Category: Free Essays

This essay will look at how social workers address ethical dilemmas in their work with service users and carers. This will be evidenced in case examples illustrating how the codes of practice and codes of ethics guide social work decisions while making them accountable for their work. When working with ethical dilemmas social workers have to understand the origins of these values and codes. Taking into account their own personal values and being aware of how these could influence their decisions.

Values and ethics are one of the most important characteristic of an individual the fundamentals define who we are and what we believe (Banks, 2001). Whether individuals are consciously aware of them or not, every individual has a core set of values and ethics. Values are socially constructed moral codes that guide and control our actions within the social world (IFSW). Values and ethics start to develop from birth and are mainly developed by major influences in an individual life. Factors of culture, religion and many more affect our beliefs and ethics. According to Banks (2001, p.6) values are “particular types of belief that people hold about what is regarded as worthy or valuable, values “determine what a person thinks he ought to do”.

Social work values are based on the principal of “respect for persons” which comes from the Deontological approach of German philosopher Immanuel Kant (1724-1804). From these writings Biestek a Catholic priest developed seven principles for effective practice. Kantian principles are individualisation, purposeful expression of feelings, controlled emotional involvement, acceptance, non-judgemental attitude, service user self-determination and confidentiality (Shardlow, 2002).

Although Kantianism is primarily focused on the sense of people’s duty, critics have argued that the perspective gives no allowance for compassion and sympathy to motivate people’s actions. Furthermore, Kantian has a lack of guidelines when dealing with conflicting requirements. Kant’s moral philosophy has been influential in the values and ethics of social work, in particular respect for people and self- determination. These philosophical underpinnings are a major influence in the social care profession.

On the other hand Utilitarianism believes that action is right if it generates, or tends to generate the best possible outcome for the majority of people that are affected by that action. Utilitarianism is a form of consequentialism where the rightness of an action is determined by its consequences. There are three main types of utilitarianism act, rule and preference. Act takes into account the individual circumstances, maintaining that the action is good if it generates the best possible outcome in a particular situation. Rule is concerned with the amount of good that a moral action produces, conforming to a rule or law. The rule or law is correct and is determined by the amount of good that is generated when the rule is followed. Preference is one of the more popular forms of utilitarianism it takes into account people’s preferences. The moral action is right if it produces a satisfaction of each person’s individual desires or preference (Banks,2001).

All of these are open to interpretation and will mean different things to different people, which is why social work codes should be referred to. Social work codes set out an expected code of conduct that social workers have to comply with in order to gain the trust of the public so that service users are informed of what they can expect from their social workers. Protect the rights and promote the interests of service users and carers the codes are as follows: Strive to establish and maintain the trust and confidence of service users and carers, Promote the independence of service users while protecting them as far as possible from danger or harm, Respect the rights of service users whilst seeking to ensure that their behaviour does not harm themselves or other people, Uphold public trust and confidence in social care services, Be accountable for the quality of our work and take responsibility for maintaining and improving our knowledge and skills.

The COP form part of the wider package of legislation, practice standards and employers policies that social care workers must meet. When codes are not adhered to there can be serious repercussions involved for all (CCW, 2002).

Social work’s professional values, as described in the British Association of Social Workers (BASW) code of ethics (COE), including respect for all person’s including service users belief’s values, culture, goals, needs and preferences, relationships and affiliations, and a commitment to social justice, including the fair and equitable distribution of resources to meet basic needs.(BASW, 2002, 3.1, 3.2). These are a set of moral principles used to set standards which regulates the social work profession. These offer a general guidance and as yet carry no sanctions if broken (Shardlow, 2002). An ethical code also contributes to the strengthening of professional identity. They add clarity to the tasks and should lead to greater ethical observance within the organisation, but the primary objective of the COE is the protection of the clients (Banks, 2001).

Ethics are generally distinguished in three different ways by philosophy, meta-ethics, normative ethics and descriptive ethics. Meta-ethics seeks to understand the nature of morality, moral judgements and moral terms such as ‘good’, ‘bad’ and ‘duty’. Normative ethics endeavours to answer moral questions, such as what is the right action to take in a particular situation or what is the right direction to take? Descriptive ethics examines how individual’s moral opinions and beliefs reflect their behaviour and attitudes towards it (Bowles, 2006). A good social worker needs to be aware of the societal and professional values underlying his or her work so as to empower individuals, families and communities. Both Anti-oppressive practice and values are embodied in the BASW code of ethics (BASW, 2012).

Parrott (2006) describes Anti-oppressive practice (AOP) as ‘a general value orientation towards countering oppression experienced by service users on such grounds as race, gender and culture.’ AOP are also values of working in partnership and empowerment. It is also a way of linking our lived experience with the categories of the relations of ruling (Parrot, 2006). While Thompson (2001) saw oppression as an inhuman or degrading treatment of individuals or groups; in hardship and in justice brought about by the dominance of one group over another; the negative and demeaning exercise of power. Oppression often involves disregarding the rights of an individual or group and this is a denial of citizenship.

Social work is often seen as the caring profession who work with service users who need help. Every service user is unique and very social worker is an individual who uses their own lived experiences and to be an effective helper needs insight into her own formation with its potentials for strength and weakness (Clark, 2011). At the core of this is what service users expect of social workers a relationship that is built on trust, being open and honest with each other and achieved by communicating in a clear way that service users understand (Care Council for Wales, 2002, 2.1 & 2.2) as well as committed, reliable and punctual. Social workers rely on traditional values of confidentiality, acceptance and user self-determination while being non-judgemental in order to gain the trust of service users. These core values are not unique to social work but shared with other caring professions in medicine, nursing and counselling (Banks, 1995).

Values have a variety of meanings referring to one or all of moral, political or ideological principles, religious, beliefs or attitudes. However the social work context uses values to mean a set of fundamental moral/ethical principles by which social workers show commitment. While moral judgements promote the satisfaction of human needs and happiness and apply to all people in similar circumstances. On the other hand ethics refers to the study and analysis of right or wrong and good or bad in social work practice. Ethical dilemmas leave social workers using careful consideration to choose between two unwelcome alternatives relating to human welfare (Banks, 1995).

Having choices does not make the decision any easier and social workers have to take responsibility and accountability for the outcomes of any decisions they make. Decisions are made by conducting investigations with both the legal and moral rights of all parties involved being taken into account. Societal values and norms are often reflected in laws, although there are some laws which we may regard as immoral the immigration laws being one. How we interpret the law is influenced by our values and ethical principles (Banks, 1995).

Social work involves balancing the complexities between one’s own moral integrity to the user, society and agency. The ability to analyse a situation and make the best decision is a critical skill which involves recognising our beliefs and behaviours and how they influence our ideas and actions. These values are derived from our culture and social norms and can change over time and across cultures. Therefore social workers need to maintain and improve their knowledge and skills in order to protect the learning and development of others (CCW, 2002, 6.8). Codes of practice(COP) guide and protect service users not be telling them what they can or cannot do but by establishing a professional identity for workers who agree to work in a trustworthy, honest, skilled and respectful manner (Bowles, 2006).

However many believe that misuse of codes can be dangerous and cause unethical actions in particular in Western Australia in 1991 emergency foster care was sought for a 4 year-old girl while her mother was in hospital. The worker of a non-government agency placed the girl in an approved foster home which they frequently used. In the home was a 15 year old youth who was a ward of state who held a prior record for sexual offences against young children. The home also had another young foster child and a 4 year-old grandchild of the foster family. The social worker who approved the foster home for the youth and foster carers were unaware of the youth’s sex offending history. Although his history was known by the youth’s previous foster carers and 4 days after the girl was placed she died from being raped by the youth (Bowles, 2006, p.78). This illustrates the issues that arise when prioritising confidentiality over client safety and welfare when applied out of context.

While the foster-carer is not a professional and does not have to abide by the COP she is guided by a moral code of ethics. Therefore confidentiality can be broken when it is considered the information puts either the client or others at harm. The foster-carer is a part of a team and a member of a child care agency so there would be employer’s policies and procedure that would have guided this ethical dilemma. Social workers have a responsibility to maintain the trust and confidence of service users and carers by respecting confidential information and explaining agency policies around confidentiality (CCW, 2002, 2.3).

Postmodernist believe that there is no single truth and that ethics have no relevance in today’s society, as they do not replicate the numerous realities of the same society, and ignore peoples individual perspectives and interpretation. Omitting cultural diversity and reinforcing the oppressive and dominant voices of the most powerful. Furthermore they are rarely used when making ethical decisions so they are considered irrelevant (Bowles, 2006). As in the above example there would have been a number of other professionals involved with the youth such as youth offending team and medical professionals so this is a prime example of lack of information sharing and poor communication as the new foster-carers should have been made aware of the issues on a need to know basis.

Below are further examples of some of the ethical dilemmas that social workers face every day:

An Asian woman with 5 children under the age of 6 years, who has fled a violent husband but still gets harasses by him. Has been locking up her children in the house and going out for help or a break. One of the workers on the Asian Women’s Project she has recently joined to help with her feelings of isolation has discovered this. The worker has spoken with the woman explaining the risks and implications of her actions. However the woman has continued to leave the children unattended. The worker eventually informed social services as she felt the welfare of the children was paramount and she had repeatedly discussed the risks and implications of her behaviour including the British Laws and her responsibilities as a social care worker (CCW,2002, 3.2 & 3.8). The worker felt the dilemma was due to the view that generally social services and other agencies have often been insensitive the holistic wellbeing of the Asian women and fail to take into account their life experiences, religious and cultural background (Banks,2012.p.156). (BASW, 2002, 2.1,4, 2.2,5)

A social worker who has been involved in admitting a woman to hospital for 28 days under the Mental Health Act starts to notice deterioration in her physical health. The woman then dies from pneumonia. The social worker felt that the deterioration in her physical health was due to the medication she received. Although at the time he felt unable to question the consultants and trusted that the hospital was the best place to pick up on any serious physical problems (BASW, 2002, 2.2,4). This is often attached to a hierarchy of power where the social worker felt the consultant was in a higher position and had more medical knowledge so was better equipped to make the decision. However in hindsight the social worker felt that he should have questioned the treatment before renewing the section for six months. While the social worker acted within the law and according to agency rules. Did he have a moral responsibility to question the diagnosis? (Banks, 1995, p.150). Also social workers should maintain clear, impartial and accurate records and provision of evidence to support professional judgements.

A young pregnant woman tells her community health counsellor that she will seek to have her child ‘circumcised’ because a girl cannot be offered for marriage if she is not clean. The woman explains that she was also a subjected to ‘Female genital mutilation’ (FGM) in her country of origin. The woman is aware that the practice is illegal and that she would have to go to a ‘backyard’ operator in her community to have it done. While the counsellor is not a social worker she would still have to abide by the rules of confidentiality and this would have been explained to the woman at the beginning of the counselling sessions (CCW, 2002, 2.3 & BASW,2.3,5). The counsellor should also explain the penalties for breaking the law including the law on child abuse. However it would be more beneficial to engage the young woman with other’s from her community who are endeavouring to break out of traditional roles who can provide her with support. Social workers have a duty to support service users’ rights to control their lives and make informed choices about the services they receive, whilst respecting diversity and their different cultures and values (CCW,2002, 1.3, 1.6).

Furthermore social workers must promote the independence of the service user this is done by identifying and providing information and support enabling her to make informed choices. The social worker also has a responsibility to the unborn child. The social worker can prevent the harm to the mother by making her aware of the law regarding FGM which is illegal in this country, which is why no hospital will perform it. She also has to make her aware of the consequences of her actions that she could have her child removed or face imprisonment. The social worker can help prevent harm to the child by putting her mother into contact with others from the same community who could help support her make the right decision (CCW, 2002, 3). In modern day society social workers have to work as part of a multi-disciplinary team and at the core of this is information sharing so that everyone is responsible for the health and welfare of service users. As with any dilemmas guidance and support should be discussed with the social workers manager.

While dealing with such ethical dilemmas social workers have to be aware of their own personal values and make sure that they do not influence the decisions that they make and while we may not always choose the options given for ourselves it does not mean that they are wrong (Bowles, 2006).

The social work role is about empowering the user by providing the service user with the information, resources and support they need to make an informed choice and be prepared to accept the consequences. Many believe that ethical dilemmas in social work may be related to ideological issues. For example to what degree are the public society responsible for an individual’s situation and how much responsibility should an individual take for their own situation. Social workers are often seen as agents of social control. This can lead to domineering and coercive practices where social workers dealing with marginalised groups or cultures can mistake their emotional reactions for firm moral truths (Bowles, 2006). While showing tolerance and doing nothing brings us back to the central tenents of ethical social work.

As the above examples show the contents of the codes of practice are very general and therefore provide little help to social workers or service users when determining how social workers behave towards client. As in the above examples its does not provide the answer to ‘Is it the social worker’s duty to inform the police if they discover that the service user has committed a crime? (Shardlow, 2002). The codes do however outline how social workers should work and interact with service users. Below is an example of when a social work student crossed these boundaries.

A social work student is allocated to the case of two children siblings who live with their parents. The social worker has access to confidential information about the family which was given to her by the mother who herself is a vulnerable adult. During her placement the social work student meets the children’s father in a night club and starts a relationship with him. She even left the children stay at her home while the mother was in hospital. The social worker did not inform her employers of this relationship. The relationship with the father is compromising her judgement, and the relationship between service users and social workers is about meeting the needs of the client not their own needs. The codes of practice state that as a social worker, you must uphold public trust and confidence in social care services (CCW, 2002, 5). It goes on to state that you should not exploit service users in any way (CCW, 2002, 5.2), abuse their trust or the access you have to personal information (CCW, 2002, 5.3) or behave in a way, outside of work which would call into question your suitability to work in social care services (CCW, 2002, 5.8). In addition social workers must inform their employer or the appropriate authority about any personal difficulties that might affect their ability to do their job competently and safely.

What are evident from the above examples are the complex issues that face social workers in their everyday practice. The core foundations of this work are values and ethics and while these can often conflict due to the variety of sources that social workers are accountable for instance the service user, carer and employer. The social worker must be prepared to explain and justify their actions and be open to scrutiny if they are to work in a professional manner (Clark, 2005). Values and ethics are a combination of thoughts and feelings which are used to weigh up the pros and cons of an argument and help make an ethical decision. However there needs to be distinctions on how to apply social work values and ethics into their professional work, without causing personal conflict. Above all the social worker must remain non-judgemental, and stay focused on the task ahead while upholding public trust in social care services.

Equality of Opportunity is put into place to safeguard everyone. An important aspect of the Equal Opportunity Policy is that it protects vulnerable adults in care. The Equal Opportunity Policy specifies that all clients will be given equal and impartial treatment regardless of their gender, age, disability, ethnic origin and race. It is important that all employees working within the care field comply with the Equal Opportunities Policy so that all clients are free from prejudice and are protected (Care Quality Commission: 2011). When concerned with the care of vulnerable adults, key legislations are put in place. These include laws, policies and strategies. All social care services are governed by legislation and government guidance which must be followed accordingly (www.legislation.gov.uk). Some Acts which are relevant to the case study include the Disability Discrimination Act (1995), the Care Standards Act (2000), the Race Relations Act (2000), the Human Rights Act (1998) and the Community Care Act (2003). The purpose of these Acts is to ensure that there are high standards set which health authorities and local authorities can follow to regulate care (Nazarko: 2002).

