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Within this essay the authors aim is to explore the challenges and opportunities of integrating the Ten Essential Shared Capabilities (ESC) into the day to day running of mental health practice. The author will also take into account Values Based Practice, Recovery, Interpersonal Relationships and Service User and Carer involvement.

Aswell as the 10 ESC there are a set of values which all mental health staff should follow. They are the Values Based Practice and it is about being aware of , and looking in a positive and respectful manner at peoples differences, beliefs and values regardless of status for example service user, carer, family or colleagues.

(Coyte et al. 2007) There are 10 points to good values based practice which staff should adhere to. They are broken down into the following :

Values Based Practice and Evidence Based Practice : The “squeaky wheel” principal (values only noticed if problematic), The “two feet” principal (evidence-based and values-based practice).

Practice Skills : Awareness, Knowledge, Reasoning and Communication

Models of Service Delivery : Multi-disciplinary, User Centred

Partnership : Service User and the Carer working in partnership in decision making.

The four main Practice Skills in values-based practice are also prominent in many if not all of the 10 ESC, all of which are required in building a working therapeutic relationship between service user and staff.

Interpersonal relationships between service users and staff are very different from social relationships in that these relationships are built up on the same principles of respect, trust, good communication and understanding, but the service user, nurse relationship should be a therapeutic and helpful relationship rather than a social one (Guimon 2003). This relationship is essential in ensuring that there is a supportive and solid route of recovery established.

Everyone has a different view on what recovery is and no one persons journey is the same as another. Recovery is all about initially having a belief that things can and will change. Some people may want a complete change in the way they live while others may want to return to how they lived before. Supporting recovery is all about assisting the person to live as fulfilling and positive life as possible, involving the service user and their carer and supporting them to take control of their own recovery (Scottish Recovery Network 2007).

The author feels that the expertise to the mental health issues are the service user , carer and their family support structure and that this is a positive route onto their journey of recovery. The main issue that staff could come across may be if the service user does not have any of the support structure that comes from a network of family, friends and professionals or if the service user themselves does not want to involve any of the above support.

This is where staff and the MDT (Multi-Disciplinary Team) may have to offer other methods or ways to support the service user on their recovery journey. Ideally, getting the service user and carer involved, by making sure that they are involved in all decision making concerning treatment would enable them to take more control of their care and treatment. However this can be challenging in that when trying to find a balance and working out what is holistically best for the service user conflicting ideas may come out, but by establishing a therapeutic relationship between the service user and staff this should help with any trust issues and enabling a better understanding and ensuring that there is a favourable outcome that can be agreed upon.

The 10 Essential Shared Capabilities (ESC) are:

Working in Partnership

Respecting Diversity

Practising Ethically

Challenging Inequality

Promoting Recovery

Identifying Peoples Needs and Strengths

Providing Service User Centred Care

Making a Difference

Promoting Safety and Positive Risk Taking

Personal Development and Learning

Working in partnership is all about building up a relationship with the service user, their family, carers and any outside services that are required to be involved in the care of the person. (Barker 2009) Staff should offer support and empower the person to enable them to have an active role in controlling their own treatment and care, with all aspects of their care being taken into account. Making sure that the whole partnership are aware of the information and advice that is available to them to enable an informed choice regarding the most suitable care is made available.

Although, working in partnership sounds good in theory, all involved in the partnership are required to put in the work to ensure that it works successfully. The staff can offer services for both service user and carers but they may not agree or want to attend. If this happens then something needs to be put in place which would benefit all parties and that they all agree on, if any of the party do not want to attend or take notice of services provided then this is their choice and confirms their ability to choose.

When respecting diversity it is to have an understanding of someone’s values, race, sexuality, age, mental health, religion and physical state. Staff need to ensure that everyone in their care are treated to proper care, treatment and support also that they are treated with dignity and respect no matter what their personal circumstances or cultural values area (Stickley and Basset 2008).

First of all, social work theory is defined as “an explanatory framework,” the accumulation of knowledge, ideas, skills and beliefs social workers draw upon to help to make sense of what social work is and how to do it. (Oko, 2008: pp.6) In other words, theory in social work helps to organise and structure the world we live in and help us to make sense. Particularly this is important when dealing with service users. Vulnerable people are those in need and under stress who often lost control under their lives. Therefore, it is critical to assist them in explaining reality to make sense of what is going on and why. Not being able to understand reality is stressful for both service user and practitioner. (Howe: 2009). Beckett (2006: pp.33) defines social work theory “as a set of ideas or principles to guide practice.” The definition stresses the importance of how theory informs practice leading to assessment and intervention. This is supported by Teater (2010: pp.1) who hold the view that “theories help to predict, explain and assess situations and behaviours and provide a rationale for how social workers should react and intervene with clients who have particular histories, problems or goals.” It is worth pointing out that theory to be right has to explain the situation and provides us to solution. However, different types of theory can be used differently in the wide spectrum of intervention. Alternative theories can lead to a different process of understanding, assessing and intervention. It is essential therefore to analyse and adapt theory all the time. (Teater: 2010) Howe (2011) similarly refers to theory as a guide that influence practice in five key area such as observation, description, explanation, prediction and intervention. According to Howe (2011), social workers must answer a serious of question to understand complexity of the situation and to see pattern. Firstly, social workers have to define problems and identify needs of the service users. Secondly, make sense of what is going on by analysing and assessing situation. Thirdly, set out goals, and make action plan. Fourthly, assess available resources, skills and methods that will be utilised in social work process. Finally, review and evaluated the whole process.

The origins of social work theory can be traced back to the early nineteenth century and are strongly embedded within the Industrial Revolution and development of social sciences. (Howe: 2009) The age of Enlightenment was very tough and disruptive period follow by the Scientific Revolution and rapid industrialisation. Migration of people, high degree of destitution, crime and poverty forced to change. Significant attempts were made to utilise developing social sciences such as psychology, sociology and economy to improve social and political conditions of society. (Howe: 2009) The work of Wilson et al. (2008) emphasises the importance of formation the Charity Organisation Society (COS) in the 1869 as the date from which social work as a recognise practice began. It has been suggested that social work originated by the COS resulted in creation a social work theory as a response to “social disadvantage and unrest”. (Wilson et al. 2008: pp.50)

The above explanation the origins of social work theory lead to justification why social work theory is contested. Social work theory has explored all types of knowledge and experience in its attempt to understand relations within society and help people. The work of Maclean and Harrison suggested that “no single theory can explain everything. An eclectic approach is usually required.” (2011: p.15) The statement means there is no dominant theory in social work practice. People their relationships and interactions are complex, consequently social work theories must derive from different sources discipline to explain human behaviour, position in society, relationships within psychological, social, economical and political context. This agrees with the view of Payne (2005: 44) who refers to “borrow knowledge” in social work practice. Oko (2008: p.7) draws attention to “social constructionism” and “fluidity” as a view of social work where everything can changed depends on context, time, legislation, policies and different expectations about people’s behaviour. Social work theory is contested because embrace a variety of different practice setting, with different groups of service users as well as working pattern and constantly changing context of policies and directives. When discussing types of social work theory, it is important to recognise that those can be seen at three different levels; theories of what social work is about, how to do social work and theories of service user world. (Payne: 2005, p.6) The first statement apply to grand theories, these are orthodox theories that seek to explain society as a whole. It is important to mention that there are three main sources of social work theory such as psychology, sociology and systemic. (Howe: 2011) However, social work theory also derive from other discipline such as philosophy, law, medicine, social policy etc. (Howe: 2009) An example of grand theories are psychoanalytic theory, behaviourism, systems theory, humanism, Marxism and Feminism. (Wilson et al. 2008) The other group are mid-range, theories that Wilson et al. (2008: p.107) called “practice theories” these indicate the methods of intervention and are the result of the contribution of grand theoretical perspective with practice experience. The last but not least, are informal theories, use to explain individual cases or behaviour. Informal theory is the practitioner’s own ideas about a situation based on personal and professional experiences. Wilson et al. (2008) refers to practice wisdom, self-awareness, intuition, not knowing and personal experience as issues related to informal knowledge. Whereas, Beckett (2006: p.185) discusses informal theory as “common sense”.

This section of the essay will examine radical social work theory and empowerment paying special attention to the factors such as professional and political contributors. By the 1960s, more attention was beginning to be paid to the social consequences of capitalism. Capitalism started to be seen as the economic order of an unequal and unfair society shaped by psychodynamic theory especially casework. (Howe: 2009) First strong critical view of the social and personal effect of capitalism and the economic structures became known as Marxism or radical social work. The origins of radical social work date back to 1970s to the Case Con manifesto. (Wilson et al. 2008) People like Karl Marx, Beatrice Webb or Octavia Hill radically questioned existing structures that caused poverty and deprivation. (Howe: 2009). Radicals expressed necessity to work with people within a wide socio-political context and not in isolation. (Wilson: 2008) Ideology of Marxism has had immense impact on social work theory as a result created collectivism, empowerment, anti-oppressive and critical theory. These lead to development of “practice method” with service user such as, anti-oppressive practice, advocacy, welfare rights, service user involvement, radical casework and community development. (Wilson: 2008: p. 107) It is clear that on the grounds of radical theory grew up the idea of empowerment. The concept was developed based on the critique that services provided often contributing to service user sense of powerlessness and lack of choice. Empowerment is about the service users having choice and control over own life. It promotes a way of working with service users based on equality and partnership.

There is no doubt that social work is deeply rooted and shaped by socio-political context. (Wilson et al. 2008) Horner (2009: p.3) rightly points out that “good practice is not a ‘truth’, but is a function of political, moral and economic trends and fashion.” Currently, it has been suggested that the “space” for practicing in an ethical and empowering manner have been progressively limited by the managerial, budget-driven polices of the last few years. (Ferguson & Woodward, 2011: p.15) Social workers still work with service users but normally in the conditions that do not depend on them. The constraints often lead to excessive caseload, lack of resources as well as lack of support, supervision and unfilled vacancies. Professional work setting can limited creative use of theories by imposing favourite well know theories, as a consequence of managerial and bureaucratic agenda. Managerialism and bureaucratisation seems to be a potential danger for contemporary social work theory and critical reflection. Meeting deadlines, filling in forms, standardised and integrated assessment framework are crucial nowadays. It looks like humanity has been lost in paperwork and one size fits all approach. In addition, issues are trivialized by media and political hostile approach to social work. (Ferguson & Woodward: 2011) This can be clearly seen when a tragedy happens such as the death of the child in care then the response is often a blaming one “bloody social” worker instead of wider social and political context. (Thompson: 2009) An illustration of this can be a case of Victoria Climbie and the social worker who was working on this case Lisa Arthurworrey. (The guardian: 2007)

When discussing political influences it is important to recognise that the publication of the Kilbrandon and Seebohm Reports are a matter of the relationship between social work and politics. It is clear that these documents and the follow legislation “lodged social work firmly within the state sector” with the voluntary sector as supplementary. (Ferguson & Woodward, 2011: p.57) Since then social work has been driven to a different degree by politics, professionals, central government and administration. The subsequent evidence of political influences can be observed in a case of Clement Attlee and Jacqui Smith, politicians who have affected contemporary social work. Clement Attlee former Labour Prime Minister has seen social workers as activists. In his understanding social workers should “..work in non-oppressive way…challenge polices and structural inequalities..” (Ferguson & Woodward, 2011: p.15) The statement shows political influences of radical tradition such as to be critically reflective, willing to change the system not the service users. It also identifies the empowerment theory and anti-discriminatory practice in working with service user. In contrast to this, Jacqui Smith, the former Minister for Health argued that “social work is a very practical job….. not about being able to give a fluent and theoretical explanation” of reasons and causes of problems. (Horner, 2009: p.3) Smith claimed that new social work degree courses had to focus on practical training. The above is an excellent example of political influences social work has to deal with. Surely, Jacqui Smith was right practical abilities are critical in social work practice but on the other hand, she has decreased the value of theoretical issues that are equally important. Only through explanation of service users world a social worker empower the individual, make sense of his/her reality, by understanding the situation service user can take control over own life. The next important point when discussing political influences are devolved administrations that shape the politics of social services (Drakeford: 2011) The actions of central government shape the terms and the capacity of social work services but the delivery of those provisions lies within local authorities. This is seen as another example of relationship between social work services and wider political and organisational context.

This part of the essay attempts to show the prospects of discrimination and empowerment in social work. It is worth pointing out that in the new global economy, neo-liberalism has become a central issue for radical social work practice. In the UK, neo-liberal policies have resulted in creating an unequal society where the rich grow richer and the poor grow poorer. (Ferguson & Woodward 2011) Neo-liberal approaches such as consumerism and marketism, undermine social work values and relationships with service users as well as limit possibilities for critical and creative practice. An example of this are the differences and dilemmas in terminology between patients, clients, service users and users of service that reflect on the way practitioners think and relate to people. A strong critique is presented by Ferguson and Woodward (2011) who blamed the management of social work for being too willing to decrease values base and increase managerial agenda. The authors also argue that nowadays too many social workers present authoritarian role in relation to service users treating them like objects rather than subjects. In relation to discrimination, radical social work theory direct social workers to work as agents of social control by helping people to understand their situation and unfairness as well as why and how it was created. In other words, social workers are raising people’s political and social awareness; consequently, people are able to recover power and control over their lives. Discrimination in social work, from radical point of view can be viewed through social policy, identification of service user needs, allocation and accessibility of resources. Therefore, it is important to recognise respect of rights, responsibilities and opportunities as main issues of anti discriminatory practice. Social workers can be discriminative because they have a power and control over people’s lives. That is why, they have to exercise them with awareness, thought and sensitivity. (Howe, 2009: p. 146) The concept is supported by Backett (2006: p.186) who suggests that “common sense” which is often used by practitioners in theories, “tends to incorporate the prejudices and assumptions of a particular time” and can be insufficiently used especially by social workers with little personal experience. Practitioners bring into social work practice and theory their own beliefs, values, histories, culture experiences and biases. Judged by these criteria, it is clear, that social workers must be critical and self-reflective. It seems to be a matter to understand that we do not live in equal society. Oppression is deeply rooted in the process of our socialisation. If social workers want to work in anti-discriminatory way they need to develop confidence and skills in exploring the way oppression operates in society. This is supported by Thompson (2009) who argues that empowerment in social work is something more than process of gaining control over service user’s life but is about taking account of discrimination and oppression at the first place. Social work theory can assist practitioners by guiding and explaining the models of oppression. This is necessary in order to support service users to understand and tackle the oppression they may face. An example of this is PCS model presented by Thompson. (2009: pp. 144) The model has been designed to express how our personal prejudices are strongly embedded within cultural influences and structural power. The PCS model operates at three levels such as personal, cultural and structural. Personal refers to individual oppression thoughts and attitudes as well as psychological factors. This can also refers to prejudice and personal views of social workers. Cultural explores the way that groups, based on commonly agreed values, define what is “normal”. Empowerment in this case will include challenging stereotypes. Structural level refers to oppression within wider socio political climate and social power and refers to the way differences are viewed by society such as class, race, gander etc… (Maclean and Harrison: 2011) It is worth pointing out that to treat everyone the same is not to treat everyone equally. Dominelli (1997, pp. 31) draws attention to “colour blind” approach based on false premise that everyone is the same. The potential discrimination when using theories can be “recommended theories” on the grounds of their effectiveness with similar case. Social workers when using theories must take into consideration that everyone is different, has different experiences, needs, problems. They have to be reflective and work against one size fits all approach. It is important not only to assess needs but also to consider differences. The intervention in people’s lives without taking account of key issues such as age, disability, ethnicity, gender, race, sexual orientation can do more harm than good. (Thomson, 2011: p106) Form this perspective social work is a part of emancipatory project promoting social equality and social justice among people who are marginalised or disadvantages. Croft and Beresford (2005) noted that empowerment has potential to “be both regulatory and liberatory”, it brings about social change based on collective obligation to the individual. Therefore, empowerment is often used as part of discourse of individual rights and responsibilities. (Oko: 2008) It is more than “enabling” is helping service users to become better equipped to deal with the problems and challenges they face. (Thomson: 2009) It is worth noting that empowerment is not about transferring power from social worker to service user this can be very disempowering as well can cause addiction to social work services. Another potential danger in utilising empowerment theory is seeing service users as weak and vulnerable rather than experts who require support to address the needs and achieve goals. (Maclean & Harrison: 2011) Wilson et al. (2008: p. 81) argues that people are “own agents” with not only rights but also the capacity to make choice and decision. Empowerment theory in contemporary practice can be seen by not only having a voice but also having an advocate; informing about services available in relation to needs, supporting in developing skills such as parental skills, information technology etc. The aim of empowerment is to increase self-esteem of service users, currently this is carried out by putting in place self-directed support and personalisation programmes.

