Author: Andre Coleman

Motivational Interviewing in a Multicultural Setting

Lawrence, Massachusetts is a city rich in cultural diversity and heritage. The Latino population alone boasts seventy three percent and continues to grow (Brown et al, 2013). This brings unique challenges to the therapeutic setting that relate directly to Latino cultural values. There are also challenges that Latinos face that are correlated to substance use. Literature states that Latinos are more likely to binge drink and use drugs more heavily (Franklin & Markarian, 2005). Lawrence also has a very young Latino population, resulting in the highest proportion of the population being under five and eighteen years old in Massachusetts (Jaysane & Center, 2002). This is imperative to note in a city that reports a high level of substance use among youth. Of many of the challenges that Latino’s face with substance use, they are one-third less likely to enter residential treatment in the state of Massachusetts (Caroll et al, 2009). This illustrates a community that has a great need for substance use treatment, yet is currently having that need unmet. As a social work intern, I will have the opportunity to practice with Latino clients and families within my community through in home therapy services. Therefore is vital, as a social worker, to better know the Latino clientele within Lawrence and the distinct factors that might set them apart from other clients within therapeutic settings.

Latinos in Therapeutic Settings

Latinos represent a very diverse group each having a unique history of social, political, and economic factors that have caused their migration into the United States, or their families migration. This diversity continues to manifest across ethnicity, race, generations, language, but especially nationality. Many Latinos identify first and foremost by their country of origin and will often differentiate, “I am Puerto Rican” over the official “I am Latino”. However, though individuals hold this diversity ascribed to their subgroup, many Latinos share core cultural values that are based on mutual experiences such as migration history, access to education and employment, as well as socioeconomic status. Due to acculturation and other psychosocial stressors, language, and poverty, Latinos may be particularly vulnerable within treatment and treatment organizations (Caroll et al, 2009). These shared experiences can impact communication styles such as the willingness to disclose sensitive information which in turn impacts the clinical setting as traditional therapy models often assume direct disclosure from the client. This creates a dysfunctional environment in which Latino clients, ones that do not follow Westernized norms, risk finding therapy to be invasive and opposing with their core cultural values. Therefore it is vital for social workers to consider cultural differences within the clinical setting. Mental health services among foreign-born, monolingual Spanish-speaking Latinos remains low when compared with bilingual Latinos born in the United States (Anez et al, 2008). This is because mental health providers are challenged to develop cultural and Spanish friendly services that will effectively address the needs of a diverse Latino community.

Substance Use Factors

Substance use is a significant problem among Latinos, who represent the largest ethnic minority group in the United States. However, treatment-related disparities have been identified as being relevant to Latinos. Specific factors that have been identified as contributing to these disparities include the following: cultural and language barriers, poverty, stigma, the lack of bilingual and bicultural staff, and the lack of treatments that are receptive to Latinos’ needs (Anez et al, 2008). The necessity for trained professionals who have the ability and empathy work with the distinct needs of Latinos is great within the therapeutic process. These noted discrepancies are of great concern because it is well documented that Latinos “… have increased morbidity and mortality rates, high incidences of suicide, school dropout, alcohol use, illicit substance use, and HIV infection (Anez et al, 2008).” Regardless of an apparent need for mental health services very few members of the Latino community actually seek professional help. It appears that these services are not considered to be a primary source of support. In fact, fewer than one in eleven Latinos contact mental health specialists, and often seek services from a primary care provider first (Anez et al, 2008). This illustrates a client group that is currently at an unmet need for alcohol and drug use treatment. Latino clients might have a reason; clients frequently complain that they feel abused, intimidated, and harassed by non-minority personnel (Sue, 2006). Latinos as a group are largely marginalized within greater society; it does not help to do so within the therapeutic setting. Many social work theories originate from a monocultural standpoint, when social workers unconsciously inflict these standards without regard for other cultures, they may be engaging in cultural oppression (Sue, 2006). Social workers must enter the therapeutic setting aware of their own prejudices in order to learn and grow from them.

Latino Youth in Therapy

Lawrence reports a high level of substance use among youth. In 2002, a survey was conducted within the city which collected the responses of 2,206 high school students resulting in respondents revealing that the majority of substances used are alcohol (52.9 percent), inhalants (39 percent), cigarettes (25.2 percent), and marijuana(19.9 percent) ( Jaysane & Center, 2002). The reported substance use rates among Lawrence youth can increase the risk of dropping out of school for many, as the drop-out rate of high school within the city has been very high in current years. Rates as much as fifty percent of high school classes dropping out between their freshmen and senior years have been reported ( Jaysane & Center, 2002). There have been a number of factors attributed to the drug use of Latino youth. For example, the role of the family has been identified as being the most important component of addiction treatment for the client. It has been shown that parent’s attitudes, and the use of drugs, play a key role in the drug use behavior of twelve-seventeen year old Latino youth ( Franklin & Markarian, 2005). Adolescents in particular have a potential ambivalence when it comes to quitting substances. However Latino youth also share an additional cultural ambivalence attributed with the Latino identity.

Motivational Interviewing in a Multicultural Setting

Motivational interviewing (MI) is a client-centred counselling approach that uses certain techniques in order to produce motivation to change among ambivalent clients (Miller and Rollnick, 2013). Latinos can be considered ambivalent clients as a result of cultural and systemic factors that are experienced collectively as a group. Ambivalence in this sense can be defined as needing to make a change, but seeing little to no reason to do so (Miller and Rollnick, 2013). MI has been found to be highly effective in the treatment of substance use disorders. However, many Latino’s do not seek needed treatment for substance use. There have been a number of cultural values that have been reported to affect the therapeutic relationship to varying degrees; the three most prominent being personalismo (personal relationships), respeto (respect), and confianza (trust) (Anez et al, 2008). MI is a therapeutic model based upon respect and trust as it is a collaboration which honors the client’s experiences and individual perspectives. Latinos have also been reported to work towards engaging in pleasant conversational exchanges, and to avoid unpleasant ones, often trying to avoid conflict. MI permits the integration of these cultural values within the therapeutic setting, as it also avoids argumentation within the therapeutic relationship. This method differs from other more challenging styles that might advise a client about changes that need to be made, instead MI creates a more cooperative therapeutic setting where the Latino client’s internal motivation is drawn out and explored. This means that the counselor is not leading sessions or dictating the client in anyway. Instead the counselor’s role is to guide the client, listen to the client, and offer knowledge when needed. This method is ideal when working within the Latino community, especially when most therapeutic approaches have shown to cross with their core identity. Clients are experts on themselves; no professional can know them better than they know themselves (Miller and Rollnick, 2013). If the counselor has the ability to show the Latino client their support of the clients personal expertise, it can create a positive relationship and rapport within the therapeutic setting, and in turn creates a catalyst for change.

Motivational Enhancement Therapy

Motivational Enhancement Therapy (MET) has been proven to help individuals resolve ambivalence around engaging in treatment as well as stopping substance use. The approach persuades change quickly through motivational methods. Research found on MET methods suggests that its effects depend on the type of drug used by participants as well as on the goal of the intervention. For example, MET has been used successfully with people who are addicted to alcohol and who want to reduce their problem drinking (Caroll et al, 2009). Brief motivational interventions (BMIs) such as this have also been identified as being particularly effective methods when working with Latino adolescents who have substance use disorders, in fact, “Brief motivational interventions (BMIs) have been identified as particularly promising for use in efforts to reduce or eliminate adolescent [alcohol and other drug] use problems (Cordaro, 2012)”. The client-counselor relationship and the counselor’s ability to engage with the Latino adolescent, has also been found to be a key factor within the motivational therapeutic setting. First impressions count as the initial therapy session appears to be significantly correlated to the client’s dropout from the intervention (Cordaro, 2012). In summary, the ability for the counselor to build rapport with the client from the first session is one of the most important factors when working with the Latino community, in particular with youth.

Client Approach

This coming fall I will begin an internship providing in-home therapy services with Lahey Behavioral Health in Lawrence, Massachusetts. I will unquestionably have the opportunity to work with Latino clients and families within the community. When working in family systems, I might come across a situation in which a client within that system might have a substance use issue that needs to be addressed. When addressing the substance use issue with either an adult or an adolescent, the first impression and rapport is extremely important during the initial session, as it has been shown to be linked to successful client engagement. My focus for motivational interviewing would rely on building a positive and strong relationship with my Latino clients so as to build enough trust to persuade towards change talk. It is important for me to note that Latino clients hold an admiration for older adult’s that is attributed to the life experience and a general perception that their wisdom holds significant value, younger generations are taught to respect their elders and greet adults with a courteous “Senor” or “Senora” (Anez et al, 2008). Pretending my client is significantly older than I am I would approach therapy in the following way. First I would begin by asking the client how they would like to be addressed, this would provide the client the ability to structure a conversation around names or nicknames that their friends or family call them, or possible formal titles such as “Senor” or “Senorita”. It is also important for me as to be able to address the client respectfully, and to take a careful note of pronunciation. I would structure questions around cultural values, such as being a buena genta (likeable person), family values, respect, trust, and personal relationships (Anez et al, 2008). . In terms of being a likeable person, I could structure a question such as, “How important is it for you to be viewed as someone who is likeable?” this shows me the importance that the person holds on their image and how others view them. I would also be interested in knowing how the client interacts in interpersonal relationships outside of therapy; this can be achieved by asking, “When you are first getting to know someone, what helps you feel comfortable?” or “What does it take for you to develop trust with someone?”. This can help me gain an understanding of the client’s strengths, stressors and coping mechanisms. I would also ask, “How do you handle conflict?” or ““Can you tell me about a moment when your trust was broken?” This can give me an understanding of how the client handles and copes with hard situations, or if the client has a resistance to talking about hard situations within a therapeutic setting. I would further ask the client what their expectations of trust are within our therapeutic setting, summarizing the session with a shared agreement using the values of trust put forward by the client. This shows the client that I value trust and the client as an expert.

Over the course of many sessions I would continue to understand the client’s value system as well as where they stand in terms of change talk. Open-ended value questions would give me an insight into what really matters to the client. I would ask the client what they value the most in life, which can sometimes help to be a motivation for change. This can especially be motivating if the client values their family, a child, being employed or having an education. Once the client has reached the point of talking about their values, I would spend time using a number scale in order to help guide conversation around where my client is in terms of changing, making sure to have all documents used with the client translated if fits the clients need. The clients identified goal during this time might be to reduce the amount of the substance used. Once a goal has been identified and set with the client, I would continue to guide the client into conversation with questions such as how life was like before drug use; questions about the future, as well as what advantages and disadvantages are in terms of their current drug use patterns. I would summarize that session with a collaborative treatment plan that the client feels is realistic for them, and will continue to check up on how the client is doing with the treatment plan during each following session, making additional adjustments along the way and talking about the process.

Summary

The community of Lawrence, Massachusetts is home to a large proportion of Latinos and the population continues to grow, bringing with them unique challenges especially pertaining substance use and therapy. Latinos drink and use drugs more heavily, a trait that often cascades to younger generations. Latino clients are in need of substance use help, however they are less likely to enter treatment, leaving the need largely unmet. As a social work intern, who will be conducting in-home therapy for families within the city of Lawrence, it is my responsibility to ensure that the cultural values of my clients are integrated into the therapeutic setting. As a Latina social worker, clients might not be as resistant to my therapeutic methods as they might to a non-Latino social worker. As a Latina, I understand and share many core cultural values with Latino clients. Because of this, I might have the ability to build a stronger rapport, one that is essential during the beginning stages of the client-counselor relationship. However, I do not speak fluent Spanish. In fact I only have the ability to speak a limited amount of words, and a few phrases. This largely limits my ability to work with clients who are predominantly in Spanish speaking households, as I am not bilingual. There is also the possibility that I might be looked down upon because I do not speak Spanish, as if I have betrayed my culture and heritage. It is important for me to be aware that these opinions exist, and to notice that they might come up during counseling sessions. If they do I would do my best to redirect the questions back onto my client in a calm and collected manner. In general, MI is the best approach when working with Latino clients as it has been proven to work with ambivalent clients as well as clients with substance use disorders. MI also fosters an environment that is inclusive towards the cultural values of Latinos, and fosters the collaborative therapeutic process between the client and counselor. When the cultural values of the Latino community are taken into consideration, it fosters change, and retains client engagement within therapy.

References

Anez, L. M., Silva, M. A., Paris Jr., M., & Bedregal, L. E. (2008). Engaging Latinos Through the Integration of Cultural Values and Motivational Interviewing Principles.Professional Psychology: Research & Practice,39(2), 153-159.

Brown, N., Chesbro, T., Lee, D. H., & Puza, H. (2013). Lawrence, Massachusetts Greenway Plan. University of Massacusetts, 1-50.

Carroll, K. M., Martino, S., Ball, S. A., Nich, C., Frankforter, T., Anez, L. M., et al. (2009). A Multisite Randomized Effectiveness Trial of Motivational Enhancement Therapy for Spanish-Speaking Substance Users.Journal of Consulting and Clinical Psychology,77(5), 993-999.

Cordaro, M., Tubman, J. G., Wagner, E. F., & Morris, S. L. (2012). Treatment Process Predictors of Program Completion or Dropout Among Minority Adolescents Enrolled in a Brief Motivational Substance Abuse Intervention.Journal of Child & Adolescent Substance Abuse,21(1), 51-68.