The Afan Nedd care study explains that the residential home cares for vulnerable adults. When concerned with those most vulnerable it is important that each service user is treated fairly and equally with their human rights taken into consideration at all times. The Afan Nedd case study shows that these basic requirements are not always met. The article states that the care home is being run by trained nurses and unqualified care assistants. In April 2002, the legislation that all residential homes in the UK must meet in order to stay registered changed. The Registered Homes Act of 1984 was replaced by the Care Standards Act (CSA) (2000). The CSA regulates and inspects all local authorities, establishes a General Social Care Council in England and a Care Council in Wales and it makes provision for the registration, regulation and training of social care workers (Nazarko:2002). The CSA ensures that the regulation of care workers is monitored closely. The Act also states that social care workers must be registered with the English or Welsh Council where each Council is required to ensure high standards of practice and training are being used at all times. It is important that Registered Social Care Workers (RSCWS) must abide by a strict code of conduct; any employees who breach this code of conduct will be called in for a disciplinary hearing which could result in suspension or being removed from the care register. In Wales, the Care Council approve courses and make allowances and grants for training to ensure that care homes care run properly (Nazarko: 2002).

Afan Nedd care home is regulated by the Care and Social Services Inspectorate Wales (CSSIW), they encourage ‘the improvement of social care, early years and social services in Wales’ (www.wales.gov.uk). CSSIW works in conjunction with the Welsh Assembly Government; they inspect local authority social services and regulate and inspect social care environments (www.wales.gov.uk). The CSSIW regulations include registration, inspection, complaints and enforcement in order to protect vulnerable adults. It appears that Afan Nedd care home does not comply with the CSSIW policies as it does not have qualified care assistants. To resolve this issue, a possible solution is that the care home should provide training for all employees to ensure the safeguard of vulnerable adults and to provide the highest standard of practice to service users.

When caring for vulnerable adults it is extremely important that their care is main priority. All care homes are regulated by the Care Quality Commission (CQC) which is responsible for monitoring the standards of care services (www.direct.gov.uk). The CQC is in place to ensure good work practice for professionals and to improve the standard of living of the service user. All care homes must follow the ‘Care Value Base;’ in nursing theory this is an ethical code which sets out rules which carers must follow within their social care setting which ensures that the carer is not discriminating the service user and are not violating their rights (Moonie: 2005). These values also include the promotion of equality and diversity and to have the ability to challenge discrimination. In 2002, the General Social Care Council (GSCC) published a code of practice for both employees and employers which explains the promotion of these values along with confidentiality and other rights and responsibilities. (Moonie: 2005).

The case study explains how John Davies, a registered general nurse, has been verbally abusing some of the clients. This should be a major concern for Afan Nedd nursing home as the service user is not receiving the correct care. The case study also explains that John Davies appears to be experienced and is very popular with the matron. This can then cause problems within the care home as issues such as discrimination and prejudice may arise.

It can be said that any type of institutional abuse is completely illegal and unprofessional. Verbal abuse within the care home cannot be tolerated as those who are physically and mentally frail are most at risk (www.direct.gov.uk). The Equality Act 2010 is a key piece of legislation which must be followed within every social care environment. The Act provides a ‘modern and accessible framework of discrimination law which protects individuals from unfair treatment and promotes a fair and more equal society’ (www.equalities.gov.uk). Every health care professional must know all key pieces of legislation before they undertake any social care and must implement the rules throughout their health care career. By law each service user has the right to be treated with respect and dignity. The Protection of Vulnerable Adults (POVA) scheme was launched by the Department of Health which provides a list of care workers who have harmed vulnerable adults in their care. It is now a statutory requirement for managers to use when appointing individuals to work with vulnerable adults (www.criminalrecordscheck.co.uk). This could mean that John Davies may have had a history of verbal abuse to service users and this may have not been checked prior to being employed as the case study explains he is an agency worker.

As mentioned earlier, John Davies appears to be popular with the matron which may cause problems if another social care worker wanted to report his verbal abuse to the service users. It could also mean that the service users do not feel confident enough to report the abuse to the matron as they feel that they may be discriminated against or they may not have the mental capacity to report this issue. Since 2006, the social services complaints procedure has changed in Wales. The CCSIW are legally obliged to have their own written complaints procedures. It is important to stress that all complaints must be kept confidential along with following the CCSIW complaints procedure (Department of Constitutional Affairs: 2007). Another issue that may arise from the fact that John Davies is popular with the matron is other employees of the nursing home may not want to be seen as a ‘whistle blower’ if they wanted to repot abuse within the care home. Knights and Willmott (2006) believe that ‘whistle blowers tend to be well respected and conscientious employees. They tend to believe that once they have informed the appropriate managerial authority of these illegal or unethical acts the organisation will take the appropriate measures to change its behaviour.’ However, it appears that many whistle-blowers feel that management do not see ‘whistle blowing’ as an act of good organisational citizenship, instead management see this as trouble making. In many cases, the whistle blower may be victimised or even disciplined, making other employees stay silent in reporting any further discrimination or abuse within the care home. The Older People’s Commissioner for Wales, created a policy where the commissioner is contacted by an employee from another organisation who is worried about unethical acts in their place of work and want to report it (www.powysweb3.ruralwales.net). The Public Interest Disclosure Act, (PIDA) protects employees who ‘blow the whistle’ about wrong doing within the nursing home, providing that they do so in the ways set out by PIDA. Any employee who is victimised by their employees for ‘blowing the whistle’ has the right to take their employer to a tribunal. The Commissioner ‘recognises that employees are often the first to realise that there may be something wrong within their organisation and therefore encourages all individuals to raise genuine concerns about wrongdoing at the earliest possible stage’ (www.powysweb3.ruralwales.net). This policy relates back to the Afan Nedd nursing home as the policy will protect them if they wanted to report the John Davies for abusing the service user. The Nursing Midwifery Council (NMC) believe that it is ‘important to establish a comprehensive vulnerable adult protection and safeguarding service to ensure good leadership and performance management, however, it appears that such arrangements are not consistently found across social services’ (www.nmc-uk.gov).

Albert and Gladys Griffiths have recently arrived at Afan Nedd nursing home, the case study states that Albert is mentally alert however his wife Gladys have early onset Alzheimer’s. The reader learns that Gladys becomes easily confused and disorientated but is usually calmed by Albert’s presence; however they do not have a double room in the nursing home. As the couple does not have a double room this can be seen as discrimination and a violation of their human rights. It can be said that to maximise Albert and Gladys’ quality of life, they have the right to a double room as they have never spent a night apart. Quality of life refers to the total living experience, which results in overall satisfaction with ones quality of life. ‘Quality of life is a multi-faceted concept that recognises at least five factors; lifestyle pursuits, living environment, clinical palliation, human factors and personal choices’ (Singh: 2009). It can be said that quality of life can be improved by bringing in these five factors into the delivery of care.

It appears that the Human Rights Act (1998) has been breached as Gladys and her husband are not able to share a room together. The Act states that ‘these rights not only impact matters of life and death, they also affect the rights you have in your everyday life: what you can say and do, your beliefs, your right to a fair trial and other similar basic entitlements.’ When working in a social care environment, it is the responsibility of the health care professional to respect the rights of the service user. Learning that Gladys has early onset Alzheimer’s, this could mean that she does not have the mental capacity to address her human rights within the nursing home. The Mental Capacity Act (2005), safeguards those with mental illness and it is also a stepping stone for those most vulnerable to receive treatment in a nursing home to improve their quality of life (Department of Health 2005). The Mental Capacity Act (2005) is designed for those who are unable to make decisions for themselves or lack the mental capacity to do so. It can be said that under the Mental Capacity Act, any person is ‘presumed to make their own decisions unless all practical steps to help him or her to make a decision have been taken without success,’ (www.nhs.uk). It is important to remember that a change of routine can affect behavioral problems with someone suffering with Alzheimer’s which can cause them to lash out of feel uneasy. It is said that Alzheimer’s do not do well to change as change causes anxiety and stress, therefore changing Gladys’ normal routine is not in her best interests when settling into a new environment (Gale: 2010). All service users of nursing homes have the right of privacy. The right of privacy is a fundamental basic right that must always be met. Each service user has the right to live in a friendly, homely and caring environment, where the care assistant always delivers the level of care that is appropriate to each individual. ‘Each person has the right to be treated as an individual, with respect and dignity, as well as having a right to privacy and to choice; it is the duty of the management and staff to safeguard these rights and to help the service user exercise them correctly’ (Ford: 2005).

The case study explains how Musad Mohammed is a Pakistani Muslim who is a resident at Afan Nedd nursing home. Musad Mohammed is finding life in the nursing home strange as he has no immediate family living in the UK; the food is an issue for him, having a female carer and the lack of privacy at prayer times. Being a Muslim man, resourcing halal food for Mr Mohammed should not be an issue as it is easily sourced in the UK (Q News: 1999). The Race Relations Act 1976 states that no person should be discriminated against on the grounds of race, colour, nationality, ethnic and national origin in the fields of employment, the provision of goods and services, education and public functions (www.legislation.gov.uk). From the information on the case study, it is clear to see that Mr Mohammed is being discriminated against as his needs are not being met. However, this type of discrimination tends to be indirect discrimination. It can be said that indirect discrimination is when a condition or rule within the workplace disadvantages one group of people more than another (www.direct.gov.uk). This applies to the case study as Mr Mohammed is being cared for by female care assistants which is against a Muslim mans beliefs. This is also a breach of his human rights which could affect Mr Mohammed’s quality of life. It is important to understand that each service user of the nursing home is entitled to privacy and an independent living. It is also important that the ‘right of every individual to select independently from a range of options, incorporating, choice of meal, bed times and taking part in activities/ entertainment’ (Rose and McCarthy: 2010). These basic needs are not being met for Mr Mohammed as he feels he has a lack of privacy at prayer times. For a Muslim man prayers play an important role in his faith and his care values are not being met. Every individual has the right to be treated as unique regardless of their beliefs and should be treated with respect at all times (Rose and McCarthy: 2010). It appears that the employees at Afan Nedd are not educated in a Muslims faith; a possible solution for this is that the staff could take part in discrimination training and multicultural awareness training.

Dilys Watkins enjoys staying up to watch the television at the nursing home, however the staff at the nursing home does not allow her to do this as it is said to interfere with the rota as everyone needs to be in bed before the night shift commences. This can be seen as a breach of her human rights and independence as Dilys says she is able to put herself to bed after her programmes have finished. It is important to avoid stereotyping an elderly person in care, mainly with regard to their own independence. This is because negative images of independence can become self fulfilling. This can cause an elderly person to have low expectations of their abilities and performance (Beaulieu: 2002). However, the case study does not state Mrs Watkins’ mental awareness, and the care assistants may feel that it is not in her best interest to stay up on her own and put herself to bed as she may fall and hurt herself. This is a possible reason as to why the Mental Capacity Act (2005) is put into place at nursing homes as the Act sets out a checklist of things to consider when deciding what is best for the service user. Another possible argument is the idea of empowerment in nursing homes. The idea of empowerment is that those who have little or no influence, such as Dilys Watkins are ‘able to acquire the capacity to have informed opinions, to take initiatives, make independent choices and influence change. It also means that those with influence actively change their attitudes and rules and change the way decisions are made through engaging with excluded people’ (www.equal.ecotec.co.uk). It can be said that the staff at Afan Nedd must show service users such as Dilys Watkins respect and dignity and must always follow the correct codes of practice; Processional Codes of Conduct are put into place to avoid discrimination and to improve the quality of life for residents at the Afan Nedd nursing home (www.npc-uk.org).

It is clear to see that Afan Nedd nursing home is beset by a number of problems where the relevant policies and legislations are not being followed correctly. The Care Council for Wales is the social care workforce regulator in Wales responsible for promoting and securing high standards within nursing homes to protect and safeguard vulnerable adults; these regulations are not being followed by Afan Nedd nursing home. There are many key issues identified in the case study such as discrimination, lack of staff training, verbal abuse, lack of privacy and poor professional practice. It is important to address these issues straight away to improve the quality of life to all service users. All social care workers are expected to meet the code of conduct set by the Care Council and serious failure to do so can result in the closure of the nursing home and suspension and the removal of employees from the Register. Nursing homes care for the highly dependent and vulnerable people. Many of them have many nursing needs that require a high level of professional knowledge and understanding. It is therefore important to ensure that all staff working at nursing homes takes part in any opportunities for improving and updating their skills along with organising educational and training days. Afan Nedd nursing home could promote and support research into the efficiency of diverse approaches to caring for the elder and those with mental disabilities.

This assignment will look issues around older people’s mental health, in particular, dementia and abuse; this will include demographics of older people, statistics, the history, definitions and causes of dementia, and finally the lack of legislation to protect vulnerable people from harm and the implications for social work practice.

The population surge at the end of world war 2 has gave rise to an unprecedented population explosion and to what we now call the ‘baby boomers’, these people are now in their retirement years'(Summers Et al, 2006), and our population now contains larger percentage of older people that ever. In society today elder people are becoming the fastest increasing population in the UK, National Statistics (2009) states that ‘the population of the UK is ageing. Over the last 25 years the percentage of the population aged 65 and over increased from 15 per cent in 1983 to 16 per cent in 2008, an increase of 1.5 million people in this age group’. Due to the increase of the ageing population we are now seeing emerging health and social care issues in our society. Many older people will be active, involved within the community, and independent of others. However, as you get older it is natural to experience pain, a decline in mobility or mental awareness.

Mind (2010) states that ‘the most common mental health problems in older people are depression and dementia. There is a widespread belief that these problems are a natural part of the ageing process, but this not the case; it can start as early 40 but is more common in older people (Royal college of Psychiatrists, 2009), however, ‘there only 20 per cent of people over 85, and 5 per cent over 65, have dementia; 10-15 per cent of people over 65 have depression’ (Mind, 2010). It is important to remember that the majority of older people remain in good mental health. ‘Dementia mainly affects older people, although it can affect younger people; there are 15,000 people in the UK under the age of 65 who have dementia’ (Alzheimer’s society, 2010). However, ‘currently 700,000 – or one person in every 88 in the UK – have dementia, incurring a yearly cost of ?17bn, and the London School of Economics and Institute of Psychiatry research calculated that more that 1.7 million people will have dementia by 2051’ reported by BBC news (2007).

‘The word dementia comes from the Latin ‘demens’ meaning ‘without a mind’. References to dementia can be found in Roman medical texts and in the philosophical works of Cicero. The term dementia came into common usage from the 18th Century when it had both clinical and legal connotations. Dementia implied a lack of competence and an inability to manage one’s own affairs. Medical use of the term dementia evolved throughout the 19th century and was used to describe people whose mental disabilities were secondary to acquired brain damage, usually degenerative and often associated with old age’ (Kennard 2006). From the 20th century onwards scientific knowledge was supplemented through the examination of the brain and brain tissue which was founded and performed by a physician Alois Alzheimer (Plontz, 2010). The National service framework (Department of Health, 2001, p96) now defines ‘dementia as a clinical syndrome characterised by a widespread loss of mental function’.

The term ‘dementia’ is used to describe the symptoms that occur in a group of diseases that affect the normal working functions of the brain. This can lead to a decline of mental ability, affecting memory, thinking, problem solving, concentration and perception, also problems with speech and understanding (Mind, 2010). ‘Dementia is progressive, which means the symptoms will gradually get worse. How fast dementia progresses will depend on the individual. Each person is unique and will experience dementia in their own way’ (Alzheimer’s society, 2010). Symptoms of dementia include: Loss of memory, Mood changes, and Communication problems. In the later stages of dementia, the person affected will have problems carrying out everyday tasks, and will become increasingly dependent on other people, two thirds of people with dementia live in the community while one third live in a care home (Alzheimer’s society, 2010). There are many types of dementia, and some of the causes of dementia are rarer than others, Alzheimer’s disease is the most common cause, damaged tissue builds up in the brain to form deposits called ‘plaques’ and ‘tangles’, these cause the brain cells around them to die (Royal college of Psychiatrists, 2009). Other most commonly known is vascular disease, Dementia with Lewy bodies, Fronto-temporal dementia. Mostly, patients themselves do not present to the clinician with dementia, owing to gradual onset and denial of the problem. There is no cure for dementia but there is medication that will help to slow down the progression of the disease. When finding help for dementia it is usually the primary carers, caregivers, supporters, partners or family members who initiate asking help and a diagnosis (Brodaty, 1990).

