Author: Andre Coleman

This essay is going to reflect on learning gained from a group task carried out in the unit lectures. I will explore group work theories, collaborative and inter-disciplinary working and the application of these theories in relation to the group work. I will also identify how I will develop my practice in relation to my current skills and areas for development. Finally, I will also reflect on how I have developed my self-awareness, professional values and professional development, in relation to group work task and how this will inform my future professional practice.

Toseland and Rivas (2008) define group work as a goal directed activity aimed at accomplishing tasks. Members of the group have the opportunity to share ideas, feelings, thoughts, beliefs, engage in interactions and also share experiences. The group members develop feelings of mutual interdependence and a sense of belonging. Martin and Rogers (2004) define inter-disciplinary working as a team of individuals with different professions, working collaboratively with a shared understanding of goals, tasks and responsibilities. This collaborative working is needed when the problems are complex, a consensus decision is required and also when different competencies are needed.

According to Cheminais (2009), the approach to the collaborative working requires clarity on roles, power, accountability and strategic planning. This was evident during the group work as the group worked collaboratively to share ideas and tasks were allocated to each member according to competencies and mutual understanding.

Salas et al. (2012) states that, group work started from the perspective of people working in partnership for a common goal. The theories of group work later materialised in regard to the dynamics of group work and the they provide an understanding of human behaviour when people are working in groups. A group or team can be understood by looking at Tuckman and Jensen’s (1977) model of group formation which comprise of forming, storming, norming, performing and later adjourning.

According to Tuckman and Jensen (1977), the forming stage is when the group members are establishing common interests and get to know one another with the desire to be part of the group. Martin and Rogers (2004) states that, in an inter-disciplinary team this is the stage where membership is established, team purpose is clarified, roles and boundaries are decided and interpersonal relationships begin.

Tuchman and Jensen (1977) state that, storming stage may involve competing for ideas and perspectives, rules are developed and members may confront one another. Conflict may emerge and when unresolved, it can inhibit the team’s progress. There is then the norming stage when members take roles and responsibilities and an agenda is established. This stage involves belonging, growth and control. The performing stage is when the group is functional and tasks are implemented and evaluated. Finally, the adjourning stage involves the goals and objectives fulfilled and task completed.

Tuckman and Jensen’s (1977) model of group formation can be applied to different settings and groups and it is easy to use. The model is flexible and can be applied regardless of type of group or task. However the model has no clear demarcation of the stages and is a linear format although the first four stages may not be in sequence. It does not explain time spent in each stage or if the stage can be repeated as some of the stages can recur for example norming and perfoming stages. (Halverson 2008)

Reflecting on the unit group task, I think my group went through Tuckman and Jensen’s (1977) model group formation which included the “forming”stage in which the group purpose was clarified. The group went through the “stormimg” stage and at that point, there were disagreements on what should be included and how the task will be presented. I was in favour for a presentation using Power Point, however the majority of the group voted for a role play which I thought was not going to address all the information due to time allocated for the group to present. I was also a bit anxious for failing the task as the group had elected me to take the lead on the role play. At that time I felt that the team wanted me to do most of the task and I rejected the ideas they were putting forward. I think I did this unconsciously because I realised my actions later on when my group members gave feedback.

Belbin’s (2010) work identified roles in teams which each offer positive contributions to team working. The roles include co-ordinator, evaluator, maintainer, innovator, shaper, implementer, expert, investigator, team and completer, Reflecting on Belbin’s (2010) group roles, each team member brought strength and perspectives grounded in their discipline and experience. During the group work task, I had the experience and knowledge in relation to the task and I found myself leading the group on sourcing information. I got positive feedback from my group colleagues such as, “goal oriented, researched well on the topic, contributed well and very good ideas on the role play”, however I was criticised of being inflexible with ideas of others.

The feedback brought awareness on how I work with others and will help me in my practice. I think I took the role of an implementer who turns the team concepts into practical actions and plans however, inflexible and somewhat reluctant to change. However reflecting on my experience from my previous placement when I was working on a project to enable young mothers to gain independent skills, the project failed because I lost interest as a result of constraint in obtaining the resources. I think at that time I took the role of an investigator.

In Belbin’s (2010) model, an investigator explores opportunities and resources from many sources however can jump from one task to another and lose interest. Looking back at it, I think this was because I tend to do things in a structured way and task oriented. The resources in the organisations did not allow me to do the task in time and I end up losing interest. I think in future I need to be flexible and think of other ways of working around the plan for the benefit of the service users. I should also seek supervision with my manager to discuss such situations as it can provide best possible support. I later understood the situation of working in an organisation team by looking at the group system theory.

According to Connors and Caple (2005), group systems theory provides an understanding of working with teams or groups in an organisation. They suggested that, group systems theory is influenced by the interactions within the group and by the external environment. All the group members influence group dynamics however, the organisation in which the group work may impacts the group work with its boundaries, resources and leadership structures. I abandoned a project which was going to benefit the young mothers and in a way the community as well. Although this was due to organisational constraints, as a future social worker, I should try to balance responsibilities in a way that supports well-informed decision making, using professional judgement and accountability (British Association of Social Workers 2012).

Salas et a.l (2012) state that, in order for me to be grounded in theories of group work, I need to formulate theoretical frameworks that are in alignment with my perspectives and inclinations. To achieve this I need to have knowledge of the strength and weaknesses of the frameworks I use. This will help me to select theories that are appropriate to the situation.

The Health and Care Professions Council (HPCP) (2012) also states that, I should “understand the key concepts of the knowledge base relevant to social work” so as to achieve change and development.

Gilley et al. (2010) suggested that the purpose of a group is to accomplish the task and for the practitioner to develop effective interpersonal skills. As a social work student, in order to work collaboratively, I need to develop skills and knowledge in decision making, effective communication and task coordination and the ability to learn from others and embrace change (D’Amour et al 2005). This is imperative as I will be working in teams with other professionals or agencies.

From the unit group work, I have learnt that mutual understanding and collaboration is vital for teamwork to be effective. Teamwork requires respecting each other’s values, beliefs and viewpoints and also self awareness of my own beliefs, values and perspectives (Hall 2005).

I also now have an understanding of the importance of effective communication, participative decision making and accepting ideas of other when working in a team. The group work enabled me to develop skills in sharing of ideas and also how to relay and support my own viewpoint with confidence.

According to Crawford (2012), I must have an understanding of my own professional identity as a social worker so as to develop confidence in myself and work with other professionals effectively.

The HCPC (2012) states that, I must “be able to engage in inter-professional and inter-agency communication” and work in partnership with other agencies as part of a multi-disciplinary team. It is also vital that I develop self awareness of my behaviour and values.

According to Hall (2005), as values are internalised, they can be invisible to other team members thereby creating obstacles in inter-professional working. As a result, I must make my professional values clear to other professionals I work with and also have an understanding of their values.

The College of Social Work (2014) states that, as a social worker, I need to develop skills, competencies and the ability to recognise the challenges and dynamics of team-working and also have an awareness of team cultures so as to be able to work effectively in a multi-disciplinary team.

The group work task and the feedback I received from my colleagues enabled me to develop awareness on how I work with others and I also managed to learn about my strengths and weaknesses. For example taking the role of an implementer I was able to execute a plan however resistant to change. I have also learnt that I need to acknowledge and appreciate the differences and adjust, adapt, and mirror interpersonal interactions when interacting with others. In future, I need to take into consideration other people’s ideas as there are different approaches to tasks and also appreciate other people’s experiences and values especially when working with professional of different background as mine.

References

The College of Social Work (2014) Roles and functions of social workers in England http://www.tcsw.org.uk/uploadedfiles/thecollege/_collegelibrary/policy/rolesfunctionsadvicenote.pdf

D’Amour, D, Ferrada-Videla, M, Rodriguez, L, & Beaulieu, M 2005, ‘The conceptual basis for interprofessional collaboration: core concepts and theoretical frameworks’,Journal Of Interprofessional Care, 19, pp. 116-131, CINAHL Plus with Full Text, EBSCOhost, viewed 14 August 2014.

http://0-eds.b.ebscohost.com.brum.beds.ac.uk/eds/pdfviewer/pdfviewer?nobk=y&vid=4&[email protected]&hid=102

Claire B. Halverson, S. Aqeel Tirmizi

Effective Multicultural Teams: Theory and Practice: theory and practice

British Association of Social Workers (2012) The Code of Ethics for Social Work :Statement of Principles

http://cdn.basw.co.uk/upload/basw_112315-7.pdf

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

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

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

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

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

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

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

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

The purpose of this essay is to discuss an observation I undertook of an 18 month year old boy, whose mother was a friend of a friend who I had no prior knowledge about. Initially I explained the observation to the mother and a contract was soon drawn up and subsequently signed. It ensured that the study was completely confidential and the child’s name would be anonymised. I have used x to refer to the child. Firstly I am going to discuss some of the challenges I faced, how intrusive I felt initially and how I struggled not to interact. I will then discuss the benefits of child observations in helping me to overcome these challenges, for instance, the benefits of seminar groups and how the observation has been beneficial in developing my reflective skills. I will then discuss some factors I felt impacted on my observation and how these will be useful to me in future social work practice.

For me one of the most challenging aspects I found with the child observation was feeling intrusive. Initially on my way to the house I felt very nervous and during the observation when x ran off to the kitchen to see his mother I felt very uneasy following him as I felt I was invading their privacy. Having read McMahon & Farnfield (1994) I now know that this is a common anxiety for students who undertake child observations as many observers feel uncomfortable about intruding in to the privacy of someone’s home. However, having read Quitak (2004) I know that social workers often have to visit client’s homes and if they are too anxious to invade a client’s privacy they may miss out on information that is vitally important. For example, social workers can feel intimidated by parents and find it difficult focussing on the child (Blom-Cooper et al, 1985). Social work will often involve infringing on a client’s privacy (Trowell and Miles, 1991). Therefore it is vital social workers have the confidence to deal with their uncomfortable feelings of intruding in order for them to be effective in their role (Quitak, 2004).

I felt the seminar groups were beneficial in helping me to overcome my fear of intruding because they felt like a safe space in which I could discuss my anxieties. McKinnon commented that the seminar group provides a “safe container” (2009: 90). The seminar creates a safe environment where students can share and discuss any uncomfortable feelings and experiences that they came across during the observation (Ruch, 2007). The term containment was developed by Bion (1962) who believed that therapeutic relationships, such as groups can act as containers for uncontrollable feelings (Ruch, 2007). In the same way a mother or carer contain the painful feelings of a child and return them in a way the child can understand in an attempt to make the child feel safe (Mckenzie & Beecraft, 2004). The seminar also acts as a container, by discussing my feelings and anxieties about intruding on somebody’s home it helped me to overcome the anxiety of feeling intrusive which was distracting me from observing properly. As I continued to visit the home for following visits, I subsequently developed my confidence in visiting the home and not feel quite so intrusive.

