Category: Free Essays

Substance addicted fathers fail to provide a safe environment that focuses on the needs of their children. While inebriated, fathers may believe they are being attentive to their children, while in reality, they tend to act on their own feelings and disregard their children’s needs and become unpredictable. Sometimes a substance addicted father will have periods of presence and periods of absence from his child’s life. At one moment, he may provide his child with security, and another, he may inflict fear. Paternal substance abuse undermines the ability to give adequate care to children and overall, the ability to support his family. Fathers with a drug addiction are judged to be irresponsible and deemed incompetent as parents. The wives of these men are implicitly left with the responsibility to care for their children with some help from child welfare services. Although, fathers exist in the lives of women and children involved with child welfare authorities, they are rarely seen by the child welfare professionals themselves. Substance abusing men tend to avoid social services due to lack of paternal responsibility, cross gender communication, and hyper-masculinity.

In the article “Engaging Fathers in Child Welfare Services: A Narrative Review of Recent Research Evidence”, Social Workers Nina Maxwell, Jonathan Scourfield, Brid Featherstone, Sally Holland, and Richard Tolman found that only thirty-three percent of mothers identified the father when asked (163). Fathers are reluctant in participating in social cases, therefore may threaten the mothers to leave them out of it. Mothers may withhold the father’s identify out of fear about letting the father know that child welfare services are involved, fear that the father may be incarcerated, and fear of the father’s reaction, especially in cases involving domestic violence. These fears reinforce the idea that women are subordinate to men. Since she is fearful of her child’s father to be able to reveal his identity, the mother cannot receive the much needed, proper assistance from her social case worker. Even if the mother were to reveal the identity of her children’s father, it is likely for him to evade contact from child welfare.

Fathers avoid contact with child welfare staff. In a focus group study, Maxwell and her colleagues found that these fathers had a wide range of explanations for the avoidance. These included fear that they cannot be good fathers for their children, fear that the involvement with the child welfare system will worsen their problems with the criminal justice system, fear that relationships with current partners not related to the child would be affected, and a perception that the system is not there to help them (164). The concerns expressed by these fathers are a prime example that substance-abusing fathers are selfish because they are only interested in fulfilling their own desires, rather than meeting their children’s needs. Social policy makers have been trying to involve fathers more in their children’s lives by increasing child support payments, but it is done so in the best interest of the child.

Over the past few years, social policy makers have made an effort to increase the participation of fathers in their children’s lives, by providing child support to the children’s mother. The income of a father, who is not living with his children, can by affected by child support obligations in several ways. For example, if a father recently received an additional income of five hundred dollars a month, his child support payments might increase by one-hundred and twenty-five dollars (Lerman 69). Increased incomes have higher taxes and when combined with increased child support orders, it lowers a fathers’ profit each month, causing them to reduce their work effect. It is found that rigorous enforcement by the child support system could cause fathers to shift from formal to informal or underground work, which makes it more difficult for the government to track true income.

Child welfare professionals acknowledge that some fathers are committed to their children, many others are not. In her study “Child Welfare Professional’s Experiences in Engaging Fathers in Services”, Professor Mahasin F. Saleh found that sixty percent of substances abusing men associated in social services cases lack paternal responsibility (126). The lack of father responsibility includes father absence, denial of paternity, alcohol or drug abuse, blaming the mother, incarceration for various reasons, and maltreatment. One child welfare professional recalls, “They don’t believe. They took the paternity test and then it’s ‘I want a blood test’. And some of them disappear because they feel like they’re not the father. That’s hard, too, getting them engaged when they don’t want to believe” (Saleh 126). This example exemplifies a lack of father responsibility. Substance addicted men deny responsibilities that come with paternal identity, because they view the responsibilities as a burden, and often want nothing to do with it. This father figure is self-absorbed, abusive, and driven by addiction and carelessness.

Child Welfare Professionals have shared that fathers who neglect their children are found to be more verbally abusive and threatening during counseling (Saleh 127). Fathers view social counseling as a vehicle for women to process their emotions and that “strong” men do not attend counseling. Hyper-masculinity causes a man to maintain a rigid gender role script (Guerrero 137). The hyper-masculine man is prepared to challenge any real or imagined taunts from other men with violence. Men have a high sense of pride when it comes to his manhood. In 2013, the National Association of Social Workers conducted a membership workforce study and reported that eighty-two percent of social workers working full time were female (Whitaker & Arrington 9). Since a majority of social workers are female, a father is reluctant to comply and subject to the words of a woman. Masculine fathers do not like to hear something from women, and they may get angry when working with female social workers, because they feel like women are trying to tell them what to do. A hyper-masculine man’s attitudes towards women are usually those of sexual or physical subjugation. A female social worker from Saleh’s case study recalls multiple times that she had to deal with male clients who had expressed romantic interests in her (130). Experiences similar to these make it difficult for female case workers to deal with a situation professionally. There are many instances when the social worker is confronted with a father that has not only has neglected his kids through his ignorance. Most of the time, they never admit they are at fault.

Fathers exist in the lives of women and children involved with child welfare authorities, and yet, they are rarely seen by child welfare. These fathers are seen as deviant, dangerous, irresponsible and irrelevant, and even further, how absence in child welfare is inevitably linked to blaming mothers. In failing to work with fathers, child welfare ignores potential risks and assets for both mothers and children. Social workers are encouraged to focus on mothers as being the protective parent, whereas fathers are considered as risks and damage potential, due to neglect, abuse, and substance addiction. In the article “Manufacturing Ghost Fathers: the Paradox of Father Presence and Absence in Child Welfare”, Leslie Brown, Marilyn Callahan, Susan Strega, Christopher Walmsley, and Lena Dominelli reveals that over sixty percent of fathers associated with child welfare are identified as a risk to children and are not contacted. Similarly, fifty percent of these men were not contacted when they were considered ricks to the mothers (26). Mothers are responsible for the care and protection of children even when they are victims of domestic violence. Child welfare holds mothers responsible for monitoring the behavior of the men in the children’s lives, essentially contracting out the surveillance of men to mothers (Chuang 457). They are expected to fill the role of both parents and further expected to mediate the relationships between children and fathers, as well as between fathers, and professionals.

While inebriated, a father may believe he is performing his fatherly duties to the best of his abilities, but in reality he is oblivious to what is happening in the environment around him, including his children. The appearance of a social worker at his home is detrimental to his mental state as a father. In a way, he may view it as insulting. The father may not realize the dangers that he put his children in as a result of his negligence. The father is too proud to realize his mistakes and may want to blame outside sources. Unfortunately, this results in an agitated and distraught way of thinking, which could result in more negligence and abuse to their families (Burrus et al. 212). Substance abusing fathers often lose custody of their children. With help from social services, mothers are able to collect child support from their children’s fathers. Since a majority of social workers are female, males feel like their manhood is undermined when they speak to these women. These fathers try to avoid any instances of conference with social workers, because they feel it may affect their life that is unassociated through relations with the child. This shows how selfish and incompetent substance-abusing fathers are. Mothers are subordinate to fathers due to fears of reactions of the fathers finding out the involvement of social services (Brodie et al. 36). Many substance abusing fathers are invisible when it comes to their children. The lack of insight to his own problems causes a father to become invisible to himself and his child’s needs. If a man cannot handle his own feelings and problems, there is no chance he will be able to handle and resolve a child’s or be able to see his development. In the state of intoxication, fathers become self-absorbed and forgetful about what happens in the world around them. Substance abusing fathers are associated as being neglecting, abusive, destruction, and often insignificant. Fathers struggle to fulfill the role of the ideal role model to his children.

Mrs. Chan has a family of four including a son and a daughter. She first came for help because of the bad father-son relationship in her family. During the interview, she disclosed the fact that she has been suffered from domestic violent for about one year.

Four interviews were conducted by the worker. The purpose was to help assess the situation and set up an intervention plan to dismiss domestic violent in the family and create a harmony family atmosphere.

Background information

The client, Mrs. Chan, is a housewife and her husband runs a grocery store. They have an 11-year-old son and an 8-year-old daughter. The financial status of the family is adequate.

Problem assessment

Client’s perception of the problems

During the interview sessions, Mrs. Chan explained her views on the problem.

Mrs. Chan worried about the bad father-son relationship in the family. For example, they seldom talk to each other. The son’s school work was getting work and had strange behaviors.

Mrs. Chan told the worker that she was abused by her husband and tolerated it for about one year. She had mentioned if her husband took out a knife, she could not stand it. When this happened, the client worried about she and her two children’s safety.

Work’s perception of the problems

According to Family-Centre Approach (Waldegrave , 2005), the family system would be disturb if there is one problem in the family. It suggest to focus on one problem and to regain the balance step by step. The worker observed that the family have several problems . The family members tolerated them but not tried to solve them, they lacked of focus on the problems.

Domestic violent

Mrs. Chan suffered from domestic violent since last year. Mr. Chan abused Mrs. Chan and even took out a knife to threat. The worker observed that the client and her children’s safety were at risk.

Spousal relationship

The unsolved domestic violent would trigger the other problem in the family (Waldegrave , 2005). The worker found that Mr. Chan was not respectful enough towards Mrs. Chan. He abused his wife and did not consider her physical hurt and trauma. Mrs. Chan tolerated it for a long time and never asked for help. Tolerate is not help for problem solving.

Father-son relationship

The family is the fundamental resource for the nurturing of children and parents should be supported in their efforts to care for their children (Waldegrave , 2005).

The domestic violent affected the father-son relationship. The children witnessed the father beat the mother, this arouse the hatred of them towards the father.

During the interviews, the worker found the client had suffered from domestic violence for a long time. She had many worries and hard to decide the arrangements, for example, financial concern and children’s school issue.

Agreed view of the clients and the worker

The client and the worker agreed that safety is the first concern. We thought that Mrs. Chan and her two children’s were in a dangerous situation. The domestic violent led to other problem in the family, such as the father-son relationship and the son’s behavior problem. Based on Mrs. Chan determination to change, it was hope that the domestic violent could be dismiss and a more harmonious atmosphere would be create in the family.

Priorities of problems

Domestic violent

Spousal relationship

Relationship of father and son

Intervention phase

The Inter-Agency Committee on Collaboration of Services for Families Where Wife Assault Occurs (1990) suggest that unless the batterer acknowledged his violent behavior and finished his own intervention plan, the worker should not bring the couple together for counseling. In this case, the client and her family member were separate for different individual intervention.

