Author: Andre Coleman

This review will consist of an introduction, aims of the review, and methods of data collection, findings on a series of questions and answers on the extent of service user involvement in the discharge process, conclusions, and possible recommendations for change. It will conclude with a reflection piece.

The following review will discuss the issue of service user involvement in the discharge/transfer procedure. The review was compiled by the author within a nineteen bedded Forensic Mental Health unit. The ward was at full capacity at the time of writing this review.

The service users’ all had different levels of mental illness, each with a different history, level of cognitive awareness, degree of institutionalisation and willingness to adapt and change. This review will assess to what extent service users are involved with the discharge planning process in the ward, if any, and give possible recommendations on how this process may be improved.

Aims of the Review

During this placement the author decided on a subject to review, this subject was service user involvement in discharge planning. While collating information for the review some questions arose these questions were:

Does the service user feel included in decision making?

How does the staff involve the service user in the decision making if at all?

Has discharge been discussed with the service user?

These questions lead to the author constructing some key questions to carry out in the review these will be discussed further in the findings.

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Methods used to construct review

The data for the review was collected over a ten week period within the ward. The author consulted service users’ notes, attended multidisciplinary team meetings and conducted a series of semi-structured, one to one interviews with service users and staff, including a consultant, doctors, ward manager, nurses, nursing assistants and occupational therapists.

A literature search was also carried out using accredited databases including CINAHL and the British Nursing Index. Relevant journal articles were found on these databases using keywords such as service user, involvement and mental health services. Nursing research books were also used to gather information along with web sites underlining national policies and models for mental health nursing.

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Findings

How are decisions made within the placement area regarding discharge planning?

A Forensic Mental Health Unit is not part of the prison services it is a service that specialises in the assessment and treatment of people who have a Mental Disorder. According to the Mental Health Care and Treatment Act 2003 a mental disorder is an illness such a personality disorder or learning disability defined by the act, whereby the mental disorder has been a contributing factor to the person offending.

Throughout the weeks on this placement research was carried out by the author on policies and procedures for discharge planning. The one in particular that was found to be relevant was the Care Programme Approach (CPA). CPA is about early identification of needs, assignment of individuals or organisations to meet those needs in an agreed and co-ordinated way and regular reviews of progress with the service user and care providers. CPA is also about involving family or carers at the earliest point. The Care Programme Approach requires that service users should be provided with copies of their care plans and it has been increasingly common for service users who have been the responsibility of forensic psychiatrists to have copies of documents relating to their care. (DOH 2008).

Systems were in place for comprehensive care planning. There was evidence to show that the service users’ social, educational and occupational needs were taken into account in the care planning process and other specialist interventions were available.

In addition to this, in some cases, discharge/transfer planning was evident from an early stage (not long after admission), although in other cases a few months had elapsed before any document noted those discussions. Discharge planning is enhanced by the Care Programme Approach (CPA) a multi-disciplinary care planning systematic approach that involves service users and their carers’. Care Programme Approach is the framework for care co-ordination and resource allocation in mental health services. Decisions for discharge are made through the multi-disciplinary team which consists of consultants, ward manager, nursing staff, occupational therapy and social workers. discharge guidance 4. This will go forward to a tribunal where the service user will be invited to take part, here all the evidence will be put forward and a decision will be made. If the service user is restricted then the decision will be made by the First Minister. When a service user is restricted it means an order has been applied to them as they are seen by the act to be a more serious offender, this then means that the Home Office is responsible for granting discharge and a representative will be invited to the Tribunal (MHCT Act 2003 SECTION 37/41).

Most service users have long term mental health problems and complex social needs and have been in contact with mental health services for more than twenty years so never think about discharge. Being in hospital for so long has become part of their lives so service users see it as pointless being discharged, “what would I do”. 488

SECTION 117 AFTER-CARE

Prior to 1983, no statutory provision was made for the after-care of patients discharged from hospital. Section 117 introduced and defined formal after-care. In particular it stated:

“It shall be the ditty of the health authority and the local authority to provide in conjunction with voluntary agencies after-care services for any person to whom this Section applies, until such time that the health authority and local authority are satisfied that the person concerned is no longer in need of such services “.

Section 117 of the 1983 Mental Health Act applies to patients who have been detained under Section 3,37, 37/41, 47/49, 48/49.

Before a decision is taken to discharge or grant leave to a patient, it is the responsibility of the RMO to ensure, in consultation with other members of the multi-disciplinary team, that the patient’s needs for health and social care have been fully assessed, and that the care plan addresses them.

The Section 117 meeting

The aim of the meeting is to draw up an after-care plan, based on the most recent multi-disciplinary assessment of the patient’s needs.

During the meeting the following areas should be covered as appropriate:

Housing Finances Relationships/family Employment Social needs

Psychology/mental health difficulties Relapse predictors Known risk factors

When the care plan is agreed the team should ensure that a key worker is identified to monitor the care plan. The Care Co-Ordinator can come from either of the statutory agencies, and should not be appointed unless they are present at the meeting, or unless they have given their prior agreement.. The process for Sec 117 can be found in Trust Policy and Procedure and applies to all patients accepted by psychiatric services.

What decisions/involvement does the service user have in this process?

Within this placement the care and treatment plans are reviewed on a regular basis. Service users are expected to meet with their key worker and other team members on a regular basis, care plans are reviewed at these meetings and a mutual agreement will be decided, on the best way forward, once the care plan has been agreed by all the service user has to adhere to the care plan.(discharge guidance)no.16

Rights, Relationships and Recovery (2006): The Report of the National Review of Mental Health Nursing in Scotland

Service users’ are encouraged to be fully involved in all aspects of their care as far as they are able to. Service users past and present wishes should be taken into account, their views and opinions with regards to their treatment plan must also be recorded, as stated in the Mental Health (Care and Treatment) Act Scotland 2003. These wishes and aspects will be turned into a care plan that is individual to the service user. The principles of the act underpin any decision made relating to a detained service user in Scotland. The Milan Committee devoted a chapter in the act that referred to high risk patients it stated that service users should have the right of appeal to be transferred from a high or medium secure facility to that of a facility with lower security conditions. (Mental Health Care and Treatment Scotland Act 2003). This however seemed to be the problem across the board, lack of medium/low secure facilities to discharge /transfer appropriate service users to.

Service users have the opportunity for regular one-to-ones with their key workers (weekly basis) or more regularly if they require. Service users have the opportunity to put forward their thoughts on discharge and any other aspect of their care at the review, such as their rights, beliefs and their right to a tribunal. The author attended these independant tribunals while on this placement and at these tribunals people had stated that their human rights had been violated (The Human Rights Act 1998). They felt they were still being discriminated against for offences they had committed 20-30 years ago and feel they were being held under “excessive security” hence the reason for the tribunal to appeal against this level of security. this would mean they would be granted grounds access on a trial period which may be supervised, then become unsupervised for a trial period to see how the service user would cope, this in turn will lead to a further tribunal taking place in a set time agreed for example 4 or 6 months away, where the service user may be granted discharge/transfer to a lower secure unit depending that all provisions that had been put in place had been adhered to, for example, risk assessment reviewed, treatment regime being followed, attend all social/therapy/strategy groups that were agreed.

The review takes place every four months, again this is a multi-disciplinary meeting and service users are invited to attend with the support of advocacy or someone of their choice. The Human Rights Act 1998 gives legal effect in the UK to certain fundamental rights and freedoms contained in the European Convention on Human Rights (ECHR). These rights not only affect matters of life and death like freedom from torture and killing, but also affect your rights in everyday life: what you can say and do, your beliefs, your right to a fair trial and many other similar basic entitlements.

During the time spent on this placement it was noted that service users and key workers met at the beginning of the week to discuss how they felt things had been for them, the service user has the opportunity to discuss what changes they would like to happen, this is then recorded in the service users’ notes and taken forward to the clinical team that week where it would be discussed if any changes in care and treatment would take place, the service user is then informed of any changes and decisions made which they have the right to appeal against (The Human Rights Act 1998). The opportunity arose for the author to take part in these weekly reviews, during this one-to-one time most service users were able to express their thoughts and feelings about issues they had encountered that week and describe what therapeutic strategies they used to get through it.

The service user will be provided with a copy of the Treatment Plan Objectives, or informed in detail of the contents of the treatment plan, in the event that any learning or specific reading or language difficulty information should be provided in a way that is most likely to be understood.

Arnstein (1969) constructed a “ladder of participation” which described eight stages of user participation in services, including mental health. These stages ranged from no participation to user controlled services. The above service users would be placed on the sixth rung of the ladder in the partnership range as they agree to share planning and decision-making responsibilities.

Partnership

Partnership, like community, is a much abused term. I think it is useful when a number of different interests willingly come together formally or informally to achieve some common purpose. The partners don’t have to be equal in skills, funds or even confidence, but they do have to trust each other and share some commitment. In participation processes – as in our personal and social lives – building trust and commitment takes time. discharge guidance 16.6 908

Does this placement area reflect its practice on local or national policies regarding service user involvement in discharge planning?

(Mental Health Care and Treatment Scotland Act 2003).
(The Human Rights Act 1998).

When asked their views on the subject the Ward manager and senior nursing staff presented documentation which reaffirmed current practice within the ward. The Ten Essential Shared Capabilities (ESC’s) DOH (2004) he explained was the model now being followed on the ward, has just been implemented into this area of placement within the last two years, which the ward staff have adopted well by providing a person-centred approach as much as possible. This new person-centred model embraced the ethos of the above, and senior staff stressed that good practice dictated that service users have the opportunity to appropriately influence delivery of care and support. A review of policies and procedures as well as discussions with staff provided evidence that the policies were actually in place.

Throughout the placement, the author noticed that efforts were being made all the time to nurse according to the new model. Included were regular one to one sessions between nurses and service users to hear their views and thoughts, these already took place before the ESC’s were introduced. Moreover some staff do find it difficult to adopt the ESC’s and the mental health act due to the restraints of the environment (secure ward); however they are prepared to embrace the opportunity for further education and support. 211

Identify barriers and constraints.

Before a decision is taken to discharge or grant leave to a patient, it is the responsibility of the RMO to ensure, in consultation with other members of the multi-disciplinary team, that the patient’s needs for health and social care have been fully assessed, and that the care plan addresses them.

Section 117 of the 1983 Mental Health Act applies to patients who have been detained under Section 3,37, 37/41, 47/49, 48/49.

While on placement and conducting this review the author noted that one of the barriers to effective involvement came from some of the service users, due to the complex nature of the area the service users had become institutionalised and found it difficult to be thinking about discharge at this stage in their lives, so they just accept the way things are and do not get too much involved as far as care plans are involved and just say what they think the staff want to hear.

In secure settings engagement of service users in assessment and treatment can be difficult, as there is a potential risk of perceived coercion. Moreover with the lack of medium secure facilities around this can hinder service users from moving on within the specified time limit agreed, as there are no provisions.

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Recommendations for Development
SMART

Most service users were more concerned about their futures and life post discharge. They wanted their time between now and then to be concerned with preparing them for discharge. It was frustrating for many service users that they felt that little in the way of such preparation was taking place. Continue to provide service users with support and skills needed appropriate to their function and skills already held, for example cookery groups, IT groups.

Provide groups that enhance social skills such as coping strategy groups, anger management, alcohol/drug treatment/groups.

High secure units should ensure that at the point of discharge patients have a copy of their discharge care plan in a suitable format which includes appropriate information about the circumstances that might result in their return to a secure mental health provision such as??????

However a recommendation that high secure units should ensure that factors to be weighed in assessing relapse are part of the risk assessment included in the discharge plan of all service users.

The National Service Framework for Mental Health states that ‘Service users and carers should be involved in planning, providing and evaluating training for all health care professionals’ (Department of Health, 1999). This is the case in most health care provisions but for more education, training and information to be more readily available.

Strengthening the user perspective and user involvement in mental health services has been a key part of policymaking in many countries, and also has been encouraged by World Health Organization (WHO) in order to establish services that are better tailored to people’s needs and used more appropriately.

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Reflection

In this review, I need to reflect on the situation that took place during my clinical placement to develop and utilise my interpersonal skills in order to maintain the therapeutic relationships with service users. In this reflection, I am going to use Gibbs Reflective Cycle Gibbs (1988). This model is a recognised framework for my reflection. Gibbs (1988) consists of six stages to complete one cycle which is able to improve my nursing practice continuously and learning from the experience for better practice in the future.

During the first week of placement I was encouraged to work closely with my mentor. This gave me the opportunity to orientate myself to the ward and get an overview of the needs and requirements of the service users. This also provided me with the chance to observe how the nursing team worked on the ward. During this time I had learned that if the concept of inter-professional working is to succeed in practice, professionals need excellent team working and communication skills. Good communication, as we have staged in our group work theory, (skills for practice 3) is crucial in the effective delivery of patient care and poor communication can result in increased risk to the service users. I have learned the valuable skills required for good communication and will transfer these into practice by adapting to the local communication procedures (expand). The NMC advices that at the point of registration students should have the necessary skills to communicate effectively with colleagues and other departments to improve patients care (NMC, 2004).

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Life is a learning process and this involves a lot of interactions and interpretations to evaluate one and evolve as a better person. The observations made by the superiors, colleagues and self have enabled me to identify my strengths, weaknesses, opportunities and threats. Below is a brief discussion on the same.

(S)trengths

Strengths just do not mean the obvious job skills one has. It means the resources a person has, to tackle a situation. These could be things like knowledge gained through a hobby, ideas absorbed from sports, family background, and sense of humor and much more. Developing a list of a person’s strengths is a time killing process as inherent skills may not be recognized as strengths until specific situation brings them on action. Similarly, strengths in dealing with a situation may not be so when a person faces other issues.

My strengths are best derived while at work. I could identify my strengths, whenever a task was assigned to me. My immediate response would be to step forward and ask the requester for his / her objective behind this task and his / her expectations out of this particular task. This has always helped me enhance my ability to focus on structuring my tasks and giving optimized output.

This reminds me of a past instance at my work place where, there was difference of opinion emerging within the team, under the supervision of a colleague of mine who was nominated as the Acting Team Lead (ATL) of the month. ATL was a concept brought in to enable the team with team leading experience. The differences emerging had led the team into a cold war. This is a situation that no supervisor or any superior would desire his/her team to be in which might cripple the performance and relationship of the team. When this started to be visible, I was asked by my General Manger to handle the team until the issues were resolved.

This task was critical for me, as this responsibility was given to me by my GM. He set his expectation and told why he chose me and I had to live up to his expectations.

