Author: Andre Coleman

The Ipswich Women’s Centre Against Domestic Violence (IWCADV) is a feminist community based organisation committed to working towards the elimination of domestic and family violence throughout the community. The primary focus of IWCADV is to provide support to women and children survivors of domestic and family violence. This includes telephone information, referral and support services, court support for women, counselling services, group work and children’s work. During my placement experience as a women’s counsellor at IWCADV I first spent a few weeks developing my understanding of the issues involved in domestic violence and the systems that are in place to support women and children who are survivors of domestic and family violence.

My knowledge of the issues affecting women and children experiencing domestic and family violence includes an understanding of the emotional impacts of abuse (such as feelings of grief and loss, anger, guilt, depression, trauma), the loss of personal and physical security, safety concerns, the financial costs, family law and other legal issues, and power and control imbalances in relationships.

I have developed my knowledge of the issues affecting women and children experiencing domestic and family violence in my university studies and my work experience. The understanding that I gained from my University studies was enhanced during my student placement at the Ipswich Women’s Centre Against Domestic Violence. It was here that I developed my understanding of feminist perspectives on domestic and family violence, including the individual, familial, legal and social issues. In this role I was able to develop my understanding of feminist informed practises and techniques. I support this framework for practice as it can empower women and help them find their voice, encouraging women who have experienced the loss of control to make choices about their own life and to take responsibility for their life choices and to take back control. I worked from within a feminist framework to empower the client to find her voice and to discover her worth and make her own choices.

In my role as a student counsellor at IWCADV I provided crisis support and advocacy work to women who have experienced domestic and family violence. During the beginning counselling sessions, I found it was quite difficult to always follow the story and set direction for the counselling. I took a strengths based narrative approach and usually after 2 -3 sessions a clearer picture had developed of the client’s experience with domestic violence, and this continued to unfold throughout the counselling sessions.

One of the most personally rewarding aspects of my counselling experience was the opportunity to explore and experience symbol and sand tray therapy. I spent some time reading Sandplay and Symbol Work – Emotional healing and personal development with children, adolescents and adults by Mark Pearson and Helen Wilson to prepare for my personal experience with symbols and sand tray therapy during my professional supervision sessions. I then had the opportunity to introduce one of my counselling clients to the sand tray. Whilst I did have feelings of uncertainty about my ability to facilitate the process, I did feel comfortable enough with the setting and with my client to create a safe place for self-discovery and self-awareness. She was very open to the process and we both found this to be an enjoyable and meaningful experience. My client reported that this was a very positive experience for her and allowed her to process some of her experiences with domestic violence and that it was a breakthrough for her in terms of learning to accept and value herself. I felt that it was an honour to share this part of my client’s journey.

With another client who was directed by the Department of Child Safety to attend counselling, setting the direction for each session was more difficult. I did not believe that this woman was ready to explore some of the emotional issues related to the trauma that she had experienced as a result of long term domestic violence. I was encouraged by her regular attendance and I believe that this was a result of my increasing ability to develop rapport. I was able to develop good rapport with my clients by being non-judgemental, using open ended questions and appropriate body language. I believe that my skill in developing rapport is reflected by the feedback and regular attendance to counselling sessions by my clients.

I did struggle with ending the sessions on time and frequently found that sessions with some clients were running over 1.5 hours long. I spoke with some of the other workers at the service about this and they agreed that it could be difficult especially when women are exploring very painful issues and that it was important to be sensitive but direct when closing a counselling session.

The group supervision times that I was included in at IWCADV were also very rewarding and inspiring times for me. The other workers at the service were all very passionate women with a strong commitment to empowering women and changing community attitudes about violence towards women. During group supervision there was opportunity and support for workers to reflect on their own feelings of despair and helplessness, and there was encouragement to extend and share your knowledge and understanding of the issues relating to domestic and family violence. The group times were also very rewarding team building occasions and there is a strong commitment at the service to supporting one another. For example, I found that after long phone calls or after a counselling session, another worker would check-in with me to provide any support and to answer any questions that I had.

The following essay examines a case study on a young child that was sexually abused and murdered by a known sex offender, and the serious case review that was written on the case. This essay will also discuss the basic legal policies and the frame work of the Children Act 1989, 2004 and Every Child Matters: National Service Framework. It will demonstrate the understanding of the different types of abuse, an understanding of the child protection system and how it applies to the common assessment frame work. Also the importance of working in a child centred manner will be understood. This essay will criticise the different approaches of multi-professional tactics on child protection. It will take a look at the Lord Laming and Munro reports that were put in place between the death of Victoria Climbie and baby P and safeguarding reforms planned to prevent future deaths.

Zuzanna Zommer was a 14 year old girl who came to live the United Kingdom with her parents and young bother from Poland. Not long after the move, Zuzanna was sexually abused and murdered by a known sex offender named Michael Clark who lived two doors down from the Zommer’s. Unknown to the family and his past history, Clark befriended the Zommer family and would go to family barbeques (Brooke 2008). See appendix 1. Statistics show that nearly a quarter of young adults are sexual abused during childhood, in 2010 and 2011 17.727 children under the age of sixteen were sexually abused in England and Wales (NSPCC 2012).

Several agencies failed in the case of Zuzanna Zommer (BBC News England 2012) due to failed communication between agencies. Michael Clark moved to Leeds after being released from Hull prison prior to meeting the Zommer. Humberside police failed to provide the public protection agencies in Leeds with enough warning that Clark would be moving to the area (BBC News England 2012). See appendix 2

A serious case review was released in March 2012 on Zuzanna Zommer which states that Clark’s childhood was ‘unhappy’. His parents divorced when he was three years old and was brought up by his mother and stepfather, of which he witnessed domestic violence with his mother regularly using physical abuse. Clark was bullied at school and then expelled from junior school before going to a school for the deaf (Cocker 2012). See appendix 3 Over the past thirty years, theories of child maltreatment have shifted from single- cause models (e.g. the transgenerational transmission of child maltreatment, which saw children who grew up with abuse becoming abusive adults) to more integrated and multi-faceted perspectives, emphasising instead a number of interacting factors (Azar et al, 1998; Thomas et al, 2003). Research repeatedly suggests that a history of childhood abuse is associated with low educational attainment and poor physical and mental health in adulthood (Gilbert et al, 2009b;

Safeguarding and protecting children are supported by a complicated system of legislation, guidance, regulation, and procedures (Stafford,Vincent,Parton 2010).

Within the UK, the Department of Health defines child maltreatment in terms of “inflicting harm” and/or “by failing to act to prevent harm” to children (Department of Health, 2006 p26).

“Significant” is not defined in the Act, although it does say that the court should compare the health and development of the child “with that which could be reasonably expected of a similar child”. So the courts have to decide for themselves what constitutes “significant harm” by looking at the facts of each individual case (NSPCC factsheet 2012 p2)

Within the overall category of child maltreatment, four categories of abuse are traditionally recognised (WHO, 2006) World Health Organisation (2006) Preventing child maltreatment: a guide to taking action and generating evidence. World Health Organization and International Society for Prevention of Child Abuse and Neglect. The abuse towards Zuzanna Zommer took 11 months to result in her death during which the sexual abuse of the child went undetected. http://whqlibdoc.who.int/publications/2006/9241594365_eng.pdf [Accessed 25 Feb 2010]

Sidebotham et al (2006) observed that a wide range of factors are associated with child maltreatment, with the strongest risks coming from socio-economic deprivation and parental background, including poor mental health. Community-level variables consistently linked to child maltreatment include lack of social support (including the availability of childcare), neighbourhood poverty and the accessibility of alcohol (Coulton et al, 1995; 1999; 2007; Korbin et al, 1998; Molnar et al, 2003). Social factors, such as beliefs about using physical punishment to discipline children and the portrayal of violence and sex in the media may additionally contribute to abusive behaviour towards children (Belsky, 1993; Straus and Mathur, 1996). Belsky, J. (1993) Etiology of child maltreatment: A developmental-ecological analysis. Psychological Bulletin 114: 413-434.

Following the death of Victoria Climbie, who was known to the social services and many other agencies within the social sector?

Victoria’s parents stated “they had noted that the social worker blames the doctors, front line staff blames the management, mangers blame the council, and the councils blame the government for lack of funding”. Response to the fallings were ‘I am poorly managed’, ‘not my job’, (Laming,2003, evidence 19 February 2002,p97).

Lord Laming was invited to carry out an enquiry looking at the situations leading up to Victoria’s death. His report had a 108 recommendation to safe guard children in the future, this inquiry became known as “the Laming Report” (Laming 2003).

Deryk Mead of Action for Children stated, “I do believe that inquiry reports have made a positive difference to the child protection system, and I have every confidence that Lord Laming’s report will do so too” (Katwala and Ciglerova 2003 p5).

However there was some criticism to his report Caroline Abrahams and Debora Lightfoot from the Action for Children stated the report was looking more at the case of Victoria Climbie and not at children in general in regards to child protection (Abraham and Lightfoot 2003).

.According to Harry Ferguson, a professor of social work at the University of the West of England, “Laming’s report focuses too heavily on the implementation of new structures and fails to understand the keen intuition that child protection work demands”. (Ferguson 2003 p5)

All areas of the UK have policies to safeguard children and young people, to be able to protect them and advertise their general well-being. In 2006 Working Together was re- published on which ideas have been further developed which was again called Working Together to safeguarding Children: A Guide to inter- agency Working to Safeguarding and Promote The Welfare of Children (HM Government 2006).

In 2004 England and Wales were the first to deliver the policy frame work Every Child Matters and recognised the five outcome for children and young people. This was a response to the Laming Report (2003) and to safeguarding children (Department of health 2002). From this the Common assessment framework (CAF) was implemented and used when assessing children and family’s Suffolk County Council (2012)

Every Child Matters was planned to be put in place in 2008, however before it was due to be released the tragic death of baby P happened and the medias response was very critical to all the services involved in his case (Stafford,Vincent,Parton 2010). The system had failed again baby p there had been over sixty visits with the family different health and social care professional he died after 48h of being in hospital (Stafford,Vincent,Parton 2010).

Criticism has been made regarding Every Child Matters and the Children Act 2004 on what should have been a positive social policy programme, is that it only relates to England.

Hilton and Mills (2006) Stated that Every Child matters invades the rights of children’s privacy under article 8 of the European Convention Rights. The loss of space the officer of the Information Commissioner found that children themselves were worried about the invasion of their own privacy (Hilton and Mills 2006).

“While they create a way of seeing and suggest a way of acting, they also tend to create ways of not seeing, and eliminate the possibility of actions associated with alternative views of the world”.(Morgan, 1986, p 202)

Other criticism has been made regarding Every Child Matters and the Children Act 2004 on what should have been a positive social policy programme, is that it only relates to England (Hoyle 2012)

All areas of the United Kingdom are committed to promoting all areas of the national frame work for young people and children. (Stafford,Vincent,Parton 2010).

There is no separate legislation for child protection but legislation covers child’s welfare, including support for children in need and children in need of protection (Lindon 2008). While all parts of the United Kingdom have had some restructuring in recent years to the child protection policy, not much change has been done to the legislation. The children Acts which was put in place the 1980s and 1990s these acts are an intervention in family life to help protect children from abuse and neglect ,and the definition of ‘significant harm’ and ‘children in need’ theses have not been amended (Owen,2009)

The 1989 Children Act still remains, but the Children act 2004has made some amendments. “The Children Act 2004 is primarily about new statutory leadership roles, joint planning and commissioning of children’s services, and how organisation ensure their functions are discharged in a way which safeguards children and promotes the welfare” (Owen 2009 p.17). Section eleven enforced agencies that are working with children and young people to safeguard and promote their welfare, another change was that the Child Protection Committees were replaced by Local Safeguarding Boards ((Stafford,Vincent,Parton 2010).