In addition, one of the biggest challenges I faced was my desire to intervene. Ruch (2009) believed that attempting to not interact with a child is arguably one of the most challenging elements of the child observation. I always felt cruel because at times I had to completely ignore the child and this felt strange and unnatural for me. Tanner & Turney (2000) and Le Riche (2006) commented that not interacting can feel strange and uncomfortable for observers because it is unnatural and goes against traditional customs. However, not interacting can be beneficial because it creates space to reflect on and explore my feelings (Tanner & Turney, 2000; Trowell and Miles, 2004). For example, I found myself in disbelief because x refused to eat the peas on his plate and x’s mother although attempting once to make them eat them, gave up quite quickly. This could be because this took me back to when I was a young child when my parents always made me eat my vegetables; otherwise I wasn’t allowed to leave the table. I was surprised at how strong and how personal my reaction was.

Having read Fawcett (1996), however I realised that as children we all grow up with certain rules our parents make us obey and these may still reside with us when we are older and can have a major influence on our attitudes (Fawcett, 1996). In my case I found myself judging x’s mother because she didn’t view eating vegetables as important. Having read McMahnon & Farnfield , they argued “It takes emotional effort for students to see that what is different is not necessarily wrong” (2004: 240). Therefore, I realised that just because x’s mother is doing things in a different way and I view my family’s experience as the ‘correct’ way, this does not mean what she is doing is wrong. Fawcett (1996) and Trowell & Miles (2004) argued that it is acceptable for students to have these attitudes and preconceptions provided that students identify these and question them through reflection. Therefore, one of the benefits of the child observation for me was significantly developing the ability to reflect and develop self-awareness. These are useful skills for me as a student social worker because by allowing time to reflect I can begin to recognise and question how my emotions and preconceptions may be affecting my judgement or an assessment of a family or individual and can incorporate this before deciding the next steps to help them (Turney,2008; Mckinnon, 2009).

One of the most significant learning points from the child observation for me was when I first met the family, one of the first things x’s mother did was explain the bruise on x’s face and how he was always falling over. Despite my best efforts to ensure the mother that it was purely an observation, I believed she still felt that she was being judged as a mother and felt anxious about being observed. At the time I did not question this because I was very anxious myself, it was only later when I was writing up my notes that I realised how significant this was. Having experienced this, it made me aware of the power imbalances that existed between the observer and the observed. Turney argues that it could be slightly anxious and uncomfortable for those being observed because they are aware of “the power of the gaze, the power of the looker in relation to the “looked at”” (2008: 124). Therefore because x’s mother knew I was observing her she perhaps felt vulnerable and anxious because she viewed me as being in a more powerful position than her. This could explain why she defended her son’s bruise so early on in the observation. During a normal assessment between a social worker and a client these feelings are intensified. Therefore, this has taught me the importance of remembering that as a social worker I can be intimidating to the client because I am perceived as the more powerful person. As a next step, I must learn the most effective methods and techniques to try and minimise the imbalance of power between myself and the service user.

For me the most meaningful aspect of the child observation was when I attempted to explain to x that he was being observed. Despite him being only 18 months old and although I did not feel he understood me due to his age, for me this demonstrated how powerless children are. Young children in particular are totally dependent on adults for their safety and well-being, by not telling the child they were being observed I felt that this was reinforcing their invisibility and undermining their views and opinions. Ruch (2009) commented that some observers believed it was oppressive by not introducing themselves to their child and this is how I felt because by not asking a child for their consent, arguably we are not valuing what they have to say. For example, reports in to the death of children such as Victoria Climbre and Jasmine Beckford, reveal how children were not effectively “seen and heard” (Fawcett, 1996:18). In addition, inquiries often revealed that there was limited understanding of the child’s world and everyday activities were inadequately described because adult’s interpretations were valued over children’s (Mckinnon, 2009; King, 2002). Turney (2008) believes that the child observation can help to develop the skills of ensuring excluded groups such as children are completely focussed on and is crucial in evaluating whether a vulnerable child is safe or not. Fawcett (1996) argued that observation allows the chance for a child’s voices, stories and opinions to be taken seriously and valued. Therefore, I believe the child observation has helped me to focus on the child, observe what they do and listen to what they say to ensure that they are not invisible. I feel I have significantly improved my understanding of the powerlessness of children which will help me to improve and adapt my communication skills with children.

To conclude, for me one of the biggest challenges of the child observation was initially feeling intrusive, however the seminar acted as a “safe container”, where I could discuss and overcome my anxieties in a safe environment. Subsequently on following visits I found these anxieties soon disappeared. In addition, I found not interacting very challenging, but soon learnt how valuable this was because it gave me an opportunity to reflect and explore my feelings. Recognising and questioning how our values and attitudes may be affecting my judgement or an assessment of a family is a valuable skill in social work and this can be taken in to account when deciding the best help for a family. The child observation has been an important reminder that as a social worker I can appear more powerful and even intimidating to the client, as well as the powerlessness of children. Therefore developing techniques to try and minimise these power imbalances is a crucial next step.

Abuse is a violation of an individual’s human and civil rights by any other person or persons, consisting in single or repeated acts, may occur in any relationship and any context, some instances of abuse will constitute a criminal offence.

A definition of abuse in vulnerable adults was given in 1997 Consultation Paper “Who Decide” by the Lord Chancellor’s Department, who said that any person who is or may by in need of community care service by reason of mental or other disability, age or illness, who is or may be unable to take care or protect of him/herself against significant harm or exploitation. Types of abuse include: physical or sexual; emotional/psychological, including that related to age, race, gender, sexuality, culture or religion; financial; institutional; self neglect; neglect by others.

The vulnerable adults could be abused by a wide range of people, including multidisciplinary team in health care setting, family, friends, strangers, one in four vulnerable elders are at risk of abuse and only a small proportion of this is currently detected. The NHS and Community Care Act 1990, have eligibile criteria for those who suffer or cause harm or exploitation. The role and responsibility of every member from multidisciplinary team is to collaborate effective in identifying, investigating and responding to allegation of abuse. This must start from staff as a operational level, line manager, corporate authority, chief executives and to the local authority members.

In the case of Stafford Hospital scandal, were found many forms of abuse against people. There was a complete failure of management what led to a totally unacceptable failure to treat emergency patients safely and with dignity. The low staffing levels, inadequate nursing, lack of equipment, lack of leadership, poor training and ineffective systems for identifying when things went wrong. Some other problems was that the patients arriving at A&E department were checked by unqualified receptionist, nurses have no trained to use vital equipment in emergency assessment unit, not enough staff to provide health assistance, not supervision for quality of care, unacceptable waiting time in A&E without assistance and no experienced surgeon for the night shift, patients left crying for help, not food and drinks being left out of reach. Cite by BBC it said that “there were between 400 and 1,200 more deaths than would have been expected between 2005 and 2008, although it is impossible to say all of these patients would have survived if they had received better treatment”.

A case of people who wanting answers include a 79 years old person whom wife 73 years old, died five weeks after she were admitted at Stafford hospital in February 2009. She was suffering from dementia and was taken ill with dehydration and an infection and had to be taken to the hospital’s A&E department. At first checking the medical staff didn’t find anything wrong with her and sent her home, but she came back few days later. The husband complaint was because during her five weeks in hospital the only treatment received was a disgrace, she was left wet, not washed, ignored by the staff members and he decided, unfortunately too late, to move her in to the care home setting.

A similarity of abusing vulnerable adults is the case of Whipps Cross University Hospital in east London hospital, where three healthcare assistants who abused elderly patients have been sentenced. Whipps Cross Univeristy Hospital provides a full range of general inpatient, outpatient and day case services, elderly patients suffering from dementia and recovering from operations, strokes and falls, as well as maternity services and a 24-hour Emergency Department and Urgent Care Centre. The hospital has a strong reputation as a centre of excellence for various specialist services, including urology, ENT, audiology, cardiology, colorectal surgery, cancer care and acute stroke care.The abuse happened in spring of last year on the Beech Ward at Whipps Cross Hospital in east London,and came out when one of student nurse LB, blew the whistle after completing a placement on the hospital’s Beech Ward. At NHS control were uncovered a large range of failings at a London hospital including dirty equipment, poor hygiene standards, staff not assisting patients with eating or drinking, not feeding tube were done, not given medication at request and a high mortality rate. Some of the wards had to share equipment which come in conflict with infection control, and this led to sores pressures developed in five patients after admission.

The three healthcare assistants worked on Beech Ward at Whipps Cross employed to carry out basic feeding and washing duties, have been suspended by the hospital and barred from working anywhere in the NHS while an urgent investigation is conducted by police and hospital bosses. They had physically and verbally abuse patients, telling them to shut up, handling them in a non professional manner, grabbing sore or painful areas of patients, pushing them and forcing to sit in chairs, make the patients believed that it was due to their conditions. The care professionals damaged patient trust and not followed the quality of care for the elderly and vulnerable at Whipps Cross.”

Outline the vulnerability of these patients, follow the codes of practice, the duty of every member of staff to report such behavior, whistle blowing policy is made clear to all staff on day one of their employment with the Trust, with ongoing statutory and mandatory training to those that providing care professionally.

In order to protect our clients of harm and abuse we had to review the risks factors by monitoring and evaluating how policies, procedures and practices are working in the workshop and receiving feedback. Work with person- centred care value, promoting empowerment, prevention and managing risk but keep a balance between managing risk and enabling independence, choice and control. Recognize and explain the new signs of abuse or potential abuse in vulnerable adults must be the basis of developing outcome measures which can be used by service users and service providers in monitor and evaluate service provision regarding safety and protection generally speaking.

References

C. Cooper, A. Selwwod & G. Livingson, Oxford Journal, Age Ageing, (2008), The prevalence of elder abuse and neglect: a systematic review, Vol.37, Issue 2, Pp.151-160

E. Salend, R.A. Kane, M. Satz & J. Pynoos, Oxford Journal, The Gerontologist, Elder Abuse Reporting: Limitations of Statutes¹, Vol24, Issue 1, Pp61-69

Links:

http://news.bbc.co.uk/1/hi/programmes/politics_show/8022608.stm, checked 09.03.2014

http://news.bbc.co.uk/1/hi/health/8531441.stm, checked 09.03.2014

http://www.bbc.co.uk/news/health-11696735, checked 09.03.2014

http://www.bartshealth.nhs.uk/our-hospitals/whipps-cross-university-hospital/, checked 08.03.2014

http://www.guardian series.co.uk/news/10461128.Whipps_Cross_nurse_left_dementia_patients__screaming_in_pain_/ ,checked 08.03.2014

http://www.bbc.co.uk/news/uk-england-23808971, checked 08.03.2014

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/194272/No_secrets__guidance_on_developing_and_implementing_multi-agency_policies_and_procedures_to_protect_vulnerable_adults_from_abuse.pdf ,checked 08.09.2014

In order to practice effectively it is necessary to have a critical understanding of the law and to recognise limitations as well as strengths. The law can lack clarity which may be open to interpretation. This essay aims to discuss Social Work roles and responsibilities in Criminal Justice settings.