Depression may be misdiagnosed as dementia the difference being that people who have depression are more likely to be aware of their issues therefore are able to discuss them, whereas someone with dementia may not be able to do this due to their symptoms. Nonetheless, the Mental Capacity Act (2005) states that every person has the right to make their own decisions and must be assumed to have capacity unless otherwise proven and people should be supported to make any decisions. Under the MCA, you are required to make an assessment of capacity before carrying out any care or treatment (Office of the public guardian, 2009). The Mental capacity act is an act that protects individual rights and ensures that the person’s liberty is not taken. ‘It is based on best practice and creates a single, coherent framework for dealing with mental capacity issues and an improved system for settling disputes, dealing with personal welfare issues and the property and affairs of people who lack capacity. It puts the individual who lacks capacity at the heart of decision making and places a strong emphasis on supporting and enabling the individual to make their own decisions’ (Office of the public guardian, 2009). However, even with a structure in place to protect individual’s rights and liberties many people who have dementia are more vulnerable to abuse due to their lack of capacity. The University College London research revealed that a third of carers admitted “significant abuse”, in total 115 carers reported at least some abusive behaviour, and 74 reported more serious levels of mistreatment (Cooper et al, 2009). Caregivers can also be on the receiving end of verbal or physical abuse directed at them by parents or spouses who are confused and angry over declining mental capacities due to stroke and Alzheimer’s disease. In some cases, Alzheimer’s disease or other forms of dementia may cause the patient to be uncharacteristically aggressive (Coyne, 1996).

It is only in recent years that abuse of the elderly has become more apparent, Crawford Et al (2008, p122) argues that over time it has very slowly come to the attention of people in the last 50 years that abuse does actually exist behind closed doors; in the 1950’s older people lived in large families where issues were hidden, and in the 60’s to 70’s older people started living alone or in residential homes and it was not until the early 80’s that abuse had started to be recognised and defined. Penhale and Kingston(1997) argue that over the years it has been difficult to emphasise the issues of abuse due to not finding a sound theoretical base to which an agreement of a standard definition can be made and applied. Action on elder abuse (2006) defines elder abuse as ‘A single or repeated act or lack of appropriate action, occurring within any relationship where there is an expectation of trust, which causes harm or distress to an older person’. Abuse comes in not just physical abuse it comes also in sexual, psychological, neglect, discrimination and financial as well. ‘Older people may be abused by a wide range of people including family members, friends, professional staff, care workers, volunteers or other service users, abuse can also be perpetrated as a result of deliberate, negligence or ignorance’ (Royal pharmaceutical society (RCA), 2007). Abuse can occur in a variety of circumstances and places such as, in own home, in a residential or day care setting or hospital and can by more than one person or organisation. Pritchard (2005) asserts that we will never have a true picture of the prevalence of elder abuse due to the unreported cases, and can only count ones that are known to organisations and services.

Most abuse is still unreported due to victims being frightened, ashamed and embarrassed to report the abuse, not realising their rights or not being able to due to tier mental health. Summers et al (2006, p7) points out that ‘those statutes that make abuse criminal are often ineffective due to them not being utilised by the victim’, and this means that this will be the biggest challenge and barrier for change in getting people to recognise the scale of the problem and raising awareness so that the government agree to change the legislation to protect older people. Abuse of any kind should not be ignored and there should be legislation to protect adults from abuse like there is in child protection, people who recognise the extent of elder abuse argue why should adults be treated as second class to children, is their suffering and deaths any less important? The Alzheimer’s Society (2010) states that ‘abuse of people with dementia should be considered in the same way as child abuse’.

Crawford and Walker (2008, p12) state that ‘prejudice refers to an inflexibility of the mind and thought, to values and attitudes that stand in the way of fair and non judgmental practice’. Thompson (2006, p13) defines discrimination as the process in which difference is identified and that difference is used as the basis of unfair treatment. A barrier to recognising the abuse of people with dementia and older people is that of social stigma, negative perceptions and connotations of words for mental health, such as confused or senile. ‘Confused is something that we all experience at some time in our lives, whereas senile is a more complex word and the first recording of its usage was neutral meaning pertaining to old age, but now has negative connotations linked to mental decline due to age (Crawford and Walker, 2008). Therefore, challenging people’s perceptions needs to done to change these social constructs to enable a change in legislation and protection of vulnerable adults. In March 2010 the department of health ran a series of campaigns to address poor public understanding of dementia which included TV, radio, press and online advertising featuring real-people with dementia (Department of health, 2009).

In 2009 the first ever dementia strategy was launched that hopes to ‘transform the quality of dementia care, It sets out initiatives designed to make the lives of people with dementia, their carer’s and families better and more fulfilled It will increase awareness of dementia, ensure early diagnosis and intervention and radically improve the quality of care that people with the condition receive. Proposals include the introduction of a dementia specialist into every general hospital and care home and for mental health teams to assess people with dementia’ (Department of health, 2009). However, this is not legislation it is just a strategy for dealing with people with dementia. The government are recognising that there is little protection for vulnerable adults and that further legislation need to be put in place and stating that dementia care is a priority (BBC news, 2007). At present, there is no one specific legislation which directly protects vulnerable adults, instead the applicable duties and powers to assess and intervene are contained within a range of legislation and frameworks, such as the Mental Capacity Act 2005 and Mental Health Act 2007 and the national service framework for older people. ‘One of the themes for national service framework (NSF) is respecting the individual which was triggered by a concern about widespread infringement of dignity and unfair discrimination in older peoples access to care. The NSF therefore leads plans to tackle age discrimination and to ensure that older people are treated with respect, according to their individual needs, specifically in standard 2 it relates to person centred care ‘ (Crawford and Walker, 2008, p8).

And expectation of NSF is that there must be systems and processes put in place to enable multi agency working. In 2000 the government published ‘No secrets which is guidance that requires local authorities to set up a multi agency framework which includes health and the police with a lead person (adult social care) to carry out procedures into the allegations of abuse whilst balancing confidentiality and information sharing’ (Samuel, 2008). No Secrets is only ‘guidance and does not carry the same status as legislation, the LA’s compliance is assessed through an inspection process, therefore the LA can with good reason choose to ignore the guidance’ (Action on elder abuse, 2006). This has concerned agencies who want to see the protection of adults given the same equivalent priorities as child protection and think that legislation is the only way to accomplish this.

A review of No Secrets guidance has been carried out in 2008 and consulted with over 12000 people (Department of Health, 2009), the report found that over half (68%) of the respondents were in agreement to new safeguarding legislation and 92% wanted local safeguarding boards to be placed on a statutory footing and still there is no legislation to protect vulnerable adults (Ahmed, 2009). A recent article in community care told the failure of the government to commit to making a policy has only strengthened campaigners fight and given rise to criticism (Ahmed, 2009).

The need to protect vulnerable people brought about the protection of vulnerable adults scheme (POVA) which is run by the Department of Health to regulate and monitor the employment of staff in the social care workforce, through this scheme a list of people who are unsuitable to work with vulnerable people is kept. More recently, the Safeguarding of Vulnerable Groups Act 2006 which was launched in 2008 replaced POVA with the Independent Safeguarding Authority (IDeA, 2009). The problem with this is that abusers of dementia sufferers are usually family member or informal carer that are under considerable stress and may not receiving help from within the health and social care system, therefore, an abusive situation can carry on for some time until the situation is found by an outsider. This situation may only be found when a informal carer starts asking for help, and when informed of the situation it is good practice and essential to make sure that carers are getting the help they need which can prevent the abusive situations. Under the 1995 Carers (Recognition and Services) Act carers are entitled their own assessment of need and by doing so this may allow for respite or payments to be made for their services (Parker Et al, 2003). University College London researchers who interviewed people caring for relatives with dementia in their own homes stated within their research that ‘Giving carers access to respite, psychological support and financial security could help end mistreatment’ (Cooper et al,2009). When working with relatives who are carers it is important to remember who is the service user, although it is important to ascertain the wishes of the relative it should not override the wishes of the service user, this is especially true when there is a break down in the care of the service user and the carer wishes the service user to be placed in care.

Many older people with dementia receive care in a residential home; this may be due to family member no longer being able to cope with the care of the person. The local authority has a duty to assess the needs of a person with dementia ensuring that their wishes are heard and adequate care is put in place. ‘Assessment is an ongoing process, in which the client participates, the purpose of which is to understand people in relation to their environment; it is a basis for planning what needs to be done to maintain, improve or bring about change in the person, the environment or both’ (Anderson Et al, 2005).

The trouble with placing people with dementia in care homes is there are not enough care homes specifically for people with dementia and people end up in a home that do not have trained staff to cope with individual needs of someone with dementia, therefore, people s wishes may not be heard. As part of the joint assessment process it is the social workers role to ascertain the wishes of the individual, this is done by assessing their needs in an holistic way which includes and medical and social aspects of the person. If there is doubt as to the mental capacity of the person then a mental capacity assessment will need to be acquired by asking to joint assess with community psychiatric nurses (CPN). Priestley (1998) states that ‘the community care reforms established the principle of joint working between health and social services authorities as a priority for effective care assessment and management with social services taking the ‘lead role’.

In conclusion there seem to have been many shifts in the direction of how policy and procedures framework and guidance care for people with dementia, although there is still no firm legislation to protect them. However, there seems to be more recognition of the issues that surround dementia and future goals are towards the training of people to understand those issues so that professionals are able to deal with the complex needs of a person with dementia.

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The stigma and prejudice attached to homosexuality encourages the perpetuation of homophobic bullying against the lesbian, gay, bisexual and Trans gender (LGBT) youth by their peers. Bullying can take the form of homophobic epithets, sexual harassment and even violence. The class room has been described by social psychologists as the “most homophobic of all institutions.” This paper examines the effects of homophobic bullying on the physical and mental health of the LGBT youth which is characterized by depression, suicide ideation and engaging in risky behaviors (alcohol and substance abuse). The paper also analyses the buffering effects provided by positive school climate, parental and peer support as well as personal resilience.

Keywords: LGBT youth, homophobic bullying, depression, hostile school climate, suicide ideation

The Effects of Homophobic Bullying on the Mental and Physical Health of LGBT Youth:

The Buffering Effects of Positive School Climate and Parental Support

A Review of the Literature

In today’s permissive society an increasing number of adolescents who are in their early and middle teens (Middle and High school students) have begun to come out of the proverbial “closet.” However, even in this day and age our society is largely intolerant of deviation from gender norms prescribed by the culture. This makes it especially challenging for lesbian, gay, bisexual and transgender (LGBT) youth who are struggling and trying to come to terms with their sexual identity and orientation. The stigma attached to homosexuality encourages the perpetuation of homophobic bullying against the LGBT youth by their peers. It is a matter of immense concern to the doctors, psychologists and the entire community that there is a high incidence of suicide within this sexual minority group as compared to the heterosexual youth. This literature review focuses on homophobic bullying and its effects on the LGBT youth who are at a challenging stage in life and are struggling with their feelings about sexual orientation and sexual gender. The effects of homophobic bullying on gay, lesbian, bisexual and transgender youth encompass challenges to their psychosocial development, emotional distress an increase in risky behavior (substance abuse), depression and suicide ideation. However, the literature review also highlights the buffering effects of a positive school environment and positive parental relations against negative effects of homophobic bullying.

Homophobic Teasing and General Peer Victimization

Homophobic teasing, peer victimization and gender non-conformity attitudes are some important mental health issues faced by the LGBT youth as result of their sexual orientation. “Homophobic teasing is often long-term, systematic, and perpetrated by groups of students; it places the targets at risk for greater suicide ideation, depression and isolation”. Homophobic teasing includes negative beliefs, attitudes, stereotypes and behaviors towards gays, lesbians, bisexuals and transgender youth, and can take the form of verbal and/or physical abuse, and in today’s advanced technological age cyber abuse. Peer victimization can take the form of verbal insults, threats of violence, physical assault, and sexual assault (Espelage, Aragon, Birkett & Koenig, 2008). A 2009 survey of more than 7,000 LGBT middle and high school students aged 13-21 years found that in the past year, because of their sexual orientation: Eight of ten students had been verbally harassed at school; four of ten had been physically harassed at school; six of ten felt unsafe at school; and one of five had been the victim of a physical assault at school (cdc.gov).

Challenges to Psycho Social Development

According to Erik Erikson’s theory of psychosocial development all individuals must master particular developmental tasks during the adolescent years in order to lead productive and healthy lives. These tasks include “adjusting to the physical and emotional changes of puberty”, forming practical social and functioning relationships with peers, accomplishing independence from primary care takers, preparing for a career, and formation of a unique identity and a set of moral values (McDermott, Roen & Scourfield 2008). However, for the LGBT adolescents achieving these developmental goals is challenged by the stress of being part of a stigmatized group. These youth also have to contend with a lack or absence of a support system such as family rejection, social isolation and harassment by peers and feelings of alienation with the school as a result of consistent homophobic bullying.

Emotional Distress

The social climate of our nation promotes heterosexist attitudes and these views are up held by our social institutions such as families, schools, the church, and government institutions. These prejudiced attitudes result in gay related stress for the LGBT youth who “experience a unique set of stressors related directly to being sexual minorities within a heterosexually oriented society.” These stressors may be both external (homophobic bullying, family rejection), and internal (internalized homophobia) in nature From the time they are children the youth have been barraged by negative attitudes towards homosexuality and this can lead to the internalization of homophobic sentiments. Internalized homophobia often results in feelings of shame and disgust towards ones sexual orientation which has been reinforced by family and society and can create conflict and dissonance and lead to emotional distress (Rosario & Schrimshaw 2002).

School Alienation and Lack of Social Support

The constant flow of negative information regarding gender non -conformity and homosexuality from figures of authority such as parents, teachers, the clergy, and government officials encourages discriminatory and prejudicial behavior towards the sexual minority group by fellow students. Their heterosexist tendencies are manifested through homophobic bullying, social isolation and violence towards the vulnerable LGBT adolescents. Peer victimization can result in creating a hostile school environment and promotes feelings of alienation from school. An on-line research conducted on 3,450 public and private students (ages13-18) in the U.S found that 88% of the students reported that homophobic remarks were used in the teacher’s presence and that teachers and staff failed to intervene during these incidents (Espelage 2008). These findings clearly indicate that teachers and staffs failure to intervene encourages and promotes peer victimization and homophobic teasing and creates and sustains a hostile environment for lesbians, gays, bisexuals and transgender youth.

Having a strong social support system (family, peers, and teachers) is vital to maintaining mental and emotional health. It works as a buffer against stress; elevates a person’s self-confidence and self-esteem; reduces feelings of loneliness and isolation to name a few. Lesbian, gay, bisexual and trans gender youth have lack or absence of a social support system by virtue of their sexual orientation that is negatively sanctioned by the heterosexual society. They face family rejection after “coming out,” social isolation by their peers, and many adults fear discrimination, job loss, and abuse if they openly support LGBT youth. Thus there is a lack of positive role models and support system which makes it more challenging to cope with the stress produced by stigmatization (Padilla, Crisp &Rew 2011).