The last section of this essay assesses how perception of theory can support to be a more effective practitioner. As presented earlier theories outline explanatory framework for helping to make sense of the situation as well as shape our thinking (Oko: 2008) In other words, theories represent organised ideas and beliefs that guide social workers thinking and practice. Doel (2012: p135) compare theory and practice to “a cup of oil and a cup of vinegar” which shaked mix for a while and separate out. Theory is necessary, in order to gain control over the situation. It not only explains the situation, from a different perspective but provide guidance about what to do with these explanations. (Doel: 2012) Theory to be useful has to be constantly verified and updated. The relationship between theory and practice can be build upon IBL so “issue based approach to learn” (Oko: p. 99). The approach inspires social workers to think about what has been learned and how this new knowledge, experience or skill can be assimilated and utilised in practice. There is no doubt that values base, skills and knowledge facilitate personal and professional development. This is a key of being a critically reflective practitioner. A good understanding of the different theories can guide practice and create effective and successful intervention. Theory makes sense of the situation and creates ideas about why things are as they are. It not only shows the direction of intervention but also explain service users behaviour and actions. Theory can indicate why an action has resulted in a specific behaviour, it also helps to see patterns. Consequently, social workers may get to know the issues affecting service user lives. Another argument for using theories is that its assist social workers to be more confident and better prepare to critique of their point of view. It is vital to be able to justify the decisions made in social work practice. Using theories give social workers a backup to justify actions and explain working practice to service users, managers, other professionals or themselves. This justification of actions on the grounds of theories leads to greater accountability. An example of this can be assessments or reports both are professional papers that look for evidence and not unjustified judgements based on common sense. When working with service user, empowerment theory can be utilised by building positive self-esteem and focus on strength and potential of service users rather than problems and difficulties. It is essential to attempt to work in partnership and collaboration with service users. Radical social theory in practice can be seen as attempt to change system to fit to service user rather than change service user to fit the system. It is important to acknowledge that even if theory seems to match to a service user, it does not always mean that this is the right understanding of service users life. Even if theory appears to work, social workers still need to stay open minded and continue the process of being critically reflective. Social work practice is part of a process of evidence making where issues have to be constantly verified and checked out in the light of new circumstances or information. As mentioned before “no single theory can explain everything”. (Maclean & Harrison: p 15) Different approaches in social work practice are needed to suit different circumstances. As a qualified social worker, having in a depth knowledge of theories will assist me to be a reflective and critical practitioner, open to a greater degree to the needs of service users. Deeply and accurately consider all facts and issues and not taking anything at face value. Instead, one must remember to always probe beneath the surface in looking for a right answer.

Evidenced Based Healthcare and Research: Appraisal. In the United Kingdom the concept of ‘Independent Living’ and ‘Self-directed Support’ has become an established approach for the delivery of health and social care services, that it is currently the preferred residential alternative for people with learning disabilities (Binnie & Titchen 1999). Independent living can be defined as ‘enabling independence by receiving the right support how and when it is required’ (Morris 2004). It has now become a key principle in various government policy documents such as the Valuing People Now Strategy (UK Department of Health, 2009) and the Personalisation through Person-Centred Planning initiative (UK Department of Health, 2010).

This assignment aims to present a detailed critique of a qualitative study entitled ‘How adults with learning disabilities view independent living’ (Bond & Hurst 2010). A critique can defined as a balanced evaluation of the strengths and limitations of a research article, in order to determine its credibility and/or applicability to practice (Gamgee 2006). This study is a welcome contribution to the current health and social care research domain because whilst independent living is the preferred residential option, it is not at all clear whether it is suitable for all people with learning disabilities, moreover if there is in fact sufficient empirical evidence to support this notion. It is therefore imperative to establish a sound evidence base that draws upon the lived personal experiences of those with learning disabilities. Using an acknowledged framework ‘A Step by Step guide to critiquing a quantitative study ‘ (Coughan et al., 2007) the relative worth of the evidence in support of independent living will be judged systematically. As well as exploring the significance of independent living as an essential nursing intervention and its application to modern clinical practice.

Ryan-Wenger (2003) suggests that in analysing published articles it is important to ascertain two fundamental aspects of a critique which can be subdivided into elements that influence the robustness of the research methodology also known as ‘integrity variables’ and elements which influence the believability of the research such as writing style, author(s), report title and abstract otherwise known as ‘credibility variables’. The latter seems to be the most logical place to commence.

Evaluation of the Journal Article

Polit and Beck (2006) state that writing style should be such that it ‘attracts the reader to read on’; this paper is well written, comprehensive and concise. The structure and layout of the paper is well organised with a logical consistency and free from jargon in comparison to some papers where the author(s) can be opaque in their approach. However slight reservation is reserved concerning the level of proof reading as there seems to be some grammatical and typographical errors which can be found on pages 288 and 289. Both authors appear to have a sound background in learning disability from both a social context and educational settings. As indicated in the ‘acknowledgements’ the authors qualifications indicate that they have a degree of knowledge in this field and this piece of research seems to be a part of a taught component of their masters programme.

The report tile seems to be descriptive and succinct, although it lacks specificity of the research methodology used in the study. This can be very useful for others who are searching for this type of paper. Although the term ‘qualitative research’ is mentioned under ‘keywords’ the title itself could be more specific. As a result the report title is ambiguous and merely eight words in length. Meehan (1999) states that a title should be between ten to fifteen words long in order to clearly identify the purpose of the study for the reader.

This paper presents both an accessible and detailed version of the abstract, but are both helpful? The accessible form includes information on the subject and the number of participants, whereas the detailed form provides an outline of the methodology used, ethical framework, findings and recommendations. On balance the summaries present a clear overview of the study, however it does beg the question in what sense is the accessible form accessible? and to whom? It seems that the authors are trying to be politically correct rather than logical because how many service users actually read the British Journal of Learning Disabilities?. It seems that this is a ‘knee jerk’ reaction which has been applied incorrectly; it would be more suitable if the document was aimed at informing an audience with learning disabilities such as Valuing People (UK Department of Health, 2001) which caters to a wide range of readers. The ‘easy -read’ version is aimed at service users whilst the denser version is aimed at professionals and service providers. Having identified and analysed variables that affect the credibility of the research presented, how believable the work appears, the authors qualifications and their ability to undertake and accurately present the study. The robustness of the research methodology and the integrity of the findings will be appraised in order to determine the trustworthiness of the study and its applicability to nursing practice.

The authors state the aim of the study is to explore the views of nine people with learning disabilities who have already achieved independence and wish to contribute to the debate of independent living. The authors suggest that this style of living is now viewed as desirable, but what is the reality for people who live with learning disabilities? This concept of desirability is held as problematic by the authors who choose to study and present the reality of living independently as opposed to the notion of general and conventional wisdom. A study conducted by Barlow & Kirby (1991) concluded that people in receipt of self-directed support had ‘more life satisfaction than those in residential care’. This finding is further supported by the publication of Independent Living (HM Office for Disability Issues, 2007). The decision to suspend judgement about independent living is justifiable and is supported by other researchers in the field of learning disabilities; as there are several implications for service users, professionals and service providers. This is for a number of reasons for instance promoting choice and control (O’Brien, 2002), health issues (Priest & Gibbs, 2004), vulnerability (Cooper, 2002) and the ability for those with learning disabilities to access services (Jansen et al., 2006).

The literature review conducted by the authors demonstrates an appropriate depth and breadth of reading around independent living. The majority of studies included are of recent origin being less than five years old; the few historical studies included put the concept of living independently into context. The authors successfully identified conflicts between the literature by comparing and contrasting findings (Burns and Grove., 1997), because although evidence exists to show people who have moved from ‘larger institutions prefer smaller group homes’ (Forrester-Jones et al., 2002) there is still ‘no accurate data detailing the number of people with learning disabilities living independently’ (Beadle Brown et al., 2004). However the authors failed to mention how they conducted their search and information on the databases used to gather papers in their review. The authors did however, use primary sources of information as opposed to secondary sources and anecdotal information, which attests to the integrity and value of the study presented.

Bond & Hurst (2010) ascertained the narratives of nine people with learning disabilities via the use of semi-constructed interviews within their methodology. The authors are to be commended for their attention to detail in terms of their ability to design and structure interviews so as to accommodate the needs of the participants. As well as conducting interviews at times and venues convenient to them. The interview structure included open-ended questions to assist understanding as communication emerged to be a key barrier for some people with learning disabilities. The authors report on a number of theoretical issues that have been adapted for the participants in order that they might fully participate in the research process. The structure of the interviews was devised using the Canadian Model of Occupational Performance (Canadian Association of Occupational Therapists, 1997), but is this model applicable to the United Kingdom population and to which care setting? Bond & Hurst (2010) adopted ‘thematic analysis’ within their methodology in assessing the narratives. The data collected was audio taped and later transcribed into coded themes, which is acknowledged in general research literature to be good practice. On balance, the authors adhered to the steps in the research process and it is conveyed between the fluidity of phases.

The critique subsequently moves onto considering the ethical framework. This research paper was supported by the local ethics committee and all participants in the study gave informed consent. Although it is not clear whether or not it was an National Health Service (NHS) ethics committee. However, the authors sought to ensure their working methods complied with the Data Protection Act (1998) but not with all government legislation applicable to the study such as the Mental Health Act (1983). Although there is mention about accessibility, the authors failed to ensure the participants had the capacity to make informed decisions as defined in the Mental Health Act (1983). In relation to the number of participants, the sample size is small and therefore may not be reflective or wholly representative for all people with learning difficulties. Small samples are more likely to be at risk of being overly representative of small subgroups within a target population (Coughan et al., 2007). Therefore slight reservation is held as the authors did not mention whether they sought to remove overall bias by generating a sample that is likely to be representative and generalisable to the target population. Parahoo (2006) states that for a sample to truly reflect of the population it represents the authors must generate a probability sample. The participants in this study were recruited via convenience sampling using a third party (Melton 1998); however several variables could have an affect on the sample which can lead to it being distorted such as the vast age range. The authors are to be commended however, in their efforts to maintain the confidentiality of their participants by offering them the choice to provide their own pseudonyms.

In the discussion the authors identified seven themes from their data analysis which reflected the views of all the participants and in turn addressed the aims of the study. Their findings supported the four key principles as stated in the Valuing People policy document, and ways in which people can be supported to achieve this includes increasing social inclusion, increasing autonomy and choice for people and raising awareness of the vulnerability of those with learning disabilities. However the study also highlighted that the majority of participants struggled with the more complex aspect of living independently, such as money management and budgeting. The government has recently introduced ‘Direct Payments’ as part of a nationwide transformation in social care services, which involves paying money directly to an individual in need to take control of their own support and care services. This initiative will aid finance management as it enables service users to have control over the care they receive and how they receive it. The majority of participants maintained that when comparing their current lifestyle of independent living to that of their previous lifestyle it was clear that they wanted to remain living independently.

Application to Clinical Practice

This section will explore the significance of independent living as an essential nursing intervention and its application to modern clinical practice. Gates & Atherton (2001) state that there is a need for evidence of ‘effectiveness in health and social care’. The most important aspect of being a practitioner regardless of ones vocation, is that collectively we as professionals seek the best evidence available on which to base our practice (Coughan et al., 2007). The evidence in support of independent living is limited and not entirely accurate, therefore when evidence is presented it should not be taken on face value. As Cullum & Droogan (1999) put it ‘not all research is of the same quality or high standard’ therefore as a learning disability nurse and social worker it is important being a care provider that although a paper has been published it can be critically appraised. This paper is of central relevance to our practice in ensuring that the lifestyles of people with learning disabilities are informed by valid and reliable evidence. This research paper adds value to the current literature available in support of independent living however caution must be expressed as it is not solely about living independently. The concept of independently living cannot be advocated for everyone; each person is different and therefore require different levels of support which will meet their needs. The publication of Valuing People (UK Department of Health, 2001) the key document that prompted a change in the way health and social care services operate. The paper made Person-Centred Planning a central component of service reform, and outlined four key principles namely: Human Rights, Independence, Choice and Social Inclusion (Mansell and Beadle-Brown, 2004). This means that people with learning disabilities should be “valued members of society, treated with dignity and respect whilst having the same rights and choices as everybody else” (O’Brien, 2002). Furthermore, people with learning disabilities should feel empowered to take control over the care that they receive in order to plan and live their lives independently.

Previously, people with learning disabilities were shunned away from the community and susceptible to abuse. The Community Care Act (1990) was introduced as a result of both political and social changes in attitudes towards the treatment of people with mental illnesses. In line with Mental Health Act (1983) the aim was to remove the stigma associated with mentally ill people away from isolation towards social inclusion (Social Role Valorisation, Wolfensberger, 1983). But does independently living mean that you get social inclusion? Currently we are seeing a culture of people who require support being effectively excluded from society, waiting for the next support worker to cook their meals, help with personal hygiene and general cleaning. This is a downward spiral in our society which is putting a demand on our system. As a care provider in line with the General Social Care Council and the Nursing and Midwifery Codes of Conduct (2008), it is our duty to advocate in the best interest of the client at all times but who is actually making the decisions?

Bond & Hurst (2010) highlighted how closely health was linked to independent living and that many of the participants suffered from chronic conditions such as asthma, diabetes and arthritis. Is it a case of compromising funding for services at the expense of overlooking health issues? It seems that the authors make a plausible case that people with learning disabilities are being seen as not a priority as they carry a disproportionate burden of health inequalities among our population. The reality for people with learning disabilities is far from the projected lifestyle of independence (Emerson UK Literature). It is a challenge to support people with learning disabilities, several factors need to be considered to prevent potential disregard. Jansen et al., (2006) points out the need to adopt integrated care approaches in treating those with learning disabilities. This will involve working with different agencies (interagency team working) and different types of professionals (multidisciplinary team working) in order to provide an holistic service to meet their needs. Current research shows that a disabled person is likely to be in contact with at least ten different care professionals in their lifetime (UK Department of Education, 2003). Issues can arise through out this time which may lead to lack of continuity and communication. Therefore, a sufficient amount of training and awareness is needed to ensure that all staff are qualified and skilled to ensure equity of service provision.

