Category: Free Essays

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.’

The prevalence of wife abuse in Thailand, the types of incidents, is the same as is found in other places in the world except that for Thai women the frequency of incidents of physical violence against women by their intimate partners alone is 41% to 47% of women over 18 (Institute for Population and Social Research at Mahidol University & FFW). This is approximately 14 million victims and international research admits that domestic violence rates are under estimates. These figures have not changed since 2001 even though legislation change occurred in 2007. The findings of this research from abused wives, service providers and policy makers reiterates that domestic violence also includes forms of violence that do not currently appear in statistical reports (See Figure 6.1). Physical abuse is the most common kind of abuse, followed by psychological abuse. As found in many countries, wife abuse is the most common type of violence against women. Healey, Smith and O’Sullivan (1998, p. 2) viewed violence against women as “physical and psychological damage to victims, deaths, increased health care costs, prenatal injury to infants, increased homelessness of women and children…”.

Thai women typically encounter more than one kind of abuse. Of the women in this study ninety percent reported physical abuse and seventy five percent of them were psychological abused. Thai women and policy makers want abandonment included as a type as abuse. The duration of marriage and length of time women remain in abusive situations shows that thirty percent of them are in abusive relationships for more than ten years, and the longest period of time that women in this study experienced repeated abuse is more than thirty years. These findings indicate that abuse of women within marriage arrangements is not only common but in some cases routine. The abuse is often described in banal items that understate its severity and down play the effects on the woman. Quarrelling can mean assault with a deadly weapon.

This study also found that women actively attempt to stop the abuse using a variety of strategies. Their strategies include discussion with the husband, avoiding the situations that result in abuse, acquiescing to the husband’s demands, fighting back and, telling other significant people (often family members and friends) (Figure 6.5). The results from these strategies are mostly unsuccessful. The first and last episode of abuse for the women studied was not significantly different (Figure 6.2) and when wives discuss the abuse with the husband the outcomes are usually worse, that is increased estrangement of the wife, worse abuse or, no change, which in itself, causes great distress to the wife (Figure 6.3). Women finally seek help because they can no longer stand the abuse, for safety and shelter, because they have been ordered to leave and because they want the violence to stop (Figure 7.4). Delays in their leaving appear to reflect Thai social norms that married happiness is the responsibility of women. Women believe that in some way they deserve to be abused because the marriage is unhappy. Women know that individually they have no means to stop the abuse.

This research shows that some of the wives expect to tolerate abuse for a whole lifetime to conform to the Thai cultural belief of a good wife, the idea of the good woman, wife and mother is taught in early socialisation and reinforced in education. Also once a woman has a child, that child must have both a mother and father. This norm too is a major social barrier that hinders women’s ability to effectively cope with the abuse by seeking out domestic violence -services where they exist or getting help within their extended families and communities. The research also shows that wives depend on their husbands socially and economically because they do not have enough resources to leave their husbands or to live alone.

The witnesses of abuse, both in the home and outside, do not get involved because they believe that violence between couples is a personal matter. This is reinforced by the lack of protection for witnesses and that women must lay the charges. In normal criminal assault matters, police lay the charges. Many times the only witnesses are children. When witnesses tried to intervene (even parents and elders), the wives reported that the intervention was unsuccessful. Witnesses themselves experienced negative outcomes from the abuse (Figure 6.15). There is no protection for witnesses. The lack of protection reduces women’s options for a safe place to go locally especially where there are no domestic violence services or refuges.

Abused wives as a result, keep silent until they can no longer stand the abusive incidents and finally decide to report to service workers. This decision means removing children from their communities and schools. Policy makers recognised that abused wives for the most part do not want their husbands to be punished or imprisoned but for the abuse to stop. Incarceration brings humiliation for the family and loss of an income stream. Imprisoning the abusive husband punishes the children as does relocating the children when the mother cannot get help locally.

The silence surrounding this problem is still deafening. Even though numerous scholars and women’s organisations in Thailand specified wife abuse as a severe health problem, women possess little information and the awareness of people in the whole country is limited. Although wife abuse is perceived as a common problem worldwide, it must be acknowledged that when compared with western countries, where the push for gender equality has empowered women with greater freedom, Thailand’s record on wife abuse demonstrates that it is in epidemic proportions.

The Causes of Wife Abuse

There are mixed and inconsistent views about the causes of wife abuse in Thai families. Wives, services providers and policy makers provided multiple focal points for possible causes of violence. Individual characteristics of the wife and husband, socio-economic status, education, social values norms and mores were all mentioned as possible causes. A majority of the abused wives and the service workers in this research identify the causes of abuse as based in the husband’s personal characteristics. Some service providers also cite individual characteristics of the woman. The largest number of the policy makers considered that cultural factors were the most important. The findings provide evidence that wife abuse in Thai culture is about power of men and the subordinate roles of women. The service providers confirm that there are men who believe that their wives belong to them, have to take care of them and be responsible for all work in the house, and are also be always available for them to release their sexual needs. There are other behaviours and characteristics of some men like alcohol and drug use, sexual desires and demands, and economic factors.

These different foci are easy to explain and reconcile. The experiences of the wives and services providers are up-close and personal. They deal daily in individual behaviour and detail. The service providers can also see patterns but it is the policy makers who see the overall trends and issues that go beyond the individual.

Thai family life, culture and history were named as causes of wife abuse and they provide only a partial explanation since, not all Thai men abuse women. The women in this study, the service providers and the policy makers agreed that the way to promote Thai women’s freedom from domestic violence or being abused is not only by empowering them through education or financial independence, but also releasing them from the ancient cultural ties. First, Thai cultural traditions and beliefs hold the man to be the head of the household and that a good wife should have only one husband. There are sayings comparing women to water buffalo and men to the farmer and which reinforce the normalcy of domestic violence as merely the clashing of the tongue against the teeth. Second, there is a belief that women are weak and therefore the weakness of wives means that they cannot be on their own. Women who incorporate this belief make the decision to allow themselves to be under the control of their husbands. Roles of men and women have been assigned in different ways since ancient times. The male roles are breadwinner, the head of the household, the ruler and the protector (Suriyasarn 1993). The wives believe that they will be safe because their husbands can take care of them and the family members, so they abdicate their rights to their husbands. The cultural mores also inform the responses of family members, service providers and police. There is a process of normalisation of the violence rather than normalisation of equality and respect.

The participants in this study identified key institutions in Thai society that promulgate cultural beliefs that are harmful to women. These are Thai religion, media, family life, business, Thai culture and social agencies (Table 6.1). All of the respondents in this study, the service workers and the policy makers, perceived that Thai culture had the greatest harmful impact on wife abuse. They stated that Thai culture causes women’s social disadvantage and imprinting of inferiority, it supports disrespect of women and it causes negative gender attitudes. Only the Thai Government as an institution was seen to be a positive influence for women.

There are interesting features of Thai domestic violence that have been uncovered by this research for instance, the level of education of fifty percent of abused wives in this study and their husbands is relatively high. A majority of the wives are employees and have their own incomes, but the husbands still decided most of the important activities in family, including household expenditure. In addition, the service providers reported that in general the wives did not depend on their husbands because they had their own income. However, some of the wives were unemployed, and they had insufficient income because their husband was a poor financial manager.

The service providers described the wives as lacking self-confidence, obedient to their husbands and afraid to make their own decisions. These characteristics however, could be consequences of the abuse itself and not an original individual trait. It would be hard to sustain the notion that 41%-47% of all Thai women over 18 lack self-confidence as an individual characteristic. It would imply that lacking self-confidence is somehow a biologically determined variation in Thailand. There is no credible evidence to support such a conjecture.

Decision-making in households that centralise male power has a great chance contributing to wife abuse (Gelles & Cornell 1990). Unbalanced authority of decision-making seems to be a cause of the relationship problems between husband and wife. This too is one of the areas where the abused women, service providers and policy makers agreed. Early learning and socialization influence the continuation of the view that Thai women lack confidence and will obey.

In previous research on relationships between wives and husbands, women’s education and employment serve as frequently used proxy measures of women’s status. Education and women’s paid employment are considered to improve women’s ability to gain greater power in decision-making, and consequently, more control over reproductive decisions. Thus, some of the scholars believe that women who are better educated and who have paid work have more options that allow them to get out of an abusive relationship. In contrast, in Thailand being a woman with economic independence can make things worse. It would appear that the strength of the cultural belief in the superiority of men leads women who have their own jobs and income, who may be in high positions and have more income than their husbands so they have perceived power outside home, to be just as much if not more at risk of wife abuse. This finding means that strategies to counter wife abuse by educating young women and ensuring equal representation of women in all levels of employment will not be sufficient. Focusing only on women, building their strengths and capacities will not lead to the hoped for reduction in wife abuse.

The location of wife abuse incidents is another important point of discussion concerning prevalence of wife abuse. Many wives reported that most of the abusive situations occurred at home. The observation is that the abusers often choose to abuse their wives in private. Abuse incidents in the home also show the power of abusers over their wives in this private arena. It is abuse out-of-sight. In any other context it would be defined as cowardly bullying that the offender knows is wrong so only does it where there are no repercussions or credible witnesses.

The service workers reported that the women who came to the agencies were nervous, stressed, depressed, despondent or scared and suspicious. The workers not only reported the psychological and physical effects to the wives, but also on other members of the family, especially children. Previous studies (National Clearinghouse on Family Violence, Canada herein after NCFV-C 1996) identified that the cost of wife abuse to society and to the victims of battering is extremely large. Clearly it is not merely a private matter but has fiscal and infrastructure implications for the country. There are implications for Thailand’s future, education, health and civil society.

This study (like the findings of the NCFV-C 1996) identifies an urgent need to establish extensive public awareness on domestic violence, wife abuse and gender equality as a critical step in addressing this problem. The above is represented graphically in

Figure 8.1.

This figure graphically displays the multi-layered nature of wife abuse and the sources of possible causes.

