Category: Free Essays

Community Care

Introduction

Foster and Roberts (1998, p. i) indicate that there are deficiencies in … the ‘triangular’ relationship between user, carer an community”. They point out that there is a “…common tendency to establish a two-way relationship, and disregard the perspective of the third party …” which “…obstructs the healthy functioning of the care system” (Foster and Roberts, 1998, p.i). Booker and Repper (1998, p. 4) expound upon the preceding in adding that “… community living is particularly difficult for people who have serious mental illness, many of whom experience frequent re-admissions in times of crisis and survive inadequately: in poverty and isolation, without work, with poor social supports and networks, and at risk of victimisation, exploitation, homelessness and imprisonment”. They add that “Indeed the community tenure of this population is often dependent upon the support of informal carers who inevitably have problems and needs themselves” Booker and Repper, 1998, p. 4).

The foregoing points to valid issues brought out regarding the community care system that indicate need further examination, and which represents the focus of this examination. Such asks the question, ‘to what extent is current community care policy and practice responsive to the needs and concerns of service users and carers? The preceding represents an expansive discussion. In order to formulate a balanced assessment of these aspects, this examination shall seek to break down the context into the three frameworks as indicated by Foster and Roberts (1998, p. i), and examine key policy frameworks, and practice developments representing the four specific areas of disability, health, mental health and older people in community care. In said examination, this study shall consider the extent to which policy and practice has been shaped by factors other than the needs and concerns of service users and carers. In a study conducted by the Hull Community Care Development Project over a three year period, it found that “… care and support issues have been largely neglected in area-based work” (Joseph Rowntree Foundation, 2004). The following shall seek to reach a determination if that assessment is true in terms of the four areas identified, disability, health, mental health and older people.

Community Care represents the help as well as support that is provided to individuals that aids them in being able to live either in their own homes, or in a home type setting in their community (careline.org.uk, 2007). The foregoing assistance can consist of representing help for the individual that needs the aid to live in the community as well as help and or assistance for the carer. The government’s policy on community care sets forth six key objectives (careline.org.uk, 2007). The first represents the providing of “… home care, day and respite services …” that enables individuals, wherever feasible as well as possible, to live in their own homes (careline.org.uk, 2007). Secondly, it entails the making of a proper assessment concerning “… need and good care management …” which represents “… cornerstone of high quality care” (careline.org.uk, 2007). The third area represents the promoting and “… the development of a flourishing independent sector alongside good quality services” (careline.org.uk, 2007). The fourth element consists of the clarification of responsibilities to thus make it easier to hold the various agencies accountable for their performance (careline.org.uk, 2007). The fifth aspect represents, “… to secure better value …” for expenditures as a result of the introduction of “… new funding structures for social care” (careline.org.uk, 2007). With the last area, sixth, representing the providing of “… additional help for carers …” as well as offering a choice for patients and the general public (careline.org.uk, 2007).

Community Care services are available to support older people, individual with physical disabilities, learning disabilities, mental health problems and chronic illness (careline.org.uk, 2007). The services that are available, which can differ slightly in some areas, basically consist of 1). Home care, that includes assistance with washing and dressing, 2) meals on wheels and frozen meals, 3) equipment as well as various adaptations to make living at home an easier prospect, 4) Day care centers that contain helpful activities, 5) respite services, 6) supported housing for individuals that with mental health and or disabilities. 7) intermediate care, 8) practical as well as financial assistance, 9) community nursing, 10) incontinence as well as NHS supplied nursing equipment (careline.org.uk, 2007).

Community Care Policy

The National Health Service and Community Care Act of 1990, that was phased into operation over a three year period, established a system whereby the needs of individuals were assessed entailing an agreed upon care plan, assigned worker and regular progress reviews (BBC News, 1998). Part of the procedural aspects of the foregoing was identifying those individuals whom might represent a significant risk, either to themselves and or others (BBC News, 1998). Those so identified where placed onto a ‘Supervision Register’ to prevent them from ‘slipping through the net’, which of course did not, and has not proven full proof (BBC News, 1998). The purpose of the National Health Service and Community Care Act of 1990 was to “… split health and social care provision between purchasers and providers to create an internal market” (Leathard, A., 2003, p. 16). This approach represented a means “To curb costs, purchasers were required to assess needs, while providers were intended to compete against each other to secure contracts from the purchasers” (Leathard, A., 2003, p. 16). The foregoing represented efficiency from the standpoint of governmental administration, however, it shortchanged the ends users, and the patients, in that it immersed them into a bidding supply system that did not place their needs and concerns upper most in the hierarchy. Leathard (2003, p. 16) states that the preceding “The split between purchasers and providers, as well as the competition between the providers themselves, led to fragmentation of services but a collaborative momentum began to build up between the purchasers”.

Important in the foregoing, is the understanding that the methodology provided the District Authorities with the power to purchase hospital care, and the family health service authorities had the responsibility “…for services provided by GPs, pharmacists, dentists and opticians, while local authorities covered the purchasing of all social services in the community” (Leathard, A., 2003, p. 18).

The Secretary of the Central Association for Mental Welfare, Evelyn Fox, in 1930 stated the pure view of community care was one that has seemingly gotten lost in the translation to practice, (Fox, 1930, p. 71):

“Community Care should vary from the giving of purely friendly advice and help to the various forms of state guardianship with compulsory power . . . It should include the power of affording every kind of assistance to the defective – boarding out, maintenance grants, the provision of tools, travelling expenses to and from work, of temporary care, change of air – in a word, all those things which will enable a defective to remain safely in his family . . . If the state has undertaken the duty and responsibility of active interference in the life of an individual by supervision, compulsory attention and so forth, it must undertake the corresponding duty of making his life as happy as possible.

The effective control of a defective at home does inevitably mean a restriction in his complete freedom to go in and out as he pleases, to make what friends he chooses, to select what type of employment he likes out of those that are open to him. To impose these limitations without at the same time giving compensating interests is to court disaster”.

Her statement, which has validity today, saw the family at the centre of community care. In fact, her view was that families should be co-opted to supply effective control (Fox, 1930, p. 73). The policy statements thus far put into action have tended to favour the carers more than the service users, which is shown by the following. The NHS and Community Care Act 1990 is based upon the “… triumvirate of autonomy, empowerment and choice (Levick, 1992, pp. 76-81). Smart, 2002, p. 102) as well as Biggs and Powell (2000, pp. 41-49) both state that the ‘Act’ has a major weaknesses in that it fails to account for any critical analysis concerning the role as well as daily practices of care managers. Clements (2000) provides a critical observation in stating that community care law bears the indelible stamp of its poor origins and that the present shape still resembles Beveridge’s vision of the welfare state. Care in the Community was a policy of the Margaret Thatcher government in the 1990’s whereby she questioned the existence of society and sought via the NHS as well as the Community Care Act 1990 to extend the privatisation agenda into health and community care through the creation of NHS trusts, the greater use of independent residential and nursing homes, and the general promotion of the mixed economy of care (reference.com, 2007). The preceding represented the second shift in the community care / health care approach. The third shift occurred under Section 6 of the Human Rights Act 1998 which casts the definition of a public authority as “to embrace any person some of whose functions are of a public nature” (Bacigalupo et al, 2002, p. 249). The preceding continues “The expansive nature of this concept was explained by the Lord Chancellor who stated that the key question is whether the body in question has ‘functions of a public nature … If it has any functions of a public nature, it qualifies as a public authority” (Bacigalupo et al, 2002, p. 249).

The foregoing means that “… private community care providers as represented by residential care home owners, and or voluntary sector service providers such as Age Concern, MIND or housing associations are ‘public authorities’ in relation to anyone for whom they provide publicly funded care” (Bacigalupo et al, 2002, p. 249). They continue that “Such providers now shoulder public responsibilities for their vulnerable clients and are accountable in public law for their actions” (Bacigalupo et al, 2002, p. 249). The Department of Health has accordingly emphasised the need for English social services departments to ‘ensure that contractors and independent providers are made aware of their new duties” (Bacigalupo et al, 2002, p. 249). Under Article number 2 of the Act, which relates to policy for the Community Care Act 1990, it requires that the government and local authorities take reasonable measures to protect life (Bacigalupo et al, 2002, p. 249). Studies conducted by the Times (1994) found that relocating institutionalised elderly people to a new residence may have a dramatic effect on their mental health and life. A study by the Journal of American Geriatric Society (1994) indicated that mortality rates run as high as 35% in such instances.

Service Users and Carer Perspectives

Both aspects point out the fact that the system was not geared to the well being of the users. Further evidence of the foregoing was also expressed by Hardy et al (1999, pp. 483-491) who pointed out that the changes as brought forth in policy by the 1989 white paper ‘Caring for People’ as well as the 1990 NHS and Community Care Act were to increase choices for users as well as carers. The preceding changes were as a result of the fact that service users had been subordinate to professional service providers (Hardy et al, 1999, pp. 483-491). In addition, their had also been an inherent bias of funding that was geared for residential and nursing care and that such had deprived service users of the choice of being cared for in their own homes (Hardy et al, 1999, pp. 483-491). This was expressed by Leathard (2003, p. 16) who stated, “The split between purchasers and providers, as well as the competition between the providers themselves, led to fragmentation of services but a collaborative momentum began to build up between the purchasers”. The preceding was a result of the efficiency the Act brought to community care which did not address the needs, wishes and concerns of the users as it put them into a bidding system that saved money, but resulted in poorer care.

The foregoing included all four areas, disability patients, health patients, as well as mental health, and elderly patients who were caught in policy and practice developments. The Kings Fund Rehabilitation Programme (Hanford et al, 1999) addresses the foregoing deficiencies through policy initiatives based upon three themes, 1) working in partnership, 2) joint planning, and 3) commissioning. The preceding has been further developed through the King’s Fund updated statements on health and social care, in community based settings (King’s Fund, 2003). The combined initiatives have been devised to loosen governmental control and provide more accountability to patients and the local community (King’s Fund, 2003). Such a shift in policy will also affect hospitals as well as other what is termed as frontline providers to thus be more responsive to local needs and potentially improved performance (King’s Fund, 2003). The King’s Fund (1999) pointed out that the primary responsibility for the improvement in health programmes, specifically with regard to community care, lies with the health authorities, The King’s Fund (1999) also pointed out the however it is the local authorities that are expected to work out the objectives in improving the health and well being of their local communities. The initiatives put forth by the King’s Fund (1999) (2003) have been designed and crafted to achieve these lends through streamlining of the policy and operational facets.

An important aspect of the 1999 King’s Fund initiative entailed calling for improved preventive services that called upon local authorities to aid users to take on as many tasks as they could for themselves for as long as they could, along with living in their own homes for as long as possible. The preceding was borne out of fiscal realities, in order to better conserve funds. However, in light of the findings of studies conducted by the London Times (1994) as well as the Journal of American Geriatric Society (1994) that found that elderly patients that were institutionalized had morality rates that ran as high as 35% in many instances, means that this approach had definitive merits beyond the saving of funds. The foregoing approach was based upon older policy documents by the government that reinforced the methodology of fostering greater independence. Such was put forth by the Department of Health that stated the promotion of independence would “… have a positive effect on informal or unpaid carers … (King’s Fund, 1999). The King’s Fund (1999) also pointed out under ‘Best Value Initiatives’ “… local authorities should reduce delays in providing housing adaptations as part of the general move towards increased accountability to local people”.

The above recognizes the need as well as better care that users would and do receive from home based care that Evelyn Fox brought forth back in 1930. Her statement “If the state has undertaken the duty and responsibility of active interference in the life of an individual by supervision, compulsory attention and so forth, it must undertake the corresponding duty of making his life as happy as possible” (Fox, 1930, p. 71). The initiatives of the King’s Fund helped to remove the stigma as indicated by Clements (2000), that community care law bears the indelible stamp of its poor origins and that the present shape still resembles Beveridge’s vision of the welfare state. The initiative also addressed the observations of Smart, 2002, p. 102) as well as Biggs and Powell (2000, pp. 41-49) who both stated that the ‘Act’ had a major weaknesses in that it failed to account for any critical analysis concerning the role as well as daily practices of care managers. Through promoting more in home care for as long as possible, signaled a change in direction.

Policy changes as brought forth in 1997 resulted in the United Kingdom government issuing in June of each year a policy document informing the Health Authorities of their purchasing intentions for the following year (NHS Executive, 1996). Resulting there from were three sets of objectives: long-term objectives and policies; medium-term priorities and objectives for the 1997/98 year; and baseline requirements and objectives for 1997/98 year (NHS Executive, 1996). In the longer term, performance will be assessed under three headings: equity, efficiency, and responsiveness (NHS Executive, 1996, pp. 11-21). Under the 1997 New Labour reforms, Health Authorities are to be responsible for drawing up three-year Health Improvement Programmes, which are to be the framework within which all purchasers and providers operate (NHS Executive, 1996, pp. 11-21). Under Section 17 of the Health Act 1999 it accords wide powers to the Secretary of State to give directions to Health Authorities, Primary Care Trusts, and NHS Trusts. Prior to the 1997 New Labour proposals, monitoring efforts in the UK’s internal market concentrated on a small set of dimensions of output: annual growth in activity, waiting times, and targets for improvements in the health of certain groups of the population (Propper, 1995, pp. 1685). The foregoing is why the Health Authorities had focused on performance being monitored, but not the needs, desires and wishes of patients and carers.

Changes in Direction

The preceding facets were thus corrected under the indicated 1997 New Labour proposals promise to broaden performance measures to “things that count for patients, including the costs and results of treatment and care” (Department of Health, 2007). This represented the backbone of the indicated King’s Fund (2003) initiatives that have resulted in better patient and carer involvement. The Human Rights Act has had implications both for service users as well as carers in terms of re-focusing upon rights afforded them. It provides for them to have the right to life, the right to be free from inhuman and or degrading treatment, as well as the right to respect for private and family life (Carers UK, 2005). These aspects might seem as being basic rights that carers should have had all along. However, governmental surveys have shown that all too often the rights of carers are ignored and need to be balanced against the people they care for (Carers UK, 2005).

