Author: Andre Coleman

Discuss the social construction of older age and how this should then contribute to anti-discriminatory social work practice How has older age been socially and historically constructed? The biological perspective of ageing believes that the process of aging is a biological fact which is universal and affects all people. It takes the view that aging is a fundamental, progressive process which continuous throughout life (Lymbery, M 2005). The biological approach believes that as a person ages there is a decline in function as cells degenerate. Therefore, this approach views age as connected to a state of dependency and weakness with no possibility for improvement (Crawford, K and J, Walker 2004). However, in contrast there are other perspectives which take into account other elements such as the social construction of old age. For example, the introduction of retirement meant that clear boundaries were created which defined the point at which a person enters older age. Also, other developments in the welfare system such as the provision of pensions, have further defined the concept of old age. Therefore, the end of employment and the start of retirement can be seen as a major influence in the way older age has been socially constructed (Lymbery M 2005).

Crawford and Walker (2004) believe that the way in which older age has been historically constructed impacts upon the current view and treatment of older people in today’s society. They note that during the Middle Ages, older people were cared for by either charities or religious institutions. The Poor Law Act, introduced in 1601, transferred the responsibility of the care of older people within the family, to care within the community. This meant that older people were now cared for by their local parish, as families were unable to support them due to the financial risks of agricultural based society.

Workhouses were then introduced for individuals who were seen as needy and unproductive members of society. This included groups such as older people, the sick and those who were disabled. As there were no welfare system in existence, this meant that older people had to reside in workhouses as they had no other means of support. As the demand for care rose, the Poor Lawn Amendment Act in 1834 was introduced in attempt to cut costs by eliminating outdoor relief, this meant that older people were no longer able to receive support in their own homes and those in need of welfare were institutionalised in workhouse. This resulted in older people being viewed as a burden on society as they no longer had power, choice or control over they way they lived their lives (Crawford, K and J, Walker 2004).

According to Phillipson (1998), the concept of old age being a separate group within society only surfaced during the end of the nineteenth century. As highlighted by Slater (1930 cited Phillipson, C. 1998) up until this period both the welfare provision for the sick, and the welfare provision for the elderly, were classified in the same way with no distinction between the two groups. Slater believes that it was at this point that societies found it necessary to end sickness benefit when an individual reaches 65, and to replace this with old age pension.

The Old Age Pension Act was introduced in 1908 and provided all citizens who were over the age of seventy with up to five shillings a week if their income was under ten shillings a year. However, although this provided support for older people, the view held by society was to remain in work until they were unable to do so due to physical difficulties. Therefore, this resulted in older people who did not work being viewed in a negative way, as they were looked upon as ‘useless’ due to the belief that they were either too stupid or too weak to work (Crawford, K and J, Walker 2004).

It was during the twentieth century when older people began to be seen as different in they way they experienced and held an inferior status within society. It was found that through this period in time, one in five people who had reached the age of seventy were very poor and were a recipient of state welfare, and the likelihood rose significantly for those who were seventy-five, to a chance of one in three. This meant that circumstances such as being in poverty and experiencing marginalisation were seen as inevitable as an individual entered later adulthood, which provided the basis for which the concept of older age was constructed.

What are the consequences for people in terms of social disadvantage?

Older people face social disadvantage in many ways, such as infantilisation. This refers to a process in which adults are treated as though they were a child. This is a form of oppression as it demeans older people by assuming that they are fundamentally different from other adults and are therefore less worthy of respect (Thompson, S 2005). For example, the desexualisation of older age plays a key role in infantilisation. This is because old age is seen as a second stage of childhood, with an inappropriate link with sexuality, which further reaffirms the idea that older people are not adults. However, as sex is seen as an action of the healthy, this also reinforces the idea that older people are unwell, dependent and frail and further excludes them from sexuality. This illustrates they way in which older people are seen to be in need of support and reliant on others, similar to the conventions of childhood (Gott, M 2005). Also, by referring to older people by names such as ‘dearie’, it can be degrading as the person using the term automatically assumes that the individual does not mind being referred to in this way, which can be seen as disrespectful and inconsiderate of their feelings. (Thompson, S 2005)

Marginalisation is also another way through which older people face social disadvantage. Marginalisation is a form of social exclusion, and is used to describe the way in which people are pushed to the margins of society, which then prevents them from taking part in activities (Thompson, S 2005). When referring to older people, this is the process where older people are excluded from society due to preconceived ideas that they have no use, and are therefore a burden to society (Thompson, N 2006). There are many ways in which older people can experience marginalisation within society. For example, Thompson (2005) highlights the lack of suitable transport for many elderly people. This can mean that they are isolated from the rest of the community as the public transport is either inaccessible or unsuitable. This shows how older people can be marginalised due to factors they are unable to control, such structural problems within society.

Dehumanisation is also another factor of social disadvantage in older people. This is because it gives older people a label of being ‘elderly’, to which the individual is then viewed in terms of this label and not as a person with unique thoughts, emotions and needs. Dehumanisation can have adverse consequences as it fails to identify that each person is different, which can cause discrimination and oppression due to its impersonal and stereotypical viewpoint

Abuse of older people is a further way in which people of an older age may face disadvantages in society. Abuse in elderly people can be physical, psychological, sexual, emotional or financial. The underlying factor in this type of abuse is the exploitation of a comparatively vulnerable group within society. The people who carry out this abuse believe that older people within society are inferior with no requirement for respect (Thompson, S 2005). The ‘No Secrets’ document (DoH 2000 cited in Crawford, K and J, Walker 2004) was created as guidance on how to implement and adhere to procedures to help protect vulnerable adults from abuse, and also clarify definitions, which would enable authorities to carry out good practice. According to Hothersall and Mass-Lowit (2010), older people who are isolated, reliant on others, have poor health, or who are considered disabled are more likely to be abused. They believe this abuse can take place in any environment, such as hospitals, residential homes or even the individuals own home.

What multiple disadvantages can impact on people’s lives?

Ethnicity within older age can be seen as a significant influence on the life a person leads. This is because there is a belief that older people, who are of an ethnic minority background, face a ‘double jeopardy’ in society, as they are oppressed by both age and their ethnicity (Thompson, S 2005). Ray, Bernard and Phillips (2009) argue that services are institutionally racist. This is because they tend to be directed towards the majority population, which can mean that people are doubly disadvantaged. This can occur as they are not recognised within the service, and instead they are they are overlooked and treated as though they are invisible. Thompson (2005) states that the common feature of racism and ageism is that they are often susceptible to dehumanisation. This is because it is easy to categorise people as ‘elderly’ or ‘Asian’, however, in reality, these terms incorporate a vast amount of people into one group who experience different religion, culture and way of life. This leaves little manoeuvre for individuality and therefore these categories should be avoided, as the person is then seen in terms of this labels and not as a unique individual. Consequently, social work should seek to recognise the barriers which face ethnic minorities who are of an older age, and attempt to work with them to overcome their disadvantage (Phillips, J, M, Ray and M, Marshall. 2006).

Gender can also be seen as a key issue which can further disadvantage older people within society. Phillips, Ray and Marshall (2006) support the idea of a ‘feminisation of aging’, as older age is now seen as a predominantly female world due to the fact that women live longer than men. This can mean that women are widowed for a greater time than men, which can lead to women having to enter residential care due to being unable to support their own needs without the help of their partner (Arber and Ginn, 1991, cited in Phillips, J, M, Ray and M, Marshall 2006). Women are also seen as less likely to have private pensions compared to men, which means that they are forced to depend upon state pension (Hunt, S 2005). This can be increasingly difficult for women living alone as it becomes the only source of household income which can leave them deprived and subjected to poverty (Phillips, J.M, Ray and M, Marshall 2006). Gender stereotypes within older age can also cause detrimental effects. Women can be seen to be oppressed due to pressure to conform to gender roles, such as to be caring and supportive, which can mean that they are undervalued as it is seen as ‘normal’ and not something which needs to be commended. However, the caring role when displayed in men receives a higher status, as it is not seen to be a typical responsibility of mans stereotypical gender role, therefore they receive greater praise and support in fulfilling the role (Rose , H and E, Bruce, cited in Thompson 2005). It is important to note that not all gender related disadvantages in older age are associated with women, as men also experience undesirable situations. For example, the male gender role is surrounded by the belief that they are the dominant, providing and protective sex. However, this expectation may come under threat in older age as work is replaced by retirement and their health declines. This can then lead to lower self-esteem as they experience a loss of role within society (Thompson, S 2005).

Multiple oppression can also be experienced in regard to ageism and economic disadvantage. Social class can be an important factor within old age, as those who belong to a lower class are significantly more likely to have a lower income and to live in poverty. Being in poverty affects a vast amount of older people, and can have negative consequences as a sufficient income is a required to be able to meet a persons fundamental needs (Crawford K, and J, Walker 2001). According to Thompson (2005) if an older person has a low socio-economic status within society then they are more likely to suffer from a state of poor health. Crawford and Walker (2001) point out that this may be due to being unable to afford to heat their home or to buy nutritional food, which increases the risk of contracting an illness as well as being able to properly recover. Also, they believe that other socio-economic factors act in a way in which reinforces multiple oppression. For example, older people may be afraid to seek medical help when it is needed due to a fear of disapproval from people of a higher and professional status, such as doctors. This can mean that an older person tolerates their condition for a longer period of time, during which it could cause their health to deteriorate. Phillips, Ray and Marshall (2006) believe that it is becoming increasingly important in modern day society to contribute to an occupational pension. This is because there is a growing inequality between older people who rely on a public pension and those with the benefit of private pension schemes. Consequently, as state pensions are low, they have to be supplemented by means-tested top up benefits in an attempt to enable older people to remain above the poverty line.

What do social workers need to think about when working with these service users with particular reference to anti-discriminatory practice

One crucial factor in which social workers need to think about when working with older people is to avoid ageist assumptions. For example, Thompson (2006) proposes that older people are often subjects of sympathy as they stereotyped as being lonely. However, it is important to realise that people of all ages can be lonely, it is not something reserved for the elderly. Also, many older people have good social relations, and although they live alone, this does not mean they are lonely. Therefore, within social work practice, each case needs to be assessed individually to avoid stereotypical assumptions about older age.

Another aspect which social workers need to think about when working with service users is to challenge the concept of ageism. This is because there are many negative stereotypes surrounding old age, which can be seen by the disproportionate media coverage when an older person is abused and dies, and when the same happens to a child. This means, that to actively challenge the concept of aging a social worker needs to perform roles such as assessing the strengths of an older person and what they are able to do, rather than focusing on their problems and inabilities. As well as other positive functions such as advocating on the behalf of the service user, to enable them to gain access to services to improve their standard of living. This will allow the service user to overcome the discrimination and oppression which they may face (Phillips, J. M, Ray and M, Marshall 2006)

To conduct good social work practice when working with older people there should be support for the service user, individual personal care tailored to their needs, and also physical assistance, especially when offering help to those who have long term illness or disabilities. There are also other factors which constitute good social work practice such as values, skills and knowledge which enable social workers to carry out anti-discriminatory practice. A value base is needed to recognise the common issues amongst older people when trying to protect their independence. Skills are needed such as being able to empower people to remain in control of their lives, to advocate on behalf of the service user, to manage risk, and to be able to communicate effectively with both the service user and their carer. And also a knowledge base, that is derived from evidence based practice, policies and similar past experiences (Ray, M. M, Bernard and J, Phillips 2009)

An important factor that social workers need to consider when working with older people is the language that is used. This is because terms such as ‘the elderly’ can be seen as demeaning as they have negative connotations which can be seen as disrespectful. Also referring to service users as ‘old dears’ or similar names, although it is not meant to be intentionally offensive it can be seen as patronising. This can then mean that the person feels inferior due to the lack of respect shown through the language used towards them and make them feel as though they are not being taken seriously. Therefore, the language used to refer to older people needs to be carefully considered to try fight ageism, rather than reinforce it. (Thompson, N 2006)

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“We know far more about how to prevent the primary occurrence of maltreatment than how to respond effectively once maltreatment has occurred” (Munro, 2010, p. 22)

Preventing harm is beneficial, therefore, to social work with the Smart family, children Zac, Karly and Tierney; their Mum, Sam; Paul, father of the girls; and Mike, father of Zac. Focus on harm prevention, however, can create defensive practice, considering only safeguarding welfare and not its promotion (Tunstill et al., 2010). Critical exploration of both safeguarding and promoting of these childrens’ welfare, therefore, forms the basis of this essay, considering the application of ‘child in need’ and ‘significant harm’ to the complexity of lives depicted. Critical evaluation of skills and methods required in assessing rights and needs of these children, will then be explored, followed by steps which could be taken to safeguard and promote their welfare. Relevant research informing my thinking provides an evidence base for substantiating arguments made. Conclusions drawn, however, are done so in recognition that actual practice would benefit from engagement with this family in assessing, planning and intervening.

The Children Act (1989) [CA] places a duty on the local authority to promote the welfare of children, provide services to those in need and safeguard childrens’ welfare by investigating, and taking action, in situations concerning significant harm, which I consider to be relevant as a social worker in a case involving concerns regarding the welfare of three children. Furthermore, as a number of professionals are involved in working with the Smart family, the importance of multi-agency co-operation in safeguarding and promoting their welfare, emphasised in Working Together (DCSF, 2010) beneficial to engagement with this family, as is the policies’ detail regarding the implementation of Children Act principles. Significant factors impacting the work undertaken with this family, however, are also determined, in my view, by local authority policy and bureaucratic process, interpreting how legislation and national policies are implemented with individual families. Differential rates of court order applications, for example have been found in demographically similar local authorities (Dickens et al., 2007), suggesting work with this family to be impacted not just through law and policy creation but also their implementation at a local level (Marinetto, 2011).

Analysing concepts of child in need and significant harm relation to this case, however, also require consideration of critically applying a researched evidence base to information gathered about the family. Nutritional deficiencies, for example, resulting from sporadic meal provision, a concern Sam’s health visitor raised, can be detrimental to all areas of child health and development (Kursmark and Weitzman, 2009), suggesting the Smart children may not achieve a reasonable standard of health and development (s.17, CA). The persistent failure to provide adequate food constitutes neglect (DCSF, 2010) suggesting the presence of significant harm, relating to health and developmental impairments (s.31, CA). Significant harm, however, must be attributable to the care given by parents not being what it is reasonable for them to give (ibid.). Regarding food provision therefore, I would argue, contexts of poverty require consideration, affecting 27% of children currently living in the UK (Adams et al., 2012). Sam and Paul’s financial situation, therefore, might dictate how possible it is for them provide regular meals, causing the children to need services which promote their welfare (s.17, CA). Without this context, however, the children may be suffering significant harm, through their parents unreasonably denying them regular meals (s.31, CA).

Food insecurity has also been associated with externalising behaviours (Belsky, et al., 2010), highlighted in Zac’s aggression at school. Furthermore, regular meals have been linked with educational achievement (Roustit et al., 2010), suggesting Zac’s current cognitive difficulties, reading 4 years below his actual age, may be attributable to a lack of food. Whilst Zac’s educational development suggests his being a child in need, relevance of significant harm is less clear, in that without assessing causes of cognitive delay, the contribution of food provision to such difficulties cannot be ascertained and, as such, the extent to which parental care is insufficient. Zac’s current delay may also be associated with poor attendance at primary school, which is linked with poor attainment (Sheppard, 2009) and behavioural difficulties (Carroll, 2011). Furtermore, Karly’s attendance at primary school is also poor, which if not addressed may lead to similar developmental impairments, relating to concepts of child in need.

