Author: Andre Coleman

In order to maintain confidentiality the names used in this piece of work have been anonymised.

The purpose of this assignment is to demonstrate the knowledge and understanding of the impact that policy and specifically Child Protection (CP) policy has made on professional practice. I will identify and analyse an incident associated with child protection in practice which will enable a discussion to debate appropriate local, national and international perspectives. I will also consider the impact of policy on other professionals involved in the event. Furthermore I will use PEST analysis as a framework to explore the impact of policy on practice.

Pest analysis is described by Mindtools, 2009 as a simple, useful and widely-used tool that helps you understand the “big picture” of your Political, Economic, Socio-Cultural and Technological environment’. It is used by business leaders worldwide to build their vision of the future and likewise can be used by practitioners to attain best practice to achieve positive outcomes for individuals.

The practice placement that is the focus of this assignment is a mixed senior school of predominantly working class white students aged 11 – 18. The incident that occurred was discussed between a female pupil – known as Beth Jones aged 12 years and a student social worker (SSW). While in a 1:1 mentoring session Beth disclosed that her mother Elaine Jones had pushed her down the stairs in her home that morning. Beth was traumatised and stated that she was fearful to return to her home that day.

Recently, the views within the UK concerning the status of children have been wide-ranging and this has had some impact on policy and practice. At a socio-cultural level children are now viewed as having the capabilities to engage in building and constructing their own lives and opinions have swayed towards autonomy of women and in particular of children. In today’s society, through the emergence of feminist writers especially on issues such as patriarchy and domestic violence, children are viewed as independents rather than being the property of men. This has been reinforced through changes in the political economy of welfare where society’s perceptions of children have transformed towards children being independent service users whose wishes and preferences have been given greater importance. (Armstrong, et al 1991).

The introduction of the Human Rights Act 1998 also ensures that children now have legal rights. (WHO, 1998). The term ‘Gillick competent’ is used to describe a child under the age of 16 who is judged to be of a ‘sufficient understanding and intelligence to be capable of making up his own mind on the matter requiring decision’ (Smith, 1996 p52) thus enabling young people like Beth to be heard. The practice implication for this is that when taking into consideration the opinions and wishes of the child, it must first be established what those wishes and views are and then whether those wishes and views are to be considered, or acted on, based on whether the child is deemed to have a full enough understanding of the implications of their decisions.

Every child living in this country is entitled to protection from abuse regardless of his or her background. With the help of the Children Act 1989, and the recommendations made by Lord Laming, (Every Child Matters, 2004), child services within the UK have been given the power to act when they feel a child is being abused. Victoria Climbie aged 8 died from 128 injuries at the hands of her carers in February 2000. The investigatory inquiry into her death conducted by Lord Laming discovered many instances where professionals including line managers had failed to fulfil their roles and numerous flaws where professional networks had failed to protect Victoria during the last months of her life. Laming criticised the lack of professionalism and cooperation between agencies (Laming, 2003 S.1.30) – the Laming Enquiry, lay the foundations for the ‘Every Child Matters’ Green Paper published in 2003.

In the U.K. the Children Act 1989 aimed to introduce key changes for practice by focusing on principles such as paramountcy of the child, partnership and parental responsibility as well as child protection and family support and the rights of the family against the rights of the child. This has lead to increasing pressures on social workers who have to prove that they have been empowering, anti oppressive and supportive to those involved in their cases. Within the U.K. these policies afford children considerable rights as individuals and these are considered primarily before those of the parents in child protection cases. This has led to a predominantly rights-based legal approach where social workers hold considerable amounts of power. (Archard el al 2002).

Farnfield (1998, p53) talks about ‘children as consumers’ and the difficulty which many social workers have in balancing the rights of the parents with the rights of the child. Given the drive towards working in partnership with parents in childcare and inclusion of all relevant parties when working within a social care field, it may be difficult, when working with families, to remain focussed on the issue of whom the client is and whose interests are best being served by any particular course of action. Trevithick (2005, p229) discusses a particular case where she was having difficulty in establishing a good relationship with parents in a child protection case. The issue of having the ‘agenda’ of protecting the children was identified as a stumbling block in the establishment of a rapport with the parents. Brayne and Martin (1999) however argue that, from a legal perspective, in child protection cases the primary client must ‘always be the child’. This is borne-out by the policy document ‘Working Together to Safeguard Children’ which states that professionals should: ‘work co-operatively with parents unless this is inconsistent with the need to ensure the child’s safety.’ This is also compatible with the ethos of child centred practice in placing the child first.

Article 19 of the UN convention on the rights of the child states governments should ensure that children are properly cared for and protect them from violence, abuse and neglect by their parents or anyone else who looks after them. The Human Rights Act 1998 is linked to the implementation of no-smacking policies and states that every child has the ‘right not to suffer ill treatment or cruel, unusual punishment.'(Flynn, 2004. p.41). As Beth disclosed to the SSW that she has been physically abused, the SSW refers the disclosure to the Child Protection officer. In line with the Data Protection Act 1998 the information is kept confidential as it is not necessary that any other member of staff need to know about the case at that time. As a result of the deaths of Jessica Chapman and Holly Wells in 2004 the Bichard Report was published and made recommendations about how information is shared and stored.Child protection information on a pupil is filed in a separate area to the school file and can only be accessed by the child protection officer and shared with other professionals in a ‘need to know basis’ a positive impact of policy to protect confidentiality of vulnerable children.

“Undoubtedly the most significant development in childcare policy in Britain over the past twenty-five years has been the preoccupation with child abuse” (Alcock et al 1998). Also it can be suggested that this increase in concern can be seen in all major European countries and constitutes a major key issue in this area of social policy. This concern has not only been emphasised through the formal and legal frameworks of society but also by the general public.

As stated above the rise in concern with child abuse has been evident from the late 60’s and early 70’s. It is from then that child abuse has become identified as a “social problem” (Alcock et al 1998) mainly through high-publicised cases of child abuse victims. The high profile case of Maria Colwell who died in 1973 after serious injuries were inflicted upon her at her home whilst under the supervision of social services demonstrates this point effectively. Even today 30 years on this case is still being analysed and discussed. When identifying the key issues within child protection it is important to consider the concept of ‘balance’. This is a main concern for all countries who find themselves victims of either jumping in too quickly with overzealous assumptions, or on the other hand holding off too long and in the end delaying intervention until in some cases it is too late.

“Any major piece of legislation develops in response to a variety of influences.” (Hill, M. and Aldgate, J. 1996). In the U.K. for example, the Children’s Act 1989 was the result of a number of influential factors. One of the biggest influences, which have already been mentioned, is that of the wave of child abuse tragedies that occurred over the years. The public inquiries and the amount of media attention that arose because of these cases shed light upon the inadequacies of practice and previous policies. Cases such as Jasmine Beckford and Kimberley Carlisle and the Orkney and Cleveland inquiries impacted public perceptions and professional practice and shaped the responses of the U.K.’s policies to the problem of child abuse. The social reaction prompted those in power to reassess their protection schemes and to readdress the issues of evidenced based practice within their policy changes. According to Alcock et al. these high publicised inquiries, “led to the promulgation of extensive procedural guidance at central and local levels to social welfare and other agencies designed to avoid repetition of tragedy and scandal” (Alcock et al 1998).

Back to the scenario with Beth, after discussion with the child protection officer, a decision is made to make a referral to social services. Policy states that any disclosure of physical abuse results in steps that must be taken to protect the child. This may produce an emergency protection order as she is deemed to be at risk of harm if she returns to her mother’s care. A social workers main aim in the U.K. is to guarantee young people like Beth’s right to protection from harm and if necessary will battle with parents and other agencies to fulfil this.

In comparison, Europe and specifically France, children have not been accorded as many individual rights independently of their family. Their position is a result of the ‘traditional’ state and family perspective’. The French policies have adapted to this cultural opinion and have enforced that child protection work should be focused on the family and that children should be considered not as an individual but as part of the family. Traditionally the focus is that the parents are superior to the children giving them the rights of decisions, protection and care. This is the view of French society where their main concern is keeping the birth family together and taking risks is acceptable. It can be suggested that in France a ‘humanistic model’ (Parton ,cited in Armstrong et al 1991) is followed to a certain degree. The country’s view that social factors are very likely to be involved in child abuse cases is evident in their policies, which apply preventative, counselling and therapeutic approaches. Examples of this can include the forcing of families to co-operate at the intervention stage, which is unheard of in Britain. One of the main concerns of this system is the fact that in most cases the Children’s Judge does not hear the child’s wishes and views, and if they are heard they are poorly represented. In the U.K. as stated the protective attitude of society is reflected in their policies that recognise the state as having direct responsibility for protecting children when the parents have failed. If Beth were in France she would not be given an independent voice and a right to immediate protection without a full family investigation.

The protective U.K. system appears to have disadvantages, Cooper proves this point by highlighting that in France there has never been any highly publicised cases of abuse as in Britain; therefore there has never been a lack of confidence in social work. The positive aspect of French child protection policy is a constructive public perception which eases tensions within the social worker and family relationship and also encourages co-operation of the family. It was also found that French social workers have a, “consistent, trusting professional relationship at the centre of their professional aims” whereas in the U.K. social workers are mainly concerned with “whether parents are guilty or innocent and with the task of collecting evidence” this impacts on UK social workers as they are on the receiving end of accusations and abuse and stereotypical blame. (Cooper, A. 1994 p59-67).

Effective communication is essential for organisations to be successful. It is the process by which information is exchanged between one group or person and another, by computer, telephone, letter, meetings, text, fax or face to face. The deaths of Holly Wells and Jessica Chapman in August 2002 sparked the Bichard enquiry into child protection procedures in the Humberside Police and Cambridgeshire Constabulary in the light of the trial and conviction of Ian Huntley for the murder of the two young girls. He had previously been suspected of committing sexual assaults on at least eight occasions and at the age of 21 Ian Huntley had sexual relationships with at least three 15-year-old girls for whom social services were aware but failed to communicate this information to the police. If the police had been aware of this information, this may have shown up when vetting checks were being carried out on Huntley and may have stopped him from getting a job at the school that the girls had attended. In December 2003 the Humberside Police said ‘the main reason for this was because of the Data Protection Act’. Information about dealings with Ian Huntley had not been available to them during vetting checks. This inquiry also stated that the problem was due to the police not having been told about this legislation regarding information about the person being vetted. A report stated that police officers were nervous about breaching the legislation, partly at least because too little was done to educate and reassure them about its impact. Michael Bichard labelled it an inelegant and cumbersome piece of legislation and the judiciary stated that better guidance is needed on the collection, retention, deletion, use and sharing of information, so that police officers, social workers and other professionals can feel more confident in using information properly. This simply indicates the importance of effective communication. The information system may have been used to its full potential if the officers had been aware of the limits of the Data Protection Act. Ian Huntley’s date of birth had been entered into the system incorrectly. If this information had been entered correctly then they would have been aware of his past behaviour. This would effectively stop him working in the school and the girls trusting him as a safe adult. The PNC (Police National Computer) only checked against the name Ian Nixon (an alias)

and not Ian Huntley. An Information system can fail completely without accurate information from the end user, highlighting the systems reliance on good communication with its users. (Bichard Inquiry, 2004).

The Children Act 2004 empowered the Secretary of State for Education to create a database (or databases) of everyone in England who is aged under 18. In July 2007, the regulations that will bring this first national database of children into being were passed by Parliament. The government has announced that the database will be called ContactPoint. It was originally known as the Information-Sharing Index, but re-branded in February 2007 because of negative publicity about information sharing. ContactPoint is effectively a file-front that serves the whole range of agencies that may be involved with a child. It is intended to provide a complete directory of all children from birth, together with a list of the agencies with which s/he is in contact. It will not hold any case records, but will enable practitioners to indicate their involvement with a family and contact each other in order to share information. It will also show whether an eCAF (an in-depth personal profile under the Common Assessment Framework) has been carried out and is available for sharing. A response from teachers in local schools have indicated that agencies are finding the procedure confusing with long waiting times for an initial reply for services. Another negative criticism of this policy as stated by Searing, 2007 ‘the danger is that once social work has become more closely aligned with an inter-agency system of surveillance and monitoring of families most people will be less open and trusting towards social workers and this will make their job more difficult’ thus further negative impact on the social worker role.

The Governments response to the Laming Enquiry was almost immediate with the production of the Green Paper ‘Every Child Matters’ 2004. In conjunction with Every Child Matters (ECM) is The Children Act 2004, which is in addition to the original Act 1989. The Act encompasses several components based on recommendations from the Laming Report and is responsible for promoting a partnership between agencies working with children including health, education and social care in a more cohesive manner (Allen, 2008). According to Smith the Children Act 1989 (CA, 1989) simplified all pre-existing legislation in relation to children and families. It imposed new duties on local authorities relating to the identification and assessment of ‘children in need’, and gave all Local Authorities new responsibilities for looked after children. The introduction of the Act also provided the Court with Emergency Protection Orders to protect children at risk of harm which replaced the Place of Safety Orders. Smith (2001) argues that the Children Act was particularly relevant because for the first time it placed more emphasis upon the importance of inter-agency collaborative working as a means of responding to the needs of both children and their families. This policy provided immediate protection to Beth, initiated within the school environment and in collaboration with social services, a good example of interagency working. If Beth had not been listened to or taken seriously she would be at risk of further abuse and may not disclose further abuse due to lack of support.

It is important that professionals and agencies co-operate and work together in child protection cases so that all the relevant and correct information is available, and accurate in order to help and support the child. In recent cases, specifically that of Victoria Climbie, this was not done and therefore Victoria was put at further harm, and subsequently died when she could have been saved if the agencies had worked effectively and shared information. This is why the Every Child Matters legislation came about, to try and prevent this in the future. Children at risk need coordinated help from health, education, social services and other agencies, including youth justice services. These professionals are required to work together in order to protect the children and keep them safe, and to help bring to justice the perpetrators of crimes against children. As a result of Every Child Matters, now children known to more than one agency will have a single named professional to lead their case. This has proved to be an effective tool in Beth’s scenario as guidance enables the professionals within the school to take action immediately to protect her as she was placed on an emergency protection order. Even though the policy is over five years old, when applied effectively stops a child falling through the net. Policy has shaped the care for this service user and had a significant impact on her outcome.

