Author: Andre Coleman

I agree that not everyone is suitable to do crisis intervention work as there are many factors that need to be considered when doing crisis work. The main factor that is essential for any crisis intervention work is the characteristics and personality of the crisis worker. James & Gilliland (2001, p.17) claim that effective crisis workers share a number characteristics and such workers demonstrate competency in their professional skills. Before we analyze the crisis worker, we need to understand crisis, crisis intervention and the difference between other therapies and crisis intervention because of the need to understand how the role of the intervener differs from other therapies and what are the characteristics that is needed specifically for the crisis intervention.

There are many definitions of crisis but a summarized definition would be that “crisis is a perception or experiencing of an event or situation as an intolerable difficulty that exceeds the person’s current resources and coping mechanisms,” (James & Gilliland, 2001, p.3). A similar definition of crisis is by Roberts (2000) who views crisis as “a period of psychological disequilibrium, experienced as a result of a hazardous event or situation that constitutes a significant problem that cannot be remedied by using familiar coping strategies” (p.7). There are many types of crisis and crisis is not simple but is complex and difficult to understand. It is essential that the individual is able to get relief from the crisis because the crisis causes disruption and breakdown to an individual’s ongoing pattern of everyday functioning. If the crisis is not handled, the situation would tend to immobilize them and they will be unable to control their lives. Apart from that, a crisis can cause individuals to have affective, behavioural and cognitive malfunctioning.

Crisis intervention is an internal helping response and is defined as “methods used to offer short term immediate help to individuals who have experienced an event that produces mental, physical, emotional and behavioural distress,” (Mitchell, n.d. para.1). The ultimate goal of crisis intervention is reducing the dangers of the crisis and allow it to be resolved positively allowing the individual to go on and thrive in life (Echterling, Presbury, & McKee, 2005, p.25). This intervention will focus on resolving the immediate problem to prevent further deterioration and to prevent negative outcome. An article by Center for School Mental Health Assistance (2002) states that, “crisis intervention will restore a sense of equilibrium for the individual in crisis and give them the ability to creatively problem-solve and feel efficacious.”

Crisis intervention differs from other therapies and traditional counselling because it “focuses on short term strategies to prevent damage during and immediately after the experience of trauma,” (Mitchell, n.d. para.5). This intervention is oriented in the present and focuses on the immediate problem which disrupts people from controlling their life. The intervener’s role is to offer immediate assistance to the individual who is struggling with a complex situation and assist them to go on and achieve a meaningful resolution (Echterling, Presbury, & McKee, 2005, p.25). In comparison to crisis intervention, other therapies deal with the totality of the individual’s personality and life issues and tend to be long term as they aim to improve the client’s mental health and personal wellbeing with an attempt to remediate more or less ongoing emotional problems. This only escalates to a crisis when there are threats to fulfilment, safety or meaningful existence (James & Gilliland, 2001, p.8-9) and this is where the crisis worker takes over.

To be a crisis worker, the helper has to have certain qualities to be able to intervene during the crisis and life experiences of the intervener are an important aspect to handle a crisis. These life experiences serve as a resource for emotional maturity that combined with training, enables workers to be stable, consistent and well integrated not only within the crisis situation but also in their daily lives (James & Gilliland, 2001, p.13). When a worker has previous experience of going through a crisis and comes across another individual who is in the similar crisis, they will be able to use their background as a resource to deal with the crisis. For example a crisis worker has previously made suicide attempts and has dealt with it, now has a client who is on the verge of attempting suicide. The crisis worker will be able to help the client overcome the issue because of the first hand experience of the crisis. James & Gilliland (2001) suggest that people who usually do crisis intervention are products of their own crisis environment and they have chosen to work with people experiencing the same kind of crisis they themselves have suffered, and they use their experiential background when working with people in crisis (p.13). Apart from this, life experiences means the helper has emotional maturity and it can enhance the dept and sensitivity with which the clients are treated.

One other characteristic that is essential for a crisis helper is remaining poised because “the nature of crisis intervention is that the worker is often confronted with shocking and threatening materials from clients who are completely out of control,” (James & Gilliland, 2001, p.14). When a helper remains poised in a situation where the client is out of control, there are chances that the stress level of the client will not be escalated. As the helper models this trait to the client, soon a stable atmosphere and a state of composure can be achieved. Eventually the situation will be brought into control and any immediate danger will be diffused. This trait of calming the victim and the situation has to be deeply abided within the helper and cannot be taught.

Aguilera & Messick (1982) stated that creativity and flexibility are major assets to those confronted with perplexing and seeming unsolvable problems (p.24). All crisis helpers are equipped with many skills and these skills have to be used in specific and creative ways personalized to the client’s needs and crisis. Sometimes to solve the crisis, untraditional and unconventional approaches need to be used. Helpers also cannot approach a crisis with a fixed and rigid formula but instead should have “a tentative plan for how to address it, combined with a readiness to let go of that approach if it does not work,” (Miller, 2012, p.6). Creating solutions is time sensitive and by being flexible to try and use different approaches, the helper will be more effective to lead the client through a comfortable intervention.

Energy and resiliency are required for crisis intervention as crisis situations can be very demanding. Being energized is largely dependent on the worker themselves to take care of their own physical and psychological needs so that their energy level remains high (James & Gilliland, 2001, p.15). Resilience on the other hand is also essential because it is natural for helpers to face failure no matter how capable or committed they were and when times of failure arise, helpers need be able to move forward and not face a meltdown.

As mentioned previously, crisis intervention compared to other therapies is time critical and helpers must have quick mental reflexes to “deal with the constantly emerging and changing issues that occur in the crisis,” (James & Gilliland, 2001, p.15). Helpers need to be able to think quickly on their feet and make quick evaluations and decisions as there is no time to reflect and slowly mull over the crisis. There is also a need for the helper to be comfortable in making decisions on their own because most of the time, they do not have another person supervising them.

Finally, one of the other trait a crisis helper should posses is the potential and desire to grow and change. Doing crisis intervention is not a static work as there is constant and rapid change in this field. The helper needs to change after each contact with a client because “successful resolution of the crisis results in two products, the first is helping the client overcome the crisis and second, effecting positive change in the helper as a result of the encounter,” (James & Gilliland, 2001, p.15).

In conclusion, I agree that not everyone is suitable to do crisis intervention because a crisis requires helpers who share a number of characteristics to demonstrate competency in their professional skills. Helpers ought to maintain poise when confronting a situation, to be creative and flexibility in their approach to deal with the situation, to be able to have energy and resilience, to be able to have quick mental reflexes and also have the potential to grow from each encounter of crisis. All of these characteristics are of enormous value to the helper and to the client and without them it is unlikely to be able to assist the client to reduce the dangers of crisis and facilitate a positive resolution.

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Personalisation is a new government strategy which has been set up to support service users who need support or care from adult social care. This policy is a new approach in supporting disabled people to enable them to lead more independent lives and exercise choice and control over the services they receive (Social Care Institute for Excellence, 2010). The overall aim is for service users to have control over how money is allocated to their care is spent, this includes direct payments, individual budgets, personal budgets, user led services, self directed support. As well as, support brokerage which would involve professionals from the wider fields of healthcare, including occupational therapists, and non professionals to provide advice and support for them (Mandelstam, 2010).

A personal health budget will enable a service user to decide how to use the money that the National Health Service has allocated to them for their care needs. It could just be a discussion with a doctor or other health care professionals, such as a care manager about the different ways the money could be spent on a care plan, or alternatively patients will be able to receive a cash payment to allow them to buy the care which has been agreed in the plan themselves (Stobbs, 2010).

The Department of Health (2007a) also state that this is a move away from the traditional welfare system to a more consumer type model of service provision which in turn will improve the quality of people’s lives. Although elements of this new policy are not legally defined, service users will be fully involved in accessing their own needs by having a personal budget by means of a direct payment, which in turn gives them control of the money.

Lymbery (2010) argues that there appears to be little recognition of the complexities and contradictions which characterize some areas of the policy, as well as having in inadequate resources bases for adult social care.

However, Dunning (2009) suggests that as the personalisation agenda advances the role of advocacy and support brokerage will be of increasing importance. However as Mandlestam (2010) argues that brokers need not be local authority employees or even professionals, which can place individuals at risk. If personalisation is to achieve its core aims, it will be essential that those accessing individual budgets can refer to sources of advice and support. Councils will also have to strike the right balance between giving people the freedom to choose their own care and protecting clients and their budgets from abuse. In addition, Mandelstam (2010) also believes that professionals will benefit from moving away from financial ‘gate-keeping’ to that of brokerage and advocacy.

Duffy & Gillespie (2009) discuss in their report that there appears to be some conflict between personalisation and safeguarding. The conflict has arisen through people thinking that that the ideas linked to the term ‘personalisation’ and those linked to the term ‘safeguarding’ is that this conflict is more likely to be a deep misunderstanding about both ideas rather than conflict. They have identified these misunderstandings around personalisation and safeguarding as; the goal for personalisation is freedom from control, not safety; the practice of personalisation is less concerned with the reduction of risk; and the rules and systems required for personalisation will increase risk. Although Pitt (2010) states that safeguarding and personalisation are seen as two sides of the same coin.

Also, they discuss the procedure with regard to the complex cases of vulnerability and abuse where careful risk management and person centred practice is required. Self-Directed Support is enshrined within the personalisation policy and states that before any individual receives any support services, six vital checks for risk are to be completed which are; First Contact, Assessment, Capacity Test, Support Planning, Plan Review and Sign-Off Outcome Review. As well as this, Self-directed support is very flexible and holds a number of tools which make it easier to solve complex cases. Resources are targeted at outcomes as this identifies the right level of funding applicable to the particular situation and needs of the individual. High quality planning; which commands that the social worker/occupational therapist identifies the best approach for the individual. Risk assessment; especially where abuse is suspected or criminal measures might become necessary, police may play an integral part to the final decision on the balance of risk. Appropriate control,; self directed support puts control of the funding into the hands of the appropriate person, such as a carer or a professional. Appropriate support; local authorities have to ensure that individuals can receive the help to manage their support that being traditional services, new or systems of peer support. Flexible resources; should be used creatively to support individuals and finally Outcome review; is essential which plays an integral part of the risk management process for the local authority.

However, as Mandelstam (2010) points out personalisation may not always work for vulnerable adults who are unable to express choices, unless they are adequately supported. Shortages of resources in some local authorities could threaten the availability of the vital support which is needed for individuals, and therefore for this system to work it is not to be seen as a cost cutting measure.

Duffy & Gillespie (2010) report that there is a misconceived idea that personalisation is simply about ‘freedom’ and treating safeguarding as it is simply about ‘control’ is wrong and to enable a person to have a good life balance you have to balance between freedom and control. Safety is one of the key goals in personalisation as control can be personalised because designing support arrangements need to be tailored to fit the person and need be justified with regard for their capacity, effectiveness and proportionality.

They also state that control does not guarantee safety, for example the current community care system is poor in providing individuals to exercise freedom and control. Individuals who need support often find they have little or no choice over the support they can receive as most social care services struggle to provide personalised support due to bureaucracy that surrounds them. This in turn can create dependency or frustration which can easily place individuals at greater risk.

The idea that personalisation may increase the risk of abuse in some way has been suggested by many professionals (Lymbery,2010. Duffy & Gillespie (2009) argue that personalisation is committed to improving safety as integral part of promoting well-being and enhancing citizenship along with offering techniques and approaches such as self-directed support which provides the framework for minimising the risk of harm and protecting vulnerable people from abuse. Personalisation is about designing support arrangements so they are more personal to the service user.

