Category: Free Essays

The United Kingdom is ageing fast. In common with much of the rest of the world the population of older people is increasing (HM Government (HMG), 2010; Nolan, 2001, Improvement and Development Agency (IDeA), 2009) and their prevalence in the population is predicted to rise to 29% by 2031 (Association of Director of Social Services (ADSS), 2003). For the first time, the number of pensioners will outweigh numbers of those under age sixteen. In 1980 it was suggested that men aged 65 could expect to reach 78, however, predicted life expectancy today would extend to 85 and by 2050 it is expected to stretch to around 89 years. This should no longer be looked upon as exceptional as older people can now expect to live over a third of their lives above pensionable age (HMG, 2009) and the advance in life expectancy can be seen as a major accomplishment for public health (Gillam et al, 2007) though it is also a major challenge.

In 2001 the Department of Health (DH) launched an ambitious policy aiming to set standards for older people’s care in all health and social care settings. The National Service Framework for Older People (NSFOP) was established to set national standards that would improve services, drive up quality and eradicate disparities in care. It was, state Williams and Webster (2002), a “key vehicle for ensuring that the needs of older people were at the heart of health and social services reform.” This essay will discuss the development of the NSFOP, and it’s progression since 2001, in a political context with particular reference to the inequalities experienced by older people associated with social exclusion.

Discussion

Life expectancy in 1856 was only 40 years and early reports recognised how the inequality of socioeconomic conditions impacted hugely on health (DH, 2008). The historical association between age and ill health is widely acknowledged. Under the Elizabethan Poor Law of 1601 the elderly were cared for in poor houses, often referred to as the feared ‘workhouses’ (Donaldson and Scully, 2009). The responsibility of the Poor Law transferred to local government and was then replaced by the National Assistance Act in 1948, just as the National Health Service launched.

Recognising the link between poverty and inequalities The Black Report (1980), commissioned by the previous Labour government in late 1970’s, saw social isolation coming under close scrutiny for the first time. It was published as the Conservatives claimed power in 1979 despite their attempts to restrain its completion, then not endorsing its findings as it disclosed a noticeable gradient between social class and disease prevalence implying the association between income and health (Lewis et al, 2008). Black et al (1980) also noted that any health improvements on the part of the impoverished could not match those experienced by the more affluent in society. On re-election of the Labour party in 1997, a further report reaffirmed the existence of the inequalities previously reported on by Black, adding that those gaps between the poor and the affluent had, if anything, widened (Acheson, 1998).

The fact that some individuals are more or less susceptible to poor health has notable ramifications for public health (Donaldson and Scally, 2009) and health inequalities experienced earlier in life have been found to continue in later life (Acheson, 1998). The term ‘health inequality’ refers to the difference in health experienced by one group above another due to one group’s advantage of the other, with the difference being noted as avoidable and unfair (Flowers, 2006). Marmot notes that this reflects New Labour’s ideology that any health inequalities which could be avoided are unjust (Marmot, 2010). Such differences may be economical, demographical (age, gender, ethnicity), social (class) or geographical (Acheson, 1998; Gillam et al, 2007; Lewis et al, 2008). Historically, older people experience more ill-health, relying on health and social care services more so than other groups in society yet often falling foul of ‘The Inverse Care Law’ which states that those in greatest need are least likely to receive support services (Tudor- Hart, 1971). This is generally due to factors such as pre-disposition to certain disease, poverty-related illness and death, the common treatment of older people and their social isolation (Lewis et al, 2008).

There is substantial evidence showing that social isolation and loneliness can be detrimental to older people’s health, well-being and quality and life (Abbott and Freeth 2008) affecting one in seven people over age 65 (Greaves and Farbys, 2006). Social isolation (and exclusion) causes inequality since it prevents people from participating in

normal activities within their society as a result of factors outwith their control (Le Grand, 2003). Marmot (2010) declares that the social characteristics of a community and how healthy behaviours are promoted and facilitated habitually can contribute to social inequalities in health. He describes the link that connects and binds older people to each other, their families and friends within and outwith their communities, as having a major impact on the effects of such inequalities as “social capital”. Muntaner et al (2000) describe social capital as “all types and levels of connections among individuals, within families, friendship networks, business and communities” and, since the 1990s, it has been widely considered to have an influence on health (Almedon, 2005; de Silva et al, 2005; Pearce and Davey Smith, 2003;Coulthard, Walker and Morgan, 2002 ). Thus, Wainwright (1996) promotes the possibilities that social capital may offer a public health policy alternative to “large scale government redistribution” such as diminishing the welfare state post World War 2. The social networks that build social capital create civic participation, trust and “reciprocity” (Gillam et al, 2007; Pearce and Davey Smith, 2003). These indicators of social capital have been strongly related to rates of mortality (Pearce and Davey Smith, 2003) as social networks are affected as people age. Losing spouses, partners and friends reduces social capital, leading to depression, loneliness and a loss of community participation (Office of the Deputy Prime Minister (ODPM), 2006). Putnam (1993) declared the following on his findings on social capital:-

“Of all the domains in which I have traced the consequences of social

capital, in none is the importance of social connectedness so well

established as in the case of health and well-being.” (Putnam, 1993)

The fact that health is generally dependent of factors such as diet and lifestyle make it somewhat beyond Government control. Increasing social capital to reduce inequalities such as social exclusion may, therefore, be an easier target for governments as they consider it to be something they can have greater control over. Hence, in 1989 Thatcher’s Government published the White Paper ‘Caring for People’. Deemed to be the starting point for considering the community care strand of policy around social exclusion it set principles to assist with social integration in later life. When New Labour came to power in 1997 with their ‘Third Way’ policies based on “rhetoric of community, partnership & strong government” (Klein, 2001) claiming they would look after the poorest first, Blair made tackling social exclusion one of his priorities (ODPM, 2004), recognising that older people sometimes get ‘lost’ between health and social care services.

The well-being of older people is not only attributable to income, but also involves housing, health, care, transport and social contacts. Recognising this the Local Government Centre directed the driver against social exclusion resulting by launching a two-year research programme, Better Government for Older People (1999), aimed at developing strategies to provide a seamless and more accessible service for older people. One result of this was the launch of the NSFOP (2001) that would set standards to reduce variations in care which result in equalities including exclusion. Blair’s Secretary of State, Alan Milburn declared, in his forward, that Labour were “determined to deliver real improvements for older people” and their priorities lay with looking after the poorest in society. The NSFOP was expected to deliver improvements in both health and social care for all older people over a set timescale of ten years.

With older people’s prevalence in the country rapidly increasing as discussed, and the subsequent costs rising substantially, the agenda was set for the development of the NSFOP. The policy making cycle continued with formulation of an External Reference Group of actors including the Professor of Health Care for Elderly People, the Chief Inspector of the Social Services Inspectorate, the Director of Social Services, and other practitioner and management groups working in the field of care for older people such as Help the Aged and the Carers National Association. Policy development also included those in Primary and Secondary Care with specific disease management knowledge and from Community Care including those forming the User Reference Group. Proposals were agreed based on evidence-based expert opinion and consideration of the values which underpin care services (NSFOP, 2001). Evidence included systematic reviews, individual intervention case studies and also fundamental experiences of older people themselves and their carers. Further input would be required across the implementation period of the policy from health and social care by forming Local Implementation Teams tasked with disseminating the policy’s objectives.

Policy implementation would be continual over the 10 year period and was based around eight ‘Standards’ of care targeting progess towards improved service provision, One and Eight being most pertinent to reducing exclusion. Standard One (Rooting out age discrimination) fit neatly with New Labour’s agenda to reduce age-related stigma and increase fair access to services based on need (Baldwin, 2003) so is perhaps predictable. It promised to audit all age-related policies, assessing service patterns across the country to establish examples of best practice with a view to setting benchmarks on which to measure future improvements arising from the NSFOP. Standard Eight (The promotion of health and active life in older age) aimed for a joint NHS/Council approach to increasing fair access to services to help people stay well and independent, hence discouraging exclusion. Health promotion initiatives for older people have been shown to provide early returns in improved health, independence and wellbeing making them economically sensible investments for any Government (DH, 2006a) particularly when promoting healthy ageing is central to the health inequalities agenda (DH, 2003).

Since the cycle of the NSFOP was set until 2011 the final stage of evaluation remains incomplete. However, several papers have been published analysing its progress and considering the next steps to be taken to meet its aims (Baldwin, 2003; DH, 2003; Commission for Healthcare Audit and Inspection (CHAI), 2006; DH, 2006b; Cornes et al, 2008; ODPM, 2006). Whilst noting that there was still a long way to go, each report agreed progress had occured and made reference to some significant development in Government policy as a result of the NSFOP including: Opportunity Age (HMG, 2005); Independence, wellbeing and choice (DH, 2005); and Our health, our care, our say (DH, 2006b). Such progress includes increased breast cancer surgery for the over 85s, 39% more hip replacement operations for the over 65s and an increased coronary artery bypass procedures for the over 65s. Although, an increasingly ageing population would logically result in increased necessity of these operations with or without the NSFOP. Other services have not faired so well. Older People’s Mental Health initiatives have focused specifically around those who are still of working-age, irrationally since many older people suffer reduced mental health after retiring due to the loss of focus and a feeling of no longer being of worth, often resulting in depression and isolation from the rest of society (CHAI, 2006). The “deep-rooted attitude to ageing”(CHAI, 2006) is still evident in some services and only 15% of older people have been found to be in contact with health and social care services at any one time. Whilst the CHAI report that spend on these services for the over 65s has increased – 40% of the NHS budget in 2001 increased to 43% for 2003/2004 and ?5.2 billion of social services budget increased to ?7billion in the same period – it is unclear whether this increased service delivery results from the NSFOP framework or is simply due to the amplified demand of an increasingly ageing society. Many of the initiatives stemming from the NSFOP designed to improve older people’s health and wellbeing whilst reducing social exclusion have been found to be inconsistently accessible to older people, resulting in continuance of the exact problem they aimed to remedy. Baldwin (2003) agrees, believing the NSFOP to be ideologically sound yet found it to ironically increase age-related exclusion in relation to some health services.

Many initiatives aimed at improving older people’s health and social care have their roots based predominantly in a top-down medical model in which the primary objective is to ensure that care is provided. Jack (1995) argues that it is vital to recognise the need for empowering older people since they are amongst the most disempowered in society, often being regarded as a problem by service providers due to their increasing numbers resulting in rising costs. Nusberg (1995) agrees and is quoted by Thompson and Thompson (2001) as stating:

“Older people are one of the last groups with which the notion of

empowerment has become associated. Yet the privilege it represents –

the ability to make informed choices, exercise influence, continue to make contributions in a variety of settings and take advantage of services – are

critically important to the well-being of elders.”

Having choices and being able to maintain control over decisions about their own health is of great importance to older people and unless the medical model is challenged, older people will continue to be social excluded and considered a minority group, being treated by service providers and policy-makers as recipients of care, rather than simply as older adults with the same range of problems as younger ones. The NSF Next Steps (DH, 2006a) recognises the potential that older people can contribute to their local communities, in turn improving their own health, independence and well-being. Through consultation with older people, the Public Service Agreement 17 (HM, 2010) acknowledges their diverse needs and aspirations noting their contribution to society as “an important factor in well-being, independence and connectedness in later life”. New Labour aimed to support older people to contribute more to society by taking forward their plans from the HM Treasury Final Report (2007) to promote and support best practice in volunteering and mentoring. Renewal of civil society formed a component part of Blair’s ideology and many policies on health inequalities developed during New Labour’s reign refer to the role of society, encouraging Wanless’s statement that ultimately everyone is responsible for their own health and that of their families (Wanless, 2004). This ideal has been reflected in some of the NSFOP progress reports, almost using older people’s lack of engagement in inequality-reducing initiatives as a ‘get-out’ clause for the timescales not having been reached. This swing towards passing the responsibility of reducing inequalities such as social exclusion over to society under the banner of ‘civil participation’ is set to continue through Cameron’s ideology of ‘The Big Society.’

Conclusion

In their 2010 manifesto, the Coalition announced that they would safeguard age-related entitlements, free travel and increased opportunities for work, all of which would move towards reduced inequalities for older people. The fact that reducing the current deficit displaces all other planned measures has quickly altered the Governments’ promises. Already the swingeing public spending cuts are causing concern for older people. Age UK (London Evening Standard, 30/9/2010) suggest the poorest will be hardest hit losing an average income of between 29% and 33.7%, yet only 12 months ago in ‘Building a society for all ages’ (HMG, 2009), Gordon Brown stated pensioners were now less likely to be in poverty than other groups with benefit changes enabling the poorest households to be on average ?2100 per year better off. Brown also boasted more employment opportunities for older people. However, unemployment rates for the 50-65 age group are higher than the rest of the working population (Audit Commission, 2008). The Coalition state one way they will tackle loneliness and encourage older people’s social interaction is through promotion of digital technology. Many older people remain connected to friends, families and social sites through internet use in venues such as libraries yet the new Government plan to close many local libraries. They also plan to alter free bus pass privileges by increasing eligibility age to 65, yet a third of over 60s used a bus at least weekly as their only form of transport throughout 2007 (Audit Commission, 2008). Such changes inevitably exclude older people further and are only likely to increase isolation. The substantial demographic shift requires a radical change in the way the Coalition Government now proposes to support its older people. Attitudes and expectations need to change across society, stereotypes should be shed and the assumptions about what growing older means must be challenged to tackle the inequality of being older along with the social exclusion that often accompanies it.

The Centre for Policy on Ageing report (2010) cites approximately 75 policy documents developed with an aim to improve older people’s services since March 2005. Even the very recent publication, ‘Building a society for all ages’ (HMG, 2009), starts by discussing the prevalence in ageing and proposing a programme to “end age discrimination and promote age equality”. ‘Equity and excellence’ (DH, 2010a), aiming to liberate the NHS, claims it will create a service which will “eliminate discrimination and reduces inequalities in care”. However, in a very unstable financial climate, NHS Primary Care Trusts (often the drivers behind the NSF’s) will struggle to achieve the NSFOP 10 year targets. Facing the prospect of huge debt, job losses and imminent abolishment any aspirations of developing further initiatives needed to meet the NSFOP final objectives will inevitably be crushed. Marmot (2010) states: “Even backed by the best evidence and with the most carefully designed and well resourced interventions, national policies will not reduce inequalities if local delivery systems cannot deliver them”. Evidence-based or not, in his 1997 manifesto TB said “What counts is what works” (Klein, 2001), however what ‘counted’ has not made any major improvements since the NSFOP launch according to the considerable body of evidence and consultation papers delivered subsequently which basically all make the same already recognised statements – that the population is ageing quickly and older people remain isolated from many essential health and social care services – yet not appearing to move forward in what is being done to address the situation.

Understanding how policy affects older people can be seen as challenging, particularly in view of the changing demographics. A key challenge in implementing policy is the need to engage older people in the process by putting their needs at the centre of policy development. Elbourne’s 2008 report to Government advises that “policy makers and service providers will be better prepared to plan & deliver policies that really do meet the needs of older people when they begin to welcome the rich diversity of views and experience owned by this group”. Likewise, Cattan et al (2005) advocate the importance to policy and practice of involving older people in planning, developing and delivering activities that prove most effective at reducing inequalities. Older people often believe their contributions are not valued and their voices go unheard only exacerbating the very problems of discrimination, poverty, isolation and social exclusion (ADSS, 2003) which the NSFOP aims to reduce. With ‘fairness as its cornerstone’, Equity and Excellence (DH, 2010b) promises to involve ‘patients, service users and the public’ in all service developments. Politicians often acknowledge the wealth of experience that older people have to offer within White Paper rhetoric – perhaps this is the time to actually listen and value that experience and then adhere to their promises and not use them simply for votes. After all, the new Coalition’s mantra is “No decision about me, without me”.

This research proposal concerns the investigation and analysis of the impact of parental misuse of alcohol on children. The perceptions of policy makers and members of society in the UK have for many years acknowledged the negative consequences of excessive alcohol consumption on health, behaviour and public safety. Such perceptions have in turn resulted in curbs on sale of alcohol to young people and to restrictions on driving under its influence. Social workers along with professionals in areas like health, medicine and law and order are also working towards reducing domestic violence and disruption on account of alcohol misuse (Bancroft, et al, 2005, p 47).

The impact of parental alcohol misuse on children has however been largely ignored, even in the midst of growing concern about increasing alcohol consumption; especially amongst young people (Murray, 2005, p 7). Recent reports highlight that children numbering more than 2.6 million in the UK live with dangerous drinkers, even as more than 8 million children are adversely affected by alcohol misuse of family members. Families where parents misuse alcohol are by and large characterised by poorer functioning. Such families are perceived to lack cohesion, ritual and routines; they have (a) lesser levels of verbal and physical expression, display of positive feelings, and caring and warmth, and (b) greater degrees of unresolved conflict (Murray, 2005, p 9).