In 2010 the Government- commissioned Professor Eileen Munro to evaluate the safe guarding practice one of the recommendation was to ask that the ministers establish a national chief social worker whom will advise minister and that the council should be obliged to ensure “sufficient provision such as sure start and other support schemes”.(Butler 2010)

“The report found that safeguarding had indeed become overly dependent on procedures and paperwork, with frontline professionals spending over 60% of their time in front of computer screens”(Butler 2010 p4)

Munro said: “A one-size-fits-all approach is not the right way for child protection services to operate. Top-down government targets and too many forms and procedures are preventing professionals from being able to give children the help they need and assess whether that help has made a difference.”( Munro review 2010)

Some key weakness were found in with the Munro Review this was from social workers, stating that the review states what is being done but dose “not offer the path to a better child protection system” in the future? (Parliament 2012).

In Conclusion this essay has examined an horrific news report on the sexual abuse and the death of Zuzanna Zommer and the back ground of her perpetrator it has looked at how the system failed to protect her from such an ordeal. It has also

The interrelationship between theory and practice is to analyse the client’s strengths based of theory and practise. The important concepts are empowerment and resilience the sources are a big factor in social work because they are the cultural and important stories that are to do with the client. Empowerment can play a big impact on the individual as this can influence their health from their emotions to their beliefs. This is the best way to help the client overcome these certain needs. For example they may need positive thinking and to ignore the negative feedback. (apa psycnet, 1996) Although theory is easy to follow it is also essential to put the theory into practice and to connect with the client.

Whereas (lennarto.wordpress.com, 2009) states that the interrelationship between theory and practice is to analyze the issue non-empirically we could proceed in one of the following two ways: either we could hypothetically take one stance and see what follows from that (e.g., say that there is a close relation between theory and practice, how can we account for that and what would be the – theoretical as well as practical – consequences); or we could make it a normative issue. It is the environmental philosophy there has been a strong suggestion that we should minimize the gap between theory and practice. Shifting the focus from value theoretical issues towards practical real-world why do we need theory in the first place? These issues could be widely extended

This is a demonstration of understanding the use of theoretical paradigms in social work. A paradigm is a group of collective idea’s it is a set of systems which is based on a topic or theme (dictionary, 2012). For this topic I will write about Bandura’s theory behaviourism as a paradigm.

Banduras theory is related to the bobo doll that the children won’t know how to react towards things until they see how their role model acts and then they will take on this behaviour. (experiment resources, 2012) As a social worker and you help the case before it gets out of hand this is changing the behaviour they have modelled to prevent other people won’t pick up this type of behaviour. Bandura’s paradigm can be used in social work because it relates to people’s behaviour. This is important to understand because if a client comes into see you, you need to understand that the client does have history of being violent and with knowing this paradigm you will know what questions to ask to what causes this behaviour. Changing the behaviour to what is considered to be the social norms. Bandura then considered that the personality has relations between three modules: the environment such as where the person lives, behaviour through aggression and the psychological development which is the ability to divert images in the mind and through language. (learning theories, 2012)

As a social worker you have to have an excellent understanding of how practise shapes theory and theory shapes practice. A Theory is a day to day basis to show us how to use practise works effectively. Theory that is evidenced based can impact the theory drastically every day. Through theory you can get the best outstanding models to use in the felid of social work from Te whare tapa wha to code of ethics that are used in practise. (How does theory shape practice in social work, 2010) Te whare tapa wha is a method that is used in social work that illustrates the four walls of MA?ori well- being. The four walls are Taha wairua (spiritual), Taha tinana (physical), Taha hinengaro (mental) and Taha whaanau (family health). (health, 2012)The use of this method is to write down questions in each section to ask your client when they come to see you. Theory shapes practice because theory is a guideline of what the social worker needs follow in order to understand the client. When the social worker is having a session with the client this is the basic needs the social worker will need to know about the client in order to have a successful conversation about what is happening currently with the client. This is where Te whare tapa wha will come in place. This gives the social worker the opportunity to ask the client the questions that they have previously written down according to the notes they had previously received. For instance if the client was a violent person and preformed violent actions towards an object or human, a question under mental health could be “tell me why you feel angry and what kind of thoughts do you have when you feel angry?”. A series of questions can be asked in order to get the right amount of information out of the client in order to help the client recover. They could feel that they have to be violent because that’s what their parents had shown them when they were younger. With this in mind you are able to relate to the client and understand where they are coming from. The Reflection cycle is important because this is what helps get the client on the right track with what they are trying to succeed. This area there are 6 elements to this area’s these are Description (to explain what has happened?), feelings (how the client is feeling and what their thoughts are?), Evaluation (What are the good points and bad points about what is happening?), Analysis (What can you tell me about this situation?), Conclusion (what else do you think you could have done) and finally the Action plan (what would you do if it was to happen again?). (brookes.ac.uk, 1998) This is a good strategy to help a client reach their goals. Each time a social has a meeting with the client the strategies have to be different but still following the format and then the cycle is to start all over again. This is a good way for the client to tell the social worker about what has been going on in their life and in their environment. With the social worker knowing these answers it then give the social worker the appropriate time to ask the client any questions to go further in depth for why they might need your help. You may then need to ask the client about what is going on and how the situation can make the client feel. Another view is that if the client was violent you would be able to trace back to when this first happened and strategize a way with the client of how they can fix this habit in their own way and own pace.

Another form of reflection is the Layers of reflection. These contain: The Reflection-on-experience which is to reflect after the event/ situation has taken place and understanding what has happened in a positive manor. Reflection-in-action to understand the experience and take the information gained towards new goals. Reflection-within-the-moment becomes aware with what is going on with the thinking and understanding of the situation and to respond in discussion. And finally Mindful practice is aware with what is happening throughout practice. (Becoming Reflective, 2004) This is also a good model for a social worker to follow to get a full understanding of their client and also the client will be able to see the progress they are making for extra encouragement if they feel that they are close to giving up.

Conclusion:

In conclusion I will have explained and demonstrated my knowledge of the relationships between social work and theory and how the theory and practise link together. I then explained what theoretical paradigms and how Bandura’s behaviourism fits into place with the paradigm and social work theory. And finally I would have linked behaviourism into Te whare tapa wha in the areas of has practise influences theory and how theory influences practise in a clear pattern with examples of reflective is important in social work theory.

This essay will outline and explain why inter professional collaborative practice in social work is important. It will also examine key factors that help or hinder effective inter professional collaborative practice. It will explain why it is important that professionals work together and effectively as a team and the consequences that can occur when professionals fail to collaborate successfully.

There has been a great deal of political and professional pressures for the development of inter professional collaborative practice. From the late 1990’s onwards there were vast amounts of official documents to promote the importance of collaborative working within the health and social care sector. The 1998 social services White Paper Modernising Social Services (DoH, 1998) and The NHS Plan (2000) devoted entire chapters to the subject. It has been argued that inter professional working has advanced further in relation to services for older people than it has in relation to children and families. The Green Paper Every Child Matters (DfES 2003) recognised this and one of the main elements of this paper focused that improved collaboration was required so as not to repeat the tragic events of the Victoria Climbie case (this case will be discussed in further detail later in the essay). Government recognition suggests that many social problems cannot be effectively addressed by any given organisation acting in isolation from others. That is, when professionals work together effectively they provide a better service to the complex needs of the most vulnerable people in society. Inter professional collaborative practice involves complex interactions between a range of different professionals and is when professionals work together as a team to reach mutually negotiated goals through agreed plans. It is a partnership that can be defined as a formal agreement between the different professions who agree to work together in pursuit of common goals. Collaborative is defined as putting that partnership into operation or into practice. It involves the different professions working together and using their own individual skills instead of working in opposite directions to meet the needs of particular service users. It is suggested that when social workers and other professions work collaboratively the service user gets a better deal. ‘Willing participation (Henneman et al, 1995, cited in Barrett et al, 2005, p.19) and a high level of motivation’ (Molyneux, 2001, cited in Barrett et al, p.19) have been stated as vital aspects of effective inter professional collaboration.

Social workers have certain ethical obligations to society that they must follow and this comes in the form of The British Association of Social Work (BASW) Code of Ethics and the National Occupational Standards for social workers. The Code of Ethics follow five basic values, Human Dignity and Worth, Social Justice, Service to Humanity, Integrity and Competence whilst the National Occupational Standards outline the standards of conduct and practice to which all social workers should adhere to. Whilst working in collaboration with other professionals, social workers should follow these Codes and Standards to ensure that the best possible outcome is achieved for the service user.

In the past inter professional collaborative practice has been difficult with many disadvantages and that this has caused problems between the different professions involved. This has in the past led to catastrophic tragedies as in the case of Victoria Climbie. Shared accountability is important for effective collaboration and all professionals should be accountable. Each profession should support one another, not be seen as self interested and that no one profession is higher than another. Some of the problems that can occur are when there is not a logical distribution of power. ‘Unequal power distribution can be oppressive’ (Payne, 2000, cited in Barrett et al, 2005, p.23) and can limit participation for some group members. Struggles for power are rooted in professional tradition and social difference. It is believed by some critics of social work that ‘social workers have often been located in settings where they were considered as subordinate to other more established professional groups’ (Brewer and Lait, 1980, cited in Wilson et al, 2008, p.401). Traditionally there have been difficulties within the medical profession and Cooke et al, (2001, cited in Barrett et al, 2005, p.23) suggests that ‘general practitioners felt threatened by a redistribution of power and had problems letting go of their traditionally held power base’. Social work in the past has been described as a semi profession and similar to nursing and teaching and not comparable to the ‘learned profession of medicine or law as it does not have the required features of those professions’ (Freidson 1994). Payne (2000 cited in Barrett et al, 2005, p.23) identifies this as ‘people’s capacity to get what they want’. Power in inter professional collaborative practice should be shared and distributed and no hierarchy of power should exist. If some professionals see themselves as more powerful than another they are not meeting the needs of the service user. Being territorial and not sharing information and knowledge has long been a problem in inter professional collaborative practice. Molyneux (2001, cited in Barrett et al, 2005, p20) ‘found that professionals who were confident in their own role were able to work flexibly across professional boundaries without feeling jealous or threatened’. ‘Professional adulthood’ was an expression used by Laidler (1991, cited in Barratt et al, 2005, p.20) to describe professionals who were confident in their own role to share information and communicate effectively with other professionals. These professionals do not feel territorial about relinquishing their knowledge and understanding to further enhance good inter professional collaborative practice. Stapleton (1998, cited in Barrett et al, 2005, p.20) suggests that ‘a combination of personal and professional confidence enables individuals to assert their own perspectives and challenge the viewpoints of others’.