Inconsistent food provision may also be impacting Tierney’s development, who at 18 months is not walking and appears to have delayed speech, developmental concerns consistent with concepts of child in need. Whilst specialist assessments may indicate medical contributions, nutritional deficiency impacts physiological and cognitive development, required in language development (Rosales et al., 2009) and learning to walk (Hanson et al., 2011). Parental neglect has also been linked to language delay (Vernon-Feagans et al., 2012) and lack of routine and poor living conditions, both identified as problematic for the Smart family, are prevalent in cases of neglect (Long et al., 2012). As such, Tierney’s home environment may be contributing to her language delay. At 18 months, however, speech development is varied and what appears to be delay, may not be indicative of problematic language development (Graham, 2011), suggesting, in my view, that the extent of current concerns, in isolation are insufficient to constitute ‘significant’ harm.

Lack of routine and boundaries, might also be related to Zac being found by the police, unsupervised in the city centre, at 10pm, suggesting neglectful parenting, through a lack of adequate supervision (DCSF, 2010), or parental control (s. 31, CA). Sleep deprivation has been linked to poor attention and impulsivity (Beebe, 2011), noted as concerns for Zac, as such current routines, or lack thereof, limiting the security of sufficient sleep, may be impacting his ability to maintain a reasonable standard of development (s.17, CA). Establishing the presence of routine, or degree of supervision, is not possible on the basis of a singular event and as such the relevance of significance harm in relation to these factors is difficult to ascertain with additional information, making it a key consideration within assessment.

Lack of family routine and predictability could also be contributing to Zac’s behaviour at school (Deater- Deckard et al., 2009), and further exacerbated if concerns regarding domestic violence between Paul and Sam are found to be accurate (Moylan et al., 2010). Living in contexts of violence increases risk to children of physical and emotional abuse (Montgomery, 2009) and can affect secure attachment development (Levendosky et al., 2011), which I consider noteworthy as Tierney is at a key age for this, requiring sensitive and responsive care givers (Beijersbergen, et al., 2012) and Zac’s early attachment relationships are likely to have been disrupted by frequent foster care placements (Leve et al., 2012). In light of this, should domestic violence be evident, significant harm may be relevant and irrespective of its presence, current conflicts and instability in the family home, are likely to be impacting the childrens’ emotional development, suggesting their being children in need (Cummings and Schatz, 2012).

Significant harm often results from the long-standing impact of an accumulation of factors, rather than requiring a singular traumatic event (DCSF, 2010). Assessment, therefore, requires skilled critical reflection upon the inter-relatedness and cumulative effect of factors, both detrimental and protective (Rose and Barnes, 2008). In isolation, for example, there may be no evidence that Sam is currently misusing any substances. Associations exist, however, between substance misuse and domestic violence (Gilbert et al., 2012) and with chaotic lifestyles (Straussner, 2011), both possible concerns for Sam. Considering their cumulative effect, therefore, the likelihood of substance use still being problematic could increase, subsequently heightening, in light of its impact on child welfare, risk of significant harm (Traube, 2012). Ecological approaches, therefore, which consider the relationships between various parts of a system, can create a context for managing the complex interconnectedness of relationships, helping to avoid minimisation occuring when problems are viewed in isolation (MacKenzie et al., 2011).

The complex interplay of factors affecting the Smart children, I would suggest, requires a thorough knowledge of the family’s case file, including events which previously escalated risk of harm or promoted the childrens’ welfare, providing insight into current circumstances. Chronologies and genograms can provide visual aids in analysing such events and relationships and their impact upon one-another. Genograms can also beneficially be constructed in collaboration with families, highlighting unknown relationships and exploring conflictual ones.

Good preparation can also support the ability to form trusting relationships quickly, in communicating care for, and competence working with, families, which I would suggest, is key in creating relationally-interactive assessments, founded on principles of empathy, respect and transparency (Healy and Darlington, 2009). Creating contexts where collaborative exploration of assessment can occur, in my view should also be valued, accumulating everyone’s views, children, parents and professionals, on problems and strengths within the family and involving them in shaping the purpose and direction of assessment (Gallagher et al., 2011). Collaboration, however, is a two-way process and should also involve being clear about concerns and regularly discussing how the childrens’ welfare is currently being safeguarded and promoted (O’Leary et al., 2012).

Families may be understandably reluctant to engage in such relationships, however, perceiving assessment to involve ‘experts’ defining parenting competency and judging them as adequate or not (Buckley et al., 2010). Exploring the presence of domestic violence with Sam, for example, may differ if she views my role as collaborating with her to implement plans which make things better for her family, than if she views my role as assessing risk to the children and her inadequacy in protecting them from harm. Effective communication, a warm, empathetic approach and persistence may therefore be required, in challenging this perception and undertaking assessment in a way which seeks genuine collaboration, rather than tokenism (Platt, 2012).

Pauls’ inconsistency within the family home and the absence of information regarding Mike’s current involvement in Zac’s life, may lead me to give less significance to their engagement in the assessment process, placing expectations to provide good enough parenting, solely upon Sam (Brown et al., 2009). Irrespective of Paul and Mike’s legal parental responsibility, however, determined by their names being on birth certificates (s.2, CA), they play an important role in the lives of their children, affecting welfare and development through presence and absence (Coakley, 2013). As such I consider it important to assess the role that these fathers currently play in family life, the involvement they would like to have and risks and strengths associated with such involvement (Maxwell et al., 2012).

Observations, in my view, are also a key element of assessment, both of relational interactions and of living environment (Urwin and Sternberg, 2012). They have the potential, however, to be intrusive, unrepresentative of actual care and undermining of collaboration with parents. Clear understanding, therefore, by all involved, of their nature and purpose should be facilitated (Welbourne, 2012). Whilst multiple observations may create a more holistic picture of family life, reducing the impact of observer effects (Gambrill, 2012), in reality, quantity may be determined by time scales. This creates opportunity, however, in my view, for collaborative assessment, discussing with Paul and Sam how interactions may have occurred differently, had I not been there, indicating insight into, and valuing their expertise in, good enough parenting.

Children have a right to have their views heard and taken seriously (UNCRC, 1989) and as such, I would argue, should be actively involved in the whole assessment process, making adaptations, in light of their developmental capabilities, to enable engagement. Clear and simple language is required in explaining the purpose of assessment, as is gaining feedback confirming understanding and exploring their views on the best ways to undertake them (Petrie, 2011). Practical activities, in light of Zac’s educational difficulties, could better enable his engagement, such as photographing important things in his life, opening up discussions around strengths, worries, wishes and feelings (Pimlott-Wilson, 2012). Karly, being younger, could engage through play activities, using toys and imaginary play to express feelings about current situations, without having to talk directly about them (Landreth, 2012). Tierney, I would suggest, is harder to engage directly in assessment due to her communicative abilities. Behavioural communication, however, I would suggest can reveal a great deal and I would suggest that skilled awareness of this would be relevant to all three children (Handley and Doyle, 2012). Consideration should not only be given regarding how to incorporate their views in plans made, but how, when made, such plans are communicated sensitively, clearly and honestly to all three children, giving consideration to their developmental capabilities (Polkki et al., 2012).

Assessment is an on-going process and should not, in my view, be seen simply as a predecessor to intervention (Brandon et al., 2009). In light of this, it is possible to begin considering steps which can be taken to safeguard and promote the welfare of these children, whilst recognising the uncertainty which accompanies the continuous changes prevalent within family life and therefore the need for dynamic plans which can adapt to accommodate these (Welbourne, 2012).

Providing it is safe to do so, children should be supported to grow up within their own family (CA, 1989). Steps taken, therefore, to safeguard and promote the welfare of Zac, Karly and Tierney should seek to uphold this right. Consideration, however, must also be given to their health and development and whether remaining within the family is likely to, or resulting in, significant harm (s.31, ibid.). Even where legal steps are being considered, however, I would argue that the continuation of collaborative relationships with parents should still be sought, as greater engagement is likely to be seen if plans are constructed in partnership with parents (Gallagher et al., 2011).

It may be that the welfare of all three children can be safeguarded and promoted by Zac temporarily living away from the family home, allowing Sam to focus on the care of Karly and Tierney, as she has demonstrated capacity, in the past, to parent younger children given sufficient support. In light of this, however, it is important that such steps are not taken because Zac is seen to be a problem but because it would be more beneficial for him than maintaining the status quo. Greater paternal contact, may be one such benefit achieved, by exploring the possibility of Zac living with his Dad under a residence order (s.8, CA). With the information currently provided, however, the suitability of such a placement needs careful consideration, including Mike’s capacity to parent, giving particular regard to his previous substance misuse and its impact on his care of Zac. If this is not possible, it may be that Zac has strong positive relationships with Paul’s extended family, whom he could live with, as kinship care has been found to have positive impacts on identity formation, stability of placement and behavioural and mental health outcomes (O’Brien, 2012).

Accommodating Zac outside of the family home, however, does not mean his welfare will necessarily be holistically promoted. His emotional and behavioural development may be indicative of attachment difficulties (Fearon et al., 2010) and a mentoring scheme, which have been found to support positive emotional development in boys displaying aggressive behaviours (Younger and Warrington, 2009), may be of benefit to Zac. Educational concerns have also been highlighted for Zac and although a more stable, home environment may support his educational development (Turley et al., 2010), sufficient impairment may have already occurred to warrant specialised support. Whilst Zac’s school may be better positioned to facilitate this, I would suggest it to be a key part of plans for promoting his welfare.

Sam’s capacity to parent, even two children, may also be significantly impacted by domestic violence (Levendosky et al., 2011). If following assessment, it is found to be present, the risk of harm to children living in contexts of violence (Stanley, 2011), could create the need for care order applications (s.31, CA) or voluntary foster care (s.20, ibid.), in respect of Karly and Tierney. If Sam is willing to engage with support, however, she could be supported to live independently, with her two children. Significant risk of violence continues, however, when domestically violent relationships end, requiring additional steps to protect Sam and her children, from continued risk of violence (Stanley et al., 2012). Enabling safe and productive contact, between Paul and his children, would also need consideration, including the girls wishes and feelings regarding this (Featherstone and Fraser, 2012). If both Paul and Sam, however, admit to the violence, engage with support and commit to removing it from their relationship, it may be that they can remain living as one family unit, although careful consideration is required as to how such commitments can be monitored and what domestic violence support is available for the whole family (Stanley, 2011). Irrespective of the presence of violence, however, Paul’s inconsistent living arrangements, combined with regular arguments, create conflict and instability which could impact emotionally upon the girls (Davies et al., 2012) and therefore steps are required to safeguard and promote their emotional welfare, exploring options of permanency for Paul and therapeutic family work being undertaken, finding less confrontational resolutions to disagreements (Cummings and Schatz, 2012).

Lack of routine, in my view, is impacting multiple areas of the childrens’ welfare, including school attendance and meal provision. Colourful charts laying out daily routines, such as meals, school, play, bathing and bedtimes, created in collaboration with the family, could reinforce the childrens’ basic needs, act as a visual reminder for maintaining routine, make tasks seem more manageable and create reassurance for the girls around their needs being met (Rees, 2011). Such a tool can support measurable outcomes, with home visits occuring at key times, to monitor progress and provide support where it is needed. For such interventions to be effective, however, the continued development of collaborative, trusting and supportive relationships is required, whilst being clear about the necessity of the childrens’ needs being met (Darlington et al., 2010).

Tierney’s welfare, in particular, could be promoted through using a local childrens’ centre, supporting language development, mobility, attachment relationships and providing parenting support (Sheppard, 2012). Whilst attendance cannot be compulsory, Sam has engaged with support in the past and, I would suggest, collaborative planning will increase the chances of her engaging again (Gladstone et al., 2012). Social workers, however, have supported this family over many years and although engagement is not described, deterioration in the childrens’ development has continued. Presuming that my interventions, therefore, will necessarily have a greater impact is uncritical and as such I would argue the importance of clarity, openness and honesty regarding expectations upon Sam and Paul and that if they are unable to safeguard and promote their childrens’ welfare, with support, care order options will be pursued, which could result in the children being adopted.

Concluding this case study, I would suggest is a complex task, particularly as assessment and welfare planning are part of a continuous process and therefore natural conclusions do not necessarily occur. Both concepts of significant harm and child in need, I would argue, to some extent have been shown to be relevant to the Smart children and that interventions to promote health and development are required. Whilst a range of assessment skills and methods have been explored, implementing these in practice is more complex than conveying them within an argument and, I would suggest, is largely dependent upon the quality of working relationships with family members (Platt, 2012). Analysing this case study has demonstrated to me the uncertainty which pervades safeguarding and promoting welfare within social work (Ferguson, 2010), the need to make purposeful space for assessing strengths and protective factors (Roose et al., 2012) and the complexity of striving for holistic analysis of inter-related presenting factors , whilst recognising that uncertainty will remain in the ever-changing reality of lives (Saltiel, 2013). Despite this, however, social work requires a degree of decisiveness, in collaboration with family and discussion with managers, as safeguarding and promoting the welfare of these children necessitates competent and effective assessment, planning and intervention (Munro, 2010).

The purpose of this essay clarifies ethics and values and how fundamental they are within social work practice. How relevant they are in modern day practice in addition raises concerns regards to professionals and personal values and ethics. Highlights serious case reviews and how they link into legislation and policies, and the difficulties with anti- oppression and anti- discrimination in relation to welfare benefit cuts and the economic climate. This assay highlights the BASW and HPCC code of ethics

Macmillan (2010) what are ethics? Ethics are somebodies beliefs, principles and morals that are important to them and propose a set of standards and values Oko 2010)) values are the theory and how you value what is good and influence our decision Ethics are the principle in which way we act.

Theory behind

Professional ethics are led by set of guidelines and processes that adhere to standards of code and ethics are implemented. Maynard A Becket (2005) believes Values are used in many forms, for example it could be financially personal or cultural in relation to faith and other religions. Values determined what we view as high priority and remain significant to your beliefs

G. Reamer (2006) suggest Social work values and ethics have developed significantly over the past few decades, acknowledging the importance of professional and personal values and ethics in relation to practice. During the 1960 values and ethic became core values of social work with growing interest towards diverse and complex issues. The National Association of Social Workers implementing a code of ethics.1970 saw a dramatic change in other professions such as nurse’s health and criminal justice on applying ethics to practice. Joyce E (2009) attitudes towards contemporary psychoanalysts practice and social work have changed in relation to ethics and value, an appreciation of cultural heritage are taken on board and therapy has been brought into the 21st century. Improvements in working together with social work have been accomplished.

Banks S ( also believes ethics’ and values have developed considerably and gain greater recognition with a global interest from various countries adopting the idea with new countries accepting social work has a profession however some countries are a little slower in moving forward but nevertheless taking on board and introducing ethics and values to practice. There is more opportunity than before to access literature and books in regards to ethics and values which makes it more obtainable, however equally feels there doesn’t appear to be a great deal of information regarding ethics in relation to politics and anti-oppressive social work even though they are very much attached.

.Domineli L(2002).Anti-oppression can be seen in many forms and links into social work practice and values and ethics. Policies and legislation usually play a big part in welfare reforms for example cutting down on benefits and welfare system; this clearly impacts on the poor marginalizing social exclusion. Individuals can often feel that they are a burden on society, especially people who are in receipt of benefits. The government can use destructive language aimed at the unemployed as well as influential through the media or public speeches their portrayed as “scroungers” and unworthy to society. This form of oppression needs to be addressed and challenged. Social workers are expected to stand up for human rights and promote equality.Gray.M,at et l (2012) believes Social workers are led by legislation and political dilemmas . Legislation and welfare reforms have impacted on public spending cuts which are taking place by the coalition government. Inequality happens when the government makes cuts to the youth services, and various other organizations and local communities, it divides the poor from rich and wealthy, this could be seen as injustice, grounds for oppression between individuals and social groups.