Misuse of alcohol by parents is seen to be causal in (a) adverse physiological and physical outcomes for children and (b) fostering of environments that are unfit for children, both for development and for living. Such environments are marked by numerous incidences of neglect and direct or indirect violence (Harwin & Forrester, 2002, p 84). There is a great deal of evidence to show that parental alcohol misuse can harm children in diverse ways and lead to behavioural difficulties in early and later life. Children exposed to domestic conditions of parental alcohol misuse are less likely to do well in the classroom and appear to be more prone to mental health problems in later life (Harwin & Forrester, 2002, p 85).

Evidence also suggests that a huge majority of alcohol dependent people in the UK had alcohol misusers for parents and work towards perpetuating the cycle for future generations (Kroll & Taylor, 2003, p 25). There is also disturbing evidence to reveal that parental misuse of alcohol is significantly associated with deaths and serious abuse. Studies of adults, who are homeless, imprisoned or have substance misuse problems show significant association of such people with parents who misuse alcohol (Kroll & Taylor, 2003, p 27).

1.2. Aims and Objectives

The proposed research study aims to study the impact of parental misuse of alcohol in detail, with specific regard its relevance for social work theory and practice. The objectives of the dissertation are as under:

To investigate the short and long term consequences of parental alcohol misuse on children?

To investigate the relevance of the issue in current social work theory and practice?

To assess the rationale, validity and effectiveness of current social work approaches in improving the situation, with regard to both results and costs

To provide recommendations on improving policy and practice approaches towards improving outcomes for children of parents with alcohol misuse problems.

2. Literature Review
2.1. Short and Long Term Consequences of Parental Alcohol Misuse on Children

Research reveals that children of parents who misuse alcohol consumption can suffer from a variety of physical, psychological and behavioural problems with short and long term outcomes. As alcohol problems differ in character, severity and time period, their impact upon children also varies (Murray, 2005, p 4). It is however clear from national and international studies that the children of families in which one or both parents engage in alcohol abuse have greater problems than others. Seven important features of the family lives of these children, namely (1) roles, (2) rituals, (3) routines, (4) social life, (5) finances, (6) communication, and (7) conflict could be adversely affected (Murray, 2005, p 5).

Whilst parents with alcohol abuse problems cannot certainly be equated with bad or uncaring parents, research does suggest that alcohol problems adversely affect parenting quality. Excessive drinking can make individuals emotionally unavailable, unpredictable and inconsistent and result in passive, neglectful or even harsh parenting (Grekin, et al, 2005, p 15). With children learning from their parents about who they are, particularly in relation to others, children of parents who engage in alcohol abuse are likely to get ambiguous and inconsistent information, mainly because of the unpredictability on the behaviour and responses of such parents (Grekin, et al, 2005, p 18).

Whilst inconsistency occurs mainly on account of the unpredictable way in which such parents behave, such impulsiveness and irresponsibility in their behaviour results in the imposition of responsibilities on children that are excessive and beyond their years, which in turn affects their education, their family life and their relationships with their peers (Murray, 2005, p 9). Such children also face high risks of social exclusion because of their urge to conceal their parental drinking from their friends. Such children sometimes carers of their parents, especially in circumstances of domestic violence and can ally with the drinking parent or against him or her. Psychologists and behavioural specialists state that children of problem drinkers could fail to internalise their feelings of worth and trust and often learn not to trust, feel or talk. They may also be worried about the abilities of their parents to safeguard them and thus find it difficult to trust others (Murray, 2005, p 9).

Children of parents with alcohol problems are at significantly greater risk of witnessing and experiencing verbal, physical, and sexual abuse, as well as neglect. Excessive alcohol consumption plays a major role in 25 to 33 % of known child abuse cases (Kroll & Taylor, 2003, p 29). Children of problem drinkers are also extremely likely to blame themselves for the difficulties experienced by their families in naA?ve attempts to make their environment become better able in supporting them. Such children are also likely to carry their experiences of childhood into adulthood. Unborn children of mothers engaged in alcohol abuse during pregnancy can develop Foetal Alcohol Syndrome (FAS), involving a variety of mental and physical health problems (Kroll & Taylor, 2003, p 34).

2.2. Resilience among Children of People with Alcohol Consumption Problems

Whilst many of the problems described above place significant demands on social workers, especially when they continue through generations, it is also true that some children of parents with drinking problems do not seem to face as many difficulties as others. They appear to have greater resilience (Murray, 2005, p 5). Contemporary research reveals that certain protective processes and factors can reduce the adverse effect of parental alcohol difficulties on children, in the short as well as the long term. Such protective factors include high degrees of confidence and self esteem, self efficacy, ability to handle change, good problem solving skills, strong and positive family functioning, close and positive bonding with one or more caring adults, and good support networks beyond the family (Murray, 2005, p 7). Protective processes on the other hand include planning on behalf of children to make their lives less disruptive by (a) reduction of the impact of risks by altering the exposure of children to such risks, and (b) development and maintenance of self efficacy and self-esteem and self efficacy, and (c) improving the care provided by parents (Murray, 2005, p 7).

2.3. Social Work Policy and Practice for Children of Parents with Alcohol Related Problems

The national policy for dealing with adults with alcohol related problems is fragmented and approaches the issue from different angles. The main components of the governmentaa‚¬a„?s national policy towards containment of alcohol misuse are as under (Galvani, 2006, p 3-7):

The National Alcohol Harm Reduction strategy for England focused upon the requirement for services in the area of alcohol and domestic abuse to function together to address the issue.

The guidance document for the delivery of alcohol strategy acknowledges the requirement for assessment of consequences of alcohol problems on children.

The guidance document on alcohol misuse intervention focuses on the ways in which PCTs, along with local authorities, criminal justice agencies and voluntary agencies should understand and implement their roles in dealing with alcohol related crimes.

The Drug and Alcohol National Occupational Standards appreciates the requirement for workers to be able to safeguard and reduce the risk of abuse, both by and to their clients.

The vision for services for children and young people who are affected by domestic violence guides commissioners on (a) the important aspects of support for children and young people experiencing domestic abuse, (b) assessment of gaps in local services, and (c) their priorities for action.

The Children Act 1989 and its subsequent amendments incorporates the witnessing or hearing of bad treatment of children by other persons to be included in parameters for assessment of harm.

The National Service Framework for children, young people and maternity services focuses upon relationship conflict and alcohol and drug use as important areas where parents could require early intervention as well as multi-agency support.

The 2009 Task Force Report in response to Lord Lamingaa‚¬a„?s Report states that many children continue to be at risk of harm on from the people they should otherwise be rely on for care and love and that the government is responsible for doing everything possible to safeguard such vulnerable children (HM Government, 2009, p 29). The 2011 Munro Report on child protection states the need for abandoning the old standardised and bureaucratic approach to child protection and customising services on the basis of the experiences and needs of children Monroe, 2010, p 1).

The recently elected coalition government is in the process of assessing and reshaping national policy towards social work and some refocus of attention of policy makers on the consequences of impact of parental alcohol misuse on children is expected.

2.4. Research Questions

The aims and objectives of the proposed research, along with the information obtained from a brief review of literature have resulted in the formulation of the following research questions.

Research Question 1: What are the short and long term consequences of parental misuse of alcohol on children?

Research Question 2: How is current social work policy and practice dealing with this problem?

Research Question 3: What is the rationale of existing policies and practices for improving the lives of children threatened by excessive parental consumption of alcohol?

Research Question 4: What is the validity of such policies and practices and what is the extent of their effectiveness?

Research Question 5: How can current policies and practices be improved for bettering the life outcomes of children at risk from parents who engage in excessive alcohol consumption?

3. Research Method
3.1. Choice of Research Method

Social research is by and large conducted with the use of positivist and interpretivist epistemologies, which in turn largely call for the respective use of quantitative and qualitative methods of research (Bryman, 2004, p 43).

With the issue under investigation being extremely complex and multifaceted, the use of quantitative methods is hardly likely to yield any substantial or new results. Quantitative surveys on the issue have already revealed the various problems that can stem from excessive alcohol consumption by parents on their children. The use of interpretivist methodology and qualitative research techniques should help in the investigation and analysis of the subject under issue.

It is proposed to obtain relevant information on the subject from appropriate primary and secondary sources, whilst information from secondary sources will be obtained from the substantial amount of information and research findings on the subject that is publicly available. The researcher proposes to obtain primary information through the conduct of detailed one-to-one interviews with three social workers who have been closely involved in providing services to the families and children of people suffering from alcohol misuse problems. The interviews will be conducted carefully with the use of a range of open and close ended questions and will hopefully lead to interesting and relevant information.

3.2. Ethics

The researcher will take all measures to follow appropriate ethical codes of conduct, with regard to informed consent, confidentiality, absence of coercion, and freedom to answer or not to answer questions. Efforts will be made to ensure that the research is totally original and devoid of any form of plagiarism (Creswell & Clark, 2006, p 69).

Care planning, provision and management are essential parts of the mental health nurse’s role. Ongoing interaction and assessment of clients needs creates a basis for providing and organising care that is inclusive, effective and adaptive through evaluation and review. The creation of a framework of care established on the premise of recovery, as it is viewed in mental health terms, can not only provide for a client’s basic needs but can also allow them to continue to grow as an individual and lead a fulfilling life even in the presence of a mental health problem or illness (Hall, Wren & Kirby, 2008). This case study will explain and discuss the nursing care of an individual that has a mental health problem. A plan of care will be outlined including the reasoning and evidence base that prompted such direction. Parahoo (2006) reminds us that all nursing practice should be based on sound principles and processes that stem from reliable sources. Firstly we will look at the specifics of the scenario and set up some working premises which will then allow us to further speculate on the development and implementation of a structured care plan.

The case study is based around a 69 year old female named Simone. After recent lapses in memory, orientation and changes in mood were disclosed to her GP she was further assessed and consequently diagnosed with early onset dementia. Simone lives with her 40 year old daughter in a semi detached bungalow in a quiet suburban area. Simone’s daughter has paraplegia after an accident ten years ago. She is able to care for herself to a certain extent but does require occasional assistance from Simone. Simone’s daughter also recently experienced bouts of depression which lasted several months. Recently Simone had an incident when she became disorientated on a trip to the local shops and had to be escorted home by a neighbour.

The role of the nurse in this case study is that of a community psychiatric nurse working with older adults. After meeting Simone and carrying out an initial assessment there are several pertinent pieces of information to continue with: Simone appears to be physically well and her home is clean and well equipped for both her and her daughter; She seems to understand where she is but at times can become flustered when unable to answer certain questions; Her daughter reports that, on a few recent occasions, Simone has burned food while cooking; She has no other family living locally and has lost touch with many of her friends since looking after her daughter; Simone states that she does not require any assistance at this time as she feels that she will be able to cope, however, she seems to be very anxious about her diagnosis and the consequences for her and her daughter and whether they will be able to continue managing to live at home.

To be able to begin to make any kind of conjecture on what plans of care may be suitable for Simone we have to make several key assumptions about the skill of the nurse. For this we will use some of the attributes identified by Gerard Egan (2010) in his ‘skilled helper’ model. Firstly we must assume that through accomplished communication skills and core empathic values a working therapeutic relationship is possible to establish. Also that the care plan proposals which are being put forward are ones that have been discussed and accepted by all involved parties as suitable to Simone’s preferences after reviewing alternatives. Finally, we must presume that through encouragement, motivation and reasoning, Simone will consent to nursing, psychiatric and other agency involvement.

From the initial assessment it would seem that Simone has an apparent need for information pertaining to her condition as well as emotional support and counselling. She may require psychiatric input in terms of ongoing assessment, medication prescribing and monitoring. It also seems as though Simone may need some sort of support or assistance in certain daily activities, this could be direct support or the creation of systems and routines which enable her to perform tasks independently. A growing level of social isolation looks to be occurring and Simone may benefit by having assistance to address this. Simone may need access to support groups relating to her diagnosis of dementia, her role as a carer but also to her social and personal interest or activities. These could promote social inclusion as well as cognitive enhancement. Simone has also stated that she has concerns over the wellbeing of her daughter if she should be unable to perform the duties for her that she has up until this point. This may require a level of involvement within Simone’s care for her daughter, to learn about Simone’s condition and also to look at possible ways in which she can assist, perhaps by considering some form of support for herself or by means of being actively involved in the care plans.

Therefore, with these needs in mind, we can begin to create an all encompassing, holistic care plan which is not purely based on the historical medical model that you are ill and we can cure you, or even the more modern social model that purports that you have needs and we can meet them but is instead more firmly based on the progressive view of recovery which states that you may have a problem but with help you can grow beyond it (Hall, Wren & Kirby, 2008). This positivity in the face of such adversity may go against the grain of traditional treatment of dementia sufferers but the goal of restoring and maintaining mental health to its achievable optimum capacity, even when it may be in inexorable decline, should remain exactly the same as in all other areas of mental health treatment (Hughes, 2006). For care plans to be efficient they also have to be specific, measurable, achievable, realistic and timed (SMART), as this allows a flexibility to the planning process because effectiveness can be evaluated and appropriate changes can be made as required (Brooker & Waugh, 2007).

So for this particular case study, the initial care plan would comprise of tasks for the nurse to complete, either as a direct care provider or as a care manager. These tasks would hopefully address the current needs of Simone over an interim period, whilst improving relations, knowledge, involvement and empowerment which could help to provide her with a greater amount of control over her current situation. The tasks will firstly be detailed in a basic format and then what each task entails will be comprehensively discussed thereafter.

As care provider:

Weekly home visits

Liaise with psychiatrist, monthly psychiatric appointments

Family work

Risk assessment

Creation of advanced statements

As care manager:

Link in with multidisciplinary team

Signpost, assist to access support/interest groups

Being able to have face to face communication with an individual on a regular basis is the cornerstone of effective nursing practice (Ewels & Simnett, 2003). As Simone had stated that she did not feel that she required any external involvement at this time, even when we are working on the assumption that she will accept it, it would be important not to initially overwhelm her. She may be feeling very frightened and vulnerable. A study of older independent living people in 1998 identified dementia as a primary fear, rating higher than cancer (Mackinlay, 2006). General awareness of dementia issues is relatively low even though it is a common enough condition to affect more than 1 in 100 people aged over 65 (Alzheimers Scotland, 2010). A bombardment of too much input or information may cause her to be defensive and withdraw her engagement with CPN services. Starting off with a planned weekly visit of around one hour in length which follows up on the preliminary visit and assessment would perhaps not seem overly intrusive. During this time the nurse can provide much needed emotional support and counselling, building up a more robust working relationship. Information about Simone’s diagnosis, such as how her dementia developed to this point, how it may progress in the future, what to expect, how to prepare, what options are available and any other pertinent questions can be answered as and when Simone feels ready to discuss such things. Overtime Simone can start to identify weaknesses to focus on and strengths which can be utilised and begin to compile her own plans and goals which she can work on in a more independent fashion. These can be more specific goals such as taking up a new hobby or interest or could even be to plan how to visit the local shops and return home safely or cook a meal without the worry of burning it. These goals can then be broken down into achievable tasks for Simone which she can carry out with minimal support. Increased independence can often involve an element of therapeutic risk and it is important not to confuse care with control (Watkins, 2009).

Weekly visits give the opportunity to provide tangible support and to continually assess the progress of Simone’s dementia, mental health, general health, the continuing suitability and condition of her residence, activity levels, relationships and inclusiveness in the wider community. Informal and also formal rating scales, such as the MMSE (Mini Mental State Examination), MADRS (Montgomery Asberg Depression Rating Scale) as well as clinical observations can be regularly recorded to monitor any developments, patterns or trends. Frequent visits allow more effective methods of communication techniques to be developed which suit Simone’s personality and current capabilities. Care becomes not only person centred but also relationship centred and this bond can foster trust and relieve anxiety, stress and agitation (Innes, 2009)

The community psychiatric nurse would work in tandem with a designated psychiatrist, reporting to them weekly. The psychiatrist that originally assessed Simone and made the diagnosis of dementia would be most preferable to aid continuity of care. For this commencement period of Simone’s involvement with psychiatric services to have a monthly appointment with a psychiatrist would be both realistic and achievable. This would be an opportunity to receive further support and review ongoing mental health and mental state assessments such as the MMSE or the more comprehensive ACE-R (Addenbrooke’s Cognitive Examination – Revised). A psychiatrist would be able to provide any ongoing prescription support if required or provide access to relevant psychosocial therapies. The NICE-SCIE Guidelines for Dementia Care (2006) states that this would depend on the results of cognitive tests and perceived cognitive functioning. Using the MMSE as an example, it is recommended that only people with a score between 10-20, denoting moderate Alzheimer’s type dementia should begin courses of acetylcholinesterase inhibitors such as donepezil, galantamine and rivastigmine. The effectiveness of these drugs for individuals scoring lower than 10 points drops dramatically. For people with mild to moderate Alzheimer’s type dementia, scores over 20, should be given the opportunity to participate in structured group cognitive stimulation programmes and alternative therapies. In the journal article, ‘Dementia: Symptoms, Diagnosis and Management’, Salama (2008) recognises the effectiveness of these programmes and therapies for the management of cognitive symptoms such as agitation, anxiety, depression and aggression. It would seem from the needs outlined from the scenario this type of intervention would be beneficial to Simone.

