Category: Free Essays

Ethics as it is being used in the health sector is a concept that has evolved over time. There is no doubt that every player in the sector seeks to continually improve their services delivery as well as attaining maximum patient satisfaction in the process. In the last few years, ethics in health has developed through a number of stages. Hippocratic culture dominated traditional ethics in the 1960s where health care providers established relationships with patients. The core values of this relationship were derived from culture. The technological advancements and intensive research has seen developments in biological sciences and biotechnology. With such changes, a new ethical dimension was introduced.

Ethical principles of human dignity, compassion, non-malfeasance and social justice

However, with time a dilemma arose from the liberalization of health care industry. There emerged a need to harmonize the differences in health needs and resources availed for filling the gap. The scope of health ethics was thus expanded to include quality control, economics, policy formulation and implementation as well as massive research and development. Such efforts and resource harmonization gave birth to an era of health policy and ethics. As time advances there are debates on human rights protection and respect of human dignity (Bryant, Hyder and Kauser, 2007). It is now a fundamental right for every individual to enjoy quality health care without discrimination of any kind. The most recent dimension of health ethics is the fusion of lauded human rights and the fundamental right to obtain quality health services.

Contrary to direct definition of health, as the entire state of well being in terms of mental social and physical status of an individual, ethics and human dignity issues are more complicated to completely expound on them. Ethics is solidly founded on cultural convictions developed over time. It derives its relevance and strength from religious and philosophical advocacies deeply embedded on the present leadership systems. It is considered as the ability of a community to clearly and amicably draw a boundary separating what is perceived as wrong and what remains a right thing.

Such a boundary touches on the aspects of life right from the way of doing things to the general perception of life. It becomes a big understatement to define ethics without mentioning the famous dimensions used to describe it. It is a cumulative approach of respect to humanity with specific focus on maintenance of autonomy of a person, delivery of justice, rights and upholding of human dignity. Ethics in health policy formulation and implementation focuses on the most cost effective means of delivering a quality health care to all. It is in this light therefore, that ethics attempts to strike a balance between the policies and values cherished by an entire community.

Equity is another paramount aspect of importance which cannot be neglected. It is about all that appertains to fairness in the ultimate distribution of gains derived from a robust health advancement which is socially acceptable. It is a concept that goes beyond just accessing health care products but touches on the response aimed at meeting the needs of all persons. Equity aims at ensuring that no one individual is favored in the allocation of resources as well as availing of equal chances of accessing health care (Bankowski, Bryant and Gallagher, 2007).

It is therefore a process justified by the outcome. It is important to examine the impact of decisions made on equity. The specific health decisions must go a long way in fostering equity in access to health care services. The health status of most vulnerable groups remains the action points of equity development. There are no specific parameters of determining a group to be classified as vulnerable. However, there are general features which help us in this. There are those who are vulnerable due to social construction while others are as a result of congenital disability. It is usually possible to get an overlap between the two possible causes of vulnerability.

The United Nations charter identifies the promotion of human dignity to be one of its core principles. This is evident in the ratifications, conventions and declarations of numerous international agreements in respect of this. One thing that we cannot fail to talk about at the mention of health care is this core principle of promotion of human rights and upholding of human dignity. A good example is the right to information an individual is entitled to on everything that affects his or her health. It is this right that compelled cigarette manufacturing companies to put an information label on their packets. In the recent past, efforts have been put on the reduction of public health burden on the rights of individuals (Sen, Germain and Chen, 2004).

Trampling on the rights of a few individuals through quarantine, mandatory testing and isolation in the name of benefiting the majority is no longer ethically acceptable. A good and most recent example is United Nations’ advocacy of elimination of discrimination against people living with HIV. Together with human rights, dignity is considered an inherent and universal concept. Wide scopes of research in the biomedical field have continued to become the center of discussion on the inherent issues on human dignity. Law enforcers must also expand their focus to other sources of human dignity violation originating from areas outside medical field. Such determinants as political influence, economic factors, technological innovations, environmental concerns and changes in demographics must be looked into.

It is important to note that advances have been made so far in the maintenance of human dignity and respect of human rights. Majority of institutions dealing with human health care services have a deliberate way of issuing instructions aimed at improving ethics amongst their staff members. The extent at which ethics instructions are being given is a clear indication of a continuous increase in the expansion in respect of human dignity. The unprecedented attention given to research on health care ethics cannot be attributed to one particular factor. There are a number of reasons as to why every player is shifting focus to this study.

To start with, the knowledge explosion on the biotechnology field has availed a number of avenues available for a medical professional in the fight against diseases. It is now possible to handle situations which were once thought to be untreatable. However, this milestone in medical field has not been a bed of roses. A series of mixed reaction continue to emanate from various sections of the society on how ethical are some of these methods.

Secondly, the cost of accessing basic health care is sky rocketing across the world. Most governments of the day are spending a substantial portion of their Gross Domestic Product on health care expenses yet most citizens cannot get the care they need. This leaves us in total agreement with Howard Hiatt who say that we have a few resources to use in provision of health care and therefore as a society, we need to ask ourselves two important questions. That is how we spend and allocate them. It is as a result of financial constraints that have made us witness denial of adequate health care, limited access and unfair rationing (Hiatt, 2005).

Situational analysis

Issues of ethics in health care are numerous. They range from an individual responsibility to the entire corporate obligations. That is why such issues can be approached from two distinct sides. To start with, macro ethical situations entail what cannot be addressed by a specific practitioner. Such issues are those in which the entire body of health professionals and the community at large must deal with in a bid to ensure that health care ethics are defined and respected. As an illustration, issues such as termination of pregnancy, health care resources allocation and organ transplants are in the category of macro situations. On the other hand, micro situations lie squarely on the hands of a single individual health care professional. It must be realized that ripple effects of macro issues are flow into micro situations.

Ideally, the topic of health ethics should commence from the generally accepted responsibility a medical officer have towards meeting the needs of patients. This brings to our thoughts the issues of competence and trustworthiness of the health care practitioners. Competency goes beyond possessing enough knowledge to deal with a situation. It includes the ability to articulate issues of health and deliver the services timely and accurately. It is also equally important for a patient to have confidence in the person he or she has entrusted his or her body to. Trustworthiness therefore forms a core factor in the satisfaction of patients which finally culminate to enhancement of health care ethics (Berger, 2003).

Legal and ethical rights

We are living in an era with serious awakening in discovery of personal rights. The medical professionals have always been assumed to be an all knowing class. A patient would accept to undergo a surgery, take drugs and have a laboratory test without any question or hesitation. This trend referred to as medical paternalism is gradually dying. Patients are becoming consumers with a right to choose what they perceive to best suit them. It is therefore a mandatory standard practice to seek a patient’s consent before carrying out any procedures aimed at restoring health. Doing anything different from this will not only be unprofessional but totally unethical. The overstepping of a practitioner’s mandate in administering health care can also attract serious legal action whose far reaching effects can be detrimental in the career of a defendant. Just like any other customer, a patient desires to attain a definite level of satisfaction. Health professionals who are unable to meet the needs of their patients may not be such attractive in future if they survive legal actions.

The legal rights of individuals are what we cannot avoid to talk about at the mention of health care ethics. The rights are those privileges a person enjoys as provided and defended in the Constitution of a country. Several legislations avails a patient with a series of rights. A patient seeking the attention of health care providers expects that clinical officers will utilize their gained experience coupled with their knowledge in striving to meet their needs. The patient’s rights ensure that independent individuals can expect the health care providers to meet their wishes of getting well without fear of otherwise.

From a broader view, health care systems are primarily based on the rights of individuals seeking treatment. Patients have a sole responsibility of selecting who or what best suits them in terms of health care facilities and doctors. It is required that the patient gives a go ahead of any process through a fairly attained informed consent. This scheme may look very attractive to a person whose has enough economic muscle to meet the cost of treatment. The patient’s right assumes that everyone patient can comfortably settle hospital bills. On contrary, this right is as good as not being there for the patient who does not have a medical cover or enough money to pay (Bankowski, 2006). Although United Nations Declaration of Human Rights says that “that all persons have a right medical treatment” you cannot walk to a health care facility and demand for treatment. It is not enough to receive medical treatment; safety and effectiveness of the services are two paramount features that a treatment seeker is entitled to put into consideration.

Ethical rights impose a responsibility on health care practitioners. The Hippocratic Oath results in a duty by the health professionals to do all they can in benefiting the patients and avoidance of any foreseeable harm. It can be argued that the health care providers must act at the best interest of the patients with disregard to how others are affected by their actions. A legality dilemma created by this Hippocratic Oath is diffused by the controversial exposition by Rem Edwards who claims that the health care providers are obligated to alleviating the aching and suffering of health care seekers.

The defects in this point of view are evident on the side of health professionals who operate under strict constraints of laws. The responsibilities of health professionals are thus in conflict with earlier mentioned rights of the patients in the light of ethical and legal correctness. Ordering a health care expert to pursue a personal approach and do what contradicts the law, yet ethical, process in the patient with total disregard of what may befall them legally is as good as telling them to suppress what is important to them in favor of the patient.

Ethical analysis

It is important for a health care provider to continually examine his action so as to ascertain whether he is doing the right thing or not. In 1989, Robert Veatch proposed a four step blueprint which can be used by the health practitioners. This method of analysis involves making sure that there is sufficient knowledge backed by facts for every situation. The second step is bringing in to play whatever is morally upright in relation to the situation at hand. Ethical principles are given a consideration it deserves at the third step. Once the three steps have been taken care of, a fourth and last step of looking in to ethical theories is done.

This provides health practitioners with a reliable, powerful tool available for use when faced with a situation demanding an ethical decision making. This theory formulated by Veatch approaches situation in a chronological manner. He goes ahead to argue that an ethical dilemma can be sorted not necessarily through the four steps but by just laying down the actual facts about a condition. If the application of step number one cannot provide a way out, step two is considered. This focuses on the moral rules guided closely by confidentiality or patient’s consent. At the event that dilemma persists, ethical guidelines of step three are used.

The ethical principle encompasses aspects such as maintenance of autonomy, fidelity, nonmaleficence and beneficence. At this point, the stalemate must have been broken. However, it is possible to have unclear solutions even with the application of ethical principles. It is because of such a situation that a health care professional is compelled to use an ultimate tool available in step four. Ethical theories are the final solution finder in a hard decision making procedure.

A particle and most recent example is seeking of consent of an organ donor. There have been several conflicting issues surrounding organ transplants. The ever growing imbalance between the number of organs demanded and those available for sale has played a major role in heightening the differences between proponents and opponents of this process. It is the obligation of clinicians to make sure that the wishes of prospective organ donors are respected to the later (Beauchamp and Childress, 2009). Various regulations have been put in place to ensure the respect of free will and human dignity of a donor whether death or alive.

Conclusion

The challenges facing health care professionals continue to rise with technological advancements and sky rocketing costs of health care. It is therefore of paramount importance to equip them with sufficient knowledge of ethical tools for use in such situations today or in days to come. Totally relying upon ethical codes, principles and theories may not be enough in decision making but serves by providing a rough idea.

Ethical dilemma

The ethical dilemma I will discuss will be based on some truth of an event that happened when I was a support worker five years ago in a mental health trust organisation. The patient will be referred to as girl ‘A’ and members of the multidisciplinary team will be referred to as professionals. A very brief description of the girls mental health illness was schizophrenia this can have an effect on a person’s mind in such a way that they can hear voices and send smells that are not real to the human eye.

Other features can include delusional thoughts this is where the person can believe that certain situations and circumstances have happened to them and it is very clear to the person on the contrary it can make a person feel that others do not believe them (CAMHS, 2002).

The ethical dilemma
Girl ‘A’ was 15 years of age, when she was sectioned under the 1983 Mental Health Act section 2.
Girl ‘A’ received a letter from a friend at home. This letter revealed that her friend had been raped from girl ‘A’s’ mother’s boyfriend.
Girl ‘A’ had prior to this letter disclosed to the nursing team that she herself had been raped from her mother’s boyfriend. She decided not to take action for fear of losing the relationship she had recently built up with her mother. At this time the girl wanted her mother to never find out about the disclosure of this rape ordeal.
The friend told girl ‘A’ that this situation was going to court.
At this point girl ‘A’ decided it was time to put closure on her own rape ordeal and therefore wanted to go to court and declare her own rape ordeal.
The ethical dilemma – is should the girl called go to court or not?

Reference – Reading from Leathard, A. & McLaren. (2007) Ethics contemporary challenges in health and social care. The Policy Press: UK.

There are three more approaches which often conflict with many ethical problems they are deontology, conceptualism and virtue ethics (Leathard & McLaren, 2007). It approaches can give directions to ethical dilemmas.

Consequentialism -also referred to as utiliarism discovered by Jeremy Bentham and John Stuart Mill. The aims of this approach are consider the consequences of taking a particular form of action (ibid). All areas of an ethical dilemma using this approach would be given equal weight when considering the outcome (ibid). In health care this approach can be seen to be used when considering decisions that need to be made about the allocation of resources (ibid).

Personal Values my personal values

You will describe your values but there is no right/wrong answer to this. It is basically how you presented your dilemma to the ethic group |Julie.

How does my personal knowledge, culture, and life experience affect this dilemma for you?

feelings

What values are in conflict and how has this made you feel?

What were your fears?

Given similar circumstances with another person would the outcome be the same?

how do these impact on the questions you asked
resp. to me as a person
PROCESS
How and why am I making a choice I am making i.e., what did I think, feel, and what did I do or not do?
How was my decision making affective by what factors of legislation, standards, policies and organisational policies/procedures and values?
What other resources would be helpful to me in making the decisions about the dilemma?
Keep using reflection I think this part Julie is where you have begun to described the different ethical approaches.

Deontology – deon means duty and ology is the science, this approach was discovered by Kantian. The aims of this approach does not consider the consequences rather it acts on what is morally right, in particular deontologists treat the situation or client with respect for individuality which is its greatest importance. This approach would not approve of telling lies to a client even if it was in the best interest. Any decision is made using deontology would have to be based on fact. Duty based theories which would allow the worker and the client to acts of the greatest outcome which would avoid harm. This approach recognises autonomy, trust and the equity of provisions (ibid).

Virtue – derived from Aristotelian ideologies. Thomas Aquinas (1990) defines virtue ethics is not only knowledge but also the approach taken to provide integration using this knowledge for an ethical dilemma situation, an area of “manifestation of ethical professional behaviour” (ibid: 71). Virtue ethics describe a person’s character beliefs and values quality is in actions that they believe are morally sound.

