Author: Andre Coleman

Critically analyse your practice of the Motivational Interviewing approach with specific reference to your classroom learning and work placement

On reflection I have learnt a great deal about the MI approach, putting the classroom learning into practice, then reviewing my performance on the DVD has been a fundamental part of my learning process. Although being familiar with many of the techniques, which are similar to skills I already possess, the actual approach was new to me.

In brief MI allows a normally client lead Person Centred Approach to have direction by allowing clients to recognise their ambivalence acknowledging that change is possible and cultivating their innate forces to make necessary changes that are acceptable to them. I have recognised that for myself I’m going to need to practice, review and hone my techniques & awareness with implementing this model.

It is emphasised with MI that the spirit of the approach is conceivably more important than techniques used . I feel the only real way to describe this phenomena is to acknowledge that the spirit would be how the therapist presents themselves & the way that he/she utilises the techniques. With MI it is the client’s responsibility to resolve their ambivalence finding intrinsic motivation to change problematic behaviours, not the therapists to impose or suggest change. The counselling approach is generally a soft, quiet eliciting style, which places importance on the working relationship being a partnership.

The extreme contrast to MI would be confrontational approaches, which may attempt to break a client’s denial through authoritative derogatory shaming approaches stripping away individuals defences and rebuilding their identities with societies or groups philosophies .

The therapeutic approach of a pure Person Centred counselling model essentially relies upon the three core conditions of Congruence, Empathy and Unconditional Positive regard these conditions contribute to the presence of the Counsellor influencing the relationship formed with the client.

With addiction treatment settings where time constraints are prevalent Motivational Interviewing can allow more structure & direction being applied to the normally client lead Person Centred Approach. By developing discrepancy between client beliefs and problematic behaviours direction can be achieved. According to “when discrepancy becomes large enough and change seems important, a search for possible methods for change is initiated” (p. 11).

I have already integrated some use of MI into my practice however, I’m aware at times my agencies policies and procedures are in conflict with the MI spirit. Recently, I have had to check my own incentives in using MI, making sure I’m not implementing it as a form of manipulation to move clients into adherence with agencies policies, which would blemish the spirit of the MI approach.

The compatibility of the MI approach in my place of work is questionable in some areas. Our treatment modality is a 12 step abstinent based approach, which immediately arises two conflicts with the MI spirit. Firstly, not all clients may wish total abstinence and those who do may wish to achieve it in some way that is not 12 step orientated. It is agency policy that all clients attend 12 step fellowship meetings every evening during their treatment duration.

In our treatment setting the MI approach has proven to be useful in several areas when clients initially arrive in treatment anxiety levels are high if not addressed can lead to dropout. Application of MI here can help the client focus on the influencing factors that motivated them to contemplate treatment in the first place. In addition, MI is acknowledged a beneficial approach to use with angry clients especially the principals of rolling with resistance and the expression of empathy .

Although the clients have attended our treatment facility for a variety of reasons, it is difficult to place them all in one bracket concerning the “stages of change” model. Taking into account their alcohol / drug use the vast majority would be in either contemplation or active change. Some clients may display signs of resistance to change around other areas of their life which may include being in a relationship with a partner who is still active in addictive behaviour. Many clients also have difficulty with assertiveness, which is going to be necessary to develop for them to help maintain addiction free lifestyles. It is a process of change for clients conversely many of these distinct essentials are met with varying degrees of resistance by individual clients.

The first example I’m going to use is a male client of 42 years of age who has been dependent upon substances for twenty years. He displays high levels of interest in the abstinent approach registering high using a Likert assessment tool to gauge his Willingness, Ability & Readiness regarding an abstinent way of life. With reference to his substance use, I would assess him to be in the action stage of Prochaska and DiCliemente “The stages of change” (see appendix A).

He has a partner who still is a substance user; he displays high levels of resistance to changing this area of his life and feels that he will be able to change her view on substance taking once he returns home after the completion of his treatment. I have been affirming the client consistently with the changes he has made to his behaviour whilst in treatment and with permission from him, pointing how his changes are in line with the 12 step abstinent based approach. What I’m trying to achieve is too reinforce his belief in himself about this particular approach. By doing this I feel that there are inconsistencies further developing between his two cognitions “I want to remain substance free, yet I want to go home to my partner who is a substance user.” As he is now beginning to question his own thinking, I can see that the cognitive dissonance is beginning to have an effect I’m hoping he will seek to alter the risky dissonant cognition by remaining in Bournemouth to attend aftercare.

A client we recently had at our facility who presented for cannabis use, and admitted his main motivation for being in treatment was to avoid going to prison displayed resistant behaviours towards the treatment modality. His resistance would manifest in ways of walking out of group therapy, getting up and walking around whilst clients were presenting personal assignments & generally showing no respect for what other clients were trying to achieve. The application of MI in this instance was quite difficult as a direct approach in line with agency policy and procedures needed to take place first. We had tried on several occasions not to take too much notice of the unacceptable behaviours he presented which could be considered rolling with resistance, however eventually had to enforce an ultimatum. In circumstances like this I found it very difficult almost impossible to remain in a totally pure orientated spirit of MI.

To say that I have mastered the “concepts & principles” of MI would be a significant over estimation. I have furthered my knowledge of the contributing elements of MI which included the “stages of change model”, the techniques used to work with ambivalence & resistance. Most importantly, I have learnt above all else MI is about allowing the client to be the expert and for me to be mindful of the type of language that I use. The spirit of MI I have no real problem with other than perhaps on occasions avoiding the “expert trap” generally I do present myself within the spirit of this model.

The application of this particular model I’m using at work in a tentative way, in other words I’m applying it in certain situations where perhaps I feel confident to use it. An example of this would be, when clients seem to be making rash decisions to leave treatment or are displaying ambivalence about an abstinent approach.

After reviewing the DVD it is clear to me that I lack confidence in the application of the MI approach. I do however feel though that practice and reviewing my practice can only help with me developing my implementation of this approach. I feel that I need to be more mindful of the language I use whilst working with clients. As it became apparent to me whilst reviewing the DVD that I can without realising fall into traps. An example of this would be at the end of the session I asked my client if I could give him something to take away. On reflection, I could have asked him how he felt he could assess his decision on getting a shed.

My future development is going to involve applying & reviewing my practice, what I have started to look for at my work setting in my own practice and that of my work colleagues is to identify what clearly is not MI.

Some observations I have acknowledged not only with this approach are the ethical conflicts that can arise between benevolence & autonomy . On reflection, the example I used earlier on in this assignment with a male client whose partner remains in active addiction. His autonomy was to return home after treatment completion my interest or benevolence is with the safety of the client. As a professional, I know it would be risky for him to return home to someone who remains actively taking illicit drugs. The question is do I then use MI as a way to manipulate the client? My answer is yes of course I do. Questionably is this really in the pure spirit of the approach?

Appendix A
The Stages of Change
Intervention process using the Stages of Change model
Source; Adapted from the work of Prochaska and DiCliemente

This study takes up the examination of social work practice in the area of mental health in the UK. It is based upon the experiences of the author in the course of her work as a Mental Health Professional in a multidisciplinary team in a community care setting.

Mental health issues, more specifically mental illnesses, have troubled humans from the dawn of human civilisation. The history and literature of all historical societies reveal numerous instances of mental disorders among people and the inevitably associated ostracism and discrimination faced by such people. Mental illnesses in the UK, till even some decades back were associated with abnormal, deviant and dangerous behaviour and thousands of people with different types of mental issues were housed in high security asylums against their will for years on end. Such blatant violations of fundamental human rights were carried out at the behest of the medical fraternity with the active support of the government, the judiciary, the legal system, enforcement agencies and society.

Social workers entered the area of mental health in the UK in the early decades of the 20th century and progressively increased their interaction and work with mentally ailing people. The involvement of social work practice in the area grew slowly until the 1960s but increased rapidly thereafter. Greater involvement of social work practice led to the development of psycho-social models for providing assistance to people with mental ailments and helped in changing societal perceptions towards such persons. The post Second World War period also witnessed a very substantial shift in governmental and medical approaches towards people with mental health disorders. The last full fledged asylum for housing the mentally ailing was closed down in ….

Medical disorders are now viewed to be strongly related to various social and economic conditions as also to phenomena like racism, oppression and discrimination. The overwhelming majority of people with mental health ailments are now treated in the community, in the midst of family and friends, and institutionalisation is resorted to only in extreme cases and that too for limited periods of time. Social work practice has become very relevant to the area of mental health. Qualified social workers like the author of the study, known as mental health professionals, work with medical professionals like doctors and psychiatrists and play active, even leading, roles in the assessment, planning, intervention and evaluation of people with mental health disorders.

This study takes up the case of Maya, a 68 year old Asian woman, who lives in East London. Maya is a first generation immigrant and has spent much of her life in an alien society. She suffers from depression and has been referred to the local social work authorities. Maya’s case is fully described in the appendix to this study and is thus not elaborated here.

The essay examines various aspects of Maya’s life and experiences in order to crystallise the various factors are contributing to her current mental difficulties. Special emphasis is given to the challenges faced by people suffering from depression and to the high incidence of depression among South Asian women. The study takes up the application of social work theory to practice, the role of oppression and discrimination in the development of mental ailments, the role of social workers in helping mentally ailing persons and the importance of adoption of anti-oppressive approaches in dealing with them. It also details the social services that are available to such service users and how such services can help Jaya.

Causes and Consequences of Depression

Maya has been intermittently suffering from depression for the last 27 years and has undergone medication and counselling on five occasions. She was specifically referred by her GP to the local social services department following an episode of some severity.

Crippling depression is one of the biggest reasons for misery in modern day Britain. It is a submerged problem of immense dimensions that is kept out of sight by family shame. The Psychiatric Morbidity Survey reveals that one in six of UK residents are liable to be diagnosed with depression. It would surprise many people to know that 40% of all physical and mental disabilities are caused by mental illness, even as 17% of such ailments are caused by depression alone. The incidence of depression among people is more than 3 times that of cardiac disease.

Psychologists agree that mental illness constitutes the most important predictor of human distress in the UK and is far more powerful than poverty or various other types of disability. With few forms of deprivation being worse than chronic depression, it is evident that social workers should give the highest priority to care for persons with depression and other mental health ailments.

Much of research on the causes of depression has necessarily being medical in nature. A number of medical studies reveal that depression can arise out of a range of factors like medical and physical disabilities, the death of loved people, social isolation, exclusion and loneliness, and abusive relationships, separation and divorce. Depression can also be initiated by economic and other types of stress, estrangement from family members, the compulsion to care for ailing family members and relocation.

Social work research on the other hand reveals that social phenomena like racism, discrimination and oppression can play significantly causal roles in the emergence of depression. Individuals from different religious, ethnic and cultural backgrounds have often been subjected to discrimination in the UK. The decades after the closure of the Second World War witnessed a large influx of people from erstwhile British colonies in Africa, Asia and the Caribbean into the UK. Such immigrants, many of whom came to the UK to escape from lives of poverty, hardship and violence in their home countries, were often subjected to various degrees of oppressive and discriminatory treatment, both in the workplace and in the community.

Such discriminatory treatment manifested itself in areas of employment, education and access to public facilities. Immigrants were treated differently and subjected to discrimination because of their lack of familiarity with the English language, their different physical appearances, religious traditions, cultural and social habits and their clothes. Such discrimination sometimes assumed distinctly undesirable dimensions like in the case of Christopher Clunis. A mentally disturbed person of African origin, Clunis murdered Jonathan Zito, a young white man, at a tube station in 1992.Whilst subsequent enquiries revealed that Clunis was mentally disturbed and he was subsequently institutionalised, the British media built up a picture of Clunis, (as a large, clumsy, unkempt and violent man), with strong overtones of racism. The numerous incidents of discrimination and ill treatment of persons of Asian origin in the USA after the September 11 attacks reveal racism and social discrimination to be a latent phenomenon that continues to work under the surface in societies and surfaces in response to different types of provocation and perceptions.

Immigrants and their families even today have much poorer levels of education, income, health and public participation than members of the mainstream white majority in the UK. Maya is a first generation immigrant who was uprooted from her familiar North Indian environment when she was still in her teens and thrust into alien surroundings; she was unfamiliar with the local language and found it extremely difficult to communicate with others. Her social life was perforce restricted to the local Indian community in east London, which itself was very small when she came to England. Her husband and children, who had to adjust to the local community and its demands and expectations in order to survive and enhance their life chances, would have in all likelihood faced numerous incidences of discrimination and oppression over the course of their lives.

Maya’s domestic problems were also intensified because of her compulsion to stay with her husband’s parents, a tradition that is still widely followed by the Asian community in the UK.

Depression among Women from South Asian Communities in the UK

A number of social work surveys and studies indicate that the incidence of depression is significantly high in South Asian women. Whilst such women originate from a large and ethnically diverse area that comprises of India, Pakistan, Sri Lanka and Ceylon, many South Asian women suffer from similar causes for mental depression. Fenton and Carlsen, (2002) state that the main causes for depression amongst such populations are experiences of racism, family difficulties, financial problems, poor physical health and lack of employment. Women from these communities experience excessive mental pressure on account of community influence and reputation. Some of them have to cope with unsuitable marriages and unhappy relationships with their in-laws. Such circumstances create enormous difficulties and life challenges and moreover do not provide any avenues for escape. Some women have described how their families and the larger Indian community made them feel inadequate and repeatedly impressed upon them that they were failing in meeting their familial obligations. Such women also feel pressurised because of social isolation, lack of friends and acquaintances, inadequate education and stressful living conditions.

The case study reveals that Maya has often been subjected to stress because of her difficult and strained relationship with her mother in law. It is also evident that the option of setting up home independently was never explored by her husband. It needs to be noted that whilst joint family living is common in South Asian communities, it is also often economically necessary because of straitened financial conditions and the additional costs that are likely to be incurred if children opt to live separately from their parents.

Depression evidences itself in symptoms like change in eating and sleeping habits, lack of interest in normal daily activity, withdrawal from children, family and friends, overlooking of necessary activities at the home and outside and finally self destructive tendencies. Depressed people are prone to self harm and develop suicidal tendencies. Maya suffers from irregular sleeping habits, often sleeps late at night, gets up late in the mornings and is sometimes unable to cook for her family. She has reduced her interaction with outsiders and is becoming distant from her immediate family. She often suffers from headaches and cries for no reason. Such manifestations and symptoms constitute strong reasons for addressing depression in an elderly person like Maya.

