Author: Andre Coleman

Critically analyse the strengths and weaknesses of using an ‘evidence based’ approach to a specific area of social work practice, referring to recent research findings in this area. Specific area: Older adults and mental health

Outlined below is an analysis of the strengths and weaknesses of using an ‘evidence based’ approach to a specific area of social work practice, referring to recent findings with regards to older people and mental health in particular. Social work practice is split into various areas in order, to effectively assist with the problems of different individuals as well as social groups such as older adults with, or affected by mental health conditions and problems such as depression and dementia. Older adults with mental health conditions do and have benefited from well-focused social work practices. The use of the evidence based approach alone or alongside other factors has the capacity to shape social work practices designed to help and protect older adults with mental health conditions.

Of course to maintain relevance as well as professional effectiveness social work practices should reflect the needs of the people being cared for not to mention altering to better practices as empirically demonstrated by the most recent research findings.^[1] As mentioned below evidence based approaches to assisting older people with mental health conditions or issues have led to suggested methods to improve the social work practices that form the basis of the services provided for those vulnerable people that need to use them being made.^[2] Social workers that are tasked with assisting older people with, or affected by mental health problems ideally should use the social work practices that have been proven to assist vulnerable older people the most. Therefore evidence-based approaches can help social workers determine the best working practices to actually use.

To begin with it can be reasonably argued that using an evidence-based approach to the specific social work practices offers social workers working with older people linked with mental health issues strengths. The need for reliable and accurate research into older people and mental health for social work practices is undoubtedly becoming more important as the British population in common with many Western societies is ageing as people are generally living for longer. ^[3]

Past and recent medical research has frequently shown that there is a strong connection between an ageing population taken as a whole and mental health issues becoming more common for older people. An ageing population raises issues and concerns for the National Health Service (NHS), and the Department for Work and Pensions (DWP), which includes the Pension Service as much as it does for social work practices.^[4]

Limited parts of medical research points to some mental health issues or conditions in older people as being preventable, and even in certain circumstances reversible. Social work practices ideally should be altered if it is possible to assist older people that can recover from temporary or reversible mental health problems to do so.

However some mental health conditions and problems affecting older people such as vascular and senile dementia cannot be prevented and reversed, though medication can delay their full onset. In such circumstances NHS or private sector health care services not to mention social work practices have to be adjusted to cope with a higher demand for their use. When possible social work practices should be altered in order to prevent, tackle, or reverse the mental health conditions and that could possibly restore older people to full health. Social work practices should also help older people whose mental health conditions cannot be reversed.^[5]

When older adults are affected by mental health conditions whether upon a short – term basis or upon a long – term basis then social work practices arguably needs to be adaptable as well as practical enough to assist those older adults more effectively. Older adults with mental health conditions may previously have been active normal people used to doing everything for them that suddenly find things much more difficult once their condition or illness becomes well established.

Ongoing medical research is slowly finding new treatments that can in the right circumstances help older adults with mental health conditions and illnesses remain as healthy as possible for as long as possible. The basic assumption here is that when older adults with mental health conditions stay healthier for a longer period of time they could therefore be less reliant upon their carers, the NHS, social security benefits, as well as the social serves provided to them by social workers.^[6]

The reversing or the delaying of the worst or most debilitating of mental health conditions in older adults can help those people to lead normal and independent lives for as long as possible. Older adults that are able to resist or overcome the worst consequences of their mental health conditions will be more likely to retain their self-dignity as well as their independence.

It is the leading of independent lives by the older adults affected to varying degrees by mental health conditions that can potentially receive the most beneficial assistance from their social workers as well as all relevant medical staff. Social work practice that enables older adults to remain in their homes and were possible within their own families gives such vulnerable people a sense of stability as well as helping to keep them in familiar surroundings.

The strengths of using evidence based approach to guide and shape social work practices towards older adults with mental health conditions are therefore in many respects straightforward to understand. As in the majority of social work fields or areas, social workers make use of an evidence-based approach to increase the effectiveness of the social work services that they actually provide to the people who require their assistance the most. Using an evidence-based approach provides data or research that provided it is gathered efficiently and interpreted accurately provides information to social workers to point out the most effective social work practices.

Using an evidence based approach has the strength of allowing the social workers who form social work practices to alter those practices to help larger numbers of older adults with mental health conditions to receive the social work services that should benefit them the most. It should also follow on logically that using an evidence-based approach would allow the resources and also the social services by the social work providers to be used most effectively. Older adults with mental health conditions can influence the type of social work provided to them by highlighting the best as well as the less effective social work practices.^[7]

At the end of the day social work practices are only there to help the most vulnerable older adults amongst other social groups and isolated individuals even though these social work practices might not always be popular with social workers themselves. The strength as well as the point of using the evidence-based approach is therefore that the best interests of the most vulnerable older adults with mental health conditions should always is taken into account.^[8] Indeed the best interests of the most vulnerable older people as revealed via the use of the evidence-based approach are incorporated into both completely new as well as revised social work practices. In theory, and also to a very large extent in practice the use of the evidence based approach is that it has the strength of providing social workers with information and indications about, which older adults that need help due to their mental health conditions and issues.^[9] The evidence based approach means social workers know where to concentrate help as well as guidance as to what kind of social work service would be most useful for these older adults.^[10]

There are actually as well as potentially sources of weakness when using the evidence based approach in forming and subsequently amending when necessary social work practices in relation to older adults with mental health conditions or issues. The evidence based approach to providing information with regard to older adults with mental health conditions is only useful in many respects when combined with other information or procedures that form the basis of social work practices.^[11]

To begin with social workers might have to make decisions with regard to the help or social services that individual older adults with mental health conditions or problems and whether or not to offer them help before the evidence based approach has provided enough information about these specific older adults.^[12] It can and indeed does take time for the evidence based approach to be gathered and evaluated before it is strong enough to alter or perhaps even entirely replace all the relevant social work practices. Social workers need to have social work practices set in place all of the time in order for them to be always able to offer vulnerable older adults their help and advice with regard to mental health conditions. When or if existing social work practices are deemed to be highly effective in helping as well as protecting older adults with mental health conditions there would have to be convincing evidence. Without wide ranging proof that the findings and suggestions from the evidence-based approach could offer profound improvements to the social work services they need not take place. It could improve the social services available for older adults that need or could eventually need to use them in the future.^[13]

One of the weaknesses of using the evidence based approach to assist in the formation and the subsequent shape of social work practices for older adults with mental health conditions is that such an approach does not take other factors or organisations into account.^[14] An over reliance upon the use of the evidence based approach to drawing up social work practices to assist older adults with mental health conditions is that a narrowly focused concentration on such an approach could lead to an underestimation of other actors.^[15] Social workers could underestimate the importance of other private sector and public sector bodies, groups, and organisations that offer services to older adults. Other private sector and also public sector bodies, groups, and organisations offer services to older adults with mental health problems either because the government tasks them with doing so, or because they can make money from doing so.^[16]

In reality this weakness of using the evidence based approach when drawing up social work practices is not really a problem. This weakness is not a profound or serious problem because social work departments are used to working with private sector as well as public sector bodies, companies, groups, and organisations when they set out to deliver social services to the general public taken as a whole.^[17] Providing the appropriate services for older adults with mental health conditions really is an example of public services being delivered by a whole host of private sector as well as public services groups, organisations, and agencies.^[18] Alongside social work departments, the DWP, the NHS, private sector care homes, local authorities, as well as charities for older adults and people with mental conditions provide services.^[19]

The weaknesses of using the evidence based approach for developing social work practices for assisting older adults is that the evidence might not be as complete as would be helpful to social workers. Research into the affects and consequences of mental health issues or problems for older adults has arguably proved insufficient until recently given the ageing populations within the majority of Western societies.^[20] Older adults with dementia or similar mental health conditions frequently need a great deal of care and support as do their carers, and also their families in order to cope with the consequences of severe mental illnesses. Sometimes it is the spouses, the children, or indeed other relatives of the older adults with the more pronounced mental health conditions who can be most adversely affected by the worst consequences of their loved ones’ illness.^[21]

There are weaknesses that the evidence based approach towards setting social work practices for older adults with mental health conditions relating to the limited scope of that approach. Research into older adults with mental health problems and conditions has not always examined the ill affects that such conditions have upon the carers and the relatives of the people with the illnesses or health complaints. ^[22] On a practical level social work practices can be as much about supporting tired or distressed close relatives and carers as it is about assisting the older adults afflicted with or by poor and worsening mental health conditions.^[23] When mental health conditions, issues, or problems adversely affect older adults then it can strain their relationships with their close relatives, especially their spouses or children, which in turn causes stress to all of them. Strained relationships between older adults with mental health conditions and the close relatives caring for them can lead to those older adults moving into care homes and hospitals rather than been cared for at home. Helping older adults with mental health conditions get better can have the benefit of allowing some of them to continue working or indeed to start working again.^[24]

To conclude it has been argued that the use of the evidence based approach to draw up and shape social work practices in relation to older adults with mental health conditions can offer strengths as well as weaknesses to social workers. The evidence based approach to drawing up or shaping social work practices for older adults with mental health conditions offers the strengths of providing social workers with relevant information and data to draw effective policies. The information and data from the evidence based approach research allows social work departments to increase the effectiveness of their social work practices towards older adults with mental health problems. The main weaknesses of using the evidence based approach towards forming and amending social work practices is that it can cause a delay in relevant information being used by social workers, and that it can underestimate the part that other organisations play in providing services to older adults.

Bibliography

Audit Commission / Better Government for Older People – Older People, independence and well-being: The challenge for public services, Public Sector Briefing

Bowers H, Eastman M, Harris J, & Macadam A (2005) Moving out of the Shadows – A report on mental health and wellbeing in later life, Health & Care Development Ltd, London

Brooke L and Taylor P, Older workers and employment: managing age relations, Ageing society 25, 2005, 415-429, Cambridge University Press

Department of Health, A Sure Start to later life, Ending inequalities for older people, January 2006

Estes, C.L. Biggs, S. and Phillipson, C. (2003), Social Theory, Social Policy and Ageing – A critical introduction, Open University Press, Maidenhead

Maria Evandrou and Karen Glaser, Combining work and family life: the pension penalty of care, Ageing and Society 23, 2003, 583-601, Cambridge University Press

House of Commons Committee of Public Accounts, – Improving Public Service for Older People, Twenty- Ninth Report of Session 2003-04 (May 2004)

Riseborough M & Jenkins C (April 2004), Now you see me…now you don’t – How are older citizens being included in regeneration? Age Concern, London

Vincent, J., Phillipson, C. & Downs M., (eds) (2006) The Futures of Old Age, Sage

1

During the last two decades social care for older adults in England has witnessed many significant changes. Implementation of the community care reform, privatisation of the social care and Direct Payments have had an impact on the social work as a profession to date. In the first part of the literature review I would like to give an overview how all of these initiatives shaped present social work practice for older adults and then focus strictly on personal budgets and recent research of the practice.

‘Traditional’ social work characterises working closely with the service user, building very much needed relationship, assessing problems, making a judgment about coping abilities, looking on range of resources and at the end making an informed professional judgment about the best way to support service user (Lymbery, 1998). Dustin (2006) presents ‘traditional’ set of skills such as communication and interpersonal skills, use of self, negotiation and mediation skills as well as appreciation of organisations and procedures as a core of the practice. In the 1980s government’s concerns about increasing number of older people as well as running very expensive residential care have been a driver for transformation delivery of social care (McDonald, 2010). Furthermore, and most significantly, a new Conservative political view included:

“a belief in the greater economy, efficiency and effectiveness of private sector management; consumerism; the virtues of competition and the benefits of a social care market; and a deep mistrust of public service professions and their claims to special knowledge and expertise” (Lymbery, 1998, p. 870)

had its reflection in implemented legislations and community care reforms. The White Paper Caring for People: Community Care in the Next Decade and Beyond and The NHS and Community Care Act 1990, implemented in 1993, introduced care management and changed the role of the social worker in statutory sector. Hugman (1994, p.30) argues that “the care management is a move away from professionally defined responses to need to managerialist responses dominated by resource priorities”. McDonald (2010, p. 28) also states that “professional discretion has to a large extend been replaced by formulaic approaches to assessment and service eligibility”. Community care reform imposed on practitioners to focus more on the processes and on more complex bureaucracy what affected other aspects of care managers/social workers practice such as limited and formal contact with the service user and therefore difficulties in building up relationships with the client, reduced emotional support, counselling role, advocacy role, group work, less attention to monitoring and reviewing (Lymbery, 1998; Postle, 2002; Weinberg et al. 2003; Carey, 2008). Carey (2008, p. 930) states that:

“the quasi-market system has also helped to create a complex administrative system based around the management of contracts, assessments, care plans and a seemingly infinite variety of bureaucratic regulations and procedures. Most such tasks are relentlessly processed by often perplexed care/case managers, many of whom quickly begin to question any initial motivations to enter social work”.

Lymbery (1998) points out that more administrative system and budgetary constraints took away from practitioners a sense of traditional role and increased monitoring of social workers’ decisions. It has been argued, that key community care reform objectives such as a wider range of choice of services, reducing unnecessary paperwork, meeting individual needs in a more flexible and innovative way have not been achieved (Scourfield, 2006; Carey, 2008).

The next important step for the shape of present social care has been introduction of direct payment schemes. The British Council of Disabled People (BCODP) presented findings of their research in publication Cash in on independence with evidence that directly provided services were inflexible, unresponsive, unreliable and take away service users’ control over the support (Zarb and Nadash, 1994). The BCODP also proved that direct payments can be cheaper and at the same time can provide a higher quality of support (Glasby and Littlechild, 2009). Under the pressure of sustained and strong campaign for reform from the BCODP and other bodies, the government finally implemented The 1996 Community Care (Direct Payment) Act (Glasby and Littlechild, 2009). The Act allowed making cash payments by local authorities to individuals to arrange their own support (McDonald, 2010). In 2000, direct payments were extended to other service user groups and from now on older adults could also benefit from it (Glasby and Littlechild, 2009).

Following direct payments, in 2003, the charity organisation in Control, focused on people with learning disabilities, developed the new way of organising care called self-directed support (Glasby and Littlechild, 2009). Browning (2007, p. 3) states that “the introduction of self-directed support is potentially the biggest change to the provision of social care in England in 60 years”. The terminology has developed during the process of implementation of this concept. By 2004 in Control started using the term ‘individual budget’ which describes budget from several different streams such as the Access to Work; the Independent Living Fund; Supporting People and the Disabled Facilities Grant; local Integrated Community Equipment Services, adult social care and NHS resources. In the pilots where funding streams were not integrated and projects relied on social care funds the term personal budgets was being used (Glasby and Littlechild, 2009). The in Control Partnership desire was to have their concept to be fitted to the existing social care arrangements, to free up available resources, which were “tied up in existing buildings and pre-paid services” and to allow people to use them flexibly and creatively (Glasby and Littlechild, 2009, p. 77). The aim of personal budgets was to shift power to service users by adaptation to the way of allocating resources, controlling and using the support (Routledge and Porter, 2008).

At the same time the government was facing challenges such as aging population, care within the family becoming less an option, more diverse communities, higher expectation form the service as well as continuing desire to retain by people control over their lives as much as possible, including risk management (DH, 2005; HM Government, 2007). Older adults are the largest group of recipients of social care with more than a one million in 2006 (Leadbeater et al., 2008). The number of people of state pensionable age is gradually increasing with twelve million in mid-2009 (ONS, 2010). Some of the above factors have been a drive for government’s increasing interest in a personalised system as a way of saving cost in already constrained budget (Glasby and Littlechild, 2009). From 2005, numerous documents such as Independence, Well-Being and Choice, Our Health, Our Care, Our Say: A New Direction for Community Services, Opportunity Age and Improving the Life Chances of Disabled People, Transforming Social Care stated government’s support and shift towards personalisation (Routledge and Porter, 2008). In 2007, The Putting People First concordat informs about reforms to transform the system, based on ?522 million Social Care Reform Grant, to include service users and carers at every step of organising care (HM Government, 2007). Although the government states the way forward, it gives little explanation what it will mean for the front-line practitioners, for their roles and tasks required under new arrangements (Lymbery and Postle, 2010). It states

“the time has now come to build on best practice and replace paternalistic, reactive care of variable quality with a mainstream system focussed on prevention, early intervention, enablement, and high quality personally tailored services” (HM Government, 2007, p 2).

The Putting People First concordat (2007, p. 3) also says about more active role of agencies, emphasises greater role of self-assessment, therefore giving social workers more time for support, providing information, brokerage and advocacy. It also underlines importance of person centred planning, self directed support as well as personal budgets being for everyone. Glasby and Littlechild (2009, p. 75) define personal budget as:

“being clear with the person at the start how much money is available to meet their needs, then allowing them maximum choice over how this money is spent on their behalf and over how much control they want over the money itself”.