Open and honest communication is a vital and probably one of the most important aspects of inter professional collaborative practice. It requires professionals to take into account each other’s views, be respectful, dignified and to listen to each other without being highly critical of one another. Constructive criticism needs to be undertaken alongside constructive suggestions and encouragement and should take place at a time when other professionals are receptive. Active listening is an important skill. To be able to recognise and respond to what is being communicated is a fundamental skill. Professionals working collaboratively should demonstrate this verbally and non-verbally to each other. This is greatly helped if all concerned put aside the typical stereotyping of each other’s professions in order to hear and listen to what the speaker is saying. Keeping good eye contact and having good body language is just as important. ‘It is estimated that approximately two-thirds of communication is non-verbal, i.e. something is communicated through ‘body language’ – by a body movement, a posture, an inflection in the voice’ (Birdwhistell, 1970, cited in Wilson, 2008, p.297). A breakdown in communication and the lack of sharing of information between the professions in the past have been major failings in inter professional collaborative practice for example in high profile child protection inquiries and this has led to tragic consequences. Effective systems of communication and knowing what information should be shared are essential not just between the professions but also between the service users.

Trust, mutual respect and support are key features to inter professional collaborative practice. Trust was highlighted by many professionals as one of the most important factors in successful collaboration. When trust is absent professionals may feel uncomfortable and insecure in their role and this in turn can lead to defensive behaviour to counteract their insecurities. Stapleton (1998, cited in Barratt et al, 2005, p.22) suggests that ‘trust develops through repeated positive inter professional experience and develops gradually over a period of time’. Trust cannot be gained overnight so it is important for professionals working collaboratively to give one another time for trust to develop. When professionals feel valued, they feel respected. This can be achieved by actively listening to each other and having an insight into one another’s professions.

Conflict between the professions can have a huge impact on the different professionals and service users. Loxley (1997, cited in Barrett et al, 2005, p.24) suggests that conflict is ‘interwoven with collaborative practice’. To counteract some of the problems associated with conflict it may be beneficial to all concerned to form ground rules. These ground rules could go some way to prevent and help the management of conflict and could include; open discussion and the obligation to be able to give each other honest feedback. Most importantly these ground rules need to benefit all parties involved.

A great deal of emphasis is placed on social workers to critically reflect their practice. It literally means that social workers reflect on their practice before, during and after, thinking through tasks carefully. Other professionals may not do this in line with social workers beliefs of critical reflection or in the same way or see that reflection on their own practice is an important aspect of successful inter professional collaborative practice.

To illustrate the above points a practice example will now be explained. The inquiry into the death of ten year old Victoria Climbie highlights the disastrous consequences when communication in inter professional collaborative practice fails. This child death case was fraught with communication breakdowns across the range of professionals associated with the case. In Lord Laming’s report (2003) he draws attention to and illustrates lack of communication as one of the key issues. Victoria Climbie was failed by a system that was put into place to protect her. Professionals failed in this protection by not communicating with each other or with Victoria herself. One of the criticisms in the Laming Report (2003) was that none of the professionals involved in the case spoke to Victoria about her life or how she was feeling and suggests that even basic service user involvement was absent. There was an opportunity which is highlighted in his report that a social worker missed an opportunity to communicate with Victoria by deciding not to see or speak to her while she was in hospital. It could be argued that if basic levels of communication with Victoria herself had been implemented, then more could have been achieved to protect her. It was not only a lack of communication with Victoria herself but a lack of communication between the professions that were investigated in the Laming Report (2003). Communication is equally important between the service user and the different professional bodies. Professionals are less effective on their clients’ behalf if they cannot communicate precisely and persuasively’. (Clark, 2000, cited in Trevithick, 2009, p.117). For successful inter professional collaborative practice to work a combination of personal and professional skills are required, together with competent communications skills to enable the different professions to challenge the views of others. Recommendation 37 of the Laming Report (2003) states ‘The training of social workers must equip them with the confidence to question the opinion of professionals in other agencies when conducting their own assessment of the needs of the child’. On at least one occasion, this did not happen when a social worker did not challenge a medical statement which turned out to be professionally incorrect which in turn led to the tragic eventual death of Victoria. Had the social worker challenged the medical opinion in this instance then it could be argued that more efficient communication and less confusion in the case may have saved Victoria. Alan Milburn (Hansard 28 January 2003, column 740, cited in Wilson et al, 2008, p.474), the then Secretary of State commented when introducing the Children Bill in the Commons that ‘Victoria needs services that worked together’ and that ‘down the years inquiry after inquiry has called for better communication and better co-ordination’. Communication lies at the heart of high quality and successful inter professional practice and Victoria is just one case of when there is a lack of communication between the professionals and the devastating consequences that can arise.

In conclusion, successful inter professional collaborative practice has many elements and all these different elements require that the different professions adopt them. Although inter professional working practice has been around for many years and is not new, it still needs to be continued, developed and incorporated into the daily work of all professions. When health and social care professionals from different disciplines truly understand each other’s roles, responsibilities and challenges, the potential of inter professional collaborative practice could be fully realised and many of the barriers alleviated, giving a more successful outcome to the service user.

“Social work practice seeks to promote human well-being and to redress human suffering and injusticeaˆ¦..Such practice maintains a particular concern for those who are most excluded from social, economic or cultural processes and structuresaˆ¦.Consequently, social work practice is a political activity and tensions between rights to care and control and self-determination are very much a professional concern”(O’Connor et al, 2006, p.1)

The Brown family case study will be referred to throughout the essay in an attempt to explore and discuss the lived experiences of service users. With such an array of difficulties faced by the family, in order to be able to provide analysis and critique, many of these difficulties and their correlation within social work practice will not be explored. The essay will begin with examining the political background from Margaret Thatcher to the current Coalition government and emphasize their continued functionalist ideologies. It will also discuss sociological constructions of the family, poverty, power, and managerialism.

The prolific cases of the deaths of Victoria Climbie and Baby P led to such media scrutiny and a downward turn in public perception of social workers. As a result, this has led to changes in social work practice with children and families.

Due to the current austerity measures, social workers gatekeeping of resources and having to meet stringent thresholds often result in limitations being put on families and creating what aˆ¦aˆ¦aˆ¦aˆ¦aˆ¦..describes as a revolving door syndrome. The Brown case study refers to there being intermittent involvement from social services over several years, which supports the suggestion of a revolving door syndrome. Although the case study is not explicit, I think it would be safe to assume that issues faced by the Brown family may have suggested that they meet the section 47 threshold set out in the Children Act which would have triggered social work involvement with the family. However, if the involvement has been intermittent, this would suggest that once significant risk had diminished the involvement with the family was stopped which suggest risk led practice was employed rather than a needs led (Axford, 2010).

Munro’s recent review of child protection (2011) included 15 recommendations. There is not scope to discuss each recommendation but she urges the government to accept that there will inevitably be an element of uncertainty, to allow professionals to have a greater freedom to use their professional judgement and expertise, and to reduce bureaucracy. The response from government is to accept 9 out of the 15 recommendations (DfE, 2011)

Poverty

The case study highlights that the Brown family are dependent on welfare benefits and that they find it difficult to manage their finances. Therefore, they are essentially living in poverty. Poverty can be described as a complex occurrence that can be caused by a range of issues which can result in inadequate resources. It impacts on childhoods, life chances and imposes costs on society

“Child poverty costs the UK at least ?25 billion a year, (equivalent to 2% of GDP) including ?17 billion that could accrue to the Exchequer if child poverty were eradicated. Public spending to deal with the fallout of child poverty is about ?12 billion a year, about 60% of which goes on personal social services, school education and police and criminal justice”. (Hirsch, 2008: Joseph Rowntree Foundation,p.5)

Cross national studies have suggested that child poverty is not a natural occurrence. Moreover it is a political occurrence, the product of decisions and actions made by the government and society. Attention concerning a dependency culture has filtered through different political parties and have been utilised with renewed enthusiasm since the formation of the coalition government in 2010. These assertions of dependency create propaganda about the attitudes of the workless and they give the wrong impression of the previous efforts of the Labour government to tackle child poverty who focus was to direct increased welfare payments towards those people who are working in low paid jobs. The coalition is currently reducing benefit payments to families in work. As a result of these cuts, many children will evidently be thrust back into child poverty (aˆ¦aˆ¦aˆ¦).

A possible contention is that the coalition government argue that they seek to treat the symptoms of poverty, rather than the causes. However, their analyses of the causes are at best partial or incomplete. While in-work poverty is acknowledged, it is often buried beneath the rhetoric of welfare dependency (ESRC, 2011). The suggestion that previous methods to tackle child poverty have inevitably robbed people of their own responsibility and therefore led them to become dependent on the welfare state that simply hands out cash is absurd (Minujin & Nandy, 2012).

Work is frequently referred to as the favoured route out of poverty. Although the government have introduced numerous policies to ‘make work pay’ there are countless families that still do not earn enough money to attempt to lift their family out of poverty (Barnardos, 2009). More than half of all children currently living in poverty have a parent in paid work (DWP, 2009). The Brown family have both parents out of work, with Anne having never been in paid work and Craig struggling to find regular employment since leaving the Army 8 years ago. Both parents have literacy difficulties and so require a complex package of support to enable them to improve their life chances of gaining employment that pays above the minimum wage in order for their family to no longer be living in poverty.

According to the code of practice (HCPC, 2012) social workers are required toaˆ¦aˆ¦aˆ¦aˆ¦aˆ¦aˆ¦aˆ¦aˆ¦aˆ¦aˆ¦aˆ¦aˆ¦aˆ¦aˆ¦aˆ¦aˆ¦aˆ¦aˆ¦aˆ¦aˆ¦aˆ¦aˆ¦aˆ¦aˆ¦aˆ¦aˆ¦

As mentioned previously, successive Neo Liberal governments uphold a functionalist ideology that frequently locates poverty in terms of personal responsibility and deficits.

Managerialism

As mentioned previously, services have changes over the past 20 years and this can be explained by the emergence of a managerial approach to how services are being delivered. Intrinsically, managerialism is a basic set of ideas that transpired from the New Right criticisms of welfare and is founded on the notion that public services need to be managed in the same way as profit-making organisations (Harris & Unwin, 2009). In the UK there has been a rise in managerialism which can often lead to weakening the role and autonomy of social work practice. In the pursuit of becoming accountable and impartial, managers are attempting to control or prescribe practice in increasing detail which inexorably leads to reducing the opportunity for practitioners to implement individual reasoning. As a result, this leads to policies that represent rules that can often be described as inept and insensitive for the service user. Therefore, the tussle between the managerial and the professional control in social work practice is often a contested issue (Munro, 2008). As managerialism takes more control, then a shift towards defensive practice develops which results in procedures that are insensitive to the needs of families. In essence, the professional role of a social worker can be progressively reduced to a bureaucrat with no possibility for expertise or personalised responses

In addition, a managerial approach causes conflict, as it emphasises the need for targets that will assess performance and the delivery of services (Brotherton et al, 20120). Furthermore, there is a correlation with an apparent distrust or autonomy of professionals. This has led to an upsurge in scrutiny by a variety of inspection bodies such as Ofsted and this has been extremely significant in the area of child protection following the high-profile cases of the deaths of Victoria Climbie and Peter Connolly.

This assignment is done to explore the international context for healthcare policy and orgs of healthcare. It also helps us to understand contemporary issues and promotion of healthcare. The political, cultural and social issues that help to determine healthcare policy are also analyzed in this assignment. Our 1st task is to analyze approaches to healthcare policy formation in some international context and here the National Drug Preference Alliance organization is chosen for assessment. The goal of this organization is to save the addicted ones and to promote effective policies, preventing, giving education and knowledge regarding the drugs consumption and its problems caused in society. This organization’s track contains how to approach the study of health care organizations from different angles of theoretical perspectives, levels of analysis, and methods. Organizational theory tries to create a healthier nation and is seen as involving the whole of the community, basically it is an interdisciplinary course of study. Rooted in sociology and social psychology, these healthcare policy approaches developed different variety of theories and methods for the study of organizations. Considering approaches, social and political science provides theories to analyze power relations and decision-making in all kinds of organizations that are held in United Kingdom.