Since I had been with the team for more than two years, I was confident that I would be able to crack the puzzle. I had to be cautious in approaching the team. A wrong move or decision could turn things around for the worst. Hence, I decided to break ice by meeting every individual of the team to get a better perspective of the issue. This way, I was able to analysis the core issue and come up with a resolution to resolve the particular issue. I initiated a “fish on table” activity for the team, where everyone from the team was allowed to speak their mind out and discuss their issues. This activity helped them understand each other and sort their differences. Post this activity, the bonding of the team was further strengthened. There was a visible change amongst the members of the teams approach toward tackling any issue. They wouldn’t wait for a third person to come and resolve their issues; rather they started walking up to each other and sort the issues themselves.

With this particular incident, I was able to identify my strengths. When my GM looked up to me to handle the situation, it showed his faith and confidence in my problem solving techniques. A one to one session with my GM made me realize that I possessed a greater level of patience. I realized some of my strengths through this particular incident, which were my approachability, decision making, ability to negotiate and solve problem.

(W)eaknesses

A It may be very easy to identify a person’s weakness, but it takes far more objectivity. For example, showing sympathy on a person’s problem is a very good human characteristic, but if it exceeds, it may cause problems in leading a team. As in the case of STRENGTHS, it is important to be aware of all your weaknesses while dealing with an issue and also to know which weaknesses could be related to a particular situation.

Some of my weaknesses that I would like to work towards is to improve my area of expertise i.e. my knowledge on MS office applications. This was necessary for me to understand and put to ease the complexities involved in my work. I also would like to bring about improvement in attaining best possible control over my emotions, to incorporate the skills attained to improve my social networking and to put to best possible use, my creativity.

The main culprit to be blamed for this absolutely is the lack of time. Due to which, I am most of the time unable enhance my knowledge as mentioned above.

Once, I planned to dig to the roots of my weakness, and approached my supervisor to give me a feedback. That’s when I realized that I couldn’t say ‘No’ when I had to say it.

Let me quote an incident which is fresh in memory. One fact that was brought to my notice during a feedback session was, I had the habit of going out of my way to help others even when I was piled up with so much of work for the day. I would land up myself doing the extra work not oblivious of the fact that if I took even a smallest of extra work, I would miss my deadlines. This began to affect my regular deliverables. Knowing the fact that an adjoin on work would affect my regular deliverables, neither did I say “No” nor did I seek help. Though I had an opportunity to say no or to get the time lines extended, I did not do so. Instead I ended up extending my shift. After this feedback from my superior, I knew I had to change myself by working towards this issue to overcome this particular weakness of mine.

(O)pportunities

It is important to examine a problem in its entirety and also to identify the opportunities that may exist in it. A simple example is that of a production manager who has to lay off workers in order to reduce the production due to a fall in demand for the product of the company which he works. This is a problem. However, if he is updated of the happenings of his industry and the economy, he can use this problem as an opportunity to optimize the operations and prepare for product enhancements for the future which the market will require at that point of time.

Similarly, I believe that my strengths could be my gateway for opportunities. I consider every challenge that I come across as an opportunity to learn. This would enable me to tackle different situations, undauntedly. I always try to learn from my own mistakes, as well as from others mistakes too. This has helped me narrow down my mistakes and even to correct the mistakes which I have already done.

To me, approaching people to understand their requirements and providing them with the desired output is one of the strengths. According to me, this is a quality which can be put to use for the advantage of the others as well me. This trend not only creates a great visibility but also enables me to understand things better and look at things from a wider perspective and from different angles.

This reminds me of an instance where in all the managers from different departments were asked by the SDL (Service Delivery Lead) to work on analyzing the attrition trend for their respective spans. The SDL also informed the managers that they could approach me for any kind of help with regard to data or for any details required for the analysis. At this moment I realized that I was noticed by my SDL and my capability to work efficiently was made transparent, by him to others. I also realized my way of working turned my strength into an opportunity of getting to know more people from the hierarchy, to widen my network and provide me the opportunity to work with all LOBs (Line of Business).

(T)hreats

A Every circumstance has its own threats. The one who faces it has to recognize it and gather his strengths to tackle those. Similarly, threats are easy to identify. But differentiating the “impossible” and the “unlikely” among them may be a difficult task. The “unlikely” is the one that often turns around to make you mad. It is the unexpected threats which could be the greatest danger than the obvious ones. Knowing the fact that the unexpected may suddenly occur and a pre-existing knowledge of one’s strengths allow for most effective response to these situations.

According to me, everything is a threat – My strengths, weaknesses and opportunities

My way of approaching people to understand their requirements creates visibility, which my competitors could find threatening and try to persuade others to go against me. This is a potential threat that I experience.

I recall an instance when I was recognized for my hard work and dedication in many occasions. I was rewarded point and vouchers as gift as an appreciation for my hard work. My competitors started envying me for getting recognized. They started stretching their shifts and began to work on weekends as well to gain attention. For which they succeeded to some extent. When I noticed their behavior and actions, I realized that I had become a threat to them and that was a threat for me.

In another instance, I had to take calls of our clients. Since I had no experience in taking calls, I found it difficult to understand their accent. This was a threat as the other were either well trained or had prior experience in taking call before they joined. Knowing the client and understanding them was the most important part of our job. Since I lacked such an understanding with the client, I was given the least importance when it came to attending client calls.

Emotions are one of the weaknesses that can be exposing me to a threat of being misused. As I very easily get carried away emotionally, people could take advantage of me and get me to do things for their selfish motives.

STAGE 2
Improvement Plan

It is important for one to identify his/her strengths and opportunities, and work towards enhancing them at the same time; it becomes equally important to work towards improving the same to overcome threats and weakness.

One of the strengths if feel is important and would add value or become an added advantage is to gain my supervisor’s reliability / confidence in me. As an individual, I was successful enough in gain my supervisors and co-worker’s confidence on any kind of work given to me. However at a supervisor level it was still verified. This could be due to the importance of the report or data or else it could be that I couldn’t gain his/her complete confidence. I had to work on this and had to overcome by improvising an improvement plan or a strategy and reach the point of confidence where my supervisor would give me complete authority to send report without he / she cross checking.

I intend to approach my supervisor and talk to him about the same. ask him to observe my work for a week and only once he is confident in me would send the reports directly to the concern departments or people. To achieve this I plan to adopt a strategic way of doing my work. This can be achieved by looking into each and every details of the given task, identifying the areas of modifications or areas which have some scope of improvement or areas of interest of the requestor and the purpose of the report. This way I would be working towards perfecting my skills, understanding the requestor’s requirements, improving on visualizing the minute details and gaining confidence of my supervisor to be confident in me.

I also had work towards improving my knowledge on MS Excel. Due to my limitation on MS Excel knowledge, most of the time, I depend on the experts for complex formulas which had become one of the core areas of improvement. Improving the knowledge on Excel would widen my areas or expertise, help me improve or modify complex formulas and enable me to create new templates to ease the work for everyone.

If I excelled on this, it would enable me to perform critical and complex tasks. Hence I intend to overcome this weakness of mine by attending some classroom trainings or online trainings on MS Excel and by reaching out the experts. I also intend to seek for help from my supervisor to help me understand complex formulas.

The second weakness I thing I would like to improve is to say “No” when required. As I feel, I might offend a person by saying No or might give an impression that I am not willing or I do not possess the ability to perform that particular task. One way to do so is by gathering courage to say No, by sympathizing myself and not allowing others to take advantage. A sincere effort would help me overcome this challenge. Probably by saying ‘No’ in different way rather than being curt. Probably addressing the same to my supervisor or by delegating / sharing the work with my colleagues would help me solve this problem.

As mentioned above, my threats, my hard work and recognitions for the same could become a threat. This could lead to a bad relationship or unhealthy competition within the team. I would try to overcome the same by changing my approach to such situations. By getting others from the team involved in all my activities and cross training everyone on each other’s work can ease the pressure off. This approach wouldn’t be a strategy to overtake others but a step or opportunity to work together as a team for good. This way both parties would get an opportunity to improve their skill and thoughts; and plan better for the best results.

The lack of experience in taking calls as mentioned earlier was one of the most important drawbacks in my career. As this could set me back or leave me behind when it come to my assessments or performance review and would become a road block in my career growth. Hence I decided to approach my superiors and colleagues to help me over come on the same. At the same time I decided to side barge with my colleagues to learn how to take client calls and speed up my learning curve. This way would be back on track for the race and wouldn’t allow this weakness to affect my performance or growth.

STAGE 3
Summary of progress

When I implemented the plan to improve my SWOT, I began to realize that my quality of work had improved. I was more confident in terms of structuring my daily activities related to work. I knew exactly how I had to achieve my goals.

When I joined the team I lacked confidence in attending client calls. I did not want this deficiency to set me back or leave me behind in the race. As planned I addressed this issue to my supervisor. He then advised me to enroll myself for a voice and accent training. As I enrolled myself to the advised training I realized that it would take longer time than expected to learn. Hence I decided to attend the training every day and post that came to the work place and side barged with my colleagues to understand and learn quickly. This strategic move helped me finish my voice and accent training in two weeks which normally takes six to seven weeks. Post this training I was back on track to compete at power with the other team members.

Post my training on voice and accent I start with my plan to gain confidence of my supervisor, I realized that this actually was working out. I approached my supervisor to seek for his help in observing my work, he was happy to do so. He in fact began giving me feedbacks regularly and gave me tips on how to overcome certain issues. And soon I got an opportunity to prove myself this was when my supervisor had to take his personal time off. This was an opportunity that helped supervisor gain confidence on me. I also received rewards from my GM for taking care of my supervisors work in his absence. This particular incident helped me to take more responsibilities and relieved my supervisor of his regular jobs allowing him to take new jobs from his supervisor. Because of this action plan it helped my supervisor and me to move ahead take up additional roles and responsibilities.

During my improvisation of improvement plan, I had enrolled myself for class room trainings and online trainings on MS Excel. This was one of the tips by my supervisor to me. Since my supervisor was also good at MS Excel, I approached him for help when ever required. He helped me to read and understand complex formulas and worked with me in creating few. This way I began to gain confidence in myself and was able develop my own templates to make our jobs easier. As I began to improve on my MS Excel knowledge, I was being observed by everyone around me and was ask to help them in creating templates for their reports. Looking at my knowledge on Excel my supervisor appointed me to set test papers on MS Excel for interviews and was asked to train the team as well on the same. This was one of the important milestones I had achieved.

As started to improve and began to receive rewards for my hard work, I was getting piled up with work. It so happened that the expectations were rising and I couldn’t do anything about it to stop it. I had reached a point where I was only accepting more and more work, and could not put a stop to it. My health began to deteriorate, as I began to stretch my shift, pushed myself to complete the assigned tasks. My co-works realized this and advised me not to accept anything and everything. When I approached my supervisor to address him of the issue, he said that he knew about the pressure I was in but could not do much about as the profile demanded for it. He then told that he would look into the issue and look for an alternative. He then decided to appoint an additional person to help me. But it was a lengthy procedure to appoint a person to assist me, as it would take at least a month to appoint one. Hence I decided to delegate some of my work to my colleagues who were well equipped with the tools I used. As I began to get my work done by colleagues, my supervisor observed this and appointed one of my colleagues to help me. A process of appointing that took at least a month now was reduced to two weeks.

This approach in fact led to more opportunity within the team and helped everyone get cross trained so as to work as a team to ease the pressure off.

This way I was getting everyone in the team involved in different activities and shared my work. This approach was eliminating possibilities of threat in the team. The team no more felt threatened by anyone, as everybody was receiving an opportunity to learn, explore and expand their area of knowledge. I was a no more a war but a healthy competition, a race to learn more and not to pull down one another. There were rewards and recognitions delegated for the most helpful person of the team, knowledge priest award, most improved person award and the best performer award. The objective of these award titles was to create more opportunities, enhance skills, direct most of the people in the team towards a healthy competition and most importantly to work as a team to achieve organizational goals.

STAGE 4
Future plan

After the completion of my SWOT analysis, I was able to identify my SWOT in the initial stage of assessment, planned to improve by setting some milestones in the second stage and implemented the action plan to see the outcome of the same in the third stage. Post the successful implementation it is time for me to work on future plans to further improve my SWOTs.

My future plans are to:

Organize a forum where the best practices can be shared and implemented and look for new opportunities or scope for developing new strategies. I look forward to implement this in all the places where I would work.

This would help the people around and me to work together towards creating a better place to learn and work. This forum can also be termed as “Focus Group”. As mentioned above, this group would concentrate on people development. Further it would focus on improvising corrective action plans, new idea generation in terms of reducing cost and time for a cost effective high performance and fun activities for stress busting in the work place.

Organize an observation forum to identify the successful and potential areas of improvement. The forum would allow every individual to share their experiences. If a strategy they implement is successful, then, the forum would discuss how it can be utilized by others and how it can be improved and if the strategy fails, then this forum would look at what went wrong and how can it be corrected. We would then be able to list down all the do’s and don’ts. Also look for new and innovative ideas to enhance our skills and work. The observation forums will observe all the implementations and give out a general feedback or individual feedback on the implementation methods. This forum would help to avoid or correct mistakes committed.

Social work practice can be seen as a very complex process as it seeks to promote social change, social justice, equality, anti-discriminatory and anti-oppressive practices and also social inclusion. It is therefore significant that as social workers, we reflect and evaluate our practice in order that the values we stand for are promoted and adhered to. Reflective practice is therefore a way of making social work professionals more accountable through an ongoing scrutiny of the principles upon which the profession is based (Fook, 2002). However, Ixer (1999) criticizes that reflective practice has simply become uncritical and orthodox mainly because it can be applied in many ways and across many professions. None the less, Donald Schon (1983) a key theorist of reflective practice, saw reflective practice as a way forward for professionals to bridge the gap between the theoretical and practical aspect of their work by unearthing the actual theory which is embedded in what they do, rather than what they say they do. He made it clear that by being reflect practitioner, one is aware of the theories or assumptions underlining your practice and what actions to take in improving your practice or providing better services for the service user. To me reflective practice is therefore like a ‘looking glass’ or mirror where you as a practitioner have the opportunity to correct or redirect your course of action. For the purpose of this assignment, I am going to use a case study from my previous practice placement to illustrate my reflection and evaluation of my own practice, how the use of self, my beliefs and values might have influenced my actions, how I have developed new meaning and understanding through peer supervision/feedback and the unit lectures and how theories underpinning reflective practice may help in improving my practice as a social worker.