The recently published, in 2009, Working to Put People First: The Strategy for the Adult Social Care Workforce in England states a bit clearer roles and tasks of front-line staff under new arrangements and recognises social worker’s role as a central in delivering personalised service.

“Social workers play a key role in early intervention, promoting inclusion and developing social capital as well as safeguarding adults in vulnerable circumstances. They are skilled at identifying models of intervention, some therapeutic, some task centred and working through with people the outcomes to be achieved. They also undertake navigator and brokerage roles as well as supporting self-assessment” (DH, 2009, p. 34).

However, Lymbery and Postle (2010) points out that the strategy does not explain who will be undertaking specified roles and tasks, “we have the right people doing the right roles and not using highly skilled workers for lower skilled tasks” (DH, 2009, p. 33), and therefore the situation from community care reforms replicates where introduction of care manager denied the unique position of social worker. On the other hand, Glasby and Littlechild (2009) point out that the change of the social workers’ role from focusing on assessment to support planning and review will give more chances to work in partnership with service users to support them, what was the reason for many to come to the social care profession.

Implementation

There is an agreement that social workers’ motivation and support are crucial for the success of personalisation and based on their education and experience they are best-placed to fulfil roles and tasks in the new arrangements (Tyson et al. 2010; Samuel, 2010). Results from Community Care and Unison this year survey regarding impact of personalisation on social workers reviled that 88% of respondents had recognised some impact on their job, with 40% saying it had been positive and 29% negative (Samuel, 2010). Two years ago in similar survey, negative impact of personalisation claimed only 18% of respondents (Samuel, 2010). One of the most important evaluation of personalised budgets undertaken by IBSEN (2008) indicates that practitioners attitude towards the new system was based on the positive experiences of service users, strong leadership from managers or implementation team. On the other hand, hindrance for positive experience included “high workloads, poor information and training about IBs, and the lack of clarity about detailed processes as new systems were put into place” (Glendinning et at., 2008, p.22). The IBSEN study also indicates that inclusion of front-line practitioners in developing documentation and processes was key factor for successful implementation. The limitations of the IBSEN study are that it have been conducted in very tight timescales and with continues policy changes and delays, however it is a crucial research on the early impact of individual budgets (Glasby and Littlechild, 2009). My research study will examine in depth the experiences of front-line practitioners of implementation of the personalisation and will also look at their positive and negative drivers.

Bureaucracy

The Community Care survey has found that two-thirds of respondents experience increase in bureaucracy as a result of transformation (Samuel, 2010). There has been an indication in the IBSEN study, two years earlier, that completing assessment and other office based duties was time consuming, however this increase was not significant. Although increased bureaucracy was an effect of more administrative approach of care management after community care reforms (Weinberg et al., 2003), it has been pointed out by Richard Jones, president of the ADASS, that some councils had over-complicated processes such as self-assessment and support planning (Samuel, 2010a). My research will provide in depth insight of the administrative role of the front-line practitioner in current system.

Processes

The social workers’ experiences varied significantly regarding assessment process based on self-assessment, with some seeing it as a complete transformation, where for others it was a move towards further development of practice (Glendinning et al., 2008). At the beginning working in dual assessment systems has been recognised as a major challenge (Glendinning et al., 2008). Moreover, the view of social workers from Community Care survey match with opinion form IBSEN study that self-assessment was not giving complete picture of a person’s needs, with no focus on risk, issues regarding carers and their needs, and putting at risk social workers skills and professionalism (Glendinning et al., 2008; Samuel, 2010). The in Control report of the Second Phase (Hatton et al., 2008) sees self-assessment approach as the way to reduce the process and at the same time social workers’ time on this task. On the other hand, Lymbery and Postle (2010, p. 11) point out that assessment is “at the heart of what social workers do” and that not all service users have a ability and knowledge to recognise their needs and then to find appropriate ways to address these needs. Front-line practitioners reported that self-assessment usually has been undertaken with support from a family member or a friend, which has been seen as essential support (Glendinning et al., 2008). It can be seen as a potential ground for conflict of interest between service users and carers with examples such as need for respite care or risk within home setting (Lymbery and Postle, 2010). On the positive side, some front-line practitioners indicated that self-assessment shows that “peoples’ views were taken seriously and as having the potential to generate positive discussions about needs and outcomes” (Glendinning et al., 2008, p. 147). The IBSEN study recognises that social workers’ involvement in this process in work with older adults may be of more importance. Older people become more isolated, have less available support from family, they tend to under-assess their own needs as well as do not perceive their behaviour as creating risk (Glendinning et al., 2008, p. 147). CSCI (2009, p. 137) back up above points regarding assessment stating that “In practice, and particularly for people with complex needs, self-assessment entailed intensive support from care managers, more demanding of staff time and skills than traditional professional assessment”. However, Community Care survey (2010) showed that two-third of social workers did not have enough time with service user to support self-assessment.

In support planning process, exploring options, co-ordination, building confidence and empowering service users and carers were the main roles and tasks mentioned by care co-ordinators (Glendinning et al., 2008, p. 147). Many co-ordinators taking part in IBSEN study admitted that the focus on outcomes had an important impact on their practice. Some participants said that one of their roles was to translate the information given by service user in order to produce a meaningful plan. One of the key issues, raised by practitioners, was confusion whether allocated monies based on for example personal care needs could be used flexibly to purchase other services. Further source of confusion and frustration for front-line staff as well as service users and carers, reported in the IBSEN study, was regarding the material good allowed to be purchased and whether family member could be paid for provided support. Specifically regarding older adults, the issue has been raised that their “needs tend to change much faster, therefore a support plan may be out of date within a couple of months” (CSCI, 2009, p. 140). In relation to support planning, the Resource Allocation System (RAS) has been perceived by front-line staff as purely mathematical, easy to use tool, on the other hand, some practitioners said that such mechanical approach to allocation of resources cannot fairly and accurately distribute resources due to complexity of service users’ needs and circumstances (Glendinning et al., 2008). This research will look at the experiences of front-line staff regarding assessment process, support planning as well as resource allocation in new arrangements.

Risk management

In CSCI report (2008) there is indication that the new arrangements for social care might increase the level of risk for service users. This issue arise especially where service user with complex needs is involved, as he/she might not be able to show distress (CSCI, 2008). Lymbery and Postle (2010) state that critical in terms of safeguarding in new arrangements is to retain professional engagement with service user. The IBSEN study states that giving service users more responsibilities and therefore more risk was in personalisation philosophy from the very beginning and also recognises that it is a difficult shift for care co-ordinators (Glendinning et al., 2008). Front-line staff had concerns that money could be spend inappropriately by service users, that they might not have appropriate skills and experience to employ PAs, that PAs had proper training to provide for example personal care tasks in safe and effective way (Glendinning et al., 2008). Contrary to that, in Control Third Phase evaluation (2010, p. 73) evidence suggests “that people feel and are safer when they are In Control of their support and their money and they can determine what happens around them on a day-to-day basis”. In in Control study 60% of professionals said that there was no change in risk management from the start of Personal Budgets (Tyson et al., 2010). On the other hand, Community Care survey (Lombard, 2010) found that 37% of social workers do not know what to do when care arranged by service user puts him/her at risk. My research project will examine in depth the view of front-line staff regarding risk assessment and implication, if any, of shifting more responsibilities to service users.

Training, knowledge and skills

The IBSEN study found out that most of the care co-ordinators had training provided before implementation of the individual budgets, however there was some who did not have any before undertaking first IB case (Glendinning et al., 2008). The participants in the IBSEN study said that training was focused more on the idea and philosophy behind individual budgets, and did not concentrate enough on processes (Glendinning et al., 2008). Successful in terms of informal training were recognised interactive activities such as team meetings, meeting with IB team workers and development officers and peer support development groups (Glendinning et al., 2008; Lombard, 2010). The Community Care survey on personalisation shows that there are significant knowledge gaps amongst social workers (Lombard, 2010). 63% of respondents admitted the need for brokerage skills, with only 31% stating that they have them. An understanding of the key terms and overall knowledge about personalisation has improved (57%), however 14% of social workers still understand little or nothing about individual and personal budgets (Lombard, 2010). Only 49% of practitioners said that they feel they have enough knowledge about employing personal assistant (Lombard, 2010). My research will examine the experiences of front-line practitioners regarding received training as well as subjective opinion about skill gaps in their practice.

Mindset, culture

The need for cultural shift and change of mindset of service users and practitioners has been recognised in several publications as one of the most important issues (Glendinning et al., 2008; CSCI, 2009; DH, 2010). The CSCI report (2009) shows that it was not expected from older adults that they will appreciate additional responsibilities in managing individual/personal budgets, however in some sites more older people decided to have Direct Payment and to manage the money by themselves. In addition, in Control report (2010, p. 135 – 136) shows that by the end of 2009 30.000 people were having Personal Budgets across 75 local authorities with older people being the largest group of receivers (53%). The in Control evaluation was based on online data voluntarily shared by local authorities, however there was no requirement on authorities to share data as well as not all authorities included breakdown by social care group, therefore the information from this report does not show an accurate national picture (Tyson et al., 2010). The Personal Budgets for older people – making it happen guidance (2010) emphasises importance of sharing successful stories and cases in order to challenge front-line practitioners’ stereotypes and increase positive attitude towards older people as a recipients of personal budgets.

Resources

In this year Community Care survey 36% of respondents said that resources have been the biggest barrier for successful implementation of personalisation. Moreover, based on the information about planned cuts in public sector by the current government, 82% of respondents said that this will slow down the progress of personalisation (Samuel, 2010). It has been pointed out in several publications (Glendinning, 2008; Carr and Robbins, 2009; Samuel, 2010) that front-line practitioners using only public resources face significant challenges in exercising choice, control and independence of service user and his/her own creativity. It is well pictured in this quote “this is more difficult when a budget is strictly for personal care that is essential – the equivalent of 30 minutes’ washing and dressing a day is not going to allow much creativity” (Fighting Monsters, 2010). Social workers under new arrangements will still be responsible for control expenditure with “funding targeted at those most in need” (HM Government, 2008, p.9) what clashes with one of the key principle Putting People First which is prevention and early intervention (Lymbery and Postle, 2010). This research project will examine in depth the view of front-line staff about using of existing social care resources in order to fulfil policies principles and meet older adults’ needs.

Services

In the CSCI report (2009) it has been emphasised that to allow people to exercise choice and control and to feel independent, together with transformation of the system, the existing services need reconfiguration. At the moment “services are limited and insufficiently flexible, where day services are traditional and predominantly based in buildings, and where block contracting arrangements limit the range of services on offer” (CSCI, 2009, p. 148). The Community Care survey (2010) found out that 56% social workers have noticed that services such as day centres are being closed down on the assumption that using personal budgets will mean reduced use of such services. Services, especially from local authority, will have to by attractive, flexible to needs, affordable, price competitive, sustainable, well structured and managed to meet service users’ needs (Tyson et al., 2010). My research will examine social workers experiences of changes in structure of services for older adults with the emphasise on increasing their choice, control and independence.

Introduction:

In United Kingdom health and social care is a team that provides integrated service about it. This unit grows absorbing the values and principles that corroborate the application of all who work in it. Health and social care is generally called “HUMAN SERVICE” in Canada and U.S. They give security to the patient and ensure that during treatment they won’t face any problem. They can take treatment safe and secure. Confidentiality, Communication, Promoting anti-discrimination, Rights, Acknowledgment is some principles o it. Confidentiality means keeping information secret. Patients don’t want to show their records. Communication is very important for this sector. It is a common allowing access between persons or place. Anti-discrimination activities means don’t make unjust or prejudicial distinction in the treatment of different categories of people.

Task 1

A young child undergoing physical abuse from his parents:

“Make Child Protective service” This Principle I would like to follow

Children’s are often physically abusing by their parents. It makes a huge effect on their health and mind. Parents should have known about the impact of physical abusing. When a child has hit or slapped on the side of head he might injured badly. Its also causes death. Child may lost their hair or teeth and also broken bones by beating. They are depends on the adults for grew up. Sometimes we see that child is murdered by their parents. They are need love not hit. Not only parents but relatives are also providing them with love and support. Local health and social service departments can arrange parenting classes. Social workers can help the parents to understand the psychology of their children.

Solution:

Multi-agencies can promote an approach. They can promote or the welfare of the children. Common assessment framework (CAF) plays a vital role for the children. They can identify the child who is abused by his parents physically. Some voluntary organization is take responsibility to stop the child abuse. They are often working very closely to a child and their family. Child can get help from them. They provide this child health treatment. Agencies can make them sure to their security system. Their motto will be we don’t need more we service more. Its mean that they don’t want more they want to serve the survived person. Inter-personal agencies can do something to eradicate this problem. Child abuse is a crime they can aware this around the people. They can arrange a psychological treatment to the parents who are psychological abnormal and hit their children.

(b) A wife whose partner is subjecting her to domestic violence:

“Promoting Anti-discrimination practice” This Principle I would like to follow

Domestic violence is comes from the discrimination between two people. Women’s are the victim of this abuse. It can be physical, sexual, mentally. It often occurs because the spouse of the women thinks that abuse is the accurate justice. Domestic violence is a complicated matter that needs sensible handling by health and social care professionals. Health and social care specialist, commissioners may take some steps to prevent it. They can contract with them who are experience domestic violence and abuse. Then make them aware of the social impact for this violence.

Solution:

Multi-agencies are aware of gender discrimination. They are work or it. Some agencies are taking some essential steps to stop it. If a women facing domestic violence she has a right to stop it. Domestic violence is caused for many reasons. If two spouses mentality is not same, If they are not educated, If two persons society is not same. The problems are small but the impact is not small. Multi agencies are making some policies to eradicate the problem. They can make this problem solve by consulting with them. If women face this type of violence she should confirm the others. She should want divorced from her spouse. The men who are occurring this violence are indicated and give them the hard punishment. Gov should regulate a strong act against the domestic violence. Multi agencies can give the affected women’s free medical treatment. They should provide them security. The un-job women are facing this problem. I agencies arrange job for this women’s for the betterment of their life.

(c) A young person living in a home for people with learning disabilities

“Increased Acknowledgment” This Principle I would like to follow

Disability means a person who are lack of experience, education, knowledge, manner, manage. Learning disability mean unexpected gap between a person’s level of experience. If a young person lives in a house which people have no knowledge, he can’t learn anything. Young boys live with his family which members are not educated, and then the young person does not understand the value o education. He don’t lean the social behaviors and articles. He is not aware of the health. Family is the primary stage of person’s acknowledgement.

Some learning disabilities are listening, speaking, reading, writing and spelling. The learning disability person have problem with concentration, memorizing something. If one is not listening he is a problem to learn.

Solution:

Some multi-agencies are working or people with learning disabilities. Their motto is give more and takes less. Agencies are beyond health and social services. They identify some people who have this problem. They are participating in some form of joint working..They are make relationship among the contestants and creating opportunity to work together. They can make a promotional program. They build a school for this type of person who is facing the problem lack of learning disability. They are making social aware of this problem. This type o person is not accepted easily in society. They are isolated by some narrow minded person. Because of this people awareness is very important. Health and care service are give them medical treatment to overcome this. When a child born If it has this problem so immediately he have to start the treatment.

Task 2

Role of Care Standard Act, 2000

Care Standard Act (CAS) 2000 was activated on 20 July 2000. It is following two white papers which are produced by the govt. in 1998 and in 1999.

It is establish by a national care standards commission. The role of this act is very meaningful. This legislation is establish to make act for the adjustment and regulation of

Summary of this act:

Establish a new and self-sufficient regulatory for social care and voluntary healthcare service.
Improvement of the care standard
Establish new councils for registration of social care workers
Gov has to introduce necessary standards of health and social care.
Reducing the poor providers.
Residence limitations such as – disposable income. Less entry to benefits. Incentive work, less independence and ordinary life.
The main motto of this act is to reform the ordinance system for care service in UK and Wales.

This act is playing a vital role on the standard health and social care.

Government can establish policies for the implementation of the health service. This sector has many policies to make the people useful. Local policies developed the service sector beneficial for people.

The regulation of care 2001:

The care homes regulations 2001 is now working under a new function of domiciliary care. “the children’s homes regulations 2001”. It is amendment with relation to “the care standard act”. A care home must be registered. Accommodation can be registered if they provide standard degree of care. It also defines that personal care should not include any activities which are done by regulation. It works independently in April 2002 under the regulation of care act 2001.

The objective of this is act:

Keep people safe.
Promote dignity
Support independence
Regulation the care service
School care system
Care home for the children and youngsters, and aged people.
Hospital care system.
Welfare of users
Personal plane
Fitness in relation to child minding;
Fitness of managers;
Facilities in care homes;
Medical practitioners in care home;

GSCC code of practice:

It is a Social care council (GSCC).it running their activities in England. It is a “public body” .it has no department. It Built in October 2000. And it is developed by “The Department of Health”.