Beauchamp and Childress (1989) describe four ethical principles that should be considered when dealing with any ethical dilemma they are: beneficence, non-maleficence, autonomy and justice (ibid: 72). However these four ethical principles at times can conflict therefore critical judgement is required when choosing a particular procedure to take. These four ethical principles they can provide a framework to assist the worker(s)/client(s) situation by empowering the thinking process, this helps with the decision process of the ethical dilemma (ibid). In virtuous practitioner must take into account the different viewpoints by recognising the potential conflicts that can happen between these four ethical principles. It is therefore recommended that a practitioner makes critical judgements as to which approach would be more appropriate to the ethical dilemma. “Gardiner (2003) comments that the virtuous practitioner is driven by deep desire to behave well and that this approach has a flexibility that can encourage innovative solutions while acknowledging that there will often be elements of pain or regret” (ibid: 76).

So from the ethical dilemma if beneficence was applied the patient’s best interest and wishes and feelings would have been considered using this approach. Although, it could appear harmful to the patient, if the sole views of her situation were considered because this could have had an adverse effect on the best interests of the patient.

Non-maleficence – applying this approach to the ethical dilemma could show how the professional has protected the patient from actual or potential harm; this is particularly successful when the practitioner evaluates his/her knowledge and skills realistically ensuring any form of intervention is taken within their professional capacity. However should the worker feel there could be limitations then they should seek and share this information with the team of professionals caring for the girl? This particular approach may have been applied from support worker/primary care worker’s point of view this is because non-maleficence provides the support worker/primary care worker with more details from the client’s perspective of the situation whereas; a professional may only work with the girl on if few occasions. Therefore the implications of the support worker/primary care worker not sharing information with other professionals can cause great harm to the patient. If the support worker/primary care worker advises the patient “there is nothing more I can do” then this will be harmful and unhelpful to the patient (ibid: 74).

Autonomy – the principle of autonomy and impact on disclosure and confidentiality. However a patient has a right to information about their condition and their situation, the patient’s views beliefs and values should be respected. Although, legally the girl in the ethical dilemma was sectioned under the 1983 mental health act section 2 and therefore their grounds a practitioner must take with regards to an appropriate decision this can conflict the patient’s best interest/wishes and feelings. Using the ethical dilemma in this instance shows when “beneficence or non-maleficence overruling patient autonomy” (ibid: 75). The practitioner will endeavour to the first duty to the patient however the practitioner must balance this duty to the patient with regard to the wider risks and involvement of others. Gillon (2003), autonomy is a component of the other three ethical principles and autonomy should take priority with respect for the patient (ibid).

Justice and equity

“The Aristotelian principles suggest that I trust system should ensure equal and should be treated equally and unequal’s unequally” (ibid: 77). Considering justice and equity to the ethical dilemma the patient may feel the decision to not go to court un-fair. However the practitioner should deliver an Albany’s about the criteria that was used to make the decisions they made about this ethical dilemma. The principles of justice and equity can allow for decisions to be made and distributed according to the patient’s need, merits, capacity or rights. In this situation a practitioner may remind the patient of her rights in respect to a complaints procedure (ibid).

ISSUES
POWER/polices
What are the rights of the child?
What rights as a person?
Are there any rights in terms of seeking closure?
All your doing here is answering and showing Why and what policies may be used with this dilemma.
Julie notes for power

every child matters is a Green paper that was published in 2003 by the government as a response to the death of Victoria Climbie. In 2000 for the children’s act became law from a thorough consultation process and it is this legislation that underpins the legalities of Every Child Matters, by ensuring five necessary outcomes are followed when ensuring the health, safety and well being of children from birth to 19 years. The five outcomes are – being healthy, staying safe, enjoying and achieving, making a positive contribution and achieving economic well-being (Every Child Matters, 2003 Cited in http://www.dcsf.gov.uk/everychildmatters/about/ on 20/10/09 @ 13:05).

RESP.OF ORG.
What is the organisations point of view?

Ie NHS, CAMHS why do they use them what are the values of these principles to s/u

Organisations policies

This report sets out a new vision for the future of mental health and

well-being in England. Based on four principles, it outlines the priorities

we believe should underpin mental health policy for the next decade.

Our four principles for mental health policy are:
Mental health and well-being is everybody’s business. It affects every family in Britain and it can only be improved if coordinated, assertive action is taken across Whitehall and at all levels of government.
Good mental health holds the key to a better quality of life in Britain. We need to promote positive mental health, prevent mental ill health and intervene early when people become unwell.
People should get as much support to gain a good quality of life and fulfil their potential from mental health services as they expect to receive from physical healthcare services. Mental health care should offer hope and support for people to recover and live their lives on their own terms.
We need a new relationship between mental health services and those who use them. Service users, carers and communities should be offered an active role in shaping the support available to them. With these principles at the heart of policy, we believe we can create a society in which good mental health is nurtured and in which mental ill health is managed well.

As a consequence, our mental well-being will be a core concern of government. Effective action to promote good mental health will be taken among people of all ages and diverse backgrounds. People who experience mental distress will receive timely support to live well and have a fair and equal chance to fulfill their potential.

The actions that would be needed to make our vision a reality are summarized overleaf.

(Health, 2009)

Organisation/mental health
What is sectioning?

Most patients in hospital wards cannot be prevented from leaving when they wish, and their consent must be obtained before treatment is given. The same applies to most patients who are in hospital for psychiatric treatment. They do not object to being in hospital or being treated and are referred to as ‘informal’ or ‘voluntary’ patients. However, the Mental Health Act 1983 allows some people to be detained in hospital. When this happens, they are called ‘detained’ patients and their consent to treatment may no longer be required. This is often known as being ‘sectioned’.

Some people are detained in hospital by the courts after being charged with a crime. (See Mind rights guide 5: mental health and the courts.) However, most people are detained under the ‘civil sections’ of the Mental Health Act, which does not involve a court at all. This booklet sets out what must happen before someone can be detained under a civil section, and outlines some of the effects. Mind rights guides 2-5 describe, in more detail, other relevant information about consent to treatment and what to do if you are being detained and you want to leave hospital.

What is the process for detaining someone under a civil section?

There are two main civil sections of the Mental Health Act 1983, which are used to detain someone: section 2 and section 3. For each section, three people must agree that the individual needs to be detained. Usually, they would be an Approved Mental Health Professional (AMHP), a section 12 approved doctor and a registered medical practitioner.

The two doctors must agree the person needs to be in hospital and recommend detention. Then, the AMHP decides whether or not to make an application for the person’s compulsory admission to hospital. The Nearest Relative (NR) (see below) has the right to make an application. However, the Mental Health Act Code of Practice makes it clear that an AMHP is the preferred applicant and applications by an NR are very rare (the preference for the AMHP as applicant over the NR is re-stated in the new Code of Practice at para 4.28). It does not matter where the person is at the time. They may be at home, in hospital, in a place of safety, or in a police station following an arrest for an alleged criminal offence.

In an urgent situation, someone may be admitted to hospital compulsorily, with only one medical recommendation to support an application (section 4). This is allowed if it is felt the criteria for section 2 (see below) are met, but there is no time to wait for another medical recommendation. The second medical recommendation must be obtained within 72 hours.

It is important to note that people need not have committed a crime to be detained under a civil section. The law allows anyone to be detained under the procedure described above.

What do the different civil sections mean?

Section 2 allows for a person to be detained if they are suffering from a mental disorder and they need to be detained, at least for a limited period, for assessment (or for assessment followed by medical treatment) for their own health or safety, or for the protection of other people.

Detention can last for up to 28 days. The section can’t be renewed, but you may be assessed before the 28 days expires to see if detention under section 3 is necessary.

Section 3 allows for a person to be detained if they have a mental disorder, and it is necessary for their own health or safety, or for the protection of other people, and treatment cannot be provided unless they are detained in hospital. A patient cannot be detained under this section unless the doctors also agree that appropriate medical treatment is available for him or her.

Detention can last for up to six months. The section can then be renewed by six months, initially, and by a year at a time, subsequently (MIND, 2009).

Other professionals

Alan suggest the Mental Health Act could be one.

What rights does she have under this ACT?

Who was present? Consider their positions, charaters, virtues, values ect.

why is it a dilemma
DEONTOLOGY

This is what is meant by your code of conduct – this is the link between philsophy and practice it is through the codes of conduct. You will show how the philosophy feeds into codes of conduct and then feeds into practice. Alan explains this is about respect for the person and autonomy. So you need to say A deontology approach would argue this…. and this approach would be used because of this……

Alan gives an example of how to apply this to your scenario: Julie you could argue from one position that deontology is a person in her own right, this does not exist therefore the duty is to the right of this person this is quite deontological this approach also looks at Law, human rights, that sort of thing. Most social workers are this approach All you have to do here is say how and why this approach may be applied to the scenario and where it come from i.e., KANT

Consequential/Unitarianism

This is what is meant by your code of conduct – this is the link between philsophy and practice it is through the codes of conduct. You will show how the philosophy feeds into codes of conduct and then feeds into practice. Alan notes. “A unitarism approach would argue this…. and this approach would be used because of this….Alan example of how to hit this, Consequentialism would suggest you look at the outcomes, if we do not intervene at this point and show some support then this person will suffer damage, they could be harmed that is more this approach and this is the link I want you to make. Most social worker are this approach. All your doing here is saying where did this approach come from how and why would it be used in your dilemma

virtue ethics

Virtue ethics = the character of the person, so in the same way that I was arguing with the boys you could argue your point of view with your dilemma Alan. Questions to ask and answer with these approaches are:

What is the thing that makes one of them valid?

“Probably the character of the person doing the argument”! other words you Julie are very dominate and persuading and therefore one needs to ask is your position genuine? I

s it a valid argument?

Are you taking it from integrity (honesty, goodness) or serenity (calm, peace, composure, calmness)? All you doing here is saying where this approach came from and why and how would it be used in this dilemma

Code of ethic & Values

These three streams of values in social work influence our practice and are described as TRADITIONAL (being to the tradition route), EMANCIPATORY (to give independence to free someone from something) AND GOVERNANCE (controlled or overlooked by government) Values. How did the GSCC; BASW; and NOS codes of ethics guide your decision and practice outcomes?

social constructionist view
bibliography

Human services are developed in anticipation and response of human needs. The profession is characterized by positive reception of human needs taking into account all of their diversity. In context of community and environment, Human services professionals offer assistance to their clients and serve their particular needs. Need of ethics in human services profession is of substantial importance (Sinclair et al., 1987).

Ethics are guidelines which represents set of standards of conduct that is considered ethical by professionals and educators. Ethics although not legal document but help to assist in settlement of problems and issues related to ethical issues in human services profession.

A brief overview of Ethical Standards for human services professionals:

Human service professionals are key players in Human services sector. In this highly customized profession, human service professional interacts frequently with families, individuals and groups etc, all these are their clients. Human services professionals are case managers, they are caregiver, teacher, doctor, consultant, lawyer, and psychologists etc. in the following section, some ethical standards are defined for human services professionals.

My ethical statement:

“As a ethical human services professional, I will endeaver to meet or exceed the statement below in day to day practices of my professional life.”

My code of ethics as a Human service professional:

As a Human service professional I would like to talk with the clients the goals, purpose, and nature of helping relationship before onset of relationship and also inform the clients about limitations of relationship.

In my opinion, clients should be treated with respect, dignity and trust.

As a Human service professional I will take care for protection of customer rights and confidentiality. Except some special cases, when this confidentiality can be harmful for customer.

As Human services professional I will try to take integrity, security and safety of client records.

I would like to have prior written consent by customer when there is need to share client information with other professionals.

As a Human services professional, I will try protect the self-determination right of clients.

I would like to be well aware of legal, federal, local and state laws related to human services.

I will keep myself informed about current social issues that can affect community and clients.

I will act as advocates that help to address the unmet needs of society and individuals.

As a Human service professional I would like take it as my responsibility to disclose my qualifications accurately.

As a Human service professional, I will work with the aim of helping people and for accomplishment of goals of human service organizations. My basic goal in human services will be to help people in living more satisfied life, more productive and autonomous life, by utilizing the resources and knowledge of society and technological innovation.

These ethics are core values of human services professionals:

Above mentioned set of ethical practices serves as set of core values of ethics in human services profession, every professional who selects human service as profession must have strong passion to serve society and individuals. As this profession is all about humans, the main concern of this profession is providing individual’s solution of their personal and social problems. When dealing with and serving humans, ethics become more important (Sinclair et al., 1987).

A human services professional can deliver its services in better way if he is well aware of importance of ethics in his profession. Code of ethics in human services profession helps to promote trust, confidentiality, recognition and negotiation of client’s right of self-determination and informed consent. Healthcare professionals and other people involved in human services process should respect right of privacy of their clients. In human service, clients are sharing their very confidential information and problems with professionals, because they want from professionals to solve their problems. It becomes ultimate responsibility of these professionals to develop the relationship of trust and integrity with clients and keep their information confidential, and do not share it with others regardless some exceptional situations when need to discuss it with their team or other professional in order to solve out the problem of their client. Even in this case, information should not be shared without written consent of client.

Evaluation

To make the individual a productive part of society, is also an ultimate goals of human services professionals. Sometimes, clients don’t know the real issue he/she is facing, this may be a psychological or health related issue, in this situation, human services professionals first find the real cause and then goes for its solution.

Each state and country has some legal framework and laws for society, these laws are made for members of society which are human beings, so the awareness and knowledge of local and federal laws of state or country is critical for human service professionals as their profession is all about humans. The professionals need to be ethical ideals, while respecting for all cultures, beliefs and relationships (Seitz, & O’Neill, 1996).

Ethical standards for human service workers require passion and dedication by professionals and workers as well. Integrity, following the laws, compliance with policies and rules, maintaining the client records and case files etc. all include professional ethics requirements. Apart from their direct service to clients, human service professionals also have responsibility to protest against social injustice and community empowerment.

If the code of ethics is not employed and practiced in human services profession, it will bring destruction to society. There will be no relation of trust and integrity can be developed among professionals and society. People will feel reluctant to share their problems with their consultants as they will have no surety that their information will be kept confidential. As a result, society will suffer at large as people will live lives full of problems and worries because human services works with aim of better lives of their clients and to make all the members of society productive and active part of society (Seitz & O’Neill, 1996). Without ethical practices and commitment of professionals to follow these practices, mission of human services cannot be achieved. Admitting the importance on ethical practices, every human services organization has code of ethics all members are encouraged to follow. So if we develop and practice our personal code of ethics to excel in our profession, it will be a good strategy to follow that will pave the way for success in future.

