Author: Andre Coleman

“The field of developmental psychology is the scientific study of age-related changes in behaviour, thinking, emotion, and personality.” (Bee and Boyd, 2002, p3). This assignment will concentrate on the early years area of the lifespan, which ranges from pre-birth to 3 years of age. During the early years, children start to develop physically as they begin to crawl, grasp and walk. Children also start to have self-determination as they begin to make choices themselves and they start to develop their vocabulary and have simple conversations with others. Additionally, children develop socially as they form attachments with their care giver and other important faces they recognise. In social work practice, it is important to understand that theories relating to lifespan development should not be used as a solid guide when viewing behaviour, as they do not take into account all aspects of an individual’s life, such as environmental and social factors, and not everybody lives a ‘text-book’ life. (Walker and Crawford, 2010). Theories are “an attempt to explain” something to give us an understanding and make sense of problems. (Thompson, 2000; page 20).

When working with young children, it is important to understand the various stages of development so that we, as social workers can identify achievements being made; such as when a child takes their first step, or when they say their first word. Theories regarding lifespan development are based around ‘normal’ development and can help social workers determine how much progress a child is making in terms of development. (Walker and Crawford, 2010).

Social workers must make sure that when working with young children they take into account their race and culture, and what impact these might have on their development. They must also take a holistic approach when trying to gain an understanding of a child, so that not only can say learn what has happened during the child’s life, they can also say why it happened and see the child as an individual. (Walker and Crawford, 2010).

“It is important to keep in mind that even a tiny baby is a person. Holistic development sees the child in the round, as a whole person – physically, emotionally, intellectually, socially, morally, culturally and spirituality.” (Meggitt, 2006; page 1).

Following the death of Victoria Climbie, Lord Laming was required to update the arrangements for child safe guarding to prevent future tragedies occurring. The Children Act 2004, was a major reform and it brought along different policies to safeguard children, such as Every Child Matters: Change for Children. (DfES, 2004). Every Child Matters was also reformed in 2009, following the death of Peter Connelly. Also, framework for Birth to Three Matters (DfES, 2002), has been published to support professionals who work with young children and families and recognises the nature of human development.

Within psychology, there are 5 different approaches that can be taken when looking at lifespan development. These 5 approaches are biological, humanistic, cognitive, behaviourist and psychodynamic. These psychological perspectives are backed up by various theories, but it is very important to remember that theories are not always true as they do not take into consideration environmental and social factors that could affect an individual’s development. This does not mean that theories cannot be used to analyse behaviour and development within individuals, but it should be remembered that all theories do have criticisms when they are applied and used in social work practice.

The first theory which is going to be looked at regarding early years development is Erikson’s psychosocial stages of development. (Beckett and Taylor, 2010). The first stage of development is Trust versus Mistrust; this stage forms the foundation of trust a child has with their caregiver. The more consistent the care is that they receive the better trust that the child will have and they will become confident and will feel secure in their environment. However, if this stage is not completed successfully, then the child will not feel secure or confident, and may not have a lot of trust in their caregiver, which can result in a number of problems, such as anxiety and insecurities about others. (Erikson, 1995).

The second stage of development is Autonomy versus Shame and Doubt; this stage shows a child starting to assert themselves and become independent, for example, picking what they want to watch, what toys they want to play with, or what they want to eat etc. Children need to be supported in this stage so that they know what they are doing is correct and become more confident in making their own decisions, otherwise if they are criticised too much, they might start to feel dependent upon others, and may doubt their ability to make their own choices. (Erikson, 1995).

In social work practice, this theory could be used to investigate any underlying issues between a child and their parent. Erikson states that if a stage is not completed successfully, it is harder to complete following stages of development and achieve the positive outcomes. (Beckett and Taylor, 2010). This theory gives social workers an overview of how a child should be progressing and what their capabilities should be. However, this theory does not take into consideration children who have disabilities or who come from different ethnic backgrounds. A child with a certain disability may not be able to make their own choices from such a young age, no matter how simply they are, or children from different cultures will have different upbringings compared to children from other cultures.

John Bowlby was a main psychologist who studied children. In particular he looked at attachment between a child and caregiver. He believed that relationships at a young age are vital because any failings in relationships in childhood would shape the development of a child’s personality. He also believed that attachment is an innate act, and children want to form an attachment with their mothers and mothers want to be close to their children so that they can protect them. Prolonged separation from the mother is known as maternal deprivation, and this is a major cause of delinquent behaviour and mental health concerns. (Walker and Crawford, 2010).

Social workers can use theory when in practice to see how a child responds to their mother or father. For example, if a child is in a care and has contact with his/her mother twice a week, the social worker should look to see who interacts with who first, who runs to who, what is the proximity like and body language etc. All of these actions will allow the social worker to determine whether something is wrong. If the mother runs to her child, why is the child not running to her mother? Does the child not feel attached? Has something happened which needs to be looked into? However, Bowlby’s theory does not take into account fathers being the attachment figure as they may be a single parent. Also, social workers need to work in a non-discriminatory manner and remember that in some families, such as Asian families, within a household it is not just the immediate family who live there, it is also the wider family. A member of the wider family could be the main caregiver, so this needs to be taken into consideration when starting to work with a child from this type of family. (Walker and Crawford, 2010).

Mary Ainsworth adapted Bowlby’s attachment theory by carrying out her own experiment on children and their caregiver so that different attachment styles between a child and the caregiver could be observed. The Strange Situation recognised four different attachment types; secure, anxious-avoidant, anxious-ambivalent and disorganised attachment. (Ainsworth et all., 1978). The experiment took place in a small room with a one way mirror so that the child could easily be observed. Throughout the experiment, the child would be left with their caregiver for some time before a stranger entered and the caregiver leaves, and then the child would be left completely alone for a short period of time before the stranger and caregiver return and so forth. The attachment type that the child would have would be dependent on their reactions to the events that happened in the experiment – upset, crying, anxious, scared, happy, distressed etc.). For example, a child who has an ambivalent-attachment would have shown no signs of distress when their caregiver left the room, but they would have avoided the stranger when they entered the room. When the caregiver returns after leaving the child alone with the stranger, the child would approach them, but may also push them away to show that they are upset. (Simply Psychology, 2008).

In social work, this theory could be used to view the attachment between a child and their caregiver. Positive attachment could result in intervention not being needed by social workers. However, negative attachment could prove that earlier intervention is needed as there is an underlying reason as to why the child is not forming an attachment with their caregiver. This theory should be used very carefully in practice as some children are more independent than others, and it does not take into account cultural differences and disabilities. For example, children who have Autism Spectrum Disorder (ASD), especially on the higher end of the autistic spectrum, find it very difficult to display feelings and show affection. This does not mean that they have not formed an attachment with their caregiver, they are more than able to, but it is how they display their attachment type which can make them appear unattached. During the mid-1980s, researchers started to observe children with ASD in the Strange Situation. Results show that 50% of the children formed a secure attachment with their caregiver. Despite this figure being low compared to children who do not have ASD, it is very impressive and proves that children with ASD can form attachments. However, when it came to the part where the caregiver returned to their child, the children acted differently compared to other children. For example, they did not initiate contact or appear to be happy. (Oppenheim et al., 2008).

The knowledge of development and attachment theories is important in social work, as these theories will help a social worker carry out assessments on a family with young children. When carrying out an assessment, it has to be done under the Common Assessment Framework, which aims to identify the following; how well the parents or carers can support their child’s developmental needs, and how they respond and meet their needs; and what impact does the environment and the wider family have on a child’s development. (DfES, 2006).

John Bowlby’s attachment theory gives an overview of the different attachment types and it allows social workers to assess and judge the quality of a relationship, and this can help as the social worker will know when to intervene, and if necessary, remove a child from a family unit. (Walker and Crawford, 2010).

Under section 17 of the Children Act 1989, local authorities have a responsibility to safeguard and promote the safety and welfare of children who are in need. (Legislation.Gov, 2012). When working with children in need, a social worker will need to carry out an assessment under the Framework for the Assessment of Children in Need. (Department of Health, 2000). Tied within this assessment, is another assessment regarding the developmental needs of a child. It covers several areas of development; health, education, identity, family and social relations, emotional and behavioural development and self-care skills. According to Parker and Bradley, children need to reach these developmental needs to achieve a healthy adulthood. (Parker and Bradley, 2007).

By using anti-discriminatory and anti-oppressive practice in social work, it allows social workers to challenge their own beliefs and values while considering others. The Every Child Matters: Change for Children policy has 5 outcomes which are considered to be the most important to children and young people; be healthy, stay safe, enjoy and achieve, make a positive contribution, and achieve economic well-being. The policy wants children and young people to be “safe from bullying and discrimination”. (Crawford, 2006; page 16).

With regards to lifespan development theories; anti-discriminatory practice and anti-oppressive practice are used in social work because these theories can be applied to all cultural and class backgrounds. The majority of the theories were based around white middle-classed children and parents when experiments were carried out, but by no means does this mean that they cannot be applied to different cultures.

In conclusion, if knowledge of lifespan development and various theories are used correctly and appropriately in social work practice, then this could give social workers a clear indication of when a child is not developing at the usual rate, and intervention can take place at the earliest possible moment, to ensure that the safety and welfare of the child is met. The advantages and disadvantages of viewing behaviour through lifespan perspectives seem to weigh each other out in relation to social practice, however, it should be remembered that the studies are theories, and are not based on solid facts, so they should only be used in practice as guidance.

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Purpose: This study explored the experiences of mid-career professional working mothers exercising integration between work, family and selves in the context of the city of Faisalabad, Pakistan. It has been examined that how the family systems included joint and nuclear, affected them and their careers.

Findings: The study showed that the professional working mothers are responsible for performing their domestic and professional roles, besides self-care. The proper incorporation of both roles is plausible with the stipulation of flexibility from both, work and family system, both, joint and nuclear family system. All women had intense feeling of motherhood; their career was also of high importance for them as they find their values and purpose. They wanted to achieve the objectives of their lives and self-fulfillment. Now they were better able to balance their family, work and individual self in comparative to start of their careers.

Research Limitations: The response rate from the audience was low, but, through in-depth, rich and contextual information, which was received during interviews, tried to overcome these flaws. The females from the targeted population became very anxious and some were refused to give audiotaped interviews.

Originality/Value: This paper contributes in the work-life integration for professional working mothers. The study explored that what type of hindrance or support a working mother living acquired form the family system and from the workplace and how they integrate the both. Kaleidoscope career model was used for this purpose.

Keywords: Professional working mothers, mid-career, joint family system, nuclear family system, work, Faisalabad

Paper Type: Research Paper

The proportions of women make up an increase in full-time workforce (Metz, 2005), especially in the professional and managerial fields around the world (Cabrera, 2007). Pakistan is in the phase of transition (Raza & Murad, 2010), since July 2009 women employment is increased by 1.7% (Labour Force Survey, 2010). The increased proportion of women in labor force creates bigger challenges for women in the incorporation of roles and responsibilities and managing time accompanied with child bearing and child rearing years (Grady & McCarthy, 2008). These challenges stimulated scientists to create a link between work, family and self (Valimaki, Lamsa & Hiillos, 2009). As a result pressure on organizations to respond towards employee’s family responsibilities has been increasing (Goodstein, 1994). Additionally the challenge for the organization to find out the adequately integration between domestic and work life by work -family (WF) arrangements (Peeters, Wattez, Demerouti & Regt, 2009), by providing equality policies, statutory entitlement, maternity leave, carer’s leave, parental leave, and non statutory arrangements like flextime, e-working, job sharing, term-time working (Glass & Estes, 1997, Grady & McCarthy, 2008).

The increasing number of working mothers, over past years, has increased pressures for them as they confront meaning in work, family and personal life (Grady & McCarthy, 2008). Work-life integration seems to be difficult for professional mothers due to increased pressures. They not only need to create meaning in their work, family, personal life by selves but they also need support at work place by the employer. The support by the employer at work place towards integration of work, family and self leads towards self-fulfillment and satisfaction which have positive outcome for them and ultimately for employer (Auster, 2001). The absence of the support by the employer may lead to the difficulties for the professional mothers. The work intensification and long hours, coupled with child rearing demands result in stress and labor turn over (Jones & McKenna, 2002).

The purpose of this study is to explore the issues, problems and experiences of mid-career professional mothers regarding work-life integration in Faisalabad, Pakistan. How the most prevailing family systems in Pakistan, joint and nuclear (Ahamad, 2002), affect them. The study examines what type of hindrance they face and what type of support they need at work place as well as from the family. Now in Pakistan, vast segment of the society based on women cannot be denied the women’s status, autonomy and equality in playing a role in social, economic opportunities and nation building (Amir, 2004, conference paper). Concerns about the economy and as well due to the changes occurred in woman’s aspirations has increased the women as work force as never before (Ahamad, 2002). According to labor force survey 2010, women’s employment rate increased by 1.7% as mentioned above. The focus is on mid-career professional working mothers because they are in the stage of career when a lot of attention is required by their family and as well for building their professional career. Professional working mothers are defined as those mothers, who manage, develop and invest their professional career throughout the period of rearing their family (Grady & McCarthy, 2008).

Work-life integration

Work and non-work are interdependent and the individuals have to play roles simultaneously or to switch frequently from one role to the other (Wilson et al., 2004). Work role is the professional duties assigned by the organization and non work includes family or domestic duties have to perform for family. Central idea of this research paper is work life integration. Work-life integration is defined that how professional workers incorporate the duties at work place accompanied with the domestic duties along self demands. This belief gained a lot of attraction in the past decade (Metz, 2005, Grady & McCarthy, 2008, Valimaki, Lamsa & Hiillos, 2009, Peeters, Wattez, Demerouti & Regt, 2009, Goodstein, 1994, Glass & Estes, 1997, Auster, 2001, Jones & McKenna, 2002, Karatepe, 2009, Wilson et al., 2004 & Burke, 2004). With rise of industrialization, the agrarian model is now replaced, the conventional role of women expected to take care of the children and men as bread winner is going to be changed (Valimaki, Lamsa & Hiillos, 2009, Grady & McCarthy). Employees need to confront the work and non-work roles corresponding. Dissolution, interference and conflict between the roles may lead to disorder, burn out, emotional exhaustion (Grady & McCarthy, 2008 & Peeters, Wattez, Demerouti & Regt, 2009), negative health outcome dissatisfaction and emotional dissonance (Karatepe, 2009). “The work-family conflict is considered bi-directional (Cohen, 2009, p. 814)”. Managing multiple tasks at a time may lead towards conflicts from work to family life and from family to work life (Kirrane & Monks, 2004). Sense of equilibrium may create by positive spillover, enrichment and facilitation (Glass & Estes, 1997, Valimaki, Lamsa & Hiillos, 2009). On the other hand women entrance in workforce in last two decades at an precedent pace (Auster,2001), resulted dual-earner and in low gap between male and female (Ahamad, 2002). Females need support from family system and spouse to make an appropriate assimilation (Valimaki, Lamsa & Hiillos, 2009).

The family system and work-life integration for mid-career women

It has been proposed that a professional women’s career is difficult to be examined without examining her non-work life – family system and spouse (Powell & Mainiero, 1992). Family, a smallest unit of a society composed of two or more people who are interconnected by marriage, blood or adoption, live together from an economic unit, has basic features of sharing and togetherness (Ahamad, 2002). Two types of household systems, dominant in Pakistan, joint family system, in which women with her husband and children lives with in-laws, and the nuclear family system, in which a woman separately lives with her husband and children (Amir, 2004). A newly married working woman prefers to live in nuclear family system but in child bearing stage this system jeopardizes her life (Aamir, 2004). Due to the lack of day care centers and unreliable servants and maids may make it difficult for the working professional mothers to take care of their dependent children particular in mid-career. In such case joint family system becomes the heart favorite of working professional mothers (Aamir, 2004), which may facilitate and may take care of their children, in their working hours. “Woman marries the whole family and she is answerable to other family members”(Ahamad,2004), tough responsibilities are on her shoulders, specifically in joint system, leads towards heavy burden when woman is working as professional and as well as an economic hand of her partner. In such case woman may feel dissonance and may prefer nuclear system where number of dependents are less, she needs support from her spouse and work place to continue her professional career.