‘There are many competing pressures to direct the service in ways that may not be consistent with Social Work principles towards greater penal and correctional models. It is therefore essential to have a clear understanding of the policy and legal framework that creates the remit and legitimacy for the operation of Social Work in the Criminal Justice process’ (Whyte, 2001, p.7).

Statute law is created by Acts of the UK and Scottish Parliaments and relies upon rulings made in Court Hearings to set precedents that define and interpret key terms i.e. Case Law. Understanding the law is fundamental to practice in Criminal Justice settings. Criminal Law is a powerful instrument of social control and sanctions and the Criminal Courts have the potential to impose restrictions of liberty of individuals. Social Workers have a responsibility towards the general public and the courts to protect the public and ensure their wellbeing however, there is also obligation towards those who are in the Criminal Justice process who may be vulnerable and in need of services provided by Social Work. It is therefore essential that all workers have an understanding of the legal frameworks that govern Criminal Justice Social Work and are aware of the scope and limitations of their mandate (Whyte, 2001). However, law is subject to change and ‘criminal justice policy is more liable to sudden, politically motivated changes of direction than is social policy in other fields’ (Smith, 2002, p.309)

The law defines what a crime is, rules of evidence and criminal procedure. However, discretion is given to those involved and therefore, the criminal justice process is not systematic. The judiciary, police and social work have differing roles, agendas, values and beliefs which are shaped by training and cultures which can make working within the system difficult due to lack of shared understanding of common aims and individual roles.

Social Work involves working with the marginalised and disadvantaged and can be both vulnerable to crime and susceptible to criminalisation and practice involves work with victims or offenders. Local Authorities have statutory responsibility to provide Criminal Justice Social Work Services to support the Criminal Justice Process through assessment of individuals, information to the Courts and supervision of offenders.

Scotland differs from the rest of the UK in that there is a unique cultural and political heritage and a separate legal system. Social Work therefore, has a central role within the Criminal Justice process in Scotland which is in contrast to England and Wales where probation work is commissioned by the National Offender Management Service (NOMS) which is separate from Local Authority control and Social Work functions and shows a difference in their approaches in responding to crime. As McAra (2005) suggests a more welfare orientated approach has been adopted due to its legal culture and political history.

The legal framework outlining powers and duties of Criminal Justice Social Work is the Social Work Scotland Act 1968 (as amended). Section 27 of this Act outlines the duty by Local Authorities to provide specific Criminal Justice services (e.g. social background reports, supervision of offenders on an Order or Licence) in respect of central government funding however, it does not explain the objectives of these services or provide guidance on their exercise. Section 12 gives Local Authorities (LA’s) discretion to provide additional services (e.g. victims) as part of the general responsibility to ‘promote social welfare.’

Probation or offender services became the responsibility of the Local Authority Social Work Departments in 1968 and had a general duty to ‘promote social welfare’ in their locality (S12, Social Work (Scotland) Act 1968). This was due to the Kilbrandon Committee (Kilbrandon, 1964) being appointed to investigate increasing juvenile crime. The Kilbrandon Report recommended a new approach to children’s services based on the needs of children and families and those who offend should be treated the same as those children requiring care and protection. Kilbrandon also suggested diversion and early voluntary intervention as crime prevention and one department for children and adults. This merge of work with adult offenders was pivotal in recognising work with offenders as having a welfare component admittedly with a level of control. Although the Kilbrandon philosophy followed trends of the time which advocated rehabilitation and treatment of offenders and an awareness of the social causes of crime, this is still highly relevant to today’s practice.

From the 1980’s onwards Criminal Justice in Scotland has undergone major legislative and

policy change due to successive governments. As there was concern for public protection

and community disposal effectiveness in 1991, 100 per cent central government funding was

introduced and the National Objectives and Standards were published which set out

core objectives, service provision and guidance on their delivery (Social Work Group, 1991).

This resulted in the government committing to Social Work delivering this role. This policy

arrangement outlined by Rifkind in 1989 has survived changes in political administration

although, it has been suggested that devolution has caused a ‘sudden and dramatic

politicisation’ of Criminal Justice issues and could undermine the welfare tradition (McNeill

and Batchelor, 2004: Croal, 2005).

Social Work with offenders should aim to address and reduce offending behaviour. Whilst the law provides a framework for practice, effective work with offenders requires Social Work skills such as communication, therapeutic relationships in supervision, assessment and risk management. The task is therefore, varied and complex as Social Workers have the power to control the individuals who are referred via the Courts and enforce any Court Orders but must also work with an offender in a holistic, inclusive way to have a positive impact on their offending behaviour and this can be through support and assistance in relation to personal and social problems but also the individual taking responsibility for their actions. Effective and ethical practice is therefore, about considering and managing the needs and rights of the Courts, the general public, victims and offenders. Although Social Workers have statutory duties and powers to interfere in people’s lives this is not always welcome but is necessary in promoting public safety. Under the Scottish Social Work Services Council (SSSC) Code of Practice Social Workers have an obligation ‘to uphold public trust and confidence’ and the Criminal Justice Authorities (CJA’s) are required by Scottish Executive guidance to develop a strategy to address this (Scottish Executive, 2006b). This strategy includes both offenders and their families and Social Workers should engage these individuals and recognise their views in the development of services.

Both Criminal Law and Social Work recognise the autonomy of individual’s choices on how they lead their lives and with this capacity is criminal responsibility. Those of which who lack capacity (e.g. children and the mentally disordered) are not culpable in the eyes of the law and may be treated differently. It is therefore recognised that criminal behaviour is not just a choice but may be about social circumstances to which they have minimal control. Social Workers should assist in allowing individuals to improve their capacity for making choices together with consequences to their actions (ADSW, 1996a).

Although Social Workers are obliged to protect the rights and interests of service users’ there is a belief amongst the general public that they have forfeited these rights when they have offended. All Criminal Justice agencies must comply with the Human Rights Act 1988 which incorporates into domestic law the fundamental rights set out in the European Convention of Human Rights (ECHR). Public Authorities are required to respect all of the provisions however, the two articles with particular relevance to Criminal Law and Social Work are ‘the right to liberty and security’ (Article 5. ECHR) and ‘the right to a fair trial’ (Article 6, ECHR). However, the state can impose restrictions on those who breach criminal law or are a threat to public safety as long as the detention is authorised by law and there is a balance between the individual, their victims and the general public. The Social Worker must assess this balance through rigorous assessment and analysis of risk. The Social Work role requires respect to offenders as individuals and ‘ensure that the offender’s ability and right to function as a member of society is not impaired to a greater extent than is necessary in the interests of justice’ (ADSW, 1996a).

Criminal Justice Social Work services are delivered in partnership with various statutory and non-statutory agencies and this can present challenges due to conflicting professional values and aims. The Management of Offenders etc. (Scotland) Act 2005 was introduced to improve joint working and co-ordinate the management of offenders especially in the transition from custody to community supervision and places a duty on Criminal Justice Authorities (CJAs) to have an information sharing process in order that relevant information is shared between agencies (s.3 (5)(g)) for improving offender and risk management. However, sensitive personal information must be handled carefully and be under the principles of the Data Protection Act 1988 and local agency protocols. Practitioners within Social Work must ensure that any information sharing decisions are fully explained and understood by the offender even when their consent to disclosure is not required.

Organisations who deliver public services have general duties to eliminate unlawful discrimination and promote equality of opportunity on the grounds of race (Race Relations (Amendment) Act 2000), sex (Equality Act 2006), and disability (Disability Discrimination Act 2005). Individuals who are involved with Criminal Justice organisations are entitled to the protection of discrimination laws which relate to sex, race, disability, religious beliefs and sexual orientation, with exception to exercising judicial functions or carrying out Court orders. In these circumstances it may be within Article 14 of the ECHR which prevents to the right to liberty and security of the individual or the right to a fair trial being interfered with on a wide range of discriminatory grounds. Criminal Justice is still influenced by prejudicial and discriminatory views.

Research has been carried out by both the Social Work and Prisons Inspectorate for Scotland (1998) which highlighted concerns about the treatment of female offenders in the Criminal Justice process. In addition to this, several inquiries in England and Wales in relation to racial discrimination by the police and prison services has subsequently raised public awareness (Macpherson, 1999; Keith, 2006). The Scottish Government has a duty to publish information of discrimination of any unlawful grounds (s.306 (1)(b) Criminal Procedure (Scotland) Act 1995) and therefore, all workers need to practice in an anti-discriminatory way.

The law outlines the limits of Social Work intervention and knowledge of the law is essential to anti-oppressive practice. ‘The only legitimacy for intervening in the life of the individual within the criminal justice process is the individual’s offending behaviour…if individuals have social needs which require to be met but are not crime related or crime producing, or if the offence is not sufficiently serious to fall within the criteria of the ‘twin-track’ approach, services should be offered, as far as possible, through voluntary provision…No-one should be drawn into the criminal justice processes in order to receive social work help’ (Moore and Whyte, 1998, p.24).

Rehabilitative intervention is not just about helping; it imposes limitations on the rights of the individual who is subject to the intervention. Risk assessment and offence based practice is an ethical approach. It aims to ensure that ‘the most intensive and potentially most intrusive services are focused on those service users who pose the greatest risk of causing harm to others (ADSW, 2003) and to prevent socially disadvantaged individuals being taken further into criminal justice control which can result in further social exclusion.

Criminal Justice Social Workers must take note that the role involves work with disadvantaged social groups. Certain types of crimes and offenders often criminalise the young, deprived, unemployed and undereducated male with an experience of the care system and this is clear from Social Work and prison statistics (Croall, 2005; McAra and McVie, 2005). There is often a complex relationship between social exclusion and offending behaviour and often the Criminal Justice process displays existing injustices within society. It is important that issues in relation to class, age and social context should be recognised together with vulnerability to discrimination.

The Social Worker’s role should be to address issues of social exclusion and empower individuals to lead law abiding lives by addressing their offending behaviour. Social Work can help offenders develop capacity to make informed choices by actively encouraging their participation in the supervision/change process and their engagement with improving their current social situation (McCulloch, 2005; McNeill, 2004). Assisting offenders to focus on their strengths as opposed to their risk and needs can have a positive impact as they learn to recognise the value in their own lives and respecting the value of others.

The sentencing stage in the criminal justice process generates the majority of Criminal Justice Social Work through provision of information to the Court in the form of Social Enquiry Reports (SERs) and the administration of community disposals, with the exception of liberty orders (tagging). SERs have no legal basis but there is a statutory duty on criminal justice social work to provide reports to the Court for disposal of a case (s.27(1)(a) SWSA 1968. ‘Reports provide the court with the information and advice they need in deciding on the most appropriate way to deal with offenders. They include information and advice about the feasibility of community based disposals, particularly those involving local authority supervision. In the case of every offender under 21 and any offender facing custody for the first time, the court must obtain information and advice about whether a community based disposal is available and appropriate. In the event of custody, the court requires advice about the possible need for a Supervised Release order or Extended Sentence Supervision on release’. (Scottish Executive, 2004d, para. 1.5)

The Criminal Procedure (Scotland) Act 1995 sets out when the court can or must obtain an SER. Failure to request a report, where required by law, can result in a sentence being quashed on appeal. The Court is not obliged to follow recommendations or opinions in the SER however, Social workers can have a direct influence on the sentence passed.