Depression, Substance Abuse, and Suicide Ideation

Suicidal ideation is defined as “thoughts of engaging in suicide-related behavior.” It can range from passive ideation- having the thought but not the intent to active ideation which includes intent as well as a plan to harm oneself. Suicidality has a number of risk factors as well as a number of protective factors. Among LGB individuals there is a higher incidence of risk factors and there are less protective factors in place. There is, for example, a higher incidence of important suicide risk factors such as depression and substance abuse in LGB youth compared to their heterosexual peers. These associations between mood disorders are borne out by research studies (Malley, Posner, & Potter, 2008). Also, LGB individuals often experience a lack of support at home and are deprived of positive environments in their schools due to avoidance or bullying. Within the LGB cohort certain factors can affect the risk of suicidality as well-for example the younger the age at which the individual discloses sexuality the higher the risk of suicide. According to the U.S. Department of Health and Human Services (2007), “It has been widely reported that gay and lesbian youth are two to three times more likely to commit suicide than other youth and that thirty percent of all attempted or completed youth suicides are related to issues of sexual identity. The Suicide Prevention Resource Centre (2008) in the United States noted a 1.5 to 7 fold (depending on the study) increased risk of attempted suicide in LGB youth as compared to their heterosexual peers. A landmark study commissioned by the US Secretary of Health found that one third of all sexual minority youth suicides occur before the age of seventeen (Malley, Posner, & Potter, 2008). Padilla, Crisp, and Rew (2010) found that in the adolescent population sexual minorities have a much higher rate of drug use with contributing factors including a greater number of psychological stressors and poor social networks. They also noted that when parents accepted the adolescent’s sexual orientation the impact of life stressors was decreased significantly.

Buffering Effects Provided by Parental Support and Positive School Climate and Resilience

As mentioned previously there is a greater prevalence of psychological problems and high risk behaviors in LGBT youth then in their heterosexual peers. These include mood disorders, suicidal thoughts and substance abuse. Espelage, Aragon, Birkett and Koenig (2008) and Poteat, Mereish, Di Giovanni & Koenig(2011) highlighted the crucial role a support system plays in preventing psychiatric and other behavioral problems in LGBT youth. Two important and beneficial support networks identified were the first of which were communicative and empathic parents and the second affirming and healthy school environments. The presence of both these networks corresponded with a markedly reduced incidence of psychological problems, suicide and substance use compared to individual where there was a lack of these support systems. Parental support and acceptance also seems to foster resilience and improve coping skills.

It appears from the review of relevant literature that contrary to popular perception and despite the efforts of most sections of the media as well as many social organizations, general and unconditional acceptance of LGBT individual remains the exception and not the norm. The alienation and stigmatization is achieved through both passive (social ostracization, not standing up for LGBT rights) and aggressive (violence and emotional homophobic bullying) means and is aggravated by the absence of a buffer against these assaults in the form of parental acceptance and positive school environments. These findings do not differ much from those of earlier studies or from studies of other minorities that face prejudices. We know that the problem exists and we have identified the enabling, aggravating and protective factors. What remains to be seen is whether society will show the will to follow words with actions. What may also be beneficial is to conduct larger studies with more statistical power so that the facts can be ascertained with a greater degree of confidence.

Annotated Bibliography

Center for Disease Control and Prevention (2011, May 19). Lesbian, gay, bisexual and transgender health. Retrieved April 3, 2012, from http://www.cdc.gov/lgbthealth/youth.htm

This website provides statistics on the prevalence of homophobic bullying in the schools. Since community psychology focuses on social issues and social institutions it is of particular interest to community psychologists that our sexual minority youth are facing harassment and violence at the hands of these social institutions such as schools, church and governmental organizations.

Espelage, D.M. (2008). Addressing research gaps in the intersection between homophobia and bullying. School Psychology Review, 37 (2), 155-58.

Homophobic bullying is a pressing and immediate problem facing our community since it affects adolescents who are members of a sexual minority group. One of the fundamental principles of Community psychology is a respect for diversity which includes race ethnicity, gender, sexual orientation and social class.

Espelage, D. L., Aragon, S. R., Birkett, M., & Koenig, B. W. (2008). Homophobic teasing, psychological outcomes, and sexual orientation among high school students: What influence does parents and schools have? School Psychology Review, 37(2), 202-216.

Another fundamental principle of Community Psychology is ecological perspective and multiple levels of intervention. LGBT youth face an increased risk of mental and emotional problems as a result of stigmatization of their sexual orientation. It is of interest to the community psychologist that the youth’s positive parental (microsystem) and school (microsystem) involvement help as a buffer to negate the effects of stigmatization.

McDermott, E., Roen, K., & Scourfield, J. (2008). Avoiding shame: young LGBT people, homophobia and self-destructive behaviors. Culture, Health & Sexuality, 10(8), 815-829. doi:10.1080/13691050802380974

Since community psychology focuses on social issues and social institutions it is of particular interest to community psychologists that our sexual minority youth are facing harassment and violence at the hands of these social institutions such as schools, church and governmental organizations.

Padilla, Y. C., Crisp, C., & Rew, D. (2010). Parental acceptance and illegal drug use among gay, lesbian, and bisexual adolescents: Results from a national survey. Social Work, 55(3), 265-275.

Community psychologists are interested in the effects of social support on our youth. Since social support has been shown to promote and maintain physical and mental wellbeing and also helps in the development of resiliency in youth who are at risk such as the sexual minority youth.

Poteat, V., Mereish, E. H., DiGiovanni, C. D., & Koenig, B. W. (2011). The effects of general and homophobic victimization on adolescent’s psychosocial and educational concerns: The importance of intersecting identities and parent support. Journal of Counseling Psychology, 58(4), 597-609. doi:10.1037/a0025095

Another fundamental principle of Community Psychology is ecological perspective and multiple levels of intervention. LGBT youth face an increased risk of mental and emotional problems as a result of stigmatization of their sexual orientation. It is of interest to the community psychologist that the youth’s positive parental (microsystem) and school (microsystem) involvement help as a buffer to negate the effects of stigmatization.

Rosario, M., Schrimshaw, E. W., Hunter, J., & Gwadz, M. (2002). Gay-related stress and emotional distress among gay, lesbian and bisexual youths: A longitudinal examination. Journal of Consulting and Clinical Psychology, 70(4), 967-975. doi:10.1037/0022-006X.70.4.967

Since community psychology focuses on social issues and social institutions it is of particular interest to community psychologists that our sexual minority youth are facing harassment and violence at the hands of these social institutions such as schools, church and governmental organizations.

Suicide Prevention Resource Center. (2008). Suicide risk and prevention for lesbian, gay, bisexual, and transgender youth. Newton, MA: Education Development Center, Inc.

Community psychology advocates the importance of context and environment because our behaviors are governed by the expectations and demands of given situations. It is vital to study the social environment of the LGBT youth to figure out what interventions can be made in order to prevent suicide within this population.

The term divorce is defined by Merriam Webster Langenscheidt’s Pocket Dictionary as an act or instance of legally dissolving a marriage. It is usually between a man and a woman. However recent evolution and other social constructs have tended to see divorce as a legal dissolution between partners, for example, a marriage between gay or lesbian partners. The latter statement goes to explain the fact that some jurisdiction recognizes marriages between the same sexes. Therefore the definition of marriage cannot be restricted to the traditional description of what marriage is. It must also be noted that various cultures have a way of dealing with divorce.

To Margulies, Sam (2004), the decision to divorce is the beginning of two streams of events. Firstly, filing for divorce triggers legal, emotional and financial process in which the house hold must be split into two. The second stream of event is the building of new lives, households, who has custody of children of the union and new protocols being negotiated.

Again, one of the things that makes divorce such a unique and often troubled experience is that it involves a complex interaction between two different processes. Firstly, divorce is a difficult emotional process. It causes intense feeling of sadness humiliation, abandonment, disappointment, rejection and rage. Most of all, divorce engenders fear, particularly fear of loss. People fear lost of identity as spouse and parents, loss of economic and security, loss of control over their lives and loss of dignity. So the emotional process of divorce is one in which people have to manage all their feelings at the same time. As with any other transition, there are stages that most people pass, beginning with initial turmoil, followed by struggle with change, and eventually with adaptation and adjustment. Children of the marriage to be honest are not speared the pain of these processes. Margulies, Sam (2004).

For the purposes of this academic discourse, a child is somebody who is primarily under the age of eighteen or someone who is not yet twenty three but still in a training program. For instance, it concerns a person who is studying in a training institution like Sheridan College. The word consequences as would be used in this research represent the various experiences, children whose parents are going through divorce face.

This paper will therefore establish and make clear a hypothesis to be analyzed. Various arguments would be adduced to support and prove the said hypothesis. On the other hand a counter argument will be made to refute the hypothesis. A balance discussion on the research will also be delved into. Finally a presentation on the outcome of the research will be done.

HYPOTHESIS

The hypothesis is “there are lifelong consequences for children whose parents go through divorce”. Almost 50 percent of children whose parents divorce show signs of psychological damage during the first year after the event. According to a 1994 policy statement from the American Academy of Paediatrics, such boys become aggressive whiles adolescent girls get depressed. To prove further the devastating nature of divorce on children whose parents go through divorce are more likely to develop drug and alcohol problems. Pemberton K.C.(1998) in reviewing Psychologist Judith Wallerstein’s twenty- five (25) year study on the impact of divorce on children, found out that although the divorcing man and woman might be able to overcome the trauma and challenges associated with divorce, the circumstances of the children are different. Children of such unions can carry the ill effects of divorce into their own adult years. Such adults tend to have fear of commitment, unstable father-child relationships and bitter memories of the legal system. In explaining this position further, Pemberton K.C. (1998), asserts “I do not argue that children have no chance of healthy or happiness after their parents had divorced but the challenges children must meet after their parents’ divorce are severe and devastating”.

As much as scholars like Pemberton K.C. (1998) and Emery (2004) have painted a horrible picture of the situation, the same scholars have conceded to the fact that some children who experience this phenomenon grow to live a healthy and a successful life. For example there are enhancing programs in our schools that go a long way to support and prepare such children for future healthy living.

ARGUMENT TO PROVE HYPOTHESIS

As it has been noted, there are various arguments that go to support the premise that, children whose parents go through divorce suffer lifelong consequences. Some of the issues are best explained when put under emotional, physical and social consequences. To most children, divorce will constitute the first major crisis of their lives. Children turn to exhibit many emotional and psychological traumas. For instance in a conversation I had with a child and youth worker at Apple wood Height secondary school as part of my preparation towards gathering information for this project, enumerated that, children whose parents had gone and are going through divorce turn to be withdrawn in class. This behaviour tends to manifest itself in their academic performance. This Psychological effect makes them act aggressive towards their peers and seems to struggle with normal processes of growing up.

In much the same way, Emery, E. R.(2004), supported this hypothesis by stating that “There are those who contend that divorce inevitable and invariable devastates children and set the stage for a lifetime of emotional problems, period”. To prove this point further, he attempted to compare the behaviour and attitudes of children who are perceived to be normal because they are under the guidance of their two parents and those children whose parents are going or had gone through divorce. He found out that, the very process of divorce between parents causes the children to struggle through the pain and upheaval of their parents’ divorce. Secondly, through sensationalistic media or our own hysteria, we lay the burden of carrying a ticking time bomb on kids by inaccurately trumpeting the “tug of war” between the parents. Even if parents seem to be doing well by handling the divorce crisis, children are inevitable doomed or damaged because of divorce.

After the divorce process, it introduces huge changes into the lives of most children. This encompasses direct involvement in parental conflict, economic hardship, changes in residence and school. To him, divorce also increases the risk for psychological, social and academic problems among children. This increased risk is a legitimate concern for children, parents and the community. Finally, he stipulated that, despite parent’s fervent desire to protect children of divorce, the mere divorce process is a burden to children.

To prove further the long term consequences divorce has on children whose parent are going and had gone through divorce, Emery, E. R. (2004), made available some statistic to throw light on his thoughts. These are; such children are twice as likely to see a mental health professional, up to twice of such children are likely to have problems managing their behaviour. He also said, perhaps 1.25 to 1.5 times are more likely to have problems with depressed moods. Again, twice of such children are likely to drop out of school before graduation. What is more interesting and sad enough to support the Hypothesis is the realization that, 1.25 to 1.5 times of children at one point or the other experienced the challenges of their parents divorced. Similarly, the same children are likely to get divorced themselves. Is this not scary enough to prove the hypothesis?

Besides, Price E. (2000), in her book “Divorce and Teens” has not described the situation in any positive way. She explained that, the issue of parents fighting each other, why are my parents divorcing, why must one parent move out, must I tell my friends and what should be my level of loyalty to each parent, all go a long way to frustrate such children. Eventually, anger takes over and this manifest itself in aggressive behaviour towards life issues.

Another practical perspective to the situation at hand is cleverly summarised by his lordship, Mr. Justice Harvey Brownstone as follows;

After more than fourteen years of presiding in family court, one question has never seized to amaze me: how can two parents who love their children allow a total stranger to make crucial decisions about their leaving arrangements, health, education, extracurricular activities, vacation time and degree of contact with each parent? This question becomes even more mind-boggling when one considers that the stranger making the decision is a judge, whose formal training is in the law, not in family relations, child development, social work, or a psychology. Now add the fact that, because of heavy case loads and crowded dockets, most judges have to make numerous child custody, access, matrimonial property and support decisions every day on the basis of incomplete, subjective and highly emotional written evidence (called affidavits), with virtually no time to get to know the parents and no opportunities to meet the child whose life is being so profoundly affected. What person in their right mind would advocate for this method resolving parental conflict flowing from family breakdown? This are some of the questions that family called judges agonize over. Some say the answer are complicated and have much to do with social conditioning, economic class, level of education, sophistication, familiarity with community resources and even culture. I say the answers are simple. The institution of marriage has not been a great success in North of America…” Brownstone, J.H. (2009). P.1.

COUNTER ARGUMENT TO THE HYPOTHESIS

In spite of the scary picture painted by the various authors supporting the hypothesis that, “there are lifelong consequences for children whose parents go through divorce”, the same topic and ongoing controversies have resulted in the change of authors views. For instance, Emery (2004) has stated that “The Risk of Divorce Are Real but Not the Whole Story”. By this, he has discounted some of the arguments he had put forward to support the hypothesis. He acknowledges that divorce increases children’s psychological problems but also sought to emphasize the need to put it into its right perspectives. To him, the large majority of children from divorced families do not suffer from psychological problems. His argument is centred on the theory of “correlation and causality”. He went further to explain that divorce is correlated with more psychological problems among children but this does not mean that it is the cause of all the problems. Scientific evidence has at least proven that divorce cannot be the cause of all the affected children’s emotional problems. Another important factor, Emery (2004), considered is that what happens after divorce can go a long way to eliminate risk and promoting resilience.

Besides, he used the “half full and half empty analogy to refute the premise that all the children who experience their parents going and had gone through divorce face, Emery (2004). He duelled heavily on a major national study conducted by Nick Zill, Donna Morrison and Mary Jo Cairo. The study looked at children between the ages of twelve and twenty-one. The study revealed that 21% of children whose parents have had divorce received psychological assistance. In comparison, 11% percent from married families also received similar help. It is a fact that, there is a 100% increase between the two groups. Once again, this situation looks scary but the truth of the matter is that, if 11% of children from the normal situation seek psychiatrist assistance, then it presupposes 89% do not. On the other hand, if only 21% of the said troubled children seek for psychiatrist assistance, then the whole phenomenon is not a case of the glass being half empty and half full but rather the statistics should be looked at in both ways. When this happens, it can be adduced that the glass is only 20% empty and 80% full.

