Author: Andre Coleman

The purpose of this meeting was to carry out an update SAP assessment, under Section 47, NHS and Community Care Act 1990, because Diane’s needs have changed.

Diane is a 69-year-old White British Female who has been living in Critchill Court since her discharge from hospital in Jan 2010. Diane had a Sub Arachnoids’ Haemorrhage, which has caused memory loss, confusion and depression in 2009. Earlier review in Feb 2010 reveals that Diane expressed a wish to return to independent living. Since then, an OT has supported Diane in re-learning independent living skills.

Prior to the meeting, I went to social service to discuss with Diane’s social worker to initiate information sharing and ask advice. We agreed on the need to complete the assessment before Diane’s review in May 2010. I also obtained permission to have this meeting from Diane, and her daughter and their agreement that my placement supervisor would attend the meeting – but only to assess me.

My aim was to identify Diane’s current and future needs with her and her daughter, who specifically stated her wish to be involved during earlier casual conversation. To do this I gained permission from Diane and her daughter during the meeting that I would seek the views of other professions, (OT, key worker, and CPN) to fill in some parts of the assessment. Diane has also given permission for me to share the information that she provided with others on a ‘need to know’ basis.

My role as a student gave me flexible time to commit in more supportive work with Diane. I had been working in partnership with Diane, her daughter, OT and social worker for 3 weeks before the meeting. I have taken Diane out, building her confidence in accessing local resources, and importantly, a relationship based on empathy, trust, and confidence.

Authority/requirement for carrying out this piece of work (Legislative context/ agency policy/ government guidelines)

The NHS and Community Care Act 1990, Section 47, which requires a needs-led assessment when appropriate and services provided accordingly if practicable.

The Mental Health Act, 1983 and the Mental Capacity Act, 2005 apply because Diane has Sub Arachnoids’ Haemorrhage, which has caused memory loss and confusion. Particular attention is required, as these laws require that one must assume a person has capacity to make decisions unless established otherwise, and that one may not treat a person as unable to make a decision unless established otherwise. In my casual interactions with Diane, I have observed considerable ability to take decisions with regard to her life.

The National Occupational Standards for Social Work (2002) and The GSCC Code (Code 1 for social workers) require the social worker to empower the service user by informing them their rights and entitlements and listening to what they have to say to involve them in taking any decision that may affect them. The Code also requires the social worker to recognise the user’s expertise in their own lives and make informed choices about services they receive.

The Disability Discrimination Act 1995/2005 defines discrimination as, treating an individual less favourably than treating another. This legislation is important because it states what the government “expects and requires of local authorities in relation to good practice” (Trevithick, 2005: 17). Macdonald-Wilson et al (2001) defines disability as the condition of being unable to perform, because of physical or mental unfitness; to this extent, this definition follows the medical model. In the case of a person with a disability, a person is being discriminatory if they fail to comply with a duty to make a reasonable adjustment in relation to the disabled person. Higgins (1980: 123) defines stigma as a “deeply discrediting trait, which may also be called a failing, a shortcoming, or a handicap.”

The Equality Act 2006 and the Care Standards Act, 2002 also have bearing on this case as it involves assessment of the care provided against need.

Community Care (Direct Payments) Act 1996 enables local authorities to make direct payments (cash payments) to individuals to enable them to secure provision of care in lieu of social services provision.

The Data Protection Act 1998, which requires the express consent of the individual prior to sharing any personal information obtained on individuals and shared with others. Additionally, all the information gathered should be kept in accordance with the data protection guidelines. Diane and her daughter had given me consent to collect and share information with other agencies if required.

Knowledge (e.g. legal, psychological, sociological, political, socio-political, procedural, social work method) applied

In undertaking this meeting I carefully prepared by brushing up on my knowledge of the relevant laws, guidelines, and different perspectives on empowerment, anti-oppressive, and anti-discriminatory practice. Besides these laws, my reflection on the case before the meeting showed me the values that would help in obtaining a positive outcome of the meeting. Theory and guidelines on ‘best practice’ in social work required that I adopt an approach that would place Diane in a position where she feels empowered to make decisions. This approach requires me to work with the person-centred theory (Rogers, 1959) that requires me to work on the premise that Diane is an expert on her own life, and to focus on her strengths i.e. what she can do rather than on what she cannot (Saleebey, 2006). Using the person centred method enables the creation of a comfortable environment where the caseworker demonstrates genuineness through a non-judgmental and non-directive approach that bases itself on empathy and unconditional positive regard (Rogers, 1957). Therefore, my approach had to demonstrate feelings of warmth, liking, caring, and being drawn to Mary instead of aversion and anger (Barett-Lennard, 1986: 440)

I also reflected on Egan’s recommendations (SOLER) that help display an encouraging and open attitude towards Diane.

In considering the assessment process, I have adopted Milner and O’Byrne’s five state model of assessment (1998). These are preparation, data collection, weighing up the data, analysing the data and utilising the data.

I used Systems Theory in the assessment process, for example, in preparation stage I sought information not only from the service user but also from family members, other professionals, etc. In data collection stage, I used brief solution focused techniques, which allowed me to use supportive questions aimed at enabling Diane to recognise her own strengths and abilities. I particularly chose to use scaled response questions, asking Diane to score the present, when she was came to Critchill and what she hope to achieve on a scale of 1 to 10. By using this technique, I was able to support Diane to identify the successful strategise she has used in the past and this gave her confidence to apply her own strategies to improve her situation now and for the future.

The brief solution focused therapy has been useful when I addressed one of the problems in the running records about the use of language to others. Diane has acknowledged this issue and was able to identify an occasion when all the triggers were present that could have caused the problem but she was able to deal with it herself and prevent the problem occurring.

Erik Erikson (1950) says that when the person is aged about 60 years old or more, “The person has time for reflection and as they look back on their life, they may have a sense of satisfaction; this will lead to a feeling of integrity. If the person’s reflection results in them feeling they missed key opportunities, then there is an increased risk of experiencing despair”

In his article, Rogers (1957) quotes a study by Kinner that found that “the client who sees his problem as involving his relationships, and who feels that he contributes to this problem and wants to change it, is likely to be successful. The client, who externalizes his problem, feeling little self-responsibility, is much more likely to be a failure.” This highlighted the need for me to help Mary see that change in her life situation is more likely if she feels responsibility for at least a part of the problem and make her want to change.

A complaint that Diane has voiced is that people (particularly her social worker) treat her like a child. Thompson (2006) says that this happens when a younger person sees an older person not able to make her own decisions and takes decisions on the older person’s behalf thinking this is natural and normal without realising the discrimination and oppression this causes.

It is often the case that the social worker or the carers see the older person as disabled to take decisions, particularly if the person suffers from some disability. The medical model of disability focuses on physical deficits and individual health needs, and it is a challenge for the worker not to fall into “disablest [sic] perceptions” by accepting this model (Parker & Bradley, 2005: 76). The individual may experience loss and bereavement (Kubler-Ross, 1976), feel they have suffered a personal tragedy, and therefore label themselves as disabled as has happened in Diane’s case. It was therefore essential that I approach the assessment with this knowledge and ensure non-discriminatory practice, not attaching any stigma to Diane’s needs and disability caused by her medical condition.

The social model of disability switches focus away from any physical limitations the impairment to physical and social environmental limitations, thus requiring promotion and empowerment of disabled people (Oliver & Sapey, 2006). Additionally, the social worker’s own attitudes and values affect how he/she applies theoretical models of disability (Crawford & Walker, 2004). The social model of disability is inclined to focus on cultural or structural aspects of disability (Priestley, 2003) and is the predominant model of disability used in social care. This is because social work approach does not look at mending something that is broken, but relies on overcoming societal barriers, which enables the treatment of a person with a disability just as others are (DDA, 1995/2005; Davies, 2002). While it is easy to comprehend the difficulties faced by an individual with a visible disability (e.g. using a wheelchair), it is also easy to ignore the wider cultural and structural factors that affect a person with a disability (Thompson, 2001). Herein lies the problem of seeing the disability as a problem with the person themselves (ibid).

What Skills did you use for this piece of work? (please distinguish between those you have and those you need to develop)

I used Planning and preparation, research, information gathering skill before the meeting and this has helped me to carry out the meeting well

In terms of working anti-oppressively I think I have made Diane feel less oppressive by reducing the power imbalance. I have involved her daughter whose presence has been a great comfort to Diane as she sometimes looks at her for answers due to her short-term memory. I have successfully conveyed my respect and understanding of her strengths and limitations by adopting Egan’s empathy skills, active listening, summarising. I used Roger’s person centred to focus my attention on Diane and this in term helping me to forget that I was assessed by my placement supervisor. I used unconditional positive regard to make Diane feel a sense of acceptance of herself when addressing an issue.

I need to develop assessment skills as I feel I don’t feel comfortable with the forms which have so many questions. Also some of the questions are very sensitive to ask for example the section of “assessment of physical health” there are questions like bladder control, bowel control, etc

Also I need to develop liaising skill, sharing information with other agencies. As evident prior to the meeting, there were some miscommunication between different agencies.

Which aspects of anti-oppressive practice were relevant to this piece of work?

In terms of working anti-oppressively, I was aware my role as a student social worker this may have lead Diane to feel oppressive and not valued because she may think that she was not good enough to have a qualify social worker. To reduce this potential oppression, I have involved Diane’s daughter and have been open and honest to tell them that I was inexperienced and has never carry out a SAP assessment before. I also offered them opportunities to decline or cancel the meeting.

My ethnic origin as a non-white British may have attributed discrimination or oppression to myself from Diane or her daughter. However, this has never been an issue in the meeting or prior to my engagement with Diane and her daughter.

“the black perspective has made clear that racism is based on white European/ white north American ideological beliefs about the claimed superiority of white people over non-white people” (Maclean and Harrison 2008:58).

Considering my gender, which is different from Diane may present a difficulty for both of us. From the feminist perspectives – if I had not recognise the extensive inequalities in society based on gender with men consistently being dominant, I may act oppressively unaware. Women is socially constructed to be a better carer as a wife, mother and daughter and the fact that the majority of social worker are female. As a male student social worker, my role may present oppressive to Diane.

“the feminist perspective has noticeably failed to adequately address structural inequalities within social care and social work organisations. In employment terms some 75% of the workforce in social care organisations are women. The proportion of men in senior management has remained stubbornly high and has only recently dropped below 75% of all senior managers” (Maclean and Harrison 2008:56)

“there has been a recognition that societal developments and social policy initiatives affect men and women differently (because of their gender). The role of women as unpaid carers of family members with personal care needs is one example” (Machean and Harrison 2008:55)

If I have not used Social vs medical model to see Diane’s depression, I may have not recognised the negative stigma associated with the labels applied to people and may have act in an oppressive way, overseeing the facts that her depression may be attributed by her despair for her current environment and loss of her abilities, eg, health and memoey,etc

In what ways would the service user and or carer have preferred your practice to be different

After the meeting, I apologised to Diane and her daughter that the outcome of this meeting may not have been as productive as they had expected and I told them that I would like to have another meeting again with them in the near future to discuss a plan to support Diane. (as I feel I have failed to conduct the meeting well, because my placement supervisor joined our discussion in the midway, and this i think should not be happen because she was there to assess me, unless she think she I needed help.)

However, Diane, her daughter said they were happy with the outcome and she especially appreciated what I have done for her mother. My placement supervisor said to me. What do you mean this meeting is not productive” she said I did very well.

The only thing that Diane’s daughter asked me was to inform her of anything I do for her mother. As there was an incident the week before that I took Diane out but forgot to ask her to check her daily. Diane’s son and daughter in law came to visit when we went out and as a result they have not spent much time together that day. I asked Diane’s daughter how she would like to be contacted and she gave me her email address as she may not be convenient to answer her mobile in her workplace.

My placement supervisor also told me that I need to share the information with her about what I do or who I have contacted for Diane.

Which key Roles, units and Values/Ethics do you think were demonstrated in this piece of work and how? (these must refer to practice discussed within the direct observation)

In making a thorough preparation for the meeting with Diane, where my placement supervisor would observe me, I demonstrated delivery of all the units of Key Role 1. I had reviewed the case notes, spoken with the staff at the Home, her social worker, and daughter to carefully evaluate my involvement.

My efforts to build a trusting relationship with Diane during my placement, and discussions with her about her preference for those elements of her care plan she likes to be included, show that I achieved important aspects of Key Role 2 (Unit 5 and 6).

In my thorough research on best practices, legal and practice guidelines, and reflection on the best way to achieve my aim showed that I have responded well to the requirements of Key Role 6 (Unit 18 and 19).

With regard to the values and ethics, I demonstrated awareness of my own values, ethics, dilemmas, and conflicts of interest (VEa). I have shown respect for and promotion of the wellbeing of Diane (VEb). I have also responded with oral and non-verbal communication skills in a way not to make Diane feel oppressed (VEc). Finally by showing my ability to build and maintain a relation of trust with Diane I have met the need identified by (VEe).

