Category: Free Essays

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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Excluding Headings and References

Evidence based practice (EBP) refers to integrating professional expertise with the best available external research, and incorporating the views of service users (Beresford, 1996). Evidence based practice has received its reputation by examining the reasons why interventions are necessary (Duffy, Fisher and Munroe, 2008). Within my placement EBP was important for refining my practice so the service user was provided with appropriate support for her individual needs. I used my EBP to carry out research to determine what evidence supported or rejected the use of a specific intervention; within this case I used a counseling approach.

The principle of social work intervention is to provide good practice and should be based on a decision-making framework (Preston-Shoot and Braye, 2009). This framework operates on four concepts:-

The legislation that informs a decision;
Social work ethics and NISCC codes of conduct;
Information to ensure a well-informed decision;
Knowledge drawn from research, theory, practice and other professionals.

In addition to powers and duties of social workers, legislation embeds notions of partnership, respect, rights and anti-discriminatory practice, which are key elements in social work practice (Preston-Shoot and Braye, 2009).

My practice learning opportunity involved working with adults with a learning disability in a day care setting. The benefits of the day centre were to provide a service for local people to access support in living with, or caring for someone, with a learning disability. Northern Ireland statistics show that in 2008 there were 9,460 people with a learning disability in contact with Trusts (www.northernireland.gov.uk). From the 9,460 people with a learning disability there were 2,574 benefiting from care management, 42% (1,086) of whom were being supported in their own homes and 35% (898) being cared for in residential homes solely for the use of people with learning disabilities (www.northernireland.gov.uk).

This evidence based case study is based on Miss A, a 35 year old woman, who has a learning disability and Spina Bifida resulting in her using a wheel chair for mobility. Within the past few years Miss A’s family life has changed dramatically. In previous years Miss A had lived in the community with her elderly parents, who cared for her. She is one of three children and has two older brothers. Miss A’s mother, after being diagnosed with Dementia, was admitted to a residential care home. Her father after having been moved to residential care himself passed away in November 2008 due to his physical health. Miss A now resides in a private nursing home and attends day care three days per week. In March 2008, there were 75 residential homes in Northern Ireland solely for people with a learning disability providing 898 places (www.northernireland.gov.uk).

Miss A has been previously diagnosed with MRSA; it is currently located in her toe, having been previously present in her urine. Treatments from the residential care staff have the infection under control, however the infection still remains.

The recent death of her father plays a significant role in Miss A’s life and continues to affect her socially and emotionally.

Some of the stereotypical assumptions I had before meeting Miss A were that because she had a physical and learning disability that she would be hard to communicate with, that she would have limited understanding and limited verbal skills. I have challenged this opinion and realised that Miss A is a very competent individual with good communication skills, and can express her likes and dislikes proficiently. As for her physical disability this does not affect her cognitive or cerebral functions. I had also made the assumption that as Miss A had MRSA that it could easily be cross-contracted due to a lack of knowledge and education. After researching the issue and contacting infection control within the Trust I deducted that MRSA is a problem within clinical settings but can be easily controlled with proper preventative procedures. This can be identified as a risk, but should not be a reason to oppress or discriminate Miss A.

After having initially met Miss A, liaised with her social worker, accessed her case file and Tuned In to her life issues, I met with Miss A to prepare for the initial assessment and gather information into how best to support her. My role with Miss A was to provide a reassessment since the changes in her circumstances and the death of her father. My role was to determine what support she may need, and to include her wishes and feelings.

Assessment:

History has shown that there has always been an importance to assessment in social work, but since the 1990’s there has been specific importance to a new form assessment to include risk. The National Health Service and Community Care Act 1990 stresses the importance of inter-agency collaboration and a multi-disciplinary assessment process (Trevithick, 2000). The purpose of an assessment may seem evident; that is, to assess the needs of individuals who may need help and/or support. In recent history however assessment seems to mean a relationship between need and available resources (Whittington, 2007, p23) leading to a question if this is ethical or effective practice?

There are many purposes of an assessment, for example to assess risk, to assess need, to act as an advocate for someone and also to implement agency and government policy (Whittington, 2007, p25-26). Coulshed and Orme (2006) explain that assessment is an ongoing process where the purpose is to understand people in relation to their environment; it is a basis for planning what needs to be done to maintain, improve or bring about change with the service user’s participation.

The initial preparation for the assessment with Miss A included visiting her social worker and studying her case file. This enabled me to gather information to dispel any preconceptions I had about meeting this service user. The social worker passed on her knowledge of Miss A, such as medical conditions, family circumstances and finances, and also any previous problems that had occurred. I felt it was important to work in partnership with Miss A’s social worker so I could keep her up to date with events, and also contact her if I required advice about Miss A. The purpose of Miss A’s individual assessment was to gather information by interacting and communicating with Miss A and others involved in her care, this was also to gain a holistic perspective to her needs. Her assessment was guided by legislation such as, the Chronically Sick and Disabled Persons Act (NI) 1978, which places a duty on health and social services to investigate a level of need, and also the Health and Personal Social Services (NI) Order 1972 which stipulates a responsibility to provide personal social services for the promotion of social welfare for the general public (http://www.understandingindividualneeds.com).