The aim of this assignment is to demonstrate links between different codes defining ethical practice, legislation and the requirements of professional conduct. The author will also discuss knowledge of traditional social work values and recent changes in the value base of social work. The relationship of ethical themes and the range of ethical theories will also be considered, concluding with the requirements of professional social work practice.

Although social work is a profession laden with contradictions, the primary task within the social work profession is to ensure that the directives and principles enshrined in social work ethics, call on social workers to establish human rights and willingly be able to challenge unjust principles (Allan et al 2009).

Moral codes and social structure is recorded as far back as the Ancient Greek Polis era with suppression of civic autonomy. The idea of life of virtue and human fulfilment leading on to the new course in ethics chartered during the Hellenistic era are the most discussed social structures discussed to date, regarding early ethics and values although forms of social structural developments were occurring in Egypt, Mesopotamia, China and India has less recorded by historians (Bryant 1996). Bisman (2004) acknowledges that the core concept of moral concerns drove social work’s development during the profession’s formative years. Although Jones (1997) cited in Bisman (2004) (pg: 110) complains that “the profession has been particularly silent over the past twenty years about the shifting patterns in social wellbeing and disadvantage” and that this silence may be a direct violation of the social work codes of ethics.

The emphasis of social change was more evident during the settlement movement and the emphasis was on Toynbee’s philosophy that there was a need to unite the advocacy of social reform and the inclusion of various classes to ensure society performs those duties (Bisman 2004). Self determination is central to the social workers ethical responsibilities to clients. Hepworth et al (2009) (pg: 60.) predict that “codes of ethics are the embodiment of a profession’s values”. Acknowledgment for principals and standards for social workers behaviours are imbedded in the Codes of Ethics circulated by the National Association of Social Workers addressing the range of responsibilities that social workers have as professionals to their clients, colleagues, employers, profession and to society as a whole (Hepworth et al 2008 ). Addams (1902) (pg: 1) “believed that ‘ethics’ is but another word for “righteousness”… without which life becomes meaningless’”.

The United Nations Convention on the Rights of a Child acknowledge that the values vary from country to country and the understanding of values universally are very problematic. However, it is not just the question of different values, but a question of relative power (Heintz 2009). Every Child Matters (2003) contains five outcomes which are being healthy, staying safe, enjoying and achieving, making a positive contribution as well as economic well-being have absorbed the UNCRC Articles into a comprehensible table. This ensures that practitioners are drawn to reflecting the ethical principles and value base when making their decisions regarding client needs.

Wilks (2005) highlights that there are two central conceptual strands that account for social work values; these are social work ethics and anti-discriminatory practice. However although these two strands lie together there are conflicts. Strategies have been adopted to bridge the gap in principle by means of social justice or equality.

Nash (2000) was also interested in the ethics of the individual self and understanding the power differences. Although seeing everyone as social actors, concerned with interaction through social behaviour can at times be fragmented, unstable, fluid and fast changing. This unpredictability is why it is very important that social workers analyse each individual case thoroughly, reflecting on where and when to employ ethical and value based decisions that will influence positive results.

Clark’s (2000) cited in Tovey (2007) acknowledges that there are five basic principles that promote ethical practice in social work are:

Respect for and promotion of individuals’ rights to self-determination
Promotion of welfare or well-being
Equality
Disruptive justice
Discipline

Furthermore, it is important that traditional social work values are employed, but it is also important that consideration for limitations of traditional social work values and how these values change at macro, meso and micro levels of practice. Dominelli 2004(pg: 63) argues that although empowering clients is seen as a way of moving forward, “it is unable to do more than deal with issues at the micro level of practice in the practitioner-client relationship, and has little impact on structural inequalities, which also need to be ended”. By being involved in transforming the knowledge base and structure of clients current or future situation, the social workers has to rethink the epistemological base on which social work is founded and establish a value base that aims to create a professional culture that can guide particular interventions (Dominelli 2004). Banks (2006) acknowledges that ethical issues are problematic in social work and that the codes of ethics and codes of conduct fail to explicitly address issues faced by those who are regulated by them. Practioner`s find themselves in difficult situations which at times results in ethical dilemmas. It is still imperative to meet the requirements of professional conduct and that the deontological approach creates a logic whereby professionals are duty-bound to follow their ethical code and where ethical practice without guiding principles is inconceivable (Gray 2009 pg: 2).

The Scottish Social Services Codes of Practice (SSSC 2005) 2005 are a key step in a system of regulation for social services delivered along with setting standards for practitioners to be accountable for their actions. SSSC (2005) state that there are six codes of practice that social service workers are required to take account of these are:

Protect the rights and promote the interests of service Users and carers.
Strive to establish and maintain the trust and confidence of

Service users and carers.

Promote the independence of service users while protecting

Them as far as possible from danger or harm.

Respect the rights of service users whilst seeking to ensure

that their behaviour does not harm themselves or other people.

Uphold public trust and confidence in social services.
Be accountable for the quality of their work and take

responsibility for maintaining and improving their

knowledge and skills.

Social work has undergone radical changes, in addition, the imperialistic approach has been highly criticised as being stereotyped and culturally preoccupied with the blame culture. Raynor (1984) recognised that there was a difference in accountability, regardless of justification. His findings were that social workers are accountable for their own actions, although social workers were only protecting the weaker party in an imbalance of power. It is important that social workers draw on empirical approaches, although the focus should be on solving problems and narrowing the problematic gap in cultural differences between social worker /client relationship working within a moral rational manner.

A postmodern approach in social work has highlighted areas in the welfare state that acknowledge that specific welfare resources are being cut due to rationalisation. Social services need to look at the way economic, social structures and regional injustices in impoverished communities are constructed and adapt to meet their individual needs. Postmodernism argues for the ‘grand’ or ‘universal’ social change on which social work was founded, but now ultimately social work must refocus its attentions on exposing global economical inequalities and oppressive gender and ethnicity-based relationships across the globe (Noble 2004).

The Kantian philosophy encourages that we should treat others as a being who has choice and desires along with a being is those who are capable of rational thought and self determined actions should have the ability to make decisions and act accordingly to their own choices and desires (Banks 2006).

Although deontological and utilitarian approaches tend to dominate social work ethics Lovat and Gray (2008) dispute that within this postmetaphysical age Habermas offers a form of proportionate ethics through the Aristotelian and Thomistic thinking offering a new and practical approach which is particularly appropriate to a modernately post-scientific, postmetaphysical age. Lovat and Gray (2008) (pg: 1101) also recognised within the moderately post-scientific age, although the thinking had a heavy reliance on science they were “aware of the limitations of science in addressing adequately all of life’s demands and providing all of its answers”. Lovat and Gray (2008) also proposed a new approach to ethical deliberation and judgment that has potential to meet the needs of those seeking greater ontological certainty than science can provide.

By implementing a Proportionism approach, which is an ethical and moral approach and holds promise for a more balanced perspective in that social work is both science and art. Overall the proportionist approach is comfortable with the inconsistent position in any ethical dilemma and by applying wisdom, commonsense and probing scientific explanations an ethical decision can be made. “The value of a proportionist position is best captured when we realise that any ethical decision which runs counter to accepted or popular norms cannot be underestimated in terms of its potential to create tension, fear or recrimination”( Lovat and Gray 2008 pg: 1107).

Changing Lives (2006) highlights the ethical and value base by means of four tier approach negotiating a balance between care and control, although the practitioner is under statutory obligation and the nature of the situation is complex the focus should be with avoiding any ethical boundary disputes working in a multi disciplinary approach focusing on the value base work with the client.

Pitts (2000) discusses the Federation International des Communautes Educatives 1998 (FICE 1998) describes that a sound ethical practice is of critical importance. A code of ethics establishes good practice and offers guidance to individual workers in difficult situations, along with acting as a template against which to test conduct and target reform of modifications that need to be made. This in turn guides the practitioners to think about best practice and new answers to ethical issues that may arise.

Within Getting it Right for Every Child (2006) Big Words and Big Tables section 2.6 Consent/Ethics, ethically empower the child or young person regardless of age to educate and promote the best services available by informing the chid or young person of all resources available. The FICE 1998 is dedicated to promoting the lives and future of children and young people around the world creating and promoting global standards for looked after children, The British Association of Social Workers has a Code of Ethics key principles reinforce what service providers should be doing to meet the needs of children and young people these are:

Human Dignity and Worth
Respect for human dignity and for individual and cultural diversity
Value for every human being, their beliefs, goals, preferences and needs
Respect for human rights and self-determination
Partnership and empowerment with users of services and with carers
Ensuring protection for vulnerable people
Social Justice
Promoting fair access to resources
Equal treatment without prejudice or discrimination
Reducing disadvantage and exclusion
Challenging the abuse of power
Service
Helping with personal and social needs
Enabling people to develop their potential
Contributing to creating a fairer society
Integrity
Honesty, reliability and confidentiality
Competence
Maintaining and expanding competence to provide a quality service

Harris (1998)(pg: 843) highlights that “in the new social services departments, social work was to exist, not simply as another branch of local authority administration, but in its own right as a state-mediated, bureau-professional labour process”.

Consideration for Biestek’s casework principles, individualisation, purposeful expression of feelings, controlled emotional involvement, acceptance, non-judgemental attitude, service user self-determination and confidentiality were the early foundations of principles that have paved the way for influencing present date values in social work (Banks 2006). Tovey (2007) insists that the principles are open to interpretation and practitioners should be aware of the limitations in ethical decision making and the focus on rules and duties influence determining actions in particular situations.

The legal framework within the Children (Scotland) Act 1995 (Act 1995) underpins what practitioners are required to do to ensure children and young people are provided for and looked after by parents, guardians or their local authority. The Act 1995 chapter 36 section 19 advises that the plan for services has to take into consideration relevant services to be provided.

References
Addams, J. 1902. Democracy and Social Ethics. Macmillan: London.
Allan, J., Briskman, L., Pease, B. Critical Social Work: Theories and Practices for a Socially Just World. Allen & Unwin: NSW.
Banks, S. 3rd Ed, 2006. Ethics and Values in Social Work. Palgrave Macmillan: Basingstoke.
Bisman, C. 2004 Social Work Values: The Moral Core of the Profession. British Journal of Social Work 2004. 34, 109-123.
Bryant, M,J. 1996. Moral Codes and Social Structure in Ancient Greece: A Sociology of Greek Ethics from Homer to Epicureans and Stoics. New York Press: USA.
Available on line: Changing Lives: Report of the 21st Century Social Work Review http://www.scotland.gov.uk/Publications/2006/02/02094408/8 [Accessed October 2009].
Available on line: Children (Scotland) Act 1995 http://www.opsi.gov.uk/ACTS/acts1995/ukpga_19950036_en_3#pt2-ch1-pb2-l1g19 [Accessed October 2009].
Dominelli, L. 2004. Social Work: Theory and Practice for a Changing Profession. Polity Press: Cambridge.
Available on line:Every Child Matters (2003) http://www.dcsf.gov.uk/everychildmatters/strategy/strategyandgovernance/uncrc/unitednationsconventionontherightsofthechild/ [Accessed October 2009].
Available on line:Getting it Right for Every Child (2006) http://www.scotland.gov.uk/Publications/2005/06/20135608/56098 [Accessed October 2009].
Gray, M. 2009. Moral Sources and Emergent Ethical Theories in Social Work. Brittish Journal of Social Work, September 22, 2009.1-18.
Harris, J. 1998. Scientific Managment, Bureau-Professionalism, New Managerialism: The Labour Process of State Social Work. British Journal of Social Work. (1998) 28, 839-862.
Heintz, M. 2009. The Anthropology of Moralities. Berghahn Books: United States.
Hepworth, H, D., Rooney, H, R., Rooney, D,G., Strom-Gottfried, K., Larsen, J. 2009 8th Ed. Direct Social Work Practice: Theory and Skill. Cengage Learning: Canada.
Lovat, T., Gray, M. 2008. Towards a Proportionist Social Work Ethics: A Habermasian Perspective British Journal of Social Work 2008.38, 1100-1114.
Raynor, P. 1984. Evaluation with One Eye Closed: The Empiricist Agenda in Social Work Research. British Journal of Social Work 1984. 14, 1-10.
Available on line: Pitts, J. 2000. Committee on the Rights of the Child: State Violence Against Children. http://www.crin.org/docs/resources/treaties/crc.25/pitts.pdf [Accessed October 2009].
Noble, C. 2004. Postmodern Thinking: Where is it Taking Social Work? Journal of Social Work. 2004. 4, 289-304.
Nash, K. 2000. Readings in Contempory Political Sociology. Blackwell Publishers Ltd: Oxford.
Available on line: The British Association of Social Workers has a Code of Ethics http://www.basw.co.uk/Default.aspx?tabid=64 [Accessed October 2009].
Available on line: The Scottish Social Services Codes of Practice 2005 http://www.sssc.uk.com/NR/rdonlyres/3A6C6F84-EB11-4DE2-90FF-5E143610C2B7/0/SSSCCodesofPracticebookletSept09.pdf [Accessed October 2009].
Tovey, W. 2007. The Post-Qualifying Handbook for Social Workers. Jessica Kingsley Publishers: London.
Wilks, T. 2005. Social Work and Narrative Ethics. British Journal of Social Work 2005. 35, 1249-1264.
Case Study

In this assignment the author had to take into consideration any ethical and value based factors before exploring a workable therapeutic intervention that would meet the needs of the client within this case study. The ethical and value based dilemmas that require consideration needed to be put into a logical workable framework. The author then can identify and progressively translate to meet the needs of any ethical issues faced by both practitioner and client. This process needs to be addressed ethically in three different ways; these are the interests, rights and power. The author will then reflect, explain, analysis and use evidence on how to approach and meet the ethical needs of the client.

The client will be given a pseudonym to protect and ensure confidentiality and privacy throughout this assignment, consent was also given by the main carers. The boy who will be referred to as Marc is now 12 years of age and has recently been diagnosed with (Attention Deficit Hyperactivity Disorder) ADHD which is now being challenged (Appendix 1).