What evidence did you use to evaluate your practice?(e.g. supervision notes, user feedback etc)

In evaluating my practice, I have used two resources. The first is a feedback from Diane, whom I asked to judge how I had done. This feedback, in the form of a written response to a questionnaire I prepared for this specific purpose. However, the feedback given by my placement supervisor after the meeting has been valuable for me in terms of understanding my performance and identifying ways to improve in future practice.

Give your evaluation of this piece of work – (e.g. what went well, what did not go well, what if anything would you do differently next time?)

I have learnt from my previous mistake in my first direct observation. I have used a mixture of open and close questions. Also I have used paraphrasing, clarifying techniques appropriately. In terms of choosing a place for the meeting, I have considered the noise and disruption and asked Diane’s opinion where she would like the meeting to be. The location of the meeting in her room turned out to be a good choice.

I feel I have reduce the potential of oppression by involving Diane’s daughter whose presence has been great comfort to Diane as Diane has short-term memory and she feel more confident as she could get answer or help from her daughter. Also, I feel that working together we have achieved more than I had expected, as I have made the meeting like informal discussion rather than a job interview or assessment.

I have achieved the aim I set for myself and completed parts of the assessment, by working in partnership with Diane and her daughter. However, I have achieved more by building a open and trusting relationship with them, this would in term enable me to devote my supportive work with Diane in the future.

I did not complete the SAP assessment in the meeting as I have not planned or anticipated. I will continue to work on this assignment with Diane, her daughter and other professionals.

I have however, failed to share the information about what I do with Diane with my placement supervisor. This has resulted in miscommunication between different agencies. I need to develop skill in liaising and sharing information with other professionals in the future.

What additional learning, in relation to knowledge, skills or anti-oppressive practice and values and ethics, would enhance your performance in the future?

In terms of working professionally I need to work in accountability way within agency, sharing information with others. System theory will help to improve my practice in the future.

I also need to use my supervision session to discuss theories, values, dilemmas and anti-oppressive practice

I have improved considerably about the use of interview techniques but with more practice I will be able to communicate in more confidence.

Signed

Placement Supervisor_________________ Date _____________

Student ____________________ Date _____________

Dementia is a chronic, heterogeneous neurodegenerative disorder which develops as a function of age, typically from 65 years old, with symptoms ranging from personality changes and losses of memory/intellect to severe reductions in mobility. Alzheimer’s disease is the most prevalent form of dementia (Cooper & Greene, 2005). The diverse and deteriorating nature of the dementia process is uncontrollable and dramatically reduces suffers ability to care for themselves independently, resulting in the need to be cared for, predominantly by informal carers, constituting family members; particularly Spouses or children of the dementia sufferer. Consequently, the majority of dementia sufferer’s remain living at home (Rabins, Mace & Lucas, 1982). Undoubtedly the role of caring for a person living with dementia has negative psychological (Dura, Kiecolt-Glaser & Stukenberg, 1990) and social effects (Rabins et al.) on carers. However, amount of social support carers receive (Haley, Levine, Brown & Bartolucci, 1987), stage of the dementia process (Quinn, Clare, Pearce & Dijkhuizen, 2008; Haley & Pardo, 1989) and symptoms expressed (Kinney & Stephens, 1989) mediate negative psychosocial effects on carers. Psychosocial effects can be also be positive (Andren & Elmstahl, 2005), with gender mediation (Fitting, Rabins, Lucas & Eastham, 1986). Indirect causes of psychosocial effects on carers are financial strain (O’Shea, 2003) whilst effects of dementia on society also exist (Wimo, Ljunggren & Winblad, 1997).

Firstly, in relation to psychological effects on carers of persons living with dementia, research proposes behavioural symptoms expressed by dementia sufferers are the predominant cause of negative effects carer’s experience. Behavioural symptoms range from embarrassing public behaviour to self-harm, causing carers to be persistently aware of the dementia sufferer’s actions which subsequently induces psychological effects of stress, anxiety, emotional upset and fatigue on carers (Dura et al., 1990). The dementia sufferers’ argumentative temperament, violence towards carers and rejecting carers help also augments psychological stress and upset, with exhaustion as dementia sufferers often wake carers at night, augmenting further fatigue and thus stress (Rabins et al., 1982). In consequentially, following extensive periods of care (approximately 74months), psychological well-being of carers reduces dramatically with 30% expressing symptoms of depression, not existent prior to commencement of caring (Dura et al.). Implying, induction of negative psychological effects on carers are a direct consequence of caring for the person with dementia.

Secondly, caring for a person with dementia induces negative social effects on carers with an average 30 of 55 carers reporting feeling social-isolated as a consequence of fulltime care, due to restricted time available for social activities/friendships, to insufficient support from family members and also due to leaving fulltime employment, as the work place is a major basis for social-interaction. Considering, carers undergo these major life changes to care for the dementia sufferer it is not surprising they feel socially-isolated, especially when dementia sufferer’s communication abilities deteriorate (Rabins et al., 1982) and feel ultimately trapped (Gaugler, Anderson, Zarit & Pearlin, 2004). Furthermore, social effects on carers elucidate the relationship between caring for dementia sufferers and depression, as social isolation amplifies the probability of carers experiencing depressive symptomology. This is vilified by carers who receive social support, remain in contact with social networks and partake in social activities and consequently report absence of depression, reduced stress and augmented satisfaction (Haley et al., 1987). Thus, effects on carers of persons living with dementia can be psychological and social; psychosocial but appear mediated by carer’s social situation. The stage of dementia is also primary (Quinn et al., 2008)

Thirdly, severity of psychosocial effects on carers of persons living with dementia, appear determined by the stage of dementia. As Quinn et al. (2008) proposed negative psychosocial effects on carers are at their peak of severity during early dementia stages due to drastic changes taking place in carer’s lives, primarily, adapting to prevalent changes in the dementia sufferer and accepting changes in the relationship with the dementia sufferer with augment carers stress (Burns & Rabins, 2000). Conversely, Haley and Pardo (1989) proposed negative psychosocial effects peak during later dementia stages, specifically augmented stress levels and social isolation as carers role becomes increasingly demanding. Particularly, care of daily needs, such as feeding and clothing due to dementia sufferers declining immobility due to the deteriorating progression of dementia. Also anxiety augments with fear of the dementia sufferers looming death (Rabins et al., 1982). Moreover, it is comprehensible both early and latter dementia stages induce negative psychosocial effects on carers, although which stage carers perceive to account for the majority of negative effects relies on individual differences. Especially as some carers conversely report later dementia stages to reduce negative psychosocial effects as behavioural symptoms become less adverse which may, be easier for some carers to cope with. Furthermore, some carers even report satisfaction from aiding daily-needs of immobile dementia sufferers (Kinney & Stephens, 1989). However, older carers seemingly experience augmented psychological stress than do younger carers (Kiecolt-Glaser, Dura, Speicher, Trask & Glaser, 1991) whereas younger carers experience augmented social-isolation and rage, with all effects appearing worse for women (Fittings et al., 1986).

In view of these individual differences, two hypotheses are proposed to account for variability in psychosocial effects experienced by carers. The first;Wear and Tear hypothesis predicts; as symptoms of dementia sufferers worsen, so do carers stress and depression levels, subsequently affecting carer’s social life, inducing negative psychosocial effects which supports Haley and Pardo (1989) findings as suggestive of later dementia stages inducing greatest negative psychosocial effects on carers. Whereas the second;Adaptation-hypothesis predicts carers adapt to caregiving requirements and subsequently experience reduced stress and increased satisfaction over time, thus reduced negative and increased positive psychosocial effects on carers (Townsend, Noelker, Deimling & Bass, 1989). Accordingly, Townsend et al. indeed revealed the majority of adult-child carers; 52% (averaging 47 years old), actually adapted overtime to their caregiving role, supporting earlier dementia stages as inductive of the most negative psychosocial effects, which accounted for both centralized and non-centralized caregivers. Although relationship between carer-dementia parent prior to caregiving mediated whether adaptation or declination occurred. Nevertheless, deciphering which carers require support during early or later stages of dementia may aid alleviation of negative psychosocial effects on carers of persons living with dementia (Townsend et al.). Although positive, psychosocial effects on carers are also reported (Andren & Elmstahl, 2005).

Andren and Elmstahl (2005) report carers experience positive psychosocial effects, specifically, portrayals of positive behaviour and interaction with dementia sufferer is gratifying for carers. Particularly because interaction is gratifying for the dementia sufferer which positively enhances carer mood; decreasing negative psychosocial effects.. Although carers experiencing positive psychosocial effects appear to be those who perceive their caring ability positively and have established coping mechanisms such as talking to others about their feelings; emotion-focused coping and learning more about what dementia is; problem-focused coping/information seeking, particularly decreasing feelings of social isolation (Haley et al., 1987). However the carers Andren and Elmstahl assessed, received help from care nurses and only cared for the dementia sufferer around every two months, thus due to their limited involvement and supplementary support, it is not surprising carers reported augmented positive as compared to negative psychosocial effects. Further suggesting time involvement as mediating negative psychosocial effects on carers, especially as O’Shea (2003) reported two-thirds of carers working approximately 80 hours per week caring for the person with dementia; double the average working week, experienced caring to be highly stressful and felt substantial social isolation due to extensive time devoted to caring. Carers reported they would exhibit greater satisfaction by receiving supplementary support allowing reduced working hours, which therefore supports Andren and Elmstahl’s findings. Although, O’ Shea reported 73% of carers do receive support from formal carers, suggesting lack of support from family members causes negative psychosocial effects or formal carers being strangers may augment carer’s stress (Burns & Rabins, 2000). Even so, other variables require investigation, particularly financial cost (O’ Shea, 2003).

The cost of caring for a person living with dementia can be up to a‚¬630 per week and considering majority of carers leave employment or work fewer hours to care for the dementia sufferer; carers are reported to averagely lose a‚¬200 per week. Consequently, two-thirds of carers report financial difficulties especially as only 30% of carers receive carer’s allowance (O’Shea, 2003), thus inducing psychological stress due to financial strain. Furthermore, caring for a dementia sufferer at home saves society ?6billion per year which stresses the high cost of dementia care being absorbed by carers which undoubtedly increases carer’s psychological stress. On-the-other-hand carers may merely desire recognition in the form of payment from society for their challenging role as a carer, as it seems stress is induced on carers due to feeling ignored by society (O’ Shea). Considering many carers stated that they would receive satisfaction from just a‚¬2.40 an hour, suggests recognition of carer’s duties with a small financial payment may convert negative psychosocial effects on carers to positive. Without this payment, society potentially face problems by inheriting the bulk cost of dementia care if carers struggle to cope and resort to early institutionalization of the dementia sufferer, which is reported to cost $166 per day in America (Wimo et al., 1997). On-the-other-hand, institutionalizations may reduce negative psychosocial effects on carers (Gaugler, Pot and Zarit, 2007).

Gaugler et al. (2007) reported alleviation of carers psychological stresses associated with daily aiding of dementia sufferers and social effects associated with social isolation due to constant care when dementia sufferers are placed in nursing homes. However these effects are reduced only temporarily as carers consequentially report psychological effects of guilt of institutionalizing the dementia sufferer, which suggests, even after their central role as a carer ends, psychological effects still remain. Although compared to nursing homes, group-living homes are designed to resemble the typical home and Colvez, Joel, Ponton-Sanchez and Royer (2002) found carers to experience less psychological stress associated with guilt when placing the dementia sufferer into group-living homes. Possibly because they are more sociable, granting dementia sufferer’s a better quality of life which feeds-back positively to carers. However this does not seem consistent for all carers (Boekhorst et al., 2008). Nevertheless, group-living homes may be an intervention to reduce negative psychosocial effects on carers. Interventions are also essential, particularly as co-existence of negative psychosocial effects on carers appear to enhance probability of physiological effects on carers such as ill health (Kiecolt-Glaser et al., 1991). Moreover, carers may benefit from training in how to effectively care for a dementia sufferer and knowledge of the nature of the dementia deterioration may make caregiving less stressful by increasing carers awareness and predictability of the dementia process (O’Shea, 2003). Personally, assigning a mentor to carers may teach effective ways of caring whilst simultaneously providing them with support, attacking both psychological and social effects on carers of persons living with dementia. Although individual carer assessments may be needed to ensure interventions are targeted at reducing the psychosocial effects particular carers experience (Rabins et al., 1982).