Next task is to assess the influence of funding on policy formation in NDPA organization. Within any of the health policy field, there are chances for formation of healthcare policy. Without creation of a policy, the organization is not worthy enough for the society. A growing literature is trying to understand the various responses of policy makers to research; they explain why certain research findings pave their way into policy and why some others are effectively ignored. It is necessary to fund the policy formation. Else the formation of policy will simply be a dream or just in theoretical papers. The members of the organization must be ready to fund the policy formation. They have to get the help of politicians, social workers, the public, technicians, etc. and they must have some members among themselves who are able to fund for the policy formation. They can also provide fund from the public, can take loans, charity funds, etc. for the formation of healthcare policy. The government is always interested in funding for NDPA organization as it has taken a great role in saving the society from drug addicts and NDPA organization has become a crucial organization for the both the society and the government.

Next task is to evaluate healthcare policy in NDPA organization. With the awareness spread by NDPA organization, the government of the country has made drugs as illegal. It has been declared that the use of drugs is illegal and can lead to the imprisonment of the user along with penalty.it has been estimated that 22% of passengers and 18% of drivers who have been involved in fatal accidents have taken illegal drugs. This statistics shows the importance and urgency that is required for the formation of policy in England. The police in the nation are always engaged in testing policies. It is also declared by the government that drug takers harm no one but themselves. The legislature is spending much part of their time for freeing the nation from the addicts. They have led the focus of government towards drugs. In today’s life the impression is that everyone is into drugs. Nowadays drugs have been considered as a style of living and Britain is leading in this style. It is considered as today’s style accessory. The government has taken many policies to reduce the consumption of drugs. Many awareness programs have been conducted in each and every part of the country. Retreat centers are open throughout the nation for helping the drug victims.

In this assignment next we have to assess the impact of culture on healthcare. Culture can be defined is the way people live. It is natural that culture affects everything we think and do, from how we look after our elders, to whom we are allowing to be a healer, and to what we do when our children are not feeling well. Culture plays an important role in our lives. Like our genes shape our health, so does culture does. The way we define ourselves culturally influences what we will do for others health. So it can be understood that a good health care provider recognizes all these facts and tries to learn about the different cultures of his or her patients. It is not possible to summarize the cultural behavior of patients. It varies from one patient to other. Culture is a vast area. There is a variation that exists among individual members of a cultural group. Learning about general health beliefs and customs of an area would prove to be good while dealing with the patients of that area. It also provides the health cares with experience.

Next is assessing the impact of society with healthcare. Society and healthcare are related deeply together. Any society with ill people won’t lead to development of society. If the society consists of healthy people, then they can lead the society and their nation towards development. Even though Britain is one of the greatest developed nations in the world, it is now the biggest drug user in Europe. Due to this addiction towards drugs different kinds of social and economic disaster can happen. For those drugs which no remedial measures were taken. Reducing its effect requires commitment from the area such as social, political, and economic across industries and governments and also through unique public-private partnerships. These three above mentioned factors force the governing and relevant non-governmental authorities on stream of continual decisions. Not depending on if the need for decisions is adequately there or addressed, unnecessary issues can promote the growth of drug addicts. Nowadays strategies were developed with regard to the research and development that is for preservations of pathogens and how they preserved. To the enhancement of preservation the wellbeing of researchers and the peoples around them these steps were taken and also to ensure the integrity of the surrounding environment.

Next we have to analyze the attitudes towards healthcare. The organization also deals with other important aspects like providing care for older patients, teamwork in teaching process and making awareness and giving training to new comers in the organization. They provide motivation to the drug addicts to live in a normal way and they motivate them to join the organization and save other victims of the drug. To determine the attitudes of healthcare and healthcare workers baseline surveys are conducted. As a result they obtain attitudes of public towards healthcare and they can assess and analyze the progress of their work. Most students in each group of the organization profession agreed that the disciplinary teamwork approach benefits patients and tries to effectively utilize the time for any productive purpose. Several studies conducted have estimated that physician’s attitudes towards prevention, cure and barriers to the delivery of preventive health strategies are effective. All that they require is the cooperation of the people, so that they can change the face of the drowning world. A standard can be considered as a level of quality against which performance can be measured. These are essential in healthcare sector to ensure safe and effective practice. Developing and maintaining the quality of services provided by the organization is a major objective for those involved in the planning, provision, delivery and review of health and social care services since there exists unacceptable variation in the quality of services provided, including timeliness of delivery and the ease of access.

Next we have to evaluate the cultural and social impacts on and attitudes towards healthcare in NDPA organization. The organization is highly influenced by cultural impacts. They study the different cultures that exist in the current society and work accordingly to save the society from the hands of drugs. Learning about general health beliefs and customs of an area would prove to be good while dealing with the patients of that area. It also provides the health cares with experience. In case of social impacts we have to consider a variety of facts. Drug addiction the cause for most of the economic and social disruption or disaster. Factors such as political, social and economic make governments and relevant non-governmental authorities upon continuous stream of decisions. NDPA organization has held a great attitude towards healthcare sector. They have taken the initiative to save the people of the nation from dying. They have always held appositive attitude towards healthcare. Depending upon the interest of public that makes some way into social organization and decision policy are made. All that they require is the cooperation of the people, so that they can change the face of the drowning world.

Net we have to analyze how healthcare policy is translated into practice in the organization. Translating the healthcare policy clinical practice is a valuable initiative for services for health so that the care given to the patient is efficient, cost-effective, and improves patient satisfaction. The studies show that on implementing and disseminating protocols, clinical practice guidelines. The objective is to identify the factors that influence healthcare and to present key international studies on them. Existing system for healthcare was examined to the formation of a plan for the research in future. As a result, various methods of healthcare policy translation are described like clinical pathways, clinical practice guidelines and protocols, a model for incorporating research based on normal and usual questions, partnerships between organizations, and implementation strategies that allow the translation of policies to practice. A lot of fund is required in translating policies to practice which are acquired by the organization in various ways as discussed above. Future research is needed on translating health care policy in the different areas like the best theoretical approaches, barriers, good strategies for nurses , the quality of empowerment approaches, the consequences of international collaboration, the mentor’s value etc.

Next task is to analyze the organizations involved in health care in a national and international context. One of such an organization is the NDPA organization. Finance needed for the health care in developing countries is created by the countries themselves. International health organizations in the developed countries only provide less than 5% of the total needs for healthcare in the developing world. It is important to find that the percentage of costs needed for the healthcare donated by the developed world is greater than the 5% average in the countries which are very poorer. Local health professionals are getting expert technical advice and training from international health organizations. These organizations produce the major documents in tropical health they also produce the most important guidelines for health care workers. Other international organizations in healthcare sector are World Health Organization (WHO) which is the premier international organization for health. The Pan American Health Organization (PAHO) works as the regional field office for WHO. The World Bank is the next major “intergovernmental agency related to the UN” related to healthcare. The United Nation Children’s Fund (UNICEF) spends the most of its program budget on health care. The United Nation Development Programme (UNDP) allocated $141 million, out of a total budget for field expenditures of $1 billion, to “health, education, employment.” Its major health concerns are AIDS, maternal and child nutrition, and excessive maternal mortality. Medecins Sans Frontieres (MSF) gives health aid to war and natural disaster victims.

Next task is to analyze the structure of healthcare delivery in NDPA organization. How health care is organized and delivered in a national context is dealt with the structural delivery of healthcare system. It includes many practical barriers like accessibility in terms of social and transport issues, funding issues, private health insurance cost, cost of treatment, safety issues, for example, in war, conflict or natural disaster areas. The organization has a chief member or director who controls all the functioning of the organization. He will be having subordinate that control sub organizations. All together they function effectively in a practical manner to achieve their goals. It exists within all levels of healthcare organizations. Beyond directives importance is given to improving health status.

Next task is to assess the practical barriers that are found in any health organization like NDPA for their health care policy. Healthcare delivery systems are filled with barriers to health communication in all the levels. Linguistic and language barriers in health communication sectors must be overcome. It exists within all levels of healthcare organizations. Language barriers influences mostly while access within a healthcare delivery system that is access, quality of care, health outcomes and self-efficiency especially. Studies that try to create standards and methods for developing information of the patients which is usable by most patients are needed. The studies must address both the written information and the simplification so that it can match the reading skills of patients and also its cross-cultural application. The major health communication loophole in the structure of care as it feels to patients lies in what is incorrectly termed ‘linguistic appropriateness’ which always takes into consideration translation of language and other elements of health communication are not taken. There are mainly cultural barriers that include health beliefs and behaviors and practitioners beliefs and behaviors. Next are geographic barriers that include rural health professional shortage areas. Then comes organizational barriers. Another barrier is socioeconomic barriers that include poor education, lack of health insurance, inability to pay money out of pocket.

The national and international socio political issues that are always present in promotion of health care is discussed here. They are considered as crucial issues, since sometimes they oppose the functioning of healthcare organization. Political factors deal with public health access and allocation of resources, prevention program’s access, treatment related topmost-exposure interventions and prophylaxis. Impact is made by international political factors in including some educational programs to detection of support, evaluation and response, also limited to information technology and telecommunications infrastructure to create links with highly risky places of the world. Migrations of people, increased trade and travel, food consumption patterns, sexual practices, new medical practices, human conflict, and the deliberate use of pathogens for hostile purposes includes the social factors, these are behavioral activities. Economic factors arise from lack of financial investment in research and development of processes; produce certain tasks such as training, procedures, technology etc. . Factors that related to economy constitute lack of support for a large number of programs that are beneficial such as public-private partnerships, market incentives to development of interventions.

Next task is to ass’s impact of international campaigns and national policies on the demand for healthcare. Various international campaigns are conducted in United Kingdom to secure the creation of a universal health care system. Campaign organizers used a framework to organize thousands of people in support of universal health care. In response to this effort, the state legislature passed health care legislation that incorporates human rights principles. It provides a framework for universal health care. By forming international campaigns it is possible to make people aware about the international issues that are possible in health care area. International campaigns and national policies allow the natives to understand the importance of health care and they make people work against the activities that affect the health of people. The organization has adopted international human rights policy for the betterment of the people. It has been the main topic of their campaign. They also analyses the health care reform bill. Healthcare Is a Human Right Campaign (HCHR) was a campaign conducted in association with the organization. By framing health care as a human right, the center organized thousands of states that had no prior involvement with political campaigning. This led the center making it possible to change the political environment and force the state legislature to enact rules that will lead to universal health care.

Next task is to evaluate the role of health promotion in determining healthcare service demand in a national setting. Health care industry takes the nation’s major financial resources. For facilitating evidence of quality controls and improvements it has come under immense pressure. Current health care consumer is now better educated and the best informed with increased knowledge. Impact of patient perception is the one aspect of health care quality that is mostly being recognized. Even though it depends more on healthcare’s service aspects it also correlates very well with health care quality objective measures. Ultimately delivered quality of health care can be dependent on ability of the health care organization to satisfy demand of the customer for convenience and information. The health care service sector is complex with multiple faces and different phases of organization. Health care system management has been relatively not sufficient before, making customers on the outside of the design of the product, incoherent and supply driven, development and also the delivery process. Many physicians think that the current emphasis on quality is not really aimed at improving health of the patient. Nowadays there is a change to an organization model in which the customer has importance and they influences every function and managers must look forward and make use of it and be instrumental in establishing a change within the entire system to focus on the quality.