Not treating depression can place her and other older people at increased risk for additional physical and mental health problems. The disinclination to get out of the house and exercise can increase her hypertension, lead to diabetes and faster deterioration of the heart, lungs, bones and muscles. It can also lead to deeper, debilitating depression.

Implications for Social Work Theory and Practice

Social work theory and practice is fundamentally concerned with the improvement of the social and economic circumstances of disadvantaged individuals and groups and the challenging of oppression and discrimination in all its forms. Systems theory in particular, whilst abstract in nature and not applied systematically, has helped social workers to move from linear and causative medical models to significantly greater multi-causal contexts for the understanding of human behaviour. General systems theory provides a conceptual scheme for realising the interactions among different variables, rather than by reducing behavioural explanations to one reason.

This is clearly evident in the area of mental health, where depression in people and their resultant behaviour is associated with a number of interacting social, biological and psychological factors. Systems theory requires social workers to examine the multiple systems in which people interact. Assessment of mentally ailing persons will for example require social workers to obtain information from different sources and place them in appropriate family and community contexts. Knowledge of social constructionism theory on the other hand enables social workers to realise how language has been used by medical experts and other dominant groups to build up images of the mentally disturbed as people who cannot look after themselves and their families and who need to be treated by medical “experts”.

Modern society’s perceptions about mental illnesses are significantly shaped by medical models, which state that medical ailments represent serious conditions that can make it hard for persons to sustain relationships and engage in employment. They can lead to self-destructive and even suicidal action (Walker, 2006, p 71-87).

Social constructionism theory states that such perceptions are built by purposely developed vocabularies of medical models, which are bursting with complex nomenclatures for mental ailments and fixed on deficits. Walker, (2006, P 72), argues that vocabularies of medical models, including that of mental illness, are social constructs, comprising of terms that detail deficits and view humans as objects for examination, diagnosis and treatment, much like machines. Such perceptions result in treatments that is focused on removal of symptoms and do not take account of actual client needs (Walker, 2006, p 71-87). Social constructionism can assist social workers in realising the disparaging chimeras that have been built by existing medical models about the mentally ill.

Social workers must also be informed by the theories of oppression and discrimination that condition and shape the behaviours of people, both the oppressors and the oppressed, towards poor, isolated and disadvantaged segments of society. Neil Thompson’s PCS theory of oppression (2001), states that oppressive and discriminatory attitudes in people are socialised over the course of their life by three strong influences, namely personal perceptions and cultural and structural influences. Personal perceptions about the mentally ill can arise through reading about such people, viewing them on cinema, thinking about them and other such associated activities. Cultural influences comprise of numerous cognitive inputs from school, friends, family and the larger community about the mentally ill and unstable. Structural influences arise from the various embedded factors in the larger environment like their lack of fitness for employment and their need to be bodily restricted. These PCS factors shape the minds of individuals and build up strong discriminatory attitudes that rest below the surface and are manifested in various ways. The media outrage over the Clunis incident and the construction of the person into a larger than life image of a socially dangerous person represents the way in which such discriminatory attitudes can often shape the behaviours and actions of people.

Chew-Graham et al (2002), state that whilst the incidence of depression among South Asian women is significantly higher than the national average, such women faced numerous barriers in accessing social services because of internal and external barriers. Whilst internal barriers occurred because of family structures and community pressures, external barriers happen because of their unfamiliarity with English, difficulty in communicating with local social services departments and the disinclination of social workers to come to their aid. Services thus tended to be accessed only at points of desperation if at all and increase the tendency of such women to engage in self destructive activities. Dominelli (2002), states that discriminatory attitudes are deeply embedded in the existing social work infrastructure and can be eliminated only if there is a genuine and widespread feeling among social workers to do so. The labelling theory states that the self identity of individuals is often determined by the terms that are used to describe them.

During placement, I worked for a charitable, voluntary organisation that supports Asylum Seekers who were destitute. For the purpose of this essay, I will utilise a pseudonym for the client, which will be Sam, to ensure that her confidentiality is maintained. Sam has authorised consent and confirmed that I may use her experience as material for this essay. I have chosen to examine this intervention as it is based upon this service user’s presenting issues upon point of contact. Firstly, I will explain the background of Sam’s situation, to give you an idea of her story, and outline the agency involvement giving a brief description of the context and setting for their work, which will include relevant legislation and policies. Secondly, I shall discuss a substantial piece of work where I have met Sam on a number of occasions whilst working at the agency and demonstrate my theoretical understanding of critical reflection that took place during this intervention. Finally, I will discuss how my own values informed the work I undertook with Sam and will demonstrate critical reflection and the skills applied during this intervention and what I had learnt through this process. Furthermore, I will discuss how this had impacted on my own identity in practice and the effectiveness and the outcomes from this intervention.

Sam is a 31-year-old woman who entered the United Kingdom (UK) on a work-visa in May 2009 from South Africa. She is of a South-African ethnicity and has faith in Christianity. She is an intelligent, resourceful woman who has more of an advantage in terms of communicating articulately in English over some of the other clients I have met; who do not acquire the basic English language. This made communication effective and according to the National Association of Social Workers (NASW, 2000) it has been stated that “Cultural competence is a set of congruent behaviours, attitudes and polices that come together in a system or agency or among professionals and enable the system, agency or processionals to work effectively in cross-cultural situations” (NASW, 2000). Sam entered the UK with leave to remain until May 2010 on her work-visa, with no recourse to public funds, which means that people who are under this bracket are not entitled to receive help from the Government.

Furthermore, at point of contact Sam was pregnant and was in receipt of Statutory Maternity Pay (SMP). SMP is a contributory benefit based upon National Insurance contributions that Sam had prior paid whilst engaged in full-time remunerative employment. As such, it is not classified as a public fund as Sam was therefore at liberty to claim and receive this benefit irrespective of not being a UK citizen. According to the Department of Work and Pensions (DWP,2009) SMP is paid for a maximum period of 39 weeks, and unfortunately remaining Social Security benefits and associated support such as Housing and Council tax benefit were not available to her as they are classed as public funds. I was concerned from a safeguarding perspective as to Sam’s welfare, especially keeping mindful that she was pregnant and that the weekly rate of SMP, ?123.06, would be insufficient for her to meet priority needs such as rent, Council Tax and subsistence/living costs (DWP, 2009).

The initial referral came from a caseworker who works for the agency and at the Children’s Centre. The agencies work in partnership. He approached me and raised concerns with safeguarding issues as mentioned above. However, a referral had to be made before the agency would accept Sam as destitute. It was essential that the referral was made as the agencies policies stated that they could only accommodate 4 people at one given time in the houses they owned across the City. The agency I worked for worked across two settings and worked in partnership in the City. It provides short-term respite accommodation for homeless and destitute women and men. Sam’s circumstances were unique as unlike other residents, she did have a source of financial income, whereas many women did not have a fixed income and had to rely on charitable donations. However, in recognition of the fact that Sam was imminent to give birth and was homeless, the agency agreed to admit her in the short-term in the first instance, thus offering her security, shelter, food, water and safety temporarily. In the longer term, she was afforded a short-term licence agreement that ran until the 2nd December 2009. The agency was of the view that Sam would have to explore other avenues of support and accommodation. I advocated this procedure to Sam in a house meeting and found that she had yet to find alternative accommodation. I understood she was pregnant and that she was not sure where to start looking or what resources were available. I went back to the office and explained this to the agency. I researched and made phone calls on how I could advocate further help for Sam and made the support worker and colleagues aware that she was concerned about her well-being and from this knowledge, a panel meeting was arranged and the licence agreement was later extended until the 12th January 2010 due to the birth of Sam’s daughter.

According to Cohen (2004) he states, “All persons have a right to well-being, to fulfilment and to as much control over their own lives as is consistent with the rights of others” which means that as every human being has fundamental values that they should be treated with respect and as individuals regardless of their circumstances. At point of contact, Sam was destitute, as she had separated from her boyfriend, who resides in Ireland. Sam had been residing as ‘hidden homeless’ which means that there is no accommodation that she is entitled to reside in or it is not reasonable for her to continue residing in that accommodation (www.crisis.org.uk, 2008). She was living in the City on a friend’s couch, but had been asked to leave due to objections with the friend’s landlord and overcrowding. It became apparent that Sam would require her own accommodation to return to following discharge from hospital once her baby had been born, and tenable longer-term accommodation thereafter. I met with Sam and built up a good working with her following the referral to the agency. I felt this because Sam would contact me at the office if she had any queries about the house and would ask for me if she wanted help or advice. We negotiated convenient times to attend house meetings and I felt she trusted me as she opened up about her personal experiences such as her experience with her ex-partner.

According to Howe (2008) ‘relationship based practice is when relationship-gifted workers are interpersonally skilled and they make the most effective and human practitioners, whether the basis of their practice is behavioural, cognitive, task orientated, psychodynamic or person-centred’. Moreover, Trevithick (2003) argues ‘relationship-based practice is at the heart of social work’. I felt working with Sam in a crisis intervention enabled me to engage with her as I aimed to reduce her stress by communicating effectively the next steps and open and honest with how long she would be able to reside at the accommodation the agency provided her with. I was genuine with her in terms of stating what the agency could provide her with and what resources were available. For example, Sam needed a pram, so we organised one for her and I reminded the support worker to drop this item off at the house as she had access to a vehicle. I also made her aware of the challenges she may face by living independently once the Social Services department provide her with an assessment and if accepted, I discussed the benefits that may be available to her, so she was aware of the process. This demonstrated significant levels of emotional intelligence, which means, “having self-awareness, emotional resilience, motivation of self and to instil in others. It also recognises the skill to have empathy and sensitivity, to be conscientious and intuitive regarding decision-making and also to know how influences and building up rapport with service users are important” (Goleman, 1996,p.2).

As cited in the British Journal of Social Work, it also underpins requirements for practitioners “to develop and maintain effective working relationships, to be able to reflect on my own background experiences and practice that may have an impact on the relationship” (Morrison, 2007, p.2). For example, recognising to self-disclose about my own independency only when it was necessary as I did not want to project or share my own values unnecessary as Sam’s circumstances were unique to her and I understood that I could empathise with her however, only she would know how she feels in this situation. We discussed her feelings and she stated she was concerned about herself and her daughter, so I reassured her by getting in touch with the caseworker who had made the appointment with the social services for an assessment and to re-confirm when this would be conducted in order to see if she is eligible for the resources available. I explained the procedures to Sam, and she understood. She expressed her gratitude to myself and the agency.

As I met Sam on several occasions at the agency and on the day that she was accommodated into the house. I began to analyse her situation in greater detail because we needed to get her involved in the decision-making process. This means that service users are informed and involved in the decision that are made in partnership (O’Sullivan, 2005,p 135-136) and the effective way to do this, was to hold house meetings and discuss her accommodation situation in a comfortable setting. Saleebey, (2006,p.108) informed my practice in this intervention as he supports an empowering approach to social work practice as it focuses on clients strengths and potential rather than on the disadvantages and the misfortunes of their circumstances. He also recognises that the social worker is viewed as the ‘expert’ and that service users are viewed as the ‘victim’ of their own disadvantage. However, as his strengths perspective challenges the traditional anti-discriminatory and anti-oppressive practice it identifies aspects of structural inequalities as the significant element of clients situations.

Furthermore, Saleeby (2006, p.108) states the strengths perspective challenges clients to acknowledge that the social worker will represent them in the assessment and the intervention process as the social worker is viewed as the expert, however it also attempts to work in partnership with service users to support and gain services to meet their identified needs. The strengths perspective also focuses on the resilience of service users and aims to provide strategies to empower and promote positive outcomes for them. Furthermore, Beresford (2000, p.108) argues this perspective as viewing the service user in a one-dimensional aspect, which reduces their identity to essential categories such as ‘elderly, disabled or black service users’, thus resulting in the support of universal services to meet their needs. He also argues that service user’s and oppressed groups should be involved in the design and delivery of their services to meet their identified needs and that service user’s voices should be used in structure of theory and practice.

I felt that the strengths perspective engages with Sam’s circumstances as the agency and I were the expert in providing the assessments and advice for Sam and worked in partnership with her to find her a possible outcome because the caseworker had contacted the Social Services and had an assessment booked in for her. He informed me about this and I contacted Sam and made her aware of the appointment and the assessment procedures.

Criticise the above and get evidence to state that another theorist states the su is the expert.

Concerning critical reflection, it is an integral part of social work as it is a route to provide efficient performance and enhances social work expertise (Adams, et al,. 2002, p. 1). They also critique that it enables social workers to question the knowledge and involvement with clients. During this intervention with Sam there were many occasions that professionals and I had to critically analyse Sam’s circumstances in order to develop a plan of action that would meet her identified needs such as creating opportunities for her to take herself and her baby to groups so she could interact with other mothers at the Children Centre.

Put in values/reflect on self/what I learnt from this process/impact on own identity

Furthermore, I had arranged appointments for her to seek assistance with her receiving help and advice in relation to her visa options with a caseworker who worked for the partnership agency. The partner agency dealt with all persons from abroad and people who required legal advice regarding their visas. The outcome was that she should return South Africa and then re-apply on another work-visa and or commence work again in the UK and then apply for the visa to be extended. Sam did not want to take up any of these options, as she did not have the money to leave her new born in a child care facility. She also stated she did not want to return to South Africa because her parents were not aware that she had a baby and because she is of a strict religious background. She stated that her parents were likely to arrange her marriage to an old man that she had said “no” to on several occasions when she was living in South Africa. It seemed her parents had power and control over her life.

Put in power and anti-oppressive practice theories hereaˆ¦ Values, non-judgemental, empathic

I discussed and arranging convenient house meetings to discuss her options in taking the next step. Therefore, I asked her to contact Right Move estate agents and private property owners to see if she can find herself long-term accommodation for her and her daughter. Adams et al (2002, p.1) states critical reflection can sometimes be transformed in our own understanding, thus changing the part of the situation by enabling the client and the professional to reflect on what has occurred. For instance regarding Sam, she did not want to call and arrange appointments because she stated when she initially looked for a room in a house share, that the landlord of the property stated that the tenants already residing in the house did not want a mother with a baby living at the property. Therefore, this disempowered her in seeking other properties. At the house meeting, after Sam and I had further discussions we looked online for flats and we found several studio flats she could rent. She did not want to make the phone calls, so in order to empower and enable her in doing this herself for today and future reference. I made the first phone call and then handed her the telephone as she did not have credits on her phone and encouraged her to query about the properties in the same manner I had done. She queried the availability of these properties, however after finding that the landlord wanted a deposit, one as to Sam could not afford, the only solution was to seek refuge from the Neighbourhood Office and present herself homeless. She would then be put up in a shelter. I learnt that this process was going to be challenging and more reflection on this matter would be necessary.

