Category: Free Essays

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.

The aspect of social work practice I feel most difficult to perform is the gerontological social work. This paper would firstly describe the context of social work practice with old people. After that, I would exam the reasons preventing me from effectively conducting helping process by evaluating my attitudes, emotions and experiences as well as by reviewing professional literature on social work practice with old people. In the end, I will shape a personal plan on how to address this weakness in the future.

There is a universal folk saying that everyone wishes to live a good long life, but no one wishes for old age. Although in virtually every helping process attempt, social workers bring their own emotional or cognitive influences to intervention, I feel especially difficult to perform in the interventions dealing with older adults.

With the development of medical and health care and with the baby boomer generation’s entering into their old years, the aging of population in the twenty-first century has become increasingly concerned by more and more people. In responding to the drastic transformation of social institutions such as elderly social service and health-care system, the social work practice with old people turns out into one of the most popular social work aspect today.

Apart from the well-known nursing homes and hospital, there are other settings for gerontological social work as well. Geriatric care management, community social service agencies, adult day health care, legal services??home health-care agencies , macro settings for gerontological social workers and community planning also play their active roles in serving the older adult in a variety of ways.

The gerontologiacal social work, which needs high level of self-awareness, commitment and professional skills, is somehow a complex mission for us to carry. Many social workers admit that social work practice with old people is both challenged and exciting for the reason that, at one hand, it reminds of feelings about death, aging of our family and one’s own attitudes toward helping the disadvantaged and vulnerable old adults; on the other hand, it also presents joys and delightful pictures and makes us think more about ourselves.

Root of difficulty
Review own personal factors

Among all the factors that influence my ability to perform this particular area, the subtle effects of my social and personal massages and the counter-transference feelings of old people would be matters of cardinal significance. Furthermore, I also affected by my characteristics and cognition to certain kind of old people.

Stereotypes. When I was a child I always heard people saying that old people are vulnerable and need help, and older adults are less valuable as human beings because they have to rely on their children. At home, I was asked to behave properly and not offend grandparents; otherwise I would get scolds and punishment. While at school, I was required to help older people for that they have trouble getting around. These stereotypes toward elderly are usually negative for me and imply an attitude or unintentional message that old people are hard to take care of, stubborn, old-fashioned and unpleasant.

Consequently, I always feel that I cannot handle the relationship with older people well and they will not like me. I feel uncomfortable in front of many of my eldership because I do not know how to keep conversations going with my poor eloquence and interpersonal skills. Even though I understand ageism is a destructive social justification when I grow older, I still cannot change the comments I once made on aging and I am a little bit afraid of old people to some extent.

Personal emotion factors. I am by nature a sentimental and emotional person from an early age. My grandma passed away when I was in primary school. She left me even before seeing my admission into university and engagement with my fiance. I always think that if she could see these, she would be very pleased and also, I would be the most delight person in the world. She always lived a difficult life when she was young and did not enjoy much in her late years. Sometimes all my family members would feel guilty for missing the chance to treat her well before she left us.

As a consequence, when facing the dying older people, especially female elderly suffered from chronic disease or cancer, I inevitably feel urgent to ‘save’ them and so scared to face the truth that they will eventually die someday. I doubt myself about what I can do for them and I am so scared that they will leave me before I can do anything right or helpful. In fact, that is one of the most difficult challenges in social work practice for me.

Real understanding of old people. As a social worker, I appreciate that getting old does not inevitably mean the loss of intelligence, memory and cognitive functioning. I also understand that developing a level of understanding is necessary from a social worker standpoint, and it helps me to anticipate client needs and perform an ongoing self-critique in order to improve and grow my helping process. However, many times I feel I am not able to truly understand them and consider things from their perspective of views as I never experienced true aging. Many decisions I made somehow reflect my own perception of the situation such as to decide whether an old adult should stay in own home or hospital, or to conclude that an older person is showing poor judgment about financial decisions. Furthermore, it would be even harder to perform my role as a social worker when a balance between the opinions of the older adult himself, his family and the social worker need to be achieved. This obstacle prevents me from behaving more successfully at building a sustainable relationship with elderly clients and I simply do the work and move on.

When everything needs more time and patience. With the tight time schedule and many objectives to be accomplish, sometimes a social worker needs to be in a hurry to push on the intervention process. And some other times even if I have explained many times, it is still necessary to have extended periods describing complicated appointments to older clients. I always tend to speed it up although in that case, in order to attain my goal I should slow down to give them more time to think about the process. Lack of patience would be another problem preventing me from effectively working with elderly or even almost every aspect of social work practice.

Reviewing the professional literature

Many social workers admit that, even though both meaningful and satisfactory, working with elderly people can need a high level of self-awareness and self-discipline. The truth that everyone must eventually face the developmental stage of aging and death for themselves and their families may contribute to the anxiety and complexity of the helping process, as social work practice in the aspects of domestic violence or drug abuse may not personally affect worker. This can impact workers with older clients on both a conscious and subconscious level.

Ageism and Death Anxiety. In most cultures around the world, particularly the Chinese culture, people feel uncomfortable when deal with death or anything related to death. From an early age, children are asked to avoid to talking death and dying, and to replace the word death with phrases such as “passed on,” or “gone on to another world”. Therefore, the social workers dealt with older people may require more self-control and comfort on the acknowledging the real pain caused by the loss of human life of family and friends.

The anxiety of aging and dying process on one’s own work, combined with generally indisposed experiences about the proximity of death surrounding older adults, bring about some social workers’ avoiding work with the aging. According to the Hong Kong Social Workers Registration Broad’s data gathered from its members about their areas of practice, despite older adults make up about 12.8 percent of Hong Kong population, less than 6 percent of social worker identify gerontological social work as their field of practice, which compared to nearly 30 percent for mental health.

Countertransference. The reactions, real, and unreal, to a certain individual can occur irrespective of origin and can be based on one’s own past or present experiences or characteristics. Counter transference can be described as social worker’s reactions involve feelings, wishes, and unconscious defensive patterns onto the client. In the professional relationship with old people, a social worker may place negative feelings or dislikes of older persons onto the client, which restrict his willingness (no matter consciously or unconsciously) to continue investigating and result in impatience or intolerance of the aging. On the other side, old clients who evoke images from one’s past such as parents, grandparents or other elderly family members can make process even more arduous to advance as a result of ‘destructive’ sympathy and the ‘need to save an older person’.

The Independence/ dependence fight. Old people want to maintain their independence to make decisions while the social worker commits to promote self-determination and dignity of the individual. But things are not that simple. When an elderly claims for increasingly supporting service and experiences growing difficulties to maintain independence on his own, it will be confrontational to live up to the elderly expectations.

McInnis-Dittrich (2008) states ‘A worker can appreciate the desperate efforts on the part of an older adult to stay in his or her own home. Yet when an older adult is struggling with stairs or a deteriorating neighborhood, and difficulties in completing the simple activities of daily living challenge the feasibility of that effort, professional and personal dilemmas abound.’ This is a good example to understand that sustaining independence in the gerontological social work is a critical goal which has no simple good answer.

Private functions become public business. Discussing the topic such as an old woman’s bladder and bowel functions or an older man’s maintaining an erection or urinating with clients may cause awkward and uncomfortable resistance when social workers and other helping professional get involved. Therefore, sometimes it is important to be sensitive to the deeply personal nature when social workers try to acquire necessary comprehension of an older adult’s health conditions. A better understanding of interpersonal skills and psychosocial adjustment to aging would be helpful and essential.