First and foremost, it is vitally important to look at the young person as a whole by using the Getting it Right for Every Child 2006 (GIRFEC 2006) My world Framework approach which is “underpinned by common values and principles along with shared models, tools and practices that are designed to support work with children and young people” (on line). Although GIRFEC 2006 -Proposal for Action: Analysis of Consultation Responses argue “is there sufficient emphasis and guidance about the child’s involvement and are there sections which need strengthening to ensure that the child or young person is at the heart of the process?” (on line). This statement reinforces the authors need to assess all aspects of the clients wellbeing. This in turn ensures that the author considers all areas of ethical value based concerns before committing to a solution based framework to employ to the service users current situation. By utilising Collingwood’s (2005) three-stage theory framework provided the author with a workable framework to apply a process that would then develop a flexible and developmental tool, which can then identify any specific ethical and value based issues to inform the authors intervention strategy.

Consideration for background information to work ethically with client

By using a Proportionism approach and by looking at the applied science model to solve any ethical issues, then by applying an existing body of professional knowledge to make sense of complex and difficult human situations. This generates an understanding of the current situation, develops a structured sequence to practice in a systematic way, then to practice in a thoughtful and professional manner to allow consideration of cultural circumstance of the current ethical dilemmas (Howe 2002). By completing the Collingwood (2005) theory circle, stage two informed the author of the theory to inform/ intervene ethically and stage three helped identify the knowledge, skills and values to work ethically with the client.

The author drew on more than one principle based ethical approach. This maximised the wellbeing and minimised harm whilst following core values, principles and codes. Although applying the deontological approach allows the author the ability to create logic and ensures that the author is following ethical codes and principles as there are moral judgments and difficult ethical decisions to be made. Gray (2009) reinforces that practitioners should not undermine the importance of principles and codes. It seems logical to utilise modern workable theory to practice by employing the proportional’s approach to explore present situation, consequences and sense of perception on the basis of evidence before the practitioner, using the best means available for forming judgments that springs directly from these means and allows for the end to justify the means (Gray 2009). By applying the Proportionism approach allows the author to build on, manufacture or complement theories, by transcending existing theories to provide a new and superior form of working ethically it can only enhance practitioner/ client relationships (Lovat and Gray 2008).

The following areas were highlighted as in need of development to address the ethical issues for the client.

The author believes that there is an insecure attachment base. Bowlby cited in Butterworth and Harris (1994) argues that insecure attachments contribute to the formation of a neurotic personality as they take the child down a psychologically unhealthy pathway.

Developmental stage using Ericson’s psychosocial stages where the child should be in the fourth stage of industry versus inferiority, recognising that it is important that the child does not run the risk of developing a sense of inferiority – a sense of inadequacy resulting in feeling worthless at this stage (Slee 2002). Leading on to the general effect of the grief, after the mind has suffered an acute paroxysm of grief, and the cause still continues, we fall into a state of low spirits or feel utterly cast down and dejected (on line) (Darwin1872).

Intervention

It has been long recognised that practitioners have been torn between the utilitarian and the deontologists approach to social work and by breaking free and proceeding on the basis inclusion, open communication, empathy and being impartial is the way forward for practitioners (Houston 2003). “A valid moral decision is reached when those affected by it endorse it as the preferred way forward. In reaching this agreement participants must accept the consequences of the decision for all concerned and its impact on everyone’s interests” (Houston 2003 pg: 822).

Therapeutic interventions are used in many different situations and the end goals of intervention programs are to inspire people to make the necessary changes to take control of their own lives again (on line) (When are Therapeutic Interventions Recommended?).

Consideration for the clients diagnosis as being ADHD is a significant contributing factor to ensuring the best therapeutic model is used to address underlying issues. Controlled longitudinal studies show that by late adolescence and early adulthood, children identified as having ADHD are at risk for a number of mental health problems the most noticeable are anti-social behaviours, cognitive difficulties, poor academic achievement and lower occupational status (on line) ( Thorley 1998). Although diagnose of the clients ADHD is in dispute, ethically the author is at duty to include the probability of ADHD until a conclusive assessment is carried out to confirm or dismiss the first diagnosis when considering play therapy interventions.

The British Association of Play Therapists (BAPT) is the foremost professional body that registers Play Therapists and regulates Play Therapy practice in Britain and have codes of practice along with play therapy standards to regulate play therapy and training (on line)(BAPT 2009). “Play Therapists need to be motivated, concerned and directed towards good ethical practice. They are required to take responsibility to maintain these standards and Play Therapists should always accept responsibility for their professional behavior and actions” (on line) (BAPT 2009).

Consideration for Biestek’s casework principles, individualisation, purposeful expression of feelings, controlled emotional involvement, acceptance, non-judgemental attitude, service user self-determination and confidentiality were the early foundations of principles that have paved the way for influencing present date values in social work (Banks 2006). The author drew on Biestek’s casework principles but found that although Biestek theory focuses on concern of the welfare of the individual it fails to offer satisfactory accounts for relationships. The author has identified that there is a strain on positive relationships, and feels that this is an area that requires prompt development. “Ethical responsibilities flow from all human relationships, from the personal and familial to the social and professional…. Ethical decision making is a process” (Webb 2003 pg: 22).

Holland (2009) acknowledges that a key element within ethic of justice is that of individual rights and that this is a very important development for looked after children. The client has be informed and made aware of all aspects of the intervention process before any structured work can take place as the vast amount of therapeutic play therapy relies heavily on parent participation. This alone poses an ethical dilemma as the client is within a residential group setting and relationships between client /staff may be inconsistent.

In conclusion to this assignment the author feels that it would benefit all parties if the play therapy was delayed until the new adoptive parents were approved. This would then enrich the relationships between client/ adoptive parents, furthermore they can subsequently build resilience in the new family unit, along with educating the new adoptive parents of the complex history and the future needs of the client. The long term value base and ethical benefits would outweigh any short term quick fix solution; the new adoptive parents require the best tools available to ensure that the new family unit works.

References
Banks, S. 3rd Ed, 2006. Ethics and Values in Social Work. Palgrave Macmillan: Basingstoke.
Butterworth, G., Harris, M. 1994. Principles of Developmental Psychology. Lawrence Erlbaum Associates Ltd: UK.
Collingwood, P. 2005. Integrated Theory and Practice: The Three Stage Theory Framework. The Journal of Practice Teaching in Health and Social Work, Volume 6, Number 1, 2005, pp. 6-23(18).
Available on line: Darwin, R, C. 1872. The Expression of the Emotions in Man and Animals http://darwin-online.org.uk/content/frameset?itemID=F1142&viewtype=text&pageseq=1 [ Accessed October 2009].
Available on line: Dr. Thorley, G. 1998. Therapeutic Intervention for Attention Deficit Hyperactivity Disorder http://www.drgeoffthorley.com/ADHD%20article%201998.pdf [Accessed October 2009].
Gray, M. 2009. Moral Sources and Emergent Ethical Theories in Social Work. British Journal of Social Work, September 22, 2009.1-18.
Holland, S. Looked After Children and the Ethic of Care. British Journal of Social Work. August 10 2009. 1-17.
Houston, S. 2003. Establishing Virtue in Social Work: A Response to McBeth and Webb. British Journal of Social Work (2003) 33, 819-824.
Lovat, T., Gray, M. 2008. Towards a Proportionist Social Work Ethics: A Habermasian Perspective. British Journal of Social Work (2008). 38, 1100-1114.
Slee, T. P. 2002. 2nd Ed. Child, Adolescent, and Family Development. Cambridge University Press: UK.
Available on line: The British Association of Play Therapists http://www.bapt.info/playtherapystandards.htm [Accessed October 2009].
Available on line: When are Therapeutic Interventions Recommended? http://ezinearticles.com/?When-is-Therapeutic-Interventions-Recommended?&id=1499263 [Accessed October 2009].
Webb, B, N. 2003. 2nd Ed. Social Work with Children. The Guilford Press: New York.
Appendix 1
Accommodated under Sec 25 C(S)Act 95

Marc was born in England. Marc’s birth parents were substance users and had a chaotic lifestyle. He was unable to remain permanently in their care and as a result was fostered in a number of placements returning to the care of his parents for short periods and having sporadic contact with them. Marc blames himself for not being able to remain in their care.

He was adopted by a couple in Scotland at the age of 5 years. The couple were not able to have their own children. The couple then went on to have a son of their own and since then he has been treated differently. There are no photos of Marc in the house, he does not have a bike (the brother does), he is the family scapegoat and blamed for problems in the parents relationship. Marc has since been diagnosed with ADHD and his diet restricted as a means of attempting to control this. There is some debate by health professionals as to whether the diagnosis is accurate, he is on low dose medication and there has been some reported improvement in his attention levels. Marc also has a developmental delay in self care i.e. knowing how to wash himself, toileting skills. Marc remained with his adoptive parents until last month when his parents asked for him to be removed due to their perception of his behaviour being unacceptable. Marc had stolen sweets. As a result of this Marc has been accommodated in residential home on a temporary basis until a long term family can be identified. Marc believes that stealing the sweets caused the breakdown in the relationship with his adoptive family consequently blaming himself.

Recently a family has been identified and the residential unit is planning to undertake a therapeutic intervention in order to prepare Marc to have an understanding of his history and build his self esteem. The prospective adoptive family are in the process of being approved by the fostering and adoption panel.

To what extent can researchers plan for ethical issues when working with children and young people? People often think of ethics or morals, as a rule for distinguishing between what is right and wrong. Something that springs to mind, is the saying; ‘Do unto others as you would have them do unto you’ or the religious creed of the Ten Commandments, ‘Thou Shalt not kill’. This is a common way of defining “ethics” and the norms for conduct that distinguish between unacceptable and acceptable behaviour.

Most people learn ethical norms within the home, at school or in other educational settings. Majority of people acquire their sense of right and wrong during their childhood as moral development occurs throughout life. Simply because as human beings, we pass through different stages of growth as we mature. Ethical norms can be classed as ubiquitous, simply because one might be tempted to regard them as simple ‘commonsense’.

A plausible explanation of these disagreements is that as humans, we can recognise some common ethical norms, but majority of individuals may apply and interpret these norms in different ways in respect of their own life experiences and own values.

Our society has legal rules that govern behaviour, but ethical norms can be broader and more informal than laws. However, most societies use laws to enforce moral standards and ethical and legal rules use similar concepts, it is however crucial to point out that law and ethics are not the same. For example, an action could be classed as legal, but illegal or unethical, but ethical. Society also uses ethical concepts and principles to interpret laws, evaluate and criticise. Within the last century, citizens were urged to disobey laws in order to protest what they classed as unjust laws that were immoral.

Within research with children and young people there are several reasons why it is important to adhere to ethical norms. Firstly, it promotes the aims of research and examples include, truth, avoidance and knowledge such as misrepresenting research data promote the truth, prohibitions against fabricating, falsifying and avoid error. Second, is that research often involves a great deal of cooperation and coordination amongst different people in different institutions and disciplines. Ethical standards promote the values that are essential to collaborative work, which include fairness, trust, accountability and mutual respect. For example, many ethical norms in research, such as guidelines for authorship, data protection policies, and confidentiality rules are designed to protect intellectual property interests, but still encouraging collaboration amongst the institutions. Therefore, researchers want to receive credit for their work and contributions to be disclosed prematurely and do not want to have their ideas stolen. Third and the main standard is that many of the ethical norms help to ensure that researchers can be held accountable to the public. Many of the norms with research are that it promotes a variety of other important moral and social values, for example social responsibility, human rights, compliance with the law, and health and safety. Critically, ethical lapses in research can significantly harm humans, students and the public. A researcher who may fabricate data in a clinical trial could harm patients and a researcher who fails to abide by regulations and guidelines, as set out in the ethical standards, could jeopardise his health and safety or the health and safety of staff and students in relation to radiation or biological safety. Consequently, ethics are often a matter of trying to find a balance between opposite extremes.

Ethical research with children has changed significantly in the past 30 years and modern standards of research ethic may considerably depend on modern transparent research methods and a respectful relationship between children and researchers. During the 1947s lawyers stressed the dangers of research and insisted that willing consent should be obtained, although it was presumed that children were too young to give consent and consequently banned from participating from research. Traditionally, children were not allowed to consent for themselves for medical

Children traditionally were not allowed to consent for themselves in terms of medical procedures and even for the simplest procedures. Today, there are three approved models of consent for children. First, children who are classed as competent, which are sometimes called ‘minors’ may provide consent on their own. Second, children may provide an assent with parental consent and third, some children, due to their developmental stage or age cannot provide consent until parental consent is sought. Critically, this can raise serious ongoing challenges and some of the difficulties can arise from assessing competence, best interests as well as, motivations. As well as dealing with conflict between children, parents and or with children and youth, many of which may be living on the street or in a crisis situation, to name just a few examples.

Children are traditionally considered more vulnerable than adults and this is because of their lack of competence to take part in making decisions. This could be especially around complex issues, such as health care and inclusion, in research. This vulnerability means that parents/ guardians, educators and health care professionals must be trusted to act in their best interests and make decisions for them. Moreover, this vulnerability has often meant that some children are simply excluded from research which is often in short-sighted attempts to protect them from harm. Consequently, this has resulted in excluding children from research and in research, failed to learn about children and to develop better and new ways to treat, approach and protect them.

Alderson (2004) states that ‘Ethicists teach the rules for ethical research are based on three main ways of thinking about what is ‘good’ research: the principles – of doing good research because it is right and correct thing to do. Rights based research – involves respect and children’s rights, such as providing for basic needs for example, healthcare and education. Protection – from child abuse and discrimination and participation – is vital during ethical research in having their own views listened to and respected by adults. This is based on good research, rather then relying wholly on adult’ principles and values. The best outcomes based ethics basically means, working out how to avoid or reduce harm and costs’.

Researchers may produce very misleading results that are produced in policies that could damage children’s lives. Researchers may upset children by worrying them by making false promises or betray them. Critically, moral questions about power, honesty and respecting people can arise throughout the research process. Although a problem, often seldom mentioned by ethicists, is a risk on published research reports that increase stigma and disadvantage children and young adults. However, these reports can help researchers address such risks and problems and learn how to deal with them.

An actual research that wasn’t properly planned and a particular ethical issue uncovered was when, as stated by Dennis, 2009 ‘A Japanese graduate student, was translating at a parent/teacher conference and the teacher asked her to pass along comments to the parents that Hanako’s thought were rude. She did not want to do it. She intervened covertly because she did not pass along the comments as they had been expressed by the teacher, but she pretended to do so. She tried to make the point the teacher was making, but in a much more polite, positive, and from Hanako’s perspective, acceptable way’. Critically, this issue would have failed to demonstrate the teacher’s irritation and pose an ethical risk, as this interpersonal intervention was not inclusive. It could pose a potential harm, as it failed to promote moral and social values and follow ethical standards that promote the values that are crucial to collaborative work, such as mutual respect and trust, especially when working with children and young people.