Overall, it is prominent that caring for persons living with dementia is a demanding role with various, predominantly negative psychological (stress and depression) and social effects (social isolation) on carers. Although there is no unified theory accountable for all carers which can predict definite psychosocial effects that will be experienced by all carers, as no single individual or situation is identical. Multiple variables have emerged which appear to mediate psychosocial effects on carers, particularly carers received level of social support (Haley et al., 1987), the stage of dementia (Quinn et al., 2008; Haley & Pardo, 1989) and the symptoms expressed (Kinney & Stephens, 1989). Although individuals adopting coping mechanisms appear more likely to experience positive psychological effects (satisfaction) and positive social effects (interaction with the patient) of caring for a person living with dementia. Although Indirect mediators; not directly related to the dementia suffer per se; financial cost of caregiving, induce stress due to financial strain. Future research needs to decipher carers at risk of experiencing negative psychosocial effects and subsequently address interventions aimed at reducing negative psychosocial effects to reduce probability of carers developing not only mental deterioration (depression) but also physiological deterioration (Kiecolt-Glaser et al., 1991).

Psychosocial Critical Evaluation: Case Study of Rory

Introduction

Psychosocial theory originates from psychoanalytic and psychodynamic casework, which has had a profound and lasting impact on social work (Kenny and Kenny, 2000). This assignment will use the case study of Rory, a fifteen year old boy living in a family home with his brother, mother and stepmother. Throughout the assignment Rory’s social environment and his relationships within this environment will be analysed in order to understand how these factors have shaped his development. Following on from this an evaluation of group work as an intervention method to support and empower Rory shall be explored. Group work will be taken as evidence for practice, where social work practice is carried out in groups (Doel, 2000, p.148). Psychosocial theories will be explored into how they influence group work and group dynamics, and the way group work can be used to change and adjust dysfunctional social environments. In doing so, the model of psychosocial theory and its relevance to social work will be explored, and how useful it is in understanding clients and promoting their best interests.

In order to critique the model of psychosocial theory, and explore how it influences our perception of the human condition, we must have a clear idea of what we mean by the term. Modern social work theorists have stressed the importance of applying the correct competency to the individual person, with regard to their social environment (Hutchinson, 2008). It sees people as ‘products of the interaction among their biogenetic endowment, the effects of significant relationships, the impact of life experiences, and their participation in societal, cultural and current events’ (Turner, 1978, p.2). The social work profession, can see the individual person as interdependent with their environment, which they are able to influence and change (Kondrat, 2002). By seeing individuals as being uniquely shaped by their environment, it helps social workers avoid the issues of social identity theory. Rather than categorising or stereotyping people, social workers are able to empathise and see all service users as individuals (Tajfel and Turner, 1979, cited in Gaine, 2010). The main ideas of psychosocial theory are reflected in other social work theories and methods, such as systems and attachment theory. Both theories developed from the need to build upon the traditional psychoanalytic model of individual therapy (Walker, 2012), and the idea that individual experiences with families were continually being shaped and influenced by the evolving interaction patterns of communication.

For group work to be beneficial there must be a mindfulness of the social context or sociology of the individual and group. Understanding individuals who compromise the group requires knowledge of ‘psychosocial functioning and development through the life cycle’ but also the impact of the group’s structure and process on the members’ behaviour. A group cannot be understood without knowledge of members in their individual social context (Northern and Kurland, 2001, p.35). This promotes and encourages diversity within the group, as practitioners are mindful of differences within the group, and how they can be addressed to promote social skills such as empathy and respect. If a client’s environment and social context has been dysfunctional, as in Rory’s case, the group work can provide a model of a healthy culture through the group values, communication patterns, and the way it addresses interpersonal conflict (Northern and Kurland, 2001).

Having explored the connection between group work and psychosocial theory, two theories of social work shall be applied and explored next. Attachment theory focuses on the quality of the attachments in the significant relationships in a client’s past (Bowlby, 1979, 1988). Bowlby’s theory of attachment stresses the importance of past relationships by determining which will develop emotionally and socially, and form relationships in the future. Bowlby was particularly concerned with the interactions and attachments that individuals had with their parents or carers. The ability of a child to attach to a parent or carer, the level of consistency of the parent or carer to meet the emotional needs of a child and the ability of the child to feel safe and secure, predicted how the child would develop emotionally. This theory has particular relevance and importance for this case study. The relationship between Rory and his mother can be recognised as a disorganised attachment. His mother’s bi-polar disorder means her behaviour is inconsistent at times, due to her having stable periods but when her mood is very bleak she neglects the needs of Rory and his brother. From this behaviour Rory receives mixed messages, leaving him feeling anxious and unable to explain and possibly understand his own feelings (Bowlby, 1988). His father appears to display as insecure or ambivalent attachment, this is due to him demonstrating an inconsistency in his attitude to Rory, neglecting contact for several weeks at a time. His unpredictable behaviour and failure to display attention in a consistent way leads to anxiety and distress for Rory.

Attachment theory is helpful to social workers in planning intervention, as they have insight into how past experiences of the service user can impact on their behaviour, and their ability to form relationships. For example, at the Youth Club Rory is seen as increasingly withdrawn and erratic by the youth workers. This may be due to his disorganised attachments impacting upon his ability to behave in social situations. Preston-Shoot and Agass (1990) explains that the development and quality of relationships can be influenced by considering the impact of the client’s feelings on behaviours.

Group work can be a powerful tool when based on attachment theory issues. Egeland and Erikson (1993) and Eriskon et al., (1992) described a group in which young, high-risk mothers were brought together for weekly group sessions from the time their children were born until they were one year old. Group work was effective here for two reasons. Firstly, through the therapeutic relationship itself, or the relationship with the group facilitator, in which ‘the facilitator maintains a healthy, supportive alliance with the parent, proving such relationships are possible’ (Erikson et al., 1992, p.501). When using any intervention, it is important to create a working alliance, in which the patient has confidence that the practitioner can help (Holmes, 2001). Due to Rory having all his immediate adult relationships in his life being inconsistent and causing him anxiety, having another which proves to be consistent in his life, one that is dependable, may improve his self-esteem and address problems he is exhibiting in social situations, such as at the Youth Club. The reason he may be attending the Youth Club could be due to him searching for that consistency and dependable person he needs, as the Youth Club is a weekly activity which is always there. The ‘therapeutic’ relationship gives Rory a ‘secure base’ (Holmes, 2001, p.17) where the task can challenge assumptions and relationship patterns.

Group work would also introduce Rory to a plethora of perspectives and individuals. Through this, Rory may become conscious of thoughts and attitudes that were previously unconscious (Holmes, 2001). In listening to and working with others Rory may build up his self-esteem. As he begins to form relationships with members of the group, he has models of healthy and functional relationships that are different from his own attachments with family members. This could increase his confidence, addressing problems of withdrawn and erratic behaviour that have been raised by Youth Workers at Youth Club. A number of studies have shown group work can improve social skills (Reid and Hammond, 2001; Fargan and Jones, 2002). Group work also promotes diversity as those it helps do not feel isolated or alienated by their problems: through sharing experiences in a respectful and tolerant environment they gain insight into the sufferings and challenges of others, and methods to overcome this. Groupwork as a form of learning extends beyond this, as groups offer members feedback that is often more effective coming from peers than from a social worker (Northern and Kurland, 2001). When done sensitively and constructively, such feedback helps clients such as Rory with their social skills and their ability to build relationships outside of the group.

A weakness of this theory, however, may that does it is not sufficiently encompassing of all the social forces that act on the individual. Psychosocial theory holds that we should acknowledge the role in human development of temperament, racism, poverty, social class, and other environmental conditions (criticism outlined in Coady and Lehman, 2007). Group dynamics and interactions cannot be understood through individual’s relationships with their parents alone. Psychosocial theory assists social workers in understanding and analysing the situations and behaviours of their client. This provides practitioners with insight into what has occurred in the past or what may occur in the future. However, some argue that attachment theory does not paint a picture of the client whole: by attributing all of Rory’s behaviours and concerns to his parents, the practitioner may neglect the wider social context that is acting on him.

Systems theory may offer a more encompassing picture of Rory’s social context. This theory holds that individuals and their environments are separate systems that are interconnected and interdependent (Teater, 2010). By thinking of families as living systems, systems theories are able to think about how dynamics are constantly altering as each family member deals with life inside and outside the family. Rory’s withdrawn behaviour, and self-destructive thoughts can be attributed to the frequency with which his family dynamics change. This change is at times dramatic – for example the breakdown of his parent’s relationship, or his sister leaving the family home- but also in the inconsistencies due to his stepfather’s temper and mother’s mental illness. Systems theory also promotes tolerance and diversity, as it recognises that there is no one model for a healthy, functioning family (Walker, 2012).

A change or movement in one of these systems results in change or movement in the others. In Rory’s case, social systems theory is useful as it allows social workers to identify which system requires an intervention (Teater, 2010). The key question is ‘does this structure work for this family’ and does it allow for the healthy development and growth of family members? As such, the Munro Report confirms that a systems perspective offers the most holistic tool for undertaking informed assessment work that takes into full account the wide environmental factors combined with the inter-personal relationship patterns that influence family experiences (cited in Walker, 2012). Furthermore, a family’s structure and organisation allows social workers to determine, to some extent what is possible within a particular family. Thinking of families systematically also ensures no family member is marginalised (Walker, 2012). One-to-one intervention with Rory will have an impact on the whole family system; his mother, brother and stepfather will be affected, and also the family dynamic as a whole.

As such, group work is an effective method of intervention according to social systems theory. This is because it avoids the risk that the family’s problems and their solutions are individualised. By placing Rory in a different group dynamic, one that has been constructed by a facilitator or practitioner, social workers may be able to assess which elements of the family’s structure need intervention, and where Rory and the family need extra support. By assessing Rory’s patterns of communication and interaction outside his family dynamic, practitioners may gain greater insight into his specific needs and methods that can be used to support and empower him.

Groupwork for families links closely to the family therapy movement (pioneered by figures such as Murray Bowen, Jay Haley, and Virginia Satir). The family therapy movement advocates systemic features as a means by which to assess the way groups of relatives organise themselves over time, creating stable patterns, that are inclined to return to familiar states. As such, one of the beliefs is that systems tend to be self-correcting, based on positive or negative feedback (Coady and Lehmen, 2007). By using groupwork intervention with Rory, he may feel empowered and supported to address and correct the patterns and familiar states of his family, rather than simply removing himself from situations. Furthermore, the counsellor or practitioner can address the dysfunctional and destructive subsystems that exist within Rory’s family.

A concern surrounding this theory of social work, however, is the emphasis social systems theory places on adaptation. The purpose of the group work intervention is to explore how systems can be adjusted and change to create a healthy and supportive structure. As such, some fear that practitioners are encouraging clients to accommodate to oppressive circumstances (Coady and Lehmen, 2007). From this perspective, Rory may be being taught to accept and adapt to the hostile and threatening behaviour of his stepfather, or the neglect he sometimes faces from his mother. This can be addressed by being mindful of social work’s traditional concern with social justice- an integration of values such as social justice and social systems based thinking is possible. To do this, practitioners must be self-reflective and question their own values and assumptions, particularly in terms of prejudice and diversity, in order to ensure that the client’s best interests are at the heart of group work intervention.

An awareness of social circumstance is also important in tackling diversity with regard to mental health. Parental mental health, and the disruption to parenting capacity has been found to have profound and persistent implications for children and their parents (Smith, 2004). As such, it has been advocated that social workers have improved access to training that assists with psychosocial interventions, such as group work (National Institute for Mental Health in England, 2005). This helps us to understand the quality of attachment between Rory and his mother. Rory himself is displaying behaviours that may point to mental health, particularly disclosing suicidal thoughts. Research shows that social work plays a significant role of social work in promoting the involvement of people using services and developing systemic approaches to practice with families (Gilbert, 2007). Diversity is important here- social workers must address societal stigmas regarding mental health. Effective intervention can also promote diversity by helping those with mental health to function and become involved in society.

A psychosocial approach helps us to understand Rory’s patterns of communication and behaviour, as it gives us insight into the formative relationships, experiences and environments that have categorised his life thus far. This puts troubling behaviours, such as self-destructive and suicidal thoughts, within a social context that can be used as the basis for assessment and intervention. Our chosen intervention method, group work, is also revealing about how Rory can be supported and empowered. By modelling healthy and secure relationships, and developing Rory’s social skills, Rory’s future relationships do not have to be influenced solely by dysfunctional attachments with his parents and stepfather. By understanding his family as a system, and observing Rory but within that system and in other groups, insight is gained into how Rory’s social context can be adapted in order to promote the healthy growth of all its members.

The birth of a child is usually anticipated with so much expectations and excitement of a very happy and successful future not only for the child but also for the family at large. However, this excited might be muted by the birth of an infant with any kind of disability. It does not matter whether the handicap is retardation, blindness or physical abnormality. Families with members with disabilities cannot live a similar style of life like that enjoyed by other families that have got normal individuals. In most cases these parents are more sensitive to the needs of the disabled individuals. According to Gillam (1999) caring for people with disabilities is not always an easy job because these are normally considered to be delicate people who need extra care. For this reason disability could have various physical and psychological impacts on the family. This paper provided a discussion of various psychological effects of disability on families. Some background information will first be provided to give an overview of what disability is all about.