Modern life is leading towards change in roles of women and men due to continuous changes in economic and demographic trends (Ahamad, 2002) The percentage of married couples increased in previous decades, in which both spouses worked full time, a spouse or a partner can provide basic support, include sharing home, parenting responsibilities, encouraging career development, interpersonal support needed by working women (Gordon & Whelan-Berrry, 2004). After passing day long activity at workplace may make a working women exhausted and make it thorny for her to take care of children along household duties. In such case professional working women particular in mid-career, where family demands with child rearing are increasing accompanied with career growth. It may become difficult to incorporate both without support from family and work place. In some cases, family and spouse do not facilitate working women but sometimes do really support (Karatepe, 2009). Working professional mother may be from Joint family system or nuclear family system, necessitate ample support. It may affect in work-life integration. By sharing common interests a flexible spouse enables working woman to manage their career and integrate work and family lives successfully (Valimaki, Lamsa & Hiillos, 2009), especially in mid-career where career has already established and women are beyond the parenting of infants and toddlers, finding new challenges in work and personal interest (Gordon & Whelan-Berrry, 2004 & Grady & McCarthy, 2008).

Thus, literature indicates when women are in their mid-career, face challenges regarding work-life integration while experiencing new opportunities in advancement of their career, they need to be supported by work place and family system, either joint or nuclear family system. Professional working mothers strive to integrate across the domains and to minimize the gap. This research paper aims to explore the gap that how professional working mothers create balance concerning work, family and individual selves; and how family system affects this integration? The following section indicates research methods used in the current study to address these research questions.

Method

Qualitative in-depth interviews were carried out with 22 professional working mid-career mothers. The criteria determination for the participants was

Professional mid-career working mothers, who joint parenting role along with career advancement

Age between 33 to 48, most agreed aged for mid-career in Pakistan

With children, at least one dependent child, less than 18 years

The sample was chosen by considering convenience and snow-ball sampling. The professional working mothers to whom authors met were asked for further contacts. The sample size of 22 professional working mothers is adequate representation of population of working professional mothers particular in mid-career in Faisalabad, Pakistan. Interviews were based upon 90 to 120 minutes and were audio-taped. Authors transliterated interviews. Table1 presents the sample questions which were asked for exploration.

Sector

Subject matter

Sample questions

1

Responsibilities/dependent care you and your family

Tell about yourself, your responsibilities at work place and self demand?

How does every day job look like?

2

Amalgamating work and family life

Do you find it easy or difficult to manage work, family, school etc at morning?

Did you ever feel frustration and think to stay at home full time?

3

The work place-flextime, support, enrichment

Is your work place family-friendly for you?

Have you availability of any flextime?

4

Career development and promotion-support or barrier

Are you on the right path of your career, you ever thought?

How did you manage during child rearing?

5

Self-fulfillment and satisfaction

Did you approach your value or purpose of mid-career?

Do you consider satisfied yourself?

6

Family system

Who does take care of your dependents while your working hours?

What type of family system may support more mid-career women?

Opt out from child day care center, house maid or relatives for your child-care?

7

Other issues

Has the study enabled you to think in a different way about your?

8

Demographic data

Source: Work-life integration: Experiences of mid career professional working mothers (Grady & McCarthy, 2008)

The content analysis was the approach used to analyze the data (Bryman & Bell, 2003). The qualitative responses were collected, grouped and the concept was examined through the organized analysis of the record. The figure below presents the content analysis framework that was derived. Framework led four subject matters along with four research questions. Further integration of work is illustrated by incorporating values and essence of balance. Final column indicates the responses of the participants towards questions

Sphere
Themes
Description
Construct of work-life integration
Respondent’s reference to theme

1.

Self-perception in relation to work and family roles

Children are a working mother’s number one priority.

When there was a clear conflict between work and children, participants made choices and children became the priority.

Sense of self

(assess values, beliefs and purposes)

100%

Work and career is very important

Career is important for participant they seem stimulation, challenges and enrichment

80%

2.

Work-related factors

Flexibility is two-way

When flexibility is experienced at work it supports commitment and increased productivity in the in the work place in addition to integrating work and family life

60%

Changing attitudinal, and social context

The changing attitudes and culture in the work place and the social and legislative changes have improved the situation for working mothers

Work itself

(paid and unpaid)

75%

Responsible for one’s own career

Working mothers took responsibility for their own career at all stages and more particularly now as mature members of the workforce and at mid-career they assess that it is up to them to create their own future direction

93%

3.

Merge work &

Family system

Whether joint system help professional mothers for working?

Joint family including husband’s parents,sisters and brothers are helpful for working mother

Sense of balance

Choices about time in each sphere

72%

Whether Nuclear system help professional mothers for working?

Nuclear system excludes members of family except husband,wife and their children is more beneficial or provide support to working woman.

28%

4.

Proper Integration

Self suffers when work and family become dominant

Integrating work and family was a key priority throughout the years with little time for self, but participants found significance in this integration.

Integration and balance across work, family and self= work-life integration

80%

Paradigm is shifting and needs are changing

Merging work and family is getting easier, children are getting older, seaking more time for self- meaning of integration is changing

80%

Findings
Demographic information and career profile

The participants in this study were 22 women in number aged from 33 to 48, fall in mid-career, who endured full time job accompanied with family rearing years. All infatuated nationality of Pakistan. All participants in this paper were interviewed, indicated their marital status as married, with at least one dependent child.

Three of the participants had four children; nine of the females accompanied three kids and eight of the respondents possessed two children and two females had 1 child. Seven of the females were living in joint-family system, three of which lived with just mother-in law and father-in law, and other four were living with other relatives as well. Fifteen of the participants lived in nuclear system. One of the females had infants and the children of other women were school-aged or above but at least had one independent child. The women possessed work experience between 8 to 22 years. The targeted sectors were medical, education, makeup industry, telecommunication, nursing and research officers including both public, private and semi-government organizations along with self-employment. Four targeted interviewees were doctors had specialization in different fields, work experience fall from 9 to 20 years. Two of the participants were Ph.D. doctors, fell under the category of research officers; eight of the respondents were from education field were working as teachers, generally owned master’s degree, as well had some completed short-courses relevant to the fields. Three of the contestants were selected from telecommuting, two from banks and one from beauty salon, preserved 10 to 18 years’ experience and possessed different relevant short courses. Nine of the women included, were form private organizations, five were from government or public organizations, five were from semi-government and three were the self-employed. One of the respondents, had the nationality of Pakistan but lived 10 years in Madinah, Saudi Arabia and worked as lecturer in the Madinah University, Saudi Arabia for ten years, and shifted to Faisalabad for last five years and running her own school.

Self-perception in relation to work and family roles

The findings point out that when the family roles as well as work roles spill over each other, the number one priority professional working mothers gave to their children. It is evident from the interviews that females were very disturbed and stressed at their work, regarding their children. Women miss their children at workplace. All women became very emotional when they talked about their children. They are not ready to do compromise over their children. The working mothers focused on giving a quality time to their children. The following statements are the evident of the way of thinking of mothers:

Being a mother, my children are my number one priority. I will never let my children neglected due to my career. I have a wish to pursue my career along with performing the duties related to my children as a mother.

As a mother, my kids were my main concern. I always tried to give them a quality time rather than a quantity time.

Self employed respondents were flexible in their working conditions. They were not bound for any one’s order. Such women indicated that the reason for their being self employed was their children. They said that it was difficult for them to give an appropriate time to their children.

I am self-employed and running my own school. I rare feel to make an adjustment difficult between children and my career. In case of any accident or sickness of child it is easy for me to take a leave.

All women had intense feeling of motherhood. But some women responded that their work as a stimulating factor for them. Females pointed out themselves much active due to their jobs and considered them as idle without job. They had more challenges in their lives so they worked hard and struggled more to accomplish. They identified them as more creative in contrast to non-professional women.

In the start of my career, I found it hard to create a balance between work and family. But now I feel myself incomplete without my job. In off days I feel myself very lazy and idle. I even don’t wash my face and take bath as I don’t have to go at work. My work creates charm in my life.

Work related factors:

Two-way flexibility is very crucial issue in business organizations. If employers give flexibility to the employees working in an organization, the employees also put more commitment over there. Parental leaves, maternity leaves, flexible working hours, carer’s leave, job-sharing, may fall under the category of flexible related factors.

Flexibility is very important. I am here; the reason is the cooperation from my colleagues at workplace. As yesterday, I had to attend mother’s meeting of my younger child. My employer let me to go. As a result, today I am putting my maximum contribution.

I am a doctor but instead of doing practice I am teaching at medical college and I got flexibility from the organization to pick my children from their school. My children are quite happy and I am also contented due to that flexibility.

Some women pointed out that they had to suffer a lot because of inflexibility of the organization; sometimes it became so difficult for them to run their career during child bearing period.

I am an employee of a private organization. During my career I thought many times to leave the job due to inflexibility from my organization specifically during my child bearing stage, I ever got unpaid maternity leaves for only one month. At that stage I became so frustrated due to my child care and had wished to shoot the employer.

From previous decade the working trend of the women is increasing and as a result, social, behavioral and attitudinal changes are also emerging. In Pakistan, it was considered strange for the women to go out of their homes for the sake of earning beside their husbands. Now-a-days male colleagues share the responsibilities and contribute to the work with their female colleagues instead of competing with them.

I have been working from eighteen years. At start of my career, my neighbors, relatives, and my male colleagues watched me in an unsophisticated way, but now at the stage of my mid-career my peer group specifically included men are very cooperative towards me. Without participation of women, it’s not easy to bear financial expenses only by male. Now society is more civilized and it is accepting this reality.

Women only considered them responsible for their career. They often had to ignore many opportunities just due to their family and child related problems. Women were not willing to leave the city due to their family and spouse.

I received much flexibility from my previous organization at Lahore. I was at the promotional stage in that unit of organization. But in case of my husband’s promotion in Faisalabad I had to compromise and to leave that unit of organization and made it possible my transfer in other unit of that specific organization in Faisalabad. Now I have to deviate from my smooth career path.

I have left many opportunities offered by organization. I don’t want to become as part of top management because I don’t want to bear burden of work more it may cause to disturb my family.

Merging work and family system:

As research evidence showed that professional working mothers have much feelings of motherhood and as well they had identified the need to come in professional fields. Women have to leave the job due to negative spillover of work and family roles; they have to leave their jobs (Glass & Estes, 1997). There is high importance for them to merge work within their family systems. As indicated before that two most prevalent family systems are joint and nuclear. Professional working females, as part of joint system, pointed that this type of family system showed cooperation with them in their career path.

I have been working from fourteen years. I have never felt any type of problem regarding my child care. I leave my children at home and their grandmother takes care of them in a best manner. My children are more confident and bold as compared to my relatives whose mothers are not working. Whenever I go home after completion of job, the happy faces of my children make me fresh. All credit goes to my mother-in-law. I love her.

I don’t have any problem regarding my children care. I never felt any need of child care center here because our joint family system is the best alternative of such day care centers. I may never feel confidence over the servants and maids as I have trust in my in-laws.

Some women indicated that they had to suffer due to joint family system because of the burden of extra responsibilities and domestic duties.

Joint family system hinders smooth career path of professional working women. Due to a large amount of domestic responsibilities I lost many opportunities. Financial expenses also increases and I have to give a big portion of my salary to my in-laws.

Respondents who lived in nuclear family system mentioned a lot of problems regarding their work and family integration. They mentioned problems regarding their child care and to perform a lot of domestic duties by selves. Working women needed a cooperative spouse.

I have to ignore my children when I come to work. I forget work when I reach at home. I wish to have a joint family system at least my children may be in a position to get safety and security because I can’t rely on maids. My husband’s career is very important and he cannot take leave for children.

It is also evident that the working mothers, who lived in a nuclear system, didn’t compromise on their careers. They didn’t have any responsibilities and bounding from other family members. They indicated much satisfaction because they didn’t need to answer anybody.

I am thankful to God that I live in nuclear family system, I am very happy in my paradise where there is no interference from typical mother, father, sister and brother in-laws. I am not answerable in front of anybody regarding my actions except my cooperative husband.

Support from partner/ spouses were identified as a key element for professional working mothers. A researcher woman pointed that she was nothing without the support from her husband because a supportive husband shared the domestic roles as well.

Today I am here due to my husband’s support. During my child bearing period I did my Ph.D. related to my field. I did work at home and my husband made it possible to examine my work from my supervisor consecutively. My husband is very cooperative in building my career. Even he does cooking if I am not there.

It was reported by all participants that they may only continue their career if support from their families were there. Joint family system was supportive for family emergency time and children care. Research indicated those women who fell under the category of nuclear family system, pointed that they were nothing without their husband’s support. Because there was no one at home, work as helping hand in spite of their spouses.

Integration of work, family and personal self:

Increasing trend of working mothers from the last decade indicated that women were in their mid-career. There felt a need to manage work family and personal selves. But respondent showed that this stage of mid-career they fully focused towards family and work and had forgotten themselves, which is supported by following statement of a gynecologist;

Work and family come at first. My profession does not let me to ignore it. I have to remain alert at all times. In such case I find no time for myself. Last day I came to workplace and my coworkers pointed that I was wearing shirt from the wrong side.

The participant women showed that they are trying for their values in their lives because at this time of mid-career the financial issues were almost solved and compensation plans are not enough. Their children have also grown up and care for children become easier. The women at their mid-career seek purpose of their lives, their needs are changing. They mentioned that they had past a lot of time with their work and family now they feel need for self care. The following statement proves these views:

In the start, my husband’s salary was very low, unable to fulfill our financial expenses; I pursued myself towards my career as right hand of my husband. That was tough time when my children required time from my side. But now I have no problem regarding children care or any financial issue. It’s now time to focus on me.

In summarized form, it is proved from the findings of the whole study that working professional mothers interplay the roles of work and family along with individual selves. Family balance is achieved through the potential, appropriate plan, family system, and workplace flexibility and a network of support. Large proportion of respondents perceived that joint family system helped them for fulfilling career and a sense of achievement. In the start career the most portion of the time, they devoted for work and family. But now in mid-career, self-balance gained a lot of importance.

Discussion and conclusion

This study explored the experiences of mid-career professional working mothers constructing integration between work, family and selves in the context of Faisalabad, Pakistan. It is examined that how family systems included joint and nuclear, affect them and their career. How these professional working mothers made integration in spite of lot of challenges and what support they require from family system. The lives of professional working mothers are very crucial. They need to run their family and children as number one priority along with significant concern for their career. Mid-career professional working mothers experienced a long time period of time for their work. They created quality in their work, which motivated them for the self-fulfillment. According to Warner and Hausdorf (2009) work-family support negatively affects the individual’s stress and leads to satisfaction in different aspects of life, family as well as the job while enhancing more commitment towards their workplace. That’s why working professional mothers’ leads towards the sense of achievement. Now organizations are struggling to better understand the factors, affect the fulfillment of this ever-growing demographic type of mid-career who is filled with intelligence and experience (Ellen R. Auster and Karen L. Ekstein, 2004).

The existence of flexible working conditions and flexible working hours are reported as favorable for the working mothers. “Schedule flexibility is a boundary-spanning resource that helps workers accomplish both their work and family responsibilities” (Carlson, Grzywacz & Kacmar, 2010, p. 331). Organizational policies are required to include flex options, for professional working mothers. Women and men particularly who are married, as c

The primary mission of Social Work profession is to enhance wellbeing and help meet the basic needs of all people with particular attention to the needs and empowerment of people who are vulnerable, oppressed and those living in poverty (luc.edu). The first part of my assignment will be looking at, the importance of the legal context of social work, different types of law and courts that social workers mostly use when representing cases, the impact of the Human Right Act (1998) upon the legislation and how it links in with anti-oppressive practice as well as the powers and duties and their implications for social work practice.

The legal context of social work is important because it provides duties and powers for social work and it provides an understanding of the statutory and legal requirements for effective and fair social work practice (Brammer, 2010). Without an understanding of law, social workers may not be able to make decisions which may be complex for example, removals of children from their own home. Their professional conduct should be legal and ethical. The NASW code of ethics (naswdc.org)[online], statement that, “social workers should promote the general welfare of society from local to global levels and the development of people, their communities and their environments…..” It added that, the knowledge of the legal system help social workers to be aware of the conflicts that may arise between their personal and professional values and how to deal with them responsibly. The knowledge of law is essential to social work practice and failure to have it may leave social workers vulnerable to being sued by service users who feels their lives where affected by a failure to use their professional act (Stein, 1893).

The law supports social workers who wish to disclose concerns about unacceptable behaviour, for example, the guidance on protecting vulnerable adults through the Public Interest Disclosure Act (1998) (Scie.org). England consists of different types of law that social workers are mostly involved in and these are; criminal and civil law, private and public law. Brown and Rice (2007) stated that, criminal law deals with some forms of conduct, for example, murder, and the state reserves the punishment by prosecuting the offender whereas the civil law concerns the relationships between private persons, their rights and their duties.

Public law consists of three types of law which are; constitutional law; controls the method of the government for example who is allowed to work or whether there was a correct procedure which was taken during an election (Martin 2002). Administrative law; controls the operation of ministers of state and other public bodies for example the local authorities. Private law consists of many branches such as tort, family law, company law and employment law.