Another actual research that the researcher planned well for ethical issues was that off, Naz Rassool. Rassool (2004) was interested in working with a group of 14 and 15 year olds that raised several ethical and practical issues. Rassool felt that the pupils should not be exploited emotionally due to the nature of the work as the pupils were in a critical phase of their development. The research had to be very sensitive through its investigations of identity formation. Therefore, the ethical issues were paramount and persisted throughout the research. Rassool found the most effective way to address the theoretical research question to the pupils, incorporating the concepts of religion, knowledgeability, social change and individual reflexivity, all provided Rassool the theoretical framework. To generate a common understanding of the purpose of the research, Rossool conducted a seminar with staff involved, which addressed the aims of the research, ethical issues and the purpose of the activities. Other ethical issues, revolved in receiving parental consent and whether this as absolutely necessary, if the activities formed a part of the teaching programme. However, since the ultimate aim is to answer research questions it is crucial that all ethical issues are applied throughout. Critically, however when working with children and young people, it is normal protocol to seek parental consent, especially when conducting research. Rossool’s research promoted the aims of research; followed ethical standards and promote the values, which are essential for collaborative work, such as mutual respect, trust and fairness. It promoted moral and social values.

Research heavily relies on the public to take part in the research and if this cooperation is to continue, then researchers have to keep high ethical standards. Alderson (2004) states ‘public anxiety about the removal of children’s organs without consent, partly for research shows how research ethics, consent and rights may change, especially when children are involved’. Similar changes may occur in social research and therefore, it is crucial to gain foresight about social research from the hindsight of medical research. Critically many medical journals refuse to publish these reports that may not have the backing of ethical committee approval and therefore, researchers need to keep abreast of the ethical standards. Gaining ethics committee approval can take time and can protect people who take part in the research and protect them from litigation and criticism.

The extent researchers can plan for ethical issue is by involving children and young people and should only be conducted when the research question posed is crucial to the well-being and health of children. Ethics help researchers to be more aware of hidden problems, but do not always provide the right and easy answers. However, a research procedure which is not intended directly to benefit the child subject is not necessarily either unethical or illegal. Such research includes observing and measuring normal development and the use of ‘healthy volunteers’ in controlled experiments. The participation of children is indispensable and this is because the information available from research on other individuals cannot answer the question posed in relation to the children. Therefore, the study method is appropriate for children and the circumstances in which the research is conducted, provides for the emotional, physical, emotional and safety of the child.

The challenges relating to ethical and consent issues involving children and young people in research are numerous and require careful consideration and yet are not insurmountable. Critically, as a priority, researchers must engage with the legal, moral and ethical imperatives offered by UNICEF. As Alderson quoted, that Rights based research – involves respect and children’s rights and as part of the UN Convention on the Rights of the Child in particular. The researcher needs to give diligence to Article 12, and the article due and diligent consideration in its entirety, by respecting the views of the child. Researchers must not only commit to inclusive practices, but also maintain assiduousness in ensuring that children and young people are respected participants in the research process, from selection of methodologies to the dissemination and reporting of results. With these guidelines in mind, children should be offered opportunities to genuinely participate in research. When adults are making decisions that affect children, children have the right to say what they think should happen and have their opinions taken into account.

Ethical considerations are paramount in children’s research and management of these considerations can be very influential on the research that is ultimately completed with children and young people. The major issues discussed include, protection and safety versus participation, the role of ethics committees and the impact of consent processes.

In summary, negotiating ethics approval and access to children and young people remains a major challenge. More attention needs to be given to facilitating information and understanding participatory research across all groups involved to minimise culture clashes and increase the understanding of the nature of participatory research. As Dennis, 2009 quotes ‘There is one ethical principle that worked differently: all people’s voices should be included in decision making thus those who oppose egalitarianism should not be allowed to make decisions that limit the inclusion of others’ voices. In this case, there is no way to achieve egalitarian inclusivity with people who would limit the egalitarian and inclusive treatment of others. Thus, the two aspects of this ethical principle do not contradict each other and do not need to be criticised on these grounds’.

The extent researchers can plan for ethical issue is by ensuring the adoption of methods which are respectful to the children and is also crucial that researchers take ethics seriously. This may mean researchers moving away from traditions that in the past may have considered children as ‘unthinking human beings’. Instead, it places the emphasis on respecting children as dynamic people, which makes this method more realistic and productive. This is consequently classed as ethical, as most ethics encourage research methods with children participants.

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Group Therapy has a variety of ethical issues one of the main issues that maybe encountered is involuntary group members. Corey, Williams, and Moline (1995) explained that ethically a counselor should advise clienteles of theirs privileges and duties and advise them of any probable concerns they face if they choose to follow treatment. Informed consent is extremely important when participation is mandatory. Informed consent is something that all psychologist, counselor, and therapist have to obtain from clients. The consent is important because certain guidelines have to be followed by the counselor during the sessions. When a client becomes involuntary this puts the counselor in a comprising position. The counselor becomes comprised because the incorporation of the client places limits on the direction of the sessions in the group.

The following is an example of legal issue where a patient refuses medical care. Website Merck (2007), stated “People who have legal and clinical capacity may refuse any medical care. They may refuse care even if it is something almost everyone else would accept or something that is clearly life-saving”. With that being said there is also a variety of issues related to right of refusal.

The following is a list of some legal issues related to refusal of consent. American Bar Association (n.d.), stated “religiously sponsored HMOs often do not cover prohibited services or provide information, counseling, or referrals to plan members who may want or need these services. Women in Medicaid managed care plans face particular challenges” (Susan, Lourdes). Because of the risk of misdiagnosis financial factors have become an issue. Psychologist and therapist are avoiding working with some clients because of what insurance they have. The reason for this is because some insurance companies cannot be reimbursed for certain diagnosis. In addition insurance companies are starting to take practitioners to civil court for incompetence.

Ethical Issues Unique to Individual Counseling

Some of the ethical issues a counselor may encounter in individual counseling may range from dual relationships, involuntary client, moral dilemmas, breach of confidentiality, and other significant factors. Ethics in psychotherapy and counseling (2007), stated “In the mid-1970s, New York Supreme Court Presiding Justice Markowitz recognized evidence that from the time of Freud to the present, the health care professions had agreed that therapist-patient sex harms patients” (Pope, Vasquez, p. 174). The extent of sexual relationships has not been fully understood until recently. Within the past quarter century a diverse series of investigations have broaden the meaning of therapist – client relationships in individual psychotherapy. Certain issues that were addressed in the investigation included how clients can be injured, physical contact with clients, and sexual attraction to patients. Studies that were conducted have concluded that certain outcomes for sexually abused clients. Clients who have been sexually involved with individual counselors produce negative outcomes.

Therapist would choose Group Therapy

Essentially, Group Therapy is targeted on assisting clients with data about specific categories in order to give supplementary means or data. Counselors believe that group therapy is more structured; in group therapy counselors also believe that clients are provided with precise categories or modules to debate and learn about. The intent is to supply individuals with access data about the categories, which is frequently recognized in the label of the group. the process group therapy is favored by counselors too. a process group is best explained as a group that targets on the experience of belonging to a group, itself, this recognition is part of the healing opportunity given within the group. An example would be the process of a client showing their ideas, emotions, and in the group, “in the here and now” can become the essential vehicle that finds change in group therapy. Counselors often choose group therapy to supplement individual therapy. Counselors believe group therapy will supply clients with access support, or as the primary part of healing work. On no account substance what issues a client may want to address in therapy, group therapy give clients the opportunity to share their thought which is part of their healing journey. Counselors believes that clients attending group gain a sense from the experience as a way to know that they “are not alone” and that there others, with similar experiences, who are supportive of them.

Therapist would choose Individual Counseling

Ethical decision making in professional psychology is important to regulate the practice of psychology. Individual counselors believe that ethical decision making procedures can produce positive psychological outcomes. In addition ethical decision making places a certain degree of accountability on the psychologist in individual counseling. Ethical guidelines and educational requirements ensure that clients receive adequate professional assistance on a one on one basis. Ethical decision making in a sense also causes a power shift. Paste psychological practices were controlled by the therapist. In modern times clients have a say so of what treatments and practices they want to receive. This is due to current ethical guidelines. Psychologists give numerous reasons why Multicultural psychology has become a subspecialty. With a society that is diverse in culture psychology had no choose but to be aware of these circumstances. Because of this factor training had to be given to researchers and psychologist in the career field. These measures were done to raise awareness of culture differences and to clarify that these differences had to be handled different individually. Cultural competence is best explained by CEO Services (2007), as “the development of skills by individuals and systems to live and work with, educate and serve diverse individuals and communities”.

Having multicultural psychology as a subspecialty eradicates negative beliefs about other cultures. In addition categories of discrimination, prejudice, lack of education, and ethical values are learned. A major issue with research done with past experiments was they were not culturally equal. Things like the above issue and other factors lead to the requirement of multicultural psychology as a subspecialty. If a professional is culturally competent they should see and understand cultural, economic, gender, and physical differences that another individual may have in society. Culturally competent professional should not be prejudiced in thought while considering another human being feelings and cultural traditions. Social Phobia has a connection with the stability-change issue. The Life -Span Development (2007) text explains the stability-change dispute consists of the point to which early traits and characteristics persist through life or change. In the stability-change issue Developmental psychologists acknowledge the concept as broken into two separate issues. On the stability side of the issue psychologist argue that early experiences in life can affect a person’s stability or there heredity can cause change in stability. But on the change side of the spectrum psychologist are arguing that people’s later experiences can cause change. So in saying that the change concept is basically that people are is constantly being molded throughout their life span.

Distinctive Features

Some of the distinctive features that are associated with social phobia range in vary areas. “Person with social phobia experience excessive fear of being humiliated or judged negatively in social or performance situations” (Heimberg, G. R., Liebowitz, R. M., Hope, A. D., Schneier, R. F., 1995). Social anxiety and panic disorder are also qualified as features in the social phobia criterion. The different experiences an individual lives through and witness can mold their mind state. If an individual has had many experiences dealing with discrimination they may perceive the world as unfair. If an individual is or maybe was raised in poverty they may perceive the world as unfair and class based.

A prime example would be a minority individual born during the civil rights era or earlier. These individuals had witnessed the inequality of America and seen the horror that come from inequality. A majority of individuals who lived during those times have negative views on white America. I have seen this in my grandmother who is 83. She can get along with other races but she is still to a degree stuck in the past. Often stating how minorities should watch they do because of inequality.

Ethical Challenges I may Face

Being a counselor some of the many ethical challenges I believe I will face will be as followed. Being a counselor whether the setting is for a group or individual counseling Being mentally aware is important for individuals so they can understand their personal ethical perspectives in life. If individuals have an understanding of their ethical perspective other attributes can be understood. Personal ethical views can influence emotions and reactive behavior in some individuals. Personal ethical perspectives are essential in formulating who an individual is and what they stand for. In addition understanding personal ethical perspective is necessary when choosing a career field. Ethical dilemmas’ can be frequent if professional ethics are opposite of an employee’s personal ethics. If personal ethics are misunderstood stress can manifest in individuals. Ethics in psychotherapy and counseling (2007), stated “Uncertainty causes stress for some of us. We cannot find that magical book that will tell us what to do, especially in a crisis” (Pope, Vasquez, p. 2).

The argument about personal and professional ethics has been debated for a while. But each ethic is unique and essentially a necessity to function in society. The United States has become a nation were ethical perspectives are revered. The evolution the United States has made is amazing. Manifesting from a primitive culture to what is now known as the ethical nation. Work ethics involve such characteristics as honesty and accountability. Basically, work ethics break down to what one does or would do in a particular situation ethics as guidelines restrict the abrasive production low safety, employees non-companies, non-compliance with legal regulations and even lawsuits. Ethical regulations decline tension; makes the environment more beneficial by fostering a goal focused climate of cooperation that even boost business. Ethical regulations purely boost a positive site for the future.

Confidentiality

Better Morale

Worker safety

Organized work environment

All organizations have laws that they have to abide by, employees, board members, and those who work voluntarily must do the same. Regardless of personal feelings toward those laws, they are to obey all laws in the performance of their work on behalf of Community Services. Ethics

is the central part, the heart of leading and include private duties of service and public duties to the common good. Therefore, personal, professional, and practical ethics are included into a multidimensional perspective of ethical leadership in human service organizations

Development of Professional Ethics through Societal Norms

Ethical standards have a role in society’s developmental norms. Social norms are explained on Sociology Guide website. Sociology Guide (2006), stated “Sociologists have offered the following definition. Social norms are rules developed by a group of people that specify how people must, should, may, should not, and must not behave in various situations”. To better understand what ethical standards really mean, the Santa Clara University (2007), stated “Ethics has to do with what my feelings tell me is right or wrong; Ethics has to do with my religious beliefs. Being ethical is doing what the law requires; Ethics consists of the standards of behavior our society accepts” (Velasquez, Andre, Shanks, S.J., and Meyer).

Evolution of cultural factors and beliefs has impacted ethical standards also. Some of these factors are responsibility, malpractice, ethical dilemmas, ethical judgment, reasoning, language, and justifications. American 18 or 1900’s social norms seem barbaric compared to 21st century norms. A prime example of disturbing social norms and ethical codes are practices of psychology. Practices such as psychosurgery left permanent damage to areas of the brain. Other primitive methods used were insane asylums, electroconvulsive therapy, and Trepanation. Robert Todd Carroll (2007) states “Trepanation is the process of cutting a hole in the skull”. If those procedures were practiced today society would consider them cruel and legally incorrect.

Ethical standards and codes have helped the American nation become civilized. Civilized behavior is a progression compared to when individuals would react by emotions. In addition the codes have formed this nation into a more business oriented society. Ethical standards have made equal right obtainable to women. Because ethical standards and codes affect social norms woman can vote, and get equal pay. Equal bus seating, right to vote, and other factors African Americans gained because of ethical standards. Disabled individuals have also gotten opportunities to work. Through the development of new ethics standards societal norms have also changed and quality of life for all individuals has improved.

