Category: Free Essays

A proposal of change to improve the quality of care for vulnerable older people who after being admitted into hospital and on discharge do not have a lot of choice in services that they receive. They are either sent home with a care package which does not meet all needs of the older person or moved to a residential home.

It has been said that independence and mobility are the two most precious commodities that the elderly, as a group, need to nurture as a significant decline in either will significantly increase their dependence and reliance on others, either in the family or in the community. (Whitely, S. et al 1996)

In general terms, the plight of the elderly in hospital is probably the most precarious of all of the age ranges, irrespective of the illness for which they were admitted. Any form of debilitating pathology, even if it only puts them in bed for a few days, may very well weaken their already tenuous grip on independence. The result may be either a prolonged stay in a hospital bed, home discharge with a care package which may not be totally satisfactory and all too often dependent on the ministrations of a group of overstretched healthcare professionals, or discharge to some form of residential care – which, although possibly seen by some as being the best option for the debilitated or infirm elderly, has an enormous impact on both the independence and the lifestyle of the elderly person.

Let us briefly consider this last option which is not as straight forward an option as may appear at first sight. Let us personalise the discussion by referring to a hypothetically representative Mrs J., a 78 yr. old lady who has lived alone since her husband died some ten years previously. She is fiercely independent but has been getting progressively more frail as the years have gone by to the extent that it is a struggle to get her shopping. As a result her diet is becoming progressively more inadequate.

Her personal hygiene, which was meticulous a few years ago, is now also failing, and she spends a great deal of her time alone and in bed. She has developed a low grade chest infection which required her to spend three days in hospital. When it came time to discharge her, her daughter could not look after her and took the decision that she would be better in a residential home. Mrs.J. had virtually no choice in the matter and on the fourth day she found herself in a residential home, surrounded by people with an average age rather greater than hers, many of whom were suffering from varying degrees of dementia.

The home had a completely imposed and inflexible regime which was a major imposition on her as she had previously been able to do what she wanted when she wanted. There was virtually no privacy and never a time, day or night, when there was silence or quiet. Her house had to be sold to pay the fees, so she knew that there was no possibility that she would ever go home again and any money that she had, she was not able to spend as her savings were also taken to pay the fees. In the space of four days her life had been overturned and although she was warm, fed and cared for, by any rationalisation her quality of life had changed for ever.

Mrs.J. is quoted as being fairly typical of many and her case used to illustrate the enormity of the life changing impact of admission to a residential home.

Critically examination the need for the proposed change

The particular change that we shall highlight in this particular essay is the need for multidisciplinary discharge planning, a move which is highlighted in the National Service Framework for the elderly (Standard Two).

As we shall discuss later in this essay, the National Service Frameworks have been conceived and drafted in response to the perceived need for change. It therefore follows that it is a self-serving argument that it is a recognition of a need for change in this area that has prompted its inclusion in the National Service Framework .This rather tautological argument is given credence by a number of studies that have both looked at, and demonstrated the need for change in this area.

The paper by Richards (et al 1998) was a first rate examination of the problem. It covered a number of areas, but, with specific relevance to our considerations here it highlighted how the patient outcome could be improved by a timely multidisciplinary pre-discharge assessment by a team which included social workers.

This paper, if nothing else, underlines the need for change and provides a model for how improvements in the multidisciplinary discharge function can produce potential benefits for patients

Evidence to support this view can be found in anyone of a number of recently published papers (such as Ham C 2004) which has specifically surveyed patient and carer satisfaction levels in the area of welfare and associated services after hospital discharge for the elderly.

An outline and critical discussion of how change can be implemented

Change can be a trophic factor in any organisation but no matter how good the intentions and aspirations, if it is badly managed, then the end result can be a catastrophic mess. One only has to consider the debacle of the implementation of the Griffiths Report (Griffiths Report 1983) in the NHS in the 80s to appreciate how a major management change could be badly implemented. The Government even set up its own commission to see what lessons could be learned from the episode. (Davidmann 1988)

If we consider the overall implications of the report in terms of change management, the innovations failed because they were imposed rather than managed. (Davidmann 1988)

Another fundamental concept in the field of change management is expressed by Marinker (1997) who points to the rather subtle difference between compliance and concordance. He suggests that human beings generally respond better to suggestion, reason and coercion rather than direct imposition of arbitrary change.

The management of change is perhaps the most critical of the elements in this discussion. There is little point in having vision or ideas if you cannot successfully implement them into reality (Bennis et al 1999).

The whole study of the Management of Change is built upon a set of constructs known as the General Systems Theory (GST). (Newell et al 1992). The process is both general and adaptable and can be summarised in the phrase “Unfreezing, Changing and Refreezing” or in simple terms, assessing a situation changing it, and then making the changes stick. (Thompson 1992).

All changes, but particularly health and welfare related ones, should only really be made after careful consideration of the evidence base underpinning that change (Berwick D 2005). In specific terms one should evaluate the need for implementation of a multidisciplinary discharge procedure by considering the evidence that the current situation could be improved, make managers aware of the findings of need and than be proactive in encouragement in terms of support of any decisions that are made to implement such moves.

The Political context

If one considers the pre-2000 structure and organisation of the NHS, one could come to the conclusion that there were three major problems which, some observers stated were not consistent with what was required of a 21^st century care provider, namely:

a lack of national standards
old-fashioned demarcations between staff and barriers between services
a lack of clear incentives and levers to improve performance

over-centralisation and disempowered patients. (Nickols 2004)

There have been a number of reforms in the NHS which potentially impinge on the cases of the dependent elderly. Arguably the most important was the NHS Plan (DOH 2000). This is a lengthy document which calls for some fundamental changes in the working practices, and in some cases the actual roles of a number of healthcare professionals.

An analytical assessment would have to conclude that, although there is a lot of detail in some areas of the plan, there is actually comparatively little detail in just how these changes should be actioned and arguably even less detail in what it expected the changes to be (Krogstad et al 2002). In the context of our discussion here, we should also note the natural ideological successor to the NHS Plan, was the Agenda for Change (2004). The National Service Frameworks were then introduced after seminal guidance from the National Institute for Clinical Excellence (NICE 2004)

The other reforms that have a bearing on our considerations are Choosing Health: making healthier choices easier (2004) and Building on the Best (2003). Both of these have considerable implications for the care of the elderly. The Choosing Health paper outlines the Government proposals for giving patients greater choice in the implementation of their health care and Building on the Best examines ways of improving and modifying current practices. There are specific references to the discharge procedures which are relevant to our discussions here.

The Health context

In the context of this essay the NHS Plan called for a number of reforms including:

Increase funding and reform
Aim to redress geographical inequalities,
Improve service standards,
Extend patient choice.

Each of these areas has a bearing our Mrs.J. The geographical inequalities were primarily due to the historical context in which each area had implemented their own services together with the balance between funding and demand in each area. The improvement in service standards is mainly driven by the National Service Frameworks and he extension of patient choice clearly has a bearing on Mrs.J. although the choices available may well be less in practical terms than the complete spectrum of what is actually available and may well be constrained by factors such as available funding and the patient’s own physical state. (Wierzbicki et al 2001)

The National Service Frameworks (amongst other things) sets out to reduce inequalities in service provision between providers and also to set standards of excellence, together with goals and targets that are nationally based rather than locality based. (Rouse et al 2001).

National Service Framework Standard Two has as its stated aim to:

Ensure that older people are treated as individuals and that they receive appropriate and timely packages of care which meet their needs as individuals, regardless of health and social services boundaries.

It is formulated within the concept of “Person Centred Care”. This is intended to allow the elderly (and their carers) to feel entitled to be treated as individuals, and to allow them to be responsible for their own choices about their own care.

The Social Care context

If we accept that a patient’s discharge from hospital is dependent on many disparate and variable factors including (apart from their obvious health considerations), for example, their financial, dependence and support network status. It therefore follows that before a considered decision can be made to discharge the patient, a full and careful assessment of these various aspects should ideally be made. (Gould et al. 1995). The input of the social worker to the multidisciplinary pre-discharge team is therefore vital in this respect as it is unlikely that other healthcare professionals will be in a position to make an assessment of all of these factors.

If one reads contemporary peer reviewed literature on the subject, the term “seamless interface” is a concept that frequently appears. (Dixon et al 2003). This reflects the moves towards the dismantling of the “Empire” concept of each health and welfare related subspecialty. (Lee et al 2004). And the positive integration of each, for the overall benefit of the patient.

Central to this process is the advent of the Single Assessment Process (SAP) which is arguably the most important new work practice to facilitate good multidisciplinary working practices. This reduces the duplication of work, derivation of facts and paperwork that hitherto was commonplace (Fatchett A. 1998).

In specific consideration of our Mrs.J. we could find that she was visited by one member of the discharge team (typically the social worker), and an assessment of all of the factors that we have discussed could be made and recorded in a single central document or reference point (computer). It is the stated aim of the SAP that the needs and wishes of the elderly patient will remain at the heart of the whole process. (Mannion R et al 2005)

To consider the requirements of the National Service Frameworks and in the context of social work we should also mention the concept of the carer’s or patient’s “Champion” that has been specifically encouraged. (Bartley M. 2004). These are designated workers (often specially trained or experienced social workers), who would stand up for the need of the patient or their carers. In Mrs.J.’s case we could postulate that such a champion could assess her needs as being more appropriately dealt with by an intensive course of both physiotherapy and an occupational therapy input rather than necessarily being arbitrarily placed in a residential home.

The social worker is ideally placed to assess and indeed to action interventions such as that of the occupational therapist, who can be shown to produce considerable impact on the ability of the infirm elderly to remain at home. (Gilbertson et al 2000). We should not leave this area without a demonstration that the evidence base in this area of social worker input as being both positive and beneficial by quoting the Logan paper (et al 1997)

References

Agenda for Change, 23 November 2004, Government White Paper: HMSO 2004

Bartley M. (2004), Health Inequality. An Introduction to Theories, Concepts and Methods. Cambridge: University Press 2004

Bennis, Benne & Chin (Eds.) 1999, The Planning of Change (2nd Edition)..

Holt, Rinehart and Winston, New York: 1999.

Berwick D 2005 Broadening the view of evidence-based medicine Qual. Saf. Health Care, Oct 2005; 14: 315 – 316.

Building on the best 2003, Department of Health: HMSO: London 09/12/2003

Choosing Health: making healthier choices easier 2004

Government White Paper, HMSO: London 16.11.2004

Davidmann 1988, Reorganising the National Health Service: An Evaluation of the Griffiths Report, HMSO : London 1988

Dixon, Holland, and Mays 2003 Primary care: core values Developing primary care: gatekeeping, commissioning, and managed care BMJ, Jul 2003; 317: 125 – 128.

DOH 2000, NHS Plan, HMSO; London 2000

Fatchett A. (1998), Nursing in the new NHS: Modern, Dependable. London: Bailliere Tindall

Gilbertson, Peter Langhorne, Andrew Walker, Ann Allen, and Gordon D Murray 2000 Domiciliary occupational therapy for patients with stroke discharged from hospital: randomised controlled trial BMJ, Mar 2000; 320: 603 – 606 ; doi:10.1136/bmj.320.7235.603

Gould MM, Iliffe S. 1995, Hospital at home: a case study in service development. Br J Health Care Manage 1995; 1: 809-812.

Griffiths Report 1983

NHS Management Inquiry Report DHSS, 1983 Oct 25

Ham C. (2004), Health Policy in Britain [5th ed.] Basingstoke: Palgrave Macmillan

Krogstad, Dag Hofoss, and Per Hjortdahl 2002 Continuity of hospital care: beyond the question of personal contact BMJ, Jan 2002; 324: 36 – 38.

Lee, Wong, Yeung Wong, and Tsang 2004 Interfacing between primary and secondary care is needed BMJ, Aug 2004; 329: 403.

Logan PA, Gladman JRF, Lincoln NB. 1997, A randomised controlled trial of enhanced social service occupational therapy for stroke patients. Clin Rehab 1997; 11: 107-113

Mannion R, Davies H, Marshall M (2005)

Cultures for Performance in Health Care. Maidenhead: Open University Press

Marinker M.1997, From compliance to concordance: achieving shared goals, BMJ 1997;314:747–8.

Newell & Simon. 1992, Human Problem Solving. Prentice-Hall, Englewood Cliffs: 1992.

NICE 2004, Management guidelines : NHS Directive; HMSO, Tuesday 7 December 2004

Nickols F 2004, Change Management 101: A Primer, London : Macmillian 2004

Richards, Joanna Coast, David J Gunnell, Tim J Peters, John Pounsford, and Mary-Anne Darlow 1998 Randomised controlled trial comparing effectiveness and acceptability of an early discharge, hospital at home scheme with acute hospital care BMJ, Jun 1998; 316: 1796 – 1801

Rouse, Jolley, and Read 2001 National service frameworks BMJ, Dec 2001; 323: 1429.

Thompson 1992, Organisations in Action. McGraw-Hill, New York: 1992.

Whitely,S. et al (1996) Health and Social Care Management, Basingstoke: Macmillan.

Wierzbicki and Reynolds 2001 National service framework’s financial implications are huge BMJ, Sep 2001; 321: 705.

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PDG

A COMPARATIVE STUDY OF ELDERLY CARE AMONG HINDUS AND MUSLIMS IN RURAL AND URBAN AREAS OF ALIGARH DISTRICT

A comparative study of elderly care among major religious community of Aligarh district

Introduction:

Since time immemorial, across the world history, care affairs of the elderly were totally family concerns, carried out mostly at home by women and elder themselves (Bookman & Kimbrel, 2011). In the twenty first century the needs, rights, concerns and problems of elderly persons are getting more attention of people from different walks of life i.e. social scientists, statesmen, administrators and social workers etc. Aging is neither a new phenomena nor a kind of ailment rather it’s a latter part of life cycle, considered one among the most challenging phenomena around the world- irrespective of developed and developing country as well. In, India, family based care of elderly is fastest growing concern for the big chunk of elderly population, about hundred million.