Applied Theoretical Analysis

Theory as explicated in Chapter 2 of this study when applied to the results leads to a multiplicity of approaches to wife abuse in Thailand none of which is sufficient in itself to stem the epidemic. For instance, the views of the women themselves, the workers and even the policy makers demonstrate gaps in their knowledge and awareness and sometimes perpetuate myths about domestic violence and the capacity of women. They recognise that better knowledge and skills training are required for all who respond to wife abuse – especially police. Feminist Theory, Social Learning Theory and Ecological Theory can all, when applied, result in a call for the establishment of a broad public awareness on domestic violence, wife abuse and gender equality as a crucial step in addressing this problem. Accurate and up-to-date information is required at all levels; the community, the workers, the policy makers, and the legislators and the courts. Feminism would push for challenging concepts and constructs that perpetuate patriarchy and which demonise or pathologise individual women or men. Social Learning Theory would support early learning and for the new information to be taught in school including strategies for children on what to do if they are witnesses of domestic violence. Children in other places are successfully taught what to do in house fires with catchy phrases and practice activities. Many of these are broadcast as community services announcements. Ecological Theory would ensure that such attention is paid to learning for hospital, health, policing, and other workers and service providers. Educational and competency standards are needed for workers and response staff. In this way a consistent message and set of service principles and standards are demonstrated when a women seeks assistance.

In this section each theory in the multidimensional framework developed for this study will be systematically applied and the resultant programs for addressing and responding to wife abuse in Thailand will be identified. Each intervention strategy is based on the results of this study and therefore is responsive to Thailand unique qualities and culture.

Social Learning Theory

The effects to the child witness of abuse, explained by social learning theory are that the social environment during childhood experiences in the family of origin can affect a child’s understanding of the world and social interactions and may contribute to the perpetuating the violent behaviour and victim response throughout subsequent generations. The linkage between witnessing violence and learning to be violent is that children from violent homes are being taught that violence is effective way to gain power and control over others, or they are more likely to accept the excuses of violent people, and they have an increased risk of being aggressive themselves; to adults as well as peers (NCFV-C 1996). Governments do not normally invite the development of future citizens who think that violence is a legitimate way to resolve conflict or who are oppositional and defiant towards authorities. Hence, a broad based educational program which indicates that domestic violence is unacceptable, what to do about it, and what are alternative ways to effectively manage disputes and conflict needs to be part of a package directed at children and young people – including young men and women. Like Singapore, the Department of Education needs to check that not one book denigrating women are used in any education of young Thais (United Nations 2007).

As the result of witnessing abuse of their mother, children can experience sadness, withdraw, have low self-esteem and/or other emotional problems. Advocacy for the victims of wife abuse, should aim to assist children who are witnesses of their mothers being assaulted as the important target. A child protection process is necessary to adequately respond to child witnesses of domestic violence. Clearly, from the reports of the women, safe places are needed so they can take older children with them when they are escaping violence and not be forced to leave those children behind. Or that the offenders are removed from the house and the wives and children’s lives are not further disrupted. The offender’s return would be based on progress in court ordered rehabilitation. Not on the wife’s guarantee.

Exchange Theory

Family conflict is difficult to avoid, but the absence of conflict resolution skills may escalate and lead to violence. For instance the release of anger, the need to gain power and control over their wives and other family members, to reduce internal anxiety or for some other benefit can only persist, according to exchange theory, if the abusers believe they have a permit to behave in this way. This perspective suggests that family members need to behave in a way that reduces the reward of being violent. That is, that violence does not lead to the preferred outcome of the violent person. Currently wives obey when someone is violent thus reinforcing the violent behaviour. If they were able to act in ways that expose the violence and increase the social cost of the violence to the perpetrator then there would be no remit for violence in the household. However, the real scenario is that the violence escalates until the woman complies or is gravely injured and she is returned to the household with no social sanction against the abusive person – indeed the sanction is culturally against her. So exchange and control theory helps explain how the current system of hospital emergency care, women’s shelters and policing in the area of wife abuse effectively control the wife and indicate to her that she has no privilege to exercise her power, thereby reinforcing for the abusive husband, that he has a positive social sanction to continue his behaviour – that is to achieve his wants by the means of violence and threats of violence.

Appropriate intervention at the family level to teach family members to resolve conflicts non-violently is likely to be ineffective since these too are based on the assumption of equality in the relationship between the man and woman and equality before the law. The external systems currently fail to lay charges of assault on behalf of the women, fail to investigate on the basis of the injuries sustained and the report of the woman to a domestic violence service or hospital or police station, and fail to charge and prosecute cases of wife abuse. For them to be able to do so legislation, policy and procedures need to be written, taught and implemented. Until that happens the current response to wife abuse in Thailand actively reinforces the practice and actively places women and children at continued and increasing risk of harm. Figure 7.4 shows clearly that women want the abuse to stop and that policy makers are aware of this need. Now legislation is in place. The political process lacks focus. Funding the administration and application of this new legislation is needed. A whole of government approach is needed overseen by executive government (Prime Minister and Cabinet) to ensure domestic violence is seen as a crime and that woman and children no longer need to be victims.

Theories of Psychopathology

The other type of personal behaviour of the abusive husbands, as perceived by a majority of the abused wives of this research, is that they easily lose their temper. The wives provided details that their husbands are irritable, easily angered, and tend to make a fuss for no reason. The service providers also state that the stress experienced by the abusers perhaps from other parts of their lives, contributes to an increase in the risk of wife abuse. In addition, the wives reported that they are isolated and neglected. These forms of abuse many not translate to physical violence, they increase the wife’s anxiety around the husband and constitute other forms of abuse.

At the individual level, personality theory is frequently used to explain the characteristics of the abuser. The violent person, who has long standing and firmly entrenched violent reactions, is viewed as ill and in need of treatment. The trigger stressor related to marital violence may be unemployment, financial problems, and/or sexual difficulties. This perspective holds that being physically abusive is a symptom of an underlying psychological problem. The treatment aims to exposing and resolving the root cause and to provide the violent person with alternative behavioural options through “individual and group psychodynamic and cognitive-behavioural therapy” (Healey, Smith & O’Sullivan 1998, p. 21). As violent reactions and patterns are long standing and firmly entrenched and treatment must be intensive, individualised and medically based (Davis 1995; Cunningham, Jaffe, Baker, et al. 1998).

Substance abuse is seen by most people as a sub-set of psychopathology – of individual failing. Alcohol and drug use by husbands is classified by the policy makers as a personal factor in perpetrators was perceived as a stimulus for domestic violence and it was the greatest risk perceived by the abused wives. In the issue of conflict over substance abuse, drug and alcohol use is increasing in family conflict that indirectly increases wife abuse. There is an argument that not all men who are drunk beat their wives and not all men who beat their wives are drunk (Geffner & Rosenbaum 1990). Nevertheless, from this research, the evidence that the wives reported is that their husbands abused them when they are drunk. Alcohol use as it correlates with wife abuse and other types of domestic violence seems to continue to be a significant risk factor for physical aggression (Kantor & Kantor 1989; Murphy, Meyer & O’Leary 1994).

Feminist Theory

There is an argument against identifying wife abuse as evidence of underlying psychopathology or an illness. Frequently mentally illness is proved to be absent in wife abusers. People who are violent as a result of a mental illness do not limit their violence to their intimate partners or their wives, but the offenders of wife abuse attack only their wives. People whose aggression is triggered by alcohol equally do not only engage in aggressive behaviours with their wives. As Dutton (1994) states the result of feminist analysis of wife abuse has been acceptance of the powerful and complex role of social factors present in the context of violence. Abuse exists within a gendered society dominated by male power. From the feminist perspective, unless male power and gendered social relationships are addressed, no effective response to wife abuse will be achieved.

Family Systems Theory

Healey, Smith and O’Sullivan (1998) comprehensively summarise the application of Family Systems Theory to wife abuse. First, both wife abuse and domestic violence are the tangible outcome of a dysfunctional couple relationship or family system. Therefore, the cause the abuse lies within the structure and interpersonal dynamics of the family. Communication problems and poor conflict resolution within intimate relationships are seen to be critical features and intervention involves and teaching communication skills, appropriate assertiveness and conflict prevention and resolution strategies for the whole family. Controversy surrounds interventions based on family systems theory as it does not address inappropriate use of power by the abuser and as interventions, which fail to address power, are potentially dangerous. In counselling the abused wife is encouraged to discuss openly unresolved problem that result in later retaliation by the batterer. This concern is a valid one. As the results of this on wife abuse in the Thai context show, conversations with abusers usually result in worse long-terms outcomes for the woman and the children.

Ecological Theories

Stress and isolation are related to the abuser’s aggression. Telch and Lindquist (1984) pointed out that abusive men have significantly poorer communication skills. The aim of intervention is to build the capacity for secure attachments between abusers and their wives, and family. A cognitive behavioural approach is used to teaching offenders alternative ways of non-violent thinking and behaviour. Anger management techniques are the primary method for the abusers in short-term intervention to make them feel they can control themselves. To develop the abusers’ behaviours to be non-violent, social learning theorists view that changing behaviours and altering outcomes leads to changed thought processes. Irrational and negative thinking often undermines a person’s attempts to change behaviour and thus short-circuits their best intention. Numerous techniques have been developed for working both with abusive men as a group and within couples aiming to eliminate violence, teach new behaviours, and change dysfunctional thoughts that serve to maintain violence in the relationship. However, again these techniques have been generated and applied in societies and cultures where there is an acceptance that men and women are equal and the deeply embedded cultural understanding about women is different from the experience in Thailand.

If we accept that the husbands are not suffering from psychopathology but that husbands’ behaviours are as a result of some external stressors then there is also an epidemic of adult males in Thailand whose needs are not being addressed. One could interpret the claims of the wives that their husbands fail to pay attention to them, that they have affairs with other women or take on minor wives, or fail to take responsibility for children, and they act irresponsibly as escape hatches that adult men are using which are akin to self-medication of people in pain. They might also be symptoms of unmet social and psychological needs in these men that require investigation and development of targeted programs. To suggest otherwise, that is to accept that more than 47% of adult men in Thailand are active abusers of women (including non-physical forms of abuse) would be damning for Thai men and the Thai way of life. If men are behaving this way, it is not because they were born to abuse or because they are sick but because something is wrong for them. Men form a large proportion of the Thai population and are worthy of study and to have their psychological, social and emotions needs considered in any examination of patterns of intimate partner abuse.