Personal plan to address this weakness
Overcome stereotype influence

First of all, I hope that from now on I will pay more attention to those featuring active, healthy, productive, and successful older persons so that I will develop a balanced understanding about aging and elderly. Aging is not painful and debilitating. Many wise, gracious, and humorous elderly have made admirable contribution to the world and have shown remarkable strength to achieve a positive as well as enthusiastic life.

Secondly, another important thing for me is to keep the lines of communication open with older adults. If I can open my heart to communicate, they will share more with me. The stronger relationship between us will help me cope better with the stereotype challenges.

Last but not least, in my future helping process I will often ask myself: ‘does it reinforce stereotypes again?’ I should start from every thing in daily life to alter the attitude that hinders my ability to face the normal changes of aging. Make a change in attitude is not easy, but I will try my best to drive myself on the right direction.

Awareness and Introspection

Awareness of the emotional influence is the first and the essential key to solve my problem. How well do I manage my own anxiety with this client’s situations should be my first concern. I will always remind myself that do not be affected by my experience and differentiate my experience of losing a family member from the intervention my client. That will help me to distinguish between the older people’s need and my own need and, to remain focused on the clients’ need.

Furthermore, I could seek help from colleagues and supervisors as well. By discussing the situations with them, I can expose and explore my own feelings and get advices in order to effectively facilitate help process.

To truly understand elderly

Above all, I will try to get in touch more with old people to truly feel their emotional and cognitive problems, as well as to open my heart and listen to them. Maybe I can join them more in their music, art activities in communities. Aging does not necessarily mean the loss of memory and cognitive capacities, and I will try to explain the information in a variety of ways so that we can build understanding relationship.

Moreover, reading more books about the psychological problems of the elderly would be really useful to analyze their psychological changes and behavior patterns. Equipped with a better look at the findings from professional social workers, I will more effectively comprehend the aging process the distinguishing features of elderly.

Finally, I should learn from experienced social workers to get more suggestions when I feel difficult to continue. For one thing, they can improve my ways of carrying intervention by pointing out my mistakes. For another, they can help me understand and get the most from their strength and weakness by providing convenient and professional advice.

This essay will explore and critically discuss issues about domestic violence and effects on children with regards to the framework for constructing childhood. I will also briefly describe the historical definition of childhood comparing it to the current definition and the links to children and domestic violence.

James and Prout (1997) stated that Childhood can be understood as a social construction as it provides an interpretive frame for contextualizing the early years of human life and it is different from biological immaturity. He also suggested that to an extent the definition of childhood is dependent on the views of the society. The concept of childhood has changed overtime, due to social construction that is fuelled by our views of children, our attitudes towards them and views constructed through human understanding. This change has a big impact on children and how society sees them; these changes are due to political and theoretical influences (James and James, 2004). James and James (2004) suggested that there is a sense loss of childhood, as children are being denied their right to childhood and they are exposed to the unpredictable and impulsive of the adult world too early.

History of childhood

In Western Europe during the middle ages children were seen as miniature adults, with same thinking capacity and personal qualities, but not the same physical abilities. From 15th century Aries suggested that the idea of childhood has changed but the images and paintings of children changed as a new understanding of childhood emerged allowing children to be seen as distinct from adults because they had their own needs. Shahar challenged the Aries views, she argues that the perceptions of children as adults goes beyond the 15th century; children were perceived as either been born innocent or sullied by original sin (James and James, 2004). The image of the child born into original sin came from the Aristotelian notions overlaid with Judeao-Christian; in this children were seen as wicked and needed redemption. Susannah Wesley recommended that parents must discipline their children so they can be saved from their sinfulness. In the 18th century, children were seen as the nature child, nature wants children to be children and not merely as adults in the making. John Wesley recommended that parents should break the will of their children in order to bring his God’s will into subjection so they will be subject to the will of God. During the 19th century children were portrayed as naughty rather than evil, but this has continued today for example in books such as my naughty little sister. Towards the end of the 18th century, the perception of childhood was influenced by the romantic and evangelical. Romantic portrayed childhood as a time of happiness and innocence, children were seen as pure and should be protected before facing trials and responsibilities of adulthood; for example by Rousseau’s Emile, but it was later propagated by Blake, Coleridge and Wordsworth. Blake saw childhood not as the preparation for what was to come but as the source of innocence, but his views were confused by Wordsworth emphasised that children were blessings from God , as childhood was seen as the age where virtue was domiciled, (James and Prout, 1997). The romantic child was short-lived by the evangelical child, the evangelical Magazine advises parents to teach their children that they are sinful polluted creatures.

Currently, childhood is seen as vulnerable to exploitation especially the way which the media plays a big role in the commercialisation of children’s merchandise such as toys and games. Childhood in Britain is often perceived as being a time of innocence and happiness, a carefree time when children should be protected and sheltered from the adult world of sex, drugs and violence (Foley et al, 2001). Children are viewed as vulnerable especially when it relates to abuse or protecting them; Holt et al (2008) suggested that the perception and understanding of children has changed overtime in relation to abuse as there is more research on children and young people who have experienced abuse.

The framework for constructing childhood consists of welfare of children, children’s rights and children in a social context. The welfare of children is still a concern which continues to change the policy and legislation in order to promote and safeguard the welfare of children in society. The UK government chose three main points in the United Nations Convention on the Rights of the Child (UNCRC) in 1999 which is quality protects (programme to support children aged 0-3 yrs and their families, sure start and National Childcare Strategy to ensure good-quality childcare for children aged 0-14 (James and James, 2004). Race, class, religion, gender and disability shape children’s lives; all these factors have an impact on their health, life chances and educational experience.

UNCRC came into force in the UK in 1992, all organizations working with children refer to UNCRC, for example Children’s express and Article 12, aim to increase children and young people’s participation in the society. Unlike adults, children have fewer rights for example they do not have the right to vote as children do not yet have the competence to make such decisions. These special rights are for their protection rather than participation (James and James, 2004).

James and James (2004) stated that the social positioning of children is inextricably linked with wider social changes associated with the roles of men and women, families and the state. Changes in the composition of the family structure and the increased involvement of women in the workforce in Western Europe and US have an impact upon the lives of children. External materials and cultural forces of the families, both subtlety and directly shape children lives; but also schools, childcare and healthcare settings influence the lives of children (James and James, 2004).

Domestic violence is a health issue that is hidden but statistics shows that it is a problem not just in England but worldwide and it is also an indicator of other forms of child abuse. Evidence from Brandon et al’s (2008) study shows that if domestic violence is present it leads to two-thirds of cases of child deaths and serious injury, therefore this shows that domestic violence is one factor that leads/contribute to death in children’s cases where children have been killed or seriously injured for example Victoria Climbe and baby P cases. It affects everyone in the society regardless of age, gender, wealth and sexuality. Home office (2010) defines Domestic violence as “Any incident of threatening behaviour, violence or abuse (psychological, physical, sexual, financial or emotional) between adults who are or have been intimate partners of family members regardless of gender or sexuality.” This includes issues of concern to Black and other Minority Ethnic communities such as ‘honour killings’. McGee (2000) stated that domestic violence is experienced by women and children of all social classes, ethnicities and abilities. BCS (2001) estimates that one in five (21%) women and one in ten (10%) men has experienced at least one incident of non-sexual domestic threat or force since they were 16. Also when financial and emotional abuse is included, 26% of women and 17% of men had experienced domestic violence since the age of 16. The most affected group as a result of domestic violence are women, as statistics shows 32% of women had experienced domestic violence from this person four or more times compared with only 11 per cent of men (Mullender, 2004). Statistics from British Crime Survey (BCS) (1996) shows that half of families who suffered domestic violence had children aged 16 or under living in the household. Mirrless-Black (1999) suggested that 29% of children experiencing domestic violence were aware of what was happening, children were more likely to be witness abuse against women who suffer abuse themselves. In the UK it is estimated that every year at least 750,000 children witness domestic violence and over a 100-day period an estimated 205,000 children will witness domestic violence (DoH, 2009).