When caring for patients it is essential as a practitioner to adopt the current best practice. To determine what this is one must be able to critically appraise evidence that is presented to them (Basset and Basset., 2003). This paper focused on the lived experiences of nine people with learning disabilities about the reality of living independently. In critiquing this paper, the authors successfully highlighted the importance of independent living as an essential nursing intervention however there were also some limitations, the most important being limited verification of the data. Furthermore the narratives of the participants were highly subjective and findings non-generalisable, thus the notion of independent living is not to be applied to all that have a learning disability, or vulnerable adults with complex needs. As recommended by the authors, further accurate, reliable and valid research is needed that will add value to the evidence-base domain.

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Excluding Headings and References

Evidence based practice (EBP) refers to integrating professional expertise with the best available external research, and incorporating the views of service users (Beresford, 1996). Evidence based practice has received its reputation by examining the reasons why interventions are necessary (Duffy, Fisher and Munroe, 2008). Within my placement EBP was important for refining my practice so the service user was provided with appropriate support for her individual needs. I used my EBP to carry out research to determine what evidence supported or rejected the use of a specific intervention; within this case I used a counseling approach.

The principle of social work intervention is to provide good practice and should be based on a decision-making framework (Preston-Shoot and Braye, 2009). This framework operates on four concepts:-

The legislation that informs a decision;
Social work ethics and NISCC codes of conduct;
Information to ensure a well-informed decision;
Knowledge drawn from research, theory, practice and other professionals.

In addition to powers and duties of social workers, legislation embeds notions of partnership, respect, rights and anti-discriminatory practice, which are key elements in social work practice (Preston-Shoot and Braye, 2009).

My practice learning opportunity involved working with adults with a learning disability in a day care setting. The benefits of the day centre were to provide a service for local people to access support in living with, or caring for someone, with a learning disability. Northern Ireland statistics show that in 2008 there were 9,460 people with a learning disability in contact with Trusts (www.northernireland.gov.uk). From the 9,460 people with a learning disability there were 2,574 benefiting from care management, 42% (1,086) of whom were being supported in their own homes and 35% (898) being cared for in residential homes solely for the use of people with learning disabilities (www.northernireland.gov.uk).

This evidence based case study is based on Miss A, a 35 year old woman, who has a learning disability and Spina Bifida resulting in her using a wheel chair for mobility. Within the past few years Miss A’s family life has changed dramatically. In previous years Miss A had lived in the community with her elderly parents, who cared for her. She is one of three children and has two older brothers. Miss A’s mother, after being diagnosed with Dementia, was admitted to a residential care home. Her father after having been moved to residential care himself passed away in November 2008 due to his physical health. Miss A now resides in a private nursing home and attends day care three days per week. In March 2008, there were 75 residential homes in Northern Ireland solely for people with a learning disability providing 898 places (www.northernireland.gov.uk).

Miss A has been previously diagnosed with MRSA; it is currently located in her toe, having been previously present in her urine. Treatments from the residential care staff have the infection under control, however the infection still remains.

The recent death of her father plays a significant role in Miss A’s life and continues to affect her socially and emotionally.

Some of the stereotypical assumptions I had before meeting Miss A were that because she had a physical and learning disability that she would be hard to communicate with, that she would have limited understanding and limited verbal skills. I have challenged this opinion and realised that Miss A is a very competent individual with good communication skills, and can express her likes and dislikes proficiently. As for her physical disability this does not affect her cognitive or cerebral functions. I had also made the assumption that as Miss A had MRSA that it could easily be cross-contracted due to a lack of knowledge and education. After researching the issue and contacting infection control within the Trust I deducted that MRSA is a problem within clinical settings but can be easily controlled with proper preventative procedures. This can be identified as a risk, but should not be a reason to oppress or discriminate Miss A.

After having initially met Miss A, liaised with her social worker, accessed her case file and Tuned In to her life issues, I met with Miss A to prepare for the initial assessment and gather information into how best to support her. My role with Miss A was to provide a reassessment since the changes in her circumstances and the death of her father. My role was to determine what support she may need, and to include her wishes and feelings.

Assessment:

History has shown that there has always been an importance to assessment in social work, but since the 1990’s there has been specific importance to a new form assessment to include risk. The National Health Service and Community Care Act 1990 stresses the importance of inter-agency collaboration and a multi-disciplinary assessment process (Trevithick, 2000). The purpose of an assessment may seem evident; that is, to assess the needs of individuals who may need help and/or support. In recent history however assessment seems to mean a relationship between need and available resources (Whittington, 2007, p23) leading to a question if this is ethical or effective practice?

There are many purposes of an assessment, for example to assess risk, to assess need, to act as an advocate for someone and also to implement agency and government policy (Whittington, 2007, p25-26). Coulshed and Orme (2006) explain that assessment is an ongoing process where the purpose is to understand people in relation to their environment; it is a basis for planning what needs to be done to maintain, improve or bring about change with the service user’s participation.

The initial preparation for the assessment with Miss A included visiting her social worker and studying her case file. This enabled me to gather information to dispel any preconceptions I had about meeting this service user. The social worker passed on her knowledge of Miss A, such as medical conditions, family circumstances and finances, and also any previous problems that had occurred. I felt it was important to work in partnership with Miss A’s social worker so I could keep her up to date with events, and also contact her if I required advice about Miss A. The purpose of Miss A’s individual assessment was to gather information by interacting and communicating with Miss A and others involved in her care, this was also to gain a holistic perspective to her needs. Her assessment was guided by legislation such as, the Chronically Sick and Disabled Persons Act (NI) 1978, which places a duty on health and social services to investigate a level of need, and also the Health and Personal Social Services (NI) Order 1972 which stipulates a responsibility to provide personal social services for the promotion of social welfare for the general public (http://www.understandingindividualneeds.com).

As a model of assessment I used Smale’s (1993) Models of Professional Care which were useful in gathering important information about Miss A. I used the procedural and questioning model to gather information into how Miss A felt about certain issues in her life, such as the bereavement of her father, contact with her other family, and other issues she felt were working or not working. I used these methods of assessment as this followed Trust guidelines. I used The Model of Professional Care to gain a holistic understanding of information. I also included the Exchange model in the assessment as I considered Miss A to be the expert of her own life. I feel the use of the Procedural model was useful in certain aspects of the assessment as it worked in collaboration with the Trust’s format of assessment and worked as a form of gathering information, but feel I could have used more of an Exchange model to communicate effectively with Miss A rather than just form filling. I feel Smale’s method of assessment provided me with tools to help Miss A identify factors that were important for her to maintain, but also issues she would like to change. By working in partnership with her I felt we would have an open and trusting working relationship.

I also focused on Person Centred Planning (PCP) in regards to the assessment with Miss A. Person Centred Planning, which evolved from the White Paper; a government policy known as Valuing People, suggested four key principles; Rights, Independence, Choice and Inclusion as a proposal of changing services (Thompson, Kilbane and Sanderson, 2008, p9). This policy also helped inform guidelines for Northern Ireland’s Equal Lives Policy (2005). Person Centred Planning focused on finding out what is important to and what is important for (health and safety) Miss A. I found PCP a continual process of listening and learning, by focusing on what’s important to Miss A now and in the future (Thompson, Kilbane and Sanderson, 2008, p27). By using person centred tools, such as a one page profile, I gained knowledge of what was important to Miss A including her family, her boyfriend and her independence, as well as knowing what was important to keep her safe and healthy. I used a person centred approach to make others aware of Miss A’s great personality characteristics as well as the help and support she would like. I feel this was fundamental to demonstrate that Miss A is a person behind her disability. I found by using this approach was an essential skill in understanding Miss A and helped me to be anti oppressive and actively support her needs

One particular piece of legislation which I found to be significant in the assessment of Miss A was the Human Rights Act (1998), which identifies Miss A’s right to family life. Since the death of her father and the institutionalisation of her mother due to her mental health, Miss A has been experiencing disintegration of her family and has lost the support connected to it. The Human Rights Act could have a great significance as Miss A needs emotional and physical support to visit her mother and has not been receiving it; therefore her right to family life is being impeded. The assessment identified that contact with her family and friends are imperative for this right to be upheld. Therefore as a result my role was to facilitate this right, and help to support Miss A in retaining family contact.

The main objectives we (Miss A and I) identified within the assessment were;

That Miss A had limited support to help discuss the death of her father.
That Miss A was not receiving contact with her mother or other family and would like to.

From the identification of objectives Miss A and I decided to work towards solutions by preparing a work plan.

Planning:

After the initial assessment was carried out with Miss A we proceeded to work towards formulating a care plan and targeting her objectives. A care plan provided clear information for everyone involved with Miss A and helped work in partnership with her and the Trust. For a person centred care plan the word ‘support’ is used in preference to ‘care’ because the verb implies that support is there to help people achieve their goals and ambitions” (Thompson, Sanderson and Kilbane, 2008). “A support plan is developed by the person with help where necessary, and it describes how the person intends to be supported in order to live their own life” (Thompson, Sanderson and Kilbane, 2008). I feel the use of a support plan with Miss A, rather than a care plan is an anti-oppressive method, as it incorporates Miss A’s feelings and opinions into how she wishes to be supported.

I used the formulation of a support plan with Miss A to record the objectives she would like to meet and used these to formulate an intervention. It was clear from the assessment and one page profile that limited contact with her mother was an issue, and that the death of her father had a significant impact on her life.

I then proceeded to investigate theory of loss and grief as I had never experienced a loss of Miss A’s magnitude before. I found the Kubler-Ross Model and the 5 responses to grief to be particularly informative. (Goldsworthy, 2005). This theory helped inform my knowledge and in turn helped me be empathetic to Miss A. I was able to identify that Miss A can experience the 5 stages of grief and that they are not necessarily in a specific order. I felt Miss A was at two stages of grief, some days she experiences anger at her father leaving, and other times she has deep feelings of depression of losing him. I was able to use Kubler-Ross’s model to identify these stages in Miss A, and also to advise her that these feelings were part of the normal process of grief.

The assessment also identified that Miss A had a lack of support in discussing her feelings of grief. Research suggests that people with learning disabilities experience many of the emotions of bereavement but are limited in the opportunities they have to resolve their feelings of grief (Cathcart, 1995; Elliot, 1995; Read, 1996). There are many reasons for this and Murray et al explains that historically, professionals, parents or carers of individuals with learning disabilities believed that those in their care did not understand the concept of death and thus were unable to grieve for the loss of a loved one (McLoughlin, 1986; Elliot, 1995; Read, 1996 cited in Murray et al. 2000). Kitching (1987) and Bradford (1984) highlight that the capacity to grieve is not dependent on a person’s intellectual ability, but that a person with learning disability may experience grief in the same way as a child. Therefore research shows that people with a learning disability experience grief and loss but have a limited support network to discuss it with. I used this research to formulate a plan for the intervention with Miss A and we concluded that I could be support for discussing her grief.

From the assessment and care plan with Miss A, and following discussions my practice teacher, I discussed that I would use counselling skills to help support Miss A with her feelings of grief. I felt Miss A needed her emotional needs met since the feelings of the death of her father were so dominant. Miss A and I also decided that I would facilitate visits to her mother for emotional and physical support, as her mother was in the latter stages of dementia and Miss A found it hard to communicate with her.

Intervention:
Rationale for Counselling Intervention:

After having conducted an assessment and care plan with Miss A, and building a rapport over numerous meetings, it was decided that a counselling intervention would be the most appropriate form of support for grief. My practice teacher and I felt that if Miss A had the opportunity to discuss her feelings this would help her grieve more effectively and perhaps help her cope better.

The two models of counselling that are prominent in social work are the work of Carl Rogers and Gerard Egan, who base their counselling approaches from psychodynamic work around inner thoughts and feelings. Both counselling theories “reflect the social work values of accepting the individual, using skills in listening to the information that is given, and work towards a joint understanding and decision making about ways forward” (Coulshed and Orme, 2006). I focused on researching counselling theory to help me understand how I could help Miss A through her grief. Trevithick explains that within social work, humanistic approaches to counselling have been particularly influential, specifically with the work of Egan (1990) and Rogers (1961), mainly because they promote personal freedom and are consistent with anti-discriminatory practice and anti-oppressive perspectives” (Trevithick, 2000). I found that the Roger’s (1961) Person Centred counselling informed me that I could show unconditional positive regard for Miss A and understand that she is the expert of her own grief.

I also analysed Egan’s (1990) Skilled Helper Model and found it to be an effective theory for an approach to counselling. I found that the structure and framework of the model and the three stages were useful as a guide to follow. I found that although this method of counselling may not be as person centred as Roger’s it could be more effective in helping Miss A understand her own grief as it followed a certain framework, could empower her and could be evaluated over time. This theory helped inform my practice by helping me realise that I do not need to be a qualified counsellor to support someone; I just need to be able to actively listen, to use empathy and be reassuring knowing that Miss A’s agenda is paramount. I consider this in itself to be a person centred way of counselling.

I decided to follow a combination of Rogerian method and Egan’s approach to help support Miss A as an intervention. I decided I would use the structure of Egan’s model to help build a logical, consistent framework to the intervention, while using the core principles of the Rogerian approach to demonstrate my skills and values, such as working with respect, empathy, genuineness and good active listening (Coulshed and Orme, 2006).

Counselling Procedure:

Egan’s Skilled Helper Model form of counselling provides a structured and solution focus basis. It is a three stage model in which each stage consists of specific skills that the helper uses to support the service user move forward (Nelson, 2007). Egan’s model is described as a three-stage process: identification of the service user’s current issue(s); identification of the service user’s desired situation; and the formulation of an action plan to achieve this. This process is facilitated by the “skilled helper” using the skills outlines by Egan (Nelson, 2007).

The goal of using Egan’s model with Miss A was to help her manage her grief and better understand the “norms” associated with it, such as anger or depression according to the Kubler-Ross Model. Egan (1998) claims his model is to ‘help people become better at helping themselves in their everyday lives’. To provide Miss A with the empowerment to help herself grieve.

The use of Egan’s Skilled Helper Model was to explore how Miss A felt about her bereavement. I used it to ask open questions about how Miss A felt about her father. We explored her past and discussed her relationship with her father before his death. I also used this stage to focus on aspects of her father before he died and what she missed about him, this was to explore and gather information about what her relationship was like with her dad. I was able to use a range of skills to gather information about Miss A’s grief. Trevithick (2000) explains that social work skills are “the degree of knowledge, expertise, judgement and experience that is brought into play within any given situation, course of action or intervention” (Trevithick, 2000).

Some of the skills I incorporated into Egan’s counselling were active listening, I used this skill with a range of non verbal cue’s to indicate to Miss A that I was interested in what she was saying. I concentrated on active listening as Miss A was portraying feelings and knowledge of the death of her father which was a sensitive subject and needed my full concentration. I portrayed active listening by nodding, giving eye contact and facing Miss A which were successful in helping build a rapport with Miss A, thus helping her open up. Another skill I feel I used well with Miss A was empathy. I feel I portrayed my feelings of empathy by responding appropriately to her answers and reassuring her that her thoughts and feelings around grief were normal. I found myself using Empathy a great deal with Miss A as I had never experienced bereavement before and she helped me understand how it felt. It’s easy to imagine how someone feels, but when you’re faced with helping them I felt I really needed to place myself in “her shoes”.

I also found I made good use of silences with Miss A, I used these to give her time to reflect on her thoughts and answers. I have found by doing this that the meetings were paced better, and showed that she was the expert of her own grief and I was just there to listen and to reassure her. I found that by using Rogerian person centred skills like genuineness, empathy, communication and active listening I was able to understand Miss A and show her that I was there to support with her agenda. Throughout the discussions of grief I feel Miss A was able to vent a lot of her feelings that she had since her father’s funeral. I feel I was able to support her understand those feelings and help her recognise that anger, depression, or denial are normal feelings that many people in her situation suffer.