Franklin, J., & Markarian, M. (2005). Substance Abuse in Minority Populations.Clinical Textbook of Addictive Disorders, 321-339.

Jaysane, A. P., & Center, M. P. (2002). The Community Context of Health in Lawrence, Massachusetts.Lawrence, MA: Merrimack College.

Miller, W. R., & Rollnick, S. (2013). The Spirit of Motivational Interviewing.Motivational Interviewing:Helping People Change(3rd ed., ). New York, NY: Guilford Press.

Sue, D. W. (2006). Principles and Assumptions of Multicultural Social Work Practice.Multicultural Social Work Practice. Hoboken, N.J.: Wiley.

In this day and age the rapid development of the word and the growing assimilation of countries can hardly fail to affect the development of new theories which attempt to explain the relationship between countries and the existing inequality between developed countries and countries of the third world. Two theories which analyze the development in third world countries are the modernization theory and the dependence theory. These two theories, while being rather different, still have several similarities in their views on the modern world and relationships between developed and developing countries.

As Alvin So explained, there are three chief and historical essentials which were constructive to the foundation of the modernization theory of development after the Second World War.First, the United States rose as a superpower.While other Western nations, such as Great Britain, France, and Germany, were undermined by World War II, the United States came out of the war stronger then before, and became a world leader with the execution of the Marshall Plan to reconstruct Western Europe.[2]Second, the idea of communist began to move throughout the world.What was once the Soviet Union spread its influence to Eastern Europe, China, and Korea.Third, there was the breakdown ofEuropean colonial empires in Asia, Africa and Latin America, creating numerous new nation-states in the Third World.These budding nation-states began searching for a form of development to support their economy and to improve their political independence. The modernization theory’s intellectual lineage has been traced back to Aristotle. Aristotle first recommended that states, just as plants, went through a natural pattern of growth. Just like Aristotle, Americans in the early Republic assumed that if societies grow in a natural manner, they must also perish. The thought that the progression of human development could be understood and controlled dates to the early nineteenth century, when France and Britain were struggling to bring back their trade empires. Since then it has tended to reappear at times and places where systems of dominance required explanation and rationalization.

The modernization theory looks at the internal factors of a country with the assumption that, with aid, “traditional” countries can be developed in the same way more developed countries have. The modernization theory tries to recognize the social variables which cause social growth and development of societies, and then tries to explain the social evolution. In order for a country to have a profitable, sophisticated, modern economy the country must follow a pattern of development. This is a very systematic theory as it means do one thing and another will happen. In order for this to happen, there need to be prerequisites for takeoff that will lead to takeoff in which will lead to mass-consumption(Mahler 45). A missing component of this theory is that the modernization theory assumes all countries will follow the set path to development. There are actually numerous variables in which will affect a states’ ability to in fact develop. An example of this is the fact that Mexico is geographically designed in a way that will cause it to have a weak economy due to the deserts, forests, and mountains. This makes it so that only 12% of the land is arable. The fact that there are no major rivers doesn’t help either. These issues all help to making it tricky for Mexico to develop because it restrains transportation, which in turn weakens the possibility of exporting and importing goods in a proficient manner.Another problem with the modernization theory is that it assumes that all states have the necessary preconditions to develop. This is not true as many states do not have proper leaders and government. The explanation for this is that if a state is controlled by weak leadership, it will in turn influence its ability to develop. For example, Saddam Hussein, made it so that his country could not develop because he took all of the wealth for himself. Perhaps, if Hussein had spread the wealth throughout his country, this will have helped education and increased invention. This could have made it so that his country developed in a more efficient manner.

One policy implication the modernization theory suggests is that the third world countries should look up to the developed western nations, while the Western countries should pass on more modern values, institutions, technology, and financial investment to the Third World countries. Another implication is that in order for the third worlds to develop, they should be moving along the path that the United States has traveled, hence move away from the ideas of communism. (READING)

A theory in which is opposed to the Modernization model which was created largely as a response to it is the Dependency theory. Dependency theories developed in opposition to the optimistic claims of modernizationtheory which saw the less developed countries being able to catch up with the West. They stressed that Western societies had an interest in maintaining their advantaged position in relation to the LDCs and had the financial and technical wherewithal to do so. A variety of different accounts of the relationship between the advanced and less developed states evolved within the broad framework of dependency theory, ranging from the stagnationism and ‘surplus drain’ theory of Andre Gunder Frank (which predicted erroneously that the Third World would be unable to achieve significant levels ofindustrialization), to the more cautious pessimism of those who envisaged a measure of growth based on ‘associated dependent’ relations with the West.

The major contribution to dependency theory was undoubtedly that of Frank, a German economist of development who devised and popularized the phrase ‘the development of underdevelopment’, describing what he saw as the deformed and dependent economies of the peripheral states-in his terminology the ‘satellites’ of the more advanced ‘metropolises’. InCapitalism and Underdevelopment in Latin America(1969), he argued that the Third World was doomed to stagnation because the surplus it produced was appropriated by the advanced capitalist countries, through agencies such as transnational corporations. Frank himself insisted that growth could only be achieved by severing ties with capitalism and pursuing autocentric socialist development strategies.

According to the dependency theory, the Global North exploits the Global South. One reason for this is that the south is highly dependent on the wealth of the north; therefore unable to advance themselves because of the vicious cycle that then ensues. An example of this vicious cycle can begin with a country being very poor and/or economically unstable. They then allow a multinational corporation to set up camp in one of their cities. This leads to many new jobs for this city, but the people are hired for very poor wages. Then the products that are produced get siphoned off by the Global North, in turn preventing that states “mass-consumption” abilities which is a generalized way that the south gets exploited by the north and the multinational corporation comes out making huge profits at the expense of desperate people just trying to survive and willing to work for pennies.

The depencde theory has several implications. First, Promotion of domestic industry and manufactured goods. By imposing subsidies to protect domestic industries, poor countries can be enabled to sell their own products rather than simply exporting raw materials. Second, Import limitations. By limiting the importation ofluxury goodsandmanufactured goodsthat can be produced within the country, the country can reduce its loss of capital and resources. Thrid, Forbidding foreign investment. Some governments took steps to keep foreign companies and individuals from owning or operating property that draws on the resources of the country.

In conclusion, both theories admit the leadership of western countries and their currently dominant position in the modern world, while undeveloped countries are characterized by socio-economic and political backwardness. At the same time, the two theories agree that the cooperation between western countries and developing countries is constantly growing and leads to their integration. However, it is necessary to underline that Modernization theory views such cooperation and integration as a conscious and voluntary act from the part of developing countries, for which modernization in the western style is the only way to overcome the existing backwardness, while supporters of Dependency theory argue that such cooperation and integration is imposed to developing countries by more advanced western countries, which simply attempt to benefit from their cooperation with developing countries and their westernization becomes a way of the establishment of control over and growing dependence of developing countries on developed ones. Regardless, the existing differences, both theories still raise a very important problem of relationships between developed and developing countries and the dominance of western countries and western civilization in the modern world.

Assessment is a vital function of social work acting as the starting point of the process and if not carried correctly can impact on the social workers relationship with the service user. There are no universal definitions for assessment however Whittington (2007) suggests the process is a meeting between a social worker and someone seeking help or services, which maybe held with an individual, family or a group of people. Sutton sees assessment as an ongoing cycle and describes it using the acronym ASPIRE, Assessment, Planning, Intervention, Review and Evaluate. Models for assessment include ecological, strength based, person centred which are often used when assessing a child. The Ecological model focusses on the service user’s environment including close family circle and their wider community, placing the service user firmly in the centre. Bronfenbrenner (1979) states there are 4 layer of environment which effects a service user, microsystem which considers immediate family, the mesosystem looks at relationships with extended family, neighbours, friends, work and school, the exosystem includes both the micro and mesosystem but also contains social infrastructure of the labour market, education systems, health and Social services, the final layer macrosystem includes systems including government policy, legislation and culture. Ecogram’s are illustrations often used to demonstrate these layers which can benefit to everyone involved to enable them to see everyone who is involve in his life.

Parker and Bradley state the strength based model focusses on the positives in a service user’s life, focussing on increasing motivation, capacity and potential for making real and informed life choices. This model also requires an extensive knowledge of the service users’ environment, living system and wider system to be able to work with them using their strengths. Within this model the power imbalance between the social worker and service user is reduced as the service users is seen as the person with the knowledge of the issues. The person centred model has a similar function as the Ecological and strength based model which places the service user at the centre of any assessment and decisions made during this process.

As well as assessment models the social workers also use a variety of approaches including questioning, procedural and exchange. The Questioning approach uses a set of questions to obtain information, the social worker can have preconceived ideas about the service user which could lead the questioning in a direction which may not identify the issues which the service user may see as their main concern, this approach can be seen as a power imbalance in favour of the social worker. The Procedural approach is a systematic process set out by an organisation or framework, with set criteria which identifies eligibility, follows the rules and policies which dictates what the service user is entitled to, this approach also leaves a power imbalance as the social worker dictates what services the service user is entitled to. The Exchange process ensures partnership working where the service users is seen as the expert with an understanding of any issues, information gathered within this process is used to enable the service user to see their potential and resources available to meet this potential.

There are specific pieces of legislation and policies which have an impact on the child assessment process, The Children Act 1989 states the welfare of the child is paramount, with an overarching system for safeguarding children, it indicates roles different agencies play and introduced the concept of parental responsibility rather than parental rights. A key principle is that Local Authorities have a duty to provide services for children and their families and all children should have access to the same range of services. The Children Act 2004 updates not supersede Children Act 1989. The aim is to encourage integrated planning, commissioning and delivery of services as well as improve multi-disciplinary working, remove duplication, increase accountability and improve the coordination of individual and joint inspections in local authorities. The Children’s act does not specifically state children referred automatically have an assessment, however if a child is deemed in need then the child must have an assessment, a decision which must be made within 24 hrs., once this decision has been made an assessment needs to take place within 7 days. The decision is based on Children’s act 1989 (section 17 subsection 10) outlines the criteria for a child in need, which states:

(10) a child shall be taken to be in need if—

(a) He is unlikely to achieve or maintain, or to have the opportunity of achieving or maintaining, a reasonable standard of health or development without the provision for him of services by a local authority under this Part;

(b) His health or development is likely to be significantly impaired, or further impaired, without the provision for him of such services;

Stefan can be seen as a child in need due to his current behavioural issues at school and the ongoing issues with in his family home, both could have an impact on his health and development. If Stefan is displaying behaviours within school this is having a significant effect on his education and therefore development.

The social worker will carry out an assessment based on the Framework for the Assessment and Children in Need and their Families 2001 which is based on three areas, often viewed as a triangle, Child developmental needs including education, Emotional & Behavioural Development, Family & Social Relationships, Stefan is displaying behaviours while at school which is having an impact on his ability to learn. There have also been domestic violence situations within the home, it is not documented if he witnessed this, however the UN convention of the child states that hearing a domestic violence attack is just as detrimental to the child as witnessing the act and therefore has the same affects, this may be a factor for Stefan. Stefan and his mother are receiving support from her sister, but Stefan may have a role in the care for his mother or younger sister. Parenting capacity including Ensuring Safety, it has been highlighted Rhian, Stefan’s mother has physical and mental health issues which resulted in Stefan and his sister being left in a local park questioning Stefan’s safety. Family and Environmental Factors including Resources, Income, Employment, Housing, Wider Family & Functioning. Stefan’s mother is unable to work due to her physical and mental health which may have financial implications on the family.

As well as the children’s act 1989 and 2004 and the Framework for the Assessment and Children in Need and their Families 2001, wales has a Children’s & families measure 2010 which was published to tackle child poverty. Section 67 of the measure looks at children’s needs arising from community care needs of their parents and applies to any child whose parents may be in receipt of care from the local authority or arranged by the local authority, or they may be in need of such services the authority must decide what services they can provide to the child and / or their family. Section 68 of the measure addresses the child’s need arising from the health conditions, including mental health, of their parents and applies when health services are provided to or funded by the NHS, the NHS must consider the effects of the medical condition on the child and if the child requires support from the local authority. Both sections relate to Stefan’s current situation, Stefan’s mother has physical and mental health issues which also may have impacted on the family.

The Human right convention of the child (1989) also has an impact on the assessment process, the convention was agree by international governments and stated all children had rights as individual’s not just objects which are cared for. The convention is made up of a 45 articles which outline the rights of a child, Stefan’s rights include a child must not be separated from their parents unless it is in their best interest, every child is able to have a say about what affects them and they must be taken seriously, each child has the right to live somewhere which is able to meet their physical, social and mental needs. If they do not then the government must support families who cannot afford to provide this, Governments must do all they can to ensure that children are protected from all forms of violence, abuse, neglect and mistreatment by their parents or anyone else who looks after them. Another pieces of legislation which needs to be complied with is the Welsh language act, Stefan currently attends a welsh school and his mother is a welsh speaker, Stefan may feel more comfortable if the assessment was carried out in welsh which Stefan is entitled to under the act.

When working with a child the social worker needs to use a variety of skills, adapt their approaches and values which include ensuring the process is child centred, at the child’s level of understanding and abilities, advocate on behalf of the child, use observational skills to observe interactions with any significate people. Parker and Bradley state research shows children prefer to be listen to, professionals to be available and accessible, non-judgemental and non-directive, have a sense of humour, straight talking, to be able to trust and, where appropriate, to have confidentiality respected. The social worker must also ensure the process is collaborative working with people involved in the service user’s life including professionals. By using these skills the social worker also complies with the Care council of wales Code of practice which states the social worker must promote the independence of Service Users while protecting them as far as possible from danger or harm. By using the fore mentioned skills the social worker using anti-oppressive practise to ensure the service user is empowered in their continued support.