The hierarchy structure of court consists of the House of Lords which is the highest in the land and that is where civil and criminal appeals are heard. The court of appeal hears civil and criminal appeals and with divisional courts, two or more high court judges may convene to hear appeals from inferior courts in cases where points of law are referred from the magistrates court or county court. Magistrate court has an important jurisdiction in both criminal and family law. The approved social worker has a duty to make an application for admission to hospital or guardianship if necessary for continuity of care and family work.

Social workers are admonished to promote the right of service users to select their own goals but at times social workers uses their professional judgement to limit the service users right to self-determination when the service user’s actions can pose a serious risk to themselves and others (Stein, 1893). Anti-oppressive practice is based on an understanding of how the concepts of power, oppression and inequality determine personal and structural relations (Davies p14). The duty of a social worker is to make sure that people have access to their rights and those who have been oppressed are empowered to regain and are promoted to change as well as taking control of their lives. The HRA 1998 came into force in October (2000) and the focus of the Act is to promote and uphold rights and the act applies to public authorities only (Mandelstam 2009), however, the courts in the past argued that, independent care providers in the context of community care are not public authorities for the purposes of HRA (YL v Birmingham cc) (Mandelstam, 2009). Mandelstam (2009) also argued that, vulnerable people are being deprived of their rights they are entitled to for example their own protection under the HRA. There are a number of rights that are relevant to the Health and Social Care for example article 2 (right to life), It is a right under the European convention on human rights for an individual to have a right to life but the courts also argue that, if a person does not have a capacity to know what is right for them, if this is in their best interest, for example withdrawing artificial hydration and nutrition; it is regarded as a principle lawful not a breach of article 2 (Mandelstam 2009).

Article 3; no one shall be subject to torture or to inhuman or degrading treatment or punishment. Article 5 is deprivation of liberty. Everyone has a right to liberty and security and nobody should be deprived to it except if it is in accordance with the law. This act was breached under ECOHR due to the absence of legal safeguards of mental health patients (jevde and surrey cc), by depriving a mentally incapacitated person by placing him in a care home and not allowing him to return to his own home. Article 6 says that everyone is entitled to a fair and public hearing within a reasonable timescale by an independant and impartial tribunal established by law (Ball and Mcdonald,2002).

Article 8 is a right to respect for his private and family life and the court held the act as it sometimes a positive obligation on the state to provide support for asylum seekers (Brammer,2010). The courts said that the LA failed to assess the physical and psychological needs of a 95yr old woman who was to be returned from the hospital to a care home, therefore it breached article 8. Article 14, “is the enjoyment of rights and freedoms set forth in this convention shall be secured without discrimination…” Ball and Mcdonald(2002).

The legal context of social work is important because it provides duties and powers for social work and it provides an understanding of the statutory and legal requirements for effective and fair social work practice (Brammer, 2010). Without an understanding of law, professionals would not be able to deal with certain situations and the majority of vulnerable people would be experiencing oppression and treated unfairly. A duty is usually indicated by shall or must and it is imposed by law therefore it is a mandatory to carry it, for example, a duty to investigate and carrying an assessment after suspicion of abuse (Brammer: 2010).

Power constitutes what may, but does not have to be done (Mandlestam: 2009; p97). It provides the authority to act in a particular way but there is a scope to decide how to act (Brammer:2010;p17). Not every country operate with social workers, others use police, relatives even the Mayor (Bean:1986). Some families use power structure to control the family and this could be due to cultural background for example male having power over women.

The second part of my assignment will be focusing on the National Assistance Act (1948), The National Health Service and Community Care Act (1990). The community Care Act 1990 was established to end the existing poor law in order to assist the person in need for example, the disabled, sick and the old age persons. This was done by the National Assistance board and the local authority. Compulsory removal from home outside the terms of the Mental Health Act 1983 can be affected. There is power of removal from home under section 47 of the National Assistance Act 1948 when a person is unable to look after themselves as well as if they are not receiving proper care and attention from their carers. The removal may be breaching that person’s human rights under article 6 of the European Convention. If people fail to cooperate and there is continuity of uncaring, the social worker would then have the power under section 48(2) of the NAA 1948 to enter the premises in order to carry out their duty.

Community Care Act 1990 governs the provision of community care services for vulnerable adults for example the older people and disable people. The National Assistance Act 1948 sec 29 defines disabled people as, “aged 18 or over who are blind, deaf or dumb or who suffer from mental disorder or any description, and other persons aged 18 or over who are substantially and permanently handicapped by illness, injury or congenital deformity os such other disabilities as may be described.” Ball et al 2002 said that, it is a duty to assess an individual need for community care services according to section 47 of the NHS and community care act.

The assessment that social workers carry out for Mr and Mrs Bertram is to make sure that an individualised package of care is provided. Assessing a service user is a way to gather relevant information inorder to make a care plan. Mrs Bertram has always want to live in her therefore the service that the social workers would be providing would have to allow her to live as independently as possible in her community rather than in a residential home. According to Davies (2000), the assessment will cover the service user’s health needs, physical, mental capacity, emotional needs, financial support, suitability of living environment and carer support. The resources provided should make the Bertram family feel enabled rather than feeling oppressed.

The process should be client based. Working with older people is rewarding and challenging because it affects their social, spiritual and emotional wellbeing and at times it will be hard to understand their complex situations that is why they should be client based. Carl Rodgers ( ) listed the three core conditions pf person centered practice. He said that a social should have unconditional positive regard and congruence and being empathetic. He said that to understand someone’s situation is walking in their shoes, understanding the nature of their experience and their unique point of view. By putting the service user at the centre is also by making informed choices as well as working in partnership with Mr and Mrs Bertram and other agencies. Section 45 of the Health Services and Public health Act 1968 contains a power to promote the welfare of older people (Ball 2002:p111). Mr and Mrs Bertram would benefit to services like meals on wheels and domiciliary care. Section 47 (2) of the National Health Service and Community Care Act 1990 requires the Local Authority to identify people whom they are in the process of assessing as disabled (Ball, 2002;p112). The local authority’s duty to the Bertram is to provide an adaptation in their home by providing facilities that can suit them for the greater safety, comfort and convenience of the family.

Mr Bertram could be facing serious threat in his marriage by not understanding what his wife is going through. He is facing a gradual loss of the woman he has lived with and that could be distressing him. The service that social workers provide should not discriminate and the service provided should not contribute to it. Social workers need to help Mr Bertram understand the condition of his wife for example attending the user and carer support groups run by the alzheimers society. This will help him to understand the condition of his wife especially when it is coming from other people facing similar life changing experiences.

Social workers can also help the Bertram with benefits issues or even advising the family to contact the local neighbourhood or citizen advice bureau regarding the financial status. Mental capacity act has brought in a standard test for mental capacity and so long as Mrs Bertram retains capacity, she can under this act appoint someone such as Mr Bertram of one of her daughters with lasting power of attorney who could write an advance directive, both to be applicable should Mrs Bertram be assessed as having lost her mental capacity.

Within my assignment I will demonstrate my knowledge and understanding of safeguarding and critically explore safeguarding and what this means in the context of working in social care today, and the impact on my role as a newly qualified social worker. I will refer to adults with a learning disability in order to examine some of the issues and dilemmas that may occur. I will examine these areas within Thompsons PCS model (Thompson,1997) in order to reflect the intricacies and dilemmas with safeguarding adults.

Although anti discriminatory practice and anti oppressive practice are often interchanged with each other, Braye and Preston- Shoot(2005) maintain that they are very different. Anti discriminatory practice challenges discrimination within a very clearly defined framework whereas anti oppressive practice is about challenging values and beliefs. According to Thompson(1997) oppression can be examined using a model that considers (P) personal (C) cultural and (S) structural, the PCS Model. This model examines oppression on 3 levels. Personal is regarding and individual, their views, beliefs and actions. Cultural is the community level and structural is regarding the socio-political and institutional level. Only by understanding power and control can we practice in anti oppressive way, by challenging the power structures on all levels personal, cultural and structural.

People with learning disabilities have been a marginalised and oppressed group who have constantly struggled for their voices to be heard. Pam Evans cited by Swain et al(1993)identified assumptions made by non disabled people which included ideas that disabled people “want to achieve normal behaviour”; “resent able bodied people” and “never give up hope of a cure”(p.102).These assumptions are based on personal beliefs, borne out of cultural ideas of disability and structurally based philosophies of disability. The medical model of disability has been the predominant model in understanding disability(Swain el al,2003) from incarceration in hospitals and in some respects to services provision today. These responses have only served to re-inforce beliefs of disability such as those Pam Evans discovered. Although there was growing concern amongst civil rights movements regarding the medical model, Mike Oliver(1983) coined the phrase social model of disability. This social model of disability led to a shift in thinking about disabilities, that it was societal attitudes that were disabling rather than matters relating to the individual capabilities(Swain et al,1993). Although the social model of disability is the accepted model particularly within social welfare the doctrine of the medical model is not easy to unlearn. Although on a structural level there have been changes in legislation and policy such as Disability Discrimination Act 1995; Community Care (Direct Payments) Act 1996; Human Rights Act 1998; Mental Capacity Act 2005 and Valuing People 2001.Putting these changes in to practice from a personal and cultural perspective is more complex and this is typified in safeguarding.

. The term “vulnerable” has become synonymous with safeguarding. The immediate connotations when using the word “vulnerable” are stark. It immediately suggests weakness, helplessness and the person is at danger or at risk(Williams,2006). Crawford and Walker(2008) also recognised that there are significant risk factors when exploring vulnerability – the person is usually socially isolated, the person has previously been at risk of abuse and requires practical and / or emotional support. In the policy document No Secrets(DOH,2000) there was an initial recognition that some groups of adults were more likely to experience abuse and the term “vulnerable adult” was used as a definition of the groups potentially at greater risk.

Although there has been a shift to try to better understand the term “vulnerable adult” The Association of Directors of Social Care (2005) wrote in their policy framework document “they include adults with physical, sensory and mental impairments and learning disabilities…”(p.4) they continue..” when an adult in this group is experiencing abuse or neglect this will have a significant impact on their independence, health and wellbeing.”(ADSS,2005,p.4).Yet I would argue anyone who experiences abuse or neglect, there would be significant impact on their health and well being and we should be striving to ensure all individual’s safety. Martin(REFERENCE) also suggests that this link with safeguarding and vulnerability and illustrates this well. Often the link with safeguarding and vulnerable adults, is with specific groups of individuals – people with disabilities, older adults etc. increasing the stereotypical view of groups and so increasing discrimination and oppression(Williams,2006). Whilst the shift in policy documents is from protection to safeguarding vulnerability and its use is still debated.

In October 2008 the Government launched a review of the No Secrets guidance. This guidance originally came in, in an attempt to “give guidance to local agencies who have a responsibility to investigate and take action when a vulnerable adult is believed to be suffering abuse.”(DOH,2000 p.7) It was intended to utilise good practice locally and nationally and offer a structure for the improvement of inter-agency policies, procedures and joint protocols. There are a range of barriers which impede good interagency working – Different core functions; cultures and practices between agencies; lack of clarity in lines of authority and decision-making; historical or current rivalries between agencies; different and conflicting social policy or legislation; lack of clarity about why agencies are involved and poor communication (Edwards et al, 2009).The repeated missed opportunities of inter agency working have resulted in disastrous outcomes for many individuals, despite the repeated findings of investigations(Flynn,2007;Bichard Report 2004;Lord Laming Report, 2009), inter agency working has been a constant blight in social welfare. As a practitioner I acutely aware of the challenges and the importance of partnership working, as well as the devastating impact resulting in deaths and shattered lives if we fail in this arena.

Some consider that there is a lack of legislation which directly covers safeguarding adults(Action on Elder Abuse,2009 and The Law Society,2009). In an article in Community Care (July,2009) Despite legislative reform being highlighted as a key area by respondents of the No Secrets review the Government have failed to implement specific legislation regarding safeguarding and the protection of adults. Some would argue there is a growing need for specific legislation regarding safeguarding. The recent report from Action on Elder Abuse(2009) to the consultation review of No Secrets(DOH,2000) there was an overwhelming request for legislation specific to safeguarding. Whilst others feel there is a lesser need than in children’s legislation, which is specific about statutory duties and responsibilities of local authorities regarding safeguarding, another arm of the debate is there have been missed opportunities to link and use current legislation effectively(Pritchard,2008).

Legislative reform has universally followed from child protection and child safeguarding. In recent years, the government has taken steps to progressively tighten up the law in this area. The law in this area has often been introduced as a reaction to events and as a result is viewed by some to lack coherence(The Law Society, 2009). Recent changes have occurred in order to address some of the gaps perceived. The recent introduction of the Safeguarding Vulnerable Groups Act 2006 is an example of legislative change that was a direct result of the murders of Holly Wells and Jessica Chapman. The perpetrator, Ian Huntley had a history of contact with police but a catalogue of system wide communication errors and intelligence sharing errors were identified (Bichard,2004).But as with any system, it is only as good as those who use it, and often investigations find it is not the procedure or system but those who use it who are at fault. Sir Michael Bichard(2004) who headed the inquiry into the Soham murders stated there were flaws in the system for creating records as well as the guidance and training offered to those inputting and deleting information. Cornwall hit the headlines with the case of Steven Hoskin who was murdered in 2006.Flynn(2008) described systemic failures of agencies to recognise Steven Hoskin as vulnerable adult and share information for a co-ordinated approach of intervention.

In 2006 the government introduced the Safeguarding Vulnerable Groups Act 2006, which laid the foundation for the new Independent Safeguarding Authority, which has enabled the introduction of the vetting and barring scheme(H.M Government, 2006). The new vetting and barring scheme may to some extent be rendered ineffective as a result of the recent expansion of the European Union. Unrestricted working rights means a more mobile workforce and for some there are no formal procedures to require notification or registration of matters occurring in individuals home countries, that would have required notification to the Independent Safeguarding Authority had they occurred in the UK(Soret,2009).

In Scotland in 2007 specific legislation was introduced but this is still yet to be proved as improving safeguarding. Some professionals in Scotland believe there are still those dilemmas about rights and risks(REFERENCE) that some in England feel would be addressed with legislation. Interestingly it isn’t just the professionals that feel the legislative changes don’t go far enough. Advocacy groups such as Action on Elder Abuse and The National Autistic Society are just two of the organisations calling for tighter legislation on safeguarding. Action on Elder Abuse refers to some key issues regarding the No Secrets review regarding timescales; sharing information; key responsibilities and recognition of some of the complexities and circumstances surrounding abuse and call for a system which recognised these complexities(REFERENCE).

The newest dimension to safeguarding adults has been the eruption of personalisation. Duffy and Gillespie(2009) maintain that personalisation will make people safer. They maintain by strengthening citizenship and reducing social isolation will reduce risk and by empowering people to take control of their lives enables people to increase their resilience. Personalisation also challenges the cultural and structural concepts, particularly misconceptions of groups of individuals such as people with learning disabilities. Rather than maintaining the medical model of disability where it is perceived a person with a learning disability has difficulties simply because of their cognitive functioning, it highlights the social model of disability where a person’s needs are not well catered for by societal structures(William, 2006).

This is probably the area which is currently leading to much debate and discussion particularly in the area of support for adults with learning disabilities as this is where the ethos of self directed support was born(REFERENCE).There are numerous arguments currently being circulated regarding the perceived risks of individuals and families being in control of their service provision in whatever format they choose(REFERENCE) and the decisions people can make regarding checking and therefore reducing the influence and control from statutory servicers.

I believe that the current tension is borne out of a misrepresentation of personalisation. Fitzgerald(2009) cited in Community Care magazine(2009) that personalisation has been viewed simply as “cash for care”, rather than from the principle of seeking to ensure that an individual is in control of their life, as much as anyone can be. This coupled with the view that safeguarding and personalisation are opposing viewpoints is causing the dilemmas of personalisation. The narrow focus on ‘cash for care’ models is preventing the much wider debate about citizenship rights in the context of social and health care. Consequently, we must start from the premise that any support package or service must be as safe as possible, constructed with a full understanding of the nature of abuse, its dynamics, and the factors that may give rise to it. That is not the same as removing risk, because to do so would make living impossible.