‘Preparing SERs demands a high standard of professional practice. It requires skilled interviewing, the ability to collect and assess information from different sources, and the art of writing a report which is dependable, constructive, impartial and brief’ (Social Work Services Inspectorate (SWSI), 1996, Foreword).

The law imposes time limits in compiling reports. The Courts require a report within three weeks (s.201(3) (a) if an offender is remanded in custody and within four weeks if the offender is on bail (s.21(3)(b) of the 1995 Act). This means in practice that there are increased demands on a worker’s time that places increased pressure in the preparation of SERs especially if there are high numbers of worker absence due to leave or whether the worker knows the offender and their individual circumstances. Whilst conducting interviews the worker must ensure that the offender understands the purpose of the report, the relevance of questions (health, addiction issues, and personal relationships) and the limits to confidentiality of this information. Social workers must balance between an informed recommendation and an awareness of the severity of the offence. The report author should be impartial and not minimise the seriousness of the offence and its impact (NOS, Scottish Executive, 2004d, para 5.5) and phrases that imply moral judgements, label or stereotype offenders should not be used (para. 5.1).

When compiling an SER workers are required to consider the suitability of disposals in relation to the risk posed by an offender and to target appropriate resources which are most appropriate and successful in addressing offending behaviour. Guidelines for the assessment and management of risk are outlined in the Management and Assessment of Risk in Social Work Services (SWSI, 2000) and there are also additional risk assessment frameworks which specifically relate to serious violent and sex offenders. In Criminal Justice the focus has moved from risk of custody to risk of reoffending and risk of harm. Risk assessment is complex and there has been a shift from concern for the offender and their needs to concern about public safety and the offender being a potential source of risk to others. Although the legislation is not explicit about offending behaviour, National Standards state that SERs should provide ‘information and advice which will help the Court decide the available sentencing options…by assessing the risk of reoffending, and…the possible harm to others. This requires an investigation of offending behaviour and of the offenders’ circumstances, attitudes and motivation to change’ (Scottish Executive, 2004d, 1.6).

Risk is defined by Kemshall (1996) as ‘the probability of a future negative or harmful event’ and assessment of risk includes: the likliehood of an event occurring, who is likely to be at risk, the nature of the harm which they might be exposed and the impact and consequences of the harmful event.

Risk assessment has changed over the years and prior to the introduction of risk assessment tools workers relied on clinical methods or professional judgement which was based on an offender’s history. These methods were criticised for being too subjective, inaccurate, open to worker bias and dependent on information given by the offender. In the 1990’s workers moved towards objective and empirically based risk assessment tools (actuarial) to support their assessment. Actuarial risk assessment tools rely on static (historical) risk factors together with dynamic (criminogenic) risk factors and to assess the risk of reoffending.

The static factors (which cannot change) take into account gender, age at first conviction, number of previous offences and custodial experiences, school progress, previous employment and personal history. The criminogenic factors (focus on current areas) include current employment, personal relationships, peer associates, use of time, substance use, mental health and attitudes and behaviour. All of these factors impact on the risk of reoffending (Bonta, 1996). The most widely used assessment tool, The Level of Service Inventory – Revised (LSI-R) devised by Andrews and Bonta (1995) incorporates both static and dynamic factors. However, it does not assess risk of harm and this shows that both actuarial and clinical risk assessments are crucial for an effective and comprehensive risk assessment. Clinical methods combine knowledge of the offender’s personality, habits’ lifestyle and an analysis of the circumstances of the offending behaviour and are therefore, the most appropriate assessment tool at identifying those who are likely to cause serious harm. Although more time consuming and require more in-depth analysis of both the offender and the offence risk is assessed on predispositions, motivation towards certain behaviours and triggers that may contribute to harmful behaviour.

Actuarial tools are not totally accurate (Kemshall, 1996) and although this is improved upon through use of clinical methods in decision making, professional judgement is also crucial. Social workers must be aware that social disadvantage plays a part and this can contribute to a higher assessment of risk and need and to be cautious about the total reliability of these factors when making recommendations that may affect an offender’s liberty.

Risk assessment and intervention or supervision should be informed by valid, reliable and ongoing assessment and Social Workers should familiarise themselves with research emerging in this area and the many assessment tools and change programmes available (Levy et.al., 2002).

To support change Social Workers have to not just think about what work is done with the offender but how that work is done. ‘Offenders under supervision have very high levels of need. Moreover, although most offenders have many needs in common, there are also significant variations that necessitate the thoughtful tailoring of individual interventions if the effectiveness of practice is to be maximised. In delivering effective practice, the accumulated weight of evidence…drives us towards recognition that practice skills in general and relationship skills in particular are at least as critical in reducing re-offending as programme content’ (McNeill et al., 2005, p.5). This recent review of core skills required for effective Criminal Justice Social Work practice raises challenges in practising ethically and effectively but when applied critically and reflectively this could achieve positive outcomes that are in the interest of the public, victims and offenders.

Although the law is crucial in framing Social Work practice in the Criminal Justice process it is equally important that Social Work skills and values are central to effective interventions as the role is both demanding and rewarding. Crime has become increasingly prominent both in the public and political agenda and therefore, Social Work has become more prominent and complex. Social Workers have a professional responsibility towards victims, the Court, community and offenders. To fulfil this role effectively, Social Workers must have a clear, confident understanding of their role, the legislative and policy context and a commitment to increasing and developing knowledge, skills and values required for effective and ethical practice.

A given scenario on Recognising Children at Risk (Child Protection). The essay should be based on a given scenario, which has been divided into three sections with question prompts at the end of each section which should assist the essay’s focus.
Section One

Stephen and Eileen have been together for seven years and have two children aged five and eleven months. Eileen also has a daughter aged ten from a previous relationship. The family seemed to function quite well until Stephen lost his job a year ago. He has been unable to find other employment and has been drinking heavily, this means that the family have financial worries and this impacts on family relationships. Eileen has recently found a part-time job and leaves the baby with Stephen. In light of his drinking problems, his being left in sole charge of a very young child would, in itself, be an area for concern. The neighbour’s concern was justified with regard to children she was used to seeing on a regular basis. Both the teacher and the school nurse have concerns with regard to the children’s wellbeing. The rows and screaming that the woman overheard tend to suggest that there is violence in the home and it is well documented that this has a deleterious effect on children and their behaviour.

The police referred the neighbour’s concerns over the Drake/Harris family and it thus warrants an initial assessment, which should take place within seven days of the original referral. An initial assessment would involve the social worker visiting the family home and seeking permission to speak with staff at the school, the Health Visitor , and the family’s G.P. as well as the family themselves. This might also involve a request for the children to be examined by the family doctor and a report made for Social Services. There would need to be some kind of assessment as to the extent of violence in the family and how that is affecting the family’s wellbeing. It is often a good idea to see how the children respond to questions regarding what has been happening at home recently. At the same time the Social Worker might want to establish that the family are receiving all the benefits they are entitled to while the man is unemployed. I think it would also be appropriate that if the mother is to continue working then alternative arrangements need to be made for the baby’s care while she is at work. Once these initial elements are addressed then a multi-agency case conference needs to be convened in order to assess what might be the best way forward for the whole family. This would usually consist of the Social Worker his/her immediate superior, someone from the child protection scheme, the police (as the referral was made by them) teacher, health visitor and the parents.

Eileen denies that her partner inflicted the bruising noted on her arms and legs and insists that she fell down the stairs. This is a common response by women subjected to domestic violence. The father has a problem with alcohol and is also known to indulge in violent outbursts and this raises serious concerns as to whether he is a suitable person to be left in charge of an eleven month old baby. Clearly the family is in need of further support under the terms of the 1989 Act and a full multi-agency assessment of those needs is required. Stephen sees this as interfering and insists that his only problems are lack of work and money. Eileen is more compliant and agrees to visit the GP with the children.

Although the GP has few concerns with regard to the children’s wellbeing other than the fact that they have lost some weight and the baby is not gaining weight at the rate expected, there are some concerns that Eileen might be suffering from depression. Staff at the school report that there are some concerns over the children’s behaviour which has altered considerably over the past few months. Jack in particular has been displaying behaviour that is normally associated with a two or three year old, doing anything to attract attention. This was also noted at the initial assessment when Jack was jumping all over the place. His reception class teacher also reported that she had noticed a lack of concentration in class. Cathy and Jack were clearly unhappy with the situation at home and with any attempt to question them about what was happening. It might be that they were simply trying to protect their parent’s privacy but Cathy’s reluctance to talk about the bruises she received and what has been going on raises concerns as to whether Stephen’s violence is restricted to their mother or whether it extends to the children. It is also of concern that a previously lively ten year old should now be withdrawn. This kind of withdrawal is a common occurrence among children who witness violence in the home and those who have worked with children witnessing domestic violence (Abbott & Wallace, 1997).

Section Two

A week after the initial visit the Health Visitor has reported that she has some concerns over the baby’s health and is also concerned for Eileen who has just discovered that she is pregnant with a fourth child and has bruising to her face. Eileen has admitted to the Health Visitor that Stephen hit her during a row over money she agrees to again visit the GP with Lucy. The doctor did not examine Eileen but noted that the baby Lucy had some bruising on her arm which her mother said had been caused by her brother Jack throwing a toy. This is new information and actually requires a further assessment of the family’s needs. Agencies, both statutory and non-statutory, have a duty with respect to safeguarding children. This was highlighted in research evidence (1995) and further documented in the Department of Health 1999 Report Working together to safeguard children. Guidance has tended to be clearer and more precised in accordance with Lord Laming’s recommendations over the Victoria Climbie enquiry (Laming, 2003). A whole series of measures have since been put in place to target families such as the Drake/Harris’s. The Joint Chief Inspector’s Report, Safeguarding children (2002) defines safeguarding children and their families in the following way:

All agencies working with children, young people and their families take all reasonable measures to ensure that the risks of harm to children’s welfare are minimized, and
where there are concerns about children and young people’s welfare, all agencies take all appropriate action to address those concerns, working to agreed local policies and procedures in full partnership with other local agencies.

Under section 17 of the 1989 Children’s Act the authority has a duty to treat the Drake/Harris children as children in need. This means that the family will need some service provision in order to ease the immediate strain and to give better prospects for the children’s emotional, physical and social development.