This study seeks to highlight the existing pattern of care affairs of elderly in the informal setting, and interaction between elders and cares in the family. Here, more emphasis has given to peep into the nuts & bolts of care relations among elderly and their family members.

Research problems

In the last couple of decades, innovation of wide range life saving drug, its availability and accessibility to common man have improved health of elderly, consequently the raised the life span of people worldwide and in India too, in contrast to previous normal age. That demanding lot of care and support for them includes medical, financial, psycho-social, spiritual and religious care. Now India is the home of about100 million people, taking care of elderly is of course a serious affair, can’t be left as it is going on. In due course of time, by the introduction of industrialization, urbanization and modernization in India, living style has drastically changed, where institution of joint family transformed into nuclear family. The industrial revolution not just change the people living standers, rather it’s too altered the age stratification resulting, lessen the power, prestige and importance of elderly people in society, finally, the elderly turn into social elite to social problems (macionics,2013). Because, the paradox, whether the responsibility of elderly care is a family matter or of government, becoming a matter of concern in India.

Literature review
Significance of study

From the prehistoric time, India has been a country of care, love, affection, companionship and intimacy, where elder’s status remained matter of high consideration and elders considered as nucleus of power. Till the pre-independence era, most of the families were living jointly and agriculture was the major source of income and elders were the headed the family. But, after the industrialization, urbanization and modernization, joint family turned into nuclear family. Now, their position is no more, some time their status worst to social problems. Elderly people above the age of 60, have less resources, income and high life expectancies, require more, need, concerns and cares.

Objectives of the study
To undertake a socio-economic, and situational analysis of the condition of the elderly people in the family.
To comprehend the pattern of family based elderly care practices in terms of various parameters such as religion, area (Rural-Urban), class and gender etc.
To develop an extensive list of needs and difficulties as faced by elders in the family.
To decipher psycho-social and emotional conditions of elderly people and associates factors.
To identify the influence of religion and religiosity on care of elderly.
To critically assess the changing value systems and social institutions that impinges upon the care and social support system with reference to the elderly.
To study the level of awareness among the elderly as regards policies, programmes and legislatives provisions & safeguards in India.

Key Words: elderly, elderly care, family based care practice, religion and religiosity

Conceptual framework
Research questions

This study will focus on the comparison care concerns and status of elderly care in the family among Hindus and Muslims in different settings i.e. rural and urban area. Further will seek to answer the following important questions concerning family based Elderly Care.

What are the existing system and patterns of elderly care in the family?
What are the dimensions and the level of care provided by the family members?
Who is the responsible person for the care of elderly in the family?
What is the quality of the elderly care in the family settings?
What are the major day to day challenges of elderly care in the family?
What is the impact of structural changes in the family on elderly care?
What are the sources of livelihood of elderly people?
What is the attitude of elders toward the care provided by family members?
What is the level of satisfaction among elderly about their care?
What are the role of religion and religiosity on care relation and care of elderly in the family?
What are the differences and similarities in the family based elderly care among Hindus and Muslims in rural areas.
Research Methodology
Scope of the study

This study will focus to study the day to day pattern of care relation and care of elderly and most possible issues and challenges, encountering elderly people within the family. This study will explore the level of differences and similarities of elderly care, among Hindus and Muslims family on the one hand and rural and urban on the other hand.

Universe and Sample

The study will be conducted in the selected rural and urban areas of Utter Pradesh, particularly in Aligarh District. The basic respondent of the study will be elderly people (60 or more age) and their potential caregiver in the family.

Sampling Frame

First of all, willing elderly people for being respondent for the purpose of study will be enlisted, respective to their economic classes, religion and sex, would be helpful to have proper result of the study.

Sampling Method & Sample Design

As elderly care is personal and sensitive issue the sample would be selected on the basis of purposive sampling stratification of the universe will be on the basis of religion (Hindu & Muslim), areas (rural & urban) economic class (upper, middle and lower), and sex.

SAMPLE DESIGN

CLASS

Urban

Rural

GRAND

TOTAL

Muslims

TOTAL

Hindus

TOTAL

Muslims

TOTAL

Hindus

TOTAL

Male

Female

Male

Female

Male

Female

Male

Female

UPPER

10

10

20

10

10

20

10

10

20

10

10

20

80

MIDDLE

10

10

20

10

10

20

10

10

20

10

10

20

80

LOWER

10

10

20

10

10

20

10

10

20

10

10

20

80

Total

30

30

60

30

30

60

30

30

60

30

30

60

240

Tools and techniques for the data collection

This study would be based on qualitative as well as quantitative data. Therefore mixed approach will be adopted, includes survey research for quantitative data to have empirical analysis and qualitative methods i.e. interview schedule and case study method will be used to comprehend a comprehensive and wider description to fill the gap of quantitative data. Through, direct observation and in-depth interview of elders, issues and concerns of their care in the family would be more elaborated and will cover all aspect of their care life, includes, their living arrangement, relationship with family members, in the family

References

Bookman, A. & Kimbrel, D. (2011) Families and elder care in the twenty-first century. Princeton University, 21 (2), 117-140.

Macionics, J.J. (2013) Social problems. New Jersey: Pearson publication.

Ageing is the universal phenomenon encountered by every human individual across the life span. All human beings expect for a healthy and happy old age but not many of them manage to get all those in reality. In this current century, world scenario is changing rapidly in the form of rise in elderly population than before. Many developing countries including Pakistan are affected by this global change. A report on global health and ageing shared recent statistics that in 2010, an estimated 524 million were aged 65 years or older making 8% of world population. It is interesting to note that by 2050 this number is expected to triple to about 1.5 billion signifying 16% of world’s population (WHO Report, 2011). Ironically, in developing countries, geriatric population between 2010 and 2050 is expected to increase more than 250 percent as compared to developed countries. Ali and Kaini (2003) add that this trend in ageing is the result of the demographic shift in fertility rates in combination with mortality rates resulting in ageing of the population (p. 1). Having a glance at our national scenario, it is estimated that the proportion of population 60 years and above in Pakistan will increase from 5.8 percent in the year 2000 to 7.3 percent in 2025 and 12.4 percent in 2050 (United Nations, 2002).

Reason for the selection of this topic

I came up with my thesis topic as every year particularly on festivals such as Eid, different media channels broadcast programs where views of elderly who are residing in their shelter homes are taken. The eye catching moment was the pain and cry these ageing parents expressed, when their children neglected and dumped them in shelter homes, when they most need support in their last years of life. This event influenced me to work for my thesis in the field of geriatrics. Therefore, in the light of the significant global and national figures, the anticipated demographic trend will result in more ageing population. Increase in ageing will predispose the elders to suffer in chronic illnesses, disabilities and new disease patterns. Another, considerable growing fact is that, due to the shift of societal paradigm, elderly population will be the most vulnerable group requiring health attention currently and in the years ahead. Therefore, it is recommended that older adults should remain socially active in their later years (Bergstrom, Holmes & Pecchioni, 2000). The findings from the proposed research contribution in this area particularly in Pakistani context will assist in filling the gap where elderly population can regenerate themselves without being isolated from social life, and can live with quality, dignity and free of violence in their empty nest days.

Significance of the problem

Many decades ago the concept of violence against women and children was objected throughout the world but researches in these areas have resulted in the protection and formation of laws for these groups. Likewise, elderly abuse is yet another novel and critical public health and social issue that need prompt attention. Infact, it is one of the most serious subject which is under reported nationally and internationally resulting in thousands of silent victims. Numerous studies are being conducted in the developed countries on the various aspects of the ageing population in order to ensure optimum quality in the later phase of life time. However, many of the South Asian countries including Pakistan are facing serious challenges of decreased economy, low savings, high inflation rates; financial benefits for few percentages of government employees, lack of health insurance coverage are making the life of this vulnerable group questionable. Apart from these encounters, elderly population are confronting with the decline of extended family system and the emergence of nuclear families (Jalal & Younis, 2012). In Asian cultures, many of socio cultural practices are grounded on concept of extended family system. Old members of the family are taken care by the young generation and it is regarded dishonorable if any elder lives alone or in nursing home. In addition to it, this transition has led to the decline in elder decision making power and position and to enjoy later years with dignity and self-worth. Due to this conversion “the elderly are at risk, as the younger and more productive members of the family take over, marginalizing the elderly into positions of dependence both social and economic”(Subzwari & Azhar, 2010, p. 2).

Another important change that has taken place in the last couple of years is that younger individuals are migrating for better employment opportunities leaving behind parents with no one to care for them, causing elderly to live alone or they are shifted to shelter homes. Sabzwari and Azhar (2010) supports that “one in five patients at the tertiary care hospital in Karachi are elderly. It is estimated that at least 6-7 % of elderly visiting geriatric clinics at the Aga Khan University Hospital Karachi are living alone with little assistance” (p. 2). Increase in life expectancy has led to substantial increase in aging population globally and it is predicted that “the world’s elderly population will continue to increase with an estimated rate at 67 % residing in developing countries by the year 2020” (Karunakara & Stevenson, 2012, Ageing population section, para. 1). In Pakistani context, 60 years is designated as the age of elderly. Jalal and Younis (2012) shares WHO report that:

5.6 % of Pakistan’s population was over 60 years of age, with a probability of doubling to 11 % by the year 2025. Pakistan’s life expectancy was increased from 45.6 years in 1950 to 66.8 years in 2008 with a probability of increasing to 72 years by 2023 (p. 2).

Hence, the decline of popular extended family system and rise of career oriented families, and change in familial values compounded by substantial increase in ageing, subjects older population to maltreatment and this area requires immediate consideration. Jamuna (2003) rationalizes that “a series of developments, such as urbanization, industrialization, and migration, and a growing sense of materialism and individualistic orientations have threatened the culture of yesteryear (p.129). One significant cause for low rate of abuse in Asian cultures is compliance to the value of respect for their elders whereas western cultures sideline them but alarming sign is that this cancer is gradually growing in our culture.

Research question

Older people are left with countless problems in their later phase of life where these years are believed to live in respect, solemnity and self-worth with their married children and grandchildren. On the contrary, this age group has to spend their lives in isolation at home or in shelter homes due to neglect and cruel treatment by them. Although, these old homes are answer to most in need yet they still not provide a solution to majority of the population. Our culture despite its gradual transformation still adheres to the value of caring for their elderly at home (Subzwari & Azhar, 2010). Elder abuse is the alarming public health issue present in both developed and developing countries. Very little information is available regarding the extent of maltreatment in elderly especially in developing countries, it is estimated that 4-6% of elderly people have experienced some form of maltreatment at home. (WHO fact sheet, 2011). However, older people are often afraid to report cases of maltreatment to family, friends, or to the authorities. There is no reliable data or research conducted in Pakistani context, where sufferings of these elderly populations living in nursing homes could be researched and addressed. Dildar, Saeed and Sharjeela (2012) mentions that “elder abuse and neglect are difficult to quantify as these occur in the privacy of the home, institutions and under reported in our country” (p. 662). Based on the above facts and literature I came up with the research question that, what are the experience and the perception of elderly people living in nursing home in Karachi, Pakistan?

Literature search strategy

Literature search was conducted in a systematic way by utilizing available electronic databases, in order to review and explore existing literature related to abuse of elderly population in nursing home. In order to detect relevant literature, two major databases, CINHAL plus with full text and PUBMED was used. Another search engine like Google scholar was also searched to find the relevant literature sources. These databases were searched for the time period between the year 2000 and 2012. Different key words or combination of key words along with the use of Boolean operators were used for all search engines, like elder abuse and nursing homes, elder maltreatment and nursing homes. A synonym for elder abuse like geriatric abuse and for nursing home like shelter home was typed on the search bar. Relevant articles were hunted when the key words were written in research title, abstract of review articles of all data bases. A separate search was carried out for identifying the available literature in Pakistan for this purpose the term Pakistan was added along with other key words to search relevant Pakistani sources. Reference lists of retrieved articles from these databases were also checked for relevant literature. Search from all data bases were narrowed down by the use search filters like year range, gender, age and language. For detail literature search and number of hits (See appendix A).

Literature review analysis on elderly abuse in nursing homes
Definition

The subject of elder abuse began to receive recognition since 1970, and the first boom on elder abuse appeared in UK medical journals in 1975 as “granny battering”. It was identified by British Gerontologist and the first population based study was done in USA in 1988.

International Network for the Prevention of Elder Abuse (INPEA) defines “elder abuse is a single or repeated act or lack of appropriate action, occurring within any relationship where there is an expectation of trust which causes harm or distress to an older person” (INPEA, 2002, p. 3). Age bracket for elderly is 60 years and above. Some predictions indicate that one million people turn 60 every month and 80 % of these are from the developing world (WHO/INPEA, 2002). All the susceptible victims of abuse who are 65 years or more and suffering from mental disorder, chronic disease, and disability largely depend on the funded institutions or NGO’s but if there is financial constraint then these vulnerable groups have to confine them to home. (srilanka 2009).

There is considerable debate on the definition of elder abuse because some cultures foster certain behaviors that may be considered as abuse in different cultural context. In Australia, “elder” refers to older local people who have specific positions of power within native communities. It was recommended that “elder abuse” be replaced with “senior abuse” in an Australian context as it referred to original and senior population (Ryan, 2009). It can be argued that abuse occurs within a relationship where there is an expectation of trust, no matter different cultures gives different definitions on elder abuse. However McFerran (2009), asserts that “research on domestic violence in elderly women asserts that, it is based on unequal power relations and traditional devaluation of women, not on relationships based on trust” (as cited in Ryan, 2009, Definition of elder abuse, para. 3). Therefore, irrespective of the type of abuse, it will definitely result in pointless miseries, pains and sorrows, and decrease quality of life of elderly.