Throughout Egan’s Skilled Helper Model and each of the sessions with Miss A I found that she responded well to being able to discuss her feelings with someone. The Rogerian influence on the intervention enabled me to build trust, partnership and a good rapport with her facilitating an open working relationship and providing her with support.

Some of the values I tried to incorporate into my counselling and indeed my relationship with Miss A were empowerment and self-advocacy, by letting her know that her agenda was central. I wanted to create a balance of power and to provide a supporting role rather than a dictator role, which I feel I achieved by being able to listen to her views and incorporating PCP. Social work has a distinctive value base with beliefs and principles playing an important role in practice (Thompson, 2005). Challenging my values has helped me to treat Miss A with unconditional positive regard, and with the respect and dignity she deserves. I have challenged my values anti-oppressively by researching MRSA and not making assumptions about the condition; I have challenged my stereotypical attitude around learning disability demonstrating that Miss A is first and foremost a person with feelings and issues before recognising she has a disability.

Evaluation:

On evaluation of the Egan’s Skilled Helper Model and my intervention with Miss A have shown that her agenda was central to the sessions, a balance of power was necessary to achieve the trust and respect of one another and that listening is paramount to providing effective counselling. I entered the sessions with Miss A being unaware of what to expect, I was troubled that I would not have enough knowledge about grief to help support her. After the initial session I soon realised that I didn’t need to be a qualified counsellor to make a difference to her understanding of grief, I just needed to be able to explain her feelings to her and reassure her that they were normal and not as she phrased it “being mental”. I found that by working with Miss A using the Skilled Helper Model I was able to apply my skills of listening, communication and empathy to help her understand her feelings. I have never personally had a bereavement of Miss A’s scale before but feel as a direct result of working with Miss A I have learned that grief is a powerful emotion for anyone to experience and it can take a significant amount of time to recover from. The only regret I have of using the Skilled Helper Model was that I feel I did not have enough time to fully help support Miss A, I feel as I had a placement of only eighty-five days I did not have enough time to fully counsel her for the best outcome.

I feel throughout the intervention process I tried to maintain person centred principles with Miss A by providing her with the opportunity to discuss what was important to her. Research shows that the use of Egan’s model is not person centred as it incorporates the counsellor to ask all the questions, and therefore have the control; but I feel by working in partnership with Miss A to discuss the death of her father was important for her emotional well being and empowered her to help resolve her grief. I also incorporated Roger’s core skills of genuineness, respect and trust to achieve this

Conclusion

Through working with Miss A I have found the experience to be invaluable learning. I have discovered that there is a spectrum of ability with adults and their learning disability. I have found that each person is an individual, and that group care is not necessarily recognising of this. In regards to Miss A I have learned not to make assumptions or stereotypes before meeting the person, as this can lead to oppression and even discrimination. Miss A is an individual, with individual needs, and at this assessment and intervention her emotional needs were prominent.

I feel I completed the aims I had intended to by supporting Miss a through her grief using Egan’s Skilled Helper Model. I incorporated Roger’s core skills into this model to help facilitate person centred sessions, and create an understanding that she was the expert, and I was there to listen and support her. If I was to repeat the intervention I would use Egan’s model again as it provided me with a structured, logical framework to work with and provided me with the identification of the skills I needed to make the sessions successful and effectively counsel Miss A.

I feel my future learning needs from working with Miss A are to use more formal language as I identified I talked to her informally using words such as “wee”. I feel I did this to appear more friendly rather than her social worker, but realise this is not a professional manner to work. Other learning needs I identified were to pace the sessions more appropriately and ensure that Miss A understands the conversation. I feel during the initial sessions with Miss A I spoke more to engage her in the discussion, and feel this was more of a nervous reaction to having to counsel Miss A. During later sessions I was able to take this skill into consideration and settle quicker into sessions to give Miss A the opportunity to discuss what she wished.

Overall I feel my relationship with Miss A was good, I feel the assessment and intervention were successful, and I feel I worked in a person centred way incorporating knowledge, skills and values to inform my practice. I feel Miss A felt positively about our work together as her feedback from sessions indicated that she was satisfied with the support I provided.

References:

1. Beresford, P. (1996) The Standards we Expect: What Service Users and Carers Want fromSocial Services Workers. London: National Institute of Social Work

2. Bradford, J. (1984) Life after a Death, Parents Voice 34: 6-7

3. Cathcart, F. (1995) Death and People with Learning Disabilities: Interventions to Support Clients and Carers; British Journal of Clinical Psychology 34: 165-75

4. Coulshed, V., and Orme, J. (2006) Social Work Practice. Palgrave Macmillan, Fourth Edition

5. Duffy P, Fisher C, Munroe D (2008). Nursing knowledge, skill, and attitudes related to evidenced based practice: Before or After Organizational Supports. Medsurg Nursing 17 (1): 55-60

6. Egan, G (1990) The Skilled Helper: A Systematic Approach to Effective Helping. Pacific Grove, CA: Brooks/Cole

7. Elliot, D. (1995) Helping People with Learning Disabilities to Handle Grief, Nursing Times 91 (43): 27-9.

8. Goldsworthy, K. (2005) Grief and loss theory in social work practice: All changes involve loss, just as all losses require change, Australian Social Work, 58:2, 167 — 178

9. Kitching, N. (1987) Helping People with Mental Handicaps Cope with Bereavement, Mental Handicap 15: 60-3.

10. McLoughlin, I . (1986) Bereavement in the Mentally Handicapped, British Journal of Hospital Medicine October: 256-60.

11. Murray, G., McKenzie, K., and Quigley, A. (2000) The Grieving Process in Individuals with a Learning Disability; An Examination of the Knowledge and Understanding of Health and Social Care: Journal of Intellectual Disabilities; 4; 77

12. Nelson, P. (2007) An Easy Introduction to the Egan’s Skilled Helper Solution Focused Counselling Approach. Palgrave and Macmillan (Online at www.f-e-t-t.co.uk) (Accessed 2 March 2009)

13. Preston-Shoot, M., and Braye, S. (2009) Social work intervention (Online) – Available at: http://www.scie.org.uk/publications/elearning/law/law08/index.asp [Accessed 5 May 2009].

14. Read, S. (1996) Helping People with Learning Disabilities to Grieve, British Journal of Nursing 5 (2).

15. Smale, G and Tuson, G. (1993) Empowerment, Assessment, Care Management and the Skilled Worker. London. HMSO

16. Thompson, N. (2005) Understanding Social Work: Preparation for Practice. Second Edition. Palgrave Macmillan

17. Thompson, J., Kilbane, J., and Sanderson, H. (2008) Person Centred Practice for Professionals. Open University Press.

18. Trevithick, P (2000) Social Work Skills: A Practice Handbook. Open University Press.

19. Whittington, C. (2007) Assessment in social work: A guide for learning and teaching; London.Social Care Institute for Excellence

20. Williams, P (2006) Social Work with People with Learning Disabilities. Learning Matters Ltd

Other:

21. http://www.northernireland.gov.uk/news/news-dhssps/news-dhssps-october-2008/news-dhssps-101008-community-statistics-for.htm (10/10/08) – (Accessed on 8 May 2009)

22. http://www.understandingindividualneeds.com/policyandprocedure/statistics.htm (Accessed on 24 April 2009)

Evaluation of Social Work Practice with Hispanic Children and Families

Example of a practice evaluation

A practice evaluation is a review and evaluation of individual practice within program and how the practice affects the person or recipient of services. Within The Place for Hope and Restoration, is the Raid and Rescue program has service practices for the “outreach workers” is to “raid” the streets to identify possible victims, such as prostitutes, exotic dancers, and/or service workers, such as cooks, busboys, waitresses, and day laborers. The outreach workers provide information about the other programs of the agency, to include how they can provide a safe place to stay, help the victim learn how to be a survivor, provision of advocacy and legal services, etc… and offer “rescue” service, to include transportation to the Safe Harbor program and the other programs within The Place for Hope and Restoration. How these service practice affect the person is essential in identifying the impact to the individual, the staff, the agency and the community. Some areas of practice to be reviewed would include: access, safety, effectiveness of outreach, raid procedures, barriers to the raid and rescue process, along with the needs of the individuals and program. Through the use of data, such as structured record reviews, individual case reviews, surveys or other data, the program practices can be evaluated regarding the efficacy, efficiency, and outcomes. Through evaluation of the practices of the Raid and Rescue program, stakeholders will be able to determine the ongoing needs of the practices, identify program deficits and determine if the practices are meeting the defined outcome measures for the target population and the community. This should assist the overall program in determining the need to continue, modify, or discontinue the practice utilized by the Raid and Rescue program to meet the needs of the stakeholders.

Example of a Program Evaluation

A program evaluation is the systematic review of a “program’s current (and future) interventions, outcomes, and efficiency to aid in case – and program-level decision making in an effort for our profession to become more accountable to stakeholder groups” (Grinnell, Gabor, & Unrau, 2012, p.26). Program evaluations come in a variety of formats, but should include evaluation of the program’s goal(s), mission, program objectives, practice objectives and activities (Grinnell, Gabor, Unrau, 2012, p. 55) to determine if the outcomes and purpose of the program are being met. As noted previously, The Place for Hope and Restoration has multiple departments including outreach, Safe Harbor, fundraising, advocacy and policy, and administrative services. Within each department there are several programs. An example of this is the outreach department has the “Raid and Rescue” and “Community Outreach” programs under it. Each program then has specific goals to meet the needs and requirements of the stakeholders and funding source(s). A program evaluation is focused on the specific program, not the department nor the specific practices, though they are part of the comprehensive program evaluation.

Utilization of the Six-Steps of the Program Evaluation Process

The first of six steps of the evaluation process for a program would include the engagement of stakeholders. To evaluate the Raid and Rescue Program, stakeholders would need to be identified and engaged to provide feedback. This will be accomplished through a variety of formats including public hearings, meeting with community service coalition groups, and the use of standardized survey tools. Both internal and external stakeholders should be involved in this evaluation process. Internal stakeholders would include those involved in the operation of the program. This includes, but is not limited to, funders, board members, administrators, staff and volunteers. External stakeholders would include law enforcement, legal services, community service programs, family members, elected officials, and the community-at-large. The recipients of services are also key stakeholders and need to be involved in the evaluation process, both those who are currently participating in the program, those who have transitioned into other programs of the agency and those who either refused or did not follow through with accessing raid and rescue.

The next step in evaluating the program would be to clearly describe the program. To do this one must identify the expected effects, activities, resources, stage of development, context, and logic model (Grinnell, Gabor, & Unrau, 2012, p. 31). This will be achieved through the review of the agencys strategic plan, the mission statement, funding requirements, and various other agency resources that describe what the purpose and goals of the program. The third step of this program evaluation process is to develop a plan of how the program will be evaluated. For the Raid and Rescue program, the Theory of Change will be utilized to determine if the program is effective and what the practices are effective within the program. This will be completed through a retrospective chart review, client and stakeholder surveys, and stakeholder focus groups. Step four is the gathering and evaluation of data (Grinnell, Gabor, & Unrau, 2012, p. 32). For this program the data from the surveys, chart reviews, and focus groups will be gathered, analyzed to determine strengths and areas of need. Data will be presented as both qualitative and quantitative data, to demonstrate success rate, completion rate and other variables, determined by the stakeholders. Outcomes towards program goals will also be evaluated to determine if Raid and Rescue is reaching victims and if their practices are helping victims. Step five is tied directly into step four of the evaluation process as this is the development of conclusions and making recommendations, based upon the data. To complete this step one must “judge the data against agreed-upon values or standards set by the stakeholders” (Grinnell, Gabor, & Unrau, 2012, p. 33) and present the conclusions in a clear and consise manner. Lastly, there is a need for follow-up regarding the program evaluation in order to ensure the process was meaningful. The results should be disseminated, meetings should take place to review the results with key stakeholders, such as advisory committees, management staff, project teams in order to prioritize any needs and outliers of the program and develop action plans, based upon the identified needs or to continue current practices. The stakeholders should also be provided information regarding the successes of the program through focus groups, reporting results back to coalition groups, and through the use of media, such as newsletter articles, social media formats, program reports to funders, and formal reports to board members.

References:

Grinnell, R. G. (2012). Program Evaluation for Social Workers (Sixth ed.). New York, N.Y.: Oxford University Press, Inc.

When researching the changes that have taken place in the last decade, it is notable that law, guidance and application to practice are constantly under revision. The aim of this project is to identify and assess the impacts of the recent changes in child protection as well as public opinion and awareness of them.

Evaluating changes in child protection is challenging as defining the rights of children has never been particularly straightforward. Once, in Victorian times, they were considered the property of parents who can treat them in whatever manner they like. Fortunately, most people today believe that children should be emotionally safeguarded and should receive protection from government agencies from physical and sexual abuse. In examining how child protection has evolved during the past ten years, this project will also be discussing the facts and misconceptions about class and sexual abuse. Different types of data were used to identify those – secondary research section underlines previous studies, findings, evaluation of government and voluntary agencies actions in order to come to a conclusion, whereas in primary research data was collected by using a questionnaire to summarise public opinion and trends about the subject. Feasibility study was conducted to identify any possible difficulties in completing the project and methods used are evaluated in methodology section.

Whilst assessing the changes in policies, the research will give an insight into public attitudes and government legislation regarding child protection which is of interest to students who are hoping to progress onto a Social Work degree course and pursue their future career working with children. For students who are hoping to work with adults, the research might provide base for understanding the problems of paedophilia and an insight into recent Acts of Parliament. This was the reason why the research topic was selected.

Secondary sources of information, such as journal articles and government publications, will be selected to identify recent changes in the system. Even though these are widely attainable, the terminology used in selected journals is exclusively directed to professionals who work with children and some additional research will be essential in order to understand the topic and some legal terms. Whilst secondary data will be obtained from books, journals and government publications, the primary data will be obtained from an interview with a child protection professional and questionnaires which will be completed regionally and anonymously by adults. Therefore, time will need to be designated for designing the questionnaire and interview questions. Questions will need to be written so that answers provided will be easy to analyse. However, primary data will not be obtained from children due to the sensitivity of the topic. Basic computer skills, forward planning, determination and patience will be necessary in producing the following.

Marina Trifunovic

Methodology Study: Analysis of the Methods Used to Complete the Project

The project is structured according to the requirements of the grade descriptors and it is outlined to meet the standardised criteria. In addition, the methods used in gathering primary and secondary data were suggested and encouraged by the college tutor. The research for the project involved gathering primary and secondary data and its cogency relies on validity of those sources. The information is independently generated using the methods which are briefly evaluated in this section.

In terms of secondary data, validity was assured by using a variety of sources, such as books, newspaper articles and web pages which demanded patience and persistence. However, it provided a fundamental base for the project and most significantly, it subsequently led to a greater knowledge of the subject. Application of this knowledge allowed the critical evaluation of the issues relating the child protection. This broad approach to secondary research imposes time limitations and requires excellent understanding of the terminology.

In addition, primary data was gathered using the questionnaire and an interview with a child protection officer, employed by the NSPCC in Manchester. The interview with the social worker provided an excellent insight into the issues related to child abuse and poverty. However, the preparation for this was time consuming and difficult due to the limited availability of the interviewee and even though she tried and stay objective, some subjectivity as well as a degree of interpretation might have influenced the findings. Measures were taken to enhance the reliability of the findings generated by questionnaire by using a public sample from various age groups, genders and occupations and similar results enhance validity of the findings. However, the questionnaire was completed regionally and with a relatively small sample (36 people took part) which does not allow generalisation. Unlike interviews, using questionnaires does not require prior arrangements and information can be collected from a large number of people relatively easy.

