Category: Free Essays

DOMESTIC VIOLENCE:

A BRIEF CRITICAL ANALYSIS OF IMPACT AND INTERVENTIONS

BUILT ON A DEFINITIONAL, HISTORICAL, AND THEORETICAL FOUNDATION

“And yet I fear you, for you’re fatal then

When your eyes roll so.

Why I should fear I know not,

Since guiltiness I know not, but yet I feel I fear.”

Introduction

The introductory quotation by Desdemona expresses her fear of Othello’s rage (Shakespeare, 1604, cited in Meyersfeld, 2003) at the same time eloquently conveying the terror implicit in domestic violence and demonstrating that domestic violence is not a new phenomenon. Neither is domestic violence a rare occurrence. According to the British government, domestic violence affects millions of lives. The following statistics are quoted from the official government website (CrimeReduction.gov.uk, Domestic violence mini-site, 2005):

one in four women and one in six men will be victims of domestic violence in their lifetime with women at greater risk of repeat victimisation and serious injury;
89 percent of those suffering four or more incidents are women;
one incident of domestic violence is reported to the police every minute;
on average, two women a week are killed by a current or former male partner; and
domestic violence accounts for 16 percent of all violent crime.

This essay will demonstrate that the issue of domestic violence is a complex one, much more complex than the term itself might convey. Indeed, domestic violence is complex in terms of its very definition, complex in terms of its theoretical explanations, complex in terms of gender relevance, complex in terms of its effects, and complex in terms of interventions to prevent and deal with its occurrence. The essay begins with a presentation and critique of various definitions for domestic violence, an exploration of the historical evolution of domestic violence as a societal concern, and a discussion and critique of theoretical explanations for domestic violence including consideration of the relevance of gender. This foundation will be used as a basis for exploring the impact of domestic violence upon its direct and indirect victims and the value and efficacy of the current resources, initiatives, and support networks used in combating domestic violence and assisting its victims. Finally, concluding remarks will be presented.

A Critique on Definitions of Domestic Violence

Finding a generally-accepted definition for domestic violence proved to be an elusive endeavor. This may be because there is no consensus definition of the term (Laurence and Spalter-Roth, 1996; Contemporary Women’s Issues Database, May 1996; Contemporary Women’s Issues Database, July 1996). Each writer seems to define the term to fit his or her topic or agenda. For instance, Chez (1994, cited in Gibson-Howell, 1996), in focusing on female victims of domestic violence, defines the term as “the repeated subjection of a woman to forceful physical, social, and psychological behavior to coerce her without regard to her rights.” Some definitions are basic and general: “a pattern of regularly occurring abuse and violence, or the threat of violence, in an intimate (though not necessarily cohabitating) relationship” (Gibson-Howell, 1996, citing Loring and Smith, 1994). Other definitions are comprehensive and specific (Manor, 1996; Neufield, 1996; Asian Pages, 1998; Josiah, 1998; Seattle Post-Intelligencer, 1999; Danis, 2003; Verkaik, 2003). The more comprehensive definitions, although phrased differently, typically possess the following common elements:

a pattern of abusive behavior (as contrasted to a single event);
the abusive behavior involves control, coercion, and/or power;
the abusive behavior may be physical, sexual, emotional, psychological, and/or financial; and
the victim of the abusive behavior is a cohabitating or non-cohabitating intimate partner or spouse.

The British government has adopted one of the more expansive descriptions of domestic violence, one that includes all of the foregoing elements: “Any incident of threatening behaviour, violence or abuse (psychological, physical, sexual, financial or emotional) between adults who are or have been intimate partners or family members, regardless of gender or sexuality.” Beyond the basic definition, the government furnishes further description of domestic violence as “a pattern of abusive and controlling behaviour” by which the abuser attempts to gain power over the victim. The government contends that domestic violence crosses age, gender, racial, sexuality, wealth, and geographical lines. (CrimeReduction.gov.uk, Domestic violence mini-site, 2005) Interestingly, the definition offered by the government expands the description to include other “family members” in addition to “intimate partners.”

Historical Evolution of the Recognition of Domestic Violence as a Societal Concern

The issue of domestic violence, particularly violence against female spouses, was a topic of societal concern dating from the first marriage law instituted by Romulus in 75 B.C. But the concern was not in preventing domestic violence; to the contrary; the concern was in support of “wife beating”—legally and institutionally—a condition that existed through the early twentieth century. (Danis, 2003, citing Dobash and Dobash, 1979). English common law, until the late nineteenth century, “structured marriage to give a husband superiority over his wife in most aspects of the relationship.” This “sanctioned superiority” gave the husband the right to “command his wife’s obedience, and subject her to corporal punishment or ‘chastisement’ if she defied his authority.” (Tuerkheimer, 2004, citing Siegel, 1996) The beginning of the twentieth century witnessed the dismantling of laws specifically condoning control and violence; however, the laws were not replaced by codes that protected victims from abuse. Instead, “marital privacy” became the standard. Essentially, abuse was considered to be a family problem, not one in which society had an interest. (Turekheimer, 2004)

Not until the feminist movement of the late 1960s and 1970s was public interest in domestic violence piqued (Danis, 2003, citing Schechter, 1982). With little public or private funding, feminist activists set up shelters for female victims of domestic violence. They also pressed for laws to punish offenders and promoted training of social workers and other professions to recognize domestic violence and treat its victims. (Contemporary Women’s Issues Database, May 1996). From these humble beginnings, over the last thirty-plus years, public awareness has been enhanced dramatically, increasing amounts of public and private funding have been allocated for shelters, domestic violence laws have been strengthened, and social workers and other professionals (e.g. school personnel, healthcare professionals, police officers) have been trained to recognize signs of, and provide treatment to those affected by, domestic violence.

Today, in the early years of the new millennium, the way in which society views domestic violence is continuing to evolve. Physical abuse of wives was the initial focus of intervention initiatives. Drawing on research presented earlier, sexual, emotional, psychological, and financial abuse have been added to physical abuse as types of domestic violence. And, many definitions of victims of domestic violence now include, in addition to wives, husbands and domestic partners of the same or different sex. Increasingly, too, children in the domestic arrangement are being included as victims of domestic violence.

Theoretical Explanations for Domestic Violence and the Relevance of Gender

Just as there is a lack of consensus on a single definition for domestic violence, “there is no single recognized causal theory for domestic violence.” In the absence of a single theory, at least four theories are used to explain why domestic violence occurs: social exchange/deterrence, social learning, feminist, and the ecological framework. (Danis, 2003) These theories, with their relevance to domestic violence, will be presented and critiqued in this section. A discussion of the relevance of gender in domestic violence will close out the section.

Under the social exchange theory, human interaction is driven by pursuing rewards and avoiding punishments and costs. (Danis, 2003, citing Blau, 1964). Gelles and Cornell (1985, 1990, cited in Danis, 2003) contend that domestic violence occurs when costs do not outweigh rewards. Costs in this context include the potential for defensive physical action by the victim, potential of being arrested and imprisoned, loss of personal status, and dissolution of the domestic arrangement.

The social learning theory suggests that people learn to be violent by being immediately rewarded or punished after they commit violent behavior, through what is called reinforcement, and by watching the experiences of others, called modeling (Danis, 2003, citing Bandura, 1973). According to some experts, there is a correlation between people who witness abusive behavior in their earlier lives and those who commit domestic violence later. (Danis, 2003, citing O’Leary, 1987).

According to feminist theory, domestic violence emanates from a “patriarchal” school system which assigns men the responsibility for controlling and managing female partners (Danis, 2003, citing Dobash and Dobash, 1979; Yllo, 1993). Under this theory, domestic violence is attributed to a flaw in societal structure rather than to any specific individual male pathology.

Finally, the ecological framework theory, in contending that no single theory can be used in explaining or predicting domestic violence, proposes risk factors for domestic violence and interventions to address it at three levels—the micro level (e.g. batterer programs), the meso level (e.g. police and the courts), and the macro level (e.g. a coordinated community approach). (Danis, 2003, citing Crowell and Burgess, 1996; Chalk and King, 1998).

Each of these four theories offers valuable insight into domestic violence. For instance, the social exchange theory offers a basis for law enforcement and prosecution of offenders; the social learning theory helps to explain why children who witness abuse sometimes grow up to be abusers themselves thereby providing rationale for corrective interventions to “unlearn” abusive behavior; and the feminist theory supports interventions targeted at helping batterers to reform and helping to empower victims. But none of these theories seems to provide a comprehensive foundation on which a comprehensive approach for dealing with the many causal and outcome dimensions of domestic violence can be built. The more integrated ecological framework theory, however, seems to furnish the needed basis for such a comprehensive approach.

Now attention will turn to the topic of the relevance of gender in domestic violence. Historically, as mentioned earlier, wives were considered to be the only victims of domestic violence. Today, husbands as well as same- or different-sex non-married partners are considered to be victims as well (Cruz, 2003). Although the statistics vary significantly (Leo, 1994), some indicating that the same number of men as women are victims of domestic violence (Leo, 1994; Simerman, 2002), most experts agree than women are most often the victims and, when they are victimized, the damage is usually more serious. The indication that women are most often victims has now gained official recognition. The British government contends that, although domestic violence is not restricted to a specific gender, “it consists mainly of violence by men against women.” (CrimeReduction.gov.uk, Domestic violence mini-site, 2005)

The Potential Impact of Domestic Violence on Females, Mothers, and Children

According to the Contemporary Women’s Issues Database (January 1996), “the most common victims (of domestic violence) are women and children.” With the acknowledgement that domestic violence affects men as well as women, the focus of the discussion in this section will be on the potential impact of domestic violence on females, generally, and on females in their role as mothers as well as on their children.

Domestic violence against women can result in serious physical injuries, psychological trauma, and mental strain (Wha-soon, 1994). According to Wha-soon, physical injuries include “severe headaches, bruises, bone fractures, loss of eyesight, nervous paralysis, insomnia and indigestion,” and psychological trauma can include “anxiety, a sense of powerlessness, and a loss of self-respect and self-confidence.” Psychological effects can lead to suicide in some cases. Winkvist (2001) echoes these psychological effects and adds that battered women are also more likely to experience sexual and reproductive health disorders. Effects are not restricted to those that are physical and psychological in nature, however. Women can be financially impacted as well. Brown and Kenneym (1996) contend that women, in an effort to flee their attackers, may “give up financial security and their homes” in favor of safety.

Mothers may experience additional negative effects from domestic violence. Starr (2001) contends that domestic violence against mothers “is associated with harmful implications for mental health and parenting, as well as for the offspring.” According to Starr, mothers who are in an environment of domestic violence suffer worse outcomes for themselves and for their children. Isaac (1997) suggests that abuse of mothers and children are linked, stating that from thirty to almost sixty percent of mothers reported for child abuse were themselves abused.

Hewitt (2002) claims that ninety percent of occurrences of domestic violence are witnessed either directly or indirectly by children. Children can be affected in at least two ways by domestic violence. According to the British government, they can be traumatized by violence they witness against others in the relationship even when they are not the specific targets of the violence (CrimeReduction.gov.uk, Domestic violence mini-site, 2005). According to Hewitt (2002), children suffer low self-esteem, isolation, trauma, and homelessness that they may not manifest until later in life. They may also suffer from maladies such as worry, sadness, focus and concentration difficulties, forgetfulness, headaches and stomachaches, lying, and “poor impulse control,” according to Salisbury and Wichmann (2004).

Importantly, there is also a strong correlation between domestic violence and child abuse, a point which reinforces Isaac’s position mentioned earlier (CrimeReduction.gov.uk, Domestic violence mini-site, 2005). Edleson (1999, cited in Spath, 2003) takes the same position in stating that “numerous research studies over the last several decades have reported a connection between domestic violence and child maltreatment within families.” And, finally, as mentioned earlier, the social learning theory would suggest that children who witness violence learn that violence is an acceptable way to settle disputes. Supporting this, Wha-soon (1994) writes that the “learning of violence causes a cycle of violence.”

An Assessment of the Value and Efficacy of Domestic Violence Interventions

Methods for dealing with domestic violence generally fall into three categories: prevention, protection, and justice (M2 Presswire, 1998). As the terms imply, prevention attempts to avert incidences of domestic violence through methods such as education and counseling; protection involves attempts to prevent further injury through methods such as removing victims from the situation and ordering offenders to stay away from their victims; and justice involves retribution against domestic violence offenders.