What is more, critical reflection can be ‘deconstructed and reconstructed’ to give us access in advancing our practice. Therefore, this continuous process provides good practice and development. Yip (2005) “encourages social work students to undergo self-reflection as it is a process for self-observation, self-evaluation, self-dialogue and self-analysis”. Furthermore, he states, “under the appropriate conditions social workers can reflect constructively which, results in enhancement”. Whereas, he also critics on the basis that if “social workers were under inappropriate conditions such as lack of supervisory sessions, hostile environments, then social workers would not be able to reflect constructively and this can create problems for the professional and personal development of the social worker”.

However, Schon, (1983) describes ‘reflective practice as a non technical, non rational process which means that he is keen to make sense of the relationship between professional knowledge and practice by knowing-in-action. This is when thinking is understood in what we do, also he states ‘reflective in action is where thinking is conscious but does not interrupt or actions’ and reflection on action is where thinking takes place after the event in order to understand our actions, predominantly in why we acted and what we learnt from this action’. Eraut (1995) critiques Schon’s theory as he states that “a practitioner cannot reflect in action as you leave the space, if not physically, certainly cognitively” Furthermore, Fook and Gardener (2007,p364) argue that critical reflection is the reflective practice which focuses on the power dimensions of assumptive thinking and therefore how practice might change social situations’. Although, Ixer (1999, p.513) argues this concept of critical reflection and argues whether social work programmes should be assessing reflection at all”.

Overall, reflecting on this intervention allowed me to assess and analyse Sam’s situation thoroughly because of her uniqueness to the agency as she had no recourse to public funds, which made it challenging in assisting her find her own solution. However, communicating effectively and working in partnership with her and the agency employees empowered Sam in coming up with a resolution for her to follow through. As social work, values have unique contributions to social work practice and assessing critically ensures that social work perspective and social work values contribute fully to the provisions of care. Furthermore, the ability of social work will depend on more than knowledge and skills; it is also about recognising practice that is mutually required in negotiating

work with various organisations and professionals. Moreover, the ability to effectively communicate and contribute will also depend on the self-esteem and the status of the social worker. In addition to this, being able to effectively research and apply effective education will be found more reliably in the ability to improve the quality of the service users and carer’s experience of assessment and it’s outcomes. This is because professional competence in assessment requires critical analysis of self in practice and these development of skills and knowledge base are required to become an emotionally capable, objective practitioner.

This assignment will discuss the case study given whilst firstly looking at the issues of power as well as the risk discourse and how this can be dominant within social work practice. Further to this a task centred approach will be explained and how it could be used when approaching this case study. Finally the strengths perspective will be explored and how this could effect change, and bring about social justice principles.

Thompson (2000) discusses that power can be a complex issue that operates on different levels. He further discusses that many service users who come into contact with social services are generally in a relatively low position of power, and that this could be due to, for example; social divisions such as, class, race, ethnicity, gender, or religion.

When looking at issues of power, it could be said that Ms. Evans who defines herself as Asian is being oppressed by many power differentials that would need to be considered. For example; Ms. Evans is currently living in naval married quarters and feels she has not been accepted into the community. It could be argued that she is living in a predominantly male domineered, white environment. Thompson (2000:56) highlights patriarchal ideology and how male dominance ‘serves to maintain existing power relations between men and women’, he also highlights how we should ‘resist the pressure to make people conform to ‘white malestream’ norms’ (Thompson 2000:141).

Healey (2005) discusses anti-oppressive practice and how this looks at the personal, cultural and structural objects that can shape the problems that service user’s experience. Healey (2005) further discusses that through anti-oppressive practice social workers aim to promote service user empowerment by encouraging them to talk about and share their feelings of powerlessness, to help them understand how cultural and structural injustices can shape their experiences of oppression. Therefore when working with Ms. Evans and her family I would need to incorporate anti-oppressive practice in order to empower, and enable her to share with me her feelings and experiences of powerlessness in order to gain a better understanding of the families situation.

However Thompson (2000) highlights, social work intervention involves the exercise of power, which if used negatively can reinforce the disadvantages that service users experience. Used positively however power can help to enhance the working relationship, the outcomes, and empower the service user, as Healey (2000:202) writes ‘postructuralists see power as an ever-present and productive feature of social relations’, and Foucault cited by Healey (2000) highlights the need for us to recognise the productivity of power, and argues that by focussing on power as only being oppressive ignores the positive dimensions of power.

Ms. Evans has been referred to social services via the Health Visitor; this could be making her feel disempowered and nervous about the forth coming intervention of social services. Therefore when working with Ms. Evans and her family I would have to recognise the power imbalances between us, (Thompson 2000). I would need to be sensitive to the issues of power and imbalances by being clear with Ms. Evans on my role and purpose, explaining professional boundaries and responsibilities (Trevithick 2005). I would also need to consider my use of language and how as Dalrymple (1995) cited by Healey (2000:184) explains ‘the way in which language can reflect power differentials and have an impact on the people with whom we are working’.

As well as recognising power issues and imbalances, as the social worker l would also need to undertake a risk assessment. As Thompson (2000) highlights, to assess the degree and nature of any risk to which Ms. Evans and her family could be exposed to. Assessing exposure to risks or a person, who is vulnerable to it is central to assessment within social work practice (Davies 2005). Stated in the Codes of Practice, ‘as a social care worker, you must respect the rights of service users while seeking to ensure that their behaviour does not harm themselves or other people’ (GSCC 2007:4). This includes ‘following risk assessment policies and procedures to assess whether the behaviour of service users presents a risk of harm to themselves or others’ (GSCC 2007: 4.2).

Therefore when working with Ms. Evans and her family I would need to be aware of my organisational and statutory duties as there are substantial policies, guidance, and frameworks to inform my practice on risk assessment. When working with children and families as Brayne (2005) highlights, I would need to be aware of the law, which under the Children Act 1989 states; my primary responsibility would be when working with Ms. Evans and her family to that of the child, or children.

Ms. Evans has stated that on occasions she and her family have experienced verbal abuse, which would need to be investigated further to decide on any risks this may pose to the family. However she has been described by the Health Visitor as suffering from post natal depression, and finds it difficult to care for her children, aged seven, five, and a ten week old baby who has spinal bifida. Therefore it could be said that my primary statutory concern would be, to what extent is her post natal depression effecting the care and welfare of her children, and does this pose any risks that need to be identified.

Risk assessment and the management of risk have become dominant in all areas of social work. Kemshall (1997:123) cited by Davies (1997:123) highlights that within social work risk assessment and risk management have become key issues and are often central in the decisions, ‘to allocate resources, to intervene in the lives and choices of others or to limit the liberties of activities of clients’. Risk assessment has become a dominant discourse within social work ‘because social workers are employed within a risk society, which searches for ways to identify and manage risk effectively’. (Higham 2005:182)

However as stated in the codes of practice, social workers should also ‘recognise that service users have the right to take risks, and help them to identify and manage potential and actual risks to themselves and others’ (GSCC 2007: 4.1). Higham (2006:182) discusses how ‘service user’s strengths that are likely to diminish the predicted risks’ should be assessed in keeping with the social work value of empowerment. Pritchard (1996) cited by Davies (1997:124) discusses how service users should not be denied the opportunities to take risks or exercise choice, and states that, ‘risk-taking is an important feature of all our lives’ (Davies 1997:124). However, as Thompson (2000) explains, the balance between care and control within social work can be difficult to maintain.

By approaching this case with a task centred approach would as Healey (2005) explains, mean focussing on enabling Ms. Evans to make small and meaningful changes in her life, that she has recognised, acknowledged and wanted to work on. Coulshed (1998) highlights that within this approach the service user is the main change agent, helping the worker to assess what the priorities for change ought to be. She further explains that because the worker is as accountable as the service user in carrying out agreed tasks this lessens the sense of powerlessness that the service user maybe feeling.

A task centred approach works on a specific set of procedures whereby the service user is helped to carry out problem-alleviating tasks (Coulshed 1998). Healey (2005) explains that it consists of the pre-intervention stage, followed by four sequential but overlapping steps. Therefore firstly I would need to understand and establish the source of referral (the Health Visitor) and negotiate with them any expectations and views. However as Healey (2005) states, by understanding the views of the referring agency does not mean that this has to be the focus of work, as I would need to work with Ms. Evans on defining the target problems.

Mutual clarity between Ms. Evans and me would need to be addressed, discussing any limits or boundaries, explaining confidentiality, my role, as well as any legal or other obligations. Working in collaboration with Ms. Evans I would seek to explore and prioritise Ms. Evans views of her problems, as the service user involvement in identifying the target problems are ‘critical to concentrating their efforts on change’ (Healey 2005:119). Epstein and Brown (2002) cited by Healey (2005) suggest a maximum of three target problems, as it is not necessary to address all problems identified. Success in a few can have a ‘knock-on effect for other problems in a service user’s life that may enable them to live with these problems or to deal with them’ (Healey 2005:113).

However as Healey (2005) writes, although within a task centred approach the service user’s definitions of their problems should prevail, in circumstances where the worker is duty bound to insist on considering certain problems, or a judgement has been made of a potential risk that the service user may pose to themselves or others, than these issues should be clearly raised.

An explicit agreement (contract) would need to be mutually clarified. This would include times, location of meetings, and detailed information on the goals of intervention, whereby the service user should be responsible for deciding the order in which problems should be addressed (Healey 2005). It should also include any goals the social worker has on behalf of their agency or statutory duties. For example when working with Ms. Evans, goals for intervention might include her health status to be investigated in relation to her post natal depression.

As well as this a statement of tasks would be listed to address target problems and to develop the service user’s problem-solving skills (Healey 2005). This is the key intention of task centred practice, ‘hence we must resist any temptation to do ‘for’, rather than do ‘with’ the service user’ (Healey 2005:122). An example of one task could be; Ms. Evans to gain more information on spinal bifida and then forward this to her partner, as she feels that he has not accepted their daughter’s condition, and this could be a fear of the unknown.

In supporting Ms. Evans in her task performance I would encourage, and help build on her strengths maybe through rehearsing set tasks with her in the form of role play (Healey 2005). This would enable for any strategies necessary to be put into place to help Ms. Evans overcome any obstacles that she may feel could hinder the completion of a certain task.

Task centred practice is a systematic process, therefore throughout my work with Ms. Evans I would need to regularly review performed tasks in order to acknowledge any gain made, as well as address any tasks that have not been performed. This would give me the opportunity to address any issues with Ms. Evans and to explore ways if deemed necessary to revise our contract.

Finally integral to the task centred structure is the need for a well planned termination. Healey (2005:124) writes that a ‘clear and looming deadline is vital for concentrating worker and service user efforts on change’. Within the termination meeting I would review with Ms, Evans the overall progress of our work, and how in the future she might maintain any progress that has been made (Healey 2005).

Healey (2005) explains that a task centred framework provides a ‘shell’ in which other theoretical perspectives can be incorporated. Incorporating a strengths perspective would, like task centred practice focus on, building a ‘service user’s capacity to help themselves’ and ‘to promote a mutual learning partnership between workers and service user’s’, (Healey 2005:158) keeping within the social work values of empowerment, respect and service user self-determination. According to Healey (2005) the strengths perspective concentrates on enabling service users and communities to work towards their future hopes and dreams, rather than looking at past or present problems.

Saleeby (1997:4) cited by Healey (2005:152) states that the strengths perspective formula is straightforward, where workers are required to ‘mobilise’ service users strengths in order to enable them to achieve their goals and objectives, which would lead to the service user having ‘a better quality of life on their terms’ (Healey 2005:152). Some of the key assumptions of the strengths perspective are, ‘all people have strengths, capacities and resources’, and people generally demonstrate resilience, rather than pathology when facing adverse life events. (Healey 2005:157).

Healey (2005) discusses the practice principles and how the social worker should adopt a positive and optimistic attitude towards service users, working in partnership with them so solutions to problems are developed collaboratively. Healey (2005:162) further states that the formation of a good working partnership can increase ‘the resources available to solve the problem at hand’. Therefore when working with Ms. Evans I would focus on listening to her story, identifying her capacities, strengths, and resourcefulness which could contribute to positive changes. I would clarify any strengths with her as Healey (2005:162) explains, service users ‘can grow when others particularly ‘helpers’ actively affirm and support their capacity to do so’.

My role as the social worker would be to facilitate Ms. Evans capacity to acknowledge, and use existing strengths and resources which would enable her to develop new ones. These strengths could be for example; the skills she has developed from parenting, most of which due to her partner being in the Navy she may have done independently. Ms. Evans defines herself as Asian and that Islam is important to her, therefore, another strength could be that of adaptability, and having the inner strength to explore new experiences, as she may have moved from an Asian community to be with her partner in the naval married quarters.

According to Saleeby (1996) cited by Healey (2005:164) ‘belonging to a community is the first step towards empowerment’. Therefore by working towards social justice principles I would explore with Ms. Evans what formal and informal help was available to her within the community. For example, a mother and toddler group, which would enable her to become part of the community that she feels she has not been accepted into. Healey (2005:164) explains ‘community support can build and draw on the capacities of service users to help themselves and to help others’.

I would also discuss with her the help she is already receiving in relation to her baby and her diagnosis of spinal bifida, which could mean the family are entitled to both financial and practical help. This could include a family support carer to give some respite, which would allow Ms. Evans some time to pursue her own interests, such as her religion. Further to this I would need to recognise any strengths and assets within Ms. Evans social networks, such as people she may feel can be supportive, maybe discussing with her possible personal support from family and friends (Healey 2005).

In conclusion this assignment has discussed the issues of power and how social workers need to be sensitive to and recognise power imbalances. .Following this, risk discourse has been explained, as well as a task centred approach to the case study. Finally the strengths perspective was incorporated which focuses on the capacities and potentialities of the service user.

Wales is a diverse country with its own national identity, language and multicultural society, however Wales also has defined issues. Within the following assignment I plan to look at the impact of poverty, discrimination and social exclusion within Wales and the role of the social worker in addressing these issues. I will then explain the role of anti-oppressive practice in creating social inclusion.

To understand the impact of poverty, discrimination and social exclusion I need to explain what is meant by these issues. People often think of poverty and social exclusion as a financial issue which affects people who are unemployed living on benefits but in reality it encompasses a far wider range of individuals (The Bevan Foundation 2009). Definitions of poverty, discrimination and social exclusion vary but I think the definition given by European Commission covers the wide spectrum of issues. It states:

“People are said to be living in poverty if their income and resources are so inadequate as to preclude them from having a standard of living considered acceptable in the society in which they live. Because of their poverty they may experience multiple disadvantage through unemployment, low income, poor housing, inadequate health care and barriers to lifelong learning, culture, sport and recreation. They are often excluded and marginalised from participating in activities (economic, social and cultural) that are the norm for other people and their access to fundamental rights may be restricted.”