The United Kingdom’s National Strategy for Carers (Carers.UK, 2005) revealed, “carers’ rights are not adequately considered”. The preceding represents that under the Human Rights Act the rights of patients is balanced against the rights of the carer to mean that their views are considered by social services in the rendering of decisions. In addition, the research uncovered that all too frequently “carers’ rights are not real” (Carers.UK, 2005). The foregoing refers to assessments of carers regarding either their opinions and or rights as well as those expressed on behalf of their patients. Research conducted uncovered that carers’ all to frequently feel that their views and opinions are not considered in assessments and or decisions (Carers.UK, 2005). The third aspect of this facet represents the fact that carers’ as well as patients feel that “resources are inadequate to allow rights to be protected” (Carers.UK, 2005). The foregoing refers to the services needed are in all too many instances not available as a result of resources that are inadequate in terms of the cost and or staff time (Carers.UK, 2005). The last aspects refer to “good practice need not be expensive” (Carers.UK, 2005). The research conducted indicated that there are instances whereby imaginative good practice helped to safeguard the human rights of carers. One such example that was provided referred to the utilization of a 24-hour hotline that enabled carers as well as patients to arrange for support in cases of emergency thus referring to the ‘right to life’ aspect of human rights (Carers.UK, 2005). However, unfortunately, there are too few such examples.

Conclusion

The King’s Fund has been most progressive in being circumspect as well as balanced in their review and analysis of legislation, policy, procedures and rights as contained in documentation and as provided by carers and patients. Steps to shore up the human rights of carers as well as patients have been implemented under the Carers Recognition and Services Act 1995 (opsi.gov.uk, 1995) that calls for a separate assessment of carers at the same time one is carried out for patients. The vagueness is being addressed to clear up ambiguities in terms of words and phrases such as ‘substantial care’ services are a result of assessment, autonomy, health and safety, management of daily care routine and involvement (opsi, 2000). The preceding represents four key criteria under the Carers and Disabled Children Act 2000 (opsi, 2000). It corrects the loopholes found under the Carers Recognition and Services Act 1995 in that anyone over the age of 16 years of age who are or intend to provide substantial care that will be on a regular basis for another individual over the age of 18 years of age is entitled to an assessment (opsi, 2000). The preceding occurs regardless of whether the individual for whom they provide care and or support to has refused community care services (opsi, 2000). Additionally, social workers are advised to provide potential carers of their rights through the hand out of a special booklet that sets forth the benefits in receiving a carers assessment (Carers.UK, 2005). All of the foregoing represent policy and practice developments that are and have addressed a number of carer and patients concerns and issues under community care for disability, health, mental health and the elderly, yet there is still room for improvement.

As shown and evidenced throughout this examination, governmental policies in terms of community care policies and practice for the areas of disability, health, mental health and the elderly has been one of evolution. Sometimes however, representing backward steps before moving forward. Evelyn Fox (1930, p. 71) represents an example of progressive thinking and understanding that was not put into practice initially, but was gradually recognized as the approach later in the process. Her statement that placed the family at the center of community care was initially usurped by the efficiency of the National Health Service and Community Care Act of 1990 was devised to curb costs, but shortchanged patients and carers (Leathard, 2003, p. 16). As the system evolved, through its triumvirate of autonomy, empowerment and choice (Levick, 1992, pp. 76-81), it was impacted by the Human Rights Act 1998 and more recently by the combined initiatives of the King’s Fund (2003). These initiatives helped to reshape the inadequacies as presented by the efficient governmental system and adding more humanity, understanding and caring. Through addressing the observations of Smart, 2002, p. 102) along with Biggs and Powell (2000, pp. 41-49) who commented that the Act’s major weaknesses represented its failure to account for a critical analysis of the roles and daily care practices of carers and the importance of maintaining home care for as long as possible. Additionally, the King’s Fund (2003) initiatives brought forth the importance of the carer, patient voice in their affairs as a part of the overall community based care programmes. Thus, after 80 years, the system as swung back to Evelyn Fox (1930. p. 71). Family, after all, is the basis for the community, and as such is the foundation of community care.

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“Standing still enough to absorb the emotional impact of (service users) experiences is something that allows the movement hidden beneath the frozen state of psychological hypothermia to emerge in a tolerable way at the right time.” (Kohli, 2007, p. 180).

This paper will address the relevance of Kohli’s statement above to the discussion on the effective communication with accompanied minors. The paper will first define the term “unaccompanied minors”. It will then provide a definition of communication, then identify and examine its main theoretical perspectives. The paper will unpack the meaning of Kholi’s quotation by advancing a discussion of the importance of timing when working with unaccompanied minors and the intricacies involved in navigating the sometimes harrowing and emotional experiences of unaccompanied minors. The paper will also examine the issue of silence and how this reflects a state of being frozen in time with unaccompanied minors and will interrogate methodologies for delving below these issues, in a timely manner while ensuring that the service feels safe revealing their often locked away emotions. All these factors will be examined in the context of how communication can impact both the practitioner and the service user and how managing each factor effectively is essential to unlocking hidden feelings, emotions and trauma from which unaccompanied minors may suffer. The paper will draw on contemporary literature to empirically ground its arguments.

Both the United Nations High Commission for Refugees (UNHCR) and the United Nations Children Fund (UNICEF) defines unaccompanied as:

“under 18 years of age or under a country’s legal age of majority, are separated from both parents, and are not with and being cared for by a guardian or other adult who by law or custom is responsible for them. This includes minors who are without any adult care, minors who are entirely on their own, minors who are with minor siblings but who, as a group, are unsupported by any adult responsible for them, and minors who are with informal foster families.” (United Nations: 2007)

More recently, there have been a plethora of studies examining the psychosocial and day to day needs after they arrive in Western countries.

Communication is said to be a difficult concept to pin down by way of definition because of its many complexities, forms and application to everything. For the purposes of this paper, the definition provided by Fiske (1990:2) that communication is “social interaction through messages”, provides a good starting point to examine the concept in relation to unaccompanied minors. Thompson (2003) contends that the social aspect of communication is vital to consider because individuals interact within a social space and the nature of this communication dictates the nature of a relationship or how that relationship develops or breaks down.

Thompson (2003) navigates various theoretical model of communication by drawing on the work of other scholars. He identifies Shannon and Weaver’s 1949 definition of communication which locates 3 elements: The transmitter (person who starts communication), noise (the actual message communicated, and the receiver (the person who the message is communicated to). This definition has received ample criticism for oversimplifying a difficult concept wherein communication is not always transmitted by noise but also through silence and body language.

In addressing these omissions, the semiotics model was advanced as an alternative. In this model, communication is described by Cobley (2001) as a form of semiosis which is concerned with the exchange of any messages whatsoever: from the molecular code and the immunological properties of cells all the way through to vocal sentences.” This definition introduces other aspects rather than the spoken word into the communication discourse and Miller (1973) articulates that “communication includes not only the study of spoken communication between people, but also the many kinds of unspoken communication that go on constantly when people interact.” In this respect, communication also encompasses culture, because culture determines shared norms and values, language and ultimately these norms affect how information is communicated or transmitted. Thompson (2003) draws on Pierre Bordieau’s concept of cultural capital based on the strength of power bases, to explain how culture and power can interact to determine how information is understood and communicated, because it informs the semantics of language and the formation of identity. The identification of language as a prominent variable in any communication discourse is inescapable because as Thompson (2003) states, language does not only reflect reality, but it also constructs reality. This fact is elucidated when certain words or actions communicate a task, or certain actions communicate joy, distress or uncertainty, as is postulated by the speech act theory. Similarly, identity is informed by cultural norms and values, and determines how individuals view themselves and how they relate to others.

It is this connection between culture, identity, language and power which informs the foundations of the discussion on how practitioners can cut through the difficulties of intercultural communication barriers to assist usually traumatized unaccompanied minors. Intercultural communication skills in the social work discipline, is fraught with difficulties. Husbands (2000) maintains that the various biographical routes and stories of practitioners does interact in the social space of service users and can affect how information is communication based on how trust is fostered when communicating to service users that difference will be accepted and not judged. Kohli (2006) deftly describes the vulnerable unaccompanied child who arrives in a new country and who is reticent about divulging details to practitioners. He, alongside other scholars (Kohli and Mather: 2003; Beek and Schofield: 2004) observes that unaccompanied children often remain silent, or emotionally closed about their past. He writes that such children have usually been told over and over by others to remain quiet about themselves in order to keep safe. Kohli (2001, 2006, 2007) insists that it is imperative that social work practitioners gain skills that enable them to probe the past of unaccompanied asylum children, in order to truly understand their needs. Kohli recognizes that demands to meet targets faced by modern day practitioners, may interfere with the time they need to build trust and safely pry open the thoughts of unaccompanied minors. In light of this, the nature of their silence and the impact their experiences may have had on them must be explored, before addressing how social workers should “time” their intervention to open communication and prompt life histories from unaccompanied minors.

The silence displayed by unaccompanied minors should not be immediately adjudged to be because they are hiding harmful secrets. In fact, scholars such as Finkenauer et al (2001), argues that the keeping of secrets are normal adolescence developmental characteristics. However, the literature on silences among refugee children often points to explanations of fear and the silencing effects of war on children. Psychological studies (Melzak: 1992) contend that children often bury extreme hurt, pain or loss in order to survive, some to the extent that they can forget some events or the sequence of events as a defense mechanism. The risk of acting out buried emotions in a harmful way, compels many practitioners and scholars to argue for methodologies to unlock these stories which according to Kohler’s quotation, presented at the beginning of this paper, may be in a “frozen state of psychological hypothermia”, wherein they are unable to communicate their hidden pain. Papadoupolos (2002) posits that this frozen state could be purposely imposed to assist in healing and may be necessary to allow affected children the space to reflect, make sense of and accept before being able to move on successfully. Kohli (2006) therefore views this silence as both “burdensome and protective”, and it requires a skillful practitioner to know when to encourage unaccompanied minors to open up.

Krause (1997) and Rashid (1996) both warn against social workers rushing to conclusions about unaccompanied minors based on their cultural backgrounds and what is known about their country of origin. Focusing on organizational targets and not the clients needs first, may result in the practitioner missing the cultural contexts of the minors’ experiences, within specific times and risks simplifying complex information that may be transmitted without adequate reflection on the communication experience overtime. In order to determine when it is appropriate to prompt for hidden information or stories from unaccompanied minors, social workers must recognize that such children may be trying to be accepted within a new culture while suffering a loss from their own (Kohli and Mather: 2003). Therefore, social workers must be observant and reflective (Schon: 1987, 1983) to determine when a child is assimilated enough and trusting of the practitioner service user relationship to reveal any hidden stories of their past lives. Richman (1989) also reminds that many unaccompanied children are very resilient because of their experiences and they may be busy trying to figure out their next move, or how to survive within a new environment and culture, or thinking about their asylum status, than they are interested in reliving past experiences which do not in their estimation contribute to their present survival.

Consequently, practitioners are encouraged to engage in “therapeutic witnessing” (Kohli and Mather: 2003) rather than feeling the need to wring past experiences from unaccompanied minors. In drawing on Blackwell and Melzak (2000), Kohli and Mather (2003: 206) states:

“In essence, workers are asked not to become action orientated helpers in the face of ‘muck and bullets’, but stay still enough to bear the pain of listening to stories of great loss as they emerge at a pace manageable for the refugee.”

While Kohli acknowledges that it is difficult for a practitioner to remain still and allow a “discovery by drip” process to unfold with the refugee, he maintains that it allows refugees to “exorcise their demons and ghosts in the process of self-recovery” (Kholi and Mathers: 2003). This does not diminish the level of practical support that workers should offer to refugees, in fact it is through assisting to order their lives, that they will also make sense of their past and be more willing or open to sharing information about themselves. However, if and when refugees begin to share their experiences, practitioners must be versed on skills to encourage such interaction and should also be cognizant of their own reactions and judgement which can also be communicated to the client nonverbally and affect the “drip” method of divulging information. It is to these issues which this paper now turns.

Relationship based interaction between service users and practitioners remain central to the core value of social work and reflect its best practice. Holloway (2003) concurs with this view by asserting that conversations between practitioner and client dictate how the trust relationship is formed and how the worker is emboldened to assist the client. In this context, a discussion on emotional intelligence (EI) and its importance to the communication process is relevant. Morrison (2007) quotes Goleman’s 1996 definition of EI as “Being able to motivate oneself and persist in the face of frustrations; to control impulse and delay gratification; to regulate one’s moods and keep distress from swamping the ability to think; to empathize and to hope.” This delayed gratification is applicable to the need for social workers to allow unaccompanied minors the space to understand themselves and their new realities while making sense of their past. It requires great empathy and being able to perceive and identifying feelings in the self and others. Morrison (2007) links emotional intelligence and successful social work as being able to be conscious of the self while establishing good communication channels with the refugee. Morrison advises that social workers must be in tuned with their own prejudices and assumptions because many vulnerable clients such as unaccompanied minors are used to reading body language and silent communication signs to determine whether they should trust individuals. Therefore practitioners must ensure that their methods of practice reinforce good communication values rather than downplay them.

One of the first methodologies used by the social work practitioner is that of assessment. Assessment frameworks in the UK give little space for the exploration of histories (Morrison: 2007). Consequently, the emotions which compel youth behaviour is often not deeply understood from unaccompanied minors, especially since they may be silent and initially provide minimal normative sketches of their past. Accurate observation during assessment will take note of feelings which may hide deeper emotions and record the moments when these windows into the past were glimpsed or sensed. Much can also be gain by the observation that expression is void of emotion, as this may also be an indicator that the unaccompanied minor realize that communication certain emotions in their language may give the practitioner space to questions their past and they may be skilled at hiding such feelings in their language and tone. If information from the refugee is sparse and void of emotion, the practitioner should make extra effort to be reflective in practice to ensure that their own perceptions or impressions are not being transmitted to the client. Goleman et al (2002) articulates that there is a situation of dissonance when one party feels like the other is out of touch with their feelings. The Audit Commission’s 2006 report (p.66) into the treatment of unaccompanied children, demonstrates how practitioner bias can affect the level of treatment given to refugee children:

“Many unaccompanied children have multiple needs because of their experiences of separation, loss and social dislocation . . . Yet in many cases they do not receive the same standard of care routinely afforded to indigenous children in need, even though their legal rights are identical.”

