper, it will further elaborate on who may be the victims of child abuse and its impact on children, how child abuse affected parents and what happened to survivors of child abuse as they grow up.

Victims of child abuse and its impact

According Chan, Chow & Elliot (2000), evidence from research stated that adolescents are also at high risk on physical maltreatment. On top of that, more commonly reported cases of physical child abuse cases involve the adolescents as well.

Therefore, what makes a certain child be at a higher risk of child abuse? Statistics consistently showed that families that are socially and economically disadvantaged have more reports on physical abuse. Based on the research, families that falls under the low income family or annual income are below poverty level, it is more likely for the child to receive more fatal or serious injuries (Chan, Chow & Elliot, 2000).

Being financially unstable may cause a child to be a victim of child abuse, however this is not the main reason to place such child at risk. Pre-matured infants, intellectually disabled and any child who are developmentally disabled can be vulnerable to being abused too (Chan, Chow & Elliot, 2000). The reasons behind it are such child is viewed as a source of stress and burden to the family and family might find it difficult to handle.

For instance, a child was being physically abused, how did the experience affects the child negatively? In accordance to Chan, Chow & Elliot (2000), it may cause impairment in child’s behaviours, varied severity of physical injuries on child, child faces difficulties at school and child may have poor interpersonal skills.

However, one of the limitations of this study is that research was carried out long ago and results are still limited and scarce in Singapore. Next, this study did not exactly mention the precise source where they gathered the statistics or how did they go about gathering and compiling the results. Lastly, this study focuses on two age groups which are the infants and toddlers and the adolescents. What about children from the older age group? How high is the risk for older children pertaining to child abuse?

Impact on parents

The term “impact on parents” refers to parents who were once victims of abuse or parents who had child who was being abused. Hence, how did once victimised parents got over the bad experience and started a new family? In addition, how did parents feel when their child was being abused by others?

Being a parent, survivor of child abuse, and yet having a child who was assaulted, it may be very distressing especially for parents who disclose their childhood abuse experience for the first time (Grant, 2006). Furthermore, these parents may start to develop a sense of guilt as they were not incapable to protect their child despite experiencing it. Parents may also have flashbacks of those painful memories after disclosing the abuse (Grant, 2006).

In addition, Grant (2006) mentioned that parents who had child being abused may begin to face many challenges. Having a child being abused, it may be hard for certain parents to accept the fact. Certain parents may be too overwhelmed and can be emotionally unstable. Parents may be in the state of confusion which in turn may impede their ability to support and provide help for their child and family throughout the investigation process (Grant, 2006).

Taking for example if parents entrust their child with a caretaker and it turn out to be the caretaker who is the perpetrator, parents may be devastated and hard to believe. In addition, parents may be in great shock and developed a sense of betrayal. Therefore, after encountering such incident, how easy or possible can the parent cooperate and trust other unknown professionals? (Grant, 2006) Additionally, parents may also put the blame on themselves for allowing their child to be abused. For instance, they may question themselves, “Why had not I (parents) see this situation?”, “Why did not I protect my child?” or ‘What type of a parent am I?” (Grant, 2006)

Upon accepting reality, it can be really hard on parents to handle the upcoming problems faced at home if they have more than one child. Parents may understand that they had to spend more time with the victim, trying to help the child to get over the bad encounter. On the other hand, parents have to ensure that they are capable to maintain a healthy relationship with other children at home. If the situation is not handled appropriately, other children may start to develop a sense of jealousy and resentment towards the victimised sibling as well as the parent (Grant, 2006).

However, one of the limitations in this study is that there was not any statistics given. Next, this study did not mention the age of the parents. Older parents may be able to handle the situation better than younger parents. Lastly, this study did not give detailed information on the parent’s family background and the relationship within the family. With a supportive family, parents as well as child may be able to recover faster from the bad encounter.

Survivors of child abuse when they grow up

As researched by Maine State Dept. of Behavioral and Developmental Services (2001), some abused children may experience lifelong emotional harm as they grow up. For instance, some abused children may experience serious mental health problems. Research estimated that abused children are 2 to 3 times more likely to develop a serious mental illness. In addition, up to 70% of women who were treated in psychiatric setting have histories of childhood abuse (Maine State Dept. of Behavioral and Developmental Services, 2001).

On top of that, some may suffer lifelong physical harm due to childhood abuse. Ranging from 3% to 6%, research shows that abused children may develop a permanent disability (Maine State Dept. of Behavioral and Developmental Services, 2001). Brain damage is an example of permanent disability and 20% to 50% of abused children suffered from brain damage but of different severity. It is further hypothesized that abused children are of higher risk of getting heart disease, cancer or even other chronic medical conditions (Maine State Dept. of Behavioral and Developmental Services, 2001). However, there is not concrete evidence to prove this hypothesis.