McGauran (2010) points out in her report that occupational therapists are placed well within the personalisation agenda as they are the only allied health professional who are widely employed throughout social and health care sectors. Personalisation is congruent to the philosophy of occupational therapy as the heart of its practice is to be client centred, and therefore occupational therapists need to seize these opportunities to pilot new ways of delivering this service which would be of benefit to the clients and enhance professional practice.

An example of this can be seen when an individual is given choice and control of a personal budget to purchase personal or nursing care for an older adult, then it would give the individual personal control over how, when and by whom the care or equipment should be provided. This philosophy is embraced with the College of Occupational Therapists Code of Ethics that ‘occupational therapists shall at all times recognise, respect and uphold the autonomy of clients, and advocate client choice.’ (College of Occupational Therapists 2005, p.2.1).

Social Care Institute for Excellence (2010) agree that occupational therapists are skilled in finding and tailoring individual solutions for people in different care settings and aim to improve the quality of life, as well as a facilitator of learning needs and can work collaboratively with people who use services, their carers, families, friends and other social care and health professionals to co-design and co-produce care and support.

Social Care Institute for Excellence (2010) believes also that by introducing this new agenda it will allow service users to become empowered and enable them to design the support packages for themselves or choose how they want to live. This in turn will enable service users to feel that are being supported in staying well and ensure that they have access to public services. This approach undoubtedly has the potential to improve the quality of people’s lives and give occupational therapists the opportunity to use their skills and expertise.

Over 70 health projects have been chosen by the Department of Health across England to pilot personal health budgets and a formal evaluation has been carried out by the Department of Health (Department of Health, 2009). Evidence suggests that although it was popular with younger disabled people, many of the older age service users found they were put off by the complexities of the scheme, especially around issues of becoming an employer if they needed to appoint paying carers (McGauran, 2010).

As Mandelstem (2010) points out there is some confusion in the legislation in the personalisation agenda as there is no new legislation or detailed statutory guidance to support this. The Department of Health have set up a ‘toolkit’ that fits personalisation into legislation but it is inadequate and contains errors. Therefore suggesting that there could be risks involved in the transformation of social care.

What is apparent from evidence on pilot studies is very early to say what the full impact of personal budgets will be on occupational therapy staff and other professionals, and that it is most likely that developments of personal health budgets need to significantly change cultural values throughout the National Health Service (Stobbs, 2010).

Personalisation in social care does have potential benefits in giving service users choice and control over their care services. Although there is no doubt that it does have some potential pitfalls. What can be recognised from this new approach is that safeguarding is essential to all service users especially complex cases where careful risk management and person centred practice are essential.

However, personalisation is in its infancy stage and a lot more debate is needed around this new policy for service users to feel confident in new transformation of our healthcare system. Equally, this can be seen as an excellent opportunity for occupational therapists to demonstrate that they are well equipped to take the lead in this personalised agenda as it sits well in the role of their profession.

In this easy, I will be discussing personalisation in considering its key elements. Looking at the impact of Fair Access to Care Services (FACS) in meeting service user needs. How it contradict in particular the notion of choice, control and independence for old people. I will also the implications for social work practice, and my own personal practice in an anti-discriminatory point of view.

The adult transforming agenda is focused on the development of personalisation of support. The 2006 Community Services White Paper, Our Health, Our Care, Our Say, announced the piloting of Individual Budgets. Personalisation had its beginnings in Direct Payment which was introduced in 1987, were people who are eligible for social care can choose to receive a cash sum in lieu of services (Henwood &Nigel, 2007).

The development of Transforming Social Care is driven by the demographic pressures and changes to public expectations. According to Chandler (2009, p2) “by 2022 20% of English population will be over 65 and the number of those over 85 will have increased by 60%”. The development of better housing options and extra care housing will be crucial for the future. Majority of older people will expect to live in their own homes for as long as they possibly can. And with more people living longer and requiring support, an increasing number of families will feel the impact of these demographic changes (Chandler,2009) [online]. One of the objectives of Putting People First was to champion the rights and needs of older people in their local authority and public services within a policy, which will involve them as active citizens who may or may not need support. However, these expectations cannot be met through traditional approaches to delivering of social care services.

A fundamental change in Adult Social care is required in order to ensure that the needs of each person can be met in a way that suits their personal individual circumstances. Putting people first (DOH 2009), laid out the vision for change in social careaˆ¦ “this vision is of a new social care system that helps people stay healthyaˆ¦aˆ¦ through a focus on prevention, early intervention and enablement, and high quality personally tailored services for those who need ongoing care social care support This new policy is referred to as “personalisation”.

According to Lloyd (2010, p 189), “the term personalisation is very contentious” she further cited Boxall et al (2009) distinguishing between personalisation which focuses on the particular needs of individuals to the preference of one size-fits-all approach of services. The self directed support is about the control that service users can exert over the definition of their needs and the ways in which these should be met. In policy terms, personalisation is both “the way in which services are tailored to the needs and preferences of citizens” and how the state empowers citizens “to shape their own lives and the services they receive” (according to the Department of Health, document Transform Social Care, Local Authority Circular 2008, p4).

Personalisation was introduced in government policy in 2007 when the Putting People First: A shared vision and commitment to transformation of adult care (DOH, 2007) Concordat was published. This outlined the reforms for social care. The key elements in the document where;

Self Assessment,

Individual Budget,

Choice, Control, Independence.

However, because personalisation is only a policy it is implemented differently across social care services. Proponents of personalisation argue that the need to personalise services arise because, services were institutionalised and driven by professional, managerial and economic agendas, rather than those of service users (Lloyd, 2010).

Historically and currently, a person in need of social care services is assessed by a social worker and other agencies. Then they decide the type of support the service user will receive, who from, where and when. For a couple of years now the government has been moving towards changing that system to one which the person in need of social care gets to decide the type of support they need and how, and this is now known as personalisation.

The drivers behind personalisation are found in the Our Health, Our Care, and Our Say White Paper (DOH). It suggests that people will be happier, healthier, and have better prospects for the future if they are put in control of their social care support.

According to Harris & White () a “milestone in the pronounced shift by new labour towards personalisation was the Adult Social Care Green Paper, Independence, Wellbeing and Choice. This saw the introduction of individual budgets as the principle route to personalisation (Harris & White).

The Department of Health describes personalisation as an approach in which “every person who receives support, whether provided by statutory services or funded by themselves, will have a choice and control over the shape of that support in all care settings” Brody(2009) [online]. One key issue identified by Griffiths (2009, p3) is that “individual budgets offers a aˆ¦ a chance to empower ‘service users’ in their dealings with public services and it puts the service user at the heart of public service reform. This is one of the key values of Putting People First (2007), to ensure people in need of social care have the best possible quality of life and the equality of independence living. Griffiths (20009, p2) further argues that individual’s budget will give “service users a greater choiceaˆ¦. by giving money to the service user to purchase services from a plurality of providers”.

However, Forster (2002.p, 85) identified that there is “little or no choice for elderly people. They can only have choice if the cost of their care is within the amount allocated by local Authority (LA) or if social workers agreed that it is suitable”. This was also highlighted by Hudson& Henwood (2008), in the CSCI document Prevention, Personalisation, and Prioritisation in social Care, that the “coexistence aˆ¦ of self directed support alongside the Fair Access to Care (FACS) criteria have create some tensions” while personalisation is concerned about promoting and maximising the choice and control of service users.” it fails to determine how the eligibility of those groups is defined (Dodd, 2009) [online]

The FACS policy guidance was publish in 2002 as a Local Authority Circular LAC (2002) 13. That Provides local authority with an eligibility framework for setting and applying their local criteria with the aim of ensuring fairer and more consistent eligibility decisions across the country (DOH).

As Crawford & Walker (2004), points out this system is failing to distribute resources to people who will benefit from early intervention. For example there are a growing number of old people with lower level needs who are likely to develop higher needs in the absence of responsive support. According to Dodd (2010), “using one of the four levels within the Fair Access to Care services (FACS) banding as a threshold for rationing resources is too rigid an instrument for fairly and responsively allocate social care budget”. He goes on to argue that currently, “people with proven care needs are not receiving the services they need”. Therefore as long as the FACS criteria remains in place as a rationing mechanism, it will be impossible to realise the universal model of self directed support envisaged within the personalisation agenda(Dodd,2010)[online]

The CSCI report argues that as the government is concerned to hold down public spending “eligibility criteria are a key mechanism, serving to regulate service provision in line with available resources and identified priorities”. In the current financial climate were resources are tight, these criteria can be adjusted by the local authority in order to narrow access to care support. Lloyd (2010), policy makers are more focused on the economic challenges than the needs of older people.

The implications for social workers according to Adams (2009, p145) is the amount of time they will have to spend with service users and carers who have individual budgets “to help them gain the necessary knowledge and skills they may need to manage their budgets”. Also, another limitation to personalization and individual budget has been identified by Griffiths (2009) that the current economic climate may pose a threat for individual budgets and may not survive the planned government spending cuts for the next few years.

In order for an individual to receive holistic, high quality health and social care services, effective communication and multi disciplinary working between professionals is imperative (Ashcroft et al, 2005). I will discuss my personal experience of interprofessional working, both in regards to the conference and the on line group work undertaken. I will also explore how the module relates to my own experiences in practice, drawing on literature and policy of both a political, professional and social nature.

The team of which I was a member consisted of students studying adult nursing and medicine. I was the only group member studying social work which initially did create a barrier in respect of the perception held by the other group members of what a social work practitioner’s role is. It was clear, following initial introductions, that some group members held a stereotypical view of social workers and were very dismissive of the work carried out by practitioners. It is essential, when working interprofessionaly that practitioners are mindful of the various methods employed by associated health and social care professionals and vital, therefore, that practitioners become aware of their own possible prejudices, through reflection on their practice. This reflective process assists to ensure potential negative stereotyping does not hinder the outcome of the work carried out by the team and have a detrimental effect on the care provided to the service user ( Fook, 2002).

Through discussion it transpired that much of this stereotypical view had been constructed through the influence of the media’s portrayal of social workers. During the conference group members cited television documentaries in which social workers failings were highlighted. Lombard ( 2009) argues that this type of media attention is damaging not just to social work but to all allied health and social care staff, attributing it to a possible lack of comprehension of the profession. Earlier this year a national advertising campaign was introduced. This aimed to draw attention to the role social workers play in safeguarding children and adults and to achieve a more positive, public perception of the profession ( McGregor, 2010).

The perceived lower professional position of social workers, held by other health professionals, however, is argued by Barbour (1985) as being a source of high anxiety for students studying on social work courses. However, it became apparent as the conference continued and discussions were held, that as a social work student I had gained experience of a wide range of practice settings and of working interprofessionally in order to achieve the best possible care provision for the service user. These practice experiences enabled me to reflect on both positive and negative factors of working with other professionals and to contribute to the group discussion with examples of interprofessional work in which I had participated. An example of which is regarding a case I care managed whilst working within a hospital social work team. In order to facilitate a safe discharge home for an older person with dementia, input was required from various disciplines. Occupational therapy support was necessary to ensure the home environment would still be suitable and assessment from the community psychiatric nurse was also completed in respect of service provision to maintain the emotional and mental well- being of the service user.

Ongoing communication between involved professionals was therefore essential, for an effective outcome for the service user to be achieved. This illustrates the highly significant role of interprofessional education for students studying to practice in the health and social care field. Reeves et al (2009) argue that interprofessional education has impacted notably on patient care in, for example, the improved knowledge and expertise of staff providing care to individuals with mental health issues.