Children are affected not only by directly witnessing abuse, but also by living in an environment where their mother (main caregiver) is repeatedly victimised. Children in a home where the mother is being abused are also at greater risk of being abused themselves, or being used to control their mother, Hidden hurt (2010). There are many ways that children and young people can experience domestic violence such as directly being abused or witnessing the abuse as children are aware of what going on, and could be listening whilst the abuse happens. Mullender (2004) stated that what children see or hear when their mothers are being abused can not only include physical violence but also emotional abuse and put-downs, threats and intimidation, sexual jealousy and abuse. Children may witness the family being kept short of money or the abuser taking money from other family members and also experience isolation from family and friends. Also children could witness domestic violence by actually seeing violent and abusive acts/behaviours, hearing arguments and seeing the physical and emotional effects of abuse and when trying to intervene to protect their mother or siblings; but young people may experience domestic violence in their own relationships (DoH, 2002).

Research has shown that children are likely to be at risk of physical, sexual and/or emotional abuse if they have witnessed or live in an abusive home. The National Children’s Home (NCH) Action for Children study (2002) found that children living with domestic violence frequently experienced direct physical and sexual assault and that ten per cent had witnessed their mother being sexually assaulted. Abrahams (1994) study found that of women and children who had left a domestic abuser 10% of mothers had been sexually abused in front of their children, 27% of the partners had also assaulted the children, including sexually and 1/3 said that the children became violent and aggressive, including towards their mothers; 31% developed problems at school; and 31% of children had low self-esteem. DoH (2009) stated that although the statistics shows that a high numbers of children witness domestic violence, official statistics are likely to underplay its prevalence. It is difficult to estimate the exact number of women or children that experience domestic violence as not every incident is report or disclosed; therefore the true figures are likely to be higher.

Domestic violence has a big impact on children emotionally, socially, behaviourally, developmentally and on their cognitive ability. It can be difficult to research the effects of domestic violence on children due to ethical issues as they are very vulnerable, but it is important to find out what children experience in order to understand the possible impact on children on how to support them to cope. Hester et al (2000) stated that there is evidence that domestic violence has an impact on children but there is lack of knowledge to how factors such as age, race, economic status, gender, disability and children’s resilience influences children.

Children can react to violence in different ways depending on whether they are witnessing or experiencing violence as some are more sensitive than others, but it depends on their age. There are two types of behaviours that can manifest in children, this could be externalised and internalised as some children could be more aggressive and are at a high risk of depression (DoH, 2009). McGee (2000) and Frantuzzo (1999) pointed out that children exposed to domestic violence tend to display more aggressive behaviour, have problems in school/home and also behavioural problems such as depression, fears, suicidal behaviours, bed wetting and low self-esteem. Other behavioural and emotional effects could be feeling powerless/helpless, withdrawn, anger, and lower academic achievements; Hester et al, (2000) suggested that this could be short or long term. However, all children could suffer from all of the above at any stage in their life without being affected or witnessing violence, research has shown that it is higher among children who witness domestic violence.

Domestic violence can also affect children’s cognitive abilities as research has shown that what is happening at home can disrupt their education. Veltman et al (2000) found that 75% of cases children had delayed cognitive development and 86% had delayed language development. Research has shown that children exposed to domestic violence have difficulty in school, lack concentration and more likely to refuse to attend school (McGee, 2000 and Humphrey and Mullender, 2001).

There are long-term consequences of exposure to domestic violence especially to younger children as it is thought that they don’t remember what happened; however the effect can be carried to adulthood and could jeopardize their development. Cunningham and Baker (2004) suggested that if domestic violence is carried into adulthood it can contribute to a cycle of adversity and violence. Osofsky (1999) stated that studies have indicated the link between exposure to violence and negative behaviours in children of all age group; similarly Cunningham and baker suggested that exposure to domestic violence can have varied impact at different stages. The social issues of domestic violence are more likely to affect adolescent due to difficulties forming healthy intimate relationships with peers as a result of their experiences; Levendosky et al (2002) suggests adolescents exposed to violence are less likely to have a secure attachment style and more likely to have an avoidant attachment style, indicating perhaps that they no longer feel trust in intimate relationships.

Violence experienced by infants and toddlers can cause more emotional or behavioural problems as they tend to have excessive irritability, immature behaviour, sleep disturbances, emotional distress, fears of being alone, and regression in toileting and language (Holt et al, 2008 and Osofsky, 1999). Due to their age they are dependent on the mothers/care-giver for care, safety and security so they form the attachment. Studies have shown a link between secure parent-child attachments in infancy with later positive developmental outcomes and these could affect how they relate to people in later life which could affect their normal development of trust and create social problems; research on attachment in infancy has shown that the more serious the level of domestic violence, the higher the likelihood of insecure, disorganised, attachments (DoH, 2009). Furthermore, it can be very difficult for these young children who often cannot describe their experiences in detail as their development is limited and their feelings/emotions are manifested as temper tantrums and aggression, crying and resisting comfort, or sadness and anxiety (Cunningham and Baker, 2004).

Children welfare and rights

Safeguarding and children welfare is defined by HM government (2006) as 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 that enables children to have optimum life chances and enter adulthood successfully (p 27). Children are defined as ‘in need’ when they are unlikely to reach or maintain a satisfactory level of health or development which will be significantly impaired without the provision of services (S17 (10) of the Children Act (1989). Some children are in need because they are suffering or likely to suffer significant harm which justifies compulsory intervention in family life in the best interest of children. The Child Act (1989) places duty on every local authority to provide a range of appropriate services to ensure that children in need within their area welfare are promoted. The Act also places a duty on local authorities to make or cause enquiries to be made, where there is reasonable cause to suspect that a child is suffering or likely to suffer, significant harm (s 47). The Children Act (1989) recognises that to promote the welfare of children, services may need to be provided to address the difficulties their parents are experiencing.

In order to promote the welfare and safeguard children, all the services and agencies working with children have to come together to provide effective support and services, as when children experience serious inquiries it is evident that there has been a failure of agencies working together; this was an issue raised in the 2003 Victoria Climbie Inquiry report. Cm 5730 (2003) from Victoria Climbie Inquiry report recommended that many agencies have to work together to safeguard and promote the welfare of the children which cannot be achieved by a single agency as every service has a part to play. The Domestic Violence, Crime and Victims Act (2004), Family Law Act (1996), Protection from Harassment Act (1997) and safeguarding children all state that it is a criminal offence if a child dies as a result of an unlawful act of the parents/adults (member of the family) who do not take actions to protect the child.

