Author: Andre Coleman

When thinking about my own personal values, I think of the customs and beliefs that I have developed through experience and education. Although these values have changed over time, I believe that they are pretty consistent with the NASW code of ethics and values of the social work profession as a whole. The preamble of code of ethics states that “The primary mission of the social work profession is to enhance human well-being and help meet the basic needs of all people (NASW, 2006-2009, p.401),” and that is exactly what I strive to do.

Temporary Assistance for Needy Families (TANF)

While I consider myself currently in a middle class American family, this has not always been the case. Growing up my family instilled in me the importance of working hard to achieve your goals, but despite their hard work my family too faced difficult financial times. I can remember times when my parents couldn’t pay their bills, had to work multiple jobs, and struggled to put food on the table. Having gone through these rough financial times, my family instilled in me the importance of giving to other people in need and to this day I consider my father one of the most generous people I know. He would give everything he had to help someone in need, whether he knew them or not. A common bias is that people in need are lazy or incompetent, but this is far from the truth. I have witnessed several families, including my own work very hard to raise their family, yet still struggle to make it.

One childhood experience that stands out in my mind is going into the grocery store with one of my best friend’s mother who was unemployed after losing her job of 12 years due to the store that she worked for closing. My friend’s mother had told us that she was going to get groceries and that we needed to distract the grocery stores doorman when we were leaving, because she had no money to pay for the groceries. Although I was aware that what she was doing was wrong, I knew she needed to feed her family. My friend’s mom did not steal lavish items as one would expect if you were stealing, she only took the items she needed to feed her family. During the car ride home, my friend’s mother apologized to us and explained that she is just too embarrassed to apply for Welfare or go on unemployment and that all of the savings she had prior to being unemployed is now gone. This has been a memory that I have carried with me since that day. Although I felt that there was little I could do at that time, I believe that it is not only my duty to help people in need, but societies as a whole.

I believe that government and society have an obligation to intervene and help families that are in need. I do not believe that any mother should have to steal food to feed her family. I consider it my duty to “promote national standards and policies for the delivery of benefits and programs that serve as a safety net for all people during times of poverty (NASW, 2006-2009, p. 364).” I agree with the NASW Code of Ethics that all people are entitled to the basic needs to survive. As a social work student, I feel responsibility to advocate for families in need and to develop programs that educate people on the need for welfare reform.

Schneider (1999) spoke of the need to reform welfare and for a shift in policy to focus on establishing universal benefits. I am in agreement with this as well as the need to “reject the perspective that views failure to develop wealth as a personal failure without reference to structural inequalities (NASW, 2006-2009, p.363).” I believe that it is important to promote education and fight the stereotypes associated with people in need. As a social worker I will provide services and counseling to families struggling to survive and I anticipate facing many challenges due to the regulations and policies that are currently in place.

Rights of Legal and Illegal Immigrants

Immigrants in the United States have faced a great deal of discrimination, inequality, and poverty throughout history. It is hard for me to understand how people can be treated so poorly just because they were not born an “American.” When I consider the United States, I believe it is a melting pot nation and that all people deserve the right to have their basic needs met despite their legal status in this country. I agree with the code of ethics that social workers need to be sensitive to cultural and ethnic diversity and strive to end discrimination, oppression, poverty, and other forms of social injustice (NASW, 2006-2009, p. 401).

Whether immigrants are legal or illegal, they are people too and should be treated with dignity and respect. Legal immigrants have to go through a difficult and extensive process to become a citizen, which I believe is one reason why there are several illegal immigrants living in the United States. I think that instead of developing harsher immigration laws, this country needs to assist illegal immigrants in the process of gaining citizenship, an education, and work. I agree with Padilla (2008) in that immigrant legislation must treat people equally, promote social justice consistently, and recognize the significance of human relationships.

NASW (2006-2009) recognizes that policies should promote social justice and avoid racism and discrimination or profiling on the basis of race, religion, country of origin, gender, etc. (p. 227). My views are consistent with NASW and I believe that the recent push for harsher immigration laws is a terrifying setback for this country. It makes me absolutely horrified that the state of Arizona would even try to instill a law that would call for police officers to check for immigration status and require immigrants to provide proof that they are authorized to be in this country. This law directly conflicts with the Universal Declaration of Human Rights that “recognizes the right to leave one’s country as a basic human right (NASW, 2006-2009, p.226).

As a social worker I think it is vital to advocate for people who have little or no political voice and who have faced such harsh discrimination throughout history. Being that I am considered a white middle class American, I will need to always be thinking about cultural diversity with my clients. Although I would be obligated to report undocumented citizens, I also feel that it is my ethical responsibility to provide all people with the information and services they need to fulfill their basic survival needs.

Emotional Expression of the Client and the Worker

I entered this profession because of my compassion to help others. For as long as I can remember, I always wanted to help people in need. During high school, my urge to help grew as I witnessed my fellow students being bullied for how they dressed or what type of house they lived in. Although I was considered a “popular” girl, I did not like that some people were considered “unpopular.” I did not think that classifying and judging people to be better then someone else was fair or justified. I was friends with everyone in high school and refused to get involved in the bullying that was happening all around me.

It was during my junior year of High School that I took action. I spoke with my high school guidance department and expressed my concern with the targeting of the underprivileged or “unpopular” students in the school. I told them that I wanted to do something about the problem and begged for their support. I was granted permission to start an Anti-harassment Group, which I successfully did with the assistance of some other recruited students. Together we went out of our way to provide all students with friendships and support. We revised the school’s policy on bullying, created anti-bullying contracts, gave presentations to all classes (high school, middle school, and elementary), and spent time with fellow students who were often targeted by others. We as “popular” students discouraged bullying and worked hard to change the reputation of bullying being “cool.”

I carry this compassion to help others with me in practice and think that it is important for social workers to show emotional expression when working with clients. I feel that it is absolutely appropriate to express ones emotions and show compassion and affection when working in this field. Although I maintain that emotional expression is important, I believe that maintaining therapeutic boundaries with clients is equally important. I also agree with The Code of Ethics that social workers should not engage in any physical contact with clients if there is a possibility that the contact may cause psychological harm (NASW, 2006-2009, p. 407).

As the Assistant Program Manager of an Adolescent Community Residence, I ran into issues surrounding therapeutic boundaries and emotional expression of client and workers on multiple occasions. Adolescents remained in the group home for approximately 1 ?-2 years. Many of the residents in the group home sought out affection from the staff. When a resident was having a rough time, I felt that it was appropriate to give them a hug and reassure them that staff was there to support them and help them get through their difficult times. I felt that by using the emotional expression of myself helped to develop a trusting and therapeutic relationship.

As it is my desire to work with children and adolescents, I imagine that I will have to confront issues of emotional expression of self and therapeutic boundaries in the future. I think that in practice, I will have to be conscious and use my discretion about the amount of emotional support used while working with clients. I also think that it will be important for me to consider a clients race, culture, gender, past experiences, etc. on how comfortable the client may or may not be with emotional expression and physical contact.

Religious Beliefs

Growing up I had very little exposure to religion; however, I was able to recognize the impact religion and spirituality has on other people’s lives. Religion and spirituality became a reality to me when I studied abroad in Thailand. Religion and spirituality was at the center of their culture, and guided their decisions and attitudes on a daily basis. Although I have limited knowledge in this area, enmeshing myself in Thai culture made me recognize the power spirituality and religion can have on people and society as a whole.

I also have witnessed the therapeutic effect religion and spirituality can have people. The NASW Code of Ethics (2006-2009) states that, “Social workers should obtain education about and seek to understand the nature of social diversity and oppression with respect to race, ethnicity, national origin, color, sex, sexual orientation, age, marital status, political belief, religion, and mental or physical disability. Although I do not consider myself a religious person, I think that it is crucial for social workers to understand the religious and spiritual beliefs of their clients. I am in agreement with Dale et al. (2006) that understanding the importance of spirituality, the nature of organized religion, and secular uses of religion is key in understanding the development of human character and social institutions. Without gaining this insight, a social worker may offend or disrespect their client simply because they are not aware of lifestyles and customs based in their spirituality or religion.

As a social worker I will encourage my clients to discuss their spiritual and religious beliefs and how it affects their lives. Based on my limited knowledge about this area, I will have to be extra cautious not to judge or stereotype people because of their religious or spiritual choice. If clients want to discuss religion and spirituality, I will be straight forward with them and let them know that I have limited knowledge in that area but that I am open to listening and learning about their beliefs and experiences with religion and spirituality.

Provision and Utilization of Social Services

I believe that the concept of social services and providing assistance to people in need is very important to the field of social work. I understand that the goal of social services is to help people financially, provide food assistance, disaster relief, medical services, and employment; however, I believe that the process to obtain these services needs to be streamlined. The lengthy and humiliating process that people/families in need have to endure can cause further emotional distress on the individual and family.

Growing up I have witnessed people too embarrassed or humiliated to utilize social services due to the stigma associated with it. I experienced this first hand while helping families at the Community Residence I worked at try to obtain the services they needed. Often times, I would wait in lengthy lines with the families I worked with trying to help them obtain assistance and then be denied do to the paperwork or documentation not being enough for what is needed, or the families to be ineligible for services. I believe that many people/families are being turned down for services based on the many provisions and specific requirements. Although some people/families that are denied services can establish other means to survive, not all can do so. I understand that there needs to be regulations on services; however, I do not believe that anyone should be denied help obtaining the services they need for survival (i.e. food, shelter, medical care, etc.).

The NASW Code of Ethics (2006-2009) maintains that “Social workers should advocate for living conditions conducive to the fulfillment of basic human needs and should promote social, economic, political, and cultural values and institutions that are compatible with the realization of social justice.” As social worker, I believe that it is their ethical responsibility to advocate for people in need and promote a person’s right to self-determination. I think that given a chance and the tools needed; people can make positive changes in their lives. Belcher et al. (2004) examined faith-based interventions and the liberal social welfare state and came to the conclusion that although faith-based interventions could provide some basic supports, the driving force for social change should remain with the state. Although I agree that the state should be taking responsibility, I do respect faith-based interventions trying to step-up the plate and fill some gaps.

As a social worker I believe that I will often find myself advocating for my clients need for social services. I believe that at times this process can become stressful and draining, as the current social service system is not meeting the needs of the people it is designed to serve. For example, if a family is denied for services because they make a couple dollars above the cutoff for services, I think that the system is being too simplistic and not considering the entirety of the situation. It is my belief that the social services system needs to take a more holistic approach instead of having extensive provisions, requirements, and cutoffs for the services.

Pro-life Versus Pro-choice

Ever since I can remember, my family instilled in me the belief that abortions were wrong and even considered them “murder.” As I approached the age of sexual activity, my family was very vocal about practicing safe sex and their views against abortion. My mother informed me that I was not a planned pregnancy and that although she was a teen mother and unprepared for the responsibility; she would have never made the choice to have an abortion. Despite my families strict beliefs regarding abortion, my values are different from my families. I believe that there are situations when abortions should occur or at least be the choice of the mother.

The NASW Code of Ethics maintains that it is the social workers responsibility to “promote the right of the client’s to self-determination (p. 404)” and defines that as being “without government interference, people can make their own decisions about sexuality and reproduction (p. 147).” Although I would not consider an abortion as an option for myself, I understand that to others, it might be the best option for them. Abramovitz (1996) pointed out that throughout history there have been policies and conditions that have forced women to make childbearing decisions based on the conditions of aid or public assistance, and I believe that is an infringement on their constitutional right of reproductive choice.

As a social worker, I believe that it is my ethical responsibility to support and provide information so clients can make informed decisions when considering an abortion. I would find myself conflicted if working with a patient who has had multiple abortions, because despite considering myself pro-choice, I also have great value for life and giving life. I believe that all people should have reproductive choice, but should not abuse the decision to abort or use abortion as a form of birth control.

Rights of Gays, Lesbians, Bisexuals, and Transgendered People

Growing up, one of my best friend’s had “two mothers,” as she would say. Throughout elementary school and middle school, I witnessed how my friend and her family were treated and I quickly understood why she did not want people to know about her mother’s sexual orientation. We grew up in a small rural community and were not exposed to people of different sexual orientations or preferences very often. This friend was bullied and ridiculed in school by peers because of her mother’s sexual orientation. I myself did not understand why two women would be together or in love; however, after getting to know my friends family, I came to realize that one could not control their feelings or who they fell in love with.

Seeing the discrimination and prejudice that my friend and her family went through was very frustrating because after getting to know the family and understanding that it is okay to have different sexual orientations or preferences, I didn’t consider them any different from my family or anyone else’s. I had a similar experience in high school with one of my friend’s father being transgender and again witnessed a great deal of discrimination against this family.

I don’t think a person should be denied the right to love someone else based on sexual identity, preference, or orientation. I do not understand how people can be denied the right of marriage, a union between two people, because they are lesbian, gay, bisexual or transgender. I agree with the NASW Code of Ethics that same gender and transgender individuals should be afforded the same rights and respect as all people (NASW, 2006-2009, p. 247).

I feel that a challenging circumstance that I could face as a social worker will be to address families that have children or other relatives who are LGBT and do not approve of them. As a social worker it would be my ethical responsibility to educate on the right of self-determination and nondiscrimination.

This short study takes up the evaluation and assessment of two social work intervention theories, namely the Task Centred Approach and the Crisis Intervention Method, with special regard to their implications and applications for social work practice.

Social workers, in the course of their practice, are often called upon to help people in coping and dealing with different types of difficulties in their lives. Human beings face situations of crisis at one time or the other during their lives (Roberts, 2000, p 11). The crisis theory postulates that the occurrence of crises is normal to life. Such crisis situations can occur suddenly, like family illnesses or a loss of jobs, or be unpredictable, like entering school or growing older (Roberts, 2000, p 11). Individuals attempt to cope with crises with their available mechanisms, but face problems when such mechanisms do not work or when earlier unresolved crises get reactivated. Social workers are often called upon to intervene with individuals and help them in coping with their crises (Roberts, 2000, p 11).

The task-centred approach is a progressive and goal-orientated method for social work practice. It constitutes a practice-based approach that is built on research and is being used in a diverse settings and circumstances (Nash, et al, 2005, p 33). It represents a social work method wherein clients are assisted in carrying out problem reducing tasks within specific time periods. It is structured, problem focused and time-restricted and is being increasingly used in contemporary social service interventions (Nash, et al, 2005, p 33).

Crisis intervention is often grouped together with the task centred approach. Malcolm Payne (1991, p 4) sees significant common ground between crises intervention and task centred approaches to social work practice. Both methods focus on problem solving, deal with brief interventions and are related to learning theory.

This essay takes up the examination and assessment of these two theories, with especial regard to their communalities, their differences and their relevance for social work practice. Due regard is given to the implications of anti-oppressive practice.

2. Crisis Intervention Theory

The crisis theory states that it is important for people to resolve their crises situations and experiences in order to cope with new developments and crises (Aguilera, 1998, p 47). If individuals are unable to resolve their earlier crises, they become more vulnerable to inability to resolve new crises. Individuals who learn new skills to resolve their crises are on the other hand strengthened in coping with future crisis situations (Aguilera, 1998, p 47). Human beings have considerable capacities for handling or dealing with difficult situations. It is only when such difficulties assume significant proportions and people do not have appropriate resources, personal, emotional, social, spiritual or physical, to deal appropriately with stressful circumstances or events that they become involved in crises. Difficult or stressful events do not by themselves result in crisis situations (Aguilera, 1998, p 47). Crises are actually determined by the responses of individuals to specific stressful circumstances or events and their responses to them. Crises develop only when individuals perceive specific events to be significant and threatening, try to handle such events with their usual coping strategies without success, and are not able to use other alternatives (Aguilera, 1998, p 47).