Case study

I e-mailed the learning mentor at N. Middle School concerning a boy named J (for confidentiality purposes). A 12-year old, of ‘White’- British background, who was referred to my previous placement agency for having behavioural problems (such as fighting with his peers, being disruptive during lessons, disrespecting his teacher and general misconduct) at school. J from an early age of about 6 had witnessed Domestic Violence in his family. My concern was that J had revealed very confidential information to me regarding his mum and her ex-boyfriend (his mum’s ex-boyfriend was violent toward his mum and he witness it as well). J was worried that this might happen again since his mum’s ex-boyfriend was back into his mum’s life and sleeps over sometimes at the family home. I informed the school about this revelation since it was a school referral and also because J had mentioned that any time his mum’s ex sleeps over it affects him and his behaviour at school becomes disruptive due to the worries he has. When I passed this information to the school authorities, the school also informed J’s mum about it which I felt was not appropriate due to the fact that J’s mum had been very wary as to what information or issues J would reveal to professionals. In my email I also pointed out the fact that the trust and confidence J had towards me could be undermined since his mum got informed about this although it was suppose to be confidential among professionals.

Reflection and Evaluation of my practice

In this case study, I felt that the school authorities should have acted more professionally. They should have contacted me first before informing J’s mum but this was not the case. I only got to know that they had informed J’s mum when she asked me questions or tried to clarify the issues that J had revealed to me. Although, this situation didn’t mar my professional relationship with the school authorities at the time, it has made me wary of how much information I can share with other professionals and how that particular information should be treated (if very confidential).

I felt that I had eroded the trust and confidence between J and I because his mum got to know about what J had revealed to me although he did not want her knowing. Order to maintain the trust and confidence we had, I should have sought J’s consent first. Also the school should have contacted me first before informing J’s mum so that my trust and confidence in the school could be maintained as well. I also felt that this broken trust and confidence might extend to other professions who might be working with J in future. This experience could therefore distance J from other professionals (including myself). He might view all professionals as untrustworthy and as enemies rather helpers. This therefore meant that I did uphold public trust and confidence in social care services as enshrined in the code of practice for social workers (TOPPS, 2004)

I felt that J was very opened and honest to me. He had trust and confidence in me as well. I listened to him as a friend in a professional capacity which I feel he needed. However, I felt I let him down in this situation because he was not made aware that his mum would be informed (issue of consent).

This issue of confidentiality posed as a big ethical dilemma for me, in that I questioned myself whether it was right for the school to have informed J’s mum about his revelation? Have I broken J’s trust and confidence by informing the school about this? And am I right to question the school authorities why they shared the information with J’s mum even though the referral was made by the school. These were ethical dilemmas I was faced with before emailing the Learning mentor. I was therefore aware of these ethical dilemmas and conflict of interest and the implication to my practice (social work value A). However, not sharing the information could also mean that I would be held responsible for my actions if something went wrong.

Furthermore, I felt this could have been an issue of potential discrimination, in that the school had overlooked the effect on J, and also the relationship between mother and son, this could have potentially estranged J’s relationship with his mum, the school and even me. If this happened, he would be reluctant in dealing with professionals and this may pose as a barrier to him accessing the needed support he may require.

Theories used in case study

In this case study, the gathering and use of information was the main focus. Establishing service user confidentiality is as important as providing the need/service for him/her. However, though the issue of confidentiality is usually negotiated and established during the agreement meeting with the service user, there are lots of ethical dilemmas surrounding this (as to whom you can share the information with and how much of that information can be shared. Seden (2005) mentioned clearly that in working with Children services it is particularly difficult to have total confidentiality because a child may reveal something or an issue in confidence which may be a child protection issue. And as a professional you would have to share this information with others so that prompt action can be taken. It highlights the fact that in child protection issues, safeguarding and promoting the child’s welfare is paramount (Children Act 1989) rather than confidentiality.

Yet the Data protection Act 1998 and my previous placement agency’s policy on confidentiality also informed me of my practice. In accordance with the Data Protection Act 1998, it entreats all agencies that have access to people’s personal information to keep it safe and must only use the information solely for the purpose for which the information was sought. It also means that if personal information about people fall into the wrong hands it can be used maliciously and our right to private and family life (Human Rights Act 1998) could be contravened. Personal data can further be use to enforce discriminatory and oppressive practice by using it to categorise people in terms of service delivery.

Another important theory in this case study was multi-disciplinary and multi-agency working. The ‘Working together’ document (DOH, 2006) highlights the importance of multidisciplinary and inter agency working in children work force. This document was put together by Department Of Health, Department for Education and Employment and the Home Office. It serves as a guide to inter-agency working to safeguard and promote the welfare of children as well. In my first placement setting, it was good practice to liaise with the lead professional/organisation that carried out the assessment and referred the case to my agency. All relevant information and process of the intervention were shared with the other agencies involved. In this way I was working according to my agency policy of liaising with other agencies, following the legal requirement of the ‘working together’ document and meeting unit 17 of the National Occupational Standards (TOPPS 2004). In doing so I was able to communicate effectively with other professionals and this also facilitated information sharing between professionals.

Theories of Reflection

Using the case study as a reference point, I realised that most of the reflection I did took place after the event. This is what Schon (1998) referred to as ‘reflection-on-action’. According to Schon (1998), reflection-on-action therefore means that as a professional, I only sit back after I have undertaken the intervention to think about what I did, how I did and whether there were any ethical considerations I took for granted. In doing so I am able to analyse and critical evaluate my actions and practice and improve on my shortcoming. For example, in the case study scenario, I realised that the trust and confidence J had in me was eroded once his mum was informed about his revelation to me. Had I reflected before the event or during my meeting with J (reflection-in-action), I would have made him aware that his mum would hear about it and hence J and I could have come to an amicable agreement as to how to inform his mum. This might have provided a more positive outcome rather than the presented outcome in the case study.

This same model of reflection-on-action can be related to Gibbs model of reflection. In Gibbs (1988) model, he identified six key stages of reflection; Stage 1: Description of the event – A detailed description of the event you are reflecting on.

Stage 2: Feelings and Thoughts (Self awareness) – Recalling and exploring those things that were going on inside your head.

Stage 3: Evaluation- making a judgment about what has happened. Consider what was good about the experience and what was bad about the experience or what did or didn’t go so well

Stage 4: Analysis- Breaking the event down into its component parts so they can be explored separately.

Stage 5: Conclusion (Synthesis) -Here you have explored the issue from different angles and have a lot of information to base your judgement. It is here that you are likely to develop insight into you own and other people’s behaviour in terms of how they contributed to the outcome of the event. The purpose of reflection at this stage is to learn from the experience.

Stage 6: Action Plan-During this stage you should think forward into encountering the event again and to plan what you would do – would you act differently or would you likely to do the same?

These six stages of Gibbs model serve as aiding tools to help professionals critically reflect on their experiences. For instance, through detail description in my case study I am able reflect on my feelings and thoughts towards the school authorities and how my actions may have affected the welfare of J. I have also been able to identify that I did not promote the social work code of practice (upholding public trust and confidence in social services). When faced with a similar situation like this in future or in practice, I believe I would think critically and reflect critically before passing information to other professionals with the view that the information will be used solely for the intended purpose.

However, another reflective model is that developed by David Kolb (1984) on experiential learning. Kolb (1984) created his famous model out of four elements: concrete experience, observation and reflection, the formation of abstract concepts and testing in new situations. These entire four elements are connected in a circular way. Kolb (1984) argued that the experiential learning cycle can begin at any one of the four points and that it should really be consider as a continuous and unending process. Meaning, the learning process often begins with a person carrying out a particular action and then seeing the effect of the action in the given event or intervention. Following this, the second stage is reached in which the professional/learner understands these effects in the event or intervention so that if the same action was taken in the same circumstances it would be possible to anticipate what would follow from the action. With this understanding, the third stage is to understand the general principle under which the particular instance happens.

Generalising may involve actions over a range of situations/events for the professional or learner to gain experience beyond the particular instance and suggest the general principle. Understanding the general principle does not imply, in this sequence, an ability to express the principle in a symbolic medium but rather implies only the ability to see a connection between the actions and effects over a range of circumstances.

When the general principle is understood, the last stage is the application through action in a new circumstance within the range of generalisations. Thus the action is taking place in a different set of circumstances and the learner is now able to anticipate the possible effects of the action. Two aspects can be seen as especially noteworthy: the use of concrete, ‘here-and-now’ experience to test ideas; and use of feedback to change practices and theories (Kolb 1984: 21-22).

Relating Kolb model to my case study, I felt that by emailing my concerns to the school mentor about how the information was treated seemed a more professional way of dealing with the issue. As the school authorities later apologised to me about their actions. I do believe that if I am faced with a similar situation with other professionals I would elegantly challenge their actions in a similar manner as I have done before and if it works I might generalise that this approach works well. This would therefore give me new meaning and a new perspective as to how to work with other professional collaborative in achieving the desired outcomes for service users.

Feedback from my peers.

During the learning sets meetings, I presented his case study to my peers and one the learning points from them was that I had assumed that the school authorities would not inform J’s mum about the revelation and because of that I hadn’t insisted on them keeping the information as confidential as possible until such a time when consent had been sought from J. I in my view this is what Brookfield (1988) called assumption analysis in critical reflection. To him, Assumption analysis describes the activity adults engage in to bring to awareness beliefs, values, cultural practices, and social structures regulating behaviour and to assess their impact on our dad to day activities. Assumptions may therefore be paradigmatic, prescriptive, or causal (Brookfield 1995). He stresses that assumptions structure our way of seeing reality, govern our behavior, and describe how relationships should be ordered. Assumption analysis as a first step in the critical reflection process makes explicit our takenaˆ‘foraˆ‘granted notions of reality. Members of the learning set also raised my awareness to the fact that the underlying assumption I had about the case could possibly being derived from my own beliefs, value base, cultural and social background, agency policies, my gender and race. Brookfield (1995) highlighted this by noting that a contextual awareness is achieved when adult learners come to realise that their assumptions are socially and personally created in a specific historical and cultural context. I should therefore have been self aware of the influences my personal, cultural and social (Thompson, 2006) may have had in the given case study.

Also, the learning sets helped me to unearthing or understand more about the power imbalances that exist between service users and professionals. One of my group members made it clear that possibly the school authorities acted the way they did because they had the power to do so and as a way of proving to his mum that the boy’s problem was generated from home rather at school because the mum blames the school authorities constantly for her son’s behaviour. According to Mandell (2008), power affects the experience and behaviour of both the practitioner and service user and so the practitioner needs to ask, or be asked, where does power lie in his/her relationship, how does it operate and who is defining the character and direction of what’s taking place. Therefore, to be a critical reflective practitioner I need to acknowledge the power imbalances in my practice before making decisions or embarking on a course of action. It’s also important for me to consider ‘all the angles’ and checks ‘out all the details before taking the plunge’ (Payne, 2002, p124) so that a more opened, honest, fair, just, anti-discriminatory and anti-oppressive practice can be achieved in my service delivery.

The case study analysis with my peers provided me yet with another very important learning point. Thus, in sharing the information with the school authorities, I was focusing more on the theory (the ‘Every Child Matters’ and ‘working together’ agenda) for ‘off the peg’ solution (Thompson, 2005, p146) or what Schon (1998) calls ‘technical rationality’, the belief that well developed theory can provide solutions for professionals. Rather, I should have used both my theoretical background and past experiences to help inform me of my practice. This would have had a more balancing effect or less impact on J. With this now, I am confident that my decisions and actions in future placements would be drawn from my theoretical or formal knowledge and that of my past experiences or informal knowledge.

Conclusion

Summing up, I feel that this unit has provided me with greater insight about how my actions or decisions are influenced by my belief system, culture, values, gender, religion, assumptions, political and social orientation. It have also learnt that drawing from the views of others, I would be able to see the issue or problem from a different perspective and this might help me develop a new meaning of the event. Mezirow (2000) called the process of developing this new meaning of the event as perspective transformation. I now also understand that as a social worker, t would have draw on knowledge from all sources (theoretical and non-theoretical) in order to address the ‘messy’ complexities of real-life situations and to consider each individual situation or event unique (Yelloly & Henkel, 1995).

Therefore, the way forward for me as a social worker is to critical reflect on the use of self, the awareness of power imbalances (deconstruction) and the development of new meaning/ perspective( re-construction) illustrated by Howe (2008).

Title: Selfie: A new unconscious illness

1.0 Introduction

People have been taking selfie as a trend that is ongoing. The word ‘selfie’ is officially named by the Oxford Dictionaries World of the Year in 2013. ‘Selfie’ is define as a photograph that one has taken of oneself, typically one taken with a smartphone or webcam and uploaded to a social media website (Oxford University Press, 2014).Moreover, selfie is often associated with social networks like Facebook, Instagram or Twitter. People take selfie wherever they are and whatever they are doing.

These days, people snap pictures of themselves wherever they are. For example, selfies taken at funerals, presidential selfies, and even a selfie from space (The Daily Hit, 2013). The popularity of selfies has dramatically increased and had become a social media phenomenon. So, should this be seen as an issues? According to Doctor Pamela Rutledge (2013), selfies can be damaging to a person’s mental health and that indulging in them is indicative of narcissism, low self-esteem, attention seeking behaviour and self-indulgence. Even Thailand’s Department of Mental Health come to a conclusion that the ‘selfie culture’ bring a potential negative impact and claiming that young people are suffering from emotional problem when their selfies is not underappreciated by others. The public does not concern about this issue [L1]because they are not conscious of the illness that selfie can bring.

2.0 Sickness of selfie

2.1 Narcissism

The meaning of narcissism is excessive self-love (Acocella Joan, 2005). Due to the improvement of the technology, taking selfie now is much more convenient. Camera are now being placed on our phones with high mega pixel, we get to edit the picture that we just snap with a touch and we can share it to everyone with a click. The more shots that are taken, the danger you are. You might feel each of the photos of you are so pretty due to the effect that make your skin smooth, fair and make you look younger. This thought may be the platform of the sickness – Narcissism. Narcissism can be also defined as a personality disorder that cause by behaviour like exploiting others, envy, lack of empathy and an insatiable hunger for attention (Acocella Joan, 2005). It is a pretty judgmental label to string up on someone who might be happy with him or herself. According to Doctor Pamela Rutledge (2013), the growing selfie trend is today being connected to a lot of psychological disorders that can be damaging to the overall psyche of the users. Psychologists and psychiatrists are reporting rising numbers of patients who are suffering from narcissism, body dysmorphic and dramatically low self-esteem, all thanks to selfie-nation. According to Doctor David Verle (2014) “Two out of three of all the patients who arrive to examine him with Body Dysmorphic Disorder since the cost increase of camera phones have a compulsion to repeatedly read and post selfies on the social media sites.” This indicates that too much selfie can actually lead to Narcissism.