The Children Act s11 (2004) and Working Together to safeguard children (HM Government, 2006) stated that safeguarding and promoting the welfare of children is everyone’s responsibility and central to all local authority functions. Similarly HM Government (2006) stated that protecting children from significant harm, safeguarding and promoting the welfare of children depends on effective joint working between agencies and professionals that have different roles and expertise (p 33). Furthermore the Local Safeguarding Children Board (LSCB) main aim is to ensure the effective safeguarding of children by all local stake holders and the promotion of their welfare, both in a multi-agency context and within individual agencies (HM Government, 2010). LSCB should ensure better collaboration and co-ordination in cases which require services such as agencies working with both children’s and adult services such as agencies working with parents experiencing domestic violence.

Working Together to Safeguard Children (HM Government, 2006) states that LSCBs should make appropriate arrangements at a strategic management level to involve among others, domestic violence forums (p 86). HM Government (2010) states that all health professionals working directly with children and young people should ensure that safeguarding and promoting their welfare forms an integral part of all elements of the care they offer. The Children Act (2004) places a wider duty on the police for example ensuring policy plans including child protection strategies. They also specify the need to respond quickly and effectively to domestic violence incidents (Cleaver et al, 2007). Police have a key role in safeguarding children and working with other agencies to stop abuse (HM Government, 2010).

In the past professionals have not worked together to address the impact of domestic violence for children, but measures have been placed to reduce this impact. As health professional we have to be able to identify the impact of domestic violence on children in order to help/support them. Research has shown that professionals struggle to identify and understand children’s experiences so cannot respond appropriately to their needs (Mullender et al, 2002). Children have several coping strategies can be through resilience and being listened to about their experiences but some children can recover quickly as children are different so we as professional need to consider each child’s coping strategy. DoH (2009) stated that identifying protective factors and increasing resilience can reduce the risk of harm (p 30). Mullender et al (2002) suggested that a secure attachment to a non-violent parent/carer is a protective factor for children in distress from violence. Similarly, Osofsky (1999) stated that the most important protective resource to enable a child to cope with exposure to violence is a strong relationship with a competent, caring, positive adult, most often a parent. This is because violence can jeopardize the development of a child’s ability to think and solve problems, but with the support of good parenting by either a parent or other significant adult, a child’s cognitive and social development can progress.

It is important as professionals that children are listened to, taken seriously and are kept informed and involved in decisions; Mullender et al (2000) pointed out that professional lack sensitivity to children who do not feel noticed or supported appropriately. Professionals need training on how to communicate to children to experience domestic violence by using language which will allow them to talk openly. Children want their voices to be heard as this will allow children to disclose any violence; Mullender et al (2002) stated that listening to children who have lived with domestic violence has meant not only hearing voices that were silent but seeing other cases of violence from a child-centred perspective (p 206). Nevertheless when assessing child’s needs, it is important to consider support for the family; Holt et al (2008) and Humphreys and Mullender (2001) both suggested that it is essential to provide an holistic assessment that will take into account the risk and protective factors in each family, especially the mother and child. Likewise Hester et al (2000) suggested that any intervention strategy needs to be individualised to children family context and should focus on stabilising the home environment to minimise disruption.

They are several service and support for children who have/are experiencing domestic violence such as the hide out, family care support, NSPCC counselling for children and counselling and strong families programme. The hide out is a child friendly website for children and young people, it was created by Women’s Aid to help children and young people to understand domestic abuse, and how to take positive action if it’s happening to you.

Stronger families programme is a 12 week therapeutic group programme from children and mothers who have experienced domestic violence. The aim is to achieve safety, empowerment and a safe place to discuss feelings. It helps towards the reparation to mother child relationship through a mother and child group. It is an inter-agency collaborative model that is offered throughout Nottingham city. The Stronger Families programme is based on the successful model originally initiated in Ontario, Canada. The Community Group programme for children exposed to women abuse has over 20 years of experience and research. It is based on early research by Peter Jaffe et al in London Ontario. In 1986 first manual and groups for children, 1996 favourable evaluation and in 1997 practitioners manual published. The London borough of Sutton has been instrumental in introducing the programme for children affected by domestic violence in the UK. Nottingham is now one of the first areas in the UK to offer the full group treatment programme to local mothers and children. In 1996 the programme was evaluated and it was found that children improved their ability to identify abusive actions and behaviours and children improved in their strategies to manage interpersonal conflict. Overall there was a positive satisfaction post group from both mothers and children.

To improve the outcomes of domestic violence for children and young people, professional need to make children more aware of domestic violence and where to get help/support if they or friends are experiencing violence, especially in the community for example schools or places young people are more likely to go. McGee (2000) suggested that children and young people need more information about domestic violence and leaflets should be avialblae thorough schools and community, whilst Humphreys and Mullender (2001) suggested that raising awareness in youth settings is another to help change people attitudes.

Young people suggested that an educational campaign involving discussion about the media pressure and peoples’ attitudes towards violence (Mullender et al, 2000); similarly McGee (2000) recommended the need to have a public education campaign which is aimed at adults and children to address domestic violence, for example the Zero tolerance campaign in schools, media campaign to direct young people for support and information and raising awareness as well as providing support in schools for children experiencing domestic violence.

Within this essay the authors aim is to explore the challenges and opportunities of integrating the Ten Essential Shared Capabilities (ESC) into the day to day running of mental health practice. The author will also take into account Values Based Practice, Recovery, Interpersonal Relationships and Service User and Carer involvement.

Aswell as the 10 ESC there are a set of values which all mental health staff should follow. They are the Values Based Practice and it is about being aware of , and looking in a positive and respectful manner at peoples differences, beliefs and values regardless of status for example service user, carer, family or colleagues.

(Coyte et al. 2007) There are 10 points to good values based practice which staff should adhere to. They are broken down into the following :

Values Based Practice and Evidence Based Practice : The “squeaky wheel” principal (values only noticed if problematic), The “two feet” principal (evidence-based and values-based practice).

Practice Skills : Awareness, Knowledge, Reasoning and Communication

Models of Service Delivery : Multi-disciplinary, User Centred

Partnership : Service User and the Carer working in partnership in decision making.

The four main Practice Skills in values-based practice are also prominent in many if not all of the 10 ESC, all of which are required in building a working therapeutic relationship between service user and staff.

Interpersonal relationships between service users and staff are very different from social relationships in that these relationships are built up on the same principles of respect, trust, good communication and understanding, but the service user, nurse relationship should be a therapeutic and helpful relationship rather than a social one (Guimon 2003). This relationship is essential in ensuring that there is a supportive and solid route of recovery established.

Everyone has a different view on what recovery is and no one persons journey is the same as another. Recovery is all about initially having a belief that things can and will change. Some people may want a complete change in the way they live while others may want to return to how they lived before. Supporting recovery is all about assisting the person to live as fulfilling and positive life as possible, involving the service user and their carer and supporting them to take control of their own recovery (Scottish Recovery Network 2007).

The author feels that the expertise to the mental health issues are the service user , carer and their family support structure and that this is a positive route onto their journey of recovery. The main issue that staff could come across may be if the service user does not have any of the support structure that comes from a network of family, friends and professionals or if the service user themselves does not want to involve any of the above support.

This is where staff and the MDT (Multi-Disciplinary Team) may have to offer other methods or ways to support the service user on their recovery journey. Ideally, getting the service user and carer involved, by making sure that they are involved in all decision making concerning treatment would enable them to take more control of their care and treatment. However this can be challenging in that when trying to find a balance and working out what is holistically best for the service user conflicting ideas may come out, but by establishing a therapeutic relationship between the service user and staff this should help with any trust issues and enabling a better understanding and ensuring that there is a favourable outcome that can be agreed upon.