Behavioural and psychological experts perceive crises to be akin to states of psychological disequilibrium. Individuals experiencing crises are likely to experience a range of emotions like feelings of apprehension, anxiety, fear, guilt and helplessness (Nash, et al, 2005, p 37). Other indicators include alterations in eating and sleeping patterns, activity and energy levels and ability to concentrate. People in crises are also commonly known to suffer from depression and withdraw from social intervention (Nash, et al, 2005, p 37). Social work experts argue that whilst the majority of crises run their course or reach some semblance of stability within one or two months, it is necessary for skilled intervention to take place to strengthen the coping mechanisms of individuals. The failure to do so will result in the existence and continuance of crisis associated behaviours, even as the opportunity for change will be forgone (Nash, et al, 2005, p 37).

People in crisis often have little by way of solutions and are receptive to external help and assistance (Roberts, 2000, p 19). The provisioning of skilled intervention by social work practitioners during the occurrence of the crises can result in opportunities for individuals experiencing crisis to learn new skills, achieve beneficial behavioural change, and regain stability. Individuals who have been able to successfully cope with crises are strengthened by such experiences and can use their skills in future times of difficulty (Roberts, 2000, p 19).

Crisis intervention is essentially a professional response that is limited in terms of time and is used to assist individuals, families, and groups (Hepworth, et al, 2002, p 83). Social workers aim to assess the openness of individuals experiencing crises to learning of new skills and mechanisms for coping. They also help individuals in reducing their feelings of helplessness, isolation, and distress and use social resources to help in restoring individuals to their prior functional levels, as soon as practically possible (Hepworth, et al, 2002, p 83). Such social work intervention is done through “listening, validation, acceptance, normalisation, reassurance, education, advocacy and brokering resources” (Nash, et al, 2005, p 38). Crisis intervention can be specifically segregated into 7 stages, namely (a) establishment of communication and development of feelings with individuals that circumstances can become better, (b) assessment of situation, (c) exploration of available strengths and resources, (d) goal setting with the use of such strengths and resources, (e) implementation of plan, teaching of new skills and mobilisation of other support if required, (f) evaluation and adjustment of the plan and (g) follow up and termination of relationship (Hepworth, et al, 2002, p 83).

It is important for social workers to be skilled in crisis intervention because of the constant demand upon them for helping people in crisis situations (Roberts, 2000, p 19). Social workers are liable to encounter clients with diverse needs, which may in turn require research, strategic planning and the providing of individualised person centred support (Roberts, 2000, p 19). The nature of crisis intervention work also calls for confidentiality and emotional separation in order to deliver services in a professional manner (Roberts, 2000, p 19).

3. Task Centred Approach

The task centred approach emerged in response to the slow and inadequate results that were being achieved through traditional casework methods (Reid, 1997, p 134). Traditional casework methods in social work were felt to be of limited use because of their resource intensive nature, their lack of focus, and their ambiguous outcomes, which were difficult to assess and quantify (Reid, 1997, p 134). Reid and Shyne engaged in extensive study in the late 1960s to explore alternate approaches to casework and developed the task centred approach for social work practice, which called for limited but intensely focused intervention periods. The approach was essentially client oriented and required the social worker to act as a facilitator (Reid, 1997, p 134). With the task centred approach helping clients to improve their difficulties quickly, the process was soon adopted for replication and development in the United Kingdom (Reid, 1997, p 134).

Studies on the task centred approach revealed that unfocused help, as was provided by the psycho-social approach and the case study method, over long periods, resulted in reduction of hope and self confidence on the part of the client (Nash, et al, 2005, p 42). It also resulted in negative dependency and unnecessary attachments to specific organisations or particular social workers (Nash, et al, 2005, p 42). It was also seen that the setting of time limits for achievement of specific outcomes helped in building expectations of the possibility of rapid change and enhanced participant energy and motivation (Nash, et al, 2005, p 42).

Whilst the task centred approach proved to be practically beneficial for clients and also served, reduce and optimise utilisation of limited social work resources, it also facilitated a shift towards the person centred approach, the negation of the assumption of the professional being the only source of expertise, and helped in achievement of greater empowerment and reduction of oppression (Naleppa & Reid, 1998, p 63). The task centred approach calls for attention to be paid to social and external issues that affect individuals rather than on perceiving individuals and their psychological histories to be the main cause of their difficulties (Naleppa & Reid, 1998, p 63).

The task centred approach involves a structured method wherein the social worker firstly assists the service user in articulating the problems in the ways perceived by service users (Hepworth, et al, 2002, p 87). The social workers subsequently helps the service user to detail and breakdown the problems, taking care to redefine them wherever necessary and helping the service user to locate important areas for action (Hepworth, et al, 2002, p 87). The social worker finally motivates the service user to categorise and prioritise his or her individual problem in line with his or her perceptions (Naleppa & Reid, 1998, p 63). The social worker and service user thereafter work in partnership to (a) specify and identify outcomes, (b) agree to contracts and (c) review and assess progress. Social workers who use the task centred approach should be able to positively engage service users and instil trust and confidence (Hepworth, et al, 2002, p 87).

Commonalities in Task Centred and Crisis Intervention Approaches

Task centred approaches and crisis intervention methods appear to merge well in both theory and practice (Watson, et al, 2002, p 96). Social work research indicates that the use of these methods have proved to be effective with a wide range of clients. Both theories emerged in response to the apparently ineffective outcomes of case work approaches that were grounded in psychodynamic theory (Watson, et al, 2002, p 96). Both methods additionally focus on brief and short term interventions. They are connected to learning theory and based upon problem solving ideas (Watson, et al, 2002, p 96).

Both these approaches call upon social workers to engage in participative and joint activity with service users, first to assess and analyse problems and their causes and then take action to deal with such problems (Sandoval, 2002, p 63). The application of these methods thus calls for the use of the person centred theory, the need to place the service user at the centre of the issue and the urgency of viewing the issue from his or her perspective (Sandoval, 2002, p 63). Social workers need to be very good listeners in order to be able to locate the real issues that are troubling service users and thereafter be able to help them with measures to tackle their difficulties (Sandoval, 2002, p 63).

Like other social work methods, the task centred approach does have its limitations. It is in the first instance predicated upon the rationality of service users and their willingness to work with social workers (Nash, et al, 2005, p 53). It is also difficult to apply it without appropriate agency support. Despite such limitations the two approaches continue to be very useful, especially because of their instrumentality in increasing empowerment and their integral anti-oppressive approach (Nash, et al, 2005, p 53). The methods increase the abilities of service users through the inculcation of new skills and allow them to deal, not just with their current situations but with future circumstances of difficulty and oppression (Nash, et al, 2005, p 53).

Conclusions

Social work practice is influenced by many factors that require the taking account of the perspectives of service users, social workers, agencies and society.

The approach of individual workers is bound to be influenced by numerous factors that can leave them confused and looking for guidance in their task of assisting service users in difficulties. The task centred approach and the crisis intervention theory provide useful tools to service users to assess the true conditions of service users, participate with them in structured, time bound and joint resolution of problems and empower them to face and overcome oppression. Social workers do however need to understand the implications of these theories and refrain from labeling their actions in all difficult situations to be task centred or critical intervention in nature. The true understanding of the potential and use of these theories will help them significantly in their practice scenarios.

The goal of social work professionals is for the well-being and empowering of those in society who are impoverished, living in oppression, and vulnerable. Social workers must also focus on the forces in a person’s environment that are involved in making and contributing to problems in living conditions.

Those people who are assisted by social workers are referred to as clients. They can be individuals, groups, families, or communities. Therefore, social workers must be attuned to cultural, racial, and ethnical differences in people. This will help put an end to discrimination, oppression, poverty, and other types of social wrongs.

There are six core values on which the social work profession is based. These are service, social justice, dignity, and worth of the person, importance of human relationships, integrity, and competence. These core values are the fundamental principles that a social worker should use in dealing with clients and helps guide them in treating the clients with dignity and respect.

The social workers Code of Ethics are at the core of the profession. These ethics are of great importance to all social work students as well. They help in making sound judgments and decisions when dealing with all segments of the population regardless of the clients’ religion, race, or ethnicity.

The six core values of social work have ethical principles which are the ideals to which each social worker should strive to meet. Service happens when a social worker uses his or her knowledge, values, and skills to help those in need. Social justice is when a social worker attempts social change on behalf of those who can’t help themselves. Dignity and worth of the person is showing respect to each client regardless of their social situation. The importance of human relationships is seen by social workers in their efforts to advance, renew, and improve the well-being of families, social groups, and communities. Integrity is behaving at all times in a trusting manner. Competence is basically a social worker knowing his or her job and taking steps to improving their professional expertise.

Pertinent Ethics and Values Dealing with Worth and Dignity

There are several ethics and values that relate to human diversity and the worth and dignity of persons. Employment of these ethics and values are of great importance to the social worker and the client. They are as follows:

1.02 Self-Determination

Social workers respect and promote the right of clients to self-determination and assist clients in their efforts to identify and clarify their goals. Social workers may limit clients’ right to self-determination when, in the social workers’ professional judgment, clients’ actions or potential actions pose a serious, foreseeable, and imminent risk to themselves or others.

1.03 Informed Consent

(b) In instances when clients are not literate or have difficulty understanding the primary language used in the practice setting, social workers should take steps to ensure clients’ comprehension. This may include providing clients with a detailed verbal explanation or arranging for a qualified interpreter or translator whenever possible.

(c) In instances when clients lack the capacity to provide informed consent, social workers should protect clients’ interests by seeking permission form an appropriate third party, informing clients consistent with the clients’ level of understanding. In such instances social workers should seek to ensure that the third party acts in a manner consistent with clients’ wishes and interests. Social workers should take reasonable steps to enhance such clients’ ability to give informed consent.

1.05 Cultural Competence and Social Diversity

(a) Social workers should understand culture and its function in human behavior and society, recognizing the strengths that exist in all cultures.

(b) Social workers should have a knowledge base of their clients’ cultures and be able to demonstrate competence in the provision of services that are sensitive to clients’ cultures and to differences among people and cultural groups.

(c) Social workers should obtain education about and seek to understand the nature of social diversity and oppression with respect to race, ethnicity, national origin, color, sex, sexual orientation, gender identity or expression, age, marital status, political belief, religion, immigration status, and mental or physical disability.

1.07 Privacy and Confidentiality

(a) Social workers should respect clients’ right to privacy. Social workers should not solicit private information form clients unless it is essential to providing services or conducting social work evaluation or research. Once private information is shared, standards of confidentiality apply.

(d) Social workers should inform clients, to the extent possible, about the disclosure of confidential information and the potential consequences, when feasible, before the disclosure is made. This applies whether social workers disclose confidential information on the basis of a legal requirement or client consent.

(f) When social workers provide counseling services to families, couples, or groups, social workers should seek agreement among the parties involved concerning each individual’s right to confidentiality and obligation to preserve the confidentiality of information shared by others. Social workers should inform participants in family, couples, or group counseling that social workers cannot guarantee that all participants will honor such agreements.

1.11 Sexual Harassment

Social workers should not sexually harass clients. Sexual harassment includes sexual advances, sexual solicitation, requests for sexual favors, and other verbal or physical conduct of a sexual nature.

1.12 Derogatory Language

Social workers should not use derogatory language in their written or verbal communications to or about clients. Social workers should use accurate and respectful language in all communications to and about clients.

1.14 Clients Who Lack Decision-Making Capacity

When social workers act on behalf of clients who lack the capacity to make informed decisions, social workers should take reasonable steps to safeguard the interests and rights of those clients.

2.01 Respect

(a) Social workers should treat colleagues with respect and should represent accurately and fairly the qualifications, views, and obligations of colleagues.

(b) Social workers should avoid unwarranted negative criticism of colleagues in communications with clients or with other professionals. Unwarranted negative criticism may include demeaning comments that refer to colleagues’ level of competence or to individuals’ attributes such as race, ethnicity, national origin, color, sex, sexual orientation, gender identity or expression, age, marital status, political belief, religion, immigration status, and mental or physical disability.

(c) Social workers should cooperate with social work colleagues and with colleagues of other professions when such cooperation serves the well-being of clients

4.02 Discrimination

Social workers should not practice, condone, facilitate, or collaborate with any form of discrimination on the basis of race, ethnicity, national origin, color, sex, sexual orientation, gender identify or expression, age, marital status, political belief, religion, immigration status, or mental or physical disability.

4.03 Private Conduct

Social workers should not permit their private conduct to interfere with their ability to fulfill their professional responsibilities.

4.04 Dishonesty, Fraud, and Deception

Social workers should not participate in, condone, or be associated with dishonesty, fraud, or deception.

My Views of the Ethics and Values Dealing with Worth and Dignity

Self-determination is a very important value when dealing with a client. This allows the client, with assistance from the social worker, to identify their goals. The client will feel a sense of ownership in reaching said goals.

Privacy and confidentiality also play a huge role in preserving the worth and dignity of someone receiving assistance. Everyone, regardless of their status in society, has a right to privacy. Some clients may not know that they have these rights or may believe that their right to privacy has been forfeited since they are receiving assistance. This, of course, is not true, and the social worker should inform the client of this fact.

The social worker also has to realize that not all of the people receiving services are literate and must therefore explain to those clients the disclosure of confidential information. This also pertains to each individual’s rights to confidentiality when providing counseling to couples or groups.

A social worker should never make advances of a sexual nature to a client. This may lead some clients to believe that the only way that they can receive assistance is to give into those advances. It may also cause others to not seek assistance at all.

Derogatory language, either verbal or written, can be demoralizing to a client. A social worker has to be aware of the culture of the person that they are addressing. What may not be significant to the social worker may, on the other hand, be offensive to the client.

The decision-making process varies from client to client. The social worker must make sure that when he or she is acting of behalf of a client that the client’s interests and rights are safe guarded.

Respect in the Social Work Code of Ethics is under the ethical responsibilities to colleagues, but it should also be under the way clients should be treated. When one shows respect to another person, communication is greatly enhanced, and communication is what social work revolves around.

Discrimination is something that can not and should not be practiced, condoned, or facilitated by a social worker. This means discrimination of any type to include; race, ethnicity, sex, color, marital status, politics, mental disability, immigration status, or sexual orientation. Discrimination has an adverse effect on the client and the social work profession.

When a social worker allows their private life to affect their work, no one wins. A social worker must be professional enough to separate the two. Another issue that deals with a social worker’s professionalism is his or her ability to not take part in any way with deception, dishonesty, or fraud.

My Application of the Ethics

When dealing with ethnicity, I will learn about what is acceptable and unacceptable with each ethnic group. I will ensure that I differentiate between ethnicity and race.

National origin has to be dealt with in a similar way as with ethnicity. Therefore, I will ensure that I am aware of the customs of the client’s homeland.

Social class requires that a social worker not form preconceived notions of the person being served. I will keep my mind open and ensure, as with all cases, to listen to what is being said.

Religion is a very touchy subject that has to be handled. I will make every effort to understand the customs and traditions of various religious groups in order not to offend.

When dealing with a client that has a physical or mental disability, I will ensure that their dignity and worth is not compromised. I will use language that they can easily understand, and I will not talk down to the individual.

Everyone has the right to live their life they way that they choose. I will never judge a client based on their sexual orientation. This and the previous subjects can be handled by simply being a professional. I will strive to be a consummate professional at all times.

This essay will look at how social workers address ethical dilemmas in their work with service users and carers. This will be evidenced in case examples illustrating how the codes of practice and codes of ethics guide social work decisions while making them accountable for their work. When working with ethical dilemmas social workers have to understand the origins of these values and codes. Taking into account their own personal values and being aware of how these could influence their decisions.

Values and ethics are one of the most important characteristic of an individual the fundamentals define who we are and what we believe (Banks, 2001). Whether individuals are consciously aware of them or not, every individual has a core set of values and ethics. Values are socially constructed moral codes that guide and control our actions within the social world (IFSW). Values and ethics start to develop from birth and are mainly developed by major influences in an individual life. Factors of culture, religion and many more affect our beliefs and ethics. According to Banks (2001, p.6) values are “particular types of belief that people hold about what is regarded as worthy or valuable, values “determine what a person thinks he ought to do”.

