Category: Free Essays

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.

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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.

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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.

According to Sines & Saunders (2009), change is something that is different from present condition or appearance. There are different types of changes and every change has it’s own impact. The grounds for proposed change can be skill mix, relocation of services, access and entitlement, referral systems, working condition, staffing levels, resource allocation, management, professional roles, responsibilities and accountabilities, reviewing and monitoring systems throughout the organizations. Wallace & Webber (2006) have stated that, the main purpose of relocation of service is to improve the existing services. For example, the Department of Health has recently improved the service for the veterans and severely injured service personnel. Some of the rationales for proposed changes are described below:

A new service along with an existing one may need to be introduced. For instant, mix of skills or new allocation of service may be necessary with an organization.

Development in technology and other progress put pressure automatically to form changes throughout the organizations. So, organizations have to undergo through a change process to cope with the new situation. A new form of services come may be introduced as a result of changes. For example, the entire NHS structure is going to be digitized because of the technological improvement in the UK.

Organizations often conduct performance appraisal to monitor and control the quality of service to find out the faults. If there is any, they try to solve that which can result change in service delivery.

Etto (2009) has stated that the customers and consumers have an ever changing mentality. So, service providers have to introduce new products or services or improve the existing one to compete with other organizations and the global market. For example, people may tend to get services from other countries or private hospitals if the services of NHS are kept unchanged where customers or patients expect more from them.

Competition with other service providers helps to introduce changes and it results satisfaction of the service users. Sometimes dramatic changes in the organizations attract non-potential customers as well.

Demographic changes like increase the number of aging people, increase of child birth or increase of critical disease will require special care which will lead health care system to change.

Satisfaction level can lead organization to change if the level is low.

Community action groups which may be regarded as pressure groups are instrumental to bring change. It is noticeable (particularly in local elections) that a local representative may be elected based on support for a community project, i.e. the building of a health clinic with the improved of plans to relocate services.

New legislations, acts, policies and requirements of these may affect the existing services which can lead changes. For example, according to the Protection of vulnerable adults (POVA) or care standard act 2000 requires criminal record bureau (CRB) check before starting their employment with vulnerable adults, children and families.

1.2 Assess potential benefits to staff, service users and communities of proposed changes.

According to Senior & Swailes (2010), change is a word which is essential in every sphere of life especially throughout the organizations because usually it brings efficiency, staff and customer satisfaction. It also cuts extra costs of the organizations, response times so that service users can get service quickly. The department of health, NHS and some other organizations are bringing changes in their organizations. Among them, the Department of Health has already laid down some targets, policy initiatives and organizational changes (both management and structural changes) which have developed the quality of care received by the patients. As a result, communities as well as all the staff and service users are being benefited from proposed changes.

Without this, Tanner & Harris (2008) have noted that, the department of health works in partnership with everyone who are directly and indirectly involved with health and social care services. This organization has focused on some important issues to improve the health care services throughout the nation and these are:

A better partnership relationship among the carers, doctors, social workers, GPs and patients. All the health care professionals can now share information among one another regarding any patients. As a result, misunderstanding, confidentiality and patients’ welfare etc. are now easy to achieve.

An improved process of commissioning. The department of health has guided to follow the commissioning process strictly so that no life of any children becomes unsafe. So, the whole community is being benefited.

Inter-professional and inter-agency collaboration and teamwork. It is very unusual that a professional must be expert of everything. But if professionals from different background work together, can solve any problem discussing with them. So, service users, service providers as well as the community are being benefited from this change.

According to Care Services Improvement Partnership (2008) and NHS (n.d.), some of the key benefits are given below:

Improved health and emotional wellbeing

controlled and improved quality of life

Lead to develop skills

Greater confidence for the individuals

Make a positive contribution

Choice, control and services which are built around the individual.

Freedom from discrimination

Economic wellbeing for the service users

Early intervention and personal dignity

1.3 Identify challenges and suggest strategies for reducing undesirable impacts.

According to Pasmore (2010), there are many challenges to take into account while making any changes in an organization. He stated that changes and new things are not always welcomed. For example, an agile and lean ideas and practices are introduced (or proposed) in established an organization, the unfamiliar ideas meet with resistance. Organizations may need to provide some extra time for employee engagement.

Challenges

Research carried out by Fullan & Ballew (2004) has found that the first challenge of change is basically a high degree to resist something new. According to them, people resist change because of fear of the unknown and may not understand what is happening or coming next or because of disrupted habits which leads them to feel upset to see the end of the old ways. In addition, people may suffer from loss of confidence or control because of change. They may think, they are incapable of performing well under the new ways and things will be being done “to” you rather than “by” or “with” you basis.

Employees may think their current timetable needs to be changed and have to work extra in terms of physically and psychologically. They may think that they will be humiliated because of changes. Also, staff may have lack of purpose not seeing a reason for the change and/or not understanding its benefits. All the things need to be considered before making any change and avoid any undesirable impact. But still people may resist the changes. There are many strategies to reduce undesirable impacts but the most suitable strategy should be applied to certain problem. According to Sengupta et al (2006), strategies to reduce undesirable impacts can be normative re-educative strategy, power-coercive strategy, Rational-empirical strategy, power- adaptive strategy.

Normative re-educative strategy: Sengupta et al (2006) have defined this strategy as a strategy that believes “the norms of the organization’s interaction-influence system (attitudes, beliefs, and values–in other words, culture) can be deliberately shifted to more productive norms by collaborative action of the people. It focuses on norms, change attitudes, and values of the organization’s members. But if attitude is changed, values and norms may behave differently. One can see this in cultural change programs that organizations introduce and in this type of change individuals participate in their own re-education.

Rational-empirical strategy: Sengupta et al (2006) have stated that, this strategy begins from the assumptions that individuals are rational and will follow their own self interests when it is revealed to them. Change is based on the communication of information and the proffering of incentives. Therefore changes achieved by highlighting to individuals affected by the change that is consistent with their own self interest to except the change. In other words individual go along-with the change because they can see that it is in their own interests to do so.

Power-coercive strategy: It is based on the application of power, whereby the process of influence is compliance (Sengupta et al 2006).This involves getting individuals with less power to comply with the plans and the directions of those with the greater power.

Environmental-Adaptive: According to Sengupta et al (2006), people argue disruption and loss but they readily settle in to new conditions. Change is usually based on building a new organization and gradually transferring people from the old one to the new one. They suggested some key checkpoints to reduce unexpected impacts for successful changes which are given below:

Benefit: it makes sure people involved see a clear advantage in the change.

Compatibility: it keeps the change as close as possible to existing values and experiences.

Simplicity: it makes the change as easy as possible to understand and use.

Triability: it allows people to try the change step-by-step, making adjustments as they go.

Making change inevitable: it creates a felt need and urgency for change.

A diagram to minimize the resistance of change is given below:

Communication

Training

Employee involvement

Stress management

Minimizing resistance to change

Coercion

Negotiation

Diagram: Minimizing resistance of change
Question 2
2.1 Devise strategies and criteria for reviewing changes.