The 10 Essential Shared Capabilities (ESC) are:

Working in Partnership

Respecting Diversity

Practising Ethically

Challenging Inequality

Promoting Recovery

Identifying Peoples Needs and Strengths

Providing Service User Centred Care

Making a Difference

Promoting Safety and Positive Risk Taking

Personal Development and Learning

Working in partnership is all about building up a relationship with the service user, their family, carers and any outside services that are required to be involved in the care of the person. (Barker 2009) Staff should offer support and empower the person to enable them to have an active role in controlling their own treatment and care, with all aspects of their care being taken into account. Making sure that the whole partnership are aware of the information and advice that is available to them to enable an informed choice regarding the most suitable care is made available.

Although, working in partnership sounds good in theory, all involved in the partnership are required to put in the work to ensure that it works successfully. The staff can offer services for both service user and carers but they may not agree or want to attend. If this happens then something needs to be put in place which would benefit all parties and that they all agree on, if any of the party do not want to attend or take notice of services provided then this is their choice and confirms their ability to choose.

When respecting diversity it is to have an understanding of someone’s values, race, sexuality, age, mental health, religion and physical state. Staff need to ensure that everyone in their care are treated to proper care, treatment and support also that they are treated with dignity and respect no matter what their personal circumstances or cultural values area (Stickley and Basset 2008).

First of all, social work theory is defined as “an explanatory framework,” the accumulation of knowledge, ideas, skills and beliefs social workers draw upon to help to make sense of what social work is and how to do it. (Oko, 2008: pp.6) In other words, theory in social work helps to organise and structure the world we live in and help us to make sense. Particularly this is important when dealing with service users. Vulnerable people are those in need and under stress who often lost control under their lives. Therefore, it is critical to assist them in explaining reality to make sense of what is going on and why. Not being able to understand reality is stressful for both service user and practitioner. (Howe: 2009). Beckett (2006: pp.33) defines social work theory “as a set of ideas or principles to guide practice.” The definition stresses the importance of how theory informs practice leading to assessment and intervention. This is supported by Teater (2010: pp.1) who hold the view that “theories help to predict, explain and assess situations and behaviours and provide a rationale for how social workers should react and intervene with clients who have particular histories, problems or goals.” It is worth pointing out that theory to be right has to explain the situation and provides us to solution. However, different types of theory can be used differently in the wide spectrum of intervention. Alternative theories can lead to a different process of understanding, assessing and intervention. It is essential therefore to analyse and adapt theory all the time. (Teater: 2010) Howe (2011) similarly refers to theory as a guide that influence practice in five key area such as observation, description, explanation, prediction and intervention. According to Howe (2011), social workers must answer a serious of question to understand complexity of the situation and to see pattern. Firstly, social workers have to define problems and identify needs of the service users. Secondly, make sense of what is going on by analysing and assessing situation. Thirdly, set out goals, and make action plan. Fourthly, assess available resources, skills and methods that will be utilised in social work process. Finally, review and evaluated the whole process.

The origins of social work theory can be traced back to the early nineteenth century and are strongly embedded within the Industrial Revolution and development of social sciences. (Howe: 2009) The age of Enlightenment was very tough and disruptive period follow by the Scientific Revolution and rapid industrialisation. Migration of people, high degree of destitution, crime and poverty forced to change. Significant attempts were made to utilise developing social sciences such as psychology, sociology and economy to improve social and political conditions of society. (Howe: 2009) The work of Wilson et al. (2008) emphasises the importance of formation the Charity Organisation Society (COS) in the 1869 as the date from which social work as a recognise practice began. It has been suggested that social work originated by the COS resulted in creation a social work theory as a response to “social disadvantage and unrest”. (Wilson et al. 2008: pp.50)

The above explanation the origins of social work theory lead to justification why social work theory is contested. Social work theory has explored all types of knowledge and experience in its attempt to understand relations within society and help people. The work of Maclean and Harrison suggested that “no single theory can explain everything. An eclectic approach is usually required.” (2011: p.15) The statement means there is no dominant theory in social work practice. People their relationships and interactions are complex, consequently social work theories must derive from different sources discipline to explain human behaviour, position in society, relationships within psychological, social, economical and political context. This agrees with the view of Payne (2005: 44) who refers to “borrow knowledge” in social work practice. Oko (2008: p.7) draws attention to “social constructionism” and “fluidity” as a view of social work where everything can changed depends on context, time, legislation, policies and different expectations about people’s behaviour. Social work theory is contested because embrace a variety of different practice setting, with different groups of service users as well as working pattern and constantly changing context of policies and directives. When discussing types of social work theory, it is important to recognise that those can be seen at three different levels; theories of what social work is about, how to do social work and theories of service user world. (Payne: 2005, p.6) The first statement apply to grand theories, these are orthodox theories that seek to explain society as a whole. It is important to mention that there are three main sources of social work theory such as psychology, sociology and systemic. (Howe: 2011) However, social work theory also derive from other discipline such as philosophy, law, medicine, social policy etc. (Howe: 2009) An example of grand theories are psychoanalytic theory, behaviourism, systems theory, humanism, Marxism and Feminism. (Wilson et al. 2008) The other group are mid-range, theories that Wilson et al. (2008: p.107) called “practice theories” these indicate the methods of intervention and are the result of the contribution of grand theoretical perspective with practice experience. The last but not least, are informal theories, use to explain individual cases or behaviour. Informal theory is the practitioner’s own ideas about a situation based on personal and professional experiences. Wilson et al. (2008) refers to practice wisdom, self-awareness, intuition, not knowing and personal experience as issues related to informal knowledge. Whereas, Beckett (2006: p.185) discusses informal theory as “common sense”.

This section of the essay will examine radical social work theory and empowerment paying special attention to the factors such as professional and political contributors. By the 1960s, more attention was beginning to be paid to the social consequences of capitalism. Capitalism started to be seen as the economic order of an unequal and unfair society shaped by psychodynamic theory especially casework. (Howe: 2009) First strong critical view of the social and personal effect of capitalism and the economic structures became known as Marxism or radical social work. The origins of radical social work date back to 1970s to the Case Con manifesto. (Wilson et al. 2008) People like Karl Marx, Beatrice Webb or Octavia Hill radically questioned existing structures that caused poverty and deprivation. (Howe: 2009). Radicals expressed necessity to work with people within a wide socio-political context and not in isolation. (Wilson: 2008) Ideology of Marxism has had immense impact on social work theory as a result created collectivism, empowerment, anti-oppressive and critical theory. These lead to development of “practice method” with service user such as, anti-oppressive practice, advocacy, welfare rights, service user involvement, radical casework and community development. (Wilson: 2008: p. 107) It is clear that on the grounds of radical theory grew up the idea of empowerment. The concept was developed based on the critique that services provided often contributing to service user sense of powerlessness and lack of choice. Empowerment is about the service users having choice and control over own life. It promotes a way of working with service users based on equality and partnership.