Before and during the assessment process the social worker needs to ensure the issues are not pre-judged, Stefan’s behavioural issues may not be due to the issues at home he may have a learning disability, being bullied at school or finding the work hard which is causing him difficulties, Stefan may be a carer for his mother or sibling which is the issue, often what is perceived as the main issues are not necessarily the same for the person being assessed, if any of the above issues have been highlighted then appropriate assessment would be requested. Other issues which need to be considered would be where to hold the assessment, Stefan may feel unable to speak openly if carried out in front of his parents or within the family home, by carrying out any assessment meetings within his school environment either setting could make him more vulnerable, careful thought needs to be given to where assessment is carried out.

While working with a child there are many ethical issues which can arise, when there is evidence a child is being neglected and their safety at risk the social worker has a decision to make, Stefan has been left in a local park due to his mother forgetting him the ethical dilemma may be if Stefan is providing a caring role for his mother and sister removing him from the situation may cause his sister to become more vulnerable and take away a support system from his mother. Another ethical issue could be within the current economic climate carrying out an assessment but being unable to offer the services required by the child and their family, when dealing with a child such as Stefan the social worker needs to gain as much information as possible however the more people who know about the situation could cause Stefan to be more vulnerable, Stefan is also entitled to privacy and the more people who know about the situation could make Stefan vulnerable amongst his peers. The final issue could be Stefan’s parents are currently refusing support, the rights of the parents to refuse services verses the right of the child to have adequate service provision.

Andrew is fifteen. He has been accused of sexually assaulting his younger sister and may be charged with this in the near future. Some of his family have a history of mental disorder and he has a history of learning and behavioural difficulties, as a result of which he has been attending a residential special school.

He does not acknowledge the accusations against him and is reluctant to discuss them.

INFORMATION FROM INTERVIEW –

Andrew presents as a tall, slim-built youth who is restlessly anxious, looking away for most of the interview, and repeatedly yawning in an exaggerated manner to indicate how little he wants to be involved in the discussion. Despite this he is essentially polite in manner and answers all questions, at least in some measure. His apparent level of intelligence puts him in the mild range of impairment, and he is also very sensitive to anything that he thinks puts him at a disadvantage or makes him look “thick”. He has some social skills, although these are not always used and sometimes he appears socially disinhibited.

He has a reasonable vocabulary and powers of speech. There are no behavioural stereotypies (repetitive apparently purposeless movements) and no perseverative behaviour (continuance of behaviours after their original purpose has been served). However, his powers of concentration are limited and he is easily distracted from discussion. His attention is focused on his perceived likelihood that he will automatically go to prison, regardless of whether he is charged or not. He hopes that a combination of his medical history and denial of the allegations will be enough to get him through any legal processes.

Andrew says he hasn’t been charged with anything “because I ain’t done nowt”. Nevertheless he is able to say that ‘sexual assault’ means “trying to make somebody do something – have sex, how to make babies” and that ‘penetration’ means “putting a finger up someone – up (the) clitoris of women”.

He has already been officially asked on one occasion about “for what’s going on now basically” but can describe no details and says that he “ain’t bothered because I haven’t done it”.

CURRENT CIRCUMSTANCES –

Andrew has his own room at his special school and has made one or two friends. The activity that he enjoys most, and gets most from, is “studying motor vehicles” and he has developed an ambition to become a mechanic.

He comes home for some weekends and for holiday periods.

At present he feels he “hasn’t got a life anymore”. This is both because of the possible pending charges and because he feels “people are dropping dead around me”. A “close friend (female)” of his died recently, and his life has not felt the same since his father died unexpectedly the day before his birthday four ago, and his paternal grandmother died about a year afterwards.

He would like to become a motor mechanic, but thinks this will not be possible, unless he can get training in prison, because of his possible court case.

PERSONAL AND FAMILY HISTORY –

He is the youngest member of his family, although his own list of his siblings and half-siblings is slightly different to that provided by his family.

His father died from a heart attack and his mother has a lot of problems with her health.

He was excluded from his first school for “throwing a brick at a teacher or something like that – they were doing my head in all the time”.

MEDICAL HISTORY –

He has been diagnosed as having “ADHD” (Attention deficit hyperactivity disorder), and says that this is why he is at boarding school. He says that he “used to get all mad and hate people and take it out on them” but that this has improved more recently.

Two years ago he tried to hang himself with two belts because he “just felt like it – I couldn’t be bothered living anymore – I did it for fun – I thought it was funny”. He also tried to cut his wrist, and still has a faint scar from this. He continues to have periodic thoughts about a quick premature death as a way of not having “to put up with living anymore”. Although these thoughts reflect a depressed view of life there is no indication that he currently has a depressive illness.

He has previously taken the antihyperactivity drug Ritalin, but has now discontinued this and describes it as “doing my head in”.

SEXUAL DEVELOPMENT HISTORY –

He first became sexually aware at a very young age, as a result of being given information either by one of his sisters or a friend. His father told him not to have sex until he was older so as to avoid having children.

His strongest sexual experience so far has been with a girlfriend who he described as “the nicest person you could meet – even though my sister called her a ‘smackhead’”.

He denies the allegations about his sister and describes them as “all lies”.

Questions –

What identifiable risks, giving your reasons, does Andrew present a) in the short term and b) in the longer term? Rank them once in their order of certainty, and again in their order of importance.

Construct an interview strategy to help investigating police officers further question Andrew about the allegations regarding his sister, explaining your rationale.

Case Study 2
Mr D Case Study
Read the following case study carefully. Using your knowledge of risk assessment, mental disorders and offending behaviour and interview and treatment strategies answer the following questions:

Describe the type(s) of mental disorder Mr D may be suffering from

Consider whether those disorders are likely to contribute to the risk he poses of future violence

Identify those risks that Mr D poses to himself and others

Consider whether you would discharge Mr D from hospital at this time and give your reasons why

(Point 5 is optional) Highlight what challenges Mr D may pose in treatment and how you might overcome them.

Background
Early Childhood

Mr D was born to a 16 year old mother and conceived following a one night stand. Mr D recalled an unsettled childhood due to his mother handing over his care to her parents. Mr D described how he liked living with his grandparents, however he also described how his grandfather frequently used alcohol and his grandmother was strict and did not allow him to socialise with other children. Behavioural problems were noted from the age of 4.

Throughout this time period Mr D began having severe tantrums which involved hitting and kicking and Mr D was referred to the Children’s Hospital at the age of 8. This followed a severe attack levied against his grandfather involving a knife. Throughout the interview process Mr D remained closed about his relationship with his grandfather. Later reports indicate he was sexually abused by his grandfather but Mr D refuses to discuss this subject.

Mr D was taken into care at the age of 8, where again he reported an unsettled period of time characterised by isolation and bullying. Mr D was able to live with a foster family whom he described as supportive for the next two years and it is of note that there were no behavioural difficulties noted for Mr D within this time period. Mr D appeared to settled with this family and their two sons, which allowed him to form secure attachments with this family. Unfortunately the family needed to emigrate to South Africa, and although he was asked to go with them, Mr D chose to remain close to his grandparents.

Mr D spent the next five years in Children’s homes, interspersed by foster placements which broke down. Mr D returned to live with his grandparents following this period. Previous reports indicate conflicting points of view about this time period, some indicating that Mr D had more positive relationships with his grandparents and mother at this time, but with others highlighting that his grandparents did not really speak to him.

Education and employment

Mr D attended approximately five different schools as he was moved due to his living situation changing. Mr D recalled an unsettled period of time at school as he was bullied. He also described himself as ‘hyper, I would scream and shout a lot’ and recalled finding lessons boring. Records indicate that Mr D began refusing school at the age of 4 and has a significant history of truancy throughout his education. Mr D left school with no qualifications but school reports describe him as exceptionally bright.

Mr D has never been in formal employment. After leaving school he was unemployed for 2 years as he reported he could not find a job that interested him and he was having difficulties with his mental health. Following this, Mr D has been detained due to the conviction for his index offence.

Substance and alcohol misuse

Mr D reports a substantial history of cannabis use and a history of binge drinking.

Psychiatric History

Mr D first came into contact with mental health services at the age of 8 when he was admitted to the Children’s Hospital for 6 weeks following a violent attack on his grandfather. An ECG and neurological examination at the time were found to be normal, however Mr D’s mother recalled a ‘black patch’ being found. Following this Mr D was referred to an Adolescent Unit at the age of 14 due to behaviour problems such as refusing to attend school and standing naked in the window. Later that year, Mr D was admitted to the hospital and was described by the doctor as an ‘isolated and withdrawn individual, having no self confidence who responded with aggressive outbursts when frustrated’. Mr D self-harmed by cutting his arms with a piece of glass.

After being convicted of two incidents of indecent exposure at the age of 17, Mr D received outpatient treatment initially, but following another charge for indecent exposure Mr D was admitted as an inpatient. At this point he was talking about injuring people before they had the chance to injure him.

On the 9th April 1987 Mr D was again charged with indecent exposure and was remanded under section 35 of the Mental Health Act (1983). During his assessment there, it was noted that he was hearing voices telling him to commit acts of violence. No specific diagnosis was made at this time, although a condition of residence and psychiatric treatment was made. Following his 18th birthday he was moved to Arnold Lodge Hospital. Whilst there it is reported that Mr D’s mental health appeared to deteriorate and violence towards others increased. At the age of 20 Mr D was transferred to a Hostel in Liverpool as it was thought that he would benefit from integration with other people, however three months after this he was discharged after assaulting another resident.

Mr D managed to live in the community on his own for approximately two and a half years before he committed his index offence. At this point he was remanded to HMP Hull for approximately 2 months. Mr D attempted to hang himself during his first night in custody. He was then transferred to Wathwood hospital due to him exhibiting paranoid ideation and experiencing auditory hallucinations commanding him to harm a female prison officer.

Whilst at Wathwood Hospital, initially Mr D’s presentation seemed to improve to the point that he was granted conditional discharge by a Mental Health Review Tribunal, however at this point Mr D’s fixation with a female member of staff began to cause concern. Mr D began exposing himself to female members of staff and his mental health deteriorated. Mr D’s presentation continued to decline over the next two years in terms of incidents of violence, aggression and sexually inappropriate. His mental health also fluctuated with episodes of paranoid ideation, delusions, thoughts of harming himself and incidents of aggression.

Forensic History

Mr D has three previous convictions for offences of indecent exposure. There are seven previous convictions for driving offences (e.g. driving whilst under the influence, reckless driving, driving without a license, insurance and MOT) and 4 convictions of acquisitive offending (2 offences of shoplifting and2 burglary offences). Mr D has no other convictions for violent offences apart from the index offence, however there has been other violence evident in Mr Driver’s past when he has been a patient in hospital.

Index Offence

Mr D was convicted of the murder of his neighbour. The offence occurred in the context of ongoing difficulties Mr D was experiencing with his neighbours in terms of loud music they were playing in the early hours of the morning. Mr D had raised this problem with his neighbours and it is reported that they responded to this in a less than positive way. Mr D then tried to involve the council to alleviate the problem, however this appeared to have had no effect. On the day of the index offence, the victim was taking his rubbish out and Mr D approached him from behind and struck him once in the back with a 5 inch bladed knife. Mr D immediately ran away from the scene and made his way to the Family and Community Services Department with whom he was in regular contact and the police were contacted and Mr D was subsequently arrested. The victim had removed the weapon himself and in the meantime had made his way to nearby premises to seek assistance. He later died of his injuries in hospital.

Mr D’s account of the offence is that he had been living next to neighbours who were ‘noisy’. He said he had lived next to them for about six months and ‘I kept knocking, asking them to turn it down, they just said it was their house’. When asked how many times this had occurred Mr D said, ‘probably approached them about 5 or 6 times’. Mr D stated that he didn’t phone the police at all, but that he did phone the housing association. He said that nothing happened as a result of this and the music continued.

On the last occasion that Mr D asked for the music to be turned down before he committed the index offence Mr Driver stated ‘he started threatening me and said ‘I’m not turning the music down’ and was arguing. I can’t remember what was being said, but I just kept asking him to turn it down. He was shouting and I think I hit him first, we had a scuffle and the police were called. The Police told me to get in touch with the housing association’. Following this incident Mr D said that a few weeks passed and the music continued. Mr D stated that he had been going out shopping he had been carrying the same knife that he eventually stabbed the victim with.

On the day of the index offence, Mr D reported being woken at 9am by music being played. He stated, ‘I felt really stressed and angry. I got up, got dressed, I was standing in my kitchen and could hear it (the music) and I saw him going to the bin. I’d come to the end of how I was feeling and looking for a way out’. Mr D stated, ‘I got a knife and stabbed him in the lower back. When asked what might have happened to resolve the situation had the index offence not occurred Mr D said, ‘If I hadn’t seen him, I probably would have gone on carrying the knife and gone round to his house’. In terms of why Mr D felt he committed the offence, he stated, ‘I couldn’t stand them playing loud music’. Mr D went onto say ‘Yes I regret it, its led to me being kept in hospital. There is nothing else I could have done. He deserved it because he wouldn’t turn down his music’.