Eileen has admitted to having suffered violence at the hands of her partner and is now concerned because she is pregnant with another child. The Health Visitor suggests a termination but as yet it is not clear whether Eileen is going to take this route. While there is no immediate reason to suspect that Lucy is being ill treated there is some concern that she is left in the care of her father for two afternoons a week while her mother is working. It is recommended that alternative care be found for Lucy. Under Section 18 (1) of the 1989 Act it may be possible to arrange nursery care for those afternoons.^[1]

At the present time there are a number of concerns associated with this family. The concern for Lucy has already been expressed and although it is not clear that either her or the other two children have suffered violence they are certainly affected by the situation. In view of this, and the husband’s resistance to outsider involvement it may be necessary to apply to the Courts for a Child Assessment Order. It seems fairly clear that the family does need some support during this crisis and that without such support the children will be at risk of harm due to a number of factors.The family circumstances i.e. unemployed father and significant financial problems, indicate that the children’s development (even without domestic violence) is liable to suffer. Sidebotham, et al’s (2002) study of parents and children and children on the At Risk Register, found that in homes where there was unemployment and financial deprivation children ran a greater risk of being abused. The researchers found a clear link between social and economic deprivation and the risk of abuse.

The Health Visitor phones the next week and explains that Eileen came into the surgery that morning in a terrible state as she thinks she is pregnant again. The health visitor noticed that baby Lucy appeared unwell again, with a bad cold and problems breathing and that there was bruising on the left side of Eileen’s face and over her right shoulder. When the HV asked her about the bruising, Eileen admitted that Stephen had hit her during a row the night before. She claimed that Stephen had been full of remorse and promised to make amends and did not want the HV to tell anyone else about it. Eileen was still worried about how he would take the news that she is pregnant again. The Health Visitor had advised Eileen about the possibilities of a termination of the pregnancy and suggested that she make an appointment to discuss this with the GP and to check her injuries and Lucy’s chest and breathing, which seemed poor. On checking with the GP after surgery this morning the HV has discovered that he only examined Lucy and gave a prescription for medication for her cold and severe nappy rash. Eileen’s own injuries and her possible pregnancy were not discussed. The Doctor however did also notice bruising on the baby, which the mother told him had been caused by Jack, her brother, throwing a toy. The second assessment was decided over the telephone by several representatives. The family receive another visit and this time the social worker is joined by the Child Protection Officer injuries to Lucy are again questioned. Steven admitted to striking Eileen while she was holding the baby and the team decided that the injuries to Lucy were non-accidental. Concern was also expressed over her significant weight loss.

Section Three

Gardner (2002) in a study undertaken for the NSPCC found that support services could be of significant help under these circumstances and that 58% of children considered to be at risk, and had access to support services, showed significant improvement in their development after these measures were put in place. In 2001 the Government commissioned the Children in Need Census^[2] which attempted to establish why children accessed children in need services, what type of provision they accessed and the costs associated with that provision. The Drake/Harris children are further at risk due to Stephen’s alcohol abuse. Harwin and Forester (2002) found that in cases where the parents misused drugs or alcohol, the children often came to the attention of Social Services as a result of concern for their safety and well being. Over 290 cases across four London Boroughs, showed that a third of those requiring long term intervention had parents with some form of substance misuse. This caused concern in a number of areas, particularly where there were children under the age of six. In the present case two of the children, Jack aged 5 and Lucy aged 11 months should be assessed as potentially being at considerable risk. It would seem that there is sufficient concern that a core assessment might be suggested at the inter-agency case conference as there is some evidence to suggest that a deeper and more comprehensive evaluation of both the family circumstances and their needs should be carried out. It is not clear how Cathy’s injuries were received and perhaps a Child Protection Plan might be considered at the Child Protection conference.

The most immediate threat, the father, has agreed to leave the house for a week. This negates the need for a care order to remove the children to a place of safety. He should receive some advice and support on how to handle his drinking. It might also be appropriate to suggest anger management. However, the father is expected to return and there is therefore a need to place all three children on the child protection register. It would seem appropriate for both Jack and Cathy to be placed on the register under two categories, emotional abuse (due to domestic violence) and physical abuse, although in Jack’s case there is no evidence and in Cathy’s case the evidence as to how she received the injuries is unclear this is still a cause for concern. Lucy is the child that raises the most concern and it would seem appropriate that she be registered under three categories, emotional abuse, physical abuse and neglect. This last is due to her significant weight loss, coupled with nappy rash which should have been seen by a doctor before the referral. Sometimes when domestic violence is an issue children become neglected because the mother is so engrossed with dealing with the violence and her own feelings that she does not always take sufficient notice of what is happening to her children (Dobash and Dobash, 1992). It might also be helpful if the family were assigned a regular family support worker who could keep an eye on the children’s development and lend support with baby until the mother was feeling better. She also needs to be given information regarding refuges and domestic violence issues in case the husband returns and is again violent.

All of the above could be problematic, many families are frightened when they hear about the child protection register and think that children remain on it. The mother would need to be reassured that when a suitable time has elapsed and the team are convinced the children are no longer at risk then they can be de-registered. Whether the father will agree to alcohol counseling and anger management is not known at this moment and if he refuses this could become quite problematic. It is for this reason that it seems appropriate to give the mother advice over what she can do to avoid the same scenario. The parenting support might also be objected but, if necessary, this can be enforced by a court order.

The school would need to be informed as to the progress of the family. The Health Visitor should continue visiting regularly and report any problem areas to the GP and to the social worker. If the father is compliant and either stays out of the family home or obtains the help outlined above then there should be no need for further police involvement or for a care order to be requested. I can see no areas where there might be conflict between the various agencies with regard to this protection plan.

Bibliography

Abbott and Wallace (1997) An Introduction to Sociology, Feminist Perspectives Routledge, London.

Department of Health (1999) Working Together to Safeguard Children: A guide to inter-agency working to safeguard and promote the welfare of children HMSO.

Department of Health (2000) Framework for the Assessment of Children in Need and their Families The Stationary office.

Department of Health (2000) Assessing Children in Need and their Families The Stationary Office

Dobash, R and Dobash, R (1992) Women, Violence & Social Change, Routledge, London & New York

Gardner, R. 2002 Supporting Families: L Child Protection in the Community Chichester Valley

Harwin J. and Forester, D. 2002 Parental Substance Misuse and Child Welfare: A study of social work with families in which parents misuse drugs or alcohol Department of Health

Sidebotham, P. et al “Children at Risk of maltreatment in Children of the Nineties: deprivation, class and social networks in a UK sample” Child Abuse 26 (12) pp 1243-1259

Wilson, K. and James, A. (Eds) (1995) The Child Protection Handbook, Bailliere Tindall.

1

There are a number of recent developments in policies relating to care, however, I am going to focus on just one of these policies which is the National Health Service And Community Care Act 1990. Community care has no single meaning, broadly, it means helping people who need care and support to live with dignity and as much independence as possible ‘in the community’. The ‘community’ is hard to define, it most often means ordinary homes, but for some people, it includes special forms of housing, residential or nursing homes.

Community care involves provision which is largely pensions, benefits, income, transport, housing, the opportunity to work, policies for essential services such as fuel, telephone, recreation, education and leisure. Community care is part of our lives. It is the web of care and support provided for frail, people have sick, dependent people both by their families or others members of the community and by public or other services. This means helping some people remain in their homes or creating homelike places appropriate support.

Community care means a preference for home life over ‘institutional’ care. It means helping people to be integrated with their local community, rather than being separate from it, in a long stay hospital, where people do live with others in what are called ‘communal settings’ or ‘group homes’. There is a general reference for smaller homes close to where people have always lived.

New arrangements are being introduced for publicly provided social services. These are often referred to as the ‘community care changes’. They were first described in 1989 Government document called ‘Caring for people’, the NHS and Community Care Act 1990 made the necessary legal changes.

Firstly, When looking at the history behind the NHS and community Care Act 1990, In 1948 the new National Health Service (NHS) and local authorities inherited 500 old workhouses that catered for, or ‘warehoused’ a mixture of elderly people, some of whom were incapable of looking after themselves, some of whom needed medical or nursing care, and some of whom simply had nowhere else to go. The NHS, wanted to get rid of its embarrassing institutions, which contained hundreds of people confined to large wards with no privacy and receiving no significant medical treatment (Townsend 1962).

The Nuffield Foundation issued a report from a committee chaired by seebohm Rowntree in 1947 on the circumstances of old people living in these homes, in smaller residential accommodation and at home. It recommended the development of small units, of no more than thirty five people, sited in the community. Central Government issued guidance to local authorities encouraging them to develop such smaller residential homes, though its own expenditure restrictions made this difficult to achieve until the 1960’s when closure of the remaining workhouses became a major policy goal and local authorities began to build up services that supported elderly people in their homes, such as home helps and meals on wheels. In NHS terminology these alternatives to long stay care in the old hospitals and workhouses came to be called community care.

The same approach can be seen in the next social group to be considered for community care, which was the mentally ill. The Royal Commission on the Law relating to mental illness and mental deficiency in 1957 saw a decline in the number of people needing long-term compulsory detention in hospitals. Many were there and their civil liberties denied merely because no alternatives were available. The preparation for the closure of large long stay hospitals for the mentally ill began in the early 1960’s but it progressed very slowly at first. It was the scandals that hit the long stay institutions for the mentally handicapped in the late 1960s and early 1970s that began a large programme of hospital closure for that group too. (Martin 1984).

The term community care came to be applied to those facilities that were developed to replace long-stay hospital care. The expectation was that local authorities would take on the role of proving such alternative care. In the 1980’s, the emphasis changed again. In their very early statement of policy priorities for the elderly, ‘growing older’, the new conservative government emphasised the importance not of care in the community but of care ‘by the community’ (Department of Health and Social Security 1981).

This essentially meant care by the family and support by neighbours and local voluntary groups, not the local authority. Community care has been a concern to shift the responsibility for care from one agency to another, from the NHS to local authorities, from local authorities to families.

The NHS and Community Care Act 1990 was introduced for a number of reasons, it introduced new procedures for arranging and paying for state funded social care. The government stated that they aim to make the best use of public money to make sure that the services which are provided by local and health authorities meet their needs. They encouraged authorities to set priorities to decide how they will spend money if there is not enough to provide for everyone’s needs. They also ensure that local authorities check on the quality of care which is being provided through inspection units, complaints procedures, care management, setting of service specifications and monitoring contracts for care and they aimed to encourage local authorities to use other organisations to provide services, not just to provide themselves.

The Audit Commission 1986 carried out a report called ‘making a Reality of Community Care’, which was a highly cogent and critical document. It discussed the fragmented nature of the so-called spectrum of care that was supposed to be available, from hospital to domiciliary care. It pointed out that many agencies were involved and that many people were either getting the wrong kind of care or not getting care at all. It criticised funding arrangements that gave more central government support to hospital care than to local authorities, which were providing an alternative. What was new was the exposure of what was happening to the social security funding of residential care.

The Audit Commission documented the rise in spending and argued that the government was being wholly inconsistent. It was telling local authorities that it wanted old people to stay at home for as long as possible because that was the most cost-effective and desirable thing to do, but at the same time it was pushing large sums of public money into expensive residential and nursing home care.