According to Estrella (2000), evaluating research survey, weightening up the evidence and comparing changes with one another can be very effective way to devise strategy and criteria for reviewing change. There are many types of changes such as subsystem change, transformational changes, incremental changes, remedial changes, developmental changes, planned changes, emergent changes, episodic changes, continuous changes etc. These changes can be reviewed on the basis of evaluation of research survey. The basics of research survey can be descriptive research, survey, successful samples, questionnaires, prediction, casual explanation, panel study, single sample, evaluation etc. Different types of data can be collected from these approaches such as attitudes, opinions, beliefs, preferences, behaviours etc.

Attitude: it means what people say they want

Opinions: it reveals what people think might be true

Beliefs: it means the things people know as truth

Behaviour: this is what people actually do

Demographic characteristics: it represents what people are

Preferences: it is that people might choose

Koontz & Weihrich (1990) have stated that, there are few basic questions which are asked to the people and these are usually linked to open response, partially open response, closed response, semantic differential scales, agreement and rating scales, ranking scales, checklists etc. Rewards, costs and trust of people must be taken into account while reviewing change by surveys. More people will help to review the impact of changes if there are more reward options. Also assessing reliability and validity are very important for reviewing change. There are many types of validity like face validity, content validity, concurrent validity, discriminated validity, predictive validity, construct validity. Reliability can be test-retest reliability, internal consistency and sstability. Sampling theory is another strategy to review change. This strategy helps to review change by providing a sample statistic or sample or census, identifying the target population, obtaining a manageable collection of objects to study and pproviding a qualitative representation of population characteristics. It can also provide a sample statistic to identify the target population. Data should be analyzed and coded at the end for a successful review of change. Thus change can be reviewed.

2.2 Measure impact against agreed criteria

According to Lock (2007) and Koontz & Weihrich (1990), the Impacts within any organization against agreed criteria are very important in terms of Staff satisfaction and Customer Satisfaction. Their satisfaction level can be measured by surveying, interviewing based on different issues e.g. what is their expectancy from the organization, what needs to be improved, what should come to light for their satisfaction etc.

Staff satisfaction: Huber (2006) has explained staff satisfaction or employee satisfaction as a measurement of happiness of employees’ in terms of working environment and job roles. Staff satisfaction is very important to a successful organization as happy employees produce more outcomes and create more satisfied customers. Organizations often need to change their policy and structures to be successful and to achieve organizational goals and conflicts and staff dissatisfaction may arise from here. As new things are not often welcome, so they may resist the changes as well. But good employers know how to satisfy their employees and cope with this situation.

Organisational changes such as skill mix, working condition, management, relocation of services, etc can lead to considerable changes in traditional roles and responsibilities (Holzemer, 2009). It has psychosocial challenges for the employees in the shape of job uncertainty, the feeling that one is not mastering the new work situation or lacks the competence to do so and consequently difficulties in implementing change processes and using new work processes. In these cases, efficient employers show direct and indirect benefits to their employees to avoid resistance e.g. cost effectiveness, reduced job stress, quick response time, and effective allocation of service.

Customer satisfaction: The impact of proposed change on customer satisfaction is an unintended consequence or outcome of an intended strategy or action. Research from Cochran (2003) has found that customer satisfaction is the most important criteria for an organization to be successful. Department of health, NHS and some private hospital have made some significant changes to their organizational structure and in terms of service delivery. So, customers are being served quickly and they can access to the service in a short period of time. Customers are now getting improved health and emotional wellbeing, improved quality of life, Choice, control and freedom from discrimination, economic wellbeing, personal dignity etc.

2.3 Evaluate overall impact of changes.

Pasmore et al eds. (2009) and Cummings & Worley (2008) have noted that every change should have positive outcome through the organizations. The overall impact of changes in an organization can be the efficiency of the employees, cost-benefit, case completion, referral rates, waiting and response times etc.

Efficiency of an organization: Efficiency of an organization means how effective an organization is to achieve its goals (Daft, 2009). Every organization should be more effective after making any changes whatever it structural change, change in referral system or relocation of services. Organisational efficiency mainly relates to the use of resources to achieve best possible outcome which refers to the amount of resources an organization uses in order to produce a unit of output. An organisation that maximises its resources in production without waste is an efficient organization. For example, NHS and GP surgeries are now becoming more efficient in terms of service delivery. Now if a patient changes their appointment time more frequently, their registration may be cancelled. They need to pay for re-registration. As a result, both clients and service providers are keen to maintain their schedule strictly. So, the NHS authority may not have to pay extra to the GPs and doctors for their unproductive works. As a result, NHS ranked first place among the countries in terms of service delivery to the patients.

Cost-benefit: according to Dompere (2004), this is an idea that tries to fix if a project worthwhile economically. The overall benefits should be greater than the costs. NHS as an example is concerned about the patients in terms of how they can be treated and the success rate of surgeries can be hundred percent. The NHS authority is also concerned about the hospital and surgery procedures, how doctors, surgeons, nurses and other clinicians perform with the skills and abilities. It is a government organization. So, profit does not take into account but it needs to take into account that how many and what kinds of patients they have served and what is the outcome based on the cost. Though the intension of NHS is not to make profit but they should balance the cost with service outcome to be a cost effective organization.

Referral rates: Baker et al (2006) have stated that, referral system in health care means having a relationship between a primary health care provider and a higher-level hospital during the transfer and discharge of a patient. In the UK, General Practioners (GPs) are responsible to see and for the primary diagnose of disease of a patient. If they fail to diagnose or give a solution to the patient, then the patients are sent to higher level hospital where they are treated by the specialist doctors. The effectiveness of a GP can be measured by the referral rates, well-being of the patients, number of cured patients etc. Once it was a time, the referral rates of the GPs were very high as sometimes they did not try their level best to serve a patient. In that time the GPs had no rewards in terms of service delivery. But now NHS has been re-structured and GPs who have high referral rates are marked as non-effective. So, they have to take compulsory training to increase their service outcome. Now, the overall referral rates are falling gradually and patients are getting good service because of these changes.

Waiting and response time: Anon (n.d.) has shown that waiting and response time of the patient is still significantly high though the department of health has been re-structured. But the overall waiting and response time is falling day by day as the NHS is trying to digitalize the whole organization. Also, they have planned to work along with the private hospitals to give the fastest and best possible care to the patients.

Question 3
3.1 key demographic and social trends in the Scotland.

Demographic and social trends in Scotland:

According to Paterson et al (2004), the population in Scotland has been declined slightly during the last twenty years. Around 117000 people have been declined over the two decades. In addition, the fertility rate is the lowest in Scotland compared to the countries in United Kingdom. The key demographic trends are given below:

Population trends: According to General Register Office for Scotland (2001) and Paterson (2004), the population in Scotland has fallen in the year to 30 June 2002 to 5,054,800 which is 0.2 per cent less from the mid-2001 where there was a level in the first half of the 20th century. A natural decrease has been experienced from the year of 1997. The mortality rate among the older people was significantly high compared to last four decades. The natural decrease (6,065 in 2001-02) was a bigger reason for population decline. In addition, Scotland’s population is getting older which is projected to continue ageing. About fifty percent of the people are now over 39, which are four years older compared to the year of 1991.