Types of elder abuse

Elder abuse is categorized into five different types: physical abuse, psychological /emotional abuse, financial/material abuse, sexual abuse and neglect (WHO/INPEA, 2002). Most recent data from USA states that, there are about 570,000 cases of elder abuse reported each year, 55% of the cases suffer from neglect which is the most common form of elder maltreatment (Facts on elder abuse, 2012). Economic abuse is one of the most frequently reported forms of abuse, followed by neglect, psychological or emotional and finally physical abuse. Sexual abuse of elders is not reported as frequently as any other type of abuse (Ryan, 2009).

Another dimension of elder maltreatment is that it is not restricted to home environment, risk is even leaving them in nursing homes, hospitals and long term care facilities. An empirical study in New Zealand reveals that psychological abuse (59%) is followed by material/financial (42%) and physical abuse (12%) were most frequently identified types of abuse. Sexual abuse occurred in 2% of reported cases (Gadit, 2009). Canada is one of the world’s highly civilized countries reports that 22% of Canadians think a senior they know personally might be experiencing some form of abuse, 90% feel that the abuse experienced by an older person often gets worse over time ( Govt of Canada,2008, quick facts on elder abuse in Canada ).

Implications of the proposed research in nursing

It is a challenging task for all health care providers to efficiently assess the elderly group so that abuse can be identified and reported for the immediate interventions. Proposed research on this subject will make people aware, that elder abuse will prevent older members from being favorable and positive members of the society. Furthermore, evidence based knowledge on this matter will assist in safeguarding and promoting welfare of the elderly clients. According to Lachs and Pillemer (1995) guidelines from the American Medical Association suggest that “all older adults be asked by their physicians about family violence, even in the absence of symptoms potentially attributable to abuse or neglect” (p. 438). A careful history taking and interviewing technique is crucial in identifying accurate information on the possible abuse. If the violence on elder is confirmed then priority is to ensure safety of the elderly person by separating from the perpetrator. In the western countries, based on their cultural background, majority of the old age population resides in shelter homes. In Karachi, nursing homes are managed by private NGO’s or religious organizations. The Catholic Church runs three old people homes in Karachi, and people residing in these old homes pay a minimal fees, and rest are generated through the church (Subzwari & Azhar, 2010). Some nursing homes are governed by religious communities functioning wihh the help of volunteer and donation support. Gadit (2009) identifies that “Edhi Foundation is one glaring example of a service where abandoned elderly people are housed. These elderly people are shunned away by their children under different pretexts like poverty, illness among elderly and general intolerance” (p. 3).

Recommendation for the prevention of elder abuse

A national policy for the promotion of better health of the elderly was designed in 1999, but implementation is yet to be seen. This policy integrated training of primary care doctors in geriatrics, availability of dental care, domiciliary care, and a multi-tiered system of health care providers for elderly including physical therapists and social workers. (sabeena jaleel 2012).

An important recommendation is the initiation of awareness programs among health care professionals on the subject and the formulation of assessment tools to detect abuse. Another, is the workshops for nursing and medical graduates should be conducted to detect and manage elder abuse more effectively resulting in prompt treatment measures. Potential research on various aspects of care of elderly can urge in the development of policy at governmental level for the protection of geriatric population1.

At national level, electronic and print media can play a key role in raising awareness on this subject. It can act as a medium for the provision of specially funded and recreational shelter homes, free health care facilities, and formation of legislative policies (Marshal, Benton & Barzier, 2000.

Research Methodology

The research approach which would best fix on the research question would be qualitative in nature. I would like to go for Phenomenological method as it deals with the truth about reality built in people’s lived experience (Polit & Beck, 2008, p. 227). This approach can be applicable on those concepts which are central to the life occurrences of the human being. The core goal is to completely understand persons lived experience and perceptions that it will generate.

Inclusion Criteria

Inclusion criteria will involve all elderly people with an age of 60 years and above in both the genders. Another would be all elderly population living in nursing homes in Karachi.

Exclusion Criteria

My exclusion criteria would be all elderly below 60 years of age.

Conclusion

Whenever a question arises, like what are the effects on children of alcohol dependent parents, we all have the option to put forward a few answers and to set this topic aside. “Alcoholism is also known as a family disease. Alcoholics may have young, teenage, or grown-up children; they have wives or husbands; they have brothers or sisters; they have parents or other relatives. An alcoholic can totally disrupt family life and cause harmful effects that can last a lifetime” (Tetyana Parsons, 2003). Life is something what we have to pass over moral values and good living examples to the next generations.

Since we all belong to family, we can never ignore the relevance of family life, and in family children are supposed to get the primary consideration and caring. But in an alcoholic’s family, the most affected group will be their children. “Parents who abuse alcohol could cause a negative impact on their children’s lives. Feelings of anger and neglect can follow a child throughout adulthood and have a detrimental effect on his relationships with others” (Bogle, D. 2010).

Dustin Bogle, an experienced fitness instructor, nutritionist and fitness article writer, gives some major problems that occur to alcoholic’s children. Aggressive behavior is one of the first characteristics that a child might develop from having a parent who abuses alcohol. The aggressive behavior of children may lead to academic failure and serious social problems.

As the second one, he mentions warning signs. Children may show warning signs of having an alcoholic parent. They may act out in anger with other children, or might find them lying about things. When scolded, children may become scared of their parents finding out, or they may be causing trouble because they want that extra attention that they are not receiving at home.

The environment that the children are placed in is often unpredictable and chaotic. This is the third point he puts forward. The oldest child in the group is taking care of the other children while the parenting skills are lacking. Other children may become trouble-makers, and some resort to isolation, often becoming shy and unresponsive to other children.

The last observation of Dustin Bogle, probably a crucial one, is the cycle of addiction. It is a very common and dangerous occurrence, and lot many dilemmas are attached with this as well. Criminal acts, teen pregnancy and other mental and emotional issues may arise. The children may become institutionalized in either jail or a rehabilitation center. Children may also be taken out of their home if the alcohol abuse becomes really bad, or they could be put in foster care or end up living on the streets.

Alcoholism is a widespread disease, and it has deep rooted health related issues and severe long lasting consequences. The funniest thing in regards with alcoholism is that still it is being considered as a medium of socialization. The behaviors of parents are the guidelines of their children, and it doesn’t matter whether it is good or bad. Amber Keefer, a famous health related article writer who has more than 25 years of experience in the field, is presenting some very good information in this particular matter. Fear, low self-esteem, self-blame, injury/illness, financial effects, and changes in Family Structure are the effects that she suggests for a review. If we can have a deeper look in to each point, we can see that all these points are very relevant.

Children of parents who abuse alcohol often live in fear, primarily because they are abused or neglected when a parent is under the influence of alcohol. They may witness domestic violence against the other parent, their siblings or even other adults living in the household. Children who are frightened for their own safety may suffer from anxiety, sleep disturbances and depression.

Children often develop low self-esteem when one or both parents abuse alcohol. When parents are more preoccupied with alcohol abuse than their parental roles, a child may not get the sense of security he needs to develop healthy self-esteem.

Children often blame themselves when a parent abuses alcohol. They think that it must somehow be their fault if a parent uses drugs or drinks too much alcohol, and that will result in the loss of their self-reliability.

Children can suffer injuries or health problems as a result of a parent’s alcohol abuse. If a pregnant woman drinks alcohol, the baby can develop long-term health problems. The unsanitary and unsafe situation at home may lead to certain type of illness and injuries.

A family with an alcohol abused parent will definitely have economic consequences, and that family will be forced to live a low income life. Such a situation may develop an inferiority complex in children.

Separations and divorces may happen in such families and those incidents will create even more stress and confusion for children. A child who is being raised in a single parent house hold, may not get proper care or even unable to get better developmental opportunities.

“Patti Kelly” a freelance writer and registered nurse with many years of experience in pediatrics, geriatrics, public health and preventive care have made some serious observations on this topic. She is describing the effects under certain specific classifications; they are: psychological, educational, economical, social and developmental.

Denial, anger, shame, anxiety, hopelessness, self-neglect, shame and isolation are a few of the psychological consequences noted in children of alcohol abused parents, and a sense of security and positive outlook are difficult to establish for such children.

Children of alcohol abused parents are at an increased risk of learning disabilities, poor school attendance, and they are also more likely to be expelled, be institutionalized or drop out of school.

An alcohol abused person is always in a risk of being either unemployed or under-employed and lack of income results in an overall decrease in the family’s standard of living and can lead to difficulty meeting basic needs.

The children of an alcoholic may be ashamed to go out in public, and such shame and fear may also prevent them from having friends over.

Trust and security are being considered as the promoting agents of promote healthy development and a family with alcohol abused parent can never provide such a situation at their home. Physical and sexual abuses are also more common when there is a parent who abuses alcohol, and these factors, may negatively impact a child’s normal development, making children more prone to suicide, anxiety, eating disorders and depression.

As a part of this research, it is very important to note about the treatment side of the alcoholism. As I mentioned earlier, alcoholism is a disease which requires specific treatment, even though there is no medical treatment for that. But alcoholism is a treatable disease and many treatment programs and approaches are available to support alcoholics. Motivation is the major portion in treatment of alcoholics, and other important step is the self-decision. We can categorize the treatment in different steps, they are, commit to stop drinking, set goals and prepare for change, withdrawing from alcohol, find new meaning in life, plan for triggers and cravings, get support and getting started on treatment. Although it is not that easy to achieve, a powerful will and support from others, the goal is so close.

The importance of this research is that what the role of a teacher in this issue is. Since the group I have taken into consideration here are children, and only because of that without any doubt I can say that a teacher can do wonders in this particular issue. Motivation is the better medicine for this and a teacher can do it very easily. Normally, almost all the parents are too much concerned about their children, and a teacher will get lots of opportunities to have detailed observation and discussion with parents. A teacher can include the topic “alcoholism” in their monthly meetings, and they can conduct one on one meeting with parents in which they can collect details of their family. The moral support for the children is the greatest part in this, and the teacher is the best ever person who can provide that.

All the above finding and studies are giving us a clear picture of the consequences that could happen to the children of alcohol abused parents. If we can have quick look, we can see that the alcoholic abuse of parents has strong influence in their children’s future. Psychological, educational, economical, social and developmental issues can be counted as the major problems of the children of alcohol abusing of parents. Even though there is no medication, treatment of alcoholics is very important. Since a teacher has an influential role in a child’s life, a teacher is supposed to pay more attention in giving moral support to children.

For me, preparation of this research paper was an exciting experience. I am sure that the pieces of information that I shared here is just like a drop of water from an ocean. Although I had a chance to do a survey in this subject before, I was quite ignorant about its consequences fully. Most of the information that I gained through this research is really worthy. If we can do a little bit more deep research, definitely there are a lot more issues that we can find. The importance of peer groups and communities in the treatment of an alcoholic is a relevant question that I would like to rise. As the alcoholism is a social disaster, what are the steps that could be taken by the official authorities, in order to have control on this, is the question that I would like to ask. As an ECE student what I can offer is my moral support to the children those who are having this issue, and my effort to educate the society in regards with this dangerous problem.

For the purpose of this assignment I will focus on the publication ‘Working Together to Safeguard Children (2006) and the General Social Care Council’s Code of Practice for Social Care Workers (2005) to critically evaluate and explore how they impact upon the role of the social worker whilst carrying out initial enquiries.

The social work profession promotes social change, problem solving in human relationships and the empowerment and liberation of people to enhance well being, utilising theories of human behaviour and social systems. Social work intervenes at the points where people interact with their environments. Principles of human rights and social justice are fundamental to social work (International Association of schools of social work and international Federation of Social Workers 2001). Social workers act as negotiators between the individual service user and the wider society in order to assist the individual with the problems they are facing. This is performed by professionals utilising theories, their own values and beliefs of human behaviour and social systems (International Association of schools of social work and international Federation of Social Workers 2001).

Working Together to Safeguard Children (2006) provides guidance for professionals who are working with children and their families to assists them in their safeguarding practice. This document places emphasis on the need for joint working as this provides a variety of knowledge, theory and skill when working with children and their families. The General Social Care Council (GSCC) identified codes of practice that aim to raise the standards in social care services, highlighting the responsibility of social care workers and their employers to ensure that the codes are followed within practice.

The General Social Care Council (2005) highlighted that the Codes of Practice were to reflect the existing good practice of professionals and shared the standards and ethical practice to which they aspired. The main aims of the Code of Practice are to inform services users and the public of the standards that they can expect from social care workers and to provide social care workers with clear lines of accountability, therefore ensuring that workers are aware of the responsibility upon them to ensure that these conduct do not fall below the standards expected of them as this can lead to the dismissal of workers (GSCC 2002).

Social workers are challenged on a daily basis to uphold the Codes of Practice while implementing government policies and procedures and have the responsibility for making difficult decisions and recommendations that will ultimately affect and impact upon the lives of children and their families. It is therefore critical that professionals are able to make these decisions by drawing and reflecting upon guidance to enable professionals to make ethical and sound decisions in the best interest of the child and their family. Social workers have to accept and be accountable for all their actions and need to be able to explain why they have acted in a certain way. Therefore social workers need to have a good understanding of how nature and society affects the way in which they practice enabling them to work competently and efficiently.

Social workers strive to ensure that children are protected from harm as best they can and in order to do so social workers are trained and led by policies and procedures set out not only by the government but also from within the employing authority. The law also forms an essential part in the decision making process to ensure that children are not subject to significant harm.

Professionals have a duty to investigate and complete initial enquiries under Section 47 of the Children Act 1989, if there is reasonable cause to suspect that a child whom is living or found within the local area is believed to be suffering, or is likely to suffer significant harm (HM Government 2006). The Children Act 1989 introduced Significant Harm as the threshold that justifies compulsory intervention and determines if a child is made subject to a protection plan or provided with support in the children and families arena (O’Loughlin & O’Loughlin 2008) therefore a child may be supported on a child in need basis.