The value and efficacy of prevention, protection, and justice methods used in dealing with domestic violence are difficult to measure. A reason for this was mentioned earlier: the lack of a consensus definition for domestic violence itself. (Contemporary Women’s Issues Database, May 1996). Nevertheless, there has been some attempt at measuring performance anecdotally. According to the Contemporary Women’s Issues Database (April 1993): “Currently, the two most common forms of social intervention are mechanisms that help her to leave (such as emergency shelters) and having him arrested…(but) neither of these interventions is ideal.” And, police and judicial interventions do not seem to fair much better as illustrated by the case of Samuel Gutierrez who killed his domestic partner, Kelly Gonzalez, in Chicago, Illinois in the United States after multiple beatings, arrests, and various court interventions (Hanna, 1998).

That domestic violence still exists as such a serious social problem is probably the best evidence that current methods for preventing it, protecting its victims, and exacting justice on offenders are not working especially well. Perhaps the future will be brighter. Newer perspectives, such as that offered by the ecological framework theory, offer some hope. It seems that taking a comprehensive, integrated approach could potentially be substantially more effective as the various public and private components work together in a cooperative, synergistic arrangement with one goal—the welfare of the potential or actual victim. One expert even suggests that this combined public-private approach could be enhanced further by adding a third component—the family (nuclear family, extended family, intimate family, close relationships)—to the formal, integrated support arrangement (Kelly, 2004).

Conclusion

Public and private organizations continue to increase their attention to domestic violence. In the United Kindgom, The Domestic Violence, Crime and Victims Act 2004 furnishes greater authority to police and the courts in dealing with cases of domestic violence and in providing protection to victims. Aditionally, the British government’s recently issued national domestic violence action plan sets forth ambitious goals (CrimeReduction.gov.uk, Domestic Violence, 2005) quoted as follows:

reduce the prevalence of domestic violence;
increase the rate that domestic violence is reported;
increase the rate of domestic violence offences that are brought to justice;
ensure victims of domestic violence are adequately protected and supported nationwide; and
reduce the number of domestic violence related homicides.

Returning to the introductory quotation, had Shakespeare’s Desdemona been alive today, perhaps she would have some hope that she would not forever be in such great fear of Othello’s rage.

References

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Dual diagnosis between drug abuse and mental illness is very common. The two problems affect and interact with each other. The number of people diagnosed with a mental illness and substance went from 210,000 to 800,000 between the years of 1998-2003. (Druss MD, Bornemann, Fry-Johnson MD, McCombs PhD, Politzer, & Rust MD, 2006) Substance abuse is the most common and clinically important dual disorder among adults with severe mental illness. Studies show that fifty percent of people with mental illness also have a substance abuse problem. (Saisan, Smith, & Segal, 2010) And more than half the persons with a substance abuse diagnosis also have a diagnosable mental illness. (Saisan, Smith, & Segal, 2010)

Clinicians believe that mental illness and substance abuse are biologically and physiologically based. “Although substance abuse and mental health disorders like depression and anxiety are closely linked, one does not directly cause the other.” (Saisan, Smith, & Segal, 2010) Both conditions can mirror each.

PROBLEM STATEMENT:

More and more people are suffering from a combination of substance abuse and mental health problems. Alcohol and/or drugs are often used to relieve the symptoms of a mental illness, side effects from their medications or just to cure symptoms they are having at the time. Alcohol and drug abuse can increase original risk for mental disorders and can make symptoms of a mental health problem worse. Substance abuse and mental illness commonly co-occur due to genetic factors, environmental factors, a brain disorder and/or a development disorders. “Co-occurring disorders, two disorders or illnesses occur simultaneously in the same person, they are called dual diagnosis or co morbidity.” (Topics in Brief, 2007) Treatment for this dual diagnosis has not been well designed. Clients have to go a treatment facility for mental health treatment and a different facility for substance abuse treatment. This kind of treat is not successful because this leaves the client trying to cope/manger a disorder on their own. It is almost impossible for them to manger the other disorder because if they could quit on their own they would not need treatment.

It can be hard to diagnose a person with a dual diagnosis of mental illness and substance abuse. One of the things that makes diagnose hard is denial by the patient. “Substance abuse and mental disorders commonly co-occur because of overlapping genetic vulnerabilities, overlapping environmental triggers like stress, involvement of similar brain regions, and drug abuse and mental illness are developmental disorders.” (Topics in Brief, 2007) Having a dual diagnosis put a person at greater risk for relapse. Violence and suicide attempts are also more prevalent among the dually diagnosed population.http://www.onlinerecoverysupport.com/wp-content/uploads/borderline.jpg

BACKGROUND:

The problem of dual diagnosis became clinically clear in the early 1980s. (Drake R. P., 2001) Substance abuse and mental illness hinders your ability to function, handle life and have a healthy social life.

Mental illnesses are mental conditions that disrupt a person’s thinking, feeling, mood, ability to relate to others and daily functioning. “The World Health Organization has reported that four of the 10 leading causes of disability in the US are mental disorders.” (National Alliance on Mental Illness, 2010) Some of the major and the most common mental illness that occur with substance abuse are manic depression, schizophrenia, bipolar disorder, attention deficit hyperactivity disorder, obsessive compulsive disorder, panic disorder, post traumatic stress disorder, generalize anxiety disorder and antisocial personality disorder. It is reported that about 57.7 million Americans experience a mental health disorder in a given year. (National Alliance on Mental Illness, 2010)

Substance abuse, also known as drug abuse, refers to a maladaptive pattern of use of a substance that is not need to sustain life or to make it better. “One in four US deaths can be attributed to alcohol, tobacco, or illicit drug use.” (Innovatory Combating Substance Abuse, 2010) The commonly abused drugs by people with a mental illness are alcohol, cocaine and/or marijuana. Substance abuse complicates some aspect of care for a person with a mental disorder. It provides challenges for the counselor to engage the individual in treatment.http://t0.gstatic.com/images?q=tbn:HOCEVK5RjjC51M:http://i206.photobucket.com/albums/bb156/elgangster214/marijuana-2.jpg

About “50% of individuals with severe mental disorders are affected by substance abuse.” (Saisan, Smith, & Segal, 2010) “Thirty-seven percent of alcohol abusers and 53% of drug abusers also have at least on serious mental illness.” (Saisan, Smith, & Segal, 2010) See the chart below. The risk of developing a drug abuse problem while having a disorder goes as high as 15.5% for antisocial personality disorder and as low as 02.1% for phobias. “The mental health problems that most commonly co-occur with substance abuse are depression, anxiety disorders, and bipolar disorder.” (Saisan, Smith, & Segal, 2010) When a person has a dual diagnosis of substance abuse and mental illness the clinician has to determine what are the symptoms/signs of the substance abuse and what are the symptoms/signs are from the mental illness.

Disorders with Increased Risk of Drug Abuse
Disorder
Risk

Antisocial personality disorder

15.5%

Manic episode

14.5%

Schizophrenia

10.1%

Panic disorder

04. 3%

Major depressive episode

04.1%

Obsessive-compulsive disorder

03.4%

Phobias

02.1%

Source: National Institute of Mental Health.

(Drug Abuse and Mental Illness Fast Facts, 2006)

At least 60% of people fighting substance abuse or mental illness are fighting both at the same time. (Bouchex, 2007) Patients with mood, anxiety or drug disorders are about twice as likely to be diagnosed with the other as well. Figure 1 (Topics in Brief, 2007) The prevalence of these dual diagnoses does not mean that one condition caused the other, even if one appeared first. The high rates show the need for better treatment and treatment centers able to deal with both at the same time. http://www.nida.nih.gov/tib/images/tib_large_images/comorbid02.jpg

WORKING DIAGNOSIS:

Substance abuse can cause mental disorders due to the fact that,

“drug abuse can cause a mental illness,”

“mental illness can lead to drug abuse,”

“drug abuse and mental disorders are both caused by other common risk factors”

all three can contribute to the establishment of specific dual diagnosis of mental disorders and addiction. (Topics in Brief, 2007)

FRAMEWORK/METHOD OF ANALYSIS:

I began my search using Google and searched using the terms “Substance abuse and Mental Illness”. This resulted in nine articles that were relevant to my topic all of which I used as references.

I then went to the Pub Med Central database and searched using the term “substance abuse and mental illness” and found many articles. I used four of those articles as references. The other references were found on website such as National Institute on Drug Abuse and the National Drug Intelligence Center.

ADDITIONAL INFORMATION (LITERATURE REVIEW):

This review looks at progress made in understanding the relation between drug abuse and mental illness. Volkow found that the relationship between substance abuse and mental illness “is likely to reflect common contributing factors and brain substrates.” (Volkow, 2001) One of the main factors substance abuse and mental illness have in common is stress. A question that still remains is the role that drug abuse has on causing psychosis in individuals with no previous psychiatric histories. Stimulant drugs induce psychosis because they increase extracellular dopamine concentration in the brain. However it does not explain why psychosis can continue after the stimulant drug is no longer present in the brain.brain image

Regier, et al, broke his study down into specific mental disorders. This review found that of people with schizophrenia forty-seven percent has some form of substance abuse problem. People diagnosed with schizophrenia have a 4 times as likely then people who do not have schizophrenia to have a substance abuse problem. (Regier, et al., 1990) The odds for people diagnosed with anxiety disorders to have a substance abuse proplem were more than fourteen percent.

It is believe that substance abuse may trigger mental illness in vulnerable individuals. Evidence show a “complex explanation in which well-known risk factors- such as poor cognitive function, anxiety, deficient interpersonal skills, social isolation, poverty, and lack of structured activities combined to render people with mental illnesses particularly vulnerable to alcohol and drug abuse.” (Drake, 2009) People that already have a mental disorder probably appear to be extremely sensitive to the effects of alcohol and other drugs, due to having a form of brain disorder.

Drake, et al, explains the term dual diagnosis as misleading because people with a dual diagnosis are diverse and tend to have multiple illnesses rather than just two illnesses. Drake discusses how researchers have established some identical finding. First, co-occurrence is common. “Second, dual diagnosis is associated with a variety of negative outcomes, including higher rates of relapse, hospitalization, violence, incarceration, homeless and serious infections such as HIV and hepatitis.” (Drake R. P., 2001) Third, the mental health and substance abuse treatment system delivers fragmented and ineffective care.

RESTATEMENT OF WORKING DIAGNOSIS (Hypothesis):

There is evidence that substance abuse can lead to a mental disorder but also a mental disorder can also lead to a substance abuse, it is not known which comes first. Like the saying which comes first the chicken or the egg. It is said that having one of the diagnosis makes you vulnerable to the other. http://t0.gstatic.com/images?q=tbn:2wcgJmOO5cR8aM:http://deepwarriors.com/wp-content/uploads/2010/07/chicken-egg.jpg

MANAGERIAL/POLICY RECOMMENDATIONS:

Why people who are having a mental disorder are so prone to drug abuse raises a lot of questions due to the limited research done on the topic. The research so far is inconsistent and has failed to address a number of issues. There is a need for more research as well as more treatment center that are equipped to deal with dual diagnosis. The patient has two brain diseases that influence one another, and which both need treatment, at the same time. This is when dual diagnosis treatment is need. It is an approach used by clinicians to treat individuals affected by two co-occurring or coexisting conditions simultaneously. Dual diagnosis affects a person physically, mentally, spiritually, emotionally and socially. There is a need for an all-inclusive approach that identifies both disorders, evaluates both disorders, and at the same time treats both disorders. Many treatment centers now only treat one or the other. Substance abuse treatment are not recommended or designed to handle a mental illness and vice versa. Awareness about the problem needs to be made public, so that people know the signs to look for and how to approach the person about their disorder correctly. Patients also need to be aware of the help that is available to them and support groups like Dual recovery Anonymous. There also needs to be better training for the counselors and physicians so that they will be able to better and accurately diagnosis patients. For recovery to be successful you must treats a client’s addiction and mental health problem.