As a model of assessment I used Smale’s (1993) Models of Professional Care which were useful in gathering important information about Miss A. I used the procedural and questioning model to gather information into how Miss A felt about certain issues in her life, such as the bereavement of her father, contact with her other family, and other issues she felt were working or not working. I used these methods of assessment as this followed Trust guidelines. I used The Model of Professional Care to gain a holistic understanding of information. I also included the Exchange model in the assessment as I considered Miss A to be the expert of her own life. I feel the use of the Procedural model was useful in certain aspects of the assessment as it worked in collaboration with the Trust’s format of assessment and worked as a form of gathering information, but feel I could have used more of an Exchange model to communicate effectively with Miss A rather than just form filling. I feel Smale’s method of assessment provided me with tools to help Miss A identify factors that were important for her to maintain, but also issues she would like to change. By working in partnership with her I felt we would have an open and trusting working relationship.

I also focused on Person Centred Planning (PCP) in regards to the assessment with Miss A. Person Centred Planning, which evolved from the White Paper; a government policy known as Valuing People, suggested four key principles; Rights, Independence, Choice and Inclusion as a proposal of changing services (Thompson, Kilbane and Sanderson, 2008, p9). This policy also helped inform guidelines for Northern Ireland’s Equal Lives Policy (2005). Person Centred Planning focused on finding out what is important to and what is important for (health and safety) Miss A. I found PCP a continual process of listening and learning, by focusing on what’s important to Miss A now and in the future (Thompson, Kilbane and Sanderson, 2008, p27). By using person centred tools, such as a one page profile, I gained knowledge of what was important to Miss A including her family, her boyfriend and her independence, as well as knowing what was important to keep her safe and healthy. I used a person centred approach to make others aware of Miss A’s great personality characteristics as well as the help and support she would like. I feel this was fundamental to demonstrate that Miss A is a person behind her disability. I found by using this approach was an essential skill in understanding Miss A and helped me to be anti oppressive and actively support her needs

One particular piece of legislation which I found to be significant in the assessment of Miss A was the Human Rights Act (1998), which identifies Miss A’s right to family life. Since the death of her father and the institutionalisation of her mother due to her mental health, Miss A has been experiencing disintegration of her family and has lost the support connected to it. The Human Rights Act could have a great significance as Miss A needs emotional and physical support to visit her mother and has not been receiving it; therefore her right to family life is being impeded. The assessment identified that contact with her family and friends are imperative for this right to be upheld. Therefore as a result my role was to facilitate this right, and help to support Miss A in retaining family contact.

The main objectives we (Miss A and I) identified within the assessment were;

That Miss A had limited support to help discuss the death of her father.
That Miss A was not receiving contact with her mother or other family and would like to.

From the identification of objectives Miss A and I decided to work towards solutions by preparing a work plan.

Planning:

After the initial assessment was carried out with Miss A we proceeded to work towards formulating a care plan and targeting her objectives. A care plan provided clear information for everyone involved with Miss A and helped work in partnership with her and the Trust. For a person centred care plan the word ‘support’ is used in preference to ‘care’ because the verb implies that support is there to help people achieve their goals and ambitions” (Thompson, Sanderson and Kilbane, 2008). “A support plan is developed by the person with help where necessary, and it describes how the person intends to be supported in order to live their own life” (Thompson, Sanderson and Kilbane, 2008). I feel the use of a support plan with Miss A, rather than a care plan is an anti-oppressive method, as it incorporates Miss A’s feelings and opinions into how she wishes to be supported.

I used the formulation of a support plan with Miss A to record the objectives she would like to meet and used these to formulate an intervention. It was clear from the assessment and one page profile that limited contact with her mother was an issue, and that the death of her father had a significant impact on her life.

I then proceeded to investigate theory of loss and grief as I had never experienced a loss of Miss A’s magnitude before. I found the Kubler-Ross Model and the 5 responses to grief to be particularly informative. (Goldsworthy, 2005). This theory helped inform my knowledge and in turn helped me be empathetic to Miss A. I was able to identify that Miss A can experience the 5 stages of grief and that they are not necessarily in a specific order. I felt Miss A was at two stages of grief, some days she experiences anger at her father leaving, and other times she has deep feelings of depression of losing him. I was able to use Kubler-Ross’s model to identify these stages in Miss A, and also to advise her that these feelings were part of the normal process of grief.

The assessment also identified that Miss A had a lack of support in discussing her feelings of grief. Research suggests that people with learning disabilities experience many of the emotions of bereavement but are limited in the opportunities they have to resolve their feelings of grief (Cathcart, 1995; Elliot, 1995; Read, 1996). There are many reasons for this and Murray et al explains that historically, professionals, parents or carers of individuals with learning disabilities believed that those in their care did not understand the concept of death and thus were unable to grieve for the loss of a loved one (McLoughlin, 1986; Elliot, 1995; Read, 1996 cited in Murray et al. 2000). Kitching (1987) and Bradford (1984) highlight that the capacity to grieve is not dependent on a person’s intellectual ability, but that a person with learning disability may experience grief in the same way as a child. Therefore research shows that people with a learning disability experience grief and loss but have a limited support network to discuss it with. I used this research to formulate a plan for the intervention with Miss A and we concluded that I could be support for discussing her grief.