The process will begin at the referral stage which is the first point of contact when information and or concerns are brought to the attention of Children’s Services, this can include a case that is already open to the associated local authority if there are an accumulation of concerns or a pre birth assessment indicates significant harm to an unborn child (DOH 2006). A team manager and a lead social worker will be allocated to the case and a decision will be made as to whether or not there are concerns which could pose potential or actual harm to the child, if this is so then a decision will be made to proceed to a strategy meeting and will be recorded at this point by management.

A strategy meeting should involve Children’s services, Police, Education, Health and any other relevant agencies who are working with the family. Working in partnership with all professionals involved is essential as sharing information helps to build a clear picture of the child, family unit and the issues causing concern, thus promoting the safety and well being of the child (Children Act 1989). However in some instances this sharing of information is done without the consent of the parents which immediately conflicts with the code of practice set out by the General Social Care Council (2005) as it states that the rights and interests of the service user must be protected, respecting and maintaining the dignity and privacy of the service user. Already there is a contradiction starting between the Working Together to Safeguard Children guidance and the Codes of Practice.

Another conflict emerges if the outcome of the strategy is to proceed with a Section 47 enquiry, due to Working Together to Safeguard Children (2006) stating that; ‘Parents and those with parental responsibility are informed of concerns at the earliest opportunity, unless to do so would place the child at risk of significant harm, or undermine a criminal investigation and that as parental consent has not been obtained any work done should be practiced in a manner which allows for future working relationships with the family’.

This sounds plausible and is aimed to be in the best interests of the child however it conflicts with the Codes of Practice (2005) which state that; ‘a social care worker must strive to establish and maintain the trust and confidence of service users’. As a social worker it is incredibly difficult to uphold the Codes of Practice whilst following the guidance of Working Together to Safeguard Children, due to not being able to be as open and honest during the initial contact as possible. The rationale for this is that the only information to be provided to the family is that, that is agreed within the strategy meeting (HM Government 2006).

Whilst carrying out a Section 47 enquiry it is essential that the child in question is spoken to alone as this gives the child the opportunity to express their wishes and feelings and allows professionals to gather further information. If the child is not spoken to alone it reduces the ability to appropriately assess the needs and risks surrounding the child. When speaking to the child it is imperative that discussions are practiced in a way that minimises distress but maximises the likelihood that they will provide accurate and complete information as gaining the child’s views can be critical in the prevention of significant harm (HM Government 2006). Clearly stating that professionals are able to speak to children without the consent of parents or anyone with parental responsibility, if there is evidence that the child would be placed at further risk should the parents be informed.

Consequently social workers are following the guidance from Working Together to Safeguard Children yet disregarding the Codes of Practice which places a duty on the social worker to ‘communicate in an appropriate, open, accurate and straightforward way’ (GSCC 2005).

Section 47 enquiries may include a medical examination and failure to consent from the parents or failure to allow the child to be seen in general may result in the professionals having to make an application to the Court in respect of being granted appropriate orders such as an Emergency Protection Order or Assessment Order, professionals will be directed by legal professionals in this instant.

Once again there are conflicts within this, in respect of the Codes of Practice, by attending Court and seeking an order, families may feel that they are not being listened to or their wishes respected, in some scenarios it may be felt by services users that their privacy and dignity is not being respected. However there is one Code of Practice that has some similarities to Working Together to Safeguard Children; ‘taking necessary steps to minimise the risks of service users from doing actual or potential harm to themselves or others’ (GSCC 2005).

It may also become evident when completing a Section 47 enquiry that the child in question and siblings if any, may need to be accommodated whilst subsequent assessment are complete. The local authority will whenever possible attempt to ensure that the child can remain at home and appropriate steps will be taken to ensure the child’s safety, however there are times when the risk is such that there is no other option than to remove the child from the family home (HM Government 2006). There is a clear contrast to the Codes of Practice as they state that ‘service users have the right to take risks’ hence placing professionals in a position whereby they need to make decisions as to whether the risks can be managed without leaving the child at risk of further harm.

As a social worker you are faced with conflict and dilemmas when attempting to work in accordance with both Working Together to Safeguard Children and the Codes of Practice. This leads to dilemmas in practice that require consideration and in order for social workers to make sound and professional judgements it is essential that social workers have regular supervision to aid their practice, allow them to reflect on decisions made, look at various interventions and possible outcomes. Supervision allows for social workers to ensure that they provide effective and efficient work with children and families.

Working within child protection is complex and the need to share information is vital therefore any decisions that are made with regards to children should be done so in a multi-agency manner. This aims to ensure that professionals are not individually held accountable for failure to work in accordance with the Codes of Practice and government guidance while incorporating inter-agency working, which is fundamental when combating child abuse (Working Together to Safeguard Children 2006).

The Codes of Practice (2005) express the need for social worker to be accountable for their own work, this includes the need for social workers to recognise and respect the roles and expertise of other professionals and work in partnership with them. Joint supervision with professionals in a similar field gives the opportunity to share knowledge and skill an may cover something the fellow professional has failed to notice therefore providing and even best quality of service to the public.

It has become abundantly clear throughout this assignment that social work is ever changing and that the decision making process, individually or jointly between professionals is never easy, especially when it involves the lives of children and young people. Adhering to The Codes of Practice whilst also adhering to government guidance, simply, causes conflict in practice this is something that may never change and as a social worker it is imperative to note this and whilst following policies and procedures we must not forget that the children we are trying to protect and the families that they belong to are people, human beings with feelings, rights and deserve to be treated correctly.

3. Why and how might shift work impact on the health of employees? What could be done to minimise the health risks of such work? In modern life shift work becomes a necessary part of life. Shift work is an employment schedule that is not in the usual daytime hours and in which two or more groups of workers work at separate times in the 24 hrs. (Finn, 1981).According to HSE(2006) approximately 14% of people in UK doing shift work in different shifts Some institutions like hospitals, ambulance services, police department, transport industry and some industries needs continuous 24 hrs shift work. But this shift work disrupts the circadian rhythm that can lead to reduction in alertness. The diurnal rhythms control pulse rate, the cardio-pulmonary system, composition of blood, blood pressure, secretions of endocrine glands, appetite and wakening and sleep cycle. So shift work interrupts these natural processes for which the human body is normally programmed. So this can cause compromise in health and safety of the workers. Lack of adequate sleep has produce adverse affects including nervous system related disorders, physical problems which can lead to accidents on job. Fatigue is also the most common reaction in shift workers. Shift work is the main cause of fatigueness in combination with physical, mental and emotional factors that causes exhaustion in workers. Shift work affects the general health and performance of the employees. Because of shift work employees have not follow any routine in their eating habits and they have not regular pattern to sleep and this may produce health problems (Finn, 1981).

According to health and safety perspective all the working hours are not same. Night shifts are more difficult and risky. Working overtime also raises the fatigueness in a worker. This can lead to other accidents. Some workers do shift work with their own choice but mostly do because of economic necessity (ACTU Guidelines on shift work& extended hours, 2000). Mostly people don’t know the extra stress that night shift workers have, is because of work in late night hours. When most people are in their beds, night shift workers are getting ready to work. Night Shifts put negative impact on health of workers because these shifts affect the circadian rhythms of the human body. These circadian rhythms change all over the day and night to regulate different biological functions of body. For example our cardiac rate and the temperature of body changes throughout 24 hrs and this is lowest at 4am and it is on the peak in the mid of afternoon. The circadian rhythms reset after 24 hrs by environmental factors like light and darkness. Temperature of body goes up with the day light and goes down at night. That’s why body is active during daytime, whereas in the night it is meant to sleep for recovering and replacing the energy of the body. But working at night disturbs “biological” clocks that’s why sleeping becomes difficult so workers feel fatigue. Work during night shifts imbalance these rhythms in spite of their regular timing. Because of this, workers who can do night shifts come across problems in sleep, fatigueness, gaining weight and problems related to digestive system. Some of these problems also become chronic diseases. According to study done by the Journal of the National Cancer institute (2001) depicts that the females doing night shifts have more risk of breast cancer because of exposure to light during night which interrupts the production of melatonin (Victoria,2010).A study found that the breast cancer risk is 60% more in women doing night shifts. Because the melatonin hormone mainly produced during sleep. However several studies found rhythmic adjustments to a new work schedule sets in 4 days to 2 days. The continuous change in day, evening and night shifts diminishes the normally programmed body rhythms.

According to Sparks and Cooper et al (1977) the field of occupational health psychology, overtime fatigue is an important factor in the health conditions and working hours plan. Because of excessive work in shifts raises in backbone injuries, bacterial infections, three times increase in accidents on job after 16 hrs of work these all have related to fatigue and overtime in shift work (Rosa, 1995)

To minimize the health risks of shift work: According to article “how lifestyle changes can reduce shift work stress” published in Sleep disorders guide (2006-08) suggests that workers have to follow some useful measures to tackle the shift work correctly. Workers should not take more than 2 night shifts regularly in one week. So that their body take rest and the workers are not faces fatigueness. Workers take frequent breaks from work when they feel tired and not able to stand in same posture for a long time. Keep entertaining by talking to your fellow colleagues if worker feel difficult to work during long hours in night shifts, but always follow the safety measures. Workers have to follow proper eating habits .Afternoon shift workers take their meal in the middle of day, not in middle of their shift. Workers are advised not take heavy meals when they go for night shifts and they take light meal throughout night shift and take moderate breakfast. A heavy meal compels the workers to sleep and this may lead to accidents and even discomfort in stomach. After completing the night shift workers have to take proper rest with adequate sleep. They have to avoid heavy exercise before going to bed because metabolism of body will still elevated for many hours and this will produce difficulty in sleep. While sleeping they relaxed their mind and keep their brain free from any disturbance. If they fail to sleep then read a book or listen some music. Workers should follow healthy life style according to their shift work and they should exercise 30-40 minutes daily. With doing regular exercise his mental and physical health remains good and this will reduces the health problems. Workers have to take proper diet to maintain their physical health. Workers drink more water in night shift. They have to socialize with other coworkers to minimize disruption in social life. Workers practices to reduce the stress. They have to schedule daily events by the calendar use. Workers choose the prioritize tasks and always tackle one task at a time (Stones, 1987).

4. Critically review the evidence that multiple roles in work and non-working life lead to negative outcomes for employees and organizations.

Work culture changes rapidly in present days. Previously concept of work done is to fulfil basic human needs but now this is not the fact. The basic needs are not enough, but standard of living is also an essential part for doing work. According to Blekesaune (2008) unemployed people are at major risk of breakdown in personal relationships .Males and females who lost their jobs have similar impact. According to Work life Balance Survey(Hurst and Richards 2003) there were more than 1200 employees who took part in internet survey done in the form of questionnaire and each one ,out of the ten participants worked more than 70 hrs every week, whereas he is being signed for 35-40 hrs. 98% of workers took their office work t home. 17% of them skip their lunch break.97% workers found that it is difficult to balance work and life.70% of workers took work as main stressor (Work life balance survey, 2003).

Work or nonwork conflict generally noticed when work and non work roles are not compatible with one another and participation in one role made difficult in participating in another role (Greenhaus and Beutell, 1985). The Spillover Model (Loscocco and Roschelle, 1991) guided well on present study related to work and non work conflict. In Spillover model, there is a positive relation given between work and non work roles to the limit of satisfaction or not satisfaction in one of the roles moves into other (Bond et al., 1998).Work and non work conflict influences the general health and mental wellbeing of workers and their families. As an example, a recent epidemiological study done in Australia establish that the parents who work regularly for long hours or back home stressed have develop more physical illness and other psychological problems(Earle,2003). According to Duxbury (2003) work and non work conflict impact on the ability of workers to bring up their families which results in lesser levels in family wellbeing and stability. Researchers found that policies which are designed to assist work and non work conflict can change workers behaviour which is good for the organization. Evidences found that the policies which are family friendly results in raises in back to work after the delivery (Squirchuk and Bourke, 1999).

When we are talking about the effect of stressors on a person, few researchers analysed to divide the life of a person into separate functional fields. Like divided between the home and work place. Because in each area individual play more than one role. Like in family they have two roles spouse as well as parents and same in their workplace they follow different roles. Researchers found that in each field person suffers from stressors and strain. So if in a demanding job person becomes stressed at work place then it’s quite possible that he come back home in same state of mind, so this create difficulities in home atmosphere also. There are two major hypotheses proposed to explain the work -home relationship.

The spillover hypotheses proposed that there are no hard boundaries between different life areas. The work and nonwork experiences will positively related to one another. So the persons, who changed, stimulate and satisfy work experiences will likewise same non work experiences. Thus stressful moments experienced in work makes person tired at work as well as when he came back home, this makes difficult to interact with the family and social life. Case studies based on early work approve this approach (Young & Wilmott, 1973, Piotrokowski, 1978).

According to compensatory hypotheses, in between home and work there will be negative relationship. As an example, for boarded and non stimulating work experience, a person compensates this with good experience at home or from other free activities (Wilensky, 1960, Rousseau, 1978). According to the compensatory hypotheses, a person majorly involved in work would be not involved at home or the other way around.

Another immaterial approach is segmentation hypotheses which approve that work and non-work areas are essentially nondependent, separated psychologically and perform separate functions (Blood and Wolfe, 1960, Dubin, 1973). This was the primary formulation of work and home relationship but ‘myth of separate worlds’ of family and work has exposed (Kanter, 1977). This model is now often dishonored. These models just gives idea that up to what extent behaviour in one area lead to same or different behaviour in other, or to which extent satisfaction or stress in one role is associated to similar feeling in other (Staines,1980).