There are no doubt that divorce disrupts the lives of almost every child who goes through those challenges. However, great majority of these children are able to sort through these difficulties and succeed. We must not also lose sight of the need to applaud and build on the strengths (strength based approach) of such children. Besides, evaluating it from both scientific and statistical point of view, shows that psychological problems of children whose parents had gone through divorce starts before the actual divorce issues begin to manifest. Emery (2004). To back up his finding, a substantial figure of 50% was found.

A BALANCE DISCUSSION ON THE RESEARCH

At this point, it is important for one to have a balanced analysis of the overall views of the topics of divorce. That is, the ideas which support the hypothesis and the ones that refutes it. On a personal reflection however, I still stand by the hypothesis that, “there are lifelong consequences for children whose parents go through divorce”.

The opponents of this hypothesis have sought to argue that divorce, in itself, does not impose any lifelong consequences. Realistically, most children from divorced families are resilient. There are instances where such children have gone through those challenges and still succeeded in their life endeavours. Most have good careers and are happily married. This disproves the stance portraying children whose parents have gone through divorce as a serious and unimaginable consequence. To me, what those children go through emotionally are equally experienced by children who stay and grow with their parents. Some have even tended to suggested that, it is a normal process of growing up. As noted above, only 20% of such kids experience the phenomenon.

Looking at my social location, I was from a divorced family. However, I had the benefits of some social and traditional structures to support me and my sibling. For instance, my grandmother took up the fathering responsibility so we never felt the absence of our father. Similarly, when we migrated to Canada, the school system has counselling facilities that helped to sustain us to go through the normal processes of growing up. I am proud to say my brother and I are now in college and are determined to succeed in our choosing endeavours. These achievements would probably have not been possible in a case of somebody living with parents. This example goes to support Emery (2004), assertion that “even after a separation, what you do is the most important determinant of whether your children are at risk or resilient.”

In-spite of the argument put up by the opponent of the hypothesis, proponents still argue that children whose parents go through divorce experience lifelong consequences. It has been proven above that such children suffer emotional and psychological consequences. It is estimated that over 21% of such children have mental health issues and are likely to fail in their marriages.

To substantiate this point further, I would like to draw once again on the conversation I had with the Child and Youth Worker at Apple Wood Height Secondary School. She explained the following points from her practical perspective. She said children who have experience the consequence of divorce lack trust. They are unable to give back love because psychologically it has been registered within their sub conscious mind that if their parents who claim to love them are fighting and doing things regardless of the interest of such children, then whom are they to trust.

Isolation of such children from peers and some school activities affects their ability to develop properly into adulthood. In most cases, they are seen to be withdrawn from extracurricular activities because of the shame, having to explain to friends that their parents are divorced. This is more prevalent in religious based schools like the Catholic schools.

The issue of step-parents does not help matters either. In the unlikely event that the step-parents do not get along with such children, it raises tension within the household and puts the child under constant psychological trauma. I am of the opinion that it is some of these problems that makes these children have mental health issues.

Finally, what is more dangerous to society is the fact that such children are unable to establish and maintain positive relationships. Some traditional views, though not fully supported by me, have suggested to the belief that it is some of these societal problems that have led to the emergence of the sub-culture like gay and lesbian communities.

Research Outcome

From the above discussion, it has been established that different communities and different scholars have divergent views on the impact of divorce on children. One perspective view is that such a situation is not serious. However, those who support the hypothesis of which I support still believe that “there are lifelong consequences for children whose parents go through divorce”.

This new found knowledge will form as the basis for new theories to be developed. It will also give the opportunity for other research to be carried out in this area. Practically, it will enable single parents form alliances to advocate for policy change in schools and child centres to strengthen child and youth counselling within such facilities.

This research will also assist people within the helping profession such as Psychologists, Child and Youth workers and Social workers to come to the realization that this phenomenon is very prevalent within our schools and that serious efforts should be made to assist children with such challenges to overcome them. As an anti oppressive Child and Youth Worker, it is necessary to pay special attention to the situation even if a child suffers as a result of our inaction to deal with the situation.

The outline of the case including factors in connection with history, presentation and the need for a revised therapeutic approach in many ways mirrors the clinical case evaluation detailed by Sherry (2006) in the application of ‘an Attachment Theory Approach to the Short-Term Treatment of A Woman With Borderline Personality Disorder and Comorbid Diagnoses’. This study highlights the difficult support/treatment pathway of borderline personality disorder (BPD) which stems from the comorbidity with other diagnoses including

severe depression, panic disorder, post-traumatic stress disorder (Zimmerman & Mattia, 1999) and harmful misuse of alcohol and other substances (Trull et al, 2000) which are all clearly present in Ruth’s life. The symptoms typically identified with these disorders are often challenging to mental health practitioners and there appears to be a groundswell of opinion that suggests the disorder is largely untreatable because they are entrenched within the personality and coping mechanisms of the individual. (Raven. 2009)

As is common with many people who experience severe mental distress, Ruth has been unable to respond to the demands of the workplace and therefore financial insecurity is likely to be a significant factor for her and also in shaping the life options and experiences of her daughter, Megan. Gould (2006) identifies some of the most pertinent and enduring difficulties that contribute to child poverty in situations where parents have poor mental health and details the difficulties of securing employment (just 24% of people with long term mental health issues in employment), the typically low level of remuneration for people in this category and inflexible nature of moving from benefit claimant through into employment as limiting factors in increasing the life chances of children and young people in this kind of situation. To support this claim the more general findings of Tunnard (2004) are highlighted which link parental ill health problems and family poverty and indicate that ‘50% of disabled people have incomes below half the national average, this rises to 60% for disabled adults with children (Gould 2006). Speculation in this report suggests that the figures would be worse in families where one or more parents experience significant and enduring mental problems. Therefore it is reasonable to presume in the case of Ruth and Megan that their level of income is and will remain at a low level without some significant lifestyle changes. Specific links between financial hardship and mental health are taken from an unpublished paper by Social Exclusion Unit in 2004 detailing the impact of poverty on mental ill health, the difficulty people experience had in accessing financial advice /services, disproportionate dependence on state benefits, fluctuating incomes determined by health status and the challenge of securing the right level if benefit/personal finance. General findings about the impact on family poverty are also relevant in the case of Ruth and Megan and it is a factor that is very likely to add to the symptomology common to people diagnosed with borderline personality disorder.

Furthermore, as benefits and social care resources are constrained against a backdrop of central government’s drive to put people back into work, Spencer and Baldwin (2007) argue “that many parents in the UK are expected to bring up their families in the context of unreasonably scarce resources’. Therefore, practitioners need to take into account Ruth and Megan’s social and economic factors when assessing their individual needs, risk and in determining a therapeutic pathway for this family. As might be expected, given these negative financial, health and well-being determinants social exclusion is a likely to be a factor that needs to be overcome if an holistic, person-centred approach is to be adopted in supporting this family. Developing strategies to overcome the destructive behaviours that Ruth has developed as her personal coping from mechanisms is a key factor in addressing the wider concern of her and Megan’s social exclusion and isolation.

Megan’s current situation, which is one of compromised opportunity, a limited social life, burdensome responsibilities, isolation, scarce personal resources and a lack of attention to her own needs, represents the situation of many carers in the UK, especially so those who have or have had responsibilities as a young carer. . Research by Aldridge and Becker,

(1999, p.306) suggests that children who provide caring support to parents with mental illness ‘ will be more susceptible to increased levels of anxiety, depression, fear, change in behavioural and social patterns as well as being more at risk of transmission of the particular parental condition’. As caring moves through into adulthood the future tends to remain bleak and research from the Health and Social Care Information Centre (2010) reports increased evidence of poor health, low income and a general sense of hopelessness for carers in the light of on-going cuts to social care budgets. The prospect for any significant improvement is equally depressing.

In considering the details of this case the eclectic and reflective nature of social work is an approach that seems suitable for the complexities supporting people with mental ill health, particularly the ever changing presentations of people who have a diagnosis of borderline personality disorder. Payne (2009, p.100) describes the usefulness of these approaches in case work highlighting how practitioners can adopt and use theories ‘together, perhaps all at once or perhaps successively’ or use ‘different theories in different cases’. Because this method requires significant skill and discernment Payne cites Epstein (1992) who suggests that flexible team approaches to reflection, debate and application offer a useful way forward to the delivery of flexible ‘moment to moment’ practice in response to complex cases. Payne (2009) identifies systems theory as being an important aspect of eclecticism. Pincus and Minahan (1973) applied the approach to social work practice and describe three types of system these being ‘informal or natural’ (friends/family), formal (community groups, etc.) and societal systems (hospital/schools, etc.). People with mental health problems are likely to have some difficulty in using helping systems to improve their health, life experiences and general well-being. Applying systems theory involves identifying the point, and problems individuals experience in the interactions with their environment. The phases of this include assessing; making/negotiating contracts; forming/coordinating actions; re-forming and influencing action systems; terminating change efforts. Payne (2005) extends the application of this approach and makes clear links to ecological systems theory, crisis theory/models and task centred working. The application of these, particularly crisis intervention, could work in connection with Ruth’s current difficulties and potentially offers short term bridge toward longer term therapeutic work. However in adopting this approach it is worth considering the caution raised by Doel (2009) and he notes that if done poorly than crisis/task centred work can become inflexible, routine and possibility lead to some level of social control. Doel suggests using these methods should be accompanied by training that considers factors such as values, attitudes and their application in practice.

Sherry (2007) identifies the increasing consideration and application of attachment theory (Bowlby 1973) in the causation of borderline personality disorder and cites numerous influences as threats to attachment in childhood. Risk factors in this regard include sexual traumas (Laporte & Guttman, 1996), parental neglect (Paris, 1997, 1998), family instability and emotional neglect all of which are considered to contribute to the development of personality styles in adult life. For practitioners, the reasoning of Ivey 1989 who suggested extreme behaviour by clients could be linked to their development history and the way they respond and bring meaning to their experiences in later life. Therefore poor parenting experienced by Ruth could have been instrumental part in the development of behaviours that for her now carry the label of borderline personality disorder (West & Sheldon-Keller (1994). Therefore the gathering of information in assessment processes can be a crucial factor in working out the style and content of social work intervention.

In considering the pathways of someone who experiences significant mental health issues it is clear that from many perspectives that society perceptions, life opportunities and thereby individual well-being are compromised in many areas of life. The fight for a more balanced and supportive approach to mental health has been carried by the service user/survivor movement for many years and the need for reform has led to many campaigns. It is easy to understand the need secure better treatment and push through system reforms given oppression, rejection and widespread ignorance that characterises the history of mental health in the UK. Ferguson (2008) highlights how the now accepted position of the survivor movements pushing for greater recognition of the plight of people with mental health issues came from the enduring effects of stigma, powerlessness, inequality and segregation which have been utilised to push governmental thinking and maintain mental health, well-being and social care as political issues. The fight for improved rights and opportunity among the survivor movement only really gathered pace in the 1970s (Campbell 1996) (Beresford, 1997) and in the early stages tended to focus on small scale self-help and mutual support initiatives. More recently there has been greater, towards collective national campaigns concerning treatment, responding the revisions of the mental health legislation and broader struggles to change attitudes and understandings of madness and distress. This has been key to shifting the stigma of mental health and clearly it is something that needs to continue.

General concerns expressed by Campbell (2005) link well to Ruth’s situation and the pressing structural concerns that tend to bring of poverty, lack of opportunity, isolation, boredom, hopelessness and therefore a continuing commitment to state imposed legal and medical restrictions are clearly relevant to the case study. Evidence of the negative impact of mental ill health can be found in the health inequalities highlighted in research carried out for the Disability Rights Commission in 2006 which showed that people with severe mental illness are at higher risk of ill health across a number of conditions. Their report ‘Equal Treatment: Closing the Gap’ highlighted increased incidence of clinical obesity, coronary heart disease, diabetes, high blood pressure among people with severe mental health issues. It also noted higher risks in connection with people developing high blood pressure, stroke, respiratory problems and bowel and breast cancer. They are also more likely to smoke. Although the reasons for this inequality are complex and have far reaching implications for public health policy makers, the consequence remains that people who experience long-term mental ill health die on average 5 to 10 years younger than other people, often from preventable illnesses. The response to this research and the continued focus on issues of inequality, injustice and stigma by organisations such as ‘Rethink Mental Illness’ is yielded some significant results with increased focus on physical health being pursued within community mental health teams, increased focus on talking therapies and Mental Health (Discrimination) Bill moving through to the House of Lords for further debate. (Rethink, 2012)

However it is increasingly apparent that people with a diagnosis of borderline personality disorder are subject to a specific type of stigma and discrimination that impacts on the relationships that are key to achieving to achieving some level of stability in their lives, these being the ‘therapeutic’ links with practitioners within community mental health services. Ruth’s condition unfortunately fits in with the perception held amongst professionals that it is almost or completely untreatable. Personality disordered patients are often described as the “patient physiatrists dislike” and are often viewed as time wasting, difficult, attention seeking, and manipulative bed blockers. (Hadden & Haigh, 2002). Having previously highlighted the significance of person-centred theory and approaches in developing therapeutic alliances, it is supremely that discrimination within helping professions can be raised so easily as central limiting factor. Markham (2003) highlights multiple differences in the reactions of professional staff towards people who have a diagnosis of BPD. The suggestion is that the label leads to increased social rejection, deceased optimism and adoption of stereo typical attitudes by staff therefore creating risk of less favourable and thereby effective treatment as compared to other groups of people with severe and enduring mental health issues. As might be expected, the research draws heavily on labelling theory:

The negative service user experience detailed by Wright & Jones (2012) in typifies Ruth’s historical therapeutic pathway and include direct quotes that are clearly relevant:

‘Rightly or wrongly, I interpreted the label as a sign that I was fundamentally flawed, that the bad parts of me far outweighed any good attributes that might also be part of my personality’

aˆ¦and being told

‘that I had a personality disorder and that there was no cure or treatment. The inference was that I was just made this way and that was the end of it.

The article also highlights the findings of Pilgrim (2001) who suggest that poor responses to personality disorder occur because causes are not known and that treatment outcomes are often unpredictable and unreliable. In considering this kind of evidence, it is easy to understand Ruth’s resignation following another A & E admission which in her mind will bring about yet another dissatisfying cycle therapeutic hopelessness with little chance of any success.

(should this paragraph be justified or left centred?)

The situation raised in the case study typifies many of the negative issues associated with

the support that people with a diagnosis of borderline personality disorder receive:

dismissive attitudes, inconsistent approaches and authoritarian approaches seem to be

consistent themes and are obviously not changing the nature and outcomes of therapeutic

interventions. While it might be difficult at this stage, it seems important for Ruth to take

some responsibility possibly self-managing some degree of the presenting risk which is

consistent with the guidance provided by Wright and Jones (2012) and is also in line with

best practice as detailed in the NICE guidance (2009). This should be clearly stated

within the care plan. Mead and Copland (2000) suggest that people are able to grow

through positive risks taking and that empowerment through person centred support can

reframe typical service user response to difficult, crisis situations. Practically this can be

supported through clear and effective care planning and this should be built into an

individual’s treatment and crisis plan. Ruth, along with her care coordinator, should carefully

consider strategies to manage acute and chronic risks developing and incorporating these in

the care plan as appropriate. This will ensure consistency when the care coordinator is

absent, ensuring that Ruth’s care and support follows boundaries and consistency agreed

with her and thereby ensuring she is treated with dignity, respect and compassion.