The discussion of practice experience, I feel, added positively to the group and perhaps began to reduce the preconceptions held by other group members of lack of professional competency executed by social workers

(Carpenter & Hewstone,1996). Through the process of exchanging opinions, discussions and working as a group, the potential to overcome stereotypical views and facilitate change was engaged in (Mullender & Ward, 1991). Being a member of a group can determine a sense of familiarity, group members may have experiences in common and this sharing of situations can act as a supportive, cathartic procedure ( Johnson & Johnson, 1994). A fundamental element of effective interprofessional partnership, therefore, is trust. If facilitation and engagement in open debate and sharing of ideas between professionals is to occur, this must be apparent ( Cook et al, 2001).

The example of interprofessional working in respect of facilitating a safe discharge home from hospital, also raised further discussion regarding the role of input from the service user and their carers. They should be seen as part of the group, not externally from it and involved fully in the decision making process. This was challenged by one of the group members studying medicine, who felt that the responsibility to make decisions about care provision should be held solely by the professionals involved. Payne (2000) argues, however, that a focus on the interactions between the professionals can undermine the participation of the people who use the services. Involvement of service users, family and carers and recognition of their role as being experts by experience, may begin to create equality of power between professionals and the individuals they are supporting ( Domenelli,1996).

We explored this further through discussion within the group and I felt concerned by some of the group members attitudes towards the notion of making a decision as professionals, whilst excluding the service user from this process. This is an oppressive way to practice and the empowerment of individuals through maximization of control and choice, should be striven towards in all provision of health and social care services ( Banks, 2006). Respect for the individual choices and interests of the service user should always be paramount throughout provision of health and social care and the assessment process, as detailed in the National Occupational Standards for social work (2009).

Ongoing communication has been actively engaged in during my personal practice experience. However, throughout the module there was very little online participation from the team via blackboard. This was disappointing, as through the proactive exchange of ideas from the varying professionals perspectives, a more cohesive and beneficial learning experience may have been achieved. Indeed, the centre for the advancement of interprofessional education (1997) has documented that there are significant benefits in students from varied fields, learning together.

In contrast to the team work which took place at the conference, my experience of working alongside allied health and social care professionals in practice has been extremely positive. An example of which is in my previous employment within an adult care community team in which I attended weekly meetings with the district nursing team and local G.P’s. enabling effective sharing of information to take place. This communication enabled all involved professionals to gain knowledge of changes in service users health and care needs and provided a forum for any concerns regarding safeguarding issues, to be shared and explored further.

Within the conference team, therefore, further discussion and exploration of the differing views regarding this topic was carried out. The conclusion of which was the establishment of one of the teams sentences as “be open minded and willing to accommodate other professionals values, within a team working environment.”

The ideologies of interprofessional working are not always apparent in practice however, resulting in catastrophic failings in care. Victoria Climbie died after suffering serious abuse whilst under the care of the NHS and social services. Lord Laming (2003) reported a lack of sharing of information between professionals and argued that when practitioners did raise child protection concerns, there was a lack of feedback and little or no further communication between agencies.

The death of Baby Peter Connelly also sadly highlights concerns regarding how professionals work together. The serious case review reports that at a significant case conference held regarding Baby Peter, there was poor attendance from professionals, with neither doctors, police or lawyers turning up ( Laming, 2009). This illustrates that even after the reported failings in communication between professionals in the Victoria Climbie case, interprofessional working does not always appear to be fully engaged in.

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Section 2
Discuss how you would take what you have learnt about Interprofessional working into practice.

Attendance at the conference provided an opportunity to explore the process of working effectively with other professionals. In practice, the active joint working between health and social care professionals and the voluntary sector has become increasingly important with the introduction of the personalisation agenda, as detailed in the social policy ‘Putting people first: a shared vision and commitment to the transformation of adult social care’ (2007). The personalisation of social care services enables service users to take increased control of their own support packages and provides a high level of empowerment.

I will discuss this further in relation to interprofessional working and it’s application in practice.

Service users are now provided with the option to choose from which provider their care is sourced ie, from the private, pubic or voluntary sector. In 2004 the strategic concurrence between the NHS, Department of health and the voluntary sector of ‘making partnership work for patients, carers and service users’ (2004) was formed, which indicated a dedication to interprofessional working and a fully person centered approach to practice. However, the change in government this year and recent significant cuts in funding to the welfare state proposed by the coalition government may impact significantly on the initial goals set out in this policy ( Dunning, 2010).Significant changes in how funding is allocated impacts greatly on social care practice. On qualification as a social worker I will endeavor to carry out effective interprofessional practice, however with increasing reductions in front line staff and higher caseloads it raises concerns regarding how achievable this will be.

My own experiences of working within an adult care management team have been of positive interprofessional working. I have attributed this to the comprehensive, ongoing sharing of information between social work practitioners and community nursing teams, which took place. The desire to strive towards a common goal and achieve the best possible care for the service users, provided an effectual construct for professionals to practice within. The recognition of individual differences regarding ethnicity, culture and relationships by all involved professionals enabled truly anti-oppressive practice to take place (Dominelli 2002).

However, during the conference, team members voiced concerns regarding how engaging in interprofessional working may cause their specific professional identity to become vulnerable. This has been identified by Frost et al (2005), who postulates that the fusion of professional margins can create apprehension and resentment between practitioners. This discussion was an interesting aspect of my personal learning within the group. As a social work practitioner the opportunity to engage in joint working with other professionals is embraced and is essential to effectual, safe practice. The varied perspectives between group members however, has provided a deeper insight into how other professionals may view this method of working and I will be mindful of this in future practice.

Interprofessional working was illustrated further during the conference by a presentation from the Bristol Intermediate care team. The team consists of health professionals working alongside social work practitioners, aiming to reduce hospital admissions, providing a holistic approach to practice and enabling service users to remain in the community and to be cared for at home (Drake & Williams, 2010). I feel the cohesive working style of this team, provides the best possible outcome for service users through application of an anti oppressive, person centered approach. This interprofessional method of practice provides for less of a risk adverse approach to practice which can be present in community care teams consisting exclusively of social work practitioners (Roe & Beech, 2005). This may be due to the presence of multi disciplinary professional opinions being readily provided, enabling a more holistic view of a situation and perhaps also the fundamental ethos of the team which is to promote independence. The ethic of empowering others to achieve independence however, is a core value of social work and I endeavor to implement this within my own future practice.

In order to facilitate change in my practice, I will be conscious of the importance of information sharing with other professionals and engaging in the process of reflection on my previous experiences of working interprofessionally (Payne, 2006). An example which occurred whilst working within an adult care management team is regarding an allocated case concerning a couple, living at home in the community, both of which had multivariate care needs. In this circumstance a wife was providing care for her husband who has dementia, however she has limited mobility and depends on him to support her with some physical tasks. Joint working with other health and social care professionals was imperative in order to safeguard the needs of both service users (Meads & Ashcroft et al, 2005).

Combined assessments were carried out by myself as a social work practitioner, the district nursing team and community psychiatric nurse, enabling all involved professionals to be aware of each others role and involvement. This method of working was also highly beneficial to the service users in respect of limiting the amount of assessment meetings which took place and avoiding repetition of the same information to several professionals, which can become exhausting and create further anxiety ( Walker & Beckett, 2003). I did encounter difficulty in interprofessional working when liaising with the GP regarding a requested review of the couple’s medication. The GP held the opinion that both service users should be placed in residential care due to their age and health problems and was reluctant to engage in any discussion regarding alternative options. Through joint working between other professionals however, funding for a live in carer was secured to support the couple, alongside ongoing support from the community matron to ensure both health and community care assessed needs continued to be met fully and safely, in accordance with the NHS and Community Care Act (1990).

On reflection this was a challenging experience and I felt frustrated by the apparent disregard of the wishes of the service users and the discriminative attitude exhibited in respect of their age, by the GP. The reluctance to engage further with any of the involved professionals following a case conference in which the GP’s opinion had been challenged by myself and others working on the case, highlighted to me the hierarchy which is still in place within health and social care professions. Monlyneux (2001) argues that professionals who are assured in their professional role, are able to explore disparities in opinions and practice outside their own profession’s margin without feeling vulnerable. The importance, therefore, of maintaining focus on the service users wishes rather than difficulties in communication between professionals, ensuring their needs are met fully, is paramount. However, this incident demonstrates the difficulties which can occur when working within a team and the need for respect and equality for all members, in order to ensure effective interprofessional working takes place (Conyne, 1999).

The discussions held amongst the team during the conference have highlighted further to me the disparity between perspectives held by health professionals, who apply the medical model of practice and social work practitioners implementing the social model. As argued by Petch (2002), in order to respond fully and positively the uniqueness of the individuals needs should be identified. Through this process, empowerment and equality can begin to be accomplished. Both perspectives, therefore, are valuable when striving towards holistic health and social care provision. These are issues I will be mindful of in my future practice and I will endeavor to continue to practice with integrity and in an anti-oppressive way in order to implement person centered care provision.

To conclude, as a result of my practice experience and learning achieved from the conference, I feel strongly that a critical part of my future role as a qualified social worker is to facilitate the sharing of information between professionals. When appropriate, to advocate the service users individual wishes and to ensure all professionals are aware of these shared common goals. I feel this will contribute significantly to achieving the highest level of care for the service user and aims to support the safeguarding of both adults and children.

(Word count – 1338 )

Section 3.
References

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Dominelli, L. (2002) Anti-oppressive social work theory and practice. Basingstoke, Palgrave Macmillen.

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Meads, G. & Ashcroft, J. With, Barr, H, Scott, R. & Wild, A. ( 2005) The case for interprofessional collaboration in health and social care. Oxford, Blackwell Publishing.

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Walker, S. & Beckett, C. (2003) Social work assessment and intervention, Lyme Regis, Russell House Publishing.

Section 4.

The objective of this research paper is to discuss the personal attributes that are required in a physically and emotionally healthy counselor. A healthy counselor has a positive effect on his or her client. The field of counseling is becoming significant part of people’s life. This paper establishes its basis on the conflict of values of counselor and its effects. Another important aspect of the paper is to research about consequence of counselors-in-training interacting with clients prior to their master’s level training. It will highlight the consequences of engaging in practice prior to the training and its effect on capability of handling the client’s issues and queries. This could also lead to issues with the credibility of the counselor. These aspects are studied through literature and case studies done by other writers. Different researches conducted in the past are the major source of information. Foundation of this paper is based on the personal characteristics that a counselor should possess and their values.

Personal Characteristic of Counselors

Counseling is about giving advice and guiding the clients through their difficult times. It relates to the mental health and emotional state of the client. People seek counseling for their careers, jobs, relationships, addictions and general issues of their lives. Counseling is usually used as a synonym for psychotherapy. When in difficult times family and friends are unable to help someone, they seek for guidance, strength and answers from their counselor. Counseling is practices in sessions of an hour or so for once or twice in a week. Counselor and client both play vital roles in the recovery of client. Counselor’s expertise will be of no use if client does not fully share his or her problem. So, both have to be supportive and persistent while conducting these sessions.