Another negative impact on abused children is that they cause self inflict harm. Some abused children may get into a depression and others may choose to attempt suicides (Maine State Dept. of Behavioral and Developmental Services, 2001). Some abused children may even abuse the use of drugs, alcohol or nicotine in order to minimise or hide their pain. It was also reported by Maine State Dept. of Behavioral and Developmental Services (2001) that sexually abused children may be more exposed to further sexual abuse or to contract sexually-transmitted disease (STD).

However, one limitation of this study is that the statistics are not up to date. Therefore, results given in this study may not be accurate enough. Findings may vary if research is done based on recent years.

Apart from the depressing impacts that happened on survivors of childhood abuse, some survivors chose to seek help from professionals such as social workers, counsellors or therapists.

This research was done by questionnaires and interviews were conducted based on respondent’s willingness. Out of 500 questionnaires mailed out, there were 384 completed questionnaires. Fifty interviews were also conducted to further supplement the data.

Out of the 15 themes that were emerges based on how helpful the services were, seven common themes were mentioned in the study. Respondents felt that professional helpers were patient and they listened. In addition, professional helpers seem to be empathetic (Palmer, Brown, Rae-Grant & Loughlin, 2001). Next, respondents felt that professional helpers were able to help them deal with their raging feelings and they no longer have to avoid those feelings. To add on, having nonjudgmental and understanding professional helpers benefitted survivors as they were encouraging too. Next, survivors felt empowered as the professional helpers believed in them. Professional helpers were also able to provide connections for the survivors with other survivors, letting them know that they are not alone. On top of that, professional helpers helped survivors to build their self-esteem and develop a value of self worth. Lastly, professional helpers were able to validate survivor’s experience giving survivors assurance (Palmer, Brown, Rae-Grant & Loughlin, 2001).

However, one of the limitations of the study is to generalise survivor’s experience across different types of abuse. In addition, the study only produced one side of the data. Findings may be different if these components are further addressed.

Conclusion

To conclude, it is important to create the awareness to parents about the raising numbers of child abuse cases in Singapore. By doing so, parents may be more aware of their own actions and not commit to any form of abuse be it accidentally or intentionally. In addition, parents are encouraged to develop an early, secure and consistent relationship with the children (Shaw & Goode, 2008). On top of that, according to Shaw & Goode (2008), parents need to provide the same level of attention to child’s emotional and social needs, not only their cognitive skills.

For future research, it would be good to research more on how one can further help victims and survivors who are really resistant to get over the bad experience. In addition, another research can be done to help children to work on their social and emotional skills after the bad encounter.

Social workers are faced with making decisions about risks whilst managing the pressures of limited resources such as a lack of social workers and society’s view of social work (11). This can cause a social worker to be risk averse and become more concerned with avoiding risk to protect themselves instead of taking action that may be right for the service user. 88% of social workers have expressed a concern that cuts in services can put people’s lives at risk and 77% stated that they were unable to manage their caseloads (1). Wales has the second highest vacancy rate of social workers in the UK at 9% with England at 11% (Lombard, 2010).

There are 3 different types of risk (Adams, Dominelli & Payne). These are the risk to service users from others, the risk to service users from themselves and the risk to others from service users.

In the statutory sector risk assessment is a mandatory part of casework as it is within law and agency policy to assess risk to an individual (Healy,2012). S17 and S47 of the Children Act 1989 places a duty on a social worker to investigate when it is believed that a child is at risk of harm. The difference between S17 and s47 is the urgency and seriousness of risks (Beckett, 2010). Risk to the child includes some form of harm and the probability of that harm occurring.

2. Factors of Risk

There are certain factors in a child’s life that may be linked to poor outcomes (Parton, ????) These include low family income, homelessness, parenting capacity, post natal depression in the mother, low birth weight, substance misuse and community factors such as residing in a disadvantaged neighbourhood. Protective factors may include a strong relationship with parents and other significant adults, parental interest and involvement in the child’s education and positive role models. There are also other protective factors if the child is outgoing, has self motivation, has intelligence and plays an active role in family and community life. The more risk factors present the more likely it is that they would experience abuse or poor outcomes (5). Early intervention to identify risks can help to reduce problems.

Identifying the risk and protective factors can give a prognosis on the child’s future development (8). Assessing their needs and risks will help to identify the services that should be in place to prevent further impairment to their health and development (BASW, 2012, 3.2).

In assessment we must recognise the factors that could have harmful consequences and the severity and the likelihood of harm (Beckett, ???). The difficulty in assessing risks is that we may see a high risk factor that may be unlikely to materialise but dismiss low risk factors which may cause more harm long term. There is the potential to reinforce social inequalities as many factors are strongly associated with socioeconomic disadvantage such as single parents, low income and previous institutional care (CCW, 2002, 1.5).