Objectives

Short-term:

Ensure safety

To dismiss violence in the family

Improve spousal relationship

Improve father son relationship

Long-term:

Create harmony and supportive atmosphere in the family

Strategies and rationales

Residential Services for Abused Women

Lowenberg and Dolgoff (1996) developed an Ethical Rules Screen which place the protection of safety as the most important principle. So the worker’s first concern was the client’s safety. Refuge centers provide temporary accommodation to females and their children in face of domestic violence or family crisis. The social worker would refer the client for the Harmony House for safety concern. She can have a safe place to stay and think about what to do next.

Domestic violence support group

Many women think that telling others or reporting to the police of the violence is betrayal and disloyal to the husband, she is also breaking the trust and friendship between the two (Towns, Adams and Gavey, 2003). According to the case, Mrs.Chan was reluctant about telling the abusing problem at first and informed that she had never told others before. So it is good for her to communicate with others in the same situation and face the problem not tolerate it. This interaction would benefit her decision making.

Emotional management and interpersonal relationship workshops

Mrs. Chan indicated that Mr. Chan was not good at controling his emotion and got hot temper. These workshops are conflict resolution trainings that help abusing men deal with their emotions in a healthy manner. The workshops emphasize empathy, forgiveness, and understanding. Through the course of the workshops he will be able to control anger .

Counseling with the children

Kolbo(1996) suggest the negative effects of witnessing domestic violence on children’s emotional and behavioral development. The domestic violent behaviors had bad effect on the children. The son worse in study and hate his father. It is necessary counsel the children for further intervention.

Apply family therapy

Use risk assessment to evaluate two of the couple are ready for the family therapy, and the safety monitoring is ongoing. In the condition that the husband was conscious that his violence was irrational and the wife was willing to counsel with the husband. The family-centre approach believe that families who seem hopeless can grow and change (Boone, 2002). All family member is responsible to the harmony of the family.

The purpose of this article is to illustrate the importance of boundary setting during parental conflict. Often children are incorporated both voluntarily and involuntarily in dyadic confrontations that involve the parents. This research shows the long term and short term effects on both the parent and child psychologically and physiologically. Boundary setting is important for the growth, development and current maintenance of a family. Involving children in arguments is not only detrimental to the parents’ marital relationship, but also damaging to the parent-child relationship. This paper illustrates cause and effect consequences of triangulation.

Family Conflict and Triangulation

Familial conflict is inevitable. A multitude of quantitative and qualitative data has been accumulated in order to improve familial relationships. Numerous studies and focus groups spotlighted adolescents and their parents to find more data on triangulation and its negative effects on families. According to Franck and Buehler (2007), a triangulation study was conducted on 506 teens and their mothers. The study focused on conflict properties, cognitive appraisals of threat and blame, emotional insecurity, and triangulation to determine the possibility of a direct relationship between adolescent behavior problems, marital distress, and maternal depression (Franck and Buehler 2007). After thorough research, it was found that marital hostility and distress were associated with adolescent behavioral problems and familial stressors (Franck & Buehler 2007). This paper will focus on parental and child triangulation and its effect on both the adolescent and the adult.

Triangulation can be defined in a multitude of ways. Some may use the term mathematically, while others use it psychologically. Fosco and Grych (2008) broadly described the psychological term for triangulation as the involvement of a third person in a dyadic conflict. Triangulation is not possible with two people; it has to involve at least three people triangulate the conversation and ensure one or more of the parties agrees with his or her opinion. Buehler and Welsh (2009) stated that “triangulation occurs when two people in a family bring a third party to dissolve stress, anxiety or tension that exists between them.” Often feuding parents might involve their children in the conflict to “gang up on” the other parent. A more in-depth definition that better describes the target group focused on in this paper illustrates a family and child triangulation as children’s direct participation in parental disagreements and their subjective sense of feeling caught in the middle (Fosco and Grych, 2008).

Due to ignorance, some parents may be unaware that they are involved in triangulation. Some statements a child might say if he or she is involved in a triangulation situation are “My parents make me feel caught in the middle when they argue” “my mom always asks if I notice how my dad starts the fights” “mom and dad always ask me questions when they are in the middle of an argument” “after an argument with mom, dad always comes to me and explains his point of view” “I hate it when mom and dad involve and ask me questions when they are arguing”. Parents should be more cognizant of accidentally or purposely involving children in marital disputes because it can be detrimental to the child.

Efforts to better understand the impact of interparental disagreements on children have identified a number of factors that may elude to the fact that exposure to continual hostile and poorly resolved conflict can cause adjustment problems. (Fosco and Grych 2008). Behavior issues may become more frequent when boundaries are not set between parental arguments and children. According to Fosco and Grych (2008), appraisals reflect children’s opinions on parental conflict. Parental conflict can be detrimental to the child’s well-being or the functioning of the family unit; therefore, the child may hold himself or herself responsible and believe that the disagreement was caused by his or her conduct. Parents who involve children in marital confrontations fail to realize how detrimental involvement can be to their child. Specifically, appraisals of threat and self-blame, emotional reactivity and distress, and triangulation into parental discrepancies each have been made known to play a key role in the relationship involving parental discord and child maladjustment, thereby making the child feel responsible for ending or resolving the conflict. (Fosco and Grych 2008).

The effects of parental triangulation on the child can cause long term damage. According to Buehler and Welsh (2009) “Parental conflict and tension are proposed to induce emotional arousal in children, triggering emotional and physiological responses. Involving children in arguments can be both mentally and physically exhausting for the child. “Families that show patterns of triangulation have emotional, and physiological, responses that tend to have difficulty differentiating when not to ‘turn off’ than in families with better boundary maintenance” (Buehler and Welsh 2009). Often parents will include the child in arguments forcing the child to choose a side. Franck and Buehler focused on triangulation that occurs when parents bring a child into an argument by using the child as a messenger or buffer between the parents; as a confidante or counselor about issues with the other parent, the child is forced to ally against the other parent during marital disputes. By allowing children to get involved in domestic disputes, not only is the child negatively affected, but the involvement is also detrimental to the marriage.

Triangulation amplifies adolescences’ risk for disruptive behavior because this process impedes with numerous prospective strategies that have been found to shield youths from the potential harmful effects of marital hostility (Franck and Buehler 2007). Research shows that repeated exposure to parental conflict can affect a child’s experience, expression and control of emotion (Fosco and Grych 2008). Children subjected to constant triangulation can experience major emotional tribulations as well. It was found through trauma theories that recurring exposure to affectively disturbing events undermines a child’s ability to regulate his or her emotions (Fosco and Grych 2008). When a child is unable to regulate his or her emotions it becomes difficult for them to maintain control.

With this information, it can be concluded that a child from an argumentative family may display a greater sensitivity to his or her parent’s conflicts (Fosco and Grych 2008). Children who are exposed to tumultuous relationships and constant triangulation by parents are not as thoroughly researched as other topics that have been researched that involve family conflict. Beuhler and Welsh (2009) stated “Triangulation into parents’ disputes has received much less empirical attention than has verbal and physical interparental aggression; however, some evidence exists that triangulation places youth at risk for adjustment problems, particularly internalizing problems such as anxiety, depressive symptoms, and social withdrawal” (2009).

Triangulation does not just occur during an argument between parents with a child present. It also occurs long term when a child is made a confidante. Franck and Buehler (2007) found that when parents get upset they have a tendency to bring children into the argument by making them messengers between the parents.

Triangulation can be caused by a number of different reasons. Martial conflict and depression have been named to be some of the main reasons triangulation occurs. Parents involved in domestic disputes have a tendency to want a witness to validate their argument. Counselors, friends, family members, and children have been known to get pulled in to the dispute. Scholars found data proving that parents that involve people in their domestic disputes may be depressed (Frank and Beuhler 2007). Parents feel validated when loved ones and friends side with them in the domestic dispute. Frank and Beuhler (2007), searched even deeper and found that a mother’s depression is more closely related to internalizing disruptive behaviors in children than fathers. Frank and Beuhler (2007) felt that a father’s depression is more closely related to poor cognitive functioning in his children than internalizing problem behaviors.

Studies show that triangulation affects both the parent and the child’s relationships in a negative way. “One of the mechanisms by which marital conflict becomes a risk factor is the triangulation of the child or adolescent into parental disputes such that youth feel ‘caught in the middle’ and torn between divided loyalties” (Buehler and Welsh 2009). During an argument, parents feel that their point is more validated if the child agrees with them. Unfortunately, the long term affects of adolescent affirmation during parental altercations are detrimental to the marital relationship. “Although their involvement in a parental disagreement may be effective in deflecting attention from problems in the marriage, it may intensify the impact of parental conflict on children’s functioning by making them the target of parental anger or disrupting their relationship with one or both parents” (Fosco and Grych 2008). Studies show that it is pertinent that the children be left out of parental conflict. “It is clear that triangulation of adolescents also is harmful to adolescents in married families. Thus, clinicians and others who work with families need to assist parents with keeping marital problems within the martial dyad. Adolescent children need to be left out or blocked from parents’ marital issues; Parents need to improve their ability to cope with and handle the anxiety associated with martial conflict in ways that do not involve their children” (Buehler and Welsh 2009).

In addition to disrupting marital stability, triangulation can cause long term issues in the growth and development of the family. Fosco and Grych (2008) stated that when children perceive conflict as a threat to themselves or the family, they tend to worry about the stability of the family relationship. Running a family requires order, with no stability, there is no foundation; and with no foundation it tends to be less order. Parents should lead by example when teaching children. Often children mimic their parents and learn from observations. “Parents who frequently resort to triangulation as a means of managing their disputes may be less prone to teaching or modeling adaptive conflict resolution to their children” (Fosco And Grych 2008).

Avoiding the involvement of children can be very difficult for some parents. Not only does triangulation temporarily diffuse marital arguments, but it can also allude to the vindication or validation of a parents actions. Fosco and Grych (2008) found information proving that triangulation could shape the impact of parental discord in children. When the child feels caught in the middle and observes that the attention of the argument is deflected from the parents and reverted to them, they may make a habit of involving themselves and marital disputes. If disruptive behavior is effective at distracting attention from marital problems, children may develop more stable patterns of acting out in stressful circumstances.