If we are committed to safeguarding then risk reduction is vital. We must refrain from individualistic concepts of risk through the notion of ‘vulnerability’. Instead of focusing solely on the protection of ‘vulnerable’ individuals, we must see beyond ‘vulnerability’ and aim to eliminate conditions that create risk. Interventions should be enabling and widespread, targeting social processes that are responsible for the creation of risk(REFERENCE). The focus on impairment as the main risk factor to abuse entails elements of a medical model approach to disability. This is too narrow a focus, but an ecological approach, takes into account both the individual and social causes of risk and of the interactions between them. Social model researchers and practitioners suggest that the safest way of protecting people with learning disabilities is to enable them to increase their self determination(McCarthy, 1999; McCarthy and Thompson, 1996; Hingsburger,1995). Self determination is shaped through social interactions and citizenship providing a tool for identifying areas for effective risk prevention interventions. We need to be clear that rights to choice and control are not irreconcilable with a right to protection. After all each citizen has rights, choices and control and equally have recourse within the law should protection be required. It is perilous to imply that safeguarding and personalisation are opposed or in conflict. People cannot organise their own care and support, or accept such care and support, if they do not feel safe and consequently a personalisation approach must have safeguarding as an integral part of its operation. Not because a person is classified as vulnerable, or because a person requires community care services, or has a learning disability but because ethically and morally for the sake of social justice it is the right thing to do.

A social worker’s role is to provide support for people who have been socially excluded or are experiencing crisis. They maintain professional relationships with service users by acting as guides or critical friends. There job includes working with people as well as working closely with other health and social care staff, such as nurses when a child has been in hospital.

Social workers job includes working in a range of settings with relevant legal laws and procedures, supporting individuals, families and groups within the community. The different settings they might work in may include client’s home, schools, hospitals and other public sectors and voluntary organisations.

There job also includes working with young people and their families, work with young offenders, people with mental health conditions, school non-attendees, drug and alcohol abusers, people with learning and physical disabilities and also the elderly. The Government legislation focus’ on the combination of health and social work services, which means that social workers often work in multidisciplinary teams.

Duty of a Social Worker

The duty of a social worker is to ensure that all families are together and are in the best relationship possible, they also ensure that all children are treated well, and if not they try their best to find a home for children. They also have the duty of keeping children safe from harm that has previously been attacked. There duty is to provide guidance and support for all users of the service and helping the users to gain confidence and support in them.

Day to Day Activities

The day to day activities of a social worker includes carrying out interviews with service users and their families to access and review their situation. They also offer information and counselling support for the clients and their families, they also recommend and sometimes make decisions about the best course of action for the client. Social workers also make referrals for their clients for example referral to rehab if they have drug issues. They also maintain records and prepare reports for legal actions, by for example giving evidence to court and participating in meetings to provide the best service possible.

Skills and Characteristics

Social workers need to have certain skills and characteristics in order to full fill their duty. Having the qualities of a social worker enables them to gain job satisfaction. The skills, characteristics and qualities that a social worker needs to have is to be good at problem solving, this is because there are many situations that will occur which need good problem solving. They also need to have the skills of being a positive person, being committed to their job, being socially competent, good time management and good communication. Being able to negotiate is a vital skill which is needed to have the skills and characteristics of a social worker and being able to work in a team and co-operating when necessary.

Social workers also need knowledge and understanding of legislations and legal procedure, but if not then this can be known whilst in training or in education.

Responsibilities

Social workers have variety of different responsibilities that they need to carry out professionally. They work with different aged clients and therefore their responsibilities differ from age groups. However the main responsibilities that they need to carry out are supporting clients, guiding them, advising them and helping people accept that some situations cannot be changed. They need to ensure that they maintain confidentiality about all clients and do not share any information without the permission of clients or they are able to share information with who they think it’s important to see.

Social workers are able to work either private or public sectors. However are commonly employed in the public sector by local authorities. This is because there is always a need for social workers as there are not many left The Independent [2001] states that children are in danger because of the lack of social workers.

Social workers are funded by the government through the local authorities. This is because they work in different locations such as, social services, hospitals, homes etc and therefore these departments have the major component of British local government expenditure.

Teamwork

Teamwork is very important during life as working with a shared group of people helps to gain success. Teamwork can be done by anyone; it can work for social workers or clients. Teamwork is very important in terms of the role of a social worker because they need to take care of all clients in the workplace and make sure that everything is up to professionally standard. Teamwork is important to maintain confidential information on the development of clients with themselves and other co-workers who need to know all this. They also need to write reports on the progress of clients and families.

Without teamwork social workers will not be able to help clients progress, the better a social worker knows their client and the situation, the better they are able to help them progress and support themselves. Social workers need good communication skills as they work closely with doctors, health visitors and child psychologists. An example where social workers did not work as a team was the case of Victoria Climbie who died because of severe physical abuse.

Images of social workers:

The above images show that social workers work with young people helping them through their problems. They also work with people with mental health conditions, school drop outs, drug and alcohol abusers, people with learning and physical disabilities and also the elderly.

Status

Status means a person’s position in a particular job. Their value in society, it is based on peoples success, gender, money and education.

Questionnaire

I carried out a questionnaire to find out what society thought about the status of a nursery nurse. To do this I had asked 10 candidates to complete my questionnaire.

The results showed that 10 out of 10 candidates said that the job role they consider to hold a higher status between a social worker and nursery nurse was social worker. This indicates that social workers have a high status. In addition to this I found out that 10 out of 10 candidates said that social workers have more social importance in society, because of better pay, better terminology and they have more responsibility, this shows social workers are better than nursery nurses. Furthermore I found that majority of the people said that having high level of qualifications gives you a boost on the status ladder because they are then more experienced in what they do. When a person has a degree in such a subject they are seem as ,more important in society than a nursery nurse because you can be a nursery nurse at only doing GCSEs whereas social worker you need to be a graduate. They also said that status refers to how skilled you are in the society because if a person has been in education for a long time they think that, that person has more knowledge in the specific area. Therefore having a job role title has an effect in society on the status ladder so from a social worker and nursery nurse the majority said social worker.

Overall my questionnaire shows that majority of my candidates consider the job role of a social worker to have a higher social importance than a nursery nurse. The variety of reasons why this is the reason is mentioned in the above paragraph. Therefore this questionnaire indicates that social workers do have social importance in society than a nursery nurse, mainly because social workers need more education in their specific work area.

Approval

I have researched 5 articles from different newspaper and websites that referred to what the media thought of social workers. I have done this to see how the media might portray a social worker to the general public. This will affect status.

The Guardian, (2010), implies that social workers are not carrying out their job properly. This shows that social workers are looked at negatively. The article is based on Baby P who died at 17 months due to being physically abused in 2007. The Guardian (2010), states “Staff at Haringey council in north London wrongly concluded that the toddler’s injuries were probably caused by lack of supervision and so used “wholly inappropriate” methods in his case”. This suggests that social workers are not carrying out their job properly. In addition the BBC (2002), also implied that social workers are failing to do their jobs correctly. The BBC (2002), informs “two social workers at the heart of the Victoria Climbie child abuse scandal have been sacked for gross misconduct”. The Free Press (2010) states “A social worker that admitted failings across the whole range of his practice, while part of a team working with Blaenau Gwent’s most vulnerable children, is beginning a two-year suspension”. This shows another negative view of social workers. However, The BBC (2010) shows that social workers are doing there very best in order to ensure that a child is safe at home, this shows a positive side to a social worker.

In conclusion the above evidence suggests that the media perceive social workers as not carrying their jobs out correctly. Although there was some positive articles found the majority articles were negative, therefore this shows that the media can strongly affect the status of a job role through the way it is communicated to people, it might be said the job role ‘Social Worker’ has a low status, therefore the media affects status.

Qualifications

The qualifications that a social worker needs to have a three-year honours degree or a post-graduate qualification in social work. They need to have 200 days of practice learning. This ensures that people have the practical skills required of them, they also have the first 6 weeks of employment social care workers will be given initial education training, which helps to extend skills and experience for social workers. Other qualifications that are needed is the National Vocational Qualification (NVQ), which has now become a part of the qualifications needed for employees who want to have a career in social care.

Qualifications that may benefit social workers are being educated further in the specific area they are working in and obtaining experiences. This is because the more a person knows and understands about being social workers the more they will be able to achieve satisfaction in their job. The more qualified a social worker is the more they are able to go up in the status ladder.

Career progression

Having a social worker career gives many opportunities to go into a different route for a career such as being a counsellor because of they can use the skills that has been gained from social working, they can become a team leader or manager in the setting.

Social workers can progress in their career by choosing to gain some other qualifications such as working in different settings e.g. working with public, private and voluntary sector as this can progress their career. By working in different settings this can help in understanding how to carry out different job roles in different settings for example working directly with the people e.g. as a councellor. They can also progress by taking other different roles such as more managent roles e.g. working as a team leader.

They can also change and progress career by working in the same role but working with a particular group of people to be able to widen their experience and specialise in a apraticular area such as working with children with learning disabilities.

Local factors

In this section I will be evaluating what I have researched about local factors that affect job opportunities in my area. Local factors, which influence job opportunities, are; job vacancies, transport such as buses, taxis, cars or cycles. It also can influence or affect job opportunities because of housing, the workplace and also because of jobs.

In the Lancashire area there are many Social workers jobs available in large places. Therefore, social workers from smaller towns are able to access larger communities were more jobs are available.

Qualified social workers in the public sector in England are eligible for help so there are able to buy homes near or away from work. Housing is a problem for all most every job if they are in big cities such as London, Manchester. This is because the housing prices are high and therefore some people cannot afford it and so they might lose out on the job or they pay extra on transport to get to and from work, and therefore this affects job opportunities.

However if workers receive help from the government then this can enable social workers to get jobs in bigger areas such as London where jobs are always available.

However forensic social worker jobs are available because they are recruiting qualified forensic social workers. These are provided by a private hospital in Bury. This gives social workers a possibility to provide services to the patients in the hospital.

In Lancashire there is a shortage of social workers due to previous cases such as Baby Peter and Victoria Climbie, because of these cases social workers are not put under pressure as they cannot allow the same situation to happen again as this will result in extreme measures such as public not being able to trust them and they all lose their jobs. As a result of shortage of staff there is workload on all staff because there has been a high rise in cases. As mentioned before in the approval section, many people do not want a career in social working because of the negative images that the media has portrayed about them. There are around 323 children in Lancashire are being cared for in other parts of the country, as there aren’t enough social workers in this area.

Research has been done on social workers and to see what has happened due to the shortage of them, and from the community care case-load survey [2010], it can therefore conclude that social workers have 40case loads each because of the rise in cases. This can affect job opportunity because this can cause problems for clients and social workers themselves because they may be under stress leading them in not being able to provide the best service for clients. This can affect job opportunity because some workers may not be able to cope with the workload and therefore leading them in not staying in a job like this.

National and Political Factors

In this section I will be evaluating what I have researched about the National and Political factors that affect job opportunities. The 2010 spending review states that about 490.000 public sector jobs are likely to be lost. Social workers faced 25% cut in October 2010 spending review, it results in a funding gap of ?2.2bn and this way only one in four elderly people will receive help from the council. This shows that social workers will not be able to care for all clients that need help and support.

As a result of the job cutsjob opportunities have been affected because social workers job are not be available in smaller areas. 1,000 jobs are expected to be cut in 2010 and 2013, so ?80million can be saved. This shows that job opportunities are affected because there will be jobless workers who might not be able to find available in smaller areas.

The 2005 European directive stated that social workers need to operate at both local and global levels. This means that they need to be aware of both local and global levels so they are able to work in different settings. The 2005 European directive introduced a new degree level professional qualification. After this was introduced almost, 10,000 social workers had applied to the UK, in order for them to gain the practice that is needed for this job. This shows that job opportunity has been affected because many social workers applied for this degree level professional qualification and therefore there will be many of them applying for jobs however they may not be enough for everyone.

Many people may be attracted to this job role because social workers are entitled to non-repayable bursaries through the NHS Business Services Authority Prescription Pricing Division. This affects job opportunity because more people will want to work as they don’t need to pay for their courses as it is NHS funded.

Public sector workers face pay freezes and potential job cuts in the emergency budgets. This hits around four in ten workers including social workers. This shows that social workers are not getting paid for their job which affects job opportunity because they are not getting paid.

Demographic Factors:

Demography means the study of human population in a country for example in the UK, this research would include aspects such as world population, composition, birth, ageing, migration, race, death and change over time. This is used by governments and other non government’s organisations because the government need to understand and study more about the populations so they are aware of the countries condition such as the economic market research. For example if there are a rise of births in the UK then there might be a rise in child abuse therefore they need to ensure enough social workers are available.

The changes in the population affects job opportunities because as the population keeps growing then the more people there will be wanting jobs, therefore there may be lots of people who want the same job, however cannot get the jobs because the job availability may be limited. Social workers are more known for having female gender workers as high as 79% whereas male workers as low as 20%. This might be because people think females have better connection with people, as they are fairly positive and are good at problem solving and multi-tasking.

Research shows that in 1993 women aged 20-24years were in cohabited relationships and having children. Therefore this shows that there are a number of children increasing, this can lead to more social workers needed if there are children e.g. getting abuse or have drug issues etc. This also can suggest that if there are not enough social workers then the workload for social workers can become high because in some areas such as in Lancashire there is a shortage of social workers.

The BBC News [2009] suggested that there is a lack of social workers because in 2008 there was up to a third of posts that were unfilled. This shows that social workers are needed but people are not taking these posts, maybe because of the pressure it puts them under. This shows that job opportunities are affected because there are people who are not taking the available jobs.

The social workers that have a high age have more experience in the social worker industry. The diagram shows that 25years or more have 20% more experience and therefore this may stop from younger workers in getting a job because the elder generation are not leaving their job because they need to provide [look at appendices]. The more experienced social workers the more experienced circumstances will be seen and be able to act accordingly without fail.

Development of New Technology:

It is important that everybody who works in both public and private sectors to gain new technology skills as this is created to help people in their daily lives. Therefore it is important that social workers use the skills required, this is because social workers can use computers to gain better access to their case studies rather than looking through a pile of papers. It is also important that even though new technologies are created for both work and home purposes it is important they have a back-up of what they do. This can affect job opportunities because there may be social workers who are much older and are not aware of the new technologies and therefore they cannot carry out their job properly or they may be made replaced.

Social workers need to have IT skills because they will be able to update, change remove any information very quickly and easily. Social workers can just type a name in their database and all the information that is required will be there depending on who inserted the information.

Conditions of work

Social workers have choices whether they want to work full time or part time, this is because they will have different job opportunities. For example a social worker who is doing a part time job, can also complete a part time qualification such as a masters degree.

The working conditions that a social worker, works in are part-time or full-time. There working hours are normally 37 hours per week. However in residential settings this may be different hours, depending on which clients they are working with.

Social workers have a lot of paper work that they need to do and interviews that they need to do and review and therefore this can be both emotionally rewarding if they win a case but there job can also be very demanding. Therefore the work conditions are different depending on the person and the work place, for example in some areas there is a shortage of social workers and therefore other social workers have a heavy workload.

Pay

Social workers get a good pay, however the more the experience and qualifications the more pay they are entitled to. For example a social workers starting salary is approximately ?19,500 in the UK. However the more experience and qualifications some social workers are entitled to get a pay of approximately ?40,000 per year. This shows that they pay is good for beginners and the more experienced and also for the public sector because they get paid more than those in the private sector, research showed this.

Holiday

Social workers who work full-time have a statutory right to 28 daysHYPERLINK “http://www.adviceguide.org.uk/index/life/employment.htm”‘HYPERLINK “http://www.adviceguide.org.uk/index/life/employment.htm” paid annual leave, including bank and public holidays. Other workers who are pert time also have holidays but this may not be paid leave. They also get paid on paid leave, this is approximately 5.6 weeks. This is similar to what a teacher gets when they are on holiday however primary teachers, high school teachers etc get more holidays, this is because when students have holidays, teachers do to, even though it may not allow them to have a holiday because of the amount of work they might need to mark. Therefore this is good for social workers because there has been research done and shown that social workers in the public sector have more days than those in the private sector.

Hour/Work pattern

Working hours are normally 37- 40 hours per week, 5 times a day. They work from 8am – 5pm every day.

Job security

Social workers all have good job security because the telegraph showed that there is a “continued high demand and pressure on social services and healthcare,” However though there is a high demand for social workers, there are many workers who have left the job because of the pressure and stress that has been put on them and therefore they left. Therefore this shows that to some extent there is job security, however this is not the case all the time.

Pension rights

When social workers work in the public sector some of their wage gets taken of them and straight into their pension account for future needs, this is money that workers in a public sector do not see. However in the private sector the workers themselves have to inquire on their pension schemes. However research has shown that ‘social workers have to pay an extra ?75 a month in to their pensions if the government’s plan to increase employee contributions goes ahead in 2012’.

Over time

Four in ten social workers have ‘unmanageable’ caseloads therefore they work overtime and some organisations give overtime pay whereas some do not give overtime pay. However sometimes, some organisations pay social workers if they work overtime however it’s not very easy to get.