Assessments

Wechsler Adult Intelligence Scale -3rd edition (WAIS III)

This assessment examines general cognitive abilities, specifically thinking and reasoning skills. It explores non-verbal reasoning skills, spatial processing skills, visual-motor integration, attention to detail and acquired knowledge such as verbal reasoning and comprehension. Mr D presented with a full scale IQ of 130.

International Personality Disorder Examination

Mr D was assessed for personality disorder using the International Personality Disorder Examination (IPDE: Loranger; 1999). The IPDE is a semi-structured clinical interview developed to assess personality disorders defined by the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV; American Psychiatric Association, 1994) and the International Classification of Diseases, 10th revision (ICD-10; World Health Organisation, 1992). Mr D’s current presentation indicates that definite diagnoses of Antisocial and Narcissistic personality disorders are warranted. The Antisocial features most relevant in Mr D include a lack of concern for the feelings of others, reckless behaviour, consistent irresponsibility, disregard for rules and punishment, low tolerance to frustration leading to acts of aggression and violence, and a proneness to rationalise and blame others for his own behaviour. The Narcissistic features which Mr D presents with include a grandiose sense of self-importance, a belief that he should be treated differently, an overinflated sense of self-entitlement, arrogance in his behaviour and attitudes, a persistent pattern of taking advantage of others to achieve his own ends and an unwillingness to recognise or identify with the feelings of others.

Psychopathy Checklist Revised (PCL-R

The Hare Psychopathy Checklist Revised (PCL-R, Hare 1991, 2003) is a rigorous psychological assessment, widely regarded as the standard measure of psychopathy in research, clinical and forensic settings. It measures different aspects of a person’s emotional experience, the way they relate to others, how they go about getting what they want and their behaviour. High levels of psychopathic traits as measured by the PCL-R are associated with high rates of re-offending and future violence (however a low PCL-R score alone does not imply low risk) and can impact on responsivity to therapeutic intervention. Mr D presented with moderate levels of psychopathic traits which fell just below the diagnostic cut off for psychopathic disorder. Items that he scored on include failure to accept responsibility for his actions, irresponsibility, lack of remorse, callous disregard for others, grandiose sense of self worth, manipulation and early childhood problems.

Presentation in interview

Mr D presented as a difficult and challenging patient to interview. He was dismissive at times, questioning my experience, qualifications and competence. He stated that psychology was not a proper science and would prefer to talk to the ‘proper doctor’ i.e. the psychiatrist. Mr D appeared to have some knowledge of psychiatry and psychology and used technical terms throughout. He appeared to have little insight into his mental disorder stating that he does need to take medication and that everyone is like him. Mr D stated he does not under stand why anyone would think he poses a risk to people and that he should be discharged from hospital immediately.

Case Study 3
Ms W Case Study
Read the following case study carefully. Using your knowledge of risk assessment, mental disorders and offending behaviour and interview and treatment strategies answer the following questions:

Describe the type(s) of mental disorder Ms W may be suffering from

Consider whether those disorders are likely to contribute to the risk she poses of future violence

Consider what techniques/strategies/considerations you would use when interviewing Ms W

Highlight what further areas of work you may wish to undertake with Ms W (concentrating on what areas of her presentation you would like to explore/assess further and why)

Background
Early childhood

Ms W was the eldest child of three, the other two children being boys. Ms W recalled an unhappy childhood due to the sexual abuse she experienced from her father (for which he received a conviction) and then the emotional detachment that was apparent between her mother and herself. Social services records support Ms W’s account of her early childhood. In addition to being sexually abused by her father, Ms W also reported being sexually abused by an uncle and a next door neighbour.

Ms W also reported that the relationship between her mother and father was a turbulent one and although she did not witness any physical violence, she did hear arguments which resulted in her repeatedly banging his head against the wall through the stress this caused. Ms W’s behaviour became uncontrollable both within school and the community, in terms of fighting at school and committing petty crime such as shoplifting.

Whilst still living with her parents, at the age of 14, Ms W became involved in a relationship with a man who was much older than her, in his 60’s. This further contributed to the deterioration between Ms W and her parents, and her parents subsequently placed her in care. Ms W remained in care until the age of 17, and upon leaving she was given support from social services and moved into independent housing in which she was happy on her own.

Education and employment

Ms W reported that her school performance was average; teachers would not have found her a management problem, but that she did get distracted easily. Whilst at school she was subject to bullying from peers and this resulted in her engaging in fights outside of school. Ms W left school with no formal qualifications.

Ms W obtained employment as soon as she left school and worked as a ‘packer’, a cleaner and in a pet shop. All of the employment she engaged in was in a short period after school, with her last job being held at the age of 20. Ms W reported that the last job she had needed to leave because her mental health was causing her difficulties and she needed to attend various appointments.

Following this period of employment, Ms W was unemployed for the next 16 years due to mental health, drug and alcohol difficulties. Ms W claimed incapacity benefits and before coming into custody she reported having an income of approximately ?800 per month.

Substance and alcohol misuse

Ms W reported that she began drinking at the age of 14 or 15 as she would visit pubs with her partner at the time. She suggested that she became a heavy drinker at age 20 and that she needed alcohol every day as otherwise she would suffer with withdrawal symptoms. Ms W would consume approximately 12 cans of Stella a day or 2 bottles of 2 litre Cider. Ms W’s drinking caused her health problems in the form of liver failure and pancreatitis. Ms W was under the influence of alcohol when committing the index offence and this followed a period where she had tried to go through a detoxification process without medical support. It is of note that Ms W reported hearing voices whilst she completed this ‘home detoxification’ process.

In terms of drug use, Ms W remembered beginning to use substances at around the age of 18. She reports using acid tabs, microdots, magic mushrooms, speed, heroin (smoking) and cannabis. She also reported that she would take prescription medication if the opportunity arose. Ms W recalls that she would use whenever she had the money to do so and that she would frequently take drugs and drink at the same time. She estimated that she would spend approximately ?14 per day, but that this would depend on what funds she had available at the time. In the early 1990s Ms W was diagnosed with drug induced psychosis.

Psychiatric history

Ms W first recalled being in contact with psychiatric services in her 20s. She was first seen by a psychiatrist due to the hallucinations she was experiencing and she voluntarily stayed in hospital for a few months. Ms W had spent time in group mental health homes and has had support from psychiatrists, CPNs and social workers.

Ms W had attempted to commit suicide on a number of occasions through taking overdoses. She was diagnosed with depression in her late 20s and has been on a number of anti depressant drugs which she combined with drink and non prescription drugs.

Whilst in custody Ms W was taking antidepressants, anxiolytics and anti psychotics. The latter were prescribed due to Ms W experiencing hallucinations and also mood instability. Ms W had most recently been diagnosed with ‘Generalised Anxiety Disorder with features of depersonalisation and derealisation’.

Forensic history

Ms W had three previous convictions. Two were received in 1989 which were both fraud offences, and then the third in 1990 for burglary and theft of a non dwelling. Ms W cannot recall specific details regarding the situations. Ms W had no other convictions for violent offending, apart from the index offence, but there has been other violence present in Ms W’s past especially within interpersonal relationships.

Index offence

The offence occurred in the shared home of Ms W and her partner. Two weeks before the index offence occurred, police had been called to the home after Ms W had taken an overdose of her partner’s medication. When Ms W’s partner had attempted to summon help, Ms W threatened her with a knife to try and prevent this. On the 10th June 2006 when the offence occurred, it was alleged that Ms W had been drinking cider from the early hours of the morning. Ms W insists that she was so drunk that she has no recall of the stabbing which then occurred and all that she remembered was seeing the blood on her partner’s stomach. After stabbing her partner in the stomach she then threatened to cut her throat with the knife. The stab wounds caused a near fatal injury. The victim was able to summons help by activating the emergency pull cord for the accommodation’s warden.

Assessments

Wechsler Adult Intelligence Scale -3rd edition (WAIS III)

This assessment examines general cognitive abilities, specifically thinking and reasoning skills. It explores non-verbal reasoning skills, spatial processing skills, visual-motor integration, attention to detail and acquired knowledge such as verbal reasoning and comprehension. Ms W presented with a full scale IQ of 75. The assessment showed that Ms W processes information more effectively when presented visually rather than verbally and that she struggles to concentrate for long periods of time.

International Personality Disorder Examination – Screening Questionnaire (IPDE-SQ)

This assessment is a screening questionnaire which indicates whether there are certain personality traits which need further investigation using the full International Personality Disorder Examination assessment. The IPDE-SQ indicated the possible presence of paranoid, schizotypal, emotionally unstable, avoidant and dependent personality disorders but this should not be considered as a formal diagnosis.

Millon Clinical Multiaxial Inventory III (MCMI-III)

This assessment is used to evaluate elements of personality and also pathological syndromes within psychiatric populations. On this occasion the MCMI- III was used to provide a more comprehensive picture of Ms W’s personality and presentation in combination with the outcome of the IPDE-SQ. This measure was not used to diagnose personality disorder but to contribute to the understanding of Ms W’s presentation. The Millon highlighted that Ms W presented with anxiety, drug dependence and post traumatic stress disorder and may possible present with thought disorder and major depression.

Presentation in interview

Ms W presented as a shy, pleasant individual with very low confidence and who suffered with anxiety. It was evident that she was lacking in confidence in terms of speaking to people and being sure of her own opinions. She had also seemed to struggle in terms of her level of concentration.

Over the course of the sessions Ms W’s mood could be quite volatile, changing from happy to depressed in the period of a couple of hours. Ms W consistently spoke of thoughts of self harm throughout the sessions and when feeling depressed would project these feelings onto others as having caused them. Ms W also presented at times as quite paranoid in terms of thinking that people were talking about her. Ms W also disclosed that she was experiencing visual hallucinations particularly when she felt stressed.

Task 1

The government has been able to understand the social policy responsibilities that it has towards Maori with respect to Article 3. By giving citizenship privileges to Maori, Article 3 forbids prejudice and needs the Government to be pro-active in decreasing social and financial differences between Maori and the non-Maori. This does not mean that Maori have continued the social policies what are proposed by the government, but arguments have not been essentially focused on matters with regard to Treaty interpretation.

The primary Treaty arguments in the area of social policy gradually relate to the explanation and implementation of Article 2. Petitions by Maori in this area are for superior sovereignty or tinorangatiratanga. Such petitions are founded on Article 2. The Government has not acknowledged the usefulness of Article 2 in the field of social strategy and Maori claims for sovereignty have been refuted. However, it is necessary to analyse the implementation of Article 2 to social policy by laying emphasis on two fields of social policy, namely the health segment along with the Department of Social Welfare’s Iwi Social Services procedure.

It is evident that the Government’s attitude to Treaty matters in the social policy field is presently vague and erratic. This might appear to be perplexing, not merely to Maori, but even to workforces of Government organisations that work in the region. Such a situation involves a great deal of danger for the Government, owing to the fact that where the Government does not take a distinct initiative, it might find the steps being initiated by the courts or even by the Waitangi Tribunal. The Government would have to decide between ignoring the concerns or choosing a pre-emptive position, after discussing freely with Maori concerning their hopes for social services policy progress.

-Partnership: Social service organisations must ensure that the needs of Maori are taken into account when interacting with Maori or when creating policy that could affect Maori.

-Protection: Social service organisations must keep resident’s information confidentially.

-Participation: Maori can access and participate in all social services.

-Permission: Maori can be permitted to participate in their cultural and traditional activities.

Task 2

1) Aotearoa New Zealand Society

Aotearoa New Zealand is composed of various ethnicities.

All social services must be constructed accessible to all ethnicities.

Social workers have to understand and respect multicultural needs when working.

2) Te Tiriti o Waitangi

Social service providers and social workers must be well-acquainted with the four principles in Te Tiriti.

3) Te Reo, Tikanga, and development of Iwi and MA?ori

Social work practice must be provided MA?ori following their customs, values, and the rights under Te Tiriti.

4) Gender and sexuality

Gender or Sexual discrimination is not permitted by The Human Rights Act.

Social work practice must be provided without prejudice or bias.

5) Human development process through the life span

Human development may cause changes.

Social workers have to consider the culture to understand the changes.

6) Social Policy in New Zealand

Social policy can be impacted and changed by the government.

Social work practice has to follow the changed policy.

7) Aotearoa New Zealand social services

New Zealand social services accept and respect multi culture.

8) Organisation and management in the social services

Organisation and management in the social services have a wide level.

9) Research methodology in the social services

Research methodology in the social services should reflect variable needs of people when performed.

10) Users of the social services

Social service providers have responsibility to inform clients of their rights.

11) Law and social work

There are lawful duties that enact the social work practice.

Legal procedures provide guidelines for the client to be safe.

12) Personal development

Social work practice plays important roles in improving social worker’s development.

13) Social work ethics

Social work ethics impact on the social work practice to be professional.

14) Models of practice, including Iwi and Maori models of practice

Maori health model are based on Te Whare Tapa Wha (four cornerstones of Maori health).

15) Working with particular client groups

Social work practice must be appropriate to any particular client according to their own needs without prejudice or bias.

16) Cross cultural practice

Cross cultural practice identify which factors are prohibited to the clients by their culture when providing services.

17) Current issues in social work practice

Social workers need to be well informed of recent information and issues regarding social work practice.