Triangulation can occur both consciously and subconsciously. Unfortunately, if in the familial setting boundaries are not in place, detrimental repercussions can occur. Triangulation can occur in many different forms. Whether it includes the parent and child, grandparent and grandchild or siblings and parent, an unconstructive outcome is almost inevitable. The need to want to be right and acquire support is human nature and understandable. However, when you engage children in tumultuous relationships and put them in the middle of altercations, serious repercussions may occur for the child and adult. Rather than involving relatives and friends in conflict, it is important that families seek out counseling to secure the growth and stability of the family structure.

Therapists can utilize a number of different techniques and or approaches to help families partaking in triangulation. Due to the difference of upbringing, social, cultural, and economic levels, it is best that the counselor incorporate an integrative approach to families who are involved in a triangulation conflict. An integrative approach incorporates all of all the approaches. It allows the therapist to utilize the “best fitting” approach for the client to obtain optimal results. Conflict is inevitable and felt to be manifest, but if familial conflict involves triangulation it is sure to end unconstructively.

CHAPTER 1

INTRODUCTION

Family is a small social system made up of individuals related to each other by reason of strong reciprocal affections and loyalties, and compromising a permanent household that persists over years and decades.It is the most significant primary unit of human society. It is the earliest institution of humankind that is mainly depends upon man’s biological and psychological needs. Without family, no other social institution like religion or government can exist. The sustainability of family is vital to the development and progress of the society. The term family has been derived from the Latin word ‘familia’ which means a house hold establishment.It indicates to a number of individuals staying and living together during important phase of their life time and they are bound to each other by biological, social and psychological relationship. It may be the joint family or an individual family in the modern society.

Famous sociologist M.F Nimkoff defines family ‘as a joint effort of husband and wife either with child or without child’. The existence of family is very significant. Family plays a major role in the society. Family generates human capital resources and also it has the power to influence single individual, each household and the behaviour of the community (Sriram, 1993).Hence family is being studied as the most basic unit in the different branches of social science. Human developments, Psychology, anthropology, economics, social psychiatry, social work are examples. Family is a major resource for the various needs of human beings. It is the family plays a major role in the nourishment of children and meeting their most basic needs such as emotional bonding, health, development and protection.There is enormous potential lies within the family and it proves it during the trouble times by providing stability and support.The growth of an individual and the society mostly depends upon this basic unit of the society. (Desai, 1995a). Culture to culture and society to society, families and family dynamics varies and they cannot be interpreted without the context of cultural factors. Culture determines the roles of family members and it explains families’ ways of defining problem and solving them.

The family in India is known as an ideal homogenous unit with strong coping mechanisms. In a large culturally diverse country like India have plurality of forms in the families that varies with class, ethnicity and individual choices. Collectivism is an important dimension of Indian culture that affects the family functioning. In other words, the basic aspects of human life such as economic, philosophic are given the outlook of interdependence amongst persons. Family cohesion, cooperation, solidarity, and conformity are the major values of collectivistic society like India. Indian joint families are considered Strength, stability, closeness, resilience, and endurance are encouraged in the Indian joint families where family loyalty, family integrity is given priority than individual choices. These unique dimensions of Indian families help the families to overcome difficult situations that they face over the course of time. When an individual in the family is struck with a disease or any other troubles, the entire community helps that individual to face that situation.

What is Family support?

Family support can be defined as the benefits a person receives from the family and friends such as physical emotional and material benefits. Positive social support helps one to improve in the ability to make healthier choices in life. Family or social support would also means being able to access people that a person can rely upon if needed. In an individual’s life, family support is essential at all times. Good support from the family enhances the individual to excel in his or her field of interest. On the contrary, poor support results in poor performance. A person hailing from a lower socio economic strata s considered to be

Mental Health and family support

Health is the most important aspect of human life. According to WHO Health is a state of absolute physical, mental and social well-being and not only the absence of disease(World health Organisation,2001) Mental health is another area where family support is an inevitable factor. In a situation where resources for mental health are scarcely available families form a valuable support system. Mental health is defined as state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to contribute to her or his community ( World Health Organisation, WHO includes social support as one of the key determinants of health. Mental illness is medical condition that affects an individual’s thinking, emotions, ability to relate with others and daily functioning. Just as any other physical conditions, mental illness are medical conditions which results in poor capacity for coping with the demands of life.

Mental illness is considered the most pathetic condition of a human life. Indian traditions considered a mentally ill person as an outcast since he or she was labelled as cursed by gods. The presence of mentally ill in a family brings huge implications. There will be only a handful in the family who will be willing to take care of the patient namely the mother or wife. When one person is ill in the family, the entire course of the family gets changed. Because society would label the family as cursed and this would bring a wide range of problems especially if the family hails from a lower social and economic strata.

On the contrary, Indian families are the key resources for the mentally ill. There are mainly two reasons for this position. First, it is mainly because of the traditional practice of collectivism and concern for the relatives in adversities. As a result, most Indian families do not hesitate to be significantly involved in all aspects of care for their relatives. The tradition of involvement of family in the care of mentally ill has always existed. Secondly, since there is a long gap between the need and thus the clinicians mostly depend on the family. Thus having adequate family support becomes the need of the patient, clinician and health administrators.

INVOLVEMENT OF FAMILY IN THE MENTAL HEALTH SERVICES IN INDIA

In the pre independence era, mental health care services in India were not organised. Usually persons with mental illness were taken care by family members or religious institutions. In other cases they roamed free.’ Mental asylums’ were introduced by Britishers where unwanted dangerous mentally ill were kept behind shut doors. Though it was initially for their soldiers, later Indian population also received the services. T was in Bombay in 1745 the first mental asylum was established. The second in Calcutta in 1781, the third in Madras in 1794 and the fourth in Monghyr, Bihar in 1795. Globally there were changes taking place in the mental health scenario, which involved ‘moral treatment’ and comprehensive community mental health approach. However, not all these changes in Europe and America made any impact on the Indian scene. Approach of the Government until 1946 was to establish custodial and no therapeutic centres.

In 1957, there was a shift in the mental health field when Dr.VidyaSagar the then superintendent of Amritsar Mental Hospital, took initiative to involve the close relatives of the mentally ill in the treatment. The family stayed in the hospital campus along with the patients in open tents. This in fact aided the speedy recovery of the patients in comparison with those patients who did not stay with the families. Christian Medical College,Vellore established family wards in the psychiatric setting which followed many advantages such as accelerated rate of recovery, low relapse rates.

Many family members started helping the community by identifying the psychiatric patients and providing the guidance. The close relatives of the patients were asked to stay with the patients in the open wards .at NIMHANS.Using family as a major resource in the process of recovery of mentally ill has the advantage of relieving the professionals.Community care has been a paradigm shift for psychiatric treatment worldwide.

Recovery in mental health

Recovery in mental health cannot be easily defined. This significant aspect depends upon many factors. A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential (Samhsa, August 2011). Recovery from mental illness is a long term process. It involves the experience of healing and transformation and by which the person learns to live a purpose oriented life in the society. He or she would learn to make use of his or her potential in the very journey of healing.

Bipolar disorder is a recurrent and long-term mental illness that can seriously affect the lives of patients and their families. Bipolar disorder is a common psychiatric disorder that includes periods of extremely elevated mood and periods of depression and periods of full or partial recovery. The cycles of high and low mood states and well periods may follow an irregular pattern. The treatment of Bipolar disorder cannot be limited to pharmacotherapy alone. Psychotherapy, psycho education, peer group support also play major role in the process of recovery.

Bipolar affective disorder

Bipolar disorder is a chronic, severe illness that can impose significant impairment on multiple aspects of a patient’s life including interpersonal relationships, occupational functioning and financial stability (APA, 2002). Globally it has been ranked the ninth highest cause of years of life lost due to death or disability and the 12^th most prevalent cause of disability among individuals aged between 15 and 44 years (World Health Organization, 2004).The distress and impairment caused by bipolar disorder is a wide spread and important issue. Globally the lifetime prevalence of all forms of the illness, often referred to as bipolar spectrum disorders, has been estimated to be 5% in the general population. Ganguli (2000) reported that the national rate of affective disorder in India as 34 per 1000 population.

This disorder significantly affects the functional capacity of the person. Apart from regular medication, support from the near and dear makes a large difference in the recovery process. The practice guideline of The American Psychiatric Association (APA) for Bipolar Disorder treatment suggests the use of certain psychotherapies which includes family therapy as well(American Psychiatric Association,2002) So there are high chances that by the sincere involvement in the care of these patients they may improve in their psychosocial functioning and also to cope with their own struggles due to the illness.

Conclusion

Unlike the institutionalized care, in the community based care for the persons with mental illness, the role of family is very important. The bio medical, socio economic, psycho- spiritual and every integral dimension of the society is necessary in the recovery process. Family being the smallest unit of the society therefore is of much importance in rebuilding the life of the persons with mentally ill. Family is pivotal to catering to the persons with mental illness as they function as the primary care givers. In short, The involvement of family is the need of the hour.

Abuse, whether it be physical, emotional, or sexual, can infiltrate a family setting and alter the dynamics greatly. Within a family there are different relationships and bonds, and each one of those relationships may have a different motive and form of abuse within it. A type of abuse within a family that does not receive much attention from society is abuse by siblings. In general, abuse within a family is thought of as a parent abusing a child and asserting their authority in such a way, but the matter of abuse by a sibling is also very important to understand and there are many implications of such abuse. This research paper will address the importance of sibling relationships to further understand the implications that come about from abuse within them, what healthy sibling relationships should look like, the commonality of different relationships of siblings having incest, types of family configurations where sibling abuse is present, and the treatments of siblings that abuse and are victims of abuse. Four articles will be used to understand the issue, “Sibling Family Practices: Guidelines for Healthy Boundaries” (2009) , “Sibling Incest: Reports from Forty-One Survivors” (2006), “Making Sense of Abuse: Case Studies in Sibling Incest” (2006), and “Treating Sibling Abuse Families” (2005).

Abuse is a very powerful word that comes with many connotations. The actual definition of abuse has problems with it because it is not universally accepted and the perceptions of abuse from individual to individual vary greatly. Everyone has their own personal opinion on what abuse consists of and in general it is typically thought of as causing harm to another person. Abuse is an issue that has many intersecting factors and many layers that are rooted deep in relationships. One type of abuse that is of great importance, as are the others, is sibling abuse. Sibling abuse is abuse that is perpetrated by one sibling to another and may be physical abuse or sexual abuse, known as incest. The importance of this type of abuse is that it is not given much attention in society and it is difficult to comprehend. Society does not recognize sibling abuse as easily as it will recognize abuse between intimate partners or even abuse between parents and their children. Due to the lack of awareness it is very important to understand what a healthy sibling relationship is, cases of sibling abuse, and treatments of the siblings. By looking at four articles, a view of the issue will come into focus and some light will be shed on the issue of sibling abuse.