Sir Roy Griffiths, Mrs Thatcher’s trusted advisor on the NHS, had already reported to her on the management of the NHS. He was called into service again. He established the Griffiths report in 1984 to review the way in which public funds are used to support community care policy and to advise the secretary of state on options which would improve the use of these funds. (Department of Health and Social Security 1988). His essential job was to sort the money problem. In his report he recommended that public finance for people, who require either residential home care or non-acute nursing home care, whether that is provided by the public sector or by private or voluntary organisations, should be provided in the same way. Public finance should only be provided following separate assessments of the financial means of the applicant and of the need of care. The assessments should be managed through social services authorities.

Local authority social services departments were responsible for the funding of support and organisation in the community, which commenced when the establishment of the NHS and Community Care 1990 was made. The blurring of the boundaries involving health and social care came into effect at the same time as the development of this Act was made. Recent debates are concerned with equality in community care over the allocation of public resources involving various client groups, income groups, localities and generations.

Local authority services departments were in charge of funding and organising care and support in the community, this was carried out by the NHS and Community Care Act 1990 to allow individuals who are affected by disability or ageing to live independently as possible. Both the idea of responsibility and community care and for its organisation has been especially hard to identify. For example, in 1981 a study by the Department of Health and Social Security distinguished the inconsistent understanding of community care by health and social services authorities. For the NHS, community care typically referred to care offered outside the health service, for example, residential care from local authorities. Residential care was referred mainly by social services departments.

The central department of social security was handed the main responsibility for funding from means testing to local service departments. Providing and planning care and assessing people’s needs was the local authority’s responsibility. This included domiciliary care as well as the allowance of money for places in residential and nursing homes.

The Act included key objectives, which were, three different types of services available for people at their homes such as respite, day and domiciliary services which includes occupational therapy, bathing services, home care and home help, various types of daytime care outside a person’s home is associated with day services. Examples of day services are lunch clubs, day hospitals and day centres. Another key objective is respite care enables people who are being cared for and carers to get a break from another. Respite services include day centre attendance, family placement schemes, sitting services and also respite care provided in nursing and residential homes. Another objective from the Act was service for carers, when an individual’s needs assessment is being prepared, carers need to be considered.

Another key objective was that a referral on behalf of a patient to social services can be made by any individual as well as any person who is a member of the primary health care team. Also, anyone who appears to need a community care service must be carried out by the local authorities. A written care plan should be then set out by the local authority which should address who, when and what will be achieved by providing services, to deal with issues with services there should be a contact point and if any circumstances change, there should be information on how the individual can ask for an evaluation of the services.

Another objective is that GP’s are expected to deliver helpful information on health to assist social services in the care assessment. There are a number of adult client groups that benefited from these objectives. The children Act 1989 introduced many changes relevant to provision for children and their protection, adult client groups include elderly people, people with physical disabilities, mental health problems, drug and alcohol problems, people with HIV or AIDS, homeless people and people who are terminally ill.

However, the National Health Service and Community Care Act 1990 have been criticisms. There is a tension between the idea of ‘user-led’ assessment and the ‘targeting’ of resources on people. Some social services departments are worried that the assessment process will raise expectations which cannot be met.

It is possible that some assessments will not reflect people’s ‘actual’ needs, but only the needs they are allowed to express in line with those the authority feels able to meet. Such a system would suppress only understandings of the true level of need, unless the unmet needs are carefully recorded and fed back into the system.

Also the community care reforms are rooted in the idea that people should have choice about how their care needs are met. Assessment should be user-led, but gives the ultimate responsibility for defining need and working out how or if it will be met to the local authority through the assessor or care manager

The Act has been also criticised for using the term ‘vulnerable adults’. They are defined as ‘at risk of abuse’. They are those meeting the criteria of the NHS and Community Care Act 1990, or being in need of community care services by reason of mental or other disability, age or illness and being unable to take care of themselves or to protect themselves against ‘significant harm or exploitation’. The term ‘vulnerability’ is being used in this Act to stress the differences between people in terms of their ability to protect themselves. However, these differences are not fixed and a disability perspective would argue that casting disabled or older people, or people with health problems, as vulnerable is a form of infantilization and further perpetuates their less than full adult status. They can be seen as helpless or dependent and unable to manage the risks of ordinary living. Examples of this are: people with learning disabilities may be over-protected by those who fear they will be exploited, in particular, sexually.

Another criticism of the Act is that Lewis and Glennerster (1996) have suggested that NHS officers regarded the 1990 Act as ‘good grounds for getting rid of their long-term care responsibilities as soon as possible’. Some health authorities stopped providing any continuing care beds at all (Richards 1996). Eventually, these developments forced the department of health publicly to accept that the 1990 Act had led to a reduction in the responsibility of hospitals for long term care, not withstanding its earlier claims to the contrary.

On a 1994 report by the Health Service Commissioner into the case of a seriously brain damaged patient, for whom the local health authority had refused to accept responsibility, The Commissioner found that, in refusing to spend resources on patients of this type, the health authority was failing to fulfil its duties. (Health Service Commissioner 1994).

Another criticism of the NHS and Community Care Act 1990 are that even though the reforms have stressed the significance of carers (primarily other family members), however, some of the individuals that need care do not have families and of the individuals who do have families do not have carers. Also the basic difference in individual’s family situation is not directly addressed by the current policy. The community care reforms, which were preceded by the white paper, found that ‘the government distinguishes that demographic movements will have repercussions for the potential availability of carers. However, it failed to explore what these repercussions might be; the reforms also persist to place the relatives at the middle of the care system. Another criticism is that there also may be no interpreting service to help people whose first language is not English, or who is death, People may not want their financial means to be assessed, disablement benefits have to be put towards services offered, when there is already difficulty making ends meet.

In conclusion the community care involves provision which is largely pensions, benefits, income, transport, housing, the opportunity to work, policies for essential services such as fuel, telephone, recreation, education and leisure. Community care is part of our lives.

The NHS and Community Care Act included key objectives, which were, three different types of services available for people at their homes such as respite, day and domiciliary services which includes occupational therapy. Criticisms of the policy include casting disabled or older people, or people with health problems, as vulnerable is a form of infantilization and further perpetuates their less than full adult status.

(2599 words)

“White Social Workers’ pejorative assessment of black families and the reinforcement of racist stereotypes through their intervention are central to the ‘social working’, i.e. social control, of black families and form the major avenues through which they ‘clientise’ black people.” (Dominelli, 1988)
Introduction

While keeping the above statement in mind this paper will discuss how assessment can be effective in assessing need and managing risk for all users. It will do this by looking at how problems and conflicts are addressed and in what ways this might be effective for users of mental health services.

Assessment

Assessment is a process that all users have to undergo in order to determine what services they might be entitled to and how their needs might best be addressed. Social workers who specialise in the area of mental health are bound by the 1995 Act which defines their responsibilities to people with mental or physical disabilities.

Disability is defined as a physical or mental impairment which has a substantial and long-term adverse effect on ability to carry out normal day-to-day activities (Brayne and Martin, 1999:460).

The Human Rights Act of 1998 is phrased in such a manner that local authorities now have a duty to act in ways that are conversant with the Act. Social workers help people with mental health difficulties to deal with the problems that they face. It is the social worker’s duty to help organise care and support for people with physical disabilities, with learning disabilities, and with mental health problems. This duty begins with an assessment of need for services, it is only once such an assessment has taken place that social workers and local authorities will be able to decide whether they can help with that need.

In the 1980s the Tory Thatcher Government brought market policies into the health service that included what is known as ‘care in the community’ this meant that large numbers of psychiatric hospitals were closed. This resulted in those who were mentally impaired, along with a small number of psychotic patients being discharged into the community. They did not receive proper treatment and a number of incidents created public unrest. Thus, whenever a social worker makes an assessment for someone with mental health difficulties they have a duty to do so with the concept of also assessing any risk that they feel users might face or that they could pose to society. Under the 1990 NHS and Community Care Act (circular LAC (92) 12 any needs assessment that a social worker undertakes needs to take into account the following:

The capacity/incapacity of the person being assessed
Their preferences and aspirations
Their living situation
Any support they might have from relatives and friends
Other sources of help

With regard to people with mental health problems and with other disabilities, just because local authorities have a duty to find out about such people in their area and offer help, does not depend on a client’s request for services rather it requires the social worker to carry out an assessment of anyone in that group who might be eligible for services (Brayne and Martin, 1999). Once an assessment has been carried out and the client’s needs identified then social workers have a duty to help people with mental health problems obtain the benefits that they are entitled to. The social worker also has a duty to ensure that the client is in accommodation that is suitable to their particular needs. The authority may need to provide extra support to enable a person to continue living in their own home or they may need to arrange a move to residential accommodation or long term hospital care. Thus working with this client group is a large and varied field and social workers are faced with a number of different duties in this respect. These duties and responsibilities are further defined under legislation and policy relating to the needs of people with mental and or physical disabilities.

A social worker whose clients are in one of the aforementioned groups may find themselves visiting clients in a number of different settings. It may be the client’s home, hospital, residential accommodation, or sometimes at the social worker’s place of employment. Generally the social worker will act as part of a team dealing with a number of different cases and in each one will need to be aware of the general legislative framework as it applies to that particular client group. Social workers are required to write reports on every case that he/she is engaged with. This will then be seen by their supervisor and by the care management team. This helps in addressing client needs and determining a care package. It is also a way of determining whether the social worker has done their job in the best way possible i.e. a way that empowers the service user and gives them some say in the decision making process. This is especially relevant where mental health is concerned as there has been some speculation as to whether social workers and other mental health professionals deal with service users in ways that are non-prejudicial.

Some research tends to suggest that over the last fifteen years those who use mental health services have been treated in a prejudicial way. This is because (and Government debates are also at fault here) this group of users have tended to be defined in terms of the risk they constitute to themselves and the wider society. This is despite all the evidence supporting the view that those with mental health problems are not generally a risk to society. Langow and Lindow (2004) argue that such a concentration on risk means that an individual so defined runs the risk of having decisions concerning their lives taken out of their hands. This is certainly borne out by government policy proposals regarding people who are considered to be a risk to themselves or others. Langow and Lindow (ibid) maintain that this concentration on risk means that social workers and other mental health workers often find it hard to distinguish the reasons why someone may behave in an aggressive manner. Is it due to psychotic behaviour, or is it just that they feel disempowered or feel themselves as having been subject to racial abuse? The danger here is simply to err in favour of the psychosis rather than believing they have to take the risk that someone would not pose a threat to the rest of society. Service users are often not aware that they are being assessed in this way. The fact that staff might consider users to be a risk to others however, could have serious implications for that person’s future.