Task 3

The first situation involved working with the socially exploited women of the Maori community, many of whom were victims of domestic violence. Dealing with this particular situation required the employment of the Social Learning Theory of social work. This theory is based on Albert Bandura’s viewpoint, according to which learning takes place through reflection and imitation. Different behaviour will linger if it is reinforced. In accordance with this theory, instead of merely listening to a new instructions or guidance and using it, the guiding process would be made increasingly beneficial if the new actions are demonstrated as well. In the case of dealing with socially exploited women from the Maori community, the integration of this theory involved working alongside women who have been able to recover from the trauma and violence that were subject to. This can be supplemented with the provision of real-life accounts of the lives of women who have been able to get back to life after experiencing such exploitation. The victims would then be able to relate to their situation in a better manner, thus bringing about more effective results, within a comparatively shorter time period. (Orange, 2011)

The next situation was the case of working for the benefit of those residents who suffer from psychosocial developmental issues. This involved the integration of the Psychosocial Development Theory, which is an eight-level theory of individuality and psychosocial development expressed by Erik Erikson. Erikson was of the belief that everyone needs to pass through eight phases of growth all through their life cycle, namely hope, will, purpose, competence, fidelity, love, care, and wisdom. Every stage is then split up into age groups from early stages to older grown-ups. People who have been subject to any kind of social oppression and exploitation would need to be treated in a specific manner by the social services workers, so as to help them overcome those hurdles and emerge free from such drawbacks.

In the execution of the duties that were necessary in both these fieldwork cases, there were a number of core values that guided the entire procedure. These included service, social integrity, self-respect and worth of the individual, value of human relations, honour, and capability. The needs of the individuals being treated were, and continue to be, of utmost importance all through the procedure that involves guiding and inspiring them to gather the necessary courage to soar above their situations and emerge victorious. It is also important to ensure that the dignity and respect of the victim be upheld at all times, so as to ensure them that they have a chance to regain their hold over their lives and live it to the fullest, accomplishing the aims and ambition that they have been cherishing. These core values are reflective of the essence of this social work service that ensures compliance with the latest policies and policies that pertain to this field of work.

Task 4

First Instance: This instance involved a client named C, who was 25 years old. She and her husband were supposedly having frequent arguments owing to his drinking habits. Unable to cope with his alcohol abuse and often violent and abusive behavior, C began to show signs of depression. It was at this point that she sought help with us. The Crisis Intervention Model was applied here, wherein C provided me with all the relevant details pertaining to her situation and the way things used to be before she started showing signs of depression. I had to be sensitive to the delicate aspects of this situation, which required me to make apt use of the core values of self-respect and worth of an individual. I also had to ensure that her dignity was upheld all through my sessions with her. Dealing with C required me to gain her trust by engaging in informal conversations with her, after which I had to present her with practical ways of coping with the stress of her relationship, while seeking ways to counsel her husband on his drinking problems. C has been receiving help and guidance for the past four months.

Second Instance: This instance involved a 16-year-old boy named K, who was involved with drugs and alcohol since the age of 14. The boy had been abandoned by his parents, who were also drug-abusers and alcoholics, after which he maintained no contact with him and lived with his friends. K has been using a number of drugs, and has recently started using crack. He has been using inhalants since he was 13 years of age and has been consuming alcohol in considerable amounts on a regular basis. However, he recently felt the need to seek help for his condition, due to which he decided to seek help from our social services centre. The Rational Choice Theory was then used to deal with his situation, wherein every action taken by an individual is viewed as rational, which requires the decision to be made after the calculation of the risks and benefits involved with it. This kept his dignity and self-respect in mind and ensured that my actions did not demean him in any way. K then needed to be guided in his choices and counselled regarding the consequences of his lifestyle choices. K has been receiving guidance and counselling for the past six months.

Apart from these two long-term instances of relationships with clients, there have been a number of similar situations, most of which have involved women who have been subject to domestic abuse, and children who are dealing with alcohol-abuse, drug-abuse, and abusive parents. Several instances of children suffering from trauma, owing to traumatic childhood experiences have also been handled. Such instances required the team to ensure that the dignity of the client is maintained, irrespective of what their background might be.

Task 5

My experiences thus far have brought about considerable changes in several aspects of my life. The first change would be that of understanding the essence of social service is the core values that it strives to uphold at all times. Irrespective of the situation that the client is going through, the primary task of the social worker is to ensure that the dignity and respect of that client is reinstated at every step. The next effect that the new learning had on me was that of helping me to gain a deeper understanding of the diversity of human issues, each of which have to be handled in a precise, systematic manner. (TeKaiA?whinaAhumahi, 2000)

These experiences will be of immense help to me in my future social work practice as they have given me the much needed exposure to the wide range of situations that social workers have to deal with on a daily basis. Since my practice has essentially been with cases of women and children, it would be of benefit to me in dealing with such cases in my future practice.

As a social worker who is skilled to work alongside Maori, I needed to gain a sound understanding of both the governmental and individual significance of Rangatiratanga to Maori consumers in the 21st century and the community accountability linked to it. My practice has helped me understand that a MA?ori viewpoint takes into consideration that any client communication is mindful of whanau, hapu, iwi. Attitude is an important aspect that I needed to develop. This is in relation to the applicant’s skills to recognise consciousness of their own limits (cultural prejudices, lack of information and comprehension) and to cultivate honesty to cultural multiplicity and a readiness to study from the rest. It required an established pledge to the continuing progress of an individual’s cultural consciousness and procedures along with those of co-workers. (Durie et al, 2012)

Skills are another necessary aspect that I had gained along the way, which involved the incorporation of understanding and approaches necessary to allow workers to relate bi-culturally, guide clients to match up their own aims and desires, and to guide social workers to get rid of all kinds of discrimination. Ability to engage in social work with Maori groups thus necessitates that the social worker: takes part in culturally appropriate manners in an inclusive way; expresses how the broader perspective of Aotearoa New Zealand both traditionally and presently can influence practice content, presents useful sustenance to Tangata Whenua for their endeavours, possesses an understanding of the Treaty of Waitangi, Te Reo and tikanga, and endorses Mana Whenua and benefits in their zone. All in all, the experience gained by me thus far in my experience will be beneficial to me in gaining competence in the future. (O’Donoghue&Tsui, 2012)

Sungkuk Hong 13020801

Abstract:

Free riders are those who take the same credit of you without exerting efforts. They are present in many groups, but it depends whether they are known early or not. Also many guys tolerate with free riders if they were their friends, but work and friendship are separated things. Every group should have a communication way, where all the group members agree on. And no one says that I did not know or I did not get the message. And this is something we suffered from. And because there are many members in the group and everyone has his own business, everyone should be on time for the meeting. When any group want to choose their topic, they should choose it wisely because wrong choosing will cost them time and effort. Working like a team is better than working like a group, but team work requires discipline, which we lacked. The abilities within the group differ, but you should try to get the maximum from everyone. Interpersonal relationship is the social connection between the group members which grow with time. Positive interpersonal relationship between group members leads the organization forward and to employees’ satisfaction. Organizations know interpersonal relationship effects, so they try to provide the appropriate working climate for it. The managers have influence on employees’ interpersonal relationship and he tries to make it positive of the benefits he can get from it. Group members working together at all times and seeking a common goal is working like a team. To have an effective team you need to work hard and combine the right people together. Team effectiveness is measured by the final outcome and employees’ satisfaction.

Introduction:

Group assignments provide postgraduate students with opportunities to improve their capabilities and demonstrate a professional behaviour. Personally, the group assignment is considered to be a valuable experiment that led me to write this reflective essay. The group assignment had a great impact on my skills as it had lot of benefits. I learned lot required behaviours from working with a diverse group. Group work differs from working individually as it involves an interaction with others that might result in conflict occurrence, misunderstanding and so on. There may be difficult times during group work, but a group member should be wise and help the group to pass those difficult times. I have relied on my diary notes captured after group meetings to write this essay to reflect reality. Although there is a distinction between friendship and work, I prefer to work with friends rather than people that I do not know. Effective cooperation among group members would be required at all times, so they can complete assigned work and deliver it in the best way with highest level of satisfaction.

Free Riding:

Free Riding is the absence of contribution and getting the benefit of that good. This view has been supported in the work of Marwell, Ames (1981). Before the module starts we knew that we had a group assignment and it must contain 4-6 individuals, so we were four friends knowing that we can make a group of friends only, but we have been thinking that if we entered two more participants it will be easier for us as everyone will write less and concentrate more on his points, and that will help us to concentrate on our other assignments also, but what we have been afraid of is that we may have two free riders who will make the work harder. From the first day that we have decided to meet at, we found that 3 of the group members were not there, so we were thinking about free riders and will we accept those free riders in our group because of the friendship we have. I and the present group members decided that this is work and we do not like to work hard and the free riders get the same credit. A personal experiment of being in a group with free riders made us insist of our situation that we do not want free riders in our group, as before the submission date they came with no work in their hand saying that we did not know what to do, so we have decided to work together all the time and to divide the work and everyone do his part, but we have a weekly meeting to ensure that there will be no one free riders. Discovering free riding before the grading is important, but detecting the free riding early is much better for the group to take the corrective action and to work all together and get those free riders involve in the work again (Free riding in group work – Mechanisms and countermeasures, n.d.). Therefore, we decided to meet often so we can ensure that we are all walking on the right side. And we have asked the professor about the grading system and she said if you were the manager and you have free riders in your group, what you would do? And I was thinking of leaving them behind as they will delay our work and make it harder, but if I must have them in my group I will give them specified tasks and ask them often about their progress with an evidence to ensure that they are really working and contributing with the group.

Misunderstanding within the group:

There was a misunderstanding regarding the time at the first meeting, as we have decided to meet at 11 am and then some of the group members changed the meeting time till 3 pm and they have said that we have sent a message on Facebook, but not all of the group members actually got the message, so we ended up blaming each other. I think that happened because we did not have that person who could take the responsibility to tell everyone about the exact time and if the time changed or there was any kind of change in plan, he would tell all the group members. Also, I think the existence of that kind of person in every group is important and will lead to a better performance and satisfaction from all the group members. Because of the misunderstanding, we have delayed our work for one more day as the members who came early had other plans to do at the time of the new group meeting appointment. Consequently, we have decided to have one communication channel for the group and it is doing a group chat on Facebook and everyone contributing in deciding the meeting time, so no one can have any kind of excuse of not attending the meeting.

Meeting time:

When we wanted to choose our meetings time, we were asking all the group members if that time was appropriate for them, because we wanted our meetings to be on time. The thing that happened was that I am there on time, but I had to wait at least an hour and half for the group meeting to start, because the members were always late. I waited and we did our meeting, but I was frustrated because of the late start. I have told them many times to choose the right time that they will be there and they have apologized for their lateness and promised to be on time for the next time. The same lateness behaviour had reoccurred as usual in which late members were acting normal, but the other group members were frustrated and complaining. The other group members had cool nerves and sometimes they have just waited others for an hour and a half to let us complete the work. I think this has affected our group performance, as if we were committed to the meeting time we would have done better in the group assignment.

Improper Subject Selection:

At the first we have choose Bloomberg as our subject because there was a Bloomberg guy who came and talked well about Bloomberg and we all found that the subject is very interesting, so we have decided to write about it. Therefore, we have decided on the points that we are going to talk about and that everyone would come back after 3 days with the information about Bloomberg. Apparently, no one has written a thing when the meeting day came and we were all complaining that there was not much available information. Therefore, our improper selection of the subject has led us to a waste some time.

Team or Group?:

I knew the difference between the team and the group from prof. Sally Sambrook, as she told us that working as group is discussing the points together, distributing the tasks and then everyone do the work individually. In the other hand, working as a team is doing everything together from discussing the points till the end of work. We tried to work as a team because it is more effective and creative than working individually, but the continuous absenteeism and lack of commitment of members in the meetings made it difficult, so we decided to work as a group. In addition, we decided to distribute the tasks in a way that please and satisfy everyone, so we wrote down the tasks and every one chose his favourite task that he would be interested to write about.

Individual differences:

There were individual differences in the abilities of the group members, as when we met to see and assess everyoneaˆ™s work we found that some members of the group have covered their tasks perfectly while other group members made it difficult because we had to modify their work. My point of view is that I do not consider them free riders because they have tried and I could feel that they made an effort on their tasks, but the abilities within the group are different. Moreover, I suppose that their aim is just to pass while other group members who wanted to have a good grade in the assignment. We found the module is interesting and easy, so there is nothing to prevent us from having A* while others saw it impossible, so there were different aims within the group. Members with high ambitions did not get disappointed from others and have worked very hard. These members with all honesty have gained my respect and gave me a lesson for life that I can do everything even if the group members are reflecting discouragement and laziness. If you want anything and you work for it very hard, you will achieve it.

Interpersonal relationship and team effectiveness:
What is an interpersonal relationship?

Interpersonal relationship is a strong social connection between two or more people. There are many types of interpersonal relationships, but what we care about is the organizational interpersonal relationship which is the relationship between individuals working together in the work place. They spend a lot of time in the work and for sure they want to talk and discuss their issues with others rather than working alone all the time and that is a natural part of the working environment. Also, there may be a previous relationship between the individuals before working together and this helps the relationship to expand. We as students knew each other before the group assignment, but within the group work we came closer and worked together for longer hours. I think that I have a stronger relationship with them now, after the group work. I would prefer working with them again rather than working with a new group members that I do not have any kind of relationship with them (Management study guide, [online], n.d.).