In Johnson, Huang, and Simpson’s research, “Sibling Family Practices: Guidelines for Healthy Boundaries,” (2009) surveys help conclude what is socially acceptable and what is not within a family. The survey was taken of five hundred people and their opinions generally corresponded. The research showed that when it came to hygiene, bathing together is acceptable for children younger than five if they are of the same gender. If the children are of different genders, the research shows that it is acceptable for children younger than four to bathe together. Showering is a similar issue, being acceptable for same gendered siblings that are younger than six and acceptable for different gendered siblings younger than four and a half years. The data also reflects adults’ opinions regarding affection, with the statistics on kissing being “37% saying siblings should never kiss on the mouth and 23% of people saying they should kiss at all ages.” (Johnson, Huang, Simpson, 2009). Hugging is widely accepted between siblings. Caffaro and Caffaro address healthy sibling development in “Treating Sibling Abuse Families” (2005). Caffaro and Caffaro lend a look at the development of sibling relationships, explaining that “sibling ties begin in childhood with parents writing the script.” (Caffaro & Caffaro, 2005). It is common for parents to assign roles for their children without actively meaning to do so. Siblings are often raised being in a natural competition with their sibling and trying to live up to the label that has been placed upon them by their parents. An example would be labeling a child as “the smart one” and their sibling as “the polite one”. These two children would compete against each other to keep their title from the other and would also strive to maintain their title, forming it into their self-identity.

Carlson, Maciol, and Schneider conducted research in “Sibling Incest: Reports from Forty-One Survivors” (2006) in order to get a concise picture of sibling sexual abuse. The research was conducted using thirty-four women and seven men and the majority of the forty-one participants were of white. The study conclusions found that three of the males initiated sexual behavior with their sisters and the other men were victims of sibling incest that was brought on by brothers of theirs. Four women of the study were victims of sibling incest because of their sisters and the other thirty women were sexually abused by brothers. The research from this article clearly shows that males are the most common perpetrators of sibling incest and women are more likely to be the victims, but men are also sometimes the victims of sibling abuse brought on by brothers. Corresponding with this data, Caffaro and Caffaro found that sixty-three percent of the women in their study were victims of incest due to their brothers’ sexual assault. In contrast to the prior study, “Treating Sibling Abuse Families” (2009) found that the second most common form of sibling incest is from one brother to another, the next most common being sisters sexually abusing their brothers, and the least common form being sisters sexually abusing their sisters. (Caffaro & Caffaro, 2005).

As discussed earlier, it is difficult for society to see all of these cases as abuse and incest because of the difficulties there are in defining abuse and there are also different views between families of what is acceptable and normal. In “Making Sense of Abuse: Case Studies in Sibling Incest” (2006), Bass, Taylor, Knudson-Martin, and Huenergardt discuss the possibility of abuse being seen as normal within a family. The research done in the article is case studies that follow two Latin American families where sibling incest was present. One of the families viewed abuse as normal and used secrecy as a way to maintain the abuse. Also, the family did not see outside systems as positive and held the opinion that the systems were invading their personal lives. The second family in the research differed from the first in the way that they viewed abuse as a mistake and unacceptable and they used secrecy to protect rather than perpetuate abuse. The second family also differed in seeing outside systems and legitimate and, although the systems caused some hardships, they saw them as appropriate and not intrusive as the first had. (Bass, Taylor, Knudson-Martin, Huenergardt, 2006).

Treatment for sibling abuse may begin with what is referred to as a Sibling Abuse Interview, or SAI for short. (Caffaro & Caffaro, 2005). The SAI functions by asking questions of all family members about the relationships that are currently between the siblings and also the history of those relationships. The SAI asks questions that deal with abuse and trauma and also points out areas of family resilience. Treatment is usually similar to treatment of other forms of abuse, but the therapy is slightly modified. There are two different perspectives when it comes to sexual abuse of children and they are the Child Protection Movement and the Feminist Movement. The Child Protection Movement holds the philosophy that the child victim is the most important at that time and that the entire family is responsible for protecting that child and providing them safety. The ultimate goal of the Child Protective Movement is to reunite the family with a healthier way of living. The Feminist Movement favors advocacy over all others. This perspective feels that it is necessary and most beneficial for the victim to have an advocate on their side that is determined to establish protection for that child in the present and the future as well. The Feminist Movement supports family reconciliation, but it does not hold it as a top priority. (Crosson-Tower, 2010). These two theories produce different forms of treatment and have different strategies for treating the victims of incest. Both hold the victim’s protection above all else but they differ in terms of what is best for the child, whether it be healthy family practices or advocacy for the victim.

The four studies discussed help to give a broad understanding of sibling incest, from the healthy sibling relationships that are used as basis, what sibling incest can be interpreted as in terms of common types, family influences on sibling incest regarding their mindsets, to the treatment and outcomes of sibling incest. The studies were largely consistent and all painted pictures that corresponded with one another. There were some minor discrepancies in findings, such as the commonality of different forms of sibling incest, but in general the larger messages were all the same. The implications of the research presented is a better awareness of sibling incest and the ability to recognize red flags when they are present. Sibling incest is more prominent than society likes to think and without understanding sibling incest, it is difficult to prevent it from happening. With understanding, family structures that allow for incest can be recognized and sibling incest can hopefully be diminished.

Abuse, whether it be physical, emotional, or sexual, can infiltrate a family setting and alter the dynamics greatly. Within a family there are different relationships and bonds, and each one of those relationships may have a different motive and form of abuse within it. A type of abuse within a family that does not receive much attention from society is abuse by siblings. In general, abuse within a family is thought of as a parent abusing a child and asserting their authority in such a way, but the matter of abuse by a sibling is also very important to understand and there are many implications of such abuse. This research paper will address the importance of sibling relationships to further understand the implications that come about from abuse within them, what healthy sibling relationships should look like, the commonality of different relationships of siblings having incest, types of family configurations where sibling abuse is present, and the treatments of siblings that abuse and are victims of abuse. Four articles will be used to understand the issue, “Sibling Family Practices: Guidelines for Healthy Boundaries” (2009) , “Sibling Incest: Reports from Forty-One Survivors” (2006), “Making Sense of Abuse: Case Studies in Sibling Incest” (2006), and “Treating Sibling Abuse Families” (2005).

Abuse is a very powerful word that comes with many connotations. The actual definition of abuse has problems with it because it is not universally accepted and the perceptions of abuse from individual to individual vary greatly. Everyone has their own personal opinion on what abuse consists of and in general it is typically thought of as causing harm to another person. Abuse is an issue that has many intersecting factors and many layers that are rooted deep in relationships. One type of abuse that is of great importance, as are the others, is sibling abuse. Sibling abuse is abuse that is perpetrated by one sibling to another and may be physical abuse or sexual abuse, known as incest. The importance of this type of abuse is that it is not given much attention in society and it is difficult to comprehend. Society does not recognize sibling abuse as easily as it will recognize abuse between intimate partners or even abuse between parents and their children. Due to the lack of awareness it is very important to understand what a healthy sibling relationship is, cases of sibling abuse, and treatments of the siblings. By looking at four articles, a view of the issue will come into focus and some light will be shed on the issue of sibling abuse.

In Johnson, Huang, and Simpson’s research, “Sibling Family Practices: Guidelines for Healthy Boundaries,” (2009) surveys help conclude what is socially acceptable and what is not within a family. The survey was taken of five hundred people and their opinions generally corresponded. The research showed that when it came to hygiene, bathing together is acceptable for children younger than five if they are of the same gender. If the children are of different genders, the research shows that it is acceptable for children younger than four to bathe together. Showering is a similar issue, being acceptable for same gendered siblings that are younger than six and acceptable for different gendered siblings younger than four and a half years. The data also reflects adults’ opinions regarding affection, with the statistics on kissing being “37% saying siblings should never kiss on the mouth and 23% of people saying they should kiss at all ages.” (Johnson, Huang, Simpson, 2009). Hugging is widely accepted between siblings. Caffaro and Caffaro address healthy sibling development in “Treating Sibling Abuse Families” (2005). Caffaro and Caffaro lend a look at the development of sibling relationships, explaining that “sibling ties begin in childhood with parents writing the script.” (Caffaro & Caffaro, 2005). It is common for parents to assign roles for their children without actively meaning to do so. Siblings are often raised being in a natural competition with their sibling and trying to live up to the label that has been placed upon them by their parents. An example would be labeling a child as “the smart one” and their sibling as “the polite one”. These two children would compete against each other to keep their title from the other and would also strive to maintain their title, forming it into their self-identity.

Carlson, Maciol, and Schneider conducted research in “Sibling Incest: Reports from Forty-One Survivors” (2006) in order to get a concise picture of sibling sexual abuse. The research was conducted using thirty-four women and seven men and the majority of the forty-one participants were of white. The study conclusions found that three of the males initiated sexual behavior with their sisters and the other men were victims of sibling incest that was brought on by brothers of theirs. Four women of the study were victims of sibling incest because of their sisters and the other thirty women were sexually abused by brothers. The research from this article clearly shows that males are the most common perpetrators of sibling incest and women are more likely to be the victims, but men are also sometimes the victims of sibling abuse brought on by brothers. Corresponding with this data, Caffaro and Caffaro found that sixty-three percent of the women in their study were victims of incest due to their brothers’ sexual assault. In contrast to the prior study, “Treating Sibling Abuse Families” (2009) found that the second most common form of sibling incest is from one brother to another, the next most common being sisters sexually abusing their brothers, and the least common form being sisters sexually abusing their sisters. (Caffaro & Caffaro, 2005).

As discussed earlier, it is difficult for society to see all of these cases as abuse and incest because of the difficulties there are in defining abuse and there are also different views between families of what is acceptable and normal. In “Making Sense of Abuse: Case Studies in Sibling Incest” (2006), Bass, Taylor, Knudson-Martin, and Huenergardt discuss the possibility of abuse being seen as normal within a family. The research done in the article is case studies that follow two Latin American families where sibling incest was present. One of the families viewed abuse as normal and used secrecy as a way to maintain the abuse. Also, the family did not see outside systems as positive and held the opinion that the systems were invading their personal lives. The second family in the research differed from the first in the way that they viewed abuse as a mistake and unacceptable and they used secrecy to protect rather than perpetuate abuse. The second family also differed in seeing outside systems and legitimate and, although the systems caused some hardships, they saw them as appropriate and not intrusive as the first had. (Bass, Taylor, Knudson-Martin, Huenergardt, 2006).