Furthermore, in relation to the abusers’ use of power and control, this research found that the victims rarely report sexual abuse. According to the context of Thai society issues about sex are not openly discussed, particularly with unfamiliar people. That is why the victims or social workers do not normally identify sexual abuse as a form of abuse. Even though, the current details in the law have changed, and women’s rights are more respected. The activities, in practice, are still ignored. The public needs more information that is correct and up-to date. Services personnel need knowledge and skill to be able to raise and address sexual assault as a routine question to reduce reticence of women.

Personal factors are deeply associated with cultural factors. Most of the policy makers consider that cultural factors are the most important citing the patriarchal values of Thai society. Cultural factors affect entire families and part of the wife abuse problem is inherited social values in the form of family behaviour that is passed on through the socialisation process. The ecological approach, formulated by Bronfenbrenner (1977 cited in Huitt 2009, p. 4), indicates that “…human beings do not develop in isolation; they develop in a variety of contexts (environments in which the individual human being is in constant interaction) have a major role in human development and behaviour”. Thus the family factors in an ecological model of wife abuse refer to processes in the family such as “parenting skills, family environment, family stressors, and family interactions” (Little and Kaufman Kantor 2002, p. 133-145). For instance family stress associated with financial difficulties, poverty and unemployment may decrease a family’s capacity to function. Further Bronfenbrenner comments on how exo-systems, that is independent systems that exist outside the family (like schools, hospitals, legal systems) have effects on the way the family operates just in the same way as building a freeway through a rainforest can affect the rainforest ecology.

In the next section the consideration of theory and the findings of this research are drawn together to develop a way to consider wife abuse in the Thai context and to form the basis for developing program and essential skills for workers who are required to respond to incidents of wife abuse. The model is shown in Figure 8.2 below.

This figure graphically displays the application of the various theoretical frameworks and the multi-disciplinary approaches which include legislative changes, policy change about education, health services, quality of training, and educational delivery, funding of health and welfare services, community education and awareness programs.

Implications for Practice

The origins and effects of wife abuse as discussed above should be the subject of conversations among all the obvious stakeholders, other victims and other strong and active agencies and advocates. Definitions of terms need to be consistent to make sense for victims. The integrated multidimensional approach to intervention that acknowledges and incorporates the complexity of this problem is the preferred model. It needs to contain psychological, interpersonal, cultural social, policy and economic considerations (Healy, Smith & O’Sullivan 1998). Integrated case management therefore is necessary since no agency and no single worker can provide all the services needed.

With regards to the “multidimensional” approach the theories of domestic violence and wife abuse (reviewed in Chapter 2 of this research) engage the societal level, the family level, and the individual level. Each perspective partially explains the cause

The purpose of the essay is to discuss and explain the child protection enquiry, its process, purpose legislation and critical issues. An accompanying leaflet has been designed to highlight the Child Protection enquiry taking into account age, diversity, oppression and anti-discriminatory practices incorporated. The age group focused on the leaflet is Young Persons aged 11-19. In addition, a commentary to justify the rationale for the design, content and structure will be carried out. Finally, an evaluation of how the issues discussed in the leaflet and essay have contributed to learning and relevance to future practice.

The focus of the new millennium according to DfES (2005) is ‘safeguarding and promoting the welfare of the child’ which by definition is the process of protecting children from abuse or neglect, preventing impairment of their health and development, and ensuring they are growing up in circumstances consistent with the provision of safe and effective care which is undertaken so as to enable children to have optimum life chances and enter adulthood successfully (DfES 2005a, p11). Wilson and James (2007) citing Working together to safeguard children (HM Government 2005a p 19 Para. 1.19) define child protection as “the activity which is undertaken to protect specific children who are suffering or at risk of suffering significant harm”.

In her view Gil (1970) considers that Child abuse consists of anything which individuals, institutions or processes do or fail to do which directly harms children or damages their prospects of safe, healthy development into adulthood. This definition was adapted by the National Commission of Inquiry into the Prevention of Child Abuse.

Bentovim (1998) sustain that there is strong association between significant harm and insecure attachments, citing Carlson et al (1989) who found out that more than 80% of significantly harmed infants had disorganised attachments compared to less than 20% in a non maltreated comparison group. Jones et al 1999 further supports that all disturbances in case of child maltreatment are linked to the relationship with parents own experiences. Attachment difficulties are associated with parental childhood experiences of Abuse and Deprivation, Parental Personality Difficulties as well as Functional Illnesses such as Depression. It is important to identify parent child attachment difficulties to make sound intervention where there is evidence in literature that persisting Parent/ Child attachment combined with evidence of psychological maltreatment on follow up is a consistent finding.

Additionally Wilczynski (1997) cited in Wilson and James (2007) ascertain that the most consequence of child maltreatment is death which indicates the necessity for early intervention to prevent the deaths of young children. It was estimated in 2003 that in the UK that the occurance of maltreatment leading to death is nine per 1 million children and as high as 24 per 1 million in USA. UNICEF (2003). The main perpetrators in most cases it was revealed were biological parents and the most affected age group was children under five years particularly babies under one year, (Brown and Lynch (1995), UNICEF (2003). This suggested that there is need to predict , prevent and protect children from birth, Axford and Bullock (2005) and the Assessment of children and families (DOH et al 2000, Brown et al 2006). As a necessity to prevent deaths and severe consequences intervention should take into account the family structure and normally comes in after a fatal consequence or maltreatment has already occurred. Protective factors need to be put in place as a deterent to raising family standards, resilience to social and environmental stress Brown and Herbert (1997).

Essentially it is through assessment that the needs of such children are identified that the needs of such children are identified as the starting point of intervention. Assessment as defined by Wilson and James (2007) is identifying the needs of children at risk of encountering significant harm so as to put in place safeguarding measures that will promote their welfare and wellbeing. Reder et al (1993), Munro (1999) and Buckley (2003) cited in Howarth (2005b) observed that in cases of maltreatment effective assessment is essential as the basis to inform meaningful planning/ intervention which will promote better outcomes for children and families. This depends on professional knowledge, skills and ability to engage in multi-disciplinary team work, the child and the family to identify family needs. Additionally practitioners need to be aware of challenges and factors that can distort assessment such as perception of abuse, their values and beliefs and the application of theory to practice.

Parton (1991) cited in Scourfield (2003) argue that one of the most contested social issue is child protection. The main reason being that the state is seen to intervene with families so as to protect vulnerable children, at the same time giving respect to the family unit structure. This has raised public scrutiny with concerns that the state has not intervened enough to protect children or social workers have been accused to negligent and not having identified significant harm. On the other hand they are accused to have intervened too much and unnecessarily impacting on families. Typical examples highlighting the controversy are (the inquiries into the deaths of Jasmine Beckford, Kimberly carlile, Ricky Nearve, Victoria Climbe and baby P. On the other hand too much intervention was cited in child abuse investigations in Cleveland 1987, Pooch dale and Orkney) just to name a few Scourfield (2003).

These contradictions and dilemmas are believed to originate from the increasing recognition that child abuse is socially constructed. This is dependent on different commentators’ perspectives of abuse and harm. Obviously this perspective will raise the argument whether the intervention to be carried is supportive or authoritative and reactive. Munro (2002) believes abuse is ways of treating a child in a harmful and morally wrong manner that impacts on their socio-psycho wellbeing. In trying to define abuse variations from different socio-economic and cultural backgrounds/values is to be considered. However article 19 of the 1989 United Nations Convention on the Rights of the Child (UNCRC) agreed on an International formulation to condemn child abuse. This defined abuse as “all forms of physical or mental violence, injury or abuse, neglect or negligent treatment, maltreatment or exploitation including sexual abuse. Furthermore it is important to acknowledge the British national commission of inquiry into the prevention of child abuse which broadened its scope outside the family. They hold that child abuse consists of anything which individuals, institutions, or processes to or fail to do which directly or indirectly harms children or damages their prospects of safe and healthy development into adulthood National Commission, (1996:2). All the above definitions mention harm as a result of actions, omissions or exploitation. As mentioned earlier individual societies in conjunction with their legal systems supply more detailed definitions and guidelines. The UK society through the department of health and social security 1988 categorised the following specifications as guidelines and standards. These are physical abuse, emotional abuse, sexual abuse and neglect. Explain these or not see word count? Munro (2002).

The Children Act (1989) was set up as a measure to encourage partnership working between families and the state. It also encouraged the provision of family support to reduce the risk of severe consequences resulting in coercive state intervention. Prevention was expanded from simply to prevent children coming into care but to focus on providing services that helped and promoted families to up bring their children within their families Munro (2007). According to the Act family preservation is paramount and fundamental as well as partnership working with parents. Nevertheless it is not always the case that some parents who are neglectful and abusive sometimes see or have no capacity to constructively and systematically engage with social service intervention which try to help them. Some it is suggested become hostile, aggressive and abusive clearly not entertaining any advise or any interference with their family life. With such a contest going on the child will continue to be affected and further significant harm may occur during this contest. As said earlier social workers need to be aware of such parents and situations and act accordingly in this case in the best interest of the child who will be the focal point Bell and Wilson (2003).