3. Assessment

In social work the assessment of children involves analysing the child’s development needs, parenting capacity and family and environment factors (Welsh Government, 2001). Using the assessment triangle gives a holistic view of the child and the influences upon them. Once all the information is gathered it can be easier to identify the areas in which a child is most at risk and how those risks maybe addressed (BASW, 2012, 3.2).

Risk is an aspect of all assessments (Whittington, 2007). The aim of a risk assessment is to consider the situation, decide on the likelihood of the risk happening and aim to reduce the identified risk having a negative impact.

There are different types of risk assessment (Coulshed & Orme, ???). These are preventative, investigative and continuation. Preventative is undertaken before intervention to decide on whether or not to intervene. It involves looking at the situation and assessing the risk factors along with balancing the rights of service users and the responsibilities of the social worker. Investigative is carried out during an initial assessment to identify the current and potential risks. Continuation assessment is balancing the risks of intervention against no intervention. A social worker should evaluate the original situation then acknowledge changes and what effect these changes will have if any at all.

In social work the actuarial and clinical methods of risk assessing are used (Cree & Myers, ?????). The actuarial method uses statistical calculations of probability and how an individual’s behaviour is judged on the basis of behaviours in other people in a similar situation. The clinical method uses personality factors and situational factors relevant to risky behaviour and the interaction between the two.

Adhering to legislation, policy and procedures and the rights of the service user should ensure good practice in relation to assessment and managing risk and protection (Adams, Dominelli and Payne, ????). Legislation and policy shapes and determines the actions, duties and powers of a social worker (CCW, 2002, 6.1). Failure to follow set policies and procedures can result in things going wrong.

4. Skills and Judgements in Assessment

Management of risk is often judged by the outcome and not the process of the assessment (7). When examining a case that has had negative outcomes it is easy to see the presence of heightened risk. This can reinforce the view that the outcome could have been avoided had the risks been realised. Conducting an initial assessment requires interview skills to get the information and reasoning skills to analyse the information and identify risks (CCW, 2002, 4.2).

Assessment is an essential skill in itself (9). It requires effective communication skills to gather the necessary information and critical analytical skills to interpret that information. A social worker will need the appropriate skills to be able to negotiate with a service user or an agency in order to provide appropriate services (BASW, 2012, 2.2.3).

Serious case reviews often highlight the importance of assessment and analysis (Good practice in assessment book). An effective assessment looks at the overall situation to explain what has happened to a child and provides a framework for analysing the needs of the child and the dangers that individuals pose to children. Particular care must be taken so that the assessment does not become over optimistic and minimise the risk to the child. The focus should be on gathering evidence to make professional judgements about whether a child is safe from harm, neglect, and abuse.

Other skills in assessing risk is the ability to predict what may happen in the future in areas of uncertainty (Trevithick, ????). If the information gathered is accurate and up to date and the social worker has a sound knowledge and skill base there is less chance of over or underestimating the risks involved. In order to gain accurate information a social worker should use effective communication and listening skills to pick up on the risks presented.

Communication between professionals and agencies may be difficult as there may be issues of power, different priorities and professional values (10). For example a doctor will be more concerned with discharging a service user once their medical issue has been addressed. A social worker will be concerned that services are put in place to ensure that the service user is safe to return home. Skills and knowledge are frequently criticised in serious case reviews into child protection services and can adversely affect risk management.

5. Risk Management

In a review of child protection services it was identified that mistakes in assessment of risk have been either over or under estimating the risk posed to the child (2). Risk management cannot completely eliminate risks only reduce them. An assessment may decide that the risk of harm to a child will be low but low risk events can still happen. A social worker should use their professional judgement when deciding on actions to take as all options will involve a certain amount of risk (CCW, 2002, 4.1). For example when a child is removed from their family and placed in local authority care they may face other risks such as being unable to settle with a new family. The principles of working in child protection are to maintain the safety, security and well being of individuals. A social worker should use their judgement to balance the possible benefits of a decision against the likelihood of possible harm. They should work with other professionals to make decisions on risk involved so that errors can potentially be reduced (BASW, 2012, 3.1). Lessons can be learnt to improve decision making from the successes as well as the failures. Positive risk taking relies on quality information. Agencies should share appropriate information on those individuals who pose a risk to others or those that are at risk from harm.

A serious case review identified several failings in the protection of Baby P (6). Two of the children in the family were already subject to child protection plans which may be seen as a risk factor. The adults involved had refused to explain P’s injuries. It would have been reasonable to believe that Baby P was at risk if the adults were not willing to provide an explanation if they had nothing to hide. It was recommended that interagency working and communication must improve to ensure that children have a greater level of protection from different professionals. Professionals should recognise and respect each other roles and be trained appropriately together (BASW, 2012, 3.14). Supervision for the social worker in the case of Baby P was inconsistent and often cancelled. When carrying out S47 enquiries a social worker should be supported by their manager and have periods of supervision to review their caseload. This provides the opportunity to view the actions of the social worker from another perspective so that other options can be explored. A criticism of social workers in child protection is over familiarity with a family (10). The social worker may have long term involvement with the family and are unable to take an unbiased view of the situation. Therefore it is important that supervision takes place to gain another perspective (BASW, 2012, 3.13).