It is a record of care employees. It describes the conduct and practice required for care workers as they go their routine work. It consists of 6 care value.

Care worker must care of the rights and must promote the interest of users.
Care worker must compete to establish the faith of users and careers.
Care worker advertise the independence of work, they protected from danger as far as possible.
Care workers must respect the rights of the service.
Must uphold public trust
Must be accountable for your work and take responsibility.

Task 3

Bereavement:

A woman is recently lost her spouse. Bereaved means the reaction of loss of a beloved person by death. Some people can cope up with the situation and some can’t. In this time she get depressed. Her mentally situation is not good. She can survive from economic problem. She may be more socially isolated. She feel lonely and affair of living home alone. If she wants to get married again the society make problem. But it varies on the soceitys culture. The main problem is that she is facing the economic problem.

Some social agencies make policies to help them who are bereaved. And help them to deal with this situation. They give them psychological treatment and try to make them normal. They can ensure their security. The impact of this policy is very effective. Society can get rid of this type of problems. The care centre can give them health treatment also. They can also give the psychological counseling. They can start a job to met financial needs. She gets help from the care centre. Government can get rid of this problem.

Relocated from one country to another:

Parents relocation is give impact on the child. For bringing up a child both of them are needed. By these child are not get proper right to bring up.

Impacts:

They feel lonely at their life. Because their parents are busy and nobody can fill up the absence of parents.
They don’t know the actual manner of time, eat, speaking, learning . They don’t know how to speak? How to speak with others? This is the responsibility of their parents to give them this learns. If they are absent the child is not grew up properly.
They feel suffocated. It makes them sick too. If they are not happy they feel many heath related problem.
They are not getting help and care from their parents in their emergency situation.
They can involve in the bad culture.
They might start to take drugs.
The society might think it negatively because o the parents absence the children may face many difficulties and they might involved with violence. Ultimately, the society is facing this problem.
Parents make some solution to recover this problem. They can make the contact with their children. The opportunity of contract between them is very important to solve this problem.

Identical twins raised in a different environment

Identical twins are look alike. They are not only look alike but their like, dislike are same. It is a matter o wonder that their decisions are sometime same. Identical twins are same in behavior but also have some distinction .genetically and physically they are same but they are influenced by the environment.

This is real evidence that a twin’s baby were separated at birth. They are being adopted by different families. They are unknown to each other. They are brought up with the different culture. But both of them have abilities in mechanical drawing and carpentry.

There are some examples of some identical twins. They have matched their school subject. They like smoking and like to drink. Sometimes they got headaches at the same time of a day

Identical twins have different cultural but their behavior or habit are same.

Some similarities of them :

They are matched their school subject.
They are got headache same time
They married same type o girls/boys.
They have same abilities to work.
They have same color of their eyes
They are like to listening same type of music.
They take same decisions at a same point.

Some distinction because of bringing up different environment:

Their culture might be varying by their environment. Such as one is bring up in UK and another is in India. Both countries culture are not same.
They are differs from their food habit.
Their language is different.
They have different height or weight.

Task 4

Responsibility and duties of my (as a manager of hospital ward)

Hospital management is vigorous and an adaptable job. The duty of the manager are not same .its varies on the area. They have to skilled, knowledgeable and sharpen. They have some essential duty such as record keeping, hiring good staff, fiscal management etc.

Hiring qualified staff:

A manager is responsible for hiring staff for a hospital. It is the main duty and he has to fulfill this responsibility carefully. Staff can be nurses, administrator, doctor, surgeon, word boy and other maintainer. Manager should check their personal files and records to ensure that they are qualified for the hospital.

Record keeping:

Some hospital manager appointed someone to keep the patient records. Because he has much work to keep the facility go on .however they ensure the patient that their records are safe and secret.

Fiscal management:

It is very important role for a manager, Hiring the medical supplies, setting rate for the service. Make financial framework by implemented new program and expended old.

Make a strong security system:

Make the clinical practice is safe and effective. Make this highly protective. Patient and their relatives are satisfied.

There have some duty for a manager

Ensure my clinical practice is safe and effective.
Give extra facilities to the patient and their relatives.
Make nurses and word boy satisfied by providing their rights.
Follow a good management process.
Give confidentiality about patients report.
Daily operation
Ensure good communication between doctor and patient.

Example:

I had been work in a hospital. My designation was “ward manager”. To be a good manager you have the knowledge about the management presses. I follow a ideal management practice. During my time I hire some qualified staff for the hospital. And I hire the best supplies for surgery. That’s why the patients are satisfied and they comfort safe at the hospital.

My recommendation about these policies in order to good practice;

1. Hire a qualified staff team.

Staffs are the essential part of a hospital. A good staff makes a hospital popular. This policy can make the good practice. If my hospital doctors are satisfied their patient by giving good treatment the patient has feel. If the nurses are properly take after the patient it impacts well.

2. Make the security system good:

The security system is also managed by the manager. He has to ensure the patient that their records are safe and nobody can see this. Patients are not wanted to show their records. They want to get secret it. If the hospital manager make it sure that their records are safe it is good to the hospital facility. Make the patient sure that the hospital management are confidential to their records.

3. Follow a good management process:

A manager has to follow the best management system. He has to think about the beneficial of the hospital. A good monitoring system is important. Choose good staff. Give the staffs proper right. Give their salary on time. Make sure that the managing system is very hard.

Conclusion

Health and social care give security to the patient and ensure that during the treatment they won’t face any problem. In task 1 we talk about some social problems like child abusing, discrimination and lack of learning we discuss the solution from get rid o this problem. How multi agencies can promote some approach to give the service.

In task 2 we discuss the care standard act 2000, the role o the act and the implement o this act. This act is playing a vital role on the standard health and social care. Government can establish policies for the implementation of the health service. This sector has many policies to make the people useful. Local policies developed the service sector beneficial for people. How this act make our society beneficial. The care home regulation and GSCC code the role o this code in our society.

Task 3 is on social emotions and different behavior of people how a widow feel when she lost her husband in a age of 35, how a child facing problem If his parents are relocated from one country to another, Parents relocation is give impact on the child. For bringing up a child both of them are needed. By these children are not get proper right to bring up Identical twins are look alike. They are not only look alike but their like, dislike are same. It is a matter of wonder that their decisions are sometime same. Identical twins are same in behavior but also have some distinction .genetically and physically they are same but they are influenced by the environment.

In the last task we talk about a Manager who works at a hospital. What his responsibility to manage the hospital and how he does it properly.

Social Work with Children and families

Response to a letter from the GP of Amita Kaur, the mother of Gurnam. As a student social worker in a local authority Children with Disability team you will undertake an assessment in relation to Gurnam and his family.

This report lays out the proposed method of assessment for Amita Kaur (DOB: 2.3.75) and her family of three children. The approach taken towards the assessment of Gurnam and his family draws from contemporary publications of professionals working in the fields of mental health, learning disabilities, education, and social service provision.

The initial assessment of Ms Kaur’s health already made by her G.P stated that Ms Kaur has been ‘in a state of some considerable distress’ and that it was the opinion of her G.P that ‘she is quite worn out as a result of having to cope with substantial family responsibilities and pressures for a long period of time.’ As Ms Kaur is showing symptoms of depression, coupled with her own expression of concern that she was unable to maintain an adequate level of support for her children I propose that some form of social support is offered to help the family for the foreseeable future. I suggest that in order to ascertain the extent of Ms Kaur’s difficulties, and before I suggest any means of intervention, I would like to hear Ms Kaur’s opinion of her and her family’s situation. As highlighted by Gallimore et al (1999, p. 56) it is necessary for social services professionals “… to regard families as partners to be empowered as active co-decision-makers rather than as cases to be managed”. The impact of parental mental-health problems on their children has already been well-established by research (Rutter & Quinton 1984; Beardslee et al. 1998; Stallard et al. 2004. In Slack and Webber (2007). That Ms Kaur is experiencing feelings of vulnerability and concern for her children is an important consideration when considering the type of service to be offered. It is important that the family recognise that social services are here to offer support based upon informed cooperative decisions made between ourselves and themselves, and that we are here to constructively assess them. In our assessment it is important to consider the family as a whole; a working dynamic that has, up until now, been successful. As research suggests, family-centred services for young children with disabilities have promoted a ‘strength-based approach in promoting positive family functioning (Dunst, Trivette, & Deal, 1988, 1994; Powell, Batsche, Ferro, Fox, & Dunlap, 1997; Weissbourd & Kagan, 1989. In Lesar, (1998), p.263). This approach highlights the strengths in families that they can build on and that ‘the family’s strengths, including the social networks and informal supports already available to and within the family, should be the foundation upon which new supports are designed or provided’ (Dunst et al., 1994. In Lesar, 1998, p.263). Through using family strengths as ‘building blocks and tools, the family becomes even stronger and more capable of supporting the well-being of individual family members and the family unit (Trivette, Dunst, Deal, Hamby, & Sexton, 1994. Ibid). It is thus the aim of this assessment to work towards providing a program of support that can help to re-establish this working equilibrium between the family members, within the varying contexts of their home, working, and education environments.

The extent of provision for the children’s disabilities while they are at home needs to be looked into, and the fact that the children are having negative experiences at school is something that also needs to be investigated further. These experiences could be related to independent stressors – such as emotional changes in the individual children, or a change in their school environment – and/or they could be directly associated to the stress being felt by Ms Kaur in their domestic environment. As suggested by Glidden, (1993, p.482), “…a family with a child who has a disability is a family with a disability.” Glidden adds that in assessing the problems faced by such families, it is important to understand and distinguish between demands and stress exacerbating and causing situations (Glidden, 1993). The situation faced by Amita and her family entails a situation that has been building slowly, but steadily, over a period of time, and now represents a point that is beyond her control in terms of mental, financial, and time control. The long-term stress and demands of her situation, along with increased personal care have prompted the situation whereby her doctor has intervened with the Children’s Directorate Children with Disability Team. Gallimore et al (1999, p. 57) refer to this sort of situation as arising from “…the emotional costs of daily demands and strains”, and that the need for a sustainable daily routine that has manageable long term solutions for helping to reduce the sources of the problems is a paramount objective to the intervention of social services (Hansen, 1993).

Throughout the assessment process we will do everything within our capabilities to reassure Ms Kaur that any intervention will be minimal and will aim to cause as little disruption to the family dynamic as possible. As research has suggested – the influence of social support on families of children with disabilities is closely associated with:

Better, more cohesive family adaptation (Bristol, 1983)
A decrease in the number of out-of-home placements (Cole & Meyer, 1989; Ger- man & Maisto, 1982)
greater maternal life satisfaction (Crnic, Greenberg, Ragozin, Robinson, & Basham, 1983)
Lowering of maternal stress levels (Kazak & Mar- vin, 1984)
Better parent-child interaction (Dunst, Trivette, & Cross, 1986). (In Marcenko and Meyers (1991), p.186).

It is thus our aim to offer a service of provision that will improve the family’s quality of life through measures which are constructive, supportive, and reliable. An efficient and prompt assessment process is essential as early intervention, can, in some cases, be crucial in avoiding the onset of more serious problems, which negatively affect parenting capacity and cause family life to ‘escalate into crisis or abuse.’ (D.O.H, 2000: p.xi).

The government document “Framework for the Assessment of Children in Need and their Families” (Department of Health, 2000) has put forth a systematic guidance for the assessment of needs through analysis and recording of what has been and is happening in the household, as well as to the children. This document is written in close association with “The Children Act 1989”. The latter document states that:

A child shall be taken to be in need if –

a. he is unlikely to achieve or maintain or to have the opportunity of achieving or maintaining, a reasonable standard of health or development without the provision for him of services by a local authority …

b. his health or development is likely to be significantly impaired, or further impaired, without the provision for him of such services; or

c. he is disabled (Children Act 1989 s17(10). In DoH, 2000: 6)

Considering that the family’s GP has already expressed concern about the children’s performance at school it is clear that the children’s needs meet the criteria as outlined in parts a-c of the Children’s Act 1989. Under that Act, the welfare of children is set forth under a series of requirements, regulations, and laws. Under Part V – Protection of Children – practice guidance suggests that child assessment orders should allow for differing techniques to be employed to see to the needs of children based upon application by their family, the child, and or agencies.

As Ms Kaur’s GP has expressed concerns for the children’s performance at school I think it appropriate that a joint assessment be undertaken by a staff member of the school and by a child support worker – who together can make an informed and unbiased assessment of the children’s behaviour and performance at school. As highlighted by the DoH (2000:p.6) professionals from different agencies, especially from health and education, are ‘a key source of referral to social services departments of children who are, or may be, in need [..] they will be key in assisting social services departments to carry out their assessment functions under the Children Act 1989.’ Information from the school could be very helpful in the overall assessment and plan for service provision. I would also recommend that a leading professional who works full time with disabled children be called in to undertake an informal assessment of Gurnam. These reports should then be submitted to the head of our department where they will be jointly discussed and used to inform our agency’s plan for services. Ms Gaur’s son Manjit, has been described by the family’s GP as ‘a cause for concern.’ The situation is described as follows:

‘He has a heart condition which has been successfully treated with surgery but which needs to be monitored on an out-patient basis. He has also been assessed as having some learning disabilities. While Amita is very satisfied with the educational programme that the school has been put in place for him, she is concerned that he has been bullied by other children for some considerable time. This has resulted in him being distressed and reluctant to go to school recently.’

The Special Education Needs and Disability Act (2001) suggests that it is the responsibility of the governing education institutional to make sure that the child is not placed at a disadvantage within the schooling system (Part 2). As Ms Akur is satisfied with the actual programme in place for Manjit there is no immediate cause for concern that he is experiencing discrimination. However, from the information given it appears that the physical problems which Manjit is experiencing is causing additional stress – possibly arising from the negative attitudes of his peers towards him. Ms Kaur should be advised to approach the school about this problem, with an accompanying letter from her GP if necessary. As suggested by Sally Beveridge in her discussion concerning schools and special education needs, there will arise certain cases where a pupil will not be able to fully participate due to their having a restrictive impairment, and it is necessary that teachers know as much about children with SEN as possible before teaching them (Beveridge: 1999, 39). Therefore we would advise that the school make individual assessments of Manjit and of Gurnam possibly discussing the outcomes and proposals for action with us.

The assessment plan will be agreed between all children and their mother.

For the planning of children’s services it is necessary to recognise how problems can be interlinked, and that ‘everyone benefits if services are properly co-ordinated and integrated.’ (DoH, 2000:1). It is also the aim of Children’s Services Planning (Department of Health and Department for Education and Employment,1996. In DoH 2000: 1) to ‘identify the broad range and level of need in an area and to develop corporate, inter-agency, community based plans of action to provide the most effective network of services within the resources available.’ (Ibid). When assessing Ms Kaur and her family we must therefore consider the nature and availability of resources in their local area and how they can be best matched with the needs of the family. As outlined by the Doh (2000) service users sometimes report that they find assessment procedures to be ‘repetitive and uninformed by previous work.’ (p.7). However, having outlined a clear and cohesive framework for this assessment I am confident that Ms Kaur and her family will receive an efficient and constructive assessment by our team; one that will provide a fully comprehensive proposal for service provision that will suit their individual needs and their needs as a family.