Anon (n.d.) & the census 2001 has shown that the total residents of Scotland were 5,062,011 until 29 April 2001 of which 48% were male (2,432,494) and 52% were female (26,29,517). Children aged fifteen and under (about one million) accounted were 19% of the population. The population in Scotland was considerably low compared to England.

Fertility rates: Research carried out by Coyle et al (2005) has found that the fertility rates are in same condition with the population trend. It is the lowest among the Scottish people and every woman has 1.48 children in average. In 2002, the entire number of births (51,270) registered was the lowest ever recorded. It is the 6th repeated year where the number has fallen with record. It shows the fact that adult women are giving birth of fewer children and having them not at early age. As a result, average completed family size fell less than two and was expected to drop further for younger women after 1953. Fertility rates in their 20s are little bit more than half the rate forty years ago when rates for women aged over 30 have gradually increased. Scholars are unable to fully understand the reason of low Scottish fertility rate. Data suggests that it may be the reflection of life choices among the couples as house prices and the price of daily chores are increasing day by day. In addition, dual earning couples, delay motherhood, low income, breakdown of relationship, religion difference etc. also may be responsible for low fertility rates.

Migration: According to Murphy (2004), historically, Scotland is a country for the immigrant people. But it is noticeable that, migration rate in Scotland has been fallen sharply during the last few decades. Data has shown that net emigration from Scotland is much lower than forty years ago. Scotland experienced around 3,000 migrants loss in 1998 to rest of the UK. Figure shows that most of the people (15-34) are immigrating to England compared with Scotland. Population projections by the General Register Office for Scotland (GRO) based on a new baseline, assume a net out-migration from Scotland of 1,000 a year.

Social trends: Research from to Paterson et al (2004) has shown that, social trend in Scotland is considerably noticeable from the last two decades. The birth rate is being controlled very strictly by the Scottish couples. Once there was a trend to give birth at early age among the women which is considerably low now. The household are breaking into smaller sizes at recent years. The average household size in Scotland was 2.31 people per household compared with 3.2 people per household in 1970s. Households are tended to spend more on services than goods. Household spending on services was more than 50% of net domestic household expenditure. They are now spending more money for travel and tourism compared to past years.

Education rate from primary level to higher level has been increased during the recent years (Gibson, 2008). More than three-fifths of three and four-year-olds are in early year’s education now. The proportion of three and four year olds enrolled in all schools in Scotland was 63 percent triple the rate in 1970s. Scotland experienced a higher unemployment rate though the education rate is growing high. Unemployment rates for men and women are 8.1% in Scotland which is 1% higher than England.

According to The Scottish government (2004), Scotland has recorded the lowest number of crime in 2001 which breaks the records of last 25 years. Totally 385,509 crimes were reported over that year for the first time when the figure has dropped below 400,000.

3.2 Potential impacts of key demographic and social trends on health and social care service delivery and provision in the Scotland.

According to Paterson et al (2004), there are some significant impacts on health and social care service delivery because of the demographic and social trends in Scotland. If current trends continue, the population will be reduced from five million in Scotland by the end of the decade. It is an issue that reduces the reserved and devolved matters. In addition, it has some particular effects for the requirement and supply of public services. On the other hand, they are becoming positive in terms of social life in some cases. Some of the examples of these are detailed below:

Transport systems will need to become accustomed for the changing demand due to East-West migration.

Supply of school buildings and teachers or lecturers will have to adapt to falling numbers of young people in some areas. For example, the number of students in publicly funded primary schools may fall by 19% over the next decade.

Scotland has not only a declining but also an ‘ageing population’ which may lead to a fall in working-aged people. So, they need to be paid higher for and to provide services. For instant, an ageing population may put extra pressures on National Health Service and they need pay extra cost for free personal care of the aging people.

The number of crimes has been fallen significantly in Scotland. So, people are now more secured and government can cut down some extra cost while budgeting. It is notified that many people become injured by the criminal. So, the healthcare services need to pay them but now this cases are lower than before which reduces health care cost slightly.

The government may need to allocate their resource newly because of population change.

Some health care service may not be available locally and service users may need to struggle and face difficulty to get service. For example, major operations may not be performed locally.

Relationship breakdown can a common issue because of late motherhood which will create extra pressure to social care services. But social services may not be available everywhere because of the small population in a particular area.

A smaller supply of key workers might guide to increase vacancies in some occupations and inflationary pressures on their salaries.

3.3 Appropriate service responses to likely changes.

Anon (2003) & Bloch (n.d.) have identified some areas which need to be considered to protect the negative changes in Scotland. Some of these are given below:

Scotland has got lots of talents and their education rate is satisfied and even better than some other parts in the UK but their employment rate is higher than other parts in the UK. Many graduates and fresh talents are tended to move from Scotland because of this reason. So, employment facility should be widened throughout the country. In addition, new industries, offices etc. can be developed to attract the people with no job. Minimum wages more than other parts of the UK can also be positive.

Unemployment rate among the older people is high and they are tended to leave their jobs early which can cause further depression in life. They may not be able to pass their lazy time by doing nothing at home which may lead them to illness. As a result, government will have to pay for their healthcare cost and that is extra burden to National Health Services as most of the people depend on it. Research from Heponiemi et al. (2007) & Bernklev et al. (2006) have shown that unemployed older people are at higher risk to become sick than the employed. Attractive salary, good and friendly working environment, available support during work time, better pension scheme can increase the employability rate among the older people.

According to O’Neill (2010), debit and credit card fraud was at record high in Scotland. About one out of nine was the victim of card fraud. So, residents had lack of financial security which leaded them to move somewhere else. So, adequate protection must be facilitated throughout the country to reduce this trend.

Motherhood is being delayed across the country. The reason for this is to take fewer children than before as price of daily living things are rising day by day. Also, dual earning families are growing. Mothers may need to away from work for long time because of motherhood which can create barrier in her career. So, safe maternity should be ensured to reduce this trend. Also, adult early birth can be encouraged by socially and benefit can be considered for this.

Tax incentives can be implemented widely to encourage having more children among the couples. Facilitating combining parenthood and full-time employment can be an advantage as well.

Migration rules can be loosening to enter in Scotland for the legal people for cultural and religion mix. People are tended to live in multi-cultural countries more than single cultural and religion countries. Without this, legal migrated people can contribute to improve local economy which can help to cut down the unemployment rate.

Religion balance, improved healthcare facility, social and political stability, improved security in social and financial life will also be a significant impact to stop the negative changes in Scotland.

Different aspects of Chinese culture are manipulated to contribute to the difficult situation of single parent families; whereby, traditional family values and family relationships are both an asset and liability to single parent families. In this case, the parental role identity need to be flexible rather than traditional gendered role identity need to be facilitate in the adjustment of divorced parents. For the welfare services to be empowering there are some critical aspects that need to be considered such as selective traditional Chinese values and cultures and the resolution of the ideological dilemma in welfare policy.