References
Allen, N. (2008) Making Sense of the Children Act 1989, 4th ed. West Sussex: John Wiley & Sons.
Alcock, P. Erskine, A. and May, M. (1998) The Students Companion to Social Policy Blackwell Publishers
Armstrong, H. and Hollows, A. (1991) in Hill, M. (Ed) Social Work and the European Community: the Social Policy and Practice Contexts. London: Jessica Kingsley Publishers, 142-161
Brayne, H. Martin, G (1999) Law for Social Workers (6ed). London: Blackstone
Bichard, M. Sir. (2004 April 21), The Bichard Inquiry – An Independent Inquiry arising from the Soham murders, (The Bichard Inquiry), Available: http://www.bichardinquiry.org.uk/, (Accessed: May 2009).
Children Act 1989- Section 47.
Children Act 1989 (c.41). www.hmso.gov.uk/acts/acts1989/Ukpga w19 March 2009.
Cooper, A. (1994) In Care or En Famille? Child Protection, the Family and the state in France and England. Social Work in Europe. Volume1No.1.
Davies, M. (2002 p107) Companion to Social Work. (2nd). London: Blackwell. (Data Protection Act 1984 and 1998).
DfES (2006) What to do if you’re worried a child is being abused. Summary. Crown Copyright. Department of Health, Home Office, Department for Education and Employment, 1999
Every Child Matters (2003) Every Child Matters (2005) Background to Every Child Matters (http://www.everychildmatters.co.uk/aims/background [Accessed online: 17/01/2009]
Farnfield, S (1998) The rights and wrongs of social work with children and young people in Cheetham, J. and Kazi, M.A.F (eds.) The Working of Social Work. London: Jessica Kingsley
Flynn, H. (2004) Protecting Children. Heinemann.
Hill, M and Aldgate, J (1996) The Children Act 1989 and Recent Developments in Research in England and Wales, in Hill, M. and Aldgate, J. (Eds.) Child Welfare Services: Developments in Law, Policy, Practice and Research, London: Jessica Kingsley Publishers
Lord Laming.2003. The Victoria Climbie inquiry. Crown London
http://www.mindtools.com/pages/article/newTMC_09.htm
Searing, H (2008). The Crisis in Social Work: The Radical Solution. Available at http://www.radical.org.uk/barefoot/crisis.htm (Accessed May 2009)
Smith P (1999) Support for Children and Families:
Trevithick, P. (2005) Social Work Skills.2nd ed. Berkshire: Open University Press.
World Health Organisation (WHO)
Bibliography
Burton S., (1997) When There’s a Will There’s a Way: Refocusing Child Care Practice – A Guide for Team Managers London: National Children’s Bureau
London Borough of Greenwich and Greenwich Health Authority (1987) The Kimberley Carlile Report
Cleveland Report (1988) Report of the Inquiry into child abuse in Cleveland 1987 London: HMSO
General Assembly of the United Nations (1989) The Convention on the Rights of the Child. Adopted by the General Assembly of the United Nations on 20 November 1989. (UN Convention) http://www.unicef.org/crc/text.htm
Parton, N. (1996) ‘Social Work, Risk and “the Blaming System”‘ in N. Parton (ed.) Social Theory, Social Change and Social Work, London: Routledge & Kegan Paul.
Trotter, C. (2004) Helping Abused Children And Their Families, London.

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Contents

BACKGROUND

LITERATURE ON THE TOPIC

STATEMENT OF THE PROBLEM

OBJECTIVES

SIGNIFICANCE OF THE STUDY

RESEARCH METHODOLOGY

Research design

Population of the study

Sampling Design

Tools for data collection

Nature of tools

Sources of data

Data analysis

LIMITATION OF THE STUDY

WORK PLAN

LIKELY OUTCOME

Reference

INTRODUCTION

The high fertility rate leading to the rapid growth of country’s population is a major hindrance towards the development of a nation. Keeping this in mind, India was the first country to launch a well-defined family planning (FP) programme in 1951 with the major objective to balance the population with resources available. India’s current demographic phase is characterized by high fertility and moderate mortality rates. As a result, the country’s population is growing rapidly with about 18 million people being added to it annually, to give a 2.1 per cent increase per annum. Despite a 40-year old Family Planning Programme, India’s 1991 census has shown a population increase of 160 million during the 1981- 91 decade. The gap between expressed favorable attitude towards the small family norm and knowledge and practice of family planning amongst Indian couples is intriguing. Family Planning basically, refers to the practices that help individuals or couples to avoid unwanted births, bring about wanted births, regulate the intervals between pregnancies, control the time at which births occurs in relation to the age of parents and determines the number of children in the family. Under the programme, various training programs have been conducted to train health care providers. Several health workers, both male and female became multipurpose workers responsible for providing a set of basic family planning, maternal and child health (MCH), and public health services. A community oriented service-network was developed to expand family planning and MCH services. In 1977 conscious shift was made in the policy to include voluntary family planning along with the other health care services under the umbrella of ‘Family Welfare’ and various centers have been set up in rural (primary health centers, community health centers etc.) as well as in urban areas (postpartum centers, urban family welfare centers, dispensaries and hospitals). Services administered through the programme have been broadened to include immunization, pregnancy, delivery and postpartum care, and preventive and curative health care.

The range of contraceptive products delivered through the programme also widened. The various contraceptive methods are categorized as barrier, chemical, natural or surgical (Weeks 2002). Surgical method includes sterilization (vasectomy and tubectomy) which is a permanent and irreversible method of birth control. Induced abortion is the post–conception method of family planning and is performed if there is a need to terminate an unwanted pregnancy because of failed contraception. Despite of many temporary methods, the emphasis was put on sterilization of male or female. Although sterilization is a safe and most effective technique it cannot serve the needs of all couples in the different stages of the reproductive life-cycle. Thus, a large proportion of couples remained unserved because of non-availability of proper contraceptive technology. So, the new approach emphasized the target-free promotion of contraceptive use among eligible couples, providing the couples a choice of contraceptive methods and encouraged them towards adequate spacing of births (at least three years birth interval). The National Population Policy (2000) has set the task of addressing unmet need for contraception as its immediate objective. Attitudes towards fertility regulation, knowledge of birth-control methods, access to the means of fertility regulation and communication between husband and wife about desired family size are essential for effective family planning (Dabral and Malik 2004). Various factors governs the acceptance of contraception e.g., religion (NFHS 1998-99, 2002), number of sons in family (Bhasin and Nag 2002), and education of husband and wife (Bhasin and Nag 2002), etc. Besides, spousal communication also increases the likelihood of contraceptive use (Kamal 1999; Ghosh 2001). Sterilization is usually accepted when the couple is sure that they have completed their family size and gender preference (Bhasin and Nag 2002).

Although the family welfare programme has made an important contribution towards improving the health of mothers and children, there are some major impediments. Even though a huge infrastructure has been established through out the country to deliver an integrated package of health and family welfare services, the quality and outreach services need improvement. According to Santhya (2003), the contraceptive prevalence rate in Meghalya is just 4.7 (2.8 for sterilization and 1.9 for other temporary methods), which is lowest in the whole India. This drew the attention towards the need to carry out a study in Meghalaya. So, the present study was conducted with an objective to study the extent of awareness of women with regard to family planning, i.e. birth control measures and awareness level regarding the Government schemes on family planning among the Khasi women of East Khasi Hills, Meghalya.

BACKGROUND

Family Planning is a program or practice to regulate the number and spacing of children in a family through the practice of contraception or other methods of birth control. Since the world and also India is facing with the problem of overpopulation. Government as well as non government agencies is taking major step to overcome this problem. In India the use of contraceptive methods increased from 13 per cent in 1971 to 56 per cent in 2005/06, and fertility declined from about 6 births per woman in the 1960s and 1970s to about 2.7 births in 2004. This decline of more than 3 births per woman represents about 85 per cent of the decline required to reach replacement fertility: 2.1 births per woman. As per the latest official data, the total number of family planning acceptors in India decreased by 5.1 % between 2011-12 and 2012-13. The data revealed that condom is the most preferred method of family planning while sterilizations the least adopted means. The number of couples adopting various methods for family planning, including spacing methods was found to be 30.2 million, with 13.9 million preferring condoms to any other means. The total Family Planning Acceptors in India have increased over the years but in recent years especially after 2007-08 the number of accepters has shown a gradual decreasing trend. The contraceptive prevalence rate for currently married women is the lowest at 24 percent in Meghalaya among all the states in India. The national average is 56 percent. The rise in contraceptive use and the pace of fertility decline, however, has not been uniform throughout the country. There are disparities in contraceptive use and fertility between the poor and the rich, and between the educated and the uneducated. While the country has also made tremendous progress in terms of economic growth, these disparities in contraceptive use and fertility have important implications for the future of the country. The purpose of this study is to review the current status of the family planning programme in East Khasi Hills District, Meghalaya, to assess the factors responsible for these inequalities.

STATEMENT OF THE PROBLEM

Over population is widely regarded as a major social and economic global problem since it is directly connected with the economic growth of the country and therefore welfare of the person and her/his family. Over population is an enormous issue and is important indicator of lack of human welfare in developing countries like India. Over population refers to the condition where the population growth of a country has overcome the economic growth of a country .It is also an indicator of poverty especially in the rural as well as urban area (i.e., more mouth to feed in). This trend has grave consequences for countries like India and many other developing countries, where population growth has been quite high and where employment generation falls far short of the rate of the population growth. It also engenders the issue of inequality and social justice. Due to this reason the government through the department of Family Welfare is implementing the National Family Welfare Programme by encouraging the production and utilization of contraceptives all over the country.

In the North East State of India including Meghalaya, women enjoy greater visibility and mobility than women of other communities in the country. This is often cited to portray a picture of equity between men and women in the region. Education has been the main catalyst in bringing about far-reaching changes in the status of women and to a great extent education of women in the region has been fairly non-discriminatory. Despite the fact still many people has a large and big family and are not aware of the various method of family planning or even if they are aware of it they are not access to it. This may be due to any social stigma or cultural factors, against their faith or maybe against their husband wish to practice it.

The literature review shows that there is large difference between the knowledge and practice of family planning and that it differs from one society to the other. The decision taken is mainly of a male dominated whereby the husband or a man takes a decision and there is less communication between the spouses regarding this matter.

But there was no study to compare and analyze the practice of family planning only among young adult who are in the most productive age of reproduction. Therefore the main aim is to study the various factors on the usage of family planning methods and the usage of different family planning methods by the targeted study population.

OBJECTIVES
To learn about the respondents’ knowledge about Family Planning method
To study the perception of married young adults towards Family Planning
To know about the utilization of family planning services among married young adults.
To learn about the misconception that the respondent has about family planning.
To know about the reasons for not practicing family planning among the respondents.
SIGNIFICANCE OF THE STUDY

With Meghalaya having recorded one of the highest decadal growth and fertility rates in the country as per the latest census, the state government has emphasized on the urgent need to reduce the population in the state to ensure sustainable economic growth and development.”The government is making efforts to stabilize the population of the country at a level consistent with the national economy,” said the Health Minister of the Government of Meghalaya. As per details from Census 2011, Meghalaya has a population of 29.67 Lakhs, an increase from figure of 23.19 Lakhs in 2001 census. Total population of Meghalaya as per 2011 census is 2,966,889 of which male and female are 1,491,832 and 1,475,057 respectively. In 2001, total population was 2,318,822 in which males were 1,176,087 while females were 1,142,735.The total population growth in this decade was 27.95 percent while in previous decade it was 29.94 percent. The population of Meghalaya forms 0.25 percent of India in 2011. In 2001, the figure was 0.23 percent. In spite of the low density and population of Meghalaya, it is worth noticing that, the state has a rapid population growth rate, and has the third fastest growing population in India, according to the Meghalaya Census 2011.

Therefore, based on this idea, the purpose of this study is to know about the life situation of married young adults their knowledge, attitude and practice also their access and utilization of various methods of family planning. Furthermore, such type of research has never been conducted before in this particular area. Therefore, it is thought to be useful to conduct this study in this area where like everywhere else, over population seemed to be a major problem that affect both the mother and the infant.

RESEARCH METHODOLOGY
Research design

The design to be adopted in this particular research is a mixture of explanatory, descriptive and research as the researcher will describe as accurately as possible the characteristics of married young adults and perception towards family planning and also to explain the causes and effect relationship between various factors that leads to the non utilization of family planning.

Population of the study

Any married young couples who come to Ganesh Das Hospital for maternal care at the period of data collection.

Sampling Design

The research will be carried out through a purposive random sampling as the sample will be selected based on judgement as to who can provide the best information to achieve the objective of the study.

Tools for data collection

Data collection will be conducted through structured interview method. This method will provide uniform information, which assures the comparability of data. Structured interviewing requires fewer interviewing skills than does unstructured interviewing

Nature of tools

Structured interview will be the tools used for data collection to ensure that all respondents are asked exactly the same set of questions in the same sequence and it is better for quantitative analysis.

Sources of data

Sources of data will be primary as well as secondary data as the researcher can obtain data through interview and also use census data to obtain information on the utilization of family planning in Meghalaya.

Data analysis

Data will be analyzed using Statistical test as per the requirement.This process will include editing, coding, classification and tabulation of collected data.

LIMITATION OF THE STUDY
Some sample may not respond to the researcher due to some ethical issues.
Over population due to high birth rate may not likely seen as a problem to everyone.

Since family planning is a wide concept, the researcher may not be able to cover all its respective area.

WORK PLAN

Sl No

Activity

Scheduled

Remark

1

Choosing of topic

April

Completed

2

Review of literature

August 2013

Completed

3

Synopsis

November 2013

4

Data Collection

December2013-January 2014

5

Analysis, interpretation and report writing

February-March 2014

6

Submission and defense

March 2014

LIKELY OUTCOME

This study is expected to describe the family planning knowledge, to identify the attitude towards family planning, highlight the factors and causes that hinder married young adult to practice family planning and to know about the rate of family planning utilization. Moreover, the study will also tell the strategies adopted by the married young adult in handling family size. Finally, the study would serve as a reference for the other like-minded individuals who would like to conduct a similar study in the future or who are interested in this field.

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One has constructed this essay in a manner in which the reader will be able to appreciate the motives of discrimination and inequality and when they could take place; as well as the meaning and the impact they have, not only on the LGBT community but on the society as a whole. Throughout this essay one will attempt to identify the manifestation of inequality in the modern society, which in spite of everything is still occurring even after the Equality Act 2010 has come into practice and it introduced the Public Sector Equality Duty (PSED). This essay will focus on and around the inequality experienced by the LGBT community only, while keeping in mind of the fact that many other communities are suffering due to the injustice caused by being discriminated against.

Supposedly, due to a recent period of advancement in law-making, the people identifying themselves as lesbian, gay, bisexual and transgender (LGBT) are benefiting from extraordinary privileges and safeguarding which were initiated in the light of the appalling experiences they had, as well as promoting diversity; these rights are protected by the legal system in the UK, but are they mere theories/ideologies whose application still remains of question? Many people have overlooked any existing inequalities post enforcement of the aforementioned laws, thinking that if the law exist it means that it will happen. This essay will critically appraise the actual application of these laws within public and private organizations as well as at an individual level.

The writer contemplates on commencing this essay with investigating the definitions of inequality and discrimination, for the reason that it will provide a solid foundation for the further understanding of the aforementioned terminology often described as a concern within the society; as well as providing reassurance that the reader is in agreement with the writer as far as the meaning of the words.

According to Collins’ dictionary, inequality is the disparity in social class, assets, health, and prospect between human beings or social classes. The inequalities may be experienced by everybody, especially those people who are part of minority groups. Inequality is often stemmed from the society’s discriminatory behaviour practiced by institutions, governmental chambers and individuals in the United Kingdom of Great Britain, Wales and Northern Ireland (UK) towards the people identifying themselves as lesbian, gay, bisexual or transgender (LGBT).