From the assessment and care plan with Miss A, and following discussions my practice teacher, I discussed that I would use counselling skills to help support Miss A with her feelings of grief. I felt Miss A needed her emotional needs met since the feelings of the death of her father were so dominant. Miss A and I also decided that I would facilitate visits to her mother for emotional and physical support, as her mother was in the latter stages of dementia and Miss A found it hard to communicate with her.

Intervention:
Rationale for Counselling Intervention:

After having conducted an assessment and care plan with Miss A, and building a rapport over numerous meetings, it was decided that a counselling intervention would be the most appropriate form of support for grief. My practice teacher and I felt that if Miss A had the opportunity to discuss her feelings this would help her grieve more effectively and perhaps help her cope better.

The two models of counselling that are prominent in social work are the work of Carl Rogers and Gerard Egan, who base their counselling approaches from psychodynamic work around inner thoughts and feelings. Both counselling theories “reflect the social work values of accepting the individual, using skills in listening to the information that is given, and work towards a joint understanding and decision making about ways forward” (Coulshed and Orme, 2006). I focused on researching counselling theory to help me understand how I could help Miss A through her grief. Trevithick explains that within social work, humanistic approaches to counselling have been particularly influential, specifically with the work of Egan (1990) and Rogers (1961), mainly because they promote personal freedom and are consistent with anti-discriminatory practice and anti-oppressive perspectives” (Trevithick, 2000). I found that the Roger’s (1961) Person Centred counselling informed me that I could show unconditional positive regard for Miss A and understand that she is the expert of her own grief.

I also analysed Egan’s (1990) Skilled Helper Model and found it to be an effective theory for an approach to counselling. I found that the structure and framework of the model and the three stages were useful as a guide to follow. I found that although this method of counselling may not be as person centred as Roger’s it could be more effective in helping Miss A understand her own grief as it followed a certain framework, could empower her and could be evaluated over time. This theory helped inform my practice by helping me realise that I do not need to be a qualified counsellor to support someone; I just need to be able to actively listen, to use empathy and be reassuring knowing that Miss A’s agenda is paramount. I consider this in itself to be a person centred way of counselling.

I decided to follow a combination of Rogerian method and Egan’s approach to help support Miss A as an intervention. I decided I would use the structure of Egan’s model to help build a logical, consistent framework to the intervention, while using the core principles of the Rogerian approach to demonstrate my skills and values, such as working with respect, empathy, genuineness and good active listening (Coulshed and Orme, 2006).

Counselling Procedure:

Egan’s Skilled Helper Model form of counselling provides a structured and solution focus basis. It is a three stage model in which each stage consists of specific skills that the helper uses to support the service user move forward (Nelson, 2007). Egan’s model is described as a three-stage process: identification of the service user’s current issue(s); identification of the service user’s desired situation; and the formulation of an action plan to achieve this. This process is facilitated by the “skilled helper” using the skills outlines by Egan (Nelson, 2007).

The goal of using Egan’s model with Miss A was to help her manage her grief and better understand the “norms” associated with it, such as anger or depression according to the Kubler-Ross Model. Egan (1998) claims his model is to ‘help people become better at helping themselves in their everyday lives’. To provide Miss A with the empowerment to help herself grieve.

The use of Egan’s Skilled Helper Model was to explore how Miss A felt about her bereavement. I used it to ask open questions about how Miss A felt about her father. We explored her past and discussed her relationship with her father before his death. I also used this stage to focus on aspects of her father before he died and what she missed about him, this was to explore and gather information about what her relationship was like with her dad. I was able to use a range of skills to gather information about Miss A’s grief. Trevithick (2000) explains that social work skills are “the degree of knowledge, expertise, judgement and experience that is brought into play within any given situation, course of action or intervention” (Trevithick, 2000).

Some of the skills I incorporated into Egan’s counselling were active listening, I used this skill with a range of non verbal cue’s to indicate to Miss A that I was interested in what she was saying. I concentrated on active listening as Miss A was portraying feelings and knowledge of the death of her father which was a sensitive subject and needed my full concentration. I portrayed active listening by nodding, giving eye contact and facing Miss A which were successful in helping build a rapport with Miss A, thus helping her open up. Another skill I feel I used well with Miss A was empathy. I feel I portrayed my feelings of empathy by responding appropriately to her answers and reassuring her that her thoughts and feelings around grief were normal. I found myself using Empathy a great deal with Miss A as I had never experienced bereavement before and she helped me understand how it felt. It’s easy to imagine how someone feels, but when you’re faced with helping them I felt I really needed to place myself in “her shoes”.

I also found I made good use of silences with Miss A, I used these to give her time to reflect on her thoughts and answers. I have found by doing this that the meetings were paced better, and showed that she was the expert of her own grief and I was just there to listen and to reassure her. I found that by using Rogerian person centred skills like genuineness, empathy, communication and active listening I was able to understand Miss A and show her that I was there to support with her agenda. Throughout the discussions of grief I feel Miss A was able to vent a lot of her feelings that she had since her father’s funeral. I feel I was able to support her understand those feelings and help her recognise that anger, depression, or denial are normal feelings that many people in her situation suffer.