Bibliography

Beveridge, S., 1999, Special Educational Needs in Schools. London: Routledge

Department for Children, Schools and Families (2008) Common Assessment Framework. Retrieved on 11 February 2008 from http://www.everychildmatters.gov.uk/deliveringservices/caf/

Department of Health (2000) Framework for the Assessment of Children in Need and their Families. Stationary Office, Department of Health, London, United Kingdom [online]. Available from: http://www.doh.gov.uk/quality.htm [Accessed 17/07/08]

Gallimore, R., Bernheimer, L., MacMilan, D., Speece, D., Vaughn, S. (1999) Developmental Perspectives on Children with High-Incidence Disabilities. Lawrence Erlbaum Associates. Mahwah, N.J., United States

Glidden, L. (1993) what we do not know about families with children who have developmental disabilities: Questionnaire on resources and stress as a case study. Vol. 97. American Journal on Mental Retardation

Hansen, D. (1993) The child in family and school: Agency and the workings of time. In Cowan, P., Field, D., Hansen, D., Skolnick, A., Swanson, G. Family, self, and society: Toward a new agenda for family research. Lawrence Erlbaum Associates, Hillsdale, N.J., United States

Hardcastle, D.A; Powers, P.R; and Wenocur, S, (2004). Community Practice: Theories and Skills for Social Workers. Oxford: Oxford University Press

Lesar, S., ‘Parental Coping Strategies and Strengths in Families of Young Children with Disabilities.’ Family Relations, Vol. 47, No. 3, (Jul., 1998), pp. 263-268 National Council on Family Relations

Office of Public Sector Information (2008) Children Act 1989. Retrieved on 11 February 2008 from http://www.opsi.gov.uk/acts/acts1989/Ukpga_19890041_en_1.htm

Marcenko, M.O, and Meyers, J.C, (1991), ‘Mothers of Children with Developmental Disabilities: Who Shares the Burden?’ Family Relations, Vol. 40, No. 2, (Apr., 1991), pp. 186-190. National Council on Family Relations

Pardeck, J.T, (1999), Family Health: A Holistic Approach to Social Work Practice. Westport, CT: Auburn House

Sheppard, M., (1991), Mental Health Work in the Community: Theory and Practice in Social Work and Community Psychiatric Nursing. London: Falmer Press

Slack, K, and Webber, M, ‘Do we care? Adult mental health professionals’ attitudes towards supporting service users’ children.’ Child and Family Social Work . London: Blackwells (2007) 13, pp 72–79

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Umbarger, G., Stowe, M., Turnbull III, H. (2005) The Core Concepts of Health Policy Affecting Families Who Have Children with Disabilities. Vol. 15. Journal of Disability Studies

In the article he discussed that children are a very vulnerable sector of our society. Child abuse can occur in every sector of our society, but some children are at a higher risk for abuse. The reason behind the research is to find out what is child abuse and to know the different forms of physical abuses. D.P.Noe said Children are at an increased risk for abuse if they were a product of an unwanted pregnancy, or have parents that are still children themselves. There is an increased risk for child abuse if the parents of a child have history of being abused when they were children. or are have been brought up in a home with domestic violence. Single parents or parents with a drug or alcohol problems put a child at a higher risk for abuse. Certain socioeconomic levels such as children living in poverty place them at a higher risk for abuse. The different types of physical abuses discussed by the author are

May present with bruises that are patterned, multiple bruises of different ages, bruising in a non-ambulatory child, burns, and lacerations.

The reason behind the research is to know the role of the family life educator that how child abuse can be prevented by the family itself. He said there are different programs to prevent child abuse there are school based programs, Schools are in a unique position to address the child abuse problem through school based programs. School based programs should stress the primary prevention of child abuse by basing content on the cultural forces contributing to abuse. He describe some teaching suggestion in the article which are effective in a family life education program emphasizing the teaching of positive discipline as a primary prevention method for child abuse for example Invite student perspective on the topic of discipline, Invite students to share their feelings with the class. Further more he discussed that what question should be asked by the student and how should they be treated. The role of the teachers. He said equally important is the need to develop activities that will provide students with an opportunity to confront feelings about discipline issues and to learn discipline and guidance strategies that help children develop social competence.

The reason behind the research is to know the reason why and how child abuse occur in step families. Evidence from the cases suggests that stepparents are overrepresented among abusers. Jean Giles-Sims and David Finkelhor explained five theories that have been used to explain this presumed relationship. The theories are: social-evolutionary, normative, stress, selection and resource theory. Author also discussed Stepparents and Natural Parents as Perpetrators In Three Types of Child Abuse (physical abuse, sexual abuse and emotional abuse). According to his research step mother conduct more physical and emotional abuse. The social-evolutionary (sometimes referred to as socio-biological) perspective predicts that stepchildren are more likely to be both physically and sexually abused than natural children, using different arguments to explain each type of abuse. According to the normative theory of sexual abuse by stepparents is consistent with a social-evolutionary perspective which argues that the justification of incest taboos is to avoid genetic degradation. However, the normative argument does not require a biologically based assumption. In the stress theory it is stated that stepfamilies experience stress, and that stress is related to child abuse. In the selection factor theory author said that it may be that the same factors which make people prone to divorce and remarriage also make them prone to abuse children. It may be that the same factors which make people prone to divorce and remarriage also make them prone to abuse children. Resource theory is the final theoretical approach which explains higher rates of child abuse by stepparents. According to this theory, the more resources a person can command, the more power and authority that person has at his/her disposal to regulate a social system.

the reason for conducting this research is to analyse the Ethical dilemmas that are commonly encountered in family sexual abuse cases. In the research the primary ethical problems faced by marital and family therapists working with families in which child sexual abuse is suspected or has occurred are examined. The sexual abuse of children is most frequently perpetrated by males upon females, with stepfather or biological father/daughter molestation being the most commonly reported form of abuse. Kitchener (1984) and Thompson (1990) suggest that the practitioner turn to the following six general ethical principles to guide ethical decision making: autonomy, fidelity, Justice, beneficence, nonmaleficence, and self-interest. These provide a framework for considering the specific ethical dilemmas encountered by family therapists who are confronted with child sexual abuse. Author also discussed the therapeutic treatment of abuse it is recommended that sexual abuse treatment with these families not be undertaken without specialized training and supervision (Principle .6). The therapist may need to refer the family, a process that can be facilitated by helping the clients understand that this action affirms the therapeutic promise to promote their welfare. Awareness of the meta-ethical principles involved in working with these families can help to identify where principles may conflict.

The reason for the study is to identify economic and cultural generative factors of child abuse. There are special circumstances affecting the occurrence of child maltreatment, such as parental youth and inexperience, parental discord and divorce, adoption, and problematic child attributes, which are explored in the research. The evidence for intergenerational transmission of abuse is also examined. The few prospective studies that have used quantitative methods have yielded mixed results, with two (Johannesson, 1974; Sears, 1961) reporting no evidence for an association between corporal punishment and child aggression, and (Lefkowitz, Eron, Walder, & Huesmann, 1977 McCord, 1979 Singer, Singer, & Rapaczynski, 1984) find a positive association. The reason why parents maltreat their children are parents own background, economic position. Economic factors leads to economic stress, Economic stress generated depression and demoralization in parents, which in turn resulted in marital conflict and “bad’ parenting-harsh, inconsistent discipline and hostile rejection or non involvement. Divorce is also the reason for the maltreatment of children by parents. Low income and single parents also become the reason for the child abuse. Data obtained from research with non abusive middle-class families. The research also focuses on facets of responsiveness (warmth, reciprocity, attachment) and demanding ness (coer- civeness, confrontation, monitoring, supervision, consistent discipline, corporal punishment) (Maccoby & Martin, 1983). Compared to parents from non abusive families, parents from both abusive and neglectful families can be expected to be less responsive and neglectful parents to also be less demanding.

The reason for conducting the research is to find the exact relationship between stress and child abuse despite the fact that stress contributes to child abuse. Author discussed three models postulating the influence of stress on child abuse phenomenological model, life change model, and social model. In phenomenological model describe that an early formulation of the stress and child abuse relationship, suggests that abusive behaviour is unleashed by figurative or solid incidents perceived as stressful by adults who are vulnerable to abuse from inadequate upbringings. Stress arises when an incident is judged to be personally threatening. Assessing the threat, including risks to self-esteem and physical comfort, occurs after the individual inventories his or her personal resources for coping. The usefulness of the phenomenological model is limited by its lack of ability to identify unique characteristics of the situation or the abuser. Such constraints as cultural factors, for one, contribute to abuse. In the life chain model describe the connection between stress and abuse. This model posits a series of changes in life situation as contributing to the potential to abuse. It also assumes that physical and psychological stress processes are equivalent. The life change model is as follows:

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The social model describes another explanation of the connection between child abuse and stress. Child abuse is largely a function of the stresses of poverty, the social model rests on accumulating evidence from child abuse researchers that diminished social or ecological resources accompany poverty and increase child maltreatment among the poor. members of lower socioeconomic groups are exposed to more stressful events than members of higher socioeconomic groups and that the poor are more helpless to the impact of those events. Social isolation is manifest in child abuse. In short phenomenological, life change and social models of stress in child abuse explains that stress in part arises from personal appraisals, cross-sectional life disruptions, and environmental deprivations.

This research is done to analyse the different effects of demographic, social, and economic factors on the number of child abuse and there are neglect reports in 18 urban, suburban, and rural counties over a period of 6 years. The analytic portion of this research consists of two parts. The first tests hypotheses about the effect of each independent variable on the dependent variable, child abuse and neglect reports.

The model is separately tested for the urban, suburban, and rural counties. The second part uses the independent variables to determine the extent to which the model replicates actual data in each type of county.

The time-series approach is used to analyse the growth of child abuse. Eighteen of 58 urban, suburban, and rural counties were selected for analysis.

Child labor has become an important discussion topic and that how childrenaa‚¬a„?s rights may be protected as globalization has increased so has concern for childrenaa‚¬a„?s rights and child labor..

Most societies believe that if children will work they will learn more but conditions that are detrimental to their health is an area of concern. Children who are appreciated by their families are able to learn more an in a less stressful manner compared to those who are not praised and whose work is also not praised. Many conventions have been held by ILO to de motivate those who employ children and force them to work in hazardous conditions. Some international organizations have also been trying to create awareness about childrenaa‚¬a„?s rights. In every country organizations are working for rights of child. New institutions are opened to guide the people. UNICEF and various nongovernmental organizations are working to protect Convention on the Rights of the Children and its effective implementation

There are several forms of child abuse and the one which has received most concern is the battered child syndrome. There are six main types of abuses that have been discussed including physical abuse and physical neglect. The reason for child abuse could be that as a child the abuser was also maltreated by his parents for not meeting their demands. Such children when marry look for spouses who have been through similar experiences during their child hood.

Parents sometimes have unrealistic expectations from their children and when the child is unable to meet these demands the parents become frustrated and become abusive towards the child. Adolescents aged 12 to 17 account for 20% of the abuse and neglect cases. These children can be treated with the help of the family and several different community services. Although the aim of the treatment is to protect the child but it also focuses on the parents.

Abusive parents have problems asking for help thus a reporting system can generate better results. Suspected child abuse may be directed by observing a sick or injured child with his parents or by listening to parentaa‚¬a„?s explanation of injuries. Parents should be told of places from where they can receive help for parenting their child in a better manner. The emotional aspects of parenting should be incorporated into parental training classes as well as into all other types of parenting education. Family life courses and family planning clinics should inform people of the responsibilities negative along with positive.

The American public health association adopted policies to prevent child abuse as a problem which has significant health problems. The cost of child maltreatment has significant and long lasting effects. Cultural acceptance for child abuse is seen in schools in the form of punishments and abuse by parents and neighbors is seen as a problem.

Thus measures should be taken to reduce acceptance for child abuse and violence. Coordinated efforts of the public sector and the private sector shall be taken in order to create awareness about the responsibility. Training programs should also be held in order to reduce abuse against children in an effective manner. These programs need funding and support to become more affordable by the society.

A conclusion that the article with draws is that those children who have been abused as a child tend to become child or spouse abusers themselves thus research shows that child abuse is directly related to family stress, financial problems and single parenting responsibilities.

Child abuse can only be prevented with the help and cooperation of all the sectors private and public including public health, law and order and educational institutes.

When people are in need of welfare, they do not have to confer with the government directly sometimes to obtain it. A social agency, defined “formally structured unit, sanctioned by society, whose goals and activities focus on meeting human needs.” (Turner, Pg 209) is simply known as one of the contacts between the government and the population that helps the people in need to obtain the services and resources of our social welfare system. On the other hand, human service organizations are known to be the secondary settings for social welfare practice who employ social workers to help meet human needs. Although social agencies and human service organizations share common features, they also have characteristics that differentiate them from others. Social agencies and human service organizations are divided into three different sectors: government, voluntary and commercial and this is where the term “a mixed economy of welfare” comes in. (Turner, Pg 209)

Government agencies are split into federal and provincial jurisdiction and they are responsible to provide welfare for income support, health care, child welfare, employment insurance, vocational rehabilitation, housing, corrections and services to veterans and First Nations citizens. (Turner, Pg 211) The federal government deals with welfare that impacts the people directly such as health care and employment insurance whereas the provincial governments give their responsibilities to municipal and local governments to take care of the community as a whole such as old age homes and daycares. Voluntary agencies are not depended on the government. They are defined as “agencies that are nongovernmental, non-profit organizations formed independently of state mandate.” Voluntary agencies provide two direct and indirect social services. Direct social services include getting people physically involved whereas indirect social services do not require direct face to face interaction. There are 161,000 volunteer organizations in Canada (Turner, Pg 212) and thousands of private agencies are sponsored by charitable, philanthropic, national organizations and special interests groups that are not incorporated or registered. Agencies in commercial sector are known as a profit-making sector and are not as large as the other two sectors. There are some services neither the government nor the voluntary sector provides. Therefore, agencies in commercial sector tend to provide services such as employee assistant programs (EAPs) and they are also known for reacting faster than the government and voluntary agencies in some areas such as residential care, chronic care and nursing care. However, since these agencies only aim for profits they reduce and provide inadequate services to clients occasionally if they have to in order to be financially active.

For this assignment I decided to choose an agency from the voluntary sector because I personally believe that they are the most important in all three sectors. I interviewed a settlement worker, named Neeru Singal at Brampton Multicultural Community Center (shortly known as BMC), one of the biggest non-profit organizations in Brampton, Ontario. The main reason why I chose a non-profit organization is because they provide extensive services such as sports and recreation, arts and culture, social service programs, medical programs, anyone who needs support, and most importantly help new immigrants settle into the community. By providing excellent services like these, the organizations enhance the quality of life in societies. Most importantly, it is very hard to imagine a community with no voluntary agencies. It allows everyone in the community to get involved and live an active life.

Agency origin and brief history

When the immigration rates were increasing rapidly in the 1980s, a large number of South Asian immigrants were trying to settle in cities such as Brampton and Mississauga. During this trend, a lot of newcomers needed support in finding jobs and settle in the community. This is when a group of diverse professionals decided to establish a multicultural community center in Brampton in order to meet certain needs of the people. Brampton Multicultural Community Center was established in 1987 as a non-profit organization in order to help newcomers settle and integrate in the society. In 1987, it all started with volunteers in volunteer management program who were involved in a variety of programs such as the Immigrant Settlement & Adaptation Pro (ISAP), the Job Search Workshops (JSW) and Multicultural Settlement & Education Partnership (MSEP). Neeru Singal has mentioned that volunteers are a backbone of their organization and they are known for creating a positive impact in their client’s lives. Brampton Multicultural Community Center slowly implemented Newcomer Settlement Program (NSP) and Social Service Program (SSP) in order to expand their services and connect people. This community center currently has about ten programs including services for seniors and medical screening.

Purpose and function

Neeru Singal has mentioned that the organization’s motto “connecting people, build communities” explains everything when I asked about the main purpose. The mission statement for this organization is to enhance the capacity of newcomers to let them participate more effectively in their communities. Therefore, by implementing more programs, the community center will attract more newcomers to get involved and take advantage of free services that are being offered. The vision statement of this organization is to strengthen the capacity of the settlement sector and see them as a strong community in future. In order to reach their objective, they plan to partner with other service providers and organizations to mutually support each other. They also want to work together with other community actors to develop the newcomer’s existing skills and talents and position them in Canadian workplaces. The way this organization operates is by dividing the programs and services offered into different categories (explained in organizational framework) most of them dedicated to newcomer community engagement and setting an overall policy which is being followed by the staff. In order for any organization to function effectively, the staff needs to consult and have open lines of communication with the board all the time.

Hence, this is what this organization is exactly doing. They work collaboratively with the board and host additional programs and events every week such as the YMCA Brampton newcomer program, free medical clinic for low income individuals and families, free tax clinics, tours and multicultural events on top of all the regular programs and services they offer. By engaging newcomers actively in these events and getting support from the regional government (Region of Peel) and the federal government (Citizenship and Immigration Canada), the organization is well set towards achieving their mission statement.

Organizational framework and funding

Neeru Singal said that the organizational structure of Brampton Multicultural Community Centre is very similar to most of the non-profit organizations. There are currently ten programs that are being offered to clients. Immigrant Settlement and Adaptation (ISAP), the Multicultural, Settlement and Education Partnership (MSEP), Job Search Workshop (JSW), Library Settlement Partnership (LSP), Newcomer Settlement Program (NSP), Social Service Program (SSP), Volunteer Management Program, Senior Connection Program, HOST, Cancer Screening Program. Of course, all these programs are grouped into several sub categories and administrated by few departments. At the highest level of the hierarchy, there is the board and under that there is the management who overlook at the operations of all departments. The smallest department is the events department because it is not something that is necessary to work on every day.

The biggest department overlooks at five to six programs – Social services program, HOST, job workshop, newcomer/immigration/settlement programs. These programs are active everyday because a lot of newcomers visit the agency frequently for consultation and help. They also provide common services such as — Skills Training & Assessment, Computer Training, Resume Preparation and Interview Skills. There is another department that administrates two to three programs such as the Cancer screening program and the senior connection program. Neeru Singal had mentioned their Cancer screening program is prominent because they do everything from holding the information sessions about breast and cervical cancer screening, booking the appointments for screening, arranging transportation to follow-ups after screening. The last department overlooks at HR, Volunteers, Funding, legal and development. As mentioned above, the management is committed with the board (executive directors) which keeps the organizational structure of non-profitable organization strong since 1987.