Counseling is a field that requires patience, rational thinking and empathy. Counselors make a difference in the lives of other people. It is important for a counselor to feel empathy for the client. As Guidon (2010)describes, a sympathetic person wants to solve the issue him/herself but a person who feels empathy does not mix client’s problem with their own. Counselors lead a demanding life. Their clients require not only their time and advice but also trust and care. Therefore, a counselor needs to have very specific qualities in their personality in order to provide effective service to their clients. Other than the obvious personal abilities like interpersonal skills, counselors require many personality traits to be effective and efficient. Corey (2009) says that there are many characteristics of counselors which seem unrealistic but these are equally essential for any counselor. Before giving advice to clients, a counselor him/herself needs to be sure of their capabilities. Sincerity and honesty are very important in this field.

A counselor needs to be observant, active listener, interviewing, influential and focused. The effective councilor also requires a sound knowledge of theory and ability to put theory into practice (Gregoire & Jungers, 2007). Corey (2009) states that it is very important for effective counselor to maintain healthy boundaries, this way they should be able to maintain a balance between their personal and professional lives. Corey also concluded from his research that counselor should have a good sense of humor in order to lighten the mood. Guindon (2010)believes that clients give a counselor many non-tangible gifts like trust, care and confidence. Corey (2009) also says that the relationship of client and counselor helps both parties. Consolers learn how to admit their mistakes and become open to change in their lives.

McLoead (2011)discusses the qualities of people who are drawn to the field of counseling. Usually people who become counselors believe that relationships are the most important aspect of human life. They are also firm believers in the values that prove the worth of people and they are clear about their role in society and their future goals. Another most important personal trait of counselor is to be honest and keep the privacy of patient. It is their moral and professional obligation.

Values and its Confilcts

Values are the standard held by people about what is desired, proper and acceptable. It gives people a criterion of standards for shaping their lives. Both personal and professional values are important. Personal values affect the way of interaction with the client. Personal values of a consoler are developed as he/she grows up; they depend upon the upbringing and culture in which the counselor spends most of the time. Personal values include honesty, truth, helping others, doing meaningful work and positive influence on others (Corey, 2009). There is always a chance that the personal values of a counselor conflicts with the work values. Busacca (2010) tells that personal values conflict with the work values. If a counselor has a personal belief that a terminally ill person should have the right to end their lives; however, he cannot impose this thinking on anyone else. Studies show that counselors, while training, question their self-concepts with those requires for their field of work. Counselors have appeared to be molding themselves in their professional values after certain period of time. They have to create their own boundaries in which they want to practice.

Research (Sanders, 2003) shows that cultural difference between client and counselor can have a major impact on the relationship and therapy. The personal biases on either side can result in failure of professional values and ethics. High level of sincerity can reduce the cultural barrier among client and counselor. The counselor has to have a non-judgmental attitude towards the client regardless of his/her personal values. Campbel & Christopher (2012)also say that the counselor has to be physically, mentally, emotionally and cognitively on the same level with the client at all times. Mostly, counselors have to deal with grief counseling for their clients. Counselors, who are more self-aware and comfortable in sharing their feelings, are more efficient and effective at their work (Ober, Granello, & Wheaton, 2012).

Professional values determine the role of a person in organization and the ability of balancing work and family. Work values of counselor include taking responsibility, empathies, develop counseling style, share responsibility with client and tolerate ambiguity. The common issues where conflict of values occurs are religion, sexual orientation and someone’s right to die. Serious consequences might occur as a result of these conflicts (Guindon, 2010).

We can conclude that personal values of counselors can conflict with the professional values. However, strong personal values will work in favor of the counselors. A counselor with strong moral and ethical values will have a positive influence on the clients. Whereas if a counselor doesn’t practice honesty, integrity and privacy of others than he or she is more likely to face difficulty in understanding a client with strong moral values. Although a counselor cannot impose their personal values on clients but they can have a very positive effect in influencing and helping the client in their difficult times. If there is a strong disagreement between the values then it might result in referral to another counselor but most of the times this conflict can be resolved with cold-mindedness and rational thinking.

Trainee Counselor

Survey (Busacca, Beebe, & Toman, 2010) shows that practicing counselors show matured level of values than trainee counselors. Yager & Tovar-Blank (2007) also comment that counseling is a profession which is very stressful, tiring and with constant threat of fatigue and burn out. Trainee counselors do not completely practice cognitive counseling and usually under their instructors influence. For students of counseling it is very important to learn the wellness of the client and themselves. The curriculum has to be designed in such a way that they are completely aware of this idea and its implications. Grief counseling is a very important aspect of psychotherapy. If the trainees indulge themselves in practice before understanding the importance of wellness, skill and knowledge required for grief counseling, they are bound to miss lead the client. Without the master’s level training, the trainee counselors are not fully prepared to help the client and understand the delicate nature of the job. At this level, trainees themselves are in conflict with requirements of their profession and their personal moral and ethical values and beliefs (Ober, Granello, & Wheaton, 2012).

Statistics by Gaubatz & Vera (2006)show that only 4-5% trainees enrolled in master’ or doctoral program are prevalent than those in undergraduate level. Statistic also shows that only 10% of students enrolled in mater’s program are suitable for the field of counseling. However, Woodside (2007) says that it is better for trainee counselors to interact with the clients. But, this interaction should be under the guidance of a practicing professional counselor. Internships are a very effective way of learning by example. Yager & Tovar-Blank, 2007 (2007) on the other hand is of the opinion that if an emotionally unstable student is enrolled in counseling program then the course should be deigned in such a way that it should enlighten the student and make him self-aware. If such a student practices before being properly trained, he will not be able to understand the client and might make the situation worse of the client.

The research (Woodside, Oberman, Cole, & Carruth, 2007) shows that the student of undergraduate level is not fully matures and trained. Most of them show signs of anxiety and confusion about converting theory into practice. Those who feel confident are not fully trained and hence experience disanointed clients and they themselves become more confused. There are three basic stages of counselor’s professional development including the helper, the beginning student and the advanced student. Passing through various techniques and training, trainees reach the next level of their professional development. Another research (Busacca, Beebe, & Toman, 2010) shows that at training level counselors-to-be explore their inner values and self-concept. This stage defines who they actually are and what they actually want to be. Being self-aware and knowing personal characteristics is as important as learning the theories of counseling. Once they are clear about their own values, they can determine the bounties in which they want to work. Not everyone can work in a profession that demands occasional conflicts of personal and professional values and ethics.

Hence, keeping the view of the research conducted by various experts, we can say that trainees who start seeing clients before their master’s level training are bound to suffer a shock. They will not be able to handle the clients. Their own values will not be in sync with their professional demands. Being not fully self-aware and lack of proper training might lead them not only to a dissatisfied client but they might also add to the misery of their client. If they give advice according to their personal ethics and values rather than professional values, their clients will doubt their sincerity towards them. All in all, it will not be a good decision to practice before having some master’s level training.

Conclusion

Counseling is not only a profession but also a great responsibility. It is a vast field which includes career counseling, grief counseling, behavior therapy, heath counseling and also covers issues like addiction, mental health and relationship issues. Clients confine everything in their therapist and seek their guidance in various aspects of their lives. To become a counselor, one has to possess certain qualities like theoretical knowledge of personality, empathy for client’s situation, understanding behavior, attentive listening ability and power of deduction.

After studying the literature pertinent to personality and values of a counselor, it can be concluded that both of these are very important for the professional development of a counselor. Their personality not only defines who they are but also determines how efficient they are in their profession. Strong moral and ethical values of a counselor can make the relationship with clients stronger. Clients will rely on the counselor for his/her advice. If in-training counselors try to treat their patients before master level training, they are more likely to have cognitive issues and difficulty in dealing with their own personality and work value conflict. So, it is better to start practicing once you are finished with training so that there is no confusion between personal and work values.

Values are part of my upbringing and play a big part in my life, as they underpin my thoughts and actions. As a social work student I need to question my personal values, beliefs and ethics as these will have a big impact on my behaviour as a professional. My personal values are congruent to the values of social work, which is the reason why I have chosen a career in a social care. This values are self – determination to promote social justice, being caring and helpful toward others, truthfulness (honesty) and respect. Working in Residential and Care Homes further developed my interest in promoting social justice and social change on behalf of the service users. I understand, that as a social work student I need to act in accordance with the values, and ethics of the profession, recognizing how personal and professional values may conflict with the needs of diverse clients.

VALUING DIVERSITY

To value diversity means acknowledging my own prejudices, allowing people to be different and respecting these differences. Being raised in Poland, where 96, 7% of population is polish my upbringing was “white” and influenced my prejudice about people from other cultures. Due to lack of contact and knowledge I have made a preconceived judgment about other races. My social environment such as religion and culture has influenced me to behave in certain ways towards other people. My religion created a stereotype and prejudice about homosexuality. My beliefs would not accept homosexuality due to influence of the church on my attitude towards sexual orientation. Moving to England and changing my social environment made me realize how wrong those perceptions were. Living in multicultural environment made me aware of different cultures, religions, races, which helped me to change my attitude towards people from diverse backgrounds. I have made friends from different parts of the world what helped me to enhance my understanding of different cultures and religions. I have learned how to accept and respect the differences. I understand and recognise that we living in a diverse society and that there is much

to be gained by having a variety of people, with a variety of backgrounds, approaches, talents and contributions.

DISCRIMINATION

My experience with discrimination started when I moved to England in 2004. I was often subject to insulting racial jokes. The stereotypes about my culture and people along with labelling were very offensive and painful. The people with whom I have been working held hostile attitudes toward Polish people and culture. I was working in Bed and Breakfast where the majority of employees were English. My employer treated me differently than other employees. When allocating the tasks, she would often give me the most of them living the rest of the staff doing almost nothing. On one occasion one of the employees did not complete the given task and she said “Let the Polish get on with this”. She would not have dared to treat other employees the way she treated me. Probably she thought that she could get away with it because I did not know my rights and my English language was very poor. I found that experience very painful and could not understand why I was treated this way. Later on I have discovered that it was a direct discrimination and it is against the law to be treated this way. There are a number of policies and legislations that could apply to my situation such as:

The 1976 Race Relations Act, which “makes it unlawful for an employer to discriminate against you on racial grounds. Race includes: colour, nationality, ethnic or national origins”. ( www.direct.gov.uk)

The Equality Act 2010 “provides a new cross-cutting legislative framework to protect the rights of individuals and advance equality of opportunity for all; to update, simplify and strengthen the previous legislation; and to deliver a simple, modern and accessible framework of discrimination law which protects individuals from unfair treatment and promotes a fair and more equal society”.( www.equalities.gov.uk)

I could also use agencies such as Citizen Advice Bureau, which provides free advice to foreigners, and often offer a translator to provide information and advice on employment rights, including discrimination. ACAS is another organisation, which provides general information on employment rights and responsibilities.

Being discriminated in the past made me realise how damaging the effects of discrimination can be. I have started to wonder why people discriminate against each other. On many occasions I have witness discrimination but due to lack of knowledge I was not able to challenge it and simply accept or ignore it. Last year on the Access Course I have developed a knowledge which helped me to understand why discrimination happens in society. I have learned different theories behind discrimination which helped me to understand its roots. Since then I have become more observant and started to reflect on my own actions and actions of others. Schon (1983) identifies two types of reflection. Reflection – in – action, which is “thinking back on what we have done in order to discover how our knowing in action may have contributed to an unexpected outcome. We may do so after the fact, in tranquillity or we may pause in the midst of action (stop and think) “(Schon,1987:26). Reflection -in -action is about challenging my assumptions, thinking again, in a new way about the problem that I have encountered. Reflection – In – Action is happening “where we may reflect in the midst of action without interrupting it. Our thinking serves to reshape what we are doing while doing it” (Schon, 1987:26).