Background Information

According to Marinelli & Orto (1999) the rate of disabilities in families has relatively reduced compared to the situation 50 years ago. The introduction of immunizations and improved medical care has also helped a great deal. However, statistics has it that in regions such as the UK, a child is diagnosed with some kind of disability every 25 minutes. Over 95% of those diagnosed with disabilities either live with their family members of their children. Another country that faces the same problem is Australia.

A person’s body is a very important part of their identity and self perception and even extends to the identity of the family. In most of the time, a family with a disabled individual will always receive similar perceptions from the society like the ones given to the disabled person. The disability is therefore normally considered in terms of the larger family. Although some people could be borne normal but later become disabled either through sickness or accidents, most of the disabilities are normally realized at birth. Family members of disabled individuals normally have an extra burden of not only taking care of their individual needs but also for the needs of the disabled in the family (Gillam, 1999). Most people in such situation would tell you that it is not as easy as most people might think. It requires sacrifice and determination.

Discussion

Giving birth to a handicapped child and taking care of him to grow into adulthood is one of the most stressful things a family could endure. The first reaction by parents on realization that their child is disabled tells it all. According to Strnadova (2006) most parents are normally in shock and wish that they could reverse the whole process. It also creates a confused situation of guilt, anger, sadness, depression all in one that some parents begin lamenting to God what wrong they might have done. Depending on the conditions of the parents, they handle these issues differently and could stay in different stages of depression longer than others.

Some parents feel like the handicapped children are their extension and may feel ashamed, ridicule, embarrassment or social rejection. The reactions by parents might be affected by economic status, marital stability and personality traits. Generally, the initial reaction of any parent would therefore be of psychological or emotional disintegration (Marinelli & Orto, 1999).

In instances where an individual was living normally and later becomes disabled, denial is normally the first psychological impact in the family. Some members refuse to accept that things have changed and their loved one is now disabled. This is very difficult especially when the person is the first one in the family to suffer from such a disability or when he is the sole bread winner and the family cannot comprehend how it will survive the next day. In situations where the family does not know much about the illness, they could also become very pessimistic about the future and act like the illness has control of their entire destiny. Although no one really checks on the parents to find out whether they get enough sleep or spent most of their time at night checking on their disabled children, research has it that families with disabled members also suffer from exhaustion and anguish.

After denial there is usually a gradual acceptance of the fact that the family member is truly disabled. The family then tries to come up with better ways of dealing with the issue because there is nothing else they could do. The acceptance stage could taking varying durations does not necessarily lead to the acceptance of the disability. Marinelli & Orto (1999) explains that sometimes members could just decide to minimize the psychological balance to an achievable degree and deal with the person. In cases where parents completely fail to accept this fact, they could even abandon the individual or give them for adoption. This is the reason why there have been cases of parents throwing their children in pits or abandoning them on the road side as demonstrated in some developing countries. There is the realization stage is where parents or family members fully accept the disability of their loved ones regardless of its consequences. However, not every family reaches this stage.

Strnadova (2006) argues that many families consider taking care of an individual with disability in terms of the cost they will have to incur throughout the existence of the disabled individual. This process could sometimes be costly that if a family is not well prepared it could lead to debts and loans. For instance, if a family member suffers from down-syndrome or Cerebral Palsy, he will definitely require some medication, counseling, therapy, physiotherapy or rehabilitation. All these services need money which is not always easy to come around. This could therefore lead to the family making use of every single cent they have just to see their own survive. Some could even end up borrowing from family members or asking for loans from their banks but there is always a limit to where you can source money from. If a family faces the dilemma of not knowing where next to turn to and ask for money, it’s normally very frustrating and hurting to know that you could make life more comfortable to a family member if only you had the money but the reality is that you have none.

Having gone through many dead ends to find assistance for their loved ones, family members often become worn out and might be discouraged to look for a different approach for assistance because they might be scared of facing yet another failure (Strnadova, 2006). This might create a feeling of hopelessness in the family in that they feel like they can no longer take care of their loved one and could even abandon him or offer him for adoption.

Stress in families with disabled individuals normally starts way back even before the disability is diagnosed. In most occasions, parents would suspect that there might be something wrong with the life of their child or family member. This normally appears in cases where the family members become disabled later in life after leading a normal life. For this reason members would request for examination from a psychologist to fully understand what might be wrong. Sometimes families with disabled members are isolated from the society like and this makes them feel like they are less equal. This could also make some of parents to feel like it is their fault that they gave birth to disabled children. What parents also fear most is the likelihood of the heredity of the disability to their future siblings. According to Power & Orto (2004) some might even get scared and feel like they do not want to have other children in future. They may also fear that they might have grand children with similar disabilities. They are also worried of what the future holds for their child with disability. The feeling of helplessness due to the fact that there is very little they can do to change the child’s disability makes them hate themselves.

The anxiety in family members stems from an attempt to strike a balance between their own life and that of the disabled individuals. A number of parents have talked of pain and anguish in their lives and their desire and hope to improve the lives of their loved ones even though sometimes it never possible. Single and unmarried mothers face more psychological problems than others. Considering that individuals with disabilities need extra care, it becomes cumbersome for one individual to keep watch of him and do his/her own duties. Disabled individuals could also be a huge burden to their own siblings especially because of the fact they require extra care (Power & Orto, 2004). This means that their siblings will have to forgo some activities and duties in order to take care of them. Unlike other children who might go playing up and down, they will be forced to offer extra care to their disabled brother or sister.

One thing most people don’t understand is that it’s nobody’s fault that they have disabled individuals in their families. However, most family members might not know how to react around such individuals and might decide to stay away. Sometimes the families might be reluctant to discuss with others about their members disability because they do really know how others would react. Fear of stigmatization from the society could make some families to hide these conditions for a long time (Warner, 2006). However, this is not always the best option because it implies that one is ashamed of a family member. A result of stigma is that the family ends up being withdrawn from the society because they are afraid of being hurt by comments or reaction from other people.

Shaw (2009) laments that sad as it might be, most people with disability are still socially unacceptable. It’s common to here whispers from all corners about families with disabled members as well as judgments being made behind closed door about how a disabled member might be behaving. Some even make comments that insinuate that the family is unable to take of their own blood and flesh. Some of these comments even come from close friends. Considering that every person might have his own opinion on how a family deals with the disability, it’s never an easy thing for a family that is trying so hard to remains brave and accept their member with his disability. When on outings, families with disabled individuals normally have to deal with stares, unpleasant gapes from both adults and kids. These annoying stares can inhibit the ability of family members especially the kids to freely interact disabled family members.

Sometimes family members especially parents have to deal with feeling of jealously from other siblings. For instance, you here of a child wishing that he was sick like his sister so that he could also receive preferential treatment from the parents. This feeling also disturbs parents psychologically and makes them feel like they are discriminating their children. Of course as you would expect there is always a good side of disability where one is treated differently and carefully more than others (Shaw, 2009). If not carefully done, it could also lead to misunderstandings in the family that could add to psychological problems.

Warner (2006) explains that some families with disabled children face so many difficulties that they even end up separating. In such a situation, kids are either split each of their parents or their custody could be awarded to one parent. Sometimes one parent in most cases the dad could run from the vicinity and disappear completely leaving the child in the hands of the other parent.

Recommendations

Families with disabled members need love and support from close friends and relatives. It is never their wish to give birth to disabled individuals. Its God will that everyone is the way he is and we should accept that and live with it. As the saying goes, disability is not inability. There are families whose brain winners are people with disabilities. As Gillam (1999) puts it these people could still be very useful to the family and the society at large unlike what people might expect. It is therefore important that families with disabilities are accepted as any other family so as to give them the moral to take care of their disabled members rather than isolating them.

It is also advisable that families with healthy and normal kids should teach their children on how to deal with other members of the society that might be living with disabilities. This will make everyone grow up with a good attitude and caring feeling for unfortunate members of the society. With increase in technology and innovation, disabled members could still survive and lead a normal life like others. Children should therefore not abandon their loved ones just because of their disability. We should all be thankful to God to whatever child he gives unto us because there are so many parents would wish to have a child but they can’t.

Independent living is about disabled people having the same level of choice, control and freedom in their daily lives as any other person. Everyone will need assistance or equipment of some kind, although many people with learning disabilities, physical and/or sensory impairments, mental health support needs, long-term health conditions or who experienced frailty associated with old age, will have additional needs for assistance. Although these additional needs for assistance and equipment may be met, it is not always giving people choice and control over the matter, others will decide on behalf of them which can lead to segregation and social exclusion. It is necessary for everyone, whatever their impairment, to express preferences and therefore express choices about their needs and how they should be met.

What evidence is there that it is an issue?

With reference to Christensen, K. (2010), ‘The late 20th century rhetoric about empowering people by providing them with more independence in their lives has recently emerged within developed welfare states and led to the introduction of cash for care systems in many European countries. These systems allow local authorities to pay people cash instead of providing care if they are assessed as eligible for community care services and are willing and able to manage the payments alone or with assistance’.

What evidence is there that different policy options will affect the issue?

The Prime Ministers Strategy Unit produced their final report on, ‘Improving life chances of disabled people’, in January 2005. Within this report it sets out an ambitious programme of action that will bring disabled people fully within the scope of the “opportunity society”. By supporting disabled people to help themselves, a step change can be achieved in the participation and inclusion of disabled people. This report sets out a strong vision for improving the life chances of disabled people, which is needed to help disabled people face fewer disadvantages. It is never going to happen straight away so they give themselves a 20-year vision:

‘By 2025, disabled people in Britain should have full opportunities and choices to improve

their quality of life, and will be respected and included as equal members of society’.

This report plans to have big changes as a result of this strategy, to make these changes the strategy will ’empower and involve disabled people, personalise the support they receive and remove the barriers to inclusion and participation’. Reference!! The centrepiece of this strategy is the promotion of independent living. Independent living is more than about being able to live in their own home, it’s about providing disabled people with; choice, empowerment and freedom.

For the government to give disabled people more choice and control over their care ‘The Community Care (Direct Payments) Act was introduced in 1996. With reference to the Directgov website, ‘Direct Payments are local council payments got people who have been assessed as needing help from social services, it gives the individual the chance to arrange and pay for their own care and support services instead of receiving them directly from the local council’.

Direct payments and individualised budgets are central to the UK government’s independent living strategy for disabled people ‘to live autonomous lives, and have the same choice, freedom, dignity and control over their lives as non-disabled people’ (ODI, 2008:27).

While Direct Payments have delivered important choice and control for some people, they are not suitable for everyone. Furthermore, the fragmentation of people’s needs across different budgets means that Direct Payments are not always sufficient to deliver a personalised and holistic response to individuals’ needs. The report, ‘Improving life chances of disabled people’, therefore suggests proposes that ‘different sources of funding should be brought together in the form of individual budgets – while giving individuals the choice whether to take these budgets as cash or as services. The overall aim would be to enable existing resources to be allocated and services delivered in ways that personalise responses to need, and give disabled people choice over how their needs are met’.

The Independent living strategy was published in 2008 and its aim was to ‘ensure that all disabled people, including those with significant learning disabilities or other forms of cognitive impairment (including dementia), are enabled to have choice and control over how their support needs are met, and also to have greater access to housing, education, employment, leisure and transport opportunities and the participation in family and community life’. REFERENCE!! Of paper. Within this strategy it includes; ‘Putting People First, a shared vision and commitment to the transformation of adult social care, introducing personal budgets and help gaining information, advice and support, ‘Lifetime Homes, Lifetime Neighbours, a national housing strategy for an ageing population’, the development of a national employment strategy to enable individuals to remain in employment when they become disabled or when an existing condition gets worse. Therefore the strategy covers all aspects of a disabled individual’s life.

Why is this an important issue?
What should we do about the issue?

Disabled people themselves, employers, health professionals,

educators, local communities, and providers of goods and services all have a key role in improving the life chances of disabled people. Disabled people’s experience of government support and services needs to change. Too often disabled people feel that they are fighting a system which is fragmented, complex and bureaucratic, and

which does not put the needs of disabled people at the heart of service provision. Public service reform and investment has not yet benefited disabled people to the extent it should. REWORD paper improving life chances of disabled people.

http://www.direct.gov.uk/en/DisabledPeople/financialsupport/DG_10016128

Introduction to Public Private Partnership

Public private partnership is a cooperative venture between the public and private sector in which the public and privates sector carry out a particular project on the basis of agreed task and risks, each party retaining its tasks and responsibility. The interest in PPPs is growing day by day because it is an efficient way of delivering the public services to the masses. The rudimentary principal behind public private partnership is that, Although Public sector entities may need to be responsible for the delivery of public services, but it is not necessary that it must be actually responsible for providing or undertaking the investment themselves. In this way all actors in public private partnership can concentrate on doing what they are likely to do in the best possible way by utilizing their resources and skills. In order to under take any public private partnership for a particular venture we have different modes or model for PPPs, Which are described briefly as under.