According to National Study of changing work force, 19% of fathers who are working and 38% of working mothers feel stress oftenly and very oftenly in the three month period of this study. The data shows that male and female both suffered by contrasting demands of the family and workplace to balance these two. These conflicts noticed in previous two decades, when labour work becomes more in organizations and females are equally take part in working in organizations. The increased ratio of working women splits their role in two areas.

In studies of Work and family conflict mental health is always targeted. Mental illness is inability to cope with the surrounding environment and reality. These studies proved that mental health depends upon the variation of experiences in work and family (Forne, 2000). In work and family conflicts there is not any selective gender but mental problems for e.g. mood changes are more in females who are working then males (Kohn, Dohrenwend &Mirotznik, 1998). In the midlife, work and family conflict and mental stress are comparatively stable. So if the worker is having mental health problems, this is not good for organization also. Worker not cooperated with co workers and the environment of work is always tensed. This will affect the production of the organization also.

There is another major problem which occurs because of work and family conflict that is drinking. When a worker not balance his both roles and because of stress start drinking alcohol and become habitual then this make the situation worse. Because he could not take care of his family properly and even not concentrate on his work. Because of this he cut off from his family as well as from society and even from his co workers. He or she might become a victim of accident at work. Because of drinking problem he lost money and this also affects his financial condition. Marriage life of worker is also affected that’s why now a day’s divorce rates are high, because of imbalance in family and work. When work and life conflict occurs care of children and elderly people becomes difficult. Sometimes person even thought about the suicidal attempt because of this worse situation.

5. Discuss and critically evaluate research that has examined the impact of bullying at work.
Introduction

Bullying at work is behaviour of annoying, offending or affecting negatively to a person in his work tasks (Einarsen, Hoel, Zapf & Cooper 2003).According to HSE bullying at work is to ignore someone, circulating rumours, annoying somebody in front of others, giving somebody a task which is not achievable, constantly underestimating somebody’s work .It is not a new behaviour but it was not much noticed till the end of twentieth century. Bullying was brought into the public arena by Andrea Adams, a journalist of UK, who wrote a book o bullying, in the year 1992.He also produced radio documentaries in which discussion was there on workplace bullying. In UK and Ireland bullying word is used whereas in Germany, Austria and Scandinavia it is called as mobbing and in US as emotional abuse. According to the study, Destructive conflict and bullying at work (Hoel &Cooper, 2000) one in every ten people bullied on work within last 6months and the number increases to one in four in last five years. According to this study women are bullied more as compare to men. Managers or persons on senior post were culprit in 74.7% cases of bullying. The obvious experienced negative behaviour at work was somebody was not giving proper information, which gives negative impact to your performance or impossible targets or deadlines. Bullying was mostly associated with bad mental health and less satisfaction in organization (Hoel &Cooper, 2000).

Types of Bullying

Bullying at work due to direct comments on employees causes harasses, humiliation and put negative impact on performance in work and this creates uncomfortable working atmosphere (Einarsen& Rakness, 1997).It is found that usually bullying behaviour has two categories: personal and work related. Personal is an again and again offensive comment regarding you and your personal life. Work related is direct comments on your work task, not giving reasonable deadlines to complete tasks, non manageable load of work. According to Zapf (1999) there were five types of bullying behavior: A. Make the task more difficult. B. Stop communicating with somebody. C.Attack on anyone’s personal life. D. Humiliate and criticize in front of others. E. Circulate rum ours. Now a day’s physical bullying or sex abuse related bullying also found with women employees in workplaces.

Impacts of bullying on psychological wellbeing

Bullying at work put direct impact on person’s psychological wellbeing. Psychological impacts are mental stress, anxiety, loss of sleep, less concentration in the given task or work, binge eating, addiction to alcohol or smoking, lack of alertness at work ,due to this sometimes accidents occurs. Psychologists noticed behavioural changes in workers, who face regular bullying at work. Worker becomes irritated, emotional, and aggressive. Some women who faced sexual bullying, later on gone into reverse personality. They become aggressive even on situations which are ignorable. They hate opposite sex either he is in his own blood relation. If a person continuously suffers from bullying he may develop Post-traumatic Stress Disorder (Bjorkqvist et al, 1994, Leyman and Gustafsson ,1996).

Impacts of bullying on physical wellbeing

The person who faces regular bullying for long time also found physically ill. Because of this his blood pressure becomes high so he is suffering from hypertension and it is one of the indicators for cardiac diseases. Their immunity which helps him to fight with diseases or infections gone done. So he got infections more easily. Because of anxiety his digestive system also disturbs, so problems like diarrhea/constipation, stomachache, acidity occurs. Studies shows that continuous mental stress could also be one of the reasons of skin diseases like irritation, psoriasis etc. sometimes mental stress is the main reason of migraine. Sometimes lot of frustration could change persons mind towards suicidal attempt.

Impact on organisations

Bullying at work place also put impact on organizations by lowering the productivity of goods. Because workers are not work properly in organizations. Due to continuous bullying some workers often took leaves from work, which also put bad impact on work. Quality of production also gone down due to the bullying, because of this profit of organization also reduces. Studies show that work efficiency of workers also lowers because of bullying at work. At times this bullying at work place led the concern organizations to the court which is also harmful for the reputation of organization.

6. Compare and contrast the effectiveness of primary and secondary/tertiary stress management strategies in improving employee wellbeing.

According to Richard Lazarus (1984) the definition of stress is that “Stress is a feeling experienced when a person perceives that demands exceed the personal and social resources the individual is able to mobilize” (Lazarus,1984).

According to Dr. Mellisa Conrad Stoppler’s book, ‘Stress, Hormones and Weight gain’ “Stress is simply a fact of nature-forces from the outside world affecting the individual”. The person responds to stress accordingly as it affect the person and his environment. Stress occurs because of external and internal factors. External factors are the environment, our home, personal relations, all outer situations, challenges, difficulties and expectations of life. Internal factors which affect your power to deal stress are nutritional status of a person, level of health and fitness, emotional status and how much rest and sleep a person got (Stoppler, 2007).

Management of stress

For managing the level of stress, organizations tried and do efforts for mental and physical health of the workers (Cooper& Cartwright, 1997). The stress prevention done at primary, secondary and tertiary levels (Murphy, 1988).

Primary intervention (preventive)

Today’s world is the world of globalization. In this world there is lot of competition, because of that stress becomes the biggest problem in employees in the organizations. Organizations are also affected due to stress level in employees. So organizations have low productivity and pay major cost for health care. For preventing the stress in organizations, primary interventions are there to reduce the level of stress. The major concentrate of primary intervention management is to search the causes of stress and to remove the causes. Primary intervention is also known as ‘Stress prevention’ intervention.

The main features of primary intervention stress management are, improving communication, re-scheduling or designing the structure of the tasks, give decision making chances to workers, lowers the work load, build cohesive teams, establish genuine policies of employment, sharing the rewards and contrast resolution skills. The primary intervention tries to modify or remove the causes of stress in the organizations so that workers work in good working atmosphere (Cooper et al., 2001).

According to Wall, T.D. & Clegg, C.W. (1981) study of work design done at confectionary company who faced troubles of demoralization in workers, gap in relations between workers and turnover problems. Organizations given the power of decision making, break for rest and after twenty eight months, they observe there was not any change in skill or not any progress in the task given to them.

Secondary intervention (Creative)

Secondary intervention is mainly related with the immediate detection and management of experienced stress by raising awareness and modifies skills of stress management of the worker with training programs (Cooper and Cartwright, 1997).In the secondary intervention workers have to manage their stress, not changing or removing the stressors. The Programmes of stress management assist and channelize the workers to know the symptoms of stress in them and other coworkers and try to get out of it. In the secondary intervention development of coping skills, management of anger, counseling and cognitive behaviour therapies are used. In the secondary intervention some class sessions or training programs are also there for increasing awareness and controlling the stressful conditions like training to do muscle relaxing exercises, educational seminars etc.

Training to the workers to do their work could lower stress and improve their efficiency or creativity (Bunce and West, 1996). Cognitive behaviour therapy improves the mental wellbeing to well tolerate the harsh experiences without changing and controlling them (Bond and Bunce, 2000).

Tertiary intervention (Reactive)

Tertiary intervention assists the workers to give treatment, compensate and rehabilitate them who are suffering from illness due to stress. This intervention usually assist workers to come out from stress occurs due to their work. The main aim of these programmes is to treat the worker who is beneficial for the organizations. This intervention includes medical intervention, treatment and ongoing counseling also. So that worker returns to their work normally. These services are provided in house counselors or foreign agencies in the form of Employee Assistance Programs (EAPS). Employee Assistance Programs give twenty four hrs telephone services. Workers are easily access these services (Cooper and Cartwright, 1997).

Meditation help to reduce stress, sleeplessness, anxiety and tensions (Alexander et al.,1993).For lowering their stress level, workers concentrate more on deep breathing and muscle relaxing exercises(Mcguigen,1994).

Comparison of stress prevention interventions

According to Kempier and Cooper (1999) now a days for stress management the secondary and tertiary interventions are more used as compare to primary ones. It was seen that these three interventions are effective in reverse order. In case of stress at the working place the primary intervention targets on the cause of stress in work place, secondary saw the effect of stress on worker and tertiary helps workers to rehabilitation and provide treatment in case of medical sickness due to stress. Secondary and tertiary level interventions play important role in preventing stress but they are not completely successful in stress management unless the cause of stress is not removed. Another limitation of secondary and tertiary interventions is that they don’t address the area to control the stressor which is important. Secondary and primary interventions are not sufficient to maintain the health of workers without removing the cause as in primary intervention (Cooper and Cartwright, 1997).

Conclusion

The secondary and tertiary interventions are useful in stress prevention but without the removal of cause they are not much beneficial. These interventions have favourable affect on indivual level and organizational level.

Mini Paper #1:Intervention Research with the Homeless

Introduction

The effects of homelessness as a social condition are both wide reaching, and difficult to grasp in its scope. It is a circumstance of varying severity, which people may move through for different lengths of time and for different reasons, making it challenging to establish an accurate breadth of its range (Biswas-Diener & Diener, 2006; Parsell, 2011). Link and colleagues (1994) have estimated that 14% of the United States may experience homelessness at some point in their life. According to The US Department of Housing and Urban Development (2011) there may be as many as 400,000 homeless individuals in the United States on a given day, and that 1,500,000 people may experience homelessness within the span of a year (HUD, 2011). A person’s familiarity with the homeless condition will vary depending on whether they experience it chronically, temporarily, or periodically (Rivlin, 1990). People may experience homelessness as a result of unemployment, natural or human-constructed adversity, mental illness, or a combination of factors (Hagen, 1987). The influences that contribute to the condition of homelessness may also play a hand in the progression and outcome of the person experiencing it, be it mental health or substance abuse issues, personal crisis, or systemic pitfalls (Chamberlain & Johnson, 2013). As a result of the potential reasons someone may enter homelessness, the rates and demographics of the homeless population vary among regions of the United States (HRI, 2012), and fluctuate in time. From the period of 2009 to 2012, homelessness as a whole decreased by 1% despite the conditions of the economic downturn, while the number of people who would have been homeless but instead doubled up with friends or family increased by 13% during this same time period (HRI, 2012).

Predictors – risk & problem

While any number of circumstances may contribute to the condition of homelessness, The Homeless Research Institute (2012) has identified four population groups who are at an increased risk of entering homelessness; people living with family and friends for economic reasons, prisoners who have been recently released, people aging out of foster care, and the medically uninsured. At its core, whether or not someone will enter or exit the condition of homelessness is influenced by a person’s income, their access to supports and social service resources, and the cost of available housing. As a result, other socioeconomic conditions associated with marginalization can increase a person’s risk of entering homelessness, such as unemployment or mental illness, and the condition of homelessness itself may even serve to fortify these things (Goodman, Saxe, & Harvey, 1991; Thoits, 1982).

Knowledge base/theoretical explanations

No clear theory explains the phenomenon of chronic homelessness better or more appropriately than another, although the perspective adopted will affect the explanations and constructs that are accounted and controlled for within research. For example, the social estrangement model posits that upon entering homelessness people experience a general sense of alienation and proceed to adapt to a lifestyle that reinforces this estrangement (Grigsby, Baumann, Gregorich & Roberts-Gray, 1990). The concept of estrangement has been adapted into a measured scale, and this model has been used in research to examine the reintroduction of employment into the lives of the homeless as a potential intervention to decrease one’s sense of estrangement and reintegrate back into society (Ferguson et al., 2012). Social constructionism has been used to explain homelessness as an artificial construct that is used to describe an extreme form of poverty that actually exists on a spectrum, and is not the binary distinction that is used to give a blanket idea to what actually amounts to a diverse range of experiences within the homeless population (Tosi, 2010). This idea has led to research and programs that operate with a continuum definition of homelessness (Anderson, & Tulloch, 2000). Social alienation theory has also been tested in the form of measuring the change of social support network of homeless adults across time spent homeless (Eyrich, Pollio & North, 2003).

Key research questions/intervention proposals

Because of the variety of factors that may exacerbate or contribute to homelessness, there are consequently any number of potential interventions and areas of concern to address. Researchers have found it useful to distinguish among cultural or demographic subgroups within the homeless population to address the concerns that appear to be more pertinent to a given subgroup (Aubry et al., 2012). Such distinctions may seek to reduce destructive behaviors or victimization associated with the homeless lifestyle itself (Justus, Burling & Weingardt, 2006). From a broader perspective, investigators may attempt to identify how the homeless will best establish and maintain long-term housing (Groton, 2013), as well as how to maximize retention and participation of services for the homeless in general (Padgett et al., 2008).

Intervention research that concerns itself with the homeless population must make educated assumptions about the most salient issues worth addressing, the causes of those issues that may be controlled, and the types of outcomes that should be attained. Meaningful intervention research should attempt to identify questions that address the preventative conditions of homelessness, the exacerbating conditions that may prolong someone’s experience with it, and the opportunities available to exit it.