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The increase in the rate of divorce may be the most dramatic change in family life and divorce is being more and more common in the modern society. Demographers suggest that about 50% of first marriages would be voluntarily dissolved in recent years (Cherlin, 1992). Compared with statistics in the middle of 19th century which only 5% of first marriages ended in divorce (Preston & McDonald, 1979), the number is shocking. Moreover, slightly more than half of all divorces involve children and adolescences aged below 18. More than one million children experience parental divorce every year (U.S. Bureau of the Census, 1998, Table 160), and Bumpass (1990) suggested that about 40% of all children will experience parental divorce before reaching adulthood. The statistics and experts’ opinions demonstrate the trend of increasing divorce rate, and thus there are more and more children experiencing parental divorce. In response to this, the essay is going to focus on the impact of parental divorce in different aspects if the event happens at the time when the children are in their adolescence and young adulthood. After that, the essay will discuss the impact on them when they grow up into young adults.

With the increasing rate of divorce, parental divorce happening at the time when children are in their adolescence and young adulthood is more commonplace. The parental divorce may affect the children in different aspects. The impact may also be widespread. A 25-year study of 60 post-divorce families with 131 children was conducted by psychologist Judith Wallerstein. Wallerstein (2001) finds out that the immediate effects of divorce on children may be different according to their gender, age and developmental stage. For adolescents which are one of the focuses of this essay, they will suffer depression. They will also have suicidal thoughts and express anxiety about having successful marriages. Sandford(2008) also suggests that some findings in 1990s indicated that children of divorce have lower academic achievement. They may also have some behavioral, psychological, relationship or even health problems.

Researches done over the past years have consistently shown that divorce has a negative impact on the academic achievement of children of divorce. (Wallerstein, Corbin, & Lewis, 1988; Popenoe, 1993). They are more likely to have low grades and score lower on academic tests. They also have lower educational aspirations and are two to three times more likely to be dropped out of school. The impact may continue to their adulthood and lower their social competence as they just achieve lower levels of education and thus lower occupational status. Thus, their income is usually less.

Adolescents experiencing parental divorce may also have different psychological problems. According to Wallerstein (2001), the level of depression and anxiety is higher in children of divorce. Their self esteem is also lower and they experience more often use of psychological services. It is found that girls from divorced families are much more depressed than girls from intact families in some cases. For boys, they are more hopeless and discouraged when there are more family distresses. It should be noted that some differences in psychological well-being may due to financial disadvantages. Compared with peers from married families, children of divorce may have a lower standard of living. It is due to two reasons. Firstly, living standard of women usually decline more than men’s after divorce (Ross, 1995). Secondly, most children live with their mothers after divorce (Smyth, Sheenhan and Felberg, 2001). Thus they usually live with a lower family income. They will probably move to new residences and to poor neighborhoods. Because of the difficult economic conditions, they would have another form of loss and become more depress.

Children of divorce are also prone to different behavioral problems. They may have disorders in conduct, difficulty with authorities and behaviors that are antisocial (Hetherington and Kelly, 2002). Compared with children from intact families, they are also two to three times more probably to engage in adolescent delinquency and the conduct problems are more common among boys than in girls. Jeynes (2001) also suggests that adolescent from divorced families have alcohol more often and in larger quantities. They are also more likely to take drugs, have pre-marital sex, end up in prison and commit murder, etc.

Apart from psychological and behavioral problems, relationship problems are common among children from divorced families. Sandford (2008) suggests that female adolescents that have experienced parental divorce are more likely to have earlier sexual activities and have more sexual partners than those without experience in parental divorce during their high school years. He also points out that they begin their menstruation earlier. And it seems to be some relationships between early menstruation and early sexual intercourse. It is suggested that the girls having earlier sexual activity have poor self-regulatory skills. It might be attributed to the avoidance of teaching the skills needed to gain self-control in divorced families. Moreover, it might be due to disengagement between these children and their parents at a younger age. Thus their relationship is not as good as that in intact family.

Divorced children’s relationship with parents is also weaker (Sandford, 2008). According to research done by Hetherington and Kelly (2002), similar proportion of children from divorced families and from intact families feel close to their mothers (70% vs. 80%). However, only less than one-third of children report such closeness with their father while 70% of children with married parents report these feelings. The findings coincide with other researches that there are high proportion of disengaged or totally absent fathers following divorces. It is the conflicts between the ex-spouses and custody arrangements that cause fathers to feel disengaged from their children. Avoidance of child support payments is also a reason for the fathers to stay away from their children. Because of the above reasons, adolescents from divorced families view their father to be less caring. Marital instability is also another relationship faced by children from divorced families when they grow up and it will be discussed later in the essay.

Although research found quite a lot of negative impacts on adolescents when they face parental divorce, positive consequences are also possible. A study by Arditti (1999) suggests that the children from divorced families, especially daughters, develop very close relationships with their custodial mother. It may be due to the extra care given by the custodial mothers as their fathers are disengaged from the families.

The impact of divorce on children may not be short term. It is possible that divorce will affect the children in different aspects even when they grow up into young adults. Several impacts are confirmed by Amato (2000) that they are consistent with prior research. Firstly, children with divorced parents are more likely to experience psychological problems in adulthood. Secondly, they have more problems in forming and maintaining stable intimate relationships with their partners. Thirdly, they have weaker ties to their parents when they grow up into young adults.

Amato (2000) suggests that divorce is undoubtedly “a risk factor for psychological problems during childhood and into adulthood”. It is agreed that there is a tendency of adults having parental divorce experience less satisfaction with their lives, higher rates of depression and lower self-esteem. Wallerstein, Lewis and Blakeslee (2001) findings also point out that about one third of the children had serious psychological problems such as clinical depression, poor performance in school or difficulty in maintaining friendships. Moreover, their 25-year in depth study also suggests that even 25 years after the divorce, the children (now adults) “still recalled the shock, unhappiness, loneliness, bewilderment and anger”. Higher level of depression has also been found to continue in adulthood. Both men and women report comparatively worse of psychological well-being. Although Amato (2000) argues that the adults who experienced parental divorce and are suffering from serious psychological problems are not as many as one third of them, the effects of divorce would probably persist into adulthood.

Weaker ties to their parents is another impact when children grown up into young adults. Weisberg and Appleton (2003) describe a survey carried out by a sociologist. 1500 adults who had experienced a divorce before the age of 14 and a comparison group of children from intact family were surveyed. It was found that children of divorce (now adults) felt they were outsiders in their own home. They also had frequent feelings of being alone and were less likely to seek comfort from their parents. The weak ties to their parents usually persist into their adulthood. Another research done by Hetherington and Kelly (2002) also found that less than one-third of children of divorce report close feelings to their fathers. And even when they grow up into adult, they doubt whether their fathers care or love them.

It is also suggested that children with parental divorce would have more problems in forming and maintaining stable intimate relationships with their partners (Amato, 2000). According to Hetherington and Kelly (2002), children of divorce are more likely than children of intact families to have marital instability and lower marital satisfaction. They generally have more thoughts about divorce and the divorce rates among children of divorce are also a bit higher when they grow up into adults. The phenomenon may be explained by the wariness to commit to a relationship, perceiving divorce as an alternative for unhappy marriages. Moreover, a contentious family life may result in generally weaker relationship skills.

Weisberg and Appleton (2003) also stated that a lot of studies have shown that parental divorce is a risk factor for other problems in adulthood. The problems include low socioeconomic attainment, poor subjective wellbeing, increased marital problems, and a greater likelihood of seeing one’s own marriages end in divorce (Amato, 1999). It might be hard to understand why the problems persist into adulthood. Weisberg and Appleton (2003) suggested that parental divorce may lead to financial crisis. The original plans to attend college may be abandoned, thus resulting in lower occupational attainment and wages throughout adulthood. For children who were exposed to poor parental models of interpersonal behavior, they might have difficulty when wanting to form stable, satisfying and intimate relationship as young adults. The above considerations suggest that it may be possible that some children show improvement soon after parental divorce in terms of behavior or relationship, however, some effects might only appear when the children reach young adulthood.

Although the essay focuses on the impact of parental divorce on children, it is also important to note some of the methods that the children can adopt in order to adjust to divorce and minimize the negative impacts brought. Kelly (2003) suggests that conflicts between parents should be diminished. Competent residential parenting such as warmth and emotional support and adequate monitoring to the children is also needed. The non-residential parents also have a role. They should offer stable financial support to the divorced family. Regular contacts with the children and involvement in issues related to their children should also be carried out in order to help with children’s adjustment to divorce. It is the effort made by the parents that can minimized the impacts mentioned above.

As discussed above, it is shown that parental divorce is an upsetting and disruptive event in the lives of the children. Although some scholars argue that children can develop successfully in a variety of family structures and view divorce as an escape from a dysfunctional home environment, more evidences and findings suggest that having experience of parental divorce may cause different problems such as psychological, emotional, behavioral and social problems. The children in divorced families may also deal with relationships in a disturbed manner. The effect may not be short term and can extent to adulthood in some cases. There may be intergenerational transmission of divorce and the adults may have difficulties in dealing with intimate relationship. The marriages of the adults with parental divorce experience would also be affected. It is arguable that not all children from divorced families suffer from these problems. And there are a lot of factors affect the impacts of parental divorce on children or the recovery process such as access to parents or parental support. Sex difference, the family structure or the relationship with parents may also be some of the factors. Although many factors should be considered, some negative impacts are proved that they would happen more frequently among children with parental divorce. And we should understand the impacts in order to find measures that can help the children adjust to divorce.

Diversity has become a popular topic in the 21st century all around the world. Diversity simply means differences. Diversity at work refers to a strategy that promote values, behavior and working practices which recognize the difference between people and thereby enhance staff motivation and performance and release potential, delivering improved services to customers (Thomas, 1991). Started with Fortune 500 corporations, the government agencies and non-profit organizations in 1980s, now more and more businesses are having diverse workforce. Diversity has been added to school curricula and courses that focus on this topic are being offered or required in many colleges.

In this assignment, an introduction about workforce diversity will be given first. The reasons for increasing diverse workforce will be discussed on the next. Following on is the discussion of how a diverse workforce is managed through fair employment practices and the key elements of diversity management. On the next part, the critical roles of each key actor – employers, labour unions, and the government, will be discussed. And finally a conclusion will be drawn.

Luthans (2008) summarizes a number of reasons that have led to increasing diverse workforce. These include changing working demographics, globalization, competitive pressure, the need for diverse viewpoints, and legal compliance.

Changing Workforce Demographics

Ageing population in many developed countries have caused more people to work at older ages. Women have increased their participation in the workforce in recent decades because of more educational and career opportunities as a result of socio-economic development in many countries.

Globalization

Globalization is the process by which firms operates on a global basis, organizing their structure, capabilities, resources and people in such a way as to address the world as one market. This encourages cross-border sales and employment. Employees that are made up of people with different cultures, customs and social norms are very common in global organizations.

Competitive Pressure

Diversity ends up with a more talented and capable workforce. Also, organizations that value diversity attract more talents. This usually results in improved product design or business strategies that make organizations more competitive.

Recognition and Desire for Diverse Viewpoints

Diversity leads to innovations. This is because of the specialized insights and knowledge from all walks of life, that is different genders, ages, ethnicities, races and sexual orientations. Innovation leads to breakthrough competitive advantages.

Legislation and Lawsuits

Many companies are under legislative mandates to be non-discriminatory in their employment practices. Organizations that fail to comply will result in fines and/or lawsuits. In such context, it is necessary for organizations to utilize a diverse workforce.

Managing Workforce Diversity

One of the principals underlying management of increasing diverse workforces is to promote fair employment practices. These include fair treatment to all employees based on merit and prohibition against all forms of illegal discrimination. Fair employment practices widen the pool of labour that employers can recruit from, and therefore increase the chances of recruiting the most qualified persons for the jobs. Fair treatment to employees also helps to retain valued employees and boost their motivation at work.

Fair employment practices intend to achieve equality of opportunity in employment policies and procedures. “Equal opportunities” has been traditionally described as rights-based, liberal, rooted in legal compliance, based upon equality through sameness and merit with a focus on non-discrimination, and equality for women and other under-represented groups in senior roles in organizations (Kirton and Green, 2000; Colgan and Ledwith, 1996). Dickens (in Bach and Sisson, 2000) defines equal opportunities initiatives as concerning policy and practice designed to tackle the differential distribution of opportunities, resources and rewards among workers, based on their membership of a social group.

Key Elements of Diversity Management Initiatives

Initiatives for managing a diverse workforce may vary among companies and countries, but the basic principals are very similar around the world. The followings are some common key elements of such initiatives summarized from the Fair Employment Statement of the Warrington Borough Council (2010) in United Kingdom, and the guidelines suggested by the Tripartite Alliance for Fair Employment Practices (2010) in Singapore.