When it comes to funding, all the services offered in the agency are absolutely free. Therefore there is no income generated through the agency. Neeru Singal said that most of the funding is obtained from different levels of government and charitable organizations. I believe fundraising is the most common tool to get financial support; therefore the management should get involved in fund raising activities frequently. However, if management spends a lot of time on fundraising then the services will be affected. Political Climate is something that will make a huge impact on funding. Currently, Brampton Multicultural Community Center obtains most of its funding from the regional government (region of peel) and grants from the federal government. Neeru Singal mentioned that the government’s support has been going down since few years and the agency is not having enough funds to provide special services to their newcomer settlement program.

Method of service delivery

There is no direct or indirect delivery methods associated with the services provided by Brampton multicultural community centre. Existing clients and newcomers will have to visit the agency in order to get started with the programs. I have looked at several flyers and brochures that have information about the current programs. It is also a really good tool for promoting those programs to new clients. There is a particular order to get involved in every program. For instance, consider the Social Service Program (SSP). The clients have to attend an information sessions first and register for the programs. Then they go through several sessions such as skills Training & assessment, Computer Training, Resume preparations, Interview Skills, Workshops & information Sessions and Job Search Support Activities. By using this approach and providing these types of quality services, it will surely develop the clients’ skills and abilities and help them settle commendably.

Pertinent legislation that affects the agency

There are a lot of legislations that affect Brampton multicultural community centre. I expanded on three acts briefly to give an idea of how it affects this non-profit organization. Firstly, this agency is well-known for their settlement programs for new immigrants. Therefore, the Immigration Act, created in 1976 affects the most. This act gave provinces to set their own immigration laws which makes more people immigrate or not immigrate, subsequently increasing or decreasing the number of newcomers looking for settlement assistance. Secondly, the Income Tax Act lets the charitable corporations to register themselves as charities with the Canada Revenue Agency. This will allow the corporation to issue “official tax-deductible receipts” to the ones who contribute to their cause. If more people contribute to these charitable corporations (non-profit organization), there is more revenue being generated, thus helping the NPO’s to offer more quality programs. Thirdly, Canada Not-for-Profit Corporations Act gives the non-profit organization s more legal responsibility by the modern corporate governance framework. This act will also make the government sector more independent and help making it a government partner.

Effectiveness and efficiency review

I have looked at some of the feedbacks from clients regarding the settlement programs. All the reviews had positive responses which answers why this organization has been successful since 1987. Neeru Singal has repeatedly mentioned a lot of clients are loyal to their agency and they are very satisfied with the services offered. She also pointed out that clients often donate to this agency after getting a good job. As for my opinion, I would give this agency a perfect score, firstly, because she let me interview her for 30 minutes and secondly, because of the services offered and a high satisfaction rate.

Your thinking about the future needs and direction of the agency

I asked Neeru Singal if they are going to add more programs and she replied “we are currently doing okay, but we are considering adding 2 more programs by 2013” In my opinion, I think this agency is doing what they have to do in order to achieve their mission statement. They should add programs such as debt counselling (consider something other than the newcomer concentration) in order to increase the number of services offered. They should also enhance the quality of services offered now which will result in more clients dropping in but they should also try to increase their budget cap because she mentioned there has been a decrease lately. Therefore, if the agency can achieve their mission statement by adding unique programs (something not just for the newcomers) and getting more financial support, they will definitely make their vision statement come true.

Table of Contents

Background

Objectives

Proposed Actions

Anticipated Outcomes

Key roles and responsibilities

Timelines and resources required

Key risks

Evaluation Method

References

Background

Drugs and alcohol is a major social issue (J. David Hawkins, Richard F. Catalano, and Janet Y. Miller, 1992). It is not something that can be solved by the law (Lee P. Brown, 2008). Throughout history, many attempts have been made to try and legalize and control alcohol and drug addiction but has failed.

It requires education, international awareness and a lot of work to resolve. Whilst alcohol and certain drugs are not illegal, the potential dangers are well documented. It is in many regards, worse of a problem than other social problems such as smoking. Not only does it create health problems, but creates a habit from a young age that is hard to avoid (Kabir Ayub, 2011). This affects families, schools and the larger part of society. It creates a burden for law enforcers, violence, accidents and a lot of other side-effects.

Drugs and alcohol have especially been a major issue in NSW full of pubs and night life. Major incidents of violence at many locations have been recorded. The number of police officers required to monitor and deal with incidents have greatly increased since 2011. New laws, curfews and extreme measures had to be put in place (NSW Government, 2014). This shows that inaction is a major cost to society and is a major burden on the government and law enforcers.

Local Christian Churches have been chosen to address the issue. Drugs and alcohol is an international social problem that is very hard to tackle. The local Christian communities serves as a good attempt to address problems in the local community.

Studies have shown that peer influence is a major factor in drugs and alcohol abuse (Karl E. Bauman, Susan T. Ennett, 1996). The church will be able to put a positive influence back to society to help change this issue. The church (religion) is and has been a major influence to society. Religion helps shape lives.

Objectives

The key objectives in this action plan are to raise awareness about drugs and alcohol and to create a series of events to reduce the consumption of drugs and alcohol.

In raising awareness of the adverse effects of drugs and alcohol, we hope to increase public understanding of what they are, the potential harm and the damage it has caused to our society.

Local churches often run campaigns to promote Christianity and raise awareness of their religion. It would be viable for them to continue as is, but include flyers and other advertisements that target alcohol and drugs.

Through a series of special events, such as alcohol free nights, we create incentives for those addicted to drugs and alcohol to attend and make it a habit to reduce consumption of drugs and alcohol. These events are aimed at providing the first steps for affected people to adjust to life without harmful substances.

It is business as usual for local churches as they already run local community events. Running alcohol and drug themed campaigns fits in with their schedule and aim to promote and improve the greater community. For example, a family bbq gathering can include an extra clause of being alcohol exempt.

The key theme is to use religion and the major influence of the church to shape lives, stop alcohol and drug abuse and to increase awareness.

Proposed Actions

Use of social media to link and highlight key media that raise awareness. Through official Facebook, Twitter and other accounts of the churches, social media is a strong platform to push information.

Door to door knocking and handing out pamphlets is part of a Church’s day to day activities (Archie Poulos, 2010). Within the advertisements, the church can embed information on drugs and alcohol to further increase awareness.

Anti-drug and anti-alcohol posters can be posted within the premise. Each time people visit the church they will be able to see these media items and gain awareness to the drug and alcohol problems.

Preaches every Sunday can be used to influence the followers on reducing consumption of alcohol. Religion is known to have a major influence and the voice of god is very useful.

Prayers will help those guilty of drugs and alcohol be persuaded to change and move away from these harmful substances.

Alcohol and drug free events can be introduced as part of normal family events and gatherings. Prizes and other rewards can be introduced as an extra incentive. Families can get together and share their experiences.

Anticipated Outcomes

The anticipated outcome is increased awareness in drugs and alcohol.

Social media activities such as Twitter and Facebook can easily be measured by likes, replies, retweets and other common statistics. This can provide numbers on the number of people have read and reacted to the postings.

The local community will be more aware of its harmful effects. They will be able to spread this out to other local communities via word of mouth to further increase awareness. The community will be educated to stop alcohol/drugs based violence and help report/resolve any incidents. Parents will be able to educate their children to prevent the next generation early on.

Another anticipated outcome is reduced consumption of drugs and alcohol. Alternatives such as soft drinks and replacements can take its place. Alcohol and drugs driven violence should be reduced. Families will increase in happiness.

This will reduce load on the community and even local council/government. This means funding and resources can be better spent elsewhere and further improve lives.

Key roles and responsibilities

Within a church, many of the staff are volunteers, including the door knocking staff. Different staff will be required for each action point. The organization structure is rather flat.

The media advisor will be in charge of coordinating the social media activities. They will be spreading the message via the church’s social media account.

Door to door knocking events will coordinated by the normal door knocking organizer.

Posters will be reviewed and signed off by the priest.

Alcohol and drug free events will be reviewed by the events coordinator.

Preaches and prayers will be reviewed by the priest.

The key is to add extra roles and responsibilities to existing staff.

Timelines and resources required

The church anticipates that the promotional campaign will run for a month and based on feedback may be extended. Most of the action points are ongoing and will be held in part every Sunday as part of the Church gathering and extended events.

Social media, posters and door knocking will be incorporated with day to day activities. The idea is to enhance and set the theme for the staff to work on – to add their current jobs.

No extra resources are anticipated except a potential external graphics design company to create the promotional poster.

All other efforts are conducted by current staff of the church, such as priests and other volunteers. Families are encouraged to help out as they normally would.

Extra funding is anticipated and this will be sourced from the church’s annual budget. The church does not expect a huge burden on the budget. The staff may have to put in extra hours to meet the deadlines to get this kick-started.

The local social worker can be contacted for further assistance and to attend special events to help the church out in assisting any attenders that do have actual problems in life with drugs and alcohol.

Local doctors would also be a useful resource in helping with providing material and assisting with drug and alcohol effects on the body.

Key risks

A key risk in raising awareness about drugs and alcohol is that it may get some people that were previously never interested to try the mentioned products based on curiosity.

Many people may be unwilling to identify themselves as an addict to drugs and/or alcohol. This may be due to peer pressure, family issues and others. This will make it difficult to convince these people to join the events created especially for them.

Preaches may be seen as some as propaganda campaigns and a way to control and restrict an individual’s freedom. Care must be taken at the wording, how it is addressed and it must be linked back to Christianity. Lack of attendance or feedback may also be an issue.

Over time people could be back to their old lifestyle.

Evaluation Method

An attendance count can be used to evaluate how many people are interested in the series of events. An anonymous informal survey can be used to further gauge the situation. This helps to evaluate how effective the proposed actions are and also direction for further action. A follow up survey months later can be used to see if lifestyle has changed.

Informal discussions and interviews can be had to see what effects it has had on lifestyle of people.

Social media feedback is the most evident and can generate huge discussions. There are many statistics used to measure the success of a social media campaign, such as the number of retweets.

The local police stations can be contacted before and after to determine if the number of reported incidents related to drug and alcohol abuse has decreased.

References

Lee P. Brown, 2008, Two takes drugs are a major social problem we cannot legalize them, US News, 25^th July, 10^th May 2014, http://www.usnews.com/opinion/articles/2008/07/25/two-takes-drugs-are-a-major-social-problem-we-cannot-legalize-them

Kabir Ayub, 2011, Drug addiction: A Social Problem!, 24^th March, 10^th May 2014, http://pamirtimes.net/2011/03/24/addiction-a-social-problem/

NSW Government, 2014, New measures rolled out to target drug and alcohol fuelled violence, 21^st February, 10^th May 2014, http://www.nsw.gov.au/news/new-measures-rolled-out-target-drug-and-alcohol-fuelled-violence

J. David Hawkins, Richard F. Catalano, and Janet Y. Miller, Risk and Protective Factors for Alcohol and Other Drug Problems in Adolescence and Early Adulthood: Implications for Substance Abuse Prevention, Psychological Bulletin Vol 112, 1992, 10^th May 2014, http://adai.washington.edu/confederation/2008readings/Catalano_86.pdf

Karl E. Bauman, Susan T. Ennett, On the importance of peer influence for adolescent drug use: commonly neglected considerations, Vol 91, Issue 2, pages 185-198

Archie Poulos, 2010, Doorknocking is fun?, 25^th Match, 10^th May 2014, http://sydneyanglicans.net/blogs/churchlife/doorknocking_is_fun

Social Action Plan: Group Name

Social Action plan: Team members:

Description of the Issue:

Objective 1: Increase Awareness of drugs and alcohol and its effects

Proposed

Actions

Anticipated

Outcomes

Key

Responsibilities

Timelines and

Resources

Required

Key Risks

Evaluation

Method

1. Use of social media

2. Door to door knocking

3. Posters in premise

Increase awareness

Promote awareness via social media

Ongoing, media/marketing staff

Lack of feedback

Social media feedback

Increase awareness

Promote awareness via door knocking

Ongoing, Door knocking staff

Not as effective in the modern age

Reception of door knocking

Increase awareness

Promote awareness via posters

Ongoing, need to get posters designed

Negative influence

Surveys

Objective 2: Use religion and events as an influence to reduce drugs and alcohol consumption

Proposed

Actions

Anticipated

Outcomes

Key

Responsibilities

Timelines and

Resources

Required

Key Risks

Evaluation

Method

1. Alcohol and drug free events

2. Preaches

3. Prayers

Reduce consumption

Take attention away from drugs & alcohol

Family event organizer

Lack of attendance

Attendance record

Reduce consumption

Influence to stop drugs & alcohol

Within a fortnight, preacher

Lack of attendance

Surveys

Reduce consumption

To share and remove sin/guilty

Ongoing, Priest

People hiding their issues

Improvements week-to-week

1 | Page

“A significant learning experience is one in which the student has acquired knowledge and/or skills or where the experience has informed or shaped the student’s social care values and beliefs”. Throughout the course of my placement there have been many cases upon which I have experienced significant learning. These include conversations with both staff and service users, as well as sitting in on various meetings and programs. The main learning experience I enjoyed was in relation to Personal Centred Planning folders or PCP’s.

“Personal Centred Planning is a way of discovering how a person wants to live their life and what is required to make that possible” (NDA, 2005). Personal Centred Planning primarily focuses on the person as opposed to a disability. It is about the whole person and their life, not just their disability. Personal Centred Planning is not an assessment of service users.

PCP’s are, an extremely effective method of helping service users meet their goals in life and also, for keeping track of their basic daily activities. It was a very interesting and useful method to learn how to use. Person centred planning is based on shared action, about finding creative solutions rather than categorising people and about problem solving and working hard over time to achieve goals. It’s about changing a person’s life (Sanderson 2000). PCP’s seek to craft a vision for a person’s life in which they can play an active role in their local community or any organisation of their choice. It also describes the action necessary to make this vision come through (McGinn & Cassidy, 2006).

This is accomplished through some basic stages. Firstly you must discover, understand and then address the core issues for the individual involved. Secondly you must explore choices available to the individual before you then alert and involve the individual’s entire social network. A balance must then be reached between what is important for the individual and what is important for their social network. Ideally, the individuals goals for themselves are the ones most focused on and not the goals that the individuals friends and family have for them (McGinn & Cassidy, 2006).

There are six key principles that underpin person centred planning. These are that PCP’s are an individual’s perspective, creative approach to planning, uses all the resources available to the person, requires serious and genuine commitment, an art and not a science and that the development of the plan is not the objective. There are also several advantages to using Person Centred Planning. Some of these are that it sets out important goals for the future, provides a forum to make choices, it provides encouragement and support and may be viewed as a lifelong process and support (McGinn & Cassidy, 2006).

“Person Centred Planning is based on completely different way of seeing and working with people which is fundamentally about sharing power and community inclusion (Sanderson, 2000). A good caring service mobilises all its resources to assist people with disabilities to increase control over their lives. They also set goals that are personally meaningful and express personal preferences. They offer guidance to the individual. It is only through organisations like this that the PCP’s are a success (McGinn & Cassidy, 2006).

There are many issues to be considered when supporting people who have difficulty in making choices. Some of these issues are if you take a different perspective than that of the person, if you develop a different understanding of the person and risk assessments must be carried out. The service user also requires certain support and assistance from the PCP process. Some of these include interpreting the environment, understanding other people’s expectations and conditions for cooperation and to figure out satisfying ways to pursue what they want (McGinn & Cassidy, 2006).

Person Centred Planning has one plan per person. The service user’s key worker drives the process. The first step the key worker must take is to get to know the person. This includes getting to know their personal history, family, friends, health, hobbies and other personal details. You must talk to the person in order to gather this information. You must observe them in their natural environment too in order to get your own vision of the persons personality. A good way to add to this vision is to speak to the persons family and friends to get other opinions of the service user’s personality and goals in life. Finally reviewing previous documentation on the service user will give you other opinions on the service user, this time from a professional view (McGinn & Cassidy, 2006).

The second step is to discuss the persons own goals and dreams for the future with them. This involves sitting down with the service user in what they feel is a safe environment, so that they can reveal their dreams to you without feeling threatened or embarrassed about them. You then document the service user’s goals in their PCP file and move onto step three which is to plan a meeting. The meeting is entirely the service user’s choice. They get to decide who attends, where it is, when it is and what exactly will be discussed. It is simply our job to facilitate them by giving them any help or support they might need. The meeting itself is then step four. In the company of the service user and whoever they had wished to have at the meeting you work out what has to done is the coming weeks and months to achieve the service user’s targets.