Job satisfaction

Job satisfaction is when an individual is content with their profession. When someone feels he/she is capable and has value within their job, this helps them feel worthy of recognition.

One way to achieve job satisfaction within a company is to promote the employee’s teamwork qualities, as this motivates the individual and is a good way to build his/her satisfaction. It is crucial that his/her colleagues help handle work problems and offer support. Consequently, this encourages people to feel their work is meaningful, honourable and so it allows the individual to respect others surrounding him as well as build a close relationship with colleagues. In order for a social worker to gain job satisfaction they need to be assertive and be able to negotiate on behalf of their clients and co-workers. Being able to analyse and assess situations shows that an individual is good at their job and shows they enjoy it, as they know what they are doing, this shows that social workers can gain job satisfaction by being fairly confident in the way they carry out their job, managing their time well and at the same time being reliable to finish a task when given.

Another way for an individual to not have job satisfaction within a company is when they are not promoted by the employee’s teamwork qualities, as this stops motivating the individual. Also when there pay is not enough for them, they may start to slack in working, as they want to get the pint across that they are not getting paid enough for the job they are carrying out. Or someone can not be satisfied in their job because they haven’t got any friendly co-workers and the atmosphere is not a great place to be, therefore this can lead to dissatisfying job role. For an individual to gain satisfaction in their job they can improve the environment by trying to communicate with other co-workers and see whether they have any similar attractions or dislikes, they may work together on a case given to them to work as a team, they can listen to each others ideas to help the case to be finished.

Client outcomes

The outcome that social workers want is for all service users to have the best service provided. Their outcomes also includes offering and referring clients to relevant services, to be able to support and guide their clients and make them able to be on their own at times. It is important that social workers achieve all their outcomes because if they have not then it can lead to unprofessionalism and cases like Victoria Climbie and Baby Peter.

Stressors

Stressors means when an individual is taking on an activity, experience, condition, or a job situation, which causes them to stress. For example; Social workers have a lot of stress and things on their mind because of the amount of workload they have to deal with, role conflict, role ambiguity and family conflict. Other pressures related to being a social worker are having a tight schedule and also job performance as social workers are stigmatised by the media for not doing their job properly so this puts more pressure on them. The Guardian, (2010), implies that social workers are not carrying out their job properly. The article is based on Baby P who died at 17 months due to being physically abused in 2007. The Guardian (2010), states “Staff at Haringey council in north London wrongly concluded that the toddler’s injuries were probably caused by lack of supervision and so used “wholly inappropriate” methods in his case”.

Another stressful factor is trying to maintain a good relationship with bosses, colleagues and their clients. If job-related stress is severe this can result in physical, mental and emotional exhaustion. This type of job related stress occurs mainly in individuals who feel that they as a person and the work they do are not recognised. Research from oxford journals shows social workers who found their job satisfying felt that it was much pressured and that this adversely affected the service they provided. Social workers have indicated high levels of general anxiety. The psychological health measures have also found that in these professions if people do suffer from exhaustion they can perhaps go on a sick leave as they are known to take twice as much sick leave from work. The Daily Mail (2009) ‘social workers take more sick days than any other public service professional.’

Anti Discriminatory Practice

Anti Discriminatory Practice is a system to help fight against discrimination in the workplace. This practice helps prevent discrimination against race, class, gender, disability, age, homosexuality, domestic status, transgender, carers’ responsibility and others. This practice takes into account how an individual behaves towards other individuals in the work place and out of work places. All employees in the social worker sector take on this practice so there is no discrimination on the work grounds and promote equality for the employees and its clients.

Sex Discrimination Act

The Sex Discrimination Act helps protect females and males from discrimination. This Act protects people from being discriminated on the basis of gender, marital status, pregnancy, work accommodations, services, facilities and many more. This act also creates quality for both males and females in the work place. This is an important law within the social work grounds because it is important for all employees to treat everyone equally without discriminating who they wish to work with.

Race Relations Act

The Race Relations Act is a Law in the work place that prevents discrimination on the grounds of race. This law includes protection from discrimination of race, colour, nationality, ethnic or national origin, and many more. This is so that males and females from any ethnic background have the same equality as others in the work place. Social workers work with different people around the country, they will meet different people with different ethnic backgrounds and it is their job to make sure that all people are safe from abuse and discrimination.

DDA 1995

The Disability Discrimination Act is a civil rights law, which prevents discrimination of disabled individuals, and has the same equal rights as others in the work place. It is important that people maintain these rules and regulations for the protection of the workers in the work place. Social workers help different people, these can be able-bodied people or disabled people and it is their job to take care of everyone from abuse and other forms of violence as disabled people are more prone to it.

The health and safety (first aid) regulation

Health and safety presents regulations on the responsibilities to preserve safe, clean and protected work surroundings. In the social worker department it is necessary for them to carry out first aid, risk assessments, working safely in the kitchen and many more to keep themselves and others from risk of infection and disease.

Workplace (Health, safety and welfare) regulations

The workplace regulations 1992 state that the workplace should be safe and secure for the employers and others who are present at the work place. Therefore it is important for social workers to take care of co-workers as well as clients who are present in the building or they will be responsible to what happens.

Criminal Records Bureau (CRB check)

The CRB service enables workplaces in the public, private and voluntary sector to make safe rec

There is a lot of discussion of how disability is described. The literal meaning of disability is “difficulty with ability”. This implies some form of mental or physical impairment that can manifest problems with mobility or awareness. According to the Disability Discrimination Act 1995, disability impairments can include sensory impairments such as hearing or sight, mental impairments such as depression or learning difficulties and physical impairments such as wheelchair users.

People with disabilities may face problems, and not only because of their particular impairments but by social factors such as attitudes, stigma and physical obstructions, for example, ease of access to buildings or transport. The description of disability has varied over the years but the Disability Discrimination Act 1995 describes it as,

“he/she has a physical or mental impairment which has a substantial and long term adverse effect on his/her ability to carry out normal day to day activities”

Thompson and Thompson (2008) state that historically, people with disabilities were considered “tragic, different or in some way devious”. They were not allowed to work, mix with others or travel and many were placed in asylums. Ingstad and Reynolds, (1995) claims that, media representation of disability often relates to insanity and evil. This is evident in such things as super hero movies, where the bad character is often portrayed as physically deformed or mentally unstable.

However, throughout history there have been people with impairments that in today’s society would have been viewed as disabled, Franklin D Roosevelt, four times president of the United States, had polio. The poet Lord Byron (mad Lord Byron), who was born with “talipes”, known then as a club foot, and whose name today is still synonymous for someone dashing, “Byronic”. Admiral Nelson, known for his great naval victories against the Napoleonic French and particularly the battle of Trafalgar, he is not viewed as disabled although he was blind in one eye and only had one arm. In today’s society he would have been seen as a disabled seaman. But when we look at these people we do not see their disabilities, we see heroes, great leaders and writers. Did society just look past their impairment and just see their achievements?. (Ingstad and Reynolds, 1995).

According to Finkelstein (1980), people with disabilities have existed in comparatively large numbers throughout the world and in different societies for centuries. What is also evident is that the cultural understanding and responses to impairment and disability have varied and still do. There is a real cultural stigma towards people that have any sort of physical or mental difference to the “norm”. This can be traced back to ancient Greek and Roman times.

Finkelstein (1980) goes on to say that, all though the degree of bias has varied from time to time, people’s perceptions of impairment and disability have remained much the same since the industrial revolution in the nineteenth century. The start of the industrial revolution introduced the concepts of urbanization and paid labour. This brought new problems for people who were unable to compete for work. After being scrutinised and labelled by doctors and other professionals, these people were put in to hospitals or asylums where they remained for very long periods and sometimes indefinitely. This kind of treatment carried on throughout most of the western world and all through the first half of the twentieth century.

Drake (1999), states that the Eugenic legacy, which looked at the assumptions of human mental characteristics, was in some way influential in forming a different outlook on impairments. Drake continues, the Eugenic legacy came to a logical conclusion during the systematic murders in the Nazi death camps of thousands of disabled people considered undeserving of life, worthless and a burden on society.

In the 17th century impairments or disabilities were seen as punishments from God, and explained by using religion, superstition, or myths and legend. Some of these beliefs remain to this day such as the belief that a disabled person must have been evil in a previous life and is now being punished. (Campbell and Oliver 1995)

I remember in 2003 former England manager, Glenn Hoddle was sacked from his position for saying that disabled people are paying for sins they committed in a previous life. But in other religious cultures in societies, disability may be seen as being chosen by god. (Campbell and Oliver 1995)

Cultural values and Society can be responsible for imposing disability on someone with impairments. This is mostly done unintentionally or by misinterpretation but it results in excluding people with some form of impairment from participating in society. Therefore it is understandable that disabled people will see themselves, as an oppressed group. To understand this, there has to be a definition between the person with the impairment and the social construction, called disability. (Oliver 1996) What this means is that today’s society defines the impairment as it is seen, i.e. the lack of a limb or limbs, organism or motor functions of the body that are not working properly, and the disability as the restrictions and disadvantages that go with it. Oliver, states that,

“We see disability as the disadvantage or restriction of activity caused by a contemporary social organisation which takes little or no account of people who have physical impairments and thus excludes them.” (Oliver 1996, p22)

The common view today, according to Campbell and Oliver (1995) is that a person’s impairment is the cause of their disability and that their disability is a medical problem that has to be overcome. This refers to the ‘medical model’ approach which focuses on prevention and cure. In many countries this has caused a growth of prosperous and costly industries involved with disability comprising voluntary organisations, drug companies, private businesses, charities and government institutions. These will be staffed by an army of professionals including support workers, doctors, nurses, occupational therapists and social workers. This attitude can have a negative effect on the way society see people with impairments and will result in stigmatisation. In addition to this, if society sees the impairment as the problem, surely it is logical to see that these problems must be cured or fixed in order for them to fit in to “normal society”. The outcome is that, people with disabilities are labelled as “disabled people” this may look like a play on words but what this shows is that the disability is seen before the person. Society sees people with disabilities as, “not normal”, this implies “abnormal”, and further reinforce the stigmatisation and stereotyping of people with disabilities being seen as inadequate and dependant.

Are some people with disabilities more vulnerable than others

According to Hales (1996, p152)

“Prejudice is a negative attitude towards particular groups of people based on negative traits assumed to be uniformly displayed by members of that group”

Hales uses the example, that it is commonly assumed, that younger people with learning disabilities have no interest in forming long term relationships, an adult sex life or having children. Hales describes this as issue as being “social attitude” rather than the physical disabilities faced by the people themselves.

It is difficult to say if some people with disabilities are more vulnerable to discrimination than others as there are so many factors to consider. Cost for example. Barnardo’s (2011) state that, the costs involved in bringing up a child with a disability is much greater than raising non disabled children. Barnardo’s also state that, it may not just be the higher cost of living, no qualifications and unemployment that are causing discrimination. But the fact that living in deprived communities where the understanding of disability is lower than the more affluent areas.

One fifth of children with disabilities live in poverty stricken areas, resulting in social exclusion, discrimination and causing multiple oppressions. (Barnardo’s (2011).

Marginalisation and exclusion refers to people with disabilities not being included in everyday life. This includes non equality in the work place. (Barns and Mercer 2003) state that, while some benefits such as disability living allowance (DLA), are in place to help people cope financially with social and work factors, it can also have an adverse effect by highlighting a dependency on benefits. This again can lead to stigmatisation and oppression. New labour recognised this problem and developed the “welfare to work policy” in 1997. The government documented that unemployment for people with disabilities was far higher than it was with non disabled people. A high percentage of people with learning disabilities live in poverty. 24 % of working age people with disabilities do not have formal qualifications. (HM Government 2011)

The government recognises a link between unemployment and social exclusion. In 1989 the government set up the social exclusion unit (SEU) to improve the educational prospects for children with disabilities. Although this was a step in the right direction, it is worth noting that the minister for education at this time was David Blunkett, who is classed as a person with a disability. (Dan 2005)

When people think of disability they think of the obvious such as wheelchair users. There are some things put in place for people with physical disabilities. Examples of these are wider doors, ramps, higher power points, lower light switches, audio and visual aids, lowering busses and disabled parking (Hales 1996). But in my opinion people with learning disabilities seem to be less understood. Therefore, I feel that, it can be argued that people with learning disabilities are more vulnerable to discrimination than other.

Why do some people reject the disability label and some accept it?

According to Barnes (1991), some people will accept the disability label, feeling that they are not able to cope in society and they are in a sort of limbo, waiting for a cure and the hope that one day they may get fixed. This may be because they have been conditioned by a non disabled society to accept their lot in life; they are broken and need a cure. Some disabled people will obviously want a cure and will actively help in working to find one, thus giving their life some meaning and a reason to belong.

“Some need to succeed in order to belong, some need to belong in order to succeed.” (Hill Country Disabled Group)

According to Clapton & Fitzgerald (1997) this stems back to the medical model of disability that perceives impairment as something that has to be fixed, i.e. a person is disabled because of their individual impairment so consequently they will require medical interventions to give them the skills to adapt in our non disabled society.

There are disadvantages to being labelled as disabled. But there can also be advantages. In my experience, in having dyslexia, (which was discovered while I was at university), I am classed as a disabled student. I do not see myself as being disabled as there are no physical signs of dyslexia and it is something I have lived with all my life without knowing. Initially, I resented the disability label, but in accepting it, I received the help I need to complete my course. Some of my fellow students see such a label as stigmatising, and even though they have similar pattern of difficulties, they did not want to seek help for fear of being labelled.

There are the people who see disability as a social problem put on them by a non disabled society that impairs physically disabled people. It is argued that no one has made a specific distinction between biological impairment and social disability. (Clapton & Fitzgerald (1997)

This is seen as the key to the British ‘social model’ of disability and was originally devised by disabled rights activists in the 1970s. This move forward was developed by disabled people and their own experiences of living with impairment in Western society

(UPIAS 1976)

The social model has been widely acknowledged and developed by disability rights groups all over the world. It is now the foundation and the principle way of thinking in regard to policy-making for countries as diverse as Japan, South Africa and the USA. The social model of disability is not complicated; it just highlights the cultural, economic and environmental barriers experienced by people who are seen by others as impaired. According to Barnes (1991), these barriers can include: education problems, communication issues, problems within the working environments, insufficient disability benefits, social support services, inaccessible transport, housing and public buildings and the devaluing of people labelled ‘disabled’ by negative imagery and representation in the media such as films, television and newspapers.

From this viewpoint it is easy to see why some people will reject the label of being disabled and see their disability as a failure by society to accommodate their personal and combined needs within the confines of conventional society.

(Barnes 1991)

What can be done to effectively counter discrimination?

Oliver (1990).explains that, people’s perceptions of disability and rehabilitation are changing. The 1960s saw the start of this change with politicians, policy makers and social workers realising that the world can no longer look at the disability issue as an individualistic medical problem, (Barnes and Mercer 2003).

One of the reasons for this is that people with any form of impairment, be it cognitive or physical, are seen as abnormal and labelled as “disabled”. The fact is, that these people represent a growing segment of the global population and must be treated as equals.

In brief, this means that the social model of disability is a tool to help us recognise the disablement caused by society’s preconceptions of people with disabilities and help improve policy making. (Oliver 2004)

Ten years ago, Glasby and Littlechild (2002), stated that, what is needed to effectively counter discrimination is to move away from government run professional services. They foresaw a need for greater investment in “user led” initiatives, especially regarding direct payments. This should give thousands of disabled people across the UK a better chance of achieving real independent living.

Glasby and Littlechild go on to say that this could be achieved by setting up a new national body working directly with the National Centre for Independent Living (NCIL).

Along with the distribution of direct payments, this new organisation could produce a standardized assessment for direct payments, reducing mistakes and making it easier for service users.

Barns (2004) explained that, such an organization could also monitor local user groups that provide services for direct payment users. This would also give this new organisation the opportunity to benefit from a wealth of experience and expertise that has been developed by disabled people for over twenty years. (Barns 2004)

The problem at this time was that, the government authorities were reluctant to implement direct payment policy for a number of reasons.

Nowadays, direct payments are offered as a matter of course. During my third year placement in social services, It was actively encouraged to offer this service, in fact, I could not complete a unified assessment without doing so.

We also recognise organisations such as the Rowan. This is a registered charity that provides direct Payment and Personal Budget support for service users. The Rowan has a vision of,

“A society that is fully inclusive in which the barriers, whether environmental, attitudinal or institutional, that prevent disabled people from having equality of opportunity have been removed.” (The Rowan Organization 2012)

As social workers we have the training to act in a non discriminatory way. We follow guidelines in our codes of practice such as, upholding public trust in social services and not unlawfully discriminating service users. Anti discriminatory practice is fundamental to the practice of good social work. It is important not to assume what difficulties people have with their disabilities. This in itself is a form of oppression, as only people with disabilities will know what it’s like to face disability discrimination.