Throughout Egan’s Skilled Helper Model and each of the sessions with Miss A I found that she responded well to being able to discuss her feelings with someone. The Rogerian influence on the intervention enabled me to build trust, partnership and a good rapport with her facilitating an open working relationship and providing her with support.

Some of the values I tried to incorporate into my counselling and indeed my relationship with Miss A were empowerment and self-advocacy, by letting her know that her agenda was central. I wanted to create a balance of power and to provide a supporting role rather than a dictator role, which I feel I achieved by being able to listen to her views and incorporating PCP. Social work has a distinctive value base with beliefs and principles playing an important role in practice (Thompson, 2005). Challenging my values has helped me to treat Miss A with unconditional positive regard, and with the respect and dignity she deserves. I have challenged my values anti-oppressively by researching MRSA and not making assumptions about the condition; I have challenged my stereotypical attitude around learning disability demonstrating that Miss A is first and foremost a person with feelings and issues before recognising she has a disability.

Evaluation:

On evaluation of the Egan’s Skilled Helper Model and my intervention with Miss A have shown that her agenda was central to the sessions, a balance of power was necessary to achieve the trust and respect of one another and that listening is paramount to providing effective counselling. I entered the sessions with Miss A being unaware of what to expect, I was troubled that I would not have enough knowledge about grief to help support her. After the initial session I soon realised that I didn’t need to be a qualified counsellor to make a difference to her understanding of grief, I just needed to be able to explain her feelings to her and reassure her that they were normal and not as she phrased it “being mental”. I found that by working with Miss A using the Skilled Helper Model I was able to apply my skills of listening, communication and empathy to help her understand her feelings. I have never personally had a bereavement of Miss A’s scale before but feel as a direct result of working with Miss A I have learned that grief is a powerful emotion for anyone to experience and it can take a significant amount of time to recover from. The only regret I have of using the Skilled Helper Model was that I feel I did not have enough time to fully help support Miss A, I feel as I had a placement of only eighty-five days I did not have enough time to fully counsel her for the best outcome.

I feel throughout the intervention process I tried to maintain person centred principles with Miss A by providing her with the opportunity to discuss what was important to her. Research shows that the use of Egan’s model is not person centred as it incorporates the counsellor to ask all the questions, and therefore have the control; but I feel by working in partnership with Miss A to discuss the death of her father was important for her emotional well being and empowered her to help resolve her grief. I also incorporated Roger’s core skills of genuineness, respect and trust to achieve this

Conclusion

Through working with Miss A I have found the experience to be invaluable learning. I have discovered that there is a spectrum of ability with adults and their learning disability. I have found that each person is an individual, and that group care is not necessarily recognising of this. In regards to Miss A I have learned not to make assumptions or stereotypes before meeting the person, as this can lead to oppression and even discrimination. Miss A is an individual, with individual needs, and at this assessment and intervention her emotional needs were prominent.

I feel I completed the aims I had intended to by supporting Miss a through her grief using Egan’s Skilled Helper Model. I incorporated Roger’s core skills into this model to help facilitate person centred sessions, and create an understanding that she was the expert, and I was there to listen and support her. If I was to repeat the intervention I would use Egan’s model again as it provided me with a structured, logical framework to work with and provided me with the identification of the skills I needed to make the sessions successful and effectively counsel Miss A.

I feel my future learning needs from working with Miss A are to use more formal language as I identified I talked to her informally using words such as “wee”. I feel I did this to appear more friendly rather than her social worker, but realise this is not a professional manner to work. Other learning needs I identified were to pace the sessions more appropriately and ensure that Miss A understands the conversation. I feel during the initial sessions with Miss A I spoke more to engage her in the discussion, and feel this was more of a nervous reaction to having to counsel Miss A. During later sessions I was able to take this skill into consideration and settle quicker into sessions to give Miss A the opportunity to discuss what she wished.

Overall I feel my relationship with Miss A was good, I feel the assessment and intervention were successful, and I feel I worked in a person centred way incorporating knowledge, skills and values to inform my practice. I feel Miss A felt positively about our work together as her feedback from sessions indicated that she was satisfied with the support I provided.

References:

1. Beresford, P. (1996) The Standards we Expect: What Service Users and Carers Want fromSocial Services Workers. London: National Institute of Social Work

2. Bradford, J. (1984) Life after a Death, Parents Voice 34: 6-7

3. Cathcart, F. (1995) Death and People with Learning Disabilities: Interventions to Support Clients and Carers; British Journal of Clinical Psychology 34: 165-75

4. Coulshed, V., and Orme, J. (2006) Social Work Practice. Palgrave Macmillan, Fourth Edition

5. Duffy P, Fisher C, Munroe D (2008). Nursing knowledge, skill, and attitudes related to evidenced based practice: Before or After Organizational Supports. Medsurg Nursing 17 (1): 55-60

6. Egan, G (1990) The Skilled Helper: A Systematic Approach to Effective Helping. Pacific Grove, CA: Brooks/Cole

7. Elliot, D. (1995) Helping People with Learning Disabilities to Handle Grief, Nursing Times 91 (43): 27-9.

8. Goldsworthy, K. (2005) Grief and loss theory in social work practice: All changes involve loss, just as all losses require change, Australian Social Work, 58:2, 167 — 178

9. Kitching, N. (1987) Helping People with Mental Handicaps Cope with Bereavement, Mental Handicap 15: 60-3.

10. McLoughlin, I . (1986) Bereavement in the Mentally Handicapped, British Journal of Hospital Medicine October: 256-60.