Social work values are based on the principal of “respect for persons” which comes from the Deontological approach of German philosopher Immanuel Kant (1724-1804). From these writings Biestek a Catholic priest developed seven principles for effective practice. Kantian principles are individualisation, purposeful expression of feelings, controlled emotional involvement, acceptance, non-judgemental attitude, service user self-determination and confidentiality (Shardlow, 2002).

Although Kantianism is primarily focused on the sense of people’s duty, critics have argued that the perspective gives no allowance for compassion and sympathy to motivate people’s actions. Furthermore, Kantian has a lack of guidelines when dealing with conflicting requirements. Kant’s moral philosophy has been influential in the values and ethics of social work, in particular respect for people and self- determination. These philosophical underpinnings are a major influence in the social care profession.

On the other hand Utilitarianism believes that action is right if it generates, or tends to generate the best possible outcome for the majority of people that are affected by that action. Utilitarianism is a form of consequentialism where the rightness of an action is determined by its consequences. There are three main types of utilitarianism act, rule and preference. Act takes into account the individual circumstances, maintaining that the action is good if it generates the best possible outcome in a particular situation. Rule is concerned with the amount of good that a moral action produces, conforming to a rule or law. The rule or law is correct and is determined by the amount of good that is generated when the rule is followed. Preference is one of the more popular forms of utilitarianism it takes into account people’s preferences. The moral action is right if it produces a satisfaction of each person’s individual desires or preference (Banks,2001).

All of these are open to interpretation and will mean different things to different people, which is why social work codes should be referred to. Social work codes set out an expected code of conduct that social workers have to comply with in order to gain the trust of the public so that service users are informed of what they can expect from their social workers. Protect the rights and promote the interests of service users and carers the codes are as follows: Strive to establish and maintain the trust and confidence of service users and carers, Promote the independence of service users while protecting them as far as possible from danger or harm, Respect the rights of service users whilst seeking to ensure that their behaviour does not harm themselves or other people, Uphold public trust and confidence in social care services, Be accountable for the quality of our work and take responsibility for maintaining and improving our knowledge and skills.

The COP form part of the wider package of legislation, practice standards and employers policies that social care workers must meet. When codes are not adhered to there can be serious repercussions involved for all (CCW, 2002).

Social work’s professional values, as described in the British Association of Social Workers (BASW) code of ethics (COE), including respect for all person’s including service users belief’s values, culture, goals, needs and preferences, relationships and affiliations, and a commitment to social justice, including the fair and equitable distribution of resources to meet basic needs.(BASW, 2002, 3.1, 3.2). These are a set of moral principles used to set standards which regulates the social work profession. These offer a general guidance and as yet carry no sanctions if broken (Shardlow, 2002). An ethical code also contributes to the strengthening of professional identity. They add clarity to the tasks and should lead to greater ethical observance within the organisation, but the primary objective of the COE is the protection of the clients (Banks, 2001).

Ethics are generally distinguished in three different ways by philosophy, meta-ethics, normative ethics and descriptive ethics. Meta-ethics seeks to understand the nature of morality, moral judgements and moral terms such as ‘good’, ‘bad’ and ‘duty’. Normative ethics endeavours to answer moral questions, such as what is the right action to take in a particular situation or what is the right direction to take? Descriptive ethics examines how individual’s moral opinions and beliefs reflect their behaviour and attitudes towards it (Bowles, 2006). A good social worker needs to be aware of the societal and professional values underlying his or her work so as to empower individuals, families and communities. Both Anti-oppressive practice and values are embodied in the BASW code of ethics (BASW, 2012).

Parrott (2006) describes Anti-oppressive practice (AOP) as ‘a general value orientation towards countering oppression experienced by service users on such grounds as race, gender and culture.’ AOP are also values of working in partnership and empowerment. It is also a way of linking our lived experience with the categories of the relations of ruling (Parrot, 2006). While Thompson (2001) saw oppression as an inhuman or degrading treatment of individuals or groups; in hardship and in justice brought about by the dominance of one group over another; the negative and demeaning exercise of power. Oppression often involves disregarding the rights of an individual or group and this is a denial of citizenship.

Social work is often seen as the caring profession who work with service users who need help. Every service user is unique and very social worker is an individual who uses their own lived experiences and to be an effective helper needs insight into her own formation with its potentials for strength and weakness (Clark, 2011). At the core of this is what service users expect of social workers a relationship that is built on trust, being open and honest with each other and achieved by communicating in a clear way that service users understand (Care Council for Wales, 2002, 2.1 & 2.2) as well as committed, reliable and punctual. Social workers rely on traditional values of confidentiality, acceptance and user self-determination while being non-judgemental in order to gain the trust of service users. These core values are not unique to social work but shared with other caring professions in medicine, nursing and counselling (Banks, 1995).

Values have a variety of meanings referring to one or all of moral, political or ideological principles, religious, beliefs or attitudes. However the social work context uses values to mean a set of fundamental moral/ethical principles by which social workers show commitment. While moral judgements promote the satisfaction of human needs and happiness and apply to all people in similar circumstances. On the other hand ethics refers to the study and analysis of right or wrong and good or bad in social work practice. Ethical dilemmas leave social workers using careful consideration to choose between two unwelcome alternatives relating to human welfare (Banks, 1995).

Having choices does not make the decision any easier and social workers have to take responsibility and accountability for the outcomes of any decisions they make. Decisions are made by conducting investigations with both the legal and moral rights of all parties involved being taken into account. Societal values and norms are often reflected in laws, although there are some laws which we may regard as immoral the immigration laws being one. How we interpret the law is influenced by our values and ethical principles (Banks, 1995).

Social work involves balancing the complexities between one’s own moral integrity to the user, society and agency. The ability to analyse a situation and make the best decision is a critical skill which involves recognising our beliefs and behaviours and how they influence our ideas and actions. These values are derived from our culture and social norms and can change over time and across cultures. Therefore social workers need to maintain and improve their knowledge and skills in order to protect the learning and development of others (CCW, 2002, 6.8). Codes of practice(COP) guide and protect service users not be telling them what they can or cannot do but by establishing a professional identity for workers who agree to work in a trustworthy, honest, skilled and respectful manner (Bowles, 2006).

However many believe that misuse of codes can be dangerous and cause unethical actions in particular in Western Australia in 1991 emergency foster care was sought for a 4 year-old girl while her mother was in hospital. The worker of a non-government agency placed the girl in an approved foster home which they frequently used. In the home was a 15 year old youth who was a ward of state who held a prior record for sexual offences against young children. The home also had another young foster child and a 4 year-old grandchild of the foster family. The social worker who approved the foster home for the youth and foster carers were unaware of the youth’s sex offending history. Although his history was known by the youth’s previous foster carers and 4 days after the girl was placed she died from being raped by the youth (Bowles, 2006, p.78). This illustrates the issues that arise when prioritising confidentiality over client safety and welfare when applied out of context.

While the foster-carer is not a professional and does not have to abide by the COP she is guided by a moral code of ethics. Therefore confidentiality can be broken when it is considered the information puts either the client or others at harm. The foster-carer is a part of a team and a member of a child care agency so there would be employer’s policies and procedure that would have guided this ethical dilemma. Social workers have a responsibility to maintain the trust and confidence of service users and carers by respecting confidential information and explaining agency policies around confidentiality (CCW, 2002, 2.3).

Postmodernist believe that there is no single truth and that ethics have no relevance in today’s society, as they do not replicate the numerous realities of the same society, and ignore peoples individual perspectives and interpretation. Omitting cultural diversity and reinforcing the oppressive and dominant voices of the most powerful. Furthermore they are rarely used when making ethical decisions so they are considered irrelevant (Bowles, 2006). As in the above example there would have been a number of other professionals involved with the youth such as youth offending team and medical professionals so this is a prime example of lack of information sharing and poor communication as the new foster-carers should have been made aware of the issues on a need to know basis.

Below are further examples of some of the ethical dilemmas that social workers face every day:

An Asian woman with 5 children under the age of 6 years, who has fled a violent husband but still gets harasses by him. Has been locking up her children in the house and going out for help or a break. One of the workers on the Asian Women’s Project she has recently joined to help with her feelings of isolation has discovered this. The worker has spoken with the woman explaining the risks and implications of her actions. However the woman has continued to leave the children unattended. The worker eventually informed social services as she felt the welfare of the children was paramount and she had repeatedly discussed the risks and implications of her behaviour including the British Laws and her responsibilities as a social care worker (CCW,2002, 3.2 & 3.8). The worker felt the dilemma was due to the view that generally social services and other agencies have often been insensitive the holistic wellbeing of the Asian women and fail to take into account their life experiences, religious and cultural background (Banks,2012.p.156). (BASW, 2002, 2.1,4, 2.2,5)

A social worker who has been involved in admitting a woman to hospital for 28 days under the Mental Health Act starts to notice deterioration in her physical health. The woman then dies from pneumonia. The social worker felt that the deterioration in her physical health was due to the medication she received. Although at the time he felt unable to question the consultants and trusted that the hospital was the best place to pick up on any serious physical problems (BASW, 2002, 2.2,4). This is often attached to a hierarchy of power where the social worker felt the consultant was in a higher position and had more medical knowledge so was better equipped to make the decision. However in hindsight the social worker felt that he should have questioned the treatment before renewing the section for six months. While the social worker acted within the law and according to agency rules. Did he have a moral responsibility to question the diagnosis? (Banks, 1995, p.150). Also social workers should maintain clear, impartial and accurate records and provision of evidence to support professional judgements.

A young pregnant woman tells her community health counsellor that she will seek to have her child ‘circumcised’ because a girl cannot be offered for marriage if she is not clean. The woman explains that she was also a subjected to ‘Female genital mutilation’ (FGM) in her country of origin. The woman is aware that the practice is illegal and that she would have to go to a ‘backyard’ operator in her community to have it done. While the counsellor is not a social worker she would still have to abide by the rules of confidentiality and this would have been explained to the woman at the beginning of the counselling sessions (CCW, 2002, 2.3 & BASW,2.3,5). The counsellor should also explain the penalties for breaking the law including the law on child abuse. However it would be more beneficial to engage the young woman with other’s from her community who are endeavouring to break out of traditional roles who can provide her with support. Social workers have a duty to support service users’ rights to control their lives and make informed choices about the services they receive, whilst respecting diversity and their different cultures and values (CCW,2002, 1.3, 1.6).

Furthermore social workers must promote the independence of the service user this is done by identifying and providing information and support enabling her to make informed choices. The social worker also has a responsibility to the unborn child. The social worker can prevent the harm to the mother by making her aware of the law regarding FGM which is illegal in this country, which is why no hospital will perform it. She also has to make her aware of the consequences of her actions that she could have her child removed or face imprisonment. The social worker can help prevent harm to the child by putting her mother into contact with others from the same community who could help support her make the right decision (CCW, 2002, 3). In modern day society social workers have to work as part of a multi-disciplinary team and at the core of this is information sharing so that everyone is responsible for the health and welfare of service users. As with any dilemmas guidance and support should be discussed with the social workers manager.

While dealing with such ethical dilemmas social workers have to be aware of their own personal values and make sure that they do not influence the decisions that they make and while we may not always choose the options given for ourselves it does not mean that they are wrong (Bowles, 2006).

The social work role is about empowering the user by providing the service user with the information, resources and support they need to make an informed choice and be prepared to accept the consequences. Many believe that ethical dilemmas in social work may be related to ideological issues. For example to what degree are the public society responsible for an individual’s situation and how much responsibility should an individual take for their own situation. Social workers are often seen as agents of social control. This can lead to domineering and coercive practices where social workers dealing with marginalised groups or cultures can mistake their emotional reactions for firm moral truths (Bowles, 2006). While showing tolerance and doing nothing brings us back to the central tenents of ethical social work.

As the above examples show the contents of the codes of practice are very general and therefore provide little help to social workers or service users when determining how social workers behave towards client. As in the above examples its does not provide the answer to ‘Is it the social worker’s duty to inform the police if they discover that the service user has committed a crime? (Shardlow, 2002). The codes do however outline how social workers should work and interact with service users. Below is an example of when a social work student crossed these boundaries.

A social work student is allocated to the case of two children siblings who live with their parents. The social worker has access to confidential information about the family which was given to her by the mother who herself is a vulnerable adult. During her placement the social work student meets the children’s father in a night club and starts a relationship with him. She even left the children stay at her home while the mother was in hospital. The social worker did not inform her employers of this relationship. The relationship with the father is compromising her judgement, and the relationship between service users and social workers is about meeting the needs of the client not their own needs. The codes of practice state that as a social worker, you must uphold public trust and confidence in social care services (CCW, 2002, 5). It goes on to state that you should not exploit service users in any way (CCW, 2002, 5.2), abuse their trust or the access you have to personal information (CCW, 2002, 5.3) or behave in a way, outside of work which would call into question your suitability to work in social care services (CCW, 2002, 5.8). In addition social workers must inform their employer or the appropriate authority about any personal difficulties that might affect their ability to do their job competently and safely.

What are evident from the above examples are the complex issues that face social workers in their everyday practice. The core foundations of this work are values and ethics and while these can often conflict due to the variety of sources that social workers are accountable for instance the service user, carer and employer. The social worker must be prepared to explain and justify their actions and be open to scrutiny if they are to work in a professional manner (Clark, 2005). Values and ethics are a combination of thoughts and feelings which are used to weigh up the pros and cons of an argument and help make an ethical decision. However there needs to be distinctions on how to apply social work values and ethics into their professional work, without causing personal conflict. Above all the social worker must remain non-judgemental, and stay focused on the task ahead while upholding public trust in social care services.

Equality of Opportunity is put into place to safeguard everyone. An important aspect of the Equal Opportunity Policy is that it protects vulnerable adults in care. The Equal Opportunity Policy specifies that all clients will be given equal and impartial treatment regardless of their gender, age, disability, ethnic origin and race. It is important that all employees working within the care field comply with the Equal Opportunities Policy so that all clients are free from prejudice and are protected (Care Quality Commission: 2011). When concerned with the care of vulnerable adults, key legislations are put in place. These include laws, policies and strategies. All social care services are governed by legislation and government guidance which must be followed accordingly (www.legislation.gov.uk). Some Acts which are relevant to the case study include the Disability Discrimination Act (1995), the Care Standards Act (2000), the Race Relations Act (2000), the Human Rights Act (1998) and the Community Care Act (2003). The purpose of these Acts is to ensure that there are high standards set which health authorities and local authorities can follow to regulate care (Nazarko: 2002).

The Afan Nedd care study explains that the residential home cares for vulnerable adults. When concerned with those most vulnerable it is important that each service user is treated fairly and equally with their human rights taken into consideration at all times. The Afan Nedd case study shows that these basic requirements are not always met. The article states that the care home is being run by trained nurses and unqualified care assistants. In April 2002, the legislation that all residential homes in the UK must meet in order to stay registered changed. The Registered Homes Act of 1984 was replaced by the Care Standards Act (CSA) (2000). The CSA regulates and inspects all local authorities, establishes a General Social Care Council in England and a Care Council in Wales and it makes provision for the registration, regulation and training of social care workers (Nazarko:2002). The CSA ensures that the regulation of care workers is monitored closely. The Act also states that social care workers must be registered with the English or Welsh Council where each Council is required to ensure high standards of practice and training are being used at all times. It is important that Registered Social Care Workers (RSCWS) must abide by a strict code of conduct; any employees who breach this code of conduct will be called in for a disciplinary hearing which could result in suspension or being removed from the care register. In Wales, the Care Council approve courses and make allowances and grants for training to ensure that care homes care run properly (Nazarko: 2002).