I feel that one of the most important roles as a social worker is advocacy. This will ensure that the voices of peoples with disabilities are heard.

Legislation is main area that can help fight discrimination and oppression. The Equality Act 2010 enforces a duty on employers to make adaptations that will aid disabled people in the work place. This act also makes it illegal to treat people differently because of their disability.

According to Barns (2003), the equality movement and looking into the problems of disablement has brought forward the concept of independent living. This concept was first used in the United Kingdom during the 1970s, after being adopted by disability activists in the USA. These activists called themselves the “ILM” or independent living movement. This movement was partly developed within campuses of American universities and partly from the on-going efforts of the disability activists who were attempting to influence, not only US disability legislation in the 1960s. But also, people’s discriminating perceptions of disabled people.

Disability Wales ran a campaign from April 2010 to March 2011. This was called “independent living now”. This highlighted six main “calls to action” that disabled people had deemed essential in further development of Independent Living. These are:

1. “Improved access to information, advice, independent advocacy and peer support services for all

2. Availability of accessible and supported housing to meet individual requirements

3. A comprehensive range of options and genuine choice and control in how personalized care and support is delivered

4. Improved access to Person Centered Technology (aids & equipment)

5. A barrier free transport system, including all modes of transport

6. Enabling access, involvement and social, economic and cultural inclusion for all disabled people”.

This concept of independent living is a broad one and is usually associated with younger and middle aged people with physical and sensory conditions. But this concept does apply to everyone in the disabled population. This includes people with high support needs and people with cognitive conditions such as learning disabilities and mental illness (Barnes 2003). Because of this, independent living does have some criticisms. My own experience of working with a young man who had learning disabilities was not very successful. This person was granted independent living and was given his own flat. The problem was that all his “friends” did not have any kind of impairment. This was causing real problems as they were encouraging him to spend his disability allowance on alcohol and having parties at his flat. In turn this was causing problems with the neighbours because of the constant noise. This also resulted in him not having any money for food and being drunk most of the time. This was causing him to have health problems, which resulted in him being returned home to his parents.

Conclusion

In concluding this assignment, I have discussed why there is disability discrimination both from an historic and societal point of view and how people are disabled by these views. I have also discussed the different levels of vulnerability and who I feel are the most vulnerable in our society. In addition, I have covered why some people accept the disability label whilst others reject it, and what can be done in the hope of effectively countering disability discrimination.

3249 words
Acts

Disability Discrimination Act 1995.

Equality Act 2010

For my final year I have been assigned to produce a dissertation on a topic of my own interest. During my second year of this course I was at a placement in a Supported Housing organisation. Whilst working there I came across a lot of child abuse issues, in particular child sexual abuse and this is where my interest in seeking more knowledge about the subject came about. I have chosen to focus on the issues regarding the sexual abuse of children and how this affects their life as children and as adults. The topic itself is quite a complex one to define and understand. The issue of sexual abuse began to attract widespread attention as a social issue in the late 1970s. However, the extent of child sexual abuse has only been fully recognised over the last 20 years or so. But exact figures depend on how sexual abuse is being defined. The term child abuse refers in this dissertation to the physical or emotional mistreatment and neglect of children or their sexual exploitation, in circumstances for which the parents can be held responsible through acts of commission or omission (cited in Doyle, 2006). The possibility of child sexual activities taking place arouses feelings of disgust and horror; it is condemned by society as a violation of what is normal sexual behaviour.

I have chosen to structure this dissertation into 6 sections. In the first chapter I will start of by defining and explaining what child sexual abuse is. The second chapter will consist of describing who the perpetrators of child sexual abuse are. I will explore further into their reasons for committing such an offence and if it is linked with their past. Most people who have suffered sexual abuse when they were younger do not grow up to abuse. Jones (2002) states that, a significant minority of those who sexually abuse children have themselves suffered physical and sexual abuse in their own childhood. The most potent predictors of who is likely to commit the most serious and prolonged sexual abuse are childhood family violence, loss of a carer, and family breakdown. Sex offenders are noted for their invisibility. When people think of a sex offender they may visualize a stereotypical image of a man filthily dressed, hanging around street corners though in truth the sex offender appears in many forms and in all walks of life. When people hear of a sex offence, they generally associate total strangers to be the ones who carry out the crime, what they don’t realise is that sex offending itself takes many forms. In some cases the abuser may be diagnosed as having serious mental health problems. For example, a woman drowns her twin 6 month old daughters. Another mother throws her daughter off a bridge into icy water. A father has sexual intercourse with his 6 month old daughter. These descriptions are often enough to convince most people that only someone who is mentally disturbed or truly psychotic would inflict such grievous harm onto a defenceless child (Gelles & Cornell, 1990).

The third chapter is based on the victims of child sexual abuse. Children who are sexually abused generally find it harder to talk directly and clearly about their experiences. Although some children disclose, many do not. Many children assume that, if their parents mistreat them, it is because every parent behaves in that way (Doyle, 2006). Children can become attached to abusing parents. They often want the abuse to stop but crave the abuser’s love. Every child has a right to receive a good standard of care and protection, and parents have a duty to provide this, however, this is not always the case.

Sexual abuse victims may protect their self-image by convincing themselves that there is nothing wrong in sexual relationships between adults and children. Wyre (1986) noted that many men who had raped children had been sexually abused as children and had incorporated their experiences of abuse into their own sexuality. Findings from Trickett and Putnam (1998) show that about a third of sexually abused children who have been sexually abused are at specific risk of developing sexual problems and sexualised behaviour. For some children, being inappropriately sexual with other people is the only way they know to love and get close to people. As adolescents, some boys who have been sexually abused show an increased likelihood of exposing their genitals to women, or being sexually coercive. Some girls become sexually, and often indiscriminately very active. Sexual promiscuity can get both young boys and girls into social difficulties. In the case of early sexual activity amongst sexually abused girls there is the risk of teenage pregnancy (Trickett and Putnam 1998, cited in Howe 2005).

The fourth chapter outlines the long term and short term effects child sexual abuse has on victims. I will describe the extent an abused child’s developmental stage is impaired. The more forceful and violent the abuse, the more the individual is likely to suffer trauma. The most crucial period of a child’s life is when assumptions about the world, others and the self are being formed. Unlike adults, children’s lives are affected and traumatised during this period. REFERENCE These posttraumatic reactions can easily collide with a child’s social and psychological maturation, which leads to a potentially typical dysfunctional development. The amount of damage caused to the victims is unpredictable. Survivors of sexual abuse are often described as having a number of emotional, cognitive, and social difficulties. The child perceives the self as unworthy of being loved or protected. This leads to low self-esteem.

Chapter 5 illustrates a case study in relation to my second year work placement at a supported housing organisation intended for individuals who are just released from prison. Whilst working there, my main interests were within the YOT team. During my first few days I read a particular client’s file, who was part of the Program X scheme. I found his file very interesting as there were serious issues of child sexual abuse associated with his life, which later led to extreme depression and suicide attempts.

Last but not least, the next stage is to determine how these issues can be addressed and if victims find a way to escape the nightmares associated with the abuse. Do they ever live a normal life again? This can prove difficult at times as many abuse survivors inappropriately assume responsibility for what was done to them as children and are often believed to have provoked it in some way, REFERENCE some deny that abuse ever occurred in the first place, and underestimate their personal rights to self-determination and safety. There are many agencies and organisations that provide help and support to individuals suffering from child sexual abuse. Getting help through therapy allows the survivor to find closure.

Finally, I will end the dissertation with concluding comments regarding the issues discussed throughout the dissertation.

Chapter 1 – What is Child Sexual Abuse?

Sexual violence and childhood sexual abuse are two of the most serious and damaging crimes in our society. for victims, these crimes represent a violation which can have a significant and ongoing consequences for health and wellbeing. REFERENCE Many patients who have been abused do not talk about sexual issues with their health care providers. REFERENCE They often feel disconnected from their bodies and health needs. REFERENCE

Sexual abuse is defined in the Department of Health 1999 guidelines as:

‘Involving, forcing or enticing a child or young person to take part in sexual activities, whether or not the child is aware of what is happening. The activities may involve physical contact, including penetrative (e.g. rape or buggery) and non-penetrative acts. They may 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.’ (Department of Health 1999: 6, cited in Corby, 2006).

The above definition states that the sexual abuse of a child does not necessarily need to involve physical contact. It provides examples of such non-contact abuse but does not mention intra-familial abuse or anything about the age of the perpetrator. Another definition used is:

‘Any child below the age of consent may be deemed to have been sexually abused when a sexually mature person has, by design or by neglect of their usual societal or specific responsibilities in relation to the child, engaged or permitted the engagement of that child in any activity of a sexual nature which is intended to lead to the sexual gratification of the sexually mature person. This definition pertains whether or not it involves genital contact or physical contact, and whether or not there is discernible harmful outcome in the short-term.’ (Glaser and Frosh 1988: 5)

The issue of defining sexual abuse in practice is both problematical and complex. In some cases, there are overlaps and connections between the different forms of abuse. For example, a child might be sexually and physically abused, neglected and physically abused and so on. Very young children as well as older ones are affected by sexual abuse and now it is a crime thought far more common than it was previously. Sexual abuse is harmful at all stages but Corby (2000) suggests it is considered to have greater effects, where the abuse is carried out by a father figure; if it is accompanied by threat, force or violence; where the sexual act involves penetration; where the abuse has continued for some time and finally where the family responds negatively regarding the abuse (Howe, 2005).

History

There is little evidence about sexual abuse of children in antiquity and medieval times. Growing up in Rome or Greece frequently involved being sexually abused by older men (de Mause 1976: 43). In Scotland 1757, incest was given the death penalty (Corby, 2006). By contrast, in England during the twentieth century, incest became a legal offence. . By the beginning of the Second World War, under the 1908 Incest Act the number of prosecutions for incest gradually increased reaching 100 a year (Corby, 2006). The definition of incest in the Sexual Offences Act of 1956 is as follows:

It is an offence for a man to have sexual intercourse with a woman whom he knows to be his grand-daughter, daughter, sister or mother….it is an offence for a woman of the age of sixteen or over to permit a man whom she knows to be her grandfather, father, brother or son to have sexual intercourse with her by her consent (Smith & Hogan, 1983: 419, cited in Howitt, 1992).

In 1937 the state of Michigan enacted a sexual psychopath legislation. In the same period of the 1930s there is also evidence that the public became more concerned about sexual offences. REFERENCE By 1960 there were some 27 states and the District of Columbia with a version of a sexually dangerous person law. From the late 1930s onwards to the early 1960s there was emphasis on the treatment of offenders through involuntary civil commitment procedures rather than punishment after conviction. Reasons for jurisdictions over such offenders varied among 27 states. Beginning in the late 1950s and continuing for nearly two decades, there was a panic over sex crimes, sexual deviance and sexual behaviour generally. By the late 1980s almost half of the states with sexually dangerous persons legislation had revoked the statutes. In 1994 a provision entitled the ‘Jacob Wetterling Crimes Against Children and Sexually Violent Offender Registration Act’ was included in the omnibus 1994 crime bill. In 1997, the Wetterling Act [1] was amended to allow for community notification, which permitted law enforcement personnel to disclose registry information to neighbourhood residents about sex offenders who live in close proximity. REFERENCE

The NSPCC began to tackle child sexual abuse within the family, which was previously ignored as an issue. The NSPCC did not bring sexual abuse to public attention, in the same way as it had publicised physical abuse and neglect, despite its awareness and recognition. This response reflected a general attitude to the issue, which was one of not wanting to know, a conspiracy of silence. Many parents keep their child’s abuse a secret even if they know of it. By contrast, however, child prostitution received far more public attention.

In the summer of 1987, newspapers reported a child sexual abuse scandal in Cleveland. It emerged that 121 children had been brought into care over a period of six months on place of safety orders on the recommendation of two paediatricians who had diagnosed them as having been anally abused. Up to this time, for child protection agencies in Britain, the issue of child sexual abuse had been a relatively minor concern. Child sexual abuse was beginning to find its way onto the official child protection agenda by 1987, although the response to such abuse throughout Britain was patchy and variable. The Cleveland report had an impact on the passage of the 1989 Children Act through Parliament. Findings from the Cleveland inquiry report confirmed that, child sexual abuse was a more widespread phenomenon than had previously been thought to be the case. Similarly, in 1991 in Clwyd, residential social workers in two children’s homes were prosecuted for serious sexual offences against children in their care. As a result, Clwyd County Council set up its own independent inquiry which commenced in 1996 and reported in 2000. Its findings were that there was evidence of widespread physical and sexual abuse of girls and boys in Clwyd during this period (Corby, 2006).

Concerns about the use of child pornography have risen since the 1990s. Sadly, only a fraction of the sexual abuse of children is ever reported. Silverman and Wilson (2002) reported that in 1995 the Obscene Publications Unit of Greater Manchester Police seized about a dozen images of child pornography during the whole year, but in 1999 the unit recovered 41,000 images and by 2001 so many images were being recovered that they had to stop counting. REFERENCE

Public concern over the sexual abuse of children is a relatively recent phenomenon. It is only recently that the general public in Britain has begun to realise that, far from being an extremely rare phenomenon, the sexual abuse of children is much more widespread. As in the USA, a number of tragic cases in the 1990s in England and Wales have attracted widespread publicity, provoked public outcry and provided a legislative and organisational change. In Britain, media interest in sexual offenders released from prison and allowed to live anonymously in the community created an outbreak in public anxiety following the abduction and murder, of seven year old Sara Payne in July 2000 in Sussex. Here newspaper accounts criticised the probation service for failing to prevent Sarah Payne’s death. REFERENCE. Since then, Britain’s local newspapers have been concerned about the risks to children from sex offenders living in the community. It is seen from all this that sexual abuse of children occurs at all levels of society.

The issue and prevalence of young people (under 18) drinking alcohol in recent years has become a matter of increasing public concern, with current trends ‘amongst the worst in Europe’ (Gunning et al 2010). Drinking during childhood, particularly heavy drinking is associated with a range of problems including physical and mental health problems, alcohol-related accidents, violence, and anti-social behaviour (Gunning et al 2010). Young bodies are still growing, and alcohol can harm their development; regular drinking can lead to cancer, liver disease, and heart disorders in later life (Bateman 2011). Deaths from liver disease have risen vastly in the 25-34 age groups over the last 10 years; thought to be a consequence of increased drinking starting from an earlier age (Thomson et al 2008).

In England in 2007/2008, ‘more than 7600 children under 17 were admitted to hospital as a result of drinking alcohol’ (Gunning et al 2010). It is believed that young people who start drinking alcohol at an early age, drink more, and drink more often than those who delay the onset of drinking until they are older. They are also more likely to develop alcohol abuse/dependence problems in adolescence and adulthood; dependence is also likely to occur from a much younger age (Gunning et al 2010).

A recent survey carried out in 2010 by the National Centre for Social Research (NatCen) to determine the ‘smoking, drinking and drug use of secondary school pupils aged 11 to 15’; (7,674 pupils in 247 schools through the use of questionnaires) interestingly found that the proportion of young people who ‘have drunk alcohol’ had decreased in comparison with earlier findings from 28 per cent in 2001 to 21 per cent in 2006 (DH 2008). However it must be stated that although there had been a marked decrease in the number of ‘young people’ who had ‘drunk alcohol’; many of the 11 to 15 year olds who do drink were described to be consuming larger amounts of alcohol, more often, to deliberately ‘get drunk’ (Bateman 2011). This study also conveyed that ‘18% of pupils had drunk alcohol recently, is equivalent to around 540,000 young people’ (Gunning et al 2010); suggesting that more still needs to be done to reverse these prominent trends, as despite the marked ‘decrease’ alcohol misuse in young people is still a serious problem that is affecting the health of the youth today and greatly impacting the wider community, in that alcohol misuse carries a financial burden; and has been estimated to cost nearly ?11,000 million each year, in terms of health, social welfare and criminal justice resources (Waller et al 2002).

Collecting this type of data can prove difficult, as drug and alcohol misuse are of a sensitive nature and often individuals do not wish to share this information candidly when questioned. It is particularly difficult to obtain from ‘young people’ (under the age of 18), as this often has to be carried out within a school environment, via questionnaires. The extent to which ‘honest reporting’ occurs is again complex, as young people will often exaggerate to peers, and conceal from parents (Gunning et al 2010). Honesty is not the only factor affecting accuracy of responses in young people, precision of estimates and the recall of the amount of alcohol drunk can also be problematic, given that pupils’ patterns of behaviour between the ages of 11 and 15 may be described as ‘experimental’ and ‘sporadic’ opposed to ‘habitual’ and ‘regular’ (Gunning et al 2010). The National Treatment Agency (NTA) has recently stated that young people’s substance misuse is a relatively ‘new area of academic study’ and so research on effective treatment interventions are inconsistent (NTA 2010).