It is always important to remember that often people with dementia do not exist solely in isolation and inevitably family members and friends will become involved in their journey. Innes (2009) talks about the importance of a partnership between the nurse and individual diagnosed with dementia and states that these partnerships can extend to close family members or carers creating a triad of care. With Simone’s consent, sessions could include her daughter, helping to educate and inform her therefore better preparing her to cope with the possible demands of continued cohabitation with her mother. The NICE- SCIE Guidelines for Dementia Care (2006) state that people living in the community diagnosed with dementia should be supported to remain living in their own homes for as long as possible rather than being uprooted to an unfamiliar environment. Also if Simone’s dementia is seen to have a possible genetic link her daughter should be briefed on the risk of developing the condition herself. Simone’s daughter may be able to inform of ways in which she may be able to assist, however, the information provided in the case study suggests that due to Simone’s daughter’s disability her ability to support her mother in some aspects of care may be limited. Studies have consistently shown that stressors faced by family members of people with dementia are amongst the most difficult to cope with of all chronic illnesses and this can lead to an increased risk of depression, loneliness and self injury (Keady cited in Norman and Ryrie, 2009). As Simone’s daughter is already prone to depression a recommendation of how to assist her mother could be to receive more direct support herself subsequently alleviating some of the caring duties for Simone. The importance of relationships and friendships should not be underestimated. The emotional support from an extended social network can be invaluable and Simone should be encouraged to renew links with family and friends to strengthen existing relations and reduce isolation. Leff and Warner (2006) identify social inclusion as one of the key factors to maximising mental health in dementia.

One of the most important duties of the community mental health nurse is to ensure the health and wellbeing of the client, their family and wider community. In order to do this they have to assess the risks involved within the situation. For Simone, her recent dementia symptoms pose new risks, to herself and others, which consequently have to be identified and managed. The most appropriate way to assess risk is in conjunction with the individual you are working with, even though their view of the risks involved may vary from yours. This collaboration means that any decisions feel agreed rather than imposed and are therefore more likely to be conformed to whilst also enhancing the therapeutic relationship between the individual and nurse (Ramsay et al, 2001). From the case study we can see that there are possibilities for Simone to inadvertently bring harm to either herself, her daughter, her neighbours or even the wider community through a number of negative eventualities such as wandering, causing fire hazards or lapses while driving if she does indeed drive. However, although assessing risk can highlight the dangers a situation or condition can cause it can also help to recognise positive skills and strengths which may be utilised. As part of a recovery focused care plan therapeutic risk must be considered and encouraged in order for Simone to maintain the sense that she is still author to her own story. Barker (2009) promotes the idea that personal growth and development through new or continued experiences does not stop with a diagnosis of mental illness or dementia but should be encouraged to continue unabated.

Another consideration which could be brought to Simone’s attention is advanced statements. These are personal statements of preference in terms of the types of treatments a person with a mental illness may or may not wish to have in the future in the event of a decline in their mental health. These wishes and preference must then be upheld under Part 18 of the Mental Health (Care and Treatment) (Scotland) Act 2003. Simone may not feel ready to start compiling these statements straight away but if she is aware of them, over time, her preferences can be documented. Under Part 17 Chapter 2 of the same mental health act Simone also has the right to independent advocacy which she may wish to utilise to create any advance statements or to reinforce them if required. If Simone’s dementia does decline to the stage where she is no longer deemed to have adequate capacity for appropriate decision making she would come under the legal realm of the Adults with Incapacity (Scotland) Act 2000. In times of better mental health Simone may wish to select a named person to act on her behalf should this be required in the future. All decisions made on Simone’s behalf must be to her benefit and be the least restrictive option. With these factors in mind, part of the community psychiatric nurse’s role would be to promote the use of advance statements in order that Simone may continue to be cared for in a manner of her choosing, even after the possible loss of capacity, thus maintaining a sense of self and control over her own treatment. Both of these elements are identified by Pilgrim (2009) as being key points in aiding recovery in mental health treatment.

Multidisciplinary team and multiagency working is an essential part of modern health care provision (Brooker and Waugh, 2007). Community nurses can appear to be working autonomously but are often supported by and linked in with a number of other health professionals and social care workers such as physiotherapists, dieticians, occupational therapists, social workers, general practitioners, psychiatrists and care assistants to name but a few. Norman and Ryrie (2009) claim that the effectiveness of this way of working lies in the diversity of skills and experience which is able to be drawn upon to facilitate more effective care for specialist needs or requirements. In the case of Simone any identified needs that would be unable to be met by the community nurse or that would be more effectively met by other workers could be referred on. In this way Simone’s care becomes collaborative, with her at the centre and people with the specific knowledge and skills being utilised around her.

As well as engagement with health and social care professionals there are numerous charities, agencies, groups and organisations that offer external support. For Simone this could be in the form of local support groups for issues that affect her, such as dementia, stress or being a carer, or could perhaps be more focused on activities that suit her general interests. The community psychiatric nurse could possibly assist Simone to source, access or even in the short term, attend these kinds of pursuits. Interacting with others in groups or focusing on enjoyable tasks has the therapeutic benefit of enhancing both social and cognitive proficiency for a person diagnosed with dementia (Gilhooly et al 2003). Leff and Warner (2006) also stress the importance of social inclusion by naming it amongst their four key areas for improved quality of life alongside independence, health and choice.

So in summary, we have outlined the case study scenario of Simone, identified her needs and created a plan that is intended to meet these needs. In addition to meeting the identified needs, a deeper analysis of the plan depicts how it will benefit Simone in a more holistic sense. By keeping the notion of recovery firmly in mind, the overall aim is to build up Simone, the person, as a whole and not purely to assist with the symptoms of dementia. For Simone to ‘recover’ she must be supported to live a full life in the existence if her dementia, be able to remain independent for as long as possible, be included in the community, plan for the future and enjoy a quality of life that she finds gratifying. As this care plan created for Simone progresses, being updated and augmented as required, it should mean that her dementia should become to be viewed as illness which is being managed and not as a defining characteristic of her personality. Paraphrasing from a letter written to the notable neurologist Oliver Sacks: A person does not consist of memory alone. They have feeling, will, sensibilities and moral being, matters of which neurology cannot speak. It is here, beyond the realm of an impersonal psychology, that you may find ways to touch them, and to change them (Luria cited in Sacks 1985).

Introduction:

We are living in an ageing society where majority of population live longer and the age of the people over 60 is more than the children under the age of 16 years in United Kingdom.

Most of the older people need care. As Bracht (1978) noted, “Social works uniqueness come from its persistent focus on the physical, social-psychological and environmental health needs of clients” (p – 13)

1.1 Explain how principles of support are applied to ensure that the individuals are cared in health care settings.

All staff have a responsibility to ensure good standards of care are maintained and organisations need to have internal systems to monitor social care governance arrangements.

Communicate in an honest, open, positive and friendly manner that is appropriate to the Patient’s/clients’ need.

Ensure you have consent for everything you do with the patient/client.

Provide person-centred care and respect the person’s individuality and dignity.

Protect patients/clients from infection, accidents, injuries and breaches of confidentiality.

Carry out basic observations safely and effectively.

Record and report your findings accurately in the appropriate place.

Use your interactions with patients/clients as an opportunity to promote health.

Know and respect your role and the roles of others in the health care team.

Accept accountability for your actions and behaviour.

Be open to learning new knowledge and skills and to developing your role safely.

All patients should expect the same standard of care, whoever delivers it.

The level of supervision provided must be appropriate to the situation and take into account the complexity of the task, the competence of the support worker, the needs of the patient and the setting in which the care is being given.

1.2 What are the procedures for protecting clients, patients and colleagues from harm?

Many health care settings are now part of national and international initiatives to promote workplace health. The Health promoting Hospitals Network of the World Health Organization, for instance, recognizes the importance of workplaces as settings for promoting the health of service users and service providers. A big part of looking after others – clients you care for, the people who live with, visit and accompany them and the colleagues you work with and looking after your workplace. People cannot remain healthy in unhealthy and unsafe environment.

As individuals, all health professionals have a duty to protect patients. All health care professionals are personally accountable for their actions and must be able to explain and justify their decisions. While the scope of their practice varies they all have a duty to safeguard and promote the interests of their patients and clients. Health care professionals must act quickly to protect patients, clients and colleagues from risk of harm especially if either their own or another health care worker’s conduct, health or performance may place patients or clients at risk.

There are many things we can do that will help to make workplace safer and healthier we for instance:

Make sure keep working environment clean and tidy, using organization’s cleaning guidelines.

Keep equipment and furnishings safely stored when not in use and remove trailing electric cables from floors.

Report damaged equipment, floor coverings and lights immediately.

Look for signs that clients, staff and others, including yourself, may be in danger of harm or abuse or have been harmed or abused. This would include recognizing and dealing with early signs of violent or aggressive behavior.

Always follow organization’s waste disposal stream policies, particularly with sharps.

Clean away spillages immediately, using approved procedures and personal protective equipment if necessary guidelines.

Work with patients/clients in a way that respects their dignity, privacy, confidentiality and rights.

Keep equipment and furnishings safely stored when not in use and remove trailing electric cables from floors.

1.3 What are the benefits of following person centered approach with users of health & social care services.

‘There is only one way and that is the person centered way – it is a journey worth taking.’

Sally, member of the Transforming Adult Social (Care service user reference group)

Recent survey shows that around ?2.7 billion could be saved each year by providing person-centered support for people with long-term conditions. Our society is based on the belief that everyone has a contribution to make and has the right to control their own lives. This value drives our society and will also drive the way in which we provide social care. Services should be person-centered, seamless and proactive. They should support independence, not dependence and allow everyone to enjoy a good quality of life, including the ability to contribute fully to our communities. They should treat people with respect and dignity and support them in overcoming barriers to inclusion. They should be tailored to the religious, cultural and ethnic needs of individuals. They should focus on positive outcomes and well-being, and work proactively to include the most disadvantaged groups. We want to ensure that everyone, particularly people in the most excluded groups in our society, benefits from improvements in services.

The trend towards a person-centred approach can be found in the work of Carl Rogers (1958) and his approaches to client-centred psychotherapy (Brooker, 2004) initially developed to support people with learning difficulties. Person-centred planning has since influenced work across the range of social care services. Person-centered planning is for learning how people want to live, to learn what is important to them in everyday life and to discover how they might want to live in the future. However, a plan is not an outcome. The only reason to do the planning is to help people move toward the life that they want and person-centered planning is only the first part of the process.’

In order for people to have real choice and control over their life and services, the people who support them will want to consider the following questions:

a-? What is important to the person, so that services and supports are built around what matters to them as anindividual – instead of people being labelled according to a condition, an impairment or a stereotype.

a-? How, when and where the person wants support or services delivered -rather than a standard ‘one size fits all’ approach.

1.4 What are the ethical dilemmas and conflict that a care worker may face when providing care, support and protection.

Ethics play a central role in the clinical decision making of all healthcare practitioners; however dilemmas can arise with practitioner morality and ultimately professional judgment being central to the correct management. As healthcare professionals there is a duty of care to increase the quality of life of those who present for treatment and above all else to cause no harm.The social worker can also provide emotional support and clarification to the patient and family as things unfold. Many times, the social worker acts as the voice of the patient and family, explaining to the consultants what their wishes are and advocating for them to be respected (Rothman, 1998).

Healthcare practitioners must “always place the welfare of the patient before all other considerations” (College of Optometrists Members’Handbook, 2007) Example of possible dilemmas includes being asked to prescribe the contraceptive pill to under – 16s without parental consent.

(Health and social care Book 2 Level -2)

2.1 Explain the implementation of policies, legislation, regulations and codes of practice that are relevant to own work in health & social care.

UK government had made numerous policies, legislation and regulation in order to protect everyone in health and social care setting including employers, employees, service users and their families as well.

Care Standards Act (2000):

Ensures all care provision meets with the National Minimum Standards.

Sets standards for the level of care given to individuals requiring social care.

Requires that all staff have a thorough police check before they begin working with children and adults and that a list is kept of individuals who are unsuitable to work with children or vulnerable adults.

Children Act (1989)

Made major changes to childcare practice;

Introduced concept of ‘significant harm’.

Introduced concept of ‘parental responsibilities’ rather than ‘rights’.

Made wishes and interests of the child paramount.

Children Act (2004)

Introduces Children’s Commissioner, Local Safeguarding Children Boards and provides legal basis for Every Child Matters.

Disability Discrimination Act (2005)

First came into force in 1995 and was amended in 2005.

Requires the providers of public transport to reduce the amount of discrimination towards

People with disabilities on their buses and trains.

Requires public facilities and buildings to be made accessible to those who have disabilities.

Requires employers to make reasonable adjustments to allow an individual with a disability to gain employment.

Data Protection Act (1998) Data Protection Amendment Act (2003)Access to Medical Records (1988):

Provide for the protection of individuals’ personal data with regard to processing and safe storage. The Acts cover:

Storage of confidential information

Protection of paper-based information

Protection of information stored on computer

Accurate and appropriate record keeping.

Health and Safety at Work Act (1974)

Aims to ensure the working environment is safe and free from hazards.

Employers and employees should share responsibilities for:

Assessing risks before carrying out tasks

Checking equipment for faults before use

Using appropriate personal protective clothing

Handling hazardous/contaminated waste correctly

Disposing of sharp implements appropriately.

Management of Health and Safety at Work Regulations (1999)

Explain to managers and employers what measures they must take to keep staff safe. The main focus of the regulations is risk assessment.

The regulations explain how to conduct a risk assessment and what the assessment should contain.

Mental Health Act (2007)

Updates the Mental Health Act 1983. The main changes are:

16 and 17 year olds can accept or refuse admission to hospital and this decision cannot be overridden by a parent.

Patients who are detained in hospital under a section of the Act are entitled to an independent advocate who will speak for them at a review to decide on their future.

Under Supervised Community Treatment Orders, patients who are discharged will be visited at home by a mental health professional to ensure that they take their medication.

There are many more policies and legislations which are relevant and need to be understand in health and care such as; Food Safety (General Food Hygiene) Regulations (1995), Lifting Operations and Lifting Equipment Regulations (1998), Manual Handling Regulations (1992), Mental Capacity Act (2005), Reporting of Injuries, Diseases and Dangerous Occurrences Regulations (1995) (RIDDOR).

2.2 Explain how local policies and procedures can be developed in accordance with national and policy requirements.

Several stages are involved in shaping care policies, and nurses can play an important role in all of these. When trying to disentangle policies, it makes sense to look at the roles of the different organisations that develop them. Things that seem to be a matter of local decision-making, for example, what type of incontinence aids to use, can be determined by policies at a regional or national level. These might cover how suppliers or equipment should be chosen (for example, through tendering processes), or set budget or resource levels. In turn, national policies might be shaped by international policies: for example, a trade embargo might preclude the purchase of equipment from suppliers a certain country. One type of continence pad may be more comfortable for patients, more absorbent or more secure, but if it is too expensive, or made in a country that does not trade with the UK, it will not be used at local level.

National policies have a major impact on the resourcing of health-care services but, increasingly, they also set performance indicators and evaluation criteria. For example, if one criterion for evaluation is that every patient should have a ‘named nurse’, then this will affect how you organise work, or at least the way you welcome a patient into your unit. Similarly, if a set of performance indicators set by national government focuses on measuring ‘throughput’ of patients, you may find yourself under pressure to discharge people from your care more quickly than otherwise.

The first type of policy-making process has the advantage of transparency – everyone knows what the process and outcomes are. It can, however, be very slow to respond to changing circumstances. If every change has to be discussed and debated by the full committee, and then formally communicated across the organisation (perhaps with opportunities for people to give their responses before the policy is finally adopted), it can take a long time for things to change.

The second type of policy-making process is more flexible, and arguably more responsive to change, but its informality can mean people in the organisation are not clear about what policies are, or how they were developed. It can sometimes be difficult to have an open debate if there is no process for doing this, and it is difficult for people to be updated on policy change with no clear dissemination mechanisms.

2.3 Evaluate the impact of policy, legislation, regulation and codes of practice on organizational policy and practice.

Every organization has some policies and producers that promotes equal opportunities and reinforce the codes of practice of specific professional bodies. Organizational policies are the mechanism by which legislation is delivered and implemented.

Policies in organization’s are includes:

Health and safety

Harm Minimization

Risk Assessment

Equal Opportunities

Confidentiality

Bullying and Harassment

Conflict of Interests

Since 2000, health and social care services have become strictly regulated and then it became essential for all settings to have a professional code of practice.Organizations have to follow government policies strictly. The code of practice for everyone working within the social care sector includes information on protecting the rights, and promoting the interests, of individuals who are receiving the care and their careers. Policies, legislation and regulation enable the organizations to perform their role efficiently and professionally.

3.1 Explain the theories that underpin health & social care practice

Social Care Theory for Practice is a major component in Social Care. Professional’s role can often be a powerful one. As a care worker you are potentially able to exercise a relatively high degree of control in a situation.