The fifth and final step is to implement everything that had gone before. It is now that the staff starts working on achieving the agreed goals. Any progress gained should be recorded in a progress plan form. A review sheet must also be completed at the end of each month and at the six month review meeting (McGinn & Cassidy, 2006).

The staff involved in the Person Centred Planning process, play a crucial role and have extremely important responsibilities in ensuring the process is a success. “Person centred planning requires that staff adopt a flexible and responsive approach to meeting people’s changing needs and circumstances, guided by general principles of good practice rather than standard procedures” (Sanderson, 2000). It is important that the staff do not underestimate the scale of the task and should allow sufficient time for it to be completed. Initially the process involves identifying people who are likely to support the idea and then, running some information and basic training sessions for everyone likely to be directly involved, impacted or called upon for support (McGinn, 2006).

The unit manager also plays an important role in the Person Centred Planning process. “Managers have a significant role to play in enabling staff teams to adopt a person centred approach” (Sanderson, 2000). Sanderson advocates that managers extend the principles of person centred planning to their staff teams, in order to develop what she describes as person centred teams (McGinn, 2006). There are characteristics that a person centred team leader needs in order to be successful. Some of these include being able to bring the best out in people, having a clear vision and direction, encouraging personal involvement with the people being supported and investing in community connections (Sanderson, 2003).

The leader of this process needs to develop a very clear understanding of the key principles and processes of Person Centred Planning (McGinn, 2006). The leader must ensure that staff work together as a team and not as individuals which will only drag the process in different directions, accomplishing nothing. They must ensure that there is good, ongoing communication at individual plan level. It is also their job to maintain and update plans over time or assign somebody the role of doing so.

At a more general level, it is important to establish a routine process of monitoring, evaluating reviewing and developing the way person centred planning is being done, so as to ensure it is having a positive effect on lives and services. Every effort should be made to ensure that the role and responsibilities of every individual, group and organisation participating in the person centred planning process is clearly understood and agreed by them and adequately supported (McGinn, 2006).

Success will be achieved will the Person Centred Plan if the staff team ensure that the needs of the service user are met to the greatest extent possible, consistent with their responsibility to assess risks involved and ensure that they are acceptable and considered. It is also necessary that they build a closer relationship with the service user in order to become more acutely aware of their needs and wishes. The staff team must ensure that all risks are identified and action is taken to minimise them. They must seek to maximise opportunities for the service user’s self development, self esteem and independence in order to realise their fullest potential (McGinn, 2006).

Finally the role of the Key worker is crucial to the success of the Person Centred Plan. The Key worker’s objectives are to develop a close and positive relationship with the service user. They must also work co-operatively with other staff, family, external services/professionals etc, on the service user’s behalf to ensure that a quality service is provided. The Key worker’s team role is to enable the team to effectively support the service user. To do this the Key worker must listen to others, respect and support team members, maintain commitment and communicate effectively. The Key worker enables the service user to advocate for themselves, develop new skills and build enjoyable relationships with others (McGinn, 2006).

There are of course challenges to implementing Person Centred Planning. The need for everyone to develop a new perspective on people with disabilities is defiantly one of the larger ones. For a goal like that to be reached it will take a global effort and one that is not easily achieved. Other challenges include the need for a new general perspective on services, resistance to change and risks and learning curves (McGinn, 2006).

All of this was being carried out on a constant basis in RehabCare Cavan while I was there. Sitting in on meetings between the key workers and the service users was an eye opening experience. It also really stood out to me just how much Unconditional Positive Regard is used in services and why it is so crucially important in a programme such as Person Centred Planning. Without it the programme would be a complete failure.

The entire PCP programme worked well while I was on my placement. It was being managed very sufficiently and all staff members had an excellent relationship with each other. I personally felt that I helped the staff to show unconditional positive regard towards the service users when they were finding it tough. Most importantly I have learned and witnessed just how positive an impact the PCP programme can have on the service users when managed properly. Seeing the delight on service users faces when they achieved goals which would have been impossible without Person Centred Plans made me realise how much they need the programme and educated social care workers to manage it for them.

Critical Reflective Paper

My twelve week placement in RehabCare Cavan provided me with sufficient opportunities for learning and to enhance my social care knowledge, skills and values. Throughout the duration of my placement I enjoyed the experience of working with a vast variety of service users most of whom had disabilities and problems that were completely unique to themselves within the centre. I also had the chance to compare my skills as a social care worker with a number of people from different occupations including social care workers, community nurses and psychologists. They all both worked together as a team and then as individuals. Overall my placement in RehabCare Cavan was an immensely enjoyable and positive experience. There were however, a number of difficulties to deal with along the way. These included challenging behaviours from the service user’s and limitations from the staff. Altogether though, I believe my placement would not have been as educational had it not been for the combination of positive and negative factors.

The part of my placement which I feel most facilitated my learning was working with the inter-disciplinary team. This team consists of a list of professionals from different occupations and also collaborates with the parents or friends or next of kin for each of the service users. The service user decides who they wish to have present at the meeting from their family or friends. There are strong positive relationships between the different members of the team. At the beginning of my placement I found it quite overwhelming and complicated to understand how a team consisting of so many people managed to perform sufficiently and how mistakes weren’t made. I also struggled to understand how there was need for so many individuals and how they each had their own unique role within the group. At first I just sat in the corner of the room and observed the team meetings. I felt I didn’t know the clients well enough to make contributions and that the staff didn’t know me well enough to be able to justify accepting my contributions. It was my job for the first few weeks to simply sit, observe and analyse what was being discussed and proposed within these meetings.

Over the following days and weeks I started to become more familiar with the staff, the service users and the cases. I began to feel more confident interacting with the staff and service users and believed I had a place within the centre. I could see advantages of using the interdisciplinary team system, however I quickly realised too that mistakes were made. These mistakes were few though and no system or person is flawless so they were generally accepted as small human errors and rectified. Each team member had adequate knowledge of the other team members, their profession and their disciplines. This allowed each team member to answer questions and give guidance, even if was only to tell the person involved which team member was most likely to solve their problems. As my placement progressed I was able to become more involved with the staff as I became more aware and familiar with each case. By having the opportunity to observe and ultimately work with the different professionals involved I was able to gain valuable knowledge and skills relevant to each discipline which will prove valuable throughout the rest of my course and beginning of my own professional career.

One aspect of the service or the centre which limited my learning was unfortunately due to cutbacks. Due to lack of funds the service was severely understaffed which meant there was an extremely heavy workload on the remaining staff members. This in turn meant that there were long periods were they had work to do and I was unable to participate. During these periods I would socialise with the service users, talking to them, playing games with them and helping them in whatever way possible. Although from a professional perspective this reduced my learning experience, personally it greatly increased it. It was during this time that I got to know the service users, their likes and dislikes, their personal ambitions and most importantly, what it was like for them individually growing up in the community with their disabilities and how RehabCare has greatly improved their lives and self-esteem. I felt that it was this information that would help and inspire me to progress through my placement and academic years ahead.

While on my placement I took a leading role in facilitating a few programmes in particular for the service users. As I have a great interest in sport personally I became involved in all sport related programmes with the service users. Every Tuesday six service users went swimming and I accompanied them. I observed how much excitement and pleasure they got on a weekly basis out of this one simple activity. I also got involved with a soccer programme with the service users. As I have a good knowledge of the game I took some training sessions with them and helped them develop their skills. They are hoping to compete and win out a regional RehabCare Soccer tournament in the New Year.

I also became heavily involved in programmes that were not sport related. I helped set up a woodwork programme which had not existed before I arrived. I trained the service users in the basic skills of carpentry and through this they learned how to work on a project as a team, but most importantly they could see that they were making a difference and that their project was evolving into beautiful furniture. I witnessed a sense of pride amongst the service users that was almost unprecedented. A pleasure as small as completing a piece of furniture was enough to have them busting with pride for days. Overall the programme was a remarkable success. I am particularly proud of this group as I feel this is an area in which I was able to apply a lot of knowledge and skills to that nobody else in the centre could have.

One other Key programme which I participated in was the Writing skills programme. The activities or skills that were focused on during this programme were writing, pronunciation and basic maths skills. Under these heading we worked on different needs of each client which included spelling, counting and oral communication skills. As this was a continuous weekly programme I had the opportunity to observe these service users as week by week they worked in their weaknesses and I could observe a marked improvement from when I first arrived. I was able to monitor their progress and have evaluated that it was a very effective programme. I was able to contribute my knowledge towards the class which meant that more progress was gained in the same length of time.

One aspect which I feel contributed positively towards my learning was working with and witnessing the staff handle particular cases which involved serious and cautious matters involving the service users. Examples of these cases are when violence is threatened by service users or a case where one service user was being unfairly manipulated into giving away the money they earned on social benefit. The staff team in RehabCare are quite a close-knit team and conduct their work very professionally. Working alongside them was an extremely positive experience and I had no problems in asking them questions when I had queries. The staff all worked together in serious cases and did not just leave it to the service user’s Key worker. I could see that this was an extremely effective and positive way for them to operate as each staff member brought their own ideas and together they were able to formulate a plan more effectively than if it were just one of them. Initially I was too nervous to make contributions myself but as the weeks passed I began to make a few suggestions some of which were used in solving certain cases.

As a result of my experiences on placement I have significantly enhanced many of my social care skills and values and expanded my knowledge. One particular area in which I feel more confident in is my communication skills with a range of professionals and services, especially when communicating with people who suffer with intellectual disabilities. I gained experience and built my ability to show empathy and unconditional positive regard, particularly when being on the receiving end of insults. It is essential that social care workers have the ability to demonstrate empathy to allow them to be more responsive to the service user’s needs and build better relationships based on trust and honesty.

Learning about the Person Centred Planning approach was probably the most valuable information I gained. I saw firsthand how well the plan works when managed sufficiently. It is a goal based system, focusing on what the service user wants to achieve in their lives. It is person focused which is the secret to is success and why it is so popular.

The medication procedures in the supported accommodation branch of RehabCare were extremely interesting. The service user had to put their pills into an egg cup and then swallow them all. The support worker then had to check the service user’s mouth to make sure they were all swallowed. I realised then the extreme of the medication policy within RehabCare. I found it rather unsettling that the support worker had to look into the service user’s mouth to make sure the medication had been swallowed. Previous to distributing the medication each daily dose had to be counted to make sure that the pharmacy didn’t make any mistakes while distributing it. It was surprisingly frequent how often the pharmacy had made mistakes.

In conclusion my time spent on work placement has been an invaluable experience to me. I have learnt and developed many skills that will be a great attribute to me in my career as a social care practitioner. Some of these skills have included learning how to manage a Person Centred Plan, gaining practical experience in solving a wide variety of cases involving people with intellectual disabilities, improving my overall knowledge on disability awareness and most importantly learning that I can make a positive impact in any social care field that I wish to pursue. I am fully aware that becoming a successful, fully trained social care worker does not happen overnight but takes years of hard work and practice. However, seeing the positive impact that I can make of people’s lives with my career is the inspiration I need to go on and succeed. It is a long journey to get where I want to be, one that started years ago and is set to continue for a good time to come. This journey will change who I am, will change who I will become but only for the better. With the knowledge that I am gaining from my social care class, the lessons I am learning about myself I am sure that I will evolve into a fully competent and successful social care practitioner.

Personal Learning Account
Profile

For the purpose of this placement, I have received a position in RehabCare Cavan, working with the Programme Facilitators at the facility. RehabCare is the health and social care division of the Rehab Group. Their aim is to enhance the lives of all of their clients through the provision of high quality, flexible, person centred services. They presently provide and are developing a number of services, including Resource Centres, Residential Services, Respite Care, Supported Accommodation and Home Based Services for people with disabilities. The role of the Programme Facilitator in the facility is to report to the Community Service Manager through the Programmes Supervisor. The Programme Facilitators facilitate service users in their choices, developing programmes within the context of a person centred model of service delivery. The programmes may include independent living, personal development and occupational and leisure activities within the context of a quality of life model.

For this placement, there are a number of personal attributes and learned knowledge which will assist in getting maximum benefit from completing placement with the Programme Facilitators.

Some personal attributes which play an important role in the social care role are patience, understanding, kindness and the ability to apply learned knowledge to a specific situation. Having talked to one of the Programme Facilitators I also became aware that being open-minded, compassionate flexible and a good listener play particularly important roles in this service. These are all equally important attributes as at different times they can individually and collectively be the difference between dealing well any given situation in comparison to dealing poorly with it. Due to the unfortunate discrimination that, many of the older service users received when they were younger, the Programme Facilitator must take an understanding therapeutic approach when working with these service users. For this to be successful the Programme Facilitator must apply Carl Roger’s conditions for the outcome to be successful. Rogers created three conditions which a service user must believe are present before a therapeutic relationship can develop. These are empathetic understanding, congruence and unconditional positive regard (Sherry and Lalor, 2009).

The skills and knowledge that I gained through Creative Studies (both art and drama), will play a great role in helping me assist the Programme Facilitators, in trying to ensure the service users get the best experience possible from the service. Arts and Crafts as well as drama are programmes which receive a lot of focus from the Programme Facilitators at the facility. A good understanding of people with disabilities which I gained from modules, such as Issues in Social Care and Theories in Social Care along with, reading Applied Social Care by Perry Share and Kevin Lalor will assist me throughout my placement. Also the knowledge that I gained doing woodwork in secondary school will be of great benefit, as the Programme Supervisor is planning on starting up a woodwork programme for the service users but no Programme Facilitator has any experience in the field.

Communication plays a crucial role in working in RehabCare or any organisation which is designed to fit the needs of adults with intellectual disabilities. Listening is a function which we do every day without paying much notice to the information we are obtaining. However, in a facility such as RehabCare the ability to listen to clients and then digest what they are saying is of crucial importance. The ability to listen attentively to service users problems and concerns and to then support them in whatever form necessary is a skill that cannot be replaced. Considering the fragile state of mind of many of the service users you must always be compassionate when listening to them and your response must be swift.

Needs Analysis

Within the learning contract there are a number of objectives identified as part of key learning. Enclosed in the professional learning objectives, the task is outlined of using and critiquing social care theories. As a second year social care student I felt that it was important for me to identify theories and then critique them and recognise limitations within the theories structure and their application to real life situations. My personal learning objectives surrounded interactions with the service users. I was lacking confidence and very unsure of myself when I first started my placement. The staff were very supportive though and within a few days I found my confidence improved dramatically and with it so did my effectiveness in helping the staff and having a controlling but compassionate authority over the service users. I became firm and assertive when dealing with problematic service users and fights between them. I hope my abilities and confidence continue to grow in this area which will leave me in a very strong position by the time my placement is completed.

Showing Unconditional Positive Regard towards some of the service users is something I struggled with for the first few days. It was left difficult when service users were constantly rude, disruptive and fighting. I have felt myself improving though and believe over the next few weeks I will have perfected it. During my induction week I had numerous policies and procedures to familiarise myself with. There are policies and procedures regarding health and safety, fire evacuation, risk management, prevent and control, child and adult protection, swine flu, confidentiality, medication policy and staff supervision etc. A basic knowledge of these policies and procedures is paramount in order for me to play an effective and positive role during my placement.

Action Planning and Activity

Throughout the course of this placement, I shall partake in a number of activities with the service users, which will assist me in meeting my learning objectives. Areas of activity include practical work such as arts and crafts and woodwork while sports and drama both play key roles in the centre too. Communication skills and independent living skills have a high priority too, as RehabCare is an organisation, designed to bridge the gap from full support to independent living.

Assisting the programme facilitators in training the service users through these programmes, I felt I would meet my learning objectives. The programmes are usually done on a 10(service users)-2(programme facilitator and myself) basis. I will have several opportunities to practice my communication skills as I will have to give my input and express my opinion in different cases involving different service users and different programme facilitators. Through the communications programme I will also get a chance to train some of the users in the basic forms of communication, i.e. teach them how to, write a letter to a friend, use the telephone and practice various verbal and non- verbal communication skills.

During the placement it is highly important that I test a number of theories which I learned through academic means. Through applying theories to real life situations, and recognising when a theory is used, the applicability and usefulness of the theory should be examined. As a social care student, the ability to recognise the limitations within theories will assist in identifying the best practice for the service user. I can practice this in different programmes and in free time that I spend just talking to the service users.

Throughout placement knowledge of policies and procedures surrounding disability awareness will be obtained through dealing with the different cases and service users. I will have to familiarise myself with all government and RehabCare policies and procedures. I shall also become aware of them through hands on work throughout the duration of my placement.

Evaluation

A consideration of the learning goals following the completion of the placement, there is a sense of achievement as I believe all learning goals were reached and an in dept knowledge of disability awareness and the role of a programme facilitator were gained.