Next task is identifying contemporary issues in health care of the organization. Nowadays whooping cough cases rises in England. As ministers pass the buck and applications for taking children into care continue to rise, councils’ problems just keep growing. There were volunteers translating health messages from English into local languages and thus providing a vital service for Non-Government Organizations and freeing up thousands of extra dollars to be used for medical aid. There are many policy issues that are contemporary in the financing and delivery of health care services. The role of bureaucratic agencies, legislative committees, interest groups and major health care policies are analyzed for obtaining information such as how to deal with the issues of the health care sector. Problems that related to quality of death and life gets its importance. This is broadly classified to include infant mortality, AIDS policy, occupational safety, government regulation of consumer products, and fiscal issues such as national health insurance, prospective payment, and the rationing of health care. More attention will be given to the legislative and political aspects of these various policy areas, ethical issues will also be considered because they are unavoidable.

Next task is evaluating the impact of these issues on national and international policy discussed above. There are growing dependence between security, health policy and foreign policy so that with developments in these fields having much importance for health in the United Kingdom and globally. The major issue in foreign policy was always health so as its prominence increases, the need of assessment is important if it is appropriately prioritised and how on the national basis the government interacts with business and civil society. Efforts to improve preparedness for acting against all the activities that affects the health of society and policies for tobacco control provides examples where health is highly mixed with high politics. Since 1th September 2001, health and development agenda has also been widely linked with the international policy priorities of preventing state failure and improving global security. The main security issue was become the health and foreign policy for a range of actors both inside and outside government. Policy-makers before think that rather distant fields of security, health and foreign policy must try to consider each other’s work as they are met by the play of issues at the global level. Implications of globalisation for health now are considered as the international issue.

Next task is to evaluate practical responses to contemporary issues that are discussed above. The main method to avoid all the issues is to create public awareness among people. They must be aware of the hazards that might occur due to activities that lead to lesser health of people in society. They must try to make other people aware about the problems that might occur due to careless living of their lives. Health care policy managements must be created in every area of the nation to administer the health aspects in those areas. Current international and national healthcare issues are identified and they must be treated accordingly for the betterment of the society. The current health care consumer is now better educated and the best informed with increased knowledge. International political factors can have an Impact made by international political factors includes limited or non-existent educational activities to support identification and verification, detection, and response. In this assignment a research related to the organization in health care sector is conducted. The political, social and cultural issues are identified. Analyzed the importance of health care policy. It helped to critically assess the policies and aspects of the organization.

As a social worker, having an awareness of how my philosophy may influence my decision-making in a professional setting is important for future practice. In order to give my clients the most beneficial advise. I must be aware of my responsibilities in following the value practices of social work. Know my position in the helping domain According to the Association of Australian Social Workers, social work practice should aim to help individuals achieve success in both personal and social endeavours in order to encourage wellbeing of the individual (aasw 2002,p 5). My self-evaluation will analyse how personal philosophy compliments or contradicts the value set out in social work practice. I will explore my values in relation to individual relationships and speak about my hopes for the future of the world I shall also explore the origins of my philosophies, the pillars that sustain them and the events in my life that have shaped my beliefs. I will then examine the steps I would take to prevent conflicts of interest between my client and me

Personal life Philosophy

Human beings irrespective of gender, race, or status govern their lives according to a series of rules that show the way to behave among family, friends, and the wider community. These are called values and are signals that give direction about right and wrong (Dolgoff et al, 2009, p20, Beckett & Maynard, 2005, p5). Values stem from a variety of areas, as children we are raised in communities that influence our behaviour Beckett and Maynard (2005) refer to these as value systems. The ideals we take from our societies can be static and others can change overtime. (Beckett & Maynard, 2005) Culture has a major impact on our value systems; it influences our professional lives, as well as our private lives. (Otima Doyle, Shari E. Miller, F. Y. Mirza, 2007). I also govern my actions according to values learned as a child and my philosophy has been shaped by a cross-cultural upbringing, I was raised in Papua New Guinea where I received a western education that encouraged individualism and in Uganda, I received a Catholic education where I learned the values of community. I experienced the liberal lifestyle in university. These diverse environments have contributed to how I view the world today. I value people above all other beings because of the way I was raised in Uganda with family members that supported each other economically I did not experience great hardship. However I knew that my parents did. This awareness taught me to respect hard work and value integrity, because my parents despite their struggles resisted the pressures of the government to sacrifice personal integrity for wealth. I value honesty and for me that includes being open about my abilities to take cases that may cause me great distress and I consider credibility in matters pertaining to worker client confidentiality valuable Compassion and charity are also important to me because I believe that in order to be an effective helper, a charitable nature goes along way towards understanding the needs of a client. I am aware however that emotional distance must be exercised. I need to be careful not become emotionally attached to the client In order to prevent my imposing my values upon my client.

I believe in being committed to all my relationships, and feel that in order to achieve success in either my personal or professional life I must be faithful in keeping private details in confidence. Finally I believe that in order for a relationship to grow there needs to be acceptance for differences in all aspects of life, from how someone behaves, to the opinions they hold. Therefore if I choose to interact with people regularly I should be able to accept them completely. I may not like their actions but I should acknowledge that my clients come from different backgrounds and as a social worker my duty lies in not judging them, but rather I am there to help them work through their problems.

Hope for the future and the world

The future is truly an unknown that holds a lot of uncertainty for me; at present I can not clearly picture what my hopes and dreams are. However there are some things I would like to see change in the next ten years: The first area of concern for me is the climate change debate, instead of the constant rhetoric from the major world leaders like the United States, Russia, Great Britain, and China. I would like to see concrete steps being taken to reduce greenhouse gas emission coming from industries around the world. Secondly I wish that in the next few years the millennium development goals (MDGs) are achieved before the dead line in 2015 so far very limited success has been reported according to the United Nations MDGS report of 2009 progress has been noted in only four goals of the ten goal program. The report outlines the progress made in reducing infant deaths, from its 1990 figure of 12.6million to 9 million in 2007; the report also cites progress in the areas of education, poverty and reduction of pollutants. They however admit that more progress is needed in order to meet the 2015 deadline. Finally I hope that more pharmaceutical companies will join the global initiative to find cheaper alternative solutions to the medical needs of the world. I hope the companies like Glaxo smith Kline and its many rivals dispense with the need to make money and consider saving lives as their priority

Origins of values and reinforcement

My philosophy comes from many experiences. As a child I grew up with cataracts that affected my vision. The condition over the course of my education has caused me great frustration. However, the love and strength of my mother ensured that I had the best possible start. She taught me never to give up; the support of my educators also showed me that despite the presence of obstacles, if I worked hard I would achieve my goals. The challenges due to my visual impediment have taught me to be compassionate towards all people who have challenges in their own lives, I have experienced the hardship of trying to live and work with people who have few physical limitations. Reading is a skill that I love but at times I dislike it because the fonts used in books are often too small and cause me to be slower these seemingly minor worries cause me some frustration. I however find great inspiration from men like the Australian born Nick Vujicic who was born with no limbs and with only a tiny foot lives life to the full. With a double degree in accounting and financial planning He speaks with strength about his journey “I found the purpose of my existence, and also the purpose of my circumstance.” (Nick Vujicic 2010). His ability to succeed in the way he has despite his obvious challenges, amazes and humbles me into the realisation that I can achieve any goal if I truly want it.

My life philosophies are sustained by my belief in God to whom I turn to for guidance; guidance I find in the writings of the Old and New Testament of the Bible. In the Old Testament writings, especially in the book of Deuteronomy, I find the moral values by which I govern my life. Set out in The Ten Commandments (NIV Bible, Duet; 5:1-32) that guide me on how to live my life in accordance to Gods wishes.

Other values that have contributed to who I am come from other books I have read. Books by Charles Dickens such as Oliver Twist and Hard Times have painted harsh pictures of poverty in industrial England during the 19th and early 20th century these stories sparked an interest in perusing solutions to human suffering. Before coming to Australia I had completed a degree in International relations with the hope of leading my nation towards finding solutions to our domestic problems in the International arena these aspirations however have not been achieved so far

Personal values in relation to Social work

After reading the Australian association of social workers code of ethics I have found parallels to my own philosophy of life. The association has five core values that provide social work professionals with guidelines that inform their practice. These values are:

Human dignity and worth

Social justice

Service to humanity

Integrity

Competence

(AASW, 2002, 1999, p 8)

At this stage in my live I can appreciate and accept that these values are essential for every day life. However, I must express some reservations in saying that I would adhere to these values completely. The major problem that I can foresee is that I am an individual with mixed ideals in some situations for instance where the question of life is posed I am fairly mixed I do not believe in the death penalty, yet I cannot fully disagree about the abortion questions. I can cite a specific time in my life when I was 22 and a friend told me she was dating a married man and had become pregnant. She wanted to have an abortion and I tried to talk her out f it however she went ahead and had the abortion, my first instinct when I got the news was to be critical of her and I see now that my distaste regarding infidelity and abortion prevented me from being more considerate, as a social worker I must learn to suppress my own views in order to be more receptive to my clients

In situations where my values may conflict with those of a client Ralph Dolgoff etal says clashes occur in many client worker dynamics (Dolgoff etal 2009, p112) mainly because social workers tend to give greater value to social harmony, equality, free choice and social justice. These values differ from culture to culture and may change over time. An example is the question of a woman’s right to choose between an abortion and not having one in the early 20th century women in Europe and North America could not get safe access to abortion services and as a result many died in back alley clinics in the attempt. However as laws around the world have changed so have values and in many societies having an abortion is now just another alternative to a woman who may have no choice but to seek such services.

These differences according to Dolgoff etal may cause problems for the social worker and the client In the initial stages of therapy, however in order to ensure that my point of view does not conflict with my clients values, Dolgoff suggests that social workers need to peruse knowledge relevant to the cultural requirements of clients, this information can be compiled through interviews of clients (Dolgoff etal 2009). As social workers we need to be knowledgeable about the various issues pertaining to cultural or religious beliefs (Dolgoff, etal, 2009, 113).Although I may need to have a better understanding of where my client position on certain values comes from, it is vital that I maintain a clear impartial reserve Dolgoff emphasises the dangers inherent in identifying too closely with the clients he points out that bias will most likely result and affect the success of an intervention. However having a similar background to my client can enable a better rapport to develop between my client and myself.

Further gaps that may arise and cause me problems as a social worker deal with the matter of power; in the social work profession I have assumed power over the client. And because of this assumed power, the client is likely to feel unequal to me by virtue of my knowledge, and the client’s position of service user. This power dynamic can be detrimental to the success of a social worker in trying to gather helpful insight into a clients problem, if not channelled correctly In the text Ethical decisions for social work practice Ralph Dolgoff etal suggest a number of ways in which I can ensure that my client feels comfortable enough to let go of the fear that may hamper the helping exercise. They suggest that as a social worker I need to find out what the clients values are and decide whether conflict of interests exists, and if there is conflict I must next approach the client in a way that does not mention the value in order to understand the nature of my client’s problem.