French and Raven (1959) identified five types of power:

Reward Power – based upon the perceived ability to guarantee positive consequences

Coercive Power – based upon the perceived ability to ensure negative consequences

Legitimate Power – based upon the perception that someone has the right to expect certainbehaviors (sometimes called position power)

Referent Power – based upon the desire of subordinates to be like leaders they believe have desirable characteristics

Expert Power – based upon the perception that a leader has expert knowledge the

Subordinates don’t have (sometimes called information power).

Motivation Theory:

According to Stefanle Haffmann(2006), Motivation is a psychological process and it can be explained as willingness of individuals to do something for satisfies a need. When a worker motivated about his job/work employer can get more efficiency. (Robbin and Coulter, 2002) said that, in everyday life, people ask themselves the question why they do something or why not. A need is a psychological or physiological deficiency, which makes the attainment of specific outcomes attractive.

Maslow’s Hierarchy of Needs:

Abraham Maslow (1908 – 1970) along with Frederick Herzberg (1923) introduced the Neo-Human Relations School in the 1950’s, which focused on the psychological needs of employees.

Physiological; hunger, thirst, etc.

Safety and Security

Belongingness and Love

Esteem

Cognitive; understanding, knowledge

Aesthetic; order, beauty

Self-Actualization; fulfillment and realization of potential

Self-transcendence; connection with something beyond the ego or to help others fulfill their potential

Maslow put forward a theory that there are five levels of human needs which employees need to have fulfilled at work.

Maslow Hierarchy of Needs

Taylor Theory:

Frederick Winslow Taylor (1856 – 1917) put forward the idea that workers are motivated mainly by pay. His Theory of Scientific Management argued the following:

Workers do not naturally enjoy work and so need close supervision and control. Therefore managers should break down production into a series of small tasks. Workers should then be given appropriate training and tools so they can work as efficiently as possible on one set task. Workers are then paid according to the number of items they produce in a set period of time- piece-rate pay. As a result workers are encouraged to work hard and maximise their productivity.

3.2 Scrutinize how social processes impact on users of health & social care services.

Marginalization and social exclusion describe the process whereby individuals or groups are pushed to fringes and edges of mainstream activity, where minority groups are excluded from the available to the majority of people. The effect of marginalization is to disadvantage many people and sideline any social, economic and moral concerns for their wellbeing. It is likely that if a group of people experience discrimination and social exclusion, they are also experience health inequalities.

Since the Black Report of 1980, it has been acknowledged that those from the lowest social grouping experience the poorest heath in society. Iike in UK inequalities in heath is still persisting. The statistics are stark: For example:

Young Black men are six times more likely to be sectioned under the Mental Health Act for compulsory treatment than their white counterparts.

Gay and bisexual men are seven times more likely to attempt suicide compared with the general population.

GPs often do not accept Gypsies or Travellers on their lists or refuse treatment after first visits.

24% of deaf or hearing impaired people miss appointments, and 19% miss more than five appointments because of poor communication (such as not being able to hear their name being called).

Take-up of breast screening is just 26% in women with a learning disability compared with over 70% for other women.

Children in the lowest social class are five times more likely to die from an accident than those in the top class.

Someone in social class five is four times more likely to experience a stroke than someone in class one.

Infant mortality rates are highest among the lowest social groups.

Under the age of 65, men are 3.5 times more likely to die of coronary heart disease than women.

Women experience more accidents in the home or garden, while men experience more accident in the workplace or while doing sports.

Suicide is twice as common in men as in women.

The poorest people in England are over ten times more likely to die in their fifties than richer people.

Obesity and smoking, two of the leading causes of preventable death, are more common in lower socio-economic groups.

Over recent years, we have become increasingly aware of our responsibilities in regard to issues such as equality, diversity and human rights. Like other public sector services, the NHS is under a legal and moral obligation to provide services to all people, regardless of gender, ethnicity, age, disability, sexual orientation, religious or cultural belief. From a public health perspective, the key concern is the extent to which people who are socially excluded or disadvantaged as a result of their ethnicity, sexual orientation or religious belief etc. all too often experience the poorest health and poorest experience of healthcare services.

3.3 Evaluate the effectiveness of inter-professional working.

According to Barrettet et al, (2005) Quality of service depends on how effectively different professionals work together. Schein (1972) believes that education of health professionals should be mixed in order for professionals to obtain new blends of knowledge and skills.

Recently Government stressed the need of inter-professional working which making a difference that our health system must move from one in which a multitude of participants, work alone focusing primarily on managing illness, to one in which they work collaboratively to deliver quality effective care to clients. Professionals working in collaboration provide care which is designed to meet the needs of clients’ .When a person seeks hospital care; they will interact with more than one healthcare professional. The number of professionals involved and the importance of their ability to work collaboratively increases with the complexity of the client’s needs. New initiatives to improve management of diseases such as asthma and diabetes invariably points to the need for a more collaborative approach (Iah and Richards, 1998)

4.1 Explain own role, responsibilities, accountabilities and duties in the context of working with those within and outside the health & social care workplace

Health service providers are accountable to both the criminal and civil courts to ensure that their activities conform to legal requirements. In addition, employees are accountable to their employer to follow their contract of duty. Registered practitioners are also accountable to regulatory bodies in terms of standards of practice and patient care (RCN et al., 2006).

The law imposes a duty of care on practitioners, whether they are HCAs, APs, students, registered nurses, doctors or others, when it is “reasonably foreseeable” that they might cause harm to patients through their actions or their failure to act (Cox, 2010).

HCAs, APs and students all have a duty of care and therefore a legal liability with regard to the patient. They must ensure that they perform competently. They must also inform another when they are unable to perform competently. This applies whether they are performing straightforward tasks such as bathing patients or undertaking complex surgery. In each instance there is an opportunity for harm to occur.

Once a duty of care applies, the key question to ask is: what standard of care is expected of practitioners performing particular tasks or roles?

In order for anyone to be accountable they must:

Have the ability to perform the task.

Accept the responsibility for doing the task.

Have the authority to perform the task within their job description, and the policies and protocols of the organisation.

Registered nurses have a duty of care and a legal liability with regard to the patient. If they have delegated a task they must ensure that the task has been appropriately delegated.

This means that:

The task is necessary and delegation is in the patient’s best interest.

The support worker understands the task and how it is to be performed.

The support worker has the skills and abilities to perform the task competently.

The support worker accepts the responsibility to perform the task Competently.

Employers have responsibilities too, and as HCAs and APs develop and extend their roles the employer must ensure that their staff are trained and supervised properly until they can demonstrate competence in their new roles (Cox, 2010).

Employers accept ‘vicarious liability’ for their employees. This means that provided that the employee is working within their sphere of competence and in connection with their employment, the employer is also accountable for their actions.

Delegation of duties is summarised in this statement from NHS Wales (NLIAH, 2010) “Delegation is the process by which you (the delegator) allocate clinical or non-clinical treatment or care to a competent person (the delegatee).

You will remain responsible for the overall management of the service user, and accountable for your decision to delegate. You will not be accountable for the decisions and actions of the delegatee”.

Delegation must always be in the best interest of the patient and not performed simply in an effort to save time or money.

The support worker must have been suitably trained to perform the task.

The support worker should always keep full records of training given, including dates.

There should be written evidence of competence assessment, preferably against recognised standards such as National Occupational Standards.

There should be clear guidelines and protocols in place so that the support worker is not required to make a clinical judgement that they are not competent to make.

The role should be within the support worker’s job description.

The team and any support staff need to be informed that the task has been delegated (e.g. a receptionist in a GP surgery or ward clerk in a hospital setting).

The person who delegates the task must ensure that an appropriate level of supervision is available and that the support worker has the opportunity for mentorship. The level of supervision and feedback provided must be appropriate to the task being delegated. This will be based on the recorded knowledge and competence of the support worker, the needs of the patient/client, the service setting and the tasks assigned (RCN et al., 2006).

Ongoing development to ensure that competency is maintained is essential.

The whole process must be assessed for the degree of risk.

4.2 Evaluate own contributions to the development and implementation of health and social care organizational policy.

You will need to know and understand:

Codes of practice and conduct, and standards and guidance relevant to your setting and own and the roles, responsibilities, accountability and duties of others when developing, implementing and reviewing care plans

Current local, national and European legislation and organisational requirements, procedures and practices for:

data protection

health and safety

risk assessment and management

employment practices

protecting individuals from danger, harm and abuse

your responsibility for keeping yourself, individuals and others safe

making and dealing with complaints and whistle blowing

multi-disciplinary and multi-agency working

working in integrated ways to promote the individual’s well-being

the planning and provision of services

developing, implementing and reviewing care plans

How to access, evaluate and influence organisational and workplace policies, procedures and systems for developing, implementing and reviewing care plans

How to access and record information, decisions and judgements for care plans

How different philosophies, principles, priorities and codes of practice can affect inter-agency and partnership working when developing, implementing and reviewing care plans

Knowledge of the physical, emotional and health conditions of the individuals for whom you are developing, implementing and reviewing care plans and how to use this information to make informed decisions for the content of the care plans

The factors to take account of when evaluating whether your organisation has the resources (human, physical and financial) to provide the services and facilities

Methods of supporting staff to work with individuals, key people and others to deliver, implement and evaluate care plans

The stages, procedures, paperwork and people involved in developing, implementing and reviewing care plans

The use of evidence, fact and knowledge based opinions in records and reports and why it is important to differentiate between these and make clear the source of evidence

Legal and organisational requirements on equality, diversity, discrimination, rights, confidentiality and sharing of information when developing, implementing and reviewing care plans

Knowledge and practice that underpin the holistic person-centred approach which enable you to work in ways that:

place the individuals’ preferences and best interests at the centre of everything you do

provide active support for the individuals

recognise the uniqueness of individuals and their circumstances

empower individuals to take responsibility (as far as they are able and within any restrictions placed upon them), and make and communicate their own decisions about their lives, actions and risks (when developing, implementing and reviewing care plans)

How to manage ethical dilemmas and conflicts for individuals, those who use services and staff/colleagues when developing, implementing and reviewing care plans

Contribute to, participate in and run meetings and discussions to agree revisions to care plans, taking account of any benefits and risks

Ensure that review meetings are arranged and run in ways which promote the full participation of individuals and key people

Collate review information and revise care plans within agreed timescales

Ensure that individuals and key people understand the revisions that have been made to the care plans and the implications of these for the health and care services that individuals receive

Complete, and support individuals to complete, any necessary paperwork when the final plan has been agreed

Ensure that the plan is stored and able to be accessed within confidentiality agreements and according to legal, organisational and any service requirements

4.3 Make recommendations to develop own contributions to meeting good practice requirements.

Protect the rights and promote the interests of service users.

Strive to establish and maintain the trust and confidence of service users.

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

During this assignment I will examine and critically analyse both the medical and social models in relation to mental health and mental distress. I will also look into several mental health problems and see the effect it has not only on the person who has mental health issue but also towards the society in general. I will identify certain treatments which are used to work with people with mental health problems including complementary and alternative medicine (CAMs)

Initially it is important to actually understand what mental health problems are and take a brief look into the history of mental health. Mental health problems can range from someone feeling slightly down and not quite themselves to more serious issues where people struggle or can’t carry on their normal life (schizophrenia, dementia). In most mental health situations people don’t need any assistance and support and just carry on living day to day life and just recover naturally. Nevertheless some people do need help whether that is by medical or social professionals to help deal with their symptoms. It has been stated that around 16% of the United Kingdom are experiencing a common mental health disorder and that 1 in 4 people in their life will have a mental health issue. It is estimated that the annual cost to the economy of United Kingdom through mental distress is 77 billion. (Gould, N. , 2009)

A brief look at the history of mental health and illness shows that for many years’ people who were financially secure and from a decent class of society who had a mental health issues would normally have been looked after by their family. Unfortunately if you had no status or wealth then you were put into mental asylums. From the beginning of the 19th century asylums and mad houses changed. Rather then been for just people in poverty, people started to accept a greater willingness for the need of a more medical view to madness. Asylum numbers peaked at over 150000 in 1950 but however due to changes of ideas with regards to understanding human problems and pharmaceutical medical advances at the start of the 20th century meant that asylum numbers started dropping and the mentally ill started to be seen within their communities. (Pilgrim, D. & Rogers, A. 1999)

The medical model is the dominant model within medical organisations with regards to mental health. The medical model is used by medical professionals to diagnose and treat mental ill health on the pretence that all mental health issues are generic or chemical imbalances and that those illnesses can be treated with medication or medical treatments. The medical model treats mental health illnesses similar to the way it treats physical illnesses which to a certain degree is an impossible thing to do. If someone has a bad heart or lungs for example then medication can in all probability heal there issues but if someone has a bad mind then medication can perhaps help them in the short term but will the medication actually fix or cure them long term. Whilst drugs can give the short term quick fixes there are also many anxieties about possible side effects associated with taking medication and the long term damage that drugs can have on the body obviously with other non-medical models this would not be the case. (Mental Health Care, Feb 2010)

Whilst the Medical Model is good to the degree that you can put a name to your disorder so you know what is wrong with you medically, which can also reassure family members the downside is unfortunately the stigma and prejudice associated and received towards people who have been diagnosed with a mental health issue.(Kinderman, P; Sellwood, W; Tai, S , 2008 : 96)

The Medical models stance would presume that social, cultural and environmental issues which are present in an individual’s life are a result of the medical condition rather than part of it. (Bogg, D. , 2008).

The Social Model

The social model fits well with the general holistic approach of social work and that there are numerous examples of practice where the social model underpins effective practice. (Golightley, M. 2008).

The social model is service user centred and treats the person as a unique individual which realises that everyone’s issues are different to the next person The social model takes in to account when dealing with people with mental health illnesses the many environmental, social and cultural factors that could lead to a person having mental health issues. Once knowing what elements brought on a service users illness it enables a worker to be able to find probable solutions to individual’s mental health issues. This is called social causation. These issues range from poverty, unemployment, relationship break up, bereavement, education. By reducing service user’s vulnerability issues and increasing their resilience to these issues the service user can then consequently improve their mental health issues however this is no quick fix and can take a considerable amount of time. The social model empowers the service user to tackle and take responsibility of their situation whilst the social worker is there to advocate and listen to the person and try to assist the person through their journey. There are cognitive behavioural therapies that the service user can go to. Talking therapies can have great successes as the service user has the opportunity to discuss their thoughts, feelings, anxieties, assumptions and beliefs.

When we start to critically analyse both these two theories it becomes apparent that the Medical Model has various trepidations. Whilst the Social Model is individual tailored to the service users’ needs, the Medical Model sees symptoms and diagnoses them with an illness and offers a quick fix through medication. This approach does not take into account the reasons why the service user suffered and might suffer more mental health/distress issues.

One of the major issues with the medical model is the stigma associated towards people who have been diagnosed with mental health issues. The stigma received to mentally ill people from society can have a truly distressing effect on people who are receiving treatments to the degree that a mentally ill person could stop taking and attending treatments because of the stigma and label associated with that person’s illness. The media also plays its part in increasing negative stigma due to all the detrimental things that are circulated either on television or in newspapers. It is a very rare commodity that the media contributes a positive image towards mental health and illness. While less than 3% of mentally ill patients could be categorised as dangerous, 77% of mentally ill people depicted on prime-time television are presented as dangerous. (Fink, J , 1992). Although this statistic is from American it clearly shows the contribution the media creates with regards to the negative stigma directed towards people suffering with mental health issues.

Another disadvantage the medical model has is that mental illnesses are not like physical illnesses. If you have an illness like cancer then medication can relive pain and suffering however if you have a mental illness medication might not actually fix your symptoms. It has not been proven enough that mental illnesses are genetic or that pharmaceutical drugs always deal and fix the problem the person might have. However pharmaceutical companies depend greatly on the medical model as it makes their companies lots of money and that’s is why they invest many millions of pounds in to research and into drugs that supposable fix and heal mental health illnesses.

Figures show that pharmaceutical research and development in the UK has risen to ?3,172 million amounting to nearly ?9 million every day. (The Association of the British Pharmaceutical Industry, 2010)

Also in this modern era it is also important not to eliminate the use of complementary and alternative medicine (CAMs) over the use of the medical and social models due to the fact of the amount of people who have had success using these forms of treatment. There are many different and varied treatments available ranging from

An April 2001 survey by the Office for National Statistics (ONS) found that one person in ten in the United Kingdom had used a complementary therapy in the previous 12 months (NHS Careers ,2010). Once a person has had success with complementary and alternative medicine then usually if that person became ill again they would refer to complementary and alternative medicine as a first point of contact in the future.

Depression

Depression is a good example of mental illness that the medical and social models approach from completely different angles. There are numerous different types of depression ranging from seasonal affective disorder (SAD), postnatal depression and bipolar disorder (manic depression). It is stated that around 1 in 6 people in life will suffer from one of the types of depression. In its lowest form depression can be someone just feeling down but in its worst form depression can be life threating leading to a person feeling suicidal or just wanting to give up on life. (Mind , 2010)

The medical model would involve the person going to their general practitioner who would then prescribe anti depression medication to overcome the depression. In worse case scenarios of depression the medical model would if necessary admit a person to hospital where they can have a calm safe environment where they can be observed, monitored and medicated. It was quite normal practice in the past within hospitals to use Electroconvulsive therapy (ECT) on people who had severe depression which did have positive results. More recently a treatment called Transcranial Magnetic Stimulation (TMS) is used for depression which stimulates the certain areas of the brain where depression is located.