Dilemmas and Conflicts

It is not always easy working with people with mental health problems. A social worker may undertake an assessment and then find that the client does not want the help that is on offer. This really can be problematic as the legislation implies that local authorities must make an assessment of needs once mental health problems or disability have been identified. This further implies that they will produce a care package to address those needs. If a client refuses to allow a social worker entry then they are not able to do their job and undertake an assessment or provide services as required by the legal framework. If an assessment is made then the social worker has to try and identify areas where family and friends can help the person. When such arrangements break down and there are no alternatives in place then problems may arise. Thus a person who may previously have been assessed as being able to remain in their own home may later have a need for either supported living (particularly in the case of people with mental health problems or learning disability) or for residential care. If a person is deemed unfit to live alone or is a problem to others then the social worker has a duty to call in the medical officer of health who then has to obtain an order from the magistrates court. Removal to residential accommodation then involves the social worker in another set of rules as to how the accommodation is financed. This is also pertinent to regular inspection of such accommodation and other welfare services that the client is entitled to.

Clearly there are a growing number of legal and policy requirements that a social worker must adhere to when dealing with specific client groups. Mental health is an increasingly problematic area because new regulations are coming up all the time and the wording is not always clear or precise. This means that the social worker’s job can be a minefield as they try to adhere to the needs and wishes of the client and yet remain within the legislative framework.

Factors that Promote and Limit Service User Involvement in Decision Making

Current debates on the needs and rights of services users show that although there has been a move to ensure individual’s rights to equality of service, some service users still face discrimination. Under these circumstances it is vital that power imbalances between service users and professionals be acknowledged and the contributing factors addressed. Once they come to such an acknowledgement the parties can then work together to minimalise any factors that contribute to the marginalisation and exclusion of some service users (Carr, 2004). Some of these issues might include the fact that there is still a tendency for some professionals to ignore service users’ views or to at least misinterpret them. This means that instead of being enabled through greater user participation, service users may end up feeling further disempowered. Institutional barriers have to be overcome, and the continuing use of professional jargon can also serve to exclude service users from the decision making process. Carr (2004) found that service users often saw such gaps as a disempowering and exclusionary factor, but, once aware of this fact, most professionals were more than happy to try to modify their language in order to encourage greater service user participation.

It is sometimes very difficult for people with mental health problems to communicate their needs in a way that is fully understood by the professionals trying to assess them. There is a need for different models and levels of participation depending on the service user’s circumstances. Some service users will be so empowered by participation that they will go on to be involved in how services are delivered, still others are not able to be truly involved at any recognisable level without the intervention of a third person. Thus advocacy is an important element of lower levels of service user participation. An advocate can help to empower people because service users will then have someone who is impartial, who can inform them as to what is available in terms of services and support and who will promote their best interests among other professionals and make sure that their wishes are made known. Carr (2004) notes that the service user movement has been instrumental in promoting the rights of people’s entitlement to as ordinary way of life as is possible. People with mental health problems may have multiple and complex needs, nevertheless under the 1998 Human Rights Act, they are entitled to be treated with dignity and local authorities have a duty to abide by the requirements of this Act (Moore, 2002).

Conclusion

Ethical and effective social work should involve a thorough assessment of the needs of users with mental health problems and a care package that takes their problems and wishes into account. This should be tailored to suit an individual’s needs and there should be room for changes and adjustments if the care package is not to become an imposition (Kerr et al, 2005). Where a person is not fully cognisant of what is happening then anti-oppressive practice should involve the use of an entirely independent advocate.

Effective social work is client centred and this is achieved through the social worker’s own reflective practice. If criticisms and accusations of prejudicial attitudes are to be avoided then it might be argued that advocacy, coupled with reflexive and effective social work practice should bring an end to service user disempowerment and become one that assesses need and manages risk in a way that is beneficial for both users and professionals.

Bibliography

Brayne and Martin 6^th ed. 1999 Law for Social Workers London, Blackstone Press

Carr, S. 2004 Has Service User Participation Made a Difference to Social Care Services? London, SCIE

Department of Health (2002b) Information Strategy for Older People (ISOP) in England. London: Department of Health

Dunning, A. 2005 Information, Advice and Advocacy for Older People York, Joseph Rowntree Foundation

Langow and Lindow. 2004. “Mental health service users and their involvement in risk assessment and management” Findings, Joseph Rowntree Foundation

Leason, K. 2005 “Fear and freedom” Community Care April 14^th 2005 p. 32-34

Moore, S. 2002 3^rd Edition Social Welfare Alive Cheltenham, Nelson Thornes

Ruch, G. 2000 “Self and social work: Towards an integrated model of learning” Journal of Social Work Practice Volume 14, no. 2 November 1^st 2000

Disability Discrimination Act 1995 http://www.drc-gb.org/thelaw/thedda.asp

http://www.after16.org.uk/pages/law5.html

Koster (2003) stated that “supervision leads to a mental and emotional education that can guide practical work, frees fixed patterns of experience and behaviour and promotes the willingness as well as the ability to act suitably, carefully and courageously”(p1). This essay will explore Koster’s quotation about best practice in supervision, in relation to supervision in the area of counselling. This essay will also identify the benefits and difficulties of supervision, in regards to counselling, that can arise in supervision. Examples from a personal perspective will be presented on how supervision throughout work experience enabled difficult situations to be handled. Furthermore, an analysis of how effectively supervision was conducted throughout work experience, as well as personal suggestions on improvements of supervision in that work setting.

Koster’s quote does speak truth as supervision can lead to all sorts of positive and negative developments (Pelling, Bowers & Armstrong, 2007). In particular he claims that it can lead to mental and emotional education that guides practical work, frees from fixed patterns of experience and behaviours. Supervision in counselling is very vital as it aims to increase self-awareness and enhances professional competence which will guide the supervisee throughout their work in a confident manner (Pelling, Bowers & Armstrong, 2007), which is similar to what Koster is trying to state.

The goal of supervision is primarily about the supervisee’s developmental growth and professional awareness (Pelling, Bowers & Armstrong, 2007). Which again leads back to Koster’s quote about how supervision leads to development; and that development of experience will guide the supervisee throughout their work in counselling. Thorough supervision, the supervisee will grow, reflect and develop in their professional and personal skills. It is through these developments that will alter their behaviour that will eventually guide them through their work to act in a suitable, careful and courageously; throughout their career in counselling. Which in return, is vital for a counsellor as his or her mental and emotional education needs to continually develop, and this can be accelerated through supervision.

It can be said that a number of individuals and organisations can benefit from quality clinical supervision. Quality supervision is about making sure the client is not being harmed and is being assisted to accomplish established goals in competently appropriate ways, the receiver of counselling services is the first to benefit (Page & Wosket, 1994). The majority of the conversation in supervisory sessions centres on interventions being used for the client and advance to how the supervisee is stressed with various parts of the case.

While the supervisor is interacting, clarifying, explaining, educating, supporting and coming up with helpful professional interventions, another person is benefiting from this while interacting back to their supervisor – the supervisee.

As Pelling, Bowers, and Armstrong (2007) suggests:

This is where the supervisee’s scope of practice, expertise and insight is being intentionally and incrementally expanded. Engaging supervisors in the struggle for understanding is valuable for deep learning to occur. In this sense it is the clinical material that is the teacher, not just the supervisor themselves. Supervision can insulate the supervisee from work-related stress, variously referred as burn-out. (p. 126)

In addition, if the supervisee is an apprentice from an educational establishment, the organisation itself benefits with the development of a more proficient and safe practitioner (Pelling, Bowers & Armstrong, 2007). This gives the organisation an excellent reputation for supporting and appropriately training the people in their charge in a professional manner, hence supervision being provided by the organisation benefits the organisation with a good positive professional reputation.

Last of all, the clinical supervisor gains a great deal from offering supervision. While they support the supervisees, their understanding of clinical work, knowledge, experience, the world and themselves develops a great deal and the sense of fulfilment of being additive to so many is indeed rewarding and satisfying (Pelling, Bowers & Armstrong, 2007).

Supervision can be a valuable constructive learning tool, but at times difficulties in supervision can make it a negative experience. Moskowitz and Rupert (1983) found in their research, within USA, that supervisees reported that 38% of those surveyed claimed that there had been difficulties and conflict in their supervision that interfered with their learning. Their research further found that there are three major areas of difficulties and conflict that arise in supervision: theoretical orientation, style of supervision and personality issues (Moskowitz & Rupert, 1983).

Differences in theoretical orientation may lead to difficulties and conflict in supervision (Carroll & Gilbert, 2006). In various organisations, supervisees may not have a choice of a supervisor and may perhaps end up getting supervised by somebody who has a different theoretical to their own. For example, a supervisor may be convinced of the ‘rightness’ of their orientation and is not ready to accept interference that arise from a different school of psychology. These differences in theoretical orientation are a common problem in supervision and it may lead to rifts between the supervisor and supervisee, therefore failing to negotiate differences of this kind (Holloway, 1995).

Secondly, difficulties and conflicts may arise in supervision when it comes to the style of supervision. Some supervisors have a formal style whilst others have an informal style of approach (Carroll & Gilbert, 2006). There are four unsatisfactory styles of supervision that cause conflicts and difficulties: constrictive supervision; amorphous supervision; unsupportive supervision; and ‘therapeutic’ supervision’ (Abott, 1984).

In the constructive type, there is limited autonomy. In the amorphous type, there is very little supervisory contribution and the supervisor may have a somewhat laissez faire outlook to the entire process, where ‘whatever happens goes’. Unsupportive supervisors are unfriendly and distant and supervisees would not willingly approach them with their difficulties. Therapeutic supervision transforms the supervisee into a ‘patient’ while the supervisor takes on the position of the ‘therapist’ often in a persistent and pushy manner that infantilizes the supervisee (Carroll & Gilbert, 2006).

The last style of supervision that causes conflict and difficulties is known as personality issues. This is when there is a ‘personality clash’ between the supervisor and supervisee which can result to a rupture in the supervisory alliance (Carroll & Gilbert, 2006). These ruptures are often caused by confusion in communication, for example the supervisor may misinterpret something the supervisee has said in a negative way. Furthermore, the rapture may be simply be caused by the supervisees own defensiveness. An example would be that the supervisee may act defensively when the supervisor gives feedback, therefore causing a strain in the supervision relationship.

Supervision is a valuable tool for a supervisee when they are having difficulty dealing with their client in an effective professional manner. Whatever the problem is, in regards to the well-being of the client, the supervisee can discuss these issues throughout supervision in order to uncover helpful interventions in dealing with the matter (Wosket, 1999).

An example from work experience in which supervision enabled to deal effectively with a difficult situation, is when there was a client who brought up an issue that was difficult to handle. The reason the issue was difficult to handle is because there was limited knowledge in that area and there was no confidence in dealing with the matter. So in order to deal with this dilemma, it was brought up to the attention to the supervisor throughout the supervision session.

Throughout the supervision session the supervisor, listened to the dilemma and asked explorative questions, made encouraging statements and shared self- disclosure. She also in return, working the supervisee, came up with interventions to put together in order for the supervisee to handle the struggling case. The supervisor clarified the problem to the supervisee and explored potential explanations and interventions for the supervisee to consider. The supervisee filled in the gaps of the knowledge and asked the supervisee to reflect and explore options on how he will put the explored interventions in to action. The supervisor also used modelling and role-plays to show the supervisee on how they might be able to assist their client. So through supervision, the supervisor’s challenges and confrontations facilitated the supervisee’s critical reflection and learning, hence this gave confidence to the supervisee to handle and deal with their difficult situation.