Routine services are the services that help single families to overcome their difficulties with sufficient resources should be explored. Benefits should be provided in a way that it can able to help the families such as housing and education allowances for the low income families. Effectiveness of the provision on welfare benefits in helping the families to develop competence and independence should be evaluate in a crucial way in order that the families are able to gain further competence and independence through the temporary assistance of welfare.

Family friendly work policy has to be supported. The policy reforms in work or family policy which recognizes the legitimacy of employees’ family involvement that will largely reduce the dual role dilemma of the single parents. The hidden structural problems that increase welfare dependence rate should be addressed in addition to the enhancement of individual skills and competence. For example, flexible time, childcare provision and; support and parental leave as part of the benefit to all families including single parent families are implemented in some European countries.

Cairney, J., Boyle, M., Offord. D. R., & Racine. Y. (2003). Stress, social support and depression in single and married mothers. Soc Psychiatry Epidemiol 38, 442-449.

Stress and social supports are the important mediators of the relationship between single and married mothers. The effect of life events in depression was stronger for married mother compared to single mothers because they are less reactive to negative events due to the experience significant chronic stresses and strains. Single mothers have used to dealing with adversity and less affected by negative events compare to married mothers who are lack of experience of the adversity.

Social support to have a relatively impact in terms of explaining the link between family structure and mental well-being. Among the three variables, social support was the only significant variable in the research that stated social stressors have an impact of accounting for the relationship between single parent status and depression compare to the previous research found financial problem to be the main factor in the relationship between single parent status and psychological well-being.

Additional knowledge regarding single parenthood and depression are being gained in this research but the nature of the inter-relationship between family structure, stress, social support and depression remains unclear. However, not only an effect relationship exists between single parent status and depression but the changes in stress and social support over time may lead to changes in psychological well-being. The impact of moving into and out of single parenthood will help us in a better understanding of the consequences of taking up the single parent role and the factors that might occur in and out of this status.

Gladow, N. W., & Ray, M. P. (1986). The impact of informal support systems on the well being of low income single parents. Family Relations 35, 113-123.

Different types of support affect different aspects of well being. Thus, informal support systems do have a positive impact on well being of low income single parents. For example, support from friends and relatives make a unique contribution to reduce the problems of single parents lives where low income single parents can rely on the both parties for support that can lead to reduce the problems they are going to face. Support from friends appears to have the greatest impact on reducing loneliness but then support from relatives is not related to loneliness. This might happen because friends provide more opportunity for free and open conversations that individual feels not so comfortable discussing it with relatives.

Besides that, support systems outside the nuclear family can have a very positive effect on the well being of low income single parent families such as social workers, family therapists, counselors and other professionals who can assure single parents that it is both human and helpful to need and rely on supports outside the nuclear family. Furthermore, agency programs designed to provide specific needs such as food, housing and maintenance. It is a good way if the agency workers can refer the low income single parents in groups to provide social support and building supportive relationships among the single parents. Group counseling for single parents through mental health centers can be established if the single parents’ groups might not provide the type of support that are needed by the populations.

Webber, R., & Boromeo, D. (2005). The sole parent family: family and support networks. Australian Journal of Social Issues 40(2), 269-283.

Ten participants, nine of them saw that support networks as having an essential role to play in their personal well-being and support the children in the initial stages. Support was accessed from different sources including friends, relatives, colleagues, government agencies and social welfare agencies and support can involves different things such as emotional support, practical support (baby sitting, financial, advice and household repairs). Friends and relatives contribute a large amount in emotional and practical supports. Thus, supports will change according when the needs changed.

Supports was seek and attained among community and friendship networks. Various counseling such as individual counseling, family counseling or family therapy was perceived to be the most effect one that are recommended to assist the extended family in going through terms with sorrow and relationship issues. Nevertheless, family and community support are the important factors in healthy families but then most of the participants are not satisfied with the quality of family support when it was provided in a low or critical way. As the result, parents do not cause the separation to feel the contempt of the family members and people who experienced negatively from relatives and friend tend to set a distance to those who do not validate their new status as a single parent.

Grossman, C. C., Hudson, D. B., Lefler, R. K., & Fleck, M. O. (2005). Community leaders’ perceptions of single, low-income mothers’ needs and concerns for social support. Journal of Community Health Nursing 22(4), 241-257

Social support theory, a framework used to develop focus group inquiry questions. From the group discussion by the community leaders, the needs and concerns of single, low-income mothers are social support issue, personal barriers to success and system barriers. Social support issues such as single mother needs verbal and non-verbal contact with relatives, friends and health care professionals. Needs of informational supports for single mothers including parent responsibilities, infant care tasks and resources that are available can help single mother to increase their level of parenting.

Tangible support for single mothers including housing, food, financial, child care and transportation are important. This are supported by House (1981) and Revenson et al. (1991) stated that when tangible support needs are greater than available resources, individuals will experience poor physical and emotional health outcomes. Last but not least, nursing care can identify and use standardized instruments to assess mothers’ needs and concerns besides on the nurses’ intuitive perception. Community health nurses are professional in providing single, low-income mothers with informational support, appraisal and emotional support.

Wellbeing is a subjective issue, with many attempting to define it. Recent government policies have attempted to create guidelines to improve services; however looked-after children generally have poorer wellbeing than other children. Looked-after children of school age in my area are allocated a named nurse from the school nursing team. The term ‘looked-after’ refers to children who are subject to care orders and those who are accommodated voluntarily (The Children’s Act 1989). The focus of this essay will be on the wellbeing of looked-after children of 14-18 years of age, as this is when children are approaching the end of care – often a time of great disruption to their wellbeing. Furthermore, the wellbeing of looked-after children is particularly vulnerable during the transition period from children’s to adult services.

In 2008 there were 59,500 looked-after children in the UK (Department of Health 2009). Evidence shows that a higher percentage of looked-after children will enter the criminal justice system, become teenage parents and have a higher need for Child and Adolescent Mental Health Services (CAMHS), with behaviour and emotional problems being linked to frequency of placement moves and lack of attachment. (House of Commons 2009, Department for Children, Schools and Families 2009, Barnardo’s 2006, Department for Education and Skills 2003, Office for National Statistics 2003). To promote the wellbeing of looked-after children extra help from other agencies is required, with the emphasis on holistic assessment. Commissioned Services introduced statutory guidance and named nurses to address this (Open University 2010, Unit 6, page 82-83). It is important as a named nurse that wellbeing is defined and understood in practice. Gough et al (2006, pp4) states “aˆ¦wellbeing is an umbrella concept, embracing at least ‘objective wellbeing’ and ‘subjective wellbeing’.” Ereaut and Whiting (2008) believe that wellbeing is a cultural construct for what people collectively agree makes ‘a good life’. The Scottish Government (2011) identifies that a safe and nurturing environment is fundamental to developing into a confident and resilient adult, looked-after children’s emotional health is often affected by experiences prior to care entry. Dimigen et al (1999) identified that the level of mental health need in looked-after 11-15 year olds were 55% for boys and 43% for girls compared to 10% for other children aged 5-15. Haywood et al (2008) concur that looked-after children enter care with poorer health than their peers due to the impact of poverty and chaotic lifestyles.