Do interpersonal relationships affect the performance of the individuals?

There are many beneficial outcomes for individuals and organizations because of the positive interpersonal relationship at work. Employees can feel job satisfaction and commit to their work because of their positive interpersonal relationship within their workplace. In the other hand, a negative interpersonal relationship could affect the employees and make them upset, and that will lead to lack of commitment towards their work. Obviously, it depends on the individual himself whether he was a social person and like to communicate and interact with the others or he likes to work individually and isolated from the others. A positive interpersonal relationship within the organization will build a supportive and innovative working climate for the employees, which will lead to an increase in the organizational productivity and institutional participation, and that will lead to employees’ satisfaction (Dachner, 2011, Abstract). In our group work there was a positive interpersonal relationship which have made the work easier and more interesting. Furthermore, we were friends and knew each other before the group work, so it helped us a lot. It is interesting to have friends working together and it would form a comfortable working climate which can help to improve the performance and encourage the members to work hard. In the other hand, friendship in the group can make the members lazy; as they know that if they do not do their work; their friends will not leave them behind and will do their work. Our group had agreed from the beginning to isolate friendship from group work because we did not want the group members to keep depending on the others to do their own work. In my opinion, working with group members that I have a positive interpersonal relationship with them is much easier than working with new groups. Also, from my previous experiment of working with members that I do not know, I can say that there is a risk of being in a group with members who do not care about the grades they get, so you find yourself obligated to do their work.

How could the organization build a positive interpersonal relationship?

The variety of the advantages of the positive interpersonal relationship within the organization has encouraged organizations to build, support, and try to form a strong positive interpersonal relationship. The organization attempts to make the coworkers to become friends, because coworkers with friendship help each other more than normal coworkers. Besides, the organization helps the workers to communicate and work together in groups or teams to build a positive interpersonal relationship in order to provide the appropriate working climate for the workers to communicate and interact with each other. Moreover, the theories propose that demographic characteristics affect social relationship between individuals (Dachner, 2011, Antecedents of Interpersonal Relationships at Work). Consequently, organization could form group works with individuals who share the same demographic characteristics. Our assignment group consists of people from India, China, and I am from Kuwait, but it was easy to work with them because we all shared the same goal and were working for the same purpose. I think that it depends on the person himself if he wants to make friends with his group and try to help them with their work or he just want to do his part and leave.

How the management could affect the interpersonal relationship?

Managers want the employees to be friends, help each other, and work together so they can get the most of their performance. Managers could give them the opportunity to socialize and encourage them to be friendly with each other and become friends. There are two influences that managers could have on employees’ interpersonal relationship. The first is direct and it is forming groups and giving them the chance to work together and compete with other groups which can provide a healthy competition for the organization. The second is indirect and it is giving them appropriate working condition, and not to give them a lot of work that they do not have the time to interact with others (Department of Public Health Sciences, 2010) 2.1 interpersonal relationship at work.

A Team in an organizational point of view:

A team in an organizational setting is a group of individuals whose tasks are done by working together, who share outcomes’ responsibility, who consider themselves and are considered by others as a unit inside the organization, who work together at all the times, help each other, and correct each other’s mistakes to increase the efficiency and improve the quality of the teams’ outcome, because they are all sharing the responsibility of the final outcome (Cohen, Bailey, 1997).

As individuals who worked together for the assignment, although we shared the responsibility for the final outcome, we were not working together at all the time. If we worked as a team, it would have been better than working as a group but the conditions hindered us from working together as a team.

Team effectiveness:

Teams with high performance need to be developed and nurtured, as they do not just appear without working hard on them. The development of these teams cannot be guaranteed even with visionary leaders. Because if you want to have a high performance team, you should combine visionary leaders and motivated team members. There are many characteristics that help to build a high performance team such as, having a clear plan and a common goal, utilizing teams’ resources, valuing the differences in the team and trying to get the best from each member, the willingness of the members to give their best for their teams, managing the meetings in the perfect way, and exerting the efforts to achieve the goals. Also there are other things that affect the high performance teams and it is the teams’ size, the abilities and the skills within the team, the way of communication, and the conflict resolution (Cliffs Notes, n.d.). I agree that high performance teams needs co-operative and hardworking members. Also it requires the commitment from the team members, especially in the meetings time, because we suffered a lot from the members who were always late on our meetings.

Measuring the team’s effectiveness:

As the team members work together all the time with shared responsibility of the final outcome, it is hard to evaluate each member’s contribution to the work. The manager wants and sees the final outcome only regardless whoever contributed more to the work. The effectiveness of the team is measured by performance and personal outcomes. Measuring the final product, customer satisfaction, items sold, etc. are all kind of performance outcome measurement. While measuring team members’ commitment and satisfaction and their desire to work with the same team members again is kind of personal outcome measurement. Hence, the grade that we will get in the group essay is the performance outcome, while if I wish to work with the guys that I have worked with again is the personal outcome. In my opinion, our group works both the performance outcome and the personal outcome was excellent.

Conclusion:

In conclusion working in a group assignment has many advantages and make you learn a lot of things, but everyone should try to get the maximum benefits that he could get. I can say that the group work made me better prepared for the real practical world. Although I had many hard times during the group work, it was interesting and earned me some good friends for lifetime. It was exciting to work with my friends in a group assignment and to help each other trying to get the maximum grade. After reading a lot about the interpersonal relationship and team effectiveness, I realized its importance in the work place and it really affects any organisation, and that is why every organisation is keen on it. Working in a group is totally different from working individually, as working in a group imposes you to respect the group members and their opinions even if these opinions conflict your own opinions, but if you are working alone you are the decision maker. That is the difference that I knew from working in the group assignment and the individual assignment. Finally, working in a group has many benefits that contribute in refining the personality of the participants and often better than the individual work and this is what I had concluded from my personal experiment in the group work.

People suffering from mental illness are often looked differently and do not have equal access to all the opportunities in life. Though, patient’s family and the health care providers can play a fundamental role in the lives of these mentally ill people. Through offering a proficient care with warmth attitude they can certainly bring an optimistic change in them. But, imagine what if these caregivers are the reason of mistreatment with mental patients? This is an ethical issue which I recently came across during my clinicals and therefore decided to explore it in depth. Thus, the following paper is an attempt to analyze this issue by integrating an ethical model, highlight its significance and to discuss the causes, effects on mental health and practical strategies to overcome this immoral issue of mistreatment with mental patients.

On my clinical to psychiatric ward civil hospital I encountered a 60 years old female, married and diagnosed with obsessive-compulsive disorder (OCD). The chief complaints of patient were severe headache and aggressive behavior. Since 20 years patient had history of recurrent depressive illness characterized by weeping spells and low energy. On asking about the support system patient became gloomy and said “I am alone and nobody likes to be with me and care for me”. Further she said that due to her habit of cleaning things again and again her family becomes angry and speaks harshly to her. On spending some time with patient I came to know that how much she loved them but nobody came to meet her since she had got admitted. After taking history of patient that day I also observed that when my patient called the nurse to inquire about the medication timings, nurse replied rudely that “how many times you will ask the same thing again and again. You are mentally ill but please let us remain in good health” and then that staff nurse after making vicious gesture got out of that ward. This incident made patient further depressed. It is an issue which is ethically wrong, as caregivers who should help the patient when they are in true need are abusing them. As the professional code of ethics explains the significance of this ethical issue, which is the base of social morality that “first of all, do no harm”. It also emphasizes that the purpose of nonmaleficence includes not only definite harm but also the risk of harm (Clinical Ethics, 2004). Therefore, an ethical person must be constantly careful about the possible negative consequences of his words and actions with the mental patients. Furthermore, according to the world health organization, In Pakistan we come across upsetting stories about the mistreatment of mentally ill people due to societal hostilities daily (Gadit, 2008). Though, it is difficult to understand why such people are maltreated in Pakistan, an Islamic country where religious teachings are followed. Therefore, to discover the reasons behind this immoral deed, to identify actions to lessen this in society and also to make the caregivers inculcate this thought to support these people in their difficult times, I consider this issue as significant and therefore decided to highlight it in my paper.

As defined by SAVE project of social services that mistreatment is a breach of person’s human and civil rights causing despair. And, this violation can appear once or constantly (SAVE Project, 1995). Mistreatment of elderly person may include physical, psychological or financial exploitation and it can be intended or unintended. Intentional mistreatment involves a purposeful effort to inflict harm such as physical abuse or mauling. On the other hand, unintentional abuse takes place when an unplanned action results in damage, such as ignorance or a lack of desire of the care providers to offer proper care (Jones, Holestege, & Holstege, 1997). As verbalized by my client that at home she was beaten harshly and was always ignored by the caregivers. Moreover, nurse also verbally mistreated the patient and showed lack of desire to care. However, the empirically generated model, which is an ethical model, provided by Fulmer & Malley (1987) gives in depth details of causes and risk factors leading to mistreatment in mental patients. They divided the causal factors of mistreatment into four major categories including physical and mental impairment of the patients, increased strain on caregivers, family history of domestic violence and the societal attitudes. This model elucidates that domestic violence such as abuse and neglect are the behaviors which are learned at home and are passed from one generation to the next. Thus, elder abuse may be a continual phenomenon learned in childhood. Secondly, the stress on caregivers can also lead to mistreatment. Facing behaviors by the elderly mental persons like drug abuse, recurrent falls, incontinence or aggressive behaviors, the caregivers become exhausted and can lash out their resentment on these innocent beings. As happened with my client that due to her habit of cleaning things repeatedly, caregivers always offended and taunted her. Other external stressors such as loss of job, personal illness or low income can also place overwhelming demands on care providers which results in violent behaviors. Furthermore, this model suggests that the ill health of elderly persons in itself is a reason for abuse. Functional impairments lead to dependency on a caregiver for the activities of daily living. As these needs raises, the stress level of caregivers further increases. As faced by my patient, who was always reliant upon her family and husband for daily routine work. This created frustration for the family and at last they left her at psychiatric hospital. Lastly, there are several societal attitudes that contribute to mental person’s maltreatment. Among these attitudes, Stigma is the most common in psychiatric settings. There are many reports affirming that such patients are teased in communities by unkind names (Gadit, 2008). Moreover, according to the World Health Report (2001), stigma and prejudice are the main hindrance faced by the mentally ill today, these abstain them from seeking appropriate care (Rameela, 2004). Besides this, patients are also mistreated in the ward settings by the staffs, as occurred with my client. This is because, persons in institutional care are dependant, extremely fragile or chronically ill. In addition, problems such as low salaries, staff shortages and poor working environment increase the chances of mistreatment. (Lucas & Stevenson, 2006).

As the fundamental duty of all care providers is to perform efforts to improve the quality of life of patients. However, if these caregivers would show such an abusive behavior to the mental patients this will affect their psychological as well as physiological health. As shown in my client who along with psychological symptoms also suffered from insomnia and decreased appetite due to worries of being alone. Besides, as mentioned in literature that, negative behaviors and biases towards those having mental illness is the greatest hurdle to recovery (Chambers et al., 2010). Like, it was observed in my patient who lost all the hopes of being in normal condition as before. This was shown in her verbal comments that “everyone thinks that I am mad and therefore behaves with me in harsh manner and I am sure I will never be fine again”. This shows that how important role the caregivers and their attitude play in the development of mental patients. As very rightly said that “Support has been known to help influence and motivate a behavior change in a positive way” (Clark et al., 2005, p.20). Thus, if there would be lack of support system for these people it would lower their self esteem, intrinsic motivation and leads to decrease self concept (Lowder, 2007). If these mentally un well people are discriminated, this would hinder their ability to assimilate into society and this can lead to social isolation. Also, according to labeling theory, that once public label these people as mentally ill, their presence becomes undesirable in community hence leading them to social seclusion (Lowder, 2007). As happened with my client that when she asked her husband once to meet their relatives, he had beaten her scarcely with wooden stick just because he felt ashamed to take her in family gatherings. This affected her personality immensely and from that onwards she herself remained lonely and isolated. By reflecting upon this we can imagine that how a single dishonest action or altitude of caregivers can massively effect patient’s life. In addition, the interpersonal model of violence in mental health by Chappell and De Martino (2003) also agrees to the point that if patient’s needs and wishes are blocked till great extent, it would intensely affect patient’s mental health hence leading to disturbing effects such as ineffective adherence to treatment schedule and destruction of self (See appendices). Like, my patient tried several times to commit suicide in order to decrease her loneliness and suppress her aggression towards others. This show that it is very significant for caregivers to strengthen the mental health of these people rather than making them more vulnerable to harmful health consequences as conferred above.