There is no doubt that social work is deeply rooted and shaped by socio-political context. (Wilson et al. 2008) Horner (2009: p.3) rightly points out that “good practice is not a ‘truth’, but is a function of political, moral and economic trends and fashion.” Currently, it has been suggested that the “space” for practicing in an ethical and empowering manner have been progressively limited by the managerial, budget-driven polices of the last few years. (Ferguson & Woodward, 2011: p.15) Social workers still work with service users but normally in the conditions that do not depend on them. The constraints often lead to excessive caseload, lack of resources as well as lack of support, supervision and unfilled vacancies. Professional work setting can limited creative use of theories by imposing favourite well know theories, as a consequence of managerial and bureaucratic agenda. Managerialism and bureaucratisation seems to be a potential danger for contemporary social work theory and critical reflection. Meeting deadlines, filling in forms, standardised and integrated assessment framework are crucial nowadays. It looks like humanity has been lost in paperwork and one size fits all approach. In addition, issues are trivialized by media and political hostile approach to social work. (Ferguson & Woodward: 2011) This can be clearly seen when a tragedy happens such as the death of the child in care then the response is often a blaming one “bloody social” worker instead of wider social and political context. (Thompson: 2009) An illustration of this can be a case of Victoria Climbie and the social worker who was working on this case Lisa Arthurworrey. (The guardian: 2007)

When discussing political influences it is important to recognise that the publication of the Kilbrandon and Seebohm Reports are a matter of the relationship between social work and politics. It is clear that these documents and the follow legislation “lodged social work firmly within the state sector” with the voluntary sector as supplementary. (Ferguson & Woodward, 2011: p.57) Since then social work has been driven to a different degree by politics, professionals, central government and administration. The subsequent evidence of political influences can be observed in a case of Clement Attlee and Jacqui Smith, politicians who have affected contemporary social work. Clement Attlee former Labour Prime Minister has seen social workers as activists. In his understanding social workers should “..work in non-oppressive way…challenge polices and structural inequalities..” (Ferguson & Woodward, 2011: p.15) The statement shows political influences of radical tradition such as to be critically reflective, willing to change the system not the service users. It also identifies the empowerment theory and anti-discriminatory practice in working with service user. In contrast to this, Jacqui Smith, the former Minister for Health argued that “social work is a very practical job….. not about being able to give a fluent and theoretical explanation” of reasons and causes of problems. (Horner, 2009: p.3) Smith claimed that new social work degree courses had to focus on practical training. The above is an excellent example of political influences social work has to deal with. Surely, Jacqui Smith was right practical abilities are critical in social work practice but on the other hand, she has decreased the value of theoretical issues that are equally important. Only through explanation of service users world a social worker empower the individual, make sense of his/her reality, by understanding the situation service user can take control over own life. The next important point when discussing political influences are devolved administrations that shape the politics of social services (Drakeford: 2011) The actions of central government shape the terms and the capacity of social work services but the delivery of those provisions lies within local authorities. This is seen as another example of relationship between social work services and wider political and organisational context.

This part of the essay attempts to show the prospects of discrimination and empowerment in social work. It is worth pointing out that in the new global economy, neo-liberalism has become a central issue for radical social work practice. In the UK, neo-liberal policies have resulted in creating an unequal society where the rich grow richer and the poor grow poorer. (Ferguson & Woodward 2011) Neo-liberal approaches such as consumerism and marketism, undermine social work values and relationships with service users as well as limit possibilities for critical and creative practice. An example of this are the differences and dilemmas in terminology between patients, clients, service users and users of service that reflect on the way practitioners think and relate to people. A strong critique is presented by Ferguson and Woodward (2011) who blamed the management of social work for being too willing to decrease values base and increase managerial agenda. The authors also argue that nowadays too many social workers present authoritarian role in relation to service users treating them like objects rather than subjects. In relation to discrimination, radical social work theory direct social workers to work as agents of social control by helping people to understand their situation and unfairness as well as why and how it was created. In other words, social workers are raising people’s political and social awareness; consequently, people are able to recover power and control over their lives. Discrimination in social work, from radical point of view can be viewed through social policy, identification of service user needs, allocation and accessibility of resources. Therefore, it is important to recognise respect of rights, responsibilities and opportunities as main issues of anti discriminatory practice. Social workers can be discriminative because they have a power and control over people’s lives. That is why, they have to exercise them with awareness, thought and sensitivity. (Howe, 2009: p. 146) The concept is supported by Backett (2006: p.186) who suggests that “common sense” which is often used by practitioners in theories, “tends to incorporate the prejudices and assumptions of a particular time” and can be insufficiently used especially by social workers with little personal experience. Practitioners bring into social work practice and theory their own beliefs, values, histories, culture experiences and biases. Judged by these criteria, it is clear, that social workers must be critical and self-reflective. It seems to be a matter to understand that we do not live in equal society. Oppression is deeply rooted in the process of our socialisation. If social workers want to work in anti-discriminatory way they need to develop confidence and skills in exploring the way oppression operates in society. This is supported by Thompson (2009) who argues that empowerment in social work is something more than process of gaining control over service user’s life but is about taking account of discrimination and oppression at the first place. Social work theory can assist practitioners by guiding and explaining the models of oppression. This is necessary in order to support service users to understand and tackle the oppression they may face. An example of this is PCS model presented by Thompson. (2009: pp. 144) The model has been designed to express how our personal prejudices are strongly embedded within cultural influences and structural power. The PCS model operates at three levels such as personal, cultural and structural. Personal refers to individual oppression thoughts and attitudes as well as psychological factors. This can also refers to prejudice and personal views of social workers. Cultural explores the way that groups, based on commonly agreed values, define what is “normal”. Empowerment in this case will include challenging stereotypes. Structural level refers to oppression within wider socio political climate and social power and refers to the way differences are viewed by society such as class, race, gander etc… (Maclean and Harrison: 2011) It is worth pointing out that to treat everyone the same is not to treat everyone equally. Dominelli (1997, pp. 31) draws attention to “colour blind” approach based on false premise that everyone is the same. The potential discrimination when using theories can be “recommended theories” on the grounds of their effectiveness with similar case. Social workers when using theories must take into consideration that everyone is different, has different experiences, needs, problems. They have to be reflective and work against one size fits all approach. It is important not only to assess needs but also to consider differences. The intervention in people’s lives without taking account of key issues such as age, disability, ethnicity, gender, race, sexual orientation can do more harm than good. (Thomson, 2011: p106) Form this perspective social work is a part of emancipatory project promoting social equality and social justice among people who are marginalised or disadvantages. Croft and Beresford (2005) noted that empowerment has potential to “be both regulatory and liberatory”, it brings about social change based on collective obligation to the individual. Therefore, empowerment is often used as part of discourse of individual rights and responsibilities. (Oko: 2008) It is more than “enabling” is helping service users to become better equipped to deal with the problems and challenges they face. (Thomson: 2009) It is worth noting that empowerment is not about transferring power from social worker to service user this can be very disempowering as well can cause addiction to social work services. Another potential danger in utilising empowerment theory is seeing service users as weak and vulnerable rather than experts who require support to address the needs and achieve goals. (Maclean & Harrison: 2011) Wilson et al. (2008: p. 81) argues that people are “own agents” with not only rights but also the capacity to make choice and decision. Empowerment theory in contemporary practice can be seen by not only having a voice but also having an advocate; informing about services available in relation to needs, supporting in developing skills such as parental skills, information technology etc. The aim of empowerment is to increase self-esteem of service users, currently this is carried out by putting in place self-directed support and personalisation programmes.