Wales is the poorest country within the United Kingdom, due to the closure of much of its industry causing high unemployment, cuts in public spending, benefit changes and an aging population, it is thought that 600,000 approximately quarter of population live in poverty, even areas which are considered to be affluent are not as rich as many parts of the rest of the United Kingdom (Joseph Rowntree Foundation 2013). The Bevan Foundation defines groups of people within Wales who experience poverty, discrimination and social exclusion, these are ethnic minority groups, women, disabled people, children and young people and older people of pension age.

The BBC news and save the children have states one in three children in Wales live in a home earning 60% lower than the average income across the United Kingdom which is ?26000, as a result Wales has some of the poorest families who have stated they regularly go without food to ensure their children are able to eat and are finding it hard to purchase basis such as shoes and a warm winter coat. Some welsh parents on a low income have stated they are regularly stressed about money which impacts on their relationship with their children, this can have lasting effects on the child. Children who grow up poor are more likely to leave school without qualifications, have fewer life experiences, reduced aspiration, restricted ability to get a good job and can lead to lifelong problems with their physical, mental condition leading to shortened lives. Many of these families find themselves in the continual cycle of poverty and social exclusion, for example a child raised in poverty is more likely to leave school with low or no qualifications, which reduces employment opportunities available to them, which leads to low income which could lead to them living and bringing up their children in poverty and the cycle begins once again. These issues are then compounded by the discrimination of wider society who often view people living in poverty as ‘scroungers’ living off the state, this fed by the media reporting on people claiming large amounts of benefits and shows such as Benefits Street which the minority of people when the reality many people living in poverty are often working.

Poverty and social exclusion can be seen as an issue within large cities, there is a perception that only the rich live in rural areas, but these issues also affect Wales’s large rural areas. Pierson suggests exclusion within rural areas can be seen as an individual matter as people who currently living in poverty often live next door to someone whose home is their second or a multiple cars household, compared with people living in urban areas who live in socially deprived areas where their next door neighbour could be facing the same issues, taking this into account dealing with these issues could be harder to tackle. Pugh states it is often hard to recognising issues of social exclusion, poverty and discrimination within rural areas due to outsiders being unwelcome in smaller communities or due to the geographical areas of individuals. With the withdrawal or consolidation of services many services due to small amounts of people using them, many people are often left socially isolated. Pierson also suggests that people living in rural areas often face higher living expenses and they need to travel longer distances to purchases the basics. Young people living in poverty within rural areas often find themselves with low educational qualifications and a reduced or no opportunities for employment. Shucksmith suggests younger people and older people within rural areas often socialise more than in urban areas which can often influence their views on sexuality and social roles, this can cause discrimination or leave people unable to openly deal with l issues such as sexuality within the local community. Pugh states isolation within rural areas for people with mental health issues is often caused by peoples misunderstanding of their issues which can cause discrimination, people are often left not wanting to engage in communities where these views are present, this is often the views and experiences of homosexual men and women.

There is often an assumption within the care sector in Wales that most welsh speakers have the ability to speak English and therefore are able to receive services in English. As a result some areas of social care sector there is little or no provision for services delivered via the medium of welsh. Section one of the code of conduct ‘1.6 states respecting diversity and different cultures and value’ by not providing services for a service user in welsh the social worker is failing to meet the needs of the service user which could result in disempowerment. Welsh Government states in More than Just Words ‘Many service users are very vulnerable, so placing a responsibility on them to ask for services through the medium of Welsh is unfair. It is the responsibility of service providers to meet these care needs. Organisations are expected to mainstream Welsh language services as an integral element of service planning and delivery’.

Social workers continually addressing issues cause by social exclusion, discrimination and challenge them sensitively and constructively which is a fundamental part of their role. This is reflected in the code of practice written by the care council of Wales, throughout the code it states people must treat people as individuals and acknowledge peoples beliefs in cultures and values. The care worker must not:

5.5 Discriminate unlawfully or unjustifiably against service users, carers or colleagues

5.6 Condone any unlawful or unjustifiable discrimination by service users, carers or colleagues

Thompson states the social worker must understanding and recognise the significance of discrimination and oppression in service users’ lives and circumstances. Discrimination occurs on 3 levels (PSC) which are interlinked, P refers to personal or psychological, this looks at the individual’s thoughts, feelings, attitudes and actions, thoughts about specific groups within society are often based on people’s individual experiences. C refers to someone’s culture which impacts on how people do, think or see things, culture can be very influential on what people see as the ‘norm’ within society. The final letter S refers to Structural levels this is social division and power within society. Honer states the social worker must also understand groups and individuals can face discrimination which can be very different and personal.

The role of the social worker is multifunctional dealing with poverty, social exclusion and discrimination with emphasise on a holistic, citizen centred support which empowers people to take control of their lives while promoting social change (International Federation of social workers). Thompson sees empowerment on three different levels Personal, cultural, structural, I think this can also been seen with Dominelli as they state empowerment can be carries out on two levels. The micro level is the work the social worker carries out with the service user enabling them to take control of their lives, and the macro level is the work the social worker carries out within the wider community and challenging social policy by bring issues to the attention of relevant authorities or pressure groups, increasing the social and political power of groups which are oppressed. Unfortunately this can be lost within current targeted directed practice. People are encouraged to achieve their full potential and promotes coping strategies to ensure people succeed.

Pierson states when working with service users who are socially excluded, there are 5 building blocks required, maximising income and securing basic resources for service users and their families. The social worker needs to have a good understanding of the current benefits systems and keep up to date with any changes. Strengthening social supports and networks, working in partnership with agencies and local organisations, creating channels of effective participation for service users, local residents and their organisations. Focusing on neighbourhood and community level practice. Dominelli suggests creating power in oppressed groups by bring together people are oppressed by the same issues e.g. single mothers, and giving them the power to speak up together.

Social workers have a responsibility of the law. The Equality Act 2010, The Disability Discrimination Act 1995 and the Human Rights Act 1998 are pieces of legislation which a social worker is able to use to address issues of discrimination, including disability, sex, race and religion when services are withheld.

Dominelli suggests oppression involves something which divides people into dominant or superior group and subordinate or inferior ones, this can result in the views and contribution of the oppressed being seen as invalid and the movements of the oppressed are often controlled by the dominate party.

To address oppression the social worker must work in an anti-oppression way which rejects oppression and the way in which it disables individuals. Anti-oppressive practice holds the view each individual, group or community are diverse, equal and able to achieve their full potential and create social inclusion. To achieve social inclusion the social worker must work in partnership alongside the service user, family, local community and with organisations who are able to provide support, address highlighted needs from a clear assessment process in a holistic manner to empower them using strength based practise. The social worker also needs to create a clear plan with agreed objectives and time scales within a person centred framework with regular reviews.

Dalrymple and Burke 2006 state:

Anti-oppressive practice is based on the belief that social work should make a difference so that those who have been oppressed may regain control of their lives and re-establish their right to be full and active members of society.

While promoting anti-oppressive practice it is important the social workers do not become accepting of any issues they continually deal with as there is a risk of seeing these issues as the norm when dealing with issues over a long period of time. Thompson also states the social worker must be aware of the power which can be held within the role and do not use this inappropriately when dealing with individuals who can be seen as being disadvantaged by their lack of power. The social worker must also ensure they do not reinforce any stereotypes or discriminatory roles such as people with a disability are unable to make choices for themselves or all women are responsible for childcare.

As can be seen there are issues which affect Wales, as part of it role the welsh Government has created specific strategies to deal with the economic and social issues which affect Wales, such as The Welsh Government document Tackling Poverty Action Plan 2012-2016 which outlines how the Assembly aim to tackle the issue of poverty. The plan has 3 main areas prevention, helping people into work and Mitigating the impact of poverty. It is the role of the social worker to implement some parts of these strategies and instigate social change by empowering service users. The role of social work within Wales is continually evolving due to changes in Government policy and social change, with the promise of further powers for the Welsh Government the future holds possible further changes to the role.

Abstract

This paper looks into the issue of poverty and social justice. The paper shows the contribution of poverty to social injustice. This is done by examining a social organization which fights poverty. This paper examines the City Team Ministry one of the many organizations which is helping to reduce poverty. The beneficiaries of the organization are interviewed to shed light on the issues of poverty. The questions used in guiding the interview are appended.

SECTION I

City Team Ministries was started by Lester and Pauline Meyers in 1957. It began as a feeding program. Four years later it expanded to include women in its feeding program and still later in 1069 merged with another ministry to bring on board homeless and troubled youths. In 1983 it changed its name San Jose Rescue Mission to City Team. In 1987 the churches in Philadelphia invited the City team to start national expansion to the East Coast. This was to serve the greater Delaware valley. The City Team Ministry records that this was the period that the full long term recovery program for men was started. Further the website claims there were continued increase in the number of the children and women who suffered from abuse, addiction, crisis pregnancy, abandonment and homelessness. To bring on board the women and children the city team ministry launched three programs three programs: heritage home and house of grace in San Jose and well baby program Philadelphia. The programs caused a lot of changes in the lives of the women ands children (City Team 2010).

The City Team International was launched in 1997 in an effort to broaden the City Team. In 2007 the name was changed to New Generations International. The New Generations International is specifically concern with training, equipping and coaching national leaders in 38 countries. This division cares people through the provision of compassionate services such food, clean water, education and medical services (City Team, 2010).

The City Team Ministry has a disaster response team which started in 1989. The first beneficiaries of this team were the victims of the Loma earthquake. Afterwards the team has responded to and sheltered the victims of the Hurricane Katrina and the tsunami in 2004. Since 2005 the response team has developed a four phase framework specializing in the long term recovery of communities affected by the major disasters (City Team, 2010).

The mission statement of the ministry is, “In obedience to Christ, passionately transforming individuals, their families and communities throughout the world” (City Team Ministry para. 4). The programs which are offered by the organization are as follows: rescue missions, men’s recovery programs, youth outreach, family programs and church advancement. These programs will be explained in a detailed way in the course of the paper (City Team, 2010).

Section II

I carried out an interview on clients served by the City Team Ministry. The interview was carried out after obtaining permission from the ministry authorities. Six classes of people were interviewed one from each program offered by the City Team Ministry. The fist person interviewed was a beneficiary of the rescue mission. This program is designed to offer a hot meal and a safe night’s sleep. The program offers temporary emergency care to the homeless. A young man who had just been released from prison was one of those beneficiaries of this program who was interviewed. He has an Islamic background and was headed to the streets after being released but bounced into the agents of the ministry who enrolled him in the program. For the sake of this paper he will be called 1A.

The second person to be interviewed (2B) was a black man an addict of drugs. He was a beneficiary of the men recovery program. He was not homeless but had been driven to the streets after being left by his wife who was the bread winner. The man in desperation turned to abuse of drugs. The program agents enrolled him in the program and slowly he was making some progress in recovering from drug use.

The third interview was carried out on a group of street kids. These kids had an arrangement with the City Team Ministry whereby they met every Saturday and Wednesday. In the meetings they hold bible discussions and are groomed to become better citizens. These kids operate under the youth outreach program. Some of the have already being taken off the streets and are attending schools. The kids are of various backgrounds. The fourth interview was carried out on a family which is a beneficiary of the family program. This program offers basic needs like clothes to the families which can not afford the basic needs and view them as luxuries. The last person interviewed was a lady around the age of thirty who had been abused and was pregnant. She was taken in under the women’s programs where she was taken care of through her pregnancy.

Section III

This section presents the results of the interviews carried out above. The interviews were guided by the questions appended in the appendix. The interviews focused on how the clients have experienced social injustice as a result of poverty. Through the interview it was also possible to assess how the macro conditions of the society may have impacted upon the poverty experienced by the clients.

Person 1A: Education

The first interview carried out on person 1A who had just been released from the prison having been charged with mugging. He was a sharp young man aged 27 years who answered the questions succinctly though he was well educated having just attended the elementary level education. He could not continue with studies because he could no longer depend on his family which actually needed his help for sustenance. He therefore pulled out of school to help his family meet the basic needs of life. Education which is a basic had turned out to be a luxury for him. This is one incident which clearly shows how poverty can easily cut short and change basic needs like education into a luxury irrespective of whether one is willing to continue studies or not.

Some macro condition of the society can equally contribute to making the access of these basic services a challenge (Kirst-Ashman, 2008). According to the National Academic Press (2001), “The U.S. system of education finance is characterized by large disparities in funding and opportunities” (National Academic Press para 1). This disparity makes attaining education in some region to be expensive. Expensive education coupled with poverty makes education almost unattainable. The property tax is basically used to sponsor the education at the district level. This means that a poor district will equally be unable to fund its schools leading to disparity in education among the districts. Another macro environment factor which may contribute to insufficiency education and therefore poverty is the attitude of some communities. Education is not taken seriously by some people especially in regions which have large numbers of poor inhabitants (National Academic Press, 2001).

Person 1B: Medical Care

The second person to be interviewed is labeled person 1B. This man was a victim of depression which led him to drug abuse. He had part ways with his wife who used to provide for the family and could not take care of himself therefore resorting to the streets. He looked as a man who was well built before. Before joining the men recovery program with the City Team Ministry he could not afford medical care being unemployed. He was sick on several occasions as he narrated but could not afford medical care. From the interview, the main reason he gave for not getting something casual job to work on was his ailing status. He also made claims that he could not secure a job in his status of health.

The interview with person 1B brings into limelight the issue of the access to health insurance. Health insurance is only accessible by those who are employed. Once one’s job is no more and being not in position to submit the required periodical premiums the coverage is frozen and attaining medical care becomes hard. With the exception of such programs as Medicare and Medicaid it becomes extremely hard for the poor people to access medical care facilities (Cellini, McKernan & Ratcliffe, 2008).

Street Youths:

This was the third interview which carried out. Some street kids who are beneficiaries of the youth outreach program volunteered to give information about their lives and the program they were enrolled in. The program offers a combination of youth activities and mentorship to youth especially those who are affected by the street ways of life such as drugs. From the interview carried out it was found out that the youths mostly lacked a source of direction and mentorship. Most of the youths interviewed under this interview group were willing to work on any casual job. A close cross examination showed that they lacked the presentation skills which would be quite necessary if they were to win the confidence of those they would work for.