After thorough literature search I found out some practical interventions to promote the ways of reducing mistreatment with mental patients. It would be on individual, family, community and government level. At individual level, patients should be granted liberty to take decisions regarding their life and should not be tortured or harmed. This is supported by Human Rights Act (1998) that states “no one shall be subjected to torture or to inhuman or degrading treatment or punishment” (Clinical ethics, 2004, p.24). In addition, the stair case model illuminates intervention strategies concerning abuse prevention in 3 steps which are reluctance, recognition and rebuilding. This includes interventions such as breaking through denial, decreasing social loneliness, sorrow and self blame, providing teaching and advocacy (Loughlin & Duggan, 1998). Health care professionals can integrate these interventions in their care framework. I also attempted to apply this model in my patient’s care. I tried to make my client verbalize her feelings by providing her concrete objects like blank paper and colors. This helped her in verbalizing her internal feelings which were not shared with others since long time. Moreover, throughout my clinical weeks I remained engaged in care through non judgmental speech and body language. As supported by literature that your speech and nature should convey respect and a non-judgmental attitude (Loughlin & Duggan,1998). To lessen social isolation, I involved my client in group occupational therapy and also focused on her hobbies that were, drawing and coloring the religious names. In this way I was able to socialize her to some extent. As supported by literature that, Support groups provide a channel for people with OCD to get emotional support while learning how to manage their condition. Also, this helps victims to lessen the barriers that the memories of abuse place in the way of normal life (Davis, 2008; Child abuse, CPS facts). In addition, abuse creates sense of hopelessness and low self esteem in patients as discussed earlier therefore caregivers should be taught to encourage and praise clients on their little efforts to boost their self concept.

On family level, a good communication and involvement in patient care can be a best defense against mistreatment. Moreover, providing psycho education can also enable family members to remain involved in the care. As, the stress level of caregivers can also be reduced by providing tips of care giving to them and involving in family therapy (Davis, 2008). At community level, social and health workers including community leaders should have responsibility for identifying cases of mistreatment and then organizing interventions to lessen the risk of any future abuse (Loughlin & Duggan, 1998). Moreover, I recommend that the psychological counseling services as well as social gathering area for mental patients should be established in the community, where these people can socialize themselves. On government level, various laws and punishments for the abusers and extensive awareness campaigns on care and destigmatization of mental illness should be arranged (Raj, 2009). Besides, government should also set up monitoring system to ensure that human rights are being followed in all psychiatric facilities (Gadit, 2008). Lastly, I recommend that with the help of mass media cases of abuse with mental patients should be reported so that the strategies should be planned on local and national level to minimize the risk of any future abuse.

It was a good learning experience for me to write a scholarly paper. I have learnt the importance of promoting mental health without abusive and negative attitude. Moreover, faculty facilitation and literature review helped me to learn and integrate all concepts related to the issue which will help me in my future clinical settings.

In conclusion, the above provided evidences are overwhelming that the mistreatment with mental patients is the disobedience of human rights as strongly proved by human rights declaration that “All human beings are born free and equal in dignity and rights.” (UDHR, 2006, p.2). In addition, the paper also discussed the causes and consequences of this immoral issue of mistreatment with mental patients. Now, it’s the duty of caregivers to adhere to the strategies provided above, in order to offer a competent care with encouraging attitude and bring a positive change in the lives of these people.

Topic:

Read the report A study on girls in gangs by Hong Kong Federation of Youth and evaluate the possible explanations offered by Merton’s strains towards anomie theory.

After reading the report A Study on Girls in Gang by Hong Kong Federation of Youth , to a large extent I disagree to Merton’s strain towards anomie theory.

Let’s begin with the definition of Girls in Gang. Firstly, Girls in Gang means those girls are not contribute in any triad or serious criminal cases like murder, but they mainly committed in physical violence, stealing from shop or strangers, dishonesty to use their phone or bullying some people that they do it for fun. Secondly, they aged from 10 to 17 years old. Thirdly, gang members are or above 3 people.(Chu Yiu Kong, An Analysis of Youth Gangs in Tin Shui Wai in Hong Kong) Moreover, there are 5 types of structure in gangs. They are autonomous which is girl-dominant, auxiliary which is also girl-dominant but also rely on boy gangs, mixed which included girls and boys, independent group which is not control by anyone, satellite group which is girl-dominant, rely on boy gangs but independent. But what we know is, auxiliary and satellite are the main structures which were more common in Hong Kong society, and the decision-making are mainly from the boys.

According to the theory of Structural Functionalism, the society is co-related. The social relationship extending over time and form stable patterns of interaction, then these structures in turn constituted social institutions when time’s gone. Therefore the social problem happens when function of an institution is not being performed properly, results from the malfunctioning. Also, from Merton’s theory,’ deviant behavior and social disorganization were separate and distinct; tended to see each as causing the other.’ (Merton, 1938)

In the case of Girls in Gangs, there is malfunction in the social relationship of their family, which cannot achieve prerequisite of socialization in order to inherit values, social norms, customs or ideologies by the society. That means their relationship cannot engage those girls in such a way that we find appropriate and acceptable. At the same time, their family cannot give out as the role of the family does such as give them love and belonging, financial support. Thus, girls may easily accept the deviant behaviors such as join gang to satisfy their needs.

Refer to Merton’s theory of strains towards anomie society, separate deviance into cultural structure and social structure. First, anomie means the low level of moral regulation which regard as normlessness, on the one hand, it is about when we are free to act and not constrained by social norms. Second, cultural structures means a hierarchy of shared values that govern our behaviors and provide us with cultural goal like achievement on education or career, material comfort of wealth. On the other hand, ‘social structure means institutional norms which define and regulate the acceptable mode of reaching these goals.'(Merton, 1938) In other words, is to provide legitimate means by which members can pursue their goals. From his theory, there are five types of adaptations to achieve either cultural goals or social means. To a large extent, I agree to the conformity adaptations, but small extent agree to the ritualism adaptations, the innovation adaptation, the rebellion adaptations and the retreatism adaptation did applicable to the case of girls join gangs in Hong Kong. The reasons are as of the following.

The report of ‘ A study on Girls in Gangs’ have shown that the several reasons of the girls join gangs because of emotional attachment and protection. As most of the interviewees responded that they were lack of affiliation, which they do not have a good or even lack of relationship with their family, school or working place. In order to fulfill their mental needs or emotional attachment, they joined gangs to achieve the conformity with other people in order to lower the loneliness. Besides, girls in gangs will be named as ‘ah-so’, English means either sister-in-law or girlfriend, or ‘ka -mui’, in English means little sister, both names did not have a direct relationship, but somehow they can get protection from the gangs because of what their fake relationship is simply as same as the real family. This structure represents that the girl participating in gangs is trying to achieve their cultural goal and they do have social means which is join gangs . Thus, the girls participate in gangs does regard as an conformity adaptations since they have their cultural goals and social means.

According to the report,” A study on Girls in Gangs”, the two interviewees told that they were pleasant and happy because of they can enjoy free entertainment when they join gangs. (18 years old, student) They will go to sing karaoke, dancing or go to mainland sometimes, depend on where the gangs go, and the girls in gangs do not need to pay any money, which for boys to show their gentleness and power. (16 years old, employee). From the research, it presents the girls do have cultural goal which is free entertainment regard as use the social means, but they use the same means which do not have any new goals or new means. In addition, the society was also assume the goal as materialism or material comfort, when they did not achieve their goals in legitimacy means, so they will reject the mean. Therefore, the ritualism adaptation which refers as no goals but with means cannot apply in this case.

Nonetheless, the report ” A study on Girls in Gangs”, One of the interviewees said that she joins gang because of her boyfriend is one of the members in gangs.(16, student)Furthermore, from what she has said, girls join gangs may seem to have a new goal which is find a boyfriend and maintain a stable love relationship with their partner, but it is also talk about they need emotional attachment, love and belonging by the mean. Thus, rebellion adaptation which have new goals and new means, and innovation adaptation which have goals and new means are not applicable in girls join gangs in Hong Kong, because they do not have the new goals and new means.

The above report data’s also presented some of the girls know that when they need to leave the gang. The report shown that girls join gangs which they think they were smart enough to protect themselves, and they know what they are doing, they always did something for aim.(18, employee) This shows that they are not as what retreatlism adaptation means have no goals and no means to do some deviant behavior, and what Merton regards as true deviant. Therefore, retreatlism adaptation cannot apply in this case, as the girls join gangs for goals.

In our life, different countries or places may bring a different social structure. Compare to America, Hong Kong is rarely have serious criminal cases, and the girls in gangs which were totally different. Merton’s theory can explain why rates of deviant behavior are higher in some sectors of the society than in others. ‘American culture is characterized by great emphasis on the accumulation of wealth as a success symbol without a corresponding emphasis on using legitimate means to match toward their goal.'(Marshall B. Clinard, 1964) Refer to the theory, it told that in America society, if the one who want to achieve goals of being wealthy, they can use any means leaned success, even illegal or criminal should be accepted by the theory. Thus, American are more focus on wealth, and do not care all other things such as relationship, love, caring, academic, and they may not facing the same problems of Hong Kong girls in gangs which was lack of affiliation or facing failure. Then, compare to the case of Hong Kong girls in gangs, mainly concerned about the emotional attachment and conformity, join gangs seek as an instruments to achieve their conformity, they may have goals but they do not have any new means. So in this way, Merton’s theory may not be appropriate to apply on the girls join gangs in Hong Kong society which is more applicable on American society.

Last but not least, Hong Kong girls join gangs should be regarding something they want like affiliation to achieve with means, which is Hong Kong girls join gangs were trying to gain conformity by satisfy their emotional attachment, love and belonging. So conformity adaptation of the Merton’s theory is the only one can apply and suit on the girls join gangs in Hong Kong. On the other hand, girls in gang of Hong Kong society need to fulfill their need with means, but not with new goals or new means, so other adaptation of the Merton’s theory may not be the best to apply in Girls in Gangs of Hong Kong society. Therefore, to a large extent I disagree to Merton’s strain towards anomie theory.

Reference Readings

Chu, Yiu Kong (2005)”An analysis of Youth Gangs in Tin Shui Wai in Hong Kong” in Hong Kong Journal of Social Sciences NO.29 Spring/Summer 2005.
Clinard, Marshall B.(1995) “Robert Merton: Anomie and Social Structure” in Earl Eubington and Martin S. Weinberg ed. The study of Social Problems – Seven Perspectives, London : Oxford University Press.
Haralambos, Michael and Holborn, Martin (2000) Sociology – Themes and Perspectives ,London Collins.
Mok, James and Chan Shui-ching(2008) A study on Girls in Gangs, Hong Kong : Research Centre, Hong Kong Federation of Youth Group.

On any given night in Australia it is estimated that over 100,000 people are homeless and living without essential human rights. (MHCA, 2009. p.5) While the reasons for people’s homelessness are varying, the abuse of alcohol, drugs and other harmful substances can exacerbate the situation and lead to further problems. The use of harmful substances by many homeless people is often seen as “functional”, this meaning that the use of these substances is helping them cope with their situation, and provide them with a sense of belonging in the Australian street culture. While many of the homeless people may start using ‘soft drugs’ , this often opens the gateway to harder substances to which they can come completely reliant upon. The prevalence of heroin use in the homeless community is ten times higher than the general Australian community. (Australian National Council on Drugs, 2008) (Johnson & Chamberlin, 2008, p.347)

Australia’s homeless population, exhibit higher rates of emotional and physical health issues, anxiety, poor nutrition and difficulties in maintaining relationships (Lady Bowen Trust).

1 in 200 Australians in today’s society don’t have access to adequate housing and employment. It is estimated that 75 percent of this homeless population is suffering from some kind of mental illness, (MHCA, 2009, p.5) and that at least forty three percent engaged in substance abuse. (Johnson & Chamberlin, 2008, p.347)

A safe and secure environment is essential to physical and mental health. Mental health symptoms can often be worsened by unstable housing and social isolation. Homelessness significantly affects a person’s ability to successfully maintain employment and relationships.

When referring to mental illness, generally speaking it is an illness that has some kind of influence and effect on how a person, thinks, feels and acts. (MHCA, 2009, p.10) These can include mental health issues such as depression, anxiety personality disorders, schizophrenia and stress disorders. It is estimated that 1 in 5 people will experience a mental illness of varying degrees at some point in their lives. (MHCA, 2009, p.10) Although the exact cause of many mental illnesses are unknown, along with biological factors it is believed that environmental factors, stressful and abusing situations, substance or drug abuse and negative thought patterns all contribute to a person’s mental health.

Domestic violence, mental health, unemployment and substance abuse are among the leading causes of homelessness in Australia, along with critical shortages of affordable housing. However it is important to note that there are many contributing factors to a person becoming homeless such as family breakdown, sexual assault, gambling, mental illness, financial difficulties and social isolisation and broader social processes. (Homelessness Australia, 2010)

Having a mental illness reduces a person’s quality of life; the symptoms can make it difficult for individuals to cope with the daily demands of work and home life. In some cases this can lead to people becoming socially isolated, and even losing their jobs. This loss of employment often means people are no longer able to afford housing and a lack of social support can mean these people may become homeless. The unemployed are also less likely to receive medical treatment for symptoms of mental illness. If they do seek treatment of these illnesses they then face the problems of being able to pay for expensive prescriptions. (www.informahealthcare.com)

The current economic climate has also placed increased stress on individuals and there has been “a spike in Medicare claims for mental health consultations due to unemployment” (Dragon, 2009).

Studies have shown that homeless people have a higher prevalence of mental illness and substance abuse, with a Melbourne study showing 30 percent of homeless people surveyed had mental health issues and 43 percent suffered substance abuse issues. (MHCA, 2009, p.14)

Substance abuse is also linked to homelessness, unemployment and mental illness, as substance abuse can take hold and damage a person’s quality of life. Substance abuse begins to interfere with a individuals work and social life and this commonly leads to the destruction of relationships and loss of employment. Rather than this slide from positive relationships and employment being instant, many people tend to slide into homelessness as a result of their substance abuse. As they begin to come more dependent on these substances the transition becomes more rapid. ((Johnson & Chamberlin, 2008, p.348)

Having a mental illness can increase a person’s likelihood of abusing drugs, which may in the short term make the symptoms of their mental illness feel better, while other people’s drug use can trigger the symptoms of mental illness. (MHCA, 2009, p.22) The link can also be made in terms of unemployment and homelessness, if a person is unemployed they can experience financial difficulties that can result in being homeless, alternatively if a person is homeless it becomes difficult to gain employment and break the cycle.