Eliminate all forms of discrimination and harassment in employment

Discrimination refers to a difference in treatment or favor on a basis other than individual merit. Discrimination in employment can be under the following strands: age, gender (including gender reassignment), sexuality, race, ethnicity, nation of origin, marital status, disability, religion and belief, trade union activity, political belief, social class, and the rehabilitation of former offenders. The workplace should be free of all forms of discrimination and harassment.

Equal opportunities in recruitment, training, promotion and benefits

Equal opportunities should also apply to potential employees as well during the process of recruitment. Employee selection should be based on their skills, ability and experience regardless of other criteria such as age, gender, race, or marital status etc. All employees should have equal chances of receiving training and promotion. Benefits should be fair and equitable based solely on merit.

Reward employees fairly

Employees should be rewarded based on fair criteria, such as performance and ability. No one should be treated less favorable or is disadvantaged by unreasonable criteria that cannot be justified, such as race, gender, or social class.

Value and promote differences

Employees are different in strengths and weakness. They should be provided with suitable personal development plan based on their strengths and needs, which can help to achieve their full potential in their career.

Accommodate employees with their special needs

This include arrangements such as allowing flexibility in uniform requirements, allowing time off for caring for dependants beyond that required by law, or providing special equipment to facilitate work, such as Braille keyboards for the blind.

Legal compliance

Legal duties and responsibilities should be proactively complied in order to achieve fair employment practices.

Key Actors of Managing a Diverse Workforce

The trade unions, employers and the government all play a part in managing a diverse workforce. Each of them has its responsibilities in building a fairer workplace and a harmonized society that each individual is treated equally. The critical roles of each key actor will be discussed on the next.

The Role of Labour Unions

A labour union or a trade union is an organization of workers that have banded together to achieve common goals such as equal opportunity at work or better working environment. Broadly speaking, labour union exits in order to protect employees, to further employee interests at the workplace and to work towards a fairer, more equal society. Their existence is underpinned by the assumption of inequalities of power between employers and employees, so that employees need independent representation and need to act collectively in order to improve their conditions through negotiations with management (Kirton and Green, 2005).

The Trades Union Congress (1998) is the national centre for British trade unions. It defines the six roles of the labour unions as: giving advice when members have a problem at work, representing members in discussion with employers, ensuring enforcement of members’ legal rights at work, helping members take cases to employment tribunals, fighting discrimination, and helping to promote equality at work.

Giving advice when members have a problem at work

Trade unions are able to give advice and information to their members about their rights when they have problems at work. Some even provide legal and financial support to members who experience discrimination at work or being dismissed by employers unfairly.

Representing members in discussion with employers

Equal opportunities, equal treatment and the fight against unfair discrimination are the foundation of trade union activity (MSF, 2001). Union recognition is where employers formally agree to negotiate terms and conditions of employment with trade unions, known as collective bargaining. Traditionally unions have been reluctant to recognize diversity because they feared that highlighting plurality of interests might undermine solidarity over bargaining issues and so weaken their influence power. However, unions now recognize that different groups prioritize different issues. For example, female workers are more likely than male workers to take career breaks, minority ethnic groups are more likely than white workers to take alternate religious holidays etc.

Making sure that members’ legal rights are enforced at work

Traditionally trade unions have focused their attention to fighting a better pay and better working environment for their members. But more recently unions are concentrating on protecting the legal rights of their members, making sure that their legal rights are being enforced in their workplace. This can be done through giving legal advice to the members, and representing them in negotiation with the employers.

Helping members take cases to employment tribunals

Employment tribunals are a kind of court that deal with employment issues. Lawyers are involved sometimes but trade union officers are used as representatives in more straightforward cases. Common cases that employment tribunals usually deal with are cases about unfair dismissal, but other kinds of cases such as unauthorized deduction from wages, sex, race and disability discrimination, and unfair pay etc are also covered. Usually the tribunal will order the employers to pay back compensation.

Fighting discrimination

Labour unions help workers to fight against discrimination. Discrimination still exists nowadays in various forms in many countries. For example, women and minority ethnic groups make a lower average earning, disabled and old workers represent a large proportion in low-paid, low-skilled, and low-status jobs. Many evidences have shown the success of unions that helped improving overall pay and narrowed the wage gaps between male and female, white and black, and between healthy and disabled workers.

Helping to promote equality at work

Trade unions usually have a policy statement that declares a commitment to equality. There are also equality committees that provide regular forums in which equality issues are discussed. Some unions hold annual equality conferences with a broad agenda containing a range of equality issues. Others hold conferences dedicated to particular groups, including women, disabled members, lesbian and gay members, and black and minority ethnic members. Such conferences intend to raise the awareness of equality issues, and provide a forum in which delegates from under-represented groups can gain experience of trade union processes and procedures.

The Role of Employers

The employers have responsibilities to promote equal opportunity and celebrate diversity within the organization. There is no doubt that breach of the discrimination legislation can be costly for employers, so it is also important for employers to make sure that they are complying with the laws.

There are five major roles of how employers act in managing a diverse workforce. They are eliminating discrimination & promoting equal opportunity, expanding the definition of diversity, developing a diversity policy, raising the awareness of diversity, and encouraging training for equality and diversity.

Eliminating discrimination & promoting equal opportunity

Discrimination still remains widespread in this era when all the political rhetoric presents difference as positive and valued. For example in the UK labour market, a recent study found that significant proportions of black and minority ethnic (BME) people have been declined a job on racial grounds. Discrimination can take different forms. It can manifest as a job or promotion refusal or it can involve harassment. Not only does discrimination have economic effects, but also impacts on psychological well-being and negatively affects the working lives. It is necessary for organizations to prevent occurrences of unlawful direct or indirect discrimination, harassment and victimization, by taking lawful affirmative or positive action where appropriate. Besides fulfilling legal obligations under equality legislation and associated codes of practice, employers should regard all breaches of equal opportunities policy as misconduct which could lead to disciplinary proceedings. Employers should examine and recognize the strengths and weaknesses of each employee, and assign suitable tasks that enable them to do their best abilities. This can allow greater chance of achieving success and minimize opportunities for failure

Expanding the definition of diversity and root it in all levels in the organization

Beside visible differences such as gender and race, employers can extend the meaning of diversity to other less visible aspects such as geographic background, sexual orientation, religion, language, physical disability, communication style and people who have family status. This concept should be applied to all processes within the organization, its core values and its strategic planning. This is a responsibility of every single division in an organization, rather than just the human resources giving the effort to enforce it.

Developing a diversity policy

Strategies and action plans are to be developed to ensure diversity is being respected. Any concern regarding diversity in the workplace should be addressed at the soonest and actions are taken to follow up. This will show the employees that diversity is being seriously considered as an important factor for the organization’s success. Such policies should be monitored and reviewed on a regular basis. For example, survey or meeting can be conducted with employees regarding the workplace environment. Employees should be encouraged to voice out their opinions and take part in the discussion. This can build up understanding between each other and any existing issues can be identified.

Raising the awareness of diversity

In order to raise the awareness of diversity in a workplace, employers should promote and appreciate the fact that a diverse workforce is existing in the organization. Promote the idea of how diversity is important to make a business more competitive to survive in the global market. It is important to show the employees that diversity is embraced so that they can be more comfortable with the working environment. As a result, greater productivity can be achieved. Employers should take initiative to learn about different culture, traditions and beliefs among employees. This can show to the employees that their race or ethnicity are being respected and appreciated.

Encouraging training for equality and diversity

Employers can actively look for training on topics for equality and diversity, and encourage employees on every level of the organization to participate. Government agencies or private HR consultant firms are sources of those training programs.

The Role of Government

Valuing diversity is not a concept recognized by law, and the UK legal framework does not on the whole promote diversity. However, recent legal development such as the Race Relations (amendment) Act 2000 (RR(A)A) which places a positive duty upon specified public sector employers and service providers to promote racial equality are arguably a move in this direction as promoting equality could require accommodating difference, in other words, this shift has made a closer stop to promote diversity.

The critical roles of government in diversity management are identified as: equality and human rights legislation, promoting good practices of equality and diversity, enforcing the equality law, and positive discrimination.

Equality and Human Rights legislation

The government that develops equality and anti-discrimination legislation can contribute to promote diversity in organizations. Until 1995, the law in Great Britain was narrowly confined to gender and race. Disability discrimination became unlawful in 1995, and transsexual people were protected from discrimination in employment from 1999. Sexual orientation and religion or belief have been grounds for discrimination claims since December 2003, and age discrimination became unlawful in October 2006. The roles of government also include enforcing such laws strictly, and taking legal cases on behalf of individuals as well as legal actions to prevent breaches of Equality and Human Rights Act.

Promoting good practices of equality and diversity

The Equality and Human Rights Commission (EHRC) in UK has a role to ensure people are aware of their rights. They work with employers and organizations to help them develop good practices aiming to minimize discrimination and promote equality of opportunity for all. They also work with policymakers, lawyers, and government to make sure that social policy and the law promote equality.

Enforcing the equality law

EHRC also have the responsibility to make sure that public authorities carry out their legal duties to tackle discrimination. This is done by launching official enquiries and formal investigations.

Positive discrimination

Positive discrimination refers to policies and practices which favor groups, such as minority ethnic groups and women, who have historically experienced disadvantages in employment and education. Advocates of positive discrimination argue that such policy is necessary in order to create equality of opportunities with historically privileged groups, given the existing structure of inequalities and stereotypes. However, it is highly controversial, and has generated much legal and political debate. There has been a recent trend in European Community anti-discrimination law toward tolerating positive discrimination in favor of women to redress under-representation of women in the workforce. There has been also a growing recognition of the substantive conception of equality in European Community law that could lead to increasing use of positive discrimination to redress inequality.

Conclusion

A diverse workforce enhances the performance of the business in many ways as discussed, such as greater innovation and higher morale among employees leading to higher productivity. Furthermore, diversity also helps to create a working environment where employees are respectful to each other. Discrimination is eliminated when equality of opportunity is being promoted throughout the organization. Diversity management has become a new organizational paradigm. There has been a growing number of organizations’ diversity statements in the corporate social responsibility section of their websites, most imply that workforce diversity is not only a moral issue, but critical to their success and future sustainability. Achieving workforce diversity cannot be done by the employers alone, it requires the effort also from labour unions as well as the government. Most importantly, employees also need to take part to help prevent discriminatory behavior by challenging and reporting potentially unfair or discriminatory behaviour. By celebrating diversity, the society will become a more equal and harmonious environment with minimum discrimination, and everyone can enjoy an equal opportunity.

People are both similar and different; diversity is the recognising and valuing difference. Diversity relates to distinction such as gender, age, religion, race, culture, education, occupation, language, attractiveness, health, physical appearance. Cultural diversity is one aspect of diversity with a multitude of differences which come from our cultural heritage. Every aspect of life is touched by culture, culture affects how people perceive things, and it influences how people attribute meaning to communication. When cultural communication systems are unknown or ignored, messages are likely to be misinterpreted resulting in barriers to communication. To ensure effective communication Human Services workers require awareness of and sensitivity to cultural differences to enable them to successfully serve a diverse range of people. This essay examines effective cross cultural communication for the Human Services worker, as culture refers to the language, knowledge, rituals, values that connect any group of people, in the scope of this essay the context of cultures is that from different countries. Firstly, it looks at some of the differences and problems when communicating cross culturally. Then the essay proposes solutions to reduce communication barriers and, finally proposing principles human service agencies should adopt to enhance communication.

Working cross culturally the human service worker faces many challenges to effective communication because of the complex nature of culture, intercultural behaviours, core values and expression provide much possibility for misunderstanding. According to Fouad Arredondo “communication patterns, styles, symbols and gestures are highly culture bound and unconsciously scripted.” (Fouad Arredondo 2007 p42). Several variables can be considered to assist in the understanding of cultural differences to identify why problems arise, individualism versus collectivism is one variable. Individualistic cultures are where emphasis is on individual achievement as contrasted to collective cultures where importance is on what is best for the group. Counselling itself is a culturally specific activity having evolved from a Western philosophy of individualism, asking a client from a collective culture to focus on hyperintrospection and hyperindividualism will not resonate result in a lost opportunity. Whilst not speaking the same language is a more obvious barrier to communication, consider the communication barrier created when a client for whom English is a second language is expected to verbalise highly complex emotions. (Wheeler 2006 p150)

Cultures can also be distinguished as having low context or high context communication, in low context cultures such Australia or America communication is direct, the meaning is in the message. Asian, Mediterranean and Arab cultures are high context where communication is indirect and it is equally important to look at the implicit meanings and body language. Misunderstandings arise when there is a lack of awareness in the different style of communicating. For example, Indigenous Australians would consider it rude to directly ask a question and instead hint (Mundine 1999, p. 1). This is similar to Asian concept of “saving face” indirect communication is used to prevent discomfort for either party. In some Asian cultures this is extended to some not disclosing physical abuse for fear of losing face or embarrassing the family (Devito 2009, p. 281), however withholding such information creates a barrier to communication for the human services worker.