Social worker will need the skill and knowledge to underpin the vital importance of identifying their personal values from professional values in order to avoid poor practice and mistreatment. Forming opinions and concluding judgments based on your own assumptions and personal beliefs subsequently understanding values and ethics is imperative. According to Benchin, A., Brown,(2000) Values are encompassed in our daily life and a set of beliefs that originate from different background with expectations and ideas formed from the person’s perspective, this can impact on the way we react or behave to various situation therefore, recognizing personal beliefs and remaining open minded and respecting people as individuals will help develop your practice and achieve a better outcome for the service user. However Macmillan (2010) believes in relation to practicality social workers struggle over moral dilemmas all the time and are led by regulation, making decision can be exceptionally difficult Maynard, A Beckett.,(2005) believes Indeed at times it may be difficult not to be subjective and base your own beliefs and values on decision making, as this is what makes us what we are. As a professional you may have suffered a similar problem to the service user, this could influence your decision in deciding what is best for the service user therefore affect your practice blurring the boundaries. In this particular case the social worker may fail to overlook the service user’s needs. There is no room for judgmental practice in social work. Social workers should be professional and remain impartial to determine what’s ethically right. It is important to disregard your own values and beliefs to enable social worker to practice appropriately nonetheless when it comes to the service user needs other factors should to be taken on board in the terms of their ethnicity as the service user may have afro hair or religious beliefs therefore the social worker has to respect the individual.

Human Right Committee January (2012) BASW believe British Association of social work is fundamental document that highlights the code of practice and strongly advises how social workers should practice. It refers to ethics and values as the main topic and hugely emphasizes the necessities for social work to represent the codes of practice. Due to the nature of the social work role it raises concerns regarding ethical issues that may well occur for a social worker, the code of ethics and values clearly states the importance of implementing ethics and values as a fundamental part of social work in order to promote and empower service user’s nevertheless social workers have a duty of care and in some circumstances have no choice but to restrict someone’s freedom. Social workers are also faced with inadequate resources which impact on their duties .Higman, P (2006) it may be argued that the BASW is a set of standards in relation to confidentiality nevertheless conflicting as remaining completely confidential can be difficult for instance there is easy access through the internet and admission to statuary meetings. It is almost impossible to remain confidential due the nature of working in partnership and multiagency teams. Information sharing is important when legal obligations are in place in the terms of safe guarding issues nonetheless service user should to be informed at all times.

According to Health Care Professionals council (2012) HCPC is very prescriptive generic document in which it regulates Social workers and health profession; it has the same guidelines as BASW regards to ethics and values in addition it provides guidance on how social worker should behave appropriately and questions professional conduct outside of work which suggests integrity as large part to play in all aspect of a social works life. Macmillan p (2010) believes Social workers struggle with moral dilemmas all the time with in their career, making decisions that are led by regulations and putting it into practice can be extremely difficult.

Pattison,Roisin pill.(2004) states social worker should be accountable for their actions in many cases social workers have overacted and placed children in care without any evidence unfortunately failed to this in the Victoria cimbers case. Victoria died a tragic death in the hands of her great aunt Marie Kouao and partner Carl manning this, was damming report led by Lord Lamming. Victoria was let down by the police, several local authorities and health professionals. Ethics and values are apparent throughout Victoria case, assumptions were made towards Victoria’s ethnicity and cultural heritage highlights the dangers of overriding personal views and religious beliefs. The department of Health Lord lamming Report p116 within the report concluded a catalogue of errors. Social workers complained of lack of supervision and during supervision the social worker alleged the manager discussed her own personal problems and talk about “god “unfolding her religious beliefs which irritated the social worker therefore found it incredibly difficult to discuss important and difficult cases often failing to complete supervision consequently prioritizing personal and religious beliefs. supervision is imperative to social work.

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Childhood is idealised as a garden, protected by walls and hedges, where nature flourished at its perfect best. It is often envied and honoured. However, in reality most children are often neglected, abused and exploited. An overview of the reported cases suggests that a major part of reported child maltreatment was sexual abuse. As many as one out of every four children will be the victims of some kind of abuse.

Child Pornography and child sexual abuse are two of the most disturbing issues in the world today. This paper aims to show the ongoing debate on whether consumers of child pornography pose a risk for hands on child sex abuse offences. It provides an overview of existing research studies and their approaches concerning the linkages between child pornography and child sex abuse. In this paper I will be including arguments for and against this relationship by various authors, statistics reports and surveys to reach a conclusion. This paper also aims to talk about how the legal system attempts to control child pornography through actual legislation and a graded selection policy.

INTRODUCTION

Child pornography is a complex topic for which the standards applied are subjective and dependent upon moral, cultural, sexual and religious beliefs. Legal definitions of both “child” and “child pornography” differ globally. However, the United Nations Conventions on the Rights of Child, which has now been adapted by 191 member states, provides a universal definition of the child as any person under the age of eighteen years. It should be noted that each country’s legal definition of “child” may be different but the term “child pornography” will refer to a “sexually explicit reproduction of a child’s image”. According to the Interpol Specialist Group on Crimes against Children, “Child pornography is created as a consequence of the sexual exploitation or abuse of a child. It can be defined as any means of depicting or promoting the sexual exploitation of a child, including written or oral material, which focuses on the child’s sexual behaviour or genitals. The Council of Europe defines child pornography as material that visually depicts a minor engaged in sexually explicit conduct. The ECPAT’s definition closely mirrors Interpol’s which states the visual depiction of a child engaged in explicit sexual activity, real or stimulated, or the lewd exhibition of genitals intended for the sexual gratification of the user, and involves the production, distribution and/or use of such material. It can be seen that each definitions given by the above bodies speak of visual images or depictions, or representation of sexual activity involving the “child” or “minor” defined in Article 1 of UN Convention Rights of a Child. Each of the definition emphasises the sexual nature of the representation and seeks to distinguish child pornography from, wholly innocent images of children, for example in a family setting or on the beach, where they could be fully or partially undressed, which are appropriate to the wider lawful activity shown in the depiction.

The official definition of child sexual abuse is “forcing or enticing a child or young person to take part in sexual activities including prostitution, whether or not the child is aware of what is happening”. The activities may involve physical contact, including penetrative or non-penetrative acts. They may also include non-contact activities, such as involving children in looking at, or, in the production of, pornographic material or watching sexual activities, or encouraging children to behave in sexually inappropriate ways. Persons who exploit children sexually, in the view of ECPAT, fall into two categories. “Preferential child sex abuser” and the “situational child sex abuser” where abusers in the first category suffer from psychological disorder and the latter are experimenting with new forms of sexual contact. In the paper prepared by Julia O’Connell Davidson for the World Congress against the Commercial Sexual Exploitation of Children, she describes both of these categories. According to her, the term paedophile refers to an adult who has a personality disorder which involves a specific and focussed sexual interest in pre-pubescent children. The ‘preferential child sex abusers’ are abusers who are usually, but not always, men, and their victims may be either male or female children. Psychiatry views their taste for immature and powerless sexual partners as the manifestation of a personality disorder.

The ‘situational child sex abusers’ are men and women who sexually exploit children, not because they have sexual interest in children per se, but because they are morally/sexually indiscriminate and want to experiment.These abusers do not consciously seek out children as sexual partners, but use them when such children are available. Generally child pornography will be possessed, made and distributed by the paedophile or preferential sex abuser. However, it would appear from a number of arrests that child pornography can be accessed with ease on the internet. Its anonymity has meant that ‘situational child sex abusers’ are also using this medium.

Identifying Victims and Offenders

In most countries, street children, poor children, juveniles from broken homes, and disabled minors are especially vulnerable to sexual exploitation and to being seduced or coerced into the production of pornographic material. While impossible to obtain accurate data, the perusal of the child pornography readily available on the international market indicates that a significant number of children are being sexually exploited through this medium. According to the Home Office Statistical bulletin more than one third (36%) of all rapes recorded by the police are committed against children under 16 years of age. Another study which examined police data on rapes committed against children found that children under the age of 12 were the most likely of all those age 16 and under to have reported being raped by someone they knew well. According to the NSPCC statistics, there is a predominance of girl victims than boy victims. For example, in England and Wales there were 6,587 offences of sexual abuse on a female child under 16 and 2,821 offences of sexual abuse on a male child. Another Home Office report shows that 60-70% of sex offenders against children target girls only, about 20-30% target boys only, and about 10% children of either sex.

In the context of sexual exploitation of children, ‘sex exploiters’ can be defined as “those who take unfair advantage of some imbalance of power between themselves and a person under the age of 18 in order to sexually use them for either profit or personal pleasure”. Child exploiters and pornographers often seek occupations that bring them into habitual contact with children. Paedophiles constitute a significant sector of the offenders. Some of these paedophiles are attracted to children of the same sex, but the majority are heterosexuals. It should be noted that not all paedophiles are child molesters and that many child molesters are not paedophiles. In 2005/06 the average number of registered sex offenders was 58 per 100,000 of the population in England and Wales. An estimated 110,000 people have been convicted of sexual offences against children in England and Wales. 90% of the child victims know their offender, with almost half of the offenders being a family member. Although higher proportion of the offenders is males, the number of female offenders is also a key concern. Researchers from the Lucy Faithfull Foundation, a child protection charity that deals with British female sex offenders, said its studies confirmed that a “fair proportion” of child abusers were women. The sexual exploitation of children can happen anywhere – in schools, homes, workplaces, in communities and even own computers, and anyone can be an exploiter – a teacher, relative, religious leader, employer, aid worker, peer or pornographer. A study which examined police data on rapes committed against children found that children under the age of 12 were the most likely of all those aged 16 and under to have reported being raped by someone they knew well. Children between 13 and 15 years of age were the most likely to have reported being raped by an “acquaintance”. Since the advent of the internet and mobile telephone services linked with download and exchanging capabilities, the production and sale of child pornography has also became a profitable business. The men who sexually violate or photograph children being violated in order to sell the images are child sex exploiters. So are those who operate the websites that are the shop fronts for the illicit trade in child abuse images. When someone pays to look at child pornography, they are not just looking, they are exploiting. They are part of the chain of exploitation and in most countries, are pursued by the law as child sex offenders.

Arguments

This research assignment is aimed to answer the question of whether there is a link between child pornography and child sex abuse. This is a very controversial area, with experts differing over any casual link. Some experts argue that there is a link between the two as watching child porn increases the risk of offending, and some argue that it reduces the risk of offending. The main reason for this debate is that it is virtually impossible to conduct research in the laboratory using standard specific methods which yield statistically reliable results. The constraints of ethical research, false reporting, interviewer distortion and a whole host of other problems contribute to the difficulty of acquiring scientific results. Many researchers have come to the conclusion that there is no sound scientific basis for the conclusion that exposure to child pornography increases the likelihood of sexual abuse of children. Others have suggested that there is a consistent correlation between the use of pornography and sexual aggression. This debate will be considered in two sections, the arguments supporting that there is a link and the arguments against the link followed with a conclusion.

Arguments supporting the link between child pornography and child sex abuse

A common theme within the existing discourses surrounding child pornography is that such an activity represents a threat because it is invariable existing sexual abusers of children who possess and use child pornography as an incitement to commit child sexual abuse. It is also frequently argued that possession and use of child pornography present a real threat to children

Introduction

According to Hardcastle, Powers and Wenocur (2004), “Community practice is the application of practice skills to alter the behavioural patterns of community groups, organisations, and institutions or people’s relationships and interactions with these entities”. Drawing from this simple definition of community practice, the report focuses on the work I carried out as an Applied Community studies student working with homeless people at the Salvation Army (SA) hostel in Coventry where I completed 140 hours of practice learning as an Assistant Project Worker. For personal reflection and intellectual development the report evaluates the themes around homelessness (causes and bio-psycho-social impacts of homelessness). The theories, legislation and policy underpinning work with homeless people is discussed, and for argument`s sake, the effectiveness of intervention methods is critically analysed while particular emphasis on factors contributing to inequalities in health and social care such as ageism, gender discrimination, race and ethnicity and social exclusion to promote an anti-oppressive and anti-discriminatory practice (Dominelli 2002 and 2008). An evaluation of my learning outcomes will be made, and the report will argue that relying on funding from the local government affects the administration and provision of welfare services at the centre, which in most cases creates ethical dilemmas for Project Workers. Further, the report will argue that complying with the local authority on who to give help makes the Salvation Army to depart from its core values based on Christian principles: feeding the hungry, clothing the naked, and giving shelter to the homeless (Walker, 2001) among others Christian values, for example, its work with asylum seekers. The report also recognises that lack of continuity in the community affects casework with individuals. The essay concludes by identifying areas of good practice.

description of SA and work carried out

The Salvation Army was founded in 1865 by William and Catherine Booth to help people identified as socially undesirables (Prostitutes, criminals, drug addicts) to embrace Christianity (Murdoch, 1996; Walker, 2001). To date, the Salvation Army has centres worldwide and provides social aid to people in need, including disaster relief (Chronicle of Philanthropy 30 October 2008). It runs youth programmes and provides accommodation to homeless people but on a temporary basis. In Africa the Salvation Army works with refugees and displaced people among other community works. It operates as a non government organisation agency that provides relief to people in need. Social support intervention is guided by the Salvation Army’s 11 Christian doctrines, or soldiers’ covenant, as an army against social ills. According to the Chronicle of Philanthropy (30 October 2008: 10) the Salvation Army was the largest charity in the USA giving away more than $2 billion in social aid in 2007.

The Salvation Army hostel (Coventry) provides accommodation to 80 residents, mostly men (75 rooms are reserved for men with only five reserved for women). The implications of this gender variation will be discussed later. In addition, it takes only homeless people between the ages of 18 and 65, and this concept will also be discussed later in relation to ageism. In addition, the centre does not provide accommodation to people who have no access to public funds, such as asylum seekers, and there are no facilities for homeless families, although the Salvation Army in Leamington has only one family unit. Again, this will be discussed in relation to society stereotyping single people, especially men, as more likely to become homeless. The centre also runs a resource centre which help service users to bid for houses on Coventry Home finder, and job search. In addition, the centre also hold cooking courses to promote healthy eating and budget meals among residents, and used sport (football) to encourage healthy living interaction through sport, and clients participated in football once every week.

I worked as an Assistant Project Worker in a team of 20 staff that included 10 project workers. My job included attending referral meetings, carrying out risk assessments and identifying reasons for homelessness, profiling where a key worker asks the homeless person a series of questions in line with the National Monitoring and Evaluation Services (NMES). My duties also involved helping the service users to bid for houses, signposting them to the Job centre, organising cooking and football events.

Critical analysis of relevant theory to practice.

The report now analyses the discourse of homelessness in view of the bio-psycho-social needs of homeless people. Maslow (1954) identified seven basic human needs, of which shelter is among them (Taylor, 2010). In England, homelessness is a major issue, and between January and March 2003 there were 31 470 households identified and accepted as homeless by the Local Authority homeless (Wright et al 2003). According to Wright et al (2003), people who are homeless usually have socio, medical and psychological needs, and are stereotyped as anti-social, violent, migrants, and undeserving. Further, they also face isolation, lack of choice, and stigmatisation (Homeless Network 1999 Report). They are also likely to be discriminated and socially excluded because of their ethnicity, gender, race and age (Wright et al 2003).