The relationship between homelessness and substance abuse is well researched and documented; there is debate however on the direction of this relationship, and whether substance abuse is the cause or consequence of an individual becoming homeless.

The focus of substance abuse as a consequence of homelessness is the social adaption model. Entering into homelessness often exposes individuals to a subculture where substance abuse is accepted and common place. This model also identifies that many people start to abuse substances as a method of coping with their situation, which can often be very stressful, uncertain and traumatic. (Johnson & Chamberlin, 2008, p.343)

Johnson and Chamberlain (2008, p.350) report that thirty four percent of individuals have engaged in substance abuse before becoming homeless, while sixty six percent first start abusing substances after becoming homeless.es as they struggle to pay for their addiction. Loss of employment then leads individuals looking for alternative income which can often lead to ‘bad loans’ and illegal behaviours. (Johnson & Chamberlin, 2008, p.p347-350)

The social selection approach focuses on substance abuse as a cause of homelessness rather than a consequence. Substance abuse can be a leading factor into homelessness, as when a person becomes addicted to harmful substances they tend to start self damaging behaviours which affect social and work relationships. As their substance abuse increases, this often leads to financial difficulties and destruction of social networks.

Psychological trauma and post traumatic stress disorder have been found to be contributing factors for many of the homeless population.

There is no specific way in which each of these social detriments of health contributes to each other. For example, mental health issues may contribute or lead to people becoming homeless, while for others their mental health issues may be a result of being homeless or compounded by it. (MHCA, 2009, p.22)

The homeless population can face discrimination when trying to find and apply for housing, especially when they have experienced a mental illness. (DHA, 2005) Many landlords are something about having people with a mental illness in their accommodation, due to the negative stigma that is attached with mental illness.

Having a mental illness or past substance abuse problem can also follow a person and impact upon their lives even after they have overcome these issues. As in today’s society many jobs and housing applications require police, credit and background checks. (MHCA, 2009, p.18)

Webster (2007) reports that drug abusers with mental illnesses are likely to experience high rates of employment difficulties. Stating that individuals with mental illnesses have fewer work-related skills, poor interpersonal skills, impulse control and poor time management, therefore having less success in the workforce than individuals without mental illness and substance abuse issues. (Webster et al., 2007)

Webster (2007) also reports that employment is a key factor in breaking the cycle of drug abuse, as employment occupies time, increases self esteem, promotes a sense of belonging and responsibility and provides structure. (Webster et al., 2007)

In Australian society a quarter of the homeless population are children aged between 12 and 18, as these children age and mature they are at a higher risk of unemployment and being stuck in a vicious cycle of homelessness, unemployment, substance abuse and mental illness. (Graham, 2010, p.24)

Children are more likely to face unemployment if they are from low socioeconomic status, left school early leading to low literacy and numeracy skills, are indigenous, live with one or more unemployed person, or live in remote areas. (Graham, 2010, p.20)

A longitudinal study of Australian youth with mental health issues found that they did not suffer from mental health issues prior to unemployment. This shows the importance of employment and the effect that unemployment can have. (Graham, 2010, p.23)

In 1991, Fischer & Breakey developed three pathways into homelessness. The first being social selection which involves “a breakdown in the capacity for living independently due to mental illness. The second pathway details socioeconomic adversity in which a person experiences unemployment, low levels of education and declining income. The third pathway described involves the inability to develop “socially normative roles and support systems”. (Kim & Ford, 2010, p.40)

The sociological imagination uses a sociological approach to analysing issues such as homelessness, substance abuse, unemployment and mental illness. This approach analyses associations of public issues and personal problems by looking at the Historical, structural, critical and cultural factors which contribute to a person experiencing issues such as homelessness. A better understanding of the causes can be found and thus leading to a better understanding of how to return to normal societal function and reducing the risk of relapse into past behaviours. . (Germov, 2009, p.7).

The amount of structure and agency an individual holds in situations of homelessness, drug abuse, unemployment and mental illness is also important to note. The structure agency debate explores the amount of control a individual has over their behaviour and how much influence the social structure to which they belong plays. (Germov, 2009, p.7). Children that have grown up in an environment which is socioeconomically disadvantaged, high levels of drug abuse and unemployment, and poor work ethic, are more likely to follow in this pattern than children that have been brought up in higher socioeconomic conditions and have been instilled with a strong work ethic.

Sue is 17 years of age and has been living away from home for two years, having left her family home due to conflict and violence with parents and physical assault between siblings. In the past two years Sue has lived a typically transient lifestyle, residing in crisis accommodation, various boarding arrangements and in an accommodation program to assist young people who are homeless and in need of specialist support. Sue has lived independently in a small unit as well as with a number of friends in their accommodation and in squats.

Over the past two years Sue has engaged in self-harming behaviour and been violent and aggressive towards peers, herself and family, which has on occasion resulted in ‘cautions’ from the legal system. Sue has also engaged in petty theft, auto-theft and ‘break and enters’, all resulting in legal ‘cautions’. Sue uses alcohol, marijuana and amphetamines and has been diagnosed with depression resulting in anti-depressants being prescribed

(Mission Australia, 2005).

In December 2008, the Australian Government released a “White Paper on Homelessness: The Road Home: A National Approach to Reducing Homelessness”. This paper recognises that maintaining the current approach to homelessness will see the homeless population of Australia significantly increase in the coming years. The paper takes a holistic view and aims to find solutions in address the varying needs of the homeless population, for example employment needs, education and training, health and social support. This report has three main initiative areas. They are to ensure that services intervene early to stop people becoming homeless, making services more connected and responsive across a range of areas not limited to housing, such as health and economic and social participation and strategies to assist people who become homeless to move quickly through the crisis system to stable housing, and providing the support they need so that they do not re-enter homelessness. Through the implementation on many straggles under these initiatives and 1.2 billion dollars in funding the Australian Government aims to have a fifty percent reduction in homelessness by 2020. (MHCA, 2009, pp.12-13)

Today’s society has negative stigma and labelling associated with homelessness. Due to this attributes, the skills they poses, their personality, past achievements are often disregarded and overrun by the fact they are homeless. (Mission Australia, 2005)

As homelessness is not a ‘social norm’, it can be seen is deviant behaviour. With the rise of the medical model of health, importance is placed on the individual receiving treatment in order to restore health and conformity. (Roach Anleu, 2010, pp.242-260)

Under the ‘therapeutic model deviant individuals which can include the homeless, mentally ill, drug and alcohol abusers and those experiencing ‘adjustment problems’ require psychiatric intervention, with little emphasis in the social and environmental conditions that contribute to these issues. (Roach Anleu, 2010, pp.242-260)

Homelessness, unemployment, drug use and mental illness are all intricately connected in today’s society. These social determinants of health all coexist and can each weigh largely upon another. These linkages can lead to a viscous cycle which can be hard to break.

Conclusion

What was discussed

Reaffirm argument

http://www.health.qld.gov.au/research_information/social_determinants.asp

This research paper is going to look at the social work profession and specifically deal with mental health social work. In researching on the subject, I will use books and articles to get secondary information and at the same time carry out an interview with two social workers that are involved with mental health patients and clients. One of the social workers has a bachelor’s degree in social work while the other one holds a master’s degree in social work. Carrying out the interview will require posing a few questions which are listed below.

What is the social work profession in general all about?

What other or extra duties are social workers expected to perform?

How many categories of social workers are there in the profession?

What does a mental health worker specialize in?

What is the connection between a mental health social worker and a substance abuse social worker?

What are the services that one would expect to get when visiting a mental health social worker?

Give me a short briefing of the nature of your work as a social worker?

How is your work related to the outside and regular work environment?

What are the challenges that most mental health workers face in their jobs?

What requirements does one need to get into this profession?

Are there any exceptions for entry-level jobs in small agencies or community work?

Is there a specific amount of field experience required beforehand seeing as one gets to handle clients directly?

What other qualifications does one need apart from the educational and professional ones?

Are there any personal skills advantageous to this profession?

Is there any advancement opportunities in the mental health social work profession and what are they?

Essay

Social work is a profession which is most suitable for individuals who have a strong urge and desire to help improve the lives of other people. Therefore, social workers are the professionals who help people in coping with their day to day lives and solving their personal, family and relationship problems. In additions, there is another group of social workers that helps the clients in dealing with disabilities and life threatening or fatal diseases as well as social problems such as drug abuse and unemployment. As a result, they also end up being involved in the conducting of research, advocating for improved services and involvement in the planning and/or policy development. Basically, most of the social workers concentrate in supplying their services to a particular population or in operating in a specific background. Social workers are generally involved in different areas of practice according to one’s preference. These categories are mental health, elderly, education, political, medical or slums dwellers. If they have the right State mandated license, these workers are referred to as licensed clinical social workers in spite of whichever setting they are in.

Mental health social workers, who are often paired up with the substance abuse social workers, are the ones who treat people affected with mental illness or substance abuse problems. The reason why mental and substance abuse social workers are paired up is because more often than not, substance abuse leads to addiction and most experts concur that addiction is a brain disease. The services offered by these social workers include individual and group therapy, crisis intervention, outreach, social rehabilitation and outreach programs. In addition, they help in planning for supportive services so as to make it easier for the clients when they leave the in-patient facilities to rejoin the community and also provide services to help the family members of their clients cope with the situation.

Although most mental health workers are flexible to work in whichever setting that they are comfortable with, they usually spend most of their time in an office or a residential facility. Some of them work in outpatient facilities whereby the patients come for the treatment and medicine then leave while others work in inpatient facilities whereby the clients reside within the facility until they are well enough to go back home. In regard to the normal work environment, there are a few mental health workers who work in employee-assistance programs in which case they help people cope with job-related pressures or with personal problems that may affect the quality of their work production. Several other workers are involved in private practice where they get employed directly by a particular client. Workers may also travel locally to visit their clients, meet with service providers and attend meetings.

Even though most of the mental social workers are greatly satisfied after offering their services, the job can sometimes be very challenging. Social work, and especially in the mental health specialty, does not have a lot of professionals. Due to this, there is a regular understaffing and build up of large case load in some of the agencies thus leading to too much pressure on the available workers. Full time social work requires one to work a standard 40-hour week but due to the nature of the job, one is at times obligated to work during the evenings and weekends meeting with clients, attending community meetings and handling emergencies. Moreover, in the working with some patients especially in the mental health institutions can prove to be challenging and at times impossible. This is especially when dealing with a chronically ill patient who is unwilling to co-operate and is difficult to handle and manage. In such a case, external help might be required to calm down such a patient and acts such as man-handling and injecting them with sedatives have to be executed so as to return things back to normality. (Golightley, 159)

Just like any other profession, social workers also have minimum requirements so as to be permitted full entry into the occupation. Although some positions necessitate one to have an advanced degree, the most common minimum requirement is on average a bachelor’s degree in social work (BSW) which is sufficient for entry into the field. However there are a few exceptions whereby a major in psychology, sociology or related fields can qualify one for some entry-level jobs in small community agencies. On the other hand, a master’s degree in social work (MSW) is characteristically vital for one to get positions in both the health and teaching fields as well as in clinical work. Furthermore, for teaching position in colleges or universities, one would need a doctorate in social work (DSW or PhD). A certified bachelor’s degree program requires a minimum of 400 hours of supervised field experience while a master’s degree program includes a minimum of 900 hours of supervised field instruction. This prepares the graduates for employment in their chosen field of specialty and helps them continue developing the skills required to execute clinical assessments, handle and supervise large case loads as well as explore new ways of using social services that are helpful to the clients.

In addition to the educational qualifications, all states have licensing, certification or registration requirements regarding the use of professional titles. Most of the states call for 2 years of supervised clinical experience for any social worker to be given a license. However, one does not only need professional and educational qualifications to successfully practice a socially and emotionally challenging career of mental health social work. One also needs to have certain personal skills and traits. First and foremost, a mental health social worker should be objective and at the same time sensitive to other people and the problems they are dealing with. It is also helpful to both the social worker and the client to possess calm temperament, quiet disposition and be very patient. A social worker should also be emotionally mature, be able to manage responsibilities and to maintain good working relations with both clients and coworkers. In terms of advancement, a mental health worker can progress to become a supervisor of other workers, a program manager or an executive director of a mental health institution. In the case where one has reached a retiring age or is unable to work in a health institution, there are other career options such as teaching, consulting, researching or going into private practice.

In conclusion, despite the social work profession and most especially the area of mental health not being as popular as other careers such as medicine or law, it is just as important in the community as the others. Mental health social workers contribute greatly to the community in undertaking a task that most people do not have the heart, disposition or courage to do. If more people were to delve into the profession, the community and the families dealing with mental illnesses would benefit significantly.

NAME : Kerril Sommerville.

LOCATION : Monmouth Medical Center, Long Branch, New Jersey.

PHONE : +1 800 732-922-7300

EMAIL : [email protected]