11. Murray, G., McKenzie, K., and Quigley, A. (2000) The Grieving Process in Individuals with a Learning Disability; An Examination of the Knowledge and Understanding of Health and Social Care: Journal of Intellectual Disabilities; 4; 77

12. Nelson, P. (2007) An Easy Introduction to the Egan’s Skilled Helper Solution Focused Counselling Approach. Palgrave and Macmillan (Online at www.f-e-t-t.co.uk) (Accessed 2 March 2009)

13. Preston-Shoot, M., and Braye, S. (2009) Social work intervention (Online) – Available at: http://www.scie.org.uk/publications/elearning/law/law08/index.asp [Accessed 5 May 2009].

14. Read, S. (1996) Helping People with Learning Disabilities to Grieve, British Journal of Nursing 5 (2).

15. Smale, G and Tuson, G. (1993) Empowerment, Assessment, Care Management and the Skilled Worker. London. HMSO

16. Thompson, N. (2005) Understanding Social Work: Preparation for Practice. Second Edition. Palgrave Macmillan

17. Thompson, J., Kilbane, J., and Sanderson, H. (2008) Person Centred Practice for Professionals. Open University Press.

18. Trevithick, P (2000) Social Work Skills: A Practice Handbook. Open University Press.

19. Whittington, C. (2007) Assessment in social work: A guide for learning and teaching; London.Social Care Institute for Excellence

20. Williams, P (2006) Social Work with People with Learning Disabilities. Learning Matters Ltd

Other:

21. http://www.northernireland.gov.uk/news/news-dhssps/news-dhssps-october-2008/news-dhssps-101008-community-statistics-for.htm (10/10/08) – (Accessed on 8 May 2009)

22. http://www.understandingindividualneeds.com/policyandprocedure/statistics.htm (Accessed on 24 April 2009)

Evaluation of Social Work Practice with Hispanic Children and Families

Example of a practice evaluation

A practice evaluation is a review and evaluation of individual practice within program and how the practice affects the person or recipient of services. Within The Place for Hope and Restoration, is the Raid and Rescue program has service practices for the “outreach workers” is to “raid” the streets to identify possible victims, such as prostitutes, exotic dancers, and/or service workers, such as cooks, busboys, waitresses, and day laborers. The outreach workers provide information about the other programs of the agency, to include how they can provide a safe place to stay, help the victim learn how to be a survivor, provision of advocacy and legal services, etc… and offer “rescue” service, to include transportation to the Safe Harbor program and the other programs within The Place for Hope and Restoration. How these service practice affect the person is essential in identifying the impact to the individual, the staff, the agency and the community. Some areas of practice to be reviewed would include: access, safety, effectiveness of outreach, raid procedures, barriers to the raid and rescue process, along with the needs of the individuals and program. Through the use of data, such as structured record reviews, individual case reviews, surveys or other data, the program practices can be evaluated regarding the efficacy, efficiency, and outcomes. Through evaluation of the practices of the Raid and Rescue program, stakeholders will be able to determine the ongoing needs of the practices, identify program deficits and determine if the practices are meeting the defined outcome measures for the target population and the community. This should assist the overall program in determining the need to continue, modify, or discontinue the practice utilized by the Raid and Rescue program to meet the needs of the stakeholders.

Example of a Program Evaluation

A program evaluation is the systematic review of a “program’s current (and future) interventions, outcomes, and efficiency to aid in case – and program-level decision making in an effort for our profession to become more accountable to stakeholder groups” (Grinnell, Gabor, & Unrau, 2012, p.26). Program evaluations come in a variety of formats, but should include evaluation of the program’s goal(s), mission, program objectives, practice objectives and activities (Grinnell, Gabor, Unrau, 2012, p. 55) to determine if the outcomes and purpose of the program are being met. As noted previously, The Place for Hope and Restoration has multiple departments including outreach, Safe Harbor, fundraising, advocacy and policy, and administrative services. Within each department there are several programs. An example of this is the outreach department has the “Raid and Rescue” and “Community Outreach” programs under it. Each program then has specific goals to meet the needs and requirements of the stakeholders and funding source(s). A program evaluation is focused on the specific program, not the department nor the specific practices, though they are part of the comprehensive program evaluation.

Utilization of the Six-Steps of the Program Evaluation Process

The first of six steps of the evaluation process for a program would include the engagement of stakeholders. To evaluate the Raid and Rescue Program, stakeholders would need to be identified and engaged to provide feedback. This will be accomplished through a variety of formats including public hearings, meeting with community service coalition groups, and the use of standardized survey tools. Both internal and external stakeholders should be involved in this evaluation process. Internal stakeholders would include those involved in the operation of the program. This includes, but is not limited to, funders, board members, administrators, staff and volunteers. External stakeholders would include law enforcement, legal services, community service programs, family members, elected officials, and the community-at-large. The recipients of services are also key stakeholders and need to be involved in the evaluation process, both those who are currently participating in the program, those who have transitioned into other programs of the agency and those who either refused or did not follow through with accessing raid and rescue.