Power and Hunter (2001) concur with this assertion and argue that some of the homeless people’s most immediate challenges include nutritional deficiencies, cold weather, poor personal hygiene and drug and alcohol misuse. In addition they have higher incidents of morbidity and mortality (Wright el al 2003). Some of their medical needs/problems include “a chronic history of severe alcohol dependence, with gastrointestinal, neurological, cardiovascular or metabolic complications” (Wright et al, 2003 pg 9). They also have higher incidents of depression and risk of suicide (ibid). For effective intervention with homeless people to promote their health and well-being, staff at the Salvation Army works jointly with health partners (GPs), housing departments, non-statutory organisation and social services departments.

Most people who use the services (homeless) at the Salvation Army hostel are single white men, ex-convicts, drug and alcohol misuse, and refugees. Underlying bio-psycho-social issues included HIV, substance misuse, isolation, and unemployment. An understanding of these underlying needs was important during a risk assessment so that they could be identified and appropriate intervention provided, for example, where homelessness was caused by unemployment, the person would be sign-posted to the Job Centre, or assisted to fill in job application forms. Getting a job would empower the person to become financially independent and offer a more permanent solution to a recurring problem. Similarly, people who lost their houses due to drug and alcohol misuse would be referred to other agencies such as Recovery Partnership for rehabilitation (solution focussed intervention).

The SA worked with the Coventry City Council, who referred homeless people to the centre. The Local Authority pays ?147 per week towards the accommodation of the homeless person, while the person is required to pay ?10. The City Council is also the major funder for the agency, a concept which eroded its independence and community standing as a Christian based sanctuary for the homeless regardless of creed, race (based on verses from the Bible). As a result asylum seekers who had no recourse to public funds were denied services. This experience highlights some of the challenges faced by community workers in their quest to promote social justice, which is defined as “the embodiment of fairness, equity, and equality in the distribution of societal resources” (Flyn, 1990). This makes their role controversial as they become border guards (Ravi Kohli, 2006), and gatekeepers of resources (Limbery, 2005). The project workers also works hand in hand with GPs, the Job Centre, drug and alcohol rehabilitation centres, Community Psychiatrists and independent and local housing agencies. This requires good team working skills, and I will comment on the development of my team-working skills later in this report.

Working with homeless people for statutory organisations is underpinned by legislation such as the Housing Act 1996, and the 1985 Housing Act. Local authorities have a duty under Section 183 of the Housing Act 1996 to provide or prevent homelessness. They have to make inquiries (Part 7 of the 1996 Act) where someone is likely to become homeless within 28 days. In addition, someone is prevented from becoming homeless if there is a casework intervention that will provide the person or family with accommodation sustainable for at least six months (Communities and Local Government Recording Homeless prevention and Relief E10 of the P1E Quarterly Returns, 2009). The Local authorities can work with partner organisations to help prevent homelessness, although these partner organisations have no duty to prevent homelessness. A partner organisation is “any organisation which is assisting the local authority in tackling and preventing homelessness” (ibid: 12). It may be funded by the Local Authority to help in preventing and tackling homelessness. In addition it can also be any organisation where the Local Authorities can refer people for assistance to prevent homelessness; and these include voluntary organisations and independent organisations for housing advice under s.179(1) of the 1996 Act. The Salvation Army is one of the voluntary organisations (faith based) that provide temporary accommodation to prevent homelessness.

The Green Paper Independence, Well-being and Choice: Our Vision for the Future of Social Care for Adults in England (DoH, 2005) and the White Paper Caring for People (DoH, 1989) recognise assessments as key to any methods of intervention and good care for people. Assessments were carried out to identify the causes of homelessness, the person’s history, entitlement to services, needs (medical, social and psychological), while a risk assessment was carried in all assessments in order to protect the service user from risk of self harm (suicide, intravenous drug use, substance misuse, financial abuse etc). According to Parker and Bradley (2006:11), a risk assessment is “the likelihood of certain outcomes, whether positive or negative, occurring under certain circumstances or dependent on decisions made”. It was important to carry out a risk assessment to establish the likelihood of people repeatedly becoming homeless, as some would return within three months to the centre. As such, a risk assessment sought to establish the best method of dealing with the presenting situation to reduce repeat homelessness, and where homelessness was attributed to drug and alcohol misuse, gambling, etc, the likelihood of that happening again was assessed before appropriate intervention methods were implemented. However, Webber (2009) argue that risk assessment in social work (and this can also be applied to community work) is laden with assumptions while lacking scientific thoroughness which can lead to rationing and excluding some service users. In particular I found that in some cases risk assessment led to the exclusion of some service users whose homelessness was seen as voluntary. One can argue that is being judgemental and not in-line with an anti-oppressive and anti-discriminatory practice (Dominelli 2006). However, in the same breath as risk assessment led to exclusion of service users, it also helped to identify those at risk of harm (physical and emotional) as a result of homelessness.

After identifying risks, an assessment of needs was also carried out to identify the needs of the person, such as shelter (which would be the reason for coming to the centre), financial needs and those who were eligible to receive social security benefits would be referred to the Job Centre and/or Social Services department for housing benefit. In addition, those who were homeless because of debt would be referred to national debt agencies to device ways of alleviating the debt. Others would have lost their jobs, which led to repossession of houses or eviction. Those with medical needs were referred to specialist services. In summary, I found the role of carrying risk assessments and assessments of needs very educative while I also applied theory into practice while I assumed a managerial role (commissioning services and signposting). In addition, liaising with other agencies improved my communication skills, advocacy skills and negotiating skills, all skills which are vital to effective community practice.

Skills required by community workers include community organisation, administration, social planning, social action and social development so that citizens can become active in their own environments (Hardcastle et al 2004). The model of intervention used with homelessness is that of empowering individuals to become self reliant and self sufficient. Social planning involved liaising with other external agencies such as the Coventry City Council, Refuge Centre, Job Centre and Social Services to help clients to get houses, social security benefits, as well as to help clients get jobs. My duties of coordinating services and signposting service users to these external agencies were part of social planning, organisation and action.

One of the most intervention methods used at the centre is crisis intervention. According to Jackson-Cherry and Erford (2010), a crisis intervention involves providing emergency psycho-social care to assist individuals in crises situation to restore a balance to their bio-psycho-social functioning. Similarly, Wilson et al (2008) define a crisis as a breakdown or disruption in a person’s usual pattern of, or normal functioning. Homelessness and losing a tenancy in most cases is a result of long-term crises, and individuals respond to crises by striving to maintain their equilibrium through using their coping mechanisms (Jackson-Cherry and Erford, 2010). In addition crises can arise where problems persist and the precipitating events are threatening, and usual coping mechanisms fail to work (Wilson et al 2008). An analysis of some of the people who came to use the centre showed that they were going through crises such as financial, debt, unemployment, domestic violence, which affected usual coping mechanisms in others. In addition, losing a house can also lead to a crisis and affect the individual’s coping mechanism. In a situation of homelessness caused by a crisis, or leading to a crisis, the role of a community worker is to solve the immediate crisis by offering shelter while looking for long term solutions (Wilson et al, 2008), which in turn leads to solution focussed intervention discussed below. Crisis intervention involves carrying out an assessment to identify needs, make referrals and implement a treatment plan or solution (Roberts, 2005). However, as already argued above, not all cases presented as crises were offered appropriate intervention, such as the case with asylum seekers, families, and people below the ages of 18 and above the age of 65, who were referred to other agencies.

In addition to crisis intervention, solution focussed intervention method was also used at the Salvation Army hostel. Solution focussed intervention is change oriented, and encourages service users to find solutions to their problems (Wilson et al 2008). Solution focussed works by placing the responsibility on the service user (empowerment), providing them with tools to identify the extent of their crises, and where they are in the crisis. Gamble (1995) cited by Hardcastle et al (2004) argued that community practice involves using “empowerment-based interventions to strengthen participation in democratic processes, assist groups and communities in advocating for their basic needs and organising for social justice”. Bidding for accommodation, job search, referring service users with drug and alcohol problems to Recovery Partnership were some of the solution focussed methods of intervention provided on the model of empowerment. In addition to finding solutions as a tool for problem solving, the Salvation Army also uses person-centred intervention method which sees the client as unique thereby requiring unique intervention. Person centred care (PCC), was developed from Carl Rogers’ person centred counselling (Nay and Garratt 2004). It promotes building relationships between client and professionals, which is empowering as it seeks to put the individual at the centre of their care (Wilson et al, 2008; Nay and Garratt, 2004). The project workers at the Salvation Army recognise that homeless people are individual people with different needs, and not a homogeneous community, hence support is tailored to meet individual needs.

The report critically analysed the main functions of the Salvation Army hostel for the homeless. As a student I felt that although the faith-based centre is doing its best to help homeless people, the SA has diverted from its original ethos of helping people in need regardless of race and creed, and this was notable especially with the way asylum seekers are turned away because of their immigration statuses. The role of the Church and philanthropists in helping the need and the poor has its roots before the Reformation, when welfare assistance to the needy was provided by the Church, based on the seven corporal works of mercy (the thirsty must be given drink, the hungry to be fed, the naked to be clothed, the sick visited, the prisoners visited etc) (www.victorianweb.org); through to the Elizabethan Poor Laws (1601), when the church provided relief to people through its parishes (Payne 2002). However, because the Salvation Army gets most of its funding from the Local government, this limits what it can do as a church.

Implications for practice.

In relation to providing shelter to people between the ages of 18 to 65, one can argue that this is ageism (Dominelli 2006) because it assumes that people below 18 and over the age of 65 cannot become homeless. Ageism does not promote anti-discriminatory practice, and it is also oppressive (Dominellie 2006). In contrast The Employment Equality (Repeal of Retirement Age Provisions) Regulations 2011 abolishes the retirement age of 65 years, which means that the government recognises that people can still be active after 65 years of age. The centre also views homelessness from a gender point of view by allocating 75 of the rooms to men and leaving only five to women. This is based on the assumption that men are more likely to lose their homes especially through domestic violence (perpetrators of domestic violence) yet there is increasing evidence suggesting that there are also male victims of domestic violence (Shupe et al, 1987) . In addition to homelessness, single women are also likely to lose their homes for the same reasons that men lose their homes (such as unemployment, drug and alcohol misuse, gambling etc).

The report highlighted that there is no family unit at the Salvation Army in Coventry, while Leamington has only one family unit. Under the current economic climate, many families are losing homes due to repossession of houses and unemployment.

As such it is also possible to have families becoming homeless. During my placement I witnessed whole families being turned away because of lack of facilities to accommodate families. One can also argue that by not having family units, the system views single people as more likely to become homeless. This issue of separating families was also practiced during the Poor Laws Amendment 1834, when families were separated in workhouses to ‘punish’ the undeserving poor.

For continuity of care the Salvation Army must continue to work in partnership with GPs, Community Psychiatrists and other health professionals during the recovery pathway so that people do not relapse when they return to the community. In terms of workloads, the project workers were allocated at least 10 service users each. In relation to time, comprehensive assessment to identify risks and needs, this workload was viewed by most workers as unmanageable, especially when allocated to service users with complex needs (accommodation, medical, drug and alcohol misuse, access to benefits etc). This also reduced the time of building rapport with clients (Trevithick 2000 and 2005) for effective intervention methods.

The placement provided me with a forum to apply theory to practice, including relevant theoretical intervention methods, understanding policy and legislation, as well as exposing me to the challenges faced by community workers when they work with people towards individual and community development strategies. I also gained an insight into social and health inequalities leading to homelessness and how these impact on people’s lives. My communication and interviewing skills were also enhanced (Trevithick, 2000 and 2005) as I spoke to different service users and professionals. Working with external agencies improved my team working skills (ibid). Values of a community worker include ability to empathise, to work in a non-judgemental manner, to be patient as well as to promote empowerment through social justice.

Conclusion

The conclusions to be drawn from the above report and analysis of the role of the Salvation Army with homeless people in Coventry are that the church and the voluntary sector play a significant role in the provision of welfare to citizens. However, there is also need to reform some of the Salvation Army’s policies to address issues of ageism, gender, challenge oppression especially with asylum seekers, and become inclusive to women and families who become homeless. Recruitment of volunteers can also be encouraged to reduce workloads. While the methods of intervention may be appropriate, however, assessments are not needs led but resource led, which makes it difficult for project workers to fulfil their roles to promote social justice.

‘The process of protecting children from abuse or neglect, preventing impairment of their health and development, and ensuring they are growing up in circumstances consistent with the provision of safe and effective care that enables children to have optimum life chances and enter adulthood successfully.’ (Source: Working Together to Safeguard Children, 2006).

It is essential that children are safeguarded from maltreatment and impairment of their health and development not only to prevent the terrible day-today suffering some children are subjected to, but also to ensure that children are safe from these abuses to protect their long-term well-being (Combrink-Graham, 2006: 480). Deliberate and sustained maltreatment, which includes physical, emotional and sexual abuse of children, is not confined to any particular group or culture; it pervades all groups, classes and cultures.

So as practitioners it is our professional duty of care to ensure that every child has the same amount of safeguarding as the next. It is also vital that as Early Years professionals we understand the roles and procedures of the services available for children and families so that we may offer the best advice possible. There are two areas of guidance statutory and non-statutory.

LOC1- analyse the role of statutory, voluntary and independent service in relation to children and families.

A service which is defined as statutory is one that the Local Authority have a legal duty to supply. The Local Authority is obliged by statute to provide some services, for example, social services, NHS hospital, health professionals, the police and probation service, youth offending teams, secure training centres, childminders and schools. They all have a duty under the Children Act 2004 to ensure that their actions are clear with regard to the need to safeguard and promote the welfare of children. (Source: Working Together to Safeguard Children, 2006).

Safeguarding and promoting the welfare of children is the responsibility of the local authority (LA), working in partnership with other public organisations, the voluntary sector, children and young people, parents and carers, and the wider community. (Source: Working Together to Safeguard Children, 2006).

The role of statutory services in relation to children and families is to employ professionals who are committed to the cause of helping children to stay safe. The services need to employ staff that understands their responsibilities and duties in these difficult situations, so any organisation that deals with safeguarding children needs to make sure that all members of staff are safe to work with children and young people by providing a thorough identity check. Also the organisation that provides this service needs to be equipped to deal with any allegations including ones made against staff by having clear procedures in place. All staff have to have regular up to date training and understanding of the subject while working in this environment and they also need to understand the correct procedures if working with partner organisations.

The voluntary sector is undertaken by organisations that are not for profit and non-governmental such as charities like Childline, the NSPCC and churches. This sector plays an important part in providing information and resources to the general public who may be unable or afraid to contact other sectors about the welfare of some children. They may also specialise in a particular area of abuse and may have greater and better understanding of the subject as their members of staff have experienced more in-depth training. Like the public sector their staff paid or volunteers need to go through the same process as the staff from the public sector that is stated in paragraph 2.8 in Working together to Safeguard Children 2006.

Like the voluntary sector, the independent sector also has to abide by the regulations that come with working towards safeguarding children. The Independent sector is not financed through the taxation system by local or national government, and is instead funded by private sources. Such independent services are private schools, boarding schools, private counsellors and private charities such as UNICEF. A non statutory service is one which may or may not be supplied, at the discretion of the authority concerned.

LOC2- Evaluate the legislation framework and procedures for child protection at national and local level.