Treatment for sibling abuse may begin with what is referred to as a Sibling Abuse Interview, or SAI for short. (Caffaro & Caffaro, 2005). The SAI functions by asking questions of all family members about the relationships that are currently between the siblings and also the history of those relationships. The SAI asks questions that deal with abuse and trauma and also points out areas of family resilience. Treatment is usually similar to treatment of other forms of abuse, but the therapy is slightly modified. There are two different perspectives when it comes to sexual abuse of children and they are the Child Protection Movement and the Feminist Movement. The Child Protection Movement holds the philosophy that the child victim is the most important at that time and that the entire family is responsible for protecting that child and providing them safety. The ultimate goal of the Child Protective Movement is to reunite the family with a healthier way of living. The Feminist Movement favors advocacy over all others. This perspective feels that it is necessary and most beneficial for the victim to have an advocate on their side that is determined to establish protection for that child in the present and the future as well. The Feminist Movement supports family reconciliation, but it does not hold it as a top priority. (Crosson-Tower, 2010). These two theories produce different forms of treatment and have different strategies for treating the victims of incest. Both hold the victim’s protection above all else but they differ in terms of what is best for the child, whether it be healthy family practices or advocacy for the victim.

The four studies discussed help to give a broad understanding of sibling incest, from the healthy sibling relationships that are used as basis, what sibling incest can be interpreted as in terms of common types, family influences on sibling incest regarding their mindsets, to the treatment and outcomes of sibling incest. The studies were largely consistent and all painted pictures that corresponded with one another. There were some minor discrepancies in findings, such as the commonality of different forms of sibling incest, but in general the larger messages were all the same. The implications of the research presented is a better awareness of sibling incest and the ability to recognize red flags when they are present. Sibling incest is more prominent than society likes to think and without understanding sibling incest, it is difficult to prevent it from happening. With understanding, family structures that allow for incest can be recognized and sibling incest can hopefully be diminished.

What factors leads male young people aged 11 – 18 years old into taking illicit drugs in the UK?

Abstract

Statistical data has shown that an increasing number of young people aged between 11 and 18 are using illicit drugs either experimentally or habitually. This study examines a small sample of males aged between 11 and 18, and through unstructured interviews ascertains the reasons for their drug use. The study aims to identify ways in which prevention could be better facilitated for this particular age group.

Introduction

In men and women the misuse of illicit drugs has increased dramatically over the last 50 years (Zerbe, 1999). Research has shown that the particular age when young people begin using alcohol, tobacco, and other illicit drugs is a predictor of later alcohol and drug problems. For example, 40% of young people who begin drinking at age 14 or younger develop alcohol dependence, compared with 10% of youth who start drinking at age 20 or older. (Ericson, 2001. In Laursen and Brasler, 2002: 181). It has been long-established that users of one drug are more likely to use other drugs than non-users (Gove and Geerken,1979) and that the use of correlates with the onset of psychiatric symptoms. Contemporary research suggests that amongst girls, tobacco use is often a strong indication that other drugs will be used in the future, and in males, alcohol use has been described as a ‘gateway to other drugs.’ (In Laursen and Brasler, 2002: 181). Reasons for young people experimenting or regularly using drugs are varied, and include pressure from peers, stress and emotional factors, a desire to break convention, and the process of individualisation. Research into the consequences of divorce on young people has shown that negative consequences are most common shortly after a parental divorce (Frost and Pakiz, 1990). While research by Laursen and Brasler recorded the following responses as to why drugs were used:

“to numb the pain of abuse and neglect,”
“to be accepted,”
“peer pressure,”
“to take control of my own life,”
“for relaxation and pleasure”
“to chill”
“to improve my self-image”
“because I’m curious, stressed, or bored”
“to assert myself.” (Laursen and Brasler, 2002: 181)

Social work practice is reliant upon research in order to find the most effective ways to deal with social problems (Chavkin, 1993). The National Institute of Mental Health ( 1991) proposed that social work research is invaluable because it ‘describes the work domain of social work as touching on a multitude of human problems that inflict pain and suffering on millions of individuals and families.’ (Chavkin, 1993: 3).

As children develop into adolescence, they experience a series of dramatic changes, both physical, psychological , and psycho-social. Independence and identity are sought – often through the need to belong to a group or more general movement. Substance use increases in adolescence (Johnston, O’Malley, & Bachman, 1998. In Laursen and Brasler, 2002: 181) as ‘smoking, drinking, and other drugs become a way to appear mature while fitting in with peers.’ (Laursen and Brasler, 2002: 181).

Methodology

A qualitative research method was decided to be most appropriate. Darlington and Scott (2002) highlighted the three most prominent research methods as being:

In-depth interviewing of individuals and small groups
Systematic observation of behaviour
Analysis of documentary data (Darlington and Scott, 2002: 2)

In-depth interviewing of individuals was chosen for this project, and it was proposed to interview five individuals between the ages of 11 and 18 within the young people’s service, using a random sampling method. As suggested by Darlington and Scott (2002: 3):

‘Research methods such as in-depth interviewing and participant observation are particularly well suited to exploring questions in the human services which relate to the meaning of experiences and to deciphering the complexity of human behaviour.’

This approach also offers far more potential for establishing a greater rapport with the individual, where a more trustworthy and detailed account of personal experiences might be achieved – as opposed to observation techniques which might only offer relatively superficial or ambiguous evidence of inner thoughts and feelings. The interviews were taped; this ensured that the information was accessible, and facilitated more accurate and reliable research. For ethical reasons it was necessary to obtain the consent of the individuals being interviewed. It was made clear to participants that their information might be reproduced and possibly published as part of the study. It was necessary to obtain their consent prior to conducting the interview in case they objected to any later use of the information. In cases of younger respondents the permission of their older siblings or parents was asked prior to the interview. As the sample was chosen randomly the researcher did not have any influencer over the identity of the interviewees. Ten males were selected, of the ages: eleven, fifteen, sixteen, seventeen, and eighteen. All respondents were interviewed in their homes by trained interviewers. Data was collected primarily through interview, and also through self-reports which aimed to establish the presence of any emotional instabilities.

The present study made use of the interview format undertaken by researchers in the study by Vandervalk et al (2005) into the relationship between family problems and the behaviour of adolescents. In the 2005 study researchers used a shortened version of the General Health Questionnaire, which measured the extent to which psychological stress and depression had recently been experienced. On a 4-point scale, the respondents indicated the severity of their symptoms (e.g., feeling tense and nervous, feeling unhappy and dejected) during the past 4 weeks (1: much more than usual to 4: not at all). This was replicated for the current study. Youngsters indicated on a 4-point scale whether they had considered committing suicide during the last 12 months (1: never to 4: very often) (Diekstra et al., 1991).

To distinguish between internal and external factors the 2005 model study used an

‘Adolescent Externalizing Behavior’ approach that measured the following:

Risky habits, measuring the degree to which adolescents were involved in risky or unhealthy behavior. Self-report data on the use of cigarettes, alcohol, and soft drugs were used. On 8-point scales, youngsters indicated if and to what extent they smoked, drank alcohol, or used soft drugs
Delinquent behavior was assessed as the number of delinquent acts the respondents reported over the past 12 months. The delinquency measure consists of 21 items pertaining to 3 types of delinquent behavior: violent crime (e.g., “Have you ever wounded anyone with a knife or other weapon”?), vandalism (e.g., “Have you ever covered walls, buses, or entryways with graffiti?”), and crime against property (e.g., “Have you ever bought something which you knew was stolen?”).
Educational attainment of adolescents and young adults was assessed by asking youngsters about their current level of education or about the highest level of education achieved, in case they no longer participated in the educational system.

(Taken from Vandervalk et al (2005: 533)

Results

As the interviews were unstructured it was not possible to identify all of these factors for each individual. However, each interview did touch on these areas, and it was left to the individual concerned as to whether they wished to discuss these factors as potential reasons for their use of substances. A list of factors can be found in Appendix One.

5 out of 10 respondents said that a lack of money in their family had, on one or more occasions, led them to become involved in anti social behaviour. All of these respondents affirmed a positive link between anti social behaviour and drug taking. One male, aged fifteen, said that he would take drugs in a group, but never alone, in order to gain enough confidence to ‘cause trouble’ in their local area.
9 out of 10 respondents believed that their age group was not catered for enough in the local area and that they took drugs for ‘something to do’ rather than being forced into it by emotional or stress factors.
However, one respondent, aged eighteen, said that he used cocaine regularly because it ‘made his stress go away.’ When asked about the nature of the stress involved he said that he felt under pressure to achieve at school. He expressed concern that if he didn’t achieve then his family would continue to struggle financially. An added stress in this case was that the withdrawals he experienced from his use of the drug were negatively affecting his relationship with his family, and reducing his ability to complete his school work.
When asked about the amount and regularity of drug use, more than half of respondents said that they used drugs more than occasionally. 3 of those said they used regularly ‘for something to do.’ And another said that they used ‘whenever they were bored.’
Major positive correlations were found between the respondents’ self-reports, where negative thoughts and stress prevailed, and the number of occasions that they confessed to using drugs. Although this link appears to be a significant one, it is possible that some interviewees did not give a completely accurate account of their use patterns, possibly in fear of being ‘found out’ by parents.
More than two respondents said that they were attracted to drug taking because of its associations with criminality

Results were consistent with the premises of the Social construction approach to defining and explaining the use of drugs in young people. Past research has defined drug use by minority youth as ‘a dysfunctional effort to escape problems stemming from poverty and racism or as an alternative means of making money in the face of underclass isolation from legitimate economic opportunities’ (Merton, 1957; Cloward and Ohlin, 1960; Finestone, 1957; Williams, 1990; Harrell and Peterson, 1992; Currie, 1993. In Covington, 1997: ) However, Covington criticises the social construction of drug problems amongst young people as too easily explaining away reasons for use through emphasis on individual differences – as opposed to collective conditions. She suggests that trends in minority and majority drug use should receive separate treatment.