2.2 Addiction

Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry (ASAM, 2011). Selfie can be an addiction to everyone, not only youngsters, elderly may also addicted to the selfie phenomenon. It seems that some people can’t stop turning the camera their way for that perfect shot, and now psychologists say taking selfie can turn an addiction for people already affected by certain psychological disorders. Research found that UK’s first selfie addict is the teen and has had therapy to treat his technology addiction (Fiona Keating, 2014). They believe that the addiction toward selfie is because “Selfies frequently trigger perceptions of self-indulgence or attention-seeking social dependence that raises narcissism or low self-esteem,” (Pamela Rutledge, 2013). Someone that who are addicted to selfie can snap more than 200 times selfie per day. The first case is of Danny Bowman who is 19, a British teen diagnosed with selfie addiction. He reportedly spent 10 hours daily with 200 photos of himself, but the numerous shots cannot still satisfy his desires. He eventually tried to commit suicide to break free from addiction (Aldridge Gemma; Harden Kerry, 2014). Due to the addiction of selfie, he quit school to have more time for selfie, shutting himself in the house for six month, lost 13 kg just to get a better feature from the camera and become aggressive with his parents when they tried to stop him from selfie. Danny says that he constantly search for the perfect selfie and when he realise the he couldn’t he wanted to suicide. Because of the addiction of selfie, he lost his friends, disappoint his family, giving up his education, health and almost scarifies his own life. The addiction of selfie is most likely to the addiction of drugs, alcohol or gambling which require a lot of efforts to be recover.

3.0 Dealing with selfie

3.1 How parents can help to reduce this issues

Most of us do practice selfie, but how to deal with it, how to prevent from getting any illness but still enjoying selfie. First, parent’s education is most important. Knowing what is your children going through and having a better example of selfie phenomena. Some of the children go through rebellious period, they tend to do the opposite thing when their parents say not to (Rutledge Pamela, 2013). So due to this, parent should know their kids well and have a good communication between them to solve this issue. Next, parents should keep the habits of taking selfie when their children is not around because the behaviour of a parent’s influence their children because children tends to modify what their parents doing. Furthermore, parents should also educate their children on what negative effect can selfie bring. Parents play an important role in a child’s life and what they have made changes what they think.

3.2 Time limitations on phone

Other than having the parents educate, time limitation on the phone also helps in dealing with selfie. The lesser the time you spend on your mobile phone, the lesser your addiction towards selfie. Most of us search for photo perfection for example Danny Bowman. After selfie, we spend most of the time on choosing the perfect picture and spend time on editing. Due to the advance technology, there are now thousands of applications for you to edit your picture. From the case of Danny Bowman, there is a cure toward the addiction of selfie – which is to limit his time on his mobile phones. Danny claimed that the doctor confiscate his phone from him for ten minutes, then half an hour, then an hour (Aldridge Gemma; Harden Kerry, 2014). It was tough for him at first, but the idea of living keeps him motivated. According to Doctor Veal, the usual treatment for selfie is where a patient gradually learns to work for a longer period of time without satisfying the urge to submit pictures. There is not much worried because there is a cure for addiction and narcissism.

4.0 Conclusion

Selfie addiction is so new there are, as yet, no statistics on it (Aldridge Gemma; Harden Kerry, 2014) so it causes people to be unconscious about it. How can the society help to improve the selfie phenomena is to spread the word and inform about what illness can bring when they having too much of selfie. Other than that, self-conscious is also important as we. Always control yourself on the number of selfie and the time spent on selfie, make sure you are not addicted to it. If you were addicted, find someone to talk to, get some opinion or seek for a further medical check-up if you can’t manage to get out from the illness that you are having. Lastly, we can make the selfie phenomena a better world by reminding each other not to take too much shots to avoid all the illness and educate them on how to deal with selfie.

Reference List

Acocella Joan. (2014) Selfie.New Yorker, 0028792X, 5/12/2014, Vol. 90, Issue 12. Retrieved from

http://eds.a.ebscohost.com/eds/detail/[email protected]&vid=1&hid=4202&bdata=JnNpdGU9ZWRzLWxpdmUmc2NvcGU9c2l0ZQ==#db=a9h&AN=96140839

Addiction. (2011). American Society of Addiction Medicine. Retrieved form

http://www.asam.org/for-the-public/definition-of-addiction

Aldridge, G., & Harden, K. (2014). Selfie addict took Two Hundred a day – and tried to kill himself when he couldn’t take perfect photo. Retrieved from

http://www.mirror.co.uk/news/real-life-stories/selfie-addict-took-two-hundred-3273819

Martino Joe. (2014). Scientists Link Selfies to Narcissism, Addiction & Mental Illness. Retrieved from

http://www.collective-evolution.com/2014/04/07/scientists-link-selfies-to-narcissism-addiction-mental-illness/

Rutledge Pamela. (2013). Making Sense of Selfies. Retrieved from

http://www.psychologytoday.com/blog/positively-media/201307/making-sense-selfies

Rutledge Pamela. (2013). The psychology of the selfie. Airtalk. Retrieved from

http://www.scpr.org/programs/airtalk/2014/02/11/35997/the-psychology-of-the-selfie/

Selfie. (2012). In Oxford dictionaries. Retrieved from

http://blog.oxforddictionaries.com/press-releases/oxford-dictionaries-word-of-the-year-2013/

The Daily Hit. (2013). The Selfie Addiction ?s Top 16 worst types of selfies. Retrieved from
http://www.dailyhiit.com/hiit-blog/hiit-life/selfie-addiction-top-16-worst-types-selfies/
The Huffington Post. (2014), ‘Selfie Addiction’ is No Laughing Matter, Psychiatrists Say (VIDEO). Retrieved from
http://www.huffingtonpost.com/2014/03/25/selfie-addiction-mental-illness_n_5022090.html

Growing up in a strong Christian household, my parents always emphasized the importance of helping others. My father was a Methodist Minister at three local churches and encouraged my family to take part in the community. He was very active in the Urban Missions Christian Care Center located in Watertown N.Y, participated in Bridge meetings (an alternative to incarceration program), and was also the founder of the Watertown N.Y based Wheels to Work Program. I remember as a young child having my dad come home with the look of pure joy on his face when he gave his first car away to a single mom. I was so amazed how he could literally transform the lives of individuals through his ministry and participation in the community. One of my fondest memories as a child was going to the Urban Mission with my dad on the weekends and just following him around. The Urban Mission offers many great services to individuals in need such as a food pantry, thrift store, critical needs assistance, housing assistance, and the Christian Care Center, which provides a place of caring and acceptance. It was always wonderful seeing the joy on the recipients’ faces after receiving such services. My dad definitely set the foundation for my interest in the social work profession.

Up until my dad died in 2005, I would often volunteer my time at picnics that my dad hosted for families in need, primarily those with little or no income who were regular visitors at the Christian Care Center. I enjoyed preparing food for the picnics because I knew how much these individuals looked forward to a cooked meal. During the picnic, I loved socializing with teens my age. At first I was uncomfortable because I did not know what to expect from someone whose lifestyle differed so much from mine. But soon I determined that these individuals were not that different from myself. Yes, they were less fortunate than I, some were even homeless, but these girls still had the same aspirations and goals as I did, still enjoyed the same activities, and still needed someone they could relate with. I realized how much of a difference I was making just by looking past our differences and embracing our similarities. From that point I recognized the true importance of treating others with dignity, regardless of their lifestyle. Eventually, I realized that I, like my dad, had developed a genuine passion for helping others.

Upon entering 12th grade, I knew that I wanted to enter the human services profession. I originally wanted to become a Licensed Mental Health Counselor, so I did my undergraduate work in psychology. But I soon realized that the MSW degree was a more effective degree for my career choice. My ultimate goal is to become a Licensed Clinical Social Worker with a concentration in Mental Health, and open a private practice. Currently, treatment by LMHCs is not covered by insurance. Therefore, becoming a LCSW is the better option for me because in regards to treatment, I will be able to bill insurance, which will make my services more affordable. In addition, opening a private practice will allow me to be financially flexible with those who do not have insurance. It is extremely important to me to help those with low income and give them the option to take advantage of such services.

Inadequate resources is a huge social problem faced by many, primarily those with low income. I feel as though everyone has the potential to improve their overall well-being if the proper resources are available. However, all too often, certain resources such as counseling are not available financially to those with low income. Without these resources, many individuals may not have the chance to reach their highest potential and become productive members of society. That is why I have a passion to enter the Social Work field, and provide beneficial services to those even in the low income population.

Another major social problem is that there is a strong stigma attached to mental illness. Many believe that having a mental disorder such as depression is attached to personal weakness. As a result, those suffering from mental illness are sometimes reluctant to seek out treatment. I strongly affirm that it is important for society not to label individuals with mental illness. I personally encourage others not to define people as their illness but to see their illness as just a part of who they are.

Thankfully, religious institutions have a role in society in promoting social and economic justice, by providing behavioral guidelines and offering moral support. The Methodist churches that I have been a part of growing up were non-judgmental and worked to provide social equality. As a teen, I was able to experience the diverse community of the congregation at my church. The organist of the church was gay but the congregation did not discriminate against him. Not all churches accept homosexuality, but my dad lived by the rule that you should treat others how you want to be treated. He emphasized the fact that you do not have to support their lifestyle, but you still need to treat them with dignity and respect. He was very accepting, and encouraged our family to be the same way. He always enforced living by the Ten Commandments, which gave our family a solid Judeo-Christian foundation. My dad definitely had an extraordinary influence on how I live my life today. Religion was and still is an important aspect of my family, and these values have continued with me throughout my adult life.

I strongly believe that my solid family and religious foundation has enabled me to acquire characteristics, which will help me succeed in the Social Work field. One characteristic I am blessed with is empathy. I am able to understand others’ emotions and feelings and convey my understanding of how they are feeling. My parents always said when I was younger, aˆ?How would you feel if you were in his/her shoes?aˆ? I often think of that statement, and I do put myself in others’ shoes and I am able to understand what others are feeling. In regards to counseling, I believe empathy is an important characteristic because it allows the client to feel heard and understood. Empathy will help me as a counselor to connect with my clients. I also believe that I have exceptional communication skills. One strong component of communication that I often demonstrate is active listening. I believe this will be beneficial in a counseling setting because it will allow me to interpret what the client is saying and as a result will enable me to deliver a beneficial response. Most importantly, active listening is important in the counseling setting because it will enable the client to develop trust and respect for me as their counselor.

Aside from my strengths, I also have areas in which I need to grow and change. One weakness of mine is that I often find it difficult to establish boundaries. I believe that being able to set up boundaries in the Social Work profession, especially counseling is critical. My main problem is not being able to say no to individuals. I feel as though if I say no to people, they will be disappointed and I therefore, will experience a strong sense of guilt. However, with the direct practice offered at Roberts Wesleyan College, I believe I can transform my weaknesses and learn effective ways of setting up boundaries. I believe that the ability to set boundaries relies on self-confidence. At Roberts Wesleyan College, I know I will be able to develop a stronger sense of self-confidence through the compassionate and supportive environment. Based on the Christian context offered at Roberts, I trust that my weaknesses will be accepted and my strengths will be recognized which will ultimately lead to my growth and development.

Overall, I’m convinced that the MSW program offered at Roberts Wesleyan College is the best program for me. I believe aside from my determination, my current GPA reflects my ability to succeed. My grades have placed me on the President’s list for the last two semesters here at Potsdam. I know that graduate level work will be challenging, but with my motivation and determination I have faith that I can succeed. I am determined to get accepted into the best MSW program, which I believe is offered at Roberts Wesleyan College. Education and religion have always been important to my family and I. I know that my dad would truly be proud to have a daughter attending Roberts Wesleyan College, which offers a solid education foundation along with a Christian context. I know this is the best college for me and will ultimately allow me to achieve to my fullest potential and improve my overall well-being.

Intervention is rarely defined. It originates from the Latin inter between and venire to come and means coming between Trevithick, 2005: 66. Interventions are at the heart of everyday social interactions and make ‘inevitably make up a substantial majority of human behaviour and are made by those who desire and intend to influence some part of the world and the beings within it’ (Kennard et al. 1993:3). Social work interventions are purposeful actions we undertake as workers which are based on knowledge and understanding acquired, skills learnt and values adopted. Therefore, interventions are knowledge, skills, understanding and values in action. Intervention may focus on individuals, families, communities, or groups and be in different forms depending on their purpose and whether directive or non-directive.

Generally, interventions that are directive aim to purposefully change the course of events and can be highly influenced by agency policy and practice or by the practitioner’s perspective on how to move events forward. This may involve offering advice, providing information and suggestions about what to do, or how to behave and can be important and a professional requirement where immediate danger or risk is involved.

In non-directive interventions ‘the worker does not attempt to decide for people, or to lead, guide or persuade them to accept his/her specific conclusions’ (Coulshed and Orme, 1998: 216). Work is done in a way to enable individuals to decide for themselves and involves helping people to problem solve or talk about their thoughts, feelings and the different courses of action they may take (Lishman, 1994). Counselling skills can be beneficial or important in this regard (Thompson 2000b).

Work with service users can therefore involve both directive and non-directive elements and both types have advantages and disadvantages (Mayo, 1994). Behaviourist, cognitive and psychosocial approaches tend to be directive but this depends on perspective adopted and the practitioner’s character. In contrast, community work is generally non-directive and person-centred.

Interventions have different time periods and levels of intensity which are dependent on several factors such as setting where the work is located, problem presented, individuals involved and agency policy and practice. Several practice approaches have a time limited factor such as task-centred work, crisis intervention and some behavioural approaches and are often preferred by agencies for this reason. In addition, practice approaches that are designed to be used for a considerable time such as psychosocial are often geared towards more planned short-term, time limited and focused work (Fanger 1995).

Although negotiation should take place with service users to ensure their needs and expectations are taken into account, it is not common practice for practitioners to offer choice on whether they would prefer a directive or non-directive approach or the practice approach adopted (Lishman, 1994). However, this lack of choice is now being recognised and addressed with the involvement of service users and others in the decision-making process in relation to agency policy, practice and service delivery (Barton, 2002; Croft and Beresford, 2000).

The purpose and use of different interventions is contentious. Payne (1996: 43) argues that ‘the term intervention is oppressive as it indicates the moral and political authority of the social worker’. This concern is also shared by others with Langan and Lee (1989:83) describing the potentially ‘invasive’ nature of interventions and how they can be used to control others. Jones suggests that in relation to power differences and the attitude of social workers especially with regards to people living in poverty: ‘the working class poor have been generally antagonistic toward social work intervention and have rejected social work’s downward gaze and highly interventionist and moralistic approach to their poverty and associated difficulties’ (Jones, 2002a: 12). It is recognised that intervention can be oppressive, delivered with no clear purpose or in-depth experience however, some seek and find interventions that are empathic, caring and non-judgemental due to practitioners demonstrating ‘relevant experience and show appropriate knowledge’ (Lishman, 1994:14). For many practitioners, these attributes are essential in any intervention and are demonstrated through commitment, concern and respect for others which are qualities that are valued by service users (Cheetham et al. 1992; Wilson, 2000).