Social networks play an important role in people’s lives, and the homeless are no exception. Some forms of social support may serve to normalize the homeless experience (Auerswald and Eyre, 2002), while others may offer support for exiting homelessness (Zlotnick, Tam, & Robertson, 2003). An appropriate research question in this area would ask; what are the characteristics of social networks that serve to contribute to a person’s successful attempts to exit homelessness? An intervention program that would attempt to capitalize on known social support networks that reinforce a person’s decision to exit homelessness could be as simple as incorporating a series of questions into existing outreach programs that are designed to identify such relationships. Once these relationships are identified, practitioners could be instructed to attempt outreach with these social network members to include them in their work with their clients.

One of the issues associated with homeless encampments is their proximity to necessary services (Chamard, 2010), of these healthcare access may be included. To build off of research which has identified that demographics as well as distinct lifestyles among the homeless may mean the difference between healthcare access or not (Nakonezny & Ojeda, 2005), a further relevant research question may ask how can people living in homeless encampments attain more consistent and accessible healthcare? Intervention work in this vein could seek to implement medical outreach programs in areas known to have higher concentrations of homeless encampments, identify how medical conditions are impacted as a result, and further modify outreach techniques depending on the results.

Homeless youth have been shown to have increased rates of victimization relative to their housed counterparts (Tyler, Gervais & Davidson, 2013; Tyler & Melander, 2012), and that victimization is associated with higher rates of substance use (Bender et al., 2012). Potential interventions in this area could include fusing a program designed to address substance use among homeless youth with training staff to have heightened awareness of who may be at risk for increased victimization, and address individual cases as needed. The potential for intervention research within the homeless population is plentiful.

References

Anderson, I., & Tulloch, D. (2000). Pathways through homelessness: A review of the research

evidence. Edinburgh: Scottish Homes.

Aubry, T., Klodawsky, F., & Coulombe, D. (2012). Comparing the housing trajectories of different classes within a diverse homeless population. American Journal Of Community Psychology, 49(1-2), 142-155.

Auerswald, C. L., & Eyre, S. L. (2002). Youth homelessness in San Francisco: A life cycle

approach. Social Science & Medicine, 54(10), 1497-1512.

Bender, K., Thompson, S. J., Ferguson, K., Komlo, C., Taylor, C., & Yoder, J. (2012). Substance

use and victimization: Street-involved youths’ perspectives and service implications.

Children And Youth Services Review, 34(12), 2392-2399.

Biswas-Diener, R., & Diener, E. D. (2006). The Subjective Well-Being of the Homeless, and

Lessons for Happiness. Social Indicators Research, 76(2), 185-205.

Chamard, S., United States, & Center for Problem-Oriented Policing. (2010). Homeless encampments. Washington, DC: U.S. Dept. of Justice, Office of Community Oriented Policing Services.

Chamberlain, C., & Johnson, G. (2013). Pathways into adult homelessness. Journal Of

Sociology, 49(1), 60-77.

Eyrich, K. M., Pollio, D. E., & North, C. S. (2003). An exploration of alienation and replacement theories of social support in homelessness. Social Work Research, 27(4), 222-231.

Ferguson, K. M., Bender, K., Thompson, S. J., Maccio, E. M., & Pollio, D. (2012). Employment

status and income generation among homeless young adults: Results from a five-city, mixed-methods study. Youth & Society, 44(3), 385-407.

Goodman, L. A., Saxe, L., & Harvey, M. (1991). Homelessness as psychological trauma:

Broadening perspectives. American Psychologist, 46(11), 1219-1225.

Grigsby, C., Baumann, D., Gregorich, S. E., & Roberts-Gray, C. (1990). Disaffiliation to

Entrenchment: A model for understanding homelessness. Journal of Social Issues, 46(4), 141-156.

Groton, D. (2013). Are housing first programs effective? A research note. Journal of Sociology And Social Welfare, 40(1), 51-63.

Hagen, J. L. (1987). The heterogeneity of homelessness. Social Casework, 68(8), 451-457.

The Homelessness Research Institute (HRI). (January, 2012). The State of Homelessness in

America, 2012. National Alliance to End Homelessness. Retrieved from:

http://lhc.la.gov/downloads/esg/TheState_of_Homelessness_in_America2012.pdf

Justus, A. N., Burling, T. A., & Weingardt, K. R. (2006). Client Predictors of Treatment Retention and Completion in a Program for Homeless Veterans. Substance Use & Misuse, 41(5), 751-762.

Link, B.G., Susser, E., Stueve, A., Phelan, J., Moore, R.E., & Struening, E. (1994). Lifetime and

five-year prevalence of homelessness in the United States. American Journal of Public

Health, 84(12), 1907–1912.

Nakonezny, P.A., & Ojeda, M. (2005). Health Services Utilization Between Older and Younger

Homeless Adults. The Gerontologist, 45(2), 249-254.

Padgett, D. K., Henwood, B., Abrams, C., & Davis, A. (2008). Engagement and retention in services among formerly homeless adults with co-occurring mental illness and substance abuse: Voices from the margins. Psychiatric Rehabilitation Journal, 31(3), 226-233.

Parsell, C. (2011). Homeless identities: Enacted and ascribed. British Journal Of Sociology,

62(3), 442-461.

Rivlin, L. G. (1990). The significance of home and homelessness. Marriage & Family Review,

15(1-2), 39-56.

Thoits, P. A. (1982). Life stress, social support, and psychological vulnerability: Epidemiological considerations. Journal of Community Psychology, 10(4), 341-362.

Tosi, A. (2010). Coping with Diversity. Reflections on Homelessness in Research in Europe.

O’Sullivan, Eoin/Busch-Geertsema, Volker/Quilgars, Deborah/Pleace, Nicholas (Hg.): Homelessness Research in Europe. Brussel, 221-236.

Tyler, K. A., Gervais, S. J., & Davidson, M. (2013). The relationship between victimization and

substance use among homeless and runaway female adolescents. Journal Of

Interpersonal Violence, 28(3), 474-493.

Tyler, K. A., & Melander, L. A. (2012). Poor parenting and antisocial behavior among homeless

young adults: Links to dating violence perpetration and victimization. Journal Of

Interpersonal Violence, 27(7), 1357-1373.

US Department of Housing and Urban Development (HUD). (2011). The 2010 Annual

Homeless Assessment Report to Congress. Washington, DC. (2010 AHAR).

Zlotnick, C., Tam, T., & Robertson, M. J. (2003). Disaffiliation, substance use, and exiting homelessness. Substance Use & Misuse, 38(3-6), 577-599.

1

Introduction

Domestic violence is also known as spousal abuse, domestic abuse, intimate partner violence (IPV) or child abuse. It is therefore defined as abusive behaviors by either one or both partners in a relationship. Such intimate relationships include: family, dating, marriage, cohabitation or friends. Domestic violence take many forms such as physical aggression or abuse (biting, kicking, throwing objects to a partner, hitting, restraining, slapping, shoving), or threats, stalking, intimidation, dominating or controlling, sexual abuse, emotional abuse, economic deprivation and passive abuse which is also known as covert abuse such as neglect. These abuses if constantly repeated can lead to self harm, mental illness and an attempt to commit suicide.

Drug abuse is also known as substance abuse; it is referred to as a maladaptive behavior of the use of drugs and alcoholic substance that is dependent. Some of the drugs which can be abused include: bhang, cocaine, alcohol, methaqualone, benzodiazepines, opioids and amphetamines among others. Using these drugs regularly can lead to permanent addiction, social, physical and psychological harm which can be irreversible if not treated at the early stages.

According to the research conducted, drug and alcohol abuse have a direct correlation between these emerging domestic violence issues. The research findings indicated that, domestic violence is caused by high rates of drug and alcohol abuse used by these violent and arrogant people. Batterers abuse drugs and alcohol which in turn increase the probability of domestic violence. Drug abuse and domestic violence interact and they are correlated hence both of them should be addressed simultaneously. A few cases of domestic violence can offer adequate guiding and counseling or health services programs for drug and alcohol abusers.

Spousal abuse

Spousal abuse is a wider issue including sexual abuse, psychological abuse or emotional abuse, verbal abuse, financial abuse, economic abuse and physical abuse. The research shows that the perpetrators of spousal abuse can either be the female or male as can be the victims. However, most of the data collected after conducting research shows that, abused victims are mostly female and battered men cases are rare. Drug abuse was rated as the major cause of this problem brought about by the abuse of drugs. A partner who is abused can become lame, die and lack social power of interaction hence staying an isolated life from his or her friends.

Gender of assailant

In most cases, women fall victims of murder by an intimate partner either in a marriage, cohabitating, dating or in a friendship. A research conducted in United States of America (USA) shows that; out of 1,642 cases reported, three quarter (1,218) are female and only 424 are male who are killed by their intimate partner. This is regardless of which partner (male or female) started the violence. According to the analysis done by Dr. Martin, F. from California State University in the department of Psychology, it indicated that women are more physically aggressive than their male counterparts in the relationship. However, research carried out by Kimmel Michael found out that, men are the main cause of domestic conflicts and violence; because women overestimate the use of violence as men underestimate it. On the other hand, the National Institute of Justice on its studies found out that, men are abused by women equally or even more than they abuse women. In both studies, it does not give facts on who started or initiated the violence or conflict.

Straus and Gelles found out that, domestic violence resulting from drug abuse is usually mutual with both partners brawling and responding equally. Women have been known to use weapons while fighting (domestic violence) whether by throwing frying pans, plates, cups or mugs. It has also been proven that, women can seek assistance from other people if they are determined to kill their intimate spouse; however, such incidences are not counted as domestic violence but murder. There are three common types of domestic couple violence associated with drug abuse and these are: common couple violence (CCV), violent terrorism (IT) and mutual violent control (MVC). The common couple violence arises when either of the partners or both try to control the behavior of his or her spouse lashing out at the other partner with hostility. Intimate terrorism is more common type of violence and it is not mutual hence will involve serious injuries and bruises. It may include psychological and emotional abuses if one partner is dominant and he or she is under the influence of drugs.

Barrett, Meisner and Stewart, Sharper. What constitutes prescription drug misuse: problems and pitfalls of current conceptualization? Pittburgh: Pittburgh Publishing Press, 1999 (3) 260-28

Barrett and Steward (1999) in their book have mentioned the drugs and alcohol abuse and how it causes domestic violence. Both of these authors explain the measures to be taken in order to combat domestic violence. This is very important when analyzing the causes of drug addiction and the negative effects to ones spouse and other family members. The authors too have given statistics on the research conducted in America in the last twenty years. The research findings as explained by the authors show that drug abuse and domestic violence is on the rise.

With the evidence of research findings, it makes this book effective and reliable to its audience because of the facts articulated. This book is essential because it explains the causes and effects of the abuse of drugs on the family members especially between two partners (husband and wife). The findings as expressed by the authors target the entire community (family members, relatives, neighbors and friends) because drug abuse and domestic violence take place in the community where people live. The information in this book is effective because it explains the negative effects

Ferraro, Kathleen. Domestic Violence. Journal of Marriage and the Family, vol. 5, Issue 45, September/October 2008, Pages: 34-46

The journal by Ferraro (2008) explains how domestic violence has been promoted by drug and alcohol abuse by some members in the family. The article by Ferraro, 2008 have provided proven research evidence that men abuse drugs and alcohol at a high rate than women. The author has also made it clear that, stress and difficult economic and financial situation are the major reasons for most people to abuse drugs. However, in this article, the author has failed to explain other negative effects of drug abuse apart from domestic violence. The author too has targeted (audience) the youths, parents and community at large by ensuring that the journal is affordable to the majority of these audiences. This makes the journal to be reliable and effective with well researched information. The journal has given types of domestic violence and the definition of drug abuse and domestic violence. The author has used simple, clear but easy to understand terms so as to make the information on drug abuse and domestic violence to be comprehended easily by all users.

Follingstad, Daniel. The Role of Emotional Abuse in Physically Abusive Relationships. Journal of Family Violence, vol. 4, Issue 5, January/February 1998, Pages: 107-120

This journal of family violence by Follingstad (1998) is another essential and useful article in my research; on effects of drug abuse and alcoholism on domestic violence. The author of this journal has vividly brought out how drug abuse can affect relationship in the family. He has also elaborated that women and children suffer most in the family from emotional and physical abuse than men. However, he has indicated that, some men too are victims of domestic violence but not at a high rate as women experience. This journal will be effective and reliable when analyzing the effects of drug and alcohol abuse because, it gives a general understanding on the causes and effects especially to those in an intimate relationship and other family members. The author has evidence on the drug and domestic violence collected from the research he conducted in many countries such as Germany, United States of America, France, Canada, Nigeria, Singapore and Iraq. This article will help me give an elaborate conclusion because of the facts contained in it. This article is important because it targets all people in the society including youths, men, women, children, married and people in any form of relation who may fall victims of domestic violence.

Jaffe, Hellony. Drug addiction and abuse. Journal of Drugs and substance abuse, vol. 4. Issue 12, November/December 2002, Pages 50-69

This is an article by Jaffe (2002) about drug addiction and abuse; it has given facts on drug and substance abuse. The author has connected ideas and gave elaborate information that concerns the society on the negative effects of the drugs and alcohol. The journal also exemplifies into the health concerns of the people and mostly on the domestic violence caused by those who misuse the drugs such as cocaine and bhang. Jaffe’s research findings have been used to educate people especially the youths who are in school to avoid using illegal drugs. From an analysis of this journal, one is able to realize and appreciate how it has helped many people change their lives and attitude towards drugs. It is clear that, the author of this article is systematic and direct to the point in expressing his views and ideas. This is actually good because the journal has addressed main issues on drug abuse and domestic violence and how to deal with this problem. This journal having systematic information ensures that its audience gets reliable information hence ensuring effectiveness during implementation of recommendations the author suggested.