Subsequently, one would like to define the term discrimination, similar words that relate are bigotry, bias, injustice, favouritism, unfairness, inequity, prejudice, and intolerance. In essence, it refers to certain individuals or groups of people behaving unfairly (discriminating), toward a person or a group of people they perceive to be different from themselves or the group of people they associate with.

Discrimination often stems from people’s evolutionary fear of the unknown, promoted by the lack of education and obliviousness towards phenomena that are regarded as out of the ordinary. Lorde, A talks about her opinion on the social division present in our society “It is not our differences that divide us. It is our inability to recognize, accept, and celebrate those differences.” Lorde, A. (1995)

The society became indoctrinated overtime and the discriminatory practices have come to be accepted as culturally/societally and furthermore unswervingly tolerable. This of course, should have been subject to change in the modern society of the twenty first century. Regrettably, the society has learned nothing from history, and an abundant amount of discrimination is still present and it leads to societies morals being questioned. This is mainly due to argumentum ad populum[1] which leads people to have unthinkable preoccupations just to belong and feel accepted. The reader may be familiar with the concept of “othering” also known as “otherness”. Classified as a psychological approach, it is fundamental to sociological studies and it illustrates the imbalance within political power between the majority and the minority groups. It appears that from a sociological perspective the majority versus minority power balance leans towards the majority. Othering is a manner of obtaining one’s own definite individuality as a result of the defaming of an “other”. Bauman, Z claims that the notion of otherness is based on the fact that the human individualities are established as irreconcilable difference and he approves of the idea of otherness as an acceptable social concept. One would argue that this theory is defending the need for social classification based on the higher number of people which belong to a certain set of criteria which are more commonly found; furthermore making this theory very short sighted. One must aim for equality as a social norm, Goldwater, B explains that” Equality, rightly understood as our founding fathers understood it, leads to liberty and to the emancipation of creative differences; wrongly understood, as it has been so tragically in our time, it leads first to conformity and then to despotism. “Goldwater, B (1964)

LGBT communities often live with “The sword of Damocles”[2] hanging above their heads meaning that they live under constant real and perceive threat during their lives, having an impact on their relationships with friends and family, health status, mental health (there are higher risks of depression, suicide, anxiety and mental distress in the LGBT population), and financial deficits. These people feel the need to “come out” in front of their friends and family, and want to be accepted without the fear of rejection and guilt. Then again, why the notion of “coming out of the closet”? The society is building closets to hide what they want to avoid, i.e. skeletons in the closet. Do heterosexual people have to make their sexual orientation public and fear of disapproval, rejection, and discrimination? One of the reasons for all this unwanted attention towards people’s sexual orientation may be because focusing on the LGBT community and spending energy and time on discriminating (please see otherness) is a red herring[3] used to distract the society’s attention from more important problems such as poverty and recession. The aforementioned theory is a mere extrapolation, such trying to find reason in madness or a as Nietzsche portrays it “….there is also always some reason in madness” Nietzsche (1914) although some people do prefer to accept it as oppose to admitting that people can be so venal. Wilkinson et al believes that “although sexual orientation is only one component of an individual’s sexual identity there is a common misconception that the components of a person’s sexual identity operate in parallel. For example, when people are described as possessing cross-gender sex roles, they are more likely to be perceived as being gay or lesbian.” Wilkinson, Wayne and Roy, Andrew (2005)

One cannot avoid drawing attention to the standing of the Christian Church and its philosophies, and their impact on people’s way of life (at least from a historical perspective). Therefore, one of the reasons behind the inequality and discrimination people within the LGBT community are experiencing, it is due to the intransigent position of the Abrahamic religions[4] as far as sexual orientation. The Church is (was) profoundly engrossed within the social and cultural background, especially in the very religious population but not limited to; this has engendered fallacies emerged from pious puritanical dogmas regarding the individuals with non-heterosexual orientation. Therefore these individuals exposed to the aforesaid ideologies have grown up to think that it is unnatural and dehumanizing to have a non-heterosexual orientation. This may affect the individual as far as their own sexual orientation thus often causing them to deny who they are, keep it hidden and even practice suicidal behaviour (please see closet); or practice homophobic behaviour with a view in being accepted in their communities. On the other hand, many Christian denominations adopt newer and more open ideas about homosexuality, which allows more people to keep following their faith while being themselves. Many people/health professionals/social worker fail to understand that homosexuality is only a small aspect of a person’s individuality.

The reader may inquire about the impact of the inequality towards the LGBT community on today’s society and vice versa. It is causing a social problem, for the reason that the society ends up persecuting prolific members of the society who would be able to elicit much beneficial changes for the posterity. Unfortunately the lack of opportunities, the mental distress and disapproval they experience leads to them not being able to achieve their full potential and thus impedes the social growth and progress. On the other hand, the constant discrimination and harassment experienced by these individuals could evoke strengths of character in certain people, who would eventually become leaders of the resistance against inequality and discriminatory practices. They may devise strategies to further educate the masses by becoming transparent and open themselves up to sharing their private experiences with others. Ultimately, fighting for the rights to be heard and accepted as parents, as spouses, as teachers, as friends, colleagues, leaders, care providers and furthermore human beings as well as form closely knit groups which provide emotional support to one another. One of these people is Lorde, A, a well-known civil rights, feminist movements activist and writer emerged from the LGBT community as an advocate by voicing her view on the importance of community support; “The outsider, both strength and weakness. Yet without community there is certainly no liberation, no future, only the most vulnerable and temporary armistice between me and my oppression.” Audre Lorde (1996)

One could argue that there are many people within the society who are celebrating the differences in people and that in the ideal world people would accept the variety of sexual orientation as a norm and utilizing the knowledge regarding the aforementioned only when offering personalized support. One’s outlook about the necessary awareness of individual’s sexual orientation by the private and governmental institutions is further explained by Trevor Phillips, Chair of Equality and Human Rights in his speech as it follows “Commission Data matters– because injustice that goes unseen goes uncorrected. How can we expect care homes to be sensitive to the needs of older LGB residents, or schools to the needs of the children being brought up by same-sex couples, if they don’t even acknowledge they’re there?”

Sadly, the society teaches their children that discrimination is a tolerable practice thus leading towards an impasse and further narrowing of the acceptance. The homophobic views of the parents get transferred onto their children, people may be able to see children from an early age i.e. in the kindergarten using terminology such as “gay” or “lesie” as insults among themselves and others, leading to a negative view of homosexuality from an early age. Should a modern society accept this sort of behaviour from the future generations?

The reader may think that the aforementioned statements could not be accurate, taking in consideration the Human Rights Act of 1989 as well as the Equality Act of 2010 and other laws and policies which support the equality of the individual at large. Well, in the light of such thoughts one feels the need to go even further and illustrate with examples these inequalities. Ellison et al explains that “Nearly four in ten lesbians and gay men reported that they had been bullied, felt frightened and had suffered from low self-esteem.” Ellison and Gunstone, 2009

Social workers will without a doubt come in contact with service users which identify themselves as LGBT. Therefore they must be able to communicate by using acceptable terms, be respectful and take in consideration the person as a whole, pertaining to their physical, emotional and financial needs. Disregarding a person’s sexual orientation, would be like ignoring somebody’s arm, it is part of them, a piece of the puzzle. One must carefully identify areas of inequality and discrimination, which the service users may be experiencing and make use of this information to further one’s understanding and awareness of the support needed. Spirituality, togetherness, health needs, age and other factors must be taken in consideration when evaluating a service user’s needs. The sad truth is that there is a tendency in the social and health professionals to assume heterosexuality in the elderly. This is inadvertently discriminative practice. On the other hand, the social worker must be able to reflect honestly on their own feelings and beliefs regarding other people’s various sexual orientation; being aware of any prejudices one may have would help to provide anti discriminative support to the service users.

To be able to explain the seriousness of the issues discussed within this essay, one must quote Ellison et al for a second time, they claim that “55 per cent of gay men, 51 per cent of lesbians and 21 per cent of bisexual women and men said they would not live in certain places in Britain because of their sexual orientation.” Ellison and Gunstone, (2009). This is unacceptable by the moral and ethical standards expected from today’s society, therefore the social worker must be aware of the people who do live in those areas and empower and safeguard them as necessary. On the other hand Ellison et al also explains that “Seven in 10 lesbians (69 per cent) and gay men (70 per cent) felt they could be open about their sexual orientation in the workplace without fear of discrimination or prejudice. This contrasts sharply with only around two in 10 (23 per cent) bisexual men and three in 10 (30 per cent) bisexual women who felt the same.

83 per cent of respondents would be happy or felt neutral about having an openly LGB manager at work” Ellison and Gunstone, (2009). This provides proof that the society has grown to be more accepting of the LGBT community and that the laws and policies are being enforced within private and governmental organisations. It appears that education seems to make a big difference as far as being open and accepting of diversity.

There is evidence of bullying due to sexual orientation at school levels, were people get physically and emotionally abused. ‘People call me “gay” everyday, sometimes people kick me or push me, they shut me out of games during school gym and they steal my belongings.’ James, 17, secondary school (South West). Hunt and Jensen, (2007)

The social worker, needs to be able to act as an advocate for these people, they must be empowered and supported so they learn to accept themselves.

In summary, the society inclines to be critical of the people in the LGBT community due to different factors; these are religious, cultural, fuelled by fear of unknown, lack of education, upbringing, and avoidance behaviour(i.e. questioning own sexuality). Unfortunately, this translates into discrimination and inequality, which leads to many unwanted effects.

Due to the fact that this paper is a mere literature review, one could not offer more specific examples of actual cases, therefore this article talks more generally about inequality and where it may be present, it’s impact on the society and the individuals as well as the impact of the law on the changes that have taken place towards acceptance of the LGBT community.

As a future social worker, one finds that the knowledge acquired through the present paper will be of great aid to further one’s knowledge in understanding not only the lesbian, gay, bisexual and transgender population, but also other minority groups that more often than many people would expect suffer in silence.

After much research, one must admit that there is very little literature present about the ageing and LGBT population. As the population is getting older, many people in the aforementioned community are interested in their future, especially if their partners pass away. Many transgender population live in fear that if they lose their capacity, will they still be able to get their hormonal treatment to maintain their identity. Therefore, one would suggest further research in that area, in form of an empirical study.

Dementia and Incontinence
An exploration of the impact that these conditions have on quality of life and a discussion of strategies that may be employed to manage the problem and/or enable the sufferer and carers to cope.

Based on the 2001 census, it is estimated that the total number of people living with dementia in the United Kingdom (UK) is 775,200 and that this figure will rise to 870,000 by the year 2010 and to 1.8 million by 2050 (Alzheimer’s Society 2004). Dementia affects about one person in 20 over the age of 65 years. This figure rises to one person in three for people over the age of 90 years (Gow and Gilhooly 2003). Studies have estimated that 18,000 people with dementia are under the age of 65, and that the number of people in the UK with dementia in minority ethnic communities could be as high as 14,000 (Alzheimer’s Society 2004).

Dementia is described as “a syndrome due to disease of the brain, usually of a chronic or progressive nature” (World Health Organization 2001). Dementia is associated with a range of symptoms including impaired memory, disorientation, poor concentration and difficulty in naming and use of language. Patients with dementia have an impaired ability to learn or recall learned information, difficulty in using motor skills and co-ordination, difficulty thinking in a clear and coherent way and in understanding or following a sequence (Jacques and Jackson 1999). The significant disabilities associated with

dementia can be accompanied by personality and mood changes, and changes in judgement. The term “dementia” is an umbrella term used to describe a number of conditions in which these symptoms occur, and where a differential diagnosis has been undertaken to rule out other causes for these symptoms (Cheston and Bender 1999). These include Alzheimer’s disease, vascular dementia and Lewy body dementia.

It is proposed that dementia commonly leads to incontinence of urine, faeces, or both. Urinary incontinence us up to four times more common in individuals with dementia than in people without dementia. Loss of continence may be more prevalent in Alzheimer’s disease than in vascular dementia, and becomes more common with increasing dementia severity (Skelly and Flint 1995). Men are more at risk than women, possibly because of associated prostatic problems. Faecal incontinence is less common than urinary incontinence, however both urinary and faecal incontinence are strongly associated with caregiver stress and possible premature entry to nursing and residential homes (Armstrong 1999). In fact, the rates of incontinence are particularly high among patients in hospitals, nursing homes and residential homes, where it is debated that approximately half might be affected (Irwin 2001).

This essay will briefly discuss the pathophysiology of the different types of dementia and incontinence with a view to investigating how these linked conditions affect quality of life. There will also be a discussion about various strategies that may be employed to manage the problem and/or enable the sufferer and carers to cope.

It is proposed that approximately 55 percent of patients diagnosed with dementia have Alzheimer’s disease, also known as Alzheimer’s dementia (Killeen 2000). It is a degenerative disease affecting the brain. This is a result of changes in the structure and function of two proteins, beta-amyloid and tau that cause the formation of plaques and neurofibrillary tangle form in areas of brain tissue, which destroy them (Burns et al 1997). The cause of this process is not yet fully understood. The temporal and parietal lobes of the brain are generally affected in Alzheimer’s disease, which can result in significant memory loss and an inability to recognise people and places. This can be extremely distressing, particularly if the person no longer recognises his or her image or that of friends and family (Kitwood 1997). As the condition progresses, basic skills and capabilities can be lost. Visual-spatial skills can become impaired, resulting in the patient becoming unable to put sequences of an activity or movement together (Jenkins 1998). The frontal lobe can also be affected and this can result in difficulties in communication and judgement resulting in disinhibited behaviour (Jacques and Jackson 1999). In Alzheimer’s disease the symptoms progress gradually but persistently over time (Burns et al 1997).

Vascular dementia, also referred to as multi-infarct dementia, is another common type of dementia. It is caused by problems in the circulation of blood to the brain, which results in multiple strokes to brain tissue resulting in significant cognitive impairment (Sander 2002). These strokes can cause damage to areas of the brain responsible for speech or language and can produce generalised symptoms of dementia. As a result, vascular dementia may appear similar to Alzheimer’s disease. Vascular dementia can progress in an irregular manner with episodes of sudden loss. It can also take the pattern of gradual change, as in Alzheimer’s disease. The rate of memory loss and impairment of insight appear to progress at a slower rate than in Alzheimer’s dementia. Vascular dementia has been identified as a distinct condition in up to 20 percent of people with dementia (Miller and Morris 1993); however, as with all types of dementia it can co-exist with other forms of the condition. Vascular dementia is considered the second most common form of dementia in the western world (Nor et al 2005).

Another common form of dementia is Lewy body dementia. Lewy body dementia is characterised by fluctuations of cognitive impairment, which are defined by episodic confusion and lucid intervals. These fluctuations in cognition can occur over minutes, hours or days. They can occur in as many as 50-70 percent of patients and are associated with shifting levels of attention and alertness (Archibald 2003). Patients with Lewy body dementia can experience visual and auditory hallucinations, secondary delusions and falls. These symptoms can result in the person presenting with behaviours that are challenging. Lewy bodies are tiny spots containing deposits of a protein called alpha-synuclein. These are found in the hippocampus, temporal lobe and neocortex in addition to the classic sites in the substantia nigra and other subcortical regions (Del Ser et al 2000). Lewy body dementia is ranked as the third major type of dementia. It is estimated that around 20 per cent of people with dementia will have the Lewy body form of the disease (McKeith et al 1995). However, this figure could be much higher, and it is estimated that up to 36 percent of people with dementia could have this type (Del Ser et al 2000).