Dependent on the nature of help sought there are different opinions on whether interventions should be targeted on personal change or wider societal, environmental or political change. Some may want assistance in accessing a particular service or other forms of help and not embrace interventions that may take them in a particular direction i.e. social action (Payne et al. 2002). In contrast, problems may recur or become worse if no collective action is taken.

Importance has reduced in relation to methods of intervention over recent years as social work agencies have given more focus to assessment and immediate or short-term solutions (Howe, 1996; Lymbery 2001). This is strengthened by the reactive nature of service provision which is more concerned with practical results than with theories and principles. This has a reduced effect on workers knowledge of a range of methods resulting in workers using a preferred method which is not evidenced in their practice (Thompson, 2000). Methods of intervention should be the basis of ongoing intervention with service users, but often lacks structured planning and is reactive to crisis. This reactive response with emphasis on assessment frameworks is concerning, as workers are still managing high caseloads and if not supervised and supported appropriately, workers are at risk of stress and eventual burn-out (Jones, 2001; Charles and Butler, 2004).

Effective use of methods of intervention allows work to be planned, structured and prioritised depending on service users’ needs. Methods can be complicated as they are underpinned by a wide range of skills and influenced by the approach of the worker. Most methods tend to follow similar processes of application: assessment, planning of goals, implementation, termination, evaluation and review. Although the process of some methods is completed in three/four interactions others take longer. This difference shows how some methods place more or less importance on factors such as personality or society, which then informs the type of intervention required to resolve issues in the service user’s situation (Watson and West, 2006).

More than one method can be used in conjunction with another, depending on how comprehensive work with service users needs to be (Milner and O’Byrne, 1998). However, each method has different assessment and an implementation process which looks for different types of information about the service user’s situation for example, task centred looks for causes and solutions in the present situation and psychosocial explores past experiences. Additionally, the method of assessment may require that at least two assessments be undertaken: the first to explore the necessity of involvement and secondly, to negotiate the method of intervention with the service user.

An effective assessment framework that is flexible and has various options is beneficial but should not awkward or time consuming to either the worker or the service user. As Dalrymple and Burke (1995) suggest, a biography framework is an ideal way as it enables service users to locate present issues in the context of their life both past and present.

Workers should aim to practice in a way which is empowering and the process of information gathering should attempt to fit into the exchange model of assessment, irrespective of the method of intervention and should be the basis of a working relationship which moves towards partnership (Watson and West, 2006). As part of the engagement and assessment process, the worker needs to negotiate with the service user to understand the issue(s) that need to be addressed and method(s) employed and take into account not only the nature of the problem but also the urgency and potential consequences of not intervening (Doel and Marsh, 1992).

Importance should be placed on presenting and underlying issues early in the assessment process as it enables the worker to look at an assessment framework and approach that assists short or long-term methods of intervention. An inclusive and holistic assessment enables the service user to have a direct influence on the method of intervention selected and be at the heart of the process. The process of assessment must be shared with and understood by the service user for any method of intervention to be successful (Watson and West, 2006).

The worker’s approach also has an influence on method selection as this will affect how they perceive and adapt to specific situations. The implementation of methods is affected by both the values of the method and value base of the individual worker. The worker will also influence how the method is applied in practice through implementation, evaluation, perceived expertise and attitude to empowerment and partnership.

Methods such as task centred are seen to be empowering with ethnic minority and other oppressed groups as service users are seen to be able to define their own problems (Ahmad, 1990). However, when an approach is used which is worker or agency focused the service user may not be fully enabled to define the problem and results in informing but not engaging them in determining priorities.

Empowerment and partnership involves sharing and involving service users in method selection, application of the method, allocation of tasks, responsibilities, evaluation and review and is crucial in enabling facing challenges in their situations and lives. However, service users can have difficulty with this level of information-sharing and may prefer that the worker take the lead role rather than negotiating something different and not wish to acquire new skills to have full advantage of the partnership offered.

Selecting a method of intervention should not be a technical process of information gathering and a tick box process to achieve a desired outcome. Milner and O’Byrne (2002) suggest it requires combining various components such as analysis and understanding of the service user, worker and the mandate of the agency providing the service otherwise intervention could be is restrictive and limit available options. However, negotiation and the competing demands of all involved parties must be considered and the basis of anti-oppresive practice established.

Methods of intervention can be a complex and demanding activity especially in terms of time and energy and therefore, short-term term methods are seen as less intensive and demanding of the worker as well as more successful in practice. However, Watson and West (2006: 62) see this as ‘a misconception, as the popular more short-term methods often make extensive demands on the workers’ time and energy’.

Workers are often dealing with uncertainty as each service user have different capabilities, levels of confidence and support networks. Therefore, there is no one ideal method for any given situation but a range of methods that have both advantages and disadvantages and as Trethivick (2005: 1) suggests workers need to have ‘a toolkit to begin to understand people’ and need to widen the range of options available in order for them to respond flexibly and appropriately to each new situation (Parker and Bradley, 2003).

When using methods of intervention, workers have to be organised to ensure that the task is proactively carried out and often attempt to prioritise involvement with service users against both local and national contexts and provide an appropriate level of service within managerial constraints. This prioritisation means in practice that, given the extensive demands, work using methods can only be with four or five service users at any one time and with the additional pressure of monitoring and supervising service users and reports, risk response is often responsive and crisis driven (Watson and West, 2006).

To work in an empowering and anti-oppressive perspective is to ensure that intervention focuses clearly on the needs of the service user, is appropriate to the situation than the needs of the service. An understanding of these competing demands and the worker’s ability to influence decision-making processes does impact on method selection however, this should not mean that the service is diluted and methods be partially implemented as this is not conducive to managerial or professional agendas on good practice. Thompson (2000:43) sees this as ‘the set of common patterns, assumptions, values and norms that become established within an organisation over time’ and a concern of workers is competitive workplace cultures where ability is based on the number of cases managed rather than the quality that is provided to service users which may result in use of less time-consuming methods.

For work to be effective, an ethical and a professional not just a bureaucratic response to pressures faced is required and is not about the service user fitting into the worker or agency’s preferred way of working but looking at what is best for the service user and finding creative ways to make this happen.

Workers need to be careful not to seen as the ‘expert’ who will resolve the situation as even the most established and experienced practitioners have skills gaps and often develop skills when working with the service users. This process of learning in practice requires good support and supervision, enabling the worker to reflect on assumptions about service users and their capabilities especially in relation to gender, race, age or disability to prevent internalised bias to impact on what the service user requires to work on to change the situation (Watson and West, 2006).

It is crucial to appreciate the situation from the service user’s perspective and see them as unique individuals as Taylor and Devine (1993: 4) state ‘the client’s perception of the situation has to be the basis of effective social work’. This concern is also shared by Howe (1987:3) describing ‘the client’s perception is an integral part of the practice of social work’. Service users often have their own assumptions about what social work is and what workers are able to provide which is generally based on past relationships and experiences for example, black service users experience may reflect a service which in the past was not appropriate to their needs (Milner and Byrne, 1998: 23) but to alleviate this practitioners need to work in an open, honest and empowering manner and recognise that although service users may be in negative situations they also have strengths and skills that need to be utilised in the social work relationship.

Workers should ensure that written agreements are developed that acknowledge all participants roles and responsibilities and avoid assumptions or issues (Lishman, 1994), this avoids breakdown in trust and encourages honesty and open shared responsibility between service user and worker. This involves negotiation on what should be achieved, by whom, including agency input. Agreements can provide the potential for empowering practice that involves partnership. However, cognisance has to be taken to ensure that the agreement does not become a set of non-negotiated tasks that service users have no possibility of achieving, combined with no reciprocal commitment or obligations by the worker as this does not address the issue of empowerment or oppression and can reinforce the power difference (Rojek and Collins, 1988).

The final stage of the process is termination which should be planned and allow both parties time and opportunity to prepare for the future however, it has to be carefully and sensitively constructed and is much easier to achieve if the work has been methodical with clear goals as it demonstrates what has been achieved. Evaluation is beneficial as it enables the service user and worker to be reminded of timescales and can acknowledge the service user’s increasing skills, empowerment, confidence and self-esteem which can be utilised after the intervention has ended. Endings can however, be difficult for both the worker and service user resulting from various factors such as complexity of service user’s situation, issues of dependency and lack of clarity about purpose and intervention. This lack of clarity can result in a situation of uncertainty for both worker and service user (Watson and West, 2006). Finally, termination as part of the change process creates opportunities but also fear, anxiety and loss (Coulshed and Orme, 1998).

It is important for workers to take a step back and reflect on their practice and review their experiences to ensure that they are providing the best possible service in the most ethical and effective manner. Reflective practice provides support and enables workers to not just meet the needs of the organisation but also develop their own knowledge and skills and increased understanding of their own approach and the situation experienced by service users. A good tool to facilitate this is the use of reflective diaries. Reflecting in action and on action both influences and enhances current and future practice. The use of effective supervision is another process where workload management, forum for learning and problem-solving should take place which should be supportive and enabling to the worker (Kadushin and Harkness, 2002). However, the worker’s role in supervision is often viewed as passive as the supervisor sets the agenda. This can lead to disempowerment of the worker in relation to the agency and is potentially oppressive and discriminatory and provides a poor role model for work with service users and therefore consideration must be given on how they can create a positive and empowering relationship (Thompson, 2002).

In conclusion, good practice requires workers to have knowledge to understand the ‘person in situation,’ (Hollis, 1972) understanding both sociological (society and community) and psychological (personality and life span) and the interrelation and impact on the service user (Howe, 1987). A critical skill for effective and ethical practice is empowerment which is based on knowledge and values and is the difference between informing and genuine partnership and the importance of active participation of service users throughout the process.

Social work is a value based activity and workers through reflection and supervision can all learn from experiences, adapt and enhance these to develop practice and gain self-awareness to understand how they themselves and their approach impacts on service users.

The Scottish Government together with local authorities, partners and stakeholders have initiated reforms in the way in which public services should be provided to achieve ‘a sustainable, person-centred system, achieving outcomes for every citizen and every community’. (Scottish Government 2011a)

It is believed that everyone has to make a contribution. The Government set the aims to the services that should be person-centred, seamless and proactive. Services that would allow everybody to have best quality of life and give the full potential of contribution to the communities people live in. The key aspects involved in the public service provision focus on equality, respect and dignity, support in overcoming inclusion barriers and general positive outcomes and well being. The underlined values relate also to the individualised needs such as religion, culture or ethnic.

Problems such as growth in public spending, social inequalities, poverty, lack of clarity in what lies behind organizations etc. have their origins in the way different services are funded, planned and managed. However, the aim of the Scottish Government remains unchanged and is to reduce the frustration resulting on long standing problems such as inefficiency of the public services, and the gaps that frequently exist within care systems. (Scottish Government Publications 2000).

Researchers investigate what people value most to archive real-life improvements in the social and economic wellbeing of the people and communities. Half of the public finds that the Government’s foreground for service provision should be “what is good for everyone in society as a whole” (Ipsos MORI, 2010). This show that a progress in the development of an integrated public service has already occurred but requires continuation to success.

Reaching an understanding

It needs to be understood that public services and support systems exist for the society that use them. Evidence such as Christie Commission report (Christie, 2011), demonstrate that the needs have not always been central to the planning of services.

The people that use the services often perceive themselves to be not sufficiently informed and not fully able to take part in the growth process of the services.

Some changes in the service provision in relation to ‘shifting the philosophy ’ have already taken place. This makes the service provision more user centred and allows the user to participate actively in the changes and benefit the majority. (Rose, 2003)

Client ‘centredness’ became the watchword for the twenty-first century; however the progress in the implementation of person-centred planning in practice appears slow.

Since devolution, there has been development, changes and new policies for health care, with reorganisations taking place, that are generally called reforms. These refer mainly to patients’ choice; system efficiency; quality of care and accountability acquired through transparency.

In Scotland, for example, the separation of purchasing from provision of health care was abolished (National Health Service and Community Care Act 1990); it is not recommended for the providers to compete; The National Health Service (Free Prescriptions and Charges for Drugs and Appliances) (Scotland) Regulations (2011) implemented free drugs prescriptions as well as personal social care for the over-65s (Community Care and Health (Scotland) Act 2002).

Recent changes relate to the abolition of primary care trusts (PCTs) and strategic health authorities (SHAs), new commissioning of clinical groups (CCGs) and Healthwatch England.

Other examples of success relate to improving the quality of services that include smoking ban legislation; lower mortality levels or decrease in heart disease and stroke through a number of governmental initiatives. These changes led Scotland to become a leader in public service reforms and made visible improvements for the Scottish society.

The system’s integration with social services discourages provider competition and encourages patient choice and strong performance management. The Scottish Government’s 2020 Vision (Scottish Government (a) 2013) aims to enable everyone to live a life that is longer, healthier; possibly at home or in a homely setting. To achieved that the healthcare system that focuses on prevention and anticipation and on the integration with social care.

Positive changes improving people’s lives do take place at national and local levels. However, studies show that the public are overall more negative about services nationally and show positive stance about local services. This can be reasoned by the affirmative actions in which the public can have a bigger impact on how local services operate and the on the decision making. Public Service Trust states that more than a half (58% ) of the public would like to be actively involved in shaping public services. Although this is more than a half of the public it proves that there is the need for more community and local activity an engagement in relation to the public services in order to reduce and minimise the substantial barriers.(Ipsos MORI 2010)

These are only a few examples of the improvement that has occurred due to the governmental actions focused at partnetships between service providers and investment in people. (Scottish Government (c ) (2013)

New legislation was introduced ( The Scottish Government (c)2013) to improve the integration of health and social care provision to make care for the citizens better. This affects particularly older people – free personal care for them and acknowledging the facts highlighted in the Christie report (Christie, C. 2011) that by 2033, the number of people aged over 75 will increase by 84%.

The report ( Christie, 2011) estimates however that additional demands on social care and justice services will be costly (

Although there is evidence demonstrating progress especially in implementing diverse and innovative approaches that appeal to healthcare and social care professionals, practitioners and policymakers there are also many challenges of implementing the client-centerness.

Achieving outcomes for every citizen and every community

While many professionals espouse the principles of client-centred practice it seems much more difficult to implement these into everyday practice.

Health care providers, staff and clients must work together to facilitate changes and ensure that each client receives respectful, supportive, coordinated, flexible and individualized service where standards affirm basic ethical principles, beneficence and social justice. This is however a real change, due to many factors including changes in funding, culture and power relations, as well as in approaches to service management and staff supervision.