The next step in evaluating the program would be to clearly describe the program. To do this one must identify the expected effects, activities, resources, stage of development, context, and logic model (Grinnell, Gabor, & Unrau, 2012, p. 31). This will be achieved through the review of the agencys strategic plan, the mission statement, funding requirements, and various other agency resources that describe what the purpose and goals of the program. The third step of this program evaluation process is to develop a plan of how the program will be evaluated. For the Raid and Rescue program, the Theory of Change will be utilized to determine if the program is effective and what the practices are effective within the program. This will be completed through a retrospective chart review, client and stakeholder surveys, and stakeholder focus groups. Step four is the gathering and evaluation of data (Grinnell, Gabor, & Unrau, 2012, p. 32). For this program the data from the surveys, chart reviews, and focus groups will be gathered, analyzed to determine strengths and areas of need. Data will be presented as both qualitative and quantitative data, to demonstrate success rate, completion rate and other variables, determined by the stakeholders. Outcomes towards program goals will also be evaluated to determine if Raid and Rescue is reaching victims and if their practices are helping victims. Step five is tied directly into step four of the evaluation process as this is the development of conclusions and making recommendations, based upon the data. To complete this step one must “judge the data against agreed-upon values or standards set by the stakeholders” (Grinnell, Gabor, & Unrau, 2012, p. 33) and present the conclusions in a clear and consise manner. Lastly, there is a need for follow-up regarding the program evaluation in order to ensure the process was meaningful. The results should be disseminated, meetings should take place to review the results with key stakeholders, such as advisory committees, management staff, project teams in order to prioritize any needs and outliers of the program and develop action plans, based upon the identified needs or to continue current practices. The stakeholders should also be provided information regarding the successes of the program through focus groups, reporting results back to coalition groups, and through the use of media, such as newsletter articles, social media formats, program reports to funders, and formal reports to board members.

References:

Grinnell, R. G. (2012). Program Evaluation for Social Workers (Sixth ed.). New York, N.Y.: Oxford University Press, Inc.

When researching the changes that have taken place in the last decade, it is notable that law, guidance and application to practice are constantly under revision. The aim of this project is to identify and assess the impacts of the recent changes in child protection as well as public opinion and awareness of them.

Evaluating changes in child protection is challenging as defining the rights of children has never been particularly straightforward. Once, in Victorian times, they were considered the property of parents who can treat them in whatever manner they like. Fortunately, most people today believe that children should be emotionally safeguarded and should receive protection from government agencies from physical and sexual abuse. In examining how child protection has evolved during the past ten years, this project will also be discussing the facts and misconceptions about class and sexual abuse. Different types of data were used to identify those – secondary research section underlines previous studies, findings, evaluation of government and voluntary agencies actions in order to come to a conclusion, whereas in primary research data was collected by using a questionnaire to summarise public opinion and trends about the subject. Feasibility study was conducted to identify any possible difficulties in completing the project and methods used are evaluated in methodology section.

Whilst assessing the changes in policies, the research will give an insight into public attitudes and government legislation regarding child protection which is of interest to students who are hoping to progress onto a Social Work degree course and pursue their future career working with children. For students who are hoping to work with adults, the research might provide base for understanding the problems of paedophilia and an insight into recent Acts of Parliament. This was the reason why the research topic was selected.

Secondary sources of information, such as journal articles and government publications, will be selected to identify recent changes in the system. Even though these are widely attainable, the terminology used in selected journals is exclusively directed to professionals who work with children and some additional research will be essential in order to understand the topic and some legal terms. Whilst secondary data will be obtained from books, journals and government publications, the primary data will be obtained from an interview with a child protection professional and questionnaires which will be completed regionally and anonymously by adults. Therefore, time will need to be designated for designing the questionnaire and interview questions. Questions will need to be written so that answers provided will be easy to analyse. However, primary data will not be obtained from children due to the sensitivity of the topic. Basic computer skills, forward planning, determination and patience will be necessary in producing the following.

Marina Trifunovic

Methodology Study: Analysis of the Methods Used to Complete the Project

The project is structured according to the requirements of the grade descriptors and it is outlined to meet the standardised criteria. In addition, the methods used in gathering primary and secondary data were suggested and encouraged by the college tutor. The research for the project involved gathering primary and secondary data and its cogency relies on validity of those sources. The information is independently generated using the methods which are briefly evaluated in this section.

In terms of secondary data, validity was assured by using a variety of sources, such as books, newspaper articles and web pages which demanded patience and persistence. However, it provided a fundamental base for the project and most significantly, it subsequently led to a greater knowledge of the subject. Application of this knowledge allowed the critical evaluation of the issues relating the child protection. This broad approach to secondary research imposes time limitations and requires excellent understanding of the terminology.