Practitioners must therefore guard against treating unaccompanied minors as “another client”, because the literature identifies them as being particularly in tune to all forms of communication within the interaction process, and they use this as a guide on who, when and how to trust.

A vital part of the assessment is the interviewing of the unaccompanied minor. Wilson and Powell (2001: 1) maintain that “a child’s thinking is dependent on a number of factors including memory, conceptual development, emotional development and language formation.” They further assert that there are three aspects to remembering information: knowledge, sequencing and prioritizing. They contend that practitioners must seek to gain all three trough safe methods when interviewing and practice patience. It is important to note their guidance that a memory may not always be told in the right sequence, and be prioritized according to the present needs of the child or in the case of this paper – the unaccompanied minor. Furthermore, they remind us that a child’s memory may not be accurate, this could be deliberately so (as already explored by Kohli: 2006), and they argue that it is up to the interviewer to use a method of questioning when appropriate to maximize the accuracy of responses.

The Achieving Best Evidence in Criminal Proceedings (2007) document which provided information on interviewing children stated that interviewers must approach the interview with an open mind and that enquiries should not increase the distress of a child by allowing them to reluctantly relive bad experiences. Similarly, the 1998 Cleveland Inquiry Report suggests that: All interviews should be conducted by a professional with child interview training; Interview questions should be open-ended; There should be one and no more than two interviews for the purpose of assessment and it should not be too long; the interview should be paced by the child not the adult among others and it is recommended that the both the police and the social worker (if necessary) interview the child at the same time. These guidelines ensure that the interview adopts a child-centered approach. Another method that is advised with unaccompanied children is the phased interview approach.

The phased interview approach is structured in three parts: the introduction and initial rapport establishment, the free narrative section and questioning section where the child is given space to communicate, alongside being questioned, and the closure of the interview. It is important to prepare children for the interview, through pre-interview contact to lessen any stress which may arise from being fearful of the process. Children should get ample time to consider whether they wish to share their stories or keep them locked away. Furthermore, the skill to actively listen is paramount to a social work practitioner as it not only assists with accurately observing, but it assures the child that what they are saying is being heard (Wilson and Powell: 2001). To assist in accuracy, the interviewer should reflect back the child’s responses to them for affirmation of clarification paying particular attention to maintaining neutral body language and tone while doing so (Thompson: 2002). However, Wilson and Powell (2001) maintain that if a term is not familiar to the interviewer or seems like slang, the interviewer should make every effort to clarify its meaning with the child in order to maximize accuracy and assist in avoiding possibilities of intercultural communication. Bradford (1994) further posits that the interviewer has the responsibility to ensure the validity of the communication process by pursuing the statement validity analysis (SVA). The SVA checks that the testimony contains no contradictions or logical inconsistencies, the abundance of details, the accuracy of contextual evidence which may be verifiable, the ability to reproduce conversations and interactions and the presence of complicated obstacles. However, Davies (2006) warns that while this tool may be useful, it is not a accurate fix, particularly in the case of silent children who may choose to withhold traumatic information (Kohli: 2006).

Wilhelmy and Bull (1999) argues that the use of drawings within interviews with child by practitioners should be encouraged where appropriate because it also provides assurance to the child that the interviewer is child centered. If this method is used, the interviewer must be very observant that this method does not make the child uneasy. While drawing may presents many opportunities to further question the child, the practitioner must as Kholi’s quotation suggests be extremely patient to unlock information and allow the interview to be paced by the child, thereby giving them space to trust the interviewing process. A child’s comfort with drawing, ay actually provide an opening to more difficult or painful areas and care should be taken to note and protect the child’s wellbeing and level of distress when painful information is disclosed. The use of role play and storytelling also offers unique methodologies to social workers to assist children in disclosing painful information.

Outside of the interview process, Chamberlain (2007) recounts the use of storytelling by the Medical Foundation for the Care of Victims of Torture to assist refugee children from war torn countries to unlock their deeply buried painful memories when they are ready. He quotes Sheila Melzack the centers consultant child and adolescent psychotherapist as saying:

“Many are in a state of suspended animation because they do not know whether they will be forced to return home. We are trying to give them coping strategies to deal with all these issues. But instead of saying directly what they saw or did we deal with it through displacement. They can be extracted through stories which create safe arenas to talk about these issues.”

Therefore, Chamberlain (2007) and Davis (1990) asserts that stories can be utilized as a therapeutic intervention method to assist unaccompanied children to recall incidents, not necessarily airing them, but developing coping strategies that assist in building resilience in a new environment.

There are however, instances where unaccompanied children come from countries whose language differ from that of the receiving country. Gregory and Holloway (2005) maintain that language is used both to grant and restrict access to a society or organization. Chand (2005) identifies the lack of adequate interpreting and translation services within the UK social work sector. Chand’s research located many instance where the services of interpreters and translators were needed but they did not show, usually because of lack of resources, so they prioritise which cases they believe are more important such as more formal case conferences. Humphreys et al (1999) found that many interpreters left case conferences and assessment early, or that interviews or conferences may be rushed because of lack of resources. In light of the previous discussion on the need for social workers to be patient and allow unaccompanied minors to work through past recollections until they are in a space to share, this practice of rushing sessions to facilitate interpreters, is detrimental to the communication process between practitioner and the unaccompanied child and could discourage disclosure and engender trust issues.

As was discussed earlier in the theoretical section of this paper, language is closely related to power and can be used to control and regulate discourses and effect social control, based on its ability to include or exclude. The client-practitioner relationship is one in which the practitioner asserts their professionalism and therefore must take great care that such imbalance of power is not misunderstood by the client or imposed on them to hinder effective communication (Gregory and Holloway: 2005). Unaccompanied children, who have suffered trauma are usually used to being victimized by relationships of power imbalances, and therefore the social worker must always recognize that the relationship with such individuals is aimed at building their resilience and capacity :to adjust to all or any part of their new environment.

While keeping practice client focused, recent years have seen the introduction of numerous guidelines, new legislation and policy changes which require the adherence and commitment of the social work practitioner. Some critics (Young: 1999; Malin: 2000), debate that social work has become mediatory and managerial under modern day guidelines and stipulations which risk the developing of solid client-practitioner relationships and the development of trust. While Gregory and Holloway (2005) argue that the language of such guidelines can be interpreted as the social control of the social work profession which ultimately seeks to “fix” the meanings of grounded work with vulnerable clients to suit political agendas. Social workers must remain committed to the ethic of the profession and promote good social work values by ensuring that such language of control is not transferred from the managerial spheres to what Schon (1983) terms as the trenches of social work, that is, the interpersonal communication with clients. It is this regard that social workers must be aware of the power of language in working with unaccompanied minors, and ensure that the practice language is not dominated by a controlling or power induced thrust, but recognizes the vulnerability of clients and their need to slowly build trust and thaw their emotions (Kohli: 2006, 2007).

As with language, the relations between social work practitioners and other services, can directly affect relationship with unaccompanied minors and how they trust the professionalism of those who communicate to them that they care. The death of eight year-old Victoria Climbie presents an example of how the lack of effective communication between professional practitioners can result in harm, especially to children from foreign cultures. The Laming Report of 2003, an inquiry into Victoria’s death concluded that the young girl’s death could have been avoided if individual social workers, police officers, doctors and nurses who came into contact with the girl, had effectively responded to Victoria’s needs. The National Service Framework for Children and Young People (NSF) and the Common Assessment Framework (CAF), both strive to ensure the effective communication between service providers across sectors. Glenny (2005) states that:

“a lot of inter-agency collaboration is not about collaborative activity as such, but about communicating effectively with regard to individual pieces of work , ensuring patchwork of individual effort in relation to a particular [case], made sense…”

Ensuring proper communication between agencies when dealing with unaccompanied minors, is therefore essential to build trust in the client-practitioner relationship (Cross:2004) and to remove any doubts the minor may have that the capillaries of power that agencies appear to be, will work for their benefit and well being and not contribute to any further victimization they may have suffered.

It is therefore conclusive to say that the issue of managing effective communication is absolutely essential to successful social work practice with unaccompanied minors. The paper navigated the theoretical intricacies of the concept of communication to highlight its broad nature and how culture, language, body language and even silence are powerful communication tools tapped into by both practitioner and the unaccompanied minor in establishing boundaries of trust. One of the most evident revelations of this paper, is the need for practitioners to practice patience to allow unaccompanied minors the space to unlock their hidden stories, while providing them with support for their daily needs. Furthermore, the issue of intercultural communication difficulties that lack of interpreting and translation resources can cause in fostering best practice with accompanied minors was explored and it was identified that despite the lack of resources, unaccompanied minors are better served when they are not rushed for their hidden experiences. Finally, the paper identified the how the language of managerial control within social work can hinder best practice, if control of power imbalance is communicated even non-verbally to unaccompanied minors, who are very attuned to detecting such relations in order to protect themselves.

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‘Analyse the contribution of Ecological theory to our understanding of typical and atypical child development, and discuss this model in relation to the factors and possible interventions for child abuse’

‘The importance of insight regarding the parent/child bond has always been a component of social services custom, but the significance has not always been indentified of the interaction that the environment plays on a parents ability to act in their child’s best interests’ (Department of Health, 1999). A significant breakthrough in the knowledge of child abuse appears to have emerged through the application of an ecological model of child maltreatment, ‘The ecological paradigm is currently the most comprehensive model we have for understanding child abuse’ (Gallagher 2001; 76). Such a perspective has generally been derived from theory based on Bronfenbrenner’s (1979) pioneering work, in which he defines to which ‘The ecology of human development involves…the progressive, mutual accommodation between an active, growing human being and the changing properties of the immediate settings…this process is affected by relations between these settings and by the larger contexts in which these settings are embedded’. (Sidebotham, 2001; 105).

The importance of an ecological standpoint in the perception of abuse is, firstly, that it widens the boundaries of the unfavourable effects of maltreatment on children beyond just the parent-child relationship to consider the familial and social context in which such abuse occurs. Second, the ecological model is transactional; in the sense that it acknowledges the individual and the immediate and wider influences as actively interacting with each other. However, it should be noted that this ideology holds some limitations in the sense that it would not seem to account very well for child sexual abuse. Any pairing together of juxtapositions forms of behaviour ‘as occurs with ‘child abuse’ or ‘child maltreatment’, is bound to result in some loss of specificity…It would be foolish to think that ecological models are the final word on child abuse…there is not single solution to abuse’ (Gallagher 2001; 77).

Specific hazardous factors contribute to parents abusing their children. Although maltreatment does not often occur without numerable of these factors interacting in the same household simultaneously. Firstly, the risk of abuse increases in any household exposed to significant stress, regardless if this stress arises from unemployment, poverty, neighbourhood violence, a lack of social support, or an especially demanding infant (CDC, 2006). Bronfenbrenner’s predominant layer, or microsystem, refers to the collaborations that occur within the child’s immediate environment. The child’s own genetic and social characteristics affect the habits, behaviour and patience of their peers, For example, a temperamentally tiresome infant could disaffect their parents or even create friction between them that may be sufficient to damage their marital relationship (Belsky & Crnic, 1995). Also, the relationship between any two individuals in the microsystem is likely to be influenced by the introduction of a child. Fathers, for example, clearly influence mother-infant interactions, happily married mothers who have close supportive relationships with their husbands tend to interact much more patiently and sensitively with their infants than mothers who experience marital tension, little support from their spouses, or feel that they are raising their children on their own (Cox et al, 1992).

In regards to the emphasis on family, the notion to which a parent regards their competence and rates the performance of their parenting role is also a relevant matter. Parenting competence has been noted as problematic among abusive parents (Marsh & Johnston, 1990) and linked with increased abuse possibility. Whilst acknowledging that improvement of parenting capacity is an important objective ‘one must be cautious in concluding that improved competency in parenting directly results in a reduction in child maltreatment as observations on interactions based under experimental conditions rarely reflect in daily life’ (Gallagher,2001;248).

Direct exposure to abuse can have a dangerous impact as abused children tend to function less adaptively than their non-abused peers in many areas (Cicchetti, Rogosch, 1993). According to Hipwell et al (2008) Children in a caring and loving environment feel more secure in their immediate surrounds in regard to the microsystem, they develop greater self-confidence, are altruistic and show higher signs of being empathetic. These children are also shown to have larger IQ’s throughout their schooling life, and show lower levels of anger and delinquent behaviour. As Bronfenbrenners ecological model would present, higher degrees of affection can even buffer a child against the negative implications of otherwise precarious environments (Bartley & Fonagy, 2008). Several studies of children and teens growing up in poor, dangerous neighbourhoods show that the single ingredient that most clearly distinguishes the lives of those who do not become delinquent from those who do is a high level of maternal love (McCdord, 1982).

The Mesosystem is the connections or interrelationship among such microsystems as homes, schools, and peer groups. Bronfenbrenner argues that development will be increased by supportive and strong connections between Microsystems. For example, children who have instigated attached and secure relationships with parents have a tendency to be accepted by others and to have close, supportive peers during their development (Perry, 1999). According to McAdoo (1996) a child’s competence to learn in a schooling environment is dependent upon the quality of the teaching provided and also the degree to which their parents place value upon education capital and how they interact with the teacher and vice-versa. However, this can also impact negatively at this level as when deviant peer groups or friends of the child devalue scholastics, they will tend to undermine that child’s school performance in spite of teacher and parents best efforts.

Numerable research has revealed that exposure to abuse had a severe negative impact upon a child’s academic functioning. Schwab-Stone et al (1995) concluded that as the consistency of maltreatment increased this had a direct negative correlation with academic performance. Likewise, Bowen (1999) found in a sample of over 2000 high school students that exposure to community and school violence put limitations on school attendance, behaviour and results. Warner and Weist (1999) revealed that children from low income families who are witnesses to household and neighbourhood violence demonstrated atypical symptoms of PTSD, anxiety and depression. The symptoms continue upon the latter to include atypical externalising behaviours such as anger, inability to form relationships and a decline in academic performance.