Although risk to self which Sherry (2007) clearly links to the diagnosis of borderline personality disorder must be responded to in the context of community mental health services, admission to psychiatric inpatient unit should only take place as a last resort and the least restrictive options should be pursued. The stepped care model offers a useful statutory response and if risks remain elevated then Ruth should be considered firstly for the high intensity team then a referral crisis resolution and home treatment team, notwithstanding any negativity that may surround her historical presentations. If possible extra support from care coordinator would be the ideal solution, as this would utilise the therapeutic relationship in place to support and guide Ruth through her crisis. In consistently challenging situations Ruth’s care coordinator could also explore with Ruth and Megan a self-directed support (SDS) package. This package could support with activities of her choice and it is possible for this to be used for Ruth to explore and access some community resources therefore building social networks for Ruth and relieving Megan of some of the pressure of her carer’s role. Hatton and Waters (2011) identify the relative success of SDS/personalisation in connection with people experiencing mental health issues and this is at its most beneficial when individuals pursue direct payments and secure support on their own terms.

Whichever option in terms of on-going support is chosen then it seems that there is need for a more collaborative, shared approach both in connection with risk and also around longer-term support strategies. The work and theories of Rogers (1956, 1957) define the core conditions of counselling including unconditional positive regard (UPR), empathy and congruence for therapeutic relationships to succeed particularly so in the context of personality change. It is important to note that this is a value based approach and faith that the person can shape their own positive future if the condition highlighted above can be provided. It is not a set of tools and techniques that can be turned on and off to suit practitioner needs at a given time or opportunity. It links well to considerations around motivational approaches and Ruth’s and Megan’s desire to move on is a good indicator in this regard. Fundamentally, by adopting humanistic approaches, the aim is to develop a pattern of interaction and support which keeps Ruth centrally involved in the nature and shape of the therapeutic relationship which will naturally involve key decisions about, risk, treatment options, care planning and goal planning. Clearly this type of interaction is difficult to outline to all involved professionals but careful entries and assessment within electronic records can help significantly in modifying the responses all statutory workers who may encounter Ruth in the professional work. If this person-centred approach is adopted then it will represent a significant shift in the care and support Ruth has received in her ‘short psychiatric career’.

The beginnings of community care date back the Griffiths Report in 1988, particular Community Care: Agenda for Action and the government White Paper Caring for People. (Guthrie; 2011) The papers emphasised choice, independence and involvement service users and carers. A series of shifting strategies and priorities developed such as; move from institutionalisation to promote independent living within community, from service led to needs led provision. (Petch; 2008) In 1990, the NHS and Community Care Act (NHS&CCA1990) was introduced that draws attention to the term “care in the community” which for many service providers opened door to market of services, leading to privatisation and managerialism. (Ferguson & Woodward; 2009) Although community care was introduced by the NHS&CCA1990, this operated in Scotland to amend the Social Work (Scotland) Act 1968 (SW(S)A1968). The addition of section S12(a) into the SW(S)A1968 created a duty to assess the needs of the individual who may require services.

Potentially the statutory legislation that could be used in the case of Mrs. Sheerer are; Mental Health (Care and Treatment) (Scotland) Act 2003, (MH(C&T)(S)A2003), Adults with Incapacity Act 2000 (AWI(S)A2000), mentioned above SW(S)A1968 amended under section 13(za) and Adult Support and Protection (Scotland) Act 2007 (ASP(S)A2007). (Mackay; 2008)

It seems to be very unlikely to use MH(C&T)(S)A2003 because there are no clear evidence that Mrs. Sheerer suffer a mental disorder, defines as; a mental illness, personality disorder or learning disability which is caused or manifested S328(1) of MH(C&T)(S)A2003. She also based on information provided, does not appear to put herself or others on significant risk and her decision making is not obviously impaired. It is worth noting that the act is very controversial due to impact of stigma, coercion and breaching of human rights.

The AWI(S)A2000 could be used on the grounds that Mrs. Sheerer is deemed to lack capacity to make decision in relation to her future care needs, S1(6) of AWI(S)A2000 states “incapable means incapable of making decision” and this seems to be relevant to the case. It is important to note based on legislation that if Mrs. Sheerer is unable to make decision in some areas, she is likely to take decisions in others. In Scottish law, there must be clear evidence that a person lack of capacity before any action will be permitted. (Scottish Government; 2008) However, in England and Wales the same rule is statutory, the adult must be assumed to have capacity unless proven otherwise as stated in S1 of Mental Capacity Act 2005 (MCA2005). It may be questioned if Mrs. Sheerer actually lack of capacity, based on single SMART test in hospital condition. Hospital could exacerbate confusion, as a result of unfamiliarity, lack of sleep, medication or pain. When intervening in Mrs. Sheerer live, the principles defines in S1 of AWI(S)A2000 must be taken into account such as; intervention will benefit the adult and will be least restrictive option in relation to the freedom of Mrs Sheerer. Account shall be taken of the present and past wishes and feeling of service user and the views of other relevant people. It is worth noting that principle three only requires views are taken into account but it does not mean they are given effect to. The principle four of the AWI(S)A2000, to promote the participation in decision making, is slightly different in England and Wales, where decisions being taken in the best interest of and adults according to S1(5) of MCA2005. It is important to check if Mrs. Sheerer did not take advantage of the options such as; negotiorum gestio, which allow the authorised person to act on the behalf of an incapable adult, attorneys or guardians to take decision on behalf of an adult. An attorney is appointed by the person before lost of capacity, at the presence of the solicitor whereas, a guardian is appointed by the sheriff court. (Guthrie; 2011) Application for a guardianship order when Mrs. Sheerer is in hospital ready to discharge, could cause unnecessary process known as delayed discharge code 51X. (Scottish Government, 2010) The delays in guardianship order could be caused, by difficulties in obtaining legal aid by relatives. If social worker felt the delay in discharge result in negative consequences for Mrs. Sheerer, it would be considered taking over the guardianship application. To apply a guardian Mrs. Sheerer according to S57 of AWI(S)A2000 must be incapable and it must be likely that incapacity will continue. Therefore, the application for the guardian could be irrelevant in a situation of Mrs. Sheerer because there are no evidences of continuity of incapacity and the current state can only be temporary. If Mrs. Sheerer was not able to make decision, only for a short period of time, regarding her welfare or finance, where decision had to be made quickly, a social worker of behalf of local authority has duty to apply for an intervention order under S53 of AWI(S)A2000. Potentially AWI(S)A2000 could be used to imposed care at home or residential care to Mrs. Sheerer.

Assuming that Mrs. Sheerer does not have appointees and lack of capacity to make decision about future care needs, it would has to be considered if the application for an order under the AWI(S)A2000 is necessary or alternatively use the power of the SW(S)A1968 amended under section 13(za). This section, give social worker a power to provide community care services that has been assessed as needed to Mrs. Sheerer due to incapability to consent receiving such services. In accordance with S13(za) of SW(S)A1968 Mrs. Sheerer could be move to care home or agree with proposed care intervention. Before using any of those two acts, the issues to discuss are; adoption of principles, deprivation of liberty, assessment of needs and risk as well as financial arrangements.

The last but not least legal option to consider is ASP(S)A2007, the act refers to the law that concerns not only protection but providing support to promote independence and welfare of service user. Mrs. Sheerer meets two condition of the act to be applied such as; she is at risk and may need protection of well-being, due to her lack of capacity, poor nutrition as well as risk of falls. The ASP(S)A2007 gives social worker working on behalf of local authority duty to investigate and assess Mrs. Sheerer. Most of assessments are undertaken on a voluntary basis but the act gives power to assess without consent of service user and is known as the first of three “protection orders.” (Mackay: 2008a) The act also established a duty to cooperate between agencies and creates multi-disciplinary Adults Protection Committees to implement, monitor and support the work.

One could envisage that the use of ASP(S)A2007 seems to be the most appropriate option because is the less restrictive according to Mackay (2008) pyramid of statutory intervention. What is more, the act itself does not stigmatise, the least breach human right or freedom. It will give social worker time to get know and build better relationship with Mrs. Sheers. Consequently, it will result in having more information and better picture of situation. When using ASP(S)A2007 one assume Mrs. Sheerer’s situation could be caused by experiencing some difficulties in her life or even suffer distress such as bereavement, lost or abuse. The intervention in Mrs. Sheerer live will depend on many factors to be discussed; service user’s opinion, adaptability of house to current needs, the condition of house and accessibility, opinions of other professional and relatives. One might expect that Mrs Sheerer, regardless of age but due to femur fracture will require intense home care services or adaptation of the house such as; raised toilet seat, grab or lifting handles, community alarm, hospital bed or others. The application of the above will be possible under S13(za) of SW(S)1968 envisaging that Mrs. Sheerer expresses consent to such services to be provided. Social worker has duty to assess the needs of Mrs. Sheerer under ASP(S)2007 but the consent to provide services is needed to use S13(za) of SW(S)A1968. Otherwise, social worker could take action under AWIA(S)2000. The principles of these acts required to take the view of Mrs. Sheerer and carers if involved, into account when deciding what services to provide, this is also in accordance with Community Care and Health (Scotland) Act 2002 (CC&H(S)A2002) amended under S12(a) of the SW(S)A1968. It is worth pointing out that Mrs. Sheerer was nutritionally compromise but had home care services and limited family intervention. This raises the questions of why it was not noticed, how adequate is the result of SMART test in hospital conditions and how this had affected Mrs. Sheerer. There are a lot of speculations and factors to consider but taking into account the limited information that were given and assuming social worker investigates this case for the first time, it seems be discriminative to use other legislation. One must remember that legislative context of intervention, mainly, is driven by the relationship between social worker and service user, which is a core element to success intervention in social work. It is an important source of information to understand the reality behind the situation and how best to help. Wilson et al. (2008: p.7) referring to relationship-based practice called it “the medium” through which social worker can engage with and intervene in the complexity of internal and external world of service user.

This part of the essay examines responsibilities, rights and role of people involved. The legislation gives the social worker acting on behalf of local authority a general responsibility to promote well being, to minimise the effect of intervention and give an adult the opportunity to lead as normal live as possible. Local authority is responsible for assessing needs for community care services, arranging and providing these services as well as cooperation with other professionals such as; occupational therapist, housing officers, GPs. This is according to the integration agenda between health and social care services. (Age Scotland, 2011)

Social worker has statutory duties underpinned not only by the law but also professional codes and values. Expectation of social work profession is presented in code of ethics issued by British Association of Social Workers (BASW) and code of practice represented by Scottish Social Services Council (SSSC). Social work values grew on the idea of respect for the equality, worth and dignity of all people. Human rights and social justice are at the heart of social work intervention. The five principles indicates by BASW (2012) regarding human rights are; to promote and respect well being, support people to make own choices and decisions, promote involvement, participation and empowerment of people using services, treating each person as a whole to recognise all aspects of service user’s life, identifying and developing strengths. While, code of practice (SSSC; 2007) requires; to protect the right and promote the interest of service user, maintain the trust and confidence, promote independence while protecting from harm and danger, respect the rights of service user.

The Scottish Parliament and public authorities are required to uphold the European Convention of Human Rights, incorporated into the UK law through Human Rights Act 1998. (Johns; 2008) It can be in some cases that the law can breach human rights. Therefore, in relation to Mrs. Sheerer social worker most of all has to respect, Mrs. Sheerer’s right to liberty and security, the article five established three conditions to be met before it will be breached such as certified mental disorder within significant degree and persistency. Article eight states that Mrs. Sheerer has the right to privacy, family life, home and correspondence. (Johns, 2008) She also has the right to access a solicitor or advocacy included under S6 of ASP(S)A2007.

The role of social worker will be to ensure Mrs. Sheerer understand legal processes and if she is aware of her rights. The legislation framework is complex, consequently; information given must make sense and be understandable for service user, the role of social worker is to take time to explain and answer questions. Social worker must use appropriate and effective method of communication and skills to understand and to be understood. The aim is to support Mrs. Sheerer to make informed choices as far as possible. Social worker must ensure that Mrs. Sheerer’s views are heard and she understands a situation. There are six core roles of social worker such as; case worker, advocate, partner, assessor of risk and needs, care manger, agent of social control. The above roles are affected by changes in wider social context, welfare policy and ideology like for example demographic changes, communications technologies, consumerism etc. (Scottish Government; 2005) Social worker role is to work together with Mrs. Sheerer to assist her to address personal issues, provide information and advocacy. Provide services to meet the needs of service user and not to try to fix Mrs. Sheerer to services available.

This part of the essay attempts to show the prospects of anti-discrimination, participation and empowerment in social work. Social worker is obligated by law, values and ethics to support and work with service user in anti-oppressive and anti-discriminatory way. Knowledge and understanding of professional codes such as; BASW and SSSC is crucial in being aware of anti-discriminatory practice in social work by defining rights and responsibilities. The anti-discriminatory trends in social work values and practice are deeply rooted in radical social work that aims to work towards a society based on equality, justice and involvement. According to the maxim popularised by Marx “from each according to his ability, to each according to his needs.” (Doel; 2012, p. 27) Social justice is still a basic value in social work practice. Dalrymple and Burke (2006) refer to emancipator issues that driven contemporary social work such as social justice, empowerment, partnership and minimal intervention. Participation is a key element in the development of anti-discriminatory practice. Wilson (2008) refers to involvement of service user in social work practice based on partnership and empowerment. The term partnership is used to refer to practice, based on working with service users, towards together agreed goals, rather than doing things for them. (Thomson, 2011) Dalrymple and Burke (2006) defined partnership as process of information sharing and involvement in decision-making. Taking the above into account social worker have to involve Mrs. Sheerer in the process of decision making and intervention such as defining needs, decide how best to help, implementing, agreeing and evaluating. Empowerment is not simply a matter of facilitating or enabling. It also involves taking account of the disadvantage and oppression that are so characteristic of the service user day to day experiences. (Thompson, 2008) Work in anti-discriminatory way means to see Mrs. Sheerer within her wide social context include environmental, societal and cultural factors such as race, gender, ethnicity, age, sexual orientation, disability and so on.

The last section of the essay assesses social policy that inform legislative context of this case. It is seems to be clear that social worker needs to work in integration with other professionals within all aspects of assessment and intervention process. The legislation defines responsibilities in social work but social policies outline a plan of action, a set of rules that guide practice.