Under this interview some macro conditions came into play (Kirst-Ashman, 2008). The first which was quite noticeable was the community. Some employers are likely to avoid employing individuals from some communities because of stereotypes which might be associated with them. For instance not all employers will be willing the street youths work for fears that they may steal from the workplace and cause some kind of conflict. The youths were mentored on presentation skills through the program offered by City Team Ministry.

Family

The fourth interview was carried out on a family which is a beneficiary of the family programs. This program is designed to help poor families have an access to basic necessities. This is done in form of giving the families quality second hand appliances, clothes and furniture. This has gone a long way to raise the standard of living of the families in the family programs. The family which were interviewed were able to live a comfortable life and invest money businesses which they could have spend buying the basic home necessities. Having a comfortable home environment is a basic for a family to concentrate on developing itself. This is quite significant especially for the parents who wish to see their children having a smooth life. From the family interview it was realized that children in a comfortable family set up are less likely to fall sick and have a potential of performing better in the schools.

This interview implicated that comfort at homes is a necessity which is vital in helping families fight poverty in by creating peace of mind. This helps the family members to maximally concentrate in their duties.

Abused Lady

The last interview was on a lady who was an orphan staying with uncle. The uncle sexually abused her for some times after which she decided to run away after learning about the women programs at the City Team Ministry. During the interview the lady appeared tormented by the acts of her uncle. She could not report the uncle to the police because she dependent on him for the payment of her college fee. When she could not bear it any more she run way terminating her studies and later realized that she was pregnant.

The interview brought to surface the social injustice which silently takes place without anybody being aware of them. In this case poverty created a forum which an elderly person advantage of and exploited a young person. Poverty could not allow the lady to report the person for fear that she could lose her college sponsorship.

Section IV

This section will look at the issues of poverty at large. According to Anup Shah (2009) the poverty is caused by both individuals and governments. He examines this in a global perspective. He starts by analyzing the causes at individual levels. Being lazy and making poor decisions are the two reasons he gives which contribute to poverty. This is true but the he fails to talk about the victims of circumstances who find being born in poor families where despite any wise decisions made it takes a lot time to escape poverty. This happens to most of the children born in the ghettos of America. They start life with no basic education and nothing as a heritance. With no education and no money wise decision almost become a vague idea though not in most cases. Street musicians have been known to rise from dust but it should be noted that this may not happen to everybody born in the street (Anup Shah 2009).

Anup Shah (2009) also brings in the issue of the corruption and unwise government policies. Corruption is predominantly responsible for poverty in the third world countries. In the U.S. government decision may make some region poor. For instance the federal government should come in to aid those districts which are in a position to support their own schools (Anup 2009). NCLB Act is one way the federal government is doing that but there should be more efforts to ensure that all the school age going kids are included especially in the poor regions. The government should adapt a friendly way of drug war techniques. Instead of just hundreds of youths to prisons they should find a way keeping these youths busy (Cellini McKernan & Ratcliffe, 2008).

Conclusion

Poverty and social injustice are two issues which seem to go hand in hand. Poverty creates a gate for many social injustices to be committed. This is so because poverty seems to handcuff the power of the people involved from shouting and demanding for their rights. Despite the many non governmental organizations which are fighting poverty across America, t he government has a responsibility in changing some of its policies which seem to foster poverty.

References

Anup, S. (2009). Causes of Poverty. Retrieved on February 4, 2010 from: http://www.globalissues.org/issue/2/causes-of-poverty

Cellini, S, McKernan, S. & Ratcliffe C. (2008). The Dynamics of Poverty in the United States: A review of data, methods, and findings. Journal of Policy Analysis and Management 27(3), 577-605.

City Team. (2010). City Team Ministry. Retrieved on 4th February, 2010 from: http://www.cityteam.org/about/programs/

Kirst-Ashman, K. (2008). Human Behavior, Communities, Organizations & Groups in the Macro Social Environment: An Empowerment Approach (2nd Ed.) Thousand Oaks, CA: Thomson.

Kissane, R. (2008). Teaching and Learning Guide for: Assessing Welfare Reform, Over a Decade Later, Sociology Compass 2(3), 1115-1126.

National Academic Press. (2001). Equity and Adequacy in Education Finance. Retrieved on February 4, 2010 from: http://books.nap.edu/openbook.php?record_id=6166&page=1

Appendix (interview questions)

1st interview (to person 1A)

Do you view education as basic need?
Given a sponsorship can you go back to school?
How do you think would you be if your family had enough money?
What could you have avoided if you had enough money?

2nd interview (to person 2B)

Give us your story?
How has the men recovery program helped you?
What do you think has kept you in poverty

3rd interview (to the street youths)

What are doing to get out of your current situation?
How have you benefitted from the youth outreach program?

4th interview (family)

How is the family program helping you to fight poverty?

5th interview (abused lady)

Why did you give in to be abused?

This essay will discuss what is meant by the term “Poverty”, how it affects individuals and the wider community as well explaining why it is important for Social Workers to have a clear understanding of these issues. By looking at the organisations in place in the UK, in areas such as education and health and social care establishments; this essay will demonstrate how the structures of these organisations both help and hinder Social Workers in their role and how it affects the workings of daily practice.

The UK has the oldest and biggest National Health Services in the world, so this essay will also go on to compare the provision in this country with that in the USA. As a first world country, the USA has an economy and culture not vastly different from that in the UK, which makes for some interesting comparisons of the care they both provide. Both the UK and the USA spend the same proportion of their annual budget on social services and education and have a similar rate of poverty.

Poverty is a common term which many people would define as simply being a lack of financial resources. This is a very constricted view which makes it difficult to determine how many people live in poverty because the definition is vague and subjective. To understand and measure poverty and its impact upon individuals and the community, it is important to define it further.

Instead of one main definition for poverty, sociologists have agreed there are two main types; absolute and relative poverty, as described by Giddens (2009). Absolute poverty is used to describe the inability to provide the basic human needs; food, accommodation and clothing, on a budget of around $1 US dollar per day. The idea of absolute poverty is a global one which can be applied regardless of country or culture and applies equally to people of similar ages and abilities. According to a recent study by UNDP (2010), as many as a third of the world’s population live in absolute poverty.

Due to the modern welfare state and benefit system in place in the UK today, no one is expected to survive on $1 per day. However, figures provided by The Poverty Site (2010) show that approximately 9% of the population in the UK have an income which equates to only 40% of the national median income. This has risen almost 7% in just over 20 years and suggests that poverty is on the increase in the UK. These statistics would also suggest that people living in the UK are affected by relative poverty as opposed to absolute poverty.

Relative poverty compares the income of individuals to the national or local average, and where it falls below 40-60% of that average, the individual is said to be living in relative poverty. There is still some debate about where the percentage rate should fall but many agree it should be 60% of the national median income (Giddens, 2010). This is referred to as the poverty line; those below this line live in relative poverty.

Certain groups of people are more likely to find themselves living in poverty, these include; children, women (particularly single mothers), people with disabilities, ethnic minorities and the elderly. Cunningham & Cunningham (2009), Giddens, (2010) and Llewellyn, et al (2008) all agree the reason these groups are more likely to suffer from poverty than other groups is a direct result of social exclusion.

Social exclusion is a term which grew in popularity in 1997 when New Labour was re-elected into government. Part of the pre-election campaign of New Labour was to tackle the root causes of the issues affecting those who were marginalised by main stream society (The Poverty Site, 2010). People, who for reasons including; age, race, gender and class are often denied access to service and opportunities making it easier to exclude them from society. This was evident when the BBC undertook a survey, and found that when considering job candidates, whose qualifications and experience were almost identical; those with a name traditionally given to people from non-white backgrounds were far less likely to be called to interview, proving that racism is still present in the workplace, (Cunningham & Cunningham 2009).

To tackle some of the inequalities present in mainstream society, New Labour introduced a number of initiatives and policy changes to improve the standard of life, these included;

The introduction of Tax Credits for families and individuals on low incomes,

Every Child Matters – a 5 point framework to improve the quality of life for all children,

Connections – an easily accessible advice point on a range of topics for young adults ages 13 – 19yrs,

SureStart – aimed at giving babies and young infants the best start in life by providing advice, drop in centres and child care for their parents.

People who face social exclusion often live in the same locality; council house estates for example, which tend to have a higher proportion of single parents and high rates of unemployment. These groups of people are frequently given negative labels, which over time can become self-fulfilling. For example, a young child growing up in a single parent family on an council estate as indicated above is more likely to be viewed negatively and given such labels as; ‘trouble’, ‘lazy’, ‘good for nothing’, which over time can have a detrimental effects upon the child who will begin to view themselves as the labels placed upon them (Llewellyn et al, 2008). This negativity can lead to an increase in truancy, which in turn will lead to a poor education and employment prospects, thus setting up a life in poverty (Mail Online, 2007).

According to Bebbington and Miles (1989), children from an impoverished background are 700 times more likely to be involved with social services than children from a wealthy background. This statistic alone shows how vital it is for social workers to have a strong understanding of the impact and experiences living in poverty can have. It is argued by Cunningham and Cunningham (2009) that many professionals in the social work field feel overwhelmed by the structural inequalities faced when tackling poverty, this tends to mean that poverty is dealt with on an individual case basis. Changes in policy, both at national and at local level can have an impact on poverty by the way services are implemented and delivered. As social workers are present at both the point of service and within the organisations where policies are made, it puts them in a prime position to affect change.

Understanding and recognising the factors that cause and keep poverty part of modern society will allow a social worker to understand how they can interrupt the poverty cycle encouraging positive change.

Placing some of the responsibility for poverty on society and within the structural inequalities that exist, can sometimes be viewed as taking responsibility away from the individual and the choices they have made, making them less accountable. A social worker should always maintain a positive and optimistic outlook and believe that despite the inequalities that exist, change is still possible regardless of the situation. It is important to understand how the education system and health and social care organisations are set up in the UK to recognise how this can impact the access to care.

Responsibility for education in the UK has become a devolved matter for each individual country and overseen by their own government. The Department of Education and The Department for Business, Innovation and Skills predominately oversee the education system in England, with involvement from Local Authorities. Since 2005/2006, Local Authorities are given a grant which is ring fenced for the purpose of education and with consultation from all schools under the Local Authorities control, the finance is distributed, (Department for Education, 2010). There are approximately 20,000 public schools in the UK; a growing number of these are faith schools, almost 7000 at present.

In addition to these state schools, there are a growing number of independent schools, almost 2600; responsible for the education of 7% of the population, (Independent Schools Council, 2010). There schools are funded primarily through tuition fees and in some faith schools, donations from the associated church. A large proportion of these schools are faith schools who do not take children outside the designated faith of the school within their catchment area.

Historically, health and social care has been provided by the private and voluntary sector. Until the introduction of the Poor Law Act 1930, the majority of care for those in need was provided by charities and the work houses. People who lived in poverty had to rely on hand-outs, if they were deemed worthy of charity, or would have to pay at the point of service. Often it was those most in need of the service that were unable to pay forcing them to go without. The Poor Law Act 1930 moved the responsibility of care from these sectors to the Local Authorities, who began to take over the work houses and Poor Law hospitals (Spicker, 2010).

The National Health Service was established in 1948 with the ideology that everyone should be entitled to the same level of health and social services which were free at the point of service. Today’s modern National Health Service is overseen by the Department of Health. The country is split into 10 Strategic Health Authorities who control the care provided by the trusts in its area. Care is split into two main areas, Primary and Secondary care. Primary care services include; GP’s, Opticians, Dentists and NHS Direct. Secondary care is acute health care and normally only accessed in emergency or extreme situations and includes; The Ambulance Trust, Emergency and Urgent Care Units, Mental Health, Care and NHS Trusts. (NHS, 2010).

The National Assistance Act 1948 called for Local Authorities to set up Health and Welfare comities, providing the first form of residential care. In 1970, The Local Authority and Social Services Act of the same year created the first Social Services departments including; children’s, welfare and mental health. (The National Archives, 2010).

The National Health Service remained largely unchanged until 1990 when the first major reforms took place. With the general population living longer, the cost of providing care was increasing and becoming unviable. The organisation of the National Health Service had also become unproductive and unyielding to those it was meant to help. Bureaucracy and red tape became the norm when trying to access any services or treatment.

The National Health Service and Community Care Act 1990 was the first step in the reforms to the health and social services departments. The introduction of the Purchaser/Provider split meant for the first time since the establishment of the National Health Service, government departments were no longer responsible for the provision of all services (Kirkpatrick et al, 1999). The reason for this was threefold; firstly, to lessen the financial responsibility of care provision, secondly, removal of public provision would allow the private and voluntary sectors to grow and expand, making the care market more competitive, and thirdly, to increase choice for service users. This act was also the start for a number of large care homes and institutions being closed and the care provided in the community.

The principles behind these changes were well intentioned; allowing people to be cared for within the community promoting independence and control over personal care. However, in reality what was offered were standard care packages and limited resources which did not deliver the true freedom of choice that was promised, (Llewellyn et al, 2008).

To supplement the care provided for under the new system, many people have turned to charities to help fill the gap left by the lack of financial assistance. Providing people with the finances to pay for their own care, rather than provide the care itself, has meant people are able to choose how and by whom the care is provided. Many people have chosen to pay friends and relatives for the provision of care rather than rely on agencies and strangers. For Social Workers, this gives an opportunity to think outside the box when producing care plans with individuals. In communities, people are now able to form groups and committees to address and tackle problems and difficulties to provide a tailor made solution. This not only gives people control over their own care but also encourages the community to take action and to help itself.

Although the UK has the biggest National Health Service in the world (NHS, 2010), the change in direct care provision and growing reliance on the private and voluntary sectors is more in line with the health and social care services in the United States of America (USA).

The USA has a minimalist National Health Service which provides the most basic of health care; caring for those on very low incomes and or in emergencies. Many people living in poverty will be eligible for “Medicaid” which is a healthcare programme paying for the whole cost of care, but poverty alone is not an automatic eligibility criteria. Many older people, 65yrs and over, are reliant on the “Medicare” system, which only covers 80% of the cost of care, the remaining 20% must be funded by other means. Anyone who is outside the eligibility for these benefits must pay for private health care insurance, unless it is provided for through employment, (US Department of Health & Human Services, 2010).

Another benefit provided by the USA government is food stamps; however this is being phased out and replaced by Temporary Assistance for Needy Families, which is a short term benefit aimed at getting families back on their feet, (US Department of Health & Human Services, 2010).

The health and social care system in the USA is structured much the same as the UK, in that the government provides each state (Local Authority) with a budget to spend on care. In addition to this, states in the USA are allowed to set its own tax rates on things such as Income Tax, Sales Tax and House Tax. The proportion of money put back into care differs between states, some providing a higher level of benefits than others.