Afan Nedd care home is regulated by the Care and Social Services Inspectorate Wales (CSSIW), they encourage ‘the improvement of social care, early years and social services in Wales’ (www.wales.gov.uk). CSSIW works in conjunction with the Welsh Assembly Government; they inspect local authority social services and regulate and inspect social care environments (www.wales.gov.uk). The CSSIW regulations include registration, inspection, complaints and enforcement in order to protect vulnerable adults. It appears that Afan Nedd care home does not comply with the CSSIW policies as it does not have qualified care assistants. To resolve this issue, a possible solution is that the care home should provide training for all employees to ensure the safeguard of vulnerable adults and to provide the highest standard of practice to service users.

When caring for vulnerable adults it is extremely important that their care is main priority. All care homes are regulated by the Care Quality Commission (CQC) which is responsible for monitoring the standards of care services (www.direct.gov.uk). The CQC is in place to ensure good work practice for professionals and to improve the standard of living of the service user. All care homes must follow the ‘Care Value Base;’ in nursing theory this is an ethical code which sets out rules which carers must follow within their social care setting which ensures that the carer is not discriminating the service user and are not violating their rights (Moonie: 2005). These values also include the promotion of equality and diversity and to have the ability to challenge discrimination. In 2002, the General Social Care Council (GSCC) published a code of practice for both employees and employers which explains the promotion of these values along with confidentiality and other rights and responsibilities. (Moonie: 2005).

The case study explains how John Davies, a registered general nurse, has been verbally abusing some of the clients. This should be a major concern for Afan Nedd nursing home as the service user is not receiving the correct care. The case study also explains that John Davies appears to be experienced and is very popular with the matron. This can then cause problems within the care home as issues such as discrimination and prejudice may arise.

It can be said that any type of institutional abuse is completely illegal and unprofessional. Verbal abuse within the care home cannot be tolerated as those who are physically and mentally frail are most at risk (www.direct.gov.uk). The Equality Act 2010 is a key piece of legislation which must be followed within every social care environment. The Act provides a ‘modern and accessible framework of discrimination law which protects individuals from unfair treatment and promotes a fair and more equal society’ (www.equalities.gov.uk). Every health care professional must know all key pieces of legislation before they undertake any social care and must implement the rules throughout their health care career. By law each service user has the right to be treated with respect and dignity. The Protection of Vulnerable Adults (POVA) scheme was launched by the Department of Health which provides a list of care workers who have harmed vulnerable adults in their care. It is now a statutory requirement for managers to use when appointing individuals to work with vulnerable adults (www.criminalrecordscheck.co.uk). This could mean that John Davies may have had a history of verbal abuse to service users and this may have not been checked prior to being employed as the case study explains he is an agency worker.

As mentioned earlier, John Davies appears to be popular with the matron which may cause problems if another social care worker wanted to report his verbal abuse to the service users. It could also mean that the service users do not feel confident enough to report the abuse to the matron as they feel that they may be discriminated against or they may not have the mental capacity to report this issue. Since 2006, the social services complaints procedure has changed in Wales. The CCSIW are legally obliged to have their own written complaints procedures. It is important to stress that all complaints must be kept confidential along with following the CCSIW complaints procedure (Department of Constitutional Affairs: 2007). Another issue that may arise from the fact that John Davies is popular with the matron is other employees of the nursing home may not want to be seen as a ‘whistle blower’ if they wanted to repot abuse within the care home. Knights and Willmott (2006) believe that ‘whistle blowers tend to be well respected and conscientious employees. They tend to believe that once they have informed the appropriate managerial authority of these illegal or unethical acts the organisation will take the appropriate measures to change its behaviour.’ However, it appears that many whistle-blowers feel that management do not see ‘whistle blowing’ as an act of good organisational citizenship, instead management see this as trouble making. In many cases, the whistle blower may be victimised or even disciplined, making other employees stay silent in reporting any further discrimination or abuse within the care home. The Older People’s Commissioner for Wales, created a policy where the commissioner is contacted by an employee from another organisation who is worried about unethical acts in their place of work and want to report it (www.powysweb3.ruralwales.net). The Public Interest Disclosure Act, (PIDA) protects employees who ‘blow the whistle’ about wrong doing within the nursing home, providing that they do so in the ways set out by PIDA. Any employee who is victimised by their employees for ‘blowing the whistle’ has the right to take their employer to a tribunal. The Commissioner ‘recognises that employees are often the first to realise that there may be something wrong within their organisation and therefore encourages all individuals to raise genuine concerns about wrongdoing at the earliest possible stage’ (www.powysweb3.ruralwales.net). This policy relates back to the Afan Nedd nursing home as the policy will protect them if they wanted to report the John Davies for abusing the service user. The Nursing Midwifery Council (NMC) believe that it is ‘important to establish a comprehensive vulnerable adult protection and safeguarding service to ensure good leadership and performance management, however, it appears that such arrangements are not consistently found across social services’ (www.nmc-uk.gov).

Albert and Gladys Griffiths have recently arrived at Afan Nedd nursing home, the case study states that Albert is mentally alert however his wife Gladys have early onset Alzheimer’s. The reader learns that Gladys becomes easily confused and disorientated but is usually calmed by Albert’s presence; however they do not have a double room in the nursing home. As the couple does not have a double room this can be seen as discrimination and a violation of their human rights. It can be said that to maximise Albert and Gladys’ quality of life, they have the right to a double room as they have never spent a night apart. Quality of life refers to the total living experience, which results in overall satisfaction with ones quality of life. ‘Quality of life is a multi-faceted concept that recognises at least five factors; lifestyle pursuits, living environment, clinical palliation, human factors and personal choices’ (Singh: 2009). It can be said that quality of life can be improved by bringing in these five factors into the delivery of care.

It appears that the Human Rights Act (1998) has been breached as Gladys and her husband are not able to share a room together. The Act states that ‘these rights not only impact matters of life and death, they also affect the rights you have in your everyday life: what you can say and do, your beliefs, your right to a fair trial and other similar basic entitlements.’ When working in a social care environment, it is the responsibility of the health care professional to respect the rights of the service user. Learning that Gladys has early onset Alzheimer’s, this could mean that she does not have the mental capacity to address her human rights within the nursing home. The Mental Capacity Act (2005), safeguards those with mental illness and it is also a stepping stone for those most vulnerable to receive treatment in a nursing home to improve their quality of life (Department of Health 2005). The Mental Capacity Act (2005) is designed for those who are unable to make decisions for themselves or lack the mental capacity to do so. It can be said that under the Mental Capacity Act, any person is ‘presumed to make their own decisions unless all practical steps to help him or her to make a decision have been taken without success,’ (www.nhs.uk). It is important to remember that a change of routine can affect behavioral problems with someone suffering with Alzheimer’s which can cause them to lash out of feel uneasy. It is said that Alzheimer’s do not do well to change as change causes anxiety and stress, therefore changing Gladys’ normal routine is not in her best interests when settling into a new environment (Gale: 2010). All service users of nursing homes have the right of privacy. The right of privacy is a fundamental basic right that must always be met. Each service user has the right to live in a friendly, homely and caring environment, where the care assistant always delivers the level of care that is appropriate to each individual. ‘Each person has the right to be treated as an individual, with respect and dignity, as well as having a right to privacy and to choice; it is the duty of the management and staff to safeguard these rights and to help the service user exercise them correctly’ (Ford: 2005).

The case study explains how Musad Mohammed is a Pakistani Muslim who is a resident at Afan Nedd nursing home. Musad Mohammed is finding life in the nursing home strange as he has no immediate family living in the UK; the food is an issue for him, having a female carer and the lack of privacy at prayer times. Being a Muslim man, resourcing halal food for Mr Mohammed should not be an issue as it is easily sourced in the UK (Q News: 1999). The Race Relations Act 1976 states that no person should be discriminated against on the grounds of race, colour, nationality, ethnic and national origin in the fields of employment, the provision of goods and services, education and public functions (www.legislation.gov.uk). From the information on the case study, it is clear to see that Mr Mohammed is being discriminated against as his needs are not being met. However, this type of discrimination tends to be indirect discrimination. It can be said that indirect discrimination is when a condition or rule within the workplace disadvantages one group of people more than another (www.direct.gov.uk). This applies to the case study as Mr Mohammed is being cared for by female care assistants which is against a Muslim mans beliefs. This is also a breach of his human rights which could affect Mr Mohammed’s quality of life. It is important to understand that each service user of the nursing home is entitled to privacy and an independent living. It is also important that the ‘right of every individual to select independently from a range of options, incorporating, choice of meal, bed times and taking part in activities/ entertainment’ (Rose and McCarthy: 2010). These basic needs are not being met for Mr Mohammed as he feels he has a lack of privacy at prayer times. For a Muslim man prayers play an important role in his faith and his care values are not being met. Every individual has the right to be treated as unique regardless of their beliefs and should be treated with respect at all times (Rose and McCarthy: 2010). It appears that the employees at Afan Nedd are not educated in a Muslims faith; a possible solution for this is that the staff could take part in discrimination training and multicultural awareness training.

Dilys Watkins enjoys staying up to watch the television at the nursing home, however the staff at the nursing home does not allow her to do this as it is said to interfere with the rota as everyone needs to be in bed before the night shift commences. This can be seen as a breach of her human rights and independence as Dilys says she is able to put herself to bed after her programmes have finished. It is important to avoid stereotyping an elderly person in care, mainly with regard to their own independence. This is because negative images of independence can become self fulfilling. This can cause an elderly person to have low expectations of their abilities and performance (Beaulieu: 2002). However, the case study does not state Mrs Watkins’ mental awareness, and the care assistants may feel that it is not in her best interest to stay up on her own and put herself to bed as she may fall and hurt herself. This is a possible reason as to why the Mental Capacity Act (2005) is put into place at nursing homes as the Act sets out a checklist of things to consider when deciding what is best for the service user. Another possible argument is the idea of empowerment in nursing homes. The idea of empowerment is that those who have little or no influence, such as Dilys Watkins are ‘able to acquire the capacity to have informed opinions, to take initiatives, make independent choices and influence change. It also means that those with influence actively change their attitudes and rules and change the way decisions are made through engaging with excluded people’ (www.equal.ecotec.co.uk). It can be said that the staff at Afan Nedd must show service users such as Dilys Watkins respect and dignity and must always follow the correct codes of practice; Processional Codes of Conduct are put into place to avoid discrimination and to improve the quality of life for residents at the Afan Nedd nursing home (www.npc-uk.org).

It is clear to see that Afan Nedd nursing home is beset by a number of problems where the relevant policies and legislations are not being followed correctly. The Care Council for Wales is the social care workforce regulator in Wales responsible for promoting and securing high standards within nursing homes to protect and safeguard vulnerable adults; these regulations are not being followed by Afan Nedd nursing home. There are many key issues identified in the case study such as discrimination, lack of staff training, verbal abuse, lack of privacy and poor professional practice. It is important to address these issues straight away to improve the quality of life to all service users. All social care workers are expected to meet the code of conduct set by the Care Council and serious failure to do so can result in the closure of the nursing home and suspension and the removal of employees from the Register. Nursing homes care for the highly dependent and vulnerable people. Many of them have many nursing needs that require a high level of professional knowledge and understanding. It is therefore important to ensure that all staff working at nursing homes takes part in any opportunities for improving and updating their skills along with organising educational and training days. Afan Nedd nursing home could promote and support research into the efficiency of diverse approaches to caring for the elder and those with mental disabilities.

This assignment will look issues around older people’s mental health, in particular, dementia and abuse; this will include demographics of older people, statistics, the history, definitions and causes of dementia, and finally the lack of legislation to protect vulnerable people from harm and the implications for social work practice.

The population surge at the end of world war 2 has gave rise to an unprecedented population explosion and to what we now call the ‘baby boomers’, these people are now in their retirement years'(Summers Et al, 2006), and our population now contains larger percentage of older people that ever. In society today elder people are becoming the fastest increasing population in the UK, National Statistics (2009) states that ‘the population of the UK is ageing. Over the last 25 years the percentage of the population aged 65 and over increased from 15 per cent in 1983 to 16 per cent in 2008, an increase of 1.5 million people in this age group’. Due to the increase of the ageing population we are now seeing emerging health and social care issues in our society. Many older people will be active, involved within the community, and independent of others. However, as you get older it is natural to experience pain, a decline in mobility or mental awareness.

Mind (2010) states that ‘the most common mental health problems in older people are depression and dementia. There is a widespread belief that these problems are a natural part of the ageing process, but this not the case; it can start as early 40 but is more common in older people (Royal college of Psychiatrists, 2009), however, ‘there only 20 per cent of people over 85, and 5 per cent over 65, have dementia; 10-15 per cent of people over 65 have depression’ (Mind, 2010). It is important to remember that the majority of older people remain in good mental health. ‘Dementia mainly affects older people, although it can affect younger people; there are 15,000 people in the UK under the age of 65 who have dementia’ (Alzheimer’s society, 2010). However, ‘currently 700,000 – or one person in every 88 in the UK – have dementia, incurring a yearly cost of ?17bn, and the London School of Economics and Institute of Psychiatry research calculated that more that 1.7 million people will have dementia by 2051’ reported by BBC news (2007).

‘The word dementia comes from the Latin ‘demens’ meaning ‘without a mind’. References to dementia can be found in Roman medical texts and in the philosophical works of Cicero. The term dementia came into common usage from the 18th Century when it had both clinical and legal connotations. Dementia implied a lack of competence and an inability to manage one’s own affairs. Medical use of the term dementia evolved throughout the 19th century and was used to describe people whose mental disabilities were secondary to acquired brain damage, usually degenerative and often associated with old age’ (Kennard 2006). From the 20th century onwards scientific knowledge was supplemented through the examination of the brain and brain tissue which was founded and performed by a physician Alois Alzheimer (Plontz, 2010). The National service framework (Department of Health, 2001, p96) now defines ‘dementia as a clinical syndrome characterised by a widespread loss of mental function’.

The term ‘dementia’ is used to describe the symptoms that occur in a group of diseases that affect the normal working functions of the brain. This can lead to a decline of mental ability, affecting memory, thinking, problem solving, concentration and perception, also problems with speech and understanding (Mind, 2010). ‘Dementia is progressive, which means the symptoms will gradually get worse. How fast dementia progresses will depend on the individual. Each person is unique and will experience dementia in their own way’ (Alzheimer’s society, 2010). Symptoms of dementia include: Loss of memory, Mood changes, and Communication problems. In the later stages of dementia, the person affected will have problems carrying out everyday tasks, and will become increasingly dependent on other people, two thirds of people with dementia live in the community while one third live in a care home (Alzheimer’s society, 2010). There are many types of dementia, and some of the causes of dementia are rarer than others, Alzheimer’s disease is the most common cause, damaged tissue builds up in the brain to form deposits called ‘plaques’ and ‘tangles’, these cause the brain cells around them to die (Royal college of Psychiatrists, 2009). Other most commonly known is vascular disease, Dementia with Lewy bodies, Fronto-temporal dementia. Mostly, patients themselves do not present to the clinician with dementia, owing to gradual onset and denial of the problem. There is no cure for dementia but there is medication that will help to slow down the progression of the disease. When finding help for dementia it is usually the primary carers, caregivers, supporters, partners or family members who initiate asking help and a diagnosis (Brodaty, 1990).

Depression may be misdiagnosed as dementia the difference being that people who have depression are more likely to be aware of their issues therefore are able to discuss them, whereas someone with dementia may not be able to do this due to their symptoms. Nonetheless, the Mental Capacity Act (2005) states that every person has the right to make their own decisions and must be assumed to have capacity unless otherwise proven and people should be supported to make any decisions. Under the MCA, you are required to make an assessment of capacity before carrying out any care or treatment (Office of the public guardian, 2009). The Mental capacity act is an act that protects individual rights and ensures that the person’s liberty is not taken. ‘It is based on best practice and creates a single, coherent framework for dealing with mental capacity issues and an improved system for settling disputes, dealing with personal welfare issues and the property and affairs of people who lack capacity. It puts the individual who lacks capacity at the heart of decision making and places a strong emphasis on supporting and enabling the individual to make their own decisions’ (Office of the public guardian, 2009). However, even with a structure in place to protect individual’s rights and liberties many people who have dementia are more vulnerable to abuse due to their lack of capacity. The University College London research revealed that a third of carers admitted “significant abuse”, in total 115 carers reported at least some abusive behaviour, and 74 reported more serious levels of mistreatment (Cooper et al, 2009). Caregivers can also be on the receiving end of verbal or physical abuse directed at them by parents or spouses who are confused and angry over declining mental capacities due to stroke and Alzheimer’s disease. In some cases, Alzheimer’s disease or other forms of dementia may cause the patient to be uncharacteristically aggressive (Coyne, 1996).