Child protection conferences should involve the parents (AWCCP). Professionals should determine how information about the case will be shared with them to ensure that a child is not put at further risk. Unless the criteria for exclusion are met parents should always be encouraged and supported to attend the conference. By attending the conference parents will be clear on what the concerns are, understand the risk to their children and the reason for the involvement of the different agencies. This will ensure that they are aware of the changes that need to be made to protect their children from harm. During the conference professionals involved must consider the risks of harm if the child were to remain at home and how those risks can be managed. A plan will be created which will detail the arrangements for managing the risks identified and how it will be monitored. The child protection plan must consider the wishes of the child and the parents (CCW, 2002, 1.2).

A solution focussed approach can be utilised by the social worker to plan the necessary services required to manage the risk (Creer and Myers). This approach is used when finding solutions to the current situation. A social worker may consider services such as family counselling to explore and understand the issues the family have.

6 Values and Ethics etc

There are times when taking a risk is a positive move (Beckett, ???). It provides an opportunity to learn to manage risk. If a child is over protected they cannot be expected to understand how and when to take risks. If risks are unavoidable then the positives and negatives of the outcome should be analysed. In child protection the dilemma may arise when deciding on whether to remove a child and place them in foster care or remain with the family. As previously identified there are risks in placing a child in foster care. If they are unable to settle they may experience multiple moves. When there are risks of harm to children there will be pressure on the social worker to act quickly but this may be difficult as exploring the risks and benefits effectively may take time.

There are also risks to social workers from aggressive parents when working in child protection (Lindon, ???). The social worker should acknowledge the parents feelings and refrain from arguing back. As the social worker has a responsibility towards the children they should attempt to diffuse the situation to prevent upsetting the children (CCW, 2002, 5.7). The anger from the parents could present a risk to the children and should be acknowledged as such.

A child has the right under Article 19 of the United Nations Convention on the Rights of the Child to protection from abuse and neglect (WAG, 2008). The parents could also argue that they have the right to a private family life under Article 8 of the Human Rights Act 1998 but if they are subjecting their child to abuse or neglect then this right is over ridden.

There are many uncertainties regarding risk in child protection (Adams, Dominelli and Payne). There may be no right or wrong decisions if it is approached correctly. However, there is always the possibility of a negative outcome which can be difficult for all involved and have serious implications for a child. It is difficult to make decisions where there is incomplete knowledge and uncertainty of a situation. The social worker must use their professional judgement to ensure they have taken as much care as possible to address risks with the information available (BASW, 2012, 2.3.4)

In conclusion risk can be difficult to manage as it contains many areas of uncertainty. The negative factors should be identified early to prevent further risks occurring. The assessment must take into account all areas in a child’s life to ensure a complete picture is gained and all risks are acknowledged. If the social worker has good communication skills then the quality of the information gained should be high and will enable them to make a more informed assessment. If the relevant information is not gathered then appropriate decisions may not be made. Several recommendations were made in the serious case review of Baby P. Supervision is important as it can ensure the quality of a social worker’s practice, provide other perspectives on relevant cases and potentially can improve outcomes for service users. Multi agency working is a requirement in social work. It must be utilised to gain a holistic view of the child and identify various services that can be put in place to manage risks. A service user still may not experience a positive outcome even though the most appropriate services are utilised to reduce and manage risks. If the social worker has carried out their duties correctly in accordance with legislation and policies, identified the risks and worked with others to manage those risks then they can be satisfied that they have done all they can and accept that not all outcomes will be positive.

Social workers are put into difficult situations on a regular basis. The Health and care professions council (HCPC) set guidelines to aid the challenges social workers face. To remain registered, a social worker needs to abide by the HCPC code of ethics to ensure delivery of the best possible service for users. Working within the guidelines set can be challenging as it may cause conflict with the service users values or potentially the social workers own values. For the purpose of this essay, ethics will be defined as “professional obligations and rules of conduct” (Meacham, 2007). Social work values will be defined as “a range of beliefs about what is regarded as worthy or valuable in a social work context” (BASW, 2012 p17). This essay focuses on two areas of the personalisation agenda that can cause challenges for social workers; accommodation and personal budgets. The target service user group for the purposes of this essay is people with disabilities. Using the definition stated in the Equality Act, (2010) “A person is considered disabled if they have a physical or mental impairment that has a ‘substantial’ and ‘long-term’ negative effect on their ability to do normal daily activities”. Legislation and requirements to support adults with disabilities is increasing for the “over eleven million people with a limiting long term illness, impairment or disability in Great Britain” (office for disability issues, 2012). However, disabled people report mixed feelings and reactions to the legislations and rules put in place regarding their care and allowances (Dalley, 1991). The social philosophical approaches to social work will be used to deal with the challenges and conflicts social workers face. This essay touches upon Kant’s deontology; Bentham’s and Mills utilitarianism and Biestek’s 7 principles approach.