By observing others in my current work place I have identified negative experiences present in a Care Home based on feelings of discrimination and unfair treatment which was against my own values and believes. One of the examples of discrimination that I have witness was discrimination through the language. Working in a Residential Home as a carer I have noticed a member of staff using patronising and insulting language towards residents. I found that language very disrespecting and decided to challenge my colleague. I have realized that he held a negative attitude towards older people, as he regards to residents as ” dirty old woman”, and call them as “useless “. I have explained to him that one day he also will be old and

is that the way he would like to be seen. At this point my Manager came in and after explaining what has happen, the member of staff was asked to leave the premises. In reflection on this experience I have realized that people have different attitudes to aged population, which are different to my own attitude.

Another observation involves a resident having negative attitudes towards black people. The resident would not allow a black member of staff to provide any kind of help or personal care. She would shout and swear using insulting language as soon as they entered the room. Because the majority of carers are black it is hard to allocate a white member of staff to help her. When asking her why she does not want a black member of staff she answered that she “does not want blacks to help or touch her because they are dirty and “useless”. On one occasion when attending this resident I decided to challenge her perceptions about black people and called a new black member of staff to help me when giving personal care. I have explained to the resident that she is a new member of staff and she will only observe me. She accepted it but was not very happy about it. While working with resident I started to ask the girl questions, such as why she wants to work here and does she like her job. She responds that she was looking after her grandmother who passed away recently and has a lot of experience and that she enjoys helping other people. The resident was listening but did not say anything. I was hoping that she will change her negative attitude after spending some time with the black member of staff, after watching me having a positive interaction with her. Not being aware of the resident attitude the girl asked her if she would like her to do her hair because she used to do it very nice to her grandmother. The resident did not answer just sat on the chair and gave the girl a hair brush. On that stage I have left the room hoping that this experience will change her attitude and prejudice against black people. The resident now is being attended by black staff without any problems, and communicating in a respectful way.

REFLECTION ON THE POLICIES OF CHALLENGING DISCRIMINATION IN MY WORK PLACE (JEWISH RESIDENTIAL HOME)

The use of Anti – Discriminatory practice at my work place is fundamental to the ethical basis of care provision, and equality legislation is crucial to the protection of service users dignity. It imposes particular responsibilities on public and service providers to avoid stereotyping and to respect service user’s diverse needs and cultural diversity. To challenge discrimination Jewish Care has put into place a written policies and procedures to deal with discriminatory behaviour and practice.

CHALLENGING DISCRIMINATION AND OPPRESSION

A starting point in challenging discrimination and oppression is having awareness of the different types and ways that discrimination and oppression can occur. Thompson PCS Analysis provides a clear and understandable method of consideration discrimination and oppression in the context of personal, cultural and societal levels. The process of empowerment is also crucial in challenging oppression. On a personal level we could empower individuals to take control over their lives, for example through enhancement of self-esteem and confidence. On a cultural level empowerment is concerned with becoming aware of ideologies premised on inequality. Discriminatory assumptions and stereotypes should be challenged in order to break down an oppressive culture. On a structural level empowerment involve abolition of structural inequalities from the structure of society. Education plays important role in challenging discrimination. By educating people to understand the causes and effects of discrimination we can challenge traditional beliefs and practices concerning particular groups and promote equality, diversity, inclusion and tolerance.

ANTI – DISCRIMINATORY PRACTICE

Anti – discriminatory practice is an approach which seeks to combat discrimination and oppression, in terms of challenging all forms of discrimination and oppression from our own practice and practice of others (Thompson, 2006).

As a social work student I need to develop further my anti – discriminatory practice. To do so I have to recognise the significance of discrimination in people’s lives, especially in the lives of disadvantaged people. I also need to develop self-awareness and make sure, that my own action does not reinforce discrimination.

The aim of this essay is to critically evaluate my readiness to start counselling employment. There will be a number of key issues integrated into this essay that will explore my learning needs in the context of my professional counselling. These will include personal reflexive and reflective practice where I will introduce Argyris & Schon’s ( 1974) Increasing Professional Effectiveness Model, self awareness, issues of difference, placements and supervision.

I will discuss the values and moral qualities of the BACP ethical framework in relation to experiences of my placement. I shall discuss and explore the importance of professional boundaries along with contracts within the counselling setting. I will introduce Kolb’s experiential learning inventory and apply its elements to how it has influenced my learning since starting my counselling degree and how it has become a part of who I am. In relation to placement and supervision I hope to discuss some of my experiences with clients in therapy, the organisation in terms of policies and procedures, as well as how I found the experience of supervision to be.

In relation to this I will also discuss beginnings and endings, my feelings around both and how I manage these. I will discuss the topic of stress and burn out and strategies for preventing the risk of this as I prepare myself for a career in the field of counselling.

The end is near, my counselling journey I mean and although I am full of mixed emotions revolving around the end, I am at a stage of this journey where I feel comfortable in relation to who I am and where I am going in terms of a career in counselling. All endings bring mixed emotions, for some it is change, rebirth and goodbyes, for me it is the question of what is expected of me next and will I meet these expectations. Schon (2001) states that change is a fundamental feature of modern life.

I never had many negative experiences around beginnings and I think one of the reasons for this is because of my top character strength which is social intelligence. I always seem to be aware of the motives and feelings of others and know what to do to put people at ease along with knowing what to do to fit in to various social situations. Although in saying this I found making the contracts with my clients a difficult task.

It wasn’t that my clients didn’t want to make the contract, the difficult part was collaboratively working together on a contract that best fitted each client, bearing in mind two of them were under eight years of age. I successfully managed to make a contract with each of my clients and it was a great experience, for two of them were pieces of clay. According to Molteni and Garske (1983) contracts may increase compliance with the processes of the therapeutic process.

Endings on the other hand are not as easy for me, I understand they are part of life and sometimes we need to end so we can grow and develop as individuals. This course and especially this module has helped me to bring these fears and emotions into awareness and reflect on them so I can understand what lies behind them. It is important for individuals to let go and move on as this is like the child leaving home for the very first time.

The child needs to leave to gain independence and knowledge about the world. I seem to be experiencing quite a lot of endings this year in particular. I have just recently finished a placement where I was working as a trainee counsellor with children.

I have been working with three clients close to a year and was quite worried at how these endings would go. Along with the ending work with my clients I was also ending with my supervisor who has been very supportive of me during my time there, I never once felt isolated or alone. I am quite pleased to say that these endings went extremely well as I have been working hard for a number of months with my clients on them.

During these months I would make small endings at the end of each session as it was like a countdown for my clients so when we got to the final session it wasn’t a big dramatic ending, they were well aware and ready for it. I feel extremely proud of the therapeutic work I have done with each of my clients. It was not easy at times but I persevered and learned a lot from my struggles. It is not easy to hear a child introduce erotic material but I coped well.

On reflection of these endings in particular, I was surprised at how well I managed my own, I have come to the understanding that I managed mine so well because I knew my clients where ready to end and move on. This allowed me the incentive to then manage mine so well. I love the metaphor that Dallas and Stedman (2009) use to describe reflection. They describe it as a mirror reflecting our own image back to us (Dallas and Stedman 2009). Dallos and Stedman (2009) suggest that reflective practice is best seen as a process of analysing and reanalysing important episodes of activity.

The term reflection in action is used to refer to the spontaneous act of reflecting in the moment (Dallas and Stedman 2009). I have had a lot of these spontaneous acts and found myself at times getting lost in them. When working with children, metaphor and symbols act for a lot of the communication. I have often found myself questioning something in my head while I am reflecting in action and at times had to snap myself out of it as I was aware my focus was coming away from the client.

Reflecting on action which Dallas and Stedman (2009) call reflexivity is a great way to question what was going on for me at that time and what was it about that particular episode that I lost my focus. I find reflection is a great strategy for promoting self care. For me this means quiet time for myself to reflect and get lost in my own cognitions without being disturbed. I feel it is important to look after ones self as this can prevent the cause of stress and burnout. Also by having quiet time to yourself to mull over the day or week that has passed is an excellent way to manage ones stress.

The feedback from supervision has been outstanding with reference to how quickly I built trusting relationships with my clients and the depth I was able to work at despite this being my first year of any placement. The experience around ending with my supervisor was another healthy ending. I think the biggest reason for this is after all of the positive feedback I received from her I knew I was then ready to end.

This brings me to the conclusion that it isn’t really the endings I have trouble with, it has more to do with how I end. What I mean is that I may not deal with a spontaneous ending as well as one I know is coming, which makes sense. Although saying this I know I would handle it better than I think I would. My counselling endings remind me of personal endings I have experienced in the past. The ending that comes to mind is when I left my family home in Ireland for the first time. I remember how lonesome I felt after moving away as myself and my family are very close. It was like the end of an era and even though I visit them quite often, every time I leave them to come back to London, its another ending in itself.

In relation to ending with my clients, if I ended and seen that they weren’t ready to end, or that I knew I hadn’t been doing all I could to apply emotional support to my them, then I am sure the endings would not have went so smooth for me. I have learned a valuable lesson from these ending experiences, although they went well, its ok that I feel sad, it shows that I care. The feelings I have are quite calm and peaceful , of course I wont forget my first clients and I will think about them from time to time but the important thing for me is that I don’t have any emotional ties with them so It is ok for me to think about them and move on. I really don’t think these endings would have gone as well if it hadn’t been for all of the support I received from supervision.

My supervisor and I jelled straight away and because of my honesty and openness in supervision it allowed us to examine my work in depth and maximise my learning. I feel the greatest compliment I have received from supervision is being told that I have begun to develop my own internal supervisor.

Ongoing supervision is a requirement of the BACP (2010). The BACP (2010) believes that supervision can positively contribute to the maintenance and development of ethical professional practice. In my opinion it is a necessity for all counsellors to have ongoing supervision to support counsellors, to enhance effective practice and a supervisor can act as a safety net for the counsellor. According to Feltham (2010) supervision is mandatory for all counsellors regardless of their experience even if it is difficult to find a suitable supervisor.

The atmosphere always seemed quite calm and relaxed which I enjoyed. I like to avoid confrontation at all costs, a negative atmosphere in the work place doesn’t just effect who is involved in it but affects everyone. This can have quite a negative effect on the job that one is doing and the clients whom we are working with. It can also lead to stress and burn out as research has shown that people who don’t feel supported and are not happy in the work place are more prone to stress (Salami 2011). I am quite lucky as I have very rarely experienced confrontation in the work place.

On the rare occasion that I have, I dealt with it by discussing the problem and having it out in the open. We were then able to keep our professional heads, get past it and focus on the job at hand. Money could not by the experiences I have had on my placement. I followed all the rigorous procedures for dealing with a child protection matter which I dealt with very well and in context to the BACP (2010) ethical framework.

When placing myself in the context of values, moral qualities and personal boundaries of the BACP (2010) Ethical Framework I feel that I am ethically mindful when delivering these services required by the BACP(2010). My moral qualities include empathy, resilience, respect, Integrity and courage. I believe one of the reasons I am so mindful comes from my therapeutic core model which is person centred (Rogers 1961). The emphasis is on creating a safe environment to discuss issues in a warm and non judgemental way. By using the core conditions effectively I feel there is little chance of harming my clients.

I followed all of the Place 2 be policies and procedures from the no touch policy to holding the boundaries firmly. It was quite difficult at times to avoid my clients trying to hug me but after a while I was able to use my body to my advantage of avoiding my client hugging me as I would intuitively know when it was going to happen and was able to move my body to the side so it would be avoided, keeping in mind that I didn’t want it to come across as rejection.