It is only in recent years that abuse of the elderly has become more apparent, Crawford Et al (2008, p122) argues that over time it has very slowly come to the attention of people in the last 50 years that abuse does actually exist behind closed doors; in the 1950’s older people lived in large families where issues were hidden, and in the 60’s to 70’s older people started living alone or in residential homes and it was not until the early 80’s that abuse had started to be recognised and defined. Penhale and Kingston(1997) argue that over the years it has been difficult to emphasise the issues of abuse due to not finding a sound theoretical base to which an agreement of a standard definition can be made and applied. Action on elder abuse (2006) defines elder abuse as ‘A single or repeated act or lack of appropriate action, occurring within any relationship where there is an expectation of trust, which causes harm or distress to an older person’. Abuse comes in not just physical abuse it comes also in sexual, psychological, neglect, discrimination and financial as well. ‘Older people may be abused by a wide range of people including family members, friends, professional staff, care workers, volunteers or other service users, abuse can also be perpetrated as a result of deliberate, negligence or ignorance’ (Royal pharmaceutical society (RCA), 2007). Abuse can occur in a variety of circumstances and places such as, in own home, in a residential or day care setting or hospital and can by more than one person or organisation. Pritchard (2005) asserts that we will never have a true picture of the prevalence of elder abuse due to the unreported cases, and can only count ones that are known to organisations and services.

Most abuse is still unreported due to victims being frightened, ashamed and embarrassed to report the abuse, not realising their rights or not being able to due to tier mental health. Summers et al (2006, p7) points out that ‘those statutes that make abuse criminal are often ineffective due to them not being utilised by the victim’, and this means that this will be the biggest challenge and barrier for change in getting people to recognise the scale of the problem and raising awareness so that the government agree to change the legislation to protect older people. Abuse of any kind should not be ignored and there should be legislation to protect adults from abuse like there is in child protection, people who recognise the extent of elder abuse argue why should adults be treated as second class to children, is their suffering and deaths any less important? The Alzheimer’s Society (2010) states that ‘abuse of people with dementia should be considered in the same way as child abuse’.

Crawford and Walker (2008, p12) state that ‘prejudice refers to an inflexibility of the mind and thought, to values and attitudes that stand in the way of fair and non judgmental practice’. Thompson (2006, p13) defines discrimination as the process in which difference is identified and that difference is used as the basis of unfair treatment. A barrier to recognising the abuse of people with dementia and older people is that of social stigma, negative perceptions and connotations of words for mental health, such as confused or senile. ‘Confused is something that we all experience at some time in our lives, whereas senile is a more complex word and the first recording of its usage was neutral meaning pertaining to old age, but now has negative connotations linked to mental decline due to age (Crawford and Walker, 2008). Therefore, challenging people’s perceptions needs to done to change these social constructs to enable a change in legislation and protection of vulnerable adults. In March 2010 the department of health ran a series of campaigns to address poor public understanding of dementia which included TV, radio, press and online advertising featuring real-people with dementia (Department of health, 2009).

In 2009 the first ever dementia strategy was launched that hopes to ‘transform the quality of dementia care, It sets out initiatives designed to make the lives of people with dementia, their carer’s and families better and more fulfilled It will increase awareness of dementia, ensure early diagnosis and intervention and radically improve the quality of care that people with the condition receive. Proposals include the introduction of a dementia specialist into every general hospital and care home and for mental health teams to assess people with dementia’ (Department of health, 2009). However, this is not legislation it is just a strategy for dealing with people with dementia. The government are recognising that there is little protection for vulnerable adults and that further legislation need to be put in place and stating that dementia care is a priority (BBC news, 2007). At present, there is no one specific legislation which directly protects vulnerable adults, instead the applicable duties and powers to assess and intervene are contained within a range of legislation and frameworks, such as the Mental Capacity Act 2005 and Mental Health Act 2007 and the national service framework for older people. ‘One of the themes for national service framework (NSF) is respecting the individual which was triggered by a concern about widespread infringement of dignity and unfair discrimination in older peoples access to care. The NSF therefore leads plans to tackle age discrimination and to ensure that older people are treated with respect, according to their individual needs, specifically in standard 2 it relates to person centred care ‘ (Crawford and Walker, 2008, p8).

And expectation of NSF is that there must be systems and processes put in place to enable multi agency working. In 2000 the government published ‘No secrets which is guidance that requires local authorities to set up a multi agency framework which includes health and the police with a lead person (adult social care) to carry out procedures into the allegations of abuse whilst balancing confidentiality and information sharing’ (Samuel, 2008). No Secrets is only ‘guidance and does not carry the same status as legislation, the LA’s compliance is assessed through an inspection process, therefore the LA can with good reason choose to ignore the guidance’ (Action on elder abuse, 2006). This has concerned agencies who want to see the protection of adults given the same equivalent priorities as child protection and think that legislation is the only way to accomplish this.

A review of No Secrets guidance has been carried out in 2008 and consulted with over 12000 people (Department of Health, 2009), the report found that over half (68%) of the respondents were in agreement to new safeguarding legislation and 92% wanted local safeguarding boards to be placed on a statutory footing and still there is no legislation to protect vulnerable adults (Ahmed, 2009). A recent article in community care told the failure of the government to commit to making a policy has only strengthened campaigners fight and given rise to criticism (Ahmed, 2009).

The need to protect vulnerable people brought about the protection of vulnerable adults scheme (POVA) which is run by the Department of Health to regulate and monitor the employment of staff in the social care workforce, through this scheme a list of people who are unsuitable to work with vulnerable people is kept. More recently, the Safeguarding of Vulnerable Groups Act 2006 which was launched in 2008 replaced POVA with the Independent Safeguarding Authority (IDeA, 2009). The problem with this is that abusers of dementia sufferers are usually family member or informal carer that are under considerable stress and may not receiving help from within the health and social care system, therefore, an abusive situation can carry on for some time until the situation is found by an outsider. This situation may only be found when a informal carer starts asking for help, and when informed of the situation it is good practice and essential to make sure that carers are getting the help they need which can prevent the abusive situations. Under the 1995 Carers (Recognition and Services) Act carers are entitled their own assessment of need and by doing so this may allow for respite or payments to be made for their services (Parker Et al, 2003). University College London researchers who interviewed people caring for relatives with dementia in their own homes stated within their research that ‘Giving carers access to respite, psychological support and financial security could help end mistreatment’ (Cooper et al,2009). When working with relatives who are carers it is important to remember who is the service user, although it is important to ascertain the wishes of the relative it should not override the wishes of the service user, this is especially true when there is a break down in the care of the service user and the carer wishes the service user to be placed in care.

Many older people with dementia receive care in a residential home; this may be due to family member no longer being able to cope with the care of the person. The local authority has a duty to assess the needs of a person with dementia ensuring that their wishes are heard and adequate care is put in place. ‘Assessment is an ongoing process, in which the client participates, the purpose of which is to understand people in relation to their environment; it is a basis for planning what needs to be done to maintain, improve or bring about change in the person, the environment or both’ (Anderson Et al, 2005).

The trouble with placing people with dementia in care homes is there are not enough care homes specifically for people with dementia and people end up in a home that do not have trained staff to cope with individual needs of someone with dementia, therefore, people s wishes may not be heard. As part of the joint assessment process it is the social workers role to ascertain the wishes of the individual, this is done by assessing their needs in an holistic way which includes and medical and social aspects of the person. If there is doubt as to the mental capacity of the person then a mental capacity assessment will need to be acquired by asking to joint assess with community psychiatric nurses (CPN). Priestley (1998) states that ‘the community care reforms established the principle of joint working between health and social services authorities as a priority for effective care assessment and management with social services taking the ‘lead role’.

In conclusion there seem to have been many shifts in the direction of how policy and procedures framework and guidance care for people with dementia, although there is still no firm legislation to protect them. However, there seems to be more recognition of the issues that surround dementia and future goals are towards the training of people to understand those issues so that professionals are able to deal with the complex needs of a person with dementia.

Word count 2969

The stigma and prejudice attached to homosexuality encourages the perpetuation of homophobic bullying against the lesbian, gay, bisexual and Trans gender (LGBT) youth by their peers. Bullying can take the form of homophobic epithets, sexual harassment and even violence. The class room has been described by social psychologists as the “most homophobic of all institutions.” This paper examines the effects of homophobic bullying on the physical and mental health of the LGBT youth which is characterized by depression, suicide ideation and engaging in risky behaviors (alcohol and substance abuse). The paper also analyses the buffering effects provided by positive school climate, parental and peer support as well as personal resilience.

Keywords: LGBT youth, homophobic bullying, depression, hostile school climate, suicide ideation

The Effects of Homophobic Bullying on the Mental and Physical Health of LGBT Youth:

The Buffering Effects of Positive School Climate and Parental Support

A Review of the Literature

In today’s permissive society an increasing number of adolescents who are in their early and middle teens (Middle and High school students) have begun to come out of the proverbial “closet.” However, even in this day and age our society is largely intolerant of deviation from gender norms prescribed by the culture. This makes it especially challenging for lesbian, gay, bisexual and transgender (LGBT) youth who are struggling and trying to come to terms with their sexual identity and orientation. The stigma attached to homosexuality encourages the perpetuation of homophobic bullying against the LGBT youth by their peers. It is a matter of immense concern to the doctors, psychologists and the entire community that there is a high incidence of suicide within this sexual minority group as compared to the heterosexual youth. This literature review focuses on homophobic bullying and its effects on the LGBT youth who are at a challenging stage in life and are struggling with their feelings about sexual orientation and sexual gender. The effects of homophobic bullying on gay, lesbian, bisexual and transgender youth encompass challenges to their psychosocial development, emotional distress an increase in risky behavior (substance abuse), depression and suicide ideation. However, the literature review also highlights the buffering effects of a positive school environment and positive parental relations against negative effects of homophobic bullying.

Homophobic Teasing and General Peer Victimization

Homophobic teasing, peer victimization and gender non-conformity attitudes are some important mental health issues faced by the LGBT youth as result of their sexual orientation. “Homophobic teasing is often long-term, systematic, and perpetrated by groups of students; it places the targets at risk for greater suicide ideation, depression and isolation”. Homophobic teasing includes negative beliefs, attitudes, stereotypes and behaviors towards gays, lesbians, bisexuals and transgender youth, and can take the form of verbal and/or physical abuse, and in today’s advanced technological age cyber abuse. Peer victimization can take the form of verbal insults, threats of violence, physical assault, and sexual assault (Espelage, Aragon, Birkett & Koenig, 2008). A 2009 survey of more than 7,000 LGBT middle and high school students aged 13-21 years found that in the past year, because of their sexual orientation: Eight of ten students had been verbally harassed at school; four of ten had been physically harassed at school; six of ten felt unsafe at school; and one of five had been the victim of a physical assault at school (cdc.gov).

Challenges to Psycho Social Development

According to Erik Erikson’s theory of psychosocial development all individuals must master particular developmental tasks during the adolescent years in order to lead productive and healthy lives. These tasks include “adjusting to the physical and emotional changes of puberty”, forming practical social and functioning relationships with peers, accomplishing independence from primary care takers, preparing for a career, and formation of a unique identity and a set of moral values (McDermott, Roen & Scourfield 2008). However, for the LGBT adolescents achieving these developmental goals is challenged by the stress of being part of a stigmatized group. These youth also have to contend with a lack or absence of a support system such as family rejection, social isolation and harassment by peers and feelings of alienation with the school as a result of consistent homophobic bullying.

Emotional Distress

The social climate of our nation promotes heterosexist attitudes and these views are up held by our social institutions such as families, schools, the church, and government institutions. These prejudiced attitudes result in gay related stress for the LGBT youth who “experience a unique set of stressors related directly to being sexual minorities within a heterosexually oriented society.” These stressors may be both external (homophobic bullying, family rejection), and internal (internalized homophobia) in nature From the time they are children the youth have been barraged by negative attitudes towards homosexuality and this can lead to the internalization of homophobic sentiments. Internalized homophobia often results in feelings of shame and disgust towards ones sexual orientation which has been reinforced by family and society and can create conflict and dissonance and lead to emotional distress (Rosario & Schrimshaw 2002).

School Alienation and Lack of Social Support

The constant flow of negative information regarding gender non -conformity and homosexuality from figures of authority such as parents, teachers, the clergy, and government officials encourages discriminatory and prejudicial behavior towards the sexual minority group by fellow students. Their heterosexist tendencies are manifested through homophobic bullying, social isolation and violence towards the vulnerable LGBT adolescents. Peer victimization can result in creating a hostile school environment and promotes feelings of alienation from school. An on-line research conducted on 3,450 public and private students (ages13-18) in the U.S found that 88% of the students reported that homophobic remarks were used in the teacher’s presence and that teachers and staff failed to intervene during these incidents (Espelage 2008). These findings clearly indicate that teachers and staffs failure to intervene encourages and promotes peer victimization and homophobic teasing and creates and sustains a hostile environment for lesbians, gays, bisexuals and transgender youth.

Having a strong social support system (family, peers, and teachers) is vital to maintaining mental and emotional health. It works as a buffer against stress; elevates a person’s self-confidence and self-esteem; reduces feelings of loneliness and isolation to name a few. Lesbian, gay, bisexual and trans gender youth have lack or absence of a social support system by virtue of their sexual orientation that is negatively sanctioned by the heterosexual society. They face family rejection after “coming out,” social isolation by their peers, and many adults fear discrimination, job loss, and abuse if they openly support LGBT youth. Thus there is a lack of positive role models and support system which makes it more challenging to cope with the stress produced by stigmatization (Padilla, Crisp &Rew 2011).

Depression, Substance Abuse, and Suicide Ideation

Suicidal ideation is defined as “thoughts of engaging in suicide-related behavior.” It can range from passive ideation- having the thought but not the intent to active ideation which includes intent as well as a plan to harm oneself. Suicidality has a number of risk factors as well as a number of protective factors. Among LGB individuals there is a higher incidence of risk factors and there are less protective factors in place. There is, for example, a higher incidence of important suicide risk factors such as depression and substance abuse in LGB youth compared to their heterosexual peers. These associations between mood disorders are borne out by research studies (Malley, Posner, & Potter, 2008). Also, LGB individuals often experience a lack of support at home and are deprived of positive environments in their schools due to avoidance or bullying. Within the LGB cohort certain factors can affect the risk of suicidality as well-for example the younger the age at which the individual discloses sexuality the higher the risk of suicide. According to the U.S. Department of Health and Human Services (2007), “It has been widely reported that gay and lesbian youth are two to three times more likely to commit suicide than other youth and that thirty percent of all attempted or completed youth suicides are related to issues of sexual identity. The Suicide Prevention Resource Centre (2008) in the United States noted a 1.5 to 7 fold (depending on the study) increased risk of attempted suicide in LGB youth as compared to their heterosexual peers. A landmark study commissioned by the US Secretary of Health found that one third of all sexual minority youth suicides occur before the age of seventeen (Malley, Posner, & Potter, 2008). Padilla, Crisp, and Rew (2010) found that in the adolescent population sexual minorities have a much higher rate of drug use with contributing factors including a greater number of psychological stressors and poor social networks. They also noted that when parents accepted the adolescent’s sexual orientation the impact of life stressors was decreased significantly.