The first significant policy in terms of promoting partnership working across health, housing and social care is Joint Future 2000. This is a unique partnership between the Scottish Executive, the Convention of Scottish Local Authorities (CoSLA) and NHS Scotland that focus on to improve joint working through financing join services, management and resources. A key component of Joint Future has been development of Single Shared Assessment (SSA) that aims to shorten and improve flow of information between professionals and agencies, avoid duplication, provide faster access to support with less bureaucracy. (Age Scotland, 2012)

The policy Changing Lives 2006 has concerned on anti-discrimination, to do not look at service user in the context of vulnerability but to focus on strength and building true relationship. The aim set out through report were promoting participation; taking a whole-person approach; understanding each individual in the context of family and community. (Scottish Government; 2006)

The another policy that seems to be important in relation to scenario, with the assumption of that Mrs Sheerer is an older person because the policy aims mainly to older people, is All our Future. It supports older people to stay at home as long as possible by providing free personal care, telecare development programme, care and repair, travel scheme; free bus travel etc.. (Scottish Executive; 2007) It is noteworthy that Mrs. Sheerer may be entitled to free personal care that was introduced by the Sutherland report and statutory implemented through the CC&H(S)A2002. (Guthrie; 2011) In Scotland every person over 60 years is entitled to free personal care in other cases it will depend on needs, priority and categories of risk. The policy Reshaping Care for Older People (SCSWIS; 2011) focuses on the “3R’s” rehabilitation, re-ablement and recovery to optimise the independence of people at home. The reablement is a new service, initially aims at people coming out of hospital. In Glasgow it is a partnership between Social Work Services, Cordia, NHS Greater Glasgow and Clyde. If Mrs. Sheerer lives in the area, she will be provided with services up to six weeks, the reablement aims to build confidence by helping to regain the skills to do what Mrs. Sheerer can and want to do for herself at home.(Glasgow City Council: 2011)

Recent consultation on integration agenda sets out proposal to inform and modify the way that the NHS and Local Authorities collaborate, and work in partnership with the third and independent sectors. This includes integrated budget and joint accountability. The proposal extends the services provision to all adults and not only older people, so the speculations regarding the age of Mrs. Sheerer would not be needed. The Integration of Adult Health and Social Care Bill plans to create Health and Social Care Partnerships, which will replace Community Health Partnerships and will be the joint and equal responsibility of Health Boards and Local Authorities. (Scottish Government; 2012) Ineffective partnership between health and social services is a real dilemma of contemporary social work practice. On the one hand, the problem is finance and the eternal question; who are going to pay for services? On the other, the issue of finding appropriate resources that will meet the needs of Mrs. Sheerer, both processes are time consuming. Consequently, Mrs. Sheerer can be detained in hospital longer that necessary that can affect her emotional and physical condition, which usually will deteriorate. Other issues are; blocked bed and retained the flow of a new patient. One strongly believe that new integration agenda of health and social care such as one budget and consolidated partnership will make a difference in new social services. The new social policies and legislation present a wide range of possible options and choices such as; personalised services and self-directed support. It this week government has been discussing the Social Care (Self-directed Support) (Scotland) Bill (SDS Bill) that has been passed stage three on 28th of November 2012. (Scottish Parliament, 2012) What that means for social work today is a shift from service led to outcome led provision, The Talking Points: Personal Outcomes Approach promoted by the Joint Improvement Team will change the process of assessment of needs that now will be more focus on targets. Based on SDS Bill social worker will have a duty to offer; direct payment to Mrs. Sheerer in order that she will arrange her support; can make arrangement for services that have been chosen by Mrs. Sheerer or can select appropriate support and make arrangement. (IRISS; 2012) One could seriously question if Mrs. Sheerer will have skills and knowledge to manage these variety of options such as; possibility to employ own carers or buy own services, if she have not done before. It seems to be clear that the role of social worker will have change form procedural care management towards support and brokerage.

To sum up, contemporary social work practice drifting away from paternalism to seeing service users as experts of own life an illustration of this is work in partnerships, service user involvement or SDS. There is no doubt that relationship between social worker and Mrs. Sheer is a key in the process of intervention. It is significant to talk to and listen to service user. The more time spend, the more social worker will understand Mrs. Sheerer within wider social context. One must remember that when intervening in someone’s life taking no action is an action, otherwise the option of minimal intervention or less restrictive option must be put in place.

1.1 Describe the duties and responsibilities of own role

My duties as a care worker involve giving clients personal care, such as assisting with washing, dressing, toileting requirements including catheter and convene care. Assisting with nutritional requirements such as meal planning/preparation/feeding, prompting/administering medication, shipping, cleaning. It is my responsibility to ensure that the client maintains an acceptable level of health and to promote the clients well-being. It is also my responsibility to ensure that all company policies and procedures are carried out and to maintain records for the service delivered, along with responsibility for ensuring that my training needs are kept up-to-date so that I am at the level of standards required to undertake my role. Finally, it is my duty and responsibility to treat clients with respect and dignity at all times.

Question: Identify standards that influence the way the role is carried out

The standards I have identified that influence the way I carry out my role as a carer working in domiciliary care are:

Care Standards Act 2000
Domiciliary Care Regulations 2002
Health and Safety at Work Act 1974
Manual Handling Operations Regulations 1992
Management of Health and Safety at Work Regulations 1999
Codes of Practice
National Occupation Standards
Care Quality Commission Standards

These make up the standards to follow for good working practice within Health and Social Care.

Question: Describe ways to ensure that personal attitudes or beliefs do not obstruct the quality of work

To ensure that personal attitudes or beliefs do not obstruct the quality of work carried out a carer should dedicate themselves to excellence, develop good work ethics and be professional at all times. It may also be possible to change personal attitudes through further training.

2. Be able to reflect on own work activities

Explain why reflecting on work activities is an important way to develop knowledge, skills and practice

Reflecting on work activities can help a care worker gain a better/clearer understanding of social, cultural, personal and historical experiences. Reflecting is learning through experience, so by deliberating in an orderly fashion we can learn from our own (or others) mistakes, and conversely from what we (or others) have done well and use this new knowledge to help us in future situations. Therefore, reflection can help us to find an awareness of our thoughts and feelings which may relate to a particular area of our working practice. Thus enabling a link between theory and practice, so allow ‘integrated’ learning.

Assess how well own knowledge, skills and understanding meet standards

Since starting work in the care industry I have undertaken a considerable amount of formal training, along with practical ‘on the job’ training/learning. I now have knowledge and understanding of many health and social care policies and procedures and undertake my role in a professional yet empathetic manner. I respect each clients diversity and equality, ensure a high level of confidentiality and promote their independence and well-being by maintaining a high level of personal respect.

Demonstrate the ability to reflect on work activities

The ability to reflect means to look back on something and think about it in a logical manner. So in a work capacity reflecting on what went well, what didn’t go so well, what could be changed and why this change would be necessary all helps regarding possible outcomes of future client calls. For example, in my own work practice when I am on a client call I try to fit my personality to the individual client and work in a way that will enable them to interact well with me. However, sometimes the communication isn’t as effective as I would hope for it to be upon working with a new client, I therefore tend to go away and reflect on how I can change my communication strategies with that particular client and approach the situation from a different angle on the next visit to help ensure that the call runs more smoothly on this occasion.

3. Be able to agree a personal development plan

Identify sources of support for own learning and development

The first point of support regarding own learning and development should be your line manager. Between the two of you you can discuss and agree further training possibilities and a personal development plan which may include accessing company and possibly external training. Discuss options with colleagues/team members/other professionals. Finding a mentor to work alongside of, and gain further support/skills and knowledge from.

Describe the process for agreeing a personal development plan and who should be involved

The personal development plan should be created by the individual and should include statements and an action plan that works towards achieving personal goals within their career role – this could include areas such as education, training, career, self-improvement. This plan should then be discussed with the line manager to check whether the goals are in line with the organizations expectation of the individual and then regular meetings should be arranged to ensure that the personal development plan stays on an achievable track.

Contribute to drawing up own personal development plan

A personal development plan is unique to each individual and tailored to suit the individual’s personality and goal aspirations. When developing my own personal development plan I would do the following:

Determine the strongest aspects of my personality traits.
Determine my goals
Create a ‘mission statement’ to help me focus on my plan
Create the plan, which will include how my goals will be accomplished – by breaking them down into smaller tasks and into timescales
Keep a planner/schedule to track my progress
Re-assess and update my personal development plan at regular internals as necessary. In line with regular management appraisals.
4. Be able to develop own knowledge, skills and understanding

Show how a learning activity has improved own knowledge, skills and understanding

I attended a one day dementia awareness course within my organization, which gave me a much greater understanding of the functioning of the brain and the areas of the brain involved in different kinds of dementia. This gave me a much greater understanding of why clients with dementia behave in the manner that they do and why they react as they do, which ultimately has enabled me to be pro-active in my actions and reactions to clients with dementia.

Show how reflecting on a situation has improved own knowledge, skills and understanding

Actively reflecting on a particular situation enables me to evaluate the pros and cons of a situation that has already happened. By taking into account other peoples perspectives and viewing from all sides in an objective way I gain further knowledge and understanding, which enables me to subtley alter my own manner for a beneficial outcome to both myself and the client.

Show how feedback from others has developed own knowledge, skills and understanding

Receiving feedback from managers, colleagues and clients helps me to gain a better understanding of my strengths and weaknesses in my job role. It then enables me to reflect on the comments and act on them accordingly. So, for example, if a colleague should feedback that I do not work well as part of a team I could integrate this comment and work on my team building skills. If my line manager should feedback that a client has commented on my high quality of care I will also use this as a positive marker of my abilities as a care worker. Thus, with either positive or negative feedback it gives me an understanding of others perspectives of my work and I have therefore gained the knowledge that will facilitate me with honing my skills accordingly.

All Professional occupations are guided by ethical codes and underpinned by Values (Bishman, 2004) and from the very beginning of Social Work, the profession has been seen as firmly rooted in values (Reamer, 2001) (Cited by Bishman, 2004) ‘Every person has a set of beliefs which influence actions, values relate to what we think others should do and what we ought to do, they are personal to us.’ (Parrot, 2010:13) Although society may been seen as having shared values we are all brought up with different personal values bases, this is an important point to consider when working with others, because our values can influence the way we behave. It would therefore be seen as foolish to underestimate the significance of values within the Social Work Profession. (Thompson, 2005: 109)

Our Personal Values can change over time, and our behaviour can alter as a result of the situation we are in. From a young age one of the most important values instilled in me by my parents was to have respect for others, this should be carried throughout life as we should treat others the way in which we would expect to be treated.

‘The importance of having a value base for Social Work is to guide Social Workers and protect the interest of Services Users.’ (Parrot, 2010:17) As a practising Social Worker it is important to recognise personal values and to be able to understand, situations will present themselves were personal and professional values can conflict. It was only when we had the speakers in that I began to question my own values.

NISCC outlines a code of Practice for Social Workers to adhere to, from listening to the speakers in class one issue that was highlighted was that of partnership. Partnership is now a very evident part of everyday language of people involved in the process of providing care. (Tait and Genders 2002) However it is not always put into practice. Mr Y referred to being ‘kept in the dark’ about his illness, he was eventually given a diagnosis, but it was never explained to him what the meaning of this diagnosis was or how it would affect his life. Social Workers have to exercise professional discretion, due to the nature of their work; judgements have to be made which involve values and consequences that make the worker accountable for their actions. (Thompson 2009)

Partnership working is very important for people with a disability, I was able to recognise a conflict with my personal values when one of the Mr X spoke about a visit to the GP, where the GP was asking the carer how the Service User was feeling rather that asking them, from listening to this I was able to recognise that this is something that I have done in the past and possible infantilises the individual with comments such as referring to them as ‘we dote’ or ‘wee pet’ and I never thought that there was anything wrong with using these statements, however from the experience gained I can recognise that my personal values and the professional values are in conflict at this point. It is a way of oppressing this individual, and failure to promote their rights as an person.

When viewing this in conjunction with the NISCC Code Of Practice, it was clear that there was a conflicting of values. NISCC states that as a Social Care worker we must protect the rights and promote the interests of service users and carers as the Disabled Movement states ‘Nothing about us, without us.’ We need to consider the Service User perspective, one of the speakers stated ‘effective partnership working should include the professionals and the Service user.

‘Partnership is a key value in the professional value base underpinning Community Care.’ Braye and Preston-Shoot 2003’43) Partnership should be promoted in several ways such as keeping an open dialogue between professionals and Service Users, setting aims, being honest about the differences of opinion and how the power differences can affect them and providing the Service User with information that helps to promote their understanding. (Braye and Preston-Shoot 2003) In the case if the speaker who was not given a diagnosis for a long time and was just put out of the consultant’s office this key areas did not apply.

Another issue that was striking was that of independence, initially my personal view was not of someone with a disability being independent, my personal experience in the past had led me to believe that people with a disability required a lot of help and were dependant on a carer to provide that help, I didn’t view them as being in employment. Some of these values were quite dormant until I began working in the Social Care Field. The Speakers that we had in from Willow bank explained that they all have jobs and aim to be as independent as possible. This highlighted the conflict between my personal and professional values which I need to be aware of. The NISCC code of practice states a Social Worker should promote the independence of Service Users, this is one conflict that I can acknowledge with my personal values, I need to look at the bigger picture an view the service users as individual people with unique traits and interests it is important that they are not labelled due to their disability, It is viewed that it is society which disables physically impaired people, disability is something imposed on top of impairments by the way we are unnecessarily isolated and excluded from full participation in society. (Oliver 1996) My Personal view was that I believe that we should aim to do things for people with disabilities, I have often found myself carrying out tasks for them that I know they are able to perform themselves, when the speaker from sixth sense spoke about how she had been spoon fed and pushed around the playground as a child had gave her a sense of learned helplessness, it made me acknowledge my own actions. Again this is another area where my personal values conflict with the professional values. Respect for persons in an extremely important values, although I believe I was brought up to show respect for others by creating dependency in a way is disrespectful to the individual.

The promotion of independence is important, it is crucial to see those with a disability as individual people. The NISCC code of practice highlights As a social care worker, you must respect the rights of service users while seeking to ensure that their behaviour does not harm themselves or other people. Keeping in line with the NISCC Code of Practice I need to actively challenge my own prejudices in order to ensure that I am promoting anti-oppressive practice.

Being able to understand the value conflicts in practice can prove to be very beneficial. It can help us acknowledge the differences in the power structure, which can oppress the service user. Social Workers aim to empower the Service User, to help them help themselves. It is important that Professional values are always at the forefront to promote anti-oppressive practice. Social Work Practice is underpinned by laws, policies and procedures.

It is important to always be aware of the Service Users perspectives, this will help ensure more effective and efficient practice.

Both our personal and professional values need to be acknowledged for effective and efficient practice. It is of little use if Social Workers have a professional value base which doesn’t inform or influence their practice, Social Work ethics can be understood as Values put into actions. (Banks, 2006)

An individual would be considered to be acting deviantly if they are in violation of significant social norms of a particular society. What causes humans to act certain ways has been a largely disputed topic among researchers for some time now. With respect to numerous studies that have been performed throughout history, no one group or researcher has come up with an accurate reason as to why people behave deviantly. My own curiosity is to discover the influences or reasons behind the deviant behavior of drug using among adolescents. The proliferation of drug using among adolescents signals a larger societal problem that may include, a rejection of societal norms, which is the product of social conditions and relationships that cause anguish, frustration, hopelessness, and general feelings of isolation or alienation. I believe the greatest threat concerning the popularity of drugs is the dramatic increase of their recreational use within the mainstream, the “normalization” of such drugs represents to some a serious set of risk factors that need to be addressed.

Drug using behaviors can be analyzed on the basis of the social process theory which consists of three major classes: social learning theory, social control theory, and social reaction theory. The various social process theories of delinquency examine the interaction between individuals and their environments for clues to the initial causes and reasons for deviant behaviors; in this case drug using and possible addictions. Most youngsters are influenced by the family, the school experience, and their peers; it is the process of socialization occurring within these social institutions that, along with social structure, provides the forces that either protects adolescents/teenagers from or influences them to commit deviant acts.

It is no mystery that teenage drug using is on the rise; one of the most popular drugs is marijuana as a result of its accessibility and affordability. Marijuana is a mixture green and brown flowers, sticks, seeds, and leaves produced from the plant Cannabis. The main chemical in marijuana is called THC. Marijuana can be smoked in the form of a cigarette or pipe. It is also smoked in cigars that have been emptied of tobacco. Marijuana’s ingredients with can be mixed in food or tea. Each year in America, an estimated 20,000 deaths are from the use of illegal drugs. Different drugs have different effects on people. Scientists have studied and learned about THC and how it affects the brain. When marijuana is smoked, THC passes from the lungs to the bloodstream, and carries the chemical to the brain and all other organs in the body. The chemical produces a number of cellular reactions that lead to users experiencing a “high” when smoking marijuana. Illegal drug use causes fatal infections and illnesses in the body and brain damage; the cognitive thinking process is destroyed from the chemicals used in drugs.