I understand that life in general can be suffering and we don’t have all the answers to our issues but it is about managing that suffering so it doesn’t take over our lives. Becoming a counsellor may have different meanings for many individuals. It can be the lust for power to sit in the power chair, for others it may be the need to feel needed, for me it comes down to supporting clients emotionally so they can end as much of their suffering as possible.

I believe self awareness to be one of the most significant skills I have learned during this degree. Over the duration, my self awareness has developed and I have a greater understanding of my inner and outer self. I think self awareness is crucial for understanding my own feelings as well as the client’s feelings in the therapy room. I believe it is extremely important to be mindful of the diversity in the counselling profession. I am well aware of my biases towards other individuals but I will leave them outside of the therapy room.

My mentality is that I am here to provide a service and why should I let my own values and beliefs get in the way of applying emotional support to an individual. I also feel that a lot of my biases come from being uneducated around a certain culture or race. I feel it is my professional duty to educate myself around these different culture so I am not creating unnecessary boundaries. Lago (2006) states that counsellors should educate themselves about the specificities of different cultures in order to develop competence for working with what has been classed as the culturally different.

I have found reflection to be very useful in relation to areas of the Johari window (Evans 2007). The area in which I seem to struggle with the most is giving constructive feedback. The reason for this is the individual may misinterpret what I am saying if they feel the feedback is negative. I have enjoyed learning about the johari window (Evans 2007) and have used it in a number of different areas of my life.

I found supervision to be an excellent way of acquiring my blind spots. I think personal therapy would be fundamental in relation to the johari window (Evans 2007), not only would it help to discover areas within myself but I feel talking around them may to become more aware of them.

I believe this is sufficient for all trainee counsellors before they start to practice. I don’t believe it is fair to start counselling without having experienced what it is like to sit in the clients chair. My plan to access a counsellor will be through a professional body such as the BACP (2010) because anyone can advertise themselves as counsellors. I believe this is the safest way as the counsellor will be an accredited member of a professional body. Personal therapy enhances professional development and relational capacities aswel as increasing personal development capacities and well being of the counsellor (Orlinsky, Schofield, Schroder and Kazantzis 2011).

In conclusion of this essay I am very pleased with my development thus far, both personally as well as professionally. I feel I am shifting every time I learn something new. I am so enthusiastic about the work with clients and I feel I would benefit from fully recognising my strengths and letting my confidence grow still further. I would also benefit from further reading of a variety of different theoretical approaches which I plan to do as should every counsellor regardless of experience. I am proud of the feedback I received from my supervisor, this has influenced my competence levels as a counsellor.

For further training and professional development needs I would like to work with adults using symbols and metaphor. My greatest influence has come from the work of Carl Jung’s Archetypes (Jung 1961) and the magic of metaphor through working at the Place 2 be. I would also be interested in more work with children as I would like to gain more experience in this field. According to my supervisor I seem to have a natural style of being with children. I have really enjoyed working with them, it has been very experiential and exciting. I go from here in search of a new placement where I hope to get a similar experience although knowing if I don’t I will learn something knew.

PERCEPTIONS OF HEALTH, DISABILITY, ILLNESS AND BEHAVIOUR

How health and social care users relate to the concepts of impairment and challenging behaviours

Users of health and social care are usually in need of social care depending on the nature and intensity of their illness. Disabled individuals like Mr. Holland Park are why the importance of the underlying relationships between health, disability and illnesses must be understood and further develop strategies that will ensure better quality of life for him and other users alike. Severe medical conditions can result in limited access to proper healthcare; even as many in the general public have the misconception about how healthcare is received by individuals with disabilities. Recent laws and policies by the government like the Disability Discrimination Act, which covers all community health care services and hospitals compels service providers to make specific adjustments to healthcare practices, and also to ascertain the practicality of these adjustments is directed towards users with specific needs as is the case with Mr. Holland Park.

Impact of past and present policies and legislations on available healthcare services

Mr. Holland Park is currently a member of a family that cares for him for very much hence it is typical for other members of his family to worry about his wellbeing in any care home he lives in.

In the past, legislations and social policies are developed in general terms that encompasses every health and social sector with policies affecting the general public and everyone residing within the United Kingdom. However, changes that been made over the years to suit specific aspects of the community, and precise laws are developed and others redefined to guarantee that every individual regardless of their medical condition, race, social class, religion or ethnicity receives the best care available.

Mr. Holland Park is over a certain age and may be worried about being subjected to any kind of abuse or neglect due to his health. This is because the society may sometimes be unwelcoming to behaviours exhibited by individuals with certain illness, as some exhibit behaviours that may view as strange and unusual. This is why the legislations are defined in such a way that people, especially workers of care homes must abandon the general negative perceptions about disabled users, and commit only to the provision of suitable and adequate health care services to such individuals.

The family of Mr. Holland Park will have nothing to worry about as every kind of misconception about any kind of illness will be overlooked and the best care made available for him in this care home or whichever one as the policies are well monitored and regular unannounced checks are done to certify adherence to these legislations.

The promotion and protection of disability rights has been improved majorly in the United Kingdom, making the United Kingdom a pioneer in liaison of the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD).

Policies and Legislation in recent years

Under the Disability Discrimination Act 1995 (DDA 1995), it is a violation of law to discriminate against disabled people in areas of including provision of services, employment, goods or facilities. Hence making it an obligation for service providers to ensure sensible modifications are made to engage disabled individuals in using their services. Consequent modifications were made via derivative legislations like Disability Discrimination Act 1995 (Amendment) Regulations 2003 through principal legislation like the Disability Discrimination Act 2005 and Special Educational Needs and Disability Act 2001. These acts made provision for a Disability Equality Duty making it a responsibility for public authorities to take passive roles in the promotion of fairness in treatment of disabled people.

The Human Rights Act 1998 calls for the need for every public authority to operate in a way which is attuned with the rights put in place in the European Convention on Human Rights. Should public authorities fall short, affected individuals and their families are permitted to seek a judicial remedy. Public authorities include central social and health care homes, National Health Service (NHS) and their trusts, Government, and most providers of public services.

In recent times, there is a more direct approach to the UK anti-discrimination legislation via the Equality Act 2010 which annulled and replaced the DDA in Great Britain alone. This Act not only encompasses the protection of disabled individuals from any kind of segregation, but also applied modifications to certain responsibilities of the public authorities regarding the participation of disabled individuals in policy decisions.

The Equality 2025 was created in 2006 as a government has a themed goal ‘Improving the Life Chances of Disabled People’ with a year 2025 target for disabled individual living in Britain to the treated as equal members of the society and have full access to develop their quality of life. It is particularly designed to assist disabled people attain independent living by moving gradually towards individual budgets that will bring together various services they will be entitled to and giving them various choices over diverse support from either direct provision of services and/or money.

HOW HEALTH AND SOCIAL CARE SERVICES SUPPORT INDIVIDUALS WITH SPECIFIC NEEDS

Available care needs for Mr. Holland Park

Mr. Holland Park being an elderly man in the early stages of dementia and additional visual and hearing disabilities means he will be needing special attention as his behaviours might sometimes be queer, and at other serious times sporadic and violent. The care home will be focused on providing assistance that will uphold his independence and therefore enable his stability whilst receiving dependable services that will suit his individual needs.

Provision of audio-visual equipment will assist Mr. Holland Park to make the best of his little sight. This will be after a proper assessment has been carried out by professionals to determine the seriousness of his blindness. As he is also hearing impaired, it will be best to make sure that he moves around the care home safely by having rotational care staff check on his whereabouts on a regular basis and a log kept to this effect. Also, he will need to participate in regular activities to keep him in good spirit.

Being partially deaf-blind can be challenging for Mr. Holland Park as he may sometimes feel less capable, it is the duty of our care home to ensure that he feels less challenged by engaging him in peer group activities that involves other service users. This way, he feels more active and energetic and he can take his mind off any heavy thought of being a burden to others.

The most important factor to providing the best care services to Mr. Holland Park is that the care staffs will never regard his challenging behaviours as a form of challenge, but will work towards providing him with a comfortable lifestyle by ensuring his hygiene is well taken care of. Also, his laundry will be done for him and meals and drinks will be prepared as he wants it on a timely basis and he will have a variety of menu of choose from. Should he be entitled to any benefits, we will make it our duty to assist him in claiming these benefits for him and the family and provide any necessary references or letters to state that he is under our care.

Available local services to support Mr. Holland Park and his family

Disabled individuals like Mr. Holland Park with dementia care are eligible for Special Rehabilitation Services that are provided by Disability Service Teams via direct referrals from health care providers. He and his family will benefit from this service as it will help to develop his independence and quality of life.

A register for blind and partially blind are kept by the local authority, for provision of further assistance with the Eye Care Trust, and Mr. Holland Park is entitled to receive subsidised and mostly free consultation and treatment, and extra support should he choose to register.

The Alzheimer’s Society is an organisation that assists individuals with dementia (as is the case with Mr. Holland Park) and is supported by the National Health Service (NHS) and Community Care 1990, to assess his needs and provide certain services as required. His family will benefit from subsequent aids and care that will not affect their budget heavily.

Powers of Attorney

It is possible sometime in the future when Mr. Holland Park’s symptoms become very serious and he is unable to decide on his finances or medical treatment. It is best to make arrangements for this by drawing up different Lasting Powers of Attorney- the first to take care of financial decisions and the other to handle health and welfare decisions. Mr. Holland Park will need to appoint a trusted member of the family to act on his behalf should his disability get to this extent. You can find out more information about this, you can call AGE UK or Carers Direct.

APPROACHES AND INTERVENTION STRATEGIES FOR INDIVIDUALS WITH SPECIFIC NEEDS

Intervention strategies for Mr. Holland Park who is the early stages of dementia focuses primarily on tackling the cognitive symptoms that can lead to erratic behaviours. The effectiveness of these interventions will help to enhance his individual functioning and reduce stress, depression or agitation which is common in individuals experiencing disability.

The best therapy applied to Mr. Holland Park and other service users alike was to promote his independence and this boosted his confidence and willingness not just to survive but to live an active daily life and make the best of his body. The promotion of independence will delay or change the later stages of dementia which is usually much harder to manage. Independence in Mr. Holland Park was encouraged by engaging him in reasonable activities up to any level he can tolerate. Also, a balance of maintained for him across personal care and productive leisure, while monitoring his tolerance level.

Potential impact of emerging developments on service users with specific needs

It is critical to access the needs and strengths of service users with specific needs to determine the effectiveness of interventions implemented. The best strategies are accessed through initial stages and the environment was considered to determine the continuity and they include:

Effective communication: Communication strategies applied involved using non-verbal cues and language and sentence structure to integrate high level of individual comprehension and enhanced sensory abilities. Effective communication is essential to the provision of high value health and social care. Without it there cannot be a significant coordination amongst service users and carers. Poor communication is frequently a considerable causative reason for complaint against Health and Social Care organisations and is the basis of numerous depressing user experiences.

Involvement of individuals with challenging behaviours and their carers in the planning, delivery and monitoring of services ascertains that the care and support received meets their desires and objectives.

Activities of Daily Living (ADL) Skills Training: ADL involved accessing users’ abilities, impairments and task performance to understand the psychological factors inhibiting their capabilities. Skills training are carefully assessed during activities that focus on empowering users to independently carry out ADL tasks. During the programmes, users are required to complete individual tasks with minimal assistance. Minimal assistance provided include: visual gestures, facial expressions, physical direction and partial physical assistance.