Buffering Effects Provided by Parental Support and Positive School Climate and Resilience

As mentioned previously there is a greater prevalence of psychological problems and high risk behaviors in LGBT youth then in their heterosexual peers. These include mood disorders, suicidal thoughts and substance abuse. Espelage, Aragon, Birkett and Koenig (2008) and Poteat, Mereish, Di Giovanni & Koenig(2011) highlighted the crucial role a support system plays in preventing psychiatric and other behavioral problems in LGBT youth. Two important and beneficial support networks identified were the first of which were communicative and empathic parents and the second affirming and healthy school environments. The presence of both these networks corresponded with a markedly reduced incidence of psychological problems, suicide and substance use compared to individual where there was a lack of these support systems. Parental support and acceptance also seems to foster resilience and improve coping skills.

It appears from the review of relevant literature that contrary to popular perception and despite the efforts of most sections of the media as well as many social organizations, general and unconditional acceptance of LGBT individual remains the exception and not the norm. The alienation and stigmatization is achieved through both passive (social ostracization, not standing up for LGBT rights) and aggressive (violence and emotional homophobic bullying) means and is aggravated by the absence of a buffer against these assaults in the form of parental acceptance and positive school environments. These findings do not differ much from those of earlier studies or from studies of other minorities that face prejudices. We know that the problem exists and we have identified the enabling, aggravating and protective factors. What remains to be seen is whether society will show the will to follow words with actions. What may also be beneficial is to conduct larger studies with more statistical power so that the facts can be ascertained with a greater degree of confidence.

Annotated Bibliography

Center for Disease Control and Prevention (2011, May 19). Lesbian, gay, bisexual and transgender health. Retrieved April 3, 2012, from http://www.cdc.gov/lgbthealth/youth.htm

This website provides statistics on the prevalence of homophobic bullying in the schools. Since community psychology focuses on social issues and social institutions it is of particular interest to community psychologists that our sexual minority youth are facing harassment and violence at the hands of these social institutions such as schools, church and governmental organizations.

Espelage, D.M. (2008). Addressing research gaps in the intersection between homophobia and bullying. School Psychology Review, 37 (2), 155-58.

Homophobic bullying is a pressing and immediate problem facing our community since it affects adolescents who are members of a sexual minority group. One of the fundamental principles of Community psychology is a respect for diversity which includes race ethnicity, gender, sexual orientation and social class.

Espelage, D. L., Aragon, S. R., Birkett, M., & Koenig, B. W. (2008). Homophobic teasing, psychological outcomes, and sexual orientation among high school students: What influence does parents and schools have? School Psychology Review, 37(2), 202-216.

Another fundamental principle of Community Psychology is ecological perspective and multiple levels of intervention. LGBT youth face an increased risk of mental and emotional problems as a result of stigmatization of their sexual orientation. It is of interest to the community psychologist that the youth’s positive parental (microsystem) and school (microsystem) involvement help as a buffer to negate the effects of stigmatization.

McDermott, E., Roen, K., & Scourfield, J. (2008). Avoiding shame: young LGBT people, homophobia and self-destructive behaviors. Culture, Health & Sexuality, 10(8), 815-829. doi:10.1080/13691050802380974

Since community psychology focuses on social issues and social institutions it is of particular interest to community psychologists that our sexual minority youth are facing harassment and violence at the hands of these social institutions such as schools, church and governmental organizations.

Padilla, Y. C., Crisp, C., & Rew, D. (2010). Parental acceptance and illegal drug use among gay, lesbian, and bisexual adolescents: Results from a national survey. Social Work, 55(3), 265-275.

Community psychologists are interested in the effects of social support on our youth. Since social support has been shown to promote and maintain physical and mental wellbeing and also helps in the development of resiliency in youth who are at risk such as the sexual minority youth.

Poteat, V., Mereish, E. H., DiGiovanni, C. D., & Koenig, B. W. (2011). The effects of general and homophobic victimization on adolescent’s psychosocial and educational concerns: The importance of intersecting identities and parent support. Journal of Counseling Psychology, 58(4), 597-609. doi:10.1037/a0025095

Another fundamental principle of Community Psychology is ecological perspective and multiple levels of intervention. LGBT youth face an increased risk of mental and emotional problems as a result of stigmatization of their sexual orientation. It is of interest to the community psychologist that the youth’s positive parental (microsystem) and school (microsystem) involvement help as a buffer to negate the effects of stigmatization.

Rosario, M., Schrimshaw, E. W., Hunter, J., & Gwadz, M. (2002). Gay-related stress and emotional distress among gay, lesbian and bisexual youths: A longitudinal examination. Journal of Consulting and Clinical Psychology, 70(4), 967-975. doi:10.1037/0022-006X.70.4.967

Since community psychology focuses on social issues and social institutions it is of particular interest to community psychologists that our sexual minority youth are facing harassment and violence at the hands of these social institutions such as schools, church and governmental organizations.

Suicide Prevention Resource Center. (2008). Suicide risk and prevention for lesbian, gay, bisexual, and transgender youth. Newton, MA: Education Development Center, Inc.

Community psychology advocates the importance of context and environment because our behaviors are governed by the expectations and demands of given situations. It is vital to study the social environment of the LGBT youth to figure out what interventions can be made in order to prevent suicide within this population.

The term divorce is defined by Merriam Webster Langenscheidt’s Pocket Dictionary as an act or instance of legally dissolving a marriage. It is usually between a man and a woman. However recent evolution and other social constructs have tended to see divorce as a legal dissolution between partners, for example, a marriage between gay or lesbian partners. The latter statement goes to explain the fact that some jurisdiction recognizes marriages between the same sexes. Therefore the definition of marriage cannot be restricted to the traditional description of what marriage is. It must also be noted that various cultures have a way of dealing with divorce.

To Margulies, Sam (2004), the decision to divorce is the beginning of two streams of events. Firstly, filing for divorce triggers legal, emotional and financial process in which the house hold must be split into two. The second stream of event is the building of new lives, households, who has custody of children of the union and new protocols being negotiated.

Again, one of the things that makes divorce such a unique and often troubled experience is that it involves a complex interaction between two different processes. Firstly, divorce is a difficult emotional process. It causes intense feeling of sadness humiliation, abandonment, disappointment, rejection and rage. Most of all, divorce engenders fear, particularly fear of loss. People fear lost of identity as spouse and parents, loss of economic and security, loss of control over their lives and loss of dignity. So the emotional process of divorce is one in which people have to manage all their feelings at the same time. As with any other transition, there are stages that most people pass, beginning with initial turmoil, followed by struggle with change, and eventually with adaptation and adjustment. Children of the marriage to be honest are not speared the pain of these processes. Margulies, Sam (2004).

For the purposes of this academic discourse, a child is somebody who is primarily under the age of eighteen or someone who is not yet twenty three but still in a training program. For instance, it concerns a person who is studying in a training institution like Sheridan College. The word consequences as would be used in this research represent the various experiences, children whose parents are going through divorce face.

This paper will therefore establish and make clear a hypothesis to be analyzed. Various arguments would be adduced to support and prove the said hypothesis. On the other hand a counter argument will be made to refute the hypothesis. A balance discussion on the research will also be delved into. Finally a presentation on the outcome of the research will be done.

HYPOTHESIS

The hypothesis is “there are lifelong consequences for children whose parents go through divorce”. Almost 50 percent of children whose parents divorce show signs of psychological damage during the first year after the event. According to a 1994 policy statement from the American Academy of Paediatrics, such boys become aggressive whiles adolescent girls get depressed. To prove further the devastating nature of divorce on children whose parents go through divorce are more likely to develop drug and alcohol problems. Pemberton K.C.(1998) in reviewing Psychologist Judith Wallerstein’s twenty- five (25) year study on the impact of divorce on children, found out that although the divorcing man and woman might be able to overcome the trauma and challenges associated with divorce, the circumstances of the children are different. Children of such unions can carry the ill effects of divorce into their own adult years. Such adults tend to have fear of commitment, unstable father-child relationships and bitter memories of the legal system. In explaining this position further, Pemberton K.C. (1998), asserts “I do not argue that children have no chance of healthy or happiness after their parents had divorced but the challenges children must meet after their parents’ divorce are severe and devastating”.

As much as scholars like Pemberton K.C. (1998) and Emery (2004) have painted a horrible picture of the situation, the same scholars have conceded to the fact that some children who experience this phenomenon grow to live a healthy and a successful life. For example there are enhancing programs in our schools that go a long way to support and prepare such children for future healthy living.

ARGUMENT TO PROVE HYPOTHESIS

As it has been noted, there are various arguments that go to support the premise that, children whose parents go through divorce suffer lifelong consequences. Some of the issues are best explained when put under emotional, physical and social consequences. To most children, divorce will constitute the first major crisis of their lives. Children turn to exhibit many emotional and psychological traumas. For instance in a conversation I had with a child and youth worker at Apple wood Height secondary school as part of my preparation towards gathering information for this project, enumerated that, children whose parents had gone and are going through divorce turn to be withdrawn in class. This behaviour tends to manifest itself in their academic performance. This Psychological effect makes them act aggressive towards their peers and seems to struggle with normal processes of growing up.

In much the same way, Emery, E. R.(2004), supported this hypothesis by stating that “There are those who contend that divorce inevitable and invariable devastates children and set the stage for a lifetime of emotional problems, period”. To prove this point further, he attempted to compare the behaviour and attitudes of children who are perceived to be normal because they are under the guidance of their two parents and those children whose parents are going or had gone through divorce. He found out that, the very process of divorce between parents causes the children to struggle through the pain and upheaval of their parents’ divorce. Secondly, through sensationalistic media or our own hysteria, we lay the burden of carrying a ticking time bomb on kids by inaccurately trumpeting the “tug of war” between the parents. Even if parents seem to be doing well by handling the divorce crisis, children are inevitable doomed or damaged because of divorce.

After the divorce process, it introduces huge changes into the lives of most children. This encompasses direct involvement in parental conflict, economic hardship, changes in residence and school. To him, divorce also increases the risk for psychological, social and academic problems among children. This increased risk is a legitimate concern for children, parents and the community. Finally, he stipulated that, despite parent’s fervent desire to protect children of divorce, the mere divorce process is a burden to children.

To prove further the long term consequences divorce has on children whose parent are going and had gone through divorce, Emery, E. R. (2004), made available some statistic to throw light on his thoughts. These are; such children are twice as likely to see a mental health professional, up to twice of such children are likely to have problems managing their behaviour. He also said, perhaps 1.25 to 1.5 times are more likely to have problems with depressed moods. Again, twice of such children are likely to drop out of school before graduation. What is more interesting and sad enough to support the Hypothesis is the realization that, 1.25 to 1.5 times of children at one point or the other experienced the challenges of their parents divorced. Similarly, the same children are likely to get divorced themselves. Is this not scary enough to prove the hypothesis?

Besides, Price E. (2000), in her book “Divorce and Teens” has not described the situation in any positive way. She explained that, the issue of parents fighting each other, why are my parents divorcing, why must one parent move out, must I tell my friends and what should be my level of loyalty to each parent, all go a long way to frustrate such children. Eventually, anger takes over and this manifest itself in aggressive behaviour towards life issues.

Another practical perspective to the situation at hand is cleverly summarised by his lordship, Mr. Justice Harvey Brownstone as follows;

After more than fourteen years of presiding in family court, one question has never seized to amaze me: how can two parents who love their children allow a total stranger to make crucial decisions about their leaving arrangements, health, education, extracurricular activities, vacation time and degree of contact with each parent? This question becomes even more mind-boggling when one considers that the stranger making the decision is a judge, whose formal training is in the law, not in family relations, child development, social work, or a psychology. Now add the fact that, because of heavy case loads and crowded dockets, most judges have to make numerous child custody, access, matrimonial property and support decisions every day on the basis of incomplete, subjective and highly emotional written evidence (called affidavits), with virtually no time to get to know the parents and no opportunities to meet the child whose life is being so profoundly affected. What person in their right mind would advocate for this method resolving parental conflict flowing from family breakdown? This are some of the questions that family called judges agonize over. Some say the answer are complicated and have much to do with social conditioning, economic class, level of education, sophistication, familiarity with community resources and even culture. I say the answers are simple. The institution of marriage has not been a great success in North of America…” Brownstone, J.H. (2009). P.1.

COUNTER ARGUMENT TO THE HYPOTHESIS

In spite of the scary picture painted by the various authors supporting the hypothesis that, “there are lifelong consequences for children whose parents go through divorce”, the same topic and ongoing controversies have resulted in the change of authors views. For instance, Emery (2004) has stated that “The Risk of Divorce Are Real but Not the Whole Story”. By this, he has discounted some of the arguments he had put forward to support the hypothesis. He acknowledges that divorce increases children’s psychological problems but also sought to emphasize the need to put it into its right perspectives. To him, the large majority of children from divorced families do not suffer from psychological problems. His argument is centred on the theory of “correlation and causality”. He went further to explain that divorce is correlated with more psychological problems among children but this does not mean that it is the cause of all the problems. Scientific evidence has at least proven that divorce cannot be the cause of all the affected children’s emotional problems. Another important factor, Emery (2004), considered is that what happens after divorce can go a long way to eliminate risk and promoting resilience.

Besides, he used the “half full and half empty analogy to refute the premise that all the children who experience their parents going and had gone through divorce face, Emery (2004). He duelled heavily on a major national study conducted by Nick Zill, Donna Morrison and Mary Jo Cairo. The study looked at children between the ages of twelve and twenty-one. The study revealed that 21% of children whose parents have had divorce received psychological assistance. In comparison, 11% percent from married families also received similar help. It is a fact that, there is a 100% increase between the two groups. Once again, this situation looks scary but the truth of the matter is that, if 11% of children from the normal situation seek psychiatrist assistance, then it presupposes 89% do not. On the other hand, if only 21% of the said troubled children seek for psychiatrist assistance, then the whole phenomenon is not a case of the glass being half empty and half full but rather the statistics should be looked at in both ways. When this happens, it can be adduced that the glass is only 20% empty and 80% full.

There are no doubt that divorce disrupts the lives of almost every child who goes through those challenges. However, great majority of these children are able to sort through these difficulties and succeed. We must not also lose sight of the need to applaud and build on the strengths (strength based approach) of such children. Besides, evaluating it from both scientific and statistical point of view, shows that psychological problems of children whose parents had gone through divorce starts before the actual divorce issues begin to manifest. Emery (2004). To back up his finding, a substantial figure of 50% was found.

A BALANCE DISCUSSION ON THE RESEARCH

At this point, it is important for one to have a balanced analysis of the overall views of the topics of divorce. That is, the ideas which support the hypothesis and the ones that refutes it. On a personal reflection however, I still stand by the hypothesis that, “there are lifelong consequences for children whose parents go through divorce”.

The opponents of this hypothesis have sought to argue that divorce, in itself, does not impose any lifelong consequences. Realistically, most children from divorced families are resilient. There are instances where such children have gone through those challenges and still succeeded in their life endeavours. Most have good careers and are happily married. This disproves the stance portraying children whose parents have gone through divorce as a serious and unimaginable consequence. To me, what those children go through emotionally are equally experienced by children who stay and grow with their parents. Some have even tended to suggested that, it is a normal process of growing up. As noted above, only 20% of such kids experience the phenomenon.

Looking at my social location, I was from a divorced family. However, I had the benefits of some social and traditional structures to support me and my sibling. For instance, my grandmother took up the fathering responsibility so we never felt the absence of our father. Similarly, when we migrated to Canada, the school system has counselling facilities that helped to sustain us to go through the normal processes of growing up. I am proud to say my brother and I are now in college and are determined to succeed in our choosing endeavours. These achievements would probably have not been possible in a case of somebody living with parents. This example goes to support Emery (2004), assertion that “even after a separation, what you do is the most important determinant of whether your children are at risk or resilient.”

In-spite of the argument put up by the opponent of the hypothesis, proponents still argue that children whose parents go through divorce experience lifelong consequences. It has been proven above that such children suffer emotional and psychological consequences. It is estimated that over 21% of such children have mental health issues and are likely to fail in their marriages.