Qualitative data used in the research covers a very broad area of different aspects to child protection. This is gathered from secondary as well as primary sources. Though information is brief comparable to that gathered by quantitative approaches, it poses difficulties when measuring it with reliability. Qualitative data found in secondary research such as in numerous books and journals require intensive reading and analysis in order to determine appropriate sources of information, e.g. finding and recognising the objective data in newspapers articles. Qualitative data is descriptive and this method was used to gather information using an interview. Nevertheless, the qualitative data poses risks in terms of written work as it is easy for a researcher who is still learning about the subject to express it in a descriptive rather than analytical manner. In this project, a degree of critical analysis was maintained by constantly questioning why findings are in a way as they were found.

Quantitative data was obtained by counting and coding the information gathered by the questionnaire in primary research. The information was transformed into numerical data and represented by using charts and graphs in the primary research section. This was further used to numerically measure the public opinion of child protection as well as to support the qualitative data and evidence found and analysed in secondary research. However, quantitative data in this project is not an infallible indicator on how people actually feel about child protection. The questions which were left unanswered in a questionnaire might be interpreted as the information which could not be limited to numerical descriptions and due to the sensitivity of the topic, some socially desirable answers are expected.

Marina Trifunovic

Secondary research: Changes in Child Protection During the 2000s

Law and guidance which regulates the child protection is constantly under revision. Nevertheless, the twentieth century featured the shift in attitudes when the family moved on from Victorian times where “Children were seen and not heard (Morgan,1985, p.89)”. Fortunately, most people today believe that children are not property of their parents and that they should be emotionally safeguarded and when necessary receive protection from government agencies from physical and emotional abuse. Therefore, when a report is made, the child is usually taken from the parents and put into care. Many sociologists believe that this is primarily associated with the lower socio-economic classes because poverty is believed to be related with increased chances of instability in the family (NSPCC, 2011). Although that is statistically correct, children in more desirable neighbourhoods may be more vulnerable if there is a general belief that childhood abuse could not possibly happen in these areas as poor children appear to be the easy choice for the sexual predators of the world. In examining how child protection has evolved during the past ten years, also the secondary research section involves analysis of the facts and misconceptions about class and sexual abuse.

Child Protection Reforms

Every society has an interest in protecting its children, not only because they are the stewards of the future, but because one of the merits which grades the level of development of civilisation is how well a particular culture treats its children. In England, there have been some arguments about reinforcing social values of the English way of parenting on people from foreign cultures. However, the tragic story of Victoria Climbie had influenced politicians to discuss the ways to improve the law in place with regards to child protection in the UK. The Labour government also analysed how the holes in the system could be closed and systematically, the media had played a role in informing the public of what was regarded by the journalists as a ‘ blinding incompetence’ of government agencies (Lonne, 2009). The inquiry into the case discovered that a number of agencies such as the police, NHS, NSPCC and local churches that Victoria attended all noticed the signs of abuse, but had done nothing to assess the situation. As a result of the ‘blinding incompetence’ in which way this case was assessed, Parliament passed an amendment to the original 1989 Children Act to the ‘updated’ 2004 Children Act (The National Archives, 2011). These amendments to the Act gave much greater discretion to child protection agencies and power to react when protecting children and the new principle of ‘every child matters’ led officials to not dismiss certain cases because of the social or cultural background of the child in question.

The Home Secretary appointed a review of safeguarding children in June 2007 and measures were put in place to ensure better communication and cooperation between the agencies and the government agencies are exchanging data regarding sex offenders in England and Wales under the guidance of ‘multi-agency public protection arrangements’ (MAPPA). In a controlled way, information is also made available to various people, such as teachers, employers, landlords and parents. The extent to which information is reviled involves regional variations and is further stimulated by a campaign for sex offenders disclosure scheme, commonly referred to as ‘Sarah’s Law’. This scheme was piloted in Hampshire, Cleveland, Cambridgeshire and Warwickshire over a one year period in 2008 and it allowed members of the public to attain information from the police about any sex offending convictions of an individual, for example, a family friend or a neighbour. However, the scheme does not mean that information is unreservedly made public. During the pilot period a total number of 585 enquiries were initiated, 315 of which were preceded further and resulted in a total of only 21 criminal disclosures being made. Also, 43 disclosure applications prompted other safeguarding actions such as referral to social services (Almandras, 2010) which indicates the scheme’s useful application in practice.

The Home Office carried out the research which concluded that criminal justice agencies had benefited from ‘Sarah’s Law’ which resulted in increased intelligence as well as in an improvement in a way which public concerns are handled. This led to an announcement in August 2010 that the scheme would expand to twenty more police force areas and remaining forces were invited to consider the introduction of the scheme by March 2011. However, even though police seniors feel confident that information which is disclosed under the scheme will remain confidential, organisations such as NSPCC have stressed that criminal disclosure might encourage violent attacks.

When evaluating this extent of information disclosure, it is important not to forget that it only involves the information about individuals who have been convicted for a sexual offence. This does not eliminate the need for public awareness to safeguard children from yet unknown offenders.

Other significant methods to tackle the child abuse include a cultural shift of condemning violence within the home to the same extent as violence outside the home, and some researchers argue that Parliament could pass more amendments in safeguarding children, notably against corporal punishment, such as the case in sixteen European countries, as a part of a revised Children Act in future (Wilson and James, 2007). Nevertheless, designing a strategy to tackle the issues of child protection involved creating a profile of child abuse, for example, assessing which families would be more at risk to abuse children and social workers concluded that a degree of risk is strongly correlated with poverty, social isolation, family breakdown and poor parent-child relationships (Wilson and James, 2007). This has led government and voluntary agencies to focus their work on poorer households where such risks are statistically more possible as the economic factors inevitably create stress that can accumulate and result in parents to take out their frustration on their closest family, most notably on their children.

Struggling to survive and financial problems, however, are not the primary reason behind the child abuse among middle and higher class families. Studies have found that abuse in the higher social circles are directly related to factors such as the abuse of drug and alcohol, and there is some hesitation to prosecute perpetrators from middle-class and upper-class backgrounds because they would be unable to provide economic support to their family members if they are prosecuted and put in prison. In addition, such an individual would be able to bring more financial resources to fighting the legal charges and it is argued how it would be easier for such a person to obtain personal references from affluent friends and family as well as have an advantage of the access to greater funds for legal help (Faller, 1993).

New Labour reforms and Children Act 2004 aim to prevent children from being on repeated reports on the child protection registers (Powell 2002). In practice, this means that children would be much less likely to be removed from one abusive situation and placed in another. The reforms of the government legislations reinforce increased measures for assessment of the prospective foster parents, and more strict evaluation of the biological parents who are hoping to gain back the custody of their children (Powell 2002).

Protecting children online

Government experts argue that parents, influenced by media, are contributing in creating the ‘paranoid’ culture and thus are overprotecting their children. The ‘risk-averse’ approach to raising children has resulted in an increasing number of children who are exploring the world of the internet and particularly social networking sites as they are disallowed to play outside. London School of Economic had carried the comprehensive survey which found that ninety eight percent of children have access to internet (UK Children Go Online, 2006) and another study concluded that nearly all questioned parents (95%) do not recognise the slang that their children use to let other people know that their parents are supervising them (Netlingo, 2011). Nevertheless, the generation gap often leaves parents unable to fully understand the complexity of the conduct of ‘cyber bulling’ nor significance of online safety (Khan, 2009). This influenced the government to react and the agencies such as CEOP, UKCAS and IWF are developed and designed to provide information and support for the victims as well as minimise the availability of images of child sexual abuse and help to prosecute the offenders. The number of intelligence reports from Child Exploitation and Online Protection Centre (CEOP) that led to police arrests increased from eighty three in 2006-2007 to four hundred seventeen in 2009-2010. In 2009, Prime Minister Gordon Brown, marked the UK approaches to online child protection as ” one of the most effective in the world (IWF, 2009)”.

Childhood Sexual Abuse: A Class Distinction

Childhood sexual abuse in reputable families was often undetected because the biggest percentage of the higher classes appears to consist of respectable citizens. From a sociological point of view, taking children into care would be a more difficult decision in these cases as sexual abuse that involves immediate biological relatives is statistically more rare comparing to those involving lovers of the parents. Career people, doctors, teachers, and successful men, sometimes women, as well as ministers of church were therefore able to carry on the sexual abuse of children because of the widespread misconception that such terrible things could not possibly be committed by these ‘model citizens.’ Another reason why many offenders were successful in hiding their crimes was because they chosen the victims who were often vulnerable and lonely children that did not have warm relationships with parents and intended to obey authority. For example, in one case study, a child was abused in front of the neighbours who simply looked the other way because the father of the abused child had created a ‘negative opinion’ of the child in their minds by repeatedly telling them what a naughty and difficult child she was. So when he chased her around while she was undressed and hit her outside, the neighbours thought nothing of it as it was an all white, middle class neighbourhood where ‘such things never happened’ (Itzin 2009).

‘Their targets are not the conventionally perceived social underclass, though many victims will be drawn from that, but are rather from a collection of groups who form the fodder of abusive networks; who are subjected over and over again throughout their lives to multiple abuses’ (Itzin 2000, p. 390).

Unfortunately, there is no way to completely eliminate the horror of sexual abuse from society, but there is a way to encourage a shift toward making children less vulnerable. Children Act 2004 recognised children as individuals in their own right who do not deserve to be beaten, raped, or psychologically tortured. Protecting children from harm should be a responsibility of all adults as well as implementing a zero-tolerance policy on child abuse and prosecution as well as rehabilitation of all offenders, regardless to the social class.

Ethics as it is being used in the health sector is a concept that has evolved over time. There is no doubt that every player in the sector seeks to continually improve their services delivery as well as attaining maximum patient satisfaction in the process. In the last few years, ethics in health has developed through a number of stages. Hippocratic culture dominated traditional ethics in the 1960s where health care providers established relationships with patients. The core values of this relationship were derived from culture. The technological advancements and intensive research has seen developments in biological sciences and biotechnology. With such changes, a new ethical dimension was introduced.

Ethical principles of human dignity, compassion, non-malfeasance and social justice

However, with time a dilemma arose from the liberalization of health care industry. There emerged a need to harmonize the differences in health needs and resources availed for filling the gap. The scope of health ethics was thus expanded to include quality control, economics, policy formulation and implementation as well as massive research and development. Such efforts and resource harmonization gave birth to an era of health policy and ethics. As time advances there are debates on human rights protection and respect of human dignity (Bryant, Hyder and Kauser, 2007). It is now a fundamental right for every individual to enjoy quality health care without discrimination of any kind. The most recent dimension of health ethics is the fusion of lauded human rights and the fundamental right to obtain quality health services.

Contrary to direct definition of health, as the entire state of well being in terms of mental social and physical status of an individual, ethics and human dignity issues are more complicated to completely expound on them. Ethics is solidly founded on cultural convictions developed over time. It derives its relevance and strength from religious and philosophical advocacies deeply embedded on the present leadership systems. It is considered as the ability of a community to clearly and amicably draw a boundary separating what is perceived as wrong and what remains a right thing.

Such a boundary touches on the aspects of life right from the way of doing things to the general perception of life. It becomes a big understatement to define ethics without mentioning the famous dimensions used to describe it. It is a cumulative approach of respect to humanity with specific focus on maintenance of autonomy of a person, delivery of justice, rights and upholding of human dignity. Ethics in health policy formulation and implementation focuses on the most cost effective means of delivering a quality health care to all. It is in this light therefore, that ethics attempts to strike a balance between the policies and values cherished by an entire community.

Equity is another paramount aspect of importance which cannot be neglected. It is about all that appertains to fairness in the ultimate distribution of gains derived from a robust health advancement which is socially acceptable. It is a concept that goes beyond just accessing health care products but touches on the response aimed at meeting the needs of all persons. Equity aims at ensuring that no one individual is favored in the allocation of resources as well as availing of equal chances of accessing health care (Bankowski, Bryant and Gallagher, 2007).

It is therefore a process justified by the outcome. It is important to examine the impact of decisions made on equity. The specific health decisions must go a long way in fostering equity in access to health care services. The health status of most vulnerable groups remains the action points of equity development. There are no specific parameters of determining a group to be classified as vulnerable. However, there are general features which help us in this. There are those who are vulnerable due to social construction while others are as a result of congenital disability. It is usually possible to get an overlap between the two possible causes of vulnerability.

The United Nations charter identifies the promotion of human dignity to be one of its core principles. This is evident in the ratifications, conventions and declarations of numerous international agreements in respect of this. One thing that we cannot fail to talk about at the mention of health care is this core principle of promotion of human rights and upholding of human dignity. A good example is the right to information an individual is entitled to on everything that affects his or her health. It is this right that compelled cigarette manufacturing companies to put an information label on their packets. In the recent past, efforts have been put on the reduction of public health burden on the rights of individuals (Sen, Germain and Chen, 2004).

Trampling on the rights of a few individuals through quarantine, mandatory testing and isolation in the name of benefiting the majority is no longer ethically acceptable. A good and most recent example is United Nations’ advocacy of elimination of discrimination against people living with HIV. Together with human rights, dignity is considered an inherent and universal concept. Wide scopes of research in the biomedical field have continued to become the center of discussion on the inherent issues on human dignity. Law enforcers must also expand their focus to other sources of human dignity violation originating from areas outside medical field. Such determinants as political influence, economic factors, technological innovations, environmental concerns and changes in demographics must be looked into.

It is important to note that advances have been made so far in the maintenance of human dignity and respect of human rights. Majority of institutions dealing with human health care services have a deliberate way of issuing instructions aimed at improving ethics amongst their staff members. The extent at which ethics instructions are being given is a clear indication of a continuous increase in the expansion in respect of human dignity. The unprecedented attention given to research on health care ethics cannot be attributed to one particular factor. There are a number of reasons as to why every player is shifting focus to this study.

To start with, the knowledge explosion on the biotechnology field has availed a number of avenues available for a medical professional in the fight against diseases. It is now possible to handle situations which were once thought to be untreatable. However, this milestone in medical field has not been a bed of roses. A series of mixed reaction continue to emanate from various sections of the society on how ethical are some of these methods.

Secondly, the cost of accessing basic health care is sky rocketing across the world. Most governments of the day are spending a substantial portion of their Gross Domestic Product on health care expenses yet most citizens cannot get the care they need. This leaves us in total agreement with Howard Hiatt who say that we have a few resources to use in provision of health care and therefore as a society, we need to ask ourselves two important questions. That is how we spend and allocate them. It is as a result of financial constraints that have made us witness denial of adequate health care, limited access and unfair rationing (Hiatt, 2005).

Situational analysis

Issues of ethics in health care are numerous. They range from an individual responsibility to the entire corporate obligations. That is why such issues can be approached from two distinct sides. To start with, macro ethical situations entail what cannot be addressed by a specific practitioner. Such issues are those in which the entire body of health professionals and the community at large must deal with in a bid to ensure that health care ethics are defined and respected. As an illustration, issues such as termination of pregnancy, health care resources allocation and organ transplants are in the category of macro situations. On the other hand, micro situations lie squarely on the hands of a single individual health care professional. It must be realized that ripple effects of macro issues are flow into micro situations.