However the medical model never actually looked at what it was that was actually causing the depression which would probably mean that the depression would return. However with the social models holistic approach a deeper emphasis would be applied into the origins of the depression and in turn try to find solutions in how to fix or reduce the causes. There could be many issues that actually brought about the depression ranging from drug and alcohol misuse, unemployment, abuse, loss, poverty, crime and social exclusion to name a few. The social model would attempt to improve the area of the person’s life which was creating the depression. With regards to complementary and alternative medicine (CAMs) there are any different types of treatment which are available to help deal with the depression. These treatments would range from yoga, acupuncture, talking therapies, taking of herbs and vitamins and homeopathy.

Dementia

Dementia is mental illness that affects brain which causes a person to have memory loss which in turn effects a person’s personality and behaviour although it is not known what actually causes dementia it is thought that it is brought on due to chemical changes within the brain. They are different types of dementia ranging from Alzheimer’s disease, vascular dementia, mixed dementia (mixture of Alzheimer’s and vascular) and Dementia with Lewy bodies (DLB). The medical model plays an influential part when dealing with dementia. Initially a person would approach their general practitioner who would diagnose the person with dementia and refer to a more specialised medical practitioner. The GP would prescribe the relevant drug which would be able to slow down the progression of symptoms in some people. However there is no permanent cure or fix for dementia. That is why there is an importance for the social model to be there for the person as well. With dementia the social models personal centred care is important because no two service users’ needs will be the same. The care is very much personalised to the needs of that particular person. The social models treat the service user as an individual. It is important to ensure that a person with dementia is happy in the environment that they live in. A person with dementia wants to have familiarity around them whether that is clothes, food or family and the social model would look at these sorts of factors and ensure that all family members have the support they need to assist the person with the dementia. (Brooker, D. 2006). One of the best forms of treatment with regards the social model and assisting people with dementia is cognitive behavioural therapy. Talking therapies have been shown to really help people with dementia due to the fact that it stimulates the mind. It is also good for people with dementia to reminisce about the past whether that is there childhood, relationships or middle age. Using prompts like old letters and photos can help. (Marshall, M. 2004). With regards to complementary and alternative medicine (CAMs) the only CAM to show any evidence of helping a service user with dementia is aromatherapy as this has shown to help service user feel less aggravated.

In summary the perfect scenario would be to combine both Medical and Social Models with regards to Mental Health and Mental distress. However the biggest dilemma is getting the professional people who work in their chosen fields whether that is medical practitioners or social work practitioners to actually be prepared to work to a combined model. There is a need for the Medical Model to treat the illness with medication however there is also the need for the Social Model to look into the reasons around why the service user became mentally ill and to prevent relapses. From the social workers perspective it is important to look at things holistically and to take into account the external factors in someone’s life that may be causing them mentally ill health. Whilst for the medical practitioner’s perspective there main ethos is to preserve and maintain life and discharge people back to their homes. I think that the perfect situation would be to have strong multi agency relationships between medical and social work professionals. Where planning and discussion with regards to the patient/client is paramount as so both the medical and social models are working together in harmony. The consequential effect would be that the client would receive the best from all professional workers involved and ensure that the client would stand a better chance of getting the best treatment available both within the medical setting and within the community that they live. I also think that it is important that professionals whether from medical or social backgrounds are actually prepared to embrace models from different professional occupations. However this is one of the major apprehensions and conflicts due to the different training and working environments that the professional workers come from.

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Discrimination of marginalized groups is a major problem facing many societies. Most societies have marginalized groups which are discriminated against by the rest of society. Such groups include the poor, sick, old, disabled and others. In some societies, racial or religious discrimination is prevalent and people of different ethnic origin from the majority are discriminated against. During the 1960s, the United States had many cases of discrimination especially against African Americans. Clark in his book “Dark Ghetto” captures the racial discrimination against blacks during this period. Clark discusses problems which inhabitants and communities which live in American ghettos experience. This paper aims at comparing the experience at the Geel Organization with the experiences addressed by Clark in the book “Dark Ghetto”. The Geel Organization provides mentally ill patients with housing and health support to ensure they recover and achieve their potential. Since the mentally ill are usually discriminated against by society, the paper will compare the discrimination which African Americans experienced during the 1960s with the discrimination mentally ill patients experience today. The discussed issues will be summarized at the end.

“Dark Ghetto” by Clark

Clark analyzes problems faced by African Americans living in ghettos. He acquires an “involved observer’s” view, which includes empathy for the suffering as he undertakes his research work (Clark, 1989). Clark studies the sociological and psychological impacts which ghetto life has on African Americans. He views the problems which African Americans living in slums face as significant since they are made to believe that they cannot rise above poverty due to racist actions and policies. Clark also points out that in spite of this suffering; there is still hope for African Americans. The book evaluates the inability of people in power to empower the suffering in ghettos and the specific use of racist policies to oppress African Americans. The author finally offers solutions to end this major problem affecting the American society.

Geel Community Services

Geel Community Services is an organization geared towards catering for the mentally ill patients in New York City. It was founded in 1976 by the Bronx community members and health care professionals to cater for housing and health needs of mentally disables people (Geel Community Service Organization, 2011). The organization offers mentally ill patients with reliable, stable and safe places to live in. In addition, the organization ensures that they have access to support services such as health and counseling services needed for their steady recovery. This ensures that they achieve their potential and are respected by the society at large. Geel appreciates the role mentally ill patients may play in the community if they can access support needed to address their illnesses. The organization provides housing needs among other needs to achieve the organizational objectives of ensuring mentally ill patients have decent housing and health services.

How the issue impacts on the work of Geel Services

The paper will specifically focus on discrimination which was discussed by Clark in the book “Dark Ghetto”. Clark analyzes how the black community was discriminated against by the American government. During this period, there were various policies which were specifically developed to discriminate against African Americans. For instance, they were not allowed to vote, most had no access to education and work opportunities, slave trade was legalized in some states, they had no access to political positions and power, among many other forms of discrimination (Murrin et. al., 2003). Clark specifically focuses on the African Americans living in ghettos who in addition to having poverty problems, they also suffered under discrimination. Discrimination against this population segment reduced their chances of reducing poverty through empowerment. Since the blacks could not access education and employment opportunities, their subsequent generations also suffered from poverty. This was intentionally planned by the government to ensure that this racial group was oppressed.

The issue of discrimination of African Americans is similar to the issues addressed by Geel Services. This organization aims at empowering the mentally ill through providing them with housing and other forms of help in order to empower the mentally unwell and reduce discrimination by society. The mentally ill are discriminated against by society due to their mental conditions. Young mentally ill children are ridiculed by their peers, and in some cases, their guardians and parents. They usually do not have access to superior educational and health facilities as bodied children do. In addition, many mentally ill people are from poor families and they lack decent housing. When mentally disabled children are through with schooling, there are few employment opportunities. This further marginalizes them and makes it difficult for them to overcome poverty.

The discrimination which black people suffered during the 1960s as addressed by Clark is similar to that experienced by disabled people today. The black people who suffered discrimination were handicapped by poverty, which made it difficult for them to escape the poverty cycle. Mentally ill people today are handicapped by disability which when combined with discrimination, makes it challenging to escape from poverty. Geel Services organization therefore strongly relates with the concepts discussed by Clark in the book “Dark Ghetto”.

How current social policy impacts the field of practice

After the 1960s, the government reversed the policies against discrimination of the Black community after the society rejected oppression of blacks. After the media highlighted the challenges faced by the black community and the African Americans demonstrated against oppression, the society rejected racial discrimination. The government therefore developed a policy where people received equal treatment in spite of their racial or ethnic backgrounds. In modern society, discrimination against the disabled is also an offence under law. Disabled people including the mentally ill should receive equal education, health and employment opportunities with able bodied people. Although this is not effectively implemented in society, public support for the mentally ill has increased over the years.

The social policy barring discrimination on people based on any criteria has been important in achieving the objectives of Geel Services. Discrimination is an offense in law and people who discriminate against disabled people may be liable in courts of law. In addition, after racial discrimination declined after the 1960s, the society began accepting the marginalized in society (Kenneth & Trotter, 2005). Many lobby groups and organizations emerged to cater for various causes including illnesses, education and human rights. The embracement of the marginalized in society has encouraged the Geel Services organization to spread its mission to the public in order to mobilize support to assist the mentally ill. The public has been very supportive of this cause and a high proportion of financial and non-financial support can be traced to the general public. Finally, the social policy of offering health assistance to people who cannot afford health care cover has also enabled Geel Services improve the welfare of the mentally ill. Since most of these patients are poor, the government and private sector support for healthcare has ensured that a large number of mentally ill people gain healthcare services they need.

Implications for social work practice within the field of practice in an urban setting

Social work practice by Geel Organization in the field of mental health has had positive impacts on society. The organization has improved public knowledge about how to deal with people suffering from mental illnesses. This has been important in mobilizing support for mentally ill patients across New York City. In addition, the activities undertaken by this organization have led to the mobilization of resources needed to take care of the mentally ill. Public knowledge of the illnesses has encouraged generous contributions which have been used to establish decent housing and health care for the mentally ill. In addition, cooperation with the private sector and government has led to a more effective focus on the mentally ill by society. The government has drafted laws which discouraged discrimination of the mentally ill. It has also provided personnel, resources, infrastructure and funds needed to improve the standards of living of the mentally ill.

The social work practice by Geel organization has also encouraged broad research on mental illnesses and their interventions. Due to increased knowledge on mental illnesses by the society, the organization has influenced numerous researches on mental illnesses and the various treatment interventions which are effective for treating these conditions. As a result, treatment interventions which combine the use of therapy and drugs have been developed and these are useful in treatment of various mental disorders. The government and private firms are increasingly donating funds towards mental health research. Undertaking research and developing treatment interventions is arguably the best way of dealing with the mental health problem in society.

Community strengths currently existing regarding the issues under discussions

There are various community strengths which are present in New York City as the needs of the mentally ill are addressed by Geel Organization. One of the major strengths is the public knowledge about the needs of the mentally ill. Due to extensive educational efforts by Geel Organization and other organizations which cater for the needs of the mentally ill, a large proportion of the public is aware of the needs of the mentally ill (Weare, 2000). Many people are aware of the support they require in order to recover completely. Due to this knowledge, many individuals and firms have donated resources aimed at ensuring the mentally ill have access to decent housing and health care services. This has provided the bulk of resources needed to meet Geel Organization’s objectives.

Another community strength currently existing in New York is support from the local and state governments in supporting the mentally ill. Unlike many states, New York has developed policies and allocated resources to effectively deal with the mentally ill people among the population. The state laws are strict regarding discrimination and this has deterred people from discriminating against the mentally ill. In addition, the government has provided resources, healthcare personnel, infrastructure and funding to ensure mentally ill people live decent lives in society. They have educational curricular and schools meant to cater for their unique needs. This makes it easier for Geel Organization to help the mentally ill in the community.

Clark’s work and relevance to fieldwork placement

Clark’s work is very relevant to the activities which are undertaken by Geel Organization. As has been discussed, Clark undertook a research to analyze how African Americans were discriminated against by the government on the basis of racial backgrounds. The research also analyzed the challenges faced in slums with regards to this marginalized grouping. This research is similar to the activities which are undertaken by Geel Organization. Geel supports another marginalized group which has been discriminated against by society; the mentally ill. The challenges which the mentally ill face in society today are similar to those faced by African Americans during the 1960s. Both the mentally ill people today and African Americans then did not have access to education, quality healthcare, decent housing, employment opportunities and other rights. The research conducted by Clark is therefore relevant to problems faced today by the mentally ill.

In addition, Clark advances some solutions to the problems which African Americans faced. These solutions included an end to discrimination, better access to healthcare, education and employment opportunities, mobilizing local support for an end to discrimination, passage of strict laws which discouraged racial discrimination and giving African Americans voting rights to make political decisions. These solutions are similar to the approaches which are used by the Geel Organization to cater for needs of the mentally ill. They include advocating for health care access and housing for the mentally ill as well as mobilizing support from the public to satisfy needs of this marginalized group. This makes Clark’s work relevant to the activities undertaken by Geels Organization.

Summary and conclusion

Various issues which relate to discrimination have been extensively addressed in the paper. Clark in the book “Dark Ghetto” explores the discrimination which the black community living in ghettos experienced in the 1960s. In addition to the problem of poverty, the black community was discriminated against through unequal access to opportunities and resources and this made it difficult for them to overcome poverty. However, eventually the government reversed the policies which discriminated against blacks after pressure from the American population. Geel Organization relates to the “Dark Ghetto” in several aspects. The organization cares for mentally ill people who have been discriminated against by society. It advocates for decent housing and health care for the mentally ill as well as an end to their discrimination. The mission of Geel Society is therefore similar to that of Clark; and end to discrimination of the marginalized.

Geel Organization has succeeded in increasing awareness on the challenges facing the mentally ill. It has also contributed to mobilizing resources from individuals, private firms and the government to help the mentally ill. In addition, the organization has encouraged wide research on mental health illnesses to develop treatment interventions for the mentally ill. The government has played a crucial role of proving resources, healthcare personnel, infrastructure and funding to ensure mentally ill people live decent lives in society. In addition, strict laws have been passed to guard against discrimination of this group. This has helped improve the living conditions of the mentally ill in society. The government should allocate more resources towards infrastructure and research on mental health in order to manage mental illnesses. The local community should also continue providing support to mentally ill people in order for them to feel appreciated by society.

Social work involves working with some of the most vulnerable people who have been oppressed or disadvantaged in Society. The role of the Social Worker is to challenge these oppressions to help service users help themselves. It is about promoting change, and is underpinned by laws, theories, policies and procedures. ‘Social Work as a profession has never experienced so many changes in policy and practice (Iwaniec and Hill 2009’9) Theory is far from benign and practitioners need to ensure that their understanding of theory has not stopped, slowed or become misplaced (Helm 2010) although they cannot represent an absolute truth they can help understand, explain and bring about change. (Howe 1990)

For the purpose of this assignment the assumption is that this is a heterosexual married couple where the husband is committing domestic violence against his wife.

The Gateway team is the first point of contact when children are involved, when the referral is made, their input; although may be short term has a crucial impact in ensuring the safety of the children. It is their duty to investigate, the Social Worker must see this family within twenty four hours or the reasons why this cannot be achieved must be clearly recorded (Laming, 2003, Recommendation 53) It is the Social Workers duty to make contact with this family as soon as possible.

It may be beneficial to look at the four main parts of the helping cycle which are Assessment, Care Planning, Implementation and Review. (Taylor and Devine 1993) Although Gateway doesn’t tend to execute care plans, except possibly on a short term basis, this cycle can provide a firm foundation for the Social Work process.

On receipt of this referral the Social Work process begins, Social work is never mechanistic or predictable and any encounter is seen as unique, Social Workers need to be properly prepared to ensure effective practice. One of the most important methods of preparation for Social workers is that of ‘Tuning in’ which should begin when the referral has been received. Shulman (1992) has described this as involving effort from the workers to get in touch with potential feelings and concerns the Service User may bring to the helping encounter. This should help the Social Worker prepare for undertaking the referral with a more objective approach; they may equip themselves with information to be provided as a means of empowering the family such as agencies they can connect with.

Social work has been described as a ‘practical moral activity.’ (Parrott 2010 ‘3) Before attending any referral it is important the Social Worker takes into account their own values, we all have a set of beliefs that influence our actions they relate to what we believe others should do or what we should be doing (Parrott 2010) Values are influenced by things such as culture, family, and life experience. As a Social Work practitioner there is a professional set of values that must be reflected in practice. It is important to be aware of our own values and understand that there will be occasions when our personal and professional values will conflict.

The Cornerstone of a high quality assessment is a sound value base, which challenges oppression and respects individual’s rights. Middleton (1997) believes the process of assessment is firmly rooted in the context of Social Work values and individual difference is central if the process is not going to disempower the individual. Several potential pitfalls in making judgement are identified by Milner and O’Byrne (2009) such as, stereotyping, labelling people and attributing certain characteristics to people because how we perceive they are likely to behave, as a Social Worker it is important to be able to recognise these downfalls and try to avoid them, to ensure effective practice. ‘Our values and views of childhood can play a part in the assessment process.’ (Helm 2010’162)

Due to the possible risk to the children it may be difficult to feel respect for the father; he is allegedly carrying out domestic violence in the family home, putting both his wife and children at risk from harm. It is important as a Social Worker to be clear that, although the actions may not be respected it is a professional duty to respect the persons as an individual in their own right. Recognising potential value conflicts can contribute to effective practice.