To substantiate this point further, I would like to draw once again on the conversation I had with the Child and Youth Worker at Apple Wood Height Secondary School. She explained the following points from her practical perspective. She said children who have experience the consequence of divorce lack trust. They are unable to give back love because psychologically it has been registered within their sub conscious mind that if their parents who claim to love them are fighting and doing things regardless of the interest of such children, then whom are they to trust.

Isolation of such children from peers and some school activities affects their ability to develop properly into adulthood. In most cases, they are seen to be withdrawn from extracurricular activities because of the shame, having to explain to friends that their parents are divorced. This is more prevalent in religious based schools like the Catholic schools.

The issue of step-parents does not help matters either. In the unlikely event that the step-parents do not get along with such children, it raises tension within the household and puts the child under constant psychological trauma. I am of the opinion that it is some of these problems that makes these children have mental health issues.

Finally, what is more dangerous to society is the fact that such children are unable to establish and maintain positive relationships. Some traditional views, though not fully supported by me, have suggested to the belief that it is some of these societal problems that have led to the emergence of the sub-culture like gay and lesbian communities.

Research Outcome

From the above discussion, it has been established that different communities and different scholars have divergent views on the impact of divorce on children. One perspective view is that such a situation is not serious. However, those who support the hypothesis of which I support still believe that “there are lifelong consequences for children whose parents go through divorce”.

This new found knowledge will form as the basis for new theories to be developed. It will also give the opportunity for other research to be carried out in this area. Practically, it will enable single parents form alliances to advocate for policy change in schools and child centres to strengthen child and youth counselling within such facilities.

This research will also assist people within the helping profession such as Psychologists, Child and Youth workers and Social workers to come to the realization that this phenomenon is very prevalent within our schools and that serious efforts should be made to assist children with such challenges to overcome them. As an anti oppressive Child and Youth Worker, it is necessary to pay special attention to the situation even if a child suffers as a result of our inaction to deal with the situation.

The outline of the case including factors in connection with history, presentation and the need for a revised therapeutic approach in many ways mirrors the clinical case evaluation detailed by Sherry (2006) in the application of ‘an Attachment Theory Approach to the Short-Term Treatment of A Woman With Borderline Personality Disorder and Comorbid Diagnoses’. This study highlights the difficult support/treatment pathway of borderline personality disorder (BPD) which stems from the comorbidity with other diagnoses including

severe depression, panic disorder, post-traumatic stress disorder (Zimmerman & Mattia, 1999) and harmful misuse of alcohol and other substances (Trull et al, 2000) which are all clearly present in Ruth’s life. The symptoms typically identified with these disorders are often challenging to mental health practitioners and there appears to be a groundswell of opinion that suggests the disorder is largely untreatable because they are entrenched within the personality and coping mechanisms of the individual. (Raven. 2009)

As is common with many people who experience severe mental distress, Ruth has been unable to respond to the demands of the workplace and therefore financial insecurity is likely to be a significant factor for her and also in shaping the life options and experiences of her daughter, Megan. Gould (2006) identifies some of the most pertinent and enduring difficulties that contribute to child poverty in situations where parents have poor mental health and details the difficulties of securing employment (just 24% of people with long term mental health issues in employment), the typically low level of remuneration for people in this category and inflexible nature of moving from benefit claimant through into employment as limiting factors in increasing the life chances of children and young people in this kind of situation. To support this claim the more general findings of Tunnard (2004) are highlighted which link parental ill health problems and family poverty and indicate that ‘50% of disabled people have incomes below half the national average, this rises to 60% for disabled adults with children (Gould 2006). Speculation in this report suggests that the figures would be worse in families where one or more parents experience significant and enduring mental problems. Therefore it is reasonable to presume in the case of Ruth and Megan that their level of income is and will remain at a low level without some significant lifestyle changes. Specific links between financial hardship and mental health are taken from an unpublished paper by Social Exclusion Unit in 2004 detailing the impact of poverty on mental ill health, the difficulty people experience had in accessing financial advice /services, disproportionate dependence on state benefits, fluctuating incomes determined by health status and the challenge of securing the right level if benefit/personal finance. General findings about the impact on family poverty are also relevant in the case of Ruth and Megan and it is a factor that is very likely to add to the symptomology common to people diagnosed with borderline personality disorder.

Furthermore, as benefits and social care resources are constrained against a backdrop of central government’s drive to put people back into work, Spencer and Baldwin (2007) argue “that many parents in the UK are expected to bring up their families in the context of unreasonably scarce resources’. Therefore, practitioners need to take into account Ruth and Megan’s social and economic factors when assessing their individual needs, risk and in determining a therapeutic pathway for this family. As might be expected, given these negative financial, health and well-being determinants social exclusion is a likely to be a factor that needs to be overcome if an holistic, person-centred approach is to be adopted in supporting this family. Developing strategies to overcome the destructive behaviours that Ruth has developed as her personal coping from mechanisms is a key factor in addressing the wider concern of her and Megan’s social exclusion and isolation.

Megan’s current situation, which is one of compromised opportunity, a limited social life, burdensome responsibilities, isolation, scarce personal resources and a lack of attention to her own needs, represents the situation of many carers in the UK, especially so those who have or have had responsibilities as a young carer. . Research by Aldridge and Becker,

(1999, p.306) suggests that children who provide caring support to parents with mental illness ‘ will be more susceptible to increased levels of anxiety, depression, fear, change in behavioural and social patterns as well as being more at risk of transmission of the particular parental condition’. As caring moves through into adulthood the future tends to remain bleak and research from the Health and Social Care Information Centre (2010) reports increased evidence of poor health, low income and a general sense of hopelessness for carers in the light of on-going cuts to social care budgets. The prospect for any significant improvement is equally depressing.

In considering the details of this case the eclectic and reflective nature of social work is an approach that seems suitable for the complexities supporting people with mental ill health, particularly the ever changing presentations of people who have a diagnosis of borderline personality disorder. Payne (2009, p.100) describes the usefulness of these approaches in case work highlighting how practitioners can adopt and use theories ‘together, perhaps all at once or perhaps successively’ or use ‘different theories in different cases’. Because this method requires significant skill and discernment Payne cites Epstein (1992) who suggests that flexible team approaches to reflection, debate and application offer a useful way forward to the delivery of flexible ‘moment to moment’ practice in response to complex cases. Payne (2009) identifies systems theory as being an important aspect of eclecticism. Pincus and Minahan (1973) applied the approach to social work practice and describe three types of system these being ‘informal or natural’ (friends/family), formal (community groups, etc.) and societal systems (hospital/schools, etc.). People with mental health problems are likely to have some difficulty in using helping systems to improve their health, life experiences and general well-being. Applying systems theory involves identifying the point, and problems individuals experience in the interactions with their environment. The phases of this include assessing; making/negotiating contracts; forming/coordinating actions; re-forming and influencing action systems; terminating change efforts. Payne (2005) extends the application of this approach and makes clear links to ecological systems theory, crisis theory/models and task centred working. The application of these, particularly crisis intervention, could work in connection with Ruth’s current difficulties and potentially offers short term bridge toward longer term therapeutic work. However in adopting this approach it is worth considering the caution raised by Doel (2009) and he notes that if done poorly than crisis/task centred work can become inflexible, routine and possibility lead to some level of social control. Doel suggests using these methods should be accompanied by training that considers factors such as values, attitudes and their application in practice.

Sherry (2007) identifies the increasing consideration and application of attachment theory (Bowlby 1973) in the causation of borderline personality disorder and cites numerous influences as threats to attachment in childhood. Risk factors in this regard include sexual traumas (Laporte & Guttman, 1996), parental neglect (Paris, 1997, 1998), family instability and emotional neglect all of which are considered to contribute to the development of personality styles in adult life. For practitioners, the reasoning of Ivey 1989 who suggested extreme behaviour by clients could be linked to their development history and the way they respond and bring meaning to their experiences in later life. Therefore poor parenting experienced by Ruth could have been instrumental part in the development of behaviours that for her now carry the label of borderline personality disorder (West & Sheldon-Keller (1994). Therefore the gathering of information in assessment processes can be a crucial factor in working out the style and content of social work intervention.

In considering the pathways of someone who experiences significant mental health issues it is clear that from many perspectives that society perceptions, life opportunities and thereby individual well-being are compromised in many areas of life. The fight for a more balanced and supportive approach to mental health has been carried by the service user/survivor movement for many years and the need for reform has led to many campaigns. It is easy to understand the need secure better treatment and push through system reforms given oppression, rejection and widespread ignorance that characterises the history of mental health in the UK. Ferguson (2008) highlights how the now accepted position of the survivor movements pushing for greater recognition of the plight of people with mental health issues came from the enduring effects of stigma, powerlessness, inequality and segregation which have been utilised to push governmental thinking and maintain mental health, well-being and social care as political issues. The fight for improved rights and opportunity among the survivor movement only really gathered pace in the 1970s (Campbell 1996) (Beresford, 1997) and in the early stages tended to focus on small scale self-help and mutual support initiatives. More recently there has been greater, towards collective national campaigns concerning treatment, responding the revisions of the mental health legislation and broader struggles to change attitudes and understandings of madness and distress. This has been key to shifting the stigma of mental health and clearly it is something that needs to continue.

General concerns expressed by Campbell (2005) link well to Ruth’s situation and the pressing structural concerns that tend to bring of poverty, lack of opportunity, isolation, boredom, hopelessness and therefore a continuing commitment to state imposed legal and medical restrictions are clearly relevant to the case study. Evidence of the negative impact of mental ill health can be found in the health inequalities highlighted in research carried out for the Disability Rights Commission in 2006 which showed that people with severe mental illness are at higher risk of ill health across a number of conditions. Their report ‘Equal Treatment: Closing the Gap’ highlighted increased incidence of clinical obesity, coronary heart disease, diabetes, high blood pressure among people with severe mental health issues. It also noted higher risks in connection with people developing high blood pressure, stroke, respiratory problems and bowel and breast cancer. They are also more likely to smoke. Although the reasons for this inequality are complex and have far reaching implications for public health policy makers, the consequence remains that people who experience long-term mental ill health die on average 5 to 10 years younger than other people, often from preventable illnesses. The response to this research and the continued focus on issues of inequality, injustice and stigma by organisations such as ‘Rethink Mental Illness’ is yielded some significant results with increased focus on physical health being pursued within community mental health teams, increased focus on talking therapies and Mental Health (Discrimination) Bill moving through to the House of Lords for further debate. (Rethink, 2012)

However it is increasingly apparent that people with a diagnosis of borderline personality disorder are subject to a specific type of stigma and discrimination that impacts on the relationships that are key to achieving to achieving some level of stability in their lives, these being the ‘therapeutic’ links with practitioners within community mental health services. Ruth’s condition unfortunately fits in with the perception held amongst professionals that it is almost or completely untreatable. Personality disordered patients are often described as the “patient physiatrists dislike” and are often viewed as time wasting, difficult, attention seeking, and manipulative bed blockers. (Hadden & Haigh, 2002). Having previously highlighted the significance of person-centred theory and approaches in developing therapeutic alliances, it is supremely that discrimination within helping professions can be raised so easily as central limiting factor. Markham (2003) highlights multiple differences in the reactions of professional staff towards people who have a diagnosis of BPD. The suggestion is that the label leads to increased social rejection, deceased optimism and adoption of stereo typical attitudes by staff therefore creating risk of less favourable and thereby effective treatment as compared to other groups of people with severe and enduring mental health issues. As might be expected, the research draws heavily on labelling theory:

The negative service user experience detailed by Wright & Jones (2012) in typifies Ruth’s historical therapeutic pathway and include direct quotes that are clearly relevant:

‘Rightly or wrongly, I interpreted the label as a sign that I was fundamentally flawed, that the bad parts of me far outweighed any good attributes that might also be part of my personality’

aˆ¦and being told

‘that I had a personality disorder and that there was no cure or treatment. The inference was that I was just made this way and that was the end of it.

The article also highlights the findings of Pilgrim (2001) who suggest that poor responses to personality disorder occur because causes are not known and that treatment outcomes are often unpredictable and unreliable. In considering this kind of evidence, it is easy to understand Ruth’s resignation following another A & E admission which in her mind will bring about yet another dissatisfying cycle therapeutic hopelessness with little chance of any success.

(should this paragraph be justified or left centred?)

The situation raised in the case study typifies many of the negative issues associated with

the support that people with a diagnosis of borderline personality disorder receive:

dismissive attitudes, inconsistent approaches and authoritarian approaches seem to be

consistent themes and are obviously not changing the nature and outcomes of therapeutic

interventions. While it might be difficult at this stage, it seems important for Ruth to take

some responsibility possibly self-managing some degree of the presenting risk which is

consistent with the guidance provided by Wright and Jones (2012) and is also in line with

best practice as detailed in the NICE guidance (2009). This should be clearly stated

within the care plan. Mead and Copland (2000) suggest that people are able to grow

through positive risks taking and that empowerment through person centred support can

reframe typical service user response to difficult, crisis situations. Practically this can be

supported through clear and effective care planning and this should be built into an

individual’s treatment and crisis plan. Ruth, along with her care coordinator, should carefully

consider strategies to manage acute and chronic risks developing and incorporating these in

the care plan as appropriate. This will ensure consistency when the care coordinator is

absent, ensuring that Ruth’s care and support follows boundaries and consistency agreed

with her and thereby ensuring she is treated with dignity, respect and compassion.

Although risk to self which Sherry (2007) clearly links to the diagnosis of borderline personality disorder must be responded to in the context of community mental health services, admission to psychiatric inpatient unit should only take place as a last resort and the least restrictive options should be pursued. The stepped care model offers a useful statutory response and if risks remain elevated then Ruth should be considered firstly for the high intensity team then a referral crisis resolution and home treatment team, notwithstanding any negativity that may surround her historical presentations. If possible extra support from care coordinator would be the ideal solution, as this would utilise the therapeutic relationship in place to support and guide Ruth through her crisis. In consistently challenging situations Ruth’s care coordinator could also explore with Ruth and Megan a self-directed support (SDS) package. This package could support with activities of her choice and it is possible for this to be used for Ruth to explore and access some community resources therefore building social networks for Ruth and relieving Megan of some of the pressure of her carer’s role. Hatton and Waters (2011) identify the relative success of SDS/personalisation in connection with people experiencing mental health issues and this is at its most beneficial when individuals pursue direct payments and secure support on their own terms.

Whichever option in terms of on-going support is chosen then it seems that there is need for a more collaborative, shared approach both in connection with risk and also around longer-term support strategies. The work and theories of Rogers (1956, 1957) define the core conditions of counselling including unconditional positive regard (UPR), empathy and congruence for therapeutic relationships to succeed particularly so in the context of personality change. It is important to note that this is a value based approach and faith that the person can shape their own positive future if the condition highlighted above can be provided. It is not a set of tools and techniques that can be turned on and off to suit practitioner needs at a given time or opportunity. It links well to considerations around motivational approaches and Ruth’s and Megan’s desire to move on is a good indicator in this regard. Fundamentally, by adopting humanistic approaches, the aim is to develop a pattern of interaction and support which keeps Ruth centrally involved in the nature and shape of the therapeutic relationship which will naturally involve key decisions about, risk, treatment options, care planning and goal planning. Clearly this type of interaction is difficult to outline to all involved professionals but careful entries and assessment within electronic records can help significantly in modifying the responses all statutory workers who may encounter Ruth in the professional work. If this person-centred approach is adopted then it will represent a significant shift in the care and support Ruth has received in her ‘short psychiatric career’.

The beginnings of community care date back the Griffiths Report in 1988, particular Community Care: Agenda for Action and the government White Paper Caring for People. (Guthrie; 2011) The papers emphasised choice, independence and involvement service users and carers. A series of shifting strategies and priorities developed such as; move from institutionalisation to promote independent living within community, from service led to needs led provision. (Petch; 2008) In 1990, the NHS and Community Care Act (NHS&CCA1990) was introduced that draws attention to the term “care in the community” which for many service providers opened door to market of services, leading to privatisation and managerialism. (Ferguson & Woodward; 2009) Although community care was introduced by the NHS&CCA1990, this operated in Scotland to amend the Social Work (Scotland) Act 1968 (SW(S)A1968). The addition of section S12(a) into the SW(S)A1968 created a duty to assess the needs of the individual who may require services.