Immanuel Kant (1785) developed the theory of deontology. This means that social workers need to be promoting good actions and the correct motive, however the consequence is not important and the idea of an acceptable motive is subject to judgement (Adapted by Hartsell, 2006; Banks, 2001; Reiman, 2009; Meacham, 2008). Subsequently, Kant introduced the idea of a categorical imperative (CI). A CI maintains a person’s motives for their actions and they therefore should be acceptable as a universal law. Thus people should act on motives that can be used by everyone in a moral society and lead to respect for people (Darwell, 2002 cited in Reiman, 2009). From this it is seen that people should be treated as an end, for example a choice or desire, rather than a means (object) to our own ends. He believed that everyone should be treated with respect regardless of their characteristics or behaviour (Banks, 2001).

Kant talks about respect for the individual person and promoting self – determination. Biestek (1961) produced 7 principles that over time have become highly influential to social workers looking at values and ethics within their practice. 5 main principles have been used:

Individualisation; Recognition that each service user has unique qualities, good and bad.

Purposeful expression of feeling; Recognition that service users need to express their feelings (especially negative ones) freely.

Acceptance; The social worker should be able to work with a service user without passing judgement and accepting Individuals for who they are, including their strengths and their weaknesses.

Non – judgemental attitude; Social workers should be able to not pass judgement or assign guilt to the service user. It is about judging the service users behaviour

User self – determination; the social worker should be able to guide the service user, depending on their on their capacity, to have freedom in making their own decisions and choices (Adapted by Banks, 2001).

Utilitarianism focuses on a consequentialist approach as it focuses on the consequences of the action, rather than the actions themselves. (Scheffler, 1994 cited in Reiman, 2009). Decisions should be made on the results and consequences it could have on society rather than on a personal and individual basis, and to promote maximum good within society. The right action produces the greatest balance of good over evil – the principle of utility. (Banks, 2001). Utilitarianism is based on a theory developed by Bentham and Mills who looked into two branches of utilitarianism; hedonistic and ideal utilitarianism. Bentham explored hedonistic utilitarianism, where good was matched with happiness. Mills explored the idea of ideal utilitarianism. This focused on good being about virtues, truth and knowledge, not just happiness. (Banks, 2001). The theory promotes the greatest good for the greatest number of people. When making a decision it is imperative that the consequence is considered. Therefore as a social worker, it would be beneficial to look at the consequences of the forthcoming action and evaluate what would be most beneficial and least harmful to the service user.

In the late 1980’s, the Government recognised that an improvement in access to community services was required. The Government were committed to providing more support for people with long term needs by assisting and supporting individuals to manage their conditions and providing services they require in the community rather than in long-stay hospitals.(Oliver, 1996) Morris (1993) conducted a study that looked into disabled individuals who needed day to day services. He found that disabled individuals were starting to feel a sense of hopelessness and helplessness when trying to access statutory services. Historically, social workers assessed and told service users what services they needed. Through the personalisation agenda, and the introduction of direct payments, service users told the social worker their needs. For the first time, the social worker had to accept the service user’s self-assessment and then use the assessment to see if the highlighted issues were eligible under Fair Access to Care (2003) legislation. Direct payments were introduced in 1997 and social workers had to translate service user needs into a monetary value to enable them to purchase their own service. The aim was to give individuals control over their care and their lives. Direct payments evolved into personalised budgets and have further evolved into a more individualised budget / service plan. The need for change and equality of service provision has been recognised as more views are being voiced by people with disabilities. In line with Beistek’s theory, service users are using purposeful expression of feeling and self-determination to enable the social workers to know their wants and needs. This has resulted in changes which could reduce the potential for conflict in the future.

A further challenge is budgetary control. Service users often want services that are financially unavailable to them. Although ethics state that service users should be encouraged to have self- determination, be treated as a whole and the social worker should promote and provide information regarding their care (BASW, 2012), the service users choice cannot always be guaranteed. Utilitarianism would suggest that this is because if service users always received the services they wanted, the social worker would not be promoting the greatest good for the greatest number, instead would be taking a more Kantian approach of promoting moral good. These two philosophical approaches cause conflict within themselves.