In addition, primary data was gathered using the questionnaire and an interview with a child protection officer, employed by the NSPCC in Manchester. The interview with the social worker provided an excellent insight into the issues related to child abuse and poverty. However, the preparation for this was time consuming and difficult due to the limited availability of the interviewee and even though she tried and stay objective, some subjectivity as well as a degree of interpretation might have influenced the findings. Measures were taken to enhance the reliability of the findings generated by questionnaire by using a public sample from various age groups, genders and occupations and similar results enhance validity of the findings. However, the questionnaire was completed regionally and with a relatively small sample (36 people took part) which does not allow generalisation. Unlike interviews, using questionnaires does not require prior arrangements and information can be collected from a large number of people relatively easy.

Qualitative data used in the research covers a very broad area of different aspects to child protection. This is gathered from secondary as well as primary sources. Though information is brief comparable to that gathered by quantitative approaches, it poses difficulties when measuring it with reliability. Qualitative data found in secondary research such as in numerous books and journals require intensive reading and analysis in order to determine appropriate sources of information, e.g. finding and recognising the objective data in newspapers articles. Qualitative data is descriptive and this method was used to gather information using an interview. Nevertheless, the qualitative data poses risks in terms of written work as it is easy for a researcher who is still learning about the subject to express it in a descriptive rather than analytical manner. In this project, a degree of critical analysis was maintained by constantly questioning why findings are in a way as they were found.

Quantitative data was obtained by counting and coding the information gathered by the questionnaire in primary research. The information was transformed into numerical data and represented by using charts and graphs in the primary research section. This was further used to numerically measure the public opinion of child protection as well as to support the qualitative data and evidence found and analysed in secondary research. However, quantitative data in this project is not an infallible indicator on how people actually feel about child protection. The questions which were left unanswered in a questionnaire might be interpreted as the information which could not be limited to numerical descriptions and due to the sensitivity of the topic, some socially desirable answers are expected.

Marina Trifunovic

Secondary research: Changes in Child Protection During the 2000s

Law and guidance which regulates the child protection is constantly under revision. Nevertheless, the twentieth century featured the shift in attitudes when the family moved on from Victorian times where “Children were seen and not heard (Morgan,1985, p.89)”. Fortunately, most people today believe that children are not property of their parents and that they should be emotionally safeguarded and when necessary receive protection from government agencies from physical and emotional abuse. Therefore, when a report is made, the child is usually taken from the parents and put into care. Many sociologists believe that this is primarily associated with the lower socio-economic classes because poverty is believed to be related with increased chances of instability in the family (NSPCC, 2011). Although that is statistically correct, children in more desirable neighbourhoods may be more vulnerable if there is a general belief that childhood abuse could not possibly happen in these areas as poor children appear to be the easy choice for the sexual predators of the world. In examining how child protection has evolved during the past ten years, also the secondary research section involves analysis of the facts and misconceptions about class and sexual abuse.

Child Protection Reforms

Every society has an interest in protecting its children, not only because they are the stewards of the future, but because one of the merits which grades the level of development of civilisation is how well a particular culture treats its children. In England, there have been some arguments about reinforcing social values of the English way of parenting on people from foreign cultures. However, the tragic story of Victoria Climbie had influenced politicians to discuss the ways to improve the law in place with regards to child protection in the UK. The Labour government also analysed how the holes in the system could be closed and systematically, the media had played a role in informing the public of what was regarded by the journalists as a ‘ blinding incompetence’ of government agencies (Lonne, 2009). The inquiry into the case discovered that a number of agencies such as the police, NHS, NSPCC and local churches that Victoria attended all noticed the signs of abuse, but had done nothing to assess the situation. As a result of the ‘blinding incompetence’ in which way this case was assessed, Parliament passed an amendment to the original 1989 Children Act to the ‘updated’ 2004 Children Act (The National Archives, 2011). These amendments to the Act gave much greater discretion to child protection agencies and power to react when protecting children and the new principle of ‘every child matters’ led officials to not dismiss certain cases because of the social or cultural background of the child in question.

The Home Secretary appointed a review of safeguarding children in June 2007 and measures were put in place to ensure better communication and cooperation between the agencies and the government agencies are exchanging data regarding sex offenders in England and Wales under the guidance of ‘multi-agency public protection arrangements’ (MAPPA). In a controlled way, information is also made available to various people, such as teachers, employers, landlords and parents. The extent to which information is reviled involves regional variations and is further stimulated by a campaign for sex offenders disclosure scheme, commonly referred to as ‘Sarah’s Law’. This scheme was piloted in Hampshire, Cleveland, Cambridgeshire and Warwickshire over a one year period in 2008 and it allowed members of the public to attain information from the police about any sex offending convictions of an individual, for example, a family friend or a neighbour. However, the scheme does not mean that information is unreservedly made public. During the pilot period a total number of 585 enquiries were initiated, 315 of which were preceded further and resulted in a total of only 21 criminal disclosures being made. Also, 43 disclosure applications prompted other safeguarding actions such as referral to social services (Almandras, 2010) which indicates the scheme’s useful application in practice.