In the early 1990s a number of cases involving organised and institutional abuse were revealed which were outside the family context. The most prominent one being the Orkney incident in which children were taken into care following allegations of organised sexual abuse. The court hearing dismissed the case after five weeks leading the children to be returned home. Media coverage concluded injustice on caring parents fighting injustice inflicted by intolerant inconsistent social workers. This enquiry led to the selling up of regulations and procedures for dealing with organised abuse Bell (1999). Messages from research (1995) published and summarised the functioning of the child welfare system. It revealed cumulative effect of adverse publicity and policy changes that pinpointed professional’s especially social workers as prioritising abuse concerns over other types of referrals. There was a division between child protection and child abuse and revealed an emphasis on tackling immediate risks to the child and ignoring the wider social and psychological needs. There was a call to refocus of child protection in a holistic child in need context not just protection from abuse. Messages from Research (1995). (Bell 1999, Thoburn, Lewis and Shemmings 1995) revealed that the emotional impact of investigation on families whether guilty or innocent is traumatic and intrusive. Professionals need to be aware of this impact on families and seek to minimise it.

The death of Victoria Climbe was a shocking event that revealed abuse and inconsistencies within professionals who had seen her. A public inquiry led by Lord Lamming (2003) also revealed that the voice of the child was ignored despite so many professionals being involved. Laming Report (2003). Gough (1997) assets that research revealed that not too often children are ignored as a active participants either as a source of knowledge/ information about their family situation/ circumstances or a reliable source of opinion on what needs to be done. Laming Report (2003). Contrary to this shortcoming one of the Children’s Act 1989 is to respect the children’s views and wishes about key decisions affecting their lives. The Act guarantees that children’s wishes and feelings must be taken into account in any matter that affects or involve them be it in court hearings, reviews and conferences. This also applies to Looked after children by local authorities, they have greater rights and voice on the quality and care they receive. Coby (2006)

The death of Victoria Climbe prompted the safeguarding agenda and policy Every Child Matters: Change for the Children Treasury (2003). The agenda proposed a radical transformation of both the organisation and culture of practice from a reactive service for a few to a more pro-active approach where all children’s needs are identified addressed at grass roots level before escalating to major serious problems. Innovative ideas such as the integrated children’s services would be essential tools. The every child matters agenda highlighted 5 outcomes for children i.e. are healthy, staying safe, enjoy contribution, and achieve economic wellbeing. Every Child Matters (2003). Working together to safeguard children DFES (2006b) highlighted the new arrangements to be implemented by different agencies to promote inter-agency co-operation to safeguarding and respond to the concerns that a child might be at risk of significant harm.

The child protection policy and practice begins when a concern has been raised that a child may be at risk of abuse through neglect, physical, emotional, sexual harm. A number of sources could raise such a concern ranging from NSPCC, police, social services, a parent, neighbours, health worker, or nurse or teacher from school/nursery. It might be the case that some concerns are made anonymously or malicious. At times some anonymous concerns turn out to be true and this call that they are treated seriously. As soon as any concern is raised Social services will act as soon as possible Buckley (2003). The first response at the early stage is to make enquiries about the family concerned with other agencies linked to it such as schools, hospitals, GP, nursery or health services by carrying out an initial assessment following LSCB procedures. Initial assessment as defined by the Framework for the Assessment of Children in need and their families (DH 2000) is a brief assessment of each child referred to social services with a request for services to be provided.

If the core assessment concludes that a child is in need of further support they will be classified as a ‘child in need ‘ as defined by Section 17 of the Children’s Act 1989. The section mentions that it is the duty of the local authority to provide services to safeguard and promote the child’s welfare and needs. If no harm is suffered the case is closed. If need be that the child needs to be seen by a S/W or police this is usually done within 24 hours after the allegation has been reported. When these initial enquiries are complete a decision is made as to whether there is need to pursue the matter or no further action required it is the duty of social workers to inform parents of any developments as soon as possible. Information such as the source of the allegation will be given to parents as long as it does not put the investigation into jeopardy or put anyone at risk. If for instance the allegation came from an institutional source like nursery, hospital or school it will be revealed. Members of the public names or identities are not revealed.

During questioning or inquiries if it becomes necessary to ask a child/ the victim parents may be allowed to be present or may not be allowed if they are the perpetrators mainly or for any other reason. Depending on circumstances, Social Worker will work with both parents and child but in the best interest of the child. This is the time when parents can explain their views, concerns and what actions to be taken to address the concerns. Parents are also interviewed with their language if they don’t speak English an interpreter will be available by social worker. If the need be the child may be seen by a doctor or paediatrician to ascertain what happened, treat the injuries or to seek clarity on injuries. Parents need to give permission for this if they refuse a court order will be sought for permission to have a medical examination. If a parent does not agree with proceedings they may seek legal advice. If a child is old enough to understand they may agree to be examined themselves if it is proved that they are old enough to, make such a judgement. All this is dependent on how well a child understands what is happening Merrick (1996).

The medical examination is dependent on the nature of alleged abuse. It is important for the doctor to have a full understanding of the child’s health and development. The examination forms part of the enquiry process as it is a way of gathering evidence and preserve any evidence to understand the abuse. The examination will reassure the parent and child that they will recover. The child may have preferences of who conducts the exam and who should be present. Social worker will also accompany or be present. If the results of the examination convince social workers that injuries were accidental not abuse no further action is taken. If the results conclude that there is likely to be significant harm or abuse further enquiries will be carried out. This may also involve enquiries regarding other family members so as to ensure that no harm has happened to them. A video recording interview may follow conducted by Social Worker and police if maybe they want to sue. This will also help if police want to pursue criminal proceedings. This is done by trained officers who specialise in these procedures. It may be the case that the police need to remove the child from parent’s care to safeguard their protection and welfare. All necessary arrangements will be made in line with the intention of keeping the child within their family. If necessary Social Services may call a child protection conference if there is evidence of significant harm. Parents are invited and all the professionals involved with the child as well. These include social workers, police officers, doctors and other people interested in the welfare of the child.

If the child is classified as having suffered or at risk of significant harm a strategy discussion meeting is pursued. A meeting consisting of all professionals from relevant agencies will meet to decide whether to proceed with a section 47 inquiry under the Children Act 1989. Under section 47 the Local Authority will investigate the case of a child in their area. Serious case review is conducted by the Local Safeguarding Children Board when a child dies or seriously injured, abused or neglected. This is an inter agency forum set up by Local Authorities to define and agree how best professional groups co-operate to safeguard children and also to ensure good outcomes for children are in place and achieved . Working Together to Safeguard Children Guidance (2010)

Buckley (2003) identifies Child protection conference as a meeting arranged by social services if people are worried about a child’s Safety. Child Protection Conference is carried out to decide whether a child is still at risk of continuous significant harm. The purpose of child protection conference is to bring under one roof all concerned and interested parties who are key to the welfare /wellbeing of the child. These include care professionals, medical professionals, lawyers, police, teachers and nursery practitioners. An independent child protection advisor chairs the conference and will meet the parents before the conference to explain all procedures and objectives of the meeting. Previously it was observed before the conference was introduced that the Child Protection system was regarded as inefficient and lacking since all stakeholders were not united and did not communicate effectively amongst themselves exposing a child to further harm and creating opportunity for further harm by not addressing potential risks or communicating concerns. All professionals who attend the conference are required to evaluate the welfare of the child, determine if there is potential danger and decide whether to put the child on the protection register. Care professionals will also decide course of action, such as upholding legal proceedings or criminal investigation if a decision to put the child on the protection register. A child protection plan is designed to control future proceedings regarding safety/welfare of child. The plan will highlight roles within the inter agency and enhance productive communication between individual agencies. After three months a further meeting is held to review and monitor progress. Every six months review child protection conferences are carried out. If any concerns or any of the elements in the plan are not working well they can be altered. There will also be discussion on every conference whether your child needs to remain on the Child Protection register. Access to file, confidentiality and complaints procedures will be adhered to.

A number of legislation is relevant to the Child Protection agenda. The Children’s Act 1989 believes ‘Children are generally best looked after within the family, with both parents playing a full and without resorting to legal proceedings. The welfare of the child is significant and their wishes should be taken into account seriously. The act seeks where possible to protect children within their families. A number of provisions were designed to improve the family and home environment to protect children. Inter communication between multi disciplinary agencies was encouraged to indentify/ address risks to a child/children so as to safeguard and protect children. Sections 17. 27 and 47 (cite) the Children’s Act 2004 highlights the need for increased accountability, integrated planning, multi- disciplinary planning and delivery of services and above all providing for children with special needs. The Human Rights Act 1998 embraces the European Convention on human Rights into UK law. Although it does not specifically mention children because they are treated as persons in the eyes of the law just as adults. The adoption and Children’s Act 2002 amends the Children’s Act 1989 by recognising the definition of harm to include witnessing domestic violence.

Following Victoria Climbe’s death at the age of eight Lord Laming was asked to conduct an inquiry to establish whether a new legislation was needed or any other recommendations to improve the Child Protection in England. As a response keeping child safe report (Dfes 2003) and the Every Child Matters Green Paper DEFS (2003) which later became Children’s Act (2004). The Children’s Act (2004) does not add/ subtract anything from Childeren’s Act 1989 instead it sets out an approach to integrate services to children so that every child matters meets the five outcomes: being safe, healthy, achieve, enjoy, make a positive contribution and achieve economic wellbeing.

The Children’s Act further places a duty to Local Authorities to appoint children’s Commissioner for England who is accountable for the delivery of service. Local authorities and their partners (police, health services and the youth justice system) have a duty to co-operate in promoting the wellbeing of children and young people and to make necessary arrangements to promote children’s welfare and wellbeing. As required in the lay out working together to safeguard children statutory guidance, non statutory ( area in protecting committees are replaced by the new local safeguarding children bears. They are trusted with further functions of reviewing and investigating (section 14) which they use to review all child deaths in their area. It also revises legislation regarding physical punishment by making it an offence to hit a child to an extent of causing mental harm on the skin (section 58) which repeats the defence provided to parents on reasonable chastisement of the children and Young Persons Act 1993.

The 2006 Children and Adoption Act enforces contact / contact orders when separated parents are in dispute giving more flexible powers to facilitate contact. As recommended in the Care Matters White Paper (Dfes 2007) the children and Young Persons Act is expected to give and provide high quality care and services for children in care and places a duty on registrars to notify local safeguarding board on all deaths Daniel and Ivatts (1998).