The Mental Capacity Act (2005) says “a person lacks capacity in relation to a matter if at the material time he is unable to make a decision for himself in relation to the matter because of an impairment of, or a disturbance in the functioning of, the mind or brain”. (s2). This leads to challenges and conflicts for social workers. If the service user had capacity, there could be conflict over the way they spend their budget which could lead to the social worker treating that individual without respect. Following the BASW code of ethics (2012), it states that social workers should respect the right to self-determination. Kant would support this view as, by the social worker supporting the individual to meet their own self-defined needs, the social worker is promoting good actions that will in turn produce good outcomes for the individual. The social worker needs to recognise that the individual has human rights and freedom to voice their views. Burton (1996) showed that there was a failure to recognise the unequal power relations between the social worker in control of provision of services and the service user who relies on the services. This therefore would undermine Beistek’s principles of self-determination as, although the service user is voicing their opinion, the social worker is not listening and this could be seen as jeopardising the principles of personalisation and the code of ethics that are imperative. The implementation of The Mental Capacity Act needs to be reviewed to ensure workers are following legislation and ethics. It should not be assumed someone lacks capacity because they have a disability.

On the other hand, if the service user didn’t have capacity, it could cause conflict between the social worker and the paid carer and/or unpaid carers. If the service user lacks capacity, how would the social worker or the carers be able to assess what was best for the individual? A social worker would have to uphold and promote human dignity and well-being as well as empowering the individual. (BASW, 2012). These ethics and values are supported by Beistek’s theory. Workers need to treat the service user with respect, be non -judgemental and accept the situation the service user may be in. The social worker therefore would only be able to act upon their assessment which should include the carer’s views on what is best for the service user. Utilitarianism, an alternative argument, would argue what’s the greatest good for the greatest number? What would benefit the service user more? The social workers views or the carer’s views? The outcomes need to ensure that the maximum people are happy. The social worker could reach the maximum happiness and reduce conflict by using empowerment. The social worker would respect the needs and preferences of the service user, via the carers and family members as well as recognising their own prejudices to ensure the correct services are offered. The Community Care Act (1990) promotes care in the community and people staying within their own home, allowing the individual to use their personal budget and have carers to promote independence. There is evidence to suggest for example, individuals who have fractured a limb, fare better when they recuperate in their own homes. (Pignolo, Keenan and Hebela, 2011).

Accommodation is a major concern for many service users (Davis and Wainwright, 1996). One aspect that could cause conflict is the practice of placing young people in young disability units, properties that are specifically designed for people with learning disabilities. Although this could be seen as a solution for people to interact and have support, there is a potential conflict as the individual cannot choose where they want to live and may live a distance from family/friends. If placed in a purpose built establishment, the individuals are classed as being housed by the local authority and therefore do not get to choose alternative locations (Oliver, 1996). The dilemma for the social worker is the need to take the individuals views into account whilst balancing their needs and wants, particularly if the service user lacks the capacity to make the decision.

It is unlawful for anyone to sign a tenancy agreement on behalf of an individual who lacks capacity. A capacity assessment needs to be undertaken to ensure the service user understands how to maintain that tenancy. In order to proceed, an application needs to be made to The Court of Protection. This could lead to conflict as the social worker and housing department need to uphold the law, however many families feel they have the right to sign a tenancy for their disabled family member and find it difficult to accept that this is not the case. According to BASW (2012), the social worker needs to develop professional relationships with the service user and the family, uphold the reputation and values of the profession as well as recognising diversity and treating the individual as a whole. Utilitarianism would recommend looking at what benefits the whole family, rather than just the service user. Challenges arise when the service user lacks capacity. Using the utilitarian approach, it could be said that the service user shouldn’t be given a tenancy as it doesn’t promote the greatest good for the greatest number. This view is in conflict with BASW codes of ethics. It could be seen as unethical practice and lead to further conflict. Beistek would support the view of BASW in using the specific value base that service users should be allowed to freely express their feelings, both positive and negative, and the social worker should listen and make a decision in an accepting and non-judgemental way. However, Kant would say that although the consequence of not getting a choice in where the service user lives is a negative outcome, the intention of placing them in a home, with other people to socialise is a good moral judgement that is solely benefitting the individual.

Another potential conflict could be older disabled individuals being forced into care. The Sutherland Report (1999) claimed that older disabled people were being forced into institutional care too early due to the lack of alternative care at home. Sixsmith and Sixsmith (2008) provided evidence that by 2008 there had been a shift in care provision and that the Personalisation Agenda meant that people were remaining in their home for longer and receiving appropriate services. However there is a further potential for conflict when accommodating people, with disabilities, to stay in their homes. Individuals may want to grow old at home but is this possible for people with significantly reduced mobility? Many homes are inaccessible to wheelchair users and those with significant mobility impairments (Burns, 2004). There is a Government scheme whereby disabled people can apply for a disabled facility grant to have their homes adapted, and certain individuals have to re-pay the Government, therefore the Government is not financing expensive care packages. The role of the social worker would be to negotiate, support and empower the service user to have their needs met in the most appropriate, desired way. According to Kant’s theory, having a loan is the moral good as people will be able to remain at home for longer, promoting happiness and community care. This would be supported by the values of BASW which states social workers need to treat the service user as a whole and respect their right to self-determination. In contrast to Kant’s theory, Utilitarianism would consider weighing up the consequences of removing the service user from their house and into an adapted and safe environment. I.e. a care home could be seen as an easier option for disabled people to receive care. This view could cause conflict because the social worker is going against the wishes and desires of the service user. Utilitarianism looks at the best outcome for society rather than on an individual level. Therefore, by moving individuals out of the house into the care home may provide maximum happiness for society, although it disregards the individual’s views and opinions. This is a criticism of the model as many service users could potentially not have their needs met in a manner that is acceptable to them due to the focus being on the benefit to society. This could be particularly true e.g. for people with English as a second language or who follow a religious faith. However, Beistek would agree with Kant in promoting self-determination.