‘Surviving on a low income in a bad neighbourhood does not make it impossible to be the caring, affectionate parent of healthy, sociable children. But it does, undeniably, make it more difficult’ (Utting, 1995, p. 40). Children from low-income households may display more behavioural troubles than their better-off peers. However, according to Gorman-Smith (1998) family factors, including parenting practices do not predict children’s exposure to violence. He suggests that other community factors rather than their household income will influence and operate on children and those family factors are not powerful enough to mediate or moderate their effects. Such studies have often found there to be an important correlation between communities in which citizens have described a high level of community cohesions and children safety, with an increase in child abuse being linked with a negative sense of community identity.

Self-care has the most negative effects for children in low-income neighbourhoods with high crime rates (Marshall et al, 1997). Children who begin self-care at an early age are more vulnerable to older self-care children in their communities who can damage or abuse them. These children are more likely to have adjustment problems in school and are more likely to use after-school with socially deviant peers who do not value school and undergo criminal activities. Predictably, then the positive effects of organised after school programs on academic achievement are greater for children in low-income neighbourhoods (Mason & Chuang, 2001).

Bronfenbrenner’s penultimate layer, or exosystem, consists of contexts that children and their peers may not be aware although nevertheless will influence their development. For example, parents’ work environments are an exosystem influence. Children’s emotional relationships at home may be influenced considerably by whether or not their parents enjoy their work (Greenberger, O’Neal, & Nagel, 1994). In a similar fashion, children’s experiences in school may be influenced by their exosystem, by a social integration plan taken on by the school council, or by job cuts in their community that result in a decline in the school’s revenue. Negative impacts on development can also result when the exosystem breaks down. For example, Sidebotham (2002) has shown that households that are affected by unemployment, poor housing and poor social networks are more likely to be involved in increased occurrences of child abuse. Whose comments are justified next to Beeman (1997) who concluded that a lack of social support and a high consistency of negative attitudes towards available networks all contribute towards the chances of child maltreatment.

The majority of the research on the impact of mother’s employment concludes towards a small positive influence on most children (Scott, 2004). Children whose mothers are in employment are more confident and show more admiration for their mothers in contrast to those mothers who do not work. The effect of the mothers work on influencing attitudes and results in school become less apparent, with many studies showing no difference (Gottfried, Bathurst, 1994). Muller (1995) in his large study on the latter topic distinguished a small but comprehensible negative difference on the effect on maths results if that child’s mother was in employment. However, this difference seemed to be based on the fact that mothers who do not work as much are less engrossed with their child’s work and are less likely to oversee the child’s work continuously after school, rather than from a long-lasting deficit brought about by maternal employment in the early years. Thus, working mothers who find ways to provide such supervision and who remain involved with their children’s schools have kids who do as well as children whose mothers are homemakers.

Research evidence intuitively shows that when a man becomes unemployed, it places a strain on his marriage; which in turn leads to an increase in marital conflict and both mother and father show more signs of depression. The effects of these conflicts eventually show the same characteristics as families who are experiencing divorce; both parents appear less coherent in their attitudes towards their children, become less loving and less effective at monitoring them. Similarly, children, in turn respond to this situation as they would during their parents divorce by exhibiting a series of atypical behaviours which can include depression, anger or becoming involved in delinquent behaviour. According to Conger et al (1992), the likelihood of abuse at all levels, shows an increase during times of households unemployment. However, according to Berger (2004) parents who are experiencing divorce but who have a supportive framework and emotional support from friends are increasingly more likely to provide a safe and affectionate environment for children in comparison to those who are occupied in social isolation.

Gorman-Smith and Tolan (1998), in their study of the effects of divorce, did not find that family structure and other familial influences had an independent involvement towards the prediction of exposure to abuse in comparison to that of other risk factors such as the breakdown of traditional social processes in the community. Low income parents are characterised by contributing towards their child’s atypical development as Evans (2004) concludes that parents of such a nature are less likely to communicate with their children, spend less time engaging with them in intellectually stimulating activities and in turn are harsher and more aggressive in their discipline techniques. Not all children follow the same development pathways and there are certain factors that influence their development. For example, children below the poverty line are half as likely to recall the alphabet and have the ability to count by the time they enter the first years of schooling. This development according to Brooks-Gunn (1995) also applies, and is maintained through to adolescence as older children in poverty are twice as likely as their counterparts to repeat a year of school and are less likely to go onto higher education.

In keeping with Bronfenbrenner’s model, parental values on the best way to deal with discipline will be largely in coherence with the larger culture in which they reside. According to Lockhart (Ecology of Development; 345), by striking a child it will usually stop the chid from repeating the behaviour. Although research evidence suggests that children who are spanked, like children who are abused at later ages are less popular with their peers and show higher levels of aggression, lower self-esteem, more emotional instability, higher rates of depression and distress, and higher levels of delinquency and later criminality (Mostow & Campbell, 2004).

Bronfenbrenner’s concluding layer is that of a macrosystem which entails a broad, overarching ideology in which the child is embedded, and whose principles dictate how a child should be treated and how discipline should be distributed. These principles differ across macrosystems (cultures) and sub-cultures and social classes and can have a direct influence on the types of experiences a child will have in all levels of their ecological system. To cite one example, Belsky (1993) discusses how the incidence of child abuse in families (a microsystem experience) is much lower in those cultures (or macrosystems) that discourage physical punishment of children and advocate nonviolent ways of resolving interpersonal conflict. Similarly Clarke (1997) revealed how at the level of the macrosystem, a Government policy that ensures parents have the option to take paid or unpaid leave from their jobs to see to family matters could provide a significant intervention towards child abuse allowing parents more free time to observe their child’s development and resolve difficulties that may arise within their child.

The debate that encircles the surrounding links between culture and child abuse is a complex notion, which has resulted in a myriad of concerns. For instance, recent statistics of child maltreatment has indicated that ethnic minority children are substantially more at risk of abuse than their Caucasian counterparts (U.S Department of Health, 2006). However Lassiter (1987) has countered, showing that these minorities may be over-represented to the relevant services. Lassiter argues that biased statistics do not take into consideration other influencing factors such as socioeconomic status and the level of schooling received. Without considering socioeconomic factors that may also influence the parent and child, research risks inadvertently concluding that factors that increase abuse potential are because of race or ethnicity, or are universal.

The contextual risk variable that looks to have the biggest part in forecasting child maltreatment is having a family member who has also been a direct victim of some form of previous abuse. For example, A parent suffering from the stress of having been victimised herself or having another family member who has been victimised may be overwhelmed and more disturbed by the child’s behaviour and may, therefore, have a lower threshold for viewing the child’s externalizing behaviour as problematic. Primary or universal support targets the community as a whole, with generic initiatives, campaigns and community-based services that support parents and families without entry criteria. Their aim is to prevent problems such as child abuse and family breakdown (Healy & Darlington, 1999).

MacMillan (1994) in describing child abuse interventions found it necessary to distinguish between the differing forms of prevention, including that of primary intervention to which he describes as ‘any manoeuvre that is provided to the general population or a sample of the general population or a sample of the general population to reduce the incidence of child maltreatment;, and secondary prevention, ‘early detection of a condition with the aim of shortening the duration of the disorder’, and tertiary prevention, ‘prevention of recurrence of maltreatment and impairment resulting from abuse’. MacMillan further explained the difficulties in prevention in regards to psychological and emotional maltreatment, which accounts for a high number of reported cases but difficulty arises when evidence needs to be collated, and if emotional abuse is accepted as a form of abuse, then the distinction between primary and secondary prevention or indeed tertiary prevention becomes less clear.

Osofsky (1995) in his research on primary prevention has called for a nationwide campaign that would address to change the attitudes toward maltreatment and lower peoples tolerance of child abuse. Support for an ecological approach to child welfare is evident in the Framework for the Assessment of Children and their Families (Department of Health et al, 2000), which stresses the need to consider not only the factors relating to the child and their parents, but also the wider context in which children live when assessing their needs, acknowledging the impact of social and community factors on children’s welfare. This is also justified through the Every Child Matters document which refers to the concept of ‘Making a positive contribution; being involved with the community and society’. Involving local communities in the prevention of child abuse was acknowledged by Nelson and Baldwin (2002) who asserted that the Every Child Matters model ‘has the potential to involve communities enthusiastically in partnership with agencies in identifying problems and seeking solutions and that the process can help to build communities which are more informed, aware and thoughtful about child protection’. Although the presence of risk factors, such as a poor environment or unsupportive relationships with primary caregivers, or being looked after outside the family, increases the likelihood of a negative outcome for the individual, studies of competence and resilience have shown that, regardless of background, children are generally resourceful. Competence has been shown to be a mediating variable that predicts positive or negative outcomes (Smith, Cowie, Blades, 2001; 569).

‘Analyse the contribution of Ecological theory to our understanding of typical and atypical child development, and discuss this model in relation to the factors and possible interventions for child abuse’

‘The importance of insight regarding the parent/child bond has always been a component of social services custom, but the significance has not always been indentified of the interaction that the environment plays on a parents ability to act in their child’s best interests’ (Department of Health, 1999). A significant breakthrough in the knowledge of child abuse appears to have emerged through the application of an ecological model of child maltreatment, ‘The ecological paradigm is currently the most comprehensive model we have for understanding child abuse’ (Gallagher 2001; 76). Such a perspective has generally been derived from theory based on Bronfenbrenner’s (1979) pioneering work, in which he defines to which ‘The ecology of human development involves…the progressive, mutual accommodation between an active, growing human being and the changing properties of the immediate settings…this process is affected by relations between these settings and by the larger contexts in which these settings are embedded’. (Sidebotham, 2001; 105).

The importance of an ecological standpoint in the perception of abuse is, firstly, that it widens the boundaries of the unfavourable effects of maltreatment on children beyond just the parent-child relationship to consider the familial and social context in which such abuse occurs. Second, the ecological model is transactional; in the sense that it acknowledges the individual and the immediate and wider influences as actively interacting with each other. However, it should be noted that this ideology holds some limitations in the sense that it would not seem to account very well for child sexual abuse. Any pairing together of juxtapositions forms of behaviour ‘as occurs with ‘child abuse’ or ‘child maltreatment’, is bound to result in some loss of specificity…It would be foolish to think that ecological models are the final word on child abuse…there is not single solution to abuse’ (Gallagher 2001; 77).

Specific hazardous factors contribute to parents abusing their children. Although maltreatment does not often occur without numerable of these factors interacting in the same household simultaneously. Firstly, the risk of abuse increases in any household exposed to significant stress, regardless if this stress arises from unemployment, poverty, neighbourhood violence, a lack of social support, or an especially demanding infant (CDC, 2006). Bronfenbrenner’s predominant layer, or microsystem, refers to the collaborations that occur within the child’s immediate environment. The child’s own genetic and social characteristics affect the habits, behaviour and patience of their peers, For example, a temperamentally tiresome infant could disaffect their parents or even create friction between them that may be sufficient to damage their marital relationship (Belsky & Crnic, 1995). Also, the relationship between any two individuals in the microsystem is likely to be influenced by the introduction of a child. Fathers, for example, clearly influence mother-infant interactions, happily married mothers who have close supportive relationships with their husbands tend to interact much more patiently and sensitively with their infants than mothers who experience marital tension, little support from their spouses, or feel that they are raising their children on their own (Cox et al, 1992).

In regards to the emphasis on family, the notion to which a parent regards their competence and rates the performance of their parenting role is also a relevant matter. Parenting competence has been noted as problematic among abusive parents (Marsh & Johnston, 1990) and linked with increased abuse possibility. Whilst acknowledging that improvement of parenting capacity is an important objective ‘one must be cautious in concluding that improved competency in parenting directly results in a reduction in child maltreatment as observations on interactions based under experimental conditions rarely reflect in daily life’ (Gallagher,2001;248).

Direct exposure to abuse can have a dangerous impact as abused children tend to function less adaptively than their non-abused peers in many areas (Cicchetti, Rogosch, 1993). According to Hipwell et al (2008) Children in a caring and loving environment feel more secure in their immediate surrounds in regard to the microsystem, they develop greater self-confidence, are altruistic and show higher signs of being empathetic. These children are also shown to have larger IQ’s throughout their schooling life, and show lower levels of anger and delinquent behaviour. As Bronfenbrenners ecological model would present, higher degrees of affection can even buffer a child against the negative implications of otherwise precarious environments (Bartley & Fonagy, 2008). Several studies of children and teens growing up in poor, dangerous neighbourhoods show that the single ingredient that most clearly distinguishes the lives of those who do not become delinquent from those who do is a high level of maternal love (McCdord, 1982).

The Mesosystem is the connections or interrelationship among such microsystems as homes, schools, and peer groups. Bronfenbrenner argues that development will be increased by supportive and strong connections between Microsystems. For example, children who have instigated attached and secure relationships with parents have a tendency to be accepted by others and to have close, supportive peers during their development (Perry, 1999). According to McAdoo (1996) a child’s competence to learn in a schooling environment is dependent upon the quality of the teaching provided and also the degree to which their parents place value upon education capital and how they interact with the teacher and vice-versa. However, this can also impact negatively at this level as when deviant peer groups or friends of the child devalue scholastics, they will tend to undermine that child’s school performance in spite of teacher and parents best efforts.

Numerable research has revealed that exposure to abuse had a severe negative impact upon a child’s academic functioning. Schwab-Stone et al (1995) concluded that as the consistency of maltreatment increased this had a direct negative correlation with academic performance. Likewise, Bowen (1999) found in a sample of over 2000 high school students that exposure to community and school violence put limitations on school attendance, behaviour and results. Warner and Weist (1999) revealed that children from low income families who are witnesses to household and neighbourhood violence demonstrated atypical symptoms of PTSD, anxiety and depression. The symptoms continue upon the latter to include atypical externalising behaviours such as anger, inability to form relationships and a decline in academic performance.

‘Surviving on a low income in a bad neighbourhood does not make it impossible to be the caring, affectionate parent of healthy, sociable children. But it does, undeniably, make it more difficult’ (Utting, 1995, p. 40). Children from low-income households may display more behavioural troubles than their better-off peers. However, according to Gorman-Smith (1998) family factors, including parenting practices do not predict children’s exposure to violence. He suggests that other community factors rather than their household income will influence and operate on children and those family factors are not powerful enough to mediate or moderate their effects. Such studies have often found there to be an important correlation between communities in which citizens have described a high level of community cohesions and children safety, with an increase in child abuse being linked with a negative sense of community identity.