Potentially the statutory legislation that could be used in the case of Mrs. Sheerer are; Mental Health (Care and Treatment) (Scotland) Act 2003, (MH(C&T)(S)A2003), Adults with Incapacity Act 2000 (AWI(S)A2000), mentioned above SW(S)A1968 amended under section 13(za) and Adult Support and Protection (Scotland) Act 2007 (ASP(S)A2007). (Mackay; 2008)

It seems to be very unlikely to use MH(C&T)(S)A2003 because there are no clear evidence that Mrs. Sheerer suffer a mental disorder, defines as; a mental illness, personality disorder or learning disability which is caused or manifested S328(1) of MH(C&T)(S)A2003. She also based on information provided, does not appear to put herself or others on significant risk and her decision making is not obviously impaired. It is worth noting that the act is very controversial due to impact of stigma, coercion and breaching of human rights.

The AWI(S)A2000 could be used on the grounds that Mrs. Sheerer is deemed to lack capacity to make decision in relation to her future care needs, S1(6) of AWI(S)A2000 states “incapable means incapable of making decision” and this seems to be relevant to the case. It is important to note based on legislation that if Mrs. Sheerer is unable to make decision in some areas, she is likely to take decisions in others. In Scottish law, there must be clear evidence that a person lack of capacity before any action will be permitted. (Scottish Government; 2008) However, in England and Wales the same rule is statutory, the adult must be assumed to have capacity unless proven otherwise as stated in S1 of Mental Capacity Act 2005 (MCA2005). It may be questioned if Mrs. Sheerer actually lack of capacity, based on single SMART test in hospital condition. Hospital could exacerbate confusion, as a result of unfamiliarity, lack of sleep, medication or pain. When intervening in Mrs. Sheerer live, the principles defines in S1 of AWI(S)A2000 must be taken into account such as; intervention will benefit the adult and will be least restrictive option in relation to the freedom of Mrs Sheerer. Account shall be taken of the present and past wishes and feeling of service user and the views of other relevant people. It is worth noting that principle three only requires views are taken into account but it does not mean they are given effect to. The principle four of the AWI(S)A2000, to promote the participation in decision making, is slightly different in England and Wales, where decisions being taken in the best interest of and adults according to S1(5) of MCA2005. It is important to check if Mrs. Sheerer did not take advantage of the options such as; negotiorum gestio, which allow the authorised person to act on the behalf of an incapable adult, attorneys or guardians to take decision on behalf of an adult. An attorney is appointed by the person before lost of capacity, at the presence of the solicitor whereas, a guardian is appointed by the sheriff court. (Guthrie; 2011) Application for a guardianship order when Mrs. Sheerer is in hospital ready to discharge, could cause unnecessary process known as delayed discharge code 51X. (Scottish Government, 2010) The delays in guardianship order could be caused, by difficulties in obtaining legal aid by relatives. If social worker felt the delay in discharge result in negative consequences for Mrs. Sheerer, it would be considered taking over the guardianship application. To apply a guardian Mrs. Sheerer according to S57 of AWI(S)A2000 must be incapable and it must be likely that incapacity will continue. Therefore, the application for the guardian could be irrelevant in a situation of Mrs. Sheerer because there are no evidences of continuity of incapacity and the current state can only be temporary. If Mrs. Sheerer was not able to make decision, only for a short period of time, regarding her welfare or finance, where decision had to be made quickly, a social worker of behalf of local authority has duty to apply for an intervention order under S53 of AWI(S)A2000. Potentially AWI(S)A2000 could be used to imposed care at home or residential care to Mrs. Sheerer.

Assuming that Mrs. Sheerer does not have appointees and lack of capacity to make decision about future care needs, it would has to be considered if the application for an order under the AWI(S)A2000 is necessary or alternatively use the power of the SW(S)A1968 amended under section 13(za). This section, give social worker a power to provide community care services that has been assessed as needed to Mrs. Sheerer due to incapability to consent receiving such services. In accordance with S13(za) of SW(S)A1968 Mrs. Sheerer could be move to care home or agree with proposed care intervention. Before using any of those two acts, the issues to discuss are; adoption of principles, deprivation of liberty, assessment of needs and risk as well as financial arrangements.

The last but not least legal option to consider is ASP(S)A2007, the act refers to the law that concerns not only protection but providing support to promote independence and welfare of service user. Mrs. Sheerer meets two condition of the act to be applied such as; she is at risk and may need protection of well-being, due to her lack of capacity, poor nutrition as well as risk of falls. The ASP(S)A2007 gives social worker working on behalf of local authority duty to investigate and assess Mrs. Sheerer. Most of assessments are undertaken on a voluntary basis but the act gives power to assess without consent of service user and is known as the first of three “protection orders.” (Mackay: 2008a) The act also established a duty to cooperate between agencies and creates multi-disciplinary Adults Protection Committees to implement, monitor and support the work.

One could envisage that the use of ASP(S)A2007 seems to be the most appropriate option because is the less restrictive according to Mackay (2008) pyramid of statutory intervention. What is more, the act itself does not stigmatise, the least breach human right or freedom. It will give social worker time to get know and build better relationship with Mrs. Sheers. Consequently, it will result in having more information and better picture of situation. When using ASP(S)A2007 one assume Mrs. Sheerer’s situation could be caused by experiencing some difficulties in her life or even suffer distress such as bereavement, lost or abuse. The intervention in Mrs. Sheerer live will depend on many factors to be discussed; service user’s opinion, adaptability of house to current needs, the condition of house and accessibility, opinions of other professional and relatives. One might expect that Mrs Sheerer, regardless of age but due to femur fracture will require intense home care services or adaptation of the house such as; raised toilet seat, grab or lifting handles, community alarm, hospital bed or others. The application of the above will be possible under S13(za) of SW(S)1968 envisaging that Mrs. Sheerer expresses consent to such services to be provided. Social worker has duty to assess the needs of Mrs. Sheerer under ASP(S)2007 but the consent to provide services is needed to use S13(za) of SW(S)A1968. Otherwise, social worker could take action under AWIA(S)2000. The principles of these acts required to take the view of Mrs. Sheerer and carers if involved, into account when deciding what services to provide, this is also in accordance with Community Care and Health (Scotland) Act 2002 (CC&H(S)A2002) amended under S12(a) of the SW(S)A1968. It is worth pointing out that Mrs. Sheerer was nutritionally compromise but had home care services and limited family intervention. This raises the questions of why it was not noticed, how adequate is the result of SMART test in hospital conditions and how this had affected Mrs. Sheerer. There are a lot of speculations and factors to consider but taking into account the limited information that were given and assuming social worker investigates this case for the first time, it seems be discriminative to use other legislation. One must remember that legislative context of intervention, mainly, is driven by the relationship between social worker and service user, which is a core element to success intervention in social work. It is an important source of information to understand the reality behind the situation and how best to help. Wilson et al. (2008: p.7) referring to relationship-based practice called it “the medium” through which social worker can engage with and intervene in the complexity of internal and external world of service user.

This part of the essay examines responsibilities, rights and role of people involved. The legislation gives the social worker acting on behalf of local authority a general responsibility to promote well being, to minimise the effect of intervention and give an adult the opportunity to lead as normal live as possible. Local authority is responsible for assessing needs for community care services, arranging and providing these services as well as cooperation with other professionals such as; occupational therapist, housing officers, GPs. This is according to the integration agenda between health and social care services. (Age Scotland, 2011)

Social worker has statutory duties underpinned not only by the law but also professional codes and values. Expectation of social work profession is presented in code of ethics issued by British Association of Social Workers (BASW) and code of practice represented by Scottish Social Services Council (SSSC). Social work values grew on the idea of respect for the equality, worth and dignity of all people. Human rights and social justice are at the heart of social work intervention. The five principles indicates by BASW (2012) regarding human rights are; to promote and respect well being, support people to make own choices and decisions, promote involvement, participation and empowerment of people using services, treating each person as a whole to recognise all aspects of service user’s life, identifying and developing strengths. While, code of practice (SSSC; 2007) requires; to protect the right and promote the interest of service user, maintain the trust and confidence, promote independence while protecting from harm and danger, respect the rights of service user.

The Scottish Parliament and public authorities are required to uphold the European Convention of Human Rights, incorporated into the UK law through Human Rights Act 1998. (Johns; 2008) It can be in some cases that the law can breach human rights. Therefore, in relation to Mrs. Sheerer social worker most of all has to respect, Mrs. Sheerer’s right to liberty and security, the article five established three conditions to be met before it will be breached such as certified mental disorder within significant degree and persistency. Article eight states that Mrs. Sheerer has the right to privacy, family life, home and correspondence. (Johns, 2008) She also has the right to access a solicitor or advocacy included under S6 of ASP(S)A2007.

The role of social worker will be to ensure Mrs. Sheerer understand legal processes and if she is aware of her rights. The legislation framework is complex, consequently; information given must make sense and be understandable for service user, the role of social worker is to take time to explain and answer questions. Social worker must use appropriate and effective method of communication and skills to understand and to be understood. The aim is to support Mrs. Sheerer to make informed choices as far as possible. Social worker must ensure that Mrs. Sheerer’s views are heard and she understands a situation. There are six core roles of social worker such as; case worker, advocate, partner, assessor of risk and needs, care manger, agent of social control. The above roles are affected by changes in wider social context, welfare policy and ideology like for example demographic changes, communications technologies, consumerism etc. (Scottish Government; 2005) Social worker role is to work together with Mrs. Sheerer to assist her to address personal issues, provide information and advocacy. Provide services to meet the needs of service user and not to try to fix Mrs. Sheerer to services available.

This part of the essay attempts to show the prospects of anti-discrimination, participation and empowerment in social work. Social worker is obligated by law, values and ethics to support and work with service user in anti-oppressive and anti-discriminatory way. Knowledge and understanding of professional codes such as; BASW and SSSC is crucial in being aware of anti-discriminatory practice in social work by defining rights and responsibilities. The anti-discriminatory trends in social work values and practice are deeply rooted in radical social work that aims to work towards a society based on equality, justice and involvement. According to the maxim popularised by Marx “from each according to his ability, to each according to his needs.” (Doel; 2012, p. 27) Social justice is still a basic value in social work practice. Dalrymple and Burke (2006) refer to emancipator issues that driven contemporary social work such as social justice, empowerment, partnership and minimal intervention. Participation is a key element in the development of anti-discriminatory practice. Wilson (2008) refers to involvement of service user in social work practice based on partnership and empowerment. The term partnership is used to refer to practice, based on working with service users, towards together agreed goals, rather than doing things for them. (Thomson, 2011) Dalrymple and Burke (2006) defined partnership as process of information sharing and involvement in decision-making. Taking the above into account social worker have to involve Mrs. Sheerer in the process of decision making and intervention such as defining needs, decide how best to help, implementing, agreeing and evaluating. Empowerment is not simply a matter of facilitating or enabling. It also involves taking account of the disadvantage and oppression that are so characteristic of the service user day to day experiences. (Thompson, 2008) Work in anti-discriminatory way means to see Mrs. Sheerer within her wide social context include environmental, societal and cultural factors such as race, gender, ethnicity, age, sexual orientation, disability and so on.

The last section of the essay assesses social policy that inform legislative context of this case. It is seems to be clear that social worker needs to work in integration with other professionals within all aspects of assessment and intervention process. The legislation defines responsibilities in social work but social policies outline a plan of action, a set of rules that guide practice.

The first significant policy in terms of promoting partnership working across health, housing and social care is Joint Future 2000. This is a unique partnership between the Scottish Executive, the Convention of Scottish Local Authorities (CoSLA) and NHS Scotland that focus on to improve joint working through financing join services, management and resources. A key component of Joint Future has been development of Single Shared Assessment (SSA) that aims to shorten and improve flow of information between professionals and agencies, avoid duplication, provide faster access to support with less bureaucracy. (Age Scotland, 2012)

The policy Changing Lives 2006 has concerned on anti-discrimination, to do not look at service user in the context of vulnerability but to focus on strength and building true relationship. The aim set out through report were promoting participation; taking a whole-person approach; understanding each individual in the context of family and community. (Scottish Government; 2006)

The another policy that seems to be important in relation to scenario, with the assumption of that Mrs Sheerer is an older person because the policy aims mainly to older people, is All our Future. It supports older people to stay at home as long as possible by providing free personal care, telecare development programme, care and repair, travel scheme; free bus travel etc.. (Scottish Executive; 2007) It is noteworthy that Mrs. Sheerer may be entitled to free personal care that was introduced by the Sutherland report and statutory implemented through the CC&H(S)A2002. (Guthrie; 2011) In Scotland every person over 60 years is entitled to free personal care in other cases it will depend on needs, priority and categories of risk. The policy Reshaping Care for Older People (SCSWIS; 2011) focuses on the “3R’s” rehabilitation, re-ablement and recovery to optimise the independence of people at home. The reablement is a new service, initially aims at people coming out of hospital. In Glasgow it is a partnership between Social Work Services, Cordia, NHS Greater Glasgow and Clyde. If Mrs. Sheerer lives in the area, she will be provided with services up to six weeks, the reablement aims to build confidence by helping to regain the skills to do what Mrs. Sheerer can and want to do for herself at home.(Glasgow City Council: 2011)

Recent consultation on integration agenda sets out proposal to inform and modify the way that the NHS and Local Authorities collaborate, and work in partnership with the third and independent sectors. This includes integrated budget and joint accountability. The proposal extends the services provision to all adults and not only older people, so the speculations regarding the age of Mrs. Sheerer would not be needed. The Integration of Adult Health and Social Care Bill plans to create Health and Social Care Partnerships, which will replace Community Health Partnerships and will be the joint and equal responsibility of Health Boards and Local Authorities. (Scottish Government; 2012) Ineffective partnership between health and social services is a real dilemma of contemporary social work practice. On the one hand, the problem is finance and the eternal question; who are going to pay for services? On the other, the issue of finding appropriate resources that will meet the needs of Mrs. Sheerer, both processes are time consuming. Consequently, Mrs. Sheerer can be detained in hospital longer that necessary that can affect her emotional and physical condition, which usually will deteriorate. Other issues are; blocked bed and retained the flow of a new patient. One strongly believe that new integration agenda of health and social care such as one budget and consolidated partnership will make a difference in new social services. The new social policies and legislation present a wide range of possible options and choices such as; personalised services and self-directed support. It this week government has been discussing the Social Care (Self-directed Support) (Scotland) Bill (SDS Bill) that has been passed stage three on 28th of November 2012. (Scottish Parliament, 2012) What that means for social work today is a shift from service led to outcome led provision, The Talking Points: Personal Outcomes Approach promoted by the Joint Improvement Team will change the process of assessment of needs that now will be more focus on targets. Based on SDS Bill social worker will have a duty to offer; direct payment to Mrs. Sheerer in order that she will arrange her support; can make arrangement for services that have been chosen by Mrs. Sheerer or can select appropriate support and make arrangement. (IRISS; 2012) One could seriously question if Mrs. Sheerer will have skills and knowledge to manage these variety of options such as; possibility to employ own carers or buy own services, if she have not done before. It seems to be clear that the role of social worker will have change form procedural care management towards support and brokerage.

To sum up, contemporary social work practice drifting away from paternalism to seeing service users as experts of own life an illustration of this is work in partnerships, service user involvement or SDS. There is no doubt that relationship between social worker and Mrs. Sheer is a key in the process of intervention. It is significant to talk to and listen to service user. The more time spend, the more social worker will understand Mrs. Sheerer within wider social context. One must remember that when intervening in someone’s life taking no action is an action, otherwise the option of minimal intervention or less restrictive option must be put in place.