Milner and Byrne (2009) argue assessment is a key task in social work practice. It is an ongoing process involving Service User participation, with the purpose of understanding people in relation to their environment. (Coulshed and Orme, 2006) ‘Assessment demands the ability to organise, systemise and rationalise knowledge gathered, the Social Worker needs to be sensitive and demonstrate the ability to value the uniqueness of each individual assessed.’ (Parker and Bradley 2007’16). ‘Practitioners require the skill and determination to find methods of communication to demonstrate their competence.'(Thomas and O’Kane 2000’819) One of the most controversial and complex areas of Social Work is the assessment of a child and their family when there are concerns about the welfare of the child. (Holland 2004) So it is important that all knowledge is kept up to date.

It is important that the assessment ensures full involvement of the family and any significant others, portraying respect and consideration, working in partnership with the family will be beneficial. The Social Worker needs to be open and honest and give the family a clear understanding of the assessment process and their roles within it. In this particular case the exchange model could be applied, where it is seen that the service user is their own best expert, the interview should be collaborative, the family will know what problems they are facing, they will be able to provide their perspectives on what is happening.

Part of the assessment process would be to gather information, through observation, questioning and the interview process. The Social Worker will need to be aware what they are looking to find out and decide who they need to speak with, the parents, the children and any significant other that could provide an insight into the family setting.

As Part of the ‘tuning in’ process it is important that the Social Worker works in partnership with other agencies as this might help to get a clearer understanding of the situation, they must liaise with the police as they were the ones that made the referral and it may also be beneficial to speak to the family’s GP and the health visitor, as there is an 18th month old child in the house the health visitor may have made regular visits and could give a good insight into the family and the children’s development.

Observation is a critical element of assessment (Holland 2004) Observing the family is a major part of the assessment process, visualising how they interact with each-other and how the children interact with both parents, it is important to look for signs of disruption and possibly fear on the part of the children. Observation can allow the practitioner to see how the children’s daily life looks like with particular reference to emotional abuse and neglect (Helm 2010) as both children are still young the use of observation with reference to the attachment theory could provide vital information as the attachment theory focuses on how the children interact with their parents. The child’s development can be affected by lack of attachment with parents. (Hirschy and Wilkinson 2009) What is being said and what is being done may not be easily to depict, the use of observation ‘allows the practitioner to validate what is being said or it may provide contradictory evidence that needs to be addressed.’ (Helm 2010’57)

Another crucial area of the assessment is the interview process. The parents, the children and any significant others, will need to be interviewed in relation to this case, to provide a holistic view of what is happening and the effect it may be having on the children. Interviewing others outside the family may cause controvsersy with the parents as the Human Rights act (1998) states people have the right to a private and family life, (www.legislation.gov.uk) if there is a possibility the children are at risk all avenues need to be assessed. When interviewing the parents it is important that their rights are promoted. Questions need to be appropriately structured to ensure that the family are not oppressed in anyway.

Ethics are an important part of Social Work (Banks 2006) According to the Northern Ireland Social Care Council (NISCC www.niscc.info) Social Workers should promote the independence of the Service Users while seeking to ensure that their behaviour does not harm themselves or other people. It is important to consider the mothers view of the situation, although the purpose of the Gateway team is primarily to look after the welfare of the child, they must also be aware of the oppression being faced by the other members in the family and promote their rights.

As the mother is suffering from domestic violence, it may be beneficial to provide her with advice and with information on Women’s aid who provide support for anyone who suffers from domestic violence; it may help to empower her and give her a sense of self determination. She may not wish to leave for several reasons but she should be aware that it is not only her that is suffering, her children are as well. O’Loughlin and O’Loughlin (2008) believe that some mothers experiencing domestic violence may emotionally distance themselves from their children, resulting in emotional neglect.

Information on certain laws could be provided; one main order would be The Family Homes and Domestic Violence (NI) Order (1998) which includes two orders, the non-molestation order and the occupation order. It is useful to provide the family with this information because if the problem still persists this law gives the authority for the abuser to be removed from the home where children are involved. (White 2007) Providing this information can empower the mother.

Women’s Aid believes all forms of domestic violence come from the abuser’s desire for power and control over family members or intimate partners. (www.womensaid.org.uk). When interviewing the father it is crucial the practitioner is non-judgemental and shows respect, he may view himself as the dominant figure in the family, the idea of male patriarchy may play a part here therefore it may prove valuable talking with the father to give advice and provide information on possible anger management classes that he could attend, which may be of benefit to him and his family.

When carrying out assessment with Children the Social Worker with utilize UNOCINI, which provides the framework for assessing and providing services to children and their families, by ensuring timely high quality assessments with a focus on achieving good outcomes for children. It is important to explain to the family the purpose of UNOCINI. Using the UNOCINI framework provides the Social Worker with in-depth knowledge of the circumstances at hand and can aid the Social Workers role of advocacy, representing the views of the children. It can help the Social Worker assess areas such as the children’s development, the family relationships, emotional warmth and education and learning. UNOCINI emphasises the importance of multidisciplinary contributions to the holistic assessment of the child’s needs (Boginsky 2008) such as work with GP and health visitor and adequate levels of communication between Social Work teams and can provide evidence of the level of help required.

The main purpose of the assessment is to identify possible risked posed to the children. The Children’s (NI) Order 1995 is put in place to protect the child. When assessing a case like this it is extremely important to understand the laws that are crucial, as Social Work laws unpin practice. The Paramouncy Principle states that when a child’s upbringing is being considered, the child’s welfare will be the paramount consideration. (White 2007)

The Social Worker is required to work with and on behalf of the service users. When interviewing the children it is important that the Social Worker uses appropriate language that the children understand, explain to them why your there and what the situation is. The Children’s (NI) order (1995) which states ‘children should be kept informed.’ (www.dsspsni.gov.uk) it is the responsibility of the Social Worker to ensure that both the child’s welfare is protected and their voice is heard. (Brandon et al 1998) The needs of the children must be recognised. People First NI (1995) believes that needs led assessments are the cornerstone of community care. Children have rights and needs just like adults, to have their views and feeling heard and to be treated with respect they need to be able to talk to adults they trust. (Brandon et al 1998) ‘By asking children to communicate in ways that suit adults, such as talking, reading and writing, we play to adult competencies and not to those of children.’ (Helm 2010’170)

Social Workers need to be accountable for the quality of their work and should consistently be maintaining and improving their skills (NISCC www.niscc.info) In order to ensure effective communication the Social Worker must try to build a rapport with the children; this could be done through trying to engage their attention, to help develop a relationship that will help the Social Worker to learn from the child. There are possible ways this can be done; the use of a basic kit bag may prove beneficial, containing items such as play people, soft animals or soft balls. (Brandon et al 1998) It is vital to try to understand what is happening from the children’s perspectives to help assess the level of risk they face; children need to be listened too.

Domestic violence can have a huge impact on children of all ages, age can influence the way in which children make sense of their experiences and how they demonstrate certain anxieties. The children in this family are an infant and a child of preschool age. O’loughlin and O’loughlin (2008) believe in situations of domestic violence an infant’s needs may not be met, such as personal hygiene, cognitive development may be delayed through inconsistent neglect, and they become insecurely attached which could put the infant at risk.

‘Younger children do not have the ability to express themselves verbally and research has shown that children of preschool age tend to be the group to demonstrate the most behavioural disturbances’ (Hughes 1988; Cited by Humphreys and Stanley 2006? 20) they may become withdrawn and display poor concentration, which may possibly be identified through observation of the children.

The Social Worker is required to carry out a risk assessment in relation to the children. As this is an alleged case of domestic violence the children may be at risk. Brearley’s model of risk assessment is a good focus point as it can help determine the level of risk. The four stages of Brearley’s model are predisposing hazards; situational hazards; dangers and strengths, doing so may help inform the Social Worker of the level of support the family require. Safeguarding the child is essential so it is imperative that a detailed, well informed assessment is completed.

It is vital to uncover what the children have seen or heard and if they have ever been abused themselves, due to the age of the younger child this may be difficult to ascertain. However the liaison with the health visitor could provide more information on the children’s wellbeing and also their stages of development. Bronfenbrenner’s (1979) theory of ecological development would be a beneficial theory to be aware of when observing the children. This theory looks at a child’s development within the context of the system of relationships that form his or her environment. He believes that if the relationships in the home break down, the child will not have the tools to explore other parts of their environment. (Crawford and Walker 2010)

All children witnessing domestic violence are being emotionally abused (Women’s Aid) and may be at risk of harm. Harm is defined in the Children Order as “ill-treatment” or the impairment of health or development” and from the above statements we can see adverse effect that domestic violence within the home can have on children. (Probation Board for Northern Ireland 2006) Throughout the assessment it is vital that the interests of the child are always at the forefront. ‘Frequent exposure to domestic violence can predispose children to social, emotional and physical problems and through this they may learn unhealthy ways of expressing anger teaching them that it is ‘okay’ to hit others and to get away with it.’ (Newman and Newman 2008’4)

When the assessment is completed the Social Worker must record all details accurately. The practitioner needs to be open and honest with the family about the information and findings. Review and evaluation is central to good practice (Parker and Bradley 2007) The Social Worker must review their assessment to determine the level of support and protection the children and the family require. Reflection is required so the Social Worker can determine if their practice could be improved and if they have carried out the assessment in the best interests of the children and the family. If Care planning is required, it is important that a plan is constructed that meets the needs of the family and safeguards the well being of the children.

If the assessment highlights that the children are in need; in conjunction with Hardikers thresholds of intervention, it is possible for the gateway team to put in a short term plan which would set aims and objectives within the family; to support them with partnership from other agencies involved. Gateway only work on short term basis, if this family require more support a referral will be made to the family intervention team so they can provide the appropriate support to enable the family to stay together where possible. However if it is a child protection nature, a case conference may be required to decide if the children should be placed on the child protection register.

Information should be passed within an appropriate timescale to ensure that the needs of the family are properly met. Communication between the agencies is vital to ensure the correct care is provided. The Children’s (NI) Order (1995) highlight that ‘Parents with children in need should be helped to bring up their children themselves and such help should be provided in partnership with parents.’ (www.dhsspsni.gov.uk)

‘A social worker being present at an important point in another person’s life can make a big difference.’ (Parker and Bradley 2007’90). Although the family can be a source of danger to a child, supporting the family in most cases can be the most productive way to protect the child. (Brandon et al 1998) The principles associated with the legislation require practitioners to work in partnership with children and families, (Helm 2010) to enhance the well being of the children. The key aspects of Social Work are ‘the practitioners’ interventions orientated towards enhancing children’s wellbeing; ensuring that they grow up in healthy and safe environments; and developing their full potential.'(Dominelli 2009’25)

Owen and Pritchard (1993) highlight, it is important that the rights of the parents, the child and the legal system are balanced and the role of professionals in protecting the rights of children will be promoted if we actively listen to the voices of children and take their thoughts into consideration when making decisions can act in the best interests of the child. ‘Social Work is complex and diverse and the roles and tasks allotted to it are equally varied. (Parker and Bradley 2007’117) One important point to remember is that every case is unique; everyone should be treated with respect as an individual, Social Workers should have the knowledge to deal with the different demands of different situations to ensure efficient, effective practice.

“The field of developmental psychology is the scientific study of age-related changes in behaviour, thinking, emotion, and personality.” (Bee and Boyd, 2002, p3). This assignment will concentrate on the early years area of the lifespan, which ranges from pre-birth to 3 years of age. During the early years, children start to develop physically as they begin to crawl, grasp and walk. Children also start to have self-determination as they begin to make choices themselves and they start to develop their vocabulary and have simple conversations with others. Additionally, children develop socially as they form attachments with their care giver and other important faces they recognise. In social work practice, it is important to understand that theories relating to lifespan development should not be used as a solid guide when viewing behaviour, as they do not take into account all aspects of an individual’s life, such as environmental and social factors, and not everybody lives a ‘text-book’ life. (Walker and Crawford, 2010). Theories are “an attempt to explain” something to give us an understanding and make sense of problems. (Thompson, 2000; page 20).

When working with young children, it is important to understand the various stages of development so that we, as social workers can identify achievements being made; such as when a child takes their first step, or when they say their first word. Theories regarding lifespan development are based around ‘normal’ development and can help social workers determine how much progress a child is making in terms of development. (Walker and Crawford, 2010).

Social workers must make sure that when working with young children they take into account their race and culture, and what impact these might have on their development. They must also take a holistic approach when trying to gain an understanding of a child, so that not only can say learn what has happened during the child’s life, they can also say why it happened and see the child as an individual. (Walker and Crawford, 2010).

“It is important to keep in mind that even a tiny baby is a person. Holistic development sees the child in the round, as a whole person – physically, emotionally, intellectually, socially, morally, culturally and spirituality.” (Meggitt, 2006; page 1).

Following the death of Victoria Climbie, Lord Laming was required to update the arrangements for child safe guarding to prevent future tragedies occurring. The Children Act 2004, was a major reform and it brought along different policies to safeguard children, such as Every Child Matters: Change for Children. (DfES, 2004). Every Child Matters was also reformed in 2009, following the death of Peter Connelly. Also, framework for Birth to Three Matters (DfES, 2002), has been published to support professionals who work with young children and families and recognises the nature of human development.

Within psychology, there are 5 different approaches that can be taken when looking at lifespan development. These 5 approaches are biological, humanistic, cognitive, behaviourist and psychodynamic. These psychological perspectives are backed up by various theories, but it is very important to remember that theories are not always true as they do not take into consideration environmental and social factors that could affect an individual’s development. This does not mean that theories cannot be used to analyse behaviour and development within individuals, but it should be remembered that all theories do have criticisms when they are applied and used in social work practice.

The first theory which is going to be looked at regarding early years development is Erikson’s psychosocial stages of development. (Beckett and Taylor, 2010). The first stage of development is Trust versus Mistrust; this stage forms the foundation of trust a child has with their caregiver. The more consistent the care is that they receive the better trust that the child will have and they will become confident and will feel secure in their environment. However, if this stage is not completed successfully, then the child will not feel secure or confident, and may not have a lot of trust in their caregiver, which can result in a number of problems, such as anxiety and insecurities about others. (Erikson, 1995).

The second stage of development is Autonomy versus Shame and Doubt; this stage shows a child starting to assert themselves and become independent, for example, picking what they want to watch, what toys they want to play with, or what they want to eat etc. Children need to be supported in this stage so that they know what they are doing is correct and become more confident in making their own decisions, otherwise if they are criticised too much, they might start to feel dependent upon others, and may doubt their ability to make their own choices. (Erikson, 1995).

In social work practice, this theory could be used to investigate any underlying issues between a child and their parent. Erikson states that if a stage is not completed successfully, it is harder to complete following stages of development and achieve the positive outcomes. (Beckett and Taylor, 2010). This theory gives social workers an overview of how a child should be progressing and what their capabilities should be. However, this theory does not take into consideration children who have disabilities or who come from different ethnic backgrounds. A child with a certain disability may not be able to make their own choices from such a young age, no matter how simply they are, or children from different cultures will have different upbringings compared to children from other cultures.

John Bowlby was a main psychologist who studied children. In particular he looked at attachment between a child and caregiver. He believed that relationships at a young age are vital because any failings in relationships in childhood would shape the development of a child’s personality. He also believed that attachment is an innate act, and children want to form an attachment with their mothers and mothers want to be close to their children so that they can protect them. Prolonged separation from the mother is known as maternal deprivation, and this is a major cause of delinquent behaviour and mental health concerns. (Walker and Crawford, 2010).

Social workers can use theory when in practice to see how a child responds to their mother or father. For example, if a child is in a care and has contact with his/her mother twice a week, the social worker should look to see who interacts with who first, who runs to who, what is the proximity like and body language etc. All of these actions will allow the social worker to determine whether something is wrong. If the mother runs to her child, why is the child not running to her mother? Does the child not feel attached? Has something happened which needs to be looked into? However, Bowlby’s theory does not take into account fathers being the attachment figure as they may be a single parent. Also, social workers need to work in a non-discriminatory manner and remember that in some families, such as Asian families, within a household it is not just the immediate family who live there, it is also the wider family. A member of the wider family could be the main caregiver, so this needs to be taken into consideration when starting to work with a child from this type of family. (Walker and Crawford, 2010).

Mary Ainsworth adapted Bowlby’s attachment theory by carrying out her own experiment on children and their caregiver so that different attachment styles between a child and the caregiver could be observed. The Strange Situation recognised four different attachment types; secure, anxious-avoidant, anxious-ambivalent and disorganised attachment. (Ainsworth et all., 1978). The experiment took place in a small room with a one way mirror so that the child could easily be observed. Throughout the experiment, the child would be left with their caregiver for some time before a stranger entered and the caregiver leaves, and then the child would be left completely alone for a short period of time before the stranger and caregiver return and so forth. The attachment type that the child would have would be dependent on their reactions to the events that happened in the experiment – upset, crying, anxious, scared, happy, distressed etc.). For example, a child who has an ambivalent-attachment would have shown no signs of distress when their caregiver left the room, but they would have avoided the stranger when they entered the room. When the caregiver returns after leaving the child alone with the stranger, the child would approach them, but may also push them away to show that they are upset. (Simply Psychology, 2008).