The last section of this essay assesses how perception of theory can support to be a more effective practitioner. As presented earlier theories outline explanatory framework for helping to make sense of the situation as well as shape our thinking (Oko: 2008) In other words, theories represent organised ideas and beliefs that guide social workers thinking and practice. Doel (2012: p135) compare theory and practice to “a cup of oil and a cup of vinegar” which shaked mix for a while and separate out. Theory is necessary, in order to gain control over the situation. It not only explains the situation, from a different perspective but provide guidance about what to do with these explanations. (Doel: 2012) Theory to be useful has to be constantly verified and updated. The relationship between theory and practice can be build upon IBL so “issue based approach to learn” (Oko: p. 99). The approach inspires social workers to think about what has been learned and how this new knowledge, experience or skill can be assimilated and utilised in practice. There is no doubt that values base, skills and knowledge facilitate personal and professional development. This is a key of being a critically reflective practitioner. A good understanding of the different theories can guide practice and create effective and successful intervention. Theory makes sense of the situation and creates ideas about why things are as they are. It not only shows the direction of intervention but also explain service users behaviour and actions. Theory can indicate why an action has resulted in a specific behaviour, it also helps to see patterns. Consequently, social workers may get to know the issues affecting service user lives. Another argument for using theories is that its assist social workers to be more confident and better prepare to critique of their point of view. It is vital to be able to justify the decisions made in social work practice. Using theories give social workers a backup to justify actions and explain working practice to service users, managers, other professionals or themselves. This justification of actions on the grounds of theories leads to greater accountability. An example of this can be assessments or reports both are professional papers that look for evidence and not unjustified judgements based on common sense. When working with service user, empowerment theory can be utilised by building positive self-esteem and focus on strength and potential of service users rather than problems and difficulties. It is essential to attempt to work in partnership and collaboration with service users. Radical social theory in practice can be seen as attempt to change system to fit to service user rather than change service user to fit the system. It is important to acknowledge that even if theory seems to match to a service user, it does not always mean that this is the right understanding of service users life. Even if theory appears to work, social workers still need to stay open minded and continue the process of being critically reflective. Social work practice is part of a process of evidence making where issues have to be constantly verified and checked out in the light of new circumstances or information. As mentioned before “no single theory can explain everything”. (Maclean & Harrison: p 15) Different approaches in social work practice are needed to suit different circumstances. As a qualified social worker, having in a depth knowledge of theories will assist me to be a reflective and critical practitioner, open to a greater degree to the needs of service users. Deeply and accurately consider all facts and issues and not taking anything at face value. Instead, one must remember to always probe beneath the surface in looking for a right answer.

Evidenced Based Healthcare and Research: Appraisal. In the United Kingdom the concept of ‘Independent Living’ and ‘Self-directed Support’ has become an established approach for the delivery of health and social care services, that it is currently the preferred residential alternative for people with learning disabilities (Binnie & Titchen 1999). Independent living can be defined as ‘enabling independence by receiving the right support how and when it is required’ (Morris 2004). It has now become a key principle in various government policy documents such as the Valuing People Now Strategy (UK Department of Health, 2009) and the Personalisation through Person-Centred Planning initiative (UK Department of Health, 2010).

This assignment aims to present a detailed critique of a qualitative study entitled ‘How adults with learning disabilities view independent living’ (Bond & Hurst 2010). A critique can defined as a balanced evaluation of the strengths and limitations of a research article, in order to determine its credibility and/or applicability to practice (Gamgee 2006). This study is a welcome contribution to the current health and social care research domain because whilst independent living is the preferred residential option, it is not at all clear whether it is suitable for all people with learning disabilities, moreover if there is in fact sufficient empirical evidence to support this notion. It is therefore imperative to establish a sound evidence base that draws upon the lived personal experiences of those with learning disabilities. Using an acknowledged framework ‘A Step by Step guide to critiquing a quantitative study ‘ (Coughan et al., 2007) the relative worth of the evidence in support of independent living will be judged systematically. As well as exploring the significance of independent living as an essential nursing intervention and its application to modern clinical practice.

Ryan-Wenger (2003) suggests that in analysing published articles it is important to ascertain two fundamental aspects of a critique which can be subdivided into elements that influence the robustness of the research methodology also known as ‘integrity variables’ and elements which influence the believability of the research such as writing style, author(s), report title and abstract otherwise known as ‘credibility variables’. The latter seems to be the most logical place to commence.

Evaluation of the Journal Article

Polit and Beck (2006) state that writing style should be such that it ‘attracts the reader to read on’; this paper is well written, comprehensive and concise. The structure and layout of the paper is well organised with a logical consistency and free from jargon in comparison to some papers where the author(s) can be opaque in their approach. However slight reservation is reserved concerning the level of proof reading as there seems to be some grammatical and typographical errors which can be found on pages 288 and 289. Both authors appear to have a sound background in learning disability from both a social context and educational settings. As indicated in the ‘acknowledgements’ the authors qualifications indicate that they have a degree of knowledge in this field and this piece of research seems to be a part of a taught component of their masters programme.

The report tile seems to be descriptive and succinct, although it lacks specificity of the research methodology used in the study. This can be very useful for others who are searching for this type of paper. Although the term ‘qualitative research’ is mentioned under ‘keywords’ the title itself could be more specific. As a result the report title is ambiguous and merely eight words in length. Meehan (1999) states that a title should be between ten to fifteen words long in order to clearly identify the purpose of the study for the reader.

This paper presents both an accessible and detailed version of the abstract, but are both helpful? The accessible form includes information on the subject and the number of participants, whereas the detailed form provides an outline of the methodology used, ethical framework, findings and recommendations. On balance the summaries present a clear overview of the study, however it does beg the question in what sense is the accessible form accessible? and to whom? It seems that the authors are trying to be politically correct rather than logical because how many service users actually read the British Journal of Learning Disabilities?. It seems that this is a ‘knee jerk’ reaction which has been applied incorrectly; it would be more suitable if the document was aimed at informing an audience with learning disabilities such as Valuing People (UK Department of Health, 2001) which caters to a wide range of readers. The ‘easy -read’ version is aimed at service users whilst the denser version is aimed at professionals and service providers. Having identified and analysed variables that affect the credibility of the research presented, how believable the work appears, the authors qualifications and their ability to undertake and accurately present the study. The robustness of the research methodology and the integrity of the findings will be appraised in order to determine the trustworthiness of the study and its applicability to nursing practice.

The authors state the aim of the study is to explore the views of nine people with learning disabilities who have already achieved independence and wish to contribute to the debate of independent living. The authors suggest that this style of living is now viewed as desirable, but what is the reality for people who live with learning disabilities? This concept of desirability is held as problematic by the authors who choose to study and present the reality of living independently as opposed to the notion of general and conventional wisdom. A study conducted by Barlow & Kirby (1991) concluded that people in receipt of self-directed support had ‘more life satisfaction than those in residential care’. This finding is further supported by the publication of Independent Living (HM Office for Disability Issues, 2007). The decision to suspend judgement about independent living is justifiable and is supported by other researchers in the field of learning disabilities; as there are several implications for service users, professionals and service providers. This is for a number of reasons for instance promoting choice and control (O’Brien, 2002), health issues (Priest & Gibbs, 2004), vulnerability (Cooper, 2002) and the ability for those with learning disabilities to access services (Jansen et al., 2006).