The Borders, Citizenship and Immigration Act 2009 requires UK Border Agency to recognise and promote safedguarding children’s welfare section 55 in line with other public organisations that have contact with children. The apprenticeships,skills, children and Leaarning Act 2009 requires two local lay community members sitting on each local safeguarding children board. Some of the provisions in the Act have been targeted for repealing by the coalition government including the duty on schools to promote the wellbeing of children and the requirement to set up children’s trust and draw up children and Young People’s plans (Dfe 2010)

There is also legislation that has been set up to protect children by monitoring adults who pose a risk,creating offences which they can be charged and stopping them from working with children. These are the sex offenders Act 1997, Sexual Offences Act 2003, Female Genital Mutilation Act 2003, Domestic Violence , Crime and Victims Act 2004 guidance on offences against children,the serious organisational crime and police Act 2005, the Safeguarding Vulnerable Groups Act 2006 after the death of Holly and Jessica. The forced marriages Act Civil Protection 2007 and the Criminal Justice and Immigration Act 2008. Out of all the legislation it is important to mention that they do not cover the minimum age at which a child may be left alone and how old a baby sitter should be.

Having explored the child protection system and legislation it is important to address one of the critical debates in the topic which is: Does child protection work in all communities especially the ethnic minority and disabled groups? Most recent research carried out has revealed so far some of the issues which are far reaching as shortcomings. It has been suggested that new research shold explore the family structures and values on how different ethnic minority groups slip into situations requiring child protection. Highly focused studies are neede to focus and understand how some practices and beliefs in specific minority groups such as genital mutilation or the racial abuses of mixed heritage children brought up in white families. Qualitative studies into attitudes towards sexuality in different cultural and faith groups. Maybe the time limits regulating initial assessment s into culturally sensitive work re impacting on complex work to be properly carried out (such as refugee families) The courts , conbferences and social work practice must be aware and pay attention to the needs of ethnic minoritoies . If these are addressed then the child protection system will be ethnically tolerant and culturally competent in the best of the chid and as hood practice. Thoburn et al (2006).

Disabled children are more still likely to be abused and neglected because they rely on institutions which have a history of failing over the past decades. The institutions either lack the resources, capacity and transparency in addressing abuse/neglect and also inefficient procedures to guarantee disclosure to assist disabled children to overcome the communication barrier especially on abuse. Worse still there is more vulnerability to children whose parents are disabled. There is more likelihood of them being taken into care on the grounds of neglect than those children whose parents are not disabled. Organisations and local authorities need more structures in place and transparency to help vulnerable children and families to be able to communicate and express their worries, fears and anxieties Corby (2006).

LEAFLET COMMENTARY 500 WORDS NEGLECT AND EMOTIONAL ABUSE. WHY THIS AREA? It has been a neglected area since the death of Maria Colwell Professionals focused on physical and sexual abuse. This meant the neglect and emotionally abused children and their families were not adequately represented thus getting limited resources and being filtered out of the Child protection system. When the Children’s Act 1989 was introduced it tried to address these issues and further went on to introduce registrations in the neglect/ emotional abuse category. This commitment is of great significance to practitioners whose objective is to tackle any form of child maltreatment as resources became available.

My choice to apply these two theories to the case scenario of Ms Joanna is based on the structure of these methods. Payne (2005, p 97) cites that Both crisis intervention and task-centred practice reflect a contemporary trend towards brief, focused and structured theories that deal with immediate, practical problems”. Because of the recent diagnosis of breast cancer, Joanna is faced with some difficult decisions concerning her sons future. She wants to be sure that she would make the best decision available. Therefore task-centred approach would be the best way for her to achieving this and any other problems that might arise during the exploration process.

Task-centred approach tends to be very structured and person-centred and it can be oriented to ease the most pressing problems. Task-centred practice has been developed within SW itself and tested in a wide variety of circumstances. The procedural aspect of task-centred practice has clearly been shaped by community care policy and care management. Time-limits, plan and contract based are key features of care management practice (Ford and Postle, 2000).

The method is informed by a theoretical framework, which includes elements of systems theory, ego psychology, behaviourism, and empowerment theory. Hence the precise form it may take will be influenced by one or more of these theoretical traditions. Task-centred practice draws heavily from other problem solving methodology such as positive reframing from family therapy (Payne, 1997) and is in direct contrast to the more paternalistic professional practice traditionally employed. The values of self-determination and empowerment are central, as the service user, in this case Joanna, is seen as the best authority on her problems. Task-centred work fits closely with concepts of partnership and participation, in that Joanna should be fully informed and as fully involved as possible through out this process. ‘Its principle stance on open, collaborative and accountable practice is clearly compatible with the values of AOP (Doel and Marsh, 1992).

Ford and Postle (2000, p 53) ‘the approach is focused on problem-solving, and is short-term and time-limited’. The principle aim of task-centred work is to resolve problems presented by the service user. Hence the starting point of this practice is the problem. Task-centred practice is characterised by mutual clarity and therefore should only be carried out under the following three conditions. The service user must acknowledge the problem and be willing to work on it, they should be in a position to take action to reduce the problem and the problem must be specific and limited in nature. In this scenario Joanna has presented herself to the social worker, she has asked for help in decision making.

Firstly the SW has to identify the main components and problems. For the SW this would be a task which would need careful consideration, planning and analysis.

The recent diagnosis of an advanced breast cancer requires Joanna to explore different options for planning her sons future. Therefore the initial phase of task-centred practice is problem exploration. During this phrase key problems are identified, and then prioritised. There should be a maximum of three problems where the SW would be working on with Joanna. Too ‘many selected problems will probably lead to confusion and dissipated effort’ Doel and Marsh (1992, p 31).

Having identified the problem(s) the SW would then find out what Joanna wants are. Once the basis for work is established, the SW and Joanna precede in a series of incremental steps towards the goal(s). According to Doel and Marsh (1992) ‘the journey from agreeing the objective to achieving it is measured in small steps called tasks. These are put into place by Joanna and the SW. As a result this would help Joanna in achieving her objective and the alleviation of the problem.

Methods or techniques for achieving the task(s) should be negotiated with Joanna. Task-centred practice is designed to enhance the problem solving skills of participants. Therefore it is important that tasks undertaken by clients involve elements of decision making and self-direction.

The task-centred approach would enable fast and effective support to Joanna. ‘The time-limit is a brief statement about the likely length of time needed to reach the goal’ Doel & Marsh (1992, p 51). A time limit is important for a number of reasons. ‘It guards against drift, allows time for a review and encourages accountability. It also acts as an indicator of progress (Adams, Dominelli and Payne, 2002). The task stage is made up of a series of developments and reviews. The execution of reviews is important as it allows for an assessment of the success of the steps taken. The ending of the process of task-centred work will have been anticipated at the initial phrase. The concluding session should include a review of the work that has been accomplished by Joanna in order to alleviate the target problem.

The main advantage of the task-centred practice are that it does not mean simply assigning tasks but it is a very well researched, feasible, and cost-effective method of working. The source of the problem is not presumed to reside in only the service-user. Attention is paid to external factors such as welfare rights and housing, and where there is scope to supply ‘power’ it is taken in the form of information and knowledge giving. It also addresses the strengths of people and their networks. Task-centred attempts to put worker and client on the same level Coulshed &Orme (1998, p 123).

Althought the advantages to task-centred practice can be easily identified, the disadvantages and drawbacks are not as easy, as they are based on research. Therefore, it is not only looking at the approach widely and hypothesising disadvantages, but putting the approach into practice and gathering relevant information to analyse any negative conclusions. Some of these disadvantages would be that underlying problems requiring longer term approaches may go unnoticed, it requires sustained efforts from service user who may sometimes be unable to do this due to physical or emotional strengths. Clients may be overwhelmed by problems and unable to deal with them in a structured way. However the SW would still have a positive gain by improving their capacity for clearer thinking and forward planning, which in turn brings on successful intervention Coulshed & Orme (1998, p 119).

Moving on to Crisis intervention, which can be quite diverse with the models that uses. Payne (199, p 101) states that ‘crisis intervention uses elements of ego-psychology from psychodynamic perspective. It focuses on the service-users emotional responses or reactions to external events and how to control them. Strategies of crisis intervention are based on psychological theory However, these are adapted and modified to fit the demands of the crisis situation.

Crisis is a universal concept which affects people from all cultures. James and Gilliland define a crisis as ‘a perception or experiencing of an event or situation as an intolerable difficulty that exceeds the persons current resources and coping mechanisms (2001, p 3). People in crisis situations may overlook or ignore important details and distinctions that occur in their environment and might have trouble relating ideas, events, and actions in a logical way.

Crisis intervention, therefore, is an action plan to help people cope with immediate acute stressful demands. Hence, as crisis intervention focuses on resolving immediate problems and emotional conflicts through a minimum number of contacts. The first stage would be to enable the service-user to make sense of what has happened to them and to begin to feel in control. Drawing on Joannas situation, one can easily see that this type of approach would benefit her in many ways. Joannas cancer is advanced and the life-time left may not be very long. She is aware of her health situation and would need help with her emotional situation as well as Jacobs.

Joanna sees herself in a state of emotional disequilibrium and is struggling to adjust and find a new sense of balance of all her problems, her emotional situation might seem insuperable at the time. Joana does not feel in control of her life anymore but still is trying to manage.

Crisis intervention, intervenes when people have reached a situation in their lives they can no longer cope with. Thompson (2005, p 69) describes it as a ‘turning point in peoples lives which creates a lot of energy that can be used positively to tackle problems, resolve difficulties and move beyond previous barriers to progress. This would empower and help Joanna to identify her major problems and find better coping mechanisms. By providing support such as home visits this would help with the breakdown of care for her son and family as well as offer Joanna time for herself to come to terms with her illness.