The USA has a much higher dependency than the UK on voluntary organisations, namely the church; who provide care and financial assistance to those in their communities.

Comparing the UK and the USA, there seems to be a different attitude towards the provision of care. The UK system is geared up to help prevent poverty and social exclusion, whereas the USA system is designed to help people get out of poverty but placed a bigger reliance on the individual helping themselves. Both systems are becoming more reliant on the community, voluntary organisations and the private sector for the provision of care; lessening the financial burden on the state in the face of an ever aging population. Both countries seem to be unified in the attitude that people should “help themselves out of poverty”.

Although the role of the Social Worker will always be required, there is a strong shift in the role from the provision of direct care to one of care co-ordination. To provide the best possible level of care for both individuals and the community, Social Workers must maintain a high level of knowledge of both statutory and non-statutory providers of care and how best to access them.

This essay has demonstrated that poverty is a global problem which is maintained by the way society works by socially excluding people and keeping them impoverished. It has also shown how two similar countries differ in their approach to care; the UK government provides the majority of care with assistance from charities and the private sector, whereas the USA government provides only the most basic forms of assistance which a strong reliance on the church, charities and the public sector. Both countries are in agreement that with an increasing older population, each government needs to do more to lessen their contribution to the provision of care. During this time of change, Social Workers will need to find a way of providing the best possible care for those in their charge.

Introduction

Malnutrition is the underlying cause of every one out of two deaths in children under 5 years of age.

Bryce J, Boschi-Pinto C, Shibuya K, Black RE, and the WHO Child Health Epidemiology Reference Group. WHO estimates of the causes of death in children. Lancet 2005; 365: 1147-52.

It is a largely preventable cause of over a third-3.5 million- of all child deaths. Four-Fifths of undernourished children live across 4 regions-Africa, Asia, Western Pacific and the Middle East-. These are high priority nations for action. The first of the millennium development goals was “to half between 1990 and 2015 the proportion of people who suffer from hunger.”

U.N.Mellinium Project 2005. Halving hunger:It can be done. London and Sterling, VA:Task force on hunger, 2005.

Nutrition is a neglected aspect of child health which is not justifiable as we know that it is a major risk factor for disease.

Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJL. Global and regional burden of disease and risk factors, 2001:systematic analysis of population health data. Lancet 2006: 367:1747-57.

Inappropriate feeding practices and their consequences are major obstacles to sustainable socioeconomic development and poverty reduction. Governments will be unsuccessful in their efforts to accelerate development in any significant long-term sense until optimal child growth and development, especially through appropriate feeding practices, is ensured.

WHO Global Strategy on Infant & Young Child Feeding Report of the Secretariat 55th World Health Assembly, April 2002(5)

The indicator by which progress is measured is the prevalence of underweight in children under five, specifically, the percentage of children aged 0-59 months who fall below minus two standard deviations from the median weight for age of the standard reference population.

http://www.unicef.org/progressforchildren/2006n4/index_undernutrition.html

World Bank Report on 11th May 2006, there is a dominant focus on food supplementation that detracts from aspects that are more crucial for improving child nutritional outcomes, such as improving mothers’ feeding and caring behavior – For example, only 40 percent of Indian mothers practice exclusive breastfeeding.

Also delivery of services is not sufficiently focused on the youngest children (under three), who could potentially benefit most from ICDS interventions – Growth-faltering starts during pregnancy, and approximately 30 percent of children in India are born with low birth weight, and by the age of two years most lifetime growth retardation has taken place, and is largely irreversible

The flowchart below depicts the interactions between underlying and immediate causes of malnutrition –

The Positive Deviance concept which forms the basis of this study focuses on two direct behavioural causes of malnutrition at the household level, namely inadequate dietary intake and disease prevention.

This study measures childhood malnutrition using the new growth standards that have been recently released by the World Health Organization. The new standards are based on children from Brazil, Ghana, India, Norway, Oman and the US and adopt a fundamentally prescriptive approach designed to describe how all children should grow rather than merely describing how children grew in a single reference population at a specified time.

Garza C, de Onis M. (for the WHO Multicentre Growth Reference Study Group). Rationale for developing a new international growth reference. Food Nutr Bull 2004; 25 (Suppl. 1): S5-14.
Magnitude of Malnutrition

Malnutrition is a widely prevalent problem in India and one of astonishing magnitude. According to the National Family Health Survey 3 (NFHS III, 2005-06), about a third of India’s children are born underweight, about 44 percent of children under five are underweight, 48 percent are stunted, 20 percent are wasted and 70 percent are anaemic. NFHS II (1992-93), more than half (53%) of children below four years of age are under nourished. In 1998, 29.1% children between 1-5 years of age suffered from moderate and 12.3% from severe under nutrition. This shows only a gradual decrease in the prevalence of under nutrition in India over twelve years. Nutritional adequacy is one of the key determinants of the health and well being of the children. Under-nourishment not only retardsphysical developmentbut also hampers the learning and cognitive process, leading to sluggish educational, social and economic development, according to Sanjeev Kumar in his study – Malnutrition in Children of the Backward States of India and the ICDS Programme.

According to the NFHS III data, Tamil Nadu, although considered one of the better performing states, recorded to have nearly 35% of its rural children as undernourished. This value was certainly lower than the national rural average of 49%, but according to the NNMB survey based on the NCHS standards in 2001, there was a rise in the levels of severe malnutrition in both boys and girls in the under 5 age group in Tamil Nadu

Therefore the focus of this study is to investigate how some children living in the same surroundings escape the ill-effects of malnutrition and thrive in spite of poverty and limited resources, and use these practices to eliminate malnutrition among the rest.

The Positive Deviance Approach and its benefits

Positive Deviance is based on the fact that solutions to some community problems already exist within the community and need to be discovered. It is a “strength-based” or “asset-based” approach based on the belief that in every community there are certain individuals (“Positive Deviants”) whose special, or uncommon, practices and behaviours enable them to find better ways to prevent malnutrition than their neighbours who share the same resources and face the same risks.

Through a dynamic process called the Positive Deviance Inquiry (PDI), these practices are discovered to contribute to a better nutritional outcome in under nourished child This intervention is designed to enable families with malnourished children to learn and practice these and other beneficial behaviours. The programme actively involves the mother and child in rehabilitation and learning in a home – like situation and work to enable the families to sustain the child’s enhanced nutritional status at home. The typical session consists of nutritional rehabilitation and education over a twelve-day period followed by home visits.

The development of a community-based nutrition rehabilitation model called PD/Hearth was promoted by USAID and other international organizations such as UNICEF.

The Hearth approach

In the Hearth approach, caregivers of malnourished children practice new cooking, feeding, hygiene and caring behaviours shown to be successful for rehabilitating malnourished children. The selected practices come from both the findings of the Positive Deviance Inquiry and emphasis behaviours highlighted by public health experts. The Hearth session consists of nutritional rehabilitation and education over a twelve-day period followed by home visits.

The Hearth approach promotes behaviour change and empowers caregivers to take responsibility for nutritional rehabilitation of their children using local knowledge and resources. After two weeks of being fed additional high-calorie foods, children become more energetic and their appetites increase. Visible changes in the child, coupled with the “learning by doing” method, results in improved caregiver confidence and skills in feeding, child care, hygiene and

health-seeking practices. Improved practices, regardless of mothers’ education levels, enhance child growth and development. This approach successfully reduces malnutrition in the target community by enabling community members to discover the wisdom of Positive Deviant mothers and to practice this wisdom in the daily Hearth sessions.

Positive Deviance/Hearth is an effective tool in discovering the solutions from within.

Need for the Study

Maternal and child under nutrition is highly prevalent in low and middle income countries like ours, resulting in increased mortality and overall disease burden.

It is well recognised that among the basic and underlying causes of under nutrition include environmental and economic factors with poverty having a central role. Thus for a sustainable solution to this very common problem, there needs to be an ecological and holistic approach rather than the current and commonly used approach of the government giving supplementary feeds to those who are malnourished. The latter approach not only puts a financial strain on the government but also make the community members dependent on this external aid. Therefore this study concentrates on identifying affordable and sustainable solutions within a community which can be used to prevent undernutrition. This approach is also not resource hungry unlike the traditional approaches where the focus is on finding and fixing what is wrong and missing in the community rather than identifying what is already working and build on the strengths of existing healthy practices within the community that is protecting them from undernutrition even though they are faced with same constraints of resources. This approach is known as the Positive Deviance approach.

Knowledge shared through this approach not only changes behaviour but also changes how a community perceives malnutrition and their ability to change the situation. The Positive Deviant approach has been shown in other studies and projects to quickly eliminate malnutrition and through the sustainable new behaviour; the younger siblings have also received these benefits. Positive deviance is a successful approach to decrease malnutrition and has enabled hundreds of communities the world over to reduce and prevent malnutrition. This approach is also culturally acceptable which helps bring about change in our society.

However, there are only a few studies that use this concept to reduce malnutrition in India, whereas the potential here is very high. And , although Tamil Nadu has shown gains in terms of reduction of the problem of malnutrition, it still has a high percentage of malnourished children and therefore this study was undertaken to estimate prevalence in fourteen villages within the rural field practice area of the department of community medicine of PSG Institute of Medical Science and Research and explore the feasibility, sustainability and effectiveness of combating the problem by using the Positive Deviance concept and approach.

Tamil Nadu has a high prevalence of malnutrition. Recently, there has been a paradigm shift in the primary focus from “Management of Malnutrition” to “Prevention of Malnutrition”. Towards achieving this, strategies and activities have been proposed under various components for the year 2006-07 with priority for greater attention on the health and nutritional status, by the Government of Tamil Nadu. One of the guiding principles suggested to help achieve “Malnutrition free Tamil Nadu”, is effective nutrition intervention, and communication to bring about behavioural change. To help achieve this goal, this study was undertaken in fourteen villages under the rural field practice area of the department of community medicine of PSG Institute of Medical Science and Research using the Positive Deviance concept.

Objectives
To estimate the prevalence of under 3yrs undernutrition in 14 villages of Vedapatti.
To identify Positive Deviant practices in the community.
To rehabilitate undernourished children identified in the most affected village.
To reassess families at their homes after 6 months and ensure sustainability of Positive Deviant practices.
Review of literature
Classification of under nutrition

Under nutrition is defined as the outcome of insufficient food intake and repeated infectious diseases. It includes being underweight for one’s age, too short for one’s age (stunted), dangerously thin for one’s height (wasted) and deficient in vitamins and minerals (micronutrient malnutrition) according to UNICEF. Low weight for age is termed as underweight.

Weight for age classifications are widely used in assessing nutritional status of children as it gives a picture of both acute and chronic onset malnutrition. The earlier classifications include Gomez, Indian Association of Paediatrics, and Welcome. These classifications use different reference standards, but the current recommended standards are the WHO references.

This study uses the WHO references to classify underweight. In a study done by Bridget Fenn and Mary E. Penny across three countries, fewer children were classified as underweight according to the WHO classification when compared to the NCHS reference standards.

Another study done by Marc-Andre Prost et al showed contrasting results. The WHO standards gave a prevalence of underweight 3.6 times higher early in infancy,0 – 4 months (6.1% against 1.7%) and half the estimated prevalence of the NCHS reference in the second half of infancy, 11 – 15 months(6.6% against 13.6%)

Implication of New WHO Growth Standards on Identification of Risk Factors and Estimated Prevalence of Malnutrition in Rural Malawian Infants

Marc-Andre? Prost1*, Andreas Jahn1,2, Sian Floyd1, Hazzie Mvula2, Eleneus Mwaiyeghele2, Venance Mwinuka2, Thomas Mhango2, Amelia C. Crampin1,2, Nuala McGrath1,2, Paul E. M. Fine1, Judith R. Glynn1

In a study done by P.R. Deshmukh et al , in Anji, Maharashtra, the prevalence of underweight as assessed by WHO standards was significantly lower when compared with the assessment based on NCHS reference (p<0.01). But, WHO standards gave higher prevalence of severe underweight than NCHS reference though the difference was not statistically significant (p>0.05).

Newly Developed WHO Growth Standards : Implications for Demographic Surveys and Child Health Programs P.R. Deshmukh, A.R. Dongre, S.S. Gupta and B.S. Garg

Prevalence of under nutrition

The World Bank estimates that India is ranked 2nd with 47% after Bangladesh for the most number of children who suffer with malnutrition (in 1998). The prevalence of underweight children in India is among the highest in the world, and is nearly double that of Sub-Saharan Africa with dire consequences for mobility, mortality, productivity and economic growth.

According to the National family health survey -3 the percentage of under 3 children who were underweight in Tamilnadu were 33.2 % (31.3% in the urban areas and 34.8% in rural areas)

The National Nutrition Monitoring Bureau observed that in about 40% of the households, the intake of dietary energy by preschool children was inadequate. About 55% of the preschool age children were underweight, 52% were stunted and 15% were wasted.

In a study done by Bhanderi D et al, the prevalence of under weight (wt. for age below 2SD) was 43.67%.

“An epidemiological study of health and nutritional status of under five children in semi-urban community of Gujarat.”

Bhanderi D, Choudhary SK.

A study done to find the prevalence of malnutrition in Uttar Pradesh showed that the maximum over all prevalence of malnutrition was in the age group of 13-24 months. The maximum number of grade IV malnutrition was found in the age group 25-36 months.

Harishankar, Shraddha Dwivedi, S.B. Dadral, D.K. Walia, “Nutritional status of children under 6 years of age” Indian Journal of Preventive and Social Medicine. Vol. 35 No.3 & 4 2004
Methods of assessing nutritional status

Nutritional assessments can be done by both direct and indirect methods. The method used can result in a wide variation in the prevalence of malnutrition.

P. Mohanan et al in their study evaluated the efficacy of Body Mass Index, Mid-Arm Circumference and Weight-for-age in detecting Malnutrition in terms of sensitivity, specificity and predictive value and concluded that weight-for-age is the best indicator.

P.Mohanan, A.Kamath, B.Motha, M.Philip. Evaluation of Anthropometric Indices of Malnutrition in under-five children. Indian Journal of Public Health 1994 July-September;28 (3); 91-94.

A Comparison of Anthropometric Methods for Assessing Nutritional Status of Preschool Children in the Philippines was done to identify the most reliable anthropometricmeasurements that reflect nutritional status and the Dugdale’s nutritional index, weight/height, was a reliable measurement for malnutrition. This is exceptionally useful when the age of the child is not know.