A brief overview of Prominent Models of PPPs
Operation and management contracts

In these agreements the responsibility for asset operation and management is passed on to the private sector entities. The duration for these contracts is generally short ranging from 3 to 5 years, but can normally be extended. The private party is remunerated on a fixed fee basis or on an Incentive basis with premiums linked to specific performance targets. Under this agreement the public party still bears the financial and investment risk associated with the projects. This type of contract is an efficient way to undertake a project because the private sector has enough skills and have strong interest in improving the service quality. This model of PPPs contract is suited for transaction phases which finally lead to privatization.

Potential strengths of management

The profound advantage of management contract is that many operational benefits that result from private sector can be availed without transferring the assets to the private party. Management contract are less thorny to develop as compared to others and are considered less controversial. Theses contracts are also less expensive as compared to others because fewer but efficient staff can be used to carryout the task. They can also be seen as interim arrangements, allowing for modest improvements while more comprehensive contracts and structures are developed. Similarly, a management contract can be structured to phase-in increasingly extensive involvement of the private sector over time and as progress is demonstrated.

Potential weaknesses

Despite of the aforesaid advantages of management contract it also embodies some drawbacks one of the key disadvantage of this contract is that in this contract the private sector entity who is managing a particular project does not enjoy the autonomy. This is important to achieve deep and lasting change also the division between the obligation for service and management, on one hand, and financing and expansion planning, on the other, is a tricky one.

Service contracts

It is a limited type of PPPs model in this agreement the Private party procure, operate an assets for a short span of time mostly for 2 to 5 years. In this contract the public sector is responsible for investment and management of the project which bears the financial and residual value risks. While the public sector entity provide the services. It is suited for simple and operational requirments.it is often used for toll collections.

Potential strengths of Service Contract

This contract is best suitable when the services are clearly defined in the agreement, the demand is reasonably certain and the performance of the project can easily be monitored. One of the the gigantic advantage of service contract is that it provides us relatively low-risk option for the expansion of private sector which in return brings efficiency in the system operation. It is a less expensive way to delivery the public services and due to low barrier to competition it encourage competition which in return enhance the public service delivery and it is also a good source of technology transfer and for the development of managerial capacity. The other prominent advantages include

Decrease in operation cost
Access to cheaper labor
Cut up in labor training cost
Access to advance technology at minimum cost
Enhance service delivery
Potential weaknesses

Service contracts are used for simple and short term project in this the private sector only provide their services not the capital investment. But this contract is not suitable for such situation in which the objective is to pool up capital. An other important drawback of this contract is that of loss of managerial control because it is much difficult to manage the outside service provider as compared to own employees. Also other draw backs include the loss of flexibility in reacting to changing the business condition, lake of internal and external focus, loss of competitive edge, problem in contract renewal and contractual misunderstanding. In this it is difficult to calculate the hidden cost associated with the contract like legal cost and the time require to put the contract into action.

Leasing agreements

It is a financial arrangement in which the owner of a facility sells it to another entity, and subsequently leases it back from the new owner. In this contract both public and private sectors entities may enter into sale/leaseback arrangements for a variety of reasons. An innovative application of the sale/leaseback technique is the sale of a public facility to a public or private holding company for the purposes of limiting governmental liability under certain statues. Under this arrangement, the government that sold the facility leases it back and continues to operate it. Under this agreement the private party better off only if it manages to reduce operating costs while meeting the designated service level. On the other hand the public sector bears the risks associated with the network expansion, capital improvement and financing. Its life ranges from 12 to 16 years, this type of agreement is best suited for infrastructure. Other prominent leasing contract include

Buy-build-operate (BBO)
Lease-develop-operate (LDO)
Wrap-around addition (WAA)
Potential strengths

One of the main advantage of this contract is that it brings efficiency in the public service delivery .Also in this contract the commercial risk is borne by the private sector which give a strong performance incentive and which coax the private sector to perform well. Under this contract the private sector competitively bid for providing the services which in return enhance the delivery of public services.

Potential weaknesses

As we know that in lease agreement the contractor revenue is based on the revenue stream of the customers’ payments so in such situation the question of tariff levels is of sensitive nature which can lead to possible conflict between the public and private parties. Also under this agreement the responsibility of capital investment is of public sector and the financial risk is borne by the public sector so in this contract no capital is mobilized from the private sector entity and also labour issues are of more sensitive nature as compared to other PPPs contracts.

Concession Contract

It is a type of leasing contract in which the ownership remain with the government while the private party not only provide capital investment but also responsible for the maintenance of the assets. After the completion of the project the government pays the agreed sum of money to the private party and gets the assets. It is suited for the construction and its life is from 15 to 30 years.

Potential strengths of concession contract

One of key advantage of Concessions is that it helps to mobilize capital from private sector for the construction or rehabilitation of existing projects. As we know that under this agreement the private sector also contribute capital for the project so it coax the private sector (concessionaire) to bring efficiency and effectiveness in order to increase his return in the project. It also encourages the private party to bring innovation in the delivery of public services.

Potential weaknesses

One of the major drawback of this contract is that the complexity of defining the activities of private sector entity. One of the major disadvantage of this contract rises in case of long-term projects i.e. more than 25 years because this complicate the bidding process and the contract design which hinder in anticipating the events of the project. Also due to its long term tenure it is deemed politically controversial and difficult to organize. Another drawback of this contract is that it limit the competition because of limited number of qualified contractors are available.

Green field Contracts

This type of agreement is mostly used for the development of new projects. Such projects are often demanded by engineers. Examples of Greenfield projects are new factories, power plants or airports which are built from scratch. Those facilities which are modified/ upgraded are called Brownfield projects.

Build-Operate-Transfer (BOT)

In this the private party is responsible for designing, construction and operation of the assets. In this public party bears the financial risks but it has control on important phases of the life cycle of the project. This type of contract bring efficiency in the projects and removes the important maintenance issues from public budget This integrated scheme obliges the private operator to take into account the cost of operating the asset during the design and operation phase and therefore stimulates a better planning and management of the service itself It include the following types

Build-own-operate-transfer (BOOT)
Build-rent-own-transfer (BROT)
Build-transfer-operate (BTO)
Build-lease-operate-transfer (BLOT)
Potential strengths

As we know that BOTs have been mostly used to attract private funding to the construction or renovation of infrastructure. Hence one of the key advantage of BOT agreements is that it reduces commercial risk for the private partner because there is often only one customer, i.e. public sector (government) .The following are some of the major advantages of BOT contract

Due to the efficiency of private sector the public services can be delivered with minimum cost
As the private sector directly involved in this so it reduces the public debit, balancing the beget deficit and reduce the role of public sector.
It also facility the transfer of advance technology by intruding international contractors in the host country.
Potential weaknesses

The following are some of the major disadvantages of BOT contract

The transaction cost in this case is higher as compared to other contracts
Not suitable for small projects.
The success of this project depends upon the successful raising of funds.
BOT projects are successful only when substantial revenues are generated during the operation phase.
A CASE STUDY

This case study is one of the best example of public private partnership (service contract) which is contributing to the overall economic development of Pakistan.

Faisalabad Industrial Estate Development and Management Company (FIEDMC)

This is one of the classical of PPP (service contract) .In this contract the government of Punjab provided funds and the private sector were assigned the task to develop two industrial estates at Faisalabad by contributing there services on voluntary basis. This company constitutes of 21 members in its board 5 from public and 16 from private sector. Under this agreement the private sector will contribute their expertise to develop a world standard industrial estate in order to use the public money in a fruitful way. The following two prominent projects were undertaken under this agreement.

Value Addition City.

This industrial city was basically established in order to address the need for SMEs and to provide land on small scale to the industrialist. This estate consists of 200 acres land .where all utilities and facilities to the industrialist and a great emphasis is given to the security, further more The VAC offers facilities like a state of the art road network, electricification, natural gas, optic fiber telecommunication network, hospital, commercial area and extensive landscaping for environmental friendly atmosphere.

M-3 Industrial city (M-31C)

This is a larger project as compared to value added city with a vast area of 4500 acres. This industrial city is catering for the needs of all business sectors both industrial and services It entails the fulfillment the needs and wants of the prospective investors. This industrial city provides the important facilities according to world standards including, state of the art telecommunication system, transport facilities and labor colonies to the labor. This industrial city constitute of all kinds of textile industries, high quality chemical units, engineering including automobile and agricultural machinery firms and construction material firms. It will also cater the needs of pharmaceutical companies and food processing units. Other industries include IT equipment manufacture and software industry, electrical devices, electronics and other value added products.

This is one of the classical example of PPP models in which the private party provides their services in the shape of their expertise to boost industries in Pakistan and it will boost the Pakistani economy.

A Failure of PP Project (Metronet UK)

The London underground rail system is the world first underground system which was established in 1863 and up to early twenty century it was operated by six private operators. But due to their substandard services its activities was directly or indirectly classified by the UK authorities by 1933.

In February 2002 it was decided to bring improvement in the public service delivery by entering into a PFI contract with the private sector .Under this arrangement it was decided that maintenance and renewal of London underground infrastructure would be incorporated through three PPP contracts

Under this agreement the Responsibility for stations, train operations, signaling and safety remained in the Public sector, being run by London Underground Limited, a new operating company set up for the purpose. It also had responsibility for determining service patterns and setting fares. Under this PPP project there were three private sectors companies which were called infracos namely

Infraco BCV Bakerloo, Central, Victoria, Waterloo & City.
Infraco JNP Jubilee, Northern, Piccadilly.
Infraco SSL Circle, District, East London, Hammersmith & City, Metropolitan.

To improve the Services and to ensure long-term assets management a 30 year contract was signed which is divided into 7.5 year segment. In this arrangement an Arbiter was also appointed whose role was to resolve the disputes between the London Under Ground Limited and an infaco regarding the payment and other issues.

On December 31 2002 Tube Line acquired Infraco JNP and on April 2003 Metronet acquired the other two infracos.The PPP contract give legal ownership of London Underground infrastructure during the term of the contracting In July 2007 the work of modernization of London Underground Infrastructure was entrusted to Metronet BCV and Metronet SSL.and the fund was provided by the Government under PPP.

But Metronet was unable to complete their task in the agreed time and estimated cost of bid. By March 2005 Metronet had not completed any of the eight stations due. Only 11 out of 35 stations were accepted as delivered by March and finally the London Underground Limited purchased 95% of Metrone’s outstaniding debt obligations from its private sector lenders in February 2008 rather than repaying this debt over the 30 years of the contract. The Department for Transport (DfT) made ?1.7 billion of grant available to help London Underground do so.

Causes of Failure of this Debacle of PPP

The following are some of the main reason for the debacle of this PPP contract.

Poor Corporate Governance and Leadership structure of Metronet and tied Supply chain management
Supplier was failed to give timely information to Metronet management about the costs against delivery.
Ambiguities in the scope of the project and poor program management.
Also it was found that it was unable to execute the the operation in the best possible way and lake of efficiencies in business administration activities.
Conclusions

From the aforesaid discussion on various prominent types of PPPs models we conclude that It is not always fruitful to enter to a PPP agreement .So the government should not enter into such contract without accurate and comprehensive assessment of the risk transferred to the private sector and a firm idea that what would constitute an appropriate price for taking such level of risk. If it does not transfer an appropriate level of risk to the private sector then it should not be availed. PPPs can be very helpful for the public service delivery if the underlying drawbacks are minimized and to minimize the risk associated with these models we must apply each model according to the type of problem we are solving. For instance if we need for Capital then BOT/BOO/Divestiture can be used. In case if we need for Expertise and Performance then Management Contract can be the best option. But if we need for Expertise only then Service Contract is the best option. Or if we are facing a complex problem which can not be solved with one model then a combination of these models can be used.

References
www.ncppp.org/howpart/ppptypes.shtml
Article by By Brig.Ahmad Riaz Siddiqi (Retd), X-Chief operating officer FIEDMC (Dawn Saturday, December 20, 2008)
PUBLIC – PRIVATE PARTNERSHIPS Models and Trends in the European Union Authors: Andrea RENDA (Senior Research Fellow, CEPS) and Lorna SCHREFLER (Research Assistant, CEPS)
India time.com http://www.cyfuture.com/disadvantages-of-outsourcing.htm
http://www.investorwords.com
The failure of Metronet REPORT BY THE COMPTROLLER AND AUDITOR GENERAL | HC 512 Session 2008-2009 5 June 2009 Department Of Management Sciences Ciit Islamabad

According to the World Health Organisation mental health is a state of well-being in which the individual realises his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community.