The methods I would use are the Roberts (1995, p 18) seven stage model. The first stage would be by assessing lethality. Although Joanna presented herself to the SW she might not be the only person most at risk: it might be that Jacob is facing emotional reaction that can even lead to self harm. Therefore the SW should plan and conduct a crisis assessment as well as lethality measures. ‘James and Gilliland emphasise that assessment should be a constant part of crisis intervention, because of rapidly changing emotions Payne (2005, p 105).

The second stage of this model would be establishing a rapport and effective communication skills. This can be easily achieved by genuinely respecting and accepting Joanna and her family and sometimes reassuring that behaviour is not unreasonable or unexpected, this may help to achieve the rapport building.

In the third stage the SW has to Identify what Joanna sees as her major problems. ‘Myers (2001) distinction between affective, cognitive and behavioural aspects of the reaction to the crisis are also relevant here (Payne, 2005: 107). In the fourth stage the social worker would be actively working on Joannas feelings and emotions, as when dealing with an immediate problem, it can be easy to miss out or avoid to focus on feelings. The fifth stage involves looking at the past coping mechanisms. In Joanas situation, the death of her partner can be seen as a success. ‘Success should be highlighted and reinforced Payne (2005, p 108).

In stage six Joana would be working with her SW to understand why the crisis situation was so distressing. Finding a way to manage the situation and formulating an action plan that works for her, so that she can reach her goals and would feel empowered. In the final stage the SW has to make sure that Joanna would feel able to return if further problems arise and establish an action plan for Joanna and family, to help them indentify likely stressful points in the future.

During this process, the SW should remain self aware of own biases and vulnerabilities and recognize how these could have an impact on her own judgment and actions. Payne, (1996, p 43) quotes that ‘the term intervention is oppressive. It indicates the moral and political authority of the social worker to invade the social territories of service users. Even though Joanna presented herself for help, she could still see this intervention as being intrusive; this may oppress her and make her feel powerless. She has had the main role of the parent and house keeper in the family and may feel that these have been taken away from her.

Joanna may feel detached from her family and internalize the problem, and may not focus on the situation; instead she may focus on the intrusion. So the SW may not get a true picture of her feelings and may interpret things wrongly and make assumptions. Crisis intervention can be seen as oppressive at times as it demands quick answers in a short time frame. Therefore not taking into consideration different culture background which may see this as questioning and make them feel discriminated against.

In conclusion both try to improve peoples capacity to deal with life problems. Crisis intervention uses practical tasks to help people readjust; they place great importance in the emotional response to the crises and the chances of peoples capacity to manage their everyday problems in the future. Task-centred work focuses on performances in practical tasks which will resolve particular problems. Success in achieving tasks helps emotional problems. Crisis intervention has a theory of origin of life difficulties. Task-centred work takes problems as given, to be resolved pragmatically. Payne (2005)

In summary, I have discussed task-centred and crisis intervention approaches and identified that despite their different origins and differing emphasis, both these approaches have a role to play in promoting the anti-oppressive approach in SW practice by restoring as much control as possible and validating and celebrating strengths. They both reject the long term intervention of psychodynamic work which makes the service-user more dependent on the worker. Both theories promote the time limited and more focused way of working with service-users. Although the approaches have limitations, they provide frameworks for SW to engage with the service-users in the most effective way.

This assignment will attempt to look at the role of a youth worker and identify what is meant by the term youth, and how youth work has changed over the years. This will follow by a look at how the delivery of services to young people has changed, in response to the growing influence of technology and communication between adults and young people. Furthermore, it will look at the historical changes of youth culture and the meaning and effects of ‘moral panics’. The assignment will conclude by looking at the different methods and roles of a youth worker and the current services available to young people today.

What do we mean when we say youth, how do we indentify youth; these are many questions one must ask themselves when talking about a particular group of people.

It is important to understand that when one is identifying a group of people the label is appropriate and positive, rather than a term that is used to identify negative images of that group of people. The term’ youth’ has many negative connotations attached with it and is very much used by the media to describe youths as “unruly” and “out of control”. This then reinforces people’s stereotypical view of young people and widens the gap between adults and young people. Griffin (1993) cited in Young (1999, p.22) describes ‘youth’ is described in two ways, either in terms of ‘youth as trouble’ and therefore in need of control, or ‘youth in trouble’ therefore in need of protection.

Although both the terms ‘young people’ and ‘youths’ are the same the former has no negative images attached to it, rather the opposite, it shows young people as being talented, hardworking, skilled people and part of society. Furthermore, the negatives of ‘youth’ imply young people as out of control, lazy, dirty, violent and most likely to commit crime, almost a menace of society.

Oxford dictionary (2005) defines ‘youth’ as: ‘a period between childhood and adulthood’.

The term youth worker is difficult to pin down and give one definition as it has many different meanings. This can be for example, working with a group of people in youth centre, meeting young people in their own environment, one to one work or acting as an advisory figure for the young person. To truly identify what a youth worker is, it is important to know how youth work has emerged and reinvented itself to keep up with its changing client group.

Hall (1965) cited in Jeffs and Smiths (1988) defines youth work as provision of opportunities for ‘informal education, social intercourse and the creative use of leisure through membership of a group’

It is important to look at how youth culture has changed over the years and how these changes have impacted on engagement with young people. Different groups emerging throughout the years, such as, Teddy Boys, Hells Angels, Skin Heads, Mods and Rockers, with these groups emerging there were various labels attached, furthering the gap between society and its young people. The term “moral panics” was established from the work of Stanley Cohen. He describes its characteristics as ‘a condition, episode, person or group of person’s who become defined as a threat to societal values and interests’, Cohen (1987, p.9) .He goes on and describes how the mass media can sell these issues as a national concern when in fact these matters may be resolved within the local community. In the 1960’s the Mods and Rockers were viewed as a huge threat to law and order by the general public, but this image was created and perpetuated by the media, making them appear to be a fearful and violent group of people.

The Albemarle Report in 1960, cited in article, Smith (1999, 2002) would be the key to developing and structuring the youth service and changing it forever. The report went on to identify clear objectives and commitment to working with young people, this was what gave the youth service a framework in which a service could be delivered. The report gave the aims of what the youth service should be, including association, training and challenge.

Following the Albermarle report, the aims of the youth service would be set, Smith (1999, 2002), the objective should be training, association and challenge.

The report would change the way in which services for young people would be delivered, and became part of any other public service funded by the government. A huge amount of money was spent building youth centres, clubs, and a focus and commitment towards engaging with young people.

This was largely a success up until 1970, after which the number of young people attending youth centres dropped considerably. There were many factors for this decline; one was the rapid changes in the home life of young people. With the increase of technology, many young people had access to other means of enjoyment and entertainment. Many homes now had television sets, video players and computer games, which meant they would remain in their homes. Other factors for the decrease were parent’s fear of young people going out late in the evening and young people were now using other means to socialise and meet people, such as educational settings.

The decrease of young people attending youth clubs continued throughout the 1980s and 1990’s, but youth work was still high on the government agenda. The condition of buildings was worsening and becoming less attractive to young people. The government was reluctant to invest further funding restoring or building any further youth centres, especially with the decline in young people accessing the services. This became a very depressing time for youth workers who were unable to sustain numbers and were often left to deal will things alone and without any support. The final shift to try and keep the service from disintegrating, was made, when there was a move towards issue-based work and the importance of outcomes. This was further enhanced with the development of accreditation and alternative education programmes. With the new changes and expectations the criteria for funding changed focussing on young people at risk of some kind, rather than a generic service for all young people.

Smith (1999,2002).The Labour government were to further this approach when they came into power in 1997, they went on to push the idea of delivering s service for young people rather than looking at the youth service. This bought many changes and we saw innovations such as Connexions introduced in 2001, a pilot scheme which aimed to keep young people in education, training and employment. This bought further changes as new titles such as personal advisors emerged making the role of a youth worker more varied. Smith (2005) The Connexions programme although seemingly was seen as a success, the publication of The Green Paper in 2005, showed a growing detection of the schemes failures, as young people continued to have the existing social problems which were never addressed by the youth services.

A study carried out by The Joseph Rowntree showed that in 2006 there were 75,000 young people, who were faced with homelessness, (Youth Homelessness In UK.2008) furthermore, earlier studies reported by the Rough Sleepers, produced by the Social Exclusion Unit, showed that in 1998, a quarter of street homeless were aged between 18 and 25. Rob (2007, p. 241). This again shows that a youth worker will be faced by many challenges when working with young people, including dealing with young people with drug and alcohol issues and mental health conditions.

There are many methods which have traditionally been used to deliver services to young people, which including, detach work, outreach work, one to one or centre based work. Detached work has been around for many years and has proved to be very effective way of engaging young people in their own environment. This work can be often confused with outreach work but is different as it is voluntary which give the young person total control over how much or little they want to be involved, and is not attached to any centre.

Burgess, M and Burgess, I. (2006) describes the following as a definition of detach work. The core values stated by the federation for detached youth work are as follows; a relationship with young people remains voluntary, the services should be tailored to the need and the power must remain with the young person, rather than the worker.

Workers will go out to various places in around the local community trying to engage young people; they will usually start by going out in pairs to ensure the safety of the worker and young people. Once a relationship has been established then very often one to one work will take place, discussing issues relevant to the young person and their local area. The worker will make reports after a certain period of time engaging with young people. The report will help the worker to identify a framework in which they will work with the young people, setting out aims and objectives. Not all youth services use this method of working with young people, however over the years it has proved to be a successful way of identifying and resolving issues faced by young people in their local area.

Outreach services are an extension of an organisation for example, a youth offending team, youth centre and drugs projects. The objective of this work is to encourage and engage with youths that have disengaged with services or are at risk of becoming problematic. This may be because of the area in which they are living in has been identified as an area with a high level of youth crime. Although this work is not service user led it has many positive aspects, often these young people do not have a platform in which their issues can be addressed, and an outreach service will help with both, individual problems and problems within the local community. However, it must be said, that the service is not always voluntary involvement for the service users therefore may not be as effective.