In order to maintain a professional standard I must remember the reasons I chose to join the helping profession, according Lesley Chenoweth and Donna McAuliffe (2005, p 6) the reasons some people enter the social work profession stem from experiences had ether in child hood or early adulthood. These experiences can sometimes provide a person with a passion to join the social work field because they were helped by a social worker and wanted to inspire others, as they were inspired. For some the experience with social services could have been negative and fostered a desire to bring change to the profession. No matter how we joined the profession it is important that we do not lose sight of the reasons why we chose social work these reasons will sustain me and keep me motivated to continue to work with clients even those who are difficult and hard to help.

Acknowledging personal bias before hand can often reduce the chances of having value conflicts with clients. Chenoweth and McAuliffe regard this as “effective use of self” By letting my supervisors know where I stand on certain issue can ensure that I am less likely to be assigned a case that I cannot properly deal with. Maintaining a value neutral stance is another way to avoid creating value conflicts (Weick as cited by Dolgoff etal) suggests that in order to properly understand the client the social worker needs to listen carefully to what the client truly wants and should suspend all judgement, values, and personal principles in order to provide effective help to the client (Dolgoff, 2009,p, 114).

In order for my future social work practice to be effect I must cultivate and continually strengthen my knowledge base and seek networks to keep me motivated. Self-awareness is key to understanding my role, as a professional helper, and critical reflections about my self in relation to my values is valuable. As the American author Daniel Coleman said,

“If your emotional abilities aren’t in hand, if you don’t have self-awareness, if you are not able to manage your distressing emotions, if you can’t have empathy and have effective relationships, then no matter how smart you are, you are not going to get very far.”(Coleman, 2010).

Introduction and definitions:

The World Health Organization (WHO) has defined the mental health as:

i??A state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her communityi?? (1).

According to NHS website every year in the UK, more than 250,000 people are admitted to psychiatric hospitals and over 4,000 people commit suicide (2).

Mental health inequality is a long standing problem that has been tackled for decades by epidemiologists, sociologists and health professionals.

And because this problem has both strong social and medical aspect there is no unified approach to identification and resolution.

From Sociologists viewpoint inequality with mental health is a problem that has two main explanations: people are poor because they have mentally illness that makes them unable to keep work probably (social selection), or they become mentally ill under the stress of being poor (social causation). However, in modern psychiatry other factors are believed to involve in the etiology such as genetic factors, diet, and hormonal disturbance which interact with personality disorders or emotional state to produce mental illness.

The problem of inequality is not only about the present of a true mental illness but it is possible to expand the definition of mental health inequality to include everyday feelings which is considered by United Kingdom Department of Health to be a public health indicator:

How people feel is not an elusive or abstract concept, but a significant public health indicator; as significant as rates of smoking, obesity and physical activity (3)

The table below gives examples of those factors that promote or reduce opportunities for sound mental health (4):

PROTECTIVE FACTORS

INTERNAL EXTERNAL

i?? Good physical health

i?? High self esteem

i?? Learning ability

i?? Good conflict management

i?? early and positive bonding and attachment experience

i?? make relationships and ability to maintain or break them

i?? acceptance feeling

i?? good communication skills i?? Availability of the basic needs such as shelter and food,

i?? validation by the community

i?? support from surrounding social network

i?? present of role models

i?? job security

i?? good education level

i?? feeling secure

i?? political stability

VULNERABILITY FACTORS

INTERNAL EXTERNAL

i?? congenital diseases or disability

i?? low self-esteem or social status

i?? sexuality problems

i?? relationships problems

i?? feeling of isolation

i?? institutionalisation

i?? lack of essential needs food , heat , housing ..

i?? loss and separation experience

i?? violence or abuse experience

i?? substance abuse

i?? psychiatric disorder runs in family

i?? discrimination

i?? unemployment peer pressure

i?? pressure from value systems

i?? poverty

Table 1: factors that affect good mental health

What is the evidence on mental health inequalities?

Socio-economic status:

Many Community-based epidemiological studies showed an inverse relationship between Socio-economic status and rates of schizophrenia. Saraceno found that the current prevalence (calculated up to one-year prevalence) of the schizophrenia among low-SES is higher than people of high-SES with a ratio of 3.4, and when calculated to lifetime prevalence it is 2.4i?? (5), and in Britain, suicides rates among people from lower SES nearly double that of high-SES (6).

There are five hypotheses to explain this relation (7)(8):

1: Economic stress. The mental illness is a speci?c outcome of the stress related to economic problems, such as unemployment, poverty, and housing unaffordability.

2: Family fragmentation. The inverse SESi??mental illness correlation is a function of the fragmentation of family structure and lack of family supports.

3: Geographic drift. Individuals movement from communities of subsequent to their initial hospitalization leads to inverse SESi??mental illness correlation (8).

4: Socioeconomic drift. Low employment rate related to initial hospitalization of lower SES communities.

5: Intergenerational drift. Can be explained as following i??The inverse SESi??mental illness correlation is a function of declines in community SES levels of hospitalized adolescents between their ?rst hospitalization and their most recent hospitalization after turning 18i?? (8)

Age:

i?? In elderly:

In a report for NIMHE (National Institute for Mental Health in England) (9 cited by 21) .the following point regarding mental health problems in elderly has been noticed:

i?? The number of older people with symptoms of mental problems in the UK is about 3 millions.

i?? 10-15% of older people could be diagnosed by depression when applying the approved clinical criteria.

i?? About 5% of people aged over 65 and 20% over 80 are affected by dementia

i?? The economic cost of dementia in elderly is about i??4.3 billion per year , this is more than the cost for heart disease ,stroke, cancer combined

i?? the above numbers are expected to rise by a third in the next 15 years

Mental health problems in elderly are more likely to go undiagnosed. Even where they are recognized, they are often poorly managed (10).

The UK inquiry into mental health in later life (11) listed five factors that affect the mental health of elderly: relationships; contribution in meaningful activity; physical health (capacity to do everyday tasks); discrimination (by age or culture); and poverty.

i?? in children :

WHO states that the building an effective mental health policy for child and adolescent requires first deep understanding of mental health problems among children and adolescentsi??(12)

There is an evidence that levels of distress and dysfunction during childhood are considerably high between 11 per cent and 26 per cent, while the severe cases that require interventions are around 3i??6 per cent of people under 16 years of age (13,14).

Emotionally disturbed children are exposed to abuse or neglect in their family of origin, with estimates up to 65 per cent (15).

Gender:

i?? Women and Mental Health

It is proved that mental health problems are more common among women than men with a higher incidence rates of depressive disorder than men (16).

There are many factors to explain this, first: Socio-economic problems such as poor housing conditions and poverty cause greater stress and fear of future amongst women. lack of confidence and self-esteem may be the results of educational factors such negative school experiences , Living in unsafe neighborhoods cause stress and anxiety amongst women , another common problem is addiction on prescription medications (for depressive and sleeping disorders) leads to more stress and anxiety. (16).

i?? Men and Mental Health

In today world Men tend to be more susceptible to mental health problems than ever before especially suicide, some possible reasons for this are (17):

i?? Men in general are less likely to discuss their feelings or problems or even to admit that they may have depression.

i?? Comparing to women, fewer men look for help when having mental problems.

i?? The impact of unemployment on men is deeper in general.

Some mental disorders are more serious in men. For example suicide is considered to be a leading cause of mortality among young men age group(18). Suicide rate is especially high in poor communities for men from age group 10-24 comparing to the same age group in wealthy communities. It is known also that the onset of schizophrenia is earlier in men and the clinical outcomes are poorer (18).

Risk groups for mental illness in men include (19):

i?? Older men: many of them are less willing to benefit of provided health services because of the perception that these services are for older women.

i?? Divorced men i?? because of the lack of support available from their families, and services directed to meet the needs of this group.

i?? Male victims of domestic abuse i?? especially boys in rural areas.

i?? Gay and bisexual men i?? few services are available to assist this group to deal with problems such as homophobic bullying and harassment.

i?? Sexual abuse victims, again insufficient support is provided for males of this group.

i?? Fathers i?? this is mainly due to stresses of parenthood combined with less support services when comparing to those available to mothers.

i?? Mourning men i?? With no or very few appropriate services specifically designed to men who have undergone bereavement.

i?? Men living in rural areas i?? obviously due to difficulty in getting access to proper support services.

i?? Offenders of young age group i?? less psychological services are available in juvenile justice centres in spite of the fact that there are high numbers of young Offenders who actually have mental health problems needed to be taken care of.

Ethnic group:

The i??Count me ini?? report by Commission for Healthcare Audit and Inspection ( 20) noted differences in admission rates among different ethnic groups for example that rates were lower in white British ,Chinese and Indian comparing to the national average , while in Bangladeshi and Pakistani group the rates were around the national average , the highest rates (more than three times higher than average) were found in minority black groups (African and Caribbean) and in Mixed groups (White/Black African or White/Black Caribbean).

Employment Status and Mental Health

It is well-known that getting a job is a protective factor regarding mental illness (21).

But this is not always true. As Wilkinson (22) noted that jobs which are insecure or do not achieve the required level of satisfaction could have negative effects equal to that of unemployment. The main factors that cause this are (21): stress associated with fear of job loss, feeling of imbalance between effort and reward and inability to control job circumstances, stressful relationship with colleagues and bosses, cases of harassment or bullying. All this factors can lead ultimately to serious mental health illness.

On the other hand, According to OSC Health Inequalities Review (23) people with a mental illness have five times lesser chance to get a job, and if they are already working they become more likely to be fired, financially this group has in general lesser income (twice times chance than the general population) and more likely to depend on invalidity benefits. It is noticed that among mental disorders psychotic illness has the worse impact on employment rates which decline in this group to only one in four.

Geographic variation:

Studies result on geographic variation of mental illness are inconsistent , for example Hollie (24) has concluded that regarding mental problems it is possible to see notable variation at the household level but this variations do not exist in postcode units , and there is no proven connection with geographical accessibility or quality of residential environment

Hollie noticed also that in common mental illnesses the psychosocial environment has greater importance than the physical environmenti??

Another example comes from a recent Swedish study of 4.4 million adults found that with increasing levels of urbanisation; there was a notable rise in the incidence rates of psychosis and depression (25).

Another study by Royal Commission on Environmental Pollution shows that people from densely populated areas had a 68-77% and 12-20% higher risk of developing any psychotic illness and depression respectively when compared to a control group in rural areas. Within urban areas the rates for psychoses map closely those for deprivation and the size of a city also matters; in London schizophrenia rates are about twice those in Bristol or Nottingham (26,27).

Disability and Mental Health:

Definition: According to Disability Discrimination Act (1995) (DDA) (28)

i??A person has a disability if he has a physical or mental impairment which has substantial and long-term adverse affect on his ability to carry out normal day to day activitiesi??

In the light of this definition we can focus on mental health inequality of three groups of people (21):

i?? People suffer socio-economic disadvantage caused by stigma and discrimination associated with their mental health problems.

i?? People with both physical disabilities and mental health problems.

i?? People with physical disabilities, whose experience discrimination and stigma because of their physical impairment and become mentally ill because of this experience.

Disabled people are more likely to experience stress and emotional instability than those who are not disabled.

a report by the Equality Commission for Northern Ireland (29) had found that when surveyed 52% of disabled people had experienced high levels of stress in the last 12 months comparing to 34% of people who are not disabled , and when it comes to depression disabled women have a higher rate of depression than disabled men with 44% comparing to 34%

Conclusion:

Inequality in mental health is as important as any other form of health inequality, however the interaction between social and personal level in mental illness makes it more difficult to address different kinds of mental health Inequalities associated with it.