Non verbal communication is another factor which in which meaning differs between cultures, and if these differences are not understood leads to communication breakdown. In some cultures nodding the head means no, or the nod of a head from a Chinese person does not implicitly mean that they agree. In Western culture direct eye gaze is considered a sign of honesty, in cultures such as Japan however, direct eye gaze is a sign of disrespect. De Vito (2009, p. 133) concludes “try visualising the potential for misunderstandings that eye communication alone could create.”

A Human Services worker lacking awareness of cultural-based norms, such as family structure and gender rules, risks violating these rules, their behaviour impeding trust and confidence. For example, married Muslim women cannot touch a man other than their husband. Lack of awareness or sensitivity to these norms creates conflict and a lost opportunity for engagement. Another barrier to communication results where the Human Service worker consider their own culture to be superior to others cultures. Gamble and Gamble conclude that “ethnocentrism is key to failed intercultural communication efforts.” (Gamble Gamble 2009, p.27).

Finally, cultural stereotyping is a barrier to effective cross cultural communication, whilst it is necessary to group people to simplify understanding differences, it is problematic perceive that ‘all are the same’. For example, to believe that all immigrants from the Middle East are unable to assimilate into Australian society is cultural stereotyping. Stereotyping demonstrates a fundamental lack of understanding of diversity leading to a breakdown in communication. This paper has looked at some cross cultural communication differences and problems that arise that can be covered in the scope of this essay, the paper now proposes solutions to enhance communication and reduce communication barriers.

To enhance communication and reduce barriers in cross cultural communication the Human Services worker develops knowledge and skills. Integral to this is self awareness, being aware of and challenge one’s perceptions and bias. Workers must to increase intercultural communication competence by developing knowledge of different cultural differences, Gamble Gamble confirm it is vital to make the unknown known “…we need to conduct ourselves in a manner designed to reduce the strangeness of strangers; that is, we need to open ourselves to differences by adding to our storehouse of knowledge, by learning to cope with uncertainty and by developing an appreciation of how increasing our cultural sensitivity positively affects our communication competence (Gamble Gamble 2009, p. 30). It would however be uninformed to believe that a person can ever completely understand another culture making it necessary for Human services workers to be comfortable dealing with ambiguity. As important as it is to be familiar the difference in culture conversely it is important not to allow cultural traits to hinder understanding nor to focus excessively on differences. Clients are individuals; human services workers serve a person, not a culture (Egan 2006).

Empathy listening skills are integral to effective communication and equally so when communicating interculturally. The Human services worker should put themselves in their client’s shoes to imagine what is like from his or her world view point. Listening skills and careful observation of cues such as non verbal signals should be taken into account interpret full meaning, particularly when communicating with a person from a high context culture. To enhance communication the human services worker should also regularly seek confirmation of understanding. A deeper level of trust and confidence may need to be built with people from some cultures before they disclose emotional or what they consider to be shameful. To enhance communication with these people it may take patience, time and also an appropriate level of self disclosure on the workers part. To reduce communication barriers the worker may ask permission before asking sensitive a sensitive question. Workers should also be aware and sensitive to taboo subjects, in some Indigenous Aboriginal communities it is shameful to talk about mental illness, to reduce communication barriers workers would avoid using certain words or lables (XXXXX). Working with people who speak English as a second language poses another set of challenges in communication, to reduce barriers workers should speak slowly, be patient and allow pauses, alternatively an interpreter could be offered. (Kenny 2009).

To reduce communication barriers for their diverse range of stakeholders it is vital for Human services agencies should foster their own culture where diversity is embraced and celebrated. A philosophy of respect of individuality and uniqueness which commitment to self development and ongoing learning is promoted. This philosophy should be brought to life by encourage a diverse range of workers with difference backgrounds and experience. A culturally specific approach to training programmes, developing intercultural communication competencies when working and human services workers be regularly reviewed against competencies identifying areas for development.

Culture influences everything about people, including the meaning attributed to communication, this poses challenges for the human services worker when working cross culturally. This essay has considered some of the communication differences and issues that Human Services workers face working interculturally, it has also looked at ways to enhance communication and also principles agencies should adopt to reduce communication barriers. The essence however is that ultimately no two people even those from the same culture are the same, innumerable differences makes each person unique. Human Services workers require cross cultural competency to effectively communicate with the diverse range of people that they meet the most fundamental of these abilities being willingness to learn and respect of all individuals.

Biblography

DeVito, J 2009, The interpersonal communication book, 12th edn, Pearson Education, Boston, USA.

Egan, G 2006, Skilled helping around the world: addressing diversity and multiculturalism, Thomson Higher Education, Belmont.

Fouad, NA Arrendondo, P 2007, Becoming culturally oriented: practical advice for psychologists educators, American Psychological Association, Washington.

Gamble, TK Gamble, M 2009, Communication works, 10th edn, McGraw Hill, New York.

Kenny, S 2006. “Developing communities for the future, 3rd edn, Cengage Learning, South Melbourne.

Mundine, J 1999 ‘Face to face: communication protocols’, viewed 12 August 2010, http://www.nipaac.edu.au/Face2Face_CommnProtocols.pdf.

Wheeler, S (ed) 2006. Difference diversity in counselling: contemporary psychodynamic perspectives, Palgrave Macmillan, New York.

Aboriginal Mental Health First Aid Training and research program. Cultural considerations communication techniques: Guidelines for providing mental health first Aid to an Aboriginal or Torres Strait Islander person. Melbourne: Orygen Youth Health Research Centre, University of Melbourne and beyondblue, the national depression initiative 2008

Viewed 20 August 2010

http://www.mhfa.com.au/documents/guidelines/8307_AMHFA_Cultural_guidelinesemail.pdf

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This assignment will focus on addressing the distinctive features of a professional assessment in social work. It will look into the importance of assessment, the assessment process and law and policy which relates to assessment. Finally it will address assessment in practice with regards to two service user groups’ namely older people and mental health.

Assessment is part of the foundation of social work practice, the better the quality of assessment the more effective it would be (McDonald, 2006). Coulshed (1991) describes assessment as analysing process of selecting, organising and synthesising information. McDonald (2006) describes it as an intellectual process, it is a tool used to make sense of information relevant to issues examined. Assessment is used in many different forms and with different service user groups, some forms of assessment include; risk assessment, the single assessment processes and mental health assessments. Assessment is essentially identifying the needs and risks in an individual situation to judge which intervention, services and resources would be most appropriate (Adams, Dominelli and Payne, 2009). The 1990 National Health Service and Community Care Act placed the assessment of community care services as statutory work. This enabled social workers to justifiably claim to be doing statutory work, which needed extensive knowledge and to be done quickly (McDonald, 2006). Community care assessment can be a gateway to other services, depending on the level of the patients need.

The assessment process varies between social workers because of their social work experience, theoretical orientation of the social worker, the social workers values and the relationship between service user and social worker (McDonald, 2006).

Social workers also need certain skills to be able to achieve an effective assessment these include listening and communicating skills, being able to counsel and understand a service user’s problem, have an insight of other services available to the service user and be able to weigh the risks the service user may face daily against the resources that may be available to the service user (McDonald, 2010) (Harding and Beresford, 1996).

The Victoria Climbe inquiry stressed the importance of assessment (Laming, 2003). If assessment is done properly and as a cycle constantly evaluating Laming (2003) predicts that social work practice and the help given to the family would be more effective. Parker and Bradley (2005) understand that assessment is a continual process and use the ASPIRE model to show how assessment should work. The ASPIRE model stands for assessment, planning, intervention and review and evaluation (Sutton, 1999). This model shows assessment as a process that never stops because service user’s situations change over time, reviewing and evaluating the situation and continually reassessing helps to discover if the approach taken is effective or if the service user needs a different one in place. Milner and O’Byrne (2002) have similar recommendations to Laming (2003) they conclude that intervention is more likely to succeed when assessment is effective (Parker and Bradley, 2005).

Within any setting assessment involves a number of features according to Milner and O’Byrne (2002) these include preparation, planning and engagement. The first step involves identifying the main people surrounding the case and then establishing a deadline under which information has to be collected. The next step involves the collection of information. This includes what the individual wants, their problems and information from other sources for example professional statements. The next part of the assessment process involves looking at the data and assessing their needs, by taking into account how they are currently functioning and weighing the risks. The last step involves producing an action plan. This concludes what help is needed, what resources are available and when reviews will take place (Milner et al, 2002).

There are a number of policies and guidance which highlight the importance of assessment and the need for them to be used by social workers. The National Health Service Community Care Act, 1990 section 47: Assessment of Needs for Community Care Services is an essential part of the legislation when assessing an individual’s needs. Under this section when it appears that any persons for whom the local authority may provide community care or services or may be in need of any other such services the local authority should carry out an assessment of their needs for those services. Upon receiving assessment results the local authority can then decide whether their needs are great enough to be given provision of services.

Fair Access to Care Services (2003) guidance understands that consistent access to services should be across the country but provision is prioritised into set criteria according to risk and independence. All local authorities have the same eligibility criteria. However they can come to different decisions. This is guidance not law, so any local authority can decide on the scale the individual would be on before services can be given (Clements, 2004).

Features of assessment in relation to older people

The NHS plan (Department of Health, 2000) and the National Service Framework for Older people (2001) introduced the single assessment process (SAP). The aim of this process is to provide person centred care to service users and also their carers. Parker and Bradley (2003) concluded that the government produced this new process because historically there were a number of criticisms involving team working within different disciplines. The SAP was produced to prevent questions being needlessly duplicated by different disciplines and to share the information between all and to ensure person centred care. The National Service Framework for Older People was the first wide-ranging strategy that focused on fair, quality health and social care for older people (National Service Framework for Older People, 2001). The aim of person centred care is to ensure all older people are treated individually, that they receive care appropriate to them. Social workers must also take into account anti discriminatory practice when involved in assessing any individual, the service user’s decisions must lead the process. Social workers will have previous experience of the assessment process, and possibly of older people in similar situations, it’s imperative that the service user is safeguarded against direction from the social worker to ensure that the social worker does not lead the assessment. The process must focus on the service user’s views and perspectives throughout.

The SAP involves three broad levels (McDonald, 2010). Contact assessment, which includes individuals who may need support from different services. Overview assessment involves mental, physical and social needs including the impact of their needs on the family and carers this level supports multi disciplinary teams. The last level is a specialist assessment, taken when more understanding is needed regarding an individual’s need and how they can meet it. Another assessment available is a comprehensive assessment. This is offered when the older person needs intensive and long term treatment.

A comprehensive assessment involves basic details, the category of need, the support network the individual has, current problems, carers views, a risk assessment of their current lifestyle, the individuals current strengths, social network and living situation as well as more extensive information.

Assessment uses theory and practice to understand the situations of an older person. It involves problems, risks, needs and resources of the older person. It requires professional judgement to take into account all information to give an opinion, whether the older person needs services and resources to be available for them (McDonald, 2010).

When processing an assessment with older people there are key elements the professional must consider. McDonald (2010) suggests that good quality assessments of older people involve specific components. These include using a strengths perspective, the older person still has the ability to know where their problems lie and how they would deal with them using this throughout the assessment identifies their strengths. Another component includes coping skills, as they grow older they focus more on what they can do and less on what they have difficulties with. Focusing on their strengths rather than problems ensures a positive approach to the assessment process. Social workers must ensure anti discriminatory practice takes place, an important component of this is citizenship, it involves the service user participating in decision making. When moving to a care home for example the older persons care plan should involve advocacy so they can continue to make decisions regarding their health and social care, societal changes and their living environment within the care home. Respecting their decisions is a value social workers should have in practice. Social workers need to understand that family and carers needs may be different to that of the older person and these may need to be a priority. The social worker must also tell the older person about the assessment process giving information about why it’s being conducted and what the aim of the process is.