A concise breakdown will currently be offered on how efficiently supervision was carried right through work experience. Supervision was conducted effectively because the supervisor followed a significant process in order for supervision to function at its best. The initial supervision session is when the supervisor clarified what the supervisee has done in the past in regards to practice and supervision, and asks where they would like assistance.

When it came to the daily supervision sessions, it was noted at times that the supervisor would follow a process right from beginning to end. When the supervisee had an issue, it would be looked thoroughly. Issues discussed in supervision included: intervention strategies and future plans; counsellor professional development; supervisee – client alliance and boundaries; client issues and goal setting; supervisor – supervisee relationship; ethical and legal issues; and so on.

Once the issue were discussed, the supervisor would ask a series of structured questions in order to gain clarification, as well as allowing the supervisee to reflect and offload. Such helpful questions included: What are you feeling and views about the issue?; Where do you feel most confused?; what kind of help would you like?; and what are the key details I need to know about the case?.

Furthermore, during supervision the supervisor and supervisee took notes during sessions to have an ongoing record of plans, themes, struggles, clients discussed, learning and progress. Once the issue was discussed and the supervisor asked her questions, the supervisor would then encourage the supervisee to: understand the problem; find links among the information; develop a treatment plan to put into practice; and create a working proposition (Carroll & Gilbert, 2006).

Towards the end of every supervision session, the supervisor would give feed back as well as ask for verbal feedback back from the supervisee. The supervisor would ask something as simple as ‘How was our session for you today?’ or ‘Was this session valuable or unbeneficial to you today?’

Summing up, supervision was conducted effectively because the supervisor followed a valuable process throughout the sessions. Apart from following an effective process, the supervisor herself was encouraging, respectful, genuine, empathetic, and self-disclosed, which as a result added further to the effectiveness of supervision.

From personal experience, the supervision that took place during work placement cannot be faulted. However, there is lack of knowledge of how the other supervisors function in their role, as during placement only one supervisor was given to work closely with. Focusing purely on the supervisor provided with, her name being Amy, she was nothing but professional, educated and friendly. One could suggest that Amy is the ideal supervisor as throughout work placement she always showed respect, genuineness, empathy and was always encouraging. She was also concrete and showed a great deal self-disclosure throughout supervision. As stated, Amy would be the ideal supervisor as her supervision qualities match what Carifo and Hess found in their research in what makes an ideal supervisor. Carifo and Hess (1987) found that “the ideal supervisor is a person who shows respect, empathy, genuineness, concreteness and self-disclosure in his or her dealings with supervisees” (p.247).

So as one can see, supervision cannot be faulted as it was nothing other but a positive learning experience, with the help of a true professional supervisor who knew how to function in her role. Therefore, it is too complex to come up with suggestions for improvements for supervision in the work setting because it just worked to well in order to suggest any changes.

Supervision may have its benefits and difficulties, but it is those experiences a supervisee needs to experience in order to develop their mental and emotional experience. It is these developments and experiences that allow the individual to be able to learn and handle future challenges in their area of counselling. With the right supervisor, as well as having regular supervision sessions that are conducted effectively, it will consequently transform the supervisee into a stronger counsellor who is willing to learn, act suitably, carefully and courageously; throughout their counselling career.

Loneliness is a geriatric giant leading to impaired quality of life, greater need for institutional care and increased mortality. Routasalo, Pitkala, 2003

The phenomenon of loneliness occurs in people of all ages it may be a particular problem in the elderly according to a study carried out at Edinburg University in the nursing science department. It is acknowledged that loneliness is not necessary accompaniment to ageing and that ageing is not solely responsible for the development of loneliness in the elderly people; however there is a relationship between ageing and loneliness.

There is a need to understand the casual relationship between life-events and loneliness, how to predict it and whether negative consequences maybe alleviated.(Routasalo, Pitkala, 2003).

This study is about loneliness among the elderly people. I was interested in this topic because the fact that many old people are still experiencing loneliness at different levels cannot be overlooked. ‘Loneliness’ and social isolation have often been used to characterise the social world of older people and as an indicator of their quality of life (Victor, scamber and Bond, 2009) but loneliness among the elderly has been under addressed.Like many other social science concepts,loneliness is often a taken-for-granted idea from every day life.Loneliness is a common problem among the elderly that lead to widespread unhappiness and social exclusion.

The purpose of this study is therefore to portray loneliness among the elderly ,the main influencing factors and strategies to address it.

This study is entirely based on Qualitative Research methodology by probing into different academic disciplines so as to gather a deeper understanding of this particular topic.

WHAT IS LONELINESS?

Loneliness is a situation experienced by the individual as one where there is unpleasant or inadmissible lack of (quality of) certain relationships. This includes situations in which a number of existing relationships is smaller than is considered desirable or admissible as well as situations where the intimacy one wishes for has not been realised. (De jong gierveld, 1987, p.120 quoted in vangelisti and pelman 2006, p. 585-500)

(Peplau, 1981 quoted in vangelisti and pelman 2006, p. 585-500) defines loneliness as ‘the unpleasant experience that occurs when a person’s network of social relations is deficient in some important way either qualitatively (Quality related) or quantatively (size related).

Loneliness categories

(Weiss, 1973 in vangelisti and pelman 2006, p. 585-500) categorise loneliness as:

Emotional loneliness

This is as a result of absence of an intimate figure or a close emotional attachment (a partner, best friend) e.g. in divorce or widowhood.

We can further subgroup it as:

Developmental

Experienced when there is a need for intimacy balanced by a pursuit for personal happiness and independence (goals).

Internal

Often includes feelings of low-esteem and vulnerability.

Social loneliness

This kind of loneliness arises with the absence of a broader group of contacts or an engaging social network like friends, collegues and people in the neighbourhood.

It can also be termed as Situational/Circumstantial which can be explained by situations like loosing a relationship or moving to a new city.

Measurements of loneliness among the elderly

Loneliness is subjective(It is based on somebody’s opinions or feelings rather than on facts or evidence) and is measured using questions that seek perceptions of relationships,social activity and feelings about social activity(British Columbia ministry of health ,2004)

Loneliness is very cultural and temporally specific(jylha 2004).It is and has been difficult to compare levels of loneliness accross cuntries because the meaning of ‘loneliness’ is highly cultural(and possibly temporary)specific. Variations in measures used to measure loneliness by researchers in different countries has made it difficult to make a comparison across different countries.

Findings of the study
Main factors influencing loneliness among the elderly
Health resources

Chronic poor physical or mental health, Sensory impairments, Falls and

Self-rated health and Health expectations

(Tijhuis et al 1999) found that increase in loneliness was attributed to poorer subjective health but not on activity limitation or cognative function.Lonely and isolated peoples health may deteriorate because”they lack the environmental support,social ties and assistance by others that become critical factors in the maintainance of their independence later in life.(Bosworth and schaie 1997 p.197)

Mental health issues such as depression can impact self-rated score in an indirect way as those who are depressed may evaluate their social relationships negatively and therefore create apparent associations with other risk factors when infact it is depression that is the issue.(Russel et al,1997)

Social resources

E.g. Availability of family, friends and Social contacts

Recognition of the importance of the importance of the relationship between social engagements and ‘quality of life’ is not new (Victor, scamber and Bond, 2009). Social relationships and social engagements are a very important part of quality of life in old age according to (Victor, camber and Bond 2009).Rowe and Kahn (1997) suggest that a high level of social engagement is a key factor in achieving the goal of ‘successful ageing’. This same observation has been made in ideas of ‘healthy’ ageing and ‘active’ ageing.

Demographic factors

E.g. Age, gender, household composition, neigbourhood and

Marital status

Age and gender

Being widowed and living alone are more common among women because of their tendancy to outlive male partners.

Neigbourhood

Favorable neighborhood is associated with feeling safe and secure. Immediate neighborhood is of particular importance to the well-being and quality of life of older people(bowling 2006,Victor,Scamber and Bond 2009)Whilst there has been much focus on the importance of maintaining older people at ‘home’ this has been often interpreted as the narrow confines of the built dwelling or house rather than the wider environment of neighborhood or locality. Yet place is clearly important in providing the spatial context within old age (Berkman et al., 2000; berkman and Glass, 2000, Victor, Scamber and Bond 2009)

Household composition

Most people who live alone are lonely but not all people who live alone are lonely.Living alone also interacts with many other variables to create varying pictures of loneliness.Living together with someone and living in one’s own apartment(as opposed to an institition) showed a positive influence on feelings of loneliness for this population(Holmen et al 2000 as cited in gierveld,Tilburg and Dykstra in Vangelisti and perlmans 2006)

Material resources

E.g. Home ownership, access to car and education Qualifications

Economic status and self-esteem have been found to have a relationship with loneliness. Loneliness was expressed by those older persons with less adequate self-rated economic conditions and those living in actual poverty.(Mullins,Elston and Gutkoiski,1996) agrees that the less financially adequate individuals perceive their situation to be the more lonely they were.

Access to Transport/car

Driving status and transportation have an effect on the loneliness and social isolation of the elderly because of their role in facilitating access to the social network.(Kivett 1979) categorized older rural adults with transportation problems as a high risk of loneliness. Many seniors are restricted to pre-arranged van trips with community or volunteers drivers. Dependence on others for transportation related socializing may change the nature of social interaction for those people (Hall Havens,1999). Programs for seniors will be ineffective if they cannot access them.

Life Events

E.g. Bereavement ,widowhood and onset of illness

Death of a spouse and living alone is a major additive risk factor for loneliness and isolation.

Events like widowhood emphasize that bereaved persons are especially vulnerable for emotional isolation(loneliness)rather than social isolation (Van baarsen et al,1999)

Discussions of findings

Given the potential harmful effects of social isolation and loneliness in seniors,it is important to persue this issue in order to reduce emotional damage to seniors and inappropriate health and social service usage.However,caution should be observed when again interventions without knowing the target population and assessing the possible negative consequences of the planned intervention.( British Columbia Ministry of

Health.March 2004)

Strategies to address loneliness and isolation for older people.

A survey done in campaign launced by leeds metropolitan university on behalf of the british gas to combat isolation and lonelness developed recommendations with the

older people to address the issue of isolation and loneliness.Through interviewing older people and trying to identify what they want,the following suggestions were arrived at.

Involving older people in planning,developing and deliverly of activities that target social isolation and loneliness.

Practical,flexible and low level assistance that could help older people to remain indipendent,gain confidence to identifytheir own solutions and support them in retaining their own social networks.

Individually tairoled solutions to meet specific needs,within a variety of activities available within their local neighborhood and within the reasonable travelling distance.

Transport that takes the mobility of the elderly into account.

Availability of Services that cater for specific groups such as carers,ethnic minorities,older men and those with hearing impairments or mobility problems and those who have been isolated for a long time.

Support and encouragement for the elderly to learn new skills as well as the opportunity to share their skills with other older people.