A key theme running throughout this essay is respect for the individual person as a self – determining being. Both Kant and Beistek promote this and therefore appear to be the social philosophical models best tailored towards social work values and ethics. There are clear conflicts between traditional social work and the personalisation agenda for people with disabilities. These conflicts have been reduced with the introduction of HCPC ethics. If the social worker consistently uses these theories whilst working with conflict and challenging service users then the BASW ethics will be maintained and the service users will receive the best appropriate service available within Fair access to care criteria.

Discuss the use of communication skills and values in social work

This assignment sets out to explore the use of communication skills and value in social work according to three interconnected dimensions. The first section discusses the importance of communication in the practice of social work – including building a rapport with service users and carers, and the importance of empowerment. The second section identifies and explains the centrality of effective communication skills such as negotiation, interviewing and self-awareness. After this, part three considers the impact of personal and professional values on communication. This includes traditional and radical values in social work practice and the effects of communication in ethical dilemmas. The code of practice (CCW, 2002) in the Welsh context is considered throughout.

This first section discusses the importance of communication and empowerment in social work practice with service users, carers and other professionals. Communication is defined in the Oxford English Dictionary (2013) as ‘the imparting or exchanging of information by speaking, writing, or using some other medium’. It cannot be described in such narrow terms within social work because of the different techniques involved in working with different service users in a multitude of situations. This involves social workers making judgements and getting to know the service user in order to communicate efficiently to the service users preferred method of communication (Wilson et al, 2008). Communication in social work practice is central to all inter-agency working and to building relationships with service users and carers. Good communication as a social worker requires the expertise to be both sensitive and understanding of their situation in order to build rapport with the individual (Trevethick, 2000). Rapport is how the social worker contacts and engages with the service user and carers. Developing a rapport starts with an introduction which forms the basis of the relationship, particularly as it is important to gain an understanding of the service user. This involves discussing their background, values, culture and needs, which will help develop the rapport (Knapp, 2009).

The fundamentals of communication in social work are voice and speech, body language, hearing, observing, encouraging and remembering. These skills can be used in introductions with service users and their families/ carers. Introductions can be uncomfortable and worrying for the service user if they are unsure what a social worker is there for and it depends on their previous experiences, if any. To ease this process an introduction exercise can be implemented – for example a genogram can be drawn by asking the family to collectively describe each family member in the house and those they would describe as their support and closest to them. Put simply, a genogram is a very detailed family tree using symbols to represent relationships (Parker and Bradley, 2010). This will help build a relationship with the service user as well as gain information and observe their reactions (body language) when working together and when talking about family and friends. This will show some key skills on the social workers behalf such as, listening, speech, remembering and encouraging.

Active listening uses a combination of talking and listening skills to make the service user feel you understand their situation, and encourages them to place trust in the social worker (Cournoyer, 2011). It involves positive body language and speech to invite/enable the service user to express themselves. More specifically, body language is expression through movement and facial expressions which convey emotion. Social workers should use body language to make service users feel more comfortable but also pay attention to whether the service user is showing signs of aggression, trying to hide something, or seems happy in the situation.

Empowerment is a process promoted by skills and should involve the service user. It aims to emphasise the rights and needs of people who may be oppressed by society (Leadbetter, 2002). Empowerment can be delivered in many forms, for example, personal, organisational, community based, family, group or team empowerment. Personal empowerment helps service users to gain control over their situations and overall empower themselves and others to enable change. Organisational empowerment supports staff in an organisation, promoting morale and motivation in workers so they are happy to take on more responsibilities and go to work. Community based empowerment supports the community to challenge inequalities and exclusion so everyone who lives in a certain society can feel a part of the community and take control of their environment. Family, group or team empowerment focuses on allowing each person in the group to help each other and themselves collectively. They can call on each other for support and help if they need to fight oppressive behaviour (Adams, 1996).