Other methods such as centre based work, one to one and issue based working have both positive and negatives to them, but they do help youth workers reach out to young people. Cortazzi (1993) cited in Young (1999) states ‘youth workers do not merely deliver youth work, they define it, interpret it and develop it. It is what youth workers think, what youth workers believe and what youth workers do in practice that ultimately shapes the kind of experience and learning that young people get’.

It is important to acknowledge that a youth worker’s role is unique, challenging and vital to young people. Adolescence is a time of huge changes and transitions and a youth worker’s role is central to this, not only because their work is aged based, but because they will be part of a young person’s life at a point where they will be going through the transition from childhood into adulthood and or from being dependent to becoming independent.

It is impossible to define the role of a youth worker in one definite term as this role is varied and large; youth workers will deal with young people with a catalogue of issues, concerns and problems.

These can range from family breakdown, lack of trust, drug and alcohol, mental health, crime, homelessness, lack of coping strategies, young person in crisis, confidence, self esteem and motivation. A youth worker will wear many hats whilst working with the young person from being a friend, a parent figure, an advisor, an advocate and a person who shows the young person they matter. These are some aspects of the role of a youth worker, and some of the issues which are dealt with by youth workers, making their role challenging, exciting, frustrating and very rewarding.

Where are we now? We have seen the youth service grow and develop which has made many changes to the role of a youth worker, there are many new targets and outcomes to meet to sustain funding and new challenges to face. We have many new services available to young people that are aimed to tackle many issues faced by young people, we have the government strategy of providing inclusive and diverse services, which has introduced ‘support people’, and in particular to young people we have the Foyer Project. This provides both housing, helps with education and training and has personal advisors funded by connexions. We now see extended schooling in the educational settings, youth cafe’s, youth centres and the traditional detach and outreach services.

We have seen many government initiatives that have been have been aimed to help young people engage with adults, however, little emphasis is given to address the social problems faced by young people and the changes in culture, generation, and how we regard young people as a society. This will continue widening the gap between young people and adults, resulting in young people less likely to engage with services, such as education, youth services and training schemes. Early interventions are the key to help young people learn to build trust, attachments, coping strategies and confidence when making the transition from child to adulthood and a youth worker is an integral part in this conversion.

I will approach this assignment from a political view. Firstly critically evaluating the legislation and policy context behind inter -professional practice and inter agency working within Mental Health, Discussing the key pieces of historical legislation that have been most influential in social work practice today. I will critically evaluate how professionals work together, taking into account a variety issues with reference to the Modernisation Agenda. Discussing the overall impact this has on the provision of Health and Social Care services, with particular reference to the service users, identifying high profile cases within the UK that have become a fatal consequence of professionals and integrated services not working effectively.

Secondly I will demonstrate a clear analysis of inter-professional working drawing on my own personal experience within the mental health services, identifying and critically examining key issues of working inter- professionally and inter agency, from possible barriers to strategies to promote inter -professional practice.

Legislation and policy requirements over the past decade have required health and social care agencies to work together closely and collaboratively. In the UK Major changes have taken place within the Health and Social care sector, with the transformation and growth of the many new acts being implemented and amended to meet the needs of a diverse and ever changing contemporary society. The birth of the NHS Act (1948) was the initial development brought in by the Atlee government, which brought about the hugely ambitious plan to bring hospitals, doctors, nurses, pharmacists, opticians and dentists together under one umbrella of organisation to provide services that are free for all at the point of delivery. It was the largest integrated service which required professionals to work closely together, although the link between health and social care needs were not yet focused on. (Miller,C.2001 pg4-7)

The achievements from the development of the NHS were impressive and have impacted health and Social services dramatically with productive and innovative partnerships with bodies in both the public and private sectors today.

Further developments began to emerge with the reviewed provision of social services in Britain with the Seebohm report 1968. The report highlighted that community health services and welfare services were being developed by separate departments with, poor communication and little co ordination. Therefore it was the development of a unified Social Services department and generic training. (Carnwell,R.2005 pg21)

Initially, the NHS had a three part structure, with three branches hospitals, primary care and local authority health services.

The NHS reorganisation Act 1974, a ‘unified’ structure was introduced, with three main levels of management, at Regional, Area and District level.

In the 1980s, Enthoven, (1985),an American economist, made an influential criticism of the NHS, arguing that it was inefficient and resistance to change. The reforms

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Which followed were based in the belief that the NHS would be more efficient if it was organised on something more like market principles. The NHS administration was broken up into quasi-autonomous trusts from which authorities bought services. The role of Regional Health Authorities was taken over by 8 regional offices of the NHS management executive. For the first time, the NHS became truly a nationally administered, centralised service. (R Klein, 1995). Sited (Bishop, M The regulatory challenge 1995 pg 36). The two acts which had a huge impact on Mental Health Services were the Mental Health Act 1983 it provided safeguards for people in hospital. Section 117 of the Act imposed a duty on district health authorities and social services departments to work inter professionally and alongside voluntary agencies to provide after-care services for people discharged from hospital. The second was the NHS and Community Care Act 1990 it made all the legal changes necessary for the implementation of the ‘Caring for people’ White Paper. Local authorities, in collaboration with health-service and independent-sector agencies, now became responsible for assessing need, designing care packages and ensuring their delivery. Both these developments required a strong collaboration between health and social care but the government believed that partnership working was so crucial, in order for the developments to be effective.

1997 one of the New Labour policies was the focus on the ‘Modernisation ‘of all the government sectors. With this came the promotion of partnership working within different areas of government and the collaboration of private and voluntary sectors, (Giddens,1994) described this new modern way of thinking as the third way and reflecting on this came the governments first health service white paper,

‘The new NHS: Modern and dependable’ which stated the end to centralised command and control of the 1970’s and instead there will be a third way of running the NHS, a system based on partnership. (Secretary of State for Health, 1997).

As part of improving services for Mental Health, the aim was to tackle the root causes of ill health whist promoting independence and providing excellent quality of care with regard to treatment, protection and partnership working in integrated health and social care.

Partnership in Action (DOH 1998) discussed improved outcomes on integration.

The Government made a commitment to encourage more joint working between health and social services. The paper made plans to make partnership working a reality, breaking down barriers between local government and health authority services.

The Health Act 1999, addressed legal barriers and introduced new powers with the aim to enable partners to join together to design and deliver services around the needs of service users rather than worrying about the boundaries of their organisations. These arrangements were geared to help eliminate unnecessary gaps and duplications between services. It provided pooled funds, lead commissioning, and integrated provision. One of the most recent publications was the 2007,Publication of Mental health: new ways of working for everyone – a report aimed at all mental health staff, looking at ways they can work more flexibly within teams, produced by the NIMHE National Workforce Programme. The report builds on previous guidance and promotes a model where ‘distributed responsibility’ is shared amongst team members and can no longer be delegated by a single professional such as the consultant. The report was published alongside the ‘Creating capable teams’ approach (CCTA), which provided practical guidance, and New ways of working with service users and carers.

The aim the developments in policies and frameworks was to provide a ‘seamless service’ (Griffiths,1988:Doh,1989) which the government believe can only be possible with a multi professional approach to health care, with all professionals contributing and working alongside ‘inter professionally’. The main objective is that services users can be cared for within the community or within a hospital without any barriers or gaps within the service and with a range of different professionals who are well informed of their history of intervention.

With patient care being the centre point of inter professional practice it is important to understand what effective team work consists of. It has been stated that the whole point of team work is to bring individuals knowledge, opinions, and personalities and thinking styles together, that will seek to find the best possible solutions to the matter at hand. (Paul Gorman 1998). (Thompson 1998) stated four ways in which health and social care professionals can move forward in a way that embraces diversity and learn from each other, embrace partnership, adopt a value position where anti discriminatory practiceis central and reflect on practice.

The importance of effective partnership working was central to Labours New modernisation agenda (1997), with new ways of working inter professionally and new ways of delivering integrated services working closer together, providing packages of care (Department of Health 1999b). The Labour government believed that the previous way services were delivered were considered unhelpful with professional and organisational divides, or ‘Berlin Walls’ (Parrot2002).The government argued that the existing configuration of health and social care was contributing to an artificial segregation of services.

Labour believed that in order for the modernisation agenda to be effective, professional and organisational autonomy but be completely broken down in order to achieve effective care to service users.

Poor teamwork skills in healthcare have been found to be a contributing cause of negative incidents in patient care, while effective teamwork has been linked to more positive patient outcomes. (Runicman et al., 1993).

(Barrett, Sellman and Thomas, 2005) stated that good team work requires regular reflection and supervision, education and training, reinforcement of identity, evaluation, effective managerial support and having realistic expectations.

There is a large amount of literature on inter professional working that has focused on the potential difficulties in achieving effective working relationships between practitioners from different professions. All professionals working in integrated teams face challenges due to different codes of behaviour and understandings of ethical and moral rules, this can have implications to partnership working.

(Mc Laughlin2004) argued that it remains questionable as to whether different professional groups will be able to make ideological shifts, as the Modernisation agenda required a fundamental culture shift and attitude change by all professional groups at all levels. (Aswell 2003) stated that a clash of professional culture and objectives ways of dealing with client groups is still an area that exists.

(West and Markiewicz 2006 ) suggest ways in which these problems may be avoided by using seven dimensions to achieve effective partnership working, they believe by having, shared commitment and goals, inter professional support and respect, true co operation; focus on quality and innovation, cultural congruity role clarity and independence of outcomes.

(Iles and Auluck, 1990:Gibbon,1992:Field and West,1995) also researched multidisciplinary working and stated that in order to achieve effective teamwork, not only do individual professionals need an appreciation of other members roles and their contribution to patient care, but they also require a clear understanding of their own role in the team.