The Home Office carried out the research which concluded that criminal justice agencies had benefited from ‘Sarah’s Law’ which resulted in increased intelligence as well as in an improvement in a way which public concerns are handled. This led to an announcement in August 2010 that the scheme would expand to twenty more police force areas and remaining forces were invited to consider the introduction of the scheme by March 2011. However, even though police seniors feel confident that information which is disclosed under the scheme will remain confidential, organisations such as NSPCC have stressed that criminal disclosure might encourage violent attacks.

When evaluating this extent of information disclosure, it is important not to forget that it only involves the information about individuals who have been convicted for a sexual offence. This does not eliminate the need for public awareness to safeguard children from yet unknown offenders.

Other significant methods to tackle the child abuse include a cultural shift of condemning violence within the home to the same extent as violence outside the home, and some researchers argue that Parliament could pass more amendments in safeguarding children, notably against corporal punishment, such as the case in sixteen European countries, as a part of a revised Children Act in future (Wilson and James, 2007). Nevertheless, designing a strategy to tackle the issues of child protection involved creating a profile of child abuse, for example, assessing which families would be more at risk to abuse children and social workers concluded that a degree of risk is strongly correlated with poverty, social isolation, family breakdown and poor parent-child relationships (Wilson and James, 2007). This has led government and voluntary agencies to focus their work on poorer households where such risks are statistically more possible as the economic factors inevitably create stress that can accumulate and result in parents to take out their frustration on their closest family, most notably on their children.

Struggling to survive and financial problems, however, are not the primary reason behind the child abuse among middle and higher class families. Studies have found that abuse in the higher social circles are directly related to factors such as the abuse of drug and alcohol, and there is some hesitation to prosecute perpetrators from middle-class and upper-class backgrounds because they would be unable to provide economic support to their family members if they are prosecuted and put in prison. In addition, such an individual would be able to bring more financial resources to fighting the legal charges and it is argued how it would be easier for such a person to obtain personal references from affluent friends and family as well as have an advantage of the access to greater funds for legal help (Faller, 1993).

New Labour reforms and Children Act 2004 aim to prevent children from being on repeated reports on the child protection registers (Powell 2002). In practice, this means that children would be much less likely to be removed from one abusive situation and placed in another. The reforms of the government legislations reinforce increased measures for assessment of the prospective foster parents, and more strict evaluation of the biological parents who are hoping to gain back the custody of their children (Powell 2002).

Protecting children online

Government experts argue that parents, influenced by media, are contributing in creating the ‘paranoid’ culture and thus are overprotecting their children. The ‘risk-averse’ approach to raising children has resulted in an increasing number of children who are exploring the world of the internet and particularly social networking sites as they are disallowed to play outside. London School of Economic had carried the comprehensive survey which found that ninety eight percent of children have access to internet (UK Children Go Online, 2006) and another study concluded that nearly all questioned parents (95%) do not recognise the slang that their children use to let other people know that their parents are supervising them (Netlingo, 2011). Nevertheless, the generation gap often leaves parents unable to fully understand the complexity of the conduct of ‘cyber bulling’ nor significance of online safety (Khan, 2009). This influenced the government to react and the agencies such as CEOP, UKCAS and IWF are developed and designed to provide information and support for the victims as well as minimise the availability of images of child sexual abuse and help to prosecute the offenders. The number of intelligence reports from Child Exploitation and Online Protection Centre (CEOP) that led to police arrests increased from eighty three in 2006-2007 to four hundred seventeen in 2009-2010. In 2009, Prime Minister Gordon Brown, marked the UK approaches to online child protection as ” one of the most effective in the world (IWF, 2009)”.

Childhood Sexual Abuse: A Class Distinction

Childhood sexual abuse in reputable families was often undetected because the biggest percentage of the higher classes appears to consist of respectable citizens. From a sociological point of view, taking children into care would be a more difficult decision in these cases as sexual abuse that involves immediate biological relatives is statistically more rare comparing to those involving lovers of the parents. Career people, doctors, teachers, and successful men, sometimes women, as well as ministers of church were therefore able to carry on the sexual abuse of children because of the widespread misconception that such terrible things could not possibly be committed by these ‘model citizens.’ Another reason why many offenders were successful in hiding their crimes was because they chosen the victims who were often vulnerable and lonely children that did not have warm relationships with parents and intended to obey authority. For example, in one case study, a child was abused in front of the neighbours who simply looked the other way because the father of the abused child had created a ‘negative opinion’ of the child in their minds by repeatedly telling them what a naughty and difficult child she was. So when he chased her around while she was undressed and hit her outside, the neighbours thought nothing of it as it was an all white, middle class neighbourhood where ‘such things never happened’ (Itzin 2009).

‘Their targets are not the conventionally perceived social underclass, though many victims will be drawn from that, but are rather from a collection of groups who form the fodder of abusive networks; who are subjected over and over again throughout their lives to multiple abuses’ (Itzin 2000, p. 390).

Unfortunately, there is no way to completely eliminate the horror of sexual abuse from society, but there is a way to encourage a shift toward making children less vulnerable. Children Act 2004 recognised children as individuals in their own right who do not deserve to be beaten, raped, or psychologically tortured. Protecting children from harm should be a responsibility of all adults as well as implementing a zero-tolerance policy on child abuse and prosecution as well as rehabilitation of all offenders, regardless to the social class.