According to the North Western Health Board (NWHB) mental health affects our feelings towards others and it also effects how at ease we are with ourselves. Mental health also affects some of our everyday skills, such as interacting with others around us; maintain relationships with people, whether it is intimate relationships or family relationships. Mental health can also affect the way we deal with certain events in our lives. Changes such as bereavement in a person’s life or losing or starting a job can have different have a different effect on different people at different points in time.

According to Barry & Jenkins there are three levels at which the protective and risk factors work. These three levels are known as Individual, social and structural. According to the NWHB each level is supported and reinforcing each level, thus strengthening them. By strengthening human beings we are trying to increase self-confidence and develop their abilities and skills, such as interaction with other people and developing skills to help sustain relationships.

Protective factors

The following protective factors are based on an individual level. Some of the protective factors are having good coping skills, having good social skills

Good Coping Skills

If a person is good at dealing and handling certain situations in life, this can be a huge help in relation to combatting mental illnesses. If a person can manage to deal with a certain situation which they may be experiencing without getting too worked up or letting it get them down, this can have a positive effect on their life. If a person can be optimistic about a situation and try to look on the bright side of things and realise that they will come out the other end and that things will get more positive and that they may have a brighter future in front of them, this can only have a positive effect on somebody’s life.

Social Skills

A person that has the ability to fit into society and get to know people no matter where they go will hopefully never really experience isolation. Take for example a person moving to a new area that doesn’t know anybody that lives in the area. If they have the skills to integrate themselves into that society and get to know the community they will more than likely be welcomed by members of that society. If a person makes themselves known within the community and gets involved in things going on within the community, isolation will not be a problem for them. For somebody that may be experiencing isolation this can have huge knock on effects on their mental health. If a person feels that they are alone and have nobody to turn to, this can lead to mental illnesses such as depression.

I will now discuss some of the protective factors which are based on social level. Some of these are positive experiences of early attachment and positive attachment to family.

Positive Experiences of Early Attachment

If an individual whilst growing up and while they were children had positive experiences throughout their childhood, in relation to how close they were to their parents and if they had a good relationship can have huge effects on a person later in life. If a person has had a bad relationship with their parents this can have a huge knock on effect later in life. If a person feels that they were not accepted by their parents as a child this may lead to somebody suffering from depression as they may not feel wanted or accepted into society. They may feel that nobody is there for them. If they have had a bad relationship with their parents, they may also find it quite hard to develop an intimate relationship with somebody, as they may be afraid of having such a close relationship with somebody, as they have never experienced a relationship like this before throughout their lifetime.

Attachment to family

How close an individual is to their family is based on a social level according to Barry & Jenkins. How close one may be to their family can have effects on one life. If a person knows that they have their family around them no matter what and that they will be there for them through the good times and the bad then the person knows that they are not on their own on life. They know that their family will stand by them no matter what. People experience so many problems in life, so it is good for an individual to know that no matter what they have a group of people around them that love and care for them, and will support them through life’s challenges.

Supportive Social relationships

Supportive relationships, whether it be family relationships or intimate relationships is another strengthening factor which can protect mental health. If a person knows that somebody is always there for them, through the good times and the bad and to help them carry heavy burdens which they will come across throughout life, is a huge help to them. I think right now throughout society, a large number of people are carrying heavy burdens in relation to unemployment and bills to be paid. If a person knows that they have someone to lean on and to help them along the way in life this can be a huge weight lifted off their shoulders. If a person has somebody that is supporting them, this means that they have somebody to talk to and discuss any problems that they may be experiencing. Something as simple as just sitting down and talking to someone about the problems you are experiencing in life can help protect a person’s mental health. A problem may not seem as bad after discussing it with someone. As the saying goes a problem shared is a problem halved.

I will now discuss some of the protective factors at a structural level. Some of these protective factors are economic security and employment.

Employment & Economic Security

As we all know we are currently experiencing a severe fiscal crisis in this country. A lot of people are currently unemployed. According to the Irish National Organisation of the Unemployed (INOU) statistics in October of this year 420172 people were unemployed. This is a huge proportion of people in our society that are unemployed. Unemployment is a serious issue and is more than likely one of the leading causes of mental health problems in today’s society. For those that are currently unemployed they are struggling to pay bills and meet repayments on mortgages. This can be a very worrying time for people and can lead to mental health problems. It can sometimes lead to people taking their own lives as they are unable to deal with the everyday realities of life and can see no other way out. In a recent article published by the Irish Examiner in June of this year stated that the economy and the current state that it is in is interconnected to the rise in young men taking their own lives. The newspaper article took figures from the Central Statistics Office (CSO) from 2009. The report stated that 443 males took their own life in 2009. This figure had increased by 15% from 2008. Approximately 40% of these men were out of work and 32% of them had previously worked in the building industry, according to Ella Arensman from the National Suicide Research Foundation (NSRF). It is clear to see there is a strong connection with men taking their own life and unemployment.

I will now discuss some of the risk factors in relation to mental health. Some of these risk factors are school failure, social isolation and abuse and violence.

School failure

According to Barry & Jenkins School failure is one of the risk factors in relation to mental health. School failure is based on a structural level. School failure can have negative impacts on people lives when it comes to looking for employment later in life. School achievement may not seem important but as people get older they realise how important it is. If a person fails again and again when it comes to trying to get a job this may have huge effects on their mental health.

Social Isolation

If a person is experiencing social isolation it can have huge effects on their mental health. Take example an elderly person that may have lead a very independent life ends up in long term care. This may lead to loneliness. If a person is in long term care they may be very dependent on someone to look after them and help them with their everyday lives. This can be a big change in a person’s life and could possibly lead to depression in the long run.

Abuse and Violence

Abuse and violence can have a huge effect on a person’s mental health. Emotional abuse such as bullying as we have seen over the last few weeks can have severe effects on a person’s life. Over the last few weeks numerous young people under the age of eighteen have taken their own lives because of bullying. Obviously the bullying had a huge effect on their mental health and they could see no other way out.

Conclusion

From my essay it is clear to see that there are numerous strengthening and risk factors in relation to mental health. We as a nation and as individuals should be concentrating on the protective factors. In a report published by the Health Service Executive (HSE) it mentions that the World Health Organisation stated in a report that General Practitioners spend 30% of their time with patients that are dealing with a mental illness. This makes it clear to us that there are a huge number of people are dealing with a mental illness. According to the HSE Ireland has tried to increase people’s awareness of mental health and change their attitudes towards it. They have done this by developing documents such as A Vision for Change 2006 which is based on mental illnesses and mental health. A document titled ‘Reach Out 2005’ has being developed in relation to preventing suicide. These documents may change people’s perception of mental illness and they may not look at it in such a negative light. There is a huge stigma attached to mental illness, so hopefully in time this stigma will no longer exist. Mental health can have serious effects on people’s lives. People should not feel ashamed if they have a mental illness. They should not have a stigma attached to them because of this mental illness. People need to be more open minded and not look down on people who are experiencing an illness in relation to their mental health. Hopefully in time the supports that people need will be readily available to them when they need it. A mental illness can be life changing, so for people to know that they have supports available to them on their doorstops can make a huge difference and can help them overcome their mental illness.

Reference List

Health Service Executive (2007) Mental Health in Ireland: Awareness and Attitudes, Dublin: Health Service Executive

Margaret M. Barry and Rachel Jenkins (2007) Implementing Mental Health Promotion, Philadelphia: Elesevier

The Irish Examiner (2012) ‘Suicide rise is linked to economy, says study’, [Online], Available: http://www.irishexaminer.com/archives/2012/0602/ireland/suicide-rise-is-linked-to-economy-says-study-195996.html [Accessed 21st November 2012]

The Irish National Organisation of the Unemployed (2012) ‘Live Register, Figures for the Year 2012 to date – by gender’, [Online], available: http://www.inou.ie/policy/statistics/liveregister/&_figures=national&_year=2012 [Accessed 21st November 2012]

The North Western Health Board (2005) The North western Health Board Strategy & Action Plan for the promotion of Mental Health, Dublin: The North Western Health Board

The World Health Organisation (2005) Promoting Mental Health, Concepts, Emerging Evidence and Practice. Switzerland: World Health Organisation

Tom, O’G. (2012) ‘Promoting Mental Health and Wellbeing’, SPL308: Promoting Mental Health and Wellbeing in Families, National University of Ireland Galway, Unpublished

A Project Intervention Plan on Wah Fu Estate Community

Mao Peter

Introduction of the community

Wah Fu Estate was built in 1963. It is located in Pok Fu Lam, south-western part of the Hong Kong Island. Such establishment of public estates was closely related to the fire accident at Shek Kip Mei, Kowloon in 1953, which is the milestone of public housing history in Hong Kong since that the government provide better and affordable public housing for Hong Kong residents. As a satellite town in Hong Kong, the Wah Fu Estate provides most of the basic facilities such as wet markets, schools, community hall, library, and public transportation as well. It is a quiet and pleasant place where the resident can enjoy a board sea view with hills behind. That is why the Wah Fu Estate is called a “luxurious estate for common people”.

It includes two phases of development. Wah Fu I with 12 blocks of buildings of old-slab design, and Wah Fu II with 6 blocks of twin-tower design.

Rationales for community issues

As the Wah Fu Estate has developed for more than 50 years, many of the original residents there have become the elderly. This can be seen to the latest census statistics as shown in table 1, the largest age group in the Wah Fu Estate is 45-64, about 30% of the overall population (Census and Statistics Department, 2011) and more than 20% are aged 65 and over. It is significantly higher than the ones of Southern District in general (13.7%). This demographic characteristic has greatly influenced the community need and problem of the Estate.

Table 1. Age structure of Wah Fu Estate and Southern District

Age group

Population

Wah Fu

Southern District

0 – 14

2,381

8.9%

31,800

11.7%

15 – 24

3,542

13.2%

32,600

12.0%

25 – 44

7,132

26.6%

83,100

30.7%

45 – 64

7,998

29.8%

88,900

32.8%

65 +

5,755

21.5%

34,800

12.8%

Total

26,808

100%

271,200

100%

Higher proportion of the aged people in the estate leads to the greater concern of health care and social welfare services provided in the Wah Fu estate for their deteriorating health conditions and higher demand for getting help from others.

The geographical location of the estate makes it mainly rely on the bus and minibus services. The provision of public transportation services to the MTR stations, other main districts in the Hong Kong Island and the other side of the Victoria Harbour is very crucial to the residents there.

The provision of social facilities such as shopping centres, restaurants are another concerns in the community especially those in the open area for the elder residents to take a rest and have better interactions with others.

Long history of Wah Fu Estate is reflected by the supporting pillars outside the buildings, decaying rooftop and messy electronic lines. The maintenance of the estate is a main and urgent issue in the community.

The latest development of the estate is the redevelopment, which has pronounced on the Chief Executive’s policy address this year. It can be projected that this will become the major issue of the community in the next few years.

Rationales choosing community work approach

To have the community work in such an old public estate, locality development can be used. It is one of the three models of community practices by Jack Rothman.

The relationship among the residents in the Wah Fu estate is very close as they live together for such a long time. Their bonding is strong that it is more effective to use this advantage to coordinate them in presenting and solving the community issues with the government and other stakeholders instead of advocate them to have social actions and campaigns.

The estate as a whole and even each of the buildings has their own Mutual Aid Committees or similar organizations. We can build up a close relationship with them and use their networks throughout our community work in order to have a greater effect to express their views to the public and solve the problems of the community.

There have some NGOs providing social services to the residents in the Wah Fu Estate, such as Salvation Army Wah Fu Centre for Senior Citizens and Aberdeen Kai-fong Welfare Association Southern District Integrated Elderly Service Centre, the collaboration with those NGOs which know the community situation well is also essential to have a better community work in Wah Fu estate.

Specific intervention strategies/empowerment plans

We can organize some outdoor seminars in the estate for the discussion of the community problems to let the residents concern the issues of their own community more. We can also build up the foundation of the membership and help them to set up the locality-based concern group to discuss issues faced by them including the maintenance of their apartments, provision of social facilities etc as I have mentioned before in this paper. Some sub-groups can also be set up for some typical issues like transportation and redevelopment programme. Throughout the discussion in these groups, they can have mutual support and build up their civic consciousness. They can make collaborative and informed decision or consensus by themselves and express them in one voice to the society. This is the process of empowerment to the residents of Wah Fu estate to handle issues of their community by themselves.

Another way which is more traditional to promote our community work is to set up a counter over the street and spread out our leaflets to present our service and get in touch with the residents. The periodic newsletter can be printed to the member, other relevant NGOs and organizations to publicize our activities and keep continuous contact with the residents.

Roles of Community Worker

The community worker can play the roles of enabler, instructor, facilitator and trainer.