Ideally, the topic of health ethics should commence from the generally accepted responsibility a medical officer have towards meeting the needs of patients. This brings to our thoughts the issues of competence and trustworthiness of the health care practitioners. Competency goes beyond possessing enough knowledge to deal with a situation. It includes the ability to articulate issues of health and deliver the services timely and accurately. It is also equally important for a patient to have confidence in the person he or she has entrusted his or her body to. Trustworthiness therefore forms a core factor in the satisfaction of patients which finally culminate to enhancement of health care ethics (Berger, 2003).

Legal and ethical rights

We are living in an era with serious awakening in discovery of personal rights. The medical professionals have always been assumed to be an all knowing class. A patient would accept to undergo a surgery, take drugs and have a laboratory test without any question or hesitation. This trend referred to as medical paternalism is gradually dying. Patients are becoming consumers with a right to choose what they perceive to best suit them. It is therefore a mandatory standard practice to seek a patient’s consent before carrying out any procedures aimed at restoring health. Doing anything different from this will not only be unprofessional but totally unethical. The overstepping of a practitioner’s mandate in administering health care can also attract serious legal action whose far reaching effects can be detrimental in the career of a defendant. Just like any other customer, a patient desires to attain a definite level of satisfaction. Health professionals who are unable to meet the needs of their patients may not be such attractive in future if they survive legal actions.

The legal rights of individuals are what we cannot avoid to talk about at the mention of health care ethics. The rights are those privileges a person enjoys as provided and defended in the Constitution of a country. Several legislations avails a patient with a series of rights. A patient seeking the attention of health care providers expects that clinical officers will utilize their gained experience coupled with their knowledge in striving to meet their needs. The patient’s rights ensure that independent individuals can expect the health care providers to meet their wishes of getting well without fear of otherwise.

From a broader view, health care systems are primarily based on the rights of individuals seeking treatment. Patients have a sole responsibility of selecting who or what best suits them in terms of health care facilities and doctors. It is required that the patient gives a go ahead of any process through a fairly attained informed consent. This scheme may look very attractive to a person whose has enough economic muscle to meet the cost of treatment. The patient’s right assumes that everyone patient can comfortably settle hospital bills. On contrary, this right is as good as not being there for the patient who does not have a medical cover or enough money to pay (Bankowski, 2006). Although United Nations Declaration of Human Rights says that “that all persons have a right medical treatment” you cannot walk to a health care facility and demand for treatment. It is not enough to receive medical treatment; safety and effectiveness of the services are two paramount features that a treatment seeker is entitled to put into consideration.

Ethical rights impose a responsibility on health care practitioners. The Hippocratic Oath results in a duty by the health professionals to do all they can in benefiting the patients and avoidance of any foreseeable harm. It can be argued that the health care providers must act at the best interest of the patients with disregard to how others are affected by their actions. A legality dilemma created by this Hippocratic Oath is diffused by the controversial exposition by Rem Edwards who claims that the health care providers are obligated to alleviating the aching and suffering of health care seekers.

The defects in this point of view are evident on the side of health professionals who operate under strict constraints of laws. The responsibilities of health professionals are thus in conflict with earlier mentioned rights of the patients in the light of ethical and legal correctness. Ordering a health care expert to pursue a personal approach and do what contradicts the law, yet ethical, process in the patient with total disregard of what may befall them legally is as good as telling them to suppress what is important to them in favor of the patient.

Ethical analysis

It is important for a health care provider to continually examine his action so as to ascertain whether he is doing the right thing or not. In 1989, Robert Veatch proposed a four step blueprint which can be used by the health practitioners. This method of analysis involves making sure that there is sufficient knowledge backed by facts for every situation. The second step is bringing in to play whatever is morally upright in relation to the situation at hand. Ethical principles are given a consideration it deserves at the third step. Once the three steps have been taken care of, a fourth and last step of looking in to ethical theories is done.

This provides health practitioners with a reliable, powerful tool available for use when faced with a situation demanding an ethical decision making. This theory formulated by Veatch approaches situation in a chronological manner. He goes ahead to argue that an ethical dilemma can be sorted not necessarily through the four steps but by just laying down the actual facts about a condition. If the application of step number one cannot provide a way out, step two is considered. This focuses on the moral rules guided closely by confidentiality or patient’s consent. At the event that dilemma persists, ethical guidelines of step three are used.

The ethical principle encompasses aspects such as maintenance of autonomy, fidelity, nonmaleficence and beneficence. At this point, the stalemate must have been broken. However, it is possible to have unclear solutions even with the application of ethical principles. It is because of such a situation that a health care professional is compelled to use an ultimate tool available in step four. Ethical theories are the final solution finder in a hard decision making procedure.

A particle and most recent example is seeking of consent of an organ donor. There have been several conflicting issues surrounding organ transplants. The ever growing imbalance between the number of organs demanded and those available for sale has played a major role in heightening the differences between proponents and opponents of this process. It is the obligation of clinicians to make sure that the wishes of prospective organ donors are respected to the later (Beauchamp and Childress, 2009). Various regulations have been put in place to ensure the respect of free will and human dignity of a donor whether death or alive.

Conclusion

The challenges facing health care professionals continue to rise with technological advancements and sky rocketing costs of health care. It is therefore of paramount importance to equip them with sufficient knowledge of ethical tools for use in such situations today or in days to come. Totally relying upon ethical codes, principles and theories may not be enough in decision making but serves by providing a rough idea.

Ethical dilemma

The ethical dilemma I will discuss will be based on some truth of an event that happened when I was a support worker five years ago in a mental health trust organisation. The patient will be referred to as girl ‘A’ and members of the multidisciplinary team will be referred to as professionals. A very brief description of the girls mental health illness was schizophrenia this can have an effect on a person’s mind in such a way that they can hear voices and send smells that are not real to the human eye.

Other features can include delusional thoughts this is where the person can believe that certain situations and circumstances have happened to them and it is very clear to the person on the contrary it can make a person feel that others do not believe them (CAMHS, 2002).

The ethical dilemma
Girl ‘A’ was 15 years of age, when she was sectioned under the 1983 Mental Health Act section 2.
Girl ‘A’ received a letter from a friend at home. This letter revealed that her friend had been raped from girl ‘A’s’ mother’s boyfriend.
Girl ‘A’ had prior to this letter disclosed to the nursing team that she herself had been raped from her mother’s boyfriend. She decided not to take action for fear of losing the relationship she had recently built up with her mother. At this time the girl wanted her mother to never find out about the disclosure of this rape ordeal.
The friend told girl ‘A’ that this situation was going to court.
At this point girl ‘A’ decided it was time to put closure on her own rape ordeal and therefore wanted to go to court and declare her own rape ordeal.
The ethical dilemma – is should the girl called go to court or not?

Reference – Reading from Leathard, A. & McLaren. (2007) Ethics contemporary challenges in health and social care. The Policy Press: UK.

There are three more approaches which often conflict with many ethical problems they are deontology, conceptualism and virtue ethics (Leathard & McLaren, 2007). It approaches can give directions to ethical dilemmas.

Consequentialism -also referred to as utiliarism discovered by Jeremy Bentham and John Stuart Mill. The aims of this approach are consider the consequences of taking a particular form of action (ibid). All areas of an ethical dilemma using this approach would be given equal weight when considering the outcome (ibid). In health care this approach can be seen to be used when considering decisions that need to be made about the allocation of resources (ibid).

Personal Values my personal values

You will describe your values but there is no right/wrong answer to this. It is basically how you presented your dilemma to the ethic group |Julie.

How does my personal knowledge, culture, and life experience affect this dilemma for you?

feelings

What values are in conflict and how has this made you feel?

What were your fears?

Given similar circumstances with another person would the outcome be the same?

how do these impact on the questions you asked
resp. to me as a person
PROCESS
How and why am I making a choice I am making i.e., what did I think, feel, and what did I do or not do?
How was my decision making affective by what factors of legislation, standards, policies and organisational policies/procedures and values?
What other resources would be helpful to me in making the decisions about the dilemma?
Keep using reflection I think this part Julie is where you have begun to described the different ethical approaches.

Deontology – deon means duty and ology is the science, this approach was discovered by Kantian. The aims of this approach does not consider the consequences rather it acts on what is morally right, in particular deontologists treat the situation or client with respect for individuality which is its greatest importance. This approach would not approve of telling lies to a client even if it was in the best interest. Any decision is made using deontology would have to be based on fact. Duty based theories which would allow the worker and the client to acts of the greatest outcome which would avoid harm. This approach recognises autonomy, trust and the equity of provisions (ibid).

Virtue – derived from Aristotelian ideologies. Thomas Aquinas (1990) defines virtue ethics is not only knowledge but also the approach taken to provide integration using this knowledge for an ethical dilemma situation, an area of “manifestation of ethical professional behaviour” (ibid: 71). Virtue ethics describe a person’s character beliefs and values quality is in actions that they believe are morally sound.

Beauchamp and Childress (1989) describe four ethical principles that should be considered when dealing with any ethical dilemma they are: beneficence, non-maleficence, autonomy and justice (ibid: 72). However these four ethical principles at times can conflict therefore critical judgement is required when choosing a particular procedure to take. These four ethical principles they can provide a framework to assist the worker(s)/client(s) situation by empowering the thinking process, this helps with the decision process of the ethical dilemma (ibid). In virtuous practitioner must take into account the different viewpoints by recognising the potential conflicts that can happen between these four ethical principles. It is therefore recommended that a practitioner makes critical judgements as to which approach would be more appropriate to the ethical dilemma. “Gardiner (2003) comments that the virtuous practitioner is driven by deep desire to behave well and that this approach has a flexibility that can encourage innovative solutions while acknowledging that there will often be elements of pain or regret” (ibid: 76).

So from the ethical dilemma if beneficence was applied the patient’s best interest and wishes and feelings would have been considered using this approach. Although, it could appear harmful to the patient, if the sole views of her situation were considered because this could have had an adverse effect on the best interests of the patient.

Non-maleficence – applying this approach to the ethical dilemma could show how the professional has protected the patient from actual or potential harm; this is particularly successful when the practitioner evaluates his/her knowledge and skills realistically ensuring any form of intervention is taken within their professional capacity. However should the worker feel there could be limitations then they should seek and share this information with the team of professionals caring for the girl? This particular approach may have been applied from support worker/primary care worker’s point of view this is because non-maleficence provides the support worker/primary care worker with more details from the client’s perspective of the situation whereas; a professional may only work with the girl on if few occasions. Therefore the implications of the support worker/primary care worker not sharing information with other professionals can cause great harm to the patient. If the support worker/primary care worker advises the patient “there is nothing more I can do” then this will be harmful and unhelpful to the patient (ibid: 74).

Autonomy – the principle of autonomy and impact on disclosure and confidentiality. However a patient has a right to information about their condition and their situation, the patient’s views beliefs and values should be respected. Although, legally the girl in the ethical dilemma was sectioned under the 1983 mental health act section 2 and therefore their grounds a practitioner must take with regards to an appropriate decision this can conflict the patient’s best interest/wishes and feelings. Using the ethical dilemma in this instance shows when “beneficence or non-maleficence overruling patient autonomy” (ibid: 75). The practitioner will endeavour to the first duty to the patient however the practitioner must balance this duty to the patient with regard to the wider risks and involvement of others. Gillon (2003), autonomy is a component of the other three ethical principles and autonomy should take priority with respect for the patient (ibid).

Justice and equity

“The Aristotelian principles suggest that I trust system should ensure equal and should be treated equally and unequal’s unequally” (ibid: 77). Considering justice and equity to the ethical dilemma the patient may feel the decision to not go to court un-fair. However the practitioner should deliver an Albany’s about the criteria that was used to make the decisions they made about this ethical dilemma. The principles of justice and equity can allow for decisions to be made and distributed according to the patient’s need, merits, capacity or rights. In this situation a practitioner may remind the patient of her rights in respect to a complaints procedure (ibid).

ISSUES
POWER/polices
What are the rights of the child?
What rights as a person?
Are there any rights in terms of seeking closure?
All your doing here is answering and showing Why and what policies may be used with this dilemma.
Julie notes for power

every child matters is a Green paper that was published in 2003 by the government as a response to the death of Victoria Climbie. In 2000 for the children’s act became law from a thorough consultation process and it is this legislation that underpins the legalities of Every Child Matters, by ensuring five necessary outcomes are followed when ensuring the health, safety and well being of children from birth to 19 years. The five outcomes are – being healthy, staying safe, enjoying and achieving, making a positive contribution and achieving economic well-being (Every Child Matters, 2003 Cited in http://www.dcsf.gov.uk/everychildmatters/about/ on 20/10/09 @ 13:05).

RESP.OF ORG.
What is the organisations point of view?

Ie NHS, CAMHS why do they use them what are the values of these principles to s/u

Organisations policies

This report sets out a new vision for the future of mental health and

well-being in England. Based on four principles, it outlines the priorities

we believe should underpin mental health policy for the next decade.

Our four principles for mental health policy are:
Mental health and well-being is everybody’s business. It affects every family in Britain and it can only be improved if coordinated, assertive action is taken across Whitehall and at all levels of government.
Good mental health holds the key to a better quality of life in Britain. We need to promote positive mental health, prevent mental ill health and intervene early when people become unwell.
People should get as much support to gain a good quality of life and fulfil their potential from mental health services as they expect to receive from physical healthcare services. Mental health care should offer hope and support for people to recover and live their lives on their own terms.
We need a new relationship between mental health services and those who use them. Service users, carers and communities should be offered an active role in shaping the support available to them. With these principles at the heart of policy, we believe we can create a society in which good mental health is nurtured and in which mental ill health is managed well.

As a consequence, our mental well-being will be a core concern of government. Effective action to promote good mental health will be taken among people of all ages and diverse backgrounds. People who experience mental distress will receive timely support to live well and have a fair and equal chance to fulfill their potential.

The actions that would be needed to make our vision a reality are summarized overleaf.

(Health, 2009)

Organisation/mental health
What is sectioning?

Most patients in hospital wards cannot be prevented from leaving when they wish, and their consent must be obtained before treatment is given. The same applies to most patients who are in hospital for psychiatric treatment. They do not object to being in hospital or being treated and are referred to as ‘informal’ or ‘voluntary’ patients. However, the Mental Health Act 1983 allows some people to be detained in hospital. When this happens, they are called ‘detained’ patients and their consent to treatment may no longer be required. This is often known as being ‘sectioned’.

Some people are detained in hospital by the courts after being charged with a crime. (See Mind rights guide 5: mental health and the courts.) However, most people are detained under the ‘civil sections’ of the Mental Health Act, which does not involve a court at all. This booklet sets out what must happen before someone can be detained under a civil section, and outlines some of the effects. Mind rights guides 2-5 describe, in more detail, other relevant information about consent to treatment and what to do if you are being detained and you want to leave hospital.

What is the process for detaining someone under a civil section?

There are two main civil sections of the Mental Health Act 1983, which are used to detain someone: section 2 and section 3. For each section, three people must agree that the individual needs to be detained. Usually, they would be an Approved Mental Health Professional (AMHP), a section 12 approved doctor and a registered medical practitioner.

The two doctors must agree the person needs to be in hospital and recommend detention. Then, the AMHP decides whether or not to make an application for the person’s compulsory admission to hospital. The Nearest Relative (NR) (see below) has the right to make an application. However, the Mental Health Act Code of Practice makes it clear that an AMHP is the preferred applicant and applications by an NR are very rare (the preference for the AMHP as applicant over the NR is re-stated in the new Code of Practice at para 4.28). It does not matter where the person is at the time. They may be at home, in hospital, in a place of safety, or in a police station following an arrest for an alleged criminal offence.