Self-care has the most negative effects for children in low-income neighbourhoods with high crime rates (Marshall et al, 1997). Children who begin self-care at an early age are more vulnerable to older self-care children in their communities who can damage or abuse them. These children are more likely to have adjustment problems in school and are more likely to use after-school with socially deviant peers who do not value school and undergo criminal activities. Predictably, then the positive effects of organised after school programs on academic achievement are greater for children in low-income neighbourhoods (Mason & Chuang, 2001).

Bronfenbrenner’s penultimate layer, or exosystem, consists of contexts that children and their peers may not be aware although nevertheless will influence their development. For example, parents’ work environments are an exosystem influence. Children’s emotional relationships at home may be influenced considerably by whether or not their parents enjoy their work (Greenberger, O’Neal, & Nagel, 1994). In a similar fashion, children’s experiences in school may be influenced by their exosystem, by a social integration plan taken on by the school council, or by job cuts in their community that result in a decline in the school’s revenue. Negative impacts on development can also result when the exosystem breaks down. For example, Sidebotham (2002) has shown that households that are affected by unemployment, poor housing and poor social networks are more likely to be involved in increased occurrences of child abuse. Whose comments are justified next to Beeman (1997) who concluded that a lack of social support and a high consistency of negative attitudes towards available networks all contribute towards the chances of child maltreatment.

The majority of the research on the impact of mother’s employment concludes towards a small positive influence on most children (Scott, 2004). Children whose mothers are in employment are more confident and show more admiration for their mothers in contrast to those mothers who do not work. The effect of the mothers work on influencing attitudes and results in school become less apparent, with many studies showing no difference (Gottfried, Bathurst, 1994). Muller (1995) in his large study on the latter topic distinguished a small but comprehensible negative difference on the effect on maths results if that child’s mother was in employment. However, this difference seemed to be based on the fact that mothers who do not work as much are less engrossed with their child’s work and are less likely to oversee the child’s work continuously after school, rather than from a long-lasting deficit brought about by maternal employment in the early years. Thus, working mothers who find ways to provide such supervision and who remain involved with their children’s schools have kids who do as well as children whose mothers are homemakers.

Research evidence intuitively shows that when a man becomes unemployed, it places a strain on his marriage; which in turn leads to an increase in marital conflict and both mother and father show more signs of depression. The effects of these conflicts eventually show the same characteristics as families who are experiencing divorce; both parents appear less coherent in their attitudes towards their children, become less loving and less effective at monitoring them. Similarly, children, in turn respond to this situation as they would during their parents divorce by exhibiting a series of atypical behaviours which can include depression, anger or becoming involved in delinquent behaviour. According to Conger et al (1992), the likelihood of abuse at all levels, shows an increase during times of households unemployment. However, according to Berger (2004) parents who are experiencing divorce but who have a supportive framework and emotional support from friends are increasingly more likely to provide a safe and affectionate environment for children in comparison to those who are occupied in social isolation.

Gorman-Smith and Tolan (1998), in their study of the effects of divorce, did not find that family structure and other familial influences had an independent involvement towards the prediction of exposure to abuse in comparison to that of other risk factors such as the breakdown of traditional social processes in the community. Low income parents are characterised by contributing towards their child’s atypical development as Evans (2004) concludes that parents of such a nature are less likely to communicate with their children, spend less time engaging with them in intellectually stimulating activities and in turn are harsher and more aggressive in their discipline techniques. Not all children follow the same development pathways and there are certain factors that influence their development. For example, children below the poverty line are half as likely to recall the alphabet and have the ability to count by the time they enter the first years of schooling. This development according to Brooks-Gunn (1995) also applies, and is maintained through to adolescence as older children in poverty are twice as likely as their counterparts to repeat a year of school and are less likely to go onto higher education.

In keeping with Bronfenbrenner’s model, parental values on the best way to deal with discipline will be largely in coherence with the larger culture in which they reside. According to Lockhart (Ecology of Development; 345), by striking a child it will usually stop the chid from repeating the behaviour. Although research evidence suggests that children who are spanked, like children who are abused at later ages are less popular with their peers and show higher levels of aggression, lower self-esteem, more emotional instability, higher rates of depression and distress, and higher levels of delinquency and later criminality (Mostow & Campbell, 2004).

Bronfenbrenner’s concluding layer is that of a macrosystem which entails a broad, overarching ideology in which the child is embedded, and whose principles dictate how a child should be treated and how discipline should be distributed. These principles differ across macrosystems (cultures) and sub-cultures and social classes and can have a direct influence on the types of experiences a child will have in all levels of their ecological system. To cite one example, Belsky (1993) discusses how the incidence of child abuse in families (a microsystem experience) is much lower in those cultures (or macrosystems) that discourage physical punishment of children and advocate nonviolent ways of resolving interpersonal conflict. Similarly Clarke (1997) revealed how at the level of the macrosystem, a Government policy that ensures parents have the option to take paid or unpaid leave from their jobs to see to family matters could provide a significant intervention towards child abuse allowing parents more free time to observe their child’s development and resolve difficulties that may arise within their child.

The debate that encircles the surrounding links between culture and child abuse is a complex notion, which has resulted in a myriad of concerns. For instance, recent statistics of child maltreatment has indicated that ethnic minority children are substantially more at risk of abuse than their Caucasian counterparts (U.S Department of Health, 2006). However Lassiter (1987) has countered, showing that these minorities may be over-represented to the relevant services. Lassiter argues that biased statistics do not take into consideration other influencing factors such as socioeconomic status and the level of schooling received. Without considering socioeconomic factors that may also influence the parent and child, research risks inadvertently concluding that factors that increase abuse potential are because of race or ethnicity, or are universal.

The contextual risk variable that looks to have the biggest part in forecasting child maltreatment is having a family member who has also been a direct victim of some form of previous abuse. For example, A parent suffering from the stress of having been victimised herself or having another family member who has been victimised may be overwhelmed and more disturbed by the child’s behaviour and may, therefore, have a lower threshold for viewing the child’s externalizing behaviour as problematic. Primary or universal support targets the community as a whole, with generic initiatives, campaigns and community-based services that support parents and families without entry criteria. Their aim is to prevent problems such as child abuse and family breakdown (Healy & Darlington, 1999).

MacMillan (1994) in describing child abuse interventions found it necessary to distinguish between the differing forms of prevention, including that of primary intervention to which he describes as ‘any manoeuvre that is provided to the general population or a sample of the general population or a sample of the general population to reduce the incidence of child maltreatment;, and secondary prevention, ‘early detection of a condition with the aim of shortening the duration of the disorder’, and tertiary prevention, ‘prevention of recurrence of maltreatment and impairment resulting from abuse’. MacMillan further explained the difficulties in prevention in regards to psychological and emotional maltreatment, which accounts for a high number of reported cases but difficulty arises when evidence needs to be collated, and if emotional abuse is accepted as a form of abuse, then the distinction between primary and secondary prevention or indeed tertiary prevention becomes less clear.

Osofsky (1995) in his research on primary prevention has called for a nationwide campaign that would address to change the attitudes toward maltreatment and lower peoples tolerance of child abuse. Support for an ecological approach to child welfare is evident in the Framework for the Assessment of Children and their Families (Department of Health et al, 2000), which stresses the need to consider not only the factors relating to the child and their parents, but also the wider context in which children live when assessing their needs, acknowledging the impact of social and community factors on children’s welfare. This is also justified through the Every Child Matters document which refers to the concept of ‘Making a positive contribution; being involved with the community and society’. Involving local communities in the prevention of child abuse was acknowledged by Nelson and Baldwin (2002) who asserted that the Every Child Matters model ‘has the potential to involve communities enthusiastically in partnership with agencies in identifying problems and seeking solutions and that the process can help to build communities which are more informed, aware and thoughtful about child protection’. Although the presence of risk factors, such as a poor environment or unsupportive relationships with primary caregivers, or being looked after outside the family, increases the likelihood of a negative outcome for the individual, studies of competence and resilience have shown that, regardless of background, children are generally resourceful. Competence has been shown to be a mediating variable that predicts positive or negative outcomes (Smith, Cowie, Blades, 2001; 569).

A definition of Early Intervention can be to engage in childrens and young peoples life at the earliest possible stage, regardless the fact that a problem has already emerged or not, using mainstream/ universal or targeted/ specialist services. In the first place, Early Intervention programmes provide and support children and young people with appropriate equipment (social, emotional, physical) to start or continue their life with the best chances becoming better parents in the future, for example Childrens Centre for Early Years, SEAL and PATH programmes in Primary school, Life Skill Training programmes in Secondary schools. In the second place, Early Intervention programmes provide support as soon as there is evidence that a child is or may be in need, so the situation need to be resolved at the earliest possible preventing more harm. For example, Safer Families Project where domestic abuse and conflicts are present in the family without reaching the social care intervention threshold, Family Nurse Partnership provided to the first time mothers meeting the criteria, Functional Family Therapy for young people with early symptoms of behaviour disorders. The programmes can be offered to either all children or targeted ones.

Early Intervention does not refer only to Early Years as childrens and young peoples needs may occur during several stages in their life, for example during transition or transfer from the primary to secondary settings, after a difficult and life changing situation like a death of a parent or teenage pregnancy.

According to the literature, Early Intervention provides beneficial outcomes to children, family and community; maximizes the childs and familys chances for success, provides lasting benefits in childrens life, prevents persistent social problems, social exclusion and damaging parenting and is cost-effective with long term public savings (Allen, 2011, Pithouse 2007, Barnes and Freude-Lagevardi 2002; Early Intervention: Securing good outcomes for all children and young people, 2010). In a sense it is about “break in a causal chain” (Pithouse, 2007), and we can achieve this by making children ready for school, ready for secondary school and ready for life (Allen, 2011; Allen and Smith 2008). It is, also, mentioned in Support and Aspiration: A new approach to special educational needs and disability (2011) that key aspects for childrens future success are the early identification of a problem and timely engagement and support. Moreover, independent reviews (Munro 2011, Field 2011, Allen 2011, Tickell 2011) have concluded that it is important to provide support at the earliest possible opportunity so as to improve a childs life. Even if a problem appears later than early years, early intervention means to deal with the problems as soon as possible.

Factors for effective Early Intervention

According to Doyle et al (2007) quality, dosage (intensity), timing, service orientation, differentiated benefits (able to recognize risks and address childrens multiple problems) and continuity of support (long lasting) are basic factors making Early Intervention programmes effective. Pithouse (2007) adds to this list that Early Intervention programmes need to be preventative, protective, holistic, flexible, no stigmatizing and able to build trust and provide long term beneficial outcomes.

Holistic Considering Early Intervention, we need to take into account children and young peoples context that is family and community. For example, in several cases, school attendance and behaviour are connected to issues related to family, school and community factors like parents/ carers out of employment, young carers, looked after children, high rate of community crime or gang activity. There are little chances to reach our outcomes, if we try to resolve attendance and punctuality concerns in one dimension omitting the multidimensional aspect of the problem.

According to Taylors recommendation (2012) for improving overall school attendance, we need to focus on and identify vulnerable pupils since primary school years (even nursery and reception), who raise concern and support parents who fail to get their child to school regularly. According to the Government (Gove, 2012), the main concept is to get students into good habits of attendance from an early age; which along with punctuality are important skills for their future professional life and benchmarks to maximise the opportunities to achieve their potential.

Long Lasting In Early Intervention: Next Steps (Allen, 2011), a number of programmes are presented which have been evaluated by specific standards and selected by their effectiveness and cost effectiveness. Still there is work to be done to improve, evaluate and apply them to national level. In general, regarding early intervention we need to wait for the long term effects to be present. For example, as Pithouse (2007) mentions the effectiveness of Sure Start pre-school programmes cannot be evaluated as the Government will replace them with Childrens Centre services. It is, though, important support to be provided after the intervention stage is completed to maintain the benefits and positive outcomes (Doyle, 2007).

Preventative According to Pithouse (2007), prevention is better than cure. It is well stated in Allen (2011), that English policies have funded millions in later intervention; however early intervention is cost effective with pay offs. It is also summarized in Making Sense of Early Intervention: A Framework for Professionals (Centre of Social Justice, 2011) that there is a need of commitment to prevention.

Timing Moreover, intervening early to childrens life provide better benefits in long term. Considering Early Years, early childhood is a key period for cognitive, brain and emotional development and if issues are not resolved during early years then later attempts are less likely to succeed (Allen and Smith, 2008). However, Government may be slightly oriented to Early Years (Her Majestys Treasury et al., 2006) we need to focus and engage early in childrens life and all professionals working with children, young people and families need to be able to notice the early signs of a problem and be adequately trained either to provide support or refer the case.

As mention above, within the idea of early intervention, multi-agency working is most of the times needed to address and identify needs, to implement strategies and provide support to child and his family.

The strategies of the early intervention implemented in each country, though affecting each other and based on same needs for children (illness, mental health, family, pre-school support, attainment) are part of the welfare system and defined by economic and cultural factors. There are for example the universal systems and the more targeted systems, differing on the physical and ideological nature of provision. The history and culture of the country and the definitions of normality, for example the structure of the childhood, the meaning of a good citizen define the strategies that take place and the targets that need to be met (we intervene in a childs and young persons life to provide support and guide them to a better future according to the societys standards)

One of the questions rising is after the recognition of risks and problems how we can evaluate the depth and the immense of the problem identifying the child and the services we need to provide, and how we select the child, according to which selection criteria, is he/she the right person or they are the ones asked for the programmes? For example, in a school environment a child being polite and quite may slip through the net; when there are problems we need to make professional decisions following the standards put by the school, community, government. Following, by the intensity of the provision; it will be a long term or short intervention? Also, we need to take into account the timing of the intervention and whether a proposed intervention is feasible in a communitys context and nature. Another, basic question is about the quality of the programme and how flexible it can be. As we talk about individuals needs, the targeted programmes need to be as personalised as possible to meet the childs needs. From my perspective, it cannot be one programmes fits all. Taking into account, the school community, with a small number of 700 students, and 100 students with attendance concerns; it happened to have 50 different personal attendance plan for each of them as each one had specific needs. How feasible is that to happen nationally (Education and Health plan); however, time and resource consuming it is small units may worth applying identified action and progress plans. Check QUALITY. Regarding the long lasting effect it is hard to have a general yes answer as we have narrow trials, but we can use the example of US Head Start pre-school. Finally, as we have already mention, a programme need to be holistic taking into account the childs needs, physical, emotional, social development, strengths and weaknesses and, also, taking into account family and community aspects.