There are several legislative frameworks/laws and procedures for child protection at national and local level which are continually being amended, updated and revoked. One of the significant pieces of legislation is The Children Act 2004 which led to a considerable change in the way services are directly concerned with serving children and families. As a result of consultation with children and families following Lord Laming’s enquiry into the terrible and tragic death of Victoria Climbie, the government announced its plans to restructure children’s services to help achieve five outcomes for well-being. The government outlined these outcomes in its Every Child Matters (ECM) agenda, stating that to achieve well-being in childhood and in later life children and young people want to:

be healthy;

be safe;

enjoy and achieve;

make a positive contribution; and

achieve economic well-being (DfES, 2004b).

These five outcomes for well-being are now the goals for Every Child Matters and all services that are concerned in the education and welfare of children and young people are bound to ensure these outcomes are achieved.

The Every Child Matters Outcomes Framework (DCSF, 2008b) for enabling children and families to be safe requires that Early Years settings and primary schools must demonstrate that they are enabling children to be safe from maltreatment, neglect, violence and sexual exploitation, and from accidental injury and death, and that children and young people have security, stability, are cared for and are safe from bullying and discrimination. This is a very complex area for those who work with children, or intend to work with children, in part because of the amount of legislation that is attached to these issues.

The Education Act 2002 places a duty on Early Years settings and schools to safeguard and promote the welfare of all children, including ensuring they provide a safe environment themselves and take steps, through their policies, practice and training, to identify ‘child welfare concerns and take action to address them, in partnership with other organisations where appropriate’ (HM Government, 2006:13). The Education Act 2002 also places this duty on childminders and any organisation that provides day care for children – of whatever age.

Locally the group of people responsible for co-ordinating what is done by organisations in Essex to safeguard and promote the welfare of children and to ensure the effectiveness of this activity is the Essex Safeguarding Children Board (ESCB).

Despite all of the legislation and policies, preventable tragedies like Victoria Climbie and Baby P continue to happen. It is vital therefore that child protection agencies learn from these terrible events and continue to amend their policies. Legislation is also put in place not just to protect against harm to children but also to give protection to the professionals working with children and their families.

LOC3- Debate theories of abuse such as medical, feminist, social and psychological models.

The general public’s usual opinion of an abuser is that they are abnormal, sick or criminal. The reasons for abuse may be deep and complex. The actions of an abuser are definitely wrong but why did they take them? There are lots of different theories as to why abusers abuse. Some of the more widely held theories are:

The social model definition is where it is believed that a child copies the behaviour of adults around them. Albert Bandura (1977) referred to the social learning theories of other important professionals in child development such as Vygotsky and Lave. This theory includes aspects of behavioural and cognitive learning. He believed that behavioural learning assumes that people’s environment cause people to behave in certain ways. Also he believed in cognitive learning which is when someone experiences or acquires knowledge, he presumed that psychological factors are important for influencing how people behave.

Another theory is the medical model. John Bowlby (1969-80), is recognized as one of the most prominent theorists in researching social effects on child development, in particular he is famous for his ‘attachment theory’ (Flanagan, 1999). When Bowlby first began discussing this theory his work focused on the importance of the attachment a child has with its mother. The present accepted theory is that children can form a number of attachments with adults other than their biological mother, what is important is that children need caring and nurturing relationships in order to thrive, and not simply the basic needs of food and shelter (Foley et al., 2001; 211).

Bowlby believed that there was a critical period of bonding in the first year of life. Much research has been done that suggests a strong correlation between mothers who have not formed a strong attachment to their children and child abuse and neglect. If not treated conditions such as postpartum depression (or post-natal depression as it is more commonly known) could lead to the mother having a negative attachment with the child developing into neglect which is a form of abuse without the mother realising.

Another influential theorist in the area of child development is Erikson (1902-1994) who in the 1960s devised a model of human social development that focuses more on the impact of background and environment on development, rather than genetic determiners. This is known as a psychosocial model (Miller, 2003). The importance of this theory is that it explores how the beliefs, attitudes and values we grow up to hold are shaped by our genetic predisposition towards incentive acts and how the environment we grow up in impacts on those natural characteristics. Therefore, Erikson maintains, we are distinctly shaped by our formative experiences. If this is so, then the experiences a child will have while they are young will impact on their life as an adult, including on their attitudes, beliefs and values.

A different opinion as to why abusers abuse is the psychological model. Psychological theories focus on the instinctive and psychological qualities of those who abuse. This theory believes it is abnormalities within the individual abuser that are responsible for abuse, for example, abusive parents may themselves have been abused in childhood (Corby, 2000). Although the flaw is that psychologists have failed to establish a consistent personality profile for a child abuser when compared to another form of abuser.

Feminists believe that the Feminist model may be the answer to the actions of an abuser. The feminist model suggests that child abuse like domestic violence is a result of unequal power in the family. Cossins (2000) believes that abuse is done by man to women and is about male masculinity and power. But this does not take into account female abusers. Professor Lynne Segal suggests that the ideas of masculinity emphasises control and power. This assumes that all men have power and women and children do not have power (Bell, 1993). This theory also needs to include not just gender and power issues but to consider race, class and culture as well (Reavey and Warner, 2003).

The Cycle of violence is another model, it is based on the view that children who live with domestic violence will learn that abuse is acceptable and will become either an abuser or a victim. While experiencing or witnessing domestic violence can have a serious impact on children and young people, they will respond in various ways depending on their age, race, sex, culture, stage of development, and individual personality. By no means do all children who have lived with domestic violence grow up to become either victims or abusers. Many children exposed to domestic violence realise that it is wrong, and actively reject violence of all kinds. There is not much evidence to support this model.

Although all these models give some insight into why an abuser would abuse there is no one type of abuser, so there can be no one model. What we would consider a child abuser in this country is not the same standards as other countries. Not one of these models can solely explain the actions of a child abuser. Finkelhor (1986) understood that and was a critic of single factor models. He also believed that women were just as capable of abuse as men are.

LOC4- Describe the categories of abuse and the possible effects on the child, family and workers.

What comprises abuse is open to wide debate, because some researchers will state that what one group in society deems to be abuse, another will claim is a ‘normal’ part of child rearing practice. For example, the smacking debate. Is it acceptable to smack a child? There is a legal acceptance that where a smack doesn’t leave a lasting mark it is not abuse, but if it is continuously done and escalates then this would be classed as abuse. The point at which any practice becomes abusive is the point at which it becomes ill-treatment, likely to impair health or physical, emotional, social or behavioural development (DfES, 2006).

The categories of child abuse are physical, emotional, sexual abuse and neglect. Most often if a child is suffering from one of the categories like physical or sexual abuse they are likely to be suffering from emotional abuse as well, as the categories link into one another.

As Early Years practitioners we need to keep an eye out for any signs of physical abuse, which are usually visible to the eye, such as unexplained injuries, bruises or burns. Other signs of physical abuse are if the victim refuses to discuss injuries, gives improbable explanations for injuries, has untreated injuries or lingering frequently recurring injuries. If the parents administering of punishment appears excessive, if the child shrinks from physical contact, or they have a fear of returning home or of the parents being contacted, or a fear of undressing, or a fear of medical help these could also be a sign of physical abuse. Physical abuse can lead to the child becoming aggressive towards other children and bullying. An abused child may display over compliant behaviour or a ‘watchful attitude’, have significant changes in behaviour without explanation, their work may deteriorate and they may have unexplained patterns of absences whilst bruises or other physical injuries heal. In some cases the child may even try to run away.

Another form of abuse is emotional abuse; this is one of the hardest types of abuse to recognise as there are often no outwardly visible signs. Emotional abuse is about messages, verbal or non-verbal, given by a care giver to a child. Almost all children are subjected to emotional abuse to some degree. Even the most caring of parents will at some time give children quite negative messages, this is why it is hard to detect emotional abuse.

Examples of emotional abuse are deliberately humiliating a child, making a child feel ashamed for not being able to do or understand something which they, in fact, are developmentally incapable of. Other signs of abuse are expecting a child to put the needs of other family members before their own. Persistently verbally abusing a child, or constantly threatening to leave a child on their own as a punishment is abusive whether or not the threat is carried out. Making threats of other cruel and excessive punishments and/or carrying them out, telling a child that he was not wanted, was a mistake, or was the wrong gender, isolating a child, preventing them from socialising with their peers and continually putting a child under unfair moral/emotional pressure is abuse. Some adults may also not realise that exposing a child to age-inappropriate activities such as television, films and computer games is also classed as emotional abuse.

The DfES (2006) What to Do if You Are Worried a Child Is Being Abused document defines sexual abuse as:

Sexual abuse involves forcing or enticing a child or young person to take part in sexual activities, including prostitution, whether or not the child is aware of what is happening. The activities may involve physical contact, including penetrative or non-penetrative acts. They may include non-contact activities, such as involving children in looking at, or in the production of, sexual on-line images, watching sexual activities, or encouraging children to behave in sexually inappropriate ways. (DfES, 2006: 9).

The definition of neglect is ‘the persistent failure to meet a child’s physical and/ psychological needs, likely to result in the serious impairment of the child’s health or development’ (DfES, 2006: 9).

Some examples of neglect are failure to feed a child adequately, not providing appropriate clothes or bedding, giving inadequate basic physical care, the child having no boundaries or consistency, the child not being safe, not attending to a child’s medical needs and failure to meet or recognize a child’s emotional needs.

The definition of neglect clouds with shades into the definition of emotional abuse. While both these definitions make sense, they are somewhat blurred around the edges. When we talk about ‘severe’ actions it can be difficult to decide whether, and at what level, to intervene.

There have been studies that show evidence that neglect, physical abuse and sexual abuse are all associated with reduced intelligence in children (Carrey, 1996). While this study shows an example of the effect abuse can have, sometimes a child can grow up with a positive attitude and have a successful life. But this is not to say that all survivors are successful in life and obviously some people suffer terrible ongoing issues related to their experience of abuse. Such as being able to trust anyone or in the case of sexual abuse never being able to let anyone touch them and the damage is permanent. Abuse can also affect the family by breaking it apart and separating the abuser from the abused.

LOC5- Evaluate ways of enabling children to protect themselves, and ways of supporting children who have been abused.

We can’t expect children and young babies to protect themselves. So the government and schools try to communicate a universal message to children to try to protect them. Such as bullying is wrong, to be nice to one another, to eat well and look after each other and to promote a positive environment. We should always take children seriously and listen to what they are saying, as this is a way of improving our ways of providing support.

There are four methods that are used with children in need and their families, each of which needs to be carried out effectively in order to achieve improvements in the lives of children in need. They are assessment, planning, intervention and reviewing (DfES, 2006).

As an Early Years professional you should be aware of the local procedures to be followed for reporting concerns about a particular child. If you have any concerns about a child, they must be reported to the school’s designated senior member of staff or a senior member that is appointed child protection supervisor. This may be where your involvement may end or you may need to be involved further. The practitioner will discuss with a manager and/or other senior colleagues what they think the appropriate action should be, then if there are still concerns a referral to the Local Authority children’s social care team will be made, followed up in writing within 48 hours. The social worker and manager then acknowledge receipt of referral and decide on the next course of action within one working day. An initial assessment is required to decide if there is any concern for the child’s immediate safety.

The initial assessment should continue in accordance with the assessment framework which is a chart that states what the needs of a child are. If there is reasonable cause to suspect the child is suffering, or is likely to suffer significant harm, children’s social care should arrange an immediate strategy discussion. The purpose of the strategy discussion is to agree whether to initiate section 47 of the Children Act 1989. It is also to identify the appropriate tasks and timescales for each involved professional and agency, and agree what further help or support may be necessary. If the child is likely to be harmed then the police and other relevant agencies are called.

Next there would be a child protection conference and the results from that would determine whether a core assessment is made which is where the family and other professionals agree a plan for ensuring the child’s future safety and welfare. If the results are that the child is in sufficient harm then the child becomes the subject of a child protection plan, which is where the difficulties of the child will be made known to partner agencies. This will be followed by giving the child a key worker and a child protection review conference, the purposes of the child protection review is to review the safety of the child.

Usually, the decision to keep a child’s name on the protection register is reviewed every six months, depending on the circumstances. A child protection review conference can decide that a child’s name should be removed from the register. This decision will only be made when the child protection review conference is satisfied that the child is no longer at risk of significant harm. A young person will also be removed from the register once he or she turns 18. Obviously the worst case scenario is when a child dies due to abuse and nothing was done to help them. As Early Year professionals it is extremely important that situations like this never happen and that is why these procedures are put into place.

Professionals can intervene by working with children and families to help protect them. There are support systems in place for children and their families provided by local government and sometimes connected to the school. Sure start is one such system. Sure start is a government programme which provides services for children and their families. It works to bring together early education, childcare, health and family support. Services provided include advice on health care and child development, play schemes, parenting classes, family outreach support and adult education and advice. If there is a case of suspected abuse but it is decided that there is no need to remove the child or the parent following the families’ assessment, Sure start can be recommended to the family as a place for family development.

In this country there are 11 million children, 4 million have been identified as vulnerable (disabled), 400,000 have been identified as ‘children in need’, 32,000 are on the child protection register and 63,000 are ‘looked after’ (in foster care). These statistics have gone up since the terrible tragic death of Peter Connelly (Baby P) in 2007. (http://www.statistics.gov.uk/cci/nugget.asp?id=348).

We live in a highly complex and diverse society and as professionals it is part of our responsibility to ensure we are not confusing what we think is the case, or what we would like, with what is really the case. As Early Years practitioners we need to approach individual children and families with an open mind. While we believe we know what, a perfect world is, we also know that families come in all shapes and sizes, and that all families are likely to need support to help them.

To make sure that all children get the correct and full treatment/service needed to make sure that they are safeguarded against abuse all practitioners/professionals should work together and communicate to achieve this goal.

In this essay I will demonstrate my understanding of stigma and labelling. There are certain people who are stigmatised and substance users often have a negative stereotype. This negativity will often not allow the substance user to seek the help and medical treatment that they need due to the stigma and labelling. I will be discussing the research around the impacts of stigma and labelling that will affect not only their treatment but in housing and employment.

The term stigma originates from the ancient Greek word and signifies that he or she could be a slave, criminal or traitor and was used as a sign of disgrace and shame. It is now used to describe people who are stereotyped because of their social identity (Pierson & Thomas, 2010). According to Goffman, when a person is not able to meet expectations because their behaviour or attributes are undesirable or unacceptable, then stigma disqualifies a person from social acceptance. Goffman suggests that stigma is, “an undesirable attribute that is incongruous with our stereotype of what a given individual should be” Goffmam (1963:3). Stigma is a use of negative labels and is about disrespect. It is not just a matter of using the wrong word but labels that person who has the substance use disorder. Stigma results in discrimination and abuse and is damaging to the lives of many people. The fear of stigma discourages families and many individuals from getting the support and treatment that they may need to lead normal healthy lifestyles. Stigma deprives people their full participation into society which then reinforces negative stereotypes (Goffman, 1968). The way of coping with stigma is to conceal behaviours and internalize these negative views and as a result will be subject to discrimination and exclusion within many areas. Drug problems will remain entrenched if substance users are seen as “junkies”. Landlords will be reluctant to let out their properties and employers will be wary of giving them jobs. Employment and housing are important to substance users as it can be vital in establishing themselves back into society (UKDPC, 2008). Research studies show that 80% of drug users are unemployed. Being employed is shown to be an important component into the reintegration into society. Once in work, it will help in building their self-esteem and back into normal life (UKDPC, 2008). Family members feel shame and stop trusting them and in some cases, disown him/her. Community’s will “finger point”, try to avoid contact and will gossip about them. Many would argue that society’s disapproval of drug use; especially cannabis and heroin will say stigma is necessary to demonstrate disapproval (UKDPC, 2010). Stigma can also make the substance user stigmatize themselves, make them feel alone, rejected and destroy their self-esteem. Seeking help is very difficult for the substance user and will prevent them from doing so. They will often feel that quitting would be no use and returning to normal life would be impossible because people in society will no longer trust them and so will join in with other drug users, start criminal activities to pay for their use and accepting the blame of society (UKDPC, 2010).