Conclusion and Recommendations

Future prevention through social work practice needs to focus on the areas of inclusion. A high percentage of respondents said that they used drugs recreationally, and that this had contributed to their developing addiction. That there exists positive associations with criminality reflects the need for social work policy to adapt to find more ways of addressing the needs of young people in particular areas. The findings of the Hidden Harm report commissioned by the government found that children of drug users are one of the most vulnerable groups within society, and as part of the Government response to the report it was suggested that ‘the voices of the children of problem drug users should be heard and listened to.’ (Department for Education and Skills, 2005:4). Research into this minority and publication of results could potentially help social work policy to deter young users from taking drugs, and might also deter young users from bringing up children around drugs. Future research might include a more socially diverse sample, including a greater variety in terms of race and background. Externalising factors might also include social trends and political changes, as these greatly affect the nature and accessibility of service provision within a local area.

Bibliography

Boynton, P. (2005) The Research Companion. Psychology Press

Brendtro, L., Brokenleg, M., & Van Bockern, S. (2002). Reclaiming youth at risk: Our hope for the future. (2nd ed.) Bloomington, IN: National Educational Service.

Bryman, A. (1993), Approaches to Social Enquiry. London: Routledge

Chavkin, N.F, (1993), The Use of Research in Social Work Practice: A Case Example from School Social Work. Westport, CT: Praeger Publishers

Corby B 2006 Applying Research in Social Work Practice Buckingham Open University Press

Covington, J., ‘The Social Construction of the Minority Drug Problem.’ Social Justice, Vol. 24, (1997), pp.

Darlington, Y, and Scott, D, (2002), Research in Practice: Stories from the Field. Crows Nest, N.S.W: Allen & Unwin.

Department of Education and Skills, (2005), ‘Government Response to Hidden Harm: the Report of an Inquiry by the Advisory Council on the Misuse of Drugs’ [online]. Available from: http://www.everychildmatters.gov.uk/_files/73D1398FE270B13D89AF63EF1A8B341D.pdf [Accessed 2/08/08]

Ericson, N. (2001). Substance abuse: The nation’s number one health problem. Washington, DC: U.S. Department of Justice, Office of Juvenile Justice and Delinquency Prevention.

Frost, A. K., and Pakiz, B. (1990). The effects of marital disruption on adolescents: Time as a dynamic. Am. J. Orthopsychiatr. 60: 544-555.

Goldberg, D. P. (1978). Manual of the General Health Questionnaire. General Practice Research Unit, Horsham

Gove, W.R, and Geerken, M., (1979), ‘Drug Use and Mental Health among a Representative National Sample of Young Adults. Social Forces, Vol. 58, No. 2, pp. 572-590

Laursen, E.K, and Brasler, P, (2002), ‘Harm Reduction a Viable Choice for Kids Enchanted with Drugs?.’ Reclaiming Children and Youth. Volume 11. Issue 3. P. 181+.

Marlatt, G.A. (1998). Basic principles and strategies of harm reduction. In G.A. Marlatt (Ed.), Harm reduction: Pragmatic strategies for managing high-risk behaviors (pp. 49-66). New York: Guilford Press.

Silverman, D, (2004), Doing Qualitative Research. London: Sage

Strauss, A & Corbin J. (1998), Basics of Qualitative Research. London: Sage.

Vandervalk, I; Spruijt, I; De Goede, M; Mass, C, and Meeus, W, ‘Family Structure and Problem Behavior of Adolescents and Young Adults: A Growth-Curve Study.’ Journal of Youth and Adolescence. Vol 34. Issue 6. (2005). P. 533+

Zerbe, K.J, (1999), Women’s Mental Health in Primary Care. Philadelphia, PA: W. B. Saunders

Appendix One

Unstructured Interview:

To identify the presence of influence of the following factors:

Internalizing behaviour Adolescent age

Individual-level Factors Adolescent Education

Externalizing behaviour

Family-level Factors Family Structure

Family Income

Current research by Social Care Institute for Excellence, (SCIE), suggests that one person in six will become depressed at some point in their lives, and, at any one time, one in twenty adults will be experiencing depression. I will discuss the definition of depression and its interpretation along with the biomedical model, interpersonal, psychological and institutional perspectives. Then discuss the social, economic, environmental and political factors that contribute to the developing of depression and their relation to sociological and psychological theory with particular relevance to black and minority ethnic (BME) groups.

In England and Wales the Mental Health Act 1983 defines ‘mental disorder’ as: ‘mental illness, psychopathic disorder and any other disability of mind’. There is a dual role of legislation: providing for care while at the same time controlling people who are deemed to be experiencing mental disorder to the extent that they are at a risk to the public or themselves. World Health Organization WHO (2001), marks depression as when “Capacity for enjoyment, interest, and concentration is reduced, and marked tiredness after even minimum effort is common. Sleep is usually disturbed and appetite diminished. Self-esteem and self-confidence are almost always reduced and, even in the mild form, some ideas of guilt or worthlessness are often present.”

Mental health is a contested concept which can be viewed from different medical, psychological and social perspectives, which lead to diverse views on what mental health is. Depression is a mental illness and, can affect anyone at different points in their lives, from every background and occupation. Categorizing populations as experiencing depression, involves making judgments by the use of scales of mental health and these judgments determine cut-off points on a continuum of mental health or illness and are socially constructed. A rating scale commonly used to measure the mental health of populations is the Hospital Anxiety and Depression Scale (HADS). A study by Singleton et al., (2001) found that 76 per cent of the participants, who reported symptoms of mental distress, did not receive any treatment from a health professional for their problems. Sainsbury (2002) study refers to a culture of fear within the BME populace. Causation is affected by the practitioners who diagnose and treat depression and the public perception of depression however there are many perspectives.

Biomedical model focus on biological aspects of depression and look for symptoms that relate to diagnostic categories of mental disorder with a view that a sick body can be restored to health. Interpersonal perspectives on depression focus on individual people, experiencing mental distress, together with family and friends, psychologists and counselors also taking account of the views and experiences of service users and survivors. One such perspective is to see madness as a difference rather than an illness, like the social model of disability Oliver (2002). People’s actions can be open to different interpretations which are influenced by the perspectives of those making the interpretation. However there are commonsense perspectives of depression including personal experience with the people in closest contact, a relative or friend, may form opinions of the likely causes of the distress. Their opinions may include aspects of the person’s personality and recognize the impact of external stressors such as bereavement, debt or work demands. Overall they are more likely to emphasize the impact of social, rather than biological or psychological, factors.

Psychological perspectives on depression explores unconscious thinking, possible past traumas and focuses on helping service users to realize their potential and focus on social support and psychological interventions. This has created the development of psychotherapeutic treatments or ‘talking therapies’, such as cognitive behavioural therapies (CBT) has become the psychological treatment of choice in many NHS-funded services. Advantages of CBT include having some support, someone to talk to and developing coping strategies. Disadvantages of CBT include – The focus being on here and now, when the person might want to spend more time discussing past issues. CBT is a relatively effective way of helping someone deal with their distress that puts the client back in control of their life. Despite the evidence that has been collected to support the use of different psychological treatments, their effectiveness continues to be debated and funding is mainly offered in private practice or within institutions. (McLeod, 2000; Holmes, 2002) By contrast, the prescription route is a commonly referred to and accepted path with no self-criticism or self-awareness required.

Institutional perspectives or psychiatric perspectives on depression hold biological and genetic theories of causation for depression, and prescribe biological and physical treatments. Psychiatric perspectives emphasize the diagnosis of symptoms of depression in order to place people into categories of illness. The influence of GPs and psychiatrists is powerful in determining what is and what is not considered to be a mental health problem. Psychiatrists have powers to detain patients for treatment against their will. Psychiatry, through its association with medicine, tends to take precedence over psychological and social perspectives.

The bio-psychosocial model introduced by Engel (1980) acknowledges the interactions between the person’s biology, their psychological makeup and their social situation as important in understanding their mental distress. It encourages a more holistic approach to treatment. However, it has not provided the hoped-for basis of an accepted multidisciplinary approach. The Social support perspectives believes social factors and the person’s experiences cause depression and social support restores the mentally distressed person to wellbeing and social functioning. However it is also viewed as an addition to psychiatric treatment, where the service user is established on their medication, and social issues investigated.

Puttnam cited in Gross (2005) refers to social capital as a supportive social atmosphere and discusses bridging and bonding ties and the absence of these can lead to social isolation. Cockerham (2007) makes the connection where depression and illness are most likely among those with little or no social capital. There is also a tendency for the individual to, once diagnosed, to play the ‘sick role’, Rosenhan (1975) refers to the stickiness of labels and Goffman (1961) refers to looping and deviancy amplification that is associated with stigmatization and labeling of individuals. However our social standing is not the only element that contributes to our sense of well being. The environment that we live and are brought up in greatly influence our health Ross (2000) cited in Cockerham (2007) compares advantaged and disadvantaged neighborhoods finding that higher levels of depression occur in the latter with individuals suffering psychologically because of their environment although there were links to their individualism – female sex, younger age, ethnicity, low education, low income, unemployment, unmarried with the remainder from living in a poor neighbourhood. The daily stressors of living with crime, disorder and danger all link with symptoms of depression. Those living in clean and safe neighbourhoods showed low levels of depression. Distressing neighborhoods’ produce distress beyond that from individual disadvantage with poverty and single mother households the strongest predictor of depression. However the lack of choice and powerlessness of poverty make the emotional consequences of living in a bad neighbourhood worse.

Poverty can lead to poorer mental health where access to employment and welfare benefits, can be seen as health-promoting activities. For most nations, spending on mental health promotion is low Appleby, (2004), and the resources put into mental health promotion are minuscule compared with those used for treating ill health. Schulz et al. (2000) cited in Cockerham (2007) found high psychological distress highest amongst blacks and whites living in high poverty areas, slum living conditions. Wilson and Pickett (2006) cited in Cockerham (2007) stated that stress , poor social networks , low self esteem , depression , anxiety, insecurity and loss of a sense of control are reduced and social cohesion in enhanced – when income levels are more equal- however equalizing income is inherently political.

Sir Donald Acheson’s Independent Inquiry into Inequalities in Health Report (1998) recommendations will require policy changes to occur with reference to changes in building design, planning and access to health care treatments, although most research data on interventions tend to be tested on white, middle aged well educated men and women therefore the efficacy with black or mixed ethnic BME is not proven. The report also links depression and anxiety with obesity and inactivity and encourages physical exercise as obesity and inactivity is increasing in lower socio economic classes. The media and the NIMBY phenomenon exemplifies the exclusion that often accompanies a diagnosis of depression. This raises issues of complex ethical and political issues along with human and civil rights.