Although the SAP was produced to bring all information together there were criticisms of working with different disciplines. A literature review by Challis, Clarkson, Williamson, Venables, Hughes, Burns and Weinburg (2004) found that there was a lack of trust between disciplines when implementing the SAP. The SAP is a long process and each level takes time that some professionals don’t have. Also if the older person is having difficulty they may need to make provisions to enable them to continue with tasks they find difficult until a decision is made regarding resources available to them. However they may not be given the amount of resources and services that the service user expects. Those who are not eligible have needs but are concluded to have not sufficient needs to receive help. These older people are expected to use provisions around them, for example family and friends to help with the problems they face (Henwood and Hudson, 2008). Henwood and Hudson (2008) found that those older people who had sufficient money to fund their services felt that they had to discover their own way to find the right services available, having not received the advice and information that other older people going through the assessment process would get.

Following from the assessment process the older person then receives an individual care plan. This care plan shows the objectives and outcomes from the support provided. The individual care plan builds on the older persons strengths, how they can address their needs, the older person should also agree to the care plan being implemented.

Personalisation is now being introduced in the UK. This new method of assessment involves a self assessment of needs. A Personal budget questionnaire is then completed. This questionnaire is simple and designed to help the older person give information about their needs. The social worker will complete it with the service user and family member. The decision of eligibility is then decided. If they are eligible they will be allocated a sum of money through a personal budget, further assessments would be completed to calculate how much the service user would have to contribute. Once the budget is agreed upon the service user can plan where they want to spend their allocated money on the support they want.

Features of assessment in relation to mental health

There are a number of different assessments which are involved in the mental health services. Depending upon the individual’s circumstances specific assessments would take place. Section 47 of the National Health and Community Care Act (1990) states that any individual who has needs of services under a local authority the local authority must carry out an assessment. A decision then follows this assessment. Depending on the mental health of an individual the assessment would focus on their problems and needs and how they could achieve the best outcomes. Standard 2 of the National Service Framework for Mental Health (1999) specifies “that any service user that has contacted their primary health care team with a common mental health problem should have their needs identified and assessed”.

Previously the Mental Health Act 1983 and the Common law of necessity have been used to assess the needs of individual with mental health problems. Recently the common law has been replaced by the Mental Capacity Act. Assessors within this service now use a broader approach to include the criteria of both the Mental Health Act, 1983 and the Mental Capacity Act, 2005 (Barber, Brown and Martin, 2009).

Mental health assessment involves a broad scope of information to collect. The Mental Health Act considers the mental disorder, the nature of the disorder, whether the person or others are at risk, the type of treatment necessary for example if the individual needs hospitalisation or if its possible to use community based mental health services and if it’s possible to give services without the individual being hospitalised (Barber et al, 2009). It’s much less intrusive to the individual if it is appropriate for them to receive care in their community rather than going into hospital and because of the stigma attached to using a section 2 or 3 of the Mental Health Act any social worker or professional in this setting would chose community care if they could.

Assessment with regard to the Mental Capacity Act draws upon information involving the impairment of the individual, the age of the individual, the individual’s capacity of making decisions and if the care they would receive would be a deprivation of liberty (Barber et al, 2009).

An assessment under the Mental Health Act can be done compulsorily when there is a mental disorder, or if it is in the patient’s safety or health and to protect others. Before the assessment takes place the social worker should look into previous history and liaise with other professionals involved in the case. Depending on whether you use a section 2 which last 28 days or a section 3 which lasts up to 6 months a team is needed to admit the individual. When assessing under these sections the social worker must ask questions regarding evidence of mental illness and the risk towards the individual or others, if the patient consents to informal admission or if there are alternatives to hospitalisation.

A Care programme approach assessment may be offered when an individual leaves an inpatient psychiatric unit or uses a community mental health team. This assessment is encouraged as all aspects of care are co-ordinated by one person. The assessment involves personal history, social situation, description of the illness and symptoms and length of treatment and what the individual’s needs are. The care programme approach incorporates four specific elements, as defined in Building Bridges: a guide to arrangements for inter-agency working for the care and protection of severely mentally ill people (DOH, 1995). These elements include the assessment of health care and social needs. The formed care plan, the appointment of a key worker who has a responsibility to monitor the care of the service user and the last element includes regular reviews of the care given and if needed how to adapt the care because of changes of need.

Mental health assessments are complicated because of individual’s complex situations assessing risk and needs as well as resources available. Social work practice must encompass a number of strategies when undertaking assessment for it to be effective. The care programme approach enables social workers to focus on the individual directing through all aspects of care and co-ordinating their care when the assessment process is finished.

The social worker is constantly receiving information including guidance from governments, evidence from research and literature. There is only vague guidance on how to undertake the assessment of the individual, even though assessment is so important because the results will undeniably affect the individual’s life for the upcoming future for a substantial amount of time. Social workers must balance risk, resources and the individual’s needs whilst undertaking the assessment, a process which can be very intricate and complicated when an individual has diverse needs and their risks are so great. However as social workers reflect on their previous assessments they will take away a strong idea of what works and this over time will help make assessments more effective.

Assessment is vital within social work and the features of assessment differ depending on the type of service the social worker is within. However within any service the assessment process still requires similar techniques including individualisation and citizenship and being open and honest. Many reports and papers have shown that when assessment is done correctly and uses an ecological approach which covers society and familial relationships as well as at an individual level then the assessment process will be more effective.

Elizabeth Flores

STUDY

Claireese Jones is a 16 year old African America teenager living in Harlem, New York. She is the only child of Mary Jones. Claireese has two children, one boy and one girl. Claireese daughter, Mango, is four years old and is diagnosed with Down syndrome but lives with Claireese grandmother. Her youngest son, Abdul is eight months old. Claireese is attending, Each One, Teach one, Alternative School and is currently in the eight grade. She is currently not working.

B. Setting

Harlem’s Women Center is a shelter for women who have children and were physically or mentally abuse. They work with women to reduce the physical, psychological and emotional trauma and the recurrence of domestic violence, sexual assault and incest experience by many of their clients. They work to secure their physical, emotional well being, individual freedom and economic equality. The agency offers counseling, legal services, childcare services, parenting classes, support groups and job readiness and job placement for their clients. The agency receive 97% of their revenues from government grants.

C. Reason for referral

Claireese was referred because she was recently homeless and was placed in a halfway house. She was referred by Ms. Rain, her teacher, who reported that she found Claireese in school, sleeping with her 3 day old son because her mother tried to kill her when she return home from the hospital. Claireese needs various services so she can eventually get her own place and support her children independently. She will need daycare services, so she can still continue to attend school, and earn her high school diploma. The social worker from the Welfare department reported that Claireese needs counseling to address experiences that were traumatic to her life. She will need extensive counseling. She needs to learn how to manage and care for her well being since she is already overweight and possible future health issues she will encounter in the future because of her diagnosis of HIV. Claireese has also experience episodes of blanking out and daydreaming.

D. Description and Functioning of Client

Claireese is considered overweight for her age. Her clothes are clean and she is always wearing cosmetic jewelry to match her outfits. She has her hair done and wears it differently. She can be verbal and nonverbal when talking to her at times. Client seems to be daydreaming when we discussed certain events in her life. She uses a lot of inappropriate language to describe how she feels.

E. Physical and economic environment

Claireese lives in a halfway house with her two children in Harlem, New York located in Manhattan. She receives a stipend while she attends school. She is also on welfare where she receives cash assistance and food stamps. She attends, Each One Teach One, Alternative school, Monday through Friday, in the day time.

F. Current Social Functioning (as reported by parents/caregivers or child/teen or obtained from written reports)

Claireese is estranged from her mother due to her abusive behavior towards her and her children. She has not seen her father since he last raped her, which is before she was pregnant. She knows that her grandmother would like to help her but is aware that she is also afraid of Mary. Client’s daughter, Mango, lived with great grandmother so client can attend school. Mary blames Claireese for being raped by her father and even accuses Claireese of stealing Mary’s boyfriend. Mary told her she is fat because she eats too much. Her mother never encourage her to attend school and told her it was a waste of time. Her mother is always telling Claireese, she is too stupid to learn anything. Claireese reported she never had a boyfriend but wish that she can have one in the future even though she feels she is too ugly and fat. She had two pregnancies that occur from her being raped by her father.

Claireese is a currently attending Each one, Teach One, alternative school, pursuing her High school Diploma so she can teach her children something. The client’s teacher, Ms. Rain, motivated Claireese to want read and write by encouraging her to do her best. She was surprised by her success in her ability to read and that she was actually beginning to write. Her sense of personal competence is in development; she states that she did not think that she was very smart, but that her class work and successes are changing that opinion of herself. She is grateful for having John, Ms. Rain, her friends for their support and encouragement. She never thought that there would people who would really care for her. The client’s primary social supports are her peers and her teacher in the school.

G. Personal and family history relevant to focus of assessment

Claireese was sexually abuse since the age of three by her biological father, which produced two children. She has also been mentally and physically abuse by her mother. There is also a possibility of sexual abuse by her mother. Claireese just recently learned that she contracted the HIV disease from her father who recently died of the disease. Claireese grandmother took cared of Mongo, so Claireese can go to school and Mary can still collect welfare based on fraud. Claireese has always depended on her mother up to now, even though moms have lived off of Claireese’s welfare check.

ASSESSMENT

Psychological functioning
Intellectual functioning- Client was not able to read or write but express interest in Math. Since attending the alternative school, client has been able to improve her reading and writing skills.
Reality testing- Poor, client seems to suffer from delusions. Whenever the client is dealing with stressful experiences, she is not listening and seems to be out of tune at the moment. She explains that she daydreams and imagines that she is someone else living a different lifestyle. She is not aware what is happening to her at the time of incident. She also images that the pictures in her photo album talks to her.
Coherence – Unimpaired, despite the client having delusions and has an imagination she can maintain on task whenever she is not dealing with stressful events.
Impulse control-Good, Client tries to control her behavior by not getting herself in any more trouble than she has to. She has gotten herself transfer from her old school not only because of her being pregnant again because she threaten the principal.
Judgment- Good; client have been able to make good judgments. She continues to go to school, so she can teach her children and earn her diploma.
Memory/recall- Poor: she can recall some but not all information that pertains to her traumatic experiences and whenever she addresses those experiences she goes into her fantasies.
Coping style- Poor; Client has never been able to deal with her traumatic experiences in a healthy way, even though she uses her imagination to forget what happened.
Defense mechanisms: Poor: Client daydreams and uses her imagination as a way to cope with stressful experiences.
Insight- Poor; Client has no idea how her traumatic experiences contributes to her mental issues.
Self-Perception-Fair; client has the confidence that she needs to complete school and even with her illness she is confident she can still provide for her children.
Emotional Functioning
Ability to express feelings- Good, she is able to express how she feels.
Rage of emotions-unimpaired: Client can express herself if she is more open to talking about how she feels. Once she sees that people care for her she can discuss how she is feeling.
Appropriate of affects-Impaired; Client seems to avoid talking about specific events, she will change the topic so the focus is not on her. This may be the client way of denying what happen.
Predominant mood- Poor; Client is depress and sad.
Social/behavior functioning

1. Ability to form relationships – Unimpaired; client demonstrates an ability to form relationships as evidenced by her ability to develop friendships with peers in her school. She also developed a friendship with one of the male nurses at the hospital.

2. Social skills/social competence – Poor; client demonstrates a lack of social skills.

3. Overall role performance – Improving; client’s role as mother is improving, she is now taking care of both her children and continues to attend school. Her role as a student is great; she continues to improve her grade level reading. She went from reading at a second grade level to an eighth grade level.

4. Other functional behaviors, if appropriate – Good; client has developed relationships through her school. Client has no other friends other than school.

D. Environmental issues and constraints affecting the situation.

1. Family – Poor; family is not supportive; mother is emotionally unstable and abusive towards Claireese. Her grandmother is too afraid of Mary, so she would not be able to assist Claireese.

2. Agency – Great; this agency is able to provide significant support in providing necessary services that Claireese needs. She has the availability of a daycare, so she can continue her education. She will receive housing assistance, so she can transition from the halfway house into her own place.

3. Community – Moderate; client’s neighborhood provides affordable housing and it is near public transportation and the school that she attends.