Sometimes people receiving targeted services feel stigmatised and it is better these services to be provided universally, however it may be costly. Now, if we invest in early years then less and less targeted services will be used in the future.

We can notice the governments aspiration to support families through projects like Safer Families, Family Focus, Childrens Centres (support to parents), and Family Nurse Partnership etc. Moreover, the new CAF orients to a whole family approach rather than child one.

Finally an important factor is trust and good relationship, shared decision making and cultural background so children and families can rely on the professional (see also the paper of the view of young people)

According to Pithouse, there is positive evidence for small innovative programmes regarding short and intermediate outcomes for child health, safety and wellbeing and for parent self-esteem, parenting and parent employment.

There also the following questions to be asked (1) Who does What, when, where, with whom and how we ensure that it happens (2) how we disperse the available resources and dispose them to have the desired impact (3) are we looking for short term, intermediate or long term benefits (4) decide which of the strategies in what time were effective and successful. As early intervention is a multifaceted approach

Finally, we need to take into account the relationship between universal/ mainstream and targeted services and the relationship between information technology and frontline workers.

As the pressure on professionals is increasing to meet targets and provide beneficial outcomes, there can be challenges in the relationship between universal and specialist services. For example, universal services claim that due to resources they can provide standardize and brief services however they could provide more if they have the appropriate resources and workforce, which prefer to be employed by the targeted services. At the end, children return to mainstream after the targeted services, however there is need to sustain balance and mutuality between mainstream and targeted services to sustain the gains from the provision.

Regulatory framework of assessment procedures, metrics and timelines, electronic monitoring, information sharing claim their capacity to help us react early, swiftly and transparently however is early intervention applied? Can early intervention be delivered in front of a computer rather than by front line workers? Is information reaching the front line practitioners or stays in a loop for managerial aspects? Can complex human problems be identified by computers? Are all practitioners accessing computers to share their information? Who is accessing the information, is family under surveillance? The benefit is that early needs may indeed be identified early and we can monitor if services are responding. We can check if services were timely and commensurate however we cannot check if intervention met a set of human encounters.

Emerging Paradigm

As we have already mentioned, early intervention needs to consider childrens aa‚¬” family – community outcomes. For example, we cannot improve a childs attendance when he is a young carer with one parent on drugs without any provision provided form the community; for every action taken we need to take into account this childs context. France and Utting (2005), proposed a more flexible and multi layered approach based on risk and prevention focused intervention. Our aim is to minimize and reduce risks factors and incidents of future problems via strategies that support and protect children. We need to promote resilience to children through strengthening the bonds among children, family, school and community and rewarding positive behaviours. The challenges of this approach are the timing, process and setting of the strategies and also the closeting, duration and intensity.

In the UK, work is under progress so this programme has universal and effective aspect as strategies have been taken nationally (ten years plan to improve and promote services aa‚¬” Every Child Matters, Department of Health and Department of Education and Skills 2004), regionally (multi-agency joined up working and partnership for childrens services) and locally (community based children services, extended school, family focus and support).

From the above initiatives we need to wait to see if there is evidence of benefits reducing children misfortune. For example the initiative for extended child care helps mother to get back to work. However, is that a good benefit or young children miss attachment?

Intervention programmes so far are based on UK and US studies, however we need to have clear proof of what work in there will be a new policy. (Allen, 2011). It may be politically and morally uncomfortable to wait but it is better to have assurance rather than assumption of benefits.

From a professionals point of view, early intervention is effective and provides benefits, however from a users point of view early intervention can be thought as invasive (justified by all when urgent protection is needed), ineffective and wasteful, for examples when benefits are not immediate, harmful, as users can be stigmatised and expensive, considering this money to be provided in a different urgent service. For example, students feel ashamed when parents come to school to discuss concerns and there are examples of parents refusing to come due to not be stigmatised that there is a problem. Another example, from our Extended School is that parents are reluctant to engage as there are no obvious immediate benefits for their child. A proper campaign and rise national awareness about early intervention and available services need to be on top of governments agenda.

Early intervention needs to take into account childrens right, provide participative dialogue, tackle systemic inequalities and build social capital (trust, commitment, and adherence to socially approved and legitimate norm). This can lead to minimizing crime and maximizing social stability.

There is a need for an integrated prevention paradigm taking into account the child, the family and the community. Government is in favour of prevention and early intervention (Early Intervention Grant, Early Intervention Foundation) however children are still slipping through the net as our main concerns were reorganisation, network coordination and information sharing and not provide the basics to our children. As it is made obvious from the above, multi-agency working needs to be supported and reinforced to provide effective services.

Conclusion

We need to support strategies that they can lead to solidarity supporting each other, minimizing social exclusion and dysfunction, investing in the social capital as, especially in the UK, communities are multi-ethnic and multi-racial with fewer and more subtle relationships among its members. The effects of economic and global culturalization had changed the demography, identities, competences and life pathways so we need to learn about the children and their experiences. We cant think the same cases that we thought twenty or even ten years earlier. Early intervention and early years services need to take into account shared identities and solidarity and they need to be mentioned in policy.

As we have already mentioned, early intervention programmes need to take into account the wider problems of family instability, community decline and youth disorder.

Knowledge of children in need is bigger and better; issues of risks and resilience are more familiar; importance of working together; there is a small but robust evidence for effective early intervention; early intervention needs to engage with children and families in multiple ways and levels; multidisciplinary practice and research should be high on the policy agenda; in the US clear cost benefits from early intervention, now studies are conducting in the UK.

Our meta-policy challenge of our era is with what idea, from where and with whom we will co-construct better practice to meet the challenging needs of children. There is need for more comparative policy research, national benchmarking and peer review of initiatives in other countries.

Nearly every mental health professional has faced the difficult task of having a client at one time or another that may pose a danger to themselves or someone else. This situation can present a conflict at times for therapists and others who are torn between preserving client confidentiality and protecting others from potential harm. Fortunately, there are legal procedures in place for dealing with this kind of dilemma. The downside to this, however, is that the legal guidelines are not always the same in each jurisdiction. Being aware of the specific methods for and legal obligations for dealing with these kinds of situations within each specific state is the responsibility of the practitioner, and can be difficult for therapists who may practice in more than one state or who relocate their offices from one state to another after a period of time.

However, knowing a little bit of background about the duty to warn and the duty to protect and the cases that led to the imposition of these legal duties can help guide therapists and other mental health professionals in implementing ethical strategies for dealing with these kinds of circumstances. The legal concepts of duty to warn and duty to protect were first introduced in 1976, with the case of Tarasoff V. Regents of the University of California. This case established that therapists are obligated to inform an identified third party of potential danger if a client indicates that he or she may harm another individual. However, a large number of states also have a strict set of guidelines for executing the duty to warn in that there must be evidence of the possibility of serious danger or harm, the harm is very likely to occur, and that the targeted individual has been clearly identified.

While the duty to warn refers specifically to notifying a potential third party of the imminent danger or harm, the duty to protect has broader implications. With the duty of protect, which is an option only in some states or jurisdictions, the therapist still has the legal obligation to protect a third party from danger but can do so through a variety of options such as hospitalization, more rigorous outpatient therapy, or other methods of intervention that still enable the therapist to maintain client confidentiality. While the duty to protect is a preferred method of dealing with these kinds of situations among mental health care professionals, this form of legislation is only in place in 24 states, with an additional nine states operating under this duty due to imposed court decisions in district or regional court systems.

Exceptions to the duty to warn can be seen in a number of instances when the general public is concerned. In most situations, therapists are under no obligation to warn the general public about the risk of danger from one individual, even if a threat is noted. The implications of this exception are particularly of importance when it comes to the threat of transmission of HIV and other contractible diseases. In most states it is already illegal to knowingly infect another person or group of people with HIV. However, therapists are not legally obligated, and even discouraged from, warning the general public about the risk of transmission of HIV from a knowingly infected client. In this instance, client rights and confidentiality would prevail.

Another instance where the duty to warn and the duty to protect are of importance is when it comes to the threat of child abuse. In many states, therapists and other professionals are obligated to report when a child may be in danger or is being harmed, often without regard to client confidentiality or an obligation to further provide additional intervention or treatment to the client. However, the problem that is seen in many states or situations is that there are no clearly defined guidelines as to how severe the harm has to be in order for a therapist to breach confidentiality. While most legislation specifies that there must be a “clear and immediate danger,” the definition of this can be construed differently by many people and at different times. For example, spanking could be perceived as some to be a “clear and immediate danger” to children, while to others, the threat would have to be much more severe in order to violate client confidentiality in favor of protecting a child.

While it is clear that there are many legal obligations that therapists have to warn others about potential dangers and to protect clients and others from harm when the need arises, the difficulty in executing many of these duties often lies in ambiguous guidelines in many jurisdictions. Often, it is an ethical decision that each individual practitioner must make based on their own principles, the laws within their specific jurisdiction, and their perception of the way the law is defined and the specific situation.

The impact of parental drug and alcohol misuse seriously effects child development. The negative effects of substance abuse begin during the pregnancy and continue through childhood. Groundbreaking research on this subject was published in the ‘Hidden Harm Report.’ Estimates show that in the United Kingdom today there are almost 1.3 million children living with an alcoholic parent. That is one is every eleven children. Furthermore up to 350,000 children in the United Kingdom have at least one parent who suffers from a serious drug addiction. Many of these children are hiding their problems, living in fear and without support.

The dangers of prenatal alcohol and drug exposure are widely publicised due to the particularly damaging effects that heavy drinking and substance abuse can cause to a child’s cognitive development. When a woman becomes pregnant, it is very important for her to lead a healthy life. It is essential for her own health and the health of her unborn baby that she eats plenty of nourishing food, gets plenty of rest, and exercises regularly. It is vitally important that she avoids anything that might harm her or her baby. Therefore, it is especially important to give up alcohol, cigarettes, and drugs. For a pregnant woman, drug abuse is dangerous in two ways. Firstly, drugs may harm her own health and interfere with her ability to support the pregnancy. Secondly, some drugs can directly impair prenatal development. Drugs can cause an increased chance of early delivery or miscarriage, sudden bleeding and the inability to recognise or cope with normal changes throughout the pregnancy. When the baby is born withdrawal symptoms may result in a longer hospital stay and the involvement of social services. Drugs can affect babies in many ways. The most common are; low birth weight and slower growth and development. However, the affects of drugs on the baby during the pregnancy can also cause heart problems and defects of the face and body.

Another fact to consider is that; when a pregnant woman drinks, so does her baby. Alcohol can cause serious problems for an unborn baby that can affect their entire life. The baby can be born with foetal alcohol syndrome which can cause it to be underweight, grow slower and have birth defects. The baby may have a smaller brain and suffer with a lower I.Q. Alcohol can also be passed along to a baby through breast milk. A study published in the March 2004 issue of Alcoholism: Clinical & Experimental Research explained how light to moderate drinking during pregnancy may interfere with learning and memory during adolescence. Assistant professor of psychiatry at the University of Pittsburgh’s School of Medicine, Jennifer Willford explains that;

“We have known for a long time that drinking heavily during pregnancy could lead to major impairments in growth, behaviour, and cognitive function in children. This paper clearly shows that even small amounts of alcohol during pregnancy can have a significant impact on child development.”

The damaging effects of tobacco on an unborn child cannot be underestimated. Smoking during pregnancy causes the risk of miscarriage or premature labour to dramatically increase. The primary danger is delayed foetal growth. Nicotine depresses the appetite at a time when a woman should be gaining weight. Smoking reduces the ability of the lungs to absorb oxygen. Therefore the foetus is deprived of sufficient nourishment and oxygen. As a result the baby may not grow as fast or as much as it should. The NHS acknowledges the risks of smoking to the unborn baby and has recently set up the ‘NHS Pregnancy and Smoking Helpline.’ It offers advice on how to quit and a free DVD to highlight the damaging effects. On average, babies born to women who smoked during pregnancy are significantly smaller than those born to women who did not smoke. Low birth weight is one of the main effects of smoking when pregnant. This can cause increased chance of infant illness, disability and stillbirth. Smoking in pregnancy also greatly increases the risk of cot death in babies. Statistics from the award winning ‘Baby Centre Newsletter’ suggested that;

“This risk is four times higher if you smoke between 1 and 9 cigarettes a day during pregnancy, rising to eight times higher if you smoke 20 cigarettes or more daily.”

Therefore it is clear that it is especially important for a pregnant woman to give up alcohol, cigarettes, and drugs.

Using alcohol and other drugs carry major risks. Alcohol and drugs impair your judgement, making you more likely to hurt yourself or others. Familial alcoholism can affect all areas of a child’s life, from school life through to behavioural problems and compulsive disorders. Some children go through life without support because they may not experience obvious forms of abuse. However, they do suffer from neglect or a chronic lack of the little things, which are so crucial to the wellbeing of us all. This is a result of their parents drinking and the effects it has on their state of mind and body. From moment you take your first sip, alcohol starts affecting your body and mind. After one or two drinks you may start feeling more sociable and outgoing. In contrast by drinking too much basic human functions, such as walking and talking become much harder. Effects can also include behaving out of character and saying things you do not mean. This uncertainty will frighten and unsettle the children of parents who suffer from alcohol misuse. Children will fear the way their parents speak and act when they have been drinking or using drugs. With little control over what they say parents may verbalize things which they normally would not. This can be hurtful and cruel to children or even embarrassing when outside of the home environment. The uncertainty can cause upset in the young person’s life, which can affect their schooling. Children can be distracted from their lessons as they think of what might be happening or waiting for them at home. At home many of these children are left to care for themselves while others are forced to look after their parents and siblings. Consequently, it may become the child’s role and responsibility to look after the family, cook dinner and get their younger brothers or sisters ready for school. The Advisory Council on the Misuse of Drugs conducted a survey which discovered that many of these children out of shame or fear, or simply because they are too young, rarely speak out about their experiences and can become isolated and excluded. Dr Laurence Gruer, chairman of the ACMD Prevention Working Group, said:

“From birth onwards their parents’ drug problems can endanger their health in many ways and cause a great deal of emotional and psychological damage that often goes unnoticed.”

Today in Scotland there is a range of government drug strategies and initiatives for helping these vulnerable children. Parents with serious drug and alcohol problems should not be frightened away by these services. They should feel that they can come forward and get help without encountering more trouble. The aim of many services is to keep children with their parents wherever it is safe to do so by combining treatment for the parents and support for the child. The risk of harm to children can be reduced by effective treatment and support for the addicted parents. Home Office Minister Bob Ainsworth said the Government had already invested ?1.2 billion to tackle the drug culture and would be spending ?1.5 billion by 2006. Ainsworth said;

“We agree it is essential for adult drug services, children’s services, indeed all local providers to approach the problem holistically. Only by reducing their numbers can we reduce the amount of children that have to suffer the consequences of growing up in an environment wrecked by drugs.”

Parental drug and alcohol misuse has been identified as a serious problem in the United Kingdom. The impact of parental drug and alcohol misuse on a child’s life in immeasurable. Therefore, it is the government’s responsibility to reduce the negative impact on the child’s life and offer as much support as possible.

In addition users often experience trouble with the law, poor performance at work or school and relationship troubles. As a result, many children are exposed to rage, violence and abuse on a daily basis. This becomes part of the unpredictable and inconsistent environment in which they live. Police statists show that between 60% and 80% of all violent crime is alcohol related. Interestingly, a recent survey conducted by Alcohol Concern and Police Review showed that 70% of police officers viewed alcohol as causing them greater problems than drug misuse. Research which supports this view reveals that, domestic violence is six times more common when parents suffer from alcoholism. As a result, children of drug and alcohol users often express feelings of hurt, rejection, shame and anger. More worryingly they are forced to live with the anxiety that these feelings create, often without any support. Lord Victor Adebowale, chief executive of social care charity Turning Point, said:

“It’s time that we started listening to the silent survivors of drug misuse. We cannot afford to continue to ignore the 350,000 children in the UK who are harmed by their parents’ drug problems.”

In violent situations such as these the child often feels a sense of guilt. They may see themselves as the main cause of their parents drink or drug abuse. The child may feel constantly anxious about the situation at home. They often fear the parent will become sick or injured or that the substance abuse will cause an increased level of fights and violence between the parents. Embarrassment is often another common feeling of children living with parents who suffer from alcohol or drug misuse. Parents may give the message that there is a terrible secret at home. The child may feel ashamed by their parents and the lifestyle they live. If the parents experience trouble with the law for the ways in which they fund their habit the child may feel lonely. This is due to the child’s inability to have close relationships. As a result of the child being disappointed by the parent they are often unable to trust others. The ashamed child does not invite friends home and is afraid to ask anyone for help. The alcoholic parent will change suddenly from being affectionate to angry, regardless of the child’s behaviour. A daily routine, which is very important for a child, does not exist because bedtimes and mealtimes are constantly changing. This creates uncertainty in the child’s life and can be the cause of misbehaviour as the child acts out for attention.

Alcohol and drugs also have specific health risks: they can damage major organs, increase your risk of cancers, and even cause death. This is a constant worry for children as they fear for the welfare of their parents. This can cause children to suffer from Psychologist John Bowlby Theory of Attachment. Bowlby believed that the earliest bonds formed by children with their parents have a tremendous impact that continues throughout life. One of the characteristics of The Theory of Attachment is Separation Distress. This is when a child is separated from the caregiver and becomes upset and distressed. They fear for the security and safety of their parents when they are not around to provide care. In addition children can suffer from Avoidant Attachment. This is when children will avoid going home or seeing their parents. These children will show no preference between a caregiver and a complete stranger. Research shows that this attachment style might be a result of abusive or neglectful parents.

The effects of parental drug and alcohol misuse can seriously affect a child’s life. The impact of living in such an environment lasts right through childhood and affects all areas of their life. Whilst harm from parental substance use is not inevitable, the number of children living with substance misusing parents has increased in recent years. The only way to decrease the figure is to lower the number of people abusing drugs and alcohol in society. The widespread pattern of binge drinking and recreational drug use exposes children to sub-optimal care and substance-using role models. Children of alcoholics are four times more likely than other children to become alcoholics in later life. Therefore, the effects of parental drug and alcohol misuse last throughout the child’s life and into adulthood. Preventative efforts have been introduced to discourage children from following in the same footsteps as their parents. Education is provided at school, for all children and adolescents, on the damaging effects of drugs and alcohol. Children should be given direct access to support services so that they are not facing the problems of a chaotic and unstable home alone. The education of those who work with children is also vital. Teachers and other service providers should be trained to spot signs of children living with alcohol or drug addicted parents. This would allow extra support to be provided in the education of the child and their emotional wellbeing. Due to impairment caused by being intoxicated, alcohol and drug abuse frequently lead to child neglect and an increase in Domestic violence. Witnessing domestic violence in the home, as well as living in the chaos and instability caused by intoxication, is emotional abuse to a child. Frequently domestic violence will make the child fear that the situation could escalate into physical violence against them. Many physically abusive parents insist that their actions are simply forms of discipline or ways to make children learn to behave. However, there is a big difference between giving an unruly child a tap on the wrist and twisting the child’s arm until it breaks. Physical abuse can include striking, burning, shaking or pushing a child. Another form of child abuse which involves babies is known as shaken baby syndrome. This is when a parent shakes a baby roughly to make the baby stop crying, causing brain damage or in extreme cases even death. Warning signs for teacher can be unexplained bruises or cuts. Other signs can be more subtle such as fearful and shy child who does not want to go home. If people outside of the home environment fail to spot and report these signs, many children go through life dealing with these problems alone. However, it is important for people from outside agencies to realise that not every child who lives with a drug or alcohol dependent parent will suffer physical or emotional abuse. In many cases the impact will be constant lack of the little things, which are so crucial to the wellbeing of us all.

The impact of parental drug and alcohol misuse seriously effects child development. The negative effects of substance abuse begin during the pregnancy and continue through childhood. The impact of living in an environment with drug or alcohol dependant parents can impact a child’s life from birth straight through to adulthood. Groundbreaking research on this subject has been published in many reports. The most recent has been the ‘Hidden Harm Report.’ Estimates show that in the United Kingdom today there are almost 1.3 million children living with an alcoholic parent. That is one is every eleven children. Furthermore the report shows that up to 350,000 children in the United Kingdom have at least one parent who suffers from a serious drug addiction. Many of these children are hiding their problems, living in fear and without support. This shows that parental drugs and alcohol misuse is a serious problem in the United Kingdom. Parental drug and alcohol misuse impacts on a child’s growth, education, health and development.

Introduction

According to the Australian Association of Social Workers AASW, social workers are committed to three core social values: respect for persons, social justice, and professional integrity. Social workers have strong commitments to human rights and social justice, taking into consideration the client, family, and the community needs. In court, they are mainly witnesses of fact or supporters for the client. It is important to understand how human social workers work within the law system, and how they can help more their clients.

Magistrate Court’s Intervention Programs have several courts that seek to tackle the original causes for crime in order to diminish the chances of recidivism. According to the Courts Administration Authority of South Australia website, the Drug Court is in the Adelaide Magistrate Court. The Drug court aims to diminish or/and stop drug use, and prevent recidivism. It involves intensive judicial supervision, mandatory drug testing, strict bail conditions, increasing penalties, and treatment and support services for drug abuser, in order to break the cycles of using drugs and crimes. According to some studies, the Drug court programs are having a positive influence in diminishing re-offending. The Drug Court Program is 12 months with clear and concise rules, and defendants have to comply with them throughout the program, or they are sent to custody

This paper will provide a first, a case synopsis by describing a case proceeding observed in the Drug Diversion Court. Second, there will be a description and identification of the legislation used on the offences. Third, in intervention there is a description of the court’s ruling and its purpose. Fourth, the possible social work skills and roles in John’ case will be explained. Finally, social justice and ethical issues regarding the case will be described.

Case Synopsis

The Drug Diversion Court is located in room 17, on the third floor of the Magistrate Courts of Adelaide. To enter this room, people have to ask permission to the security guard. There are approximately 20 chairs, which are occupied by a small number of lawyers, and the rest by offenders. The plaintiff seats at the right, and the defendant seats on the left side of the room. When the judge enters and leaves the room everyone has to stand as a symbol of respect. The secretary would give the judge all the cases folders, meanwhile another staff member would read the summary of the case, describing facts, such as the number of drug tests taken, and if they were negative or positive. The judge would give encouraging words to those who passed, or sentences to those who failed the drug treatment program. Reviewing cases was fast. Every offender had to bring their folder, and the lawyer would sit next to them. The prosecution did not say anything unless she was requesting more information. There was also a police officer next to the prosecutor, hearing particular cases. Unfortunately, this day the court was only hearing reviewing cases, but the prosecution provided me with a copy of John’s case.

John started the 12-month Treatment Intervention Program on 2014, and was ended when he removed his home detention anklet and left a few weeks later. During his time in the program, his drug tests resulted positive in cannabis, consumed large quantities of alcohol, recorded a home detention breach, did not go to MRT, and lost his program folder. According to the Legal Services Commission of South Australia, the court proceedings would have been the following: before the defendant appears in court, he should have legal advice. The secretary would introduce the case, the police prosecutor would outline the facts of the case (given to the defendant before the hearing), and if debated, the defendant could question the facts another day. After hearing the facts, John pleaded guilty to the multiple offences. The prosecution then would continue by providing his criminal record in court (which includes felonies since he was 14 for obtaining money to buy drugs) and the prosecution would explain any injury, loss or damaged caused by John. After reading the facts of the case, describing the offences and personal circumstances of the defendant, the prosecution requested immediate sentence of imprisonment. Then, the defendant’s lawyer argued that Frawley’s youth and lack of history of adulthood are mitigating factors, suggesting a non-parole period in his sentence, and finding that there is potential for rehabilitation. After considering all relevant factors of the case, the judge decided to give him a sentence of imprisonment, convicting each offence. In total we has sentenced to 25 months imprisonment.

Identification

The judge considered s.11 of the Criminal Law (Sentencing) Act, and he considered that other sentences than imprisonment would be inappropriate in John’s case. John was charged with multiple offences which he pleaded guilty. There were five charges for serious criminal trespass and theft. According to the Consolidation Act 1935, he was punished under 20A (a) home invasion, which is criminal trespassing. An offence (other than a serious firearm offence) is regarded a serious offence if the maximum penalty of imprisonment is at least 5 years. In the Criminal Law Consolidation Act (1935) Section 170 Serious criminal trespass in residential buildings is a maximum of 15 years, and if aggravated, imprisonment for life. Section 170a Serious criminal trespass in occupied residential building is maximum 3 years, and if aggravated, 5 years. Section 134 Theft’s penalty is maximum 10 years.

Under the same act, in 19B there can be a deferral of sentence for rehabilitation and other purposes, adjourning the proceedings, and granting bail according to the Bail Act 1985. The judge applied 19B when he postponed John’s sentence, and allowed him to enter into the intervention program. He was under the 12-months program of drug intervention. A drug treatment order may be requested by defendants with alcohol or drug problems, and who had pleaded guilty, other than sexual offences. If DTO is suspended or breached, the offender has to normally finish his sentence in custody. One of his crime was breaching the curfew of the bail conditions imposed by the Youth court. Under the Bail Act of 1985 SA, s17 (1) states that non-compliance with bail conditions is an offence, and guilty of max. $10,000 or imprisonment for 2 years.

Finally, the judge applied section 18A in sentencing for multiple offences: “it states that if a guilty defendant has committed several offences, the crown can sentence him with one penalty for all or some of them, without exceeding the total amount of each offences’ penalties.” In total, the judge sentenced him 25 months imprisonment.

Intervention

After taking into consideration the facts and the personal circumstances of John, the judge decided to sentence him with imprisonment, and to convict each offence. The judge explained that he must impose a sentence and deter him from reoffending, and others from offending. The judge said that John is now an adult and he must take responsibilities of his action, even more so if they are serious crimes. Breaking into the victims’ home is a serious and frightening experience for them, which they could suffer for many years, if not their entire life. He is likely to commit another serious offence if not punished, which is suggested by his criminal record.

In regards to the prosecution asking for a non-parole period, the judge fixed a low parole-period because of his age and the lack of being in adult custody. By balancing these factors with the gravity of these offences, the judge gave him a non-parole period of one year. The courts try to solve social justice issues, the effects of poverty, and the professional and rehabilitation services instead of imprisonment. The Drug’s Court main goal is denunciation and rehabilitation. At the beginning, the defendant had the opportunity to rehabilitate, but after breaking the program’s conditions, he was fixed a prison sentence. Therefore the court illustrates how their main goals are reached.

Social Work Role

John is 19 years old and has been reported alcohol and drug history since he was 10 years old. He started stealing and breaking into houses to obtain money to buy drugs since he was 14. He had a traumatic difficult childhood after his father died, and his mother put him into the State care, which he had multiple placements while growing up. His mother had serious psychiatric and drug history. Because of his history, in order to make progress and have a brilliant future, he will need assistance required by trained counsellors. John had a limited education, thus it is recommended that he studies and finds a job in order to avoid being in State run institutions. Social workers could help him to calculate and invest in his future, and determine long-term goals to achieve behavior change. Also, Koning & Kwant (2008, 64) argue that social workers can address issues like poverty, unemployment, problems with the police, and lack of healthy relationship in abusers’ life. Social workers could run programs to improve Frawley’s social skills and repair his relationships.

Regarding his youth, John could have had help from social workers in order to cope with his traumatic childhood, and maybe prevent his drug addiction. According to Times (2006, p2) social workers should have a heavier involvement with children of drug abusers. For example, in Scotland 5% of all children under 16 have a drug using parent (Times 2006, p3). In addition, Dennis et al (2013, 160) argue that social workers are key for identifying individuals who are prone to be drug addicts, and to treat them with time ahead. Social workers could have had a positive role on John’s life if he was given counselling since he was put into foster homes. There should be a better treatment of these children, in order to empower their future.

In John’s case, the social worker can help him by getting him into a program to stop taking drugs in less coercive circumstances. John failed the twelve month program, and it would be necessary to go further into his case and discover the reason for this failure. As Kennedy suggests (2012, 122) the social worker could be a counsellor, rehabilitation consultant, or a drug policy manager. Social workers consider that any person highly motivated can be a law-binding citizen if they receive adequate counselling, and chances to receive academic, vocational, and social education opportunities (Brownell and Roberts 20022). Therefore, John still has potential to change and live peacefully in society, under the right guidance of social workers.

Human service workers can also have several roles in courts and tribunals: as witness, lay advocates by assisting in making applications, prepare submissions, and appear on the client’s behalf before tribunals (Jo Brocato & Wagner 2003, 123). The social worker could be a supporter, arbitrator, negotiator, conciliator, and facilitator (Kennedy et all 2012, 122). Moreover, it would be necessary to help John, because the sentence might have been too rigid. Social workers can motivate John to demand and respect for his human rights. Social workers can help John to review his sentence because it was too rigid for a chronic abuser, and it is inadequate punishment for not following the conditions of the program.

Social justice and ethical issues

John started the 12-month Treatment Intervention Program, and was ended when he removed his home detention anklet and left a few weeks later. During his time in the program, he had positive drug test results in cannabis, and consumed large quantities of alcohol. Social workers could regard this not as John’s failure to comply with the rules; instead than the judicial system is not providing him with the just opportunity to succeed, due to the rigidity of the program.

Regarding concerns of social justice, law is insufficient and sometimes compromises human service values. One main concern is that rehabilitation of the addict is many times less important than the primary goal of societal protection. For example, relapse is regarded as a violation of the program’s conditions, and the person is withdrawn from the program. But, relapse is a common effect among drug addicts, and it is part of the process to achieve sobriety (Burman 2004, 200). The intervention program seems unfair if they are aiming to change the offender’s behavior, but they are putting obstacles to achieve it. Furthermore, Koning et al (2008, 67) argue the emphasis should not be on complete abstinence of using drugs, rather in the improvement of quality of life in drug-prone cities, and more access to rehabilitation treatments for addicts. Therefore, John should fight for his right to be give a real opportunity to change. He is a chronic abuser since he was 10, and a rigid and harsh program won’t provide him with the tools to succeed. Substance abuse programs are a good alternative to incarceration, but they need to be adapted for substance abusers and their long-lasting recovery.

According to the Courts Administration Authority of South Australia website, there is research stating that abusers who have been imposed treatment are as likely to succeed as those who entered voluntarily. On the other hand, Burman (2004, 199) suggests that coercive programs lead to short-term success, because the social control can compromise the willingness to behavioral and attitude change. Furthermore, Jo Brocato & Wagner (2003, 123) argue that social workers have the ethical concern of obeying the law and in promoting the client’s self-determination. They claim that true change in behavior must be voluntary, and that the intervention program should change to be more consistent to values of self-determination and social justice. In order to succeed, the authors claim that offenders need to establish their own objectives, and to learn how to solve their problems, and achievement should be based on their own goals, not imposed ones.

Another concern is the proportionality in sentencing, where the punishment cannot be greater than the offence. In John’s case, it seems unfair to be punished by imprisonment. Although he had a positive result in the drug tests, he did not commit a crime against another person, and imprisonment won’t help with his recovery, it could make it worse. Social workers would consider it unfair to have a rigid intervention program, without second chances, and to have a harsh penalty of imprisonment if failure to follow the program. Incarceration does not seem proportional as a punishment as a result of not following the conditions of the intervention program.

Conclusions

There are social expectations to denounce crimes and rehabilitate offenders. The public wants to see a decrease in crime rates, and feel more save in the community under a punitive system. The judge convicted John of each of his offences with imprisonment after not following the conditions of the program. Social workers would suggest a more rehabilitative based model, where the needs of the offender are also met, and there is a better balance of priorities in society. Consequently, in order to protect the client’s human rights and achieve social justice, social workers would recommend not having a rigid program, where there is no need of complete abstinence, and there is more self-determination in their goals. They believe, that under a voluntary program, there would be true change in drug abuser offenders, and could promote a better quality of life and society well-being.

But it is also important to consider the ethical issues of the individual, as well as the rights of the other members of society. If the results of intervention programs have resulted in a reduction of crime, it is important to continue to develop this kind of programs. But, on the other hand, the cases when these programs have failed, need to be revised, in order to understand better the reasons for this situation and make the necessary changes.

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 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.

Amber Pegg
Does NKY have the Most Effective Treatments Available?
A Review of the Literature

Drugs and alcohol have increased in acceptability over the years in the United States. Individuals use these drugs for mood alterations and medicinal purposes. Society is surprisingly very unaware of the epidemic that is occurring right under their noses. Annually, illicit drug abuse cost in average $181 billion dollars. (Office of National Drug Policy, 2010)

Addiction and dependency both play an extreme role in the increase of use and both are extremely misunderstood. During the year 2013 21.6 million individuals were classified with Substance Dependence/Addiction (Administration, 2013). With addiction on the rise in North America it has been recognized as a public health crisis that is extremely multidimensional and complex. (Larkin, 2006)

Drug addiction is classified as an actual disorder according to the medical association. Studies have began to show that genetics may indeed be a part of addiction. These studies are showing genetics may cause susceptibility to addiction in an individual. (Erickson, 2001) Drug addiction is classified into three groups; the first being preoccupation and anticipation, the second being binge and intoxication, and finally the third is withdrawal and negative effect. Those stages are described as, preoccupation with using the substance, constant cravings, using more than necessary, and experiencing tolerance. Addiction is having a severe craving for a substance. This generally also implies that a great deal of attention is devoted to the activity and interferes with the individual’s daily routine. Frank Tallis writes “At first, addiction is maintained by pleasure. But the intensity of this pleasure gradually diminishes and the addiction is then maintained by the avoidance of pain.”

Dependency is said to be the compulsion to use drugs to experience psychological or physical effects. To be considered drug dependent you must have three characteristics; First they must exhibit tolerance, which happens after the body becomes familiarized to the drug, second they must show habituation, this is continuing to have the desire to use the drug after the physical need has ended, and lastly addiction this normally means a great deal of attention is devoted to this activity. In both addiction and dependence the primary goal of an individual suffering from these is simply to attain and use the substance.

Commonly used drugs are often categorized into six groups, opioids, sedative-hypnotic, stimulant, hallucinogens, cannabis, and inhalants. In the Northern Kentucky area there are certain drugs that are more prone than others. These include but are not limited to, stimulants, opioids, cannabis and hallucinogens. Opioids include heroine and methadone. Heroin was introduced in 1898 as a cough suppressant, which depresses neural functioning. Heroin use has shifted within populations; literature shows that it was mostly low income minorities as to now where middle class Caucasians are the most prevalent users. (Cleero, 2014) The majority of opiates reduce anxiety and pain for a short period of time. Most heroin users will have the need for larger amount to get the “fix” but for some, overdose occur and death is the ultimate price. In 2011 heroin alone accounted for 16% of all admissions to treatment facilities. (services, 2012) The most common stimulant abused is known as cocaine. Cocaine is a crystallized white powder, convenient for snorting. Stimulants increase alertness, decrease the need for sleep and often suppress the feeling of being hungry. This makes it very marketable to college students. Cannabis is often described as a natural drug and is often in debate as to whether it should be classified as something addictive. Marijuana has been cultivated for over 5000 years. THC can produce several effects Marijuana has the effect of relaxation and could give someone the perception of slowing time.

What Are the Varying Types of Treatments available?

Across the United States there are several treatment types available to those who suffer from substance abuse. Addiction treatments vary due to the complexity of the disease. Individuals may benefit from rapid treatments or they may need treatments that in other terms work to “cure” and take longer amounts of time and effort. (Riessman).”In the last 30 years, there has been significant progress in the development and validation of psychosocial treatments for substance abuse and dependence, with a predominant focus on the validation of cognitive behavioral treatments” (Dutra Lissa & Stathopoulou, 2008)

The office of Drug and Crime reported in 2012, “ expressed in monetary terms, some $200-250 billion dollars would be needed to cover all cost related to drug treatment worldwide; less than 1 in 5 that need treatment will actually receive it. (Publication, 2012). Factors such as treatment length and intensity of individuals play a role into the success of treatment but studies have proven that there is a link between the two. (Finny, 1996) The following information will focus on the most dominant and relevant to NKY.

With medically assisted treatment on the rise it has quickly become one of the most popular and user “friendly” though controversy over drug substitution has arisen within the treatment community (Kleber, 2008). Mattick wrote “Medically assisted treatments are more appealing than typical drug free approaches.” (Mattick, 2009) With the up rise in heroin and opioid use these treatments will continue to grow. Medically assisted treatments normally consist of one of three drugs to help intervene within the withdrawal and detox phase; Methadone, Suboxone, and Buprenorphine. Each of the three are considered to be moderately effective. There are drop in clinics that will supply the medication and are considerably accessible to communities. Medically assisted treatments can potentially cause addictiveness to the treatment itself. According to the SAMHSA data collected more than 300,000 individuals received medically assisted treatment in 2011. (Treatments for Substance Abuse Disorders, 2014)

The National Institution on Drug Abuse classifies Detoxification and Withdrawal as the most common process. (NIDA, 2009)”Detoxification is the allowance of the body to rid itself of a drug while managing the symptoms of withdrawal.” (NIDA, 2009) Each treatment process must begin with the detoxification and withdrawal stages. An often misconception of these two are that while they are processes within each treatment they alone are not considered treatment, one must have follow up.

There are several forms of counseling and therapy available to those in need. This ranges from individual, group, psychotherapy, couples, family, open and closed meetings. These sessions are available through insurances and some are right in an individual’s own community. These groups and sessions are great means for resources, networking and general support. Literature reads that cognitive behavioral therapy for substance abuse has been deemed effective; both in combination treatment and monotherapy. (Center for Alcohol and Addiction Studies, 2009). Cognitive and Behavioral treatment programs are focused on a short term approach. Motivational Interviewing and CBT are both evidence based treatments that continue to make strides in the treatment industry, (McHugh, 2010)

Lastly, Inpatient and Outpatient rehabilitation. These facilities are structured similarly yet have extreme differences. While an individual is attending an inpatient center they are at the center 24 hours a day, each day. They will see therapist and doctors routinely for a minimum of 28 days. Outpatient facilities still routinely have therapist and doctors with their clients but they are able to return home in the evenings and be part of their normal routine. This also keeps them accessible to whatever the addiction may be. These programs allow individuals to use self autonomy in which treatment facility they feel would best suit them. Many would argue that outpatient is less affective when in fact studies have shown that there is little to no difference in outcomes between the two. (Moos, 1995) Steven Gifford included in his description of inpatient and outpatient unsettling statistics from NIDA; 23.2 billion individuals required treatment for substance abuse in 2013, only 2.4 billion were treated by some sort of drug rehabilitation. (NIDA, 2009)

Gaps Included in the Literature

The amount of literature readily assessable in regards to drug abuse and treatments available is incredible. There is an abundance of knowledge about the topic with reasonable resources at ones fingertips. We know that individuals who suffer from substance abuse are likely to choose a treatment that fits best to their needs and addiction but also at the convenience to themselves and their families. Finances and insurance can also impact ones decision to certain treatment programs. As to the question, Does NKY have the most effective treatments available the literature does not go into depth enough in geographical terms. There are many treatment options available but whether they are geographically reasonable to the rural and lower income are that is left unanswered. The statistics and information in very broad to the general. Though we know there are treatments in NKY area the question of are they the most effective continues to go unanswered.

Works Cited

Administration, S. A. (2013). Retrieved March 15, from www.drugwarfacts.com: http://www.samhsa.gov/data/NSDUH/2013SummNatFindDetTables/NationalFindin…#sthash.snuPjFav.dpuf

Center for Alcohol and Addiction Studies. (2009). Cognitive Behavioral Treatment with Adult alcohol and Illicit drug users. Journal of Studies on Alcohol and Drugs , 516-527.

Cleero, T. E. (2014). The changing Face of Heroin. Journal of the American Medical Association , 71 (17), 821-826.

Dutra Lissa, P., & Stathopoulou, G. (2008). A Meta-Analytic Review of Psychosocial Interventions for Substance Use Disorder. The American Journal of Psychiatry , 179-187.

Erickson, S. W.-M. (2001). Drug abuse and addiction Research. Journal of the American Pharmacist Association , 41 (1).

Finny, M. a. (1996). A qualitative synthesis of patient, research design and treatment. Explaining Abstinence rates following Treatment , pp. 787-785.

Kleber, H. D. (2008). Methadone Maintenance 4 decades later. American Medical Association , 2303-2305.

Larkin, M. W. (2006). Towards addiction as relationship. Addictions research and theory , 207-215.

Mattick RP, Breen C, Kimber J, Davoli M. Methadone maintenance therapy versus no opioid replacement therapy for opioid dependence. Cochrane Database of Systematic Reviews 2009, Issue 3.

McHugh, R. a. (2010). Cognitive Behavioral Therapy for Substance Use Disorders. Psychiatric Clinics of North America , 511-525.

Moos, R. P. (1995). Three models of Community residential Care. Journal of Substance Abuse , 99-116.

NIDA. (2009). Treatment. Retrieved March 30, 2015, from NIDA: http://www.drugabuse.gov/publications/drugfacts/treatment-approaches-drug-addiction

Office of National Drug Policy. (2010, December). Retrieved April 11, 20145, from National Criminal Justice Reference System: https://www.ncjrs.gov/App/Publications/abstract.aspx?ID=255037

Publication, U. N. (2012). World Report. Retrieved April 2015, from Office on Drugs and Crime.

Riessman, F. C. (n.d.). Social Policy. 27 (2), pp. 36-46.

services, N. A. (2012). Center for behavioral health statistics and quality. Retrieved 4 5, 15, from http://www.samhsa.gov/treatment

Treatments for Substance Abuse Disorders. (2014, 10 16). Retrieved March 2015, from SAMHSA: http://www.samhsa.gov/treatment/substance-use-disorders