According to Blaxter (2004) health, disease and illness are social constructs; they are categories which have been named, and defined, by human beings. Bowers (1998) argues that diagnostic classification systems are culturally influenced, but involve: – careful, detailed observation, publication and peer review. Psychiatric diagnoses are based on social judgments of behaviour and experiences. These judgments can be socially and culturally influenced. For example, you will automatically ‘get well’ by travelling to a country where your beliefs are widely shared. This obviously does not happen with heart disease. Problems of subjectivity and unrecognized cultural assumptions may complicate the process of diagnosis. ‘Neither minds nor bodies develop illnesses. Only people do’ (Kendall 2001).

Recognition that both physical and mental factors are involved in mental distress could mean that a diagnosis of depression would be no more stigmatizing than having a heart condition.

Foucault cited in Giddens (2006) was a post-structuralist theorist who believed that people’s views on depression are the results of discourse that exists to define and subjugate people in society. He also, through the process of social archaeology, examines how the issues of mental health existed in the past and how they are a modern conception of normal and deviant activity , defining them as a construct built on power in society and how that power operates , this therefore links in to social constructionist theory. Social constructionism is the belief that our understanding of depression as a reality, overlooks the processes through which the reality is constructed. Our current sociological thinking is one of a historic white male centred Eurocentric model with women historically viewed as hormonal creatures and this gender difference is still prevalent to day in the way we use language with gender differences in the way society defines these roles.

Brown and Harris (1974) model of depression drew links with unhappy life events that can lead to depression when mixed with his four vulnerability factors which he identified as ; 3 or more children under 14, loss of mother before 11, lack of employment, lack of intimate & confiding relationships. He established that these factors plus an unhappy life event led to 83% women became depressed with working class women more likely to become depressed. Kasen et al (2010) have conducted a study supporting the effects of enduring earlier stress both in childhood , poor health status and a more rapid deterioration in health and the effects this has on major depressive disorder on women in old age and the need to develop resources to counteract stress exposures in younger generations of women. These factors need to be considered in the understanding not only from a feminist perspective but also from a black perspective as black women are multiply disadvantaged, hooks cited in Giddens (2005).

Immigration has played a major part in the creation of culturally diverse communities in UK society. The majority of the UK population in the National Census (2001) census was white (92 per cent). The remaining 7.9 per cent were from different minority ethnic groups. Karlsen et al. (2002) states that ethnic groups experience significant racism, unfair discrimination and social exclusion. This needs to be considered when understanding their mental health experiences. Social inequalities in education, employment and health disproportionately affect members of minority ethnic groups. This all leads to increased mental distress. Also black male’s lives are much harder as they have to live to a set of unconscious rules written in Westernised psychiatry which leads to their current diagnosis. People from minority ethnic groups find that mental health services are not sympathetic to their particular needs. A report from the Sainsbury Centre (2002) concluded, black people are disproportionately disadvantaged and their experiences of mental health services are characterised by fear and conflict. ‘Delivering Race Equality’ was launched in January 2005 and requires health authorities, and NHS trusts to ensure equality of services. The Department of Health has set ‘action goals’ for the mental health care of minority ethnic communities and service users; these include, reduction in fear and seclusion in mental health services.

Race is a contested concept with the difference between race, having its origins in 18th and 19th century colonial assumptions about the differences between white and non-white people. The concept of race is socially constructed and is now embedded in how we identify, understand and think about people. Ethnicity is an alternative concept to race that is more acceptable to groups in society . Ethnicity refers to a sense of identity that is based on shared cultural, religious and traditional factors. Ethnic identities are always changing and evolving. Approaches to cross cultural psychiatry according to Pilgrim (2005) are either orthodox or skeptical. Orthodox definitions of depression state that culture shapes the expression and prevalence of mental disorder. Cultural sensitivity enables GP’s to read symptoms and translate them into an orthodox, western diagnosis. A sceptical reading questions the validity of applying diagnostic labels from Western culture to other cultures. Cultural differences lead to people explaining and experiencing depression in different ways. Imposing western diagnostic categories leads to misinterpreting the person’s mental distress. It is important to be cautious in making cross-cultural comparisons in diagnosing with different illnesses being stigmatized in different cultures, and so expressed differently.

Beck cited in Giddens (2005) felt that depressed peoples thinking is dominated by a triad of negative schema of, ineptness, self-blame and negative evaluation although this doesn’t take into account any social factors that have impacted on the individual. Freud cited in Gross (2005) thought that people were victims of their feelings. That the psycho-analytical theory with fixation in psycho sexual stages and repressed desires feelings are what causes mental illness as the ego is unable to exert control over our feelings and this inability to express may cause anxiety and depression. He took this further with enforcing the belief of intra psychic loss, loss of sense of self, esteem, loss of job or the loss of a major sustaining relationship. Hayes (1998) links Bowlby’s functionalist perspective in his attachment theory being the loss of significant carer and lack of maternal attachment had far reaching effects. Skinner cited in Gross (2005), believed in radical behaviourism and that learning is conditioned and emphasized the role of environmental factors. Seligman (1974) takes a humanistic approach purporting that learned helplessness is a cognitive psychological explanation of depression, where there is learned helplessness and passivity, people become dependant and unable to make decisions for themselves.

Oakley (2005) remarks on the tendency for women to specialize in mental illness and that many more women in Westernized society are classified as having neurotic disorders and women dominate in psychosomatic disorders. A correlation exists in the study of mental illness being higher in men living alone and higher in married women however women are also suffers of post partum depression which is viewed by society through the biomedical viewpoint. Oakley (2005) places this within the self perception and ideals within a male patriarchal culture where women have been, historically, subject to social, economic and psychological discrimination, as have black people. However we are all damaged in some extent, this being a state of humanity; however, connectedness is not possible without the qualities of vulnerability, weakness, helplessness and dependency. A paradox exists in that all these qualities are seen as feminine, and are, not only negatively described, but are also associated with depression. This also links to learned helplessness as a psycho social explanation that women are gendered and stereotyped into this through socialization Weissman et al (1982). Calhoun et al (1974) established data that indicated a trend for females to hold themselves more responsible for unhappy moods than males.

There are a myriad ways of thinking, behaving and experiencing the world through a combination of care and control using medical, psychological, and social support with interventions done to reduce negative factors such as poverty , unemployment racism etc, and promote social inclusion. Research will play a large part as new factors are established as demonstrated in the recently publicized link between teenagers sleep patterns and depression Gangwisch et al. (2008)

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According to the US Advisory Board on Child Abuse and Neglect, about 4,000,000 children die each year as a result of child abuse and neglect (Bob 12). “Child abuse refers to nonaccidental harm that is inflicted on children by their parents or other adults” (Magill 218). Many people do not take child abuse seriously because they either believe that harsh discipline is necessary, or they do not realize how bad it really is. Both child abuse and neglect are serious social problems that often have a lasting negative impact on the development of minors” (Magill 218). Due to the incredibly violent and graphic nature of A Child Called “It”, readers may not believe the encounters are factual. However, they most regrettably are true. The abusive actions in A Child Called “It” parallel those of real-life child abuse cases.

Abuse mostly occurs “in families who are young, poor, and single” (Palmisano 228). When families are going through hard times, there is a lot of stress that comes along with it. With all of this stress, the parents take it out on their children. Having “a crisis in the home heightens the chances that a child will be abused” (Bob 15). A family’s relationship is a very important part of the system in the household. Domestic violence and parental issues are also contributing problems in reoccurring child abuse cases. Parents who abuse each other are more likely to abuse their child as well, because “violence in one aspect of family life often flows into other aspects” (Rein 54). “Families in which the wife hits the husband, the child abuse rate was considerably higher,” resulting in 22.9 children per one hundred children (Rein 54).

There has also been found “a correlation between family income and child abuse and neglect,” (Rein 52). Child abuse cases are “more likely to occur in households where money is in short supply, especially if the caregivers are unemployed” (Bob 15). Difficulty in the family structure can also trigger child abuse. “Children in single-family households were at higher risk of physical abuse and all types of neglect than were children in other family structures” (Rein 51).

In A Child Called “It” Dave Pelzer suffers child abuse at the hands of his alcoholic mother. It was not like this all the time. At first she was a loving and caring mother, and then she changed dramatically. Together they used to have good times. They would always spend all their time together, going to the zoo and the park, until the family slowly started to split apart. Pelzer’s father was a firefighter, so he worked many twenty-four hour shifts, which caused problems between him and his wife. If parents are having problems in their relationship, then they take out their anger on others. In Pelzer’s situation, his mother took care of all her feelings by drinking and abusing her son.

Most people believe that the fathers are abusers because they are bigger and stronger, but it is mostly the women. In fact, there are many households where the woman of the family beats the man: “80% of fatal maltreatment cases were attributed to women,” that is for both child abuse, and spouse abuse (Carey 23). Many people believe that women are not capable of child abuse because of their maternal instinct, but woman are the abusive ones. According to Carey, “58% of child abuse is by the mother”. Many abusers inflict abuse onto their kids because that is how they grew up. “The severity of child abuse, and the manner in which children are abused, bears a strong resemblance to the type of maltreatment experienced by their mothers” (Kim 54).

Another big contributing factor to child abuse is substance abuse. There are some cases where there is drug abuse, but the most common substance is alcohol. “According to the Children of Alcoholics Foundation, 40 percent of confirmed child abuse cases involve the use of alcohol or other drugs” (Kim 54). In most cases, “with or without depression as a factor, studies indicate that a major contributing factor to child abuse is alcohol or drug addiction” (Kim 54).

In A Child Called “It”, the abuse is done by Pelzer’s alcoholic mother. With the father gone, the mother made herself useless and drunk. “At times while Father was away at work, she would spend the entire day lying on the couch, dressed only in her bathrobe, watching television. Mom got up only to go to the bathroom, get another drink or heat leftover food” (Pelzer 30). Shortly after this phase of being lazy, she started to abuse her son, with alcohol at her side.