We instruct the residents to speak up their opinions and views about the community issues in the concern group. We help them to coordinate different views and conflicts between them, that means to facilitate the discussion or empowerment process. Through these activities, it is an opportunity for us to train up the district leaders to help their neighbours for their own betterment of living.

Challenges and Difficulties

From the interviews conducted in our community walk, they concern more with the current issues in the estate such as health care and community facilities than the redevelopment programme that is believed to be the most concern issues in the community. They are widely believed that the redevelopment plan may take 5 to 10 years to complete which is too far away for them to think about it. As they have been waiting for a long time for the plan, their desire to concern about it has faded out. This is one of the main challenges to do the community work in Wah Fu estate.

The forums and visits from outsider about the redevelopment plan have also fatigued the residents and they have the tendency to alienate from it. It is another difficulty to get contact with them and start our community work.

Conclusion

In order to have an effective community work, helping and instructing them to present the existing problems that mentioned previously in this paper is significant to gain their trust. After that, we have to ensure the residents to know and realize that as it is one of the key statements in the policy address, the redevelopment of Wah Fu Estate will take place soon, then mobilize and empower them to work for solutions, to make their voice and requests about the redevelopment issues such as in-situ settlement can be heard by the government and the public.

References

Census and Statistics Department. (2011). 2011 Population Census. Retrieved from http://www.census2011.gov.hk/pdf/fact_sheets/estates/D_10182e.pdf http://www.census2011.gov.hk/en/major-housing-estate/10183.html

Rothman, J., Erlich, J. L., and Tropman, J. E. (eds.) 2008, Strategies of Community Intervention. (7^th Ed.) Itasca, Illinois: F. E. Peacock. Chapter 7.

United Nations Children’s Fund

“We believe in a world where ZERO children die of things we can prevent.”

The United Nations Children’s Fund, UNICEF, is an intergovernmental organization (IGO) that was started by the United Nations in 1946. UNICEF is non-profit and works to prevent childhood death by improving the healthcare, education, and nutrition of children around the world. They also provide emergency relief to those in need. Their reach is international and their goal is to have zero children die from preventable causes (UNICEF).

On December 11, 1946 the “United Nations International Children’s Emergency Fund” was started by the United Nations General Assembly. Its creation coincided with World War II in order to bring food and medical care to war-torn children in Europe, the Middle East, and China. The name was shortened to United Nations Children’s Fund in 1953 when it was made a permanent fixture of the United Nations System (UNICEF USA). Despite its name change, the fund kept the acronym UNICEF; which is still in use today. In 1965, the United Nations Children’s Fund won the Nobel Peace Prize for ‘the promotion of brotherhood among nations.” (UNICEF). In its 68 year history there have been many famous UNICEF Goodwill ambassadors including Sarah Jessica Parker, Susan Sarandon, Jackie Chan, Shakira, David Beckham, Audrey Hepburn, Danny Kaye (first celebrity ambassador), and the entire Manchester United Football Club (Borgen Project).

UNICEF focuses its energy in more than 190 countries, including the United States (UNICEF). In order to conduct their humanitarian operations they have established offices worldwide. Major operations are carried out through these offices in the event of a natural disaster or emergency. Additionally, there are programs and trainings there year-round. The United States Fund for UNICEF is located in New York City, and is the main U.S. office for UNICEF. The U.S. Fund works in cooperation with the government and non-governmental organizations (NGOs) to help UNICEF achieve the goal of zero preventable child fatalities (UNICEF USA). The United Nations Foundation in DC, Friends of UNFPA in New York, and the International Peace Institute in New York are other associations in the United States that help fund UNICEF projects (UNICEF).

UNICEF has a number of programs to help raise funds for their causes. One of the most popular UNICEF fundraisers is Trick-or-Treat for UNICEF. Since the 1950’s over $170 million dollars has been raised by children for children through the Trick-or-Treat for UNICEF program. The premise of the program is that when kids go door to door on Halloween that instead of asking for candy, they ask for spare change to donate to UNICEF. Not only does this raise money for UNICEF to use towards helping children, but it also teaches the children doing the fundraising the value of helping others (Trick-or-Treat for UNICEF). A newer campaign that they have implemented recently is the UNICEF Tap Project. This project raises funds to give those in need clean drinking water. It works by having people stay off of their phone for as long as possible, and the longer they are off of their phone, the more money that gets donated by a 3^rd party company, Giorgio Armani (UNICEF).

None of the funding for UNICEF comes from the assessed dues from the United Nations; instead their donations come from individuals, NGOs, foundations, governments, and corporations (UNICEF). For the 2011-2012 Fiscal year UNICEF had a total income of $3,866 million. When broken down fifty-seven percent of donations came from the government, and 32 percent was raised by NGOs and members of the private sector. UNICEF is known for being a reputable charity that uses a majority of its income for its cause. Of the total income $3,416 million dollars went to development, $322 million went to management, $127 was for special purposes, and $2 million was for United Nations development coordination (Charity Navigator).

There are a number of ways that individuals of all ages can get involved with UNICEF’s mission. Young children can help through programs like Trick-or-Treat for UNICEF (Trick-or-Treat for UNICEF). High school and college students can join clubs that are dedicated to raising money for UNICEF. Adults, with at least a bachelor’s degree and experience in certain fields, can even personally volunteer with UNICEFs missions. Another way that anyone can be involved is by monetary donations made to UNICEF or one of its funds (UNICEF USA).

One of the most prevalent causes of preventative childhood death is starvation. UNICEF battles childhood hunger in many ways including giving children peanut paste and micronutrient powder. Peanut paste is a high-energy therapeutic food. It works well because it is high in calories and does not require any preparation or refrigeration. Like its name suggests the micronutrient powder contains many vitamins and minerals necessary for healthy growth and development in children. It also improves immune function and helps prevent disease (UNICEF USA). For only $10 UNICEF can distribute 321 packets of micronutrient powder. UNICEF helps infants who suffer from malnutrition by teaching mothers the benefits of breast feeding. Breast fed children are six times more likely to survive the first few months than children who are not breast fed. Also, UNICEF still helps provide food in emergencies such as natural disasters (UNICEF).

Along with helping fight childhood malnutrition, UNICEF also improves children’s lives by providing healthcare, clean water, and educational supplies. More than one third of the world’s children have received a vaccination or immunization thanks to UNICEF. They have also helped 1.8 billion people have access to clean drinking water. If there are not drivable roads UNICEF will deliver supplies by bicycle, boat, and even donkey when necessary. They are well trusted and have even made cease fire agreements to get to children in war zones (UNICEF USA).

In the 68 years since it was founded, UNICEF has helped save more children’s lives than any other humanitarian organization. They are extremely dedicated to helping lower child mortality rates, and have been successful so far. A number of their programs work with children from birth to help end childhood malnutrition. Their work has reached billions of people in the last seven decades and will continue to in the future.

Works Cited

“Charity Navigator – Advanced Search.”Charity Navigator. UNICEF, n.d. Web. 1 May 2014.

“Help Children | Humanitarian Aid & Emergency Relief | UNICEF USA.” UNICEF USA. United States Fund for UNICEF, n.d. Web. 27 Apr. 2014.

“Trick-or-Treat for UNICEF.” UNICEF. United Nations Children’s Fund, n.d. Web. 28 Apr. 2014.

“UNICEF | United Nations Children’s Fund.” UNICEF. United Nations Children’s Fund, n.d. Web. 24 Apr. 2014.

“UNICEF’s First Celebrity Ambassador, Danny Kaye – The Borgen Project.” The Borgen Project RSS2. N.p., n.d. Web. 24 Apr. 2014.

As a result of the 2011 riots seen in the United Kingdom, Louise Casey (2012) was commissioned by the coalition government to write a report entitled ‘Listening to Troubled Families’. This essay will critique the report and consider if government austerity measures could impact in social care provision and outcomes for service users. It will discuss the narrative of one family identified in the report whom require intervention and support in order to safeguard their children (Casey 2012). It will give an outline of the development and impact of legislation and policy guidance on social work practice for children, families and carers. Furthermore it will consider academic research and theories that inform social work practice when working with such families; for instance; ecological theories, assessment, life span models of development, professional power and attachment theory. This essay will also discuss the skills necessary for contemporary social work practitioners to engage effectively with children and families. It will argue that inter-professional, anti-oppressive, multi-professional and reflective practice is paramount to successful outcomes for families who require support from services.

The term ‘troubled families’ was first used by David Cameron (Cameron, 2011), and later defined by the Department for Communities and Local Government (DCLG) as households having serious problems and chaotic personal histories. Cameron (2012) intends to ensure those identified in the report as troubled 120,000 families, “turn their lives around”. These families are characterised as; having no adult in employment, children who do not attend school and family members partaking in anti-social behaviour and criminal activities. By reducing costs and improving outcomes, the results based funding scheme aims to change service delivery for families (Cameron, 2011). Welshman (2012), states that this policy agenda is the latest reconstruction of the underclass debate. Giddens (1973, cited in Haralambos and Holborn, 2002) claims that Britain has an underclass of people who are disadvantaged on the labour market because they lack qualifications and skills, and may face discrimination, prejudice and marginalisation in society. The New Labour Government (1997-2010) linked disorderly behaviour to problem families and focussed on individual deficiencies rather than an acknowledgment of structural constraints, for instance; the effects of poverty on family relationships and parenting (Hill and Wright, 2003; Gillies, 2005, in Parr, 2009).

New Labour implemented Family Intervention Projects (FIP) that were framed from the Respect Action Plan in 2006. This was criticized by a parental and family support organisation Parentline Plus (2006), as threats of punishments to parents would impact negatively on families, and parents could be less willing to seek support before they reached crisis (BBC News, 2006). Initiatives like Signpost, provided intensive levels of support and understanding of multidimensional complexities, comprising of effective intervention for children and families within their communities (Dillane et al 2001, cited in Parr, 2009 ). Featherstone (2006) maintains this initiative was within the context of the social investment state, encouraging investment in human capital as opposed to direct economic provision provided by the state in the form of welfare payments. Postle, (2002 cited in Parr, 2009) argues that Signpost intervention was social work at its best allowing social workers time for effective communication and partnership working rather than the policing of families.

Levitas (2012) argued against research methodology used in the Casey Report (2012) and of the idea of multi-disadvantaged families being the source of society’s ills. Levitas (2012) claims; that the figure of 120,000 was founded on data from a secondary analysis of a Children and Families Report (2004). Literature suggests the figure of 120,000 families is underestimated, the number of multi-disadvantaged families is significantly greater (Levitas, 2012; Hern, 2012). The initial 2004 study found no evidence to indicate that the families were trouble makers as proposed but did find that they were families in trouble. As a result of changes in taxation, welfare benefits, spending cuts and the continuing effects of the economic downturn (Levitas, 2012).

Welshman (2012) advocates that history provides important lessons for policymakers and addressing both structural and behavioural causes of poverty is likely to be more effective than counting and defining such families. He believes there is little knowledge regarding reasons for behaviours and calls for research for combating problems that these families encounter. Casey (2012) has given an insight by using service users narratives and received positive responses from interviewees. However, her research does have further limitations; a small sample of sixteen families, all of whom were at crisis point when they accepted working with the FIP (Casey 2012). Soloman (2012) claims that vast number of vulnerable families are being left without any support. Casey (2012) made no reference to ethnicity and culture of the families, therefore giving no insight into diversity (Clifford and Burke, 2009). Bailey (2012) believes that the report breaches ethical standards for social research, the families interviewed are participants in the FIP and therefore had a power of sanction over them, therefore it may have been difficult for the families to decline from the study. No written information on the risks of participation was provided; he also suggests that ethical approval was not applied for. Bailey, (2012) believes that there is a risk of identifying these families. Casey (2012) acknowledged that the information was not representative of 120,000 families but claims that it provides a sound basis for policy. Nevertheless, Bailey (2012) argues that there is no place for unethical research in public policy making.

Comparative studies were not conducted on families with similar economic and social circumstances who are not described as ‘troubled’. Casey (2012) discussed intergenerational cycles of abuse, violence, alcohol and drug misuse as well as worklessness being reasons for ‘troubled families’ placing the oneness on individuals (Levitas, 2012). Kelly (2012) welcomes the Government’s commitment to aid families. He proposes that most parents on low incomes are good parents and believes that it is naive to conflate illness, inadequate housing and poverty with substance misuse and crime. Kelly (2012) also argues that many families involved with Family Action are socially isolated, invisible to support services who struggle on low incomes rather than displaying anti-social behaviours. The case studies gave the parents perspective, however, the voice and opinion of the child was unheard. Ofsted (2010) found practitioners concentrated too much on the needs of the parents and overlooked the implications for the child. The United Nations Convention on the Rights of the Child Article 12 declares, the views of the child must be respected, Article 3 states that the child’s best interests must be a primary concern (Unicef, 1992).