In an urgent situation, someone may be admitted to hospital compulsorily, with only one medical recommendation to support an application (section 4). This is allowed if it is felt the criteria for section 2 (see below) are met, but there is no time to wait for another medical recommendation. The second medical recommendation must be obtained within 72 hours.

It is important to note that people need not have committed a crime to be detained under a civil section. The law allows anyone to be detained under the procedure described above.

What do the different civil sections mean?

Section 2 allows for a person to be detained if they are suffering from a mental disorder and they need to be detained, at least for a limited period, for assessment (or for assessment followed by medical treatment) for their own health or safety, or for the protection of other people.

Detention can last for up to 28 days. The section can’t be renewed, but you may be assessed before the 28 days expires to see if detention under section 3 is necessary.

Section 3 allows for a person to be detained if they have a mental disorder, and it is necessary for their own health or safety, or for the protection of other people, and treatment cannot be provided unless they are detained in hospital. A patient cannot be detained under this section unless the doctors also agree that appropriate medical treatment is available for him or her.

Detention can last for up to six months. The section can then be renewed by six months, initially, and by a year at a time, subsequently (MIND, 2009).

Other professionals

Alan suggest the Mental Health Act could be one.

What rights does she have under this ACT?

Who was present? Consider their positions, charaters, virtues, values ect.

why is it a dilemma
DEONTOLOGY

This is what is meant by your code of conduct – this is the link between philsophy and practice it is through the codes of conduct. You will show how the philosophy feeds into codes of conduct and then feeds into practice. Alan explains this is about respect for the person and autonomy. So you need to say A deontology approach would argue this…. and this approach would be used because of this……

Alan gives an example of how to apply this to your scenario: Julie you could argue from one position that deontology is a person in her own right, this does not exist therefore the duty is to the right of this person this is quite deontological this approach also looks at Law, human rights, that sort of thing. Most social workers are this approach All you have to do here is say how and why this approach may be applied to the scenario and where it come from i.e., KANT

Consequential/Unitarianism

This is what is meant by your code of conduct – this is the link between philsophy and practice it is through the codes of conduct. You will show how the philosophy feeds into codes of conduct and then feeds into practice. Alan notes. “A unitarism approach would argue this…. and this approach would be used because of this….Alan example of how to hit this, Consequentialism would suggest you look at the outcomes, if we do not intervene at this point and show some support then this person will suffer damage, they could be harmed that is more this approach and this is the link I want you to make. Most social worker are this approach. All your doing here is saying where did this approach come from how and why would it be used in your dilemma

virtue ethics

Virtue ethics = the character of the person, so in the same way that I was arguing with the boys you could argue your point of view with your dilemma Alan. Questions to ask and answer with these approaches are:

What is the thing that makes one of them valid?

“Probably the character of the person doing the argument”! other words you Julie are very dominate and persuading and therefore one needs to ask is your position genuine? I

s it a valid argument?

Are you taking it from integrity (honesty, goodness) or serenity (calm, peace, composure, calmness)? All you doing here is saying where this approach came from and why and how would it be used in this dilemma

Code of ethic & Values

These three streams of values in social work influence our practice and are described as TRADITIONAL (being to the tradition route), EMANCIPATORY (to give independence to free someone from something) AND GOVERNANCE (controlled or overlooked by government) Values. How did the GSCC; BASW; and NOS codes of ethics guide your decision and practice outcomes?

social constructionist view
bibliography

Human services are developed in anticipation and response of human needs. The profession is characterized by positive reception of human needs taking into account all of their diversity. In context of community and environment, Human services professionals offer assistance to their clients and serve their particular needs. Need of ethics in human services profession is of substantial importance (Sinclair et al., 1987).

Ethics are guidelines which represents set of standards of conduct that is considered ethical by professionals and educators. Ethics although not legal document but help to assist in settlement of problems and issues related to ethical issues in human services profession.

A brief overview of Ethical Standards for human services professionals:

Human service professionals are key players in Human services sector. In this highly customized profession, human service professional interacts frequently with families, individuals and groups etc, all these are their clients. Human services professionals are case managers, they are caregiver, teacher, doctor, consultant, lawyer, and psychologists etc. in the following section, some ethical standards are defined for human services professionals.

My ethical statement:

“As a ethical human services professional, I will endeaver to meet or exceed the statement below in day to day practices of my professional life.”

My code of ethics as a Human service professional:

As a Human service professional I would like to talk with the clients the goals, purpose, and nature of helping relationship before onset of relationship and also inform the clients about limitations of relationship.

In my opinion, clients should be treated with respect, dignity and trust.

As a Human service professional I will take care for protection of customer rights and confidentiality. Except some special cases, when this confidentiality can be harmful for customer.

As Human services professional I will try to take integrity, security and safety of client records.

I would like to have prior written consent by customer when there is need to share client information with other professionals.

As a Human services professional, I will try protect the self-determination right of clients.

I would like to be well aware of legal, federal, local and state laws related to human services.

I will keep myself informed about current social issues that can affect community and clients.

I will act as advocates that help to address the unmet needs of society and individuals.

As a Human service professional I would like take it as my responsibility to disclose my qualifications accurately.

As a Human service professional, I will work with the aim of helping people and for accomplishment of goals of human service organizations. My basic goal in human services will be to help people in living more satisfied life, more productive and autonomous life, by utilizing the resources and knowledge of society and technological innovation.

These ethics are core values of human services professionals:

Above mentioned set of ethical practices serves as set of core values of ethics in human services profession, every professional who selects human service as profession must have strong passion to serve society and individuals. As this profession is all about humans, the main concern of this profession is providing individual’s solution of their personal and social problems. When dealing with and serving humans, ethics become more important (Sinclair et al., 1987).

A human services professional can deliver its services in better way if he is well aware of importance of ethics in his profession. Code of ethics in human services profession helps to promote trust, confidentiality, recognition and negotiation of client’s right of self-determination and informed consent. Healthcare professionals and other people involved in human services process should respect right of privacy of their clients. In human service, clients are sharing their very confidential information and problems with professionals, because they want from professionals to solve their problems. It becomes ultimate responsibility of these professionals to develop the relationship of trust and integrity with clients and keep their information confidential, and do not share it with others regardless some exceptional situations when need to discuss it with their team or other professional in order to solve out the problem of their client. Even in this case, information should not be shared without written consent of client.

Evaluation

To make the individual a productive part of society, is also an ultimate goals of human services professionals. Sometimes, clients don’t know the real issue he/she is facing, this may be a psychological or health related issue, in this situation, human services professionals first find the real cause and then goes for its solution.

Each state and country has some legal framework and laws for society, these laws are made for members of society which are human beings, so the awareness and knowledge of local and federal laws of state or country is critical for human service professionals as their profession is all about humans. The professionals need to be ethical ideals, while respecting for all cultures, beliefs and relationships (Seitz, & O’Neill, 1996).

Ethical standards for human service workers require passion and dedication by professionals and workers as well. Integrity, following the laws, compliance with policies and rules, maintaining the client records and case files etc. all include professional ethics requirements. Apart from their direct service to clients, human service professionals also have responsibility to protest against social injustice and community empowerment.

If the code of ethics is not employed and practiced in human services profession, it will bring destruction to society. There will be no relation of trust and integrity can be developed among professionals and society. People will feel reluctant to share their problems with their consultants as they will have no surety that their information will be kept confidential. As a result, society will suffer at large as people will live lives full of problems and worries because human services works with aim of better lives of their clients and to make all the members of society productive and active part of society (Seitz & O’Neill, 1996). Without ethical practices and commitment of professionals to follow these practices, mission of human services cannot be achieved. Admitting the importance on ethical practices, every human services organization has code of ethics all members are encouraged to follow. So if we develop and practice our personal code of ethics to excel in our profession, it will be a good strategy to follow that will pave the way for success in future.

The aim of this assignment is to demonstrate links between different codes defining ethical practice, legislation and the requirements of professional conduct. The author will also discuss knowledge of traditional social work values and recent changes in the value base of social work. The relationship of ethical themes and the range of ethical theories will also be considered, concluding with the requirements of professional social work practice.

Although social work is a profession laden with contradictions, the primary task within the social work profession is to ensure that the directives and principles enshrined in social work ethics, call on social workers to establish human rights and willingly be able to challenge unjust principles (Allan et al 2009).

Moral codes and social structure is recorded as far back as the Ancient Greek Polis era with suppression of civic autonomy. The idea of life of virtue and human fulfilment leading on to the new course in ethics chartered during the Hellenistic era are the most discussed social structures discussed to date, regarding early ethics and values although forms of social structural developments were occurring in Egypt, Mesopotamia, China and India has less recorded by historians (Bryant 1996). Bisman (2004) acknowledges that the core concept of moral concerns drove social work’s development during the profession’s formative years. Although Jones (1997) cited in Bisman (2004) (pg: 110) complains that “the profession has been particularly silent over the past twenty years about the shifting patterns in social wellbeing and disadvantage” and that this silence may be a direct violation of the social work codes of ethics.

The emphasis of social change was more evident during the settlement movement and the emphasis was on Toynbee’s philosophy that there was a need to unite the advocacy of social reform and the inclusion of various classes to ensure society performs those duties (Bisman 2004). Self determination is central to the social workers ethical responsibilities to clients. Hepworth et al (2009) (pg: 60.) predict that “codes of ethics are the embodiment of a profession’s values”. Acknowledgment for principals and standards for social workers behaviours are imbedded in the Codes of Ethics circulated by the National Association of Social Workers addressing the range of responsibilities that social workers have as professionals to their clients, colleagues, employers, profession and to society as a whole (Hepworth et al 2008 ). Addams (1902) (pg: 1) “believed that ‘ethics’ is but another word for “righteousness”… without which life becomes meaningless’”.

The United Nations Convention on the Rights of a Child acknowledge that the values vary from country to country and the understanding of values universally are very problematic. However, it is not just the question of different values, but a question of relative power (Heintz 2009). Every Child Matters (2003) contains five outcomes which are being healthy, staying safe, enjoying and achieving, making a positive contribution as well as economic well-being have absorbed the UNCRC Articles into a comprehensible table. This ensures that practitioners are drawn to reflecting the ethical principles and value base when making their decisions regarding client needs.

Wilks (2005) highlights that there are two central conceptual strands that account for social work values; these are social work ethics and anti-discriminatory practice. However although these two strands lie together there are conflicts. Strategies have been adopted to bridge the gap in principle by means of social justice or equality.

Nash (2000) was also interested in the ethics of the individual self and understanding the power differences. Although seeing everyone as social actors, concerned with interaction through social behaviour can at times be fragmented, unstable, fluid and fast changing. This unpredictability is why it is very important that social workers analyse each individual case thoroughly, reflecting on where and when to employ ethical and value based decisions that will influence positive results.

Clark’s (2000) cited in Tovey (2007) acknowledges that there are five basic principles that promote ethical practice in social work are:

Respect for and promotion of individuals’ rights to self-determination
Promotion of welfare or well-being
Equality
Disruptive justice
Discipline

Furthermore, it is important that traditional social work values are employed, but it is also important that consideration for limitations of traditional social work values and how these values change at macro, meso and micro levels of practice. Dominelli 2004(pg: 63) argues that although empowering clients is seen as a way of moving forward, “it is unable to do more than deal with issues at the micro level of practice in the practitioner-client relationship, and has little impact on structural inequalities, which also need to be ended”. By being involved in transforming the knowledge base and structure of clients current or future situation, the social workers has to rethink the epistemological base on which social work is founded and establish a value base that aims to create a professional culture that can guide particular interventions (Dominelli 2004). Banks (2006) acknowledges that ethical issues are problematic in social work and that the codes of ethics and codes of conduct fail to explicitly address issues faced by those who are regulated by them. Practioner`s find themselves in difficult situations which at times results in ethical dilemmas. It is still imperative to meet the requirements of professional conduct and that the deontological approach creates a logic whereby professionals are duty-bound to follow their ethical code and where ethical practice without guiding principles is inconceivable (Gray 2009 pg: 2).

The Scottish Social Services Codes of Practice (SSSC 2005) 2005 are a key step in a system of regulation for social services delivered along with setting standards for practitioners to be accountable for their actions. SSSC (2005) state that there are six codes of practice that social service workers are required to take account of these are:

Protect the rights and promote the interests of service Users and carers.
Strive to establish and maintain the trust and confidence of

Service users and carers.

Promote the independence of service users while protecting

Them as far as possible from danger or harm.

Respect the rights of service users whilst seeking to ensure

that their behaviour does not harm themselves or other people.

Uphold public trust and confidence in social services.
Be accountable for the quality of their work and take

responsibility for maintaining and improving their

knowledge and skills.

Social work has undergone radical changes, in addition, the imperialistic approach has been highly criticised as being stereotyped and culturally preoccupied with the blame culture. Raynor (1984) recognised that there was a difference in accountability, regardless of justification. His findings were that social workers are accountable for their own actions, although social workers were only protecting the weaker party in an imbalance of power. It is important that social workers draw on empirical approaches, although the focus should be on solving problems and narrowing the problematic gap in cultural differences between social worker /client relationship working within a moral rational manner.

A postmodern approach in social work has highlighted areas in the welfare state that acknowledge that specific welfare resources are being cut due to rationalisation. Social services need to look at the way economic, social structures and regional injustices in impoverished communities are constructed and adapt to meet their individual needs. Postmodernism argues for the ‘grand’ or ‘universal’ social change on which social work was founded, but now ultimately social work must refocus its attentions on exposing global economical inequalities and oppressive gender and ethnicity-based relationships across the globe (Noble 2004).

The Kantian philosophy encourages that we should treat others as a being who has choice and desires along with a being is those who are capable of rational thought and self determined actions should have the ability to make decisions and act accordingly to their own choices and desires (Banks 2006).

Although deontological and utilitarian approaches tend to dominate social work ethics Lovat and Gray (2008) dispute that within this postmetaphysical age Habermas offers a form of proportionate ethics through the Aristotelian and Thomistic thinking offering a new and practical approach which is particularly appropriate to a modernately post-scientific, postmetaphysical age. Lovat and Gray (2008) (pg: 1101) also recognised within the moderately post-scientific age, although the thinking had a heavy reliance on science they were “aware of the limitations of science in addressing adequately all of life’s demands and providing all of its answers”. Lovat and Gray (2008) also proposed a new approach to ethical deliberation and judgment that has potential to meet the needs of those seeking greater ontological certainty than science can provide.

By implementing a Proportionism approach, which is an ethical and moral approach and holds promise for a more balanced perspective in that social work is both science and art. Overall the proportionist approach is comfortable with the inconsistent position in any ethical dilemma and by applying wisdom, commonsense and probing scientific explanations an ethical decision can be made. “The value of a proportionist position is best captured when we realise that any ethical decision which runs counter to accepted or popular norms cannot be underestimated in terms of its potential to create tension, fear or recrimination”( Lovat and Gray 2008 pg: 1107).

Changing Lives (2006) highlights the ethical and value base by means of four tier approach negotiating a balance between care and control, although the practitioner is under statutory obligation and the nature of the situation is complex the focus should be with avoiding any ethical boundary disputes working in a multi disciplinary approach focusing on the value base work with the client.

Pitts (2000) discusses the Federation International des Communautes Educatives 1998 (FICE 1998) describes that a sound ethical practice is of critical importance. A code of ethics establishes good practice and offers guidance to individual workers in difficult situations, along with acting as a template against which to test conduct and target reform of modifications that need to be made. This in turn guides the practitioners to think about best practice and new answers to ethical issues that may arise.