5. Physical Constraints, if appropriate – Poor; client recently discovered she is HIV positive and future health concerns associated with the illness will become a problem for her.

6. Economic Constraints, if appropriate – Fair; client has limited income from TANF and food stamps and she is currently living in a half way house.

E. Motivation and commitment to services

Claireese is very motivated in continuing her education. She wants to get her High School diploma. She wants to be able to learn how to read and write. She feels that if she continues to learns how to read and write, she can teach her children. Despite the fact that she has HIV, she clearly feels she still can be successful and do for her children, what her mother didn’t do for her. She wants to prove to her mother that she is wrong. Her motivation is influence by her wanting a better future for her children.

F. workers understanding of clients presenting situation/problem (person-in-environment)

Client seems to be experiencing symptoms of Dissociative Identity Disorder. These symptoms include flashback, amnesia and emotional numbness. When dealing with stress, client escapes reality by daydreaming. She may have developed this disorder due to her traumatic experiences, starting with her being raped by her father. Whenever the client experience stressful events, she has fantasies about her being famous and being someone else, she even sees herself as a white blond girl. Client has no control over her daydreaming. She seems to not remember how she was first raped.

Psychoanalytic theory help explains that client’s problems can be associated with painful childhood experiences that can sometimes be repressed. These repressed memories can shape the clients feelings, thoughts and behavior. These repress memories can be seen as defense mechanism (Robbins, Chatterjee, & Canda, 2012). The client uses her fantasies as a way of ignoring what is happening at the present time, which is not healthy as the client condition can worsen and create maladaptive behaviors. Client repressing these traumatic experiences may explain how the client coped with these experiences.

It is important to look at Erickson’s stage theory because it recognizes the importance of a person’s social location and the interaction between other individuals rather than just the family system. (Berzoff et al., 2011). Since, the client family system is not the strongest support system, the school staff and students are important people that provides positive feedback to the client. This will help the client learn to establish positive future relationships.

Strengths Perspective is an approach to understanding the client in terms of her strengths, abilities, motivations, knowledge and available resources. (Guo & Tsui, 2010) These qualities help the client the ability to solve their problems. This also can give you an idea how the client, who experienced many events in her life, overcame these obstacles and continues to attend school. (Robbins et al., 2012) They also talk about the courage an individual may have. She had the courage to confront her mother and finally leave the house in order to protect her children.

Strengths Perspective focuses on the social environment as having many resources that can help individuals overcome obstacles. People have the ability to learn, grow and change. Client has the abilities to continue to grow so she can provide for her children.

References

Berzoff, J., Flanagan, L. M., & Hertz, P. (2011). Inside Out And Outside In (3rd ed.). Maryland: Rowman & Littlefield.

Robbins, S., Chatterjee, P., & Canda, E. (2012). Contemporary Human Behavior Theory (3rd ed.). Saddle River, NJ: Pearson Education.

Guo, W., & Tsui, M. (2010). From resilience to resistance: A reconstruction of the strengths perspective in social work practice. International Social Work, 53(2) , 233-245. http://dx.doi.org/10.1177/0020872809355391

The essay will look at dispersal policy; a brief background and description of the dispersal policy. Critically analysing the policy in relation to asylum seekers, elaborate the role of NASS and arguments on welfare and asylum seekers in relation to Britain’s changing laws of seeking asylum. Outline how ideologies have used those policies and the impact they have caused. Critique the policy; explain the Implications and challenges for social work practice in relation to the policy.

A policy is a concept developed by government or political party to put down decisions 0r performance and matters that will prove advantageous to society in general. Dispersal is the process of moving asylum seekers to different areas of residence, to share the call on resources and public services amongst a wider range of local authorities across the UK instead of one particular area of the country. Under the immigration and Asylum Act 1999, any asylum seeker requiring support and accommodation may be dispersed anywhere in the UK while their applications are being considered (www.ind.homeoffice.gov.uk).

Asylum is protection given by a country to someone who is fleeing persecution in their own country. It is given under the 1951 United Nations Convention Relating to the Status of Refugees. To be recognised as a refugee, you must have left your country and be unable to go back because you have a well-founded fear of persecution. The person claiming for protection is an asylum seeker. If the claim go through the person becomes a refugee (ww.homeoffice.gov.uk).

In Britain, legislation and social policy in relation to asylum and refugees has been a priority for long. Britain gave attention to the refugees they had drafted in the1951 UN convention to provide protection to people who are at risk of persecution in their own countries. People from common wealth countries were invited to fill in gaps in the ‘labour market’ following the economic boom in 1960’sand thus settled in the Greater London.

Dispersal has a history in UK, though it is only in recent years that it has come to be used routinely for asylum seekers. Before the 1990s, it was used to distribute specific groups of refugees such as the polish resettlement in 1950s, the Ugandan Asians in 1972, the Chileans in 1974-1979, the Vietnamese as an attempt to de-concentrate ethnic minority families whose numbers had had been considered too high in relation to resources such as housing and schools. (Griffiths, Sigona and Zetter, 2005).

The concentration of asylum seekers in London and south east generated localised social and economic costs that those areas were not willing to accept. As a result of local tensions, the practical problems of housing, and supporting large and unexpected numbers of additional residents, some LA started to disperse asylum seekers. From 1996 on wards, London boroughs such as Harrow sent asylum seeker to Teignmouth in Devon (Robinson et al 2003 p: 122). This inspired dispersal and more local authorities were encouraged to do so voluntarily. More so, the policy was also inspired by dispersal of Bosnians in 1993, which was hailed as an example of effective settlement based up cluster areas and the principle of ethnic community formation (Griffiths et al 2005).

Initially the policy applied to asylum seekers who are destitute. If they asked for accommodation, they could only refuse to go if they have a medical support in London, risk of domestic violence and have relatives around. The main aims of the dispersal are to relieve pressure on councils in key areas of South East and London which have been over burdened with asylum seekers and to distribute the load more evenly around the count. Those requiring accommodation would be dispersed to areas with housing to spare (www.bbc.co.uk/news).

Dispersal was also seen as a means of improving the access of minority ethnic groups to improving life chances and a way of reducing prejudice through the deconstruction of stereotypes that these groups with areas characterised by overcrowding, poverty. The dispersal would encourage informal connection between neighbours of different races who might then begin to see each other as individuals rather than as stereotypes. The objectives of the policy were to control asylum seekers to enter the UK, increasing speed of the decision making for asylum seekers, refurbishing the financial support method of welfare benefits (Griffiths et al 2005).

However, to supporters of dispersal policy, the issue is one of costs and equity: “if society has made the democratic decision admit migrants, then the whole of society should bear the costs” (Robinson 2003, P: 163). When you look at dispersal, it is not about cutting costs, sharing the burden or addressing racism, but about soothing the fears of some voters who want to believe that immigration, and who is allowed to stay in their cities is under control. The government needs to embrace asylum seeking, shift in the tone of public debate away from illegal immigration and deterrence, using the educational system to change public perceptions, and promoting community involvement, active engagement and sponsorship (www.migrationyorkshire.org.uk).

Dispersal as a form of enforced population control is primarily a means of reducing the social visibility of asylum seekers and their potential ‘pollution’ of social space. If the concentration of asylum seekers in the community is constructed as a problem for ‘race relations’, then their social dispersal is both a valid and desirable outcome (Griffiths et al 2005).

By 1990’s the number of asylum seekers had increased sharply and public opinion had turned against them, racialising the issue and labelling them as ‘bogus’ and undeserving” (Robinson et al 2003 P: 122). They are perceived to be economically motivated. Today immigration is perceived by many in Britain as a problem for our society ‘which stems from a fear of unknown. Refugees and asylum seekers create an unwanted entity of the ‘otherness’ in the margins of UK. “From the moment they arrive they face an unpredictable and often aggressively hostile local public with ‘racist political’ sentiment openly engaging in intimidation and local press making accusations of ‘bogus claims’ and ‘a drain on national resources’ “(Pierson, 2002,p: 203, Dobrowolsky and Lister 2005).

This ‘othering’ resulted in discriminatory policies, which lead to the social exclusion, and discrimination of the asylum seekers, and refugee communities to the extent that their basic human rights have been challenged and their very existence has been criminalized (Dominelli 2002). I think devising strategies to prevent refugees coming to the country are a threat to the civilisation as it violates the basic human rights. The media could be partly to blame for this concept as they often wrongly imply that all asylum seekers for example, are criminals. Glasgow suspended its participation in the scheme in the wave of press hysteria. Media portrayals are often confusing and unreliable as they represent a gloomy impression about asylum seekers. The media blow up the insecurities of the public to sale more papers, as they are the only visible group in the local communities to blame for the ill health of the welfare system in the country. They have been an easy target for all as they are powerless, dislocated, silent, and ‘do not even having the right to be here’ (Robinson et al 2003).

Before 1996, asylum seekers were entitled to use the same social services as the rest of the population for example, if they had had been homeless, they would go to a homeless person unit, for support. The conservative Government introduced the asylum and immigration Act 1996, which meant that asylum seekers were cut off from mainstream welfare benefits. This left asylum seekers with no access to services. However, this was against the 1948 National Assistance Act which requires local authorities to provide welfare support to those destitute asylum seekers. Some local authorities started providing support to asylum seekers and their dependants if they appeared to be destitute. But, this was done on ad hoc basis and there were no clear guidelines of the local authorities’ responsibilities. In 1999, a new policy had been formulated for asylum seekers and refugees, which is called immigration and asylum Act 1999.

The immigration and asylum Act 1999 gave the National Asylum support service (NASS) the responsibility to provide services and meet needs of asylum seekers. This was due to the problems encountered by the social policy of UK regarding asylum and refugees, the policymakers have decided to establish the NASS in April 2000. NASS was set up to alleviate the pressure on the LA, and also to meet the government view that access to social security benefits creates a pull factor on economic migration. The major role of NASS was to provide support and accommodation for those asylum seekers who are poor while their claim is still being considered. Individual will be given accommodation in the UK, which is usually located and on a no choice basis. This meant that NASS has the sole right to decide for the asylum seekers will be moved (Griffiths et al 2005).

In 1999 the dispersal policy marked a fundamental change in British asylum approach by Introducing new procedures for the reception and accommodation of asylum seekers pending their claim for status determination in the UK (www.fmreview.org).

Failed asylum seekers are often destitute when support is cut off 21 days after a final claim for asylum is refused (Refugee Action 2006). The Red Cross estimate some 26,000 are living off food parcels although the figure could be far higher (www.rcn.org.uk/).

Dispersal failed to relieve pressure on London. It is possible that up to 2/3 of asylum seekers decided to remain in London and stay with friends and relatives rather than take up accommodation in other parts of UK while this does not add pressure to housing, it creates problems a with health and education www.school.gov.uk/policyhub/asylum_dispersal).

There were many draw backs, in the dispersal, as there was miscommunication between NASS and agencies concerned. There was no sufficient accommodation in the dispersal areas and the whole situation was in shambles as reported by the for example, councils did not know how many people were sent to them and what language they spoke so that they arrange translating services. In general, principles of the policy were not effectively adhered to. NASS should work closely with other agencies to coordinate action to ensure the presence of asylum seekers do not harm community relations.

NASS has been criticised by Fekete as being oppressive and institutionalised racism in her report ‘Crimes of NASS’: What is so alarming about the approach of NASS is that they do not consider it their duty to protect asylum seekers from racial violence, or ensure racial harmony, NASS is probably the only body in the country with no coherent policies against racial harassment and no apparent overall strategy to promote good race relations (Fekete, 2001). Since the year 2000, the NASS took the responsibility of asylum seekers to disperse them, wherever there is accommodation without considering their culture, language or any individual needs. Those who are vulnerable were left without support or information (Cohen, 2002, p: 119).

Ethnic minority people suffer from linguistic deprivation in areas they are dispersed to. Initially, the idea was to send asylum seekers to established communities who shared a common language and provided comfort and support. However, due to limited resources and scarcity of accommodation in some places, most asylum seekers were sent to places away from the communities. Breaking up families and then dumping asylum seekers in sub-standard accommodation in some of our poorest communities was always bound to backfire. It is a policy that was neither human nor practical (www.independent.co.uk/news).

From 1996 onwards, the responsibility of asylum seekers was given to voluntary organisations, for instance, NASS who dispersed refugees away from their countrymen and families. In so doing, their networks are sabotaged and left in isolation where they do not share any ownership or sense of belonging. They are unable to convey information or attain financial assistance from their communities, and that keeps them in a state of tension.