It is posited that continence is a basic function that should be maintained in healthy elderly people, regardless of age. Loss of continence can be interpreted as a dysfunction of either the lower urinary tract or bowel, or of some other system that participates in the maintenance of continence, in particular the nervous system (Crome et al 2001). Loss of continence in the patient with dementia is related most commonly to alteration in basic factors necessary for its maintenance or to use of medication (Ouslander 2000). People with dementia are also more prone to suffer delirium which is associated often with incontinence. Immobility can soon lead to loss of continence and the frequency, and severity of incontinence is strongly associated with dementia severity and incapacity to walk or make transfers (Skelly and Flint 1995). Resnick (1995) analysed the relationship between incontinence and a series of factors outside the lower urinary tract. He found that if patients maintained independence to make transfers and to dress, even though their dementia was severe, they could maintain continence. The influence of sedative drugs, physical restrictions and other environmental or social factors must not be forgotten. Furthermore, the attitude of professionals, with over-use of absorbent or palliative products for incontinence, can itself lead to loss of continence.

Since the aetiology of incontinence in the older person with dementia may be multifactorial, it is suggested that a multidimensional assessment is required to identify the pathogenic mechanisms involved. The diagnostic assessment should be individualised, depending on the characteristics of each patient (clinical, functional, life expectancy) as well as the impact of incontinence (Khoury 2001). Generally, it is accepted that the basic assessment should include several components such as a medical history, clinical type of incontinence, the severity of incontinence, and the timing of leakages. A functional assessment focusing on mobility (transfers, walking, and skill grade) and mental function should be undertaken and a formal assessment should be made of the severity and nature of the cognitive impairment and of any depression or behavioural disorders that could influence presentation, as well as management of incontinence. Finally, an environmental assessment would prove useful to detect the existence of barriers that could limit access to the lavatory (Alzheimer’s Society 2004).

It is posited that incontinence has an adverse effect on the quality of life. Quality of life can be defined as the awareness of the capacity to meet personal, psychological and social needs on a daily basis. It is proposed that incontinence is very distressing and it can affect an individual’s sense of dignity and self-esteem especially if the person needs personal help from a carer or relative as a result of incontinence (DuBeau et al 2006).

Treatment of urinary incontinence is based on various approaches, which should be used in a complementary way to obtain the best results. It is fundamental to establish realistic therapeutic objectives. However, it is argued that it will not be easy to obtain positive results in all patients, because of immobility and lack of co-operation. Trying to reduce the severity of incontinence and maintenance of patient well-being, good perineal hygiene and “social continence” may be a more realistic goal. Thus, an individual approach is essential, adapted to the characteristics and situation of each patient (Irwin 2001).

It is proposed that treatment measures should include the identification and treatment of concurrent medical conditions, active management of constipation, hygienic-dietary recommendations (reduction of stimulant substances e.g. caffeinated drinks, modification of timing of fluid intake). An improvement in mobility, a review of usual treatment and change of drugs that are potentially involved in incontinence recommendations should be included in treatment measures. The type of clothes worn such as clothes with simple opening and closing systems can help with toileting and incontinence. Utilising environmental interventions such as; enhanced visibility by painting toilet doors bright colours, signposting and good lighting, ensuring easy access to toilets, providing grab-rails and raised toilet seats, and ready availability of mobility aids, commodes and urinals, preferably with nonspill adapters, will be of immense help. Debatably, these measures might assist the dementia patient with any possible confusion as to where the toilet is (Alzheimer’s Society, 2004).

Other strategies for the management of incontinence in the dementia sufferer could include behavioural techniques. These techniques attempt to promote a change in the patient’s (or caregiver’s) behaviour, trying to re-establish a normal pattern of bladder-emptying or to prevent the patient from being wet. Simple, non-invasive, behavioural techniques are relevant for almost all types of patients and incontinence, and can be used jointly with other therapeutic options, especially drug treatment (Khoury 2001). Two groups of techniques are differentiated: those performed by the patient (pelvic floor exercises, bladder-retraining, biofeedback) and those by the caregiver (micturitiontraining, scheduled voiding, prompted voiding). It is argued however, that the patient-dependent techniques require previous instruction as well as understanding and collaboration by the patient, so they may be impracticable for people with advanced dementia.

The most used behavioural techniques are prompted voiding, micturition training and scheduled voiding. Prompted voiding has the greatest scientific support. The objective of this technique is to stimulate the patient to be continent through periodic assessments by the caregivers and positive reward systems. Several studies demonstrate the effectiveness of behavioural techniques in institutionalised elderly subjects with dementia, especially in reduction of incontinence episodes. However, most data report its effectiveness only in the short term (Eustice et al 2002, Durrant and Snape 2003).

Dementia is a distressing long-term condition that affects both sufferers and their carer’s quality of life. Coupled with that incontinence can be humiliating for the individual with dementia and upsetting for their significant others around them. It is important to assess the person’s individual needs as incontinence in dementia is multifactorial. There are various strategies and treatments that can be put into place that will assist both the sufferer and their carer. Behavioural techniques such as prompted voiding, micturition training and scheduled voiding have been found useful as a treatment alongside environmental and current review of medical history. It is important to note that incontinence should always be viewed as associated with, rather than caused by dementia and therefore potentially treatable.

References

Alzheimer’s Society (2004) Policy Positions: Demography, www.alzheimers.org.uk/News_and_Campaigns/Policy_Watch/demography.htm, (Last accessed: August 2006)

Archibald C (2003) People with Dementia in Acute Hospital Settings: A Practice Guide for Registered Nurses, Stirling, The Dementia Services Development Centre

Armstrong M (1999) Factors affecting the decision to place a relative with dementia into residential care, Nursing Standard, 14, 16, 33-37

Burns A, Howard R, Pettit W (1997) Alzheimer’s disease: A Medical Companion, Oxford, Blackwell Science

Cheston R, Bender M (1999) Understanding Dementia: The Man with the Worried Eyes, London, Jessica Kingsley

Crome P, Smith AE, Withnell A (2001) Urinary and faecal incontinence: prevalence and health status, Reviews in Clinical Gerontology, 11, 109-113

Del Ser T, McKeith I, Anand R, Cicin-Sain A, Ferrara R, Spiegel R (2000) Dementia with Lewy bodies: findings from an international multicentre study, International Journal of Geriatric Psychiatry, 15, 11, 1034-1045

Durrant J, Snape J (2003) Urinary incontinence in nursing home for older people, Age Ageing, 32, 12-18

Eustice S, Roe B, Paterson J (2002) Prompted voiding for the management of urinary incontinence in adults, Cochrane Database Systemic Review

Gow J, Gilhooly M (2003) Risk Factors for Dementia and Cognitive Failure in Old Age, NHS Health Scotland, Glasgow

Irwin B (2001) Management of urinary incontinence in a UK trust, Nursing Standard, 16, 13, 15, 33-37

Jacques A, Jackson G (1999) Understanding Dementia, (3e) Churchill Livingstone, Edinburgh

Jenkins DAL (1998) Bathing People with Dementia: The Bathroom and Beyond, Stirling, The Dementia Services Development Centre

Khoury JM (2001) Urinary incontinence: No need to be wet and upset, North Carolina Medical Journal, 62, 74-77

Killeen J (2000) Planning Signposts for Dementia Care Services, Edinburgh, Alzheimer Scotland

Kitwood T (1997) Dementia Reconsidered: The Person Comes First, Milton Keynes, Open University Press

McKeith IG, Galasko D, Wilcock GK, Byrne EJ (1995) Lewy body dementia: diagnosis and treatment, British Journal of Psychiatry, 167, 6, 709-717

Miller E, Morris R (1993) The Psychology of Dementia, Chichester, John Wiley and Sons

Nor K, McIntosh IB, Jackson GA (2005) Vascular Dementia: Series for Clinicians, Stirling, The Dementia Services Development Centre

Ouslander J (2000) Intractable incontinence in the elderly, British Journal of Urology International, 85, 3, 72-78

Resnick NM (1995) Urinary incontinence, Lancet, 346, 94-100

Sander R (2002) Standing and moving: helping people with vascular dementia, Nursing Older People, 14, 1, 20-26

Skelly J, Flint AJ (1995) Urinary incontinence associated with dementia, Journal of the American Geriatrics Society, 43, 286-94

World Health Organization (2001) Alzheimer’s disease: The Brain Killer, Geneva, WHO

policies of past and present, explain how the quality of life for the service users have improved over time:

P1.1: Identify key historical landmarks in social welfare, focusing on the period up to 1945:

The Key historical landmarks in social welfare focusing 1945 period were: In 19th century it was the role of religion, the voluntary sector in welfare. And in early 20th century Liberalism and the foundations of British welfare, votes for women.Let us analyse the historical landmarks of Social welfare policies for a period of upto 1945.

1901 Seebohm Rowntree’s first study of poverty in York, Poverty: a study of town life

1903 Charles Booth’s study of poverty in London, Life and Labour of the People of London

(1906 – 1912) THE NEW LIBERALISM: To make people liberal in their living.It is said by Lloyd George that ‘We will draw a line below which we will not allow people to live and labour’

1906 School Meals Act

1908 Old Age Pensions Act: means-tested pensions from age 70

1909 The People’s Budget: super tax introduced, child tax allowances introduced

1911 National Insurance Act: sickness insurance and limited provisions for unemployment

(1913 -1941) CHANGE AND DEVELOPMENT: It mainly focuses on dealing with problems individually.Beveridge Report goes this way: ‘In all this change and development, each problem has been dealt with separately, with little or no reference to allied problems’.

1920 Unemployment Insurance Act: non-manual workers included.

1925 Widows’, Orphans’, and Old Age Contributory Pensions Act: first national scheme of contributory pensions

1936 J.M. Keynes’ General Theory of Employment, Interest and Money

1940 Old Age and Widows’ Pensions Act: pension age for women reduced from 65 to 60

(1942 – 1945) TOWARDS A ‘BEVERIDGE’ WELFARE STATE: Contributing for the welfare of the people.Beveridge Report goes this way:’It is, first and foremost, a plan of insurance – of giving in return for contributions benefits up to subsistence level, as of right and without means test, so that individuals may build freely upon it’.

1942 Sir William Beveridge’s Report on Social Insurance and Allied Services

1943 Juliet Rhys Williams’ work-tested Citizen’s Income

‘The Beveridge Plan,will have the effect of undermining the will to work of the lower-paid workers to a probably serious and possibly dangerous degree. The prevention of want must be regarded as being the duty of the State to all its citizens, and not merely to a favoured few’

Family Allowances Act: ?0.25 a week for each child after the first.

P1.2 Outline evolution of health and social care policies following World War II until 1979:

This is the time during the war when the government got committed to full employment through the Keynesian Policies, free universal secondary education, and the introduction of secondary allowance.

1946 National Insurance Act:Has flat-rate NI benefits.Provided a comprehensive system of unemployment, sickness, maternity and pension benefits funded the by employers and employees, together with the government .

1948 National Assistance Act: Poor Law got abolished

1955 Richard Titmuss’ Eleanor Rathbone Lecture on the Social Division of Welfare: ‘The tax saving that accrues to the individual through income tax allowances is, in effect, a transfer payment’

1959 National Insurance Act: graduated pensions got introduced

1962 Milton Friedman’s Capitalism and Freedom includes negative income tax proposals

1965 Poverty ‘rediscovered’: The Poor and the Poorest, Brian Abel-Smith and Peter Townsend

1966 Supplementary Benefit replaces National Assistance.Rate rebates got introduced.

1971 National insurance invalidity benefit got introduced.Family Income Supplement (FIS) introduced (and with it the poverty trap)

1972 Heath Government’s Proposals for a tax-credit scheme.Tax credits become Conservative policy. First national scheme of rent rebates (and higher rents)

1975 Social Security Pensions Act: State Earnings-Related Pensions (SERPS). Earnings-related national insurance contributions introduced at 5.75%

1976 One-parent benefit got introduced

1978 ‘Meade Report’ on The Structure and Reform of Direct Taxation includes a chapter on Social Dividend. SERPS gets implemented.

1977-79 Tax-free child benefit phased in, replacing taxable family allowance and child tax allowances.

P1.3 Outline health and social care policies from 1979 to the present day:

(1979 – 90) TOWARDS A RESIDUAL WELFARE STATE: It was said by Margaret Thatcher that ‘We offered a complete change in direction’.

1980 Social Security Acts 1 and 2: Instead of earnings pension upratings got linked to prices. Education Act: Local Education Authorities allowed to choose whether to provide school meals: fixed prices and national nutritional guidelines got abolished.

1982 National insurance contribution increased to 8.75%. Earnings-related supplements with national insurance unemployment and sickness benefit cease to operate.

1983 First official reference to Basic Income in the report of the Meacher sub-committee of the House of Commons Treasury Select Committee.National insurance contribution increased to 9%. National insurance sickness benefit replaced by statutory sick pay. Rent/rate rebates got replaced by housing benefit.

1984 Basic Income Research Group formed.Child dependency additions with national insurance unemployment benefit cease to operate.

1985 Norman Fowler’s Social Security Review. Billed as ‘the most fundamental since World War II’, but did not examine integrated systems.

1986 Social Security Act: Three major Bills in one (Got effective from April 1988)

1987 National insurance maternity grant replaced by statutory maternity pay. Payment of half and three-quarter rate national insurance unemployment benefit ceases.

1988 Tax cuts and benefit cuts.Top rate of income tax down from 60% to 40%. Standard rate of income tax down from 27% to 25%.The withdrawal of income support from most 16-17 year olds.Cuts in housing benefits, SERPS and national insurance widows’ pensions. Maximum rate rebate limited to 80% of liability.Child benefit frozen.Income-tested Family Income Supplement replaced by means-tested Family Credit. Free school meals restricted to families on Income Support.

1989 Child benefit frozen.Abolition of pensioner earnings rule.Social Security Act introduces actively seeking work test.

1990 Liberal Democrats’ Conference votes for Citizen’s Income.Independent taxation of husbands and wives introduced, but with married couples’ allowance for husbands

Child benefit still frozen.

(1991 – 1996) CUTS AND TINKERING: Peter Lilley said,’The changes I have announced today will help shift the balance back to a benefit system that does not discriminate against married couples, and which aims to reduce benefit dependency by helping people into work’.

1991 Child Support Act introduced.Benefits Agency established. Child benefit unfrozen.

1992 Disability living allowance replaces mobility allowance and attendance allowance for the under-65s. Disability working allowance introduced.Additional minor reforms of disability benefits.

1993 Peter Lilley launches sector by sector review of social security.

1994 Budget introduces ‘welfare to work’ measures to ease transition into paid work and encourage full-time work.Introduction of child care allowance for certain parents claiming family credit and related benefits.