APA Ethics Code

The American Psychological Association’s Ethical Principles of Psychologists and Code of Conduct consist of an introduction, a preamble, five general principles and specific ethical standards. The general principles and preamble are not enforceable rules. However, they should be considered by psychologists in arriving at a professional and ethical course of action. The Ethical Standards are set enforceable rules for conduct of psychologists/psychiatrists. Most of these standards are written so they apply to psychologists that have various roles within the field.

The American Psychological Association enforces members and student residents to comply with the standards of their ethics code and the procedures and rules that are used to enforce them. Misunderstanding or lack of awareness of the code is not considered a defense if a member and/or student resident is charged with unethical conduct.

The APA’s Ethics code ensures psychologies will protect the human and civil rights and the importance of freedom of inquiry and expression in teaching, research and publication. Psychologists perform many roles; such as educators, diagnosticians, researchers, supervisors, therapist, administrators, consultants, expert witnesses and social interventionists. The APA’s Ethics codes provide a common set of standards and principles, in which psychologist, researcher, therapist, etc. build their scientific and professional work.

APA Ethical Violations

The impact of the American Psychological Association’s (APA) ethical standards and codes on professional practice in the field of psychology includes how the ethical issues are resolved once one is accused. The ethical code deals with such matters as: misuse of psychologists’ work, conflicts between ethics and law, regulations, or other governing legal authority, informal resolution of ethical violations, reporting ethical violations, improper complaints, and unfair discrimination against complainants and respondents. (APA, 2002)

Psychologists who learn of misuse or misrepresentation of their work may take reasonable steps to correct or minimize the misuse or misrepresentation through the APA. When there is a conflict between ethics and law, regulations, or other governing legal authority and a psychologist’s responsibilities they make known their commitment to the Ethics Code and take steps to resolve the conflict. If the conflict cannot be resolved via such means, psychologists may adhere to the requirements of the law, regulations, or other governing legal authority. (APA, 2002)

Sometimes situations may call for informal resolution of ethical violations. If a psychologist believes that there may have been an ethical violation by another psychologist, they may attempt to resolve the issue by bringing it to the attention of that individual, if an informal resolution appears appropriate and the intervention does not violate any confidentiality rights that may be involved. Reporting ethical violations may be necessary when an apparent ethical violation has substantially harmed or is likely to substantially harm a person or organization. Psychologists may take further action appropriate to the situation such as referral to state or national committees on professional ethics, to state licensing boards, or to the appropriate institutional authorities. This standard does not apply when an intervention would violate confidentiality rights or when psychologists have been retained to review the work of another psychologist whose professional conduct is in question. (APA, 2002)

When a Psychologist does not file or encourage the filing of ethics complaints that are made with reckless disregard for or willful ignorance of facts that would disprove the allegation the ethics code allows for treatment of these improper complaints. Unfair discrimination against complainants and respondents in the APA ethics code demands that Psychologists do not deny persons employment, advancement, admissions to academic or other programs, tenure, or promotion, based solely upon their having made or their being the subject of an ethics complaint. This does not preclude taking action based upon the outcome of such proceedings or considering other appropriate information. (APA, 2002)

Psychology and Professional Ethics

Psychologists have an obligation to protect the people in which they counsel on a regular basis. Ethic codes have been created to protect the public and offer guidance to professionals in serving their clientele. Many different mental health organizations have their own set of ethical codes in which they follow on a day to day basis. Without these ethical codes, they would not be able to properly protect themselves or their clients in the unlikely event that they are accused or sued for malpractice.

There is believed to be three main reasons that these ethical standards and codes have been created for professional psychologists to follow. The three standards and codes are the general reason is to educate professionals about adequate ethical conduct; consultants that comprehend the standards may acknowledge prolonged alertness, ideals-interpretation, and difficult-answering abilities. Next, ethical standards encourage responsibility, also, counselors need to preserve ethical conduct encourage such from colleagues as well. Third the code of ethics helps support in cultivating preparation by proposing answers to challenging inquiries and circumstances (Herlihy & Corey, 1996).

“Ethical issues in mental-health are governed by professional codes and laws. Law defines the minimum standards of performance which society will tolerate and these standards are enforced by the government. Ethics illustrates maximum or ideal standards of performance set by the profession and are managed by professional associations, national certification boards, and government boards which regulate professions” (Remley, 1996). Ethical codes that are used in mental- health organizations are revised when new issues in the psychological community arise.

Providing a code of ethics to clients receiving psychological care has proven to be fundamental in the field of psychology. Not only to the psychologist providing treatment but also to the client who is receiving treatment on a daily, weekly, or even a monthly basis. Besides knowing these rules, a therapist must be able to think rationally and apply different ethical standards to each individual situation that may crop up while they are providing professional counseling services. Not every situation is covered under these individual codes and standards. Often a psychologist is forced to make their own decisions in regards to which way to best treat a client who is seeking help. Without these codes of ethics, a therapist would be unprotected should they provide the wrong type of treatment to one of the clients they are serving. This could often a therapist up to losing their license to practice and be sued which could end up costing them a fortune financially, professionally, and personally.

Conclusion

The APA ethics code systematically describes how psychologists and psychiatrists should behave in a professional environment. Societal norms have helped to define how professional ethics should be followed and has also contributed to how the APA’s ethics code has developed. Through communication of this ethics code among psychologists, they can hope to have greater success with clients and better relationships with colleagues.

Pashan DeShields

Introduction

Throughout the years of being a social worker, a person can come across many different ethical dilemmas. An ethical dilemma involves being faced with a situation where a decision must be made under circumstances where ethical principles are in conflict. Dealing with these types of things, there is really no perfect answer that can conform to all of the ethical principles in the professional codes. Due to the fact that social workers have established guide lines for difficult situations, we can do better decision making.

Ethical Dilemma. Jennifer, 23, is a student working at a halfway house for men on parole, who are also substance abusers. This is part of her final 480 hour field internship. Jennifer is very attracted to Sly, a 26-year-old, handsome client who is also quite charming. She finds it very difficult to avoid responding to his flattering, flirtatious advances. She is halfway through her placement and is finding it extremely difficult not to respond to Sly and secretly date him. The agency has a strict policy that no worker should date a client within six months after either have left the agency. Jennifer finds herself preoccupied thinking about him much of the time. She feels that she’s losing control.

Professional values that apply to the dilemma. A professional value cited in the NASW Code of Ethics that was used in this case in “Integrity”. It tells us how social worker’s should continuously be aware of their mission, values, as well as ethical standards. (p.6) Jennifer forgets her mission and the standards required to obtain this career. She was there on her internship and allowed herself to get caught up in a conflict of interest. In the code, it describes the precautions needed when facing this kind of dilemma. At all times, social workers should be alert and try to avoid having conflicts of interest.

Worker’s professional role and boundary issues involved. Jennifer is taking on the role as an intern which means that she should be following the guide lines for the “Social workers’ ethical responsibilities to the client”. One of the boundaries that have been crossed is Conflicts of Interest. According to the code, social workers should not engage in any dual relationships with clients or former clients (p.9). They should establish appropriate boundaries. This applies to Jennifer and Sly’s situation since they both cannot resist the flirting and are hiding their dating life. They are involved in a dual relationship. She is already in violation with site of where she is interning, who gave a strict rule of no dating clients within six months of leaving the agency.

Another boundary that has been broken is Sexual Relationships. This tells us that for no reason should a social worker participate in any type of sexual contact with a client, whether it was consented or forced. (p.13) Jennifer and Sly may not have had a moment of intimacy, but according to the dilemma, they are close to doing so. She can’t resist his advances and is finding it hard to control herself in secretly dating him. They are young, optimistic, and flirtatious; it is very possible that a mishap can occur.

What emotions, wants, and needs might characterize the worker involved in the scenario? It could appear that she is looking for an outlet herself and has found it in this relationship. Sometimes we search for answers through things, hoping that we will find our help as well. It is very important that a social worker is healthy and whole in every aspect of their life. As a social worker, you have been given trust by your patients that you will help them receive what they need and live a fulfilled life.

Alternatives available for the worker to take. Although Jennifer feels that her situation is becoming too much, there is alternatives that she can take to lessen the stress of the situation. Since she is attracted to him and is very tempted by him, she should address her feelings, sooner than later. She is halfway through with her internship and to not look bad, she should tell the site director. There, the supervisor or her educator can tell her what may be the best route for her to take in regards to her maybe later being employed at which she is interning. Or perhaps there should be a termination of the professional relationship. She should let Sly know that she will no longer be professionally working with him and find him another practitioner where he could still get proficient help from. Or, she could even just keep what has already been going on a secret. She and Sly can secretly date and wait until the 6 month rule has expired that allows her to date a client.

Potential positive and negative consequences for each alternative. Weighing the pros and cons of each alternative is a common perspective in various aspects of social work practice. It is also useful in resolving ethical dilemmas. A pro in being upfront with her supervisor is that she will possibly gain respect. She could tell the truth about her and Sly and how now avoiding him is hard and she doesn’t want to go against the code. The supervisor will see that the intern is aware of her professional responsibilities and wants to maintain the upmost respect of her patient. She could keep her internship and the client could possibly be relocated. Or, the supervisor may not trust Jennifer still being at the site since she has acted unethically. He/she may have to report her which could lead to Jennifer missing out on a good job opportunity. This record may also follow her to future job employments.

Then, there is terminating the client. If they terminate Sly as a client, a positive would be that she won’t be distracted in her work place. She can be more focused in completing her internship. This is usually the approach that is used for those who have been involved in dual relationships. Also, Sly can really continue to get the help that he needs instead of being at the facility flirting with the newly, young worker. However, in a termination, the clients’ reaction to things can be very negative. Sly can go into a mode of denial or even rage. He may not believe that they are removing him or even get mad that Jennifer is allowing this to happen. By being enraged, this could also cause Sly to relapse back into his substance abuse.

Lastly, she could keep the romance between them a secret. The pro in this is that she can continue to work on landing a good job while establishing a relationship with someone she likes. Due to the fact that Jennifer has already stated the frustration in trying to be in a secretive relationship, this could very quickly turn into a negative. She could ultimately be looked down on and could lose respect and a job. Also, she and Sly’s relationship may not even be long lasting for her to be risking her career. She would be better off being upfront and showing concern with following the code and respecting what is asked of her by the job instead of keeping it a secret, possibly ending up with the same outcome. Professionally, it would look better for her to do so.

How might each alternative affect the client and the worker/client relationship? Ways in which the alternatives can affect the client and the worker/client relationship can come in a lot of forms.

Action that the worker should take that would be the most ethical and appropriate for both worker and client? Ethical choices must be made to allow people to survive and thrive, existing with their basic needs met. There must be a decision made in regards to what is best for the social worker to take. However, before that decision has been made, critical thinking has had to have taken place. It is imperative to use critical thinking and ethical decision making to achieve the optimal result. She should talk the issue over with her supervisor or get counseling help. Face and evaluate the serious negative consequences for both her and Sly. Ultimately, she should terminate their professional relationship, referring Sly to another practitioner so that his services will continue.

Extent to which individual professional discretion is required. It is very important that when dealing with a situation like this, nothing is said or done that causes offense or reveals any private information. You have taken an oath to the service of humanity and to social justice. As a professional, the welfare of your patient is your first priority and the main focus is to make sure the client receives what he/she needs.

Conclusion

Sadly, the pattern associated with Jennifer’s unethical involvement is noticed in a small percentage of social workers, who have been associated with inappropriate behavior with their clients. Although this behavior is known, many social workers have upheld their oath and maintain a high expectancy of the honor and tradition of the social work profession.

New Hanover County Senior Resource Center: Ethical Dilemma

What are values, ethics, ethical dilemmas and a code of ethics? Values relate to principles and attitudes that provide direction to everyday living. Values also refer to beliefs or standards considered desirable by a culture, group or individual (Merriam, 2003). On the other hand, ethics means a system of beliefs that constitutes moral judgment. In essence, ethics are moral principles (Barsky, 2010, p. 12). An ethical dilemma is when a person is faced with a choice between two equally conflicting moral principles, and it is not clear cut which choice will be the right one. (Barsky, 2010, p. 6). In other words, adhering particularly to one principal might result in the violation of the other. Finally, ‘a code of ethics’ is an explicit statement of the values, principles and rules of a profession, which acts as a guide for its members and their practice (Code, 2008). In every occupation, professionals are faced with ethical dilemmas. Dilemmas at workplaces can sometimes be the hardest decision to make in life; however, as a professional we must take the proper steps to move further and not jeopardize our license or career. As a Bachelor of Social Work intern at the New Hanover County Senior Resource Center, ethical dilemmas are easy to come by.

Description of Ethical Dilemma

An ethical dilemma occurred on November, 20^th of 2014. The client that this dilemma revolves around, is on the Senior Resource Centers Home Delivered Meals program. The program serves home-bound elderly citizens age 60 and over, and they receive a lunch Monday through Friday, prepared at the center nutrition site by a local catering company (Nutrition, 2015). This specific client has been receiving meals since 2006, and in November it was time for a reassessment to be done. Reassessments are done every six months to make sure the clients are still eligible to receive meals.

I and my field instructor, Jean Wall, visited this client at their home. I knocked on the door, and after a few seconds I could smell marijuana wayfaring in the air coming out of an open window beside the door. The grandson of the client opened the door, and said the client was not there. He looked to be older than 18. My field instructor asked where the client was, and the grandson changed the story to the client was in the bedroom taking a nap. The grandson had red eyes, and was slurring his words, which are symptoms of marijuana use. Added with the smell of marijuana coming from inside, it was clear he had been smoking it. After leaving the clients home, I was unsure how to proceed with what just happened. The drug use in the home could negatively affect the clients overall health and well-being, but is it within our jurisdiction, as social workers at the senior resource center, to make a report?

The Code of Ethics of the National Association of Social Workers, also known as NASW, expresses the values and principles of the profession. By having values and principles that guides our practice, this assists our work, and helps us to act in ethical ways. In short, values and principles provide a guide and standard for ethical practice in social work (Barsky, 2010). The ethical standards that conflict, in this ethical dilemma, are standards 1.01 and 1.07. 1.01 states that a social workers primary responsibility is to promote the wellbeing of clients. Standard 1.07 part ‘a’ states that social workers should respect clients’ rights to privacy (Code, 2008). Standard 1.07 is also in conflict with North Carolina possession laws. In North Carolina, Marijuana is classified as a Schedule VI Controlled Substance, and possessing marijuana in North Carolina is considered a Class 1 misdemeanor under N.C. Gen. Stat. 90-95(d)(4).