In social work, this theory could be used to view the attachment between a child and their caregiver. Positive attachment could result in intervention not being needed by social workers. However, negative attachment could prove that earlier intervention is needed as there is an underlying reason as to why the child is not forming an attachment with their caregiver. This theory should be used very carefully in practice as some children are more independent than others, and it does not take into account cultural differences and disabilities. For example, children who have Autism Spectrum Disorder (ASD), especially on the higher end of the autistic spectrum, find it very difficult to display feelings and show affection. This does not mean that they have not formed an attachment with their caregiver, they are more than able to, but it is how they display their attachment type which can make them appear unattached. During the mid-1980s, researchers started to observe children with ASD in the Strange Situation. Results show that 50% of the children formed a secure attachment with their caregiver. Despite this figure being low compared to children who do not have ASD, it is very impressive and proves that children with ASD can form attachments. However, when it came to the part where the caregiver returned to their child, the children acted differently compared to other children. For example, they did not initiate contact or appear to be happy. (Oppenheim et al., 2008).

The knowledge of development and attachment theories is important in social work, as these theories will help a social worker carry out assessments on a family with young children. When carrying out an assessment, it has to be done under the Common Assessment Framework, which aims to identify the following; how well the parents or carers can support their child’s developmental needs, and how they respond and meet their needs; and what impact does the environment and the wider family have on a child’s development. (DfES, 2006).

John Bowlby’s attachment theory gives an overview of the different attachment types and it allows social workers to assess and judge the quality of a relationship, and this can help as the social worker will know when to intervene, and if necessary, remove a child from a family unit. (Walker and Crawford, 2010).

Under section 17 of the Children Act 1989, local authorities have a responsibility to safeguard and promote the safety and welfare of children who are in need. (Legislation.Gov, 2012). When working with children in need, a social worker will need to carry out an assessment under the Framework for the Assessment of Children in Need. (Department of Health, 2000). Tied within this assessment, is another assessment regarding the developmental needs of a child. It covers several areas of development; health, education, identity, family and social relations, emotional and behavioural development and self-care skills. According to Parker and Bradley, children need to reach these developmental needs to achieve a healthy adulthood. (Parker and Bradley, 2007).

By using anti-discriminatory and anti-oppressive practice in social work, it allows social workers to challenge their own beliefs and values while considering others. The Every Child Matters: Change for Children policy has 5 outcomes which are considered to be the most important to children and young people; be healthy, stay safe, enjoy and achieve, make a positive contribution, and achieve economic well-being. The policy wants children and young people to be “safe from bullying and discrimination”. (Crawford, 2006; page 16).

With regards to lifespan development theories; anti-discriminatory practice and anti-oppressive practice are used in social work because these theories can be applied to all cultural and class backgrounds. The majority of the theories were based around white middle-classed children and parents when experiments were carried out, but by no means does this mean that they cannot be applied to different cultures.

In conclusion, if knowledge of lifespan development and various theories are used correctly and appropriately in social work practice, then this could give social workers a clear indication of when a child is not developing at the usual rate, and intervention can take place at the earliest possible moment, to ensure that the safety and welfare of the child is met. The advantages and disadvantages of viewing behaviour through lifespan perspectives seem to weigh each other out in relation to social practice, however, it should be remembered that the studies are theories, and are not based on solid facts, so they should only be used in practice as guidance.

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Purpose: This study explored the experiences of mid-career professional working mothers exercising integration between work, family and selves in the context of the city of Faisalabad, Pakistan. It has been examined that how the family systems included joint and nuclear, affected them and their careers.

Findings: The study showed that the professional working mothers are responsible for performing their domestic and professional roles, besides self-care. The proper incorporation of both roles is plausible with the stipulation of flexibility from both, work and family system, both, joint and nuclear family system. All women had intense feeling of motherhood; their career was also of high importance for them as they find their values and purpose. They wanted to achieve the objectives of their lives and self-fulfillment. Now they were better able to balance their family, work and individual self in comparative to start of their careers.

Research Limitations: The response rate from the audience was low, but, through in-depth, rich and contextual information, which was received during interviews, tried to overcome these flaws. The females from the targeted population became very anxious and some were refused to give audiotaped interviews.

Originality/Value: This paper contributes in the work-life integration for professional working mothers. The study explored that what type of hindrance or support a working mother living acquired form the family system and from the workplace and how they integrate the both. Kaleidoscope career model was used for this purpose.

Keywords: Professional working mothers, mid-career, joint family system, nuclear family system, work, Faisalabad

Paper Type: Research Paper

The proportions of women make up an increase in full-time workforce (Metz, 2005), especially in the professional and managerial fields around the world (Cabrera, 2007). Pakistan is in the phase of transition (Raza & Murad, 2010), since July 2009 women employment is increased by 1.7% (Labour Force Survey, 2010). The increased proportion of women in labor force creates bigger challenges for women in the incorporation of roles and responsibilities and managing time accompanied with child bearing and child rearing years (Grady & McCarthy, 2008). These challenges stimulated scientists to create a link between work, family and self (Valimaki, Lamsa & Hiillos, 2009). As a result pressure on organizations to respond towards employee’s family responsibilities has been increasing (Goodstein, 1994). Additionally the challenge for the organization to find out the adequately integration between domestic and work life by work -family (WF) arrangements (Peeters, Wattez, Demerouti & Regt, 2009), by providing equality policies, statutory entitlement, maternity leave, carer’s leave, parental leave, and non statutory arrangements like flextime, e-working, job sharing, term-time working (Glass & Estes, 1997, Grady & McCarthy, 2008).

The increasing number of working mothers, over past years, has increased pressures for them as they confront meaning in work, family and personal life (Grady & McCarthy, 2008). Work-life integration seems to be difficult for professional mothers due to increased pressures. They not only need to create meaning in their work, family, personal life by selves but they also need support at work place by the employer. The support by the employer at work place towards integration of work, family and self leads towards self-fulfillment and satisfaction which have positive outcome for them and ultimately for employer (Auster, 2001). The absence of the support by the employer may lead to the difficulties for the professional mothers. The work intensification and long hours, coupled with child rearing demands result in stress and labor turn over (Jones & McKenna, 2002).

The purpose of this study is to explore the issues, problems and experiences of mid-career professional mothers regarding work-life integration in Faisalabad, Pakistan. How the most prevailing family systems in Pakistan, joint and nuclear (Ahamad, 2002), affect them. The study examines what type of hindrance they face and what type of support they need at work place as well as from the family. Now in Pakistan, vast segment of the society based on women cannot be denied the women’s status, autonomy and equality in playing a role in social, economic opportunities and nation building (Amir, 2004, conference paper). Concerns about the economy and as well due to the changes occurred in woman’s aspirations has increased the women as work force as never before (Ahamad, 2002). According to labor force survey 2010, women’s employment rate increased by 1.7% as mentioned above. The focus is on mid-career professional working mothers because they are in the stage of career when a lot of attention is required by their family and as well for building their professional career. Professional working mothers are defined as those mothers, who manage, develop and invest their professional career throughout the period of rearing their family (Grady & McCarthy, 2008).

Work-life integration

Work and non-work are interdependent and the individuals have to play roles simultaneously or to switch frequently from one role to the other (Wilson et al., 2004). Work role is the professional duties assigned by the organization and non work includes family or domestic duties have to perform for family. Central idea of this research paper is work life integration. Work-life integration is defined that how professional workers incorporate the duties at work place accompanied with the domestic duties along self demands. This belief gained a lot of attraction in the past decade (Metz, 2005, Grady & McCarthy, 2008, Valimaki, Lamsa & Hiillos, 2009, Peeters, Wattez, Demerouti & Regt, 2009, Goodstein, 1994, Glass & Estes, 1997, Auster, 2001, Jones & McKenna, 2002, Karatepe, 2009, Wilson et al., 2004 & Burke, 2004). With rise of industrialization, the agrarian model is now replaced, the conventional role of women expected to take care of the children and men as bread winner is going to be changed (Valimaki, Lamsa & Hiillos, 2009, Grady & McCarthy). Employees need to confront the work and non-work roles corresponding. Dissolution, interference and conflict between the roles may lead to disorder, burn out, emotional exhaustion (Grady & McCarthy, 2008 & Peeters, Wattez, Demerouti & Regt, 2009), negative health outcome dissatisfaction and emotional dissonance (Karatepe, 2009). “The work-family conflict is considered bi-directional (Cohen, 2009, p. 814)”. Managing multiple tasks at a time may lead towards conflicts from work to family life and from family to work life (Kirrane & Monks, 2004). Sense of equilibrium may create by positive spillover, enrichment and facilitation (Glass & Estes, 1997, Valimaki, Lamsa & Hiillos, 2009). On the other hand women entrance in workforce in last two decades at an precedent pace (Auster,2001), resulted dual-earner and in low gap between male and female (Ahamad, 2002). Females need support from family system and spouse to make an appropriate assimilation (Valimaki, Lamsa & Hiillos, 2009).

The family system and work-life integration for mid-career women

It has been proposed that a professional women’s career is difficult to be examined without examining her non-work life – family system and spouse (Powell & Mainiero, 1992). Family, a smallest unit of a society composed of two or more people who are interconnected by marriage, blood or adoption, live together from an economic unit, has basic features of sharing and togetherness (Ahamad, 2002). Two types of household systems, dominant in Pakistan, joint family system, in which women with her husband and children lives with in-laws, and the nuclear family system, in which a woman separately lives with her husband and children (Amir, 2004). A newly married working woman prefers to live in nuclear family system but in child bearing stage this system jeopardizes her life (Aamir, 2004). Due to the lack of day care centers and unreliable servants and maids may make it difficult for the working professional mothers to take care of their dependent children particular in mid-career. In such case joint family system becomes the heart favorite of working professional mothers (Aamir, 2004), which may facilitate and may take care of their children, in their working hours. “Woman marries the whole family and she is answerable to other family members”(Ahamad,2004), tough responsibilities are on her shoulders, specifically in joint system, leads towards heavy burden when woman is working as professional and as well as an economic hand of her partner. In such case woman may feel dissonance and may prefer nuclear system where number of dependents are less, she needs support from her spouse and work place to continue her professional career.

Modern life is leading towards change in roles of women and men due to continuous changes in economic and demographic trends (Ahamad, 2002) The percentage of married couples increased in previous decades, in which both spouses worked full time, a spouse or a partner can provide basic support, include sharing home, parenting responsibilities, encouraging career development, interpersonal support needed by working women (Gordon & Whelan-Berrry, 2004). After passing day long activity at workplace may make a working women exhausted and make it thorny for her to take care of children along household duties. In such case professional working women particular in mid-career, where family demands with child rearing are increasing accompanied with career growth. It may become difficult to incorporate both without support from family and work place. In some cases, family and spouse do not facilitate working women but sometimes do really support (Karatepe, 2009). Working professional mother may be from Joint family system or nuclear family system, necessitate ample support. It may affect in work-life integration. By sharing common interests a flexible spouse enables working woman to manage their career and integrate work and family lives successfully (Valimaki, Lamsa & Hiillos, 2009), especially in mid-career where career has already established and women are beyond the parenting of infants and toddlers, finding new challenges in work and personal interest (Gordon & Whelan-Berrry, 2004 & Grady & McCarthy, 2008).

Thus, literature indicates when women are in their mid-career, face challenges regarding work-life integration while experiencing new opportunities in advancement of their career, they need to be supported by work place and family system, either joint or nuclear family system. Professional working mothers strive to integrate across the domains and to minimize the gap. This research paper aims to explore the gap that how professional working mothers create balance concerning work, family and individual selves; and how family system affects this integration? The following section indicates research methods used in the current study to address these research questions.

Method

Qualitative in-depth interviews were carried out with 22 professional working mid-career mothers. The criteria determination for the participants was

Professional mid-career working mothers, who joint parenting role along with career advancement

Age between 33 to 48, most agreed aged for mid-career in Pakistan

With children, at least one dependent child, less than 18 years

The sample was chosen by considering convenience and snow-ball sampling. The professional working mothers to whom authors met were asked for further contacts. The sample size of 22 professional working mothers is adequate representation of population of working professional mothers particular in mid-career in Faisalabad, Pakistan. Interviews were based upon 90 to 120 minutes and were audio-taped. Authors transliterated interviews. Table1 presents the sample questions which were asked for exploration.

Sector

Subject matter

Sample questions

1

Responsibilities/dependent care you and your family

Tell about yourself, your responsibilities at work place and self demand?

How does every day job look like?

2

Amalgamating work and family life

Do you find it easy or difficult to manage work, family, school etc at morning?

Did you ever feel frustration and think to stay at home full time?

3

The work place-flextime, support, enrichment

Is your work place family-friendly for you?

Have you availability of any flextime?

4

Career development and promotion-support or barrier

Are you on the right path of your career, you ever thought?

How did you manage during child rearing?

5

Self-fulfillment and satisfaction

Did you approach your value or purpose of mid-career?

Do you consider satisfied yourself?

6

Family system

Who does take care of your dependents while your working hours?

What type of family system may support more mid-career women?

Opt out from child day care center, house maid or relatives for your child-care?

7

Other issues

Has the study enabled you to think in a different way about your?

8

Demographic data

Source: Work-life integration: Experiences of mid career professional working mothers (Grady & McCarthy, 2008)

The content analysis was the approach used to analyze the data (Bryman & Bell, 2003). The qualitative responses were collected, grouped and the concept was examined through the organized analysis of the record. The figure below presents the content analysis framework that was derived. Framework led four subject matters along with four research questions. Further integration of work is illustrated by incorporating values and essence of balance. Final column indicates the responses of the participants towards questions

Sphere
Themes
Description
Construct of work-life integration
Respondent’s reference to theme

1.

Self-perception in relation to work and family roles

Children are a working mother’s number one priority.

When there was a clear conflict between work and children, participants made choices and children became the priority.

Sense of self

(assess values, beliefs and purposes)

100%

Work and career is very important

Career is important for participant they seem stimulation, challenges and enrichment

80%

2.

Work-related factors

Flexibility is two-way

When flexibility is experienced at work it supports commitment and increased productivity in the in the work place in addition to integrating work and family life

60%

Changing attitudinal, and social context

The changing attitudes and culture in the work place and the social and legislative changes have improved the situation for working mothers

Work itself

(paid and unpaid)

75%

Responsible for one’s own career

Working mothers took responsibility for their own career at all stages and more particularly now as mature members of the workforce and at mid-career they assess that it is up to them to create their own future direction

93%

3.

Merge work &

Family system

Whether joint system help professional mothers for working?

Joint family including husband’s parents,sisters and brothers are helpful for working mother

Sense of balance

Choices about time in each sphere

72%

Whether Nuclear system help professional mothers for working?

Nuclear system excludes members of family except husband,wife and their children is more beneficial or provide support to working woman.

28%

4.

Proper Integration

Self suffers when work and family become dominant

Integrating work and family was a key priority throughout the years with little time for self, but participants found significance in this integration.

Integration and balance across work, family and self= work-life integration

80%

Paradigm is shifting and needs are changing

Merging work and family is getting easier, children are getting older, seaking more time for self- meaning of integration is changing

80%

Findings
Demographic information and career profile

The participants in this study were 22 women in number aged from 33 to 48, fall in mid-career, who endured full time job accompanied with family rearing years. All infatuated nationality of Pakistan. All participants in this paper were interviewed, indicated their marital status as married, with at least one dependent child.

Three of the participants had four children; nine of the females accompanied three kids and eight of the respondents possessed two children and two females had 1 child. Seven of the females were living in joint-family system, three of which lived with just mother-in law and father-in law, and other four were living with other relatives as well. Fifteen of the participants lived in nuclear system. One of the females had infants and the children of other women were school-aged or above but at least had one independent child. The women possessed work experience between 8 to 22 years. The targeted sectors were medical, education, makeup industry, telecommunication, nursing and research officers including both public, private and semi-government organizations along with self-employment. Four targeted interviewees were doctors had specialization in different fields, work experience fall from 9 to 20 years. Two of the participants were Ph.D. doctors, fell under the category of research officers; eight of the respondents were from education field were working as teachers, generally owned master’s degree, as well had some completed short-courses relevant to the fields. Three of the contestants were selected from telecommuting, two from banks and one from beauty salon, preserved 10 to 18 years’ experience and possessed different relevant short courses. Nine of the women included, were form private organizations, five were from government or public organizations, five were from semi-government and three were the self-employed. One of the respondents, had the nationality of Pakistan but lived 10 years in Madinah, Saudi Arabia and worked as lecturer in the Madinah University, Saudi Arabia for ten years, and shifted to Faisalabad for last five years and running her own school.

Self-perception in relation to work and family roles

The findings point out that when the family roles as well as work roles spill over each other, the number one priority professional working mothers gave to their children. It is evident from the interviews that females were very disturbed and stressed at their work, regarding their children. Women miss their children at workplace. All women became very emotional when they talked about their children. They are not ready to do compromise over their children. The working mothers focused on giving a quality time to their children. The following statements are the evident of the way of thinking of mothers:

Being a mother, my children are my number one priority. I will never let my children neglected due to my career. I have a wish to pursue my career along with performing the duties related to my children as a mother.