1995 Incapacity Benefit replaces Sickness Benefit and Invalidity Benefit.Phasing out of additional assistance for lone parents.Cuts in housing benefit for young people

Pensions Act reforms occupational pensions, reduces value of SERPS, extends scope of personal pensions, and equalises pension age for women born after 5th April 1955 (with phasing in from 60 to 65 for those born after 5th April 1950).

Cuts in housing benefit and in help with mortgage interest for income support claimants.

1996 Jobseeker’s allowance replaces unemployment benefit and income support for the unemployed.Contributory benefit is paid for 6 months instead of 12 and the level is reduced for 18-24 year olds.The Asylum and Immigration Act 1996, introduces restrictions on benefits, housing and employment for asylum applicants.

(1997 – 2008) NEW LABOUR: Tony Blair said ‘In future, welfare will be a hand-up not a hand-out’

1997 Tony Blair becomes Prime Minister. First Labour government for 18 years.

1999 Family Credit replaced by Working Families Tax Credit (WFTC) and Disabled Persons Tax Credit (DPTC).Winter fuel payments of ?100 per year for those aged 60 or over introduced. Payments are not means-tested.

2000 Benefit entitlement for new asylum seekers ends.

2001 Children’s Tax Credit introduced – a tax allowance for those with children.

Bereavement benefits reformed so that widowers as well as widows entitled to benefits when their spouses die.

2002 State Second Pension replaces SERPS. Carers and those with children under 6 become entitled to credits in accruing pension rights.

2003 Child Tax Credit (CTC) and Working Tax Credit (WTC) replace WFTC, DPTC and Children’s Tax Credit. Payment depends on a claimant’s annual income and is assessed annually unless there are certain changes of circumstances during the tax year.WTC includes payments for childcare but only up to 70% (later 80%) of the childcare costs and a maximum limit.9 out of 10 families with children qualify.Pension Credit introduced, replacing income support for people aged 60 or over.Guarantees a minimum income for pensioners and often paid to top up state retirement pension.Work-focused interviews for benefit claimants introduced. Claimants for certain benefits are required to participate in an interview with a personal adviser in order to meet entitlement conditions.

2005 Civil partnerships introduced for same-sex couples. Cohabiting same-sex couples treated in the same way as heterosexual couples for benefit purposes rather than as two individuals.

2006 The Government’s White Paper Security in Retirement proposes an increasing retirement age, personal savings accounts, and a basic state pension uprated in line with earnings from 2012.Winter fuel payments increased to ?200 (?300 for a person aged 80 or over).

2007 The House of Commons Work and Pensions Committee’s report on Benefits Simplification recommends a Single Working Age Benefits and publishes a costed Citizen’s Income Scheme in its evidence.

2008 Welfare Reform Act 2007 comes into force. As well as making minor changes to benefit legislation, it introduces a Local Housing Allowance to simplify Housing Benefit for privately rented tenants. The Employment and Support Allowance (ESA) replaces Incapacity Benefit and Income Support paid for new claimants on the basis of incapacity for work. Claimants face tougher tests before being granted ESA which also makes the benefit system even more complicated.

M1.1: Analyse and express your views.

Welfare services comprises of social security, which makes different provisions against disruption of earnings due to sickness, injury, old age or even unemployment. They take the forms of unemployment and sickness benefits, family allowances as well as income supplements that is being provided and financed through the insurance schemes of the government.

During 1945,the government was committed to full employment through the Keynesian Policies, and introduced free universal secondary education, and the introduction of secondary allowance.Family allowances, a national health service and full employment were the main considerations during that time.Many policies provided a comprehensive system of unemployment, sickness, maternity and pension benefits funded the by employers and employees, together with the government.

Another important aspect that needs to be considered for the social and health welfare in the UK is the social citizenship model.The issues regarding the social citizenship model was not a challenge in the anticipation of the emergence of the Conservative Party leader in 1975 and the Prime Minister in 1979. After 1975 the government actually promised low taxes, less state intervention, as well as lower levels of public spending. In the theory it involved, vital cuts in the welfare spending.

But at present,policies reduce benefit dependency by helping people into work. New Labour and social inclusion, important legislation and health and social care initiatives begin to take over the society with which we live in.

D1.1: Critically compare and explain the facts:
Upto 1945
Till 1975
At Present

It deals with role of religion, the voluntary sector in welfare. Also dealt with free universal secondary education. Sickness was a primary cause of pauperism, and the Poor Law authorities began to develop ‘infirmaries’ for sick people.

It deals with policies regarding welfare state. Beveridge report is based on three assumptions:family allowances,health service,full employment.Other than this it was during this period the Insurance,Pensions,Tax credits,Family Income supplement etc was introduced as benefits to the common man.

It deals with New Labour and social inclusion, important legislation and health and social care initiatives,New Rights and Thatcherism.Also the changes done by Peter Lilley announced that today will help shift the balance back to a benefit system which aims to reduce benefit dependency by helping people into work

Task 2.1: Explain and analyse the process of key acts coming through

the parliament to become the policy of the government. Explain in terms of Health and Social policy. Analyse the influential factors which shapes the key themes and concepts in a parliamentary act. Evaluate the impact on service users once an act becomes the policy/law.

P2.1: Identify and analyse the processes involved in development of a key Act of Parliament:

An Act of Parliament creates a new law or changes an existing law.Also Acts are Acts of Parliament which have been given Royal Assent. All Acts of Parliament start life as a Bill which must pass through Parliament. These must be distinguished from Private Members’ Bills which are Public Bills proposed by backbench MPs. Public Bills originate from a number of different sources.It may arise from government, civil service, government agencies, political parties, committees, enquiries, legislative process, green/white papers, debate.The Government decides whether or not to agree to these proposals and put them before Parliament. Once a department has decided that it wishes to ask Parliament to pass legislation on a certain topic, it will undergo a consultation process with interested parties. The extent of this process will differ depending on the complexity, importance and urgency of the matter. It may take many months or a few days. The first stage is often a consultation document called a Green Paper which sets out in general terms what the Government is seeking to do and asks for views. Once these are received and taken account of (or not) the Government will produce a White Paper, which sets out the proposals decided upon and the reasons for the legislation. These two stages may be contracted into one.These stages are not fixed by formal rules and are subject to change. For example, it is increasingly common for draft Bills to be drawn up and circulated for consultation before being formally laid before Parliament, an example being the Mental Health Bill 2002. Occasionally Bills are scrutinised by the Parliament.In terms of Health & Social department ,health policy is a set course of action (or inaction) undertaken by governments or health care organizations to obtain a desired health outcome.The overall health care system, including the public and private sectors, and the political forces that affect that system are shaped by the health care, policy-making process. Public health-related policies come from local, state, or federal legislation, regulations, and/or court rulings which govern the provision of health care services. Nurses are very familiar with institutional policies including those developed and implemented by the Joint Commission on Accreditation of Healthcare Organizations. Policy making takes place in a wide variety of settings ranging from fairly open and public systems. The location of decision making in the public or the private sector, the scope of the issue, and the nature of the policy all have an impact on the characteristics of a policy. Since a basic understanding of the policy process is the first step in strategizing how to activate potential power and influence meaningful changes in the health care system, We will discuss the three phases of policy making. Basically there are three phases of policy making: the formulation phase, the implementation phase, and the evaluation phase. During the formulation phase there is input of information, ideas, and research from key people, organizations, and interest groups. At this point the issue is framed; the purpose and desired outcomes are clearly identified & strategies most appropriate to the desired outcome are selected; and needed resources are identified and planned. The implementation phase involves disseminating information about the adopted policy and putting the policy into action. In this phase, the proposed policy is transformed into a plan of action. The policy process also includes an evaluation and modification phase when existing policies are revisited and may be amended or rewritten to adjust to changing circumstances.

P2.2: Analyse the factors that influenced the key themes and concepts in the Act:

Health depends on a number of factors, including biological factors, environmental factors, nutrition, and the standard of living.The main factors currently affecting people’s health in the United Kingdom include smoking, bad diets, alcohol, and lack of exercise. While the British government has worked to reduce the influence of these factors, only the people themselves can put an end to them by changing their attitudes toward health.Apart from these many other factors act as influential factors which shapes

the key themes and concepts in a parliamentary act.

Evaluation and evidence are not the only factors that influence policy making and service

delivery.The experience, expertise and judgement of policy makers, and those people who have responsibility for planning and delivering policies and public services, are important factors in the policy making process. So too are the finite resources that are available for policies, programmes and projects.The values and value system within which contemporary politics take place are also contributory factors to the policy making process.This includes beliefs, ideologies, and party manifesto commitments. Policy making also involves habitual and traditional ways of doing things that may sometimes defy rational explanation yet nonetheless exist and often define what can and cannot be done in making and implementing policy. The influence of lobbyists and pressure groups on policy making also paves an important way to reach the target. The policy making process can be strongly affected by unforeseen circumstances and contingencies, the response to which can sometimes be opportunistic rather than well thought through, soundly evaluated, and evidence based.

P2.3: Evaluate the impact of the Act on service users:

Generally, as the function of health and social care, it can be concluded as a body which provide services that relates to ‘care services’ but the two bodies are separated in term of governing, policies, act, and so on. The UK government are concerned with the separation of social and health care. Because of the separation, it cause a major problem such as service fragmentation, higher cost of treatment and problem in continuing care after discharge from the hospital.Reflecting to this problem, the UK government has put a priority in integrating these two entities.The Govt organization can ensure better benefits to service users by having benefits to:

Strategies for health promotion

Health and safety

Manual handling

Data protection

Food handling

Care practice

Mental health

Children Disability

Task 2.2: M2.1: Critically analyse and explain how political leaders leading the country through economic hardships and recession in the aftermath of World War 2 and leading to the World War 2, made key improvements through parliament acts for their people.

Also political leaders leading the country through economic hardships and recession in the aftermath of World War 2 and leading to the World War 2, made key improvements through parliament acts for their people.Political leaders introducing few other acts to make key improvements in parliamentary acts.They were:

Health Act 2009: It proposed measures to improve the quality of NHS care, the performance of NHS services, and to improve public health.

Health and Social Care Act 2008: It contains significant measures to modernise and integrate health and social care.

The Local Government and Public Involvement in Health Act 2007: It is an Act to make provision, with respect to local government and the functions and procedures of local authorities and certain other authorities; with respect to persons with functions of inspection and audit in relation to local government; to establish the Valuation Tribunal for England; in connection with local involvement networks; to abolish Patients’ Forums and the Commission for Patient and Public Involvement in Health; with respect to local consultation in connection with health services.

Health Act 2006: It is an Act to make provision for the prohibition of smoking in certain premises, places and vehicles and for amending the minimum age of persons to whom tobacco may be sold; to make provision in relation to the prevention and control of health care infections; to make provision in relation to the management and use of controlled drugs; to make provision in relation to the supervision of certain dealings with medicinal products and the running of pharmacy premises, and about orders under the Medicines Act 1968 and orders amending that Act under the Health Act 1999; to make further provision about the National Health Service in England and Wales and about the recovery of National Health Service costs.

Task 2.3 D2.1
Critically explain and analyse how person centred care could
be improved for the service users with the on-going policy changes from the government. Why is it important for the political sector of the country need to evaluate and understand the final impact towards the service users before processing those social acts through parliament?

Most major public policies are subject to modifications in a incremental fashion. Making smaller changes in existing policies are usually less controversial than making major changes as they require less understanding of comprehensive relationships and less effort to achieve. An example of incrementalism in health policy can be seen in the many changes that the Medicare Program has undergone since its enactment in 1965. A change to the program of importance to advanced practice registered nurses came in 1998, when the U.S. Congress added nurse practitioners and clinical nurse specialists as providers who can bill for Part B services they provide to Medicare beneficiaries. Since then, Congress has tweaked Medicare program many times and added a number of preventive services to the Medicare program. Most recently Medicare Part D, an optional prescription drug program available for Medicare beneficiaries, has been added.

If we think about why is it important for the political sector of the country need to evaluate and understand the final impact towards the service users before processing those social acts through parliament,the Govt is actually responsible for.That needs to be understood first. As any health care issue moves through the phases of the policy process, from a proposal to an actual program that can be enacted, implemented, and evaluated, the policy process is impacted by the preferences and influences of elected officials, other individuals, organizations, and special interest groups. These different factions do not necessarily view the issue through the same lens and often have diverse and competing interests. Added into the mix are the partisan agendas of the two political parties, the Democrats and the Republicans.The political party holding the majority usually has the political advantage.Decision makers rely mainly on the political process as a way to find a course of action that is acceptable to the various individuals with conflicting proposals, demands, and values.As a general rule, any policy involving major change, significant costs, or controversy will be relatively more time consuming and difficult to achieve and will require the use of more political skills and influence than will policies involving less complex changes. Throughout our daily lives, politics determines who gets what, when, and how. Political interactions take place when people get involved in the process of making decisions, making compromises, and taking actions that determine who gets what in the health care system. Special interest groups and individuals with a stake in the fate of a health care policy use all kinds of influencing, communication, negotiation, conflict management, critical thinking, and problem solving skills in the political arena to obtain their desired outcome.

Task 3.1. Explain the current policy initiatives in Health and Social Care and evaluate the impact on service users. Analyse the differences in formation and adaption of social policy initiatives from other national perspectives.
P3.1: Identify current policy initiatives in all health and social care.

The Department of Health & social care works to define policy and guidance for delivering a social care system that provides care equally for all, whilst enabling people to retain their independence, control and dignity.Government strategies and policies aimed at providing a broad range of health care services and facilities.Other current initiatives include complementary health settings, or public health arenas,with children, older people or those with disabilities.Apart from these initiatives there are also few that act as policy initiatives in all health & Social care facilities.They are disability,gender, ethnic issues, community care,poverty and social security, crime and criminal justice, health and health services. For promoting health the initiatives that need to be taken are labelling regulations to inform consumers of nutritional content of foods,Educational campaigns to promote healthy diets and special programmes targeted to children,Promotion of consumption of fruits and vegetables for the general population,Fruit and Vegetable distribution programmes for school children.Also there is a chance where there will be multi-agency partnerships that creates many job opportunities in line with government initiatives to address health improvement, health inequalities and social exclusion, the health of children, young people and families, care and wellbeing of older people, those suffering from mental health problems and community development.This inturn gave rise to increased employment opportunities in these Health & Social care.Child social care, like many public services is under pressure to make financial savings, greater use of resources and effective working practices are essential if the sector is to continue delivering high quality care.Other Initiatives may be

Employee related initiatives: Increasing skills & employability of unemployed people,working Family tax credit,National Minimum wage

Area Focused initiatives: Health focused zones

Initiatives to tackle social exclusion:National Strategy for Neighbourhood renewal (Hunter, 2003,58)

P3.2: Evaluate the impact of these policy initiatives on service users

The United Kingdom Government uses a wide range of evaluation methods to ensure that policies, programmes and public services are planned and delivered as effectively and efficiently as possible to the service users.A major driving force for high quality policy evaluation in U.K. is the Government’s commitment to evidence-based policy making. This requires policy makers, and those who implement policies, to utilise the best available evidence from national statistics, academic research, economic theory, pilots, evaluations of past policies,commissioned research and systematic consultation with delivery agents.The Government’s strategy for public spending and taxation also provides the context within which policy evaluation takes place in the U.K. The UK Government has undertaken, and is currently undertaking, a number of randomised

controlled trials of policy initiatives. In the field of labour market and welfare policy, the

Restart evaluation (1990) randomly allocated unemployed people to a compulsory major

interview at 6 months unemployment to see if this had the effect of successfully reintroducing them to the labour market. This is one of the largest and best-known randomised controlled trials in U.K and it established a clear and positive impact on exits from unemployment with lasting effects still.