There are many principles of successful multi agency working identified by the Every Child Matters, agencies and practitioners need to work together with agreed and achievable aims and objectives. Partnership working can only be effective if there is a clear purpose, good communication; co-ordination; protocols and procedures set in place and effective mechanisms to resolve conflict when it arises. Multi disciplinary working functions better when professionals are working in an organisational culture that supports teamwork and has strong leadership and effective administrative support. ( )

Effective teamwork can only be achieved when all levels of the healthcare systems work together. Effective leadership is important but practitioners are aware that this is a demanding role. There is considerable support for joint training at both the pre- and post-qualifying stages .Evaluation and monitoring is vital in ensuring common outcomes are achieved and interagency working is successful.

Findings from high profile inquiries in the UK, such as the Lamming Report (2003) into the death of child Victoria Climbie and the Ritchie inquiry into the care and treatment of mental health patient Christopher Clunis (Ritchie et al., 1994). These cases highlighted the lack of communication and poor information sharing between agencies as contributing to these tragedies. Policy documents focused on the need for better cooperation and communication between professionals in order to enhance service provision. There are a number of costs of poor integration. Perhaps the most extreme costs were reinforced by a series of enquiries into murder cases.

The inquiry into the killing of Jonathan Zito by Christopher Clunis, who was diagnosed as having schizophrenia, was notorious. At a London underground station in 1992. It highlighted the difficulties inherent in joint working between services, the duplication of effort and indeed the potential for no-one taking ultimate responsibility. The Ritchie Report did not, on the whole, blame individuals but noted that Christopher Clunis was in some sense a victim of the health and social care system since he had spent over 5 years being sent between different facets of the health and welfare service, between hospital, hostels and prison with no overall plan for his care and inadequate supervision for many aspects of the health and social services.

Victoria Climbie died at eight years old as the result of horrendous physical abuse. The neglect and the vicious beatings were carried out by her great aunt, Marie Therese Kouao, and her boyfriend Carl Manning. But she was also failed by social workers and others who could have stepped in to protect her. Victoria died of hypothermia in February 2000. She had 128 injuries. The Home Office pathologist who examined her body, Doctor Nathaniel Cary, stated that it was the worst case of abuse he has seen in his career. The inquiry heard that there was little exchange of information between the hospital and Social Services which led to a battle of conflicting assumptions, where each body believed that the other was fully aware of the situation. Doctors believed that Victoria had been abused but did not realise that neither Social Services nor the police were aware of the evidence. These cases are clear cases of breakdown in communication between multi disciplinary teams and agencies within integrated services.

In 2003 the Government published a Green Paper called ‘Every Child Matters’. This was published alongside the formal response to the report into the Victoria’s death. In addition training for professionals was vital for integrated services and tools such as information sharing need particular attention.

The Common Assessment framework (CAF) was implemented it provides an easy to use assessment that is common across agencies. It has helped to embed a shared language, support better understanding and communications amongst practitioners; facilitate early intervention; speed up service delivery and reduce the number and duration of different assessments that have been used in the past

Working for the Community Mental Health Team for Older People I worked within a multi disciplinary setting. The team consisted of Social Workers, Occupational Therapists, Community Psychiatric Nurses, Care workers, Administrative staff and a Consultant Psychiatrist. Our services were integrated as we worked closely with other agencies to deliver integrated care packages.

Over the duration of the placement I witnessed a strong work ethic amongst the team as they all shared the same common goal, which was to deliver the best possible care package. I felt that the team worked effectively, updating their training skills on a regular basis, and implementing changes where applicable with regards to developments in government legislation, frameworks and policy documents. There were clear boundaries of confidentiality and, this was highlighted in the team’s policies and procedures which I was made aware of immediately. The team’s manager held regular supervision sessions for all the team practitioners which gave everyone the chance to discuss any areas of concern. Communication was vital and regardless of your position within the team your opinion or suggestions were taken on board and would be implemented within the weekly multi disciplinary team meeting. When there was a mixture of opinions held over possible intervention strategies the case would be discussed further until there was a shared agreement. The Consultant Psychiatrist usually held the final say alongside the team manager. It was compulsory for all practitioners to attend as it was the time when all new referrals were allocated.

Each member of the team discussed new and existing referrals, providing support and advice for any concerns mentioned. Every member of the team was aware to a degree of new and existing cases, which helped during annual leaves or sickness. There team was made up of individuals with a mixture of cultural backgrounds, religious beliefs, values, training backgrounds, experience and skills therefore there were times slight clashes of personalities occurred on a personal level but as professionals the differences never seemed to get in the way of their main objective. Being community based the team held an in dept knowledge of local resources available, constantly incorporating assertive community treatment within care plans. The team respected and acknowledge the contribution of each other and worked towards a common goal. The patient’s records included shared care plans and joint decisions following consultation with the patient.

Unfortunately I noticed that working alongside other agencies did not run as successful as the team did. There were increasing numbers of complaints about information sharing, duplications, workloads, and communication. I believe that a lot of this was due to lack of awareness of roles and functions of other agencies. I also felt that because of large workloads a lot of the communication was done via email, letters or telephone therefore relationships were not established initially face to face which seemed to have a lasting effect.

Community Mental Health Teams supply effective care within the community but I strongly believe that there is the need for further training to develop better relationships with external agencies. I feel optimistic about current developments and changes as there are many opportunities, with policy emphasis on age equality, self-directed support, improved education, training and support for those who work with older people, I believe it will facilitate change. I believe there is a need for stronger professional, managerial and leadership within the team as is the effective targeting of much-needed investment and resources. This to me is a vital point, inadequate resources with particular regard to the reduction in acute bed numbers adds a certain amount of pressure for practitioners and service users.

Tyrer et al (1998) found that the advantages of community care were overshadowed by the unavoidable use of out-of-district admissions if local provision was inadequate. Beck et al (1997) demonstrated that even within a well-established community mental health service, there was often no alternative to admission for a large majority of patients admitted to acute wards. Adequate numbers of acute beds are therefore absolutely essential for the provision of effective mental health care. High volume workloads made community working more stressful making it more difficult for practitioners to develop more effective relationships externally

Inter professional practice is viewed as problematic to many as they feel the level of expertise held by many professionals will become diluted and generic training may even disappear. The Five categories of major barriers in joint working and planning in Health care services are structural issues, procedural matters, financial factors, and professional issues. (Harley et al (1992).

(Leathard, 1994), analysed inter professional collaboration and describes rivalries between professionals in terms of power and professional identity. It was stated that the power of more experienced practitioners over less experienced practitioner would result in a barrier to inter professional working. He also made reference to barriers in finance and resource allocation, stating that, professionals have different pay scales according to their professional group and their role within it. Resource allocation can be a source of conflict. There is the issue of funding for staff. Seeing funds being used to employ staff from one group to provide a service normally provided by another can cause resentment. Staff shortages can also damage interaction as groups withdraw in an attempt to limit demands made upon them.

In addition there is the fear that multi professional collaboration is designed to reduce costs. Leathard (1994) also highlights further suggestions that one of the advantages of inter professional working is ‘more efficient use of staff’.

(McPherson et al 2001), critically examined barriers and suggested that, the barriers preventing inter-professional working include a lack of knowledge of the capabilities and contributions of other professionals, and existing rivalries and resentments amongst qualified professionals. This is compounded by the wide range of stakeholders with their own aims, objectives and priorities inhibiting Inter professional working. There is also a misunderstanding among qualified practitioners who worry that Inter professional working will lead to blurring of differences between professions.

( Borrill 2002, Camron et al 2000, Watson et al 2002, 2004) argued that joint working brings many benefits but when different agencies follow different methods of working, training , goals and priorities the effect can ultimately be less effective . Sited (journal, barriers and facilitators).

Other areas that may affect effective partnership practices are geographical location, equipment, financial arrangements, referral systems, recruitment, workloads, and organisation of work, extent to which there are opportunities to challenge attitudes and change practices and failure to consider the practice of a team as a team. Responsibility without accountability, lack of leadership preparation and Resentment and lack of trust ( )

Inter professional practice has been clearly promoted through legislation and policy documents ever since The NHS 1948 Act. There are many Acts which draw on the relevance and importance of joint working when delivering an integrated service. Legislation and policy documents over time have emphasised the need to make partnership a reality throughout Britain by removing barriers which exist, and by introducing incentives of joint working to achieve better monitoring of progress towards joint objectives. There is also the importance of inter professional practice and the need for professionals to work together to develop and improve the delivery of care, by sharing the same a core objective. (Partnership in Action white paper (1998)).

The new Labour government (1997) aim was to promote and improve joint working between health and social services. This will allow for pooling of budgets and other ways to deliver truly integrated care that is geared to the needs of individuals. There was also the promotion of partnership working to improve housing and other services, and the development for stronger children’s services and planning requirements to ensure more effective co-ordination of services for children. All the changes were radical steps to modernise and promote their commitment to improve inter-agency working between social services and the NHS.

The Community Mental Health Team worked alongside Service user groups, referring people appropriately to specified groups within the community.

Age Concern offered a wide range of services for clients within the community all clients who attend the groups need to be referred by a Social Worker or a Doctor. Many clients suffered from organic or functional illnesses therefore there were services to provide support from both aspects. The services offered a wide range of facilities, depending on the needs identified in the care plans. The service user groups were essential to many clients as it gave them a sense of community feel. Services were designed to support people and to help them to maintain their independence, enable them to play a fuller part in society, protect them in vulnerable situations and manage complex relationships. The groups I had contact with also aimed at enhancing choice and control for service users and enabling them to lead meaningful lives.

Service user groups include lunch clubs, drop-in centres, befriending schemes and other social groups for older people with mental health problems. Day care has been shown to delay institutionalisation for older people with dementia. The range of interventions provided in day care settings must be increased to meet older people’s varied needs. It is vital that the correct services are implemented in order to help people live a comfortable life free from risks and neglect. Because people with dementia need a complex mix of health and social care support to help them remain healthy and independent, I found that joint working was vital and needed to be approached effectively to ensure quality of care.

Throughout this module I have become more aware of the importance of inter professional and inter agency practice and the barriers that make partnership working difficult. I have gained a clear understanding of legislation , frameworks and policy documents that have been implemented over time that draw upon the impact insufficient team working can have on service users.