The journal could have dwelled more on negative effects of drugs on their health instead of focusing only on domestic violence because it could have assisted drug addicts to change their attitude towards drugs. These journal findings are effective and reliable because of the evidences from the research conducted by the author of this journal.

Jolivet, Christie. Prevention of anti-social and violent behavior. Journal of violent behavior, vol. 2, Issue 7, March/April 2005, Pages 56-76

In this journal, Jolivet has in-depth information on prevention of anti-social and violent behaviors which are caused by the drug addicts in the community. The author has given evidence of the domestic violence in various countries. She collected this evidence, from interviews she conducted and the questionnaires she distributed to people in different countries. Her research findings are therefore reliable in writing the proposal on the effects of drugs and alcohol abuse on the family members on domestic violence. This journal by Jolivet has broad and deep exemplification of the current or recent domestic violence from different countries. This makes her journal effective since the information contained targets those who are married because most abuses occur in the family.

The author has explained how bad company (friends), media (radio, TV and magazines) and lack of set societal moral values and norms have contributed to an influence on people to indulge in drugs. The author has explained ways of curbing or combating illegal drugs from reaching many people. She has emphasized on guiding and counseling programs to be introduced in all villages, churches and schools as a way of helping people who are already drug addict and those who have been physically or emotionally abused in the past. Guiding and counseling married couples on domestic violence will help reduce such incidences by 87%. Therefore, her findings are effective and reliable since she has suggested the most possible and practical solutions to this problem together with the research findings.

Nutt, King. Development of a rational scale to assess the harm of drugs of potential misuse. Journal of Domestic violence, vol.6, Issue 8, April/May 2003, Pages 80-103

This is a journal by an author called Nutt. In his article, the author has criticized the authorities especially the government; he expressed his concerns that the governments has failed to apply the appropriate laws to arrest and prosecute the suppliers of drugs. He further blamed the people who have been victims of domestic violence for failing to report such incidences to the authorities for action to be taken. In the article, there is need for non governmental organization, government, schools and religious institutions to educate people on the effects of drugs. The author of this journal further stresses the point that, stringent rules and regulations (laws) must be legislated so as to reduces and deter people from abusing drugs; hence reducing domestic violence and abuses being experienced. Because the author has articulated on facts, this makes the journal to be reliable and effective in dealing with this menace of drug abuse causing domestic violence. This is because it targets all people in the society hence effective because it aims at solving the problem using facts.

Lert, Susan. America’s Drug Problem. Creating a Monster Newspaper, 4TH April, 2009.
National Institute on Drug Abuse. The Science of Drug Abuse and Addiction. Scholarstic Classroom Magazines Partnership, 27th September, 2002

Lert (2002) in the newspaper scholarstic classroom magazine, he gives a clear preview on America’s drug abuse problem and how it affects the economic position of a country. The author of this article in the newspaper has suggested early signs of a person who have been abused and a possible remedy. The author (Lert) further mentioned that, though the wife may abuse the husband or vice versa, the children will be affected negatively either directly or indirectly. The author further acknowledges that, societal morals and norms have deteriorated hence people lack guiding principles on what is good or bad, right or wrong.

This newspaper is reliable and effective in research because of the in-depth information on the issue of drug and alcohol abuse. Infact, the author have found out that drug abuse is highly correlated with domestic violence making it reliable because it will be used to provide solutions and a conclusion on all facts related to this topic. This magazine is therefore important when writing a proposal especially on the effects of drugs and how it contributes to the domestic violence. The author of this article in the magazine targets all people in the society (young, old, married and singles) because drug and alcohol abuse affects all people either directly or indirectly. This article will therefore be useful in trying to identify the major challenges facing most families which are under the influence of drugs.

The role of emotional abuse in physically abusive relationships. Retrieved on 29 September, 2010 from

In this website on the role of emotional abuse in physically abusive relationships, it clearly explains how partners in an intimate relationship can physically abuse one another. This is because of the drugs and alcohol influence. The website information is useful to me when analyzing the major effects and reasons as to why partners in a relationship can physically abuse one another. The website is reliable because it give the facts from the research conducted hence information is effectively communicating or conveying the message needed to solve the problem.

In this case, the information can reach many people irrespective of the country since almost all countries have a network connection hence people can log in and access the information in their computers. However, the website has no recent information on domestic violence, even though the available information is valid and reliable when making a conclusion. The website also gives an elaborate explanation on the major challenges those in authority face as they try to control drug abuse which has led to increased domestic violence.

Depression, Substance Abuse and Domestic Violence. Retrieved on 29 September, 2010from

The website above mentions how abuse of drugs causes depression, stress and domestic violence. This website is very important because it gives an elaborate dimension on drug abuse and how drug addicts have caused more harm to their families, friends and the community at large. The developers of this website who contributed to this information are experienced on issues related to drugs and alcohol and its impact. In the website, the root cause of the problem is first identified before the possible solutions are drafted.

The information contained in the web is critical because it has touched on all areas including the most sensitive information on who are the drug dealers. The information contained in this website is reliable and effective because it gives the facts based on the data collected from the drug addict people in all countries of the world.

Though this web information is elaborate, it has failed to elaborate on the most affected countries with more people who are abused. The target audiences in this web are people who can access the internet services and specifically those who have fallen victims of domestic violence. Others who are targeted are the drug addicts so that they can be rehabilitated in order to live a normal life out of drugs.

Domestic Violence and Substance abuse. Retrieved on 29 September 2010 from

The website about domestic violence and substance abuse is essential in dealing with people who use drugs and alcohol resulting to domestic violence. This website is in favor of women and children because research carried out shows that, they are mostly affected by domestic violence. The web is also elaborate because it gives statistics of the countries leading in drug and substance abuse. These countries are those in Africa and Asia. The main reason for this is the high poverty level hence people become hopeless and therefore find ways of avoiding responsibilities hence indulging in drugs.

Those who carried out this research for this website are knowledgeable because they are able to give detailed information supported by facts which can be relied upon. This website will be useful to me in the discussion of the effects of drug abuse and how it contributes to domestic violence. Though other authors of different books, journals and magazines have argued that, women are affected most when domestic violence erupts; this website has the most recent statistics showing that men who are being battered or abused are on the increase.

The website also has the most recent and the current information making it to be more reliable because it was carried out by professional researchers. Having recent statistics makes it effective in delivering the intended message in a clearer manner in that it can be understood because of its clarity and preciseness.

Causes of drug and alcohol abuse on domestic violence

There are many causes associated with drugs abuse that make people to indulge in drugs. As it is said that, bad company ruins good moral; many people have confessed that their friends introduced them to take drugs. With the influence of drugs, people become aggressive and violent especially to their intimate partner, children, friends and their boyfriend or girl friend. Research has shown that, some people can decide to use drugs because of stress, hard economic times, and depression or lose of a partner or a parent who was a sole bread winner.

Effects of drug abuse and alcohol on domestic violence

Drug abuse has negative impacts to the people and society. There are no positive effects though some people believe that, some of the drugs are medicinal in nature and can cure some illnesses. People who are drug addict have been known to cause violence especially to their partners. This is evidenced between a wife and a husband where one of the partners can be battered or abused by the other. This has been proven to increase levels of stress and depression in the family.

Due to misunderstanding, conflicts and fights between the wife and husband, will affect the children either directly or indirectly. The children will not get the attention, care and love or affection they need. Due to the influence of drugs, a partner in an intimate relationship may be killed, bruised or injured. In most countries, due to constant abuse (sexual or physical abuse) some married couples have divorced, some broke up their friendship or courtship before getting married. Under such circumstances, children schooling will not perform as expected and others may drop out because the parents are no longer responsible to pay school fees and to provide school uniforms. If children are not taken care of, they will loose hope and in the long run indulge in drugs hence causing more problems to the society, family and their bodies. Because the children lack basic needs, they will do anything bad to get some money to buy food including stealing. Insecurity will increase theft and robbery with violence and rape cases will rise due to lack of morals due to drugs influence. It is therefore clear that drugs and alcohol affects people’s health and causes disunity and tension in families.

Possible solutions

Many people especially the medical experts have suggested some possible solutions to this problem. For those who are already addicted with drugs, rehabilitation centers or institutions should be established. Such rehabilitation centers will assist those who are chronic because proper medical attention will be provided by qualified physicians.

Parents have a greater responsibility to take care of their children by instilling discipline and good morals in them. Responsible parents will discipline their children with an aim of correcting them when they do anything wrong. This will ensure that children will not associate with some people or friends with bad habits such as smoking, taking alcohol or other drugs such as cocaine and bhang.

In every society or community, there are morals, norms and rules which must be adhered to by all people. These morals and norms forbid immoral actions such as drug abuse and domestic violence. Religious institution must start guiding and counseling programs so as to guide and counsel people with psychological problems associated with drugs and domestic violence. Guiding and counseling programs should be supported by the government by ensuring that every village has atleast two qualified guiding and counseling experts.

The government should enact stringent laws to punish those involved in drug trafficking in the country. Those got engaging in domestic violence acts such as battering, sexual harassment, biting and beating must face the law and be a lesson to them and deter others from doing the same. The health department should also play a major role in educating people in villages and all learning institutions on the effects of drugs and alcohol on their health.

IntroductionDomestic violence

Domestic abuse as earlier discussed is a form of abuse which is leveled against members of a family or people who have an intimate relationship. There are different forms of domestic violence and these include emotional abuse, physical abuse, sexual abuse, economic deprivation or intimidation. Very few cases of domestic abuse are reported due to fear of reprisal from the perpetrator. This makes it difficult to ascertain the exact number of victims of domestic abuse. However, in the US, 10% or 32 million people are affected by domestic abuse.

Phases of domestic violence

There are three major faces of domestic violence and these are the honeymoon, tension building and acting-out phases. The honeymoon phase is the first phase and the perpetrator of violence apologizes and gives affection after committing a violent act. She or he feels sad and remorseful after committing violence. The next stage is the tension building stage and in this stage, the victims begin building fear and have tension whenever the batterer becomes angry. There is poor communication and victims try to calm perpetrators down in order to avoid confrontations which may turn violent. The third stage is the acting out phase and in this stage, the perpetrator hardly feels remorse for violent acts. The batterer becomes abusive and violent, in attempts to dominate over the victim.

Violence against the elderly

There has been an increase in cases of violence against the elderly. The abuse of the elderly has grown into a criminal justice and public health concern due to increase in cases. The elderly are seen as vulnerable and weak, and this makes them easy targets for perpetrators of elderly violence. Various forms of elderly violence will be discussed and these include physical abuse, economic abuse, emotional abuse and sexual abuse. It is important to note that a few cases of elderly abuse take place unintentionally, and are usually as a result of attempts to protect the elderly people. In such cases, the elderly may be forced to join homes or relieve themselves of responsibilities which other members of society view as too difficult to them. They may be forced to delegate leadership in companies or political systems due to the perception that they are too old to effectively perform their duties. This may leave them feeling depressed, isolated and demoralized (Cohn et. al., 2002). However, most of the cases of elderly abuse are done intentionally in order to have dominance over the perceived weaker age group.

Causes of domestic and elderly abuse

There are different theories which explain reasons which drive people to commit these types of violence. Some of them will be discussed below;

Psychological theory

Psychological disorders account for the largest proportion of domestic violence cases. In fact, more than 81% of cases of domestic violence are linked to psychological disorders especially the psychopathology disorders (Dutton, 2006). Psychopathology disorders affect the mental and personality behaviors of victims. People with this disorder exhibit poor impulse control, bursts of anger and low self esteem. People with psychopathology disorders are likely to project their anger at people around them, and these are family members, spouses and the elderly. This leads to domestic and elderly abuse in the long run if people with these disorders do not seek treatment.

Social theory

There are different social theories which explain domestic violence. These theories explain that socialization and the environment may influence a person to commit domestic abuse. For instance, social learning is seen to be one of the factors which lead to abuse. Social learning involves imitation of actions of people around us. If a family experiences domestic abuse, children who are raised in such a family may commit abuse in future since they view it as normal in family settings (Shipway, 2004). Stress is also another factor which may lead to commission of domestic violence. When a person has stress, she or he may project their anger at those around them. Spouses, children, the elderly and other family members may suffer from domestic violence if stressed people project their anger on them.

Resource and dependency theories

These theories explain reasons which make women susceptible to domestic abuse stay in abusive marriages. They explain that in cases where the wife or husband is dependent on the other spouse for economic well-being, it is difficult for them to leave abusive marriages. Victims are unable to leave since they believe that they cannot survive without the assistance of the other spouse. This is especially seen in relationships where one spouse has greater power than the other. This makes it possible for him or her to manipulate the other partner into living with domestic abuse.

Power and control

Many abusive relationships occur after one partner or family member attempts to dominate over the other. Spouses, especially men, use violence as a means of dominating over the other partner. Such dominance may arise out of low self esteem, childhood experiences, insecurity, and stress, resentment towards women or men amongst other causes. Spouses who are bullied accept themselves as victims and the cycle of violence continues, until it is broken by separation, divorce or rehabilitation. This is also seen amongst the elderly, and some people abuse them as a means of control and dominance over them.

Forms of domestic and elderly abuse
Physical abuse

This is a form of abuse where the perpetrator physically assaults or intimidates her or his victim. It may involve actions such as punching, striking, pulling, slapping, pushing, exposure to heat or cold, head-butting, strangling, kicking, whipping and others. These acts are performed to cause pain, intimidation or injury to the victim. Both domestic abuse and elderly abuse feature physical abuse since in both cases, the victims are perceived to be powerless by the perpetrators, and this allows them to physically dominate over them.