It is widely acknowledged that alcohol misuse in youth is inextricably linked to a number of factors; including the influence of parents/family, peers, environment, culture and socio-economic status (Templeton et al 2006). According to the Acheson report (1999), dependency upon alcohol is ‘significantly correlated with socio-economic position’, suggesting that the problem is one that is beyond the chemical impact of the substance itself (Nacro Youth Crime Section 1999) coinciding with more recent National statistics and research studies that indicate, ‘as well as sex and age, socio-economic status, ethnicity and geographical area of residence are among the factors linked to levels and patterns of harmful alcohol consumption’ (Waller et al 2002).

In order to target the issue of alcohol misuse within young people, these factors needed to be taken into account and have since been the guide by which policies regarding ‘youth’ and ‘alcohol’ are implemented (DH 2008); therefore providing alcohol education in schools; beginning in the primary phase, well before patterns of regular drinking become established, designed to educate and advise young people on sensible drinking patterns and the dangerous effects it may have upon them (DH 2008). Parents and carers also have a responsibility for whether their children drink, at all, and if they do, how much and how frequently they drink. However, for parents to ‘feel confident’ when talking to their children about alcohol and to empower them to set appropriate boundaries they need guidance from the appropriate services (DH 2008).

In terms of government strategies, to target the issue of alcohol misuse in young people; the coalition’s programme for government published in May 2010, outlines proposals designed to restrict the supply of alcohol to young people, less than 18 years of age, by increasing the control given to councils to close outlets that ‘persistently sell alcohol to children’; and to increase the maximum fines for under-age alcohol sales. Additionally, there will be a ‘ban on the sales of alcohol at below cost price’ (Gunning et al 2010), and a review of alcohol pricing and taxation, both policies expected to have particular impact on ‘young drinkers’ (Gunning et al 2010).

Whilst these policies are currently weighted towards prevention, and adopting preventative strategies, recent statistics suggest that the majority of young people accessing services and interventions have ‘problems with alcohol (37%) and cannabis (53%)’ (NTA 2010), thus suggesting that more needs to be done in the ‘preventative’ stages of alcohol awareness in children; as evidence suggests that the problem is clearly still on-going.

The choice and effectiveness of treatment approaches is typically dependent on a range of factors, such as the individual characteristics of the client for example motivation, family life, social circumstances and environment; in addition to the particular drug or drugs that are being used (Crow & Reeves 1994). The National Treatment Agency (NTA) defines young people’s treatment as: “aˆ¦ care planned medical, psychosocial or specialist harm reduction interventions aimed at alleviating current harm caused by a young person’s substance misuse” (NTA 2010).

Young people with drug related needs are supported by interventions and services within a ‘four-tiered model’ of drug and alcohol interventions which consists of a General Frontline service delivery for young people and their families (‘first port of call’) (tier 1), open-access services (such as drop in) (tier 2), Drug treatment within the community (‘Shared care’) (tier 3) and residential drug treatment (‘specialist services’) (tier 4) (NTA 2006).

Young drug and alcohol users are believed to differ from adults as they will typically not have used drugs for a prolonged period of time, in order to have developed a dependency to a substance; and as a result affecting the type of treatment generally provided to young people (Frontier Economics 2010). Young people are most likely to require psychosocial, harm reduction and family interventions, opposed to treatment for addiction, which most adults but only a small minority of young people require (Frontier Economics 2010). Psychosocial interventions are known as ‘non-pharmacological’ interventions typically involving ‘structured counselling, motivational enhancement, case management, and care-coordination, psychotherapy, and relapse prevention’. The intention is to encourage behavioural and emotional change, with the support of lifestyle adjustments and the enhancement of coping skills (Frontier economics 2011).

The most common form of therapy offered for substance misuse is some form of counselling; this may take the form of counselling for the drug problem itself, for example thoughts about using, coping strategies for reducing or counselling concerning the surrounding issues that impact on drug use (Lewis et al 2009). Counselling is a flexible approach and can be used to respond to a wide variety of circumstances surrounding misuse (Rounsaville & Carroll 1992). It is possible to identify two general approaches to counselling in use in community drug services, the first being, counselling to tackle the personal problems, underlying drug misuse and the second being that of support and advice to help manage the consequences of drug misuse (Bryant- Jeffries 2001). The vast majority of young people accessing specialist treatment need and receive counselling, sometimes alongside their families to address the underlying causes and consequences of substance misuse. Such ‘psychosocial’ interventions are the most common form of support accessed by under-18s (Frontier Economics 2011).

The National Institute for Health and Clinical Excellence (NICE) coincides with the idea of the counselling theory, and has recommended that offering brief, one-to-one advice on the harmful effects of alcohol use, and how to reduce the risks and find sources of support, is an effective approach for tackling harmful drinking amongst children and young people (NICE 2007).

The most common counselling approach to drug treatment has been cognitive behavioural approaches. The cognitive behavioural approach relies greatly on getting the user to focus on identifying problems and solutions. Cognitive behavioural counselling can be used to promote abstinence or gradual control of drug use, with an emphasis on teaching cognitive and behavioural techniques to resist drug use and related behaviours. The cognitive element of CBT is concerned with getting users to identify the reasons why they misuse, and in particular getting them to identify ‘maladaptive thought patterns’ that lead them to engage in ‘destructive behaviour’ (Jarvis 1995). The behavioural aspect of CBT is about helping people to look at the signs that encourage them to misuse drugs and to help them develop alternative ways of behaving (Jarvis 1995).

NICE has recommended cognitive behavioural therapy (CBT) as an effective intervention for treating young people’s substance misuse (NICE 2007). Providing CBT in a group setting may help young people to role-play and practice coping with ‘high-risk experiences’. The group setting allows young people to share similar problems, develop social skills, model, rehearse and gain peer feedback (NICE 2007). NICE also recommends that brief interventions using motivational interview techniques can be used as one-off interventions, or to facilitate engagement with more structured specialist substance misuse treatment (NICE 2007). Implying that individuals with social networks supportive of drinking will benefit especially from a programme that encourages attendance at AA meetings, because it is ‘the most effective means of eliminating heavy drinking friends and acquaintances from the social network’ (Connors, Tonigan and Miller, 2001).

Although NICE states that a group setting is beneficial in helping young people overcome their alcohol abuse it may in fact be criticised, as young people, especially ‘troubled’ young people may be ‘overwhelmed by group influences’, either in treatment among peers who are also recovering from chemical dependence or else after leaving treatment, in the form of familiar drug-using groups’ (Peele 1987). And so the most successful types of counselling approach used for young people needs to take into account their age, as being amongst adult’s with alcohol issues would not be beneficial to a young person as adults are often described as ‘dependent’ requiring more intensive forms of treatment; young people will have often not reached this stage of ‘dependence’ and so these adult influences may cause further negative impacts on the impressionable ‘young’ (Geldard 2010). Type of personality needs to be taken into account in order to discover which counselling approach would be most appropriate and successful for them as an individual, as some individuals may respond best to a one-to-one approach, being able to fully open up to one person (the counsellor). Whereas some may find it easier to speak within a group setting with peers, learning from others experiences. Counselling is often described as a ‘flexible approach’ (Rounsaville & Carroll, 1992) and therefore can be adopted to meet the needs of individual cases and respond to a wide variety of circumstances surrounding misuse; in addition utilising ‘a flexible approach’ suggests that it allows for the young person to access this service around other commitments such as school, so as to not jeopardise other important aspects and influences within their sphere of activity, flexibility of counselling will also allow for the involvement of the family, with evidence to suggest that family involvement enhances assessment and intervention and increases motivation in treatment (Kaufman, 1992). As young people are often depicted as ‘not yet independent’, family interventions are believed especially important in addressing the basis of their drug and alcohol involvement; (Kaufman, 1992). Also important is helping the family initiate and support the person’s involvement in an appropriate treatment program (Kaufman, 1992). Within individual treatment, compared to group therapy it is believed that much more time can be spent on issues that are unique to the individual involved, a trait that needs to be evident when working with young people (Rounsaville & Carroll 1992).

Motivational interviewing has a number of similarities with cognitive behavioural techniques but has a somewhat different emphasis in that the role of the counsellor is less directive and the responsibility is very much on the client to identify ways of changing (Bryant -Jeffries 2001). It aims, through the counselling ‘relationship’, to engage clients in a process of change and assumes that an individual’s level of motivation can be influenced by the interaction between the client and the therapist. Motivational interviewing assumes that behaviour is a prospect that can be worked on and developed (Bryant – Jeffries 2001).

It is concerned essentially with working with clients to address the confluence of factors that drug misusers consistently feel about changing their behaviour and hopefully encouraging them towards reducing or abstaining (Jarvis 1995). The theoretical basis of this approach is ‘Prochaska and Di Clemente’s transtheoretical model of behaviour change or, as it is most frequently referred to, the ‘stages of change’ model’ (Turnbull 2000). The stage of change model is a ‘social cognition model’; focusing upon readiness to change a potentially destructive form of health behaviour i.e. drug misuse. The model has been applied to other health behaviours such as eating disorders as well as to substance misuse (Wilson & Schlam 2004). It refers to a five or six stage process that people go through in their thoughts about their readiness to change. A study of alcohol users found that the number of clients motivated to change was increased by 77% when motivational interviewing was used (Miller & Sanchez 1999). Motivational interviewing is believed to increases the effectiveness of more extensive psychosocial treatments; often the chosen method of treatment used in young people (NTA 2010).

Motivational interviewing although successful, in adult treatment programmes, may not be the best choice of treatment to use when young people are concerned. As previously stated they are unlikely to have used drugs for a prolonged period of time, to develop dependencies (NTA 2010) and so readiness to change, or to contemplate change may not be something they have even thought about and so a ‘pre-occupation’ with lifelong abstinence in a young population may not only be unnecessary but unrealistic, and may actually encourage ‘regular relapse episodes’ (Peele 1987). Young people require guidance and cannot often think about the consequences of their actions, or the harm they are causing themselves by ‘heavy drinking’ (DfES 2004). It is suggested that therapy should encourage the assumption of values toward work, accomplishment, family, and social institutions that facilitate the ‘maturation process’ (Peele 1987).

Harm Reduction is one of the key public health approaches to drug use in recent years (Riley et al 1999). The harm reduction approach attempts to define and discuss drug use in terms of the harm it can be said to cause, and respectively to look at ways of reducing levels of harm (Riley et al 1999). Harm reduction is a term that defines policies, programmes, services and actions that work to reduce the health and social economic harms to the individual, the family, communities or society that are associated with the use of drugs (Newcomb 1992) ‘without necessarily reducing drug consumption’ (Wodak 2011).

A harm reducing approach to illicit drug use focuses on attracting users to services, in the realisation of the fact that many people who have problems with their drug use are not in touch with services (Wodak 2011). Thus, harm reduction policies and programs are offered to those not willing or able to cease their drug use in the short-run; aiming to make services more accessible to drug users as a first step towards treatment; however, this philosophy remains compatible with an ‘eventual goal of abstention’ (CAHM 2009); Programs requiring abstinence as an ‘immediate goal’ cannot therefore be considered harm reduction (CAHM 2009). A ‘goal sequence’ produced by the Aids and Drug Misuse report (ACMD 1988) provides a clear example of a harm reduction approach to drug use; firstly to discourage sharing, encourage the shift from injecting towards oral use, reduce the overall levels of illicit drug use and finally abstinence (ACMD 1988).

Harm reduction accepts that some use of mind-altering substances is inevitable and that some level of drug use in society is normal (CAHM 2009), for young people and alcohol use this is most definitely the case, as most individuals have their first experiences of alcohol during their early teenage years (Marlatt & Witkiewitz 2002). Based on the recent evidence young people would benefit from prevention programmes aimed to reduce the amount of harm experienced by ‘young drinkers’ this may be seen as a more realistic and effective method for educating individuals about the possible consequences associated with alcohol consumption as opposed to abstinence within this particular age group (Marlatt & Witkiewitz 2002). This suggests that Harm reduction in this sense is the best approach when looking at young people and alcohol misuse, as abstinence may be described as ‘unlikely’ within this age group, acknowledging that most ‘adolescents’ will drink, speaking of the possible harms may be enough to reduce harmful levels of drinking by the young person (Marlatt & Witkiewitz 2002).

The Life Skills Training Program and the Alcohol Misuse Prevention Study (AMPS) in the United States and the School Health and Alcohol Harm Reduction Project (SHAHRP) in Australia are described as large scale intervention studies that have been ‘systematically designed’ and ‘evaluated based’ on a ‘harm reduction philosophy’ (Marlatt & Witkiewitz 2002). The life skills training programmes is said to adopt a cognitive behavioural approach to drug abuse prevention; thus providing education on the effects of drugs, teaching skills for resisting social pressure to use drugs, and promoting the development of self-esteem and social skills (Marlatt & Witkiewitz 2002). Whilst SHAHRP combines a harm reduction philosophy with ‘skills training, alcohol education, and activities designed to encourage positive health behaviour change’ (Marlatt & Witkiewitz 2002); Results from a study comparing an intervention group of students who participated in SHAHRP with a control group over a 3-year period, conveyed that students in SHAHRP had significantly lower levels of alcohol consumption and alcohol related harms (Marlatt & Witkiewitz 2002).

In conclusion, harm reduction seems the best approach for young people and alcohol use, it must be stated that they are not as advanced as adults who misuse alcohol thus require harm reduction leading to abstinence. Young people will often ‘eventually “mature out” of harmful drinking behaviour’ (Marlatt & Witkiewitz 2002) and so harm reduction at such a stage should be an appropriate practice in order to highlight the harmful effects to young people enough so that it reduces overall consumption.

‘We need to be able to convince children that life is worth living and that they are capable, not only of avoiding drugs, but of achieving a worthwhile existence (Peele 1987); presenting them with the values of achievement and positive accomplishments; of friendship and community; of health and self-preservation; of fun and adventure; of responsibility for self and contribution to others; of consciousness and intellectual awareness; and of a commitment to life that goes beyond personal protectiveness and fear’ (Peele 1987).

Elder abuse and neglect is a critical health care issue that must be brought to the attention of health care providers and older adults family members. Adults older than 65 who live at home or in long-term care facilities may be at risk for abuse. Nurses should be aware of the causes, screening questions, symptoms of abuse, and resources in the community. Armed with information and a better understanding about the issue, nurses can minimize the devastating effects of abuse on older adults and their families.

Every man, woman, and child deserves to be treated with respect and caring. Individuals of all ages deserve to be protected from harm by caregivers (American Psychological Association, 2006). Significant policy developments during the past 20 years have focused on eliminating abuse. However, a deficit in health care providers’ knowledge and clinical skill application remains. The purpose of this article is to define and describe the kinds of abuse, their potential clinical presentations, and theoretical explanations for abuse to enhance nurses’ knowledge and understanding of their role in its assessment and management in older adults.

BACKGROUND

Abuse is defined as the infliction of injury, unreasonable confinement, intimidation, or punishment, with resulting physical harm, pain, or mental anguish (Table 1). It can also be the willful deprivation by a caregiver of goods or services that are necessary to maintain physical or mental health (American Psychological Association, 2006). Elder abuse and neglect has plagued society for centuries but only recently has the issue come to the attention of health care providers, law enforcement agencies, and protective services. Fewer research studies exist about the maltreatment of older adults than about other forms of family violence, including child abuse, rape, and intimate partner violence. The earliest reports of elder abuse and neglect in the United Kingdom in the 1970s dramatized case reports of the phenomenon, termed “Granny battering.” The health care community and the public were shocked and appalled. A decade later, studies confirmed that the problem was common in the United States as well.

In the late 1970s, the U.S. Senate Special Committee on Aging issued a series of reports on abuse and neglect occurring in nursing homes. In 1981, the U.S. House of Representatives Select Committee on Aging conducted hearings in which victimized older adults gave firsthand testimony of their experiences with abuse. In 1986, the Institute of Medicine published recommendations for preventing the maltreatment of older adults in institutions, and several years later, the Elder Abuse Task Force was created by the Secretary of the U.S. Department of Health and Human Services. The task force developed an action plan for the identification and prevention of maltreatment of older adults in their own homes, health care facilities, and communities. The action plan included data collection, research, technical assistance, training, and public education. The National Center on Elder Abuse was established as part of the Administration on Aging’s Elder Care Campaign. Adult Protective Services programs now exist in every state to serve vulnerable adults, particularly older adults, who may be at risk for abuse and neglect. Many law enforcement agencies and Offices of the District Attorney have investigative staff specifically trained to address abuse of older adults and other vulnerable populations, in collaboration with health care and protective service professionals.