I believe I successfully completed identifying and applying theories. I was very happy with my supervision classes as I was able to discuss with my supervisor what I did well and what I did not so well. I was able to discuss troubling issues which I had witnessed and discover the background stories and mental reasons for such incidents arising. Treating the service users with empathy and unconditional positive regard proved crucial time and time again as I managed to keep the service users trust in compromising and threatening situations. It also allowed some of the service users to open up about their feelings and their lives. Due to their mental disabilities some service users wouldn’t disclose such information while others would have without being treated with empathy or unconditional positive regard. They didn’t know any different. An example of where these theories didn’t work was when a service user threatened violence against both myself and the staff members in the centre. This situation arose on numerous occasions.

There was a considerable improvement in my communication skills throughout my placement. I was slightly shy on my first day in the centre both with staff and the service users. It took me the length of the induction week to overcome this shyness and be able to give a genuine account of myself. By the time my placement was completed shyness was a problem of the past and communication was free flowing between me and the service users. An example of this communication is when I took programmes with up to ten service users and took a teacher like approach with them. I regularly took the writing skills programme which involved me stand

Although there is no widely accepted definition of persons with disabilities, twodefinitions can be found in the National Policy for Special Education in Pakistan: “Disability” means the lack of ability to perform an activity in a manner that is considered to be normal.

A person with disabilities means a person who, on account of injury, disease, or congenital deformity, is handicapped in undertaking any gainful profession or employment, and includes persons who are visually impaired, hearing impaired, and physically and mentally disabled.

The 1 998 Population Census defined the term disability as, Any restrictionor lack (resulting from an impairment) of the ability to perform an activity in themanner and within the range considered normal for a human being. Impairmentmeans any loss or abnormality of psychological, physiological or anatomical structure or functional”.

According to the census for 1998, there are 3,286,630 people with disabilityconstituting 2.54 per cent of the population (Bureau of Statistics, 1998). Thefigure is underestimated, as the definition of disability did not include moderateand mild disability. Data collectors for the census were not trained to identify andclassify all forms of disability.

Disability has often been regarded as a peripheral issue in discussions onhealth services. Despite a number of progressive policies included in thePakistan’s Constitution that declares equal rights for all, disabled people are stillregarded in the main as an insignificant minority. In the health sector particularly,they are regarded as cases to be cured, tailing which they are referred towelfare for care. I he denial of human rights, and the exclusion andmarginalization of disabled people is manifested in many forms within the healthsector.

To date in Pakistan, services for disabled people have been based on anunderstanding of disability as individual pathology, the disabled person beingseen as a problem to be corrected. Its development can be traced to the greatstrides in medical science and technology, which led many to believe that dysfunction, could be explained through rational scientific argument; the cause of any condition regarded as abnormal being attributed to the malfunction of a physiological system. Pathology thus provided the means by which “dis”-ability could be distinguished from able-bodiedness, “ab”norrnality from normality. Disability as malfunction has since grown to be seen as a specialized health problem, at the heart of which is an emphasis on clinical diagnosis. Consequently the aim of medical rehabilitation is to assist the individual to be “as normal as possible”.

in traditional societies such as Pakistan where education is low and economic development has not taken off, any disability among household members is normally concealed, especially disabilities acquired from birth or those developed soon thereafter. Intellectual disabilities and physical deformities arc perceived as stigmata since their existence could jeopardize the “family name”, which becomes especially important in societies with extended Families. The existence of any disability related to psychological concerns that results From congenital antecedents is considered a serious threat to a family’s social status. The family’s concern is related to the social discrimination that other people would likely demonstrate, which in the view of the family concerned justifies concealing the existence of such offspring.

Another reason why family events relating to disabilities are concealed relates to the “exchange” phenomenon in marriages, especially on the bridegroom’s side. The fear that other children in the family concerned may also carry genes which could adversely affect their progeny means that parents often will not reveal that such a person exists in the family, since it would be difficult For them to find spouses for their other, non-disabled children. Such fears are much greater fur families that are socially mobile or who have a relatively higher social status.

The Religious/Moral model is historically the oldest and is less prevalent today. However, there are many segment of society in Pakistan that associate disability with sin and shame, and disability is often associated with feelings of guilt, even if such feelings are not overtly based in religious doctrine. For the individual with a disability, this model is particularly burdensome. This model has been associated with shame on the entire family with a member with a disability. Families have hidden away the disabled family member, keeping them out of school and excluded from any chance at having a meaningful role in society. Even in less extreme circumstances, this model has resulted in general social ostracism and self-hatred.

In poverty-stricken developing society, like Pakistan, where additional hands are always needed to assist with family work, thereby supplementing family income, the existence of a person with a disability is considered a curse orunfortunate fate for the family concerned. The loss of family labor in addition to the diversion of family resources to care for the needs of a child with a disability usually results in additional fertility to offset the loss of that child’s potential contributions to family income. The assumed need for having additional children could lead to reproduction within a short interval to neutralize potential social pressure and possible social sanctions. In following this line of reasoning, the cause of the original congenital disability and the potentially adverse consequences of another pregnancy on maternal health are relegated to a position of lower importance than the need for reproduction.

In societies lacking social norms and institutions that should provide family support in terms of the socialization and rehabilitation of persons with disabilities, families are put under extra pressure owing to the heavy demands on their time to make up for this lack of support. The presence of a disabled person in a family is thus considered a life-long problem, because the person concerned is expected to remain always dependent on other family members for support. In addition, the person with a disability represents a loss of productive potential in terms of society. The social pressure to bear additional children who can help to support such disabled persons leads to enlargement of the dependent population. Further, in their haste to respond to social pressures, couples usually ignore the possibility of giving birth to yet other children with congenital disabilities. These attitudes are among the complex sociological perspectives involved in treating the subject of disabilities.

of consider these facts, The Tragedy/Charity Model is still exists in Pakistan which actually casts the disabled person forever in the “poor unfortunate” role, It emphasizes and encourages dependence on others rather than independence one might say it is a form of “killing with kindness” since if this is taken to extremes the disabled person may lose those life skills they had and become increasingly dependent. The disabled person is represented as “brave” and “admirable” solely because they live with their impairment, an object of pity and the focus of attempts to extort money from others in order to address the person’s extensive and expensive needs. There is little or no recognition of the potential for independence or of the role of the disabled person in selecting the services they need or want. however, important changes were to occur with the evolvement of the modern era profoundly influenced by the enlightenment.

One of the difficulties likely to be encountered is the negative impression created by the very widespread presence of disabled persons, whether neighborsor relatives, for whom no rehabilitative treatment is available. The problems of disability seem to be quite familiar to the general public in Pakistan, whereas there is little or no conception of solutions. It is not surprising in these circumstances that attitudes focus on helplessness and hopelessness. It will presumably be difficult to remove this impression before there has been a major upswing in the provision of rehabilitative services. Equally it will be difficult to provide facilities without a favorable climate of opinion. Attitude and provision must advance together.

Traditionally used by charities iii the competitive business of fund-raising, the application of the Tragedy/Charity Model is graphically illustrated in the advertisement on newspapers and televised Children in Need appeals in which disabled children are depicted alongside young “victims” of famine, poverty, child abuse and other circumstances. Whilst such appeals raise considerable funds for services and equipment which are not provided by the government, many disabled people find the negative victim-image thoroughly offensive.

The idea of if being recipients of charity lowers the self-esteem of people with disabilities. In the eyes of “pitying” donors, charitable giving carries with it an expectation of gratitude and a set of terms imposed upon the beneficiary. The first is patronizing; the second limiting upon the choices opens to disabled people. Also, employers will view disabled people as charitable cases. Rather than address the real issues of creating a workplace conducive to the employment of people with disabilities, employers may conclude that making charitable donations meets social and economic obligations.

This is not to advocate dismantling charities and outlaw caring, charitable acts, which enrich our society and bring badly needed funds. But we do need to educate charity managers and professionals to review the way they operate and ensure that funds are channeled to promote the empowerment of disabled people and their full integration into our society as equal citizens — requiring our respect and not our pity.

The specific type and amount of neglection against disabled children will vary depending upon whether it occurs within the family, in the community, in institutional settings or in the work place. There are however, several key issues that appear time and again when such behavior occurs. Most striking is the issue of reoccurring stigma and prejudice. From the date of independence to date in Pakistan many although not all communities have dealt poorly with disability. Cultural, religious and popular social beliefs often assume that a child is born with a disability or becomes disabled after birth as the result of a curse,’bad blood’, an incestuous relationships, a sin committed in a previous incarnation or a sin committed by that child’s parents or other family members.

A child born in a community where such beliefs exist is at risk in a number of ways. A disabled child is more likely to face extreme negative attitudes at birth and this increased risk for ignorance reappears throughout the life span. This behavior compounds already existing social, educational and economic marginalization that limits the lives and opportunities of these children. For example, disabled children are far less likely than their non-disabled peers to be included in the social, economic and cultural life of their communities; only a small percentage of these children will ever attend school; a majority of street beggars are disabled children. Disabled children living in remote and rural areas may be at increased risk.

in societies and including Pakistan where there is stigma against those with disability, research indicates that some parents respond with ignorance because of the shame the child had brought on the family or respond with violence because a lack of social support leads to intense stress within the family.

in Pakistan, while many parents are submissive towards children where no disability exists, when a disabled child lives in these setting his or her disability often serves to compound and intensify the nature and extent of the abuse. For example, a mobility impaired child may be less able to flee when physically assaulted. A child who is deaf may be unable to communicate about the abuse he or she faces to anyone outside his or her household, unless these outsiders speak sign language or understand the home signs the child uses. A child who is intellectually impaired may not be savvy enough to anticipate a parent’s growing anger or know when to leave the room to avoid being struck.

Regular observations of child rearing practices in Pakistan indicate that a disabled child faces increased risk as the result of child-produced stress, It is hypothesized that this cycle of increasing tensions can begin long before the child is diagnosed as having a disability. For example, a child with a hearing impairment may be regarded as disobedient; a child with vision problems may not make eye contact and appear to be unresponsive, a child with a neurological disorder maybe difficult to comfort or feed. Other researchers suggest that parents who become violent towards their disabled child are reacting not to the child’s condition alone, but to the social isolation and stigma they encounter from surrounding family, friends and neighbors.

Parents of disabled children often lack social supports as family and friends distance themselves; they can find no school willing to take their child or theylive in communities where there are few or no social services to help them with their child’s needs. It is possible that both child-produced stressors and social isolation are compounded to produce a stressful in a household coping with a disabled child. It is also true that not all households with disabled children in Pakistan are stress prone and even within the same communities there are coping mechanisms in some families that prevent this behavior, while children with identical disabilities in other households are subjected to burden. As with many aspects of negative attitude towards disabled children, at this point, much more research in Pakistan is needed to allow us to adequately understand the factors that inhibit or foster these attitudes towards disabled children.

The disabled child in a majority of household may receive less food, medical care or other services. This can be subtle, for example, parents or caretakers may wait a few additional days before spending scarce money for medicine or the child may receive less food or less nutritious food than his or her sibling. The low socioeconomic status of the family and the present inflation rate prevailing in the country may worst the situation a lot. Such neglect can lead to further impairments in a vicious feedback cycle in which the disabled child continually loses ground developmentally.

Such neglect may be further exacerbated by gender for example, in Pakistan mostly parents spend huge money for boy children’s disability that for girl children, despite the fact that disability itself affects equal numbers of males and females. Neglect, in the form of the lack of adequate medical care, less nutritious food or lack of access to related resources, is the apparent cause of these deaths.

In Pakistan as a general practice, the child is kept home to ensure his or her own safety, as parents fear that the child may be struck by a cart or abused by someone in the neighborhood. But in many other instances, even in educated and/or porch families a child is kept isolated because the family fears the reaction from other members of the community. As per treatment given by clergyman, children in some communities are kept shackled in windowless storerooms, hold hands and feet with iron chain, hot household courtyards or dark attics for night, often with little or no interaction, even by those within the household. Even in the next door neighbors may not know of the child’s existence. Here is a need to create awareness among parents to send their disabled in special schools, for this see Box No. 1 for this purpose.

When it comes to convincing Pakistanis that special education is important, especially the rural poor, the key individuals that arguments must be targeted toare parents. Parents must be persuaded that special education is valuable and necessary for their children with special needs.

School administration, social service and child advocacy agencies may be aware that a disabled child Is the victim of violence or neglect, but choose to keep that child in the household because there are few or no residential care facilities are available in the country.

The response of disabled children themselves to on-going violence within the home is dictated by a number of factors. They may be aware that this type of behavior is unacceptable, but fear loss of relationship with care giver or family member. While this is an issue for many children in violent households, for disabled children dependent on their abusers for physical care, communication with the outside world or other disability-specific concerns, these issues are more complex. S/he is also be aware that this type of behavior is unacceptable, seek to alert authorities, but are not listened to or believed.

Unfortunately, in Pakistan, individuals who work as teachers, attendants for disabled children, or help transport, feed or care for such children, are often underpaid, overworked and largely unsupervised. While many who undertake such career choices do so out of the best of motives.

Very few schools have mechanisms in place that allow students, parents to complain about victimization of these negative attitudes. This is all the more serious because in many areas of Pakistan and specially in rural areas there are only a handful of schools or educational programs that are available for disabled children. Parents/caregivers or children may hesitate to complain about abusive behavior in the school, fearing that they will be dismissed from a program when no alternative exists.

Mostly in Pakistan, Disabled children are often kept in environments that can only be described as inhumane. Institutions for disabled children are often at the bottom of government priority lists and lack adequate funding, consistent support or oversight from government or civil society. Institutions are often overcrowded, unsanitary and suffer from lack of both staff and resources which lead directly to avoidable suffering and below the growth standards.

The low pay, low social status, long hours and hard working conditions in many institutions means that workers are hard to find and administrators are quick to hire anyone. Background checks on personnel often are not done. This allows some individuals, intent on harming or exploiting children, to regularly seek work in such institutions. Because of lack of a registry or oversight of suchpredators when an abusive employee is discovered it is not uncommon for that individual to be tired from one institution and soon turn up working at another institution for disabled children nearby.

Compounding this, as noted earlier, individuals with disability and their families tend to be ftir poorer than other members of the population, and this poverty can severely limit the ability of disabled children and their families to afford light for their rights. The large number of disabled children and their families who live in poverty also reduces that number of disabled young people able to afford related private special schooling.

Because disabled children frequently receive no formal education or low quality education, their working lives often begin earlier than those of their nondisabled peers. Furthermore, because they are rarely trained or apprenticed for a specific trade or skill, they are often sent to work at the most menial jobs, constituting some of the harshest forms of child labor. While it is known that many disabled children are in the workplace, little information on these children exists because most find work in informal sectors of society – as house servants, farm workers, in shops or in factories.

Honestly speaking, in Pakistan, documentation of this attitude against disabled children in the workplace is therefore absent or very rare. However, knowledge from other realms of disability research can provide some insight. For example, those disabled children who are unable to work as quickly as their non- disabled coworkers, or those who are unable to hear to understand or follow directions, are at risk of being insulted and bullied. Because finding and keeping work for individuals with disability is difficult in most societies (i.e.: even in developed countries, the unemployment rate for adults with disability often is above 80%) disabled children and adolescents have little voice in the workplace and are at risk not only for physical and verbal abuse, but are also less likely to report such abuse or to quit should they be abused.

In Pakistan, especially in rural areas and also most of the developing and under developing countries, the most common form of employment outside the household for poor disabled children may be begging. Disabled children are regularly used to generate income through begging. Some are placed on the streets to beg by their own families, some are sold by their families to others who keep stables of disabled children in organized rings of beggars. Either way, reports and anecdotes from dozens of countries indicate that such children are routinely subjected to violence both in order to keep them on the streets and once on the streets, by members of the general population, who see such children as easy prey.

In more recent times, however, the notion of ‘disability’ has come to be conceptualized as a socio-political construct within a rights-based discourse. The emphasis has shifted from dependence to independence, as people with disability have sought a political voice, and become politically active against social forces of disablism. Disability activists, in engaging in identity politics, have adopted the strategies used by other social movements commanding human and civil rights. And these strategies have brought gains, but within certain limitations.

In Pakistan, from the mid 1980’s, the country has enacted legislation which embraces a rights-based discourse rather than a custodial discourse; and which seeks to address issues of social justice and discrimination. The legislation also embraces the conceptual shift from disability being seen as an individualized ‘medical problem’ to rather being about community membership and participation, and access to regular societal activities such as employment, education, recreation and so on. Where access is inappropriate, inadequate, difficult or ignored, advocacy processes have been initiated to address situations and promote the people’s rights.

Yet, rights-based discourse, although employed as a political strategy, has also become a way of constructing disability by locking people with disability into an identity which is based upon membership of a minority group. Entitlements thus become contingent upon being able to define oneself as a person with disability. And the conceptual barrier between ‘normal’ and ‘abnormal’ goes unchallenged, so that while one may have entitlements legislatively guaranteed, ‘community’ which cannot be legislated for, remains elusive.