As a mother, my kids were my main concern. I always tried to give them a quality time rather than a quantity time.

Self employed respondents were flexible in their working conditions. They were not bound for any one’s order. Such women indicated that the reason for their being self employed was their children. They said that it was difficult for them to give an appropriate time to their children.

I am self-employed and running my own school. I rare feel to make an adjustment difficult between children and my career. In case of any accident or sickness of child it is easy for me to take a leave.

All women had intense feeling of motherhood. But some women responded that their work as a stimulating factor for them. Females pointed out themselves much active due to their jobs and considered them as idle without job. They had more challenges in their lives so they worked hard and struggled more to accomplish. They identified them as more creative in contrast to non-professional women.

In the start of my career, I found it hard to create a balance between work and family. But now I feel myself incomplete without my job. In off days I feel myself very lazy and idle. I even don’t wash my face and take bath as I don’t have to go at work. My work creates charm in my life.

Work related factors:

Two-way flexibility is very crucial issue in business organizations. If employers give flexibility to the employees working in an organization, the employees also put more commitment over there. Parental leaves, maternity leaves, flexible working hours, carer’s leave, job-sharing, may fall under the category of flexible related factors.

Flexibility is very important. I am here; the reason is the cooperation from my colleagues at workplace. As yesterday, I had to attend mother’s meeting of my younger child. My employer let me to go. As a result, today I am putting my maximum contribution.

I am a doctor but instead of doing practice I am teaching at medical college and I got flexibility from the organization to pick my children from their school. My children are quite happy and I am also contented due to that flexibility.

Some women pointed out that they had to suffer a lot because of inflexibility of the organization; sometimes it became so difficult for them to run their career during child bearing period.

I am an employee of a private organization. During my career I thought many times to leave the job due to inflexibility from my organization specifically during my child bearing stage, I ever got unpaid maternity leaves for only one month. At that stage I became so frustrated due to my child care and had wished to shoot the employer.

From previous decade the working trend of the women is increasing and as a result, social, behavioral and attitudinal changes are also emerging. In Pakistan, it was considered strange for the women to go out of their homes for the sake of earning beside their husbands. Now-a-days male colleagues share the responsibilities and contribute to the work with their female colleagues instead of competing with them.

I have been working from eighteen years. At start of my career, my neighbors, relatives, and my male colleagues watched me in an unsophisticated way, but now at the stage of my mid-career my peer group specifically included men are very cooperative towards me. Without participation of women, it’s not easy to bear financial expenses only by male. Now society is more civilized and it is accepting this reality.

Women only considered them responsible for their career. They often had to ignore many opportunities just due to their family and child related problems. Women were not willing to leave the city due to their family and spouse.

I received much flexibility from my previous organization at Lahore. I was at the promotional stage in that unit of organization. But in case of my husband’s promotion in Faisalabad I had to compromise and to leave that unit of organization and made it possible my transfer in other unit of that specific organization in Faisalabad. Now I have to deviate from my smooth career path.

I have left many opportunities offered by organization. I don’t want to become as part of top management because I don’t want to bear burden of work more it may cause to disturb my family.

Merging work and family system:

As research evidence showed that professional working mothers have much feelings of motherhood and as well they had identified the need to come in professional fields. Women have to leave the job due to negative spillover of work and family roles; they have to leave their jobs (Glass & Estes, 1997). There is high importance for them to merge work within their family systems. As indicated before that two most prevalent family systems are joint and nuclear. Professional working females, as part of joint system, pointed that this type of family system showed cooperation with them in their career path.

I have been working from fourteen years. I have never felt any type of problem regarding my child care. I leave my children at home and their grandmother takes care of them in a best manner. My children are more confident and bold as compared to my relatives whose mothers are not working. Whenever I go home after completion of job, the happy faces of my children make me fresh. All credit goes to my mother-in-law. I love her.

I don’t have any problem regarding my children care. I never felt any need of child care center here because our joint family system is the best alternative of such day care centers. I may never feel confidence over the servants and maids as I have trust in my in-laws.

Some women indicated that they had to suffer due to joint family system because of the burden of extra responsibilities and domestic duties.

Joint family system hinders smooth career path of professional working women. Due to a large amount of domestic responsibilities I lost many opportunities. Financial expenses also increases and I have to give a big portion of my salary to my in-laws.

Respondents who lived in nuclear family system mentioned a lot of problems regarding their work and family integration. They mentioned problems regarding their child care and to perform a lot of domestic duties by selves. Working women needed a cooperative spouse.

I have to ignore my children when I come to work. I forget work when I reach at home. I wish to have a joint family system at least my children may be in a position to get safety and security because I can’t rely on maids. My husband’s career is very important and he cannot take leave for children.

It is also evident that the working mothers, who lived in a nuclear system, didn’t compromise on their careers. They didn’t have any responsibilities and bounding from other family members. They indicated much satisfaction because they didn’t need to answer anybody.

I am thankful to God that I live in nuclear family system, I am very happy in my paradise where there is no interference from typical mother, father, sister and brother in-laws. I am not answerable in front of anybody regarding my actions except my cooperative husband.

Support from partner/ spouses were identified as a key element for professional working mothers. A researcher woman pointed that she was nothing without the support from her husband because a supportive husband shared the domestic roles as well.

Today I am here due to my husband’s support. During my child bearing period I did my Ph.D. related to my field. I did work at home and my husband made it possible to examine my work from my supervisor consecutively. My husband is very cooperative in building my career. Even he does cooking if I am not there.

It was reported by all participants that they may only continue their career if support from their families were there. Joint family system was supportive for family emergency time and children care. Research indicated those women who fell under the category of nuclear family system, pointed that they were nothing without their husband’s support. Because there was no one at home, work as helping hand in spite of their spouses.

Integration of work, family and personal self:

Increasing trend of working mothers from the last decade indicated that women were in their mid-career. There felt a need to manage work family and personal selves. But respondent showed that this stage of mid-career they fully focused towards family and work and had forgotten themselves, which is supported by following statement of a gynecologist;

Work and family come at first. My profession does not let me to ignore it. I have to remain alert at all times. In such case I find no time for myself. Last day I came to workplace and my coworkers pointed that I was wearing shirt from the wrong side.

The participant women showed that they are trying for their values in their lives because at this time of mid-career the financial issues were almost solved and compensation plans are not enough. Their children have also grown up and care for children become easier. The women at their mid-career seek purpose of their lives, their needs are changing. They mentioned that they had past a lot of time with their work and family now they feel need for self care. The following statement proves these views:

In the start, my husband’s salary was very low, unable to fulfill our financial expenses; I pursued myself towards my career as right hand of my husband. That was tough time when my children required time from my side. But now I have no problem regarding children care or any financial issue. It’s now time to focus on me.

In summarized form, it is proved from the findings of the whole study that working professional mothers interplay the roles of work and family along with individual selves. Family balance is achieved through the potential, appropriate plan, family system, and workplace flexibility and a network of support. Large proportion of respondents perceived that joint family system helped them for fulfilling career and a sense of achievement. In the start career the most portion of the time, they devoted for work and family. But now in mid-career, self-balance gained a lot of importance.

Discussion and conclusion

This study explored the experiences of mid-career professional working mothers constructing integration between work, family and selves in the context of Faisalabad, Pakistan. It is examined that how family systems included joint and nuclear, affect them and their career. How these professional working mothers made integration in spite of lot of challenges and what support they require from family system. The lives of professional working mothers are very crucial. They need to run their family and children as number one priority along with significant concern for their career. Mid-career professional working mothers experienced a long time period of time for their work. They created quality in their work, which motivated them for the self-fulfillment. According to Warner and Hausdorf (2009) work-family support negatively affects the individual’s stress and leads to satisfaction in different aspects of life, family as well as the job while enhancing more commitment towards their workplace. That’s why working professional mothers’ leads towards the sense of achievement. Now organizations are struggling to better understand the factors, affect the fulfillment of this ever-growing demographic type of mid-career who is filled with intelligence and experience (Ellen R. Auster and Karen L. Ekstein, 2004).

The existence of flexible working conditions and flexible working hours are reported as favorable for the working mothers. “Schedule flexibility is a boundary-spanning resource that helps workers accomplish both their work and family responsibilities” (Carlson, Grzywacz & Kacmar, 2010, p. 331). Organizational policies are required to include flex options, for professional working mothers. Women and men particularly who are married, as c

The primary mission of Social Work profession is to enhance wellbeing and help meet the basic needs of all people with particular attention to the needs and empowerment of people who are vulnerable, oppressed and those living in poverty (luc.edu). The first part of my assignment will be looking at, the importance of the legal context of social work, different types of law and courts that social workers mostly use when representing cases, the impact of the Human Right Act (1998) upon the legislation and how it links in with anti-oppressive practice as well as the powers and duties and their implications for social work practice.

The legal context of social work is important because it provides duties and powers for social work and it provides an understanding of the statutory and legal requirements for effective and fair social work practice (Brammer, 2010). Without an understanding of law, social workers may not be able to make decisions which may be complex for example, removals of children from their own home. Their professional conduct should be legal and ethical. The NASW code of ethics (naswdc.org)[online], statement that, “social workers should promote the general welfare of society from local to global levels and the development of people, their communities and their environments…..” It added that, the knowledge of the legal system help social workers to be aware of the conflicts that may arise between their personal and professional values and how to deal with them responsibly. The knowledge of law is essential to social work practice and failure to have it may leave social workers vulnerable to being sued by service users who feels their lives where affected by a failure to use their professional act (Stein, 1893).

The law supports social workers who wish to disclose concerns about unacceptable behaviour, for example, the guidance on protecting vulnerable adults through the Public Interest Disclosure Act (1998) (Scie.org). England consists of different types of law that social workers are mostly involved in and these are; criminal and civil law, private and public law. Brown and Rice (2007) stated that, criminal law deals with some forms of conduct, for example, murder, and the state reserves the punishment by prosecuting the offender whereas the civil law concerns the relationships between private persons, their rights and their duties.

Public law consists of three types of law which are; constitutional law; controls the method of the government for example who is allowed to work or whether there was a correct procedure which was taken during an election (Martin 2002). Administrative law; controls the operation of ministers of state and other public bodies for example the local authorities. Private law consists of many branches such as tort, family law, company law and employment law.

The hierarchy structure of court consists of the House of Lords which is the highest in the land and that is where civil and criminal appeals are heard. The court of appeal hears civil and criminal appeals and with divisional courts, two or more high court judges may convene to hear appeals from inferior courts in cases where points of law are referred from the magistrates court or county court. Magistrate court has an important jurisdiction in both criminal and family law. The approved social worker has a duty to make an application for admission to hospital or guardianship if necessary for continuity of care and family work.

Social workers are admonished to promote the right of service users to select their own goals but at times social workers uses their professional judgement to limit the service users right to self-determination when the service user’s actions can pose a serious risk to themselves and others (Stein, 1893). Anti-oppressive practice is based on an understanding of how the concepts of power, oppression and inequality determine personal and structural relations (Davies p14). The duty of a social worker is to make sure that people have access to their rights and those who have been oppressed are empowered to regain and are promoted to change as well as taking control of their lives. The HRA 1998 came into force in October (2000) and the focus of the Act is to promote and uphold rights and the act applies to public authorities only (Mandelstam 2009), however, the courts in the past argued that, independent care providers in the context of community care are not public authorities for the purposes of HRA (YL v Birmingham cc) (Mandelstam, 2009). Mandelstam (2009) also argued that, vulnerable people are being deprived of their rights they are entitled to for example their own protection under the HRA. There are a number of rights that are relevant to the Health and Social Care for example article 2 (right to life), It is a right under the European convention on human rights for an individual to have a right to life but the courts also argue that, if a person does not have a capacity to know what is right for them, if this is in their best interest, for example withdrawing artificial hydration and nutrition; it is regarded as a principle lawful not a breach of article 2 (Mandelstam 2009).

Article 3; no one shall be subject to torture or to inhuman or degrading treatment or punishment. Article 5 is deprivation of liberty. Everyone has a right to liberty and security and nobody should be deprived to it except if it is in accordance with the law. This act was breached under ECOHR due to the absence of legal safeguards of mental health patients (jevde and surrey cc), by depriving a mentally incapacitated person by placing him in a care home and not allowing him to return to his own home. Article 6 says that everyone is entitled to a fair and public hearing within a reasonable timescale by an independant and impartial tribunal established by law (Ball and Mcdonald,2002).

Article 8 is a right to respect for his private and family life and the court held the act as it sometimes a positive obligation on the state to provide support for asylum seekers (Brammer,2010). The courts said that the LA failed to assess the physical and psychological needs of a 95yr old woman who was to be returned from the hospital to a care home, therefore it breached article 8. Article 14, “is the enjoyment of rights and freedoms set forth in this convention shall be secured without discrimination…” Ball and Mcdonald(2002).

The legal context of social work is important because it provides duties and powers for social work and it provides an understanding of the statutory and legal requirements for effective and fair social work practice (Brammer, 2010). Without an understanding of law, professionals would not be able to deal with certain situations and the majority of vulnerable people would be experiencing oppression and treated unfairly. A duty is usually indicated by shall or must and it is imposed by law therefore it is a mandatory to carry it, for example, a duty to investigate and carrying an assessment after suspicion of abuse (Brammer: 2010).

Power constitutes what may, but does not have to be done (Mandlestam: 2009; p97). It provides the authority to act in a particular way but there is a scope to decide how to act (Brammer:2010;p17). Not every country operate with social workers, others use police, relatives even the Mayor (Bean:1986). Some families use power structure to control the family and this could be due to cultural background for example male having power over women.

The second part of my assignment will be focusing on the National Assistance Act (1948), The National Health Service and Community Care Act (1990). The community Care Act 1990 was established to end the existing poor law in order to assist the person in need for example, the disabled, sick and the old age persons. This was done by the National Assistance board and the local authority. Compulsory removal from home outside the terms of the Mental Health Act 1983 can be affected. There is power of removal from home under section 47 of the National Assistance Act 1948 when a person is unable to look after themselves as well as if they are not receiving proper care and attention from their carers. The removal may be breaching that person’s human rights under article 6 of the European Convention. If people fail to cooperate and there is continuity of uncaring, the social worker would then have the power under section 48(2) of the NAA 1948 to enter the premises in order to carry out their duty.

Community Care Act 1990 governs the provision of community care services for vulnerable adults for example the older people and disable people. The National Assistance Act 1948 sec 29 defines disabled people as, “aged 18 or over who are blind, deaf or dumb or who suffer from mental disorder or any description, and other persons aged 18 or over who are substantially and permanently handicapped by illness, injury or congenital deformity os such other disabilities as may be described.” Ball et al 2002 said that, it is a duty to assess an individual need for community care services according to section 47 of the NHS and community care act.

The assessment that social workers carry out for Mr and Mrs Bertram is to make sure that an individualised package of care is provided. Assessing a service user is a way to gather relevant information inorder to make a care plan. Mrs Bertram has always want to live in her therefore the service that the social workers would be providing would have to allow her to live as independently as possible in her community rather than in a residential home. According to Davies (2000), the assessment will cover the service user’s health needs, physical, mental capacity, emotional needs, financial support, suitability of living environment and carer support. The resources provided should make the Bertram family feel enabled rather than feeling oppressed.

The process should be client based. Working with older people is rewarding and challenging because it affects their social, spiritual and emotional wellbeing and at times it will be hard to understand their complex situations that is why they should be client based. Carl Rodgers ( ) listed the three core conditions pf person centered practice. He said that a social should have unconditional positive regard and congruence and being empathetic. He said that to understand someone’s situation is walking in their shoes, understanding the nature of their experience and their unique point of view. By putting the service user at the centre is also by making informed choices as well as working in partnership with Mr and Mrs Bertram and other agencies. Section 45 of the Health Services and Public health Act 1968 contains a power to promote the welfare of older people (Ball 2002:p111). Mr and Mrs Bertram would benefit to services like meals on wheels and domiciliary care. Section 47 (2) of the National Health Service and Community Care Act 1990 requires the Local Authority to identify people whom they are in the process of assessing as disabled (Ball, 2002;p112). The local authority’s duty to the Bertram is to provide an adaptation in their home by providing facilities that can suit them for the greater safety, comfort and convenience of the family.

Mr Bertram could be facing serious threat in his marriage by not understanding what his wife is going through. He is facing a gradual loss of the woman he has lived with and that could be distressing him. The service that social workers provide should not discriminate and the service provided should not contribute to it. Social workers need to help Mr Bertram understand the condition of his wife for example attending the user and carer support groups run by the alzheimers society. This will help him to understand the condition of his wife especially when it is coming from other people facing similar life changing experiences.

Social workers can also help the Bertram with benefits issues or even advising the family to contact the local neighbourhood or citizen advice bureau regarding the financial status. Mental capacity act has brought in a standard test for mental capacity and so long as Mrs Bertram retains capacity, she can under this act appoint someone such as Mr Bertram of one of her daughters with lasting power of attorney who could write an advance directive, both to be applicable should Mrs Bertram be assessed as having lost her mental capacity.