This is why attention is paid to more openly and transparent performance of the services .This however according to Dr Barry ( Barry, M. 2007) requires comprehensive strategies to ensure fair, good quality but foremost integrated services for people with the knowledge and well structured priorities in relation to their professional and social roles.

Across researchers (Ipsos MORI, 2010), it is to see that not all the issues policymakers find important for reforming public services resonate with the general public at the same levels. The fairness, good quality standards of customer service, local control, accountability, personalisation and choice are seen as public’s key priorities, however the first two aspects seem to be more important to the public. 63% think that standards of public services should be the same for everyone and everywhere in UK and over 47% would prefer greater local decision-making. This could be a consequence of declining trust in politicians. The findings of Ipsos MORI (2008/9) suggest that the citizens would like to feel more welcomed to take a part in an honest debate about the options ahead for public services because information about the scale of the approaching challenges has not reached citizens in a form they understand.

This demonstrates the need of more control and choice in the consumer, and facilitates individualised rather than universal services.

Roles, relationships and responsibilities of partners within an integrated public service.

Many of current public services continue to operate on the basis of the traditional model of service provision. To allow the changes in how resources are managed and allocated to happen there is a growing need for appropriately trained staff and management. However to support the reforming public services change for a well integrated ‘multi-agency’ working not just at managerial level is needed but a change to the whole culture that governs services.

Collaborative working, partnership and community involvement

Co-operation that would replace competition is required as well as focus on professional responsibility on meeting the increasing complexity. (Royal College of Nursing, 2004). The collaborative work, in practice should involve joint planning between health authorities – both local and national as well as the private and voluntary sectors and education.

Working together includes the whole process of researching, assessing, planning, implementing and evaluation. Balancing power relations in partnership across cultures, ethical, political or religious differences play an important role in promoting appropriate services for the service users. Teamwork and partnership often do not operate in an integrated way where the patient or service user would be seen as the central figure. The users involvement is vital. Working together, joining trade unions, expanding knowledge and engaging with local authorities helps find ways to reach excluded and marginalised groups of a society.(Department of Health 2000 a).

This is already notable in the programs of most of the political parties. The citizens empowerment is seen as a social manner that can influence and shape the public services to suit better the user’s need. Giving people a say in the design and delivery of public services.

This is however a social challenge as the public opinion research show a decrease from 58% to 47% in disposition to the interests in decision-making related to the local areas. ( Ipsos MORI 2010).

This is why people should be motivated to get involved in collaboration and partnerships within the public services, they should be offered the chance to share experiences and discuss actions and widen the pool of resources and skills.

The impetus for integration and collaboration has been pointed out in legislations and government policies such as The Vital Connection (Department of Health, 2000a), NHS plan (Department of Health, 2000b) or in the Government’s Equality Framework (Department of Health, 2012)

This demonstrates clearly that seamless health and social services provision has been a concern of policy makers for many years and that the UK governments underline the need for collaboration. However when the public was asked about getting personally involved in local decision-making, the commitment to involvement in decisions affecting their local area has dropped to 47% from 56%. (Ipsos MORI (2010). This could be one of the explanations why problems continue to exist.

Service planning, empowerment and engagement

The notion of empowerment is central. This however requires people’s engagement. Research shows that people find that vast majority are more interested in having a say (24%) or in knowing more (47%) than actually getting engaged. The service planning should therefore include informative element how the services are delivered and by whom for the users in order to engage them to recreate services they need.

According to the annual Audit of Political Engagement only 11% of adults can be classified as ‘political activists’ and over half the public (51%) have no interests. (Ipsos MORI 2010). It seems that co-making decisions is less important than having the influence to make them.

Managers and frontline workers

Poor image, desinformation and low pay contribute to general feelings of helplessness among many frontline workers that should be involved decision-making and planning processes (Eborall,2003).

Managerial styles need to be empathetic in order for frontline staff to adopt person-centred approaches to their work ( Sherad, D. 2004)

A good style helps demonstrate and articulate the values of the organisation, values personal commitment and relationships with the people it supports. Look for ways to use staff interests and strengths in directly supporting people.

The style shall rather review itself in decision making and in having a clear vision and direction. This encourages new ideas as well as personal involvement and helps to achieve the purpose as a team.

.

The Government support management and frontline staff in public services by implementing programmes that lead to integration of health and social care. One of the examples is The Public Bodies (Joint Working) (Scotland) Bill. The act underlines the importance of the integrated work for health and social care provision across Scotland.

They both have a key role to play reforming the public services, therefore the reform should involve more educational, council, employer and training bodies to help improve the workforce awareness and leadership development.

Also thethird sector organisations should have access to appropriate skills development opportunities, including leadership development .(The Scottish Government ( 2011 b)

Summarising it needs to be believed that people learn from the past experiences and improve partnership at local and national levels to build a well functioning system that could seamlessly provide care for the whole community, including people with complex care needs because at the end of the day we do it for us.

( words 2641)

References:

Barry, M. (2007) Effective Approaches to Risk Assessment in Social Work: An International Literature Review Social Work Research Centre University of Stirling Scottish Executive Social Research [online] available http://scotland.gov.uk/Resource/Doc/194419/0052192.pdf [accessed 11.11.13]

Christie, C. (2011) Commission on the future delivery of public services [online] available http://www.scotland.gov.uk/Resource/Doc/352649/0118638.pdf [accessed 01.12.13]

Department of Health (2000 a ) The Vital Connection – an equalities framework for the NHS [online] available http://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4007652 [accessed 11.12.13]

Department of Health (2000 b) The NHS Plan: Principles [online] available http://webarchive.nationalarchives.gov.uk/+/www.dh.gov.uk/en/publicationsandstatistics/publications/publicationspolicyandguidance/browsable/DH_4901318 [ accessed 11.12.13]

Department of Health (2012) NHS Outcomes Framework 2013 to 2014 [online] available https://www.gov.uk/government/publications/nhs-outcomes-framework-2013-to-2014 [ accessed 02.12.13]

Eborall, C. (2003) The State of the Social Care Workforce in England. First annual report of the TOPSS England Workforce Intelligence Unit [online] available www.topssengland.net [ accessed 10.11.13]

Hall, S. (2009) Spending priorities in the benefits system: Deliberative research with the public DWP Research Report No 559.

Ipsos MORI (2008/9) Real Trends Slide Pack [online] available http://www.ipsos-mori.com/researchpublications/publications/1191/Real-Trends-Flyer.aspx [accessed 11.12.13]

Ipsos MORI (2009) Public Services and Public Spending, RSA Slide Pack Leaders, Parties and spending cuts [online] available http://www.ipsos-mori.com/Assets/Docs/News/news-ipsos-mori-conferences-2009-briefing-pack.pdf [ accessed 18.12.13]

Ipsos MORI (2010) What do people want, need and expect from public services [online] available http://www.ipsos-mori.com/researchpublications/publications/1345/What-do-people-want-need-and-expect-from-public-services.aspx [ accessed 12.12.13]

Public Bodies (Joint Working) (Scotland) Bill (2013) [online] available http://www.scottish.parliament.uk/S4_HealthandSportCommittee/Public%20Bodies%20Joint%20Working%20Scotland%20Bill/PBJW0073_-_Scottish_Social_Services_Council.pdf [ accessed 01.12.13]

Rose, D. (2003) Partnership, co-ordination of care and the place of user involvement Journal of Mental Health, Vol. 12, No. 1, pp. 59–70 [online] available http://informahealthcare.com/doi/abs/10.1080/09638230021000058300 [ accessed 01.12.13]

Royal College of Nursing (2004) Collaborative working, partnership and community involvement [online] available http://www.rcn.org.uk/development/learning/transcultural_health/multiagency/sectiontwo [ accessed 11.11.13]

Sheard, D. (2004) Person-centred care: the emperor’s new clothes? Journal of Dementia Care, March/April, Vol. 12, Issue 2, pp. 22–4

The Scottish Government ( 2011 a) Commission on the Future Delivery of Public Services [online] available http://www.scotland.gov.uk/Publications/2011/06/27154527/10 [ last accessed 09.01.14]

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The Scottish Government (a) (2000) Our National Health A plan for action, a plan for change ( Deacon, S) Publications [online] available http://www.scotland.gov.uk/Resource/Doc/158732/0043081.pdf (last accessed 05.12.13)

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Reading:

Social Research (2004) Health and Community Care Research Programme Public Attitudes to the National Health Service in Scotland http://www.scotland.gov.uk/Resource/Doc/26800/0025702.pdf

– 2004 Survey Research st accessed 04.10.13)Commission on the Future Delivery of Public Services

The North East of Scotland Child Protection Committee (NESCPC) has produced this Risk Assessment Framework in response to an identified need for a Pan Grampian approach.

This framework is for use by all agencies located within Aberdeen City, Aberdeenshire and Moray with the aim of ensuring that there is a consistency of understanding and approach to risk assessment across all sectors.

The framework is written with the additional understanding that all practitioners have a responsibility to ensure that they are familiar with and follow their own organisation’s child protection procedures. These should all link to the overarching NESCPC Guidelines and give advice on who to contact, how to take immediate action and how concerns should be recorded.

Background

Several models of Risk Assessment exist but are not used in a systematic way because they are not thought to be comprehensive enough to be used in all situations (Scottish Government: Effective Approach to Risk Assessment in Social Work: an international literature review (2007).

To enable greater consistency and conformity across Scotland, the Scottish Executive (2005) proposed a programme of change: Getting it Right For Every Child, incorporating the development work undertaken on an Integrated Assessment Planning and Recording Framework (IAF). This is based on requirements to gain a thorough understanding of:

the developmental needs of a child

the capacity of a parent/carer to respond appropriately to those needs

the impact of the wider family and wider environmental factors on parenting capacity and on the child’s needs

This Framework emphasises the need to treat assessment as a process rather than an event. In evaluating the assessment and planning a response, practitioners are expected to consider the totality of the child’s development and any unmet needs rather than focusing too narrowly on a need for protection.

This approach should make sure that:

Children get the help they need when they need it;

Help is appropriate, proportionate and timely;

Agencies work together to ensure a co-ordinated and unified response to meeting the child’s needs;

The plan is used to put in place arrangements to manage risk and to co-ordinate help for the child or young person;

The plan is based on assessment and analysis of the child’s world, including the risks, needs and resilience factors.

What is Risk Assessment?

Risk Assessment is a frequently used term without practitioners always being clear about what is meant.

“Risk assessment is merely the description of good methodical practice to risky situations” (Jones, 1998).

Risk Assessment is a critical element of the integrated assessment process pulling together, as it does the identified strengths within a family as well as those areas of concern or risk that need to be addressed. It is a complex, continuous and dynamic process, which involves the gathering and weighting of relevant information to help make decisions about the family strengths, needs and associated risks and plan for necessary interventions. Good systematic assessment confirms what may have happened, how this may affect the immediate and future safety of the child or young person, places this in context and informs what needs to be done. Risk assessments can also be used to predict the escalation of the presenting behaviour as well as the individual’s motivation for change. Assessing risk is not an exact science; prediction involves probability and thus some errors are inevitable.

Basic Principles when assessing risk.

The welfare of the child is paramount.

Risk assessment should be based on sound evidence and analysis

Risk assessment tools should inform rather than replace professional judgement

All professionals involved in risk assessment should have a common language of risk and common understanding of information sharing to inform assessment

Risk assessment is influenced by professionals own personal and professional values, experiences, skills and knowledge

The judgement and experience of practitioners needs to be transparent in assessment

No tool, procedure or framework can adequately account for and predict human behaviour

Effective communication and information sharing is crucial to protecting children

Children, young people and family views should be sought, listened to and recorded with clear evidence of their involvement in decision making where possible.

A good risk assessment process should elicit and highlight both commonalities and differences in professional and family perspectives

Good risk assessment requires the best possible working relationship between worker and family members

All staff must always be alert and aware to situations where children may be at risk and address any potential concerns through their own agency’s child protection policy / NESCPC child protection guidance.

Risk Assessment Framework

This framework is adapted from the work undertaken by Jane Aldgate and Wendy Ross (“A Systematic Practice Model for Assessing and Managing Risk”, 2007) and is structured in 9 different stages:

Using the SHANNARI well-being indicators (Safe, Well, Active, Nurtured, Achieving, Respected, Responsible and Included).

2. Getting the child and family’s perspectives on risk.

Drawing on evidence from research and development literature about the level of risk and its likely impact on any individual child.

4. Assessing the likely recurrence of harm.

5. Looking at immediate and long-term risks in the context of “My World” triangle.

Using the Resilience Matrix to analyse the risks, strengths, protective factors and vulnerabilities.

7. Weighing the balance of that evidence and making decisions.

8. Constructing a plan and taking appropriate action.

9. Management of Risk

1. Using the SHANARRI well-being indicators:

The Scottish Executive (2004) agreed a vision for Scotland’s Children. They should be:

Safe

Healthy

Active

Nurtured

Achieving

Respected

Responsible

Included

Using these SHANARRI indicators, professionals consider the child’s holistic needs. In any assessment professionals should ask themselves the following key questions:

What is getting in the way of this child being safe, healthy, active, nurtured, achieving, respected, responsible and included?

Why do I think that this child is not safe?

What have I observed, heard, or identified from the child’s history that causes concern?

Are there factors that indicate risk of significant harm present and is the severity of factors enough to warrant immediate action?

What can I do?

What can my agency do?

Do I need to share / gather information to construct a plan to protect this child?

What additional help may I find from other agencies?

2. Getting the child and family’s perspectives on the risk.

The involvement and partnership with children, young people and their families is integral and essential to successful risk assessment and management. Information is incomplete and a good understanding of the risks of harm and needs of the children cannot be reached without families’ perspectives on the risks to their children’s difficulties. An open and transparent approach that actively involves all involved, including the children and families is of clear benefit in that:

Children, young people and families can understand why sharing information with professionals is necessary;

Children and families can help practitioners distinguish what information is significant;

Everyone who needs to can take part in making decisions about how to help a child;

Everyone contributes to finding out whether a plan has made a positive difference to a child or family;

Professionals behave ethically towards families;

Even in cases where compulsory action is necessary, research has shown better outcomes for children by working collaboratively with parents.

3. Drawing on evidence from research and developmental literature about the level of risk and its likely impact on any individual child.

Risks need to be seen in the wider context of short and long term risks to children’s wellbeing and development. Core factors can be identified in relation to abuse or neglect but these should not be used as predictors for current and future abuse without being considered in the context of the child’s own nature and environment.

In all cases of child abuse, parenting capacity should also be considered and this involves taking account of historical information as well as assessing the “here and now”. Protective factors need to be weighed up against risk factors and vulnerability to determine the level of risk to the individual child or young person and the likelihood of future harm. The factors should be used as a knowledge base to underpin more detailed assessments of strengths and pressures based on the “My World” triangle. (See Section 5).