While rights-based discourse, at a strategic level, has brought some additional entitlements to people with disability, it has not significantly altered the way in which disability is constructed and so, despite legislative changes, some people’s lives have not necessarily changed. Rights-based discourse fails to meet these challenges for, rather than seeking to dismantle the entire concept of disability, it actually relies upon such a construction to support its claims for rights and entitlements.

Part of the problem with the subject of education of disabled children in Pakistan is that it suffers from a lack of identity as a discipline or part of a discipline, and it operates in relative isolation from other relevant disciplines. Therefore it does not benefit from the research in other disciplines, and lacks accountability. An alternative approach would aim to acknowledge these difficulties, to draw onother disciplines where relevant, and to locate the subject within a development framework.

HOW WE IMPROVE THE SITUATION:

Improvement shall only be possible when we will work on each and every sector which prevents disability to its severe consequences. The following discussion highlights some of these areas.

1. Prevention:

The majority of disabilities are preventable. There are, however, a number of reasons why there is a failure to prevent disabilities in Pakistan. Although there are a number of policies aimed at preventing disabilities, there is no coherent coordination between the various government departments to ensure that these policies are properly carried out. Also, there are a number of areas in which policies should exist, but do not.

It is recommended that the Ministry of Health, in consultation with other relevant departments and the Directorate General of Special Education (DGSE), facilitate the development of a National Inter-SectoralDisability Prevention Strategy that will set national norms and minimum standards for the prevention of disabilities.

2. Public Education and Awareness Raising:

One of the greatest hurdles disabled people face when trying to access mainstream programs arc negative attitudes. It is these attitudes that lead to the social exclusion and marginalization of people with disabilities. Negative attitudes are continually reinforced. Disability is portrayed as a ‘problem’ People with disabilities are viewed as helpless and dependent; as ill and in constant need of care and medical treatment, or as tragic victims.

Culture plays an important role in the way we relate to people with disabilities. This contributes to the perception of people with disabilities as different or ‘outsiders’. The changing of attitudes is not something that happens automatically or spontaneously. Attitude changing is a complex process which involves moving, in a series of stages, from one set of attitudes to another. Public education and awareness are central to the changing of attitudes.

3. Health Care:

Appropriate, accessible and affordable health services at primary, secondary and tertiary level are essential to the equalization of opportunities for people with disabilities. Such services should include general medical and nursing assistance on an in-patient, out-patient or community home care basis, and specialized health professional assistance.

4. Rehabilitation:

Access to appropriate rehabilitation services can make the difference between leading an isolated and economically dependent life and leading an economically independent life and playing an active role in society. The main policy objectives should be: to enable peo5le with disabilities to reach and maintain their optimal physical, sensory, intellectual, psychiatric, and/or social functional levels; to provide people with disabilities with the tools to change their lives and to give them a greater degree of independence; to prevent secondary disabilities or to reduce the extent of disability; to take into account the specific needs of different disability groupings.

5. Assistive Devices:

Assistive/rehabilitation technology enables individuals with disabilities to participate on equal terms. If people with disabilities are to access their rights and responsibilities and participate in society as equal citizens, they must have access to appropriate and affordable assistive devices.

The production, supply and maintenance of assistive devices are presently uncoordinated. Imported devices are steeply taxed, making them very expensive. Initiatives to develop appropriate and affordable assistive technology have, to date, taken place in isolation from general technology development (i.e. they are aimed at a ‘special market’), with very little participation by consumers, or collaboration between the various sectors and agencies.

With the assistance of modern technology, products should be developed for use by people with a range of different disabilities. The aim should be to reduce costs by producing for a larger market. This may require greater standardization of products.

6. Barrier Free Access:

The way in which the environment is developed and organized contributes, to a large extent, to the level of independence and equality that people with disabilities enjoy.

There are a number of barriers in the environment which prevent disabled people from enjoying equal opportunities with non-disabled people. For example:

structural barriers in the built environment; inaccessible service points; inaccessible entrances due to security systems; poor town planning; and poor interior design.

It is recommended that the Department of Public Works, in consultation with the National Environment Protection Agency (NEPA) and other stakeholders, develop national guidelines and minimum norms and standards with regard to barrier-free access.

7. Transport:

There is a need for rapid progress in developing a public transport system that is flexible and accessible. Without this, people with disabilities will continue to remain largely ‘invisible’ and unable to contribute to, or benefit from, the services and commercial activities available to most of their fellow citizens. Given the fact that the ability to use services, or attend school or work, is largely dependent on the ability of people to get there, the lack of accessible transport is a serious barrier to the full integration into society of people with disabilities.

A large proportion of the population uses the bus services as their chief mode of public transport. Policy makers tend to focus on wheelchair-lift equipped buses when considering access. There are, however, a number of low-cost accessible features that could be considered in the short term.

Dial-a-ride services have proven particularly popular in densely populated areas. The primary distinction between this service and existing services operated by welfare organizations is that people are able to use the service for any purpose, whether to work, school or for social reasons.

Although the major airports in Pakistan have introduced extensive upgrading projects to make their facilities more user-friendly, smaller provincial and regional airports still remain extremely discriminatory against disabled commuters. This is, in part, due to a lack of information on national guidelines and minimum standards and norms. The larger airlines have introduced personnel training programs to facilitate a more sensitive service from airline staff.

8. Communications:

Sign Language is the first and natural language of Deaf people, whatever thespoken language of his or her hearing parents may be. Sign Language is thecentral focus of Deaf people’s human rights. It is important to note that Sign Language is a language in its own right, with its own grammar and syntax. Sign Language uses the modality of space, in contrast with the spoken language which uses the modality of sound. There are several regional variations of Sign Language in Pakistan.

Special Language Systems/Augmentative and Alternative Communication refer to any mode of communication used by people who can not use a spoken or sign language. They include Braille, touch, Bliss symbols or other means of communication.

Interpreter services are linked closely to the communication needs of Deaf people and people with limited or no speech. These services enable them to communicate freely with society, and arc an essential clement in the achievement of equal opportunities for people with communication disabilities. They include Sign Language interpreters, lip speakers,

Depression in single, married and widowed/divorced employed mothers

Mental health is gradually becoming a focus in today’s society. Women are diagnosed with mental illness two-to-one compared to men. Some hypothesis to the reason for these unequal statistics include hormone differences, cultural stifling of women’s creative expression leading to maladjusted coping mechanisms, or misdiagnoses by sexist doctors (News for Healthy Living, 1999). A woman’s circumstance highly influences her likelihood of developing an anxiety disorder. This paper will analyze the prevalence of mental illness, especially anxiety disorders and depression, among employed mothers who are either single parents, in a heterosexual marriage, or widowed or divorced.

Afifi, Cox and Enns found that married women suffer from the fewest psychiatric conditions, never married women slightly higher, and divorced women have significantly the highest number of psychiatric diagnoses (2006). This is possibly because married women often have far less risky behaviors and lower mortality rates than their unmarried counterparts (St. John & Montgomery, 2009). Financial hardships, low wages, working multiple jobs, unemployment, and lack of social support, contribute to depressive symptoms, though they have different effects on women with different relationship situations (Wang, 2004). These situations are merely predictors of depression not deciders and will affect single and married mothers differently. Single, widowed and divorced mothers will have higher stresses, and therefore depressive symptoms, relating to financial issues. While married women will have depressive symptoms more related to their relationship. People in unhappy marriages or those who are not satisfied with their partner may have high levels of depressive symptoms. Even more, being dissatisfied with one’s living partner is correlated with depressive symptoms in women (St. John & Montgomery, 2009).

The coping mechanisms which are often associated with depression in married, single, and divorced or widowed women are generally negative and harmful to both themselves and their social relationships. Depression and alcohol problems are often co-morbid in both single and married women (Kelly, Halford, & Young, 2000). In addition, depression and coping mechanisms often negatively affect the relationship between married women and their spouses. Depressed women and their partners report more destructive and inefficient ways of conflict communication and resolution (Heene, Buysse, & Van Oost, 2007). More effective interventions should be reviewed to address not only the cause of the depression and depressive symptoms, but to introduce more operative coping mechanisms.

Single Women and Depression

Single employed mothers have a wide variety of stressors in their lives. These stressors are associated with a higher probability of developing an anxiety disorder, especially depression. Low income, low education, family size, and ethnicity are stressors which are highly associated with depression for single mothers (Afifi, Cox, & Enns, 2006). The main stressors of a single mother’s life are centered on her children and being able to provide for them. Those who were forced to work more than one job to provide for their family, especially those who were non-white, had an increased risk of developing major depressive disorder than their married counterparts (Wang, 2004). Often, the choice between spending more time at work and more time with their family is not a difficult one and does not add to the distress felt. Ethnicity however is a stressor in every sphere of life and is often linked to lower educations, lower wage, and discrimination. It is possible that non-white single mothers are not distressed about their ethnicity, but about the situations their ethnicity forces them into with regard to the ability to provide for their family.

Reducing stressors, and therefore depressive symptom risks, is important to curb the anxiety disorders and depression among employed single mothers. Non-traditional sex-role attitudes, more time at work, higher income, low work-family strain, and high self-esteem are associated with lower levels of depression among single mothers (Keith & Schafer, 1982). All of these situations allow for greater opportunities for a woman to provide for her family, thus creating a less stressful lifestyle. However, managing stress and depressive symptoms is also an area to be involved in. Single mothers are more likely to use mental health care services than their married counterparts (Wang, 2004).Whether this is because they have a less stable social support network, or married women feel ashamed for needing these services is unclear. However these statistics are only significant before the age of 50 (Wang, 2004). This is possibly linked to the aging of the children and the support the single mother received from her adult children she no longer must support.

Married Women and Depression

For married women and mothers, stressors and triggers of depression focus less on providing for their family and more on their interactions and self-sacrifices for that family. Married women spend approximately 40 hours a week doing household chores (to a man’s 17), that is a 70/30% split (News for Healthy Living, 1999). These statistics hold true for both employed women and housewives. The increase stresses of having to be both a financial and domestic provider is a key reason married women develop depressive symptoms. Married women cite losing the opportunity to pursue higher education or dream careers due to expectations of maintaining a household and family as one of their major causes of depression (St. John & Montgomery, 2009). Even when a woman does hold a job, she feels that her income is less important than her husband’s (which is usually higher). In these situations, she is often more distressed by her husband’s performance than by her own (Keith & Schafer, 1982). Often, increased involvement in leisure activities appear to be negatively associated with well-being, suggesting that further structured time commitments beyond those to her family may be more stressful than helpful for a married mother (Janke, Nimrod, & Kleiber, 2008).

Positive work orientation, high self-esteem, less time spent at work and higher satisfaction with both domestic tasks and their partner and relationship were linked with lower depression rates among married mothers (Keith & Schafer, 1982). Partner satisfaction is an important reducer to the stresses, and ultimately depressive symptoms, in a married mother’s life. There is significantly less martial adjustment and cooperation in marriages with at least one depressed partner (Heene, Buysse, & Van Oost, 2007). Whether this is the cause or the result of the depression however is unclear. Drinking is a common form of stress control among married women; however this often leads to more stressful situations. Reductions in excessive drinking behaviors led to a modest improval in martial satisfaction rates and decreased depression (Kelly, Halford, & Young, 2000). One of the highest causes of stress in married mother’s lives is their over commitment to their surrounding friends and family. It has been shown that decreasing the number of unsatisfying social connections, such as clubs and other leisure activities, may increase a married women’s mental health (Janke, Nimrod, & Kleiber, 2008).

Widowed and Divorced Women and Depression

While single (never-married) and currently married mothers have similar prevalence rates of mental health disorders, widowed and divorced women have a much greater occurrence (Afifi, Cox, & Enns, 2006). Separated and divorced mothers have higher instances of diagnosable anxious-misery disorders including depression, dysthymia, general anxiety disorder (GAD), post-traumatic stress disorder (PTSD), and antisocial personality disorder, while widowed mothers have much higher instances of PTSD and major depressive disorder (Afifi, Cox, & Enns, 2006). For widowed women the personal bereavement period and the psychological stresses of losing a spouse are often detrimental enough to trigger depressive symptoms or a depressive episode, especially in older women. Divorced women however are triggered not by losing their spouse, but by the process of divorce itself. A more hostile divorce will lead to greater instances of anxiety disorders as more negative interactions with a spouse is associated with depression (Afifi, Cox, & Enns, 2006).

Social support after being widowed or divorced is often lacking and needs to be cultivated to provide widows and divorcees with the means to combat their depression. Rates of adult engagement in pleasant activities have been link with subsequent decreases in levels of depressive symptoms (Janke, Nimrod, Kleiber, 2008). Isolation is prevalent after a spouse has died or left a woman, especially if she has children. She must now learn to provide for her family without her partner, and often times, without her main support system. More social contact, especially in the form of leisure activities with women their own age is recommended for widows or divorcees with depressive symptoms or on the edge of developing symptoms of an anxiety disorder (Janke, Nimrod, Kleiber, 2008).

Depression Interventions

Single, married and widowed or divorced mothers all have different stressors and triggers of depressive symptoms in their everyday lives. Each woman should ideally have an intervention created specifically to her socioeconomic status, relationship level and needs, child situation and other stress-inducing lifestyle characteristics. However, there are a few general guidelines about depression interventions in women which may apply to all categories. Distress, especially in relationships, is common in women with alcohol problems. These women report low confidence about resolving disagreements with their children, bosses, and/or partners (Kelly, Halford, & Young, 2000). Alcohol use and abuse is also co-related to high rates of spousal aggressive and instances of excessive drinking in response to conflicts. While alcohol interventions alone improve relationships within the first 12 months of the decrease in drinking behavior, relapse often occurs if the original cause of the depression is not addressed and more viable coping mechanisms are not introduced (Kelly, Halford, & Young, 2000). Women need to focus more on themselves, their inner growth, family and friends with whom they have close connections before over extending themselves; this could mean either eliminating unnecessary social connections or creating them depending on one’s situation (Janke, Nimrod, & Kleiber, 2008).

Communication is the largest mechanism for combating stress and depressive disorder is women of all relationships levels. Women are more likely to express demands in relationships, whereas men withdraw themselves, and failure to have these expressed demands met often lead to feelings of hopelessness and depression (Heene, Buysse, & Van Oost, 2007). These lower levels of communication, which could include avoidance or varying demand/withdrawal relationships, lead to little conflict resolution, less constructive communication and problem solving skills, more avoidant or ambivalent relationships in couples and often fosters depression or other anxiety disorders (Heene, Buysse, & Van Oost, 2007).

A common place for miscommunication is relationships, especially marriages, is the performance of household chores. Keith and Schafer found a significant link between satisfaction over housework and the mental health of married women suggesting that homemaking may have a greater important when both spouses were equally present (1982). The traditional sex-roles which often survive in marriages lead to greater depressive symptoms and depression in married women, whereas non-traditional sex-role attitudes have been shown to decrease depression in single women (Keith & Schafer, 1982). It is not keeping the home which leads to the depressive symptoms, but the division of the work. The bigger the woman’s share of home responsibilities when compared to her partner the more likely she is to feel distressed and depressed (News for Healthy Living, 1999).

Conclusions

Single, employed mothers most often experience distress and depression relating to their financial situations and their ability to care for their children. Married women usually experience this distress relating to their relationship with their partner and the things they were forced to give up for their marriage. Widowed and divorced women’s distress is generally focused around changing familial roles and the loss of familiar social support systems. Depression is more prevalent in widows and divorcees and least prevalent in married women, though this many have to do with the stress inducers of each group and the economic depression of the time period (St. John & Montgomery, 2009).

While the stressors of these women are all different, some common interventions are useful. Self-esteem is a large factor is all depressive symptoms and in the development of depression. Interventions aimed at increasing a woman’s self-esteem will be useful for all relationship levels (Keith & Schafer, 1982). Depressed women have higher levels of attachment insecurity and therefore decreased conflict resolution skills, it is not clear however if the depression causes the decrease in relationship effectiveness, or the dysfunctional relationship is the cause of the depression (Heene, Buysse, & Van Oost, 2007). Carefully selecting relationships to cultivate is important, whether growing new social support networks or strengthening existing ones, over or under stimulation socially is a large cause of depressive symptoms in women and mothers. A large conflict between work and home roles is a significant predictor of depression in women, so dividing the housework evenly among partners will significantly reduce the occurrences of depression (News for Health Living, 1999; Wang, 2004).

While depression will always occur in relationships, due to work and home stresses, from the burden of caring for children, and as a result of changes in a person’s life; knowing the proper way to combat those stressors will significantly reduce a women’s likelihood of developing depressive symptoms or anxiety disorders and allow them to pursue healthy and fulfilling relationships.