P3.3: Analyse the differences in formation and adaption of social policy
initiatives from other national perspectives

The social & healthcare policy initiatives emerged as a distint area in the UK in the early 20th century.To make a civilized society by provision of welfare benefits to the citizens ,irrespective of their ability to pay for them and aim for universal health service,pensions & state education.

In USA health care is been controlled by private & occupational insurance schemes with the state playing no part.It is the same with Japan.

In Western Europe there are health care systems that are run by both private & state run insurance schemes.

In wales it maintains the patient centered focus and answerable to all citizens of the state.Also it involves the communities in the development of the policies for healthcare.

So many health problems are prevented before they start of.

In Scotland the plan is an contract between the government & the individual citizen.

The English policy is straightforward.It ensures commitment to improve the health service rather than the policy itself.It is a contract between govt,service & the customer.

In Welsh document it is based on the notions of community enhancement & community capacity building.But it is absent in English & Scotland documents(Adams, Robinson, 2002:63-65).

Task 3.2 (M3.1):
Critically analyse the contemporary policy developments in
Health and Social Care. How would you expect these policies could
improve quality of life of your service users under your care at a facility?

The policies can improve the life of the service users by participating in the interest groups,such as patient organizations.And it paves the way for influencing healthcare as a representative in parliamentary system.Participating in public hearing processes,participating as members in publicly appointed boards & councils.

Task 3.3 (D3.1):<

This presentation analyzes a hypothetical case study of a young girl aged six and a half years who was taken for treatment by her mother, as a result of the girl’s sexual abuse by her mother’s boyfriend.

The court has ordered Melissa and her mother Asher to go for treatment after the judge and the social workers dealing with the case established that Melissa’s claims of being sexually abused were true. When the assessment began, Melissa was 6 years old, and her mother was 27 years old. Asher had been married at 20years but was divorced from Melissa’s father and had completely distanced herself from him.

At the time of the case, Asher had moved in with her boyfriend, Tony, for about year and half. He had started molesting Melissa around seven months earlier. At first Melissa could not open up to her mother because Tony had threatened to kill her if she told anything to her mother.

When Melissa decided to break the silence her mother could not initially believe her, and had brushed it off, but she later decided to investigate when she realized that her daughter’s behavior had really changed and she had become withdrawn and fearful, it was then that she discovered the shocking revelation of what had been happening to her daughter.

The therapists also came to learn that Melissa’s mother also had an abusive childhood, she came from a broken home whereby her mother had divorce with Asher’s abusive and alcoholic dad and worse of it had been sexually abused once.

The paper discusses that although the girl is the main patient, she is part of larger system that she is connected to; which is very relevant to her case and also course of treatment.

Process of the crisis

Urie Bronfenbrenner came up with an ecological systems theory explaining how all things in a child and the child’s surroundings have an impact on how the child grows. He examined levels of the environment that impact a child’s growth, which include the micro system, the immediate surrounding of a child such as the family relationships, the mesosystem, which describes how the various parts of a child’s micro system cooperate in order to help the child. The exosystem level consist of the others that the child may not be in contact with her but still affect her in a big way for example parents’ workplaces, and relationships

Bronfenbrenner’s final level is macro system; it’s the most remote set of things to a child but still has a great impact on the child. For example freedoms permitted by the government and cultural values. All these affect how a child develops positively or negatively.

Using Urie Bronfenbrenner’s ecological model, I will examine the context of Melissa’s case, the impact of the sexual abuse in her life, the preferred treatment for both the mother and child and how to avoid future abuse.

Encompassing the mesosystem is exosystem, the broader settings that define Melissa’s life, and the macrosystem, the cultural values that determine how she and those surrounding her are required to behave. Through the abuse, Tony violated the expected values, and Asher’s early refusal to believe what her daughter told her also cut off the girl from the covering that an individual is supposed to be given by the larger society. Nevertheless, the legal system, which is normally a part of the exosystem, has got into a closer circle of Melissa’s life and attempts to correct the violations of those close to her (Finkelhor, 1986). This has led to an ecological transition, a situation in which an individuals place in ecological environment is changed due to change in the role one plays, setting, or both. Although distressing for Melissa and her mother, the transition is an important, positive move in the healing of both individuals.

Interestingly, therapists’ discovery that Asher was herself sexually abused leads to applicable considerations that will assist in the treatment both of them. These considerations are also important in explaining the current psychopathologies seen in Finkelhor (1986) where he explains that traumas and mal-adaptations during childhood reoccur many times in later generations; children from dysfunctional families mostly create their own dysfunctional families they go with the patterns they learned when growing up. Asher has given Melissa the only kind of childhood she herself knows.

Effects

When Melissa was taken for treatment the first time she looked afraid, depressed and uncertain. When we look at the effects of sexual abuse can be looked into with the conceptualization of Finkelhor, the traumatogenic impacts of sexual abuse is widely used. The effects are divided into four categories, as explained below;

Traumatic sexualization refers to ill disposed feelings about sex, and the sexual identity problems.

Stigmatization which is manifested in guilty feelings and feeling responsible for the abuse or of disclosure.

The other effect is betrayal, whereby it is downgrading the trust in people who are required to be protectors and nurturers of children.

Powerlessness includes a view of being vulnerable and a victim and the behavioral manifestations of anxiety consist of phobias, insomnia, and eating disorders;

Management of the case

In Melissa’s case management there are various considerations that need to be made. Hence, coordination is very important. The things that the team are required to put in mind at this stage of intervention are disconnection of the child /or the offender from the family, the part played by the juvenile court and the criminal court and also the plan for treatment of the family

Before a treatment plan is developed, it is vital to understand the cause abuse; there are various models as explained by Finkelhor under Sexual Abuse Causal Models. In history there have been two major models namely the family-focused and the offender-focused perspectives. Efforts have been made to integrate the two by Finkelhor who developed a causation model that involves both the family-, and offender-focused perspectives.. Finkelhor explains four preconditions that must be involved for sexual abuse to take place, factors connected to the abusers force to sexually abuse; factors inducing the abuser to overcome internal obstacles; factors inducing the abuser to overcome external inhibitors and factors inducing to overcome the child’s resistance

Modalities of treatment

In treatment modalities, whereby the main goal in sexual abuse treatment is to deal with the impacts of sexual abuse, and decrease the risks of future sexual abuse.

Treatment Issues for the Victim that will have to be attended to be are; Trust whereby; there are devastating effects on children’s relationship, especially being able to trust o people. In family sexual abuse, the effect is worse as in the case of Melissa because her stepfather, who should be her protector, exploits and violates the limits of acceptable values. A non- offending parent like Melissa’s mother who could not believe her initially accelerates this damage.

The therapist is required to establish circumstances where the child has positive participation with trusted adults in order to correct the child’s ability to trust. Emotional Reactions to Sexual Abuse whereby the child feeling being victimized in that she feels as if she is responsible and starts feeling guilty, having a disorganized sense of self and low self-esteem because of being involved in sexual abuse. The therapist is required to help the child understand and accept that she was not responsible and also make her feel good again about herself.

Protection from future victimization

Protection from Future Victimization whereby the abused child needs taught future protection strategies. The child should be taught to say no and tell a trustworthy person may be useful.

Treatment Issues for the Mother

Treatment Issues for the Mother particularly in cases involving the mothers in interfamilial as in Asher’s case. Just like the victim Melissa her mother will need to undergo treatment in several areas such as areas connected to Sexual Abuse

It is hard for mothers of victims, to comprehend why a grownup may go sexual with a child. This is an issue that the clinician should address with the mother.

The therapist can offer professional explanation into the causes of abuse specific to the case. Another issue to be addressed believing the child’s disclosure of the sexual abuse. The therapist can explain makes her believe that the child is telling the truth or conclude that children do not make false allegations on such matters. Eventually the therapist will help the mother comprehend her duty in the abuse, if she had one. She is not to blame but in some way may have played a part to prolonged abuse as in the case of Melissa and Asher for not believing her initially

Improving the mother-child relationship is also very important because it is an important step in assisting the mother to be protective of her child in future.

In the case of intrafamilial abuse like Melissa’s case, the mother should decide if she wants to cut off her relationship with the abuser or salvage her relationship. Personal issues such as past trauma as having been sexually abused herself which is the case of Melissa. Such an experience has various impacts in on the mother’s ability to deal with her child’s abuse. The mother may be not being in a position to cope because she has not dealt with her own sexual abuse. Hence her abuse has to be addressed as in the case of Asher. She may not suspect risky situation quickly and her decisions of partners, playing part in moving in with a man who goes sexual with children.

Hence in conclusion, childhood sexual abuse is a very sensitive issue that has to be dealt with to avoid future destruction of the children’s lives

Reference

Finkelhor, D. (1986). The Effects of Sexual Abuse, in D. Finkelhor et al., Eds. Sourcebook on Child Sexual Abuse Newbury Park, CA: Sage.

Human Services/Child Welfare/Child Abuse/Neglect
Loretta McKelvey

Abstract

Human Services has several departments which are doing different functions. One department that has become a needed department would be child welfare. The following will help explain why it is needed. It will also be talking about the Human Services history and systems. Human Services has several department which are doing different things. One department that has become a needed department would be child welfare. The following will help explain why it is needed. Child welfare has been more involved with today’s society because of child abuse/child neglect is going on and being heard of more today than it was in the past of Human Services fields. Human services has evolved into a network of programs and agencies that provide an array of services to millions of Americans (Burger, 2014, p. 2). Primary social supports such as family, and friends, also play role in meeting human needs, and that role will be examined (Burger, 2014, p. 2). Early approaches to human services were centered on the hazards of illness, disability, and economic dependence. Programs were designed to help people who were unable to take care of their own needs. It was recognized that people with little or no income increasingly complex industrial societies were at risk of starvation or serious distress (Burger, 2014, p. 7).

Human service background

Colonial American times, it had been a commonly held belief that individuals should assist others in need by providing appropriate care and services. Early settlers from European countries to the American colonies believed caring for others to be a personal responsibility rather than a public duty the practice of charity has been a part of life since the first settlers. The laws and traditions prominent in England at the time were often adopted in early American communities (Norris-Tirrell, 2014).The statute sanctioned use of private monies for the benefit of the public good. Early American colonists incorporated these values as they shaped the roles of government, business and community (Norris-Tirrell, 2014).

According to Norris-Tirrell “the population of the United States expanded, human service needs increased and changed role expectations for nonprofits. The impacts of disease, war, economic swings, and natural disasters were fertile ground for the creation of organizations such as the Ladies Aid Societies and the American Red Cross “(Norris-Tirrell, 2014). During the era of industrialization that followed the Civil War, voluntary organizations served many different functions including teaching vocation skills and advocating for reform (Norris-Tirrell, 2014). The latter resulted in the establishment of child labor laws and the creation of a juvenile justice system (Shields & Rangarajan, 2011). In the late 1880s, Americans including Jane Addams advanced the settlement house model as a strategy for addressing urban poverty. This new movement embraced the progressive philosophy of the time emphasizing the importance of social science knowledge, compassion and expertise in creating solutions to social problems (Hall, 2010).

After the American Revolution, the United States adopted laws based on the British Elizabethan “poor laws” to help people who could not economically provide for themselves (Van Slyke, 2002). Benjamin Franklin founded the first hospital for the care of persons with mental illness and devised a model of care that was practiced in hospital settings at the time (Van Slyke, 2002). Through the cooperative effort of community members, policy makers, and professionals from the medical field, this new model of care that arose during the “Moral Movement” was conceptually grounded in the belief that it was the responsibility of the general public to care for those in need (Van Slyke, 2002). The underpinnings of the Moral Movement therefore provided the framework for the establishment of the first mental health movement in America (Van Slyke, 2002).

The Kennedy and Johnson Administrations followed with additional policies favorable for contracting out including The Public Assistance Amendments of 1962 and 1967 and The

Economic Opportunity Act of 1964 (Van Slyke, 2002). Human services were prime candidates for privatization since existing nonprofit agencies held the necessary content expertise, thus “building on historical precedent to remove government from providing services that nongovernmental organizations already or can potentially provide” (Van Slyke, 2007, p. 159,)

One agency of Department of Human Services is the Child welfare office that handles and deals with family and the charge of child abuse or neglect. The following will be discussing about Child Welfare and child abuse /neglect.

Child welfare

In the late 1930s, the network of child welfare professionals located in private agencies, public departments, advocacy organizations, and the U.S. Children’s Bureau, had grown optimistic that federal New Deal programs— such as Aid to Dependent Children (ADC), survivor’s insurance, and unemployment insurance—would eliminate (or at least sharply reduce) the role poverty played in separating children (like those of Morris, Collins, and Lane) from their families. Although these professionals did not always speak with one voice on all matters, they developed a general consensus around a number of issues (Rymph, 2012). Child welfare reformers believed that the 1935 Social Security Act would be a godsend for children in general, keeping families together and enabling more children to be raised in their own homes by their own parents (Rymph, 2012). With child welfare formed they started to see cases of child abuse. The following will discuss what is child abuse and child neglect and how the human services has and need to handle these clients.

Child abuse

Every child deserves a loving environment where they are not afraid of parental or elderly figures (Kiran, 2011). In recent years, the community has become increasingly aware of the problem of child abuse in our society (Kiran, 2011). Child abuse is prevalent in every segment of the society and is witnessed in all social, ethnic, religious and professional strata (Kiran, 2011). Human Services has several department which are doing different things. One department that has become a needed department would be child welfare. The following will help explain why it is needed. It will also be talking about the Human Services history and systems.

One will work with children and families in need, many times they will deal with children that living in poor conditions, such as abuse, neglect, alcoholism, drug addiction, and poverty (Strolin-Goltzman, Kollar, & Trinkle, 2010). Childhood should be a happy time, filled with memories of warmth, love, and carefree times (Child Welfare Social Work Careers, 2015).Unfortunately, not every child is blessed with loving parents and stable home lives (Child Welfare Social Work Careers, 2015). Some children are forced to cope with upheaval and problems at home, such as abuse, neglect, alcoholism, drug addiction, and poverty (Child Welfare Social Work Careers, 2015).Even in the United States, one of the most advanced countries in the world, some children still want for even the most basic of necessities, including food, shelter, health care, and appropriate clothing (Child Welfare Social Work Careers, 2015). Children who grow up in happy homes where all of their needs are met, typically grow up to become happy, stable, and well-adjusted adults (Child Welfare Social Work Careers, 2015). On the other hand, those that grow up surrounded by unpleasant and dangerous situations often grow up suffering from mental and emotional unrest (Child Welfare Social Work Careers, 2015). They are plagued by the memories and images from their childhood, and some may even repeat the behavior that they witnessed, thinking that it’s normal (Child Welfare Social Work Careers, 2015). For example, studies show that children that grow up with abuse either go on to become abusers themselves or find themselves trapped in abusive relationships (Child Welfare Social Work Careers, 2015).