The potential impact of the development of these strategies is the provision of vital support to effective improvement in health of service users, especially disabled users. There is improved strength through empowerment of independence and mobility and increased endurance levels. Also the physical performance of the users is improved significantly. Another essential benefit of these support systems is the maintenance of functional capabilities of users with physical or communication impairments.

STRATEGIES FOR COPING WITH CHALLENGING BEHAVIOURS

Concepts of challenging behaviours

The relationship that exists between challenging behaviours is mostly viewed as a disorder of some form. There is no such thing as an analytical meaning for challenging behaviour but it can be categorized in various forms including psychological disorder, learning disability, mental illness and many others. A functional disorder of some form generalises the concept of challenging behaviours but will never fully define it.

Challenging behaviour is an expressive concept, which is mainly socially created, and its definition is dependent on changes in social norms and provision of service cross geological areas. The expression itself carries no analytical meaning, and no presumption about the aetiology of the behaviour is made. Challenging behaviour may not relate to psychiatric disorder, but can also be a major or resultant symptom of it.

Challenging behaviour is a moderately objective phrase that has apparent phenomenon. However, this is not the case with most mental illnesses, many of which depends on self-report by the individual for proper analysis. The need of an established expression in individuals with challenging behaviours has caused problems concerning suitable expressions. Different terms like: ‘mental disorder’, ‘mental illness’, ‘emotional distress’ have been utilised inter-changeably e.g. ‘mental illness’.

Potential impact of challenging behaviours on health and social care organisations

Managing the potential impact of challenging behaviours does not lie on one organisation, but rather a collective responsibility of every member of the health and social care system. That is how much impact the challenging behaviours of individuals have affected the health and social sector. This is because different people exhibit various disorders at diverse stages and severity ; hence the effective reason why organisations must work much harder to ensure that every individual is well taken care of regardless of his or her disability.

Organisations have been made to build larger and more effective workforce and research on increased skills and improved knowledge have been carried out.

Cost impact

The continuing occurrence of challenging behaviours in various individuals has had its impact on cost as the weekly care ranges from over ?200 to as much as ?1600 depending on the severity.

In other words, the care services offer to individuals is relative to the features of the care settings and the cost implication. It will always cost more to take care of people with severe challenging behaviours and the greater levels implying that organisations will need to increase their budget on regular basis to adapt to new fiscal year. Eventually, these cost implications will mean that larger facilities must be built and the weekly expenses are likely to increase over the years.

Strategies for working with challenging behaviours

Managing challenging behaviours involves intervention strategies that must recognise and take note of individual’s past and present experiences and must also maintain a standard environment. One of the things that must be noted is that it is inappropriate to label any service user with the term ‘challenging behaviours’ as this is very derogatory and changed the perspective they are related with. Also, the mindset with which they feel about how they fit into the environment is changed should they get used to this label.

Intervention strategies

Depending on how serious the behavioural problem is, intervention strategies are in different categories:

Biological intervention: This deals with analysis of the causes of the particular behaviour. This will mostly require professional assistance in order to source and prescribe proper medication and treatment.

Social intervention: This elemental intervention involves encouraging communities to involve disabled people in social activities so as to make them feel welcomed within the society.

Counselling: This is usually an intervention suitable for individuals with moderate disability. The counselling will involve different behavioural methods like anger-management and relaxation therapy, for possible effect. There is no clear indication as to whether direct or indirect counselling methods will work with individuals that show high level of challenging behaviours like aggression.

Psychotherapy: For over 50 years, psychotherapy has been in practice as a form of management and treatment for people experiencing challenging behaviours. The effectiveness may sometimes vary depending on the level of aggression displayed by the person.

There is a surprisingly long history of psychotherapy with

Cognitive therapies: This kind of therapy is suitable for people whose behaviours are based on personal experiences. The therapist works on improving the behaviour of the individual by changing his/her insight and perception of life.

SELF EVALUATION

Mental health problems are common and widely misunderstood; they are an integral part of public health and can affect all of us. The World Health Organisation (WHO) stated that: “The single most important barrier to overcome in the community is the stigma and associated discrimination towards persons suffering from mental and behavioural disorders” (WHO, 2001, p. 98). Mental health problems are still surrounded by prejudice, fear and ignorance, despite the fact that one in four adults has experienced them. Individuals who suffer from mental health problems often are discriminated against and have to deal with other people’s stigma; these concerns have led to national campaigns. In this essay I will attempt to discuss the concepts surrounding discrimination and stigma in relation to mental ill health and also discuss a current campaign, “See Me”, which is Scotland’s national campaign aimed at putting an end to the negative attitudes and behaviours affecting those who have mental health issues.

In 2002 a Scottish campaign called “See Me” was launched, and was aimed to tackle the issues surrounding mental health problems, and to put an end to the discrimination against mentally ill individuals. Financed by the Scottish government, “See Me” is co-ordinated by five mental health organizations: Highland User Group, Penumbra, and the Royal College of psychiatrics – Scottish division, the Scottish Association for Mental Health Support and in Mind.

In recent years, research has indicated a widespread social stigmatising attitude directed at individuals who suffer from mental health problems (Byrne, 1997, 2001). This has attracted increased attention amongst the general public, health professionals and the press. Stigma has been described by Goffman as “a situation of the individual who is disqualified from full social acceptance” (Goffman, 1963, p. 9). It refers to the negative attitudes and behaviour directed at individuals who suffer from mental health problems.

Stigma can be a variety of issues ranging from being ignored, to being bullied and physically abused. These stigmatizing attitudes as founded upon the belief that someone is not normal, or of lesser value, and can lead to discrimination. Discrimination stems from the lack of knowledge towards mental ill health. To “discriminate” means to apply special treatment, generally unfavourable, to an individual because of their gender, race, age, religious beliefs, or disability. Discrimination can be direct or indirect, positive or negative and in the negative from is unlawful. According to Corrigan and Miller (2003), discrimination is “a direct result of negative attitudes and behaviours towards a group of people.” In 1995, the Disability Discrimination Act ruled that discrimination of individuals based on their disability would be illegal. This applied to workplaces, schools, transport and the provision of goods or services.

Mental Health is a major focus of concern and interest in contemporary society, The world health organisation qualifies mental health as: “a state of well being in which every individual realises his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully and is able to make a contribution to her or his community.” NHS Scotland suggests that: positive mental health is about feeling in control, being in touch with our feelings, being able to make rational decisions and feeling good about ourselves, there are many barriers which can effect positive mental health, such as the social world, emotional resilience and structural factors, in order to achieve positive mental health we have to overcome these structural barriers and to do this we need the use of health promotion. Health promotion has been described as ‘the process of enabling people to increase control over, and to improve, their health. It moves beyond a focus on individual behaviour towards a wide range of social and environmental interventions”. The term refers to the wide variety of approaches that are applied to help improve health within people, the community and the population. Health promotion allows people the ability and resources to control and improve there overall health. “Health Promotion is concerned with making healthier choices easier choices” (Dennis et al 1982)

Discrimination of all kinds has a detrimental effect on mental health. People with mental illness say that discrimination and the stigma attached to it can in fact be more difficult to handle than the mental health problem itself. Statistics show that almost 66% of the population are in contact with an individual who has mental health problems. Discrimination can pervade every part of their daily life ranging from their personal life to the ability to maintain a basic standard of living. Penn and Wykes (2003) stated: “there is evidence of less favourable social interactions, discrimination in work opportunities and housing as well as their access to health care.” This may exclude individuals from day-to-day activities such as going shopping, going out with friends or being part of local community groups. Social exclusion can be psychologically damaging, harmful to health and can also increase risks of premature death. Statistics also show that nearly 75% of individuals who have mental health problems have been put off applying for jobs due to fear of rejection and job insecurity. Dorling (2009) said that unemployment is associated with worsening mental and can increase the levels of depressions, especially in young people. Penn et al (2003) argues this generates: “a negative worsening effect on ill health.”

The general perception of mental illness has advanced within the last three decades. However, research shows that this has not helped to reduce the levels of discrimination. Every year the Department of Health conducts a survey to find out the attitudes towards mental health. The latest statistics were published on the 8th of May 2008. Some of the key findings showed that 17% of people said that there are particular characteristics of individuals who suffer with mental ill health that distinguish them from people who do not suffer from the illness. 12% stated that they would not choose to have a neighbour who suffers from mental health problem. 7% of people agreed that the mentally ill were a burden to society. So what can we do to help?

See me Scotland was launched in 2002 with one aim ‘to eliminate stigma and discrimination’ in order to succeed in this there were set out five core aims; To challenge individual incidents of stigma and discrimination, To involve people in anti-stigma activities across Scotland at national and local levels and across sectors and communities of interest, To ensure that the voices and experiences of people with mental health problems and their carers are heard and promote a culture of learning and evaluation through all its work, so that effectiveness can be demonstrated and lessons shared. The campaign is based on a set of principles these include non-discrimination, equality, respect for diversity, reciprocity, informal care where possible, and participation. “See me” is working locally and with the media to improve people’s perceptions of mental health problems. “See Me” is also attempting to reconfigure the public’s perception, attitude and knowledge of mental health, to make sure that it is improved in the hope that it will end discrimination against the mentally ill. It will also improve the ability of people who suffer from mental health problems to challenge any discrimination they may face. It will also make sure that businesses value and include mentally ill individuals, as well as those who support them. It also looks to improve the media’s coverage of mental ill-health.

In conclusion despite research showing that knowledge about mental ill health has increased we can see that there is still a great deal of discrimination against those with mental ill health.

Autism Spectrum Disorders start without diagnosis. And ASD is unexpected. The consequences that affect the children are they do not have close relationship with their siblings, their grandparents and even with their parents. ASD children are unable to feel love from their family, especially on mother. In the school, they cannot make a good friendship with other same aged children. In their childhood, they are poorly having imaginative or creative plays. In their teenage life, they start to recognise that they are different. For some of them, they might be encouraged to learn more and try to improve their social skills when they meet the barriers however, others would feel depression, anxiety, or other mental disorders. They may not be able to find pleasure in their daily activities and the environment. People with ASD will fail to respond the emotional signs in human society. Because they are unable to build up the relationship with other people, they would not be able to understand others. This awareness may make them be helpless and hopless.

B. the Family / whanau

I think when there is a child with autism spectrum disorders, their family would suffer more from it. For their parents, they might compare with other children of same age and feel desperate and hopeless. They have to observe their children carefully. Also parents will have uncertain future for their children. Parents also are not able to have their own personal dream, future and even their job because they need to take care of their children. If their children are growing up, taking care of them is very hard and finding a job for them is also a big challenge. Stress is one of the most things that family or whanau will suffer from their children’s disorder. Specially in sleeping problem, parents will have very stressful night everyday and they will burnout so easily. For the family and whanau, there should be lots of caring centre which established by the government so they can use it without a pressure of money spend.

C. the Carers

When carers are taking care of children with autism, they have to keep their eyes on them every time and every moment. Because children with autism cannot have sufficient sleep at night, they become impatient and anxious. This might lead them to have emotional or physical abuse. When parents fail to manage their children’s behavior, children have many bad habits like splitting on the ground, frequent screaming and hitting others. Carers must be aware of their client’s health and don’t let them stay in dangerous situation. Also Carers need to be listenable for their family’s complaints.

signs and symptoms associated with people with Autism Spectrum Disorder(ASD)

Autism is a group of developmental brain disorders, collectively called autism spectrum disorder (ASD). The term “spectrum” refers to the wide range of symptoms, skills, and levels of impairment, or disability, that children with ASD can have. Some children are mildly impaired by their symptoms, but others are severely disabled. In general, they fall into three areas:

Social impairment
Communication difficulties
Repetitive and stereotyped behaviors.
Social impairment

Most children with ASD have trouble engaging in everyday social interactions.