Factors to be considered:

(This list is not complete – but is a general guide). Adapted from “City of Edinburgh Risk Taking Policy and Guidance” (2004).

Consideration of significant harm (link to Safety Threshold considerations, Section 3 NESCPC guidelines for further explanation);

Current injury/harm is severe: the more severe an injury, the greater the impairment for the child/young person and the greater the likelihood of reoccurrence;

Pattern of harm is escalating: if harm has been increasing in severity and frequency over time, it is more likely that without effective intervention the child/young person will be significantly harm;

Pattern of harm is continuing: the more often harm has occurred in the past the more likely it is to occur in the future;

The parent or care-giver has made a threat to cause serious harm to the child/young person: such threats may cause significant emotional harm and may reflect parental inability to cope with stress, the greater the stress for a person with caring responsibilities, the greater the likelihood of future physical and emotional harm to the child/young person;

Sexual abuse is alleged and the perpetrator continues to have access to the child/young person: if the alleged perpetrator has unlimited access to the child/young person, there is an increased likelihood of further harm;

Chronic neglect is identified: serious harm may occur through neglect, such as inadequate supervision, failure to attend to medical needs and failure to nurture;

Previous history of abuse or neglect: if a person with parental responsibility has previously harmed a child or young person, there is a greater likelihood of re-occurrence;

The use of past history in assessing current functioning is critical.

Factors relating to the child or young person

Physical harm to a child under 12 months: very young children are more vulnerable due to their age and dependency.

Any physical harm to a child under 12 months should be considered serious and the risk assessment should not focus solely on the action and any resultant harm, but rather that the parent has used physical action against a very young child. This could be as a result of parenting skill deficits or high stress levels.

Child is unprotected: the risk assessment must consider parental willingness and ability to protect the young child.

Children aged 0-5 years are unable to protect themselves, as are children with certain learning disabilities and physical impairments. Children, who are premature, have low birth weight, learning disability, physical or sensory disability and display behavioural problems are more liable to abuse and neglect.

The child/young person presents as fearful of the parent or care-giver or other member of the household: a child/young person presenting as fearful, withdrawn or distressed can indicate harm or likely harm.

The child/young person is engaging in self-harm, substance misuse, dangerous sexual behaviour or other “at risk” behaviours: such behaviour can be indicators of past or current abuse or harm.

Factors relating to the parent or care-giver

The parent or care-giver has caused significant harm to any child/young person in the past through physical or sexual abuse: once a person has been a perpetrator of an incident of maltreatment there is an increased likelihood that this behaviour will re-occur.

The parent or care-giver’s explanation of the current harm/injury is inconsistent or the harm is minimised: this may indicate denial or minimisation. Where a parent or care-giver fails to accept their contribution to the problem, there is a higher likelihood of future significant harm.

The parent or care-giver’s behaviour is violent or out of control: people who resort to violence in any context are more likely to use violent means with a child or young person.

The parent or care-giver is unable or unwilling to protect the child/young person: ability to protect the child/young person may be significantly impaired due to mental illness, physical or learning disability, domestic violence, attachment to, or dependence on (psychological or financial) the perpetrator.

The parent or care-giver is experiencing a high degree of stress: the greater the stress for a parent or care-giver, the greater the likelihood of future harm to the child or young person. Stress factors include poverty and other financial issues, physical or emotional isolation, health issues, disability, the behaviour of the child/young person, death of a child or other family member, divorce/separation, and large numbers of children.

The parent or care-giver has unrealistic expectations of the child/young person and acts in a negative way towards the child/young person: this can be linked to a lack of knowledge of child development and poor parenting skills. Parents or care-givers who do not understand normal developmental milestones may make demands which do not match the child/young person’s cognitive, developmental or physical ability.

The parent or care-giver has poor care-giving relationship with the child/young person: a care-giver who is insensitive to the child or young person may demonstrate little interest in the child/young person’s wellbeing and may not meet their emotional needs.

Indicators of poor care-giving include repeated requests for substitute placement for the child/young person.

The parent or care-giver has a substance misuse problem. Parental substance misuse can lead to poor supervision, chronic neglect and inability to meet basic needs through lack of money, harmful responses to the child/young person through altered consciousness, risk of harm from others through inability to protect the child/young person.

The parent or care-giver refuses access to the child/young person: in these circumstances it is possible that the parent or care-giver wishes to avoid further appraisal of the well-being of the child. Highly mobile families decrease the opportunity for effective intervention, which may increase the likelihood of further harm to the child/young person.

The parent or care-giver is young: a parent or care-giver under 21 years may be more likely to harm the child through immaturity, lack of parenting knowledge, poor judgement and inability to tolerate stress.

The parents or care-givers themselves experienced childhood neglect or abuse: however caution has to be exercised here; parenting skills are frequently learned/modelled but later positive experiences can counteract an individual’s own childhood experiences.

Factors relating to the Environment

The physical and social environment is chaotic, hazardous and unsafe: a chaotic, unhygienic and non-safe environment can pose a risk to the child/young person through exposure to bacteria/disease or through exposure to hazards such as drug paraphernalia, unsecured chemicals, medication or alcohol.

Conversely, an environment with overly sanitised conditions, where the child’s needs are not recognised or prioritised is also harmful.

4. Assessing the likely recurrence of harm.

When assessing how safe a child is consideration must be given to likelihood of recurrence of any previous harm.

Factors for consideration:

The severity of the harm (How serious was it? How long did it continue? How often?)

In what form was the abuse / harm?

Did the abuse have any accompanying neglect or psychological maltreatment?

Sadistic acts?

Was there any denial? This could include absence of acknowledgement, lack of co-operation, inability to form a partnership and absence of outreach.

Are there issues with parental mental health? This could include personality disorder, learning disabilities associated with mental illness, psychosis, and substance/alcohol misuse.

These also link to consideration of additional family stress factors, the degree of social support available to the family, the age of the children and number of children and the parents’ own history of abuse. Other agencies may be able to add additional knowledge and expertise to inform an effective risk assessment.

Looking at immediate and long-term risks in the context of the “My World” triangle.
The Assessment Triangle

Being healthy Everyday care and help

Learning and achieving Keeping me safe

Being able to communicate Being there for me

Confidence in who I am Play, encouragement and fun

Learning to be responsible Guidance, supporting me to make the right choices

Becoming independent,

looking after myself Knowing what is going to happen and when

Enjoying family and

Friends Understanding my family’s background and beliefs

Support from School Work opportunities

family, friends and for my family

other people Enough money

Local resources Belonging

Comfortable and

safe housing

An important principle underpinning the evidence-based planning in Getting it Right for Every Child is that there are many positive and negative influences in the world

each child experiences. Each child is unique and will react differently to these influences but all children will react to what is going on in different parts of the family

and the wider world in which they are growing up. This is why recent thinking in child development urges that we take a look at all the different influences in a child’s

whole world when assessing children’s development. This is called a child’s ecology

and is encapsulated in the “My World” triangle.

Each domain of the “My World” triangle provides a source of evidence that enable a full developmental holistic assessment of any individual child. The domains can be used to identify strengths and pressures, which balance risk and protective factors.

6. Using the Resilience Matrix to analyse the risks, strengths, protective factors and vulnerabilities.
The Resilience – Vulnerablity Matrix

As defined by Daniel and Wassell, (2002).

RESILIENCE

Normal development under difficult conditions eg.secure attachment, outgoing temperament, sociability, problem solving skills.

High Support / Low
Concern
PROTECTIVE ENVIRONMENT

Factors in the child’s environment acting as buffer to the negative effects of adverse experience.

ADVERSITY

Life events / circumstances posing a threat to healthy development eg. loss, abuse, neglect.

Low Support / High
Concern
VULNERABILITY

Those characteristics of the child, their family circle and wider community which might threaten or challenge healthy development eg. disability, racism, lack of or poor attachment.

Low Support / High Concern

Families assessed to be in this category are the most worrying.

Low Concern / High Support.

Families in this group have a network of support and are generally more able to cope with advice and guidance from standard services.

Resilience includes the protective factors that are features of the child or their world that might counteract identified risks or a predisposition to risk such as:

Emotional maturity and social awareness.

Evidenced personal safety skills (including knowledge of sources of help).

Strong self esteem.

Evidence of strong attachment.

Evidence of protective adults.

Evidence of support networks (supportive peers / relationships).

Demonstrable capacity for change by caregivers and the sustained acceptance of the need to change to protect their child.

Evidence of openness and willingness to co-operate and accept professional intervention.

Protective factors do not in themselves negate high risks, so these need to be cross-referred with individually identified high risks and vulnerabilities.

Vulnerabilities are any known characteristic or factors in respect of the child that might predispose them to risk of harm. Examples of these include:

Age.

Prematurity.

Learning difficulties or additional support needs.

Physical disability.

Communication difficulties / impairment.

Isolation.

Frequent episodes in public or substitute care.

Frequent episodes of running away.

Conduct disorder.

Mental health problems.

Substance dependence / misuse.

Self-harm and suicide attempts.

Other high risk behaviours.

The more vulnerabilities present (or the more serious one single vulnerability is) then the greater the predisposition to risk of harm. The presence of vulnerability in itself is neither conclusive nor predictive. These must be set alongside identified risk factors to be properly understood as part of an assessment process.
7.Weighing the balance of that evidence and making decisions.

Decisions now need to be made about what to do to address the needs relating to the child’s safety. These decisions lead to a plan to protect the child. This plan should also address the child’s broader developmental needs.

Stages of decision-making:

Data gathering

Weigh relative significance

Assessment of current situation

Circumstances which may alter child’s welfare

Prospects for change

Criteria for gauging effectiveness

Timescale proposed

Child’s plan (child in need plan, child protection plan or care plan, depending on the status of the child).

What Factors Reduce the Effectiveness of Risk Assessment?

Poor integrated working practices between agencies and individuals.

Lack of holistic assessment.

Inadequate knowledge of signs, symptoms and child protection processes.

Information that has not been shared.

Difficulty in interpreting, or understanding, the information that is available.

Difficulty in identifying what is significant.

Difficulty in distinguishing fact from opinion.

Difficulty in establishing linkage across available evidence.

Working from assumptions rather than evidence.

Over confidence in the certainty of an assessment.

A loss of objectivity.

Making Effective Risk Assessments

Assess all areas of potential risk

Define the concern, abuse or neglect

Grade the risks

Identify factors that may increase risk of harm

Consider the nature of the risk – its duration / severity

Set out and agree time scales for the assessment to be carried out

Specifically document the identified risk factors

Gather key information and evidence

Has all the required information been gathered?

Assess the strengths in the situation

Check if any risk reducing factors exist?

Build a detailed family history and chronology of key events/concerns

Assess the motivation, capacity and prospects for change?

What risk is associated with intervention?

Be aware of potential sources of error

Identify the need for specialist supports

Plan your key interventions.

Constructing a plan and taking appropriate action.

Constructing the child’s plan is a fundamental part of the “Getting it Right for Every Child” (Scottish Executive, 2005) initiative. This specifies that there will be a plan for a child in any case where it is thought to be helpful. This can be in both a single agency and a multi-agency context. The assessment of risk and the management of risk is incorporated into the child’s plan. This also includes an analysis of the child or young person’s circumstances based on the “My World” triangle and should cover:

How the child or young person is growing and developing (including their health, education, physical and mental development, behaviour and social skills).

What the child or young person needs from the people who look after him / her, including the strengths and risks involved;

The strengths and pressures of the child or young person’s wider world of family friends and community; and

Assessment of risk, detailing:

The kind of risk involved;

What is likely to trigger harmful behaviour; and

In what circumstances the behaviour is most likely to happen.

“The plan should note risk – low, medium or high – as well as the impact of the child or young person on others.” (“Guidance on the Child or Young Person’s Plan”, Scottish Executive. 2007, page 13).

The plan should address key questions:

What is to be done?

Who is to do it?

How will we know if there are improvements?

The Child’s Plan should be monitored and reviewed and amended as need, circumstances and risks change. (Scottish Executive, 2007).

Child Protection Case Conferences play a key role in the management of risk. A Child Protection Case Conference will be arranged, where it appears that there may be risk of significant harm to children within a household and there is a need to share and assess information to decide whether the child’s name needs to be placed on the Child Protection Register and be subject to a Child Protection Plan. (Link to Part 4 NESCPC guidelines)

9. Principles for Risk Management

There is a need to ensure that the ongoing shared plan:

Manages the risk

Puts the decisions into a recorded form – that clearly shows how and why decisions were reached.

Makes the risk management an ongoing process that links with all areas of agreed and informed professional practice and expertise.

Ensures that the decisions made have actions with named persons, clear timescales and review dates.

Ensures that any agreed timescales can be reduced if new risks / needs become apparent.

Ensures that new risk assessments and analysis inform reviews.

Lessons from Significant Case Reviews.

Significant Case Reviews repeatedly describe “warning signs” that agencies have failed to react to which have should acted as indicators that children and young people at risk of serious harm. Examples include:

Children and young people who may be hidden from view; are “unavailable” when professionals visit the family or are prevented from attending school or nursery.

Parents who do not co-operate with services; fail to take their children to routine health appointments and discourage professionals from visiting.

Parents who are consistently hostile and aggressive to professionals and may threaten violence.

Children and young people, who are in emotional or physical distress, but may be unable to verbalise this. Children and young people who are in physical pain (from an injury) may be told to sit or stand in a certain way when professionals visit the family or may hide injuries from view.

Children and young people who have gone missing / run away (with or without their families).

Workers should adopt an enquiring and investigative approach to risk assessment and not rely on parents or carers statements alone. Further corroboration of statements and challenging of parental views and perceptions is essential if to effectively determine the risk to the child or young person.

Interventions should not be delayed until the completion of an assessment, but they have to be carried out in accordance with what is required to ensure the child or young person’s safety, taking account of any indications of accelerated risks and warning signs. The type and level of intervention, irrespective of when it is made, must always be proportionate to the circumstances and risks faced by the child.

Workers should pay particular concern to the “rule of optimism”. Many significant case reviews have illustrated that practitioners’ views can be strongly influenced by factors such as seeing indicators of progress or apparent compliance and co-operation. This does not, however, always mean that the child or young person is safe and such factors need to be balanced against the overall balance of evidence and actual risks.

It is essential that those exercising professional judgement in relation to child protection take account of all multi-agency skills and expertise. This is of particular importance in relation to understanding of child development and the impact of child abuse and/or neglect on children and young people, both in the immediate and long term. Thus whilst immediate safety provisions have to be put in place, consideration must also be given to the longer term outcomes as a result of abuse or neglect.