Child Neglect

Abuse and neglect, however, are major concerns for most child welfare social workers (Child Welfare Social Work Careers, 2015).The signs of both neglect and abuse can be very subtle at times and difficult to spot to the untrained eye (Child Welfare Social Work Careers, 2015). As a child welfare social worker, you will be trained to recognize signs of neglect and abuse in children and investigate. Below are a few examples of identifying signs of neglect and different types of abuse (Child Welfare Social Work Careers, 2015).

Human service today

Todays United States economy did not stand out until the 1970’s, nonprofit organization today offering a complex set of programs (Noris-Tirrel, 2014). Domestic violence shelters, job training and employment programs, child care centers, foster care, child protection these are a list of human services today provided by nonprofit organizations (Norris-Tirrel, 2014), Nonprofit organizations have been known to partnering with government, private business and communities in the delivery of human services (Norris-Tirrel, 2014).

Conclusion

Human Services has several department which are doing different things. One department that has become a needed department would be child welfare. The following will help explain why it is needed. It will also be talking about the Human Services history and systems. Human Services has several department which are doing different things. One department that has become a needed department would be child welfare. The following will help explain why it is needed. Child welfare has been more involved with today’s society because of child abuse/child neglect is going on and being heard of more today than it was in the past of Human Services fields. Human services has evolved into a network of programs and agencies that provide an array of services to millions of Americans (Burger, 2014, p. 2). Primary social supports such as family, and friends, also play role in meeting human needs, and that role will be examined (Burger, 2014, p. 2). Early approaches to human services were centered on the hazards of illness, disability, and economic dependence. Programs were designed to help people who were unable to take care of their own needs. It was recognized that people with little or no income increasingly complex industrial societies were at risk of starvation or serious distress (Burger, 2014, p. 7). Human services are organized activities that help people in the areas of health care; mental health, including care for persons with intellectual and developmental disabilities and the physically handicapped; social welfare; child care; criminal justice; housing; recreation; and education (Burger, 2014, p. 8).

References

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Rymph, C. E. (2012). From “Economic Want” to “Family Pathology”: Foster Family Care, the New Deal, and the Emergence of a Public Child Welfare System. Journal of Policy History, 24(1), 7-25. DOI: 10.1017/S0898030611000352. Retrieved June 1, 2015 from http://web.b.ebscohost.com.proxy-campuslibrary.rockies.edu/ehost/pdfviewer/[email protected]&vid=19&hid=101.

Saini, M. A., Black, T., Fallon, B., & Marshall, A. (2013). Child custody disputes within the context of child protection investigations: Secondary analysis of the Canadian incident study of reported child abuse and neglect. Child Welfare, 92(1), 115-37. Retrieved May 12, 2015 from http://search.proquest.com/docview/1509394874?accountid=39364.

Strolin-Goltzman, J., Kollar, S., & Trinkle, J. (2010). Listening to the voices of children in foster care: youths speak out about child welfare workforce turnover and selection. Social Work, 55(1), 47-53.Retrieved March 31, 2015 from http://web.b.ebscohost.com.proxycampuslibrary.rockies.edu/ehost/detail/detail?vid=4&[email protected]&hid=109&bdata=JkF1dGhUeXBlPWlwLHVybCx1aWQmc2l0ZT1laG9zdC1saXZl#db=aph&AN=47234130.

As you know that diversity in the work force is one of the main object in employment favorable conditions, managing variety has been either ignored, poorly done or received little attention in some existing work organizations. To do workers some validity, many governments have tried legislating against different kind of ability to appreciate good quality or test in the workplace. However, research has demonstrated competence the defective and unfinished of such legislation since it still allows for employers to use statistically unbiased criteria in employee selection, recruitment and development providing it can be shown to be a valid qualification.

Form the view of statement above, evaluate and analyze the diversity legal context (underlying set of ideas) in UK in relation to employment policy on equality issues and the do something as custom connected with the effective management of diversity.

It is vital to understand the legal context for state of being equal and your legal duties not to recognize or identify difference in employment or the supplying of goods, facilities or services, as well as the favorable conditions, the law provides for implementing positive measures to help bring about impressively large equality at work. The law covers the six equality strands of age, restricted capability to perform particular activities, distinctiveness, gender (including pay and transvestites), religion or belief and nature of sexual preference in relation to employment and all but age in relation to services.

To make sure that you obey with the law makes good business sense and helps you to minimize both reputational and connected with money risk resulting from costly existence of lawsuit. These guides provide a broad survey or summery of the law and cover all six diversity strands however are not a conclusive and final or most authoritative legal guide. For precise layout of instructions to look for legal consultants.

Equality is about ‘creating a fairer society, where everyone can take part and has the favorable condition to satisfy their capacity for development’ (DH, 2004). It is about recognizing designs of experience based on group recognize, and the challenging series of actions that limit individual’s ‘expressing possibility’ health and life chances.

For example, occupational act of segregation. Women make up almost 75% of the NHS workforce but are concentrated in the lower-paid occupational areas: nursing, allied health professionals (AHPs), top level managers and subordinate workers (DH, 2005). People from black and minority of particular origin comprise 39.1% of hospital medical staff yet they depend only 22.1% of all hospital medical consultants (DH, 2005).

The state of being equal approach understands that our social identity – in terms of gender, race, disability, age, social class, sexuality and religion – will effect on our life experiences.

Diversity literally means difference. When it is used as a contrast or addition to equality, it is about identifying individual as well as group differences, behaving people as individuals, and placing positive value on discrepancy in the people in area and in the workforce.

In the past, employers and services have ignored many differences. However, individual and group of people from different culture should be taken into account therefore the needs of everyone and their needs are properly accounted for and understood react to within employment practice and service design and delivery.

For the matter of diversity there is a proper way on which the organization can work out on the flexibility of employees and the flexibility of work and the development of business in recent years. For example, an employer may gave permition to an employee in flexible working pattern and accommodate child care arrangements, or a General Partition surgery may offer surgeries at the weekends in accommodate people which works the whole week.

These approaches recognize that order to include many things and equal to all, organizations may need to respond distinctly to individuals/groups.

Therefore, a previously planned engagement to equality in relevant facts to recognition of diversity which means that dissimilar can be equal.

Why is equality and diversity important?

Equal opportunity and diversity is becoming very important in all points of view of our lives and work for different reasons.

• We are living in a society of increasingly diversity and need to be able to respond suitable and thoughtful and sympathetic to this diversity. Around gender the healthcare setting will reflect this diversity, race and ethnicity, disability, religion, sexuality, states and distinct age.

• Your organization believes that successful implementation of equality and diversity in all point of view of work make sure that pears, all kind of workers and students are valued, motivated and treated honestly.

• We have human rights and legal framework (underlying set of ideas) protecting employment practices and service delivery and we need to ensure we work within this and elude discrimination.

The UK framework has two parts to it: the anti- discriminatory framework (which gives individuals a way to increase complaints of discrimination around employment and service delivery) and the duties of the people (which place a proactive duty on organizations to address important organization discrimination).

Overview of anti-discriminatory framework

• Sex Discrimination Act 1975

• Race Relations Act 1976

• Disability Discrimination Act 1995

• Employment Equality (Sexual Orientation) and (Religious Belief)

Regulations 2003

• Equality Act 2006 (covers service delivery in relation to sexual orientation and religious belief)

• Employment Equality (Age) Regulations 2006

In the area of employment diversity and the age limit is the most important thing other than service delivery.

Disability Act 2001

The students who have any kind of disability they are explored with some appropriate adjustments in the Disability Act 2001 and Discrimination Act 1995.For this reason teachers are required to get more knowledge regarding the disabled student so that they could anticipate their core abilities in reputed organizations.

Diversity:

In any organization diversity is very important part of any business. To give equal opportunities to Women, men, people in relation to gender reassignment. If there are different people from different origin with diversified point of view, it can produce more chances to create different ideas that could be helpful for the organization to get their objectives. Anyone in relation to ethnic origin, nationality, color or culture.

Age, Religious or Sex:

In order to any specific religion of any believe, age, gender including men, women, gay men, bisexual and heterosexual people there are following legislative principles:

• Indirect discrimination

• Individual discrimination

• Reasonable adjustment

• Positive action

• Genuine Occupational Qualification

• Harassment

• Victimization.

Moral Duties of Public:

There are also some significant duties for which Public are bound. NHS bodies and trust, education sector, local authorities, security agencies and the health services department all come in the circle of these rules. It is possible only by the implementation of these rules in the organization to get focused and demonstrate the diversity in the organization

The duties were brought in under the following legislation: Race Relations Amendment Act (2000); Equality Act (2006): Disability Discrimination Act (2005). Each of the public duties requires organizations to:

• publish the results of any work make pledge to do something.

• produce a (race, disability and gender) equality scheme

• Carry out impact evaluate on their functions, policies and practices

• carry out equalities monitoring and take action to redress any imbalance

A brief detail is discussed below.

Ethnic and Race Disability:

Eradication of discrimination which is not in the provision. Eliminate unlawful discrimination. Establish and propagate the equal opportunities.

Always make sure that when the employees are functioning at the job in any organization, there should not be any religious or any sex discrimination between men and women or which does not come under the discrimination legislation.

In public life good attitude should be encouraged toward the anticipation of disabled people.

Disabled people should be treated with more favors as compared to the other people.

Since 1998 the UK has also included human rights within its legal framework. The Human Rights Act applies to all public right to command and bodies acting a public function. The Human Rights Acts places the following responsibility on your organization.

• Organizations must support and make safe to an individuals’ human rights. This means treating people moderately, with self respect and respect while safeguarding the rights of the big community.

• Organizations should apply essential part human rights values, such as equal opportunity, privacy, dignity, and involvement, to all organizational service planning and decision making.

The Human Rights Act facilitates a complementary legal framework to the anti-discriminatory framework and the people duties.

(“Professional Ethics”, n.d., para. 1) states, “Ethics are rules and values used in a professional setting. Professional ethics concerns the moral issues that arise because of the specialist knowledge that professionals attain, and how the use of this knowledge should be governed when providing a service to the public”. (“Professional Ethics”, n.d., para. 1) further states “the professional carries additional moral responsibilities to those held by the population in general. This is because professionals are capable of making and acting on an informed decision in situations that the general public cannot, because they have not received the relevant training”.

Most professions use professional ethics, which, are encoded in their code of ethics to internally regulate themselves and preserve the integrity of the profession as well as preventing the exploitation of clients. The codes of ethics are broad guidelines that members are required to convert to the appropriate professional behaviour. Herlihy and Corey (as cited in Corey, Corey and Callanan 2007) suggests that “a code of ethics has the following objectives:

Educate the professional about sound ethical conduct

Provide a mechanism for professional accountability

Serve as a catalyst for improving practice”

Engels, Pope and Vasquez cited in Corey, Corey and Callanan (2007) highlighted that despite these code of ethics the professional will face limitations and problems in striving to be ethically responsible. Limitations cited included:

Ethic codes may lack clarity and precision which make assessment of ethical applications difficult

A practitioner’s personal values may conflict with a specific standard within an ethics code

The codes may not align with state laws or regulations regarding reporting requirements

Ethics codes should be understood and applied within the specific cultural framework)

Professional ethics can be subdivided into two levels, namely mandatory ethics and aspirational ethics. Mandatory ethics represents basic ethics, which comply with the minimal standards, while aspirational ethics are the highest standards of thinking and conduct to be sought by the professional (Corey, Corey and Callanan, 2007, p.13). Corey, Corey and Callanan (2007) states “Aspiration ethics means that the professional will seek to go further and reflect on the effects their interventions may have on the welfare of their clients”. Aspirational ethics have been captured by the American Psychological Association (APA) in the general principles of its codes of ethics. (APA General Guidelines , n.d., par 1) states that “compliance with these guidelines are not mandatory or enforceable however they are intended to guide and inspire psychologists toward the very highest ethical ideals of the profession”. The principles stated in the APA Ethical Principles Code of Conduct include the following:

Beneficence and Non-maleficence – This requires the psychologist to strive to benefit those with whom they work and take care to ensure they do no harm. In addition, they are to seek to safeguard the welfare and rights of those with whom they interact professionally and other affected persons.

Fidelity and Responsibility – Psychologists are expected to establish relationships of trust with those with whom they work. They should be aware of their professional and scientific responsibilities to society and to the specific communities in which they work. They should uphold professional standards of conduct, clarify their professional roles and obligations, accept appropriate responsibility for their behavior, and seek to manage conflicts of interest that could lead to exploitation or harm.

Integrity-Psychologists should seek to promote accuracy, honesty and truthfulness in the science, teaching and practice of psychology. In these activities psychologists should not steal, cheat, or engage in fraud, subterfuge, or intentional misrepresentation of fact.

Justice -Psychologists should recognize that fairness and justice entitle all persons to access to and benefit from the contributions of psychology and to equal quality in the processes, procedures, and services being conducted by psychologists.

Respect for people rights and dignity-Psychologists should respect the dignity and worth of all people and the rights of individuals to privacy, confidentiality and self-determination. Psychologists should be are aware that special safeguards may be necessary to protect the rights and welfare of persons or communities whose vulnerabilities impair autonomous decision-making.

The other component of the APA Ethical Principles and Code of Conduct for psychologist is the Code of Conduct/ Ethical Standards, which are enforceable standards that should guide the actions of the psychologist in their professional lives. The APA has 10 ethical standards and, for the purpose of our discussion, we will focus on three of these namely, competence, human relations and privacy and confidentiality. The three standards cover a broad spectrum of issues, which will be discussed at a summary level.

The APA Ethical Principles and Code of Conduct competence standard requires the Counseling and Consulting Psychologist to “only provide services, teach or conduct research only within the boundaries of their competence, based on their education, training, supervised experience, consultation, study or professional experience”. Additionally they are expected to continuously undertake efforts to maintain and improve their competence. Finally, they should exercise self-awareness that will reduce the likelihood that they will undertake an activity, which their personal problems could prevent them from performing in a competent manner. Possessing the relevant competencies, maintaining and improving these competences and taking steps to ensure that personal conflicts or problems do not prevent them from properly executing their job is tied into the general principle of beneficence and non maleficence which are aimed at doing what is best for the client. Seeking to prevent personal conflicts and problems affecting the working relationship is consistent with the recommendation that Counseling and Consulting Psychologist maintain notes of their feelings resulting from interactions with clients. The counseling psychologist in the therapeutic relationship would maintain process notes, which among other things includes the therapist thoughts, feelings and reactions to clients. The consulting psychologist should keep notes, such as a diary, which details feelings and reactions to members of the client organization system. This self-monitoring should help the psychologist to identify problems during the therapeutic/consultative process that can negatively affect the relationship and therefore take the requisite steps such as getting counseling or terminating to prevent harm to the client.