The adolescent year’s is often associated with a turmoil of emotions, and feelings and all in all being a confusing, challenging time; teens want and need to feel acceptance in his/her own family and peers which can make them vulnerable to falling into a destructive pattern of deviance or drug use. Some adolescents have resorted to drug use for a variety of reasons which may include peer pressure, family relationships, or sometimes wanting to relieve themselves of stress. While most teens probably see their drug use as a casual way to have fun or “get-away”, there are negative effects that occur as a result. Even if adolescent drug use does not necessarily lead to adult drug abuse, there are still risks and consequences. These negative effects usually include a drop in academic performance or interest, and strained relationships with family or friends. Adolescent drug use can greatly alter behavior, and a new preoccupation with drugs can crowd out activities that were once previously important. Drug use can also change friendships as teens begin to associate more with fellow drug users, who encourage and support one another’s drug use.

There has been a lot of contribution in terms of studies and research that has been done in this field especially with a lot of concern due to the rise of teen drug abuse within the country and the devastating consequences that follow the issue. There are many people who point fingers at the teenagers who engage in taking drugs without actually understanding the reasons why they do so. For one, socialization is vital and takes place within the family first and foremost. From the moment a child is born to the moment they enter into adult hood, they are socialized by their families as to what is right or wrong, what is accepted and what is not; as well as throughout life. There is a relationship between family structure and adolescent drug use. A National Portrait of Family Structure and Adolescent Drug Use by John P. Hoffmann and Robert A. Johnson uses three years of data from the National Household Survey on Drug Abuse. According to this article, family structure is significant when it comes to effects on teenagers. The article looks at the distribution of drug use among adolescents aged 12-17 years by family structure. Additionally the authors identify the risk of drug use, including problem use, is highest among adolescents in father-custody families (father-only and father-stepmother families), even after taking into consideration factors such as, age, race-ethnicity, family income, and residential mobility. Low-income families are presumed to affect adolescent development in a negative manner, especially in areas of academics and child’s motivations; it is difficult for parents to support activities that are beneficial to their children. This suggests that differences in economic resources explain some relationship between family structure and negative outcomes among adolescents. The article compares the prevalence of drug use among adolescents from mother-father families, single-parent families, stepparent families, and other family types. Findings concluded that stepparent families and father-only families tend to be more mobile than other family types; the lowest prevalence of use of marijuana and other illicit drugs is reported by adolescents who live in mother-father families; the highest prevalence of marijuana use, other drug use, and problem use is reported by adolescents in father-stepmother, father-only, and other relative-only families. (640) The author recognizes that, “Family structure, especially when changes occur, affects relations between parents and adolescents. Changes in family structure are linked to heightened stress in the family, and this stress may lead to behavioral problems such as the initiation or escalation of drug use.” (643) Even though this research was useful in explaining how family structure has a relationship with whether or not adolescents choose to experiment with drugs, it does not explain the effects of patterns of parent-child socialization. Additionally, Hoffmann and Johnson concluded that hypotheses involving economic resources or mobility did sufficiently explain the effects of family structure on adolescent drug use.

The Community Context of Family Structure and Adolescent Drug Use seeks to build on the work of Hoffman and Johnson by connecting the impact of family structure on adolescent’s behavior in terms of their environment or the community in which they live. Hoffman’s new hypothesis in this article, suggests that community characteristics affect family structure in particular ways, which then leads to drug use:

Families that live in better-off communities have a host of extra familial resources to draw upon in raising children, so the community is seen as a key characteristic that affects whether adolescents from different types of families behave in deviant or normative ways. Single parents-in particulars single mothers-of-ten do not have the resources to live in well-off communities and are less able than other parents to move to more financially secure areas; thus, their ability to raise children may be hampered. Two-parent families are usually in better financial situations than single-parent families; thus, they are allowed much more flexibility about where to live. (315)

The article also states that single-parent families are constrained in their choice of communities and often must live in resource poor areas as a result of their socio-economic status which ultimately, has an influence on adolescent behavior. The article discusses the relationship between family structure and drug use; communities that are lacking economic and social resources will have an impact on adolescent behavior thus causing drug use. Disadvantaged neighborhoods increases the likelihood of drug use because it increases the number of social stressors to which individuals are exposed. Neighborhood disadvantage increases the likelihood of drug use because it decreases social resources (family contact, decreases positive social support, and increases negative social interactions). For example, communities that consist of many single-mother families often do not promote sufficient parent-child interaction, but community residents may offer alternative adult figures for adolescents from single-parent families by offering social support and supervision. The data used to support this research was taken from the National Educational Longitudinal Study (NELS), a study designed to explore the relationships among families, schools, and educational outcomes. Findings indicated that compared to mother-father families, mother-only families tend to reside in areas that are urban; more integrated, and have a higher proportion of female-headed households, joblessness, and poverty. Other family types are relatively likely to reside in high-poverty communities, whereas mother-father families are more likely to live in low-poverty areas. Father-stepmother families tend to live in relatively low-poverty communities. Compared to mother-father families, mother-only families report lower family income, more residential mobility, less parental supervision of adolescents, higher dropout risk, and are more likely to be found among Black youth than among White youth. The community context model findings indicated that the highest levels of drug use are found not in mother-only families but among adolescents in father-only and father-stepmother families. Reasons for this are adolescents from single-parent families tend to have poorer relations (interactions) with parents and they move more often. Even though this study has shown that community characteristics have adverse effects on drug use, the question that remains unanswered involves the characteristics of single-parent and step parent families that lead to consistent effects on adolescent drug use.

Drug Abuse in the Inner City: Impact on Hard-Drug Users and the Community by Johnson, Bruce D, Bruce Terry Williams, Kojo A. Dei, and Harry Sanabria seeks to explain the effects of drug abuse in the inner city. It proposes that the effects of drug abuse in the inner city has considerably contributed to a decline in the economic well-being of most users and sellers, an environment of poor health and risk of death at an early age, and lastly a weakening of family relationships. It is important to note that youths who grow up in disadvantaged communities are exposed to a range of stressful life conditions, such as their exposure to violence, crime, and drugs. In turn, these factors can increase their likelihood of developing emotional, behavioral, and drug use problems. The article states:

Massive amounts of evidence now document the deterioration of the inner city. During the period 1960-80, the number of persons living in communities (or census tracts) primarily occupied by low-income (including welfare and unemployed) blacks and Hispanics approximately doubled between 1968 and 1980, employment rates declined substantially (from 78 to 55 percent) for nonwhites-mainly blacks. (10)

Even more living situations in inner-city communities have severe social and economic implications for individuals. Involvement with drugs (that is prevalent among poverty-ridden neighborhoods) is a major factor in creating individuals who will experience multiple social problems, with wide-ranging negative impacts on their families and neighborhoods.

Delinquency and Drug Abuse: Implications for Social Services by Hawkins, J. David, Jeffrey M. Jenson, Richard F. Catalano, and Denise M. Lishner demonstrates that there is a connection between adolescent drug abuse and delinquency. The authors discusses numerous risk factors for drug abuse including early frequency and variety of antisocial behaviors in the primary grades of elementary school, parent and sibling drug use and criminal behavior (children whose parents or siblings engage in crime or drug use are themselves at greater risk for these behaviors), poor and inconsistent family management practices (children raised in families with lax supervision, excessively severe or inconsistent disciplinary practices, and little communication and involvement between parents and children), family conflict, family social and economic deprivation, school failure, Low degree of commitment to education and attachment to school, peer factors, attitudes and belief, neighborhood attachment and community disorganization, mobility, and personality factors. (260-266).

Coming back to an earlier question, adolescent drug use can be explained by parent-child interaction. Research suggests that there is a relationship between the role of parental practices and adolescents drug involvement. An article, written by Denise B. Kandel, Parenting Styles, Drug Use, and Children’s Adjustment in Families of Young Adults relates:

Drug use by children and adolescents has been found to be related to lack of affection, lack of acceptance of the child by the parent, conflictual mutual detachment, poor identification of the child with the parent, poor discipline, weak or excessive parental controls, parental control through guilt, lack of supervision of the child’s activities, and inconsistency. (185)

Data was collected from Clinical Samples in order to examine marital patterns as well as parenting and children’s behaviors in families in which one or both parents are drug abusers or alcoholics and have sought treatment for their condition. Findings found that the, “childrearing factors characterizing families with a drug-abusing or alcoholic parent or the families of adolescents in the general population who get involved in drugs are identical to the factors that have been implicated as risk factors for early manifestations of antisocial behavior among children in normal population samples.”(185)These factors included lack of parental supervision, parental rejection, and lack of parental involvement. Three hypotheses were examined by Kandel’s study including: (186)

1. Certain parenting practices-in particular, lack of monitoring, low warmth, and high parental conflict-are associated with lower levels of functioning in the children and, in particular, with greater acting-out and control problems.

2. Young adults with a history of involvement in drugs will be more likely to exhibit deficient parental practices.

3. The children of young adults with a history of drug involvement will be less well adjusted and, in particular, will manifest more control problems, than their peers.

Data was also collected from a group of young adults aged 28-29 who have been followed since they were 15-16 years old. Respondents answered self-administered, structured questionnaires in their schools in 1971 and were re-interviewed in person in 1980 and in 1984. According to this study, the strongest links were between parental discipline and child aggression, and between parental closeness and child attachment to the parent. Parents who report using harsh methods of disciplining their children or disagreeing with their spouses about how to discipline the child are more likely to report that their children are aggressive, have control problems, and are disobedient. Parents who report that they have close interactions and engage in much talk and discussion with them are more likely also to report that their children are well adjusted, establish positive relations with their parents, are not detached from them, do not have control problems, and are independent. There is a correlation between poorer parenting and drug use. Findings also included a relationship between parental drug use and control problems in their children. It is a fact that behavioral problems in childhood and early adolescence are among the earliest signs of adolescent drug involvement as well as delinquency; conduct problems and drug use appear to develop in families characterized by similar childrearing styles as put forth by Kandel. Additionally, male children who engage in both fighting and drug use appear to belong to families with the most disrupted parenting. This shows that certain parenting styles stimulate deviant behaviors in the children, who, when they grow up, reproduce these very same patterns in a spiral of self-perpetuating deviance.

The assumption that the home environment influences the behavior of youths is widely accepted. But while many might agree that family life is an important factor in precluding or promoting drug abuse, they disagree on the way in which it influences behavior. Some have argued that poor parent-child attachments leads to a lack of commitment to conventional activities, and that this is sufficient to produce conditions fostering use as already discussed. But there is a growing body of evidence that suggests that drug use is also socially induced and socially controlled by fellow peers. The school is a child’s first proving ground outside of the home. It gives the child a chance to prove his/her adaptability and capacity to conform to rules enforced by non-parental authority. Peer influences have been found to be among the strongest predictors of drug use during adolescence. It has been argued that peers initiate youth into drugs, provide drugs, model drug-using behaviors, and shape attitudes about drugs. There was a study done to determine how much peer pressure affected adolescent drug use. The most striking finding is the crucial role which peers play in the use of drugs by other adolescents. Involvement with other drug-using adolescents is the most important correlate of adolescent marihuana use. Denise Kandel examines how influential parents are compared to the peer group in, Adolescent Marihuana Use: Role of Parents and Peers. She obtained data from adolescents, their parents, and their best school friends in a sample of secondary school students in New York State. According to her findings, drug use by peers exerts a greater influence than drug use by parents. Friends are more similar in their use of marihuana than in any other activity or attitude. According to this article, the highest rates of marihuana usage are observed among adolescents whose parents and friends are drug users. The article states:

Adolescent marihuana use is strongly related not only to friends perceived marihuana use but to the friend’s self-reported use. Only 7 percent of adolescents who perceive none of their friends to use marijuana use marijuana themselves, in contrast to 92 percent of those who perceive all their friends to be users. When adolescent marihuana use is correlated with the self-reported marihuana use patterns of best school friends the proportion of users ranges from 15 percent when the best friend has never used marihuana to 79 percent when the friend has used it 60 times or more. (1068)

Most importantly, the Kandel highlights that children of non-drug using parents are somewhat less likely to use drugs, whereas children of drug using parents are more likely to use drugs.

Family and peer relations are two of the most important socializing forces affecting adolescent behavior in terms of drug use and deviance in general. Through these relationships, adolescents learn to conform to or deviate from societal standards. Differential association, drift, and social control theories, provide and outlet for understanding aspects of the social environment as a determining factor of individual behavior. Differential association theory focuses on how individuals learn crime from others, drift theory proposes that any assessment of the process of becoming deviant must take into consideration both the internal components of the individual and the influence of the external environment (otherwise known as Neutralization theory), and social control theory provides an explanation for why some young people violate the law while others resist. Theory is important in assessing behavior; Edwin H. Sutherlands and Ronald Akers formulation of differential association theory is useful in explaining how family structures, peer structures and community structures contribute to drug using among adolescent. Differential association theory implies that if individuals learn deviant behaviors from close associations with other people, then the more they are exposed to pro-social groups, the more likely it is that they will be deter from deviant behavior as in using drugs. Jackson, Elton F., Charles R. Tittle, and Mary Jean Burke, Offense-Specific Models of the Differential Association Process discuss Edwin H. Sutherland’s formulation of differential association theory where he proposed that delinquents learn crime from others. His basic premise was that delinquency, like any other form of behavior, is a product of social interaction. In developing his theory of differential association, Sutherland believed that individuals are constantly being changed as they take expectations and various perspectives of the people with whom they interact. It is difficult for one to reject the argument that juveniles learn crime or in my case criminal activities like drug using behaviors from others (primarily the family or peer groups). As already pointed out, individuals learn basic values, norms, and skills from others; accordingly, the idea is that they also learn criminal behavior. However, it is important to note that one does not have to be in direct contact with others to learn from them. They can learn such behaviors from the surrounding environment.

With the accumulated knowledge and research about drug use, it provides a framework for prevention. It appears that abuse is caused by early use of conventional drugs and by family and peer related social conditions that preclude or promote drug use. Interventions should create opportunities for adolescents to experience success in family relationships, school, and peer relationships. They should address the beliefs of parents and peers that may promote the use of illicit substances. In addition, adolescent drug use strategies should focus on strengthening those skills of parents, teachers, and youths that may lead to strong parent child attachments, consistency in discipline, clear antidrug values, and attachment to youths or adults who are committed to fundamental norms of society. To strengthen youth’s social behavioral skills, decision-making and problem-solving training should be undertaken; training should prepare youths to effectively resist peer pressures by teaching that saying “no” to offered drugs that is socially acceptable. From a community perspective, the entire social support network must be addressed such that a climate of non-drug use is created. Family approaches or school programs alone are unlikely to alter the web of influences that socializes youths to the use of drugs. Some proposed preventions for delinquency and drug use from, Delinquency and Drug Abuse: Implications for Social Services include, early childhood education with parent involvement, parent training prevention strategies, and life skills training in schools including cognitive skills training, proactive classroom management, law-related education, problem-solving and behavioral skills training, enhancement of instruction to broaden academic success, social influence strategies, and school-based health clinics. (270-276)

There are a variety of other factors that have not been taken into consideration in this research that may affect relationships and drug use among adolescents. For example, the availability of extended family members and peers who live nearby or with whom the adolescent comes in frequent contact might affect the risk of adolescent drug use. Similarly, the availability of resources such as strong schools may offer youth from single or stepparent family’s alternative activities that discourage drug use or that encourage strong attachment to families and communities. Adolescent drug use is strongly linked to patterns of risk taking or harmful behavior. In today’s mainstream, drugs such as marijuana is recognized as being one of the most popular with today’s generation of adolescence and that is most troubling.