The UNCRC commissioner’s guide (2008) recognises the widening gap between rich and poor in the UK, and associated disparities in the children’s wellbeing. A UNICEF report (2007) places the UK bottom of 21 industrialised countries for child wellbeing. Forrester (2008) believes that children in care can achieve equal wellbeing to other children, and advocates the European model that entry to care can be beneficial for a child living in deprived circumstances, rather than the UK view of care as a final resort. A study by Helseth (2010) found that quality of life is about a positive self-image, good friends and family – looked-after children often do not have these resources. Graham and Power (2004) state there is evidence that childhood disadvantage is linked to adulthood disadvantage, emphasising the importance of wellbeing during childhood. The Department of Health (2000) considers there are seven dimensions of wellbeing – health, education, identity, emotional and behavioural development, family and social relationships, social presentation, and self-care. To measure child wellbeing, the UK government’s Every Child Matters system of five outcomes is used: be healthy; stay safe; enjoy and achieve; make a positive contribution; achieve economic wellbeing (Department for Education and Skills, 2003), which aims to intervene before crisis point is reached (Barker, 2009). The outcomes relate to the 1990 United Nations Convention on the Rights of the Child, and are co-dependent. If children are not achieving any of the five outcomes, then the Framework for Assessment of Children in Need is utilised (DoH 2000). This assessment is based on needs in three domains: Developmental Needs, Parenting Capacity and Family and Environmental Factors (Appendix 1) and contributes towards the Common Assessment Framework (CDWC 2009). The CAF is used across agencies to prevent children having to undergo multiple assessments and to aid sharing of information. In practice this does not always work, as a social worker may emphasise a child’s social needs compared to health issues. 30% of looked-after children are placed outside their local authority, which has implications for commissioned health services (Doh2009). This can have a negative effect on wellbeing of children as their needs may not be met due to the lack of joined up services. In practice safeguarding supervision helps to identify children whose wellbeing may be at risk, but cross-county collaboration would help minimise these risks further.

Although looked-after children can achieve all five outcomes on paper, they may not necessarily feel a sense of wellbeing: they may be unhappy, feel different to other children and have upsetting memories (McAuley and Davis 2009, Fleming et al 2005). It has been found that more emphasis may be placed on one outcome depending on an agency’s role, creating a disparity in definitions of wellbeing between agencies. Other criticisms of Every Child Matters are that cultural needs, disability, resilience and emotional health are not taken into account (Chand 2008, Sloper et al 2009). Parton (2006) voices concerns that a low mandatory information sharing threshold could compromise confidentiality. Children leaving care have specific needs when it comes to maintaining their wellbeing, having a lasting effect on their adult lives; care leavers are more likely to be unemployed, to become homeless, to spend time in prison and often have trouble forming stable relationships. One in seven young people leaving care are pregnant or are already mothers. They have to learn how to cope financially (Barnardo’s 2011). A Panorama documentary (BBC 2011) recently showed care leavers struggling with basic living skills. This is supported by what is seen in practice; many foster carers refuse to allow children assist with preparation and cooking of meals, or ironing in case they may burn themselves. It should be raised with the independent reviewing officer that these skills are beneficial, which should then be recommended formally as part of the care plan. Foster carers now attend mandatory training, and are conscious of health and safety regulations. Often they think they are acting for the good of the child or being nurturing, but in reality they are impeding the child’s developing life skills to live independently.

A looked-after child’s statutory annual health assessment is at odds with them living as normal a life as possible – other children do not have an annual medical assessment. Fleming et al (2005) identified a low uptake (56%) and few health issues arising from the assessment, questioning its value. Bundle (2001) found that many health assessments were used as a screening exercise rather than a health promotion opportunity. The feeling in practice is that there is a responsibility by the state to ensure that all health appointments and immunisations are up to date – looked-after children generally have a poor history of routine health check-ups at entry to care. Furthermore Coman and Devaney (2011) believe that a good quality holistic assessment is the only way to achieve a meaningful measurement of outcomes for a child. The health assessment also provides an opportunity to support the child with other aspects of health which affects wellbeing such as personal issues and emotional health – issues which a child may normally go to family members with (Hill and Watkins 2003). Health assessments can be a strain on resources in practice – to provide a good quality assessment an hour should be allowed, with the assessment preferably done in the child’s home to observe interactions in their home environment. It also provides an opportunity to discuss leaving care, and to ascertain whether the young person is receiving appropriate services and support. This may require acting as an advocate for the looked-after child at their review, to ensure there is an adequate service provision. Therefore, practitioners must keep up to date with government policy, best practice, evidence, multi agency working and services available in their area. The tool used to assess emotional wellbeing is the Strengths and Difficulties Questionnaire (Goodman, 1997), however this can cause frustration when problems identified cannot be addressed due to lack of services (Whyte and Campbell 2008). Healthcare professional have a duty of care to ensure that the young person leaving care knows where to go and how to make appointments for different health services.

Models such as Maslow’s Hierarchy of Needs (1943) and Roper,Logan and Tierney’s Activities of Daily Living (2000) form the basis of the adult Single Assessment Process (Department of Health 2002), however when holistically assessing children’s wellbeing the five outcomes of ECM are used, this can create a situation where as little as a day’s difference in age could result the SAP being used rather than ECM to assess a young person’s wellbeing. The transition to adult services would benefit from an additional framework for assessment for young people between 18 and 25. To assess the wellbeing of an 18 year old using the same framework as for a 90 year cannot be in the best interests of the young person. To develop and introduce such a framework would be costly and cumbersome; however as the importance of health promotion is increasingly recognised by the government, it would be worthwhile investigating this further. Studies of young people leaving care show that their health concerns are similar to all young people with the additional stressor of learning to live independently. Local studies identify that young people value approachable healthcare professionals, and would prefer to have specific young person-friendly and accessible clinics (National Children’s Bureau 2008, Stanley 2002 ).

NICE guidelines (2010) recommend that there is an effective and responsive leaving care service for young people in transition between age 16 and 25. A key leaving care worker can help with the transition however the level of support is varied (Goddard and Barrett 2008). To help a child with the transition leaving care social workers, pathway plans, open door placements and other services should be provided (DoH 2001), but for a young person leaving care many of the domains which contribute towards wellbeing such as housing, income, family relationships, stability and safety are in turmoil and wellbeing suffers greatly as a consequence. Some looked-after children become very emotionally withdrawn leading up to their eighteenth birthday, when they will no longer be a child in care and make the transition to adult services. In 2008 the UK Children’s Commissioner’s Report found that children felt pressurised to leave care at sixteen, and recommended that no child leaves care before eighteen. Occasionally foster carers allow the child to stay within the family, however in practice when the financial incentive ends, the child has to leave. Resilience has a significant impact on the wellbeing of a child leaving care, resilience is understood as having the capacity to resist or ‘bounce back’ following adversity and is generally considered to be made up of individual, family and community factors (Glover 2009). Scudder et al (2008) believe that resilient children have belief in their ability to succeed and achieve their personal goals, and that resilience is a dynamic characteristic that can develop over time. Newman and Blackburn (2002) found that children today are less resilient compared to earlier generations, perhaps because of being sheltered from challenging opportunities, however Drapeau et al (2007) state that resilience can be nurtured in children for whom it does not occur naturally. The practitioner should believe in the child’s potential and allow them to set the level of intervention. Ahern et al (2008) suggests referring children with low levels of resilience to services such as CAMHS or peer-support groups. In practice, by addressing one problem at a time enables the child to experience and build upon success, rather than setting a huge unobtainable goal and setting the child up to fail.

Wellbeing is believed to include many factors besides health, emphasising the importance of a good quality holistic assessment and appropriate intervention. There are many additional needs for looked-after children, particularly with emotional health, if they are to achieve wellbeing. They are often poorly prepared for independent living when they leave care, and learning life skills should be emphasised during reviews of children approaching the end of care. Upon leaving care, the transition to adult services can be very traumatic and detrimental to wellbeing for looked-after children. As practitioners we should be encouraging looked-after children to prepare for independence and to take responsibility for their own health. To work towards this goal the statutory child in care health assessment should be an exercise in partnership with the child, rather than a professionally led assessment. For a looked-after child to achieve the same level of wellbeing as other children depends on variables such as resilience, attachment and ongoing support which cannot always be provided by the state. There needs to be more research into factors care leavers consider important for their health and wellbeing, which could inform an interim assessment tool between ECM and the SAP providing enhanced transition services for all children.

In this essay, the social problems I have chosen to write about is Homelessness. I will also be exploring different perspective of Homelessness and the policy responses and the impact it have on the society. The groups I will focus my discussion on are young people and rough sleepers as the evidence indicates that young homeless people experience rough sleeping before securing temporary accommodation.

There are wide ranges of definition Homelessness and it varies from country to country or among different institutions in the same country. According to |Liddiard, M (2001:119) the immediate sense of the term as regularly employed by the mass media and politicians, simplistically equates homelessness with rooflessness or literally sleeping rough on the street. This is can be a straightforward and easy to understand definition but this does not reflect the true scope of the problem so a broader definition of homeless peoples include those lacking permanent residence and living in a range of unsatisfactory housing conditions. They can include those living in temporary hostels, bed and breakfast, night shelters and squatters. However, the legal definition of someone homeless is if they do not have a legal right to occupy accommodation or if their accommodation is unsuitable to live in. They also include families and peoples who do not sleep rough and some are accommodated by friends and family on temporary basis. So from the above definition the social construction of homelessness are not the small amounts of individual that sleep on the street, looking dirty and smells of alcohol and drugs but comprises of all individual who do not have a permanent decent place of accommodation or without a regular dwelling and are on a waiting list or takes housing benefit and in temporary accommodations. (Giddens 2007)

The cause of homelessness varies as many are of the view that homelessness is a result of personal failings and consider if the economy is going on well, there is no excuse to be homeless. Shelter (2007) is of the view that homelessness is cause by a complex interplay between a personaˆ™s individual circumstances and adverse structural factors outside their direct control. Among the individual factors include social exclusion, thus when a person lack of qualification because they did not have access to good education and decent job. Ones misuse of drugs and alcohol which result in lack of personal control, lack of social support and debts especially mortgage or rent arrears. Having mental health problems and getting involved in crime at an early age also contribute to homelessness. Family breakdown and unresolved disputes are a major factor of homelessness as a result of divorce and separation and a greater number of men and women are affected. People from institutional background like having been in care, the armed forces are likely to be affected. Ex-offenders who come out of prison and lose their friend and families can become homeless and the majority from ethnic minority or ex-asylum seekers who have the right to stay but have no accommodation. Structural causes of homelessness are mostly social and economical in nature often outside the control of individual or family concerned. These may include poverty, lack of affordable housing, unemployment and the structure and administration of housing benefit.

According to the shelter (2007) the number of households found to be homeless by local authorities increased 31percent between 1997/98 and 2003/2004. Historically, homelessness had low publicity until the 1966 when the BBC screened Ken Loachaˆ™s film about homelessness Cathy Come Home. This was watch by 12million people and the film alerted the public, the media and the government to the scale of the housing crises and then Shelter was formed. Another policy response was the 1977 Housing (Homeless Persons) Acts was the first measure to place responsibilities on local authorities to rehouse homeless families and individuals permanently. (Liddiard, M .2001) The 1977 legislation had Priority Need which included women with children or pregnant, vulnerable due to age, mental illness, disability, and loss of home by natural disasters. This did not cater for everyone who was homeless and the criteria by which local authorities accepted someone as homeless was complex and restricted. Hence the 1996 section 177 amended to include domestic violence as a priority need but strict eligibility remains (Hill, M: 2000).

Young people were not covered under the existing legislation and the number of young homeless increased. Existing data on youth homelessness has significant limitation; in particular it is only possible to count young people who are in contact with services. According to ONS (2007) it can be estimated that at least 75,000 young people experienced homelessness in the UK in 2006-07. This included 43,075 aged 16-24 of which 8,337 were 16 -17 year old who were accepted as statutorily homeless in the UK and at least 31,000 non-statutorily homeless young people using supporting people services during 2006-2007. The Homelessness Act (2002) changes significantly the way in which homeless in England and Wales is tackled. The priority need categories was extended to includes 16/17 years rather those who social services are responsible for accommodating, care- leavers under the age of 21 who were looked after by social services when they were 16/17 and ex- prisoners, former soldiers and young people leaving care. This act also introduces greater flexibility with regards to social housing allocation giving more people the right to be considered for a council or housing home.

The local authorities had a statutory duty to care for all the homeless people but no extra resources were added. This had a great impact on the number of homeless people who were able to relocate permanently at a given time and especially those under priority need.

Young people experiencing disruption or trauma during childhood who may be from socio-economic background are at increased risk of homelessness. The main trigger for youth homelessness is relationship breakdown usually parents or step-parent. Among the impact of homeless on young people is poor health as they cannot take care of their health being. They lack basic food and shelter to help them grow to become healthy adults and they may suffer from depression. Homelessness can lead to increased levels of non- participation in formal education, training or employment. At times leaving school early without a qualification and a decent job may lead some young people into the misuse of drugs and some have mental health problems.

Another homeless group of concern is the rough sleepers who were in temporary accommodation but some choose to roam the streets, sleeping rough free from the constraints of property and possessions. But a large majority has no such wish at all but they have been pushed over the edge into homelessness by factors beyond their control. Once they find themselves without a permanent dwelling, their lives sometimes deteriorate into a spiral of hardship and deprivation. ( Giddens 2009:503)

The Homelessness Act 2002 extended the definition of the priority need to include new groups of vulnerable people, and requirement that all homeless people receive advice and assistance. In addition, Local Authorities are requires to periodically develop homeless strategies, including an assessment of levels of homelessness and conduct an audit of those sleeping rough. In 1998 there were around 1,850 people sleeping rough on the street of England on any one night. This follows on from the government drive to reduce rough sleeping by two-thirds in 2002. The Rough Sleeper Unit was set up in April 1999 to take the lead on delivering this challenging new target and help thousands of people to escape fro good from the humiliation and misery of life under a blanket in a shop doorway. One of the key principal of the strategy was to understand the cause of rough sleeping, why people end up on the street and what could be done to stop this from happing in the future. The strategy also place the emphasis on encouraging rough sleepers to become active members of the community, to build self esteem and bring on talent as well as helping the individual to become prepared for the life away from the street. Positive result soon follows as reductions in rough sleeping were achieves around the country in December 2001 the target set by the government was met ahead of time.