The second section discusses effective communication skills and how they support anti-oppressive practice. Skills are ‘the ability to carry out a particular activity effectively and consistently over a period of time’ (Thompson, 2005:81). Skills that shape the way social workers communicate are interviewing, negotiation and partnership and self-awareness (Thompson, 2005). An interview is a conversation with meaning and the beginning of change (Trevethick, 2000). Social workers use interviews to collect data and to build a face to face rapport with service users. An interview should be natural and the service user should not feel like they are being treated according to a checklist just going through the process, as this could be seen as oppressive if service users are not treated as individuals. The service user should have an understanding of why the social worker is there and has the right to know the process that has taken place to get to the interview. A key skill of interviewing is directing, this means although there should be a steady flow the social worker needs to keep the conversation on the subject that they are there for in a subtle way. This can be done by using phatic conversation as glue to keep it social and help keep a relationship going but redirecting to the main issue so it is a healthy balance for both taking part. It is better to use questions that will not give the service user the answer, especially children because this could create a story that is not exact. For example use, where did you get that bruise? Instead of did your mum give you that bruise? Open ended questions allow service users to expand on answers and give information that the social worker may not have thought to ask about (Hepworth et al, 2010).

Negotiation and partnership is an essential part of interagency working. Working in partnership with other professionals requires a level of negotiation when both services have different/alternative ideas of what is best for the service user. Professionals who work together quite commonly are social workers and health care professionals. Everyone involved in interagency team should have a clear role and have an understanding of each other’s place/responsibilities in the team and their point of view. Negotiation may take place in deciding the best solution for a service user. However, there may be a hierarchy between the professionals causing tensions in decision-making. This would need to be resolved in order to work in partnership. This can be achieved by building relationships and achieving trust and mutual respect through communication (Atkinson et al, 2007). The code of practice (6.5) states social workers should always treat colleagues with respect and work openly and co-operatively with them (CCW, 2002). Negotiation also takes place with service users’ in the decision of the best solution for their situation. Keeping the service user involved with all decisions helps maintain the service users’ trust and confidence in social services. This is anti-oppressive practice, which involves social workers empowering the service user to take control of their lives and help contact people in their society in similar situations. This is to help them feel part of society no matter their culture, language or lifestyle. It is seen as part of the social workers job to get rid of oppression in society (Dominelli, 2002). For example, by using a language interpreter this will make the service user more at ease and allow them to get their point across better.

Social workers need a level of self-awareness to convey attitudes, the correct emotions and self-control. Without self-control personal issues and emotional attachment to a situation could be expressed which could cloud professional judgement. The situation should always be focused on the service user and the social workers thoughts of their personal perfect solution may not coincide with the service user (Cournoyer, 2011). The code of practice (2.6) states social workers must declare issues that may create conflict of interests and making sure they do not influence their judgement or practice (CCW, 2002). The skill of self-awareness grows overtime with experience in practice, it teaches social workers to think on their feet during communication and difficult situations, deal with stress and tackle all obstacles as completely different when dealing with different people (Cournoyer, 2011).

This third, and final, section considers the impact of personal and professional values upon communication within social work practice, including how ethical issues arise in communication. Personal values need to be taken into account because they will frame many decisions; it’s the social workers instincts about safety and danger that decides, for instance, whether it is safe for a child to stay with their parents. However, personal values need to coincide with professional values because social workers cannot let personal judgements shadow their professional obligations to help all service users and abide by the code of practice (CCW, 2002). For example a social worker cannot express their personal opinions to a service user through verbal or non-verbal communication. They have to treat them with professional courtesy despite their personal feelings towards them. Social work values are underpinned by traditional and radical values. Traditional values focuses on being non-judgemental, protecting confidentiality and treating the service user with dignity and respect (Biestek, 1961). This follows the anti-oppressive practice of treating everyone as individuals and to not compare two different cases. These values underpin the core principles of the code of practice (CCW, 2002). Radical values are more modern views of social work practice which involves the service users taking more action to solve their problems themselves. For example, empowering the service user to have more confidence to build a partnership with their social worker and give input into their own plans for the future (Thompson, 2000).

According to BASW code of ethics (2012) ‘professional ethics concerns matters of right and wrong conduct, good and bad qualities of character and the professional responsibilities attached to relationships in a work context.’ Ethical issues can arise because social workers promote the welfare and rights of service users but the end result may not coincide with what the service user thinks is the right decision for them. This could cause communication barriers/issues because social workers support service users to be a part of deciding their own life changes then in some circumstances this power can be taken away from them. For example, an elderly woman wants to be able to live at home but she does not have the support and her dementia and mobility is deteriorating. The decision is made that she needs to go into supported accommodation, this effects the social workers relationship with the woman and the service users whole demeanour changes towards the social worker including body language, attitude and facial expression.

In conclusion, communication verbal and non-verbal resides at the core of social work. It is utilized in all areas of social work as an essential part of the job. Communication is used in services for elderly, children, people with disabilities, drug and alcohol abuse and mental health. It is used to build relationships, create solutions and to negotiate plans for service users. It is important that social workers work to always improve these skills and complete training so they can learn from other professionals’ experiences of how different service users, carers and professionals like to work in partnership. This includes how to communicate with people who may not want to co-operate to begin with but can use negotiation skills to improve the relationship.