Significant case reviews highlight the importance of communication between all agencies that work either directly, or indirectly with children and/or their families.

Thus it is imperative that:

Adult services MUST ALWAYS consider any potential risks for any child linked to their adult clients.

Children’s services MUST ALWAYS ascertain whether any adult services may be involved with their child clients.

All services MUST ALWAYS ensure there is effective communication where there are concerns about the protection of a child.

Concerns relating to actual or potential harm should never be ignored and are an indication that immediate intervention might be needed to ensure the protection of the child from future harm. Decisions to protect children and young people should never be delayed and where applicable, emergency measures should be considered. (see Part 3 of NESCPC Guidelines).

There is a saying that there is nothing new under the sun as far as the calamities of the world go. This saying may very well be true, but because of an increasingly larger population, school-aged children of today are forced to face more problems much earlier than their predecessors did. Because today’s children have so much to face, it is important for them to have a good support base at home as well as at school. Together with other school-based mental health professionals, school social workers are expected to support the needs of at-risk students attending public schools (Altshuler & Webb, 2009). In order to provide children with the support they need for positive development, school systems need social workers that have been properly trained in choosing the correct intervention method and in proper service delivery.

The National Association of Social Workers identifies four major areas of school social work practice: Early intervention to reduce or eliminate stress; within or between individuals or groups; problem-solving services to students, parents, school personnel, or community agencies; early identification of students at risk; and work with various groups in school to develop coping, social, and decision-making skills (). Social workers have been providing services to public schools for over a century, and there are many ways school social workers can utilize their knowledge, skills, and values to improve the lives of students. The services that workers provide have evolved over time but have maintained an overall purpose of addressing environmental barriers that negatively affect the ability of students to succeed academically (Altshuler & Webb, 2009).

There are several factors that determine the need for intervention by social workers. Family issues, attendance problems, and academic concerns are all prevalent factors presented for intervention (Kelly & Stone, 2009). There are also issues of neighborhood violence, drug use, deviant peers, teen pregnancy, and poor impulse control.

Early life experiences (while not the sole determinants of later life mental health and behavior disorders) may be important influences in children’s development and children living with substantial environmental stress early in life are at increased risk for aggressive and antisocial behavior in youth and adolescence (Hudley & Novak, 2007). It is up to today’s school social workers to find and implement more effective strategies for decreasing and eliminating these behaviors, especially now that behaving aggressively has become an essentially automatic response to stressors in some youths.

Social workers can assist students in dealing with stress or emotional problems by working directly with the children and their families. By acting as institutional and cultural brokers between families and their children’s school, social workers are filling a very important void. This is especially significant for schools where often the least successful students come from families who are experiencing poverty-related barriers and constraints. Bridging the gap between school and families is important because when parents are involved effectively in their children’s schooling, student achievement typically improves (Alameda-Lawson, Lawson & Lawson, 2010). Because school success is critical to future life tasks, interventions are worth our attention.

School social workers’ broad skill sets, ranging from advanced clinical to highly skilled generalist approaches (with particular emphasis in school mission, functioning, and processes), are essential to the assessment process and design of effective interventions. All students, their families, and school personnel benefit from access to the expertise of school social workers in implementing system level universal (school or district), evidencebased programs, as well as early-targeted interventions. This expertise is particularly critical in working with students struggling with behavioral, emotional, family system, and ecological challenges to ensure a truly systemic, comprehensive assessment.

Workers can also address problems such as misbehavior, truancy, teenage pregnancy, and drug and alcohol problems and advise teachers on how to cope with difficult students. Some of the methods that school social workers use are individual, group, and family/community therapy. Some workers teach workshops to entire classes on topics like conflict resolution. School social workers extend opportunities for students to volunteer, serve others, or contribute to their communities by referring students to existing service opportunities; facilitating service projects and clubs; or creating an array of individualized opportunities for students to help peers, younger students, adults, or the community.

By encouraging students to participate in service, social workers are helping students to develop more protective and promotive factors such as self-esteem, friendships, and confidence, as well as ensuring that the students gain familiarity with the social worker and feel more comfortable going to him or her for help with crises. Integrating youth development principles into school social work practice is a powerful application of the strengths perspective and an important way to build resiliency. Youth development activities such as service can also be conceptualized as tiered interventions within a response to intervention and positive behavioral interventions and supports system (Leyba, 2010).

While it is vitally important for the social worker to forge a positive and trusting relationship with students and their families, it is just as important that the worker remember to be empathetic without being sympathetic. Delivery of needed services is tantamount, but there are policies, ethics, and rules of practice to be considered at all times. The National Association of Social Workers and School Social Work Association of America have recommended specific requirements for professional preparation and competency of the school social worker.

Social workers shall function in accordance with the values, ethics, and standards of the profession, recognizing how personal and professional values may conflict with or accommodate the needs of diverse clients.

To work in a school setting, a social worker must have an MSW degree from a Council on Social Work Education approved program. The worker must have completed a school-based internship and have taken

In conclusion, social workers provide an invaluable service to the school system. Today, school social workers are represented across the 50 states, performing duties in a wide variety of roles, all of which are ultimately focused on facilitating systemic change to support the academic success of students (Altshuler & Webb, 2009).

Summary

This essay focuses on safety of miners in the opal fields. It looks at the major potential hazards in the opal fields and ways to ensure safety from these hazards. These hazards include explosives, unstable ground, shafts, machinery and dust.

The claim is only as safe as the miners who are working on it. If miners can not follow laws and preventions outlined then the claim will not be as safe as it could be.

Introduction

Opal mining is an exciting but potentially hazardous occupation. A responsible miner should be able to identify and minimise risks. Many people can come onto a claim such as noodlers, miners and tourists. The claim can either be current with people working or it could be old and abandoned. The condition that the claim is left in has a major impact on the safety of any person who walks onto the claim. Specific laws and regulations have been set down by the government, which must be abided by to ensure a minimum safety standard is set. The top five potential hazards are explosives, unstable ground, shafts, machinery and dust.

Content
Claim Preparation

Many risks arise from previously worked areas. Old workings such as drill holes and backfilled or covered shafts, which could be covered by vegetation, are potential risks. Shaft positions should be approximated if mining nearby. As these old shafts can collapse, it is advisable to leave a safe distance between shafts. If work is to be commenced in old shafts a number of checks should be completed. Drives, pillars and levels poor ground should all be checked and noted. Notes may include workings on two levels with the lower level directly beneath the upper. Large un-pillared areas, thin crowned pillars and fretting or cracking of pillars. Lastly cracks in the wall and roof and pillar size should also be checked.

Claim boundaries are also a key point to avoid breaking into other neighbouring shafts.

Explosives

Experience in using and handling explosives can often lead to complacency. Inexperienced people not only can be potentially dangerous to them but can also pose risks with miss fires, unstable walls and fly rock. Licences to purchase, transport, store, handle and use explosives must be acquired and kept up to date. This ensures a minimum standard of safety is achieved.

Not only are licenses important to ensure safety but storage, transport and use of explosives can be more important. Ensuring that all explosive equipment is stored appropriately is a must. Explosives should be stored correctly in a cool, dry place with detonators stored separately from explosive material. Other storage measures which should be met is that the explosive boxes are wood lined and locked. The boxes must be wood lined to ensure no static build up occurs and creates a spark.

The storage areas of diesel and Nitropril should be well separated to ensure if there is a spill that they do not mix.

Many laws are already put in place for the way explosives are transported, prepared and blasted. These laws are put in place for a specific reason which is safety, any deviation from the processes set out could result in a potential injury.

Explosive Fumes

Various gases are generated due to blasting. Gases such as carbon monoxide, nitrogen oxides along and other noxious gases pose a potential health hazard after a blast. The reason these gases are dangerous is because they displace the oxygen available for breathing. For this reason adequate ventilation is required to release these gases before entering the blasted area.

When a blast occurs a blast radius should be put in place to ensure the safety of other miners. In underground mines there is no law but it is recommended that miners do not stay underground. Gases generated from the blast can disperse throughout other shafts and may also cumulate their if there is inadequate airflow, the blast may also cause sections of the roof to collapse. Gases which are dispersed throughout the mine can cumulate in low or high cavities depending on the gas. Carbon Dioxide is heavier than air and can cumulate in low spots and floor cavities. Carbon Monoxide is lighter than air and can cumulate in high spots and roof cavities. Areas of known for having inadequate airflow should be checked after blasting to ensure the gas levels are at a safe level. Fans, blowers and other ventilation systems should be used to extract the noxious gases from the mine. These should be used in preference to natural ventilation as they are much quicker.

Unstable Structures

The geological structures of opal fields vary. There are some structures which can support a wide underground area, yet others are blocky material with faults which makes mining difficult and not recommended. Opal mining in South Australia is quite difficult as the general bearing rock is weathered, brittle and fractured. Each place in SA is different due to the stress distributions and rock types. With all of these factors it is up to the miner to decide weather it is safe to start underground mining in that area.

In certain geological structures cave-ins can occur. A survey of the underground mining area should be done, noting old workings. Whenever underground a miner has to be constantly aware of the conditions especially the roof stability. An unstable roof which could be due to hidden faults could result in a rockfall which could be fatal.

Weather conditions can also affect the wall structure and integrity. Air entering the mine can dry out ground and open up cracks, slides or faults. This drying of material can cause slabs of ground to fall. If a large amount of water gets into the mine the supporting strength of walls and pillars may be reduced. Care should be taken to identify if and fretting has occurred at the base of structures. Any operating shaft should have the entrance to it kept in good condition. Loose rocks, material and tools should all be cleared from the entrance as these can easily be knocked into the shaft. The likes of wind, weathering or even a blast close by could cause material to fall.

For all of these reasons outlined with falling objects it is essential to wear a hard hat at all times. All of these factors can potentially be fatal, but these factors are generally overlooked as miners often become complacent and do not check the stability and strength of walls and roofs very often. These checks should become essential to a miners daily routine.

Shafts

Shafts are the key entry point to the underground sections of the mine. Keeping the shaft in good condition is essential to safety. Support structures at the top of the shaft, such as timbers and pipes, should be kept in good condition. When entering any new shaft weather it is blind or dead it is essential to ventilate the shaft to clear away gases.

Underground areas must have at least two means of exit. This is in case one exit gets blocked for some reason which could be due to a rock fall. Having two exits requires regular maintenance to ensure that both mechanisms, which are subjected to corrosion and weathering, are safe to use.

There is a significant risk of people falling down an open shaft. Not only are tourists at risk but also the miners. Small shafts can catch a person’s leg or ankle and cause injuries whereas larger shafts pose risks of vehicles and people falling in. It is recommended to leave a ring of dirt around the shaft entrance to signify that a shaft is there. When a miner leaves the claim, it is their responsibility to leave the shaft and its surroundings in a safe condition. Manner

Machinery

When operating any machinery either above or below ground a pre-start check should be completed. This is to ensure the machine you are about to operate is in a safe working condition. Items which should be checked are fluid levels, tyre inflation and condition, track tension, gauges, lights, hydraulic rams, lines and buckets, brakes and steering.

Any diesel machinery in operation gives off carbon monoxide, nitrogen oxides and other noxious gases. These gases are similar to blasting gases and can be fatal if inhaled in large concentrations. When in large concentrations these gases can not be seen or smelt. Care should be taken when operating any machinery underground ensuring adequate ventilation.

Dust

A major hazard when working at a mine is dust. Dust can cause or trigger numerous health problems such as skin irritation, allergies and respiratory damage. Generally particles of dust are caught within the nose, throat and bronchial tubes. A small amount of these particles however get into the breathing system, due to their size and shape. It is these particles which cause the most respiratory problems. Dust particles which are of a particular concern are silica. Silica is found predominantly in sandstone host rocks. High exposure to small silica particles can potentially cause a fatal lung disease called silicosis. Although all dust can not be tested for silica it is essential to restrict dust exposure to a minimum.

Ways to control dust include extractors, collection systems and maximum airflow. Wearing a respirator or a dusk mask at the absolute minimum will help prevent the amount of dust that a miner will inhale. Although it is essential that the correct respirator or dust mask is used, as each one is different, depending on what cartridge is installed in the device.

Electrical

Operating machines or tools underground will generally use electricity. It is important to remember that electricity seeks the path of least resistance to earth. Most cases the path of least resistance is the human body as it is 80% water. It is vital that the design and installation of any electrical supply is safe. The miner can not come into contact with any live electrical component.

Personal protective equipment

Personal protective equipment (PPE) will help in protecting a miner from potential hazards. PPE is not a replacement for getting rid of a specific problem. It would be preferable to fit an extraction system for dust rather than wearing a dust mask.

A number of items should be worn when working in a mining area such as hard hats, footwear, breathing, hearing and eye protection. Hard hats can be uncomfortable, fall off and restrict clearance in small spaces, but these inconveniences save lives. Footwear suitable for miners are steel capped boots. They provide much more support for ankles and grip when walking on loose and rugged surfaces. The steel cap provides protection for your toes if something drops or falls onto your feet. Breathing protection general comes from dust masks either rubber of paper. Both are designed to sit on a clean shaven face. If the miner has a bear or stubble the effectiveness of these masks is reduced. Hearing protection generally comes in two forms which are ear plugs and ear muffs. Ear protection only cuts out part of the noise, usually around 20db(A). Since only part of the noise is cut out it is important to ensure that the miner realises that higher levels of ear protection is required when working next to excessively noisy machines such as jack hammers. In general eye protection should be worn at all times. There is a constant risk of particles of some nature being airborne and possibly entering the eye. Damage to the eye may be something small like a scratch to actually losing an eye.

Discussion

These rules and advised safety precautions to be taken are put in place for a reason. It is solely to help protect the individual from getting injured or killed. But miners in the opal fields generally have the she’ll be right attitude. A large amount of preventions can be put in place to help ensure safety but if the miner does not follow them these are next to useless. They may think only a short amount of exposure to dust is fine, but if they continue to have exposure to dust containing silica they could cause the onset of silicosis. Not only can you do internal damage through various noxious gases and dusts, but a lot of damage can be done to the body itself. Cuts, sprains and broken bones are a number of things which can occur depending on how safe, cautious and or ignorant the miner is.

Conclusions

The top five potential hazards in opal field mining are explosives, unstable ground, shafts, machinery and dust. All of these potential hazards have laws, regulations and precautions put in place to ensure a minimum standard of safety. This minimum standard of safety is only reached if the person who enters the claim follows the guidelines. The bottom line being that safety in the opal fields comes down to each individual that enters the claim. If the miner is ignorant, complacent or plain lazy the safety of not only themselves but for others working with them could be at risk. It is the miner’s responsibility to ensure that not only are they safe but also fellow co-workers.