Stigma discourages families and individuals from getting the support and treatment they require. Families suffer the impact when another family member has a drug use (UKDPC, 2009) and it alters all their social invitations and friends that they once had. Other family members will often withdraw and children will often be targeted by bullies. Stigma deprives people of their full interaction into society. The UK Drug Policy Commission (UKDPC) suggests that 1.5 Million people in the UK are affected by a relatives drug use. Supportive relationships are key to a successful recovery. Carers UK commissioned a study which estimated that carers in the UK made a contribution of ?87 billion in total economic value in one year. This may have excluded many who have not come forward with coping with a relative who has a drug problem but this gives us some indication of the social contribution likely to be made by the supporting families (DrugScope/Adfam, 2009). The drug user must have determination and faith in reaching their goals and there will probably be setbacks and barriers but with the support and contribution of social workers, support groups, family and friends, this will help towards the recovery process (HM Government, 2010). Families and relationships are key issues for recovery and drug users improve when their family is behind them. They are more than likely to complete treatment and maintain their new lifestyles (Best & Laudet, 2010).

DrugScope published research in 2009 by interviewing a random sample of over 1000 people aged 18 plus. The research published showed that one in five adults had a personal experience of drug use, either direct or indirect. The findings where:

19 % have “personal experience of drug addiction” either directly or among family or friends;

1 in 10 adults have a friend who has experience of drug addiction;

1 in 20 have experienced drug addiction in their family;

1 in 50 has personal experience of drug addiction.

77 % agree investment in drug treatment is “sensible use of government money”.

The poll found that 19% either had direct or indirect personal experience of a family member or knowing someone within their circle of friends. 11% were likely to have a friend who has experienced drug addiction. 6% had family members who were drug dependant, yet 2% experienced the drug dependency themselves. These figures do suggest that drug misuse and the dependency do affect many people’s lives and is a social problem (DrugScope, 2009).

Stigma to substance users will possibly make addiction recovery and treatment more difficult. Substance users often manage in secret and would rather not seek out the treatment and live in denial. The University of Nevada studied 197 drug users on the affects of stigmatization. This research identified that because of the use of stigma they would become more dependent on their drug use due to the perceived negativity that the society had on drug users. 60% of drug users in this study felt that they were treated differently after people knew that they were a drug user. 46% felt that others became afraid of them once they found out and 45% felt that their families gave up on them and wanted nothing more to do with them. 38% of their friends had rejected them and finally, 14% of employers paid a lower wage (Addiction, 2010). Users have no good reason to stop using when you look at this research study. This research identifies that stigma is conceptuality unique. Drug users also had a more difficult time in treatment at succeeding when there were higher levels of stigma. The study also showed that drug users often cope in secret due to their inability to openly discuss their addiction; this caused poor mental health and decreased their chances of recovery. By reducing shame the society could help in driving forward in helping the treatment of drug users who are not coming forward due to stigma (Addiction, 2010).

Stigmatising is not only found amongst the public but also by the professionals who may be working directly with them. Professionals, such as doctors and nurses, who work directly with drug users, will have a greater insight into the problems that drug users face on a day to day basis. Miller et al (2001) mentioned in UKDPC (2010:30) summarised research from the USA which showed an increase in negativity towards drug users. Two studies of the treatment of problems with drug users and drinkers both in the inpatient care and ‘safety net emergency department’ showed that negative views during training, continued when they became qualified and working within their practice (UKDPC, 2010). Stigma between health professionals and the drug user will prevent them from seeking help and may be one of the reasons as to why the drug user will not seek out the help or medical treatment that they require (Kelly & Westerhoff, 2010).

Everyone knows that it is wrong to discriminate, whether it is because of their race, culture or religion. Substance use is very common and is widely misunderstood. It is essential that we learn about the person and treat with dignity and respect. This will then help in emphasizing their abilities (Mental Health and Recovery Board, 2009). Public attitudes to drug addiction were explored in the UK in 2002 (Luty & Grewal, 2002). Results showed that 28% regarded drug users as having a mental health problem. 38% assumed that drug users were criminals and 78% to be deceitful and unreliable. 30% said that they deserved the misfortune that fell upon them. 62% thought that the law were too soft on drug users and 40% believed that their children should be taken into care. It was concluded by Luty and Grewal, 2002, “the results clearly indicate a negative view of drug addicts” (Luty & Grewal, 2002:94).

Yet, DrugScope in 2009 wanted to find out the attitudes of the public towards drug users and drug treatment. They commissioned a poll and the findings suggest that the public to be very sympathetic than sometimes often assumed. 80% of the people surveyed agreed that ‘people can become addicted to drugs because of other problems within their life’. 35% agreed that it was the individuals fault for drug use and that there is no excuse. A large amount of respondents 88% agreed that for the drug user to get back on track, they needed help and support and 77% agreeing that the investment of government money towards drug treatment is sensible. This research showed a sympathetic response of the majority of the people surveyed.

Drug users are the most marginalised people in society where discrimination and stigma are key into the barriers of receiving recovery. Two thirds in a recent poll showed that employers would not employ anyone with history of drug use, even though they were suitable for the job. Stigma and discrimination still remains a barrier to recovery and will clearly impact of them finding work. It will also affect being housed appropriately and accessing the healthcare that they need (DrugScope, 2009)

The things that we can do as practitioners in helping to overcome the stigmatisation is to have a better understanding of how difficult it is for people to change who may have low self-efficacy. First impressions count and for a substance user, coming through the door is hard enough. The substance user will have come because they are in a crisis and has realised it is time for change (Lecture Notes, 2012). As social workers we have to realise that engaging with the substance user will help in the first steps to recovery and help in building relationships. Building respect and trust will prevent misunderstandings that may lead to conflict. Having good communication skills is effective and at the heart of social work. It is only through our communication skills that we are able to understand the knowledge of others and work effectively (Trevithick, 2009). It is important to communicate as it helps in exchanging our thoughts and feelings and in forming the foundation of a good relationship. Communication allows you to help the substance user to be more receptive to the new ideas by creating an environment that they can trust and help in developing resolutions. To have an open and honest relationship, trust is important in succeeding this. An agreement ideally should be met with the substance user about confidentiality. They have a right to know who will be able to access any information about them (Koprowska, 2010).

Motivational Interviewing is a well known model developed by William Miller in 1982. It is a model used with people to evoke change, especially people who have problematic substance misuse. Motivational interviewing is a client-centred counselling style and helps the service user to reach their decisions about potential behaviour change (Nelson, 2012). This model helps in identifying and understanding the substance user’s motivation to change and highlight to the client their perceived negatives and benefits of change. The principles of motivational interviewing are to express empathy, develop discrepancy by helping the client in increasing their awareness of the consequences of their behaviour. Avoiding argumentation as it is them who are the expert. Roll with resistance by encouraging the client to develop their own arguments. Resistance is normal if you are uncomfortable about something and lastly self efficacy by highlighting the skills and the changes they have already made (Lecture Notes, 2012).

Assessing motivation with the substance user and finding out at which stages they may be will help in me identifying where the substance user is in their dependency. A well known model called the cycle of change developed by DiClemente and Prochaska (1982) represents the point at which the substance user passes during their change in behaviour. The different stages are:

Pre-Contemplation, this is where the service user has no desire to change.

Contemplation, this is where the service user may be considering their situation and is more aware of it.

Preparation is where the service user makes a decision to change their substance misuse.

Action and this is where the service user takes steps in bringing about change.

Maintenance is where they have stopped using the drugs and moved to a more controlled and less harmful way of using and is maintaining that change.

Relapse is where the service user will go back to their old behaviour and will have to start the Cycle of Change again (Teater, 2011:122).

The substance user may slip back or relapse in to their old behaviour because permanent behaviour is very difficult to change, particularly with people who want to make change in substance misuse. This is very difficult and may take several attempts (Nelson, 2012). Motivational interviewing will help the substance user move through the stages of change.

Having good active listening skill is important and will help in making the substance user feel that he/she is being helped. Many people will feel encouraged when they have been truly listened to without interruption and will often become encouraged and empowered (New Jersey Self-Help Group Clearinghouse). A good listener allows the person to get their own stories and opinions across, which active listening will allow them to do so. If you interrupt, the person will feel that they may not have been listened to. They will not feel respected and may hold information through being cautious. It is important to allow them to know that you were listening and will help in encouraging them to continue talking. Leaning forward, maintaining eye contact will also show them you are interested in what they have to say (MindTools, 2012). You have to remember to not let environmental factors distract you as this could make you lose focus. Giving the substance user your undivided attention and acknowledge what they are saying. Using body language either by nodding occasionally, smiling and encouraging the speaker to continue by saying verbal comments, such as ‘yes’ and ‘go on’ will encourage the speaker to continue by knowing you are listening. Giving positive feedback by paraphrasing e.g. “What I am hearing is” and “It sounds like you are saying”, are good ways of reflecting back and help in clarifying certain points that the substance user may have said and helps towards getting more background information. Paraphrasing also helps in allowing yourself to really understand what has been said and helps the substance user know that they have been heard und understood correctly (Koprowska, 2010). Having the three core conditions of counselling of empathy, respect and congruence will help to enhance the substance user’s motivation to change. Empathy allows putting you in another person’s shoes and having a better understanding of their feelings and emotions. You must ignore your own perception of the situation and accept their feelings and thoughts. By doing this does not mean that you accept the behaviour they are doing but means that you understand them. Congruence allows you to be yourself and that you are only human and a real person. This will help in reducing the stress the substance user may have. Having respect is accepting the person for who they are regardless of what the person says or does. When others have possibly made that person feel negative, it is very hard for them to feel positive. Showing the substance user respect will show willingness that you want to work with them, which will allow them to grow confidence (Trevithick, 2009).

Change is difficult, so it is normal for the substance user to feel ambivalent. Using the Decisional Balance will help in identifying the positives and negatives of their behaviour. If you are going to change, you need a reason to and people change when the positives outweigh the negatives. We always have to be aware of the short term or long term risk factors including their level of usage and what type of drugs they are using (Miller & Rollnick, 2002). Motivational interviewing helps the substance user in identifying the importance of their behaviour change and also helps the practitioner help in doing so by enhancing their motivation. This model works well alongside the ‘cycle of change’ as it is useful to assess where the substance user may be in their cycle of change and help in identifying the strategies you may use (Nelson, 2012).

In conclusion, if a person does not conform to social stereotypes, they are more than likely to be marginalised and bear stigma. People with substance misuse are of all types and come from different backgrounds (Pycroft, 2010). Working with individuals who are experiencing substance use, it is important to remain focussed. Providing constant feedback and offering support will help in engaging the drug user towards solving the crisis the substance user may have. Having a non-judgemental attitude underpins social work along with empathy and advocacy (Trevithick, 2009). People with substance misuse are often viewed as less worthy and deserving. Stigmatisation can cause prejudice, marginalisation, discrimination and oppression and is often reinforced by the media and even our own families (Theory and practice, 2011). People who substance use are often stigmatised and feel shameful of it and can happen if the substance user has had several attempts. When you are ashamed of something and you disclose it, it is very hard especially if you’re unsure as to how the other person is going to respond. It is important for myself to reflect upon my own value base and prejudices that I may have.

Referances

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This essay will relate to an observation of professional social work practice in a Crisis Centre, for people with mental health issues who require support, and short-term accommodation, with the goal of returning home or to a new environment. This essay will focus upon the role of multi disciplinary collaboration regarding the Crisis Centre staff, and Crisis Resolution Home Treatment Team (CRHTT), and to discuss why collaboration appears to play an important and fundamental role within social work practice. The essay will also aim to demonstrate good practice and possible strengths and weaknesses of multidisciplinary working.

Within the field of social work practice it does seem evident that ‘multidisciplinary working is work undertaken jointly by workers and professionals from different disciplines or occupations’ (Pearson & Thomas, 2010:342) and has evolved at varying speeds over the past 30 years, in response to imperatives of central government. (What evidence)?Evidence suggests that the area mental health was among the first professions to adopt teams of workers from different professions, and the Community Mental Health Team is widely regarded as the model for multidisciplinary working (Community Care, 2010). It seems that , in relation to social work, the distinctive quality that has to be demonstrated is anti discriminatory practice and a holistic approach, by working with a range of situations and people having an attribute for developing multidisciplinary and partnerships (Higham,2006:).

The Crisis Centre that has been observed is run by a Local Council????,Can u not say Liverpool and is a National Health Service Trust based in the community. The centre also corresponds (look up meaning in dictionary)does this word apply here??.-The centre works within the— or to the guidelines set down in the with the 1975 White Paper entitled ‘Better Services for Mentally Ill’. This highlight’s the importance of professions, working together to provide a community based service (Social Care Institute for Excellence (SCIE), 2010) demonstrating that collaboration is fundamental to social work. The Crisis Centre provides beds for adults suffering from mental health issues who have been referred to them from the CRHTT, for instance by referral from their Doctor or health department. The next step is to complete an assessment in line with local authority guidelines and procedures, then produce a care plan and risk assessment. If they decided the service user is in crisis and cannot return home contact will be made to the Crisis Centre. Average sentence length is 15/20 words long.Have a look at your’s.

CRHTT use numerous ways and methods of contact to inform social workers, such as, E-mail, telephone calls and home visits. This can demonstrate collaboration through good practice and communication which is essential to social work. Effective collaboration between staff at the ‘front-line’ is a crucial ingredient in delivering the government’s broader goals of partnership between services’ (Whittington, 2003). Also, in the audit commission 2002 it seemed evident that service users who seem to require social workers, will, and can, collaborate with other professionals to provide appropriate service.

During this observation multidisciplinary working was witnessed between the Crisis Centre staff, and the CRHTT regarding a service user in the centre through a telephone call. The CRHTT seemed to be following the National Occupational Standards key roles section three, by ‘supporting the individual, representing their needs, views and circumstances by acting as an advocate’ (Higham 2006: 98) and had been informing the Crisis Centre of what was happening. The Crisis Centre staff asked questions in a way that was treating the service user as an individual, by listening to their individual case, respecting and maintaining dignity by only asking questions relevant to the Crisis Centres needs and criteria. Staff spoke clearly and discussed the dynamics of other service users (respecting confidentiality) already in the centre, declaring any conflict or positive interactions that had arisen since their last visit (General Social Care Centre (GSCC), 2010).These skills are seen as fundamental to social work practice as they are valuing the individual and provide a holistic approach. This will also ensure the social worker is not using their power in an inappropriate way.

Furthermore, in the 1990’s the New Labour government recognised that problems cannot be addressed by people and organisations working in isolation. As a result the Department of Health (DH) (1998) intruded the White Paper ‘Modernising Social Services’, which had multidisciplinary working as a key objective (Wilson, et al. 2008:388). The DH (2000) No Secrets legislation actively promoted that multidisciplinary teams will empower, and promote, well-being of vulnerable adults through the services they provide and the ‘need to act in a way which supports the rights of the individual to lead independence’ (DH, 2000).