Whenever child abuse is suspected, the most important thing to do is to report it. Many people do not report child abuse, which may result in the child dying. There are so many reasons that people do not report child abuse, and it becomes a big mistake: “60% failed to report child maltreatment because they did not have enough evidence that the child had been maltreated” (Rein 23). Whether there is a lot of evidence or not, all child abuse suspicions should be reported because it could save a child’s life. Also, around “16% failed to report because they did not think CPS would do a good job” (Rein 23). Whether it is believed that they would do a good job or not, letting someone know what is going on can make the smallest difference in a child’s life. “One-third of the mandated reporters thought the abuse was not serious enough to warrant reporting” (Rein 23). There are many organizations today that will help if there is suspected child abuse, without putting the victim in any further danger. For example, there are the Societies for the Cruelty to Children, American Human Association, Child Welfare League, National Council on Child Abuse and Family Violence, and much more (Dolan 60-68).

In A Child Called “It” all of the teachers knew about Pelzer’s abuse but did not say anything. According to Pelzer, every day when he walked into school he went to the nurse for their daily routine. She would ask him to remove his clothes and check all over his body for new marks. All of the teachers knew but were afraid to say something. Mr. Hansen, one of the teachers that knew about this, even called home one night to talk to his mother. When Pelzer got home that night he got a beating because of it.

Child abuse is a serious crime. Many people are afraid to intervene, but they should. Many people do not really believe that child abuse is as bad as they hear from different stories, but it really is. In A Child Called “It”, most things that happen in real life child abuse cases, was present in the book. In both real life and in Pelzer’s story, the family was experiencing trouble in the structure and relationships. Also, the abuser was the mother figure. And the worse thing of all is the community negligence. Many people do not say anything, whether what they suspect is really happening or not. Child abuse is real and Dave Pelzer experienced it first hand.

Change is a process of transitioning from a current situation to a desired future condition. Whether we like change or not, we are all caught up in a never-ending cycle of change in our organizations. Some people welcome change and enjoy the uncertainty it often brings, thinking that it offers a new challenges and opportunities at work. Others are cautious about change, fearing that something valued will be altered or lost or that risk brings unnecessary stress. In care, health and social care services are essentially about people, both those who need to use services and those who provide services. People are sensitive to the impact of change and as a manager I have a particular responsibility to take care over how changes in services that are intended to deliver care within the organization.

One of the reasons why change seems to be constant is that there are many potential stimuli for change and there are several factors driving change. The stimulus for change may come from inside an organization but it is more usual for it to come from outside. Change initiated within the organization is often a response to a force outside the organization that triggered the change. For example, factors that have a significant impact on health and social care services include government legislations and policies. Many aspects of health and social care are subject to legislation. New legal requirements emerge constantly as government seek to improve health and social care, often through introduction of systems to set standards and to control or modify service provision. Like the Health and Safety at Work Act 1974, this was enacted because of increasing numbers of accidents and incidents that happened in the past related to work. Its main purpose is to protect and minimize people from harm. It places a general duty on employers to ensure health, safety and welfare of all employees as far as is reasonably practicable. This legislation situates an impact not only on health care industry but all kinds of work. That is why until now it was expanded its scope, clarified responsibilities and responded to new circumstances as they have arisen without changing the overall principles of the original Act.

Legislation also affects service provision though legislation relating to employment, health and safety, use of public funding and through related services including education and housing. Recently, the government commence key modification which affects the eligibility of all non-EU workers who wants to work in the UK. Those individuals must ‘earn’ a minimum number of points. The new rules state the less points will be given for employees earning lower salaries in UK and no points to those who are paid less ?20,000 per annum compare to the old rules that give a minimum points for those workers having ?17,000 salary per year. It means the employer will have to pay new workers at least ?20,000. In addition, the care providers were enormously concerned about the present government removing the senior carers from shortage status because it might cause damage on the quality of care and in the business.

Moreover, new technology is also a reason that is why change arises in health care setting. One great example is the development of internet. It change the way of sending information to the multi-disciplinary team through e-mail. Making it easier for senior staff to send and receive relevant information from GPs and other professionals and vice versa regarding service user’s condition while promoting privacy and confidentiality. It also change our ways of using records and libraries. Staffs in health and care services have access to an increasing range of information that is available to practitioners in health and social care. Service users expect us to make use of evidence in making decisions and database of best practice models are increasingly available. In my workplace, the management use the internet to provide trainings for staff which is more suitable and can be done in our own convenient time. For residence and relatives, it’s a fact that most of the relatives of our service users are far away from each other. However with the utilization of the internet, distance is not a big deal anymore. For relatives and services user who have personal computers or laptops can make conversation and see each other with the use of webcam and chat rooms through the internet.

Service delivery is also influence by use of new developments in equipments. Like the new equipment acquired by Barts and The London NHS Trust the two state-of-the-art Lifeport organ transporters. It endow with a valuable sustenance for patients needing a kidney transplant. It stores healthy kidneys after they are removed from the donor before being transplanted into the recipient. This is a critical period for ensuring that the organ does not deteriorate and become unusable. Unlike before that they rely on ice to conserve the kidney, the new equipment maintains the organ in a fluid rich in nutrients and oxygen, which significantly extends the storage period. For the new equipments, it does change the old method to a new way that allows hope for more patients to have successful kidney transplants. In care home settings, the acquisition of new equipments like the air pressure mattress is indispensable equipment for anyone at high risk of developing pressure ulcers or who have existing pressure ulcers. The alternating pressure of the mattress depends on the weight of the service user allowing relieved on a regular basis and trim down the number of times a person needs to be turned, greatly enhancing the comfort of the very poorly or terminally ill.

In addition, economic factors also drive change. These factors include the general prosperity of the country and its neighbourhood, the rate of unemployment, areas of poverty, the level of inflation and exchange rates in relationships involving other countries and currencies. The state of the economy affects the level of demand for goods and services, the prosperity of communities and the availability and cost of raw materials and labours. The economy tends to move in cycles, but these are not easy to predict. All services, whether public services, private services or charity provision, are affected by changes in the economy.

At present, there were lots of changes in the health and social care sector due to the recent financial crisis that affects the economy of United Kingdom. As a result, the coalition government have wasted no time to save money in reshaping parts of the health services. According to the health secretary, the popular NHS direct services will be substitute with cheaper alternative. Under the government’s plans, some strategic health authorities and hundreds of primary care trust are to be abolished affecting thousands of employees and service users. Examples of recent cost-cutting measures cited by professionals are hospital bed closures, pressure to give patients cheaper, slower-acting drugs, cuts to occupational health support, and reductions in community health services. Furthermore, according to a study, it make known that for the most part of job losses it involved frontline staff as patient services are withdrawn. Along with mounting numbers of patients are being deprived of treatment for conditions such as loss of sight, arthritis and infertility as the NHS increasingly rations healthcare in order to save money. But, the spending cuts done by the government does not only affect the health and social care sector but the life of Britons as a whole. It affects the sick, the disabled and Britain’s poorest families. Among the biggest cuts are only allowing claimants to have the replacement for Incapacity Benefit, the Employment and Support Allowance for one year, Cutting Disability Allowance for those people in care. Cutting Council Tax benefit by 10%. Reductions in the help given for childcare to working families, and slashing housing benefit for the under-35s by paying them the “shared room rate” instead of enough to live on their own etc.,

To be able to facilitate change in health and social care, as a manager I need to be able to understand the principles of change management. According to John Kotter, an authority of leadership and change, change has both an emotional and situational components and methods for managing each are expressed in his 8 step model. To value his model, as a managers there must be an understanding about the suppression and to cause employees emotion. During any period of change, a manager must deal with feelings of complacency, anger, false pride, arrogance, panic, exhaustion and anxiety among staffs. These are all emotions that can challenge and undermine attempts at promoting change. As managers I need to be able to turn these negative feelings into positive and proactive feelings such as faith, trusts urgency, hope, passion and enthusiasm which are emotions that promote change.

On the first phase the model explained the phase of creating a climate for change. As a manager, there is need to develop a sense of urgency to staff. That action is needed regarding a foreseen difficulty. This can be done during meetings by explaining the situation through showing related videos and sharing stories. As the urgency grows among the staffs, as a manager, there is necessity to develop a guiding team that guide the change throughout the remaining steps. Members of the guiding team could be unit managers, senior carers or persons who have a relevant knowledge about the changes that occur in the organization, the ability to establish credibility and trusts to peers, the formal authority associated with managerial skill and the leadership. With the manager, alongside with the guiding team, must develop a vision expressed in a clear, concise statement about the direction in which the organization is headed.

Engaging and enabling the whole organization is the second phase of Kotter’s model. Here, anxiety, anger, panic, among staff will rise because the manager or guiding team announces the impending change. Whenever, change is about to take place, people begin to wonder. That is why the guiding team needs to communicate to the individual or groups that are to be affected by change. And need to address these feelings and help staff to think and act in accordance with the new direction. An effective way to communicate the vision is to develop an engaging story that catches the attention of the change initiates. If there is a resistance to the staff at certain point, a dialogue between the guiding team and staff initiates a question and answer session. Staffs displays understanding when they realized the advantage, rewards and perquisites that they will gain once the change is completed. As the pathways to change are cleared, staffs must need to carefully choose and complete tasks that clearly show that the change is succeeding. Tasks completed provide further urgency and momentum among the organization and lessen the impact of negative comments.

At the final phase, the action plan is implemented fully allowing staff not to let up of the change. Collaboration occurs when staffs are willing to endorse or stand behind the change and displays commitment. As managers, at this phase, should sustain the change. It is done when a new way of operating has been shown to staff to succeed over the some minimum period of time Staffs at this point, displays advocacy that maintains the attitudes and behaviours supporting the change..

To relate this in my work, in my care home, there are recent changes that were implemented due staffs failing to do proper documentation. Firsts, the home manager scheduled a meeting and consultation to all the unit managers. At the meeting, to develop a sense of urgency among staff, she used a video based scenario regarding right documentation. The video shows the positive and negative effect of proper documentation to staffs, residents and management. In the meeting, everyone was asked about the ways to improve the situation. Then, decided that every staff should be knowledgeable and competent enough to do appropriate documentation at work through trainings and observations to make sure that they have the awareness, understanding and collaboration about the agenda of the meeting. On the other hand, the unit managers are to be the guiding team to lead, direct and show the proper way of documentation to unit staffs. Before the meeting ends, she makes sure that everyone understands about the directions in which the organization is headed and there would be recognition as the best unit that could implement the change.

Finally, now every staff is confident regarding answering the forms in the care plans of every resident and certain to do the right documentation. The as proposed the guiding team use appraisal and supervision to measure the change. Plus the home manager monitored the change by evaluating the care plans of the residents with the help of a unit manager every end of the month for this change to become a culture in the care home.