Within Getting it Right for Every Child (2006) Big Words and Big Tables section 2.6 Consent/Ethics, ethically empower the child or young person regardless of age to educate and promote the best services available by informing the chid or young person of all resources available. The FICE 1998 is dedicated to promoting the lives and future of children and young people around the world creating and promoting global standards for looked after children, The British Association of Social Workers has a Code of Ethics key principles reinforce what service providers should be doing to meet the needs of children and young people these are:

Human Dignity and Worth
Respect for human dignity and for individual and cultural diversity
Value for every human being, their beliefs, goals, preferences and needs
Respect for human rights and self-determination
Partnership and empowerment with users of services and with carers
Ensuring protection for vulnerable people
Social Justice
Promoting fair access to resources
Equal treatment without prejudice or discrimination
Reducing disadvantage and exclusion
Challenging the abuse of power
Service
Helping with personal and social needs
Enabling people to develop their potential
Contributing to creating a fairer society
Integrity
Honesty, reliability and confidentiality
Competence
Maintaining and expanding competence to provide a quality service

Harris (1998)(pg: 843) highlights that “in the new social services departments, social work was to exist, not simply as another branch of local authority administration, but in its own right as a state-mediated, bureau-professional labour process”.

Consideration for Biestek’s casework principles, individualisation, purposeful expression of feelings, controlled emotional involvement, acceptance, non-judgemental attitude, service user self-determination and confidentiality were the early foundations of principles that have paved the way for influencing present date values in social work (Banks 2006). Tovey (2007) insists that the principles are open to interpretation and practitioners should be aware of the limitations in ethical decision making and the focus on rules and duties influence determining actions in particular situations.

The legal framework within the Children (Scotland) Act 1995 (Act 1995) underpins what practitioners are required to do to ensure children and young people are provided for and looked after by parents, guardians or their local authority. The Act 1995 chapter 36 section 19 advises that the plan for services has to take into consideration relevant services to be provided.

References
Addams, J. 1902. Democracy and Social Ethics. Macmillan: London.
Allan, J., Briskman, L., Pease, B. Critical Social Work: Theories and Practices for a Socially Just World. Allen & Unwin: NSW.
Banks, S. 3rd Ed, 2006. Ethics and Values in Social Work. Palgrave Macmillan: Basingstoke.
Bisman, C. 2004 Social Work Values: The Moral Core of the Profession. British Journal of Social Work 2004. 34, 109-123.
Bryant, M,J. 1996. Moral Codes and Social Structure in Ancient Greece: A Sociology of Greek Ethics from Homer to Epicureans and Stoics. New York Press: USA.
Available on line: Changing Lives: Report of the 21st Century Social Work Review http://www.scotland.gov.uk/Publications/2006/02/02094408/8 [Accessed October 2009].
Available on line: Children (Scotland) Act 1995 http://www.opsi.gov.uk/ACTS/acts1995/ukpga_19950036_en_3#pt2-ch1-pb2-l1g19 [Accessed October 2009].
Dominelli, L. 2004. Social Work: Theory and Practice for a Changing Profession. Polity Press: Cambridge.
Available on line:Every Child Matters (2003) http://www.dcsf.gov.uk/everychildmatters/strategy/strategyandgovernance/uncrc/unitednationsconventionontherightsofthechild/ [Accessed October 2009].
Available on line:Getting it Right for Every Child (2006) http://www.scotland.gov.uk/Publications/2005/06/20135608/56098 [Accessed October 2009].
Gray, M. 2009. Moral Sources and Emergent Ethical Theories in Social Work. Brittish Journal of Social Work, September 22, 2009.1-18.
Harris, J. 1998. Scientific Managment, Bureau-Professionalism, New Managerialism: The Labour Process of State Social Work. British Journal of Social Work. (1998) 28, 839-862.
Heintz, M. 2009. The Anthropology of Moralities. Berghahn Books: United States.
Hepworth, H, D., Rooney, H, R., Rooney, D,G., Strom-Gottfried, K., Larsen, J. 2009 8th Ed. Direct Social Work Practice: Theory and Skill. Cengage Learning: Canada.
Lovat, T., Gray, M. 2008. Towards a Proportionist Social Work Ethics: A Habermasian Perspective British Journal of Social Work 2008.38, 1100-1114.
Raynor, P. 1984. Evaluation with One Eye Closed: The Empiricist Agenda in Social Work Research. British Journal of Social Work 1984. 14, 1-10.
Available on line: Pitts, J. 2000. Committee on the Rights of the Child: State Violence Against Children. http://www.crin.org/docs/resources/treaties/crc.25/pitts.pdf [Accessed October 2009].
Noble, C. 2004. Postmodern Thinking: Where is it Taking Social Work? Journal of Social Work. 2004. 4, 289-304.
Nash, K. 2000. Readings in Contempory Political Sociology. Blackwell Publishers Ltd: Oxford.
Available on line: The British Association of Social Workers has a Code of Ethics http://www.basw.co.uk/Default.aspx?tabid=64 [Accessed October 2009].
Available on line: The Scottish Social Services Codes of Practice 2005 http://www.sssc.uk.com/NR/rdonlyres/3A6C6F84-EB11-4DE2-90FF-5E143610C2B7/0/SSSCCodesofPracticebookletSept09.pdf [Accessed October 2009].
Tovey, W. 2007. The Post-Qualifying Handbook for Social Workers. Jessica Kingsley Publishers: London.
Wilks, T. 2005. Social Work and Narrative Ethics. British Journal of Social Work 2005. 35, 1249-1264.
Case Study

In this assignment the author had to take into consideration any ethical and value based factors before exploring a workable therapeutic intervention that would meet the needs of the client within this case study. The ethical and value based dilemmas that require consideration needed to be put into a logical workable framework. The author then can identify and progressively translate to meet the needs of any ethical issues faced by both practitioner and client. This process needs to be addressed ethically in three different ways; these are the interests, rights and power. The author will then reflect, explain, analysis and use evidence on how to approach and meet the ethical needs of the client.

The client will be given a pseudonym to protect and ensure confidentiality and privacy throughout this assignment, consent was also given by the main carers. The boy who will be referred to as Marc is now 12 years of age and has recently been diagnosed with (Attention Deficit Hyperactivity Disorder) ADHD which is now being challenged (Appendix 1).

First and foremost, it is vitally important to look at the young person as a whole by using the Getting it Right for Every Child 2006 (GIRFEC 2006) My world Framework approach which is “underpinned by common values and principles along with shared models, tools and practices that are designed to support work with children and young people” (on line). Although GIRFEC 2006 -Proposal for Action: Analysis of Consultation Responses argue “is there sufficient emphasis and guidance about the child’s involvement and are there sections which need strengthening to ensure that the child or young person is at the heart of the process?” (on line). This statement reinforces the authors need to assess all aspects of the clients wellbeing. This in turn ensures that the author considers all areas of ethical value based concerns before committing to a solution based framework to employ to the service users current situation. By utilising Collingwood’s (2005) three-stage theory framework provided the author with a workable framework to apply a process that would then develop a flexible and developmental tool, which can then identify any specific ethical and value based issues to inform the authors intervention strategy.

Consideration for background information to work ethically with client

By using a Proportionism approach and by looking at the applied science model to solve any ethical issues, then by applying an existing body of professional knowledge to make sense of complex and difficult human situations. This generates an understanding of the current situation, develops a structured sequence to practice in a systematic way, then to practice in a thoughtful and professional manner to allow consideration of cultural circumstance of the current ethical dilemmas (Howe 2002). By completing the Collingwood (2005) theory circle, stage two informed the author of the theory to inform/ intervene ethically and stage three helped identify the knowledge, skills and values to work ethically with the client.

The author drew on more than one principle based ethical approach. This maximised the wellbeing and minimised harm whilst following core values, principles and codes. Although applying the deontological approach allows the author the ability to create logic and ensures that the author is following ethical codes and principles as there are moral judgments and difficult ethical decisions to be made. Gray (2009) reinforces that practitioners should not undermine the importance of principles and codes. It seems logical to utilise modern workable theory to practice by employing the proportional’s approach to explore present situation, consequences and sense of perception on the basis of evidence before the practitioner, using the best means available for forming judgments that springs directly from these means and allows for the end to justify the means (Gray 2009). By applying the Proportionism approach allows the author to build on, manufacture or complement theories, by transcending existing theories to provide a new and superior form of working ethically it can only enhance practitioner/ client relationships (Lovat and Gray 2008).

The following areas were highlighted as in need of development to address the ethical issues for the client.

The author believes that there is an insecure attachment base. Bowlby cited in Butterworth and Harris (1994) argues that insecure attachments contribute to the formation of a neurotic personality as they take the child down a psychologically unhealthy pathway.

Developmental stage using Ericson’s psychosocial stages where the child should be in the fourth stage of industry versus inferiority, recognising that it is important that the child does not run the risk of developing a sense of inferiority – a sense of inadequacy resulting in feeling worthless at this stage (Slee 2002). Leading on to the general effect of the grief, after the mind has suffered an acute paroxysm of grief, and the cause still continues, we fall into a state of low spirits or feel utterly cast down and dejected (on line) (Darwin1872).

Intervention

It has been long recognised that practitioners have been torn between the utilitarian and the deontologists approach to social work and by breaking free and proceeding on the basis inclusion, open communication, empathy and being impartial is the way forward for practitioners (Houston 2003). “A valid moral decision is reached when those affected by it endorse it as the preferred way forward. In reaching this agreement participants must accept the consequences of the decision for all concerned and its impact on everyone’s interests” (Houston 2003 pg: 822).

Therapeutic interventions are used in many different situations and the end goals of intervention programs are to inspire people to make the necessary changes to take control of their own lives again (on line) (When are Therapeutic Interventions Recommended?).

Consideration for the clients diagnosis as being ADHD is a significant contributing factor to ensuring the best therapeutic model is used to address underlying issues. Controlled longitudinal studies show that by late adolescence and early adulthood, children identified as having ADHD are at risk for a number of mental health problems the most noticeable are anti-social behaviours, cognitive difficulties, poor academic achievement and lower occupational status (on line) ( Thorley 1998). Although diagnose of the clients ADHD is in dispute, ethically the author is at duty to include the probability of ADHD until a conclusive assessment is carried out to confirm or dismiss the first diagnosis when considering play therapy interventions.

The British Association of Play Therapists (BAPT) is the foremost professional body that registers Play Therapists and regulates Play Therapy practice in Britain and have codes of practice along with play therapy standards to regulate play therapy and training (on line)(BAPT 2009). “Play Therapists need to be motivated, concerned and directed towards good ethical practice. They are required to take responsibility to maintain these standards and Play Therapists should always accept responsibility for their professional behavior and actions” (on line) (BAPT 2009).

Consideration for Biestek’s casework principles, individualisation, purposeful expression of feelings, controlled emotional involvement, acceptance, non-judgemental attitude, service user self-determination and confidentiality were the early foundations of principles that have paved the way for influencing present date values in social work (Banks 2006). The author drew on Biestek’s casework principles but found that although Biestek theory focuses on concern of the welfare of the individual it fails to offer satisfactory accounts for relationships. The author has identified that there is a strain on positive relationships, and feels that this is an area that requires prompt development. “Ethical responsibilities flow from all human relationships, from the personal and familial to the social and professional…. Ethical decision making is a process” (Webb 2003 pg: 22).

Holland (2009) acknowledges that a key element within ethic of justice is that of individual rights and that this is a very important development for looked after children. The client has be informed and made aware of all aspects of the intervention process before any structured work can take place as the vast amount of therapeutic play therapy relies heavily on parent participation. This alone poses an ethical dilemma as the client is within a residential group setting and relationships between client /staff may be inconsistent.

In conclusion to this assignment the author feels that it would benefit all parties if the play therapy was delayed until the new adoptive parents were approved. This would then enrich the relationships between client/ adoptive parents, furthermore they can subsequently build resilience in the new family unit, along with educating the new adoptive parents of the complex history and the future needs of the client. The long term value base and ethical benefits would outweigh any short term quick fix solution; the new adoptive parents require the best tools available to ensure that the new family unit works.

References
Banks, S. 3rd Ed, 2006. Ethics and Values in Social Work. Palgrave Macmillan: Basingstoke.
Butterworth, G., Harris, M. 1994. Principles of Developmental Psychology. Lawrence Erlbaum Associates Ltd: UK.
Collingwood, P. 2005. Integrated Theory and Practice: The Three Stage Theory Framework. The Journal of Practice Teaching in Health and Social Work, Volume 6, Number 1, 2005, pp. 6-23(18).
Available on line: Darwin, R, C. 1872. The Expression of the Emotions in Man and Animals http://darwin-online.org.uk/content/frameset?itemID=F1142&viewtype=text&pageseq=1 [ Accessed October 2009].
Available on line: Dr. Thorley, G. 1998. Therapeutic Intervention for Attention Deficit Hyperactivity Disorder http://www.drgeoffthorley.com/ADHD%20article%201998.pdf [Accessed October 2009].
Gray, M. 2009. Moral Sources and Emergent Ethical Theories in Social Work. British Journal of Social Work, September 22, 2009.1-18.
Holland, S. Looked After Children and the Ethic of Care. British Journal of Social Work. August 10 2009. 1-17.
Houston, S. 2003. Establishing Virtue in Social Work: A Response to McBeth and Webb. British Journal of Social Work (2003) 33, 819-824.
Lovat, T., Gray, M. 2008. Towards a Proportionist Social Work Ethics: A Habermasian Perspective. British Journal of Social Work (2008). 38, 1100-1114.
Slee, T. P. 2002. 2nd Ed. Child, Adolescent, and Family Development. Cambridge University Press: UK.
Available on line: The British Association of Play Therapists http://www.bapt.info/playtherapystandards.htm [Accessed October 2009].
Available on line: When are Therapeutic Interventions Recommended? http://ezinearticles.com/?When-is-Therapeutic-Interventions-Recommended?&id=1499263 [Accessed October 2009].
Webb, B, N. 2003. 2nd Ed. Social Work with Children. The Guilford Press: New York.
Appendix 1
Accommodated under Sec 25 C(S)Act 95

Marc was born in England. Marc’s birth parents were substance users and had a chaotic lifestyle. He was unable to remain permanently in their care and as a result was fostered in a number of placements returning to the care of his parents for short periods and having sporadic contact with them. Marc blames himself for not being able to remain in their care.

He was adopted by a couple in Scotland at the age of 5 years. The couple were not able to have their own children. The couple then went on to have a son of their own and since then he has been treated differently. There are no photos of Marc in the house, he does not have a bike (the brother does), he is the family scapegoat and blamed for problems in the parents relationship. Marc has since been diagnosed with ADHD and his diet restricted as a means of attempting to control this. There is some debate by health professionals as to whether the diagnosis is accurate, he is on low dose medication and there has been some reported improvement in his attention levels. Marc also has a developmental delay in self care i.e. knowing how to wash himself, toileting skills. Marc remained with his adoptive parents until last month when his parents asked for him to be removed due to their perception of his behaviour being unacceptable. Marc had stolen sweets. As a result of this Marc has been accommodated in residential home on a temporary basis until a long term family can be identified. Marc believes that stealing the sweets caused the breakdown in the relationship with his adoptive family consequently blaming himself.

Recently a family has been identified and the residential unit is planning to undertake a therapeutic intervention in order to prepare Marc to have an understanding of his history and build his self esteem. The prospective adoptive family are in the process of being approved by the fostering and adoption panel.