DH No Secrets (2000) legislation was carried out by the service user, Crisis Centre and CRHTT via staff communicating throughout the day, and providing an environment where service users can come and go freely, yet still have support during their crisis. An example of encouraging independence was allowing the service user to cook and clean for them selves. Ryan’s (2010) evaluation of Crisis Centre and CRHTT asked service users what they valued best about their stay. Their responses included ‘I was on the lowest rung of the ladder in terms of depression and self esteem’. ‘Now I can cook and iron’. It has restored my ‘get up and go’ and ‘it is given me a sense of life back and helped me to find myself. I could not have gone on any longer’. ‘Staff have taught me to cope better and manage my panic attacks.’ This seemed to demonstrate partnership working with the service user and multidisciplinary working. The 2006 White Paper Our Health, Our Care, Our Say emphasises the importance of people having more control over their lives and access to responsive, preventative services by working together in multidisciplinary teams (DH, 2006). The Crisis Centre appears to fulfil this.(Empowerment) u could mention this if u think it would help

Throughout the day through discussions, and observations, it appeared that the Crisis Centre staff and CRHTT encouraged emancipatory practice by involving the service user in their support. This shows good practice and also that staff were not routinized as each day was different, for example, they discussed how each individual was unique. If social workers become oppressed by working in routines this does not always benefit the service user, it is not good practice and is not fundamental to social work values.Who says this?? An example of this was observed when a member of the CRHTT came to the Crisis Centre and completed a visit with a service user. During her visit she was contacted from her office through telephone calls, one of which was a new service user needing to be assessed urgently. She had to re-evaluate her cases as the new referral seemed more of a priority. She did this by speaking to her manager on the telephone and re -arranging for another colleague to see her service user, then asked the office to let the service user know about this change showing collaboration, good practice.

This commitment demonstrates multidisciplinary working and partnership working with the service users are fundamental and collaboration is needed for social work and the interpretation from the staff involved demonstrates good practice. ‘Collaborative working is required by government. To show partnership working with service users in the Crisis Centre, Ryan (2010) Is this reference in the right place or should it be after-required by Government ???. asked service users how they felt about staff. Service user’s responses included ‘any questions or anything you are upset over, you can go and ask the staff’ and ‘staff are very supportive and helpful.’ Social work is about working with people to help them sort their own problems out. Kaggs read this highlighted part again, does it sound right, were u sleepy ????

This essay has aimed to demonstrate positive multidisciplinary working through observation at the Crisis Centre. However, it appears that multidisciplinary working can be negative and dysfunctional. When a group of diverse people with varied skills come together into a team, things do not always go accordingly (Community Care, 2010). Cree (2003) cites ‘multidisciplinary working can also be positive, but also frustrating and isolating (Dalrymple & Burke, 2006). Wilson, et al. (2008) agrees multidisciplinary working does not always work effectively and as a result failures have been documented, such as, Victoria Climbie enquiry and Baby Peter. In addition Thompson (2005) believes multidisciplinary can also appear to do more harm than good and can make situations worse.

During the day it was bought to attention through a staff handover that one of the service users in the Crisis Centre had experienced a negative experience of multidisciplinary working. Consequently, this seemed due to the breakdown of communication between, his social worker, CRHTT, Crisis Centre staff and medical staff. According to Thompson (2009) without effective communication the notion of multidisciplinary becomes unobtainable. Staff at the Crisis Centre believed it was due to lack of budgets and lack of communication. During this handover reflective practice was witnessed and as a team they spoke about what, why and how things had gone wrong for the service user and how they could approach the situation to get the best outcome. Staff at the Crisis Centre spoke about how they valued supervision meetings as it gave them chance to voice any concerns they had and gave the manger chance to deal with any systematic practice that was leading staff to become unfocused (Thompson and Thompson, 2008). Supervision meetings demonstrate good practice and are part of social work codes of practice to develop through opportunities to strengthen skills and knowledge.

This essay has demonstrated through observation the important of working with other professionals as one person cannot solve another person’s problems alone (Thompson and Thompson, 2008). Also that multidisciplinary working is integral for social workers and many other professionals. This essay has aimed to provide a balanced outlook on multidisciplinary working as it demonstrated positive points, as working with other professional’s by pooling skills together is essential. Correct use of legislation and commitment to social work practice can all enrich a service user’s life. Problems do occur though when multidisciplinary teams do not always communicate effectively and this can be frustrating. Through observation it became apparent that lots of people contributed to multidisciplinary teams and showed that collaboration, good practice and communication were not always ideally used within practice.

Family Power structure plays a critical role in family health functioning. Power has been defined as the ability to control, influence or change another person’s behavior (Friedman, 1998). Power is related to resources. Control over resources (eg. money) infers power. In most families, parents control these resources. There are three types of family power namely chaotic power, symmetrical power and complementary power (Hanson, 2001).

The power structure in my family is complementary power. It is defined as requiring dominion-submission dynamic within the family structure. In this family-power type, healthy families are characterized by parents having a clear family advantage that their children recognize and accept. Although my father brings home the bacon every month, power is mainly shared between my parents. The decision-making in my family is highly dependent on my parents. Although my sister and I are involved in the decision-making, my parents are mainly responsible for making all sorts of decisions in the family from purchasing household furniture to deciding on a holiday destination to the meals we have together.

Family power structure is not fixed. As I turned 18 this year, my parents recognize me as an adult and would listen to more to what I have to say and how I feel. My parents are not as power-dominant as they were 10 years ago.

1.2 Subsystems

All families develop networks of co-existing subsystems formed on the basis of gender, interest, generation or function that must be performed for the family’s survival. Each member of a family may belong to several subsystems. Each subsystem can be thought of as a natural coalition between participating members. Subsystems in a family relate to one another according to rules and patterns.

There are three types of subsystems in my family namely spousal, parental and sibling subsystems.

For example, the spousal subsystem educates children about male-female intimacy and commitment by providing a model of marital interaction. Ways of accommodating one another’s needs, making decisions together and managing conflict etc.

Another example, my parents define the boundary of a parental subsystem by telling me as the oldest child to not interfere when they are reprimanding my younger sister. Parental subsystem also includes child guidance, nurturing, limit-setting and discipline.

1.3 Boundaries

Boundaries are invisible barriers that keep subsystems separate and distinct from other subsystems. They are maintained by rules that differentiate the particular subsystem’s tasks from those of other subsystems. Boundaries may either be rigid, diffuse or clear. Disengaged families have rigid boundaries which leads to low levels of effective communication and support among family members. Enmeshed families have diffuse boundaries which make it difficult for individuals to achieve individualization from family. Clear boundaries are more of a balance as they do not fall on either extreme ends of rigid or diffuse. Clear boundaries are firm yet flexible, permitting maximum adaptation to change.

The boundary in my family is clear. For example, my parents temporarily redefine the boundaries of the parental subsystem when she tells me to be in-charge of the house when they are away from home. Many years ago, my parents would ask my aunt to come over to care for my sister and I while they are away. This shows that the parental subsystem is flexible enough to include other people temporarily.

1.4 Triangulation

Triangulation is used to describe a situation in which one family member will not communicate with another family member unless a third family member is present, forcing the third family member to then be part of the triangle.

In this triangulation, the third person will either be used as a messenger to carry the communication to the main party or as a substitute for the direct communication. Usually this communication is an expressed dissatisfaction with the main party.

For instance, my family used to be very united until a year ago when my sister who was one of the top PSLE students in her primary school dropped out from secondary school at secondary two suddenly. She stopped attending lessons and was extremely rebellious towards my parents and me. My parents having high expectations from my sister were absolutely furious and upset when she decided to quit school. Numerous attempts to persuade her to attend school failed again and again until a point when my parents gave up convincing her. However, they still talk about my sister to me all the time, mentioning how stubborn/ignorant she is and that she would regret her decision later in life.

2. Communication patterns

McLeod and Chaffee (1972) came out with a scheme to analyze family communication patterns (FCP) to examine the role of family communication. In this model, the family communication environment is characterized by the extent to which the family emphasizes on socio-orientation and concept-orientation. Socio-orientation stresses the importance of harmony in the family and avoidance of conflicts. Concept-orientation encourages children to think about and discuss political and social issues. In a highly socio-oriented family, children should not argue with parents and should not express opinions different from other family members’ so as to maintain social harmony. On the other hand, in a highly concept-oriented family, parents believe that children should look at both sides of issues and talk freely about these issues.

Using these two dimensions, McLeod and Chaffee (1972) introduced a four-fold typology of family communication patterns as seen in Figure 1.

Figure 1

High on both dimensions of socio-orientation and concept-orientation, the communication pattern in my family is consensual. Consensual families emphasize both relational harmony and free communication exchange. Every member in my family is able to express our ideas freely as long as internal harmony in the family is maintained. Since young, my parents have encouraged both my sister and I to voice out displeasures in the family openly but stresses the importance of logical reasoning behind it.

Like most traditional Asian families, my family tends not to express affectionate behaviors in the form of hugging or kissing towards or saying mushy words to one another. Instead, my parents would constantly ask me questions regarding about my school life, the friends that I go out with, among many others that revolve around my daily life. I suppose these are ways of displaying affectionate behaviors in my family.

There are few conflicts in my family. Nevertheless, whenever one arises, we tend to face each other openly and voice out our concerns. My father would always play the middle-man whenever I had an argument with my sister and he would always ensure both parties are treated fairly and just.

3. Family environment

Based on Olson, Russell and Sprenkle’s (1979) Circumplex Model, the Circumplex Model assumes that the difference between functional and dysfunctional families is determined by two interrelated dimensions: cohesion and adaptability.

Cohesion is defined as the degree of attachment and emotional bonding among family members. There are four various degrees to the cohesion dimension namely disengaged, separated, connected, and enmeshed. Families that are disengaged lack family bond and loyalty, and are characterized by high independence. On the other hand, families identified as enmeshed are characterized by high levels of closeness, loyalty, and/or dependency.

Adaptability is the ability of the family to change power structure, roles, and relationships in order to adapt to various situational stressors. It too has four degrees namely rigid, structured, flexible, and chaotic. Families with low levels of adaptability are considered inflexible or rigid. Rigid family types are characterized by authoritarian leadership, infrequent role modification, strict negotiation, and lack of change. Families with high levels of adaptability are considered chaotic as it is changing too frequently. Chaotic family types result from a lack of leadership, dramatic role shifts, erratic negotiation, and are characterized by frequent change.

Based on the Circumplex Model, my family environment is balanced. It has moderate level of both adaptability and cohesion. Power structure is not fixed and there are times when there is a temporary shift in power to adapt to various situations. For example, I am responsible for taking care of my sister when my parents are out. Another example is when an deciding on a holiday getaway, power is shared among each family members to be involved in decision making.

4. Family Rules

Family rules help family members to get along better, and make family life more peaceful. Effective rules are positive statements about how family members want to look after and treat one another. I have become so accustomed with my own family rules that sometimes I do not even realize that some of my daily activities are actually in fact, family rules.

“Dos and don’ts rules regarding family members’ safety, manners and daily routines were set up in my family since I was young. Of course these rules are constantly changing as my sister and I grew older with more responsibility in our hands. Rules such as “be home by 10pm” and “do not lock the doors at home” are a thing of the past when I was much younger. Today, the rules are much more flexible. For instance, if I were to return home late or spend the night at a friend’s house, all I have to do is to call home to inform my parents.

There are also fewer family rules as my sister and I are expected to be able to care for ourselves. Moreover, rules set when we were young are already deep-rooted in our daily life.

5. Family values and attitudes

Family values are political and social beliefs that hold the nuclear family (parents and children) to be the essential ethical and moral unit of society.

5.1 Money

From a very young age, my parents have taught me the importance of saving up money and spending them wisely. Every week, I was to slot in leftover coins in a piggy bank. Years passed by and today I still have the habit of keeping all my loose change in a piggy bank and when it became full, I would then deposit the money into the bank. My parents are prudent in spending money; they only buy what is deemed necessary and seldom splurge on luxury goods.

However, there are times when my parents think that it is worthwhile to spend more money such as holding birthday celebrations or Chinese new year celebrations at home.

5.2 Religion

My family is a little religious. My parents are Buddhists and they made an effort to pay their respects to the deities at temples annually. However, my sister and I do not have a religion but our parents do not force us to join a religion too. There are no altars at home and my parents do not carry religious charms either like a pendent or a talisman with them.

5.3 Education

Like most parents in Singapore, my parents take education very seriously. My father stresses that education is the key to survival in Singapore and this is especially more true since Singapore has been ranked the most competitive country in the world in 2010 by Time. Although my parents view education as important, they also know that each individual has their own limitations towards studying. My parents want my sister and me to have a positive mindset towards studying but yet at the same time not to overwork ourselves. The ideal model is to strike a balance between work and recreation.

5.4 Success/failure

My parents are rather reasonable and they know that success and failure are part and parcel of life. My parents view success as achieving one’s goals. For instance, one of my goals in secondary school was to get into Singapore Polytechnic (SP) and I did well enough during my O levels to enroll in SP. My parents were very happy and proud of me. On the other hand, I did not get into the course of my choice so I felt disappointed because it felt like I had succeeded and failed at the same time. My parents told me that one couldn’t always get what we have aimed for and as long as I have tried my best, that’s all that counts.

6. What I have learnt from my parent’s relationship

What I learnt about marriage from my parent’s relationship is to treat your partner as a friend. Marriage is a lifelong process full of ups and downs. My parents are both committed to overcome obstacles and being the best spouse and friend to each other. My parents are always joking around. My mother loves my father’s sense of humor and they always laugh at the silliest things. This taught me that being playful is a crucial part of marriage and nothing should be taken too seriously in a family.

My parents also speak kindly of each other. My mother always told me that my father was a good father and a hardworking man. In addition, they also give each other nicknames as some term of endearment.

I learnt the significance of having interests/hobbies different from your spouse’s too. My father and mother have different interests. My father enjoys watching detective crime television programs while my mother loves watching Korean Dramas serials. My mother would never last an episode of detective crime programs but that seems okay because they respect each other’s alone time as well. This also taught me that it is fine to have a degree of independence in a marriage too.

7. Attitude towards authority

I have a positive attitude towards institutional authority (parents, teachers, police, and the law). I tend to respect the rules and abide by it. I held many student leader positions in schools too. Positions such as class monitor in primary school, student counselor and National Police Cadet Corp (NPCC) non-commissioned officer (NCO) in secondary school and class chairperson in my polytechnic life. This is mainly due to my strict upbringing from early childhood. My father was a very strict man. I still remember the times when my father would cane me whenever I got into trouble in primary school. Furthermore, I would have to write a reflection about my wrongful actions. I used to be very afraid of my father when I was very young. However looking back in time, I realized that my father just wanted me to grow up to be a good person and I am grateful for what my father had done to make me the person I am today.

8. Attitude towards sibling

My relationship with my sister has definitely seen better days. We used to be very close and play with each other a lot. However in recent months, my sister’s attitude has grown worst. She became very temperament and gets annoyed very easily. We had a lot of quarrels with each other and soon grew distant. Nowadays, we seldom speak to one another.

9. Level of differentiation from family

Level of differentiation refers to the degree of one’s ability to distinguish his own thoughts and emotions from that of his own family. Individuals with low level of differentiation are more probably to become reliant on others’ approval and acceptance. They either conform themselves to others in order to please them, or attempt to force others to conform to themselves. Thus, they are more vulnerable to stress and they struggle more to adapt to life changes.

Individuals with high levels of differentiation recognize that they need others, but they rely less on other’s acceptance and approval. They do not only adopt the attitude of those around them but take into account their principles thoughtfully. These enable them decide significant family and social issues, and resist the feelings of the moment. Thus, despite conflict, criticism, and rejection they can stay calm and clear-headed to differentiate thinking rooted in a careful assessment of the facts from thinking clouded by emotion. Well differentiated individuals choose thoughtfully and act in the best interests of the group.