Emotional abuse

According to Johnson (2005), this abuse is meant to calculatingly injure the emotions of the victim. It includes humiliating victims publicly or privately, withholding information, controlling the victim, blackmail, isolation from family and friends or verbal abuse. This form of abuse may be difficult to detect and victims may realize that their partners dominate over them or control them only through the intervention of third parties. Victims who undergo emotional abuse may suffer from eating disorders, drug abuse or may attempt suicide. Emotional abuse is common in both domestic and in cases of elderly abuse.

Economic abuse

In this form of abuse, the perpetrator withholds resources or money from the victim in attempts to control their actions. Usually, the perpetrator has control over the resources and money, and withholding it is meant to force the victim to perform what the perpetrator wants in order to have access to the resources. This form of abuse is common in families where one spouse is economically dependent on the other. It is also common in cases where the elderly are dependent on their children or other people economically. The person who holds the resources deliberately manipulates victims into performing what she or he wants in order for them to have access to these resources. This creates dominance over them.

Sexual abuse

This is a form of abuse in which a person is forced to engage in sexual acts against their consent. This includes rape, degrading sexual activities and unsafe or unwanted sexual activities. Sexual abuse is more common in domestic violence than in cases of elderly violence although the latter has become common over the years. This form of abuse, just like physical abuse, is meant to dominate over the victim.

How to prevent domestic and elderly abuse

There are various steps which should be taken to reduce cases of domestic abuse and abuse against the elderly. These will be briefly discussed below;

Legislation

Legislation is a very effective deterrent to crime. Harsh sentences deter potential perpetrators of crime and reduce crime levels. Since domestic violence and violence against the elderly is a crime, harsh legislation should act as a deterrent to crime. Lawmakers should pass laws which give long prison sentences to people convicted of all forms of violence (Neil & John, 2000). This will reduce the overall violence crime levels.

Rehabilitation

Rehabilitation can effectively treat people who have mental disorders which make them commit violence. Rehabilitation can also make a person who commits violent acts against others realize the harmful impacts to victims, and stop the vice (Hamel & Nicholls, 2007). People who practice any form of abuse should be advised to seek counseling or rehabilitation aimed at encouraging them to change their attitude towards violence. This will enable them to be accepted back into society and to live with other members of society in harmony.

Social services

Governments should offer social services free of charge to victims of domestic and elderly abuse. According to Wilcox (2006), these services should include legal, medical, psychological and financial services which will ensure that they recover from the abuse and that the perpetrator is arrested and charged with the offence. The government should ensure that these victims reside in a safe place free from any form of violence.

Public awareness campaigns

This is among the most effective tools of fighting violence in society. The government and civil society should organize campaigns which are aimed at increasing awareness on domestic violence and violence against the elderly. These campaigns should encourage people to report such cases to law enforcement agencies. The campaigns should also provide potential victims with information about where they can access help in case they experience these forms of violence.

With particular emphasis on education this work will examine the effects different types of discrimination and oppression can have on minority groups in general, before progressing to address the effects on specific minorities. This will include considering the effects, personal, cultural and structural levels of discrimination have on groups such as: ethnic minorities, non-English speaking and disabled and low socio-economic status children.

Focus will then shift to evaluate the success some informal measures have had in combating such effects and if they have redressed the balance for societies minority groups. In this respect, the impact of equal opportunities, anti-discriminatory practice, social inclusion, participation and empowerment and advocacy will be analysed through experiences of non-English speaking families, children of different sexual orientations, disabled and traveller children. The inter-relationship of these informal measures will be noted as will the multiplicity and increased magnitude the effects of discrimination will have on children belonging to more than one minority group.

Social stratification refers to the way societies rank people into hierarchical categories, this is a means by which one group exerts power over another and can result in minority groups being discriminated against and oppressed when this power is unjust or cruel (Macionis and Plummer 2008). Discrimination can therefore be described as behaviour that has the effect of disadvantaging a particular group of people, and within multi-faceted societies a tendency exists to discriminate against groups based on factors such as gender, disability, religion, race and class (Malik 2009).

Thompson (2003) argues, the major outcome of discrimination is oppression and the insidious relationship between the two, is that the former causes the later. Thompson (2006) also refers to his PCS analysis as a framework in recognising discrimination takes place via interlinked and constantly interacting relationships between one’s personal feelings, cultural beliefs and messages received from a powerful structural level. This re-enforces the complex nature of the roots and explanations of discriminating behaviour.

Adding to the complexities of discrimination are the types and various vehicles used to perpetuate it, one of which is stereotyping which can be both an unconscious and conscious processes (Malik 2009). Through stereotyping, some minority groups are labelled and negative images or expectations are attached to these groups (ibid). The effect of this, for young people from any of the previously mentioned minorities, can result in them engaging in a self-fulfilling prophecy loop, whereby one is conditioned to conform to other people’s expectations of them. Through this process the child will not fulfil their potential in life and their self-perception will be seriously affected resulting in low self-esteem (Malik 2009). Allowing some children to claim social superiority over another group based on race, gender, class and other social groupings, will result in false perceptions about society and an opposite self-fulfilling prophecy (Lindon 2004).

The notion of racial discrimination resulting in low self-esteem was examined by Clark and Clark in a study into the effects of discrimination on self-perception of black children. They concluded, racial discrimination resulted in black children entering a cycle of self-hatred based on skin colour and consequently positive peer group identification suffered (Sturt 2000).

In addition, children from ethnic minorities are at greater risk, than their non-ethnic minority peers, of experiencing direct discrimination in an educational setting through name calling or physical abuse from other children. This may result in negative feelings including isolation/exclusion from mainstream society, low self-worth, culminating in low educational attainment thus constructing barriers to future employment, health and life chances (United Nations 2000).

This may be further compounded if these children do not have English as their first language, with non-English speaking parents and without adequate language support within the structure of the school setting. Discrimination such as this may be described as unconscious or institutionalised, or both, affecting a child’s emotional, social and cognitive development whilst giving rise to feelings of; lack of cultural dignity, being ignored and avoided with a general lack of independence or empowerment leading to depression (Moonie et al 2000). This example provides a working illustration of interactions and relationships between Thompson’s personal, cultural and structural levels of discrimination (Thompson 2006).

Concerns over institutionalised and unconscious discrimination towards disabled children within school playgrounds were highlighted, in recent research by Wooley et al (2006). The effects of organisational, social, physical and attitudinal barriers on disabled children ranged from; shortened or no break-times, grouping all disabled children together during breaks, heightened concerns over risk taking resulting in limited play opportunities thus exclusion from peers, a disproportionate length of playtime spent in exclusively adult company to the playground environment not being adapted to suit the needs of disabled children (ibid). This gives rise to concerns including; isolation and exclusion of disabled children, educational institutions fostering a learned helplessness self-concept, and the increased probability of re-enforcing negative stereotypes of disabled children (Wooley et al 2006).

The impact of discrimination for disabled children is heightened within education for those with dual memberships to minority groups, such as belonging to a low socio-economic group and being disabled (Oliver 2009). Effects of discrimination on disabled children outlined above, coupled with evidence that poorer children do not attain the level of qualifications their better off peers aspire to, are significant (Gentleman 2009). This is linked to a lack of equivalent advice, mentoring and support available to middle class children, as well a lack of finances playing a role in lower leaving age and non-take up of further/ higher education (ibid). The implications of belonging to poorer families has a bearing on children’s health, diet and impinges on all areas of development which then discriminates against high educational achievement, and low expectations of such children is reflected in results throughout the education system (Harman 2010).

Bernstein (2003) further argues, through his elaborated and restricted code theory, lower class children are discriminated from any learning environment, as they are more comfortable using a restricted language code which assigns significantly different meanings to spoken language than their middle class peers who use an elaborated language code. He explains educators use this elaborated code, thereby discriminating against working classes, resulting in these children turning away from education due to feelings of; inferiority, boredom and not being represented in educational role models, resulting in low grades hence a repetitive cycle of generational poverty (ibid).

Effects including those outlined above are a growing concern for society and have highlighted the increasing need to tackle discrimination with a positive attitude to change. Thus resulting in a two-pronged approach, using best practice/informal measures underpinned by formal legislation/policies (Millam 2002). Informal measures are not mutually exclusive in tackling discrimination. This is illustrated by elements of anti-discriminatory practice overlapping, supplementing and feeding into equal opportunities and social inclusion, thus promoting participation, hence enabling empowerment and advocacy (Malik 2009).

Promoting equal opportunities within education is crucial if unfair inequalities between groups are to be successfully addressed (UN 2000). Therefore in schools which have children from ethnic minorities whose first language is not English, all barriers should be eliminated to ensure full participation from the child and their family (Moonie et al 2000). This might include ensuring newsletters and welcome signs within school can be understood by all families, arranging interpreters during parent/school consultations and providing children with individual support within the classroom (ibid). It is also important associated negative stereotypical images are eradicated from books within the classroom, and might also involve cultural and religious differences being celebrated by encouraging appropriate culture tables to be displayed and discussed (MIllam 2002).

Whilst this informal measure might redress some imbalances and promote equal opportunities for non-English speaking children, teachers unions are concerned about the added burdens this incurs. Their worries relate to increased financial and resource pressures on individual schools and local educational authorities arguing promoting equal opportunities to this minority group seriously undermines the quality of education given to pupils as a whole (Kirkup 2007).

Applying equal opportunities through anti-discriminatory-practice to eradicate discrimination and oppression can be aided by using Thomson’s PCS analysis to understand and challenge such behaviour (Thompson 2006). Applying this theory to explain why children and teachers might practice hetrosexualism reveals that personal, direct prejudice against gays, lesbians or bisexuals is commonplace and rarely challenged, this is re-enforced culturally by negative stereotypical images and jokes aimed at this minority group and is backed up structurally by being seen as threatening to religious beliefs and family values (ibid). Understanding this relationship allows anti-discriminatory practice to be actioned on all three levels by; challenging discriminatory language, whether delivered through jokes or otherwise (Teacher Net 2007). Ensuring discussions are raised within school settings in order to eliminate negative stereotypes associated with persons of ] different sexual orientations, warranting all books do not depict only typical nuclear families and promoting sexual diversity in society in a non-threatening but serious manner (ibid).

Some of the afore-mentioned anti-discriminatory practices may be relatively easily implemented in primary school settings, however, secondary schools prove more challenging environments to confront such discrimination and deep rooted prejudices (Curtis 2008). In some secondary schools staff report being afraid to challenge homophobia for fear of making themselves targets of abuse, or being seen to promote homosexuality. Teachers also feel they will not be supported by parents if they tackle homophobic behavior (ibid). This again highlights the interplay between Thompson’s PCS levels and the direct, indirect and institutionalized nature, within education, of discrimination against this minority group (Thompson 2006).

Social inclusion of disabled and special educational needs (SEN) children into mainstream education has been embraced by the Scottish Government (2007) whose main aim was, ‘the achievement of equal access to, and participation in skills and learning for everyone, including those trapped by persistent disadvantage’. CSIE (2008) believes inequalities and discrimination will reduce as a result of integration. Through valuing diversities between students and embracing all types of learners within the school community they see developmental benefits to all children. Integration is viewed as integral to the de-structuring of physical, societal, attitudinal and legal barriers confronted by disabled learners (ibid). There is however growing concern appropriate staff training and increased numbers of specialist staff are not in place within Scottish Education to make social inclusion of disabled children work (Montgomery 2004). These concerns are added to when statistics of exclusions from Scottish Schools show that children with SEN’s in mainstream education are three times more likely to be excluded than non SEN children and thirteen times more likely if the child is also in receipt of free school meals and looked after by a local authority (Scottish Government 2008).

Many minority groups feel their voices are not heard and their level of participation in decision making is compromised, this can be a particular concern for children as this ageism can lead to discrimination (ATL 2010). Schools can address this by practicing simple measures ensuring participation such as: children deciding on story endings, meaningful decision making through representative pupil councils and involvement in writing positive behaviour policies (ibid). Engaging children in participation and by listening to their views raises self-esteem and equips children with valuable decision making skills (Clark n.d.). The quality and degree of participation can be assessed using Hart’s Ladder of Participation; which shows the higher the level of participation the more autonomous the child feels. It also outlines the dangers in appearing to allow children to participate which may be simply tokenistic or manipulative on the part of the adult (Fletcher 2008).

Levels of participation links to increased empowerment and the minority group of traveller/gypsy children has consistently been identified as segregated from society and requiring advocacy in order to have equal opportunities (STEP 2009). Due to racial discrimination, cultural mistrust of educational establishments, and the nomadic nature of their lives, the uptake of education has been low and has been influential in rendering empowerment out of reach to the majority of travelling children. In efforts to combat this inequality and provide much needed advocacy, outreach teachers educate the children in their communities whilst trying to encourage mainstream take-up (O’Hanlon and Holmes 2004). This approach has had limited success in bridging the equality gap and eliminating discrimination and oppression, but has had some success at promoting more positive images of travellers and providing/maintaining vital links with other services (Myers and Bhopal 2009).

It is hoped this analysis has been successful in highlighting devastating life-long impacts discrimination and oppression can have on the lives of minority groups in society. These effects span all developmental areas and can result in compromised health, education, life chances thus impinging access to societal services. Complexities surrounding why people discriminate against minority groups can be better understood and more effectively challenged using Thompson’s PCS theory.

Whilst informal measures are important factors in combating discrimination and oppression their success concerning some minority groups is measured, illustrated in problems encountered by education services integrating disabled children within mainstream education. General consensus appears to be; more funding and training is required rendering this workable. Similarly promoting equal opportunities to non-English speaking children is important, making significant differences to cultural identity and inclusion within the wider community but financial concerns arise. Informal measures have had little impact on travelling communities as they are still generally socially-excluded. Negating effects of discrimination is a complex balancing act with no easy solution.