This essay will now discuss social work practice in relation to one of the families identified in Louise Casey’s Report (2012) Chris and Julie (appendix 1). In the past, adults like Chris and Julie who had learning disabilities may have been prevented from becoming parents, eugenic theories dominated, with the aim to ensure children with similar disabilities were not procreated (Cleaver and Nicholson 2007). However, in recent years attitudes are changing in favour of people with learning disabilities giving them the same rights as other citizens regarding sexuality and family life. An increased number of people with learning difficulties now have wider opportunities for independent living. According to Haavik and Menninger (1981 cited in Booth and Booth, 1993, p 203) deinstitutionalization enabled many people with learning disabilities to participate in their community. Duffy (2006, cited in Thompson et al 2008), states that self-determination is a core principle in attaining citizenship in western society.

The shift in opinions and principles is evident in government legislation and guidance thus impacting on social work practice, for instance; Valuing People: a new strategy for learning disability for the 21st century (2001), (DoH 2001) and Valuing People Now: The Delivery Plan (20102011) ‘Making it happen for everyone’ gives guidance for all professionals supporting people with learning disabilities living in the community (DoH 2011). In relation to the case scenario, Article 8 of The Human Rights Act 1998 (.1) provides Chris and Julie with

aˆ¦ ‘a right to respect for private and family life, his home and correspondence’; however, any interference with this right must be necessary and lawful with regard to public safety, national security, prevention of public disorders and crime, or for the protection of rights and freedoms of others’.

Both Julie and Chris have a protected characteristic of disability and therefore under the Equality Act (2010) should be protected from direct and indirect discrimination from service providers. However, children’s rights are paramount and override those of their parents or carers (DoH, 1998). Access to learning disability services in England was governed by Fair Access to Care Services (FACS) (DoH, 2003), until it was superseded by Putting People First (2007) and highlighted the need for a personalised Adult Social Care System (DoH, 2007).

Emerson et al (2005) found one in fifteen adults with learning disabilities living in England were parents and this research emphasised that approximately half of

children born to parents with learning disabilities are at risk from abuse and twenty five per cent no longer lived with their parents (McGaw,2000). Further research indicates that the majority of services are as yet inadequate in meeting the needs of families with learning disabilities (McGaw 2000). McInnis et al (2011) similarly found complexities in determining eligibility for service users. They indicated that decisions regarding eligibility are not only determined by assessment results but by local government resources. They advocate equality and argue that changes in assessment tools are necessary when working with families with learning difficulties. Chris and Julie reflect these findings as they only received intervention when they faced difficulties caring for their children.

The parental skills model would be advantageous for practitioners as it is designed to assist the assessment process when working with Chris and Julie. The model focuses on life skills, familial history and access to support services. McGaw and Sturmey (1994) found that if difficulties arise for parents in any of the three areas it Service users maybe uncooperative and reluctant to engage with services, perhaps due to anxieties and fear of consequences. For example; their children being removed from their care and their own childhood experiences. Cultural awareness and age appropriate interventions are necessary to enable partnership working (Egan, 2007 cited in Martin, 2010). Horwath (2011) found that although some social workers faced barriers to the Child-focused Assessment Framework, due to heavy workloads, time restrictions, performance targets and limited training opportunities. Others found that additional bureaucracy gave them a security in their practice. Smale, et al. (1993) highlighted the following models of assessment; questioning, procedural, and exchange model. The latter may be beneficial when working in partnership with this family as the service users are viewed as experts and aids their potential for working together towards goals.

When working with families communication can be complex; effective communication would include active listening skills, person centred planning and intervention, also avoiding the use of professional ‘jargon’ (Anning et al, 2006). The worker should be aware of non-verbal communication and power imbalances in their working relationship (DoH, DfES, 2007). It may be advisable for this family to access advocacy services to promote equality, social inclusion and social justice (actionforadvocacy.org.uk, 2012). According to Yuill and Gibson (2011), advocacy promotes anti-oppressive practice.

Horwath (2010) suggests positive relationships are built on trust. This echoes the person centred principles of Rogers (1961, cited in Thompson et al, 2008) enabling the practitioner to observe realistic emotional, somatic and behavioural responses from the child and family, that are essential for effective information gathering for assessments (DoH 2006). Martin (2010) argues in order to ensure an understanding of the service user narrative within a multi-professional context the practitioner should reflect and summarise and make accurate recordings. Information should be stored in accordance to the Data Protection Act, 1989 (legislation.gov.uk) and also be shared effectively between multi-agencies and safeguarding departments (Laming, 2003).

Numerous children have died from abuse and neglect in the United Kingdom (Brandon et al, 2005). In 2000, Victoria Climbie was subjected to cruelty by her aunt and her partner which resulted in her loss of life. Laming (2003) describes Victoria’s death as a ‘gross failure of the system and inexcusable’ and recommended reforms (1.18 p.3). In England, the government published the Framework for the Assessment of Children in Need and their Families (DoH et al 2000) and additional policy guidance came about in Every Child Matters: Change for Children (2003) that made all professionals accountable for safeguarding, child development, focusing on early intervention, joint sense of responsibility and information sharing with integrated front line services and an emphasis on children fulfilling their potential (dcsf.gov.uk 2012). The following year the Children Act (2004) Section 11 (DfES, 2005) gave clear guidance on multi-agency working and states that safeguarding children is everyone’s business.

The Children Act 1989 (DoH,1989) and the Children Act 2004 (DoH,2004a) currently underpin child welfare practice in England. The former Act considers the concept of a ‘child in need’ (section 17) and accentuates the importance family support services who both promote the child’s welfare and help safeguard and assist parents in their role. In addition Working Together to Safeguard Children (2010) gives extensive guidance on collaborative working and defines roles and responsibilities of professionals (HM. Government 2010). This guidance is presently being revised and reduced to alleviate bureaucracy for professionals, however Mansuri (2012, cited in McGregor 2012) argues that the real safeguarding concerns are unmanageable caseloads, plummeting moral and cuts to support staff and criticises the government for failing to consult more practitioners regarding these changes.

An example for effective working together that may benefit the family in the case scenario is Team around the Family (TAF) intervention. This encourages effective, early identification of additional need, it assesses strengths and is restorative in approach that provides the family opportunities for change and enhances multi-agency collaboration (cheshirewestandchester,2012). Family mentoring services may also be useful in this case (catch-22.2012).

Children’s Services in England and Wales adhere to The Framework for the Assessment of Children in Need and their Families (DoH et al 2000). The Assessment Framework provides an ecological approach of the child’s developmental needs, parenting capacity, family and environmental factors. This ecological approach was championed by Bronfenbrenner, (1979, cited Martin, 2010) found that by incorporating the microsystem, exosystem and macrosystem benefited both practitioners and service users by enabling wider societies influences of culture and economic circumstances to be considered in assessment (Wilson et al, 2011). This evidenced- based framework aims to ensure that the child’s welfare is both promoted and protected (Cleaver et al, 2004).

This framework provides a consistent method of collating and analysing information, thus giving practitioners a more coherent understanding of the child’s developmental needs, the capacity of their parents and the influence of the extended family and other environmental factors that impact on the family (DoH al, 2000). However, Garrett (2003; Rose, 2002 in Crisp et al, 2007) believe that the underpinning evidence for the Framework for the Assessment of Children in Need and their Families (2000) is problematic. Howarth (2002 in Crisp et al, 2007) suggests that accompanying specific guidance for children from black and ethnic minorities are less widely circulated than the framework document. Katz (1997, cited in Crisp et al, 2007) accuses the framework as being mechanistic checklists used by inexperienced staff as data collection tools and loosing focus on identifying and meeting the needs of children (Horwath, 2002 cited in Crisp et al 2007).

Likewise, Munro (2011) challenged all professionals to ensure that our child protection system is centred on the child or young person, as she believes the system has lost its focus on the child’s needs and experiences and has been too focused on rules, time-frames in assessment and procedures. At present an initial assessment is carried out ten days from referral and a core assessment must be completed within thirty-five days of an Initial Assessment, and would be undertaken to initiate child protection enquires (DoH et al, 2000). Practitioners use twin tracking and pursue other possibilities for the family (scie-socialcareonline.org.uk). This may be ethically and emotionally difficult for practitioners; they should ensure supervision and adhere to their professional standards of proficiency and ethics (HCPC, 2012).

Munro (2011) urges the government to value professional expertise and revise statutory guidance on service intervention and delivery and calls for more focus on understanding the underlying issues that influenced professional practice that resulted in Serious Case Reviews. Munro (2011) also calls for reforming social work training and placement provision for students. The government accepted Munro’s recommendations and changes to the system will be implemented in 2012 (DfE 2011).

Damien (see appendix 1) meets the threshold criteria for intervention under section17 (10) of The Children Act (1989) as his health or development may be significantly impaired without support services. At present he does not appear to be at risk of significant harm, however a core assessment may be beneficial in determining the appropriate support services (HM Government, 2010), examples include Youth Offending Teams (YOT) who deliver crime prevention programmes (youth-offending-team, 2012), Special Educational Needs Coordinators (SENCO) and learning mentors provide support in educational settings (Good schools guide,2012). It is vital throughout the assessment process that practitioners are non-judgmental and use reflective practice and have an awareness of transference and counter-transference to disperse any negative responses and feelings (DoH, 2000; Wilson et al, 2008).

The practitioner should draw on theories of human development through the lifespan as well as sociological, biological, psychological and psychosocial theories. For example; biological theory would consider genetic influences, physical development and instinctual behaviours whereas the sociological perspective would emphasise the importance of social factors (Horwath, 2010). It may be that the family are living in poverty and had have not been in receipt of full benefit entitlements or support services; it would be advisable to contact relevant welfare agencies and seek professional assistance for financial support to aid this family (family-action, 2012).

The Children Act (1989) states that for the majority of children their family is the most appropriate place for them to live. However, the local authority has a duty of care and Madison (see appendix 1) needs to be accommodated under section 20 of the Children Act (1989), as she is a child in need (section 17) or a child at risk of significant harm (section 47). Chris and Julie have parental responsibility for their children until they are adopted (D of H, 1989; 2000; HM Government, 2010).

When assessing families the practitioner should have an understanding of theories that inform practice. In relation to Erikson’s (1982) theory of psychosocial stages of development, it could be suggested that Madison is in the fifth stage of development known as; Identity and Repudiation versus Identity diffusion. This stage usually will occur between ages 12-18. Throughout adolescence children are becoming more independent and developing a sense of self. Madison could experience confusion in this stage as she has spent time in kinship and residential care. Erikson (1982) believes with encouragement, reinforcement, and through personal exploration adolescents can leave this stage with a strong identity and direction in life. If Madison fails to pass through this stage successfully she will be insecure about herself and her future (Erikson, 1982 cited in Wilson et al 2008). Hamachek (1988) suggests this theory is ambiguous in identifying behaviours of an individual’s psychological growth throughout different stages of development.

Chris and Julie have had one child adopted and have been unable to parent eight of their nine children. During assessment practitioners should have an understanding of attachment categories and relating behaviours; it could be that some of Chris and Julies children developed anxious-ambivalent attachments. Role reversal may have taken place, thus resulting in the children becoming angry about the unreliability of the carer and possibly the reason for them displaying anti-social behaviours Ainsworth (et al., 1978 cited in Becket and Taylor, 2010). Early attachment theory was criticized for denying women equality in the workplace by implying that the risk of mothers leaving their children would be detrimental to their children’s development (Beckett and Taylor, 2010). With regard to Julie and Chris, the local authority could undertake a pre-birth assessment and multi-professional case conference under (section 47) of the Children Act (1989) to evaluate parenting capacity, family and environment, and their ability to sustain parenting to meet the child’s developing and changing needs (Department of Health 1989; Department of Health, 2010).

Specialist assessment tools for parents with learning disabilities would assist the couple in their understanding and partnership planning (McGaw, 2000; cited in Wallbridge, 2012). Both Chris and Julie have completed a parenting course and this is positive as they had not done so previously (Casey 2012). Wallbridge (2012) claims successful support packages offer intensive, continuous training for parenting, for example group work and life skills in the home, both parents feeling valued are often positive catalysts of change. A recent government report (2012) however, identified the child protection system as being reactive rather than proactive with regard to young people accessing services. It warned that professionals gave the parents numerous changes to improve their parenting skills and children were left to live with neglectful parents (publications.parliament.uk, 2012)

This essay has critiqued the report ‘Listening to Troubled Families’ by Louise Casey (2012) and found limitations in the methodology. It considered the needs of a family identified and critiqued the role and skills of a social worker in safeguarding. It has argued the importance of effective multi-professional collaboration, knowledge of contemporary legislation, practice and theories with regard to implementing partnership working to support children, families and carers. It also identified external explanations ; poverty, isolation and late intervention can impact on these families. Munro (2011) urges the government to value professional judgements and change statutory guidance in order to help safeguard children.

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