I think my level of differentiation from my family is balanced. I have my own thinking and my own point of view. I am not afraid to have a different mindset from my family members. My parents also encouraged my sister and I to become more independent, to be ourselves and not conform for the sake of pleasing others.

10. Family strengths
10.1 Caring and Appreciation

I think I am very fortunate to have a family who is caring and appreciative. Even if a family member makes mistakes, other members would to encourage and support one another. My parents notice and share positive qualities of each other. For example, they pay attention to another person’s polite behavior or something nice he or she did or said. They notice the characteristics, skills, achievements and special qualities that make the other person unique.

My father would write encouragement messages on his red packet during Chinese New Year. These messages are inspirational and reassured me that my family members do care about me.

10.2 Good Communication

Furthermore, there is communication between me and my parents. We talk and share our feelings, hopes, dreams, joys, sorrows, and experiences. I would tell the daily happenings in school or with my friends just to update my parents about what’s going on in my life. My parents take the time to listen and respond to what I have to say.

10.3 Openess to change

There is a set of family rules in my family. These rules are ways to deal with daily life. Some of the more obvious rules consist of who does the cooking, who washes the dishes, who does the laundry or who clean the toilet. Other less obvious forms include: Who has the authority to make what decisions? How are differences of opinion handled? How are anger, affection, or other emotions expressed at home?

10.4 Working together

Most of the time, my family make decisions, solve family problems, and do family work together. Everyone participates. Parents may be in charge of the decision-making at home but the children’s opinions and efforts are invited, encouraged, and appreciated. For example, whenever my parents decided to buy a new television set, they would always ask for opinions about which television is suitable for the family. It makes my sister and I involved in the shopping as well and let us know that what we say counts.

I learnt that if parents allow their children to make real decisions, it enables children to grow up to be responsible adults. Children need opportunities to make decisions, to be involved in family decisions, and to observe the parents’ decision-making process and outcomes.

Children are more motivated to carry out their responsibilities if they have some say as to what those responsibilities are and can see how these particular activities help the family. Teenagers are keener to go along on a family vacation if they help decide the destination and itinerary.

11. How has my family affected my personality? What are the weaknesses you want to improve and what are the strengths you want to maintain in yourself.

Based on a study on more than 100 children conducted by psychologist Diana Baumrind, she identified four important dimensions of parenting which affects the child’s personality. They are disciplinary strategies, warmth and nurturance, communication styles and expectations of maturity and control.

Based on these dimensions, Baumrind suggested that the majority of parents display one of three different parenting styles. Further research by also suggested the addition of a fourth parenting style (Maccoby & Martin, 1983).

The four parenting styles include authoritarian parenting, authoritative parenting, permissive parenting and uninvolved parenting.

My parents’ parenting style suit authoritarian the most. My parents establish house rules and guidelines and expect my sister and I to follow them. However, my sister and I were also involved in the rules setting so we were able to find them realistic. This parenting style is much democratic. When children fail to meet the expectations, authoritative parents are more nurturing and forgiving rather than punishing. Although my father punished me whenever I broke the house rules; he would always end it off with nurturing and kind words. My parents are assertive, but not intrusive and restrictive. Their disciplinary methods are supportive, rather than punitive.

I think I grew up to be a socially responsible and cooperative person. I tend to avoid conflicts with people and adopt the “make more friends than enemies mindset”. I lean more towards the extrovert scale as I enjoy the company of my friends. My friends told me that I am a good-tempered person too. They don’t see me get angry because I am not bothered by the slightest issues.

Another strength that I have is being persistent and committed. Once I set my mind on a target or a goal. I would thrive to achieve it. My parents have been teaching me the importance of goal-setting since young. I also gain a huge sense of pride and satisfaction whenever I accomplished my goals.

One weakness that I have is being perfectionist. I am very attentive to details and would not be satisfied unless I get the exact results that I wanted. Most of the time striving for perfection is tiring and time consuming. My project members would sometimes find me a pain in the neck when I was not satisfied with their research work.

Another weakness I have is laziness. I think I have been too pampered from young. I seldom do household chores because my mother is a housewife and she does all the housework. Well, almost all, my father did his part too. As such I became reliant on my parents to do my own laundry, to wash my dishes etc. I have been trying to increase my contribution to my family by doing some household chores but it’s hard to do so especially since I have done almost no housework since young but I’m not giving up easily.

In summary, family relationships are one of the longest relationships we would ever have in our life. We should never take our family members for granted but should cherish them instead.

During mental health rotation I came across the scenario, which forced me to reflect on it. A 30 years old male patient diagnosed with schizophrenia since four to five years and has multiple admissions during past years. During examination and history taking I came to know that he is being admitted since two year back in Civil Hospital with the complaint of aggression, hallucination and suspiciousness. He was admitted by his sister who wanted to get rid of the responsibility of taking care of him. Furthermore he belongs to low socioeconomic background from the outskirts of Karachi. He is married and has 4 children, his elder brother and all other relatives are supporting him menially. According to his sister he should be restrained with “Zanjeer”. They think that he is putting up an act. His elder brother has left him because of his disease. He has left taking his medications since six months and with nobody realizing it. After six month when he became very aggressive and his family was unable to control him, he was brought for admission in Civil Hospital.

Looking at my patient’s scenario I believe that there were multiple factors which led him to mental illness. Most severe of these were poverty, illiteracy, low socio-economic status, stigmatization and eventually all of they evolved family support from him. If we just see what family is: according to Shomaker (2006 )

“aˆ¦A group of individuals who are bound by strong emotional ties, a sense of belonging and a passion for being involved in another’s lives.” (pp.163)

Therefore it could be said with substance that families live in different compositions including nuclear, extended, multigenerational, single-parent and same gender families. According to B.A.Marry(2005): “aˆ¦so either they are connected emotionally or by blood or in both ways”. Hence family is composite institution where every member is mentally and emotionally affected by the existence of other members. Also that, the presence of family members in healthy state influences the metal health of rest of the family members. In Pakistan, the extended family system is most common family system. In such family systems, individual autonomy is equivalent to group autonomy and the group is the complete family unit. People in Pakistan dearly follow the joint family system and live their life along with their folks. (Naeem, 2005).In other words, it can be said that extended family system has many advantages, it is also of harm in some cases to the members. Due to the sheer size of the family, the members are denied individual attention and care that is so required for any patient. The same happened to my patient who was left alone by his extended family.

According to De Sousa(2009):

“The family is both a system and a unit in society, a primary multifunctional institution into which all human beings are born, brought up and nurtured by various interpersonal relationships. Thus family serves as the basic architect of the individual’s personality. The relationship between the individual and the family members determines the disposition to illness and health in every stage of life right from infancy to old age. He further says that the family is strategic centre to understand human emotions and relationships that play pivotal roles in both positive health and disease. It is the major support system for the patient that is mentally ill but at times the patient is often deprived of psychiatric treatment due to family burdens that exist”.

Family support and role of each member starts since the time of birth as parents as brother as sister and many other different roles which shows their care and affection through bodily gestures, verbal and nonverbal communication and provides a sense of security to the infant and it go on throughout the life. De Sousa(2009) share that the individuals who receive a lack of support early in life remain at an increased risk of experiencing poor health later in life”. If one has lack of family support than he/she might be not able to withstand of normal stressors and ultimately the person will end up in mental illness. It would thus be apt to say that our lives are closely in need of support from other people, without which our existence may not be possible.

Family members of person with mental disability can play a critical role in enhancing the care and treatment of their ill family members; however the ability of family to fulfill their caregivers’ role- is negatively affected by numbers of barriers alike. Lack of family support it can be due to social stigma and this is the main reason that mentally ill people’s social network becomes narrow. Gotlib and Feely (2000) supports that the notion by saying that “over time, due to social stigma associated with serious mental illness, developing and maintaining relationships can be difficult”. A support system is vital for people living with mental illness yet at the same time the illness places relationship at risk. The negative effects are at risk of being exacerbated in case of family not being present and poor prognosis and relapse may be the result.

According to Naeem (2005)”While the attitudes people hold towards mental illnesses has been studied to some extent in Europe. Nothing is known about what people think about mental health problems in Pakistan. Still we are far behind to know the role of family in mental health.” as we did not have enough literature to support and, thinking ahead for the roles of family to contribute will take time.

In our society mental illness is taken as a stigma and still people are not clear about the causative factors of the disease, rather they are connecting it with supernatural forces as cited by Karim.S. et al(2004) “it is widely perceived that mental illness is caused by supernatural forces such as spirit possession, punishments for one’s sins. “if we connect these believes with literacy status of our country then it is quite evident that the lower the literacy rate the greater the force of these believes will be . He further says “the literacy rate was 47.1% in 1997-2000” not only low literacy rate but low socio economic status which is letting people to strive for their basic needs. Though in Pakistan living together family is our culture but the trend lacks definitive approaches. For example, the family members do not realize the roles they are expected to play. This breeds in confidence among the family members preventing them from leading mentally healthy lives.

Family support is required at every age of life, family support and social network shows positive effect on health and well being. Mustafa (2005) suggests that support of family is important to maintain the mental health of individuals. As he mentioned in his work that “Social net work communicates love and affection to them who are in their network’ though patient has a social network (family) despite of them he is left alone. There is a process of social support which includes; (family, friends, neighbors etc) and social climate. In this process first” need” is identified than emotional and instrumental support is delivered through family network and when all parties combine together than a social climate is made for each other’s need. After each type of support is provided outcome appears in a form of mental health promotion. Need is about identification of need of family support, willingness of receiving support, and willingness of giving support in different circumstances.:

If I relate this stage need with my patient then his need was attention, caring attitude from his family however he was fail to receive it. No positive supports identified and if it was identified than it was the only physical part of his care, they were taking care of his physical need however nobody was realizing what actually his need was? This deficit of supportive family role leads to ending patient in the withdrawal of all his medication. So the effects of family presence and mental health problems play a major positive role during the treatment like increase chances of early rehabilitation and prevent relapse.

David.T(2006)” distinguishes between two facets of family involvement-family involvement with the client (apart from treatment) and family involvement specific to the client’s treatment because they may have different antecedents and consequences and because families may be involved in one way, but not the other. For example, a family member may provide financial assistance to the client but not be involved in the client’s treatment. Both types of involvement are operational zed in terms of the quantity, nature, and perceived quality of the involvement. Like although his mother was present with him but most of the time she was worried about his physical need

Calgary Family Intervention Model (CFIM): One way to think about change.CFIM is an organizing framework conceptualizing the intersect between a particular domain (i.e., cognitive, affective, or behavioral) of family functioning and a specific intervention offered by a health professional (Wright, Lorraine & Leahey, 1994). This model emphasis on early involvement of family in patient’s cares where positive and negative feedback can be given to encourage and improve dealing. Families are required to be involved in every level of interventions. As family education and awareness about disease, its management and prognosis is very important. In keeping above scenario in mind for group level interventions one can refer to Gravois, Paulsson and Fridlund (2006) grounded theory model of mental health professional support (MHP). It is based on the needs of families with a member suffering from severe mental illnesses. In this model researcher give four category of MHP support that being present, listening, sharing and empowerment.

In this model ‘Being present’ refers to the early contact, early identification o f role changing and giving early information about coping and disease management. Listening plays very important role in mental illness management. In this model assessment is based on active listening of patient and family experiences. After assessing the burden and worries of family and patient .Health care professional can do intervention that can help family to understand patient needs and learn effective coping skills to deal with the patient. They can also form support groups for family so that they can share their feeling and motivate each other to take better care of patient and relieve pain of stigma. Sharing in this model means maintaining coordination with family and as team could take decisions for the patient. Interaction with shared responsibility will create sense of security in family that will lead to open communication between MHP and family .Thus leading to good prognosis of patients.

Lastly, the empowerment which implies that when the family members cope with the situation and obtain a deeper understanding of mental health/illness, they seem to have gained empowerment. Thus, MHP counseling about mental health/illness, in a group or individually, empowered the family” (Gravois,Paulsson & Fridlund(, 2006.)

At individual level, I actively listened to the patient After through assessment of patient, data were organized and those areas were highlighted which need change .This is the very important step as in the scenario the main problem with the patient was disease process which was aggravated due to lack of support .As with good family support patients can live better life. So I focused the family as well as the individual to deal with the problem. Firstly I planned to give patient education about disease process, developing insight and dealing with delusion, as due to withdrawal of psychiatric medication since six months he was very aggressive and his grandiose delusion were very strong indeed, so I tried to give awareness about himself so the co-operation from his side could make family support easier for him. Secondly I involved patient in different activities to improve her social network and beside this I have planned patient teaching for the family that include awareness about mental illness and discharge teaching. “To improve the quality of life, psychosocial intervention with the family and the mentally ill person e.g. family problem solving, drug compliance, crisis management, training of social skills and cognitive behavioral strategies are suggested”. (Gravois & Fridlund, 2006). But unfortunately I was not able to interact with client’s family. Interventions were carefully planned in keeping culture and educational level of client in mind .

Support groups can be made for better coping. Perese and Wolf (2005) say, “The primary goal of a support is to increase members’ coping ability in the face of stress, to strengthen ‘the central core’ of individuals” beside this supporting family functioning and cohesiveness via acknowledging their values, and advocating for maintaining sense of self worth. Support groups will also give a sense of friendship. Moreover psycho education sessions could be done to help the families. In addition, school plat forms could be utilized to deliver health education to increase awareness and to build support groups. Moreover, I will plan this strategy with the help of psychotherapist in identifying the same patients who are suffering from lack of family support. In implementation I will make them share their life experiences; this will help them learn through each other’s experiences. To evaluate a mini survey could be done to compare the social support system before and after the involvement with support group and beside this I have planned patient teaching for the family that include awareness about mental illness and discharge teaching. “To improve the quality of life, psychosocial intervention with the family and the mentally ill person e.g. family problem solving, drug compliance, crisis management, training of social skills and cognitive behavioral strategies are suggested”. (Gravois & Fridlund, 2006). As cited by Gotlib &Feely (2000)” an approach to developing strengths is to help families develop knowledge or competencies that can enable them to cope and develop. Families can be assisted to locate and access experiences or materials to augment their knowledge.” But unfortunately I was not able to interact with clients. Institutionally health awareness sessions can be done to make people aware of life needs and importance of mental health promotion. Media can be utilized for Speeches to convey our messages to the government to resolve some psychosocial factors: poverty, lack of parental support. Some steps should be done to improve poverty as this is the common factor for mental illnesses. Could work with NGO’s to conduct different seminars for mental health promotion, this will enhance education level of the population and they themselves will take step to overcome factors contributing to mental illness. To plan a seminar at institution level I would make a plan of what need to be discussed in this seminar, I will discuss the target population with directorial level. In this seminar psychiatrists can be included for broadening the horizon of knowledge. After this I will make sure that on implementation media coverage is there. To evaluate this, small research could be done to see the prevalence of mental illness in the community. In addition, small questionnaires can be used to compare the knowledge level before and after seminar.

When I visited the psychiatric hospital I was upset by looking at patients’ condition. I was amazed that how this disease has took hold of patient and how this is done all of a sudden. It was my prejudice that genetic and biochemical factors are the most prominent ones, to cause any disease however it is not true psychosocial factors can be the most influencing one to have a disease as it is in my patient’s scenario. I assumed that the lack of family support only exists in Pakistan however through literature search I came to know that it is global issue. It is also very important to keep this fact in mind that family members and mental health care professional frame the role of family members in the care process. After analysis my patient’s life with the present condition I felt that I am blessed by God by having the supportive family, friends, and the community.