The literature review conducted by the authors demonstrates an appropriate depth and breadth of reading around independent living. The majority of studies included are of recent origin being less than five years old; the few historical studies included put the concept of living independently into context. The authors successfully identified conflicts between the literature by comparing and contrasting findings (Burns and Grove., 1997), because although evidence exists to show people who have moved from ‘larger institutions prefer smaller group homes’ (Forrester-Jones et al., 2002) there is still ‘no accurate data detailing the number of people with learning disabilities living independently’ (Beadle Brown et al., 2004). However the authors failed to mention how they conducted their search and information on the databases used to gather papers in their review. The authors did however, use primary sources of information as opposed to secondary sources and anecdotal information, which attests to the integrity and value of the study presented.

Bond & Hurst (2010) ascertained the narratives of nine people with learning disabilities via the use of semi-constructed interviews within their methodology. The authors are to be commended for their attention to detail in terms of their ability to design and structure interviews so as to accommodate the needs of the participants. As well as conducting interviews at times and venues convenient to them. The interview structure included open-ended questions to assist understanding as communication emerged to be a key barrier for some people with learning disabilities. The authors report on a number of theoretical issues that have been adapted for the participants in order that they might fully participate in the research process. The structure of the interviews was devised using the Canadian Model of Occupational Performance (Canadian Association of Occupational Therapists, 1997), but is this model applicable to the United Kingdom population and to which care setting? Bond & Hurst (2010) adopted ‘thematic analysis’ within their methodology in assessing the narratives. The data collected was audio taped and later transcribed into coded themes, which is acknowledged in general research literature to be good practice. On balance, the authors adhered to the steps in the research process and it is conveyed between the fluidity of phases.

The critique subsequently moves onto considering the ethical framework. This research paper was supported by the local ethics committee and all participants in the study gave informed consent. Although it is not clear whether or not it was an National Health Service (NHS) ethics committee. However, the authors sought to ensure their working methods complied with the Data Protection Act (1998) but not with all government legislation applicable to the study such as the Mental Health Act (1983). Although there is mention about accessibility, the authors failed to ensure the participants had the capacity to make informed decisions as defined in the Mental Health Act (1983). In relation to the number of participants, the sample size is small and therefore may not be reflective or wholly representative for all people with learning difficulties. Small samples are more likely to be at risk of being overly representative of small subgroups within a target population (Coughan et al., 2007). Therefore slight reservation is held as the authors did not mention whether they sought to remove overall bias by generating a sample that is likely to be representative and generalisable to the target population. Parahoo (2006) states that for a sample to truly reflect of the population it represents the authors must generate a probability sample. The participants in this study were recruited via convenience sampling using a third party (Melton 1998); however several variables could have an affect on the sample which can lead to it being distorted such as the vast age range. The authors are to be commended however, in their efforts to maintain the confidentiality of their participants by offering them the choice to provide their own pseudonyms.

In the discussion the authors identified seven themes from their data analysis which reflected the views of all the participants and in turn addressed the aims of the study. Their findings supported the four key principles as stated in the Valuing People policy document, and ways in which people can be supported to achieve this includes increasing social inclusion, increasing autonomy and choice for people and raising awareness of the vulnerability of those with learning disabilities. However the study also highlighted that the majority of participants struggled with the more complex aspect of living independently, such as money management and budgeting. The government has recently introduced ‘Direct Payments’ as part of a nationwide transformation in social care services, which involves paying money directly to an individual in need to take control of their own support and care services. This initiative will aid finance management as it enables service users to have control over the care they receive and how they receive it. The majority of participants maintained that when comparing their current lifestyle of independent living to that of their previous lifestyle it was clear that they wanted to remain living independently.

Application to Clinical Practice

This section will explore the significance of independent living as an essential nursing intervention and its application to modern clinical practice. Gates & Atherton (2001) state that there is a need for evidence of ‘effectiveness in health and social care’. The most important aspect of being a practitioner regardless of ones vocation, is that collectively we as professionals seek the best evidence available on which to base our practice (Coughan et al., 2007). The evidence in support of independent living is limited and not entirely accurate, therefore when evidence is presented it should not be taken on face value. As Cullum & Droogan (1999) put it ‘not all research is of the same quality or high standard’ therefore as a learning disability nurse and social worker it is important being a care provider that although a paper has been published it can be critically appraised. This paper is of central relevance to our practice in ensuring that the lifestyles of people with learning disabilities are informed by valid and reliable evidence. This research paper adds value to the current literature available in support of independent living however caution must be expressed as it is not solely about living independently. The concept of independently living cannot be advocated for everyone; each person is different and therefore require different levels of support which will meet their needs. The publication of Valuing People (UK Department of Health, 2001) the key document that prompted a change in the way health and social care services operate. The paper made Person-Centred Planning a central component of service reform, and outlined four key principles namely: Human Rights, Independence, Choice and Social Inclusion (Mansell and Beadle-Brown, 2004). This means that people with learning disabilities should be “valued members of society, treated with dignity and respect whilst having the same rights and choices as everybody else” (O’Brien, 2002). Furthermore, people with learning disabilities should feel empowered to take control over the care that they receive in order to plan and live their lives independently.

Previously, people with learning disabilities were shunned away from the community and susceptible to abuse. The Community Care Act (1990) was introduced as a result of both political and social changes in attitudes towards the treatment of people with mental illnesses. In line with Mental Health Act (1983) the aim was to remove the stigma associated with mentally ill people away from isolation towards social inclusion (Social Role Valorisation, Wolfensberger, 1983). But does independently living mean that you get social inclusion? Currently we are seeing a culture of people who require support being effectively excluded from society, waiting for the next support worker to cook their meals, help with personal hygiene and general cleaning. This is a downward spiral in our society which is putting a demand on our system. As a care provider in line with the General Social Care Council and the Nursing and Midwifery Codes of Conduct (2008), it is our duty to advocate in the best interest of the client at all times but who is actually making the decisions?

Bond & Hurst (2010) highlighted how closely health was linked to independent living and that many of the participants suffered from chronic conditions such as asthma, diabetes and arthritis. Is it a case of compromising funding for services at the expense of overlooking health issues? It seems that the authors make a plausible case that people with learning disabilities are being seen as not a priority as they carry a disproportionate burden of health inequalities among our population. The reality for people with learning disabilities is far from the projected lifestyle of independence (Emerson UK Literature). It is a challenge to support people with learning disabilities, several factors need to be considered to prevent potential disregard. Jansen et al., (2006) points out the need to adopt integrated care approaches in treating those with learning disabilities. This will involve working with different agencies (interagency team working) and different types of professionals (multidisciplinary team working) in order to provide an holistic service to meet their needs. Current research shows that a disabled person is likely to be in contact with at least ten different care professionals in their lifetime (UK Department of Education, 2003). Issues can arise through out this time which may lead to lack of continuity and communication. Therefore, a sufficient amount of training and awareness is needed to ensure that all staff are qualified and skilled to ensure equity of service provision.

When caring for patients it is essential as a practitioner to adopt the current best practice. To determine what this is one must be able to critically appraise evidence that is presented to them (Basset and Basset., 2003). This paper focused on the lived experiences of nine people with learning disabilities about the reality of living independently. In critiquing this paper, the authors successfully highlighted the importance of independent living as an essential nursing intervention however there were also some limitations, the most important being limited verification of the data. Furthermore the narratives of the participants were highly subjective and findings non-generalisable, thus the notion of independent living is not to be applied to all that have a learning disability, or vulnerable adults with complex needs. As recommended by the authors, further accurate, reliable and valid research is needed that will add value to the evidence-base domain.

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