Such actions have led to increased public and health care provider awareness about elder abuse and neglect. Researchers have also sought to grasp the full scope and causes of maltreatment among older adults. Laws that require health care providers to report suspected cases have been instituted in nearly every state. The Joint Commission on Accreditation of Healthcare Organizations’ (2006) standards for emergency departments and ambulatory care centers call for improved identification and management of elder abuse, in addition to intimate partner violence and child abuse.

As the U.S. population ages, demands placed on health care systems to care for older adults are increasing. More than 36 million people who live in the United States are older than age 65, and 600,000 older adults will require assisted living (U.S. Department of Health and Human Services, Administration on Aging, 2006). Currently, there are approximately 17,000 nursing homes in the United States, with 1.6 million residents (U.S. Department of Health and Human Services, Administration on Aging, 2004). Unfortunately, older adults are becoming victims of intentional abuse and neglect within their own homes, as well as in assisted living and long-term care facilities.

Each year in the United States, 1 to 2 million adults older than age 65 are injured, exploited, or mistreated by their caregivers (National Research Council Panel to Review Risk and Prevalence of Elder Abuse and Neglect, 2003). One community-based, cross-sectional survey reported that 32 of every 1,000 older adults reported that they had experienced some form of maltreatment at least once since reaching age 65 (Pillemer & Finkelhor, 1988). Underreporting is typical with all kinds of abuse, and it is estimated that only 1 in 14 elder maltreatment cases are reported. Health care providers can expect to see a steady increase in the number of cases of elder maltreatment as the older adult population rapidly increases.

THEORIES OF ELDER ABUSE

Elder abuse is a complex problem with multiple risks and causes. Dysfunctional family lives, cultural issues, and caregiver inadequacies have been implicated as contributing factors. Awareness of such factors may help nurses understand and anticipate situations where maltreatment may be preventable.

Several theories attempt to explain the existence and increasing occurrence of elder abuse. The transgenerational, or social learning, theory asserts that violence is a learned behavior. Individuals who have witnessed or been victims of family violence are more likely to try to resolve challenging and difficult life situations with violent tactics they learned in their formative growth. Although 90% of perpetrators of elder abuse are reported to be family members, this cannot account for all cases (Fulmer, Guadagno, Bitondo, Dyer, & Connolly, 2004).

Situational theory supports the idea that the greater the burden on caregivers, the more likely caregivers are to abuse. Exchange theory addresses the dependence of older adults on their caregivers as a risk of abuse, along with inadequate methods of problem solving as an established pattern of family behavior. Political economic theory addresses the changing roles of older adults. Their loss of independence and income may cause them to look to others for care and support (Fulmer et al., 2004).

Psychopathology of the caregiver theory studies caregivers with severe emotional or mental health problems or addictions that put the older adults for whom they care at risk of being abused. For example, a caregiver with a mental health problem who cares for a frail older adult with cognitive impairment is a dangerous combination and may lead to resistant behavior and maltreatment. Although theoretical frameworks cannot explain all cases of elder maltreatment, they can provide a foundation for nurses to begin to understand the combination of factors responsible for the occurrence of elder abuse and initiate a holistic plan of care.

NURSING ASSESSMENT & INTERVENTIONS

Nurses are in an ideal position to play a significant role in the detection, management, and prevention of elder maltreatment and may be the only individuals outside of the family who have regular contact with an older adult. Nurses are uniquely qualified to perform physical and psychological assessments, order confirmatory diagnostic tests (e.g., blood tests, x-rays), and collaborate with physicians and protective services. They may authorize services, such as home health care, or recommend hospital admission as they initiate further investigation by the appropriate local agencies.

Opportunities for abuse detection and intervention occur daily in health care settings. In institutional settings, nurses may monitor patient health and perform health history interviews and physical, psychological, sexual, and financial abuse assessments that may be crucial to elicit reports, expose or prevent abuse, and intervene for patients’ safety (Wieland, 2000). Nurses and other health care providers are part of an interprofessional team collaborating to ensure appropriate, sensitive, and safe outcomes for older adult patients.

Institutional maltreatment occurs in long-term care facilities, board-and-care homes, and other assisted-living facilities. Institutional medical directors, private practitioners, nurses, and all health care workers in daily contact with older adults have a responsibility to identify, treat, and prevent abuse.

Abuse may be perpetrated by a staff member, another patient, an intruder or a visitor, or a family caregiver. Abuse may include failure to implement a plan of care or provide treatment, unauthorized use of physical or chemical restraints, and use of medication or isolation for punishment or staff convenience. Nurses must be aware of patient diagnoses, medical orders for care, and medications and their side effects to recognize what is suspicious and needs further evaluation or warrants a report to supervisors. However, most elder maltreatment does not occur in institutions but in the home at the hands of a caregiver, often a family member.

Unless nurses are educated about abuse and how to observe suspicious injuries, elder abuse may be difficult to detect. Definitions of the kinds of abuse and their signs and symptoms should be included in the training and education of family members and health care workers who care for older adults. Older adults experiencing abuse may be unable to communicate clearly, their bruises may be attributed to the aging process, or they may be fearful and hesitant to report abuse (Wieland, 2000). Indications of physical abuse should signal health care providers to evaluate for other kinds of abuse, such as sexual abuse.

In addition to inadequate information, training, and the caregiver’s experience of caring for older adults, older adults are at risk for maltreatment due to other vulnerabilities. Older adult residents in institutions are typically dependent and chronically ill and may have cognitive, visual, and auditory impairments. They are usually more frail than are younger patients and may not have regular visitors who monitor their mental status, physical condition, or health care. In older adults, each vulnerability increases their mortality risk (Fulmer et al., 2004).

Co-existing conditions and medical diagnoses may lead to worse outcomes for older adults who are abused. They may have a decreased ability to heal after injury and may experience greater trauma from physical injuries than do younger people. Their bones are more brittle and tissue more easily bruised, abraded, and lacerated with minimal trauma. Injured older adults differ from the younger population in terms of cause of injury, physical and psychological responses to abuse and injury, and outcomes.

Dementia is common in 50% of residents of long-term care facilities (National Center for Health Statistics, 1985), and cognitive impairments often cause older adults to behave in a more resistant manner toward caregivers. Impaired cognition, along with insufficient resources, staff shortages, high staff turnover, and inadequate supervision and training, may increase the risk of elder maltreatment. In addition, societal ignorance about required standards for quality care and victimized older adults’ acceptance of abusive or neglectful behavior can lead to exacerbation of elder abuse in institutions.

Routine questions related to elder abuse and neglect can be incorporated into daily nursing practice. Diminished cognitive capacity does not necessarily negate older adults’ ability to describe maltreatment. It is always reasonable for nurses to ask about abuse or neglect. A brief mental status examination can be helpful in evaluating patients’ cognitive status.

Assessment for elder abuse should include caregiver, as well as victim, evaluation. Nurses should conduct interviews and examinations with the patient first, in a private setting separate from the caregiver.

Clinical settings should have a protocol for the detection and assessment of elder maltreatment. Protocols should consist of a narrative, checklist, or standardized forms that enable rapid screening for elder abuse and provide guidelines for sound documentation that may help disclose patterns of abuse over time and will withstand scrutiny in court. Basic demographic questions should be included and should allow the interviewer to determine the family composition and socioeconomic status. Interviews should proceed from general questions that assess the patient’s sense of well-being to those focusing on specific kinds of abuse. Common signs and symptoms of maltreatment should be evaluated (Table 2).

Elder abuse screening instruments are summarized by Fulmer et al. (2004). Questions recommended by Wieland (2000) for general abuse screening and assessment include:

* Do you feel safe where you are living?

* Who is responsible for your care?

* Do you often disagree with your caregiver(s)? If so, what happens?

* Does anyone scold or shout at you, slap or hit you, or leave you alone and make you wait for care or food?

After general screening questions, more specific questions about kinds of abuse may follow:

* Has anyone ever touched you without your consent?

* Has anyone ever made you do things you did not want to do?

* Has anyone ever taken something that was yours without asking?

* Have you ever signed any documents that you did not understand?

Health care providers do not have to prove that elder maltreatment has occurred. They need to screen and document suspicious verbal and physical findings, which may be as simple as stating that the patient seems to have health or personal problems and needs assistance. Sound documentation may include drawings of injuries on body diagrams or photographs to support written reports. Suspicious claims for abuse and neglect may be difficult to quantify. Diagnosis of elder maltreatment depends on education about abuse and application of that knowledge by the multidisciplinary team of health care providers, law enforcement agencies, advocates, and patients. Protocols for elder abuse screening, assessment of risk factors, and documentation should be posted in all health care facilities.

ABUSE AND THE LAW

National standards for care in nursing homes are based on the Nursing Home Reform Act of 1987. The law is part of the Consolidated Omnibus Budget Reconciliation Act of 1987, often referred to as OBRA 87. The intent of the law is to promote high-quality care and prevent substandard care. The law also seeks to ensure that the rights of nursing home residents are respected. These include:

* The right of protection against Medicaid discrimination.

* The right to participate in health care decisions and to give or withhold informed consent for particular interventions.

* The right to safeguards to reduce inappropriate use of physical and chemical restraints.

* The right for provisions to ensure proper transfers or discharges.

* The right to full access to a personal physician, long-term care ombudsman, and other advocates.

* The right to be free from verbal, sexual, physical, or mental abuse, corporal punishment, and involuntary seclusion.

* The right to be free from physical restraints or psychoactive drugs administered for the purpose of discipline or convenience.

Nearly all states have mandatory reporting laws that require health care professionals and paraprofessionals to report suspected elder abuse and neglect to a designated authority. Some state laws specify that after authorities have been alerted to suspected elder abuse or neglect, an agent of the state must make an onsite investigation in an attempt to corroborate the report. Uniform reporting systems are established, and cases are assigned and investigated by protective services in a timely fashion. Cases are assigned and investigated by protective services in a timely fashion. Nurses may play an important role in preventing and identifying elder abuse, as well as in the subsequent investigation.

CONCLUSION

Elder abuse is a significant problem in the United States and often goes unreported and unrecognized. Elder abuse may be physical, emotional, psychological, sexual, or financial. Immediate care, overnight housing, and care in a safe location, in addition to long-term care and home-delivered food, may be necessary. Elder abuse may be a minor issue that can be easily resolved or it can result in severe and life-threatening debilitation.

The more knowledge health care providers have, the more likely they are to institute strategies for abuse prevention and management. No matter how minor or severe the abuse, nurses have a duty to assess elderly patients according to recommended protocols and report suspected abuse to designated authorities. The multidisciplinary team then works together to help resolve the issue. The application of knowledge about elder abuse includes screening, assessment, and sound documentation in an attempt to enhance the quality of life and maximize the functional ability of older adults.

[Sidebar]

Domestic violence is acknowledged as a significant issue within Malaysia. Historically, women non-government organizations (NGOs) have made violence against women a visible issue and have laws and protection services for victims of gender violence. In the year of 1994, the Domestic Violence Act was finally passed by Parliament, making Malaysia the first Asian and Muslim country to adopt such legislation. Government and Women’s groups have make hard afford in raising awareness around the issues of domestic violence due to Malaysia has a high level of physical abuse of women by husbands and boyfriends. The 1992 WAO/SRM (Women’s Aid Organisation and Survey Research Malaysia) survey revealed that 39 percent of women have experiencing battering. In the year of 1995, there were 1409 police reports of domestic violence. 1n 1997, the first full year of the implementation of the Domestic Violence Act, increase to 5477 reports, representing a 388 percent increase. To sum up, the statistics of domestic violence cases are increasing year by year according to the statistics on marital violence cases of the Department of Social Welfare of the Ministry of National Unity and Social Development (Department of Social Welfare, 1999-2009).

Except the studies on the number of cases reported for domestic violence, there has also been a small body of research conducted in order to recognise the consequential costs to governments in responding to the consequences of such violence. Studies of the prevalence of violence against women indicate that violence is an issue that permeates every corner of society, is widespread and costly. The costs that spend on domestic violence can be found in Justice, Health, Social Services, Education, Business Costs, Personal or Household Costs. Consequently, the costs of violence against women drain resources from many sectors including private businesses and agencies, the government, community groups and individuals. In brief, for the long run, violence against women will impede economic and social development in Malaysia.

Majority of the research on domestic violence tend to place the attention on its causes and consequences as well as short-term crisis intervention such as provision of accommodation, welfare assistance and other emergency support and advocacy services. However, less attention has been given to the long-term impact of intimate partner violence on battered women’s career development and the role of career counselling interventions in empowering battered women to become economically independent. Therefore, this paper aim at exploring a more comprehensive and extended framework by which the focus is given to the importance of long-term planning in areas such as job search and career development. Thus, rather than continues to concentrating on immediate needs, focusing on the area of career development will reduce the overall expenditure spend by the government or society and also provide an opportunity for the victims of domestic violence for long-term independence as more people enter the workforce. According to the Women’s Aid Organization annual report, there is a need for a more long-term approach to the issue of domestic violence in Malaysia.

Since the topic of this paper is to discuss about the domestic violence and career development in Malaysia, thus, firstly, the author will examines the impact of domestic violence on career development. Second, it places the issue of career barrier encounter by battered women, and third it explores the work of Bandura (1989) and Gianakos (1999) to understand career orientation. Finally, by drawing on these concepts builds a framework which provides a pathway for domestic violence victims to attain sustainable employment and independence.

The Impact of Domestic Violence on Women’s Career Development

The impact of domestic violence on women’s career development can be devastating. The constant denigration associated with emotional abuse destroys women’s beliefs in their competence and worth. Physical states and injuries resulting from physical and sexual abuse limit women’s ability to go to work, complete job tasks, and advance in their job positions (CDC, 2003; Chronister & McWhirter, in press). Battered women also may be isolated and as a result, have fewer opportunities to engage in positive learning experiences, observe role models, and build support networks. These factors, considered from a social cognitive career theory (SCCT) perspective (Lent, Brown, & Hackett, 1994), severely restrict battered women’s range of career interests, formulation of career goals, and persistence toward those goals.

Poverty and employment have been at the forefront of economic and social policy debate in Australia for the last three decades (Saunders 2006). Domestic violence victims not only suffer from a range of physical and mental health problems, but are more likely to have been unemployed in the past and also have higher levels of job turnover (Lloyd and Taluc 1999; Costello et al. 2005). Some work in the USA suggests that women who had experienced aggression from male partners had only one third the odds of maintaining employment for at least 30 hours per week over a six month period (Browne et al. 1999). While some abusers simply prohibit their female partners from working, others take measures to undermine any attempts at employment such as denying them transportation, tearing up clothing, beating them before job interviews and generally demoralising the partner to such an extent that work becomes impossible (Brandwein 1998; Lloyd and Taluc 1999). Such women then have more interrupted work histories, are less likely to seek or achieve promotion and often operate in low paid/low skilled work (Costello, Chung and Carson 2005: Lloyd and Taluc 1999).

In the Australian context unemployment or joblessness as it is now known continues to be the perennial cause of poverty (Saunders 2006). However, there is a lack of Australian research on the links of domestic violence and employment, but what limited work there is has found that training and employment transition services were considered a low priority even though the financial, social and emotional benefits of such interventions were considered significant (Costello et al. 2005, 257). This is very different from Britain and Ireland where the issue of poverty and joblessness has been addressed in a comprehensive way with the setting of anti-poverty targets and long-term solutions (ACOSS 2004).

Domestic violence, no matter whether it be physical, emotional, verbal, economic or social, leads to lower self-esteem and self worth, social isolation, poverty and welfare dependency and poor health for the women and children who are subjected to such abuse (Partnerships Against Domestic Violence 2001, 7; Tolman and Wang 2005, 148). They find they are unable to set short-term goals, have limited information through their social and economic isolation and exist in a climate of fear and these become barriers to seeking full employment and becoming financially independent (Trent and Margulies 2007).

Domestic violence, also known as domestic abuse, spousal abuse or intimate partner violence (IPV), can be broadly defined as a pattern of abusive behaviors by one or both partners in an intimate relationship such as marriage, dating, family, friends or cohabitation.[1] Domestic violence has many forms including physical aggression (hitting, kicking, biting, shoving, restraining, slapping, throwing objects), or threats thereof; sexual abuse; emotional abuse; controlling or domineering; intimidation; stalking; passive/covert abuse (e.g., neglect); and economic deprivation.[1] Alcohol consumption[2] and mental illnessHYPERLINK “http://en.wikipedia.org/wiki/Domestic_violence#cite_note-dutton1994-2?[3] can be co-morbid with abuse, and present additional challenges when present alongside patterns of abuse.