The APA ethical standard on human relations encompasses the avoidance of unfair discrimination of clients, avoiding harm, multiple relationships, use of informed consent, and managing conflict of interest among others. Discussions in this paper will be on avoiding harm, multiple relationships and informed consent. The standard requires the counseling and consulting psychologist to “take reasonable steps to avoid harm to clients, organisational client, supervisees and others with whom they work and to minimize harm where it is foreseeable and unavoidable”. Seeking to minimize harm where it is foreseeable and unavoidable bears significance for the consulting psychologist as their interventions and the resulting changes may have an impact on persons unknown. This results from the nature of the consulting relationship, which usually involve three parties, the consultant, the consultee/client system and the client groups served by the consultee (Lowan, 2002, p. 733). Additionally, the APA standard states the Counseling and Consulting psychologist should “avoid multiple relationships with clients directly or thorough a person closely associated with or related to the client”. Lowman, (2002) defines multiple relationships as “those situations in which the psychologist functions in more than one professional relationship, as well as those in which the psychologist functions in a professional role and another definitive and intended role”. Specific risks associated with such relationships outlined in the code of ethics include loss of objectivity and exploitation of the client by the psychologist (Lowman, 2002, p. 739). The consulting psychologist needs to be aware of the potential harm that can result from their failing to effectively manage relationships within the organization and that it can affect not only those in the dual relationship but also others in the organization (Lowman, 2002, p. 740). The challenges facing consulting psychologists in this regard are special, as in most instances a dual relationship will exist. Dual relationships in and of themselves are not always bad and they can be considered inevitable however, they need to be managed carefully. If the consultant is hired based on a referral from a member of the consultee system with whom the consultant has a previous social or professional relationship, this can present several issues. These issues includes how the consultant’s perspective may be affected by information received from this person, expectations that the persons may have in terms of access to or influence on the consultant, how the dual relationship is perceived by other in the organization and is resultant impact on these persons interaction with the consultant.(Lowman, 2002, p.741). The presence of dual or multiple relationships in the therapeutic relationship can create situations in which the client feels they cannot be assertive or take care of themselves. This arises primarily due to the existence or previous existence of a therapeutic relationship that creates and uneven balance of power between the therapist and the client. These multiple relationships can include romantic involvement with a previous client after the 2 years stipulated by the standards or the therapist involvement in a business relationship with the client. The avoidance of these dual relationships are advocated for family member and close friends as the increased intimacy can reduce the therapist effectiveness as a professional. The psychologist objectivity and maintenance of professional distance is usually impaired if dual relationships are established.

Informed Consent is a particularly important area covered by this ethical standard. Freeman (cited in Lowan 2002) defined informed consent in terms of four essential elements “(1) the competence of participants to make rational decisions regarding whether or not to participate; (2) the voluntary nature of participation; (3) access to full information regarding the purposes, potential risks and benefits, and the likely outcomes of participation; and (4) the ability to comprehend relevant information”. The Consulting psychologist faces peculiar challenges in obtaining informed consent, as the client is more difficult to identify. The consulting psychologist will rightly identify the organization as the client but the organization is made up of groups of individuals organized in a hierarchical structure that intrinsically carries power differentials. While the consulting psychologist can say that the organization is represented by whom ever contracted them, and these persons may be supportive of the consultation, can the same be said of others in the lower levels of the organization. The organization hierarchical structure makes one question whether participation is truly voluntary (Lowman, 2002, p.737). Additionally, contrary to group therapy where all the individuals sign an informed consent, this may not be practical for all the persons that may be involved with the consultative process. A dilemma exists even if the contracting person (organisational representative) signs an informed consent, can it be said to be truly be on behalf of all the persons in the organization? In my opinion, the matter of persons having full information regarding the purposes, potential risks and benefits of the process can also be questioned. Again, full information may be available to top management, but not to all members of the organization.

The counseling psychologist is expected to obtaining informed consent from the individuals, families, couples or groups members in the early stages of establishing the therapeutic relationship. Corey, Corey and Callanan state, “The main purpose of the informed consent is to increase the chances that the client will become involved, educated and a willing participant in therapy”. Informed consent involves providing the client with sufficient information to make informed choices about entering into, and continuing the client/therapist relationship. Providing the client with information, is a way of protecting the client’s rights and teaching them about their rights, which encourages the developments of a healthy sense of self and personal power (Corey, Corey & Callanan, 2007, p.154). It is important, as it outlines the basis of the relationship and is one of the means of establishing boundaries within the relationship.

The APA Privacy and Confidentiality ethical standard states “Psychologists have a primary obligation to take reasonable precautions to protect confidential information obtained through or stored in any medium”. The importance of confidentiality is emphasized by Bersoff (cited in Lowan 2002) who states “except for the ultimate percept -above all, do no harm – there is probably no ethical value in psychology that is more inculcated than confidentiality”. The psychologist is required to protect the information and to disclose the limitation on that confidentiality as dictated by legal or other requirements. Confidentiality in the organizational setting, poses challenges, such as the number of persons who have legitimate access to the data collected, for example management personnel or committees (Lowman, 2002, p. 738). The consulting psychologist will have to address these limitations openly and seek to establish a collective responsibility with members of the consultee system, which will promote a collective approach to the handling of such matters (Lowman, 2002, p. 738). Unlike the counseling psychologist, who deals with clients one to one, by their choice or acts on behalf of a third party, in which case the client is informed and can chose what information to divulge. The consulting psychologist has to work to overcome the perception of possible victimization that less powerful persons within an organization may feel if they disclose certain information. This can prevent the psychologist from obtaining important information, and if it is received, he/she may be faced with an ethical dilemma of how to use the information, taking into consideration how it can affect the individual or the organization.

Based on the fore going discussions it is seen that the professional code of ethics is vital for the counseling and consulting psychologist. Professional ethics are a requirement for the profession of psychologist, just as a society cannot exist with rules and laws so psychological profession cannot exist without ethics. The counseling and consulting psychologist needs to know and practice these ethical requirements in their professional practice, failing which, they could be barred from the profession or face legal action. Compliance is required for the profession and for the individual to be economically viable, as the service provided must be of a quality that can be trusted. Professions are built on the trust that the public places in it and if that trust is eroded, it is doomed. Additionally, professional ethics protect the consumers of the service by the establishment of standards and removing some of the personal values or morals, which could be harmful. It has its limitations, as it does not provide ready-made answers for everything, only provide broad guidelines.

Attachment theory derives from psychoanalyic psychology, however it is used in social work to attempt to understand behaviour in infancy and childhood to show the way in which children develop emotionally WALKER 2009

This theory centres on the idea that children need to form secure relationships with other people, such as parents or guardians, as it is a significant contributer to their emotional development. Social bonds and relationships that are made in early childhood are believed to influence an individuals life and can impact upon their well-being to determine their emotional and social stability later in life. Consequently, attachment is seen as an integral component within infants and young childrens lives, as these experiences can shape a persons personality and identity in future years. (WALKER, J and K, CRAWFORD 2010). If these experiences of attachment are negative, and the child does not develop adequate relationships with their caregivers, then this can have detremental consequences on their psychological and emotional development. (WALKER, J 2009).

The Attachment theory originates from the ideas of John Bowlby who believes that humans are biological predispositioned to seek attachment from others. He proposes that survival is closely related to the ability to possess emotional bonds with other individuals (GREEN 2003). This is because by forming an attachment with an authority figure who is seen as the stronger of the species, this reduces the vulnerability of the individual as it provides increased security and protection from harm posed by potential predators (BOWLBY 1958, cited in LISHMAN 2007). The theory looks at the way that attachment relationships are formed, and the reasons behind their manifestation. Children are seen to form these relationships for reasons such as safety, comfort and to provide guidence. These attachment behaviours, according to learning theorists, are displayed in infancy through talking, laughing and crying. This enables them to persue their basic needs for survival, such as food for nurishment, by their attachment to their mother who is able to support them in fulfilling their needs (WALKER, J and K, CRAWFORD 2010). This initial attachment to caregivers also guides the individuals thoughts, feelings and expectations as they become aware of peoples responses towards them which help them recognise how to behave (WALKER 2009).

There are four assumptions of Bowlby’s attachment theory which attempt to explain his beliefs. The first, is that infants and young children develop emotional ties with individuals early in life, which acts as a biological function and plays an integral part to their survival. The second assumption is that the way a child is treated early in life has a major contributing factor to their future relationships and the way their personality is formed. The third assumption is that attachment behaviour can form an ‘internal working model’ which guide the child’s thoughts, feelings and expectations as a result of the reactions of others towards their behaviour. The final assumption of Bowlby’s attachment theory is that although it is difficult to alter attachment behaviour, it is not impossible, thereofre there is the possibility of alteration at any point in life, both in a positive and negative way (GREEN 2003).

Although infants and young children are able to have more than one attachment figure, they are still affected when they are exposed to seperation from their primary attachment figure. This can happen for many reasons, such as a child being removed from a family home and placed into care, or perhaps death. This can be a very distressing and confusing time for a child as they are unsure of who to turn to for security and protection. This is evident in social work practice in instances where an abused child wants to remain with its parents, even though it is not a stable or supportive attachment (LISHMAN 2006). Bowlby proposed that children who have experienced seperation from their main attachment figure will suffer in a process involving protest, dispair and detachment, in an attempt to overcome their loss (BOWLBY 1958, cited in LISHMAN 2006).

However, although Bowlby provided an important contribution to the idea of attachment, his research can be criticised in many ways. This is because Bowlby tends to focus his ideas on one primary figure of attachment, often the mother, when it is possible for children to form attachments with other people within their lives such as their father. Also, developing relationships with other people alongside the attachment figure is also important, this is because having to rely on the caregiving relationship of one person can be detrimental due to the fact it often results in dependency and does not allow other relationships to be formed with others, which can the hinder the social and emotional development of the child (WALKER, J and K, CRAWFORD 2010).

According to Lishman (2007), the attachment theory believes that when a child is stressed or afraid, they exhibit particular behaviour and emotions which can be perceived as attachment. This is because they seek protection from harm through the help and security of an adult who they see as stronger than themselves. This is closly linked to two types of behavioural systems: the exploratory behavioural system and the fear behavioural system. The exploratory behavioural system is based of the belief that when an infant or young child feels comfortable and safe, the attachment behaviour remains dormant and therefore the child will be willing to explore the people around them and their surroundings. However, if a child feels threatened or vulnerable, the fear behavioural system will become active, where the child will no longer seek exploration and instead they will seek protection from their attachment figure and exhibit behaviour related to that attachment.

However, the behaviour that they display is not intended to provoke affection from the attachment figure, instead it is to aˆ?regain a state of equilibriumaˆ? (p59). This means that infants and young children are not dependent upon the caregiving nature of the attachment figure, instead their aim is to diminish their fears.

There is a classification of attachment patterns which identifies four different types of attachment, which attempts to enanble professionals to assess young childrens behaviour and emotions (secure, ambivalent, avoident and disorganised). Secure attachment is based of the belief that children depend upon their caregiver as a base for exploration. The caregiver is available to the child and responds to the childs needs, therefore the child behaves in a positive manner. Ambivalent attachment looks at how children are unwilling to explore their surroundings as the caregiver is not consistent in their support. This can leave the child distressed, clingy and dependent. The third category is avoident patterns of attachment, and features an unresponsive caregiver, therefore the child feels rejected and they view themelves as dependent whilst actively avoiding or ignoring the caregivers presence. And finally, disorganised attachment is where children are fearful of their caregivers, and they themselves may feel confused or depressed. This type of attachment is most often seen in children who have suffered abuse (HOWE 2001, cited in LISHMAN 2007).

How a critical understanding of Attachment Theory can contribute to Social Work Practice.

Social workers are seen to have three roles to play when working within an attachment perspective: assessment, planning and direct work with children, parents and carers. Assessment looks at areas within attachment such as the needs of a child, the parenting that they receive, their emotional and behavioural development and the relationships which they have formed. There are also tests created specifically for measuring attachment, such as Ainsworth’s stranger test which provide an indication of the pattern and quality of their attachments.

The second role, planning, looks at how planning for new attachments when placing children with new families needs to be approached carefully. This is because they need finding the most suitable parenting figures where new attachments can be made.

The third role is direct work with children, parents and carers. This is because direct contact and communication is necessary to achieve the best possible outcome when working with children and families. For example, when a child has been removed from their home and is being placed with new carers, direct work can provide support to the child to prepare them for change. It can also be useful with the adoptive or foster family to provide guidence and support towards what to expect and to help with any problems they face (LISHMAN 2007)

Attachment theory has been used within social work practice as the basis for many child care policies. This is because the idea of a infant or child being ‘attached’ to their family, which can influence their development in many ways, has been used as the basis for many legislation (LISHMAN 2007). For example, Sure Start Children’s Centres have been introduced in response to the importancy of family support to enable them to build and maintain positive family relationships (LAMING REPORT 2009, cited in BRAMMER 2010). Attachment theory had also contributed to policies such as shared parental responsibility, as it has emhasised the need for emotional and social relationships with caregivers, whilst also suggesting possible consequences to a childs development and the negative impact later in life if these needs were not met effectively. (LISHMAN 2007).

Attachment theory also provides guidence to enable social workers to judge the quality of a relationship between a child and it’s parents. This can enable them to gain an understanding of at what point, if at any, intervention is necessary as it gives them the ability to evaluate the attachment that is present within the relationship. The attachment theory also gives a more comprehensive understanding of the loss experienced by an infant or child when they lose their main attachment figure. This means that people working within social work practice are aware of the common and typical behaviours of a child who is going through this process and can therefore support them to overcome it. A further way the attachment theory is used to benefit social work practice is that as it is known that attachment figures are necessary for children to develop adequately, individuals such as adoptive parents can be taught to exhibit behaviour which will encourage new attachmentment from the child which is needed for personal growth (WALKER, J and K, CRAWFORD 2010). However , care needs to be taken when placing a child with a new family as to prevent a repeating loss of attachment figures which can cause them to blame themeselves and produce feelings of worthlessness. This can mean ensuring that the child is appropriatly prepared and ready to form new bonds of attachment and that the new carers of the child receive sufficient support within their role. (LISHMAN 2007).

Attachment theory can also be linked to the way in which a mother bonds with her new born baby. However, these early bonds are not solely restricted to mothers, it is also possible for fathers. Although, this bond is typically formed within the first few hours after birth as the mother and baby connect both physically and emotionally. The initial bond that is made is thought to have a significant effect on their future relationship as it is the beginning of their ‘attachment’. This knowledge enables social workers to support mothers who are particularly vulnerable to poor parenting, although this is only effective if the support continues throughout the first few months after the baby is born.. However, it is important to note that just because a mother fails to achieve an initial bond with her baby, this does not mean that abuse is inevitable.

How are issues of ‘diversity’ relevant to human growth, behaviour and development?

GREEN, V. 2003. Emotional development in Psychoanalysis, Attachment Theory and Neuroscience: Creating Connections. East Sussex: Brunner-Routledge

LISHMAN, J. 2007. Handbook for Practice and Learning in Social Work and Social Care: Knowledge and Theory. London: Jessica Kingsley

WALKER, J and K, CRAWFORD. 2010. Social Work and Human Development. Exeter: Learning Matters

WALKER, J. 2008. Studying for Your Social Work Degree. Exeter: Learning Matters

BRAMMER, 2010. Social Work Law. London: Longman