Make little eye contact

Do not readily seek to share their enjoyment of toys or activities by pointing or showing things to others

Misread or not notice suitable social cues – a smile, a wink or a grimace – that help them understand social relationship or interaction

Have difficulties following directions, being cooperative and doing things on other people’s terms

Their facial expressions, movements, and gestures are often vague or do not match what they are saying. Their tone of voice may not reflect their actual feelings either.

Communication difficulties- both verbal (spoken) and non-verbal (unspoken, such as pointing, eye contact, and smiling)

Develop language at a delayed pace

Learn to communicate using pictures or their own sign language

Use words that seem odd, out of place, or have a special meaning known only to those familiar with the child’s way of communicating.

Repetitive and stereotyped behaviors-repeating words or actions, obsessively following routines or schedules, and playing in repetitive ways
They may insist on eating the same exact meals every day or taking the same exact route to school.
Children with ASD may become fascinated with moving objects or parts of objects, like the wheels on a moving car. They might spend a long time lining up toys in a certain way, rather than playing with them. They may also become very upset if someone accidentally moves one of the toys.
Other related disorders
Sensory disorders

Dislike or show discomfort from a light touch or the feel of clothes on their skin

Experience pain from certain sounds, like a vacuum cleaner, a ringing telephone, or a sudden storm; sometimes they will cover their ears and scream

Have no reaction to intense cold or pain.

Impacts on the diverse dynamics of the family/whanau

To care of children with autism spectrum disorder, family members spend a lot of time and put efforts till their energy burns out. It makes their parents difficult to have a moment for their own interest and their lives. They lose their relationship and social contact with other people. It brings a lack of communication and finally it occurs decreasing of life quality. They cannot spend time for their parents as well because it is too busy to care of their autistic children. The other children in the family would be lack of love because their parents put every attentions and every interest to autistic child so parents cannot spend time for others. The family also experience role changes. Change of the roles requires new skills and grabbing with new ideas. They need to collect the information about ASD, search for the programs or facility supports. On the other hand, change of roles empowers family. Perhaps, children with ASD’s siblings might not like to walk or, even, talk with them.

4. The way in which the individual, family/whanau , and carers interact and respond to evolving stressors

There are many ways that individual, family, and carers interact and response to stressors. Autistic children focus on what they want to and what they can do. Need to get information and supports from the family or friends when take care of them. Family and carers can receive a help from their friends. Friends can take care of the autistic children and family and carers can have a break to recover their energy. For example, having a catch up with good friends, sharing the worries and information with other family member who has autistic children and attending activities or teachings related of supporting ASD people are very helpful, cheerful and encouraged to the group of people who have a lot of stress from caring autistic people. They need to make best product with environment, help and support of others who are around them. Visiting a Day care centre or hiring of a community support worker can be a good idea as well.

5. The way in which the Code of Right is applied to people with Autism Spectrum Disorder (ASD)
The right to effective communication

People with autism have the right to effective communication in a form, language, and manner that assists the client to understand the information provided. Where necessary, this includes the right to a competent interpreter.

Rights in Respect of Teaching or Research

People with autism have the right to give informed consent to participate in research, including risks, and whether this treatment is new (or new for this purpose).

Right to be Treated with Respect

People with autism has the right to be treated in a respectful manner, regardless of her/his race, culture, colour, religion, sex, age, mental or physical disability, class/economic position, sexual orientation, gender identity, diagnosis, inpatient status, or legal status, Like using recognized name, respect for choice and privacy.

6. The needs ( support and other) which I have identified for the people with Autism Spectrum Disorder (ASD)
Child Disability Allowance

Child Disability Allowance is a payment made to the main carer of a child or young person with a serious disability. It is paid in recognition if the extra care and attention needed for that child.

Services for children with special education needs

Some service are providing information about play techniques to teach the child new skills, offering ways to improve social and learning skills and manage behaviour and co-ordinating physiotherapy, occupational theraphy and equipment.

Support for students with high special education needs

Some supports are the Communication Service to support children who have difficulties with talking, listening and understanding language, the Severe Behaviour Service to assist children experiencing behaviour difficulties.

2) People with Dementia

1. Consequences of people with Dementia in relation to
A. Individual

Those with dementia need help with everyday tasks such as showering, dressing, etc because they forget how to do them. They no more have interests in their hobbies and what they do unlike how they used to be. At the same time, they do not want education and trying out new ideas. They also tend to avoid communicating with others as they cannot respond and catch complex ideas since they make them uncomfortable. People with dementia may have to give up their work due to the lack of planning, organization and decision making-skills. They have difficulties going out by themselves, because they cannot find the way back home. They become less interested in their surrounding environment and take less care about others. They tend to find someone to blame when something is wrong. During Dementia progress, they sometimes confuse children or grandchildren to their relatives or friends. This can hurt their family members. They find it hard to name objects and how to use them. Furthermore, they require reminders to eat, wash, dress and using toilet. Their communication skills drastically worsen because they get difficulty understanding what is said to them and their words and sentences only make little sense. Hence, people with dementia totally become isolated.

B.Family / Whanau

They cannot believe that the one they love have dementia, and it is unacceptable when the person with dementia fail to recognize them. They feel shame and are unwilling to let others know. When they fail to cope with the difficult situation, they feel anxious, irritable and impatient with themselves and others. They lack energy and burnout which result in the decrease in strength of their immunity system and the increase in the frequency of getting the flu and becoming sick. Thus, they lose concentration and become forgetful which lead to bad performance at work. They express negative thoughts about themselves, thinking they are losing control of everything like a failure. They need to deal with emotions like grief and guilt. Watching the person slowly deteriorate can be particularly stressful as often the family members feel they have lost the person they love. When they think that they have not done or are not doing enough for the person, they feel guilty.

C. Carers

Reduced leisure time and personal freedom is one consequence on the carers. They may not be able to spend as much time as they would like with their friends and colleagues, loss of regular contact with friends who can share hobbies. They become so involved in caring for the person with dementia; they do not take care for themselves or their own health. They have not found the time to take a moment that day to smell the scent of a rose or to look at the beauty of nature. Heavy workloads or hard physical works cause tiredness, loss of appetite and poor digestion. Most of the carers experience tension or pain in the muscle, chest, abdomen and shoulders. Getting responsibility for maintaining standards and for observing and recording changes can be very stressful. It is annoying when they have conflicts with others in the support team. Some of the carers may suffer oral or physical abuse from the one they are caring for; it is unacceptable and hurtful which leads to the decision of giving up the job

2. The signs and symptoms associated with people with dementia.

Dementia is a broad term to describe the symptoms which caused by a large of illness that result in a progressive decline in a person’s ability to remember, to think, reason and response to others in an appropriated way. The signs and symptoms of dementia:

Gradual memory loss

They have trouble in remembering the telephone numbers, where they put their bag, keys, and wallet, what they did yesterday.

Repeating statements or questions

They can constantly repeat one or more phases or sounds again and again.

Wander

They wander around home or streets, perhaps at night, sometimes becoming complete lost.

Decline in ability to perform routine tasks

A person might have trouble with certain skills such as dressing. As the dementia progress, people become slower and more disorganised.

Impaired judgement

They may show poor judgements and have difficulties making judgements.

Disorientation of time and place

They confuse about daytime and nighttimes and fail to find their way home.

Changes in mood or behaviour

They take their clothes off inappropriately and become angry or unset or distresses very rapidly.

Changes in personality
Some people with dementia retain a similar personality to their earlier life, although sometimes a little exaggerated – the person who was always irritable, stubborn and difficult to get on with may remain so. The person who was friendly and affectionate may remain sweet and loving.
Loss of language skills

They are unable to express themselves using a whole sentence, just repeating one word or phrase again and again

Or their speech may make little sense.

Difficulty handling money

They forget to pay their bills and manage their account.

Loss of initiative

They loss of motivation and feeling of worthlessness and uselessness

Deterioration in driving skills

Some may no longer drive their car.

However, a person with dementia may not experience all of these symptoms.

3. Impacts on the diverse dynamic of the family/whanau

When there is a person living with dementia in a family, it affects all the family members who are challenged physically, emotionally and financially. When the dementia develops as the illness progresses, those who are close to them are constantly faced with the loss of the person as they used to be, the gradual loss of the person as their companion, and the loss of their relationship. Children would be angry or may withdraw if it is too painful to see their parents suffer dementia, grandparent or family member slowly deteriorating. Husband s or wives may be upset or worried about living the rest of their lives without their partner. Family member may spend their time due to the increasing demands of care for the person living with dementia. Leaving work and taking an extended break may cause financial struggle. The loss of income causes the poor quality of life and it comes as a stress. Paying for home alterations, transport to places and medical supports are the extra costs. However, some people feel pleased of their new abilities if they are competent for their roles. They improve the relationship with the person with dementia while supporting. Thus, caring for the person living dementia may tie up the whole family members together. Also they share the responsibility within the family so they become more close.

The way in which the individual, family/Whanau, and carers interact and respond to evolving stressors

Essentially, we need to understand how dementia affects people. When the person living with dementia show challenging behaviors, group of carers are not going to be panic and know how to deal with it. Knowledge and skills are the most important one when take care of dementia people. Knowing what works for each of the people being able to interact with them in their preferred way is a skill that is developed overtime in dementia care. This helps the carer to understand the process that the person is going through. Having a break, attending relaxation group or meditation, practice positive thinking everyday and get support from friends or other workers are all helpful and releasing stress for the workers and family. These rests bring them to have their own time for interest and make their stressful life be peaceful.

5. The way in which the Code of Right is applied to people with dementia
The right to complaint

Person with dementia have the right to make a complaint if they are unhappy with a heath or disability service they received. If they are not satisfied with how they complaint was handled by the provider, or do not feel comfortable making a complaint to them, talk to their nearest health and disability advocate.

The right to support

Person with dementia has the right to assistance in obtaining; financial support, housing, recreation, employment supports, social support, and community supports in keeping with their needs and wishes

The right to dignity and independence

People with dementia have the right to have services provided in a manner that respects the dignity, independence and self-determination of the individual. They have the right to contact with clergy or other spiritual advisors of her/his choice, and to exercise religious and spiritual observances, rituals, customs, and dress.

6. The needs (support and other) which I have identified for the people with dementia
Disability allowance

The Disability allowance is a weekly payment for people who have regular, ongoing costs because of a disability, medical condition or illness. It can help for things like regular visits to the doctor, prescriptions or some travel costs.

Social Workers

Social Workers provider counseling, support for grief and loss, adjustment to change, relationships, problem solving and decision making.

Community Day Services

Community day services help disabled adults who can’t find work to take part in their community and improve their personal skills by providing access to regular meaningful social contact and stimulating activities.

The services will include a range of activities depending on the provider, and what you’re interested in and able to do. Activities may include:

daily living skills

education and learning activities

social activities

recreation and leisure activities.

People with dementia can go to day services as well as getting other Ministry-funded support services.

REFFERRENCE

http://www.hdc.org.nz/the-act–code/the-code-of-rights

http://www.helpguide.org/elder/alzheimers_disease_dementias_caring_caregivers.htm

http://www.nichd.nih.gov/health/topics/asd.cfm

http://www.medicinenet.com/dementia/article.htm

http://www.ehow.com/dementia/

http://www.health.govt.nz/