A Comparison of Anthropometric Methods for Assessing Nutritional Status of Preschool Children: The Philippines Study Marilyn D. Johnson, MS,William K. Yamanaka, PhDandCandelaria S. Formacion, MS
Factors associated with malnutrition
Gender
A case-controlled study conducted in a rural area in Tamil Nadu, India, on 97,000 children showed that female gender was a significant risk factor for malnutrition.

YALE JOURNAL OF BIOLOGY AND MEDICINE 70 (1997), pp. 149-160. Copyright C 1997. All rights reserved. A Case-Control Study of Maternal Knowledge of Malnutrition and Health-Care-Seeking Attitudes in Rural South India Kaori Saito, Joshua R. Korzenika, James F. Jekel and Sara Bhattacharji

Also another study in Tamilnadu on a total of 2954 children attending the TamilNadu Integrated Nutrition Project (TINP), showed that there was an association between female sex and malnutrition. In this study the malnourished children were referred to as negative deviants.

Use of Positive-Negative Deviant Analyses to Improve Programme Targeting and Services: Example from the TamilNadu Integrated Nutrition Project

MEERA SHEKAR, JEAN-PIERRE HABICHT AND MICHAEL C LATHAM

Girls showed only a slightly higher level of prevalence of malnutrition in the study done by The Research and Special Studies Division of the Department of Census and Statistics, Sri Lanka
A study done in the slums of Chandigarh on 1286 preschool children found no significant gender difference. This study shows similar reports as our study in Vedapatti.

H.M. Swami, J.S.Thakur, S.P.S.Bhatia, Vikas Bhatia. Nutriotional status of preschool children in an ICDS block of Chandigarh. Journal og Indial Medical Association; 99(10): 554-556

The sex of the child was found to be significantly high in association to malnutrition. The percentage of female children that were malnurished was higher in school going children.

“Epidemiology of malnutrition in a rural field practice are of Navi Mumbai” By Sumedha Joshi and Santosh S. Walgankar… Indian Journal of Preventive and Social Medicine Vol 35, 1 and 2, 2004

Mother’s Literacy
The Research and Special Studies Division of the Department of Census and Statistics, Sri Lanka, undertook a methodological study to investigate the prevalence of malnutrition in children under five years of age, and the factors contributing to such a situation. The study found that 25% of pre-school children that were undernourished had mother’s who had not gone beyond the primary level of school education. The effected proportion dropped to 11% when the mother has had at least secondary education.
Mother literacy was found in this study to have a positive effect on bringing down the incidence of malnutrition in socio-economically backward villages around Agra.

“Positive Deviance determinants in Young Infants in rural Uttar Pradesh” by Vani Sethi1, Sushma Kashyap1, Veenu Seth1 and Siddharth Agarwal, Department of Foods and Nutrition, Lady Irwin College, New Delhi, India. Indian Journal of Pediatrics Volume 74, June 2007.

Sandip Kumar et al in a study among 600 under 5 children in West Bengal showed that illiteracy of both parents was a significant risk factor for malnutrition.

Sandip Kumar Ray, Anima Halder, Biswajit Biswas, Raghunath Mishra, Satish Kumar. Epidemiology of Under Nutrition. Indian Journal of Pediatrics 2001 November: 68:1025-1030.

Socio-economic status

This study in 2003 on 4187 children showed contrasting results in Nigeria. The southeast and southwest regions had large inequalities between the poor and the rich whereas northeast and northwest regions had a considerably small gap between the rich and the poor on malnutrition.

Using extended concentration and achievement indices to study socioeconomic inequality in chronic childhood malnutrition: the case of Nigeria

Olalekan A Uthmancorresponding author1,2

A study done in 1000 under 5 children in Rajasthan showed that 82% of the malnourished children belonged to the socio economic classes 4 and 5.

“Nutritional disorders in rural Rajasthan” A.L.Soni1, R.N.Singh1and B.D.Gupta. Indian Journal of Peadiatrics, May, 1980,Vol 47: 199-202.

A case-control study of maternal knowledge of malnutrition and health-care-seeking attitudes in rural Tamilnadu, showed that socio-economic status was a stronger risk factor for malnutrition than health-care availability and health-care-seeking attitudes.

A case-control study of maternal knowledge of malnutrition and health-care-seeking attitudes in rural South India, Saito K,Korzenik JR,Jekel JF,Bhattacharji S.

Birth order

The study done by Vani Sethi et al also evaluated other factors that contribute to malnutrition in the society and found that third or earlier born infants escaped malnutrition

“Positive Deviance determinants in Young Infants in rural Uttar Pradesh” by Vani Sethi1, Sushma Kashyap1, Veenu Seth1 and Siddharth Agarwal21Department of Foods and Nutrition, Lady Irwin College, New Delhi, India. Indian Journal of Pediatrics Volume 74, June 2007

Another study in Uttar Pradesh observed that grade III malnutrition was absent in the children whose birth order was one and two. A significant rise in Malnutrition was found in the children of birth order IV and above.

Health and Population – Perspectives & Issues 4(2):106-112, 1981

A community based, cross-sectional study was conducted in the Mollasimla village of Hooghly district of West Bengal, showed a significantly higher proportion of malnutrition was found to be present among female children of higher birth order and those belonging to families with lower per capita income compared to the males.

Gender inequality in nutritional status among under five children in a village in Hooghly district, West Bengal. Dey I,Chaudhuri RN.

PROTEIN ENERGY MALNUTRITION IN CHILDREN – A CASEFOR THE NEED OF A PLANNED FAMILY Deoki Nandan*, J. V. Singh** and B. C Srivastava

A study done by Harishankar et al showed that the highest percentage of malnourished children was seen in the first born children (47.2%) and the least in children with birth order 3 and above (17.8%)

Harishankar, Shraddha Dwivedi, S.B. Dadral, D.K. Walia,”Nutritional status of children under 6 years of age” Indian Journal of Preventive and Social Medicine. Vol. 35 No.3 & 4 2004

Spacing

The same study in Uttar Pradesh, by Deoki Nandan et al also studied the relationship to spacing and malnutrition showed that there was a direct association between Protein energy Malnutrition and less spacing between sibilings.

Health and Population – Perspectives & Issues 4(2):106-112, 1981. Protein Energy Malnutrition In Children – A Case For The Need Of A Planned Family Deoki Nandan*, J. V. Singh** and B. C Srivastava

Studies using Positive Deviance concepts

The successful application of the PD approach has been documented in more than 41 countries in nutrition and a variety of other sectors from public health to education to business.

Positive deviance is not specific to nutrition practices, but can be used for many other behaviours.

Ref:http://www.positivedeviance.org/PD_Evaluation_Report_for_DEPKES_FINAL.pdf

Positive Deviance was used in two Colombian hospitals to combat the spread of MRSA Infection. All hospital staff up to the security guard involved themselves by reminding the visitors to practice good hand hygiene. As a result the infection rates have dropped down my more than 75% from 1.1 infections per 1000 patient days to less than 0.2 infections per 1000 patient days.

Ref: http://www.positivedeviance.org/projects/healthcare.html?id=49

In West Bengal, India, ICDS has undertaken pilots projects in the use of the PD approach in Nutrition and Child Care Program (NCCP) in 4 districts to improve the nutritional status of children under three years of age. The projects substantially decreased the number of malnourished children by promoting good care practices. The PD informed project enabled families to break the dependence on donated food, by identifying cheap locally available and bringing it daily to the NCC session to prepare and feed their malnourished children. Every month the malnourished child is weighed and in most cases, mothers find their children gaining weight between 100 and 600 gm.

Ref:http://www.positivedeviance.org/projects/nutrition.html?id=77

Ref:http://www.unicef.org/india/nutrition_1557.htm

In 1990 Save the Children initiated a PD program in Viet Nam to enable poor villages to address the pervasive problem of childhood malnutrition. At that time 60% of children under the age of 5 suffered from malnutrition in Viet Nam. The initial pilot project was in the first 4 villages. In each of the villages, six of the poorest families with well nourished kids were chosen and caretakers were questioned and observed. In every instance where a poor family had a well-nourished child, the mother or father was collecting tiny shrimps or crabs or snails (the size of one joint of one finger) from the rice paddies and adding these to the child’s diet along with the greens from sweet potato tops. Although readily available and free for the taking, the conventional wisdom held these foods to be inappropriate, or even dangerous, for young children. Along with these food and atypically strict hand hygiene in 5 of the 6 PD households, other positive deviant behaviors emerged, involving frequency and method of feeding and quality of care and health-seeking behaviors. Through the PD inquiries, community members had discovered for themselves what it took for a very poor family to have a well-nourished child. Rehabilitation started as for two weeks every month, mothers or other caretakers would bring their malnourished children to a neighbor’s house for a few hours every day. Together with the health volunteer, they would prepare and feed an extra nutritious meal to their children. This showed great success by reducing malnutrition by as much as 80%. The project was then applied in large scale reaching more than 2 million people and in 250 communities and sustainabily rehabiliteted 50,000 malnourished children under the age of 5. This is probably the best known and best documented large scale application of PD.

Ref: http://www.positivedeviance.org/projects/nutrition.html?id=105

In Nepal a PD project to cover more than 8000 children under 3 years of age from 15 very disadvantaged communities was started with an aim of reducing child malnutrition in a sustainable manner. Positive practices regarding child feeding, caring, health seeking and maternity care are identified from the poor families having well nourished children through the PDI and then are made accessible to the families with malnourished children through a “learning by doing” process.

Ref: http://www.positivedeviance.org/projects/countries.html?id=82

In the year 2000 a Positive Deviance Inquiry to identify specific behaviors and strategies that contribute to healthy pregnancy outcomes amongst poor women was conducted. The inquiry determined that mothers-in-law played a central role in assisting women in obtaining medical care. Low-income women with weight gain greater than 1.5 kg per month in the second trimester of

pregnancy reported multiple antenatal care contacts, increased rest during pregnancy, and more consumption of meat and vegetables. These results were incorporated into a program for 200 women that resulted in a decrease in the prevalence of low birth weight.

Ref: http://www.positivedeviance.org/projects/public_health.html?id=117

The following is illustrative of the impact of Positive Deviance over the last 15 years:

Sustained 65 to 80% reduction in childhood malnutrition in Vietnamese communities, reaching a population of 2.2 million people. Significant reduction in childhood malnutrition in communities in 41 countries around the world. Reduction in neo-natal mortality & morbidity in Pashtun communities in Pakistan and minority communities in Vietnam with near universal adoption of protective behaviors and social change. Estimated 50% increase in primary school student retention in 10 participating schools in Missiones, Argentina.

Community intervention methods to combat under nutrition

Traditional nutrition interventions include growth monitoring, counselling and the provision of supplemental foods and micronutrients But over decades the weighing of children undertaken by several National health ministries has brought little or no change to the nutritional status. In fact, in a study done by Sridhar Seetharaman, in Uttar Pradesh and Rajasthan, it was found that the Mid Day Meal did not make any appreciable and significant impact on improving the nutritional status of the children.

Impact Of Mid Day Meal On The Nutritional Status Of School Going Children, Sridhar Seetharaman, NIRD, Hyderabad

Zulfiqar A Bhutta et al used a cohort model to study the interventions that affect maternal and child undernutrition and nutrition-related outcomes. The interventions included promotion of breastfeeding; strategies to promote complementary feeding, with or without provision of food supplements; micronutrient interventions; general supportive strategies to improve family and community nutrition. They found that these interventions could reduce stunting at 36 months by 36%; mortality between birth and 36 months by about 25%; and disability-adjusted life-years associated with stunting, severe wasting, intrauterine growth restriction, and micronutrient deficiencies by about 25%.

Prof Zulfiqar A Bhutta PhDa, Tahmeed Ahmed PhDb, Prof Robert E Black MDc, Prof Simon Cousens PhDd, Prof Kathryn Dewey PhDe, Elsa Giuglianif, Batool A Haider MDa, Prof Betty Kirkwood PhDd, Saul S Morris PhDd, Prof HPS Sachdevg, Meera Shekar PhDhand for the Maternal and Child Undernutrition Study Group, Lancet Volume 371, 8 February 2008, Pages 417-440

Reasons for age selection

Care is an important determinant of nutritional status. It determines the delivery of food and health care resources to the child by optimizing the existing resources to promote good health and nutrition in children.

Ramakrishnan U. UNICEF-Cornell colloquium on care and nutrition of the young child-planning. F Nutr Bull 1995; 16: 286-92.

The first two years of life are the “window of opportunity” to prevent early childhood undernutrition that causes largely irreversible damage. This is proved by the following studies across the world.

Study shows more benefit from reaching all at-risk children

One could suggest, to have a full understanding of the concept of child care polices within Ireland, we must first look at childcare and its practice from a historical perspective. According to Kelleher, Kelleher & Corbett, (2000) modern social care in Ireland evolved in part from the insufficiency in the running of children’s institutions, schools and other care facilities; with a litany of abuse and atrocities now documented, social policy reformation has been a key component in integrating safe and secure work practice and care. This assignment will seek to define two macro policies in relation to child care within the social care sector, while emphasis will be given on application within Children’s residential units, other care providers for example after school programmes and youth programmes will also be given consideration.

According to Curry (1998) social policy in relation to child care services has been slow to emerge. The developments and new recommendations for policy have been the combination of many forces; public outcry coupled with state intervention resulted in high profile reports being commissioned and published; namely ‘The Kennedy Report’ and the ‘The report of the task for on Child Care Services’. The Kennedy report called for an introduction of a revised and complete children’s act, the subsequent introduction of The Child Care Act 1991 has been described as a ‘watershed in child care policy in Ireland’ (Curry, 1998:171). Among the many provisions within the act, the main emphasis was on the safety and security of the care of children, with particular emphasis placed on children who had been abused, neglected or who were deemed at risk.

While Curry notes the provisions within the Act were slow to be implemented, several high profile abuse cases, The x Case 1992, ‘Kilkenny incest case 1993 and the Kelly Fitzgerald case 1994 prompted the government to respond thereafter with urgency; however it was 1996 before all the provisions within the act would be fully realised. Curry (2003) also notes that following a documentary aired by RTE ‘States of Fear’, which highlighted the systematic abuse imposed on children within Residential and Reformatory schools, in turn forced the Taoiseach Bertie Ahern on the 9th May 1999, to address the nation to apologise on behalf of the state, to its citizens who had been abused in state institutions as children.