There are questions about the long-term impacts on social cohesion, because clustering can deprive these groups of people of integrating in the community. Also, clustering led to emergency of ‘Ghettos’ in deprived areas of asylum seekers. “This may in turn hinder refugees’ future integration into communities” (The Guardian 2005).

In addition to that, dispersal has led asylum seekers being sent to live in the very poorest areas where there were large numbers of people living on either benefits or in the lowest-paid jobs where they were not only more likely to face assaults but were also twice as likely to face racial harassment. More so, the accommodation of these dispersed people is made with no choice as to the location and anyone leaving the accommodation offered to them will lose the right to support. As a result, they are will be impoverishment, poverty, exploitation, ill health and sometimes death. Secondly; some of them whose claims are still pending are sometimes taken to detention centres where they are dealt with brutally with discrimination and abuse (Cohen, Humphries & Mynott, 2002).

In relation to housing some private landlords force asylum seekers to live as a family with people they do not even know. Overcrowding has become an issue for larger families, which are given smaller accommodation. Others return to their homeless charities after failing to cope with the situation (Audit Commission 2000, p: 3). NASS housed accommodation has no legal protection from eviction and the legislation of 1999 deteriorated in relation to housing conditions for asylum seekers and where by landlords growing richer on contracts in order to accommodate asylum seekers (Cohen et al, 2002).

One of the worst impacts of the Asylum and Immigration Act is the extension of immigration checks to housing and to all homeless applications. If the Home Office learns that a refuge has received public funds, he might lose the right to stay in the country or fail to renew their permission to stay (Cohen et al 2002).

Again, the vouchers are stigmatising, as they are used in fewer shops and less on public transport. Asylum seekers and Refugees who are skilled, experience high unemployment and low pay as there are not as many jobs in rural areas as the cities, and the policy sabotage them from their networks that would help them. As a result of this, asylum seekers are discriminated against instead of being offered opportunities and strategies for help (Ibid).

The government initiative towards asylum seekers preserved within the 2004 Asylum Act did not include the children welfare or to ensure that their human rights were thought of. On the contrary, children of asylum seekers whose claims failed are threatened to be removed from their families due to the powers of this act. “A government which sets out to make the children of failed asylum seekers destitute cannot seriously argue, ‘Every child matters” (Lavalette and Pratt, 2006, p. 200). It destabilizes the domestic and international human rights commitment and undermines the Third Way ambition of ‘every child matters’.

The detention centres, prisons and enforcement of dispersal programmes together with the 2002 Nationality Immigration and Asylum Seekers Act are all stereotyping asylum seekers as criminals, agree to be dispersed anywhere to get support, accommodation taken off them if they try to choose, taken in to isolation with high levels of crime directed to them, lack of legal representation. According to the Joint Council for the Welfare of Immigration: These policies are not only discriminatory against one of the most vulnerable sections of our community but also, of the worst kinds of social engineering which is destined to fail (www.lga.gov.uk).

More so, the Audit Commission has reported that asylum seekers and refugees get poor health care though they are entitled to free healthcare. Some of the GPs have taken their names off the lists as there is a tendency that it might impact on their surgeries. On the other hand, the examinations refugees take at ports of entry, have no follow ups due to poor health check ups. They are again registered temporary which does not allow keeping frequent medical records and cannot put their needs into account due to the rights and responsibilities of healthcare. For instance, most refugees experience post-traumatic stress disorder as they escape. (Audit commission 2000a).

The dispersal is reported to have improved recently, but this is down to the NASS working closely with other agencies like police, landlords, and local councils. They had all been included in the deciding in the area that was to be used, monitored the impact of the arrival of the asylum seekers on schools and other services and monitored community tension (guardian 2005). The policy has some success; this is evidenced by the larger number of refugees and asylum seekers in Birmingham, Liverpool and Manchester areas, and Birmingham hosts a sizeable refugee population in Wet midlands. There has been a corresponding growth of refugee community organisations (RCO) in these areas compared to before the dispersal policy of 1999 (Griffiths et al 2005).

In this section the will look at implications and challenges of social workers face in their work with asylum seekers and refugees in the context of dispersal policy in the UK are: Social workers tasks include giving assistance and proper attention to these individuals and ensuring that they receive the services which are included in the immigration and asylum Act. NASS is responsible for identifying who among the asylum seekers have the right to be given the services offered by such agency. The NASS should coordinate with the social workers, and the members of the enquiry lines to know if there are asylum seekers who need assistance of the government (Dominelli, 2008).

Hayes and Humphries (2006, p: 44) argue that “it is often the most vulnerable who suffer from lack of additional support; parents worry for the health and well-being of their children”. For example, a mother who can not breastfed her child because she is HIV positive and cannot afford to buy formula milk for her child. This puts social workers in a dilemma as they are forced to decide on eligibility based on immigration status, and the tension between social work values of providing for those in need and the requirement to exclude people from services. Social workers are forced to negotiate between this role of controlling access to support and that of providing care.

In addition to that, social workers working with asylum seekers experience a growing demand for the services as a result of new arrivals in a period of the budget constraint and their work tended to be dominated by assessing eligibility and providing for immediate needs rather than a broad social work role.

Social workers need to understand the impact of negative stereotyping on asylum seekers. Thompson (2009, P: 158) “the need to recognise the significance of discrimination and oppression in clients lives and circumstances has been emphasised”. As we have seen that asylum seekers will be subject to racist media portrayals and hostile views from members of the public, these factors will not help to integrate them into the community once an application has been successful. Thompson (2009, p: 18) argues that “the role of social work is to contribute to social stability, to ensure that the level of social discontent does not reach a point where the social order may be threatened”. Therefore, it is the role of social workers to help asylum seekers to integrate into local communities and adjust to a new culture. They will need to help asylum seekers to become more empowered as individuals and groups so that they can better represent themselves in the wider community. Empower involves practitioners having to reinvent their practice and their perceptions of particular problems and solutions (Trevithick, 2005, p: 219). Social workers were under pressure as Social Services are using their already over stretched budgets to provide for asylum seekers. Following the negative media portrayals; the local populations made the assumption that the social services budgets were drained, not as a result of government not providing enough money, but because of the asylum seekers. A discussion about who pays the taxes for public welfare and costs of migration devalues immigrant’s contributions to economic growth (Dominelli, 2008).

In some cases social workers were seen as supporting asylum seekers and neglecting the rest of the population. The role of a social worker is to address issues of oppression and discrimination on a daily basis yet their involvement is too little. Emphasis on the health and welfare of children allow social workers to become focused on specific issues such as safe case transfer of unaccompanied asylum seeking children, while not focusing on the needs of the vulnerable adult. (Hayes et al, 2006). Instead of the centralised NASS service provision, it would be better if asylum seekers could use local Social Services teams and benefits offices as these are more accessible. However, limited resources and staffing, the government should provide more support within the existing mainstream structures. Instead of training more social workers and community workers to support the asylum seekers, the government set up NASS, whose staff are not trained in anti-discriminatory principles, and had not got enough experience in housing and settlement issues. NASS’ work practices lead to more discrimination and social exclusion of the asylum seekers.

Social workers must seek clarification within their services concerning the issues related to asylum seekers. As the most asylum seekers do not speak English or cannot command the language well, social workers should make good use of interpretation services and make sure that these services are available for the asylum seekers and able to communicate appropriately. Patel and Kelly (2006, p:5) suggest that “ensuring access to interpreting services, and more equitable access to language learning opportunities, is essential for the appropriate provision of social care to Asylum seekers”.

It is my belief that all human beings deserve respect and dignity and should be treated will equal concern; however, looking at the media it is evident that the UK is struggling to sustain the support required for asylum seekers, which is becoming a growing problem within the UK today. The Human Rights Act 1998 applies to anyone living within the UK’s borders regardless of circumstances or nationality; until an asylum seeker receives refugee status they are often in a state of limbo and regularly their equal rights are denied. Therefore, anti discriminatory practice and humanitarianism is vital within Social Work practice.

Social workers should be involved in campaigning for the rights and ensure that they are observed (Dominelli 2008). The role of a social worker is to adhere to enhancing an atmosphere of acceptance, tolerance and equality for all individuals no matter what their background is. It is essential that Social Workers and those accountable for providing services and support to the most vulnerable in our society do not lose sight of the fact that asylum seekers, regardless of their immigration status, are human beings, with fundamental and basic human rights, needs and aspirations.

In conclusion, although dispersal policies are always understood as ways of temporarily accommodating asylum seekers as they wait for their decision on their asylum claims, the government needs to look at things on a long-term basis so that they are dispersed where they are able to integrate. Therefore, policy makers should also think of the future employment probability and service as they are most of the requirements for the future. NASS should work together with agencies concerned to make sure that asylum seekers are not put at risk. I have critically describe the policy, explained the implications of the policy into social work practice.

Being in the institution was bad. I got tied up and locked up. I didn’t have any clothes of my own, and no privacy. We got beat up at times but that wasn’t the worst. The real pain came from being a group. I was never a person. I was part of a group to eat, sleep and everything… it was sad. (As cited on Mencap.org)

Historically people with learning disabilities have suffered disempowerment by being excluded from mainstream society through segregation in large institutions. ( Wolfensberger, 1972) people were dismpowered by having little control over how they lived their lives. Although the Community Care Act 1990 has resulted in the closure and the resettlement of people with learning disabilities, people are still suffering disempowerment through exclusion by not being able to choose how to live their lives (Ramcharan,et al 1997).

Empowerment is: ‘aˆ¦”concerned with how people may gain collective control over their lives, so as to achieve their interests as a group, and a method by which social workers [and other care providers] seek to enhance the power of people who lack it’ (Thomas and Pierson 1996, p.134).

‘The Same As You? review’ is the Scottish Government’s strategy for learning disability services in Scotland. The review sets out the Scottish Government’s wider policies of social inclusion, equality and fairness to enable changes to happen for the better in the lives of people with learning disabilities. A key area identified within The Same As You? is Person Centred Planning. Person-centred planning means starting with the individual and putting the supports around them that will enable them to have the life that they want.

Person centred planning is a tool that can be used to plan with a person. This can be to help the person think about what is important in their life now and also to think about what what they would like in the future. Planning should include the persons circle of support and involve all the people who are important in the persons life. (Stalker and Campbell, 1998).

The idea behind person central planning was to respond to problems of social exclusion, disempowerment and de-evalution. Person centred planning was developed in the 1980’s by a small number of people including John O’ Brian and Michael Smull. As a way of enabling people with learning disabilities to move out segregated institutions and back into the main community. Person-centred planning is designed specifically to ’empower’ people, to directly support their social inclusion, and to directly challenge devaluation. By looking at what support is needed to allow the person included and involved in the community. (Magito-Mclaughlin et al., 2002).

Person centred approaches offer a different alternative to the traditional model of planning used for service provision. The traditional methods of service provision operated around the individual receiving the service, with health and social care professionals making all the decisions on the type of support the individual received. The traditional model was disempowering to people with learning disabilities as it focused on the persons medical problems, ignoring the qualities of the person as human being. (Sanderson, 2003)

Person centered planning places the individual at the center of the decision making process, allowing family members to become involved in the planning as Joynab, Mohammed’s mother states:

“Person-centred planning has given us hope and a vision for a better future for Mohammed. We feel now we can have a say in how and what service support he receives. We no longer believe that only professionals know best for our son. Mohammed’s faith and cultural needs are recognised and responded to.”(DoH, 2010)

Person centred planning looks at the persons qualities and is a way of listening to what is important in the persons life. People can direct their own services and supports, in a personalised way rather than attempting to fit within pre-existing service systems.

An area where person planning has helped the person by listening to what they want enabling them to direct their services and support is through training and employment. People with learning disabilities have been marginalised from gaining employement, through the employers lack of understanding about learning disabilities and stereotypical beliefs that they are incapable of working. As a mother states “

I have a son who has Down syndrome..I go to the supermarkets and ask if they could try my son outaˆ¦I explain that he has Down syndrome, then they change the subject and say they will give me an application form.I explain my son cannot write, and they tell me he cannot get an interview without an application form.Is this a way of eliminating the disabled?” (Anonymous contribution as cited by Williams,2009)

People with learning disabilities benefit from working as it helps them to gain fiancial independence and security, increