Category: Free Essays

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.

The National Institute for Occupational Safety and Health (NIOSH) defines workplace violence as violent acts directed toward persons at work or on duty. Workplace violence is any physical assault, threatening behavior, or verbal abuse occurring in the work setting. A work setting is defined as any location, either permanent or temporary, where an employee performs work-related duties. This comprises, but is not limited to, the buildings and surrounding perimeters, including the parking lots, field locations, clients’ homes, and traveling to and from work assignments. (Anderson, D. 2008).

Workplace violence ranges mostly, from unpleasant or threatening language to homicide. Elements of workplace violence includes beatings, stabbings, suicides, shootings, rapes, psychological traumas, threats or obscene phone calls, fear, irritation of any kind, as well as being confirmed at, shouted at, or followed. Nurses are at the most risk of workplace violence among health care providers .Violence inflicted on employees may come from many sources external parties such as robbers or muggers and internal parties such as coworkers and patients.( Boldt, A., & Schmidt, R. 2006) There are many risk factor of work violence which affecting in nursing in this essay will discuss type of violence and how to prevent the violence in work place.

The reasons for workplace violence and stress are identified at organizational, societal and individual levels, showing complex interrelationships. The accumulation of stress and tension in demanding health occupations aa‚¬” under strain from societal problems and the pressure of health system reforms aa‚¬” contribute to emerging violence. At an individual level, health workers tend to rank the personality of patients as the leading factor generating violence, followed by the social and economic situation in the country and, well behind, work organization and working conditions. (Duxbury, J. 2009). However, when categorized into individual, societal and organizational factors, all three contributing factors appear to be of equal importance in the analysis of risks of violence and stress, with organizational factors playing a key role.

Examples of violence in the workplace include the following: Verbal threats to inflict bodily harm, including vague or covert threats Attempting to cause physical harm: striking, pushing and other aggressive physical acts against another person Disorderly conduct, such as shouting, throwing or pushing objects, punching walls, and slamming doors Verbal harassment; abusive or offensive language, gestures or other discourteous conduct towards supervisors or fellow employees Making false, malicious or unfounded statements against coworkers, supervisors, or subordinates which tend to damage their reputations or undermine their authority (Contrera- L., & Moreno, M. 2004).

Type of violence affecting in nursing:

Nursing to nursing which nurse are often the first line of victims. This act of violence can include spousal abuse and child and elderly abuse. Other to nurse which violence toward health care professional is extensive, and nurse are frequency the victims. The perpetrators can include patient. Patient families and other health care worker. Nurse to nurse who is difficult for nurses to discuss violence against other nurse.horizantal aggression is define as aggressive behavior that one registered nurse commits against another in the work place.( Duxbury, J. 2009). The aggressive behavior may be verbal. Non verbal or physical. It may be expressed directly toward another person or indirectly toward their property or work. The behavior can be expressed openly or in more subtle manner. Other type is nurse to other: violence includes patient abuse and neglect with nurse as aggressor.

CATEGORIES OF WORKPLACE VIOLENCE

Workplace violence has many sources. To better understand its causes and possible solutions, researchers have divided it into four categories dependent upon the type of perpetrator like person committing the violence. The four types are: violence by strangers, violence by customers or clients, violence by co-workers, and violence by someone in a personal relationship( Felblinger, D. 2008).

Type I: Violence by a Stranger: In this type of workplace violence the perpetrator is a stranger and has no legitimate relationship to the organization or its employees. Typically, a crime is being committed in conjunction with the violence. The primary motive is usually robbery but it could also be shoplifting or criminal trespassing. A deadly weapon is often involved, increasing the risk of fatal injury.

Type I is the most common source of worker homicide. Eighty-five percent of all workplace homicides fall into this category

Workers who are at higher risk for Type I violence are those who exchange cash with customers as part of the job, work late night hours, and/or work alone. Convenience store clerks, taxi drivers, and security guards are all examples of the kinds of workers who are at increased risk for Type I workplace violence.( Gates, D., Fitzwater, E.etal. 2004)

Type II: Violence by a Customer or Client: In Type II incidents, the perpetrator has a legitimate relationship with the organization by being the recipient or object of services provided by the workplace or the victim. This category includes customers, clients, patients, students, and inmates. The violence can be committed in the workplace or, as with service providers; outside the workplace but while the worker is performing a job-related function. (Hughes, H. 2008).

Violence of this kind is divided into two categories. One category involves people who may be inherently violent, such as prison inmates, mental-health service recipients, or other client populations. Attacks from “unwilling” clients, such as prison inmates on guards or crime suspects on police officers, are examples of this type of workplace violence. The risk of violence to some workers in this category may be constant or even routine.

The other category involves people who are not known to be inherently violent, but are situation ally violent. Something in the situation induces an otherwise nonviolent client or customer to become violent. Provoking situations may be those that are frustrating to the client or customer, such as denial of needed or desired services or delays in receiving such services. (Hegney, D., Tuckett, A., Parker, D., & Eley, R. 2010).

Service providers, including healthcare workers, schoolteachers, social workers, and bus and train operators, are among the most common targets of type II violence. A large proportion of customer/client incidents occur in the healthcare industry, in settings such as nursing homes, hospitals, or psychiatric facilities. (Woodtli, M., & Breslin, E. 2006).

Type III: Violence by a Co-Worker, Type III violence occurs when an employee or past employee attacks or threatens co-workers. This category includes violence by employees, supervisors, managers, and owners. In some cases, these incidents can take place after a series of increasingly hostile behaviors from the perpetrator. The motivating factor is often one, or a series of, interpersonal or work-related disputes. The perpetrator may be seeking revenge for what is perceived as unfair treatment. (Hughes, H. 2008)

Type IV: Violence by Someone in a Personal Relationship, In Type IV workplace violence, the perpetrator usually has or has had a personal relationship with the intended victim and does not have a legitimate relationship with the workplace. The incident may involve a current or former spouse, lover, relative, friend, or acquaintance. The perpetrator is motivated by perceived difficulties in the relationship or by psychosocial factors that are specific to the situation and enters the workplace to harass, threaten, injure, or kill. Victims of type IV violence are devastatingly, but not exclusively, female.( Opie, T., Lenthall, S., etal 2010)

This type of violence is often the spillover of domestic violence into the workplace. In some cases, a domestic violence situation can arise between individuals in the same workplace. These situations can have a substantial effect on the work environment. They can visible as high absenteeism and low productivity on the part of a worker who is enduring abuse or threats, or the sudden, prolonged absence of an employee fleeing abuse. (Woodtli, M., & Breslin, E. 2006).

RISK FACTORS

Healthcare and social service workers face an increased risk of work-related assaults stemming from several factors. These include:

The prevalence of handguns and other weapons among patients, their families, and friends The increasing use of hospitals by police and the criminal justice system for criminal holds and the care of acutely disturbed, violent individuals The increasing number of acute and chronic mentally ill patients being released from hospitals without follow-up care (these patients have the right to refuse medicine and can no longer be hospitalized involuntarily unless they pose an immediate threat to themselves or others) The availability of drugs or money at hospitals, clinics, and pharmacies, making them likely robbery targets Factors such as the unrestricted movement of the public in clinics and hospitals and long waits in emergency or clinic areas that lead to client frustration over an inability to obtain needed services promptly (Lisboa, M., de Moura, F., & Reis, L. 2006). The increasing presence of gang members, drug or alcohol abusers, trauma patients, or distraught family members Low staffing levels during times of increased activity such as mealtimes, visiting times, and when staff are transporting patients Isolated work with clients during examinations or treatment Solo work, often in remote locations, with no backup or way to get assistance like , communication devices or alarm systems, this is particularly true in high-crime settings Lack of staff training in recognizing and managing hostile and high-risk behavior as it escalates Poorly lit parking areas. (Nelson, H., & Cox, D. 2004)

WORKPLACE VIOLENCE PREVENTION PROGRAM

A workplace violence prevention program demonstrates an organization’s concern for employee emotional and physical safety and health. The program encompasses the following elements: Management commitment and a system of accountability Employee involvement Worksite analysis Hazard prevention and control Training and education, Recordkeeping and evaluation of the program

The first two elements, management commitment and employee involvement, are complementary and essential to a successful workplace violence prevention program. Management commitment provides the motivating force for dealing effectively with workplace violence. (Whitley, G., Jacobson, G., & Gawrys, M. 2007). Employee involvement enables workers to develop and express their commitment to safety and health. Employee involvement should include:

Understanding and complying with the workplace violence prevent program and other safety and security measures Participating in employee complaint or suggestion procedures covering safety and security concerns Reporting violent incidents promptly and accurately Participating in safety and health committees or teams that receive reports of violent incidents or security problems, make facility inspections and respond with recommendations for corrective strategies Taking part in a continuing education program that covers techniques to recognize escalating agitation, high risk behavior or criminal intent and discusses appropriate responses A key element of the workplace violence prevention program is the threat assessment team, or safety committee. (Whitley, G., Jacobson, G., & Gawrys, M. 2007). The primary function of the team is to provide a thorough workplace security/hazard analysis and establish prevention strategies. An effective team will assess the organization’s vulnerability to workplace violence, make recommendations for preventive actions, develop employee training programs in violence prevention, establish a plan for responding to acts of violence, and evaluate the overall workplace violence prevention program on a regular basis (Stanley, K. 2010).

Violence in the healthcare workplace threatens the delivery of effective, quality care and violates individual rights to personal dignity and integrity. Assaults on nurses and other healthcare workers occur in all areas of practice and constitute a serious hazard. Current literature suggests that to ensure a safe and respectful workplace environment, mandatory protections must be provided such as zero-tolerance policies against violence in the workplace, as well as comprehensive prevention programs, reporting mechanisms and disciplinary policies. (Woodtli, M., & Breslin, E. 2006). Under occupational health and safety laws, all health care facilities are required to have in place strategies to proactively, prevent and manage occupational violence. An occupational health and safety risk management framework, consistent with, occupational health and safety legislation, Work Safe guidelines and contemporary knowledge, will assist health care facilities, to achieve legislative compliance. (Nelson, H., & Cox, D. 2004). Violence and Abuse Prevention Task Force members that

A Workplace Violence Prevention Program is one step in the process of protecting nurses and other, healthcare workers from violence and abuse. Violence and Abuse Prevention Programs must be supportive, to workers and avoid blame and retaliation. Further recommends that violence aftercare. Plans identify a debriefing process that includes all workers impacted by a violent incident whether, or not they were personally involved in the incident. (Hughes, H. 2008).

There are two terms of poverty ‘absolute’ and ‘relative’. Absolute refers to the amount of basics that we need to survive and relative is the standards of living in a society at any particular time (Kelly & McKendrick 2007). This essay aims to discuss the impact of poverty on community and social care, the influences it has on health across the lifespan, the relevance to nursing practice, services available to address the problem and local policies on poverty.

Poverty is when a household income (adjusted for the size and make-up of the household) is less than 60% of the UK average income. The circumstances that cause poverty are wide-ranging and include many day-to-day things including health, housing, education, employment and access to services (The Scottish Government 2010).

There has been a steady growth of child poverty in Scotland and in the UK in the last few years. Accordingly households in Scotland where income is lower than most can be considered to be living in poverty (Kelly & McKendrick 2007).

The Government wants to provide children and young people with the best start in life. The Government’s pledge in 1999 to end child poverty by 2020 has already led to 600,000 fewer children in poverty in the UK. Although progress has been made, 2.9 million children still remain in poverty. With the introduction of The Child Poverty Bill in 2009 the Government will be answerable to Parliament on the progress of this Bill (DCSF 2009).

Poverty is not only happening in this country but all over the world. A report out by a leading charity has announced that 4 million children are living in poverty and about 1.7 million children are living in severe poverty in the UK – one of the richest countries in the world (Save the Children 2010).

Child poverty restricts children’s involvement to activities and services. While some children will grow up in low income households and go on to achieve their goals many will not. Poverty places stress on family life and excludes children from everyday activities which other children take for granted (David Piachaud 2005).

The barriers which Lone parents face when they try to move from benefits to work can be that Employers are often reluctant to employ them; which means that lone parents worry about combining work with their childcare responsibilities. Financial stability is crucial, but it is often hard to achieve. Some lone parents working into low-paid jobs find they are simply worse off in work than living on benefits. Citizens Advice argues that adequate support for parents lies in breaking down the barriers to going back to work, the re-organising of the tax and welfare systems, ensuring appropriate childcare; and for employers to provide more flexible jobs (Citizens Advice 2008).

Adair Turner’s Pension Commission report has set out new policies on pensions. The changes to retirement ages which are set to rise to 66 by the year 2030, 67 by 2040 and 68 at 2050. Turner proposes that the Basic State Pension would increase in line with earnings instead of prices from 2010 bringing a rise in income for pensioners. There would also be a reduction in means-tested benefits such as Pension Credit which the Commission believes act as a deterant to saving.

After some pressure by Help the Aged, among others, Adair Turner has decided that entitlement to pensions should be based on residency instead of contributions from the age of 75, while the complex State Second Pension (S2P) would eventually become a flat-rate extra payment. Turner has also set up a National Pension Savings Scheme (NPSS) which would mean workers would pay 4 per cent of their salary into their pension, alongside additional contributions from the Government and employers (Help the Aged 2010).

There are a number of benefits available to help people on low incomes. These are Jobseekers Allowance, Incapacity Benefit, Severe Disablement Allowance, Disability Living Allowance, Pension Credit and Income Support and from April 2004 Child Tax Credit and Child Benefit.

Income Support is a means tested benefit for people whose income falls below a specified level or who have no other source of income. Welfare payments are an important source of household income in Scotland almost one sixth of household income in Scotland comprises welfare payments and state pensions combined. Therefore making household incomes in Scotland more reliant on welfare benefits than any other parts of the UK (Kelly & McKendrick 2007).

The introduction of a National Minimum Wage (NMW) was a major feature of the Labour Party’s manifesto. Following their election the Government set up an independent Low Pay Commission to recommend the level of the NMW and how it should apply to young people and people in training.

The reasons put forward to support an NMW cover three broad areas; social – a minimum wage would target low pay and poverty; equity – a minimum wage reduces exploitation, protects employers, and cuts the cost to taxpayers of topping up low incomes via the social security system; economic – extra demand in the economy would increase employment; a minimum wage could also boost investment and productivity (CIPD 2009).

Child Trust Fund (CTF) is a savings and investment account for children. Children born on or after 1 September 2002 will receive a ?250 voucher to start their account. The account belongs to the child and can’t be touched until they turn 18, so that children have some money behind them to start their adult life (Child Trust Fund 2010).

A large income gap between the most weathly and the worst off in society is closely associated with higher death rates worldwide, especially for younger adults, finds a study published on bmj.com today as part of a global theme issue on poverty and human development. Studies show that greater income inequality in a nation is associated with higher mortality rates, but most have focused on wealthier nations. However, it has recently been suggested that the effects of income inequality on health are of importance worldwide, not just in wealthy nations. There is also some evidence that this effect is more pronounced at different ages. They confirm that the impact of income inequality on health is real and that it has a greater influence on mortality in wealthier countries between the ages of 15 and 29, and worldwide between the ages of 25 and 39 (BMJ 2007).

If being poor is bad for you, living in a cold home can be lethal. The annual figures published on ‘excess winter deaths’ are the best we have from official sources – however there are no figures which take in the knock-on costs to the NHS of cold-related illnesses, In the last set of figures, covering the winter months of 2004-2005, the number of winter deaths reached nearly 30,000. There are policies in place to help people who are ‘fuel-poor’, but they do not know that they are fuel poor and can access help. This is where community nurses come in. Health professionals are usually welcome visitors in any house and enjoy a degree of trust from the public. People who need help with their fuel poverty needs probably claim it the least. Many are isolated by poor health or their own poverty. Community nurses do not have the time to become experts but helping their clients to benefit from these programmes would help them to feel better. So encouraging older people who may be cold and poor to explore ‘benefit health checks’ could transform their income, warmth and health (Mervyn Kohler 2006).

Someone living in a deprived area is more than twice as likely to have a long term illness compared with someone in a weathly area. People living with a long term illnesses are likely to be more disadvantaged across a range of social factors such as employment, qualifications, home ownership and income. The impact of deprivation can also be seen in terms of mental health and wellbeing, with a recent Scottish survey reporting higher levels of mental wellbeing being associated with those on higher incomes (Scottish Government 2007).

Studies on the impact of temporary unemployment have demonstrated that being out of work is bad for an individual’s health. Those analyses did not control for the economic cycle, however. In a recent study, Strully24 looked at US interview

data taken from 1999, 2001 and 2003 Panel Study of Income Dynamics. People were asked about certain aspects of their employment, their health and a variety of health conditions. Losing your job was associated with a 54% chance of reporting fair or poor health, and for a person with no pre-existing health conditions, the chances of reporting a new one increased by 83% with job loss. Low unemployment is also associated with the reporting of more poor health conditions (S Bezchruka 2009).

The Black Report, published in 1980 stated that although the establishment of the National Health Service the differences between the health of the rich and poor had widened not narrowed, health had improved over all socio-economic groups but had been greater among the educated and wealthy (Oxford Journal).

The Acheson Report, published in 1998, called for an increase in benefit for women of childbearing age, expectant mothers, young children and pensioners and said that many people on low incomes had insufficient money to buy the food and services necessary for good health. It also called for more funding for education in deprived areas; better nutrition at schools; Children should learn about parenting and relationships, and should receive sex education. (Telegraph 2010).

The above reports by Black and Acheson collected information which showed that ill health and disease are socially patterned with the more wealthy groups of society living longer and enjoying better health than deprived groups. Nevertheless health has slowly improved but there is still a great divide between socioeconomic groups and their health status (Naidoo & Wills 2009).

The Index of Multiple Deprivation 2007. There are seven measurements of deprivation these include income, employment, health and disability, skills and training, education, housing, living environment and crime. There are also six district summary scores for each Local Authority district (there are 354 districts in England) and for each County Council and higher tier (there are 149 of these). A relative ranking of areas, according to their level of deprivation is then provided. There are also supplementary Indices measuring income deprivation amongst children and older people: the Income Deprivation Affecting Children Index (IDACI) and the Income Deprivation Affecting Older People Index (IDAOPI) (Communities.gov 2007).

In conclusion although the Government’s pledge to eradicate child poverty by 2020 is underway there is still a great deal to consider in order to help both young and old people.

Empowerment can be defined in general as the capacity of individuals, groups and/or communities gain control of their circumstances and achieve their own goals, thereby being able to work towards helping themselves and others to maximise the quality of their lives. In health and social care empowerment means patients, carers and service users exercising choice and taking control of their lives. It is not that one is empowered means he or she become all powerful like God. Even if we are empowered still we have limitation. Actual meaning of empowerment is that one feels that he or she able and feels powerful enough in certain situations to take part in decision making. I also will explain how politics played a part in disempowering women in health and social care services. It is a greatest challenge in health and social care to achieve progress with the empowerment of carers and people who receive services.

Beginnings of twentieth century women were disempowered because of politics played a part. Emancipation is a commonly used word in other western European countries to refer to what in the UK mean by empowerment. The word emancipation has is useful because it has overtones of the struggle for votes for women in Britain at the beginning of the twentieth century, so it reminds us that empowerment in the health and social services has a political aspect. When carers and people who use services experience being disempowered and excluded, this is a form of political disenfranchisement. In other words, it is as though they have no vote and are not treated as full members of society. In contrast, when people become empowered, they can exercise choices and have the possibility of maximising their potential and living full and active lives.

There is a tension between enabling people to take control of their lives and recognising that workers may need to intervene and take control sometimes, in order to protect other people. This applies to both empowerment and advocacy.

Empowerment for people with learning disabilities is the process by which they develop increased skills to take control of their lives. This will help them achieve goals and aspirations, maximising their quality of life.

A key feature in empowering people is giving them a voice and actively listening to what they have to say. Empowerment is, therefore, closely linked to the concept of advocacy.

Empowerment in learning disability can be described as a social process, whereby people who are considered as belonging to a stigmatised social group can be assisted to develop increased skills to take control of their lives. This increased control will help them to achieve their goals and aspirations and thus potentially maximise the quality of their lives. The concept has connections with assertiveness and independence and is clearly linked to the various forms of advocacy.

When considering the current climate it is somewhat an indictment on our times that the Government sees the need to name the White Paper regarding its vision for learning disability services as ‘Valuing People’. The title alone inversely suggests that as a society we are ‘not valuing people’. The content presents the evidence on levels of exclusion, disempowerment and lack of valued social roles facing those with a learning disability and how services should be planned to address this. (A similar Scottish Executive Review of Learning Disability has the title ‘The Same As You’.)

For the individual with a learning disability, the subjective experience of empowerment is about rights, choice and control which can lead them to a more autonomous lifestyle. For the professional, it is about anti-oppressive practice, balancing rights and responsibilities and supporting choice and empowerment whilst maintaining safe and ethical practice.

Education is often seen as the main engine of empowerment, equality and rights of access. Thus, as a group, people with a learning disability can be at a particular disadvantage. They may have to be enabled and supported to perhaps overcome social obstacles and can be dependent on others to make important information accessible to them, assist them with advocacy and help safeguard their rights.

A key feature in empowering individuals is giving them a voice and then listening actively to what they have got to say. Person Centred Planning with its focus on placing the individual at the centre of the process and using techniques to obtain meaningful participation can be a major contribution to finding out what people have got to say. Empowerment will bring along with it rights and responsibilities plus also potential risks for people. It is often the fear of physical risk which can inhibit empowerment processes for people who see themselves as responsible for vulnerable people. They may fear a blame culture if things go wrong. Surprisingly, as recently as 1998, the Social Services Inspectorate noted there were no systematic approaches for risk assessment and management in the field of learning disability.

The Foundation for People with a Learning Disability set out to identify good practice in how to reconcile the tension between ensuring the safety of an individual with a learning disability and empowering them to enjoy a full life in the community. A report was produced called Empowerment and Protection (Alaszewski et al, 1999) which suggested that organisations needed to develop risk policies which embrace both protection and empowerment issues at the same point. The definition of risk should look at consequences and probability. Procedures should also include, from the start, the wishes and needs of the person who has the learning disability and involve them throughout, including the decision making stage.

Such comments about organisations developing appropriate risk strategies show that empowerment is not there just as a concept for front line staff, but should penetrate the strategic planning levels. ‘Valuing People’ states (Section 4.27) that people with a learning disability should be consulted for their views on services and these views utilised at a corporate planning level.

In Mrs Ali case she is empowered by Muslim religious faith to take of her bed-bound husband although in contrast her care taker Jean believes that Mrs Ali should be empowered. This indicates religion also empower some people to take care vulnerable people.

We live in a culture where families are challenged with problems all the time. Regardless of what the problems may be, families need help developing skills to communicate effectively and strengthen their relationships. While most individual can recognize that their families need help, they frequently are not adequately prepared to help their families make needed changes. Obtaining a Masters of Arts in Family and Consumers Science- Family Studies Concentration will help me to help others prepare for change and ultimately achieve both my short-term and long-term goals.

In the short term, I hope to work my way up to become the Lead Housing Resource Specialist at Community Rebuilders. Currently, I’m a Housing Resource Specialist. This experience has created a passion in me to work in the family studies field and learn more about it. A key component that I have found common among all of my clients is that they all wish they could have been prepared for their problems. That tells me that if my clients had prevention methods in place, their problems may not have been a major problem to begin with. Family Life Education works from the prevention model because it teaches individuals and families how to improve family life and to prevent problems before they occur. Family problems, when they can be addressed through prevention, are less damaging for people and less expensive for society.

My long term goal is to help educate families as an Executive Director of a non-profit agency. While studying for the Masters program, I hope to develop the education and skill-set in order to reach my goals. I want to become an effective and innovative professional who can provide effective education and prevention services for families through services my agency can provide. I want to become an individual of high moral and ethical standards whose agency can function as a change agent in my community.

Studying for the Masters of Arts in Family and Consumer Science- Family Life Education is a wonderful opportunity because I will be able to learn the different parts of the family and learn to see how they function as a whole. The Fundamentals courses should give me the framework, while the advanced courses will provide a more specific training. During study, I will also look to take an internship and/or supplemental classes to help further my experience. It is the ability to understand the many different aspects of the family that will prepare me to accomplish my long-term goal of becoming an Executive Director. Equally important, I hope to learn from my fellow students and share with them some of the lessons I have gained from my experience. The best lesson I have learned while working at Community Rebuilders is to step out of the box and think of new solutions to old problems. These creative moments are what will move a family forward during hard times. I expect that graduate work at Western Michigan University will be demanding, challenging, and exciting, and I look forward to attending. During my time in graduate school, I expect to receive the opportunity to learn, grow, and evolve as a person and a family life educator. I am prepared and look forward to investing myself, my time, and my energy toward earning that degree. I hope I will be allowed to do so at WMU.

TOMARA L. MITCHELL
____________________________________________________________________________________

3841 Yorkland Drive NW Apt. No. 9

Comstock Park, MI 49321

(616)337-1852

[email protected]

Profile

Seeking a position which will enable me to utilize interpersonal and leadership skills to positively impact social issues affecting families. Interact effectively with people of varying cultures, backgrounds and professional levels. Committed to establishing connection and building strong relationships with all people. Skilled at identifying strengths and weaknesses in strategies and in creating compassionate and non-judgmental solutions to problems. Proven to be highly motivated and hard working. Possess excellent time management skills.

Education

Bachelor’s Degree in Sociology/General University Studies- April 2009

Western Michigan University, Kalamazoo, MI

Minor: Social Work

Related Coursework:

Crises and Resilience in Families

Social Work Services and Professional Roles

Social Welfare as a Social Institution

Intro to Culture, Ethnicity, and Institutionalized Inequality in Social Work Practice

Social Work Research Methods

Human Behavior and the Social Environment

Group Community and Organizational Behavior

Child Psychology

Global Ecology of the Family

Employment Experience

Community Rebuilders, Grand Rapids, MI February 2010 -Present

Housing Resource Specialist

Operate assigned rapid re-housing and prevention programs

Assist participants in locating and securing housing of their choice

Assist participants in development of strength-based goal and action plans that promotes permanent housing

Provide counseling and advocacy to participants

Facilitate and coordinate supportive service activities for participants

Serve as an ongoing liaison between property managers and participants

Hope Network, Grand Rapids, MI October 2009 – March 2010

Community Living Support

Provided direct supervision to individuals in residential programs.

Displayed appropriate behavior and teaches life skills to residents.

Provided evaluation and instruction in areas of daily living skills or independent living skills to enhance the residents’ ability to reach his/her highest level of independence.

Muskegon Heights Public Schools, Muskegon Heights, MI, September 2009 – February 2010

On-Call Substitute Teacher

Followed lesson plans, left by the permanent teacher.

Created and maintained a climate of respect and fairness for all students.

Used classroom instructional time appropriately and wisely

Tax Connection Worldwide, Muskegon, MI, January 2009 – March 2009

Seasonal Tax Preparer

Prepared customers federal and state returns

Provided customer service by quickly and effectively processing transactions to ensure return business and customer satisfaction

Answered multi-line phones, greeted customers and performed light clerical work

MOKA Inc., Grand Haven, MI, July 2006 – January 2008

Resident Support Staff

Supporting small groups of developmentally disabled and/or mentally ill individuals in residential setting

Teaching skills with the goal of independent living.

Heritage Community, Kalamazoo, MI, September 2005 – December 2005

Personal Care Assistant

Provided comprehensive, quality patient care in the area’s top retirement community

Used acquired formal knowledge and skills

Represent the concerns of the resident and their family

Collaborate with team members towards the development and achievement of optimal resident goals.

Family and Children Services, Kalamazoo, MI, February 2005 – July 2005

Respite Care Worker

Managed small group home-like setting for children 4 – 17 with severe emotional and/or developmental disabilities

Served as role model, encouraged and supported personal behavioral growth and helped develop professional and life skills

Maintained healthy environment, inventoried and ordered supplies, and complied with local and state regulations

Lowe’s Home Improvement, Portage, MI, July 2003 – December 2004

Customer Service Representative

Provided customer service by quickly and effectively processing transactions to ensure return business and customer satisfaction

Informed customers of new items and promotions that were available to improve the customer shopping experience

Completed paperwork, handled cash, answered phones, and transferred calls when needed.

Muskegon Heights Public, Muskegon Hts., MI, September 2001 – July 2002

Office Assistant/ Summer Program Tutor

Answered multi-line phones, greeted customers and performed light clerical work

Acquired high level of communication skills and learned to quickly assess and expedite customer needs.

Ran tutoring sessions on daily basis for elementary aged kids during summer school program

Graded work weekly and tracked individual progress

This report will highlight the issue on discrimination against elderly people in countries such as Singapore, America and United Kingdom (UK). Similarly, all three countries face employment discrimination but there were slight improvements in UK. Situation of discrimination against elderly is considered to be the worse in America because they are also denied of opportunities to seek health care. The importance, impact of social discrimination and measures taken at the company and national level to combat this discrimination are also discussed.

Section 2- The issues and who are involved

Singapore is rapidly facing ageing population where the proportion of residents aged 65 and above contributes to 14% of the resident population in 1998 and this will increase to 27% in 2015. An increase in life expectancy has led to the increase in proportion of elderly people. Other reasons were due to the ageing of the baby boomers, decrease in infant and early childhood mortality rate and low birth rates.

In today’s society, our perception of elderly people is often that of dependency, slow and disregarded. Misconceptions arise about ageing, leading to stereotyping and social discrimination. A common stereotype states that most elderly people are ill. When elderly people are unsure of themselves, they are considered to be senile and they are also accused of being old when they forgot a sentence.

The older generation have worked hard and they deserve to be respected by the society. With more and more people becoming old, it is important to pay attention to these legal issues surrounding the older generation. It is necessary to confront such concerns now so that we can look forward in enjoying our old age in the future. Addressing the problem of discrimination in Singapore is therefore vital in further developing and building up our nation. By undertaking these suggestions, we can then hope towards a better future for Singapore, one free from discrimination. Therefore, it is necessary that companies and individuals change their mindset and be more supportive towards the older generation.

Discrimination of elderly people is prevalent in the workplace in Singapore. Age discrimination occurs when older worker is discriminated against by an employer because of their age. A recent survey by Kelly Services discovered that majority of the 1,500 respondents polled in Singapore, experienced some type of prejudice when applying for a job in the last five years and the main reason for discrimination, which contributed to 29 percent, was age. Older adults are often viewed negatively such as having high wage expectations because of their experiences, lacking new skills and unable to meet the physical demands of the job.

Majority of the older workers did not complete their secondary education due to limited educational opportunities. Hence, they have a lower skilled job. As firms seek higher productivity, with current jobs being automated and improvised, it results in multiple and higher skills requirements. This eventually leads to older workers, with low education and holding unskilled jobs, being retrenched.

Even if low skilled jobs are available, older workers still face competition from younger and cheaper foreign workers. Many companies are biased against older workers and still prefer to hire younger employees. Such discrimination fails to tap fully the older workers’ contributions.

In addition, high cost of hiring older workers and perception among employers that they are less productive and open to new ideas are some of the common reasons why many firms are less likely to hire them. As such, employers may encourage early retirement or layoff disproportionately older workers. This is usually seen in computer and entertainment industries. As a result, we often see older workers picking up empty cans or selling tissue papers. Other stereotypical old-age occupations that come into mind will be cleaners and servers at fast food restaurants.

Based on Singapore’s laws (with some exceptions), the government cannot take any legal action against employers who choose to discriminate. Individuals also cannot sue employers.

Employment discrimination is also similar in America where there are a large number of aging employees in the workplace (due to the baby boomer generation). Employers engage in age discrimination when they sack or refuse to hire older workers because of ageist stereotypes. However, they have the United States Federal Age Discrimination in Employment Act (ADEA) which prohibits age discrimination. Employers are not allowed to discriminate when hiring and firing employees who are aged 40 or older.

United Kingdom (UK) also faces similar discrimination against the elderly in the workplace as Singapore and America. However, there were improvements these recent years. Employers are positive about retaining older workers as they are seen as a valuable resource. Older workers want to work beyond state pension age and various surveys also show that there is a keen attitude among them for flexible working and flexible pensions. The government also encourages older workers to continue working.

UK employment equality law is effective as it helps to combat prejudice in the workplace as it prohibits discrimination against people based on gender, race, religion and age etc. It is illegal to discriminate against an employee under the age of 65 due to age. In addition, employers who sack workers or deny them training opportunities as their colleagues will break the law. Based on UK’s Office for National Statistics, the number of older workers in UK employment rose by 8.8% from March 2007 to March 2008.

In Singapore, there is not much issue on discrimination against the elderly in terms of health care because we have a universal health care system where both government and private sectors will provide treatment to patients regardless of age.

Unlike Singapore, the elderly in both America and UK are discriminated against when seeking health care because health professionals refuse to meet the elderly needs. When a person reaches the age of 60, health services are based on a person’s age and some have been denied care as a result. Age discrimination is still practiced in all levels of health care but nothing has been done to curb this prejudice against older people. Older people feel like outcasts of society because care is offered to young people regularly.

Another example of discrimination against the elderly people was the incapability of making independent decisions such as living independently. People see this as a negative attitude which is often translated into their ageist actions. However, research has shown that older people value their independence. They want to make their own decisions and have access to information in order to make the best choices in life.

There seems to be a trend for the elderly to live on their own, away from their children. According to Brunk (1998) “it is a decision that is usually forced by a sudden decline in their health or mental abilities, or the realization that they can no longer get the kind of care they need at home or from family caregivers.” This results in family member putting the elderly in the care of caregivers in the elderly homes, thinking that they have provided them the best in terms of basic needs. By doing so, they have unnoticeably discriminated against them by having a perception that they are dependent and a burden.

Section 3- Why is it important for us to talk about it?

Age discrimination has a negative impact on both the economy and society. Discriminating age is harmful to companies because older people are usually full of experiences. By not hiring them, it will result in a big loss of expertise; deprive them of securing a job and not tapping fully on their contributions to the society.

The effect on the economy is also evident in older workers depleting life savings which were needed for retirement. Borrowing money from financial institutions and maxing out credit cards may be the only few solutions for some unemployed people to survive. Medical needs can go unmet and they have to seek help via subsidies to pay for their medication. Depression also rises when people are not being employed as they faced difficulties to make the ends meet.

However, In Singapore, the government has implemented Central Provident Fund (CPF) which gives many working Singaporeans a sense of security and confidence in their old age. CPF also provides them with a retirement income to meet their basic needs when they are old.

In countries such as UK and America, ageism will have an effect on health care providers’ professional training and service delivery. This, in turn, affects older patients’ treatment and health outcomes negatively.

Therefore, it is important to understand the importance of older people to society because the quality of life can be improved when they are engaged in the society. Age discrimination serves as a barrier to their participation in the community. Awareness of age discrimination is therefore necessary to overcoming it. As we are living longer and healthier lives, it is essential that we recognise the talents of older workers and giving opportunities to them if they want to carry on working. Older workers are valuable and they perform well in a learning environment which involves hands-on practices, usually those which require customer-sales relationships e.g. sales promoter.

The growing importance of services industry in Singapore will recruit more older workers as the nature of work will be more dependent on soft skills e.g. in service delivery. As a result, we should appreciate old age and understand that there is nothing wrong about growing old instead of identifying old age with imagery of despondency. There is a need to think on how we can care for the elderly and combat this social discrimination.

Section 4-Where can we start to fix the problem?

Discrimination against the elderly creates inequality in Singapore’s society because older workers are often associated with lower skilled jobs and lower income due to their low education background. Nevertheless, many firms still prefer to hire younger workers as money spent on them in terms on health care and training problems is minimal compared to older workers.

However, Singapore empathises on meritocracy where jobs should be given to employees who have the necessary skills and experiences. An article “Age bias: Firms’ mindset change is key” also states that “the focus should be on the actual job-related criteria. This way, older candidates are given the opportunity to work and contribute to the organisation.” Research led by Prof Albert Hermalin, University of Michigan, also revealed that older people in Singapore actually want to work but it will only be possible if there are positive perceptions about productivity of older workers.

Therefore, Singapore government has come up with various measures to help the older workers to remain employed. These measures include the extension of the retirement age to 62, reduction in the costs of employing older workers and various programmes to encourage the older workers to work and upgrade their skills.

To reduce the cost of employing older workers, the employer’s CPF contribution rate for older workers aged 55 and above has decreased and employers can cut wages of workers aged above 60 by up to 10%. This is to encourage employers to hire older workers.

Employers have also moved away from the seniority wage system and turned to a performance-based wage system. An SHRI (2007) survey revealed that only 14% of Singapore employers use a seniority wage system, while 61% are offering a performance-based wage system. By using a seniority wage system, wages will increase with age, resulting in many firms not willing to hire the older workers because of high costs. The change from the seniority wage system to a performance-based wage system will enable older workers to be hired.

In the workplace, employers are encouraged to employ older workers and to job redesign. An example will be NTUC FairPrice where they hired older workers and assisted them in job upgrading and career transitions. Older workers can also enrol themselves in training programs to upgrade their skills and this ensures their employability. This is especially so in an increasingly knowledge based Economy. For older workers, learning should not only be seen as an advantage for employment but also for self enrichment and fulfilment. Furthermore, the raising of the retirement age to 62 also enables older workers to secure jobs.

Employers have to be positive towards employing older workers and perhaps make some adjustments e.g. modification of work processes to accommodate older workers. For example, in McDonalds, icons of hamburgers and fries are printed on the cash registers to help older workers key in the right orders. However, their success still depends heavily on employers because it is important that they change their attitudes so that they do not employ employees on the grounds on age.

Recently, a “tripartite” committee, which consists of Singapore National Employers’ Federation, National Trades Union Congress and the Ministry of Manpower, was set up. They have implemented a set of guidelines on non- discriminatory job advertisements to discourage employers from adopting discriminatory criteria i.e. age, race or religion when recruiting employees. One of the guidelines is that age should not be a requirement for employment. Public and private sector employers have to pledge to comply with the non-discriminatory practices. The implementation of the guidelines was successful as there was a significant drop in the percentage of newspaper advertisements stipulating discriminatory criteria from 30% in February to less than 1% in April this year.

In countries like America and UK, there should be improvements in the health system so that older people can have proper care and health care equality. Health care professionals should provide treatment for every patients including older people as they have a duty to treat the patients regardless of age. Organisations like Age Concern and Help the Aged were also established to give advice on this issue. The government is currently reviewing ageism within the health care sector and in the progress of introducing new laws.

In conclusion, government policies and laws which were implemented can have an impact in combating discrimination against the elderly people. Most importantly, it is still the perception of one’s mind that leads to positive/negative stereotypes about the elderly people. As quoted by Ralph B. Perry,

‘Age should not have its face lifted, but it should rather teach the world to admire

wrinkles as the etchings of experience and the firm line of character.’