Macro Policy

Children First – National Guidelines for the protection and welfare of children (Department of Health & Children, 1999) & Our Duty to Care (Department of Health and Children, 2002)

Curry (1998) notes, as a result of the high profile cases noted above, The Children first guidelines were introduced in 1999, they were intended to support & inform the professional, teacher, community worker or any person who would have regular contact with children through sporting or community organisations, in best practice on reporting and identification of child abuse. These set of guidelines set out ways in which professional practice in both statutory and voluntary agencies and organisations, which offer services for children and families can be improved upon and adhered to, the specific objectives of the guidelines are;

“Improve and focus on identification, reporting, assessment, treatment and management of child abuse and to clarify the responsibilities of various professionals and individuals within organisations” (Children First Summary, 1999:5)

The main ethos of the guidelines is the ‘welfare of the child is paramount, among its aims are to achieve a consolidated and specific identification and reporting functions for all persons concerned in child welfare. As indicated within the guidelines each organisation must have a designated person who is wholly responsible for overseeing the procedures and policies are adapted in house. Special emphasis is given to a holistic approach to welfare of the child, the child, the guidelines state must be considered in the family setting and parent and carers should be respected and consulted as ongoing concerns are addressed. The child ultimately has the right to be heard and must also understand the procedures; so it would be an important function within residential setting for example to have a child friendly policy which the child can understand (dohc: Children First Guidelines, 2010).

According to the Children first summary (1999), any investigations should not cause the child undue distress and investigations should be respectful of the family unit; however the child’s safety is of upmost importance. The criminal aspect of any investigation into child abuse should not and cannot be ignored and where necessary the Garda should be informed as appropriate by the health boards. The guidelines also indicate a compulsory training for personnel or staff, this would seem extremely important and relevant that all prospective and current social care staff should be fully updated and trained in the National Guidelines. Training one could suggest should also incorporate specific ways in which to identify abuse as defined with the guidelines and subsequent avenues for reporting same. It would also be extremely important that a statement, knowledge and understanding of best practise, as indicated in the guidelines should be the expected standard within any residential or child care setting.

Further to the Children’s first guidelines a document entitled Our Duty to Care was produced by the department of Health and Children (2002), this document sets out to detail ways to improve upon child welfare and the development of safe practices when working with children. It is specifically aimed at community and voluntary organisations regardless of size so would be of particular relevance to social care sector. Our Duty to care lists specific principles, which if adopted across the organisation, will create a safe environment where children’s rights, safety and protection are at the forefront; the guidelines are representative of the recommendations within the Children’s first guidelines as noted above.

These guidelines also advices the recruitment of staff and volunteers within the organisation should fall under clearly defined guidelines and be consistent with best practice; for example Garda Vetting forms for prospective staff members working within children. Ongoing and updated training should be provided for all workers within the organisation. The recommendations also advise developing a policy of openness with parents, consulting and advising parents/caregivers at every possible opportunity (dohc: Our Duty to Care, 2010). One could suggest communication in this respect would be extremely important; sitting with parents on a one to one basis if necessary and having clear guidelines or an explanation of what is happening in a format which can be easily understood.

Macro Policy
National Standards for Children’s Residential Units – Department of Health & Children

According to the National Standards for Children’s residential Units (2010), the guidelines were produced in conjunction with various agencies and the Social Services Inspectorate. These particular guidelines set out standards which any residential facility both statutory and non-statutory must adhere too.

According to information available through Social Services Inspectorate (2010) over 4,870 Children are within the care system. This also incorporates foster care, with 172 residential centres, 102 in the statutory sector with 74 in the non-statutory sectors. The Social Services Inspectorate is responsible for inspecting said premises under the provisions within the 1991 Child Care Act. Within the National guidelines every health board has responsibility to notify the SSI of new premises being established as residential care facilities. There must be a written statement within each centre/facility which details and describes what the centre does. In effect the ethos and mission statement could incorporate this information. This must be kept up to date and contain relevant information which is clearly visible to all visiting persons. The centre must be effectively managed with suitably qualified staff. Each staff member prior to job placement must be properly vetted by An Garda Siochana. There must also be adequate levels of staff to care and supervise young person’s residing in the facility. Each new staff member must receive an induction into the centre, supervision and support, coupled with training and further development in line with position should also be provided.

Any files pertaining to the child or young person in care should be kept in a safe and secure environment and administrative files should be co-ordinated in line with the Freedom of information Act 1997 (dohc, 2010). The facility/centre is required to have an authorised person to ensure that compliance with all the standards within the National Guidelines are adhered to. This person should not be part of the current management. They should facilitate meetings with the young person’s to enquire about general happiness or care within the centre and ensure young person has an outlet to voice concerns. Any reported incidents should be recorded and the appropriate authorities informed accordingly.

According to the guidelines (2010) a Statutory Care plan is required for each and every child/young person within care centre. This care plan should be facilitated by the assigned social worker, the staff and management within the care centre should be informed of necessary information prior to or shortly after the young person has joined the centre. This differs from the placement plan within care, which is referred to as a ‘placement plan’; this plan may detail day to day specific activities or future goals within the centre.

The guidelines (2010) make reference to the importance of the young person having a voice, the young person should be provided with every opportunity to discuss their care. They along with the family should be informed of any decisions which will affect their future. Parents/guardians should be informed of all decisions and where appropriate be part of the future care plan. If emotional or specialist support is required it is the responsibility of the centre to ensure the child has an adequate inter disciplinary team or available service to alleviate issues.

The guidelines are very clear on the role and involvement of the family while the young person is in residential care. Family visits must be accommodated and indeed encouraged; these should also be facilitated in a private area. Staffs are required to support the visits and contact unless directed otherwise by the courts which will also be indicated within the statutory care plan, this one could suggest firmly establishes the important role of social care worker, facilitating the voice of the young person and encouraging family involvement where appropriate (dohc: National Standards Children’s Residential Centres, 2010).

In this essay, the social problems I have chosen to write about is Homelessness. I will also be exploring different perspective of Homelessness and the policy responses and the impact it have on the society. The groups I will focus my discussion on are young people and rough sleepers as the evidence indicates that young homeless people experience rough sleeping before securing temporary accommodation.

There are wide ranges of definition Homelessness and it varies from country to country or among different institutions in the same country. According to |Liddiard, M (2001:119) the immediate sense of the term as regularly employed by the mass media and politicians, simplistically equates homelessness with rooflessness or literally sleeping rough on the street. This is can be a straightforward and easy to understand definition but this does not reflect the true scope of the problem so a broader definition of homeless peoples include those lacking permanent residence and living in a range of unsatisfactory housing conditions. They can include those living in temporary hostels, bed and breakfast, night shelters and squatters. However, the legal definition of someone homeless is if they do not have a legal right to occupy accommodation or if their accommodation is unsuitable to live in. They also include families and peoples who do not sleep rough and some are accommodated by friends and family on temporary basis. So from the above definition the social construction of homelessness are not the small amounts of individual that sleep on the street, looking dirty and smells of alcohol and drugs but comprises of all individual who do not have a permanent decent place of accommodation or without a regular dwelling and are on a waiting list or takes housing benefit and in temporary accommodations. (Giddens 2007)

The cause of homelessness varies as many are of the view that homelessness is a result of personal failings and consider if the economy is going on well, there is no excuse to be homeless. Shelter (2007) is of the view that homelessness is cause by a complex interplay between a personaˆ™s individual circumstances and adverse structural factors outside their direct control. Among the individual factors include social exclusion, thus when a person lack of qualification because they did not have access to good education and decent job. Ones misuse of drugs and alcohol which result in lack of personal control, lack of social support and debts especially mortgage or rent arrears. Having mental health problems and getting involved in crime at an early age also contribute to homelessness. Family breakdown and unresolved disputes are a major factor of homelessness as a result of divorce and separation and a greater number of men and women are affected. People from institutional background like having been in care, the armed forces are likely to be affected. Ex-offenders who come out of prison and lose their friend and families can become homeless and the majority from ethnic minority or ex-asylum seekers who have the right to stay but have no accommodation. Structural causes of homelessness are mostly social and economical in nature often outside the control of individual or family concerned. These may include poverty, lack of affordable housing, unemployment and the structure and administration of housing benefit.

According to the shelter (2007) the number of households found to be homeless by local authorities increased 31percent between 1997/98 and 2003/2004. Historically, homelessness had low publicity until the 1966 when the BBC screened Ken Loachaˆ™s film about homelessness Cathy Come Home. This was watch by 12million people and the film alerted the public, the media and the government to the scale of the housing crises and then Shelter was formed. Another policy response was the 1977 Housing (Homeless Persons) Acts was the first measure to place responsibilities on local authorities to rehouse homeless families and individuals permanently. (Liddiard, M .2001) The 1977 legislation had Priority Need which included women with children or pregnant, vulnerable due to age, mental illness, disability, and loss of home by natural disasters. This did not cater for everyone who was homeless and the criteria by which local authorities accepted someone as homeless was complex and restricted. Hence the 1996 section 177 amended to include domestic violence as a priority need but strict eligibility remains (Hill, M: 2000).

Young people were not covered under the existing legislation and the number of young homeless increased. Existing data on youth homelessness has significant limitation; in particular it is only possible to count young people who are in contact with services. According to ONS (2007) it can be estimated that at least 75,000 young people experienced homelessness in the UK in 2006-07. This included 43,075 aged 16-24 of which 8,337 were 16 -17 year old who were accepted as statutorily homeless in the UK and at least 31,000 non-statutorily homeless young people using supporting people services during 2006-2007. The Homelessness Act (2002) changes significantly the way in which homeless in England and Wales is tackled. The priority need categories was extended to includes 16/17 years rather those who social services are responsible for accommodating, care- leavers under the age of 21 who were looked after by social services when they were 16/17 and ex- prisoners, former soldiers and young people leaving care. This act also introduces greater flexibility with regards to social housing allocation giving more people the right to be considered for a council or housing home.

The local authorities had a statutory duty to care for all the homeless people but no extra resources were added. This had a great impact on the number of homeless people who were able to relocate permanently at a given time and especially those under priority need.

Young people experiencing disruption or trauma during childhood who may be from socio-economic background are at increased risk of homelessness. The main trigger for youth homelessness is relationship breakdown usually parents or step-parent. Among the impact of homeless on young people is poor health as they cannot take care of their health being. They lack basic food and shelter to help them grow to become healthy adults and they may suffer from depression. Homelessness can lead to increased levels of non- participation in formal education, training or employment. At times leaving school early without a qualification and a decent job may lead some young people into the misuse of drugs and some have mental health problems.

Another homeless group of concern is the rough sleepers who were in temporary accommodation but some choose to roam the streets, sleeping rough free from the constraints of property and possessions. But a large majority has no such wish at all but they have been pushed over the edge into homelessness by factors beyond their control. Once they find themselves without a permanent dwelling, their lives sometimes deteriorate into a spiral of hardship and deprivation. ( Giddens 2009:503)

The Homelessness Act 2002 extended the definition of the priority need to include new groups of vulnerable people, and requirement that all homeless people receive advice and assistance. In addition, Local Authorities are requires to periodically develop homeless strategies, including an assessment of levels of homelessness and conduct an audit of those sleeping rough. In 1998 there were around 1,850 people sleeping rough on the street of England on any one night. This follows on from the government drive to reduce rough sleeping by two-thirds in 2002. The Rough Sleeper Unit was set up in April 1999 to take the lead on delivering this challenging new target and help thousands of people to escape fro good from the humiliation and misery of life under a blanket in a shop doorway. One of the key principal of the strategy was to understand the cause of rough sleeping, why people end up on the street and what could be done to stop this from happing in the future. The strategy also place the emphasis on encouraging rough sleepers to become active members of the community, to build self esteem and bring on talent as well as helping the individual to become prepared for the life away from the street. Positive result soon follows as reductions in rough sleeping were achieves around the country in December 2001 the target set by the government was met ahead of time.

The target was met amid the controversy about how rough sleepers were counted and concern about the emphasis on street homelessness, which campaigners claimed was only tip of the homelessness iceberg. According to BBC New Magazine, housing minister Grant Shapps believes that the government figures on the count of rough sleeper is low and the system of counting is flawed. He argues that, under previous governmentaˆ™s system, councils with fewer than 10 rough sleepers were not obliged to count them, and that vagrants sitting up in sleeping bags were not counted as homeless. After Mr. Shapps insisted that councils provide estimates, the England wide figure rose to 1,247, this comprised 440 from 70 authorities that count and 807 from 256 authorities that provided estimates. Despite government investment in hostels to accommodate rough sleepers many are on waiting list as resources and financing is limited. Overcrowding, lack of bed space and sharing rooms or limited facilities with others are also identified as a problem especially if you have a partner or a dog, your choices narrow considerably. Although the quality of hostels has improved considerably, hostels are often considered unsafe. Over 57 percent of those who stayed in hostels mentioned problems with other residents, including drug and alcohol use, violence, theft, bulling, noise and arguments. And some are of the view that it is not a place to go if you want to stay clean of drugs. People are under the same legislation and the local authorities are unable to permanently house all in priority need.

In addition to the above, there are certain groups who are excluded from hostels, such as people from the EU and asylum seekers from non-EU countries who are homeless and destitute in the street of the UK. Their entitlement to benefits is restricted until they have lived and worked and paid into the UK system through national Insurance and tax for one year continuously. Such laws bring about social exclusion as street homeless people have reduced access to health care and dental services. They face discrimination and general rejection from other people and may have increased risk to suffering from violence and abuse. The impact of rough sleeping is limited access to education, not being seen as suitable for employment and loss of usual relationship with the mainstream. Most of all, living on the streets is dangerous as rough sleepers die young with the average life expectancy at 42.

Inequalities among the population still remain one factor of homelessness. Privatisation and residualisation of the council housing meant that fewer houses are available for council tenant. This imposes greater long term risks on the former council tenants while also generating considerable costs for the taxpayer. The process also excludes the many tenants who either reject transfer or are not given the choice and therefore exacerbates inequalities. There are 1.4 million unfit home in England as the majority of homeowners are in the private sector. The increase of housing association rents and increases in house prices means most people cannot afford a decent accommodation. Low income families are the most affected as 4 million people receiving housing benefit. ( Quilgars D. et al 2008)

In conclusion, the problem of homelessness has been tackled by the governments over the years through policies and legislation. However, the problem require long term policy solutions such as changes in the benefit system, the building of more affordable homes and ensuring that a wider cross- section of society benefits from the fruits of economic growth. For many people, there is no single event that results in sudden homelessness; instead homelessness is due to a number of unresolved problems outlined above building up over time. The achievement of one government policy on rough sleepers indicates much could be done to reduce the impact of homelessness as the number still rises. Ministers are now focusing on the prevention of rough sleeper and youth homelessness through a new government homelessness strategy.