Stakeholders

Every decision we make affects other people. Social workers have a moral obligation to consider the ethical implications of their decisions on others. Each person, group, or institution likely to be affected by a decision is a stakeholder with a moral claim on the decision maker (Barsky, 2010). There are individuals, groups, and organizations that can be affected by the ethical decision made concerning this client who lets their drug using grandson live with them. First of all, the client is most likely to be affected by the decision because this ethical dilemma revolves around the client and questions what is best for the client. The grandson is also a stakeholder. More individuals that are stakeholders are Jean Wall and myself, because we are the social workers involved with the case. The organizations that are also stakeholders are the New Hanover County Senior Resource Center, the Apartments where the client lives, The Department of Social Services, and The Wilmington Police Department.

Possible Courses of Action

Identifying all possible courses of action and the participants involved in each, along with possible benefits and risks for each, is important for making the best decision when it comes to ethical dilemmas. In this case, there are three possible courses of action; doing nothing, reporting the drug use, and discussing it with the client.

The first course of action, doing nothing, entails not reporting the drug use or confronting the grandson or client with the matter. Essentially, the participants with this option are the social workers involved with the case, which are Jean Wall and myself. We would document the home visit like we are required to, but no further investigation would take place concerning the drug using grandson living with the client. The benefit to this option is that the client gets to have the grandson continue to live there, which may help if she has an accident or medical emergency, where she would need help calling 911 or getting to the hospital. The risks of this option are that the grandson may become abusive as an effect of the marijuana use, and that the client’s health could be negatively affected from inhaling the smoke.

The second course of action, reporting it, entails making a report of the drug use to the police department, or to Adult Protective Services. The participants in this option are, myself, my field instructor, the client, the client’s grandson, the Wilmington Police Department, and the Department of Social Services. The benefits for this option are that the client is no longer living in an unhealthy environment, and that, if the police reprehend the grandson for possession, then drugs have been taken off the street. The possible risks are that the client is displeased and makes complaints to the agency, and another risk is that the police can do nothing about the drugs being in the home, and in retaliation, the client may want nothing to do with the senior resource center anymore.

The third course of action is discussing the issue with the client, and letting the client decide what they want to happen. Participants is this option would be the client, the grandson, myself, and my field instructor. The benefits are that the client becomes aware that there is an issue, and starts to take steps to get the grandson out of the house, and that the grandson will be aware that this could lead to a bad environment for his grandmother. The possible risks are that the client may get angry with us trying to get involved, the grandson may get violent and defensive, and that the agency may lose the client.

Analysis of Courses of Action

The courses of action mentioned previously need to be thoroughly examined. Doing this entails going over the reasons in favor of and opposed to each possible course of action. Option number one of doing nothing, entails not reporting the drug use or confronting the grandson or client with the matter. Reasons in favor of this option include the Code of Ethics ethical standard 1.07. That standard prohibits social workers from sharing client’s personal information (Barsky, 2010, p. 98). Social workers should respect the client’s rights to privacy, and this applies to this option because we would be protecting the clients privacy by not reporting the drug use. Another reason in favor of this option is that it’s not in our jurisdiction to do, or say anything, about the apparent drug use because there was no evidence of elder abuse, and we could see no actual drugs. The reasons opposed to doing nothing revolves around the Code of Ethics standard 1.01. It is a social workers responsibility to promote the wellbeing of clients. In this case, doing nothing would not adhere to following that standard.

Option number two, of reporting it, entails making a report of the drug use to the police department, or Adult Protective Services. One reason in favor of this option is that it would adhere to the ethical standard 1.01 of promoting the clients wellbeing. Another reason in favor of this option is because it would follow with my own personal value about being against drug use. Additionally, possession of marijuana is against the law in North Carolina. Reasons opposed to reporting is that it would compete with ethical standard 1.07 where it states that social workers have to respect client’s rights to privacy. Also, reporting this issue to police would go against the ethical principle of dignity and worth of the person. The NASW Code of Ethics (2008) states that, “Social workers seek to enhance clients’ capacity and opportunity to change and to address their own needs”.

Finally, option number three, of discussing the issue with the client, and letting the client decide what they want to happen, has reasons in favor of and against it. Reasons in favor of talking it over with the client includes the ethical theory that the client is the expert on their own life, and the ethical principal of dignity and worth of the person. Option three adheres to this theory and principal because we would be giving the client the opportunity to change and to address their own needs instead of making the decision for the client, without the clients consent. A reason opposed to this option is the legalities involved with North Carolina law. Drug possession is against the law, so just discussing the issue with the client may not be enough.

Consultation

Consulting with colleagues and appropriate experts about ethical dilemmas can aide in the decision making process. With this case, I consulted with Jean Wall, who is my field instructor, and then I consulted with another intern at the New Hanover County Senior Resource Center. The reason I consulted with the other intern was to try and get a sense of what her opinions on the case are, and to see what her decision would have been. The outcome of that consultation was that she was stumped on what to do also, but that she agreed with me on that it was an issue. She was not sure what should be done about it either. Next, I consulted with my field instructor about the home visit in general, then asked what should be done with the issue. Jean stated that, first, it was not part of our job to advise our clients on what should be done. We are to only give them the resources and tools they ask for. Second, that since there was no sign of abuse or neglect we could not make a report.

Determining a Course of Action and Documentation

The course of action that was chosen was to do nothing about the issue. This option was chosen because there was no sign of abuse or neglect, so we could not make a report to Adult Protective Services, and because we did not actually see any drugs while we made the home visit. The Senior Resource Center does not have a particular method of documenting ethical dilemmas. Documentation is done for all client interaction with the agency and staff. I documented the reassessment, like I would any other reassessment, once we could get in touch with the client and do the full reassessment.

Ongoing Evaluation and Documentation

After making the decision, monitoring, evaluating, and documenting the decision comes next. After documenting the first home visit we did to see the client, my field instructor set up another appointment with the client, and did the full reassessment for Home Delivered Meals. After the assessment, my field instructor and I debriefed on how the second home visit went. My field instructor stated that the house was very cluttered and smelled of smoke. The grandson was still living with the client, but he was out of the room for the visit. The client was found to still be eligible for Home Delivered Meals, and in six months, my field instructor will conduct another reassessment.

Conclusion

In conclusion, an ethical dilemma is a conflict of moral principles, occurring when a person is faced with a certain situation where adhering particularly to one principal might result in the violation of the other. Over the course of this internship, I have found that dilemmas at workplaces can sometimes be the hardest decisions to make in life; however, as an aspiring professional I must take the proper steps to move further. While interning at the New Hanover Senior Resource Center, this ethical dilemma occurred during a home visit. The client’s grandson had been smoking marijuana within the client’s home. The reason this was an ethical dilemma was because two standards in the NASW Code of Ethics were in conflict, specifically 1.01, and part ‘a’ of 1.07. In the end, my field instructor and I were not able to do anything about the smoking of marijuana in the client’s home. We could not report it to Adult Protective Services because there was no sign of neglect or abuse to the client. However, there will be further monitoring of the situation due to the client still being on the Home Delivered Meals program, and having to do reassessments every six months.

References

Barsky, A. E. (2010). Ethics and values in social work: An integrated approach for a comprehensive curriculum. Oxford: Oxford University Press.

Code of Ethics of the National Association of Social Workers. (2008). Retrieved February 7, 2015, from https://www.socialworkers.org/pubs/code/code.asp

G.S. 90-95. (2015). Retrieved February 7, 2015, from http://www.ncleg.net/EnactedLegislation/Statutes/HTML/BySection/Chapter_90/GS_90-95.html

Merriam-Webster, Inc. (2003). Merriam-Webster’s collegiate dictionary. Springfield, Mass: Merriam-Webster, Inc.

Nutrition. (2015). Retrieved February 7, 2015, from http://src.nhcgov.com/services/nutrition/

Selecting an appropriate method of intervention is central to ethical and effective practice with service users. The aim of this essay is to define what is meant my method of intervention, explore the main factors which influence the worker when selecting a method and critically consider the role of partnership working and empowerment.

‘Intervention is rarely defined. It originates from the Latin inter (between) and venire (to come) and means ‘coming between’ (Trevithick, 2005: 66). Interventions are at the heart of everyday social interactions and make ‘inevitably make up a substantial majority of human behaviour and are made by those who desire and intend to influence some part of the world and the beings within it’ (Kennard et al. 1993:3). Social work interventions are purposeful actions we undertake as workers which are based on knowledge and understanding acquired, skills learnt and values adopted. Therefore, interventions are knowledge, skills, understanding and values in action. Intervention may focus on individuals, families, communities, or groups and be in different forms depending on their purpose and whether directive or non-directive.

Generally, interventions that are directive aim to purposefully change the course of events and can be highly influenced by agency policy and practice or by the practitioner’s perspective on how to move events forward. This may involve offering advice, providing information and suggestions about what to do, or how to behave and can be important and a professional requirement where immediate danger or risk is involved.

In non-directive interventions ‘the worker does not attempt to decide for people, or to lead, guide or persuade them to accept his/her specific conclusions’ (Coulshed and Orme, 1998: 216). Work is done in a way to enable individuals to decide for themselves and involves helping people to problem solve or talk about their thoughts, feelings and the different courses of action they may take (Lishman, 1994). Counselling skills can be beneficial or important in this regard (Thompson 2000b).

Work with service users can therefore involve both directive and non-directive elements and both types have advantages and disadvantages (Mayo, 1994). Behaviourist, cognitive and psychosocial approaches tend to be directive but this depends on perspective adopted and the practitioner’s character. In contrast, community work is generally non-directive and person-centred.

Interventions have different time periods and levels of intensity which are dependent on several factors such as setting where the work is located, problem presented, individuals involved and agency policy and practice. Several practice approaches have a time limited factor such as task-centred work, crisis intervention and some behavioural approaches and are often preferred by agencies for this reason. In addition, practice approaches that are designed to be used for a considerable time such as psychosocial are often geared towards more planned short-term, time limited and focused work (Fanger 1995).

Although negotiation should take place with service users to ensure their needs and expectations are taken into account, it is not common practice for practitioners to offer choice on whether they would prefer a directive or non-directive approach or the practice approach adopted (Lishman, 1994). However, this lack of choice is now being recognised and addressed with the involvement of service users and others in the decision-making process in relation to agency policy, practice and service delivery (Barton, 2002; Croft and Beresford, 2000).

The purpose and use of different interventions is contentious. Payne (1996: 43) argues that ‘the term intervention is oppressive as it indicates the moral and political authority of the social worker’. This concern is also shared by others with Langan and Lee (1989:83) describing the potentially ‘invasive’ nature of interventions and how they can be used to control others. Jones suggests that in relation to power differences and the attitude of social workers especially with regards to people living in poverty: ‘the working class poor have been generally antagonistic toward social work intervention and have rejected social work’s downward gaze and highly interventionist and moralistic approach to their poverty and associated difficulties’ (Jones, 2002a: 12). It is recognised that intervention can be oppressive, delivered with no clear purpose or in-depth experience however, some seek and find interventions that are empathic, caring and non-judgemental due to practitioners demonstrating ‘relevant experience and show appropriate knowledge’ (Lishman, 1994:14). For many practitioners, these attributes are essential in any intervention and are demonstrated through commitment, concern and respect for others which are qualities that are valued by service users (Cheetham et al. 1992; Wilson, 2000).

Dependent on the nature of help sought there are different opinions on whether interventions should be targeted on personal change or wider societal, environmental or political change. Some may want assistance in accessing a particular service or other forms of help and not embrace interventions that may take them in a particular direction i.e. social action (Payne et al. 2002). In contrast, problems may recur or become worse if no collective action is taken.

Importance has reduced in relation to methods of intervention over recent years as social work agencies have given more focus to assessment and immediate or short-term solutions (Howe, 1996; Lymbery 2001). This is strengthened by the reactive nature of service provision which is more concerned with practical results than with theories and principles. This has a reduced effect on workers knowledge of a range of methods resulting in workers using a preferred method which is not evidenced in their practice (Thompson, 2000). Methods of intervention should be the basis of ongoing intervention with service users, but often lacks structured planning and is reactive to crisis. This reactive response with emphasis on assessment frameworks is concerning, as workers are still managing high caseloads and if not supervised and supported appropriately, workers are at risk of stress and eventual burn-out (Jones, 2001; Charles and Butler, 2004).

Effective use of methods of intervention allows work to be planned, structured and prioritised depending on service users’ needs. Methods can be complicated as they are underpinned by a wide range of skills and influenced by the approach of the worker. Most methods tend to follow similar processes of application: assessment, planning of goals, implementation, termination, evaluation and review. Although the process of some methods is completed in three/four interactions others take longer. This difference shows how some methods place more or less importance on factors such as personality or society, which then informs the type of intervention required to resolve issues in the service user’s situation (Watson and West, 2006).

More than one method can be used in conjunction with another, depending on how comprehensive work with service users needs to be (Milner and O’Byrne, 1998). However, each method has different assessment and an implementation process which looks for different types of information about the service user’s situation for example, task centred looks for causes and solutions in the present situation and psychosocial explores past experiences. Additionally, the method of assessment may require that at least two assessments be undertaken: the first to explore the necessity of involvement and secondly, to negotiate the method of intervention with the service user.

An effective assessment framework that is flexible and has various options is beneficial but should not awkward or time consuming to either the worker or the service user. As Dalrymple and Burke (1995) suggest, a biography framework is an ideal way as it enables service users to locate present issues in the context of their life both past and present.

Workers should aim to practice in a way which is empowering and the process of information gathering should attempt to fit into the exchange model of assessment, irrespective of the method of intervention and should be the basis of a working relationship which moves towards partnership (Watson and West, 2006). As part of the engagement and assessment process, the worker needs to negotiate with the service user to understand the issue(s) that need to be addressed and method(s) employed and take into account not only the nature of the problem but also the urgency and potential consequences of not intervening (Doel and Marsh, 1992).

Importance should be placed on presenting and underlying issues early in the assessment process as it enables the worker to look at an assessment framework and approach that assists short or long-term methods of intervention. An inclusive and holistic assessment enables the service user to have a direct influence on the method of intervention selected and be at the heart of the process. The process of assessment must be shared with and understood by the service user for any method of intervention to be successful (Watson and West, 2006).

The worker’s approach also has an influence on method selection as this will affect how they perceive and adapt to specific situations. The implementation of methods is affected by both the values of the method and value base of the individual worker. The worker will also influence how the method is applied in practice through implementation, evaluation, perceived expertise and attitude to empowerment and partnership.