The target was met amid the controversy about how rough sleepers were counted and concern about the emphasis on street homelessness, which campaigners claimed was only tip of the homelessness iceberg. According to BBC New Magazine, housing minister Grant Shapps believes that the government figures on the count of rough sleeper is low and the system of counting is flawed. He argues that, under previous governmentaˆ™s system, councils with fewer than 10 rough sleepers were not obliged to count them, and that vagrants sitting up in sleeping bags were not counted as homeless. After Mr. Shapps insisted that councils provide estimates, the England wide figure rose to 1,247, this comprised 440 from 70 authorities that count and 807 from 256 authorities that provided estimates. Despite government investment in hostels to accommodate rough sleepers many are on waiting list as resources and financing is limited. Overcrowding, lack of bed space and sharing rooms or limited facilities with others are also identified as a problem especially if you have a partner or a dog, your choices narrow considerably. Although the quality of hostels has improved considerably, hostels are often considered unsafe. Over 57 percent of those who stayed in hostels mentioned problems with other residents, including drug and alcohol use, violence, theft, bulling, noise and arguments. And some are of the view that it is not a place to go if you want to stay clean of drugs. People are under the same legislation and the local authorities are unable to permanently house all in priority need.

In addition to the above, there are certain groups who are excluded from hostels, such as people from the EU and asylum seekers from non-EU countries who are homeless and destitute in the street of the UK. Their entitlement to benefits is restricted until they have lived and worked and paid into the UK system through national Insurance and tax for one year continuously. Such laws bring about social exclusion as street homeless people have reduced access to health care and dental services. They face discrimination and general rejection from other people and may have increased risk to suffering from violence and abuse. The impact of rough sleeping is limited access to education, not being seen as suitable for employment and loss of usual relationship with the mainstream. Most of all, living on the streets is dangerous as rough sleepers die young with the average life expectancy at 42.

Inequalities among the population still remain one factor of homelessness. Privatisation and residualisation of the council housing meant that fewer houses are available for council tenant. This imposes greater long term risks on the former council tenants while also generating considerable costs for the taxpayer. The process also excludes the many tenants who either reject transfer or are not given the choice and therefore exacerbates inequalities. There are 1.4 million unfit home in England as the majority of homeowners are in the private sector. The increase of housing association rents and increases in house prices means most people cannot afford a decent accommodation. Low income families are the most affected as 4 million people receiving housing benefit. ( Quilgars D. et al 2008)

In conclusion, the problem of homelessness has been tackled by the governments over the years through policies and legislation. However, the problem require long term policy solutions such as changes in the benefit system, the building of more affordable homes and ensuring that a wider cross- section of society benefits from the fruits of economic growth. For many people, there is no single event that results in sudden homelessness; instead homelessness is due to a number of unresolved problems outlined above building up over time. The achievement of one government policy on rough sleepers indicates much could be done to reduce the impact of homelessness as the number still rises. Ministers are now focusing on the prevention of rough sleeper and youth homelessness through a new government homelessness strategy.

Supervision is the practice where a counsellor can talk to a professional who is trained to identify any psychological or behavioural changes in the counsellor that could be due to an inability to cope with issues presented by clients. A supervisor is also responsible for challenging practices and procedures, developing improved or different techniques, and informing clients of alternative theories and/or new practices, as well as industry changes. The supportive and educative process of supervision is aimed toward assisting supervisees in the application of counselling theory and techniques to client problems (Bernard & Goodyear, 2009).

Supervision is a usually a regular, formal arrangement for counsellors to discuss their work with someone who is experienced in counselling and supervision. The task is to work together to ensure and develop the efficiency of the counsellor/client relationship, maintain adequate standards of counselling and a method of consultancy to widen the horizons of an experienced practitioner (ACA, 2009).

Aim of Supervision

Generally, supervision has two primary goals: to monitor client care and ensure clients are receiving appropriate therapeutic counselling, and to enhance professional functioning (Bernard & Goodyear, 2009).

Supervision provides benefits for counsellors such as support, an opportunity to discover new ideas and strategies, as well as personal and professional development. Another benefit in addition to counsellor support and development is learning across the professional lifespan of counsellors – life long learning (Borders & Usher, 1992).

The intention of supervision is to provide a means of support, and ongoing learning and professional development for counsellors who frequently work with difficult and stressful cases. This serves to prevent excess stress and burnout (Haynes, Corey, & Moulton, 2003).

The educational and encouraging role of the supervisor focuses on creating a secure setting where the supervisee can reflect on their work, get feedback, direction, reassess their capabilities and gain greater understanding about their work, clients and themselves with the aim of protecting the client and offering best possible counselling practices (Powell, 1993).

In order to promote counsellor development supervision needs to take place in a safe and appropriate environment. To achieve this, as in a counselling session, empathy, openness, and positive regard are essential (Egan, 2007). Both parties must also trust in the integrity and honesty of the other.

An ethical framework is necessary to promote this trust, and there should be an appreciation of the importance of the supervision process, which reduces the pressure on the counsellor to produce an outcome at the cost of the process and the working relationship.

The ethical principals of counselling are intended as a guide and framework for the responsibilities of counsellors: showing consideration for the trust of participants, respecting their independence, committing to the promotion of the well-being of all participants and at a minium, to do no harm, to respect each individual and treat everyone justly and without bias, and seeking professional development (Egan, 2007).

The obligation to work ethically will improve provision and the reception of services, and allow opportunities for development for both parties to take place. The supervisor has a responsibility to ensure that confidentiality is maintained, and any information obtained in a clinical or consulting relationship is discussed only for professional purposes and only with persons clearly concerned with the case (ACA, 2009).

Different ways of evaluating the supervisory process can be important both for the supervisor and the supervisee. Establishing a contract for the supervisory relationship makes evaluation easier. The contract should include the student’s developmental needs, the supervisor’s competencies, and supervisory goals and methods (Stoltenberg & Delworth, 1987). Ground rules set up at the start are important to clarify the expectations of the supervisor as well as the supervisee, and that the responsibility for success of the process rests with both parties. As part of the contract it is important to discuss what can and can’t stay confidential. Throughout the supervision process, the supervisor is responsible for evaluating the quality of the supervisory relationship (Powell, 1993).

Occasionally things happen between a supervisor and supervisee that has nothing to do with the individuals themselves, but with what and who the person reminds them of. Feelings can be transferred from other associations onto the supervisor. Also the feelings a supervisor may experiences towards a supervisee can be linked to experiences and associations in the past. In order to ensure the safety of both parties the practitioners must subscribe to a set code of practice and ethics (Powell, 1993).