Question 2: word count (2000)

Tackling inequalities in mental health

Introduction:

Many researchers agree that mental illness could be considered one of the fundamental social and health determinants, and it is difficult to separate these both sides because in most cases social exclusion and social inequalities are both cause and consequence of mental disorders (30)

Some studies refer particularly to two characteristics that distinguish mental illnesses when it comes to public health problems (30): first they are the recent high rates of incident and second is the early onset which affect much younger age group comparing to other health problems

Mental health diseases have two distinct characteristics as a public health problem: first very high rates of prevalence; secondly : onset is usually at a much younger age than for other health problem , Mental health diseases effects all aspects of peoplei??s lives : personal relationships, employment, income and educational performance. (31,32)

Who is at risk for mental health problems?

Defining risk groups enables policies makers to determine how to manage available resources to achieve better health equality. Furthermore, these groups are the main targets for health equality promotional programs.

A review of recent evidences on mental health inequalities can help to define the large groups at risk (33):

i?? People living in institutional settings: such as care homes or those in secure care or subject to detention.

i?? People living in unhealthy settings and who may not be reached by traditional health care such as veterans or the homeless.

i?? People with physical and/or mental illness, people misusing drugs, people with alcohol problems, people who are victims of violence and abuse.

i??children whose parents have problems with alcohol or with drugs, children whose parents have a mental illness and looked after and accommodated children,

i?? People from groups who experience discrimination.

Key policies:

These policies can be long term policies focusing on deep change over a long period or short term seeking fast results such as health promotion.

Long term aims:

Inequalities in mental health are not only about equality of access, but also about the quality of access.

In the year 2009 Mental Health Foundation has published a report on resilience and inequalities in mental health (Mental Health, Resilience and Inequalities) (30, 34)

This report mentioned four points that should be consider as priorities:

1- Factors that support the life of the families mainly the Social, cultural and economic conditions:

This can be done by reduce child poverty , parenting skills training and high quality preschool education , providing secure places for the children to play in particularly outdoors, and cooperation between the different governmental agencies to compact violence and sexual abuse.

2- Establishing an educational system that can effectively support children on both emotional and economical scale by:

i?? Schools health promoting programs, involving teachers, pupils, parents and working with families to enhance the home learning environment (HLE).

i?? Taking steps to encourage sport activities and social events beside academic performance.

3- Reduce unemployment and poverty levels to reduce their negative effect on mental health, and while this is not an easy goal but the steps that could be taken my include:

i?? Supporting efforts to improve pay, work conditions and job security.

i?? Taking advantages of workplace based support by early detecting and caring of personal problems or psychiatric symptoms before developing into serious stages.

.

4- Tackle economic and social problems, which cause the psychological distress. Such as housing/transport problems, isolation, debt, beside that art and leisure centres can help to reduce stress too.

However, these strategies take a long time to be effective, that means the need for more rapid actions or short term aims.

Short term aims: Mental health promotion:

To build an effective strategy to promotion for health equality the following points should be achieved (30,35).

i?? Comprehensive: promotion of mental Health is not only the responsibility of health services alone; other sectors of society should join that effort.

i?? Based on evidence

i?? Responding to the needs of the local communities, and with the agreement of these communities.

i?? Under continuous assessment: The strategy should undergo critical evaluation and can be changes should be made when necessary.

A good example of such strategy is the Mental health national evidence based standards which have been issued by The National Service Framework for Mental Health (36). The idea of these standards is to deal with mental health discrimination and compact social exclusion in patients with mental illness. And that can be achieved by promotion:

i?? Increase the awareness about the importance of mental health in the society

i?? Take strong position against discrimination affecting individuals with mental illness, and promote the steps that make the social inclusion possible for them.

Tackling inequalities for special risk groups:

The Suicide prevention strategy:

One of the best example is the strategy based on work by The NSPSE (National Suicide Prevention Strategy for England), the report was the result of literature review of suicide prevention programs around the world and has reached the following goals (38):

1. To identify and work on people with the highest suicidal risk.

2. To raise the awareness about mental well-being in the society .

3. To target common suicide methods and limits the possibility to get access to such methods if possible.

4. Work with the media for better coverage of suicidal behaviour and its dangers.

5. Support the research for better understanding of suicide and the possible way to reduce it.

6. To evaluate the steps taken to achieve lower rates of suicide.

Women and Mental Health: Preventing:

The results of UK-based survey (38 cited by 21) shows that mental health services for women:

i?? Do not respond to special need of mental health in women.

i?? Can be unequal.

i?? Sometimes prove to be unsafe for women.

i?? May not reflect to the gender effects on social inequalities, which present in deferent levels such as class and race.

However, in their response to a survey conducted in England and Wales (38), women said that they services should:

i?? Provide Sense of Security for them.

i?? Encourage the feelings of independence and ability to make choices and control their life again.

i?? Try to identify and deal with the real causes beyond the stress and the problems they face not only the symptoms of these problems.

i?? support motherhood by directly address this group problems, such as suitable accommodation, jobs opportunities, education.

i?? Embrace their inner strength and potentials of recovery.

These points are crucial to build a need-based action plan for better equality in health services.

Men and Mental Health: Preventing:

The Equal Minds conference workshop which had special focus on men and mental health listed some changes to the support services that make these services more related and directed to solve men mental health issues: (21):

i?? the services should be designed especially for men and with easy access in mind , this include both the place and timing of the selected service , for example choosing places that men usually meet in , or including sport activities or introducing programs that run only by men

i?? Holistic approach, works on the person as a whole, not just on mental health.

i?? Early intervention to prevent anxieties and concerns build up, especially in stress and anger management.

i?? Trust and confidence are vital to solve problems of identity and role which can cause a lot of stress and self-image problems in men.

Ethnicity and Mental Health: Preventing:

One of the main problems in this group is the accessibility to the mental health services due to many factors such as:

i?? Linguistic communication.

i?? Stereotypic approach to their problems.

i?? Ignorance about the importance of mental health.

Sashidharan in his report titled: i??Inside Outsidei?? (39 cited by 21) discussed the mental health services provided for black and minority ethnic groups in England and Wales. And he noticed that these services are different when comparing to services provided to the majority white population in some aspects:

i?? Patients are less likely to receive specialist mental care.

i?? Patients are more likely to undergo obligatory admission (there are differences exist between different ethnic groups and different age groups).

i?? Patients are more likely to be wrongly diagnosed.

i?? Patients are more likely to be treated with psychiatric drugs and Electroconvulsive therapy (ECT), more than receiving talking therapies.

i?? To have higher readmission rates and stay for longer in hospitals.

i?? To be admitted to secure care/forensic environments.

i?? Their social care and psychological needs are less likely to be addressee within the care planning process.

i?? To have worse outcomes.

A strategic approach in Ethnicity and Mental Health:

In England and Wales a framework has been developed for action for i??delivering race equalityi?? in mental health (40 cited by 21)

The framework introduces three points which are essential to reach the targets of better services and results in mental health problems in minority ethnic groups, these points are:

i?? Providing high quality Information services.

i?? To insure that the provided services are easy to access and can respond quickly to minority groupsi?? needs.

i?? Involve the community in the efforts toward better mental health.

In other words any approach should take in consider both quality of health services and the already existing socio-economic inequalities that ethnic groups may face.

Some suggested steps for this approach may include (21):

i?? Providing interpretation and translation services beside mental health service to insure highest possible quality.

i?? Adopting equalities practice in mental health services, that mean better understanding for cultural identity, the impact of racism, and culture differences in the ways people express of mental stress.

i?? Researching better tools and assessment measures that can better assess patients from different backgrounds and ethnicities.

i?? Ensuring that services understand and respect spiritual requirements for different cultures.

i?? Ensuring access equality to services that more culturally accepted including, counseling, psychotherapy and advocacy.

i?? Addressing common problems of black and minority communities, such as housing, employment, welfare benefits, and child-care.

Disability and Mental Health:

people with disabilities may experience high levels of socio-economic disadvantage due to discrimination and stigma , this group need a special interest regarding mental health services , they are liable for what Rogers and Pilgrim (41) described :i??inequalities created by service provisioni??.

Mental health services for disable people should be customized to their needs, some recommendations for such services may include:

i?? Promotion for well-being, mental health, and living with disability.

i?? Early intervention: for people who show symptoms for possible mental illness.

i?? Personalised care based on individuals’ wishes and needs.

i?? Stigma: work for better social inclusion and try to deal with problems associated with stigma and discrimination associated with some disabilities.

Elderly and mental health:

In order to achieve better equality for this group, policy makers should insure better access to mental health services in the first place.

In the year 2005 the Department of Health introduced a report titled i??Securing Better Mental Health for Older Adultsi?? (42) to launch a new program to enhance the levels of services provided for elderly suffering mental illnesses or problems, this report promoted for a new policy that depends on two important steps:

i?? Ensuring equality in the provided mental services; that means that the availability of these services should depend on the actual need for it not on selective age groups.

i?? The approach of these services should be Holistic and personalized to meet both mental and physical needs for older age group.

Here, it is essential to emphasis the importance of specialist mental health service for older adults.

Sexual Orientation and Mental Health:

In this group health promotion plays a prominent role to address the mental problems associated with sexual orientation.

PACE organization has published practice guidelines for mental health services working with lesbian, gay and bisexual people (43 cited by 21).

The guidelines suggest that these services should especially designed to meet the needs of LGB people, examples of such services include particularly counseling and advocacy.

In response to these guidelines and other studies about LGB such as (44 cited by 21). Mental health services for LGB people should:

i?? Deal with the problems of heterosexism and homophobia that this group frequently faces.

i?? Raise the community awareness about the problems that this group suffer especially social exclusion and discrimination.

i?? The services directed to LGBT people should be able to interact effectively with this group i??culturally competenti??.

Preventing in Mental Health Problems:

People with mental health problem are in need for i??resilience factorsi?? which may be the only way to heal from mental distress and to fight the stigma and discrimination they frequently face (21), we can name some of these factors such as confiding relationships, social networks, self-determination, financial security, however, support health services are essential for individual recovery and to achieve socially inclusive i??accepting communitiesi?? (45).

Examples for these services can be found in i??report on Mental Health and Social Exclusioni?? which has been introduced by Social Exclusion Unit. The report included a 27-point Action Plan especially designed to deal with discrimination and stigma (21).

In this action plan the health and social care services play an decisive role to fight the problem of social exclusion and provide the proper support for community and families, this support may include help to find better accommodation, and provide financial (46).

Beyond this report, it is essential that policy makers be aware of connection between inequalities and mental health as a result and a cause, this will encourage more holistic approach that aim prevention at the long run.

Conclusion:

It is essential to put the different recommendations on mental health inequalities into everyday practice , for example a recent study by Glasgow Centre for Population Health found that policies are not driving practice for effective reduction in inequalities levels in mental health within primary care, and the primary care organization studied is not Contributive to tackle inequalities in mental health. (47).

For that reason, it is the responsibility of government, health services and health professionals to put these strategies and plans into action to insure a better and healthier society.