Methods such as task centred are seen to be empowering with ethnic minority and other oppressed groups as service users are seen to be able to define their own problems (Ahmad, 1990). However, when an approach is used which is worker or agency focused the service user may not be fully enabled to define the problem and results in informing but not engaging them in determining priorities.

Empowerment and partnership involves sharing and involving service users in method selection, application of the method, allocation of tasks, responsibilities, evaluation and review and is crucial in enabling facing challenges in their situations and lives. However, service users can have difficulty with this level of information-sharing and may prefer that the worker take the lead role rather than negotiating something different and not wish to acquire new skills to have full advantage of the partnership offered.

Selecting a method of intervention should not be a technical process of information gathering and a tick box process to achieve a desired outcome. Milner and O’Byrne (2002) suggest it requires combining various components such as analysis and understanding of the service user, worker and the mandate of the agency providing the service otherwise intervention could be is restrictive and limit available options. However, negotiation and the competing demands of all involved parties must be considered and the basis of anti-oppresive practice established.

Methods of intervention can be a complex and demanding activity especially in terms of time and energy and therefore, short-term term methods are seen as less intensive and demanding of the worker as well as more successful in practice. However, Watson and West (2006: 62) see this as ‘a misconception, as the popular more short-term methods often make extensive demands on the workers’ time and energy’.

Workers are often dealing with uncertainty as each service user have different capabilities, levels of confidence and support networks. Therefore, there is no one ideal method for any given situation but a range of methods that have both advantages and disadvantages and as Trethivick (2005: 1) suggests workers need to have ‘a toolkit to begin to understand people’ and need to widen the range of options available in order for them to respond flexibly and appropriately to each new situation (Parker and Bradley, 2003).

When using methods of intervention, workers have to be organised to ensure that the task is proactively carried out and often attempt to prioritise involvement with service users against both local and national contexts and provide an appropriate level of service within managerial constraints. This prioritisation means in practice that, given the extensive demands, work using methods can only be with four or five service users at any one time and with the additional pressure of monitoring and supervising service users and reports, risk response is often responsive and crisis driven (Watson and West, 2006).

To work in an empowering and anti-oppressive perspective is to ensure that intervention focuses clearly on the needs of the service user, is appropriate to the situation than the needs of the service. An understanding of these competing demands and the worker’s ability to influence decision-making processes does impact on method selection however, this should not mean that the service is diluted and methods be partially implemented as this is not conducive to managerial or professional agendas on good practice. Thompson (2000:43) sees this as ‘the set of common patterns, assumptions, values and norms that become established within an organisation over time’ and a concern of workers is competitive workplace cultures where ability is based on the number of cases managed rather than the quality that is provided to service users which may result in use of less time-consuming methods.

For work to be effective, an ethical and a professional not just a bureaucratic response to pressures faced is required and is not about the service user fitting into the worker or agency’s preferred way of working but looking at what is best for the service user and finding creative ways to make this happen.

Workers need to be careful not to seen as the ‘expert’ who will resolve the situation as even the most established and experienced practitioners have skills gaps and often develop skills when working with the service users. This process of learning in practice requires good support and supervision, enabling the worker to reflect on assumptions about service users and their capabilities especially in relation to gender, race, age or disability to prevent internalised bias to impact on what the service user requires to work on to change the situation (Watson and West, 2006).

It is crucial to appreciate the situation from the service user’s perspective and see them as unique individuals as Taylor and Devine (1993: 4) state ‘the client’s perception of the situation has to be the basis of effective social work’. This concern is also shared by Howe (1987:3) describing ‘the client’s perception is an integral part of the practice of social work’. Service users often have their own assumptions about what social work is and what workers are able to provide which is generally based on past relationships and experiences for example, black service users experience may reflect a service which in the past was not appropriate to their needs (Milner and Byrne, 1998: 23) but to alleviate this practitioners need to work in an open, honest and empowering manner and recognise that although service users may be in negative situations they also have strengths and skills that need to be utilised in the social work relationship.

Workers should ensure that written agreements are developed that acknowledge all participants roles and responsibilities and avoid assumptions or issues (Lishman, 1994), this avoids breakdown in trust and encourages honesty and open shared responsibility between service user and worker. This involves negotiation on what should be achieved, by whom, including agency input. Agreements can provide the potential for empowering practice that involves partnership. However, cognisance has to be taken to ensure that the agreement does not become a set of non-negotiated tasks that service users have no possibility of achieving, combined with no reciprocal commitment or obligations by the worker as this does not address the issue of empowerment or oppression and can reinforce the power difference (Rojek and Collins, 1988).

The final stage of the process is termination which should be planned and allow both parties time and opportunity to prepare for the future however, it has to be carefully and sensitively constructed and is much easier to achieve if the work has been methodical with clear goals as it demonstrates what has been achieved. Evaluation is beneficial as it enables the service user and worker to be reminded of timescales and can acknowledge the service user’s increasing skills, empowerment, confidence and self-esteem which can be utilised after the intervention has ended. Endings can however, be difficult for both the worker and service user resulting from various factors such as complexity of service user’s situation, issues of dependency and lack of clarity about purpose and intervention. This lack of clarity can result in a situation of uncertainty for both worker and service user (Watson and West, 2006). Finally, termination as part of the change process creates opportunities but also fear, anxiety and loss (Coulshed and Orme, 1998).

It is important for workers to take a step back and reflect on their practice and review their experiences to ensure that they are providing the best possible service in the most ethical and effective manner. Reflective practice provides support and enables workers to not just meet the needs of the organisation but also develop their own knowledge and skills and increased understanding of their own approach and the situation experienced by service users. A good tool to facilitate this is the use of reflective diaries. Reflecting in action and on action both influences and enhances current and future practice. The use of effective supervision is another process where workload management, forum for learning and problem-solving should take place which should be supportive and enabling to the worker (Kadushin and Harkness, 2002). However, the worker’s role in supervision is often viewed as passive as the supervisor sets the agenda. This can lead to disempowerment of the worker in relation to the agency and is potentially oppressive and discriminatory and provides a poor role model for work with service users and therefore consideration must be given on how they can create a positive and empowering relationship (Thompson, 2002).

In conclusion, good practice requires workers to have knowledge to understand the ‘person in situation,’ (Hollis, 1972) understanding both sociological (society and community) and psychological (personality and life span) and the interrelation and impact on the service user (Howe, 1987). A critical skill for effective and ethical practice is empowerment which is based on knowledge and values and is the difference between informing and genuine partnership and the importance of active participation of service users throughout the process.

Social work is a value based activity and workers through reflection and supervision can all learn from experiences, adapt and enhance these to develop practice and gain self-awareness to understand how they themselves and their approach impacts on service users.

Haiyang Li

There are many kinds of relationships in the world, for instance, parents and children, husband and wife, boyfriend and girlfriend, friends, neighbors and etc. Normally, people think the relationship between supporters and clients is the same as doctor and clients. However, there are a lot of differences. In this essay, I will demonstrate what a supporting relationship should be, identifying the key theoretical principles to establish a supporting relationship. In between, I will connect the theoretical principles with the case study, and demonstrate how the principles work in the real situation. To build a supporting relationship, the supporter needs to put his heart in the support work using all the helping skills and Personal-Certred Approach as a guide in the real work.

The relationship between supporter and client was seen as someone who can talk to. It looks very simple. However, the supporter is the one who can be trust, the one who can understand the problems or the situation the clients in, the one can accept the fact of clients hold, and the one can be allowed to provide help for the client. In order to become that kind supporter, the helper need to prepare relevant knowledge to understand the situation, history, strength and worries the client has. the relationship is about building a rapport and trust with the supporter. The client may feel comfortable enough to open up and address their problems. This kind of relationship is built on confidentiality and reliability.

In this case, ‘Spider’, he is a 19 years old boy.

The situation of him is that he is sleeping in the nearby park. He is lack of education but he learned from street knowing how to survive on the street but poor living conditions.

The history of him is that he has family abuse history and has been lived in foster homes for a few years and change foster home frequently in those years. He was not good at school study left school when he was 14. After he turned to 18, he lost government support and then he had to live in the street in the poor living condition and use street drugs for himself.

The strength of him is that he identifies himself as a resourceful, determined and smart street dweller. He wants to start a new way of life which is moving out from the street, finding a job, requiring more knowledge and having his own living place. He hopes that he can have his own family. He has very strong desire to move on for his life to start working forward to his dream.

The worries of him are homelessness, unemployment and reuse street drugs.

From case study, I think the Person-Centred Approach is suitable and helpful for us to understand and care for him. The Person-Centred Approach developed from the work of Dr. Carl Rogers. The research (Richard, 1992) indicates that the Person-Centred Approach theory aim to develop or create a relationship that can allow the clients to be themselves. The relationship can be felt safe for the client and give them space to develop and grow. To achieve this goal, the supporter would be a person who was deeply understanding which is empathic in the theory; accepting which is having unconditional positive regard and genuine which is congruent in the principle.

Using Person-Centred Approach theory, the supporter needs to understand what has happened to him. Firstly, when he was young, he was suffering from neglect and abuse in his family. The research (Smith & Segal, 2012) shows that Negligence, on the part of parents or caretakers, can cause children both physical and mental health problems. Parents or caretakers carelessness can be seen as a kind of physicalabuse. Children’s fear is also from unpredictable environment change and behavior of their guardians. The guardians successfully manage to plunge fear in the hearts of the children. As a result children who suffered from family physical abuse always pay attention on the negative emotions of their caretakers or parents. So, when these children grow up, the childhood experience has impacted on their personalities and behavior as well. Research (Soomro, Abbasi & Lalani, 2014) shows that they may encounter physical problems such as asthma, high blood pressure, ulcer, allergies, etc; psychological problems such as personal disorders and aggressive demeanor and behavior problems such as felony, drug habits and poor academic performance. In this case, ‘Spider’ shows his behavior problems which are not successful in school and drug problems. And street drug problem still drag him back to the street.

Secondly, he had been into the foster home but change frequent between foster homes. The foster care system seems another ideal choice for them; however, it is not always helpful when these young people need help. These adolescents have been impacted by the homeless issue and cause their social and health problem (Joanne & Patricia, 2006). Children who have been put in the foster care home experienced about the relationship attached between them and their caretakers or their foster home parents. This link is very important for children’s development. Research (American Psychiatric Association, 1994) indicated that Disruptions in attachment relationships can lead to Reactive Attachment Disorder of infancy or early Childhood. In this case, ‘Spider’ has experienced the frequently changes in foster care homes. This impact may shows on him when he grows up. He may have difficulty trust or related with somebody else such as our supporters. So this may be a barrier in establishing supporting relationships.

So from this case, as a supporter, I understand that the most problems of him have not controlled by himself. He has no choices that born from a family where abuse him when he was young. For rescuing him, he has been put into foster care. The child abuse experience makes his misbehavior in the foster home and school. He does not prepare enough for his independent life before he had been abandoned from foster care home. He has to live in the street in a rough condition so that he has the opportunity to connect with street drugs. I am also glad that he is still holding his hope on his future. He wants to be employed, educated and to have a living place. The internal motivation is the most important helper for him to reach his goal because an important part of this theory is that in a particular psychological environment, the fulfillment of personal potential is a desire to know and be known by other people (British Association for the Person Centred Approach, 2015).

After understanding about the client, the supporter needs to preparing himself with communication skills, action skills, mind skills and using unconditional positive regard to start a conversation with the client. Richard (2012) indicates that the Communication and action skills are what people do and how they do it rather than what and how they feel and think. The skills include listening skills, questioning skills and challenging skills. Supporter and clients can use verbal messages, vocal messages, body messages, touch messages and taking action messages to communication with each other.

In the Person-Centred Approach theory, supporter needs to use positively acceptant response to the client. Use warm and appropriate expression to send messages to build a different kind of relationships so the client may feel free to talk and express himself. Also, in genuine part, the supporter need to show client that client has been heard. It is important to show that the supporter is paying attention in the conversation they have. The supporter may use verbal messages to reflecting what the client said; may use face expression to let client know the support was thinking about what client said; or the supporter, may use taking action messages to make a note to show his listening. That is the main difference of the relationship with doctor, nurse or social worker. John and Julia (2011) research shows that these professional people tend to provide advices response rather than listening. They are looking for the solution rather than the process of helping people finding their own problems the helping relationship is focus on people. It is the way for people to rescue themselves.

I understand of mind skills is the process to know yourself and your own experience in order to use your own experience to help the client. in this case, we can share the same experience when ourselves in the difficult situation. Out experience may difference with his abuse, foster care, homelessness history but we have our difficult time such as hard to find a job and do not know what to do next in life. The important that we share how we concur the difficulty, what effort we made and never lose the hope.

To sum up, the support work is how you treat someone who needs help and how to provide help. The first to start a relationship, as the Person-Certred Approach suggested, understanding what the client is, such as who he is, what the situation he is in, what the problem he has and what worries he may have. Then before start a conversation, the supporter needs to provide a comfortable and safe environment for the client. One meaning of the environment is physical environment that may include the nice place to sit, comfortable and no interrupting noise. The other meaning of the environment is between supporter and the client. The supporter need to prepare an environment that the client can open his heart and willing to share his story. In order to do so, the supporter need to use the communication and action skills, use his voice, use positive unconditional regards, use acceptance attitude and use congruent skills to show that the supporter is ready and willing to accept the client. Also, the supporter needs to keep the confidentially of the conversation. So the client feels trustworthy and safe to talk to the supporter.

References

British Association for the Person Centred Approach, 2015. What is the Person-Centred Approach? Retrieved fromhttp://www.bapca.org.uk/about/what-is-it.html

Joanne, O.,& Patricia, L. (2006). Adolescent Homelessness, Nursing, and Public Health Policy. Policy, Politics, & Nursing Practice, 7(1), 73-77. doi: 10.1177/1527154406286663

John, M., & Julia, M. (2011). Counseling Skills a practical guide for counselors and helping professionals. (2nd ed.). New York, USA: Open University Press

Richard, N. (1992). Lifeskills Helping A text book of practical counseling and helping skills. (3nd ed.). NSW, Australia: Harcourt Brace & Company.

Richard, N. (2012). Basic counseling skills a helper’s manual. (3rd ed.). London, UK. Sage publications Ltd.

Smith, M., & Segal, J. (2012, July).Child Abuse and Neglect. Retrieved July 25, 2012, from Helpguide:http://www.helpguide.org/mental/child%5Fabuse%5Fphysical%5Femotional%5Fsexual%5Fneglect.htm

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