Personal Experience

My personal experience of supervision has for the most part been very general, discussing casework and looking for feedback, ideas and strategies, and wide-ranging discussions concerning my personal experiences. My practicum has involved spending three hours a week at a local men’s hostel, with some time set aside for discussion, coffee, and exchange of ideas. This time has been most helpful in dealing with feelings of frustration that arise, that can be very challenging for me and could present difficulties if not addressed. The assistance can come in the form of a reminder that it is not really about me, that change cannot be forced from the outside, or just a comment that things move slowly, and a positive outcome may take years.

Unfortunately, there are few unique cases at the hostel, even if these cases are challenging and complex. Many of the individuals in residence present with dual diagnosis, and are well known to staff. There are no quick fixes or easy solutions, and staff cannot indulge in irritation or frustration over lack of resolutions. Sometimes, there will be no resolution or positive outcome. One resident was feeling very positive and looking forward to work one week, but was unable to return in subsequent weeks due to drug and alcohol use. I still that he will be able to return at a later date.

It is also very distressing to see such young people with permanent impairment from drug and alcohol use, and realise that no amount of counselling or medical treatment will be able to provide them with a standard type of existence. Supervision can be used as a place to debrief, to share experiences, and brainstorm alternatives. It can be very reassuring to have someone to fall back on, and gain support from, in challenging or complex situations. I find it very useful to be able to talk things through, and then come to an individual understanding and acceptance of any given situation.

Seeking a second opinion, background information on a resident and discussing approaches seems to make up most of supervision time, and some other functions of supervision have also happened more informally, over a cup of coffee in the staff room, particularly in relation to future employment.

Unsurprisingly, as graduation draws nearer, it is also the career development aspect of supervision that has taken up a great deal of my thoughts – where to go next, what sort of work would I best be suited to, what type of educational opportunities do I see coming up. This has for me been very valuable, as I can seek advice and tips from people in the field, and get a genuine appreciation for what it means to work in this field.

Overall, I think it is generally expected, and helpful, for those who receive supervision to do some preparation before starting supervision, and to build up an awareness of what the supervision is to achieve. Not to consider it an obligation but as an opportunity to develop as a more effective counsellor

Reviewing and reflecting on casework is a good way to think through what has happened in the past week, and where it will take us. Preparation can also help with bringing concerns and questions to ask supervisor, with seeking confirmation and clarification, and start the thought processes about what I need from the supervisor.

Evaluation

Fundamental to developmental models of supervision is the theory that as people and counsellors we are continuously growing and maturing; like all people we develop over time, and this development and is a process with stages or phases that are predictable. In general, developmental models of supervision define progressive stages of supervisee development from novice to expert, each stage consisting of discrete characteristics and skills (Bradley & Ladany, 2000).

Stoltenberg and Delworth (1987) depict a developmental model with three levels: beginning, intermediate, and advanced. In each level a counsellor may begin in an imitative way and move toward a more competent, self-assured and self-reliant state for each level. Beginning supervisees would find themselves relatively dependent on the supervisor to understand or explain client behaviours and mind-sets and establish plans for intervention. Intermediate supervisees would depend on supervisors for an understanding of more complex clients, but would be irritated at suggestions about more simple cases. Resistance is characteristic of this stage, because the supervisee’s sense of self cab feel easily threatened. Advanced supervisees function independently, seek consultation when appropriate, and feel responsible for their own choices.

For example, at my current beginner stage, I am expected to have limited skills and lack confidence as a counsellor, as I am only starting out as a trainee. With more time on the job, I should develop more skills and confidence, and perhaps conflicting feelings about perceived independence/dependence on my supervisor. In a later developmental stage, I would be expected to show high level communication abilities, good problem-solving skills and be reflective about the counselling and supervisory process (Haynes, Corey, & Moulton, 2003).

An awareness of these development stages can be very comforting, as I am not expected to be perfect on the first day on the job, or know everything about the field immediately. Rather, the expectation is that I have a capacity to learn, grow and improve, and each day be a little bit better.

Supervision and professional development is important as it assists in the maintenance and improvement of my standard of practice. It can incorporate self directed and assisted learning, on the job training and coaching, include education through case discussions and presentations, and learning from our successes and mistakes (Powell, 1993).

It is very encouraging to know that supervision can be something in addition to just making things clearer or providing a fresh approach to casework. Something more than focus and insight from a third party, or a sign that I am on the right track, or the opportunity to vent my frustrations concerning clients.

In counselling, it has been put forward that supervision be entrenched into a broader discussion of lifelong learning, where supervision is viewed as one of a range of support and learning tools that counsellors may be encouraged to access (McMahon and Patton, 20002).

Lifelong learning is being seen as essential for everyone, and, just as supervision in focused on preventing burn out and promoting personal development, lifelong learning is also primarily focused on sustaining longevity and endurance within working life (Holmes, 2002).

Learning is the process of “individuals constructing and transforming experience into knowledge, skills, attitudes, values, beliefs, emotions” (Holmes, 2002), all of which are also sought after outcomes of supervision, and of practical use in counselling.

Supervision encourages counsellors to reflect on their knowledge, skills, values and beliefs in order to bring to supervision an account of their experience, and through supervision transform it in such a way that it is significant and substantial, and able to be transferred into their work and personal learning (McMahon and Patton, 20002).

Assisting and promoting the supervisee’s learning and professional development is primarily a matter of providing appropriate teaching and learning environments (Stoltenberg & Delworth, 1987) and may involve the supervisor in providing students with opportunities to reflect on their values and to examine the influence of such values in the counsellor’s work with clients.

The aim is to take full advantage of and recognise growth needed for the future, continuously identifying new areas of growth in a life-long learning process (McMahon and Patton, 20002).

Conclusion

Administrative supervision is something I am very familiar with after working in the public service for a dozen years. More often as peer supervision due to availability of personnel and cost, but also group and one-on-one supervision applied to different kinds of tasks. It was an activity that I found very helpful for my work, as it allowed me to be more efficient, effective, provide a more professional output, and to promote information sharing concerning best practice, improvements and innovations.

This kind of supervision was strictly impersonal, and all about work. Unfortunately, there was little attention paid to the workers, and their well being, growth and development.

Counselling supervision, on the other hand, has an extra dimension that is not considered when dealing with purely administrative matters. It takes a more holistic view of helping others, and acknowledges that we cannot help others unless we also help ourselves. Counselling supervision acknowledges that the counsellor is a part of the dialogue, and cannot be removed from the equation, and so takes steps to limit harm for all parties, to ensure that prejudices or preconceptions of the counsellor do not impact on any therapeutic relationship. Counselling supervision takes it that extra step to look at supporting the counsellor in their work, and in their development.

Egan focuses very well on this when he looks at a certain level of self-knowledge, self-awareness and maturity as an essential requirement to being an effective counsellor (Egan, 2007). Supervision provides a space where counsellors can acknowledge and challenge any blind spots, overcome biases and become better counsellors.

An appropriate supervisory relationship can help broaden therapeutic skills. It can be used to develop interventions and provide insights for assessments. Supervision can be used to focus on relational issues in order to cultivate patient/client resources, and to build up and support a counsellor’s own therapeutic influence. Supervision should enable counsellors to acquire new professional and personal insights through their own experiences.