Personal networks are an important factor in people’s daily lives. People who are embeded in a network of personal relationships experience a higher level of well-being than those who are socially isolated.The following is a critical reflection analysis about themes that I found to be most meaningful during the course of the term. The themes include the importance of a social network for the older adult, as well as how this type of network can impact their quality of life. An exploration of these themes will be provided using literature along with my own personal experience. This reflection will highlight the insight that I have gained from this analysis as it relates to my future nursing practice. In addition this reflection will address nursing implications for providing superior client relations.

Exploration of Themes

Social relationships of older adults along with their access to social support networks can influence the general health and well being of this population ( ). The existences of social support networks are important for the older adult’s identity, self-respect, social integration, feeling of security, companionship, as well as practical and emotional support. For example, my grandparents live alone, however, at the same time they have a network of friends, relatives and inter-faith community members on which they can depend on. On the other hand, my neighbour who is 76 years and widowed, is isolated from meaningful and supportive social relationships. My insight into the plight of the elderly, combined with my compassion towards this vulnerable population, compels me to visit her home and spend prolonged time in conversation. We talk at length about her day, her baking, and her fond memories. My neighbour often expresses a deep sense of appreciation for my frequent visits and I feel satisfacation that she allows me to participate in her enthusiasm and happiness.

A social network can stimulate the mind of the older adult as well as increase their level of energy and motivation. If the older adult lacks the support of a social network, it can often lead to isolation and depression ( ). There are a variety of social factors that contribute to an older adult being socially isolated. This includes being female, having a low income, being widowed or divorced, are experiencing family conflicts, and lastly who are experiencing ageism (BC article). According to these criteria, my neighbour is definitely at risk of being socially isolated. Evidence suggests that there are health promoting effects of social relationships. Socially isolated older adults have a two-fold increase in mortality from all causes (Jeannette, 2009). A lack of social support among the older adult population has been associated with a variety of adverse health outcomes in older age, ranging from depression and self-harm, to deteriorating physical health. (Jeanneate) (Dennis et al., 2005). Research supports that various types of social support from different sources are associated with positive health outcomes. Social relationships are also thought to be a key factor in psychological health including an individual’s happiness and subjective well being (tomaka).

In a study that looked at the ranking of importance of different aspects of life for adults over the age of 65, they consistently ranked their relationships with their family and friends as the second most important factor after their health (Kobayashi, Cloutier-Fisher & Roth, 2008). Among the older adult population, the social integration and overall participation in society are considered vital indicators of productive and health ageing ( ). According to the World Health Organization (2003), social support for the older adult population has a strong protective effect on overall health and can influence their quality of life (QOL). The QOL for the older adult that have chronic illnesses and who live at home are highly influenced by the presence of and the accessibility to social networks. Therefore, finding ways to help older adults engage in social networks that are productive and enjoyable is an important aspect of ageing.

Future Nursing Practice and Nursing Implications

Throughout my analysis, I have gained a great deal of insight with regard to the importance of a having a social network and its impact on the QOL of older adults. It has increased my awareness and compassion to the importance of friends, family and community support in creating a social network for the older adult in order to maintain or increase their overall QOL. It is important to reduce the amount of isolation that older adults face – even those that have families. In practice, it is paramount for nurses to be aware of the older adult’s social support networks, along with advocating for the creation of further networks in order to tailor to the complex needs of older adults. Upon reflection, I would use Newman’s theory of Health as Expanding Consciousness as my approach when I consider the importance of ensuring that social support networks are in place for my clients prior to discharge from a hospital. Newman (2004) describes human beings as open energy systems in constant interaction with the environment. Therefore, the way for nurses to understand the health of an older adult is by understanding the individual’s pattern of relating to the environment. Thus being said, the social network of an adult is crucial to reduce dependency among the older adult population by improving time spent with this group and having more interaction with the elderly (Souraya & LeClerc, 2008)

In conclusion, despite the salience of recent studies devoted to ageism that examines social support and well-being, this body of nursing research has paid limited attention to the increasing prevalence of social isolation among older adults in Canada or its relationship with health status. More research is needed in these areas as older adult Canadians are living longer, alone, and with a reduced number of social contacts (McPherson, 2004). Social isolation is not an easy topic for policy. It is a problem that cannot be identified with more familiar social topics as education, economic independence, societal participation and social cohesion. Nurses need to advocate on the importance of gaining emotional, practical and relational support for this population.

This reflection has brought up the issue of mental health among the older adult population. From a personal standpoint, it saddens me to see the lack of interaction that exist among the older adult population suffering from a mental illness. I believe that further attention needs to be focused in this area by creating more social support programs and increasing access to these services for this cohort. As a result of this experience I have become more professionally attentive to my interactions with the older adult client on the units that I am working on. Being empathetic has made me realize that it must be challenging for the older adult to be looked after as they were once independent individuals who could take care of themselves. I can see how nurses can become frustrated with this population combined with a heavy workload, but I do feel that this population carries with them a lot of wealth and wisdom.

Introduction

Identification of theme(s) in your reflective writing.

Exploration and analysis of themes that are most meaningful to you

Significant learning or insights gained from your analysis that will guide your practice

Nursing implications

Choose any 2 topics; use references; combination reflection + scholarly

Jeannette, G., et al. (2009). Loneliness, social support networks, mood and wellbeing in community-dwelling elderly. International Journal of Geriatric Psychiatry,24 (7): 694- 700.

Tomaka, J., Thompson, S., Palacios, S. (2006). The relation of social isolation, loneliness, and social support to disease outcomes among the elderly. Journal of Ageing and Health, 18(3), 359-384.

Kobayashi, K., Cloutier-Fisher, D., & Roth, M. (2008). Making meaningful connections: a profile of social isolation and health among older adults in small town and small city, British Columbia. Journal of aging and health, 21(2), 374.

When measuring the level of access that older adults have to social support networks or the risk of social isolation, it can provide a valuable means to gathering information on their living arrangements (stats can).

Social work involves working with some of the most disadvantaged and vulnerable people in society. It is working with individuals, groups and communities, putting into practice Social Work Values that aid people to overcome possible oppression they face. The actions of Social Workers are to promote social change, help solve problems and empower and liberate people to help enhance their well being. (British Association of Social Workers, 2002) It needs to be understood that Social Workers must be vigilant against the possibility of exploitation or oppression of Service users through ‘unethical Practices.’ (Thompson, 2005: Pg 108)

All Professional occupations are guided by ethical codes and underpinned by Values (Bishman, 2004) and from the very beginning of Social Work, the profession has been seen as firmly rooted in values (Reamer, 2001) (Cited by Bishman, 2004) ‘Every person has a set of beliefs which influence actions, values relate to what we think others should do and what we ought to do, they are personal to us.’ (Parrot, 2010:13) Although society may been seen as having shared values we are all brought up with different personal values bases, this is an important point to consider when working with others, because our values can influence the way we behave. It would therefore be seen as foolish to underestimate the significance of values within the Social Work Profession. (Thompson, 2005: 109)

Our Personal Values can change over time, and our behaviour can alter as a result of the situation we are in. From a young age one of the most important values instilled in me by my parents was to have respect for others, this should be carried throughout life as we should treat others the way in which we would expect to be treated.

‘The importance of having a value base for Social Work is to guide Social Workers and protect the interest of Services Users.’ (Parrot, 2010:17) As a practising Social Worker it is important to recognise personal values and to be able to understand, situations will present themselves were personal and professional values can conflict. It was only when we had the speakers in that I began to question my own values.

NISCC outlines a code of Practice for Social Workers to adhere to, from listening to the speakers in class one issue that was highlighted was that of partnership. Partnership is now a very evident part of everyday language of people involved in the process of providing care. (Tait and Genders 2002) However it is not always put into practice. Mr Y referred to being ‘kept in the dark’ about his illness, he was eventually given a diagnosis, but it was never explained to him what the meaning of this diagnosis was or how it would affect his life. Social Workers have to exercise professional discretion, due to the nature of their work; judgements have to be made which involve values and consequences that make the worker accountable for their actions. (Thompson 2009)

Partnership working is very important for people with a disability, I was able to recognise a conflict with my personal values when one of the Mr X spoke about a visit to the GP, where the GP was asking the carer how the Service User was feeling rather that asking them, from listening to this I was able to recognise that this is something that I have done in the past and possible infantilises the individual with comments such as referring to them as ‘we dote’ or ‘wee pet’ and I never thought that there was anything wrong with using these statements, however from the experience gained I can recognise that my personal values and the professional values are in conflict at this point. It is a way of oppressing this individual, and failure to promote their rights as an person.

When viewing this in conjunction with the NISCC Code Of Practice, it was clear that there was a conflicting of values. NISCC states that as a Social Care worker we must protect the rights and promote the interests of service users and carers as the Disabled Movement states ‘Nothing about us, without us.’ We need to consider the Service User perspective, one of the speakers stated ‘effective partnership working should include the professionals and the Service user.

‘Partnership is a key value in the professional value base underpinning Community Care.’ Braye and Preston-Shoot 2003’43) Partnership should be promoted in several ways such as keeping an open dialogue between professionals and Service Users, setting aims, being honest about the differences of opinion and how the power differences can affect them and providing the Service User with information that helps to promote their understanding. (Braye and Preston-Shoot 2003) In the case if the speaker who was not given a diagnosis for a long time and was just put out of the consultant’s office this key areas did not apply.

Another issue that was striking was that of independence, initially my personal view was not of someone with a disability being independent, my personal experience in the past had led me to believe that people with a disability required a lot of help and were dependant on a carer to provide that help, I didn’t view them as being in employment. Some of these values were quite dormant until I began working in the Social Care Field. The Speakers that we had in from Willow bank explained that they all have jobs and aim to be as independent as possible. This highlighted the conflict between my personal and professional values which I need to be aware of. The NISCC code of practice states a Social Worker should promote the independence of Service Users, this is one conflict that I can acknowledge with my personal values, I need to look at the bigger picture an view the service users as individual people with unique traits and interests it is important that they are not labelled due to their disability, It is viewed that it is society which disables physically impaired people, disability is something imposed on top of impairments by the way we are unnecessarily isolated and excluded from full participation in society. (Oliver 1996) My Personal view was that I believe that we should aim to do things for people with disabilities, I have often found myself carrying out tasks for them that I know they are able to perform themselves, when the speaker from sixth sense spoke about how she had been spoon fed and pushed around the playground as a child had gave her a sense of learned helplessness, it made me acknowledge my own actions. Again this is another area where my personal values conflict with the professional values. Respect for persons in an extremely important values, although I believe I was brought up to show respect for others by creating dependency in a way is disrespectful to the individual.

The promotion of independence is important, it is crucial to see those with a disability as individual people. The NISCC code of practice highlights As a social care worker, you must respect the rights of service users while seeking to ensure that their behaviour does not harm themselves or other people. Keeping in line with the NISCC Code of Practice I need to actively challenge my own prejudices in order to ensure that I am promoting anti-oppressive practice.

Being able to understand the value conflicts in practice can prove to be very beneficial. It can help us acknowledge the differences in the power structure, which can oppress the service user. Social Workers aim to empower the Service User, to help them help themselves. It is important that Professional values are always at the forefront to promote anti-oppressive practice. Social Work Practice is underpinned by laws, policies and procedures.

It is important to always be aware of the Service Users perspectives, this will help ensure more effective and efficient practice.

Both our personal and professional values need to be acknowledged for effective and efficient practice. It is of little use if Social Workers have a professional value base which doesn’t inform or influence their practice, Social Work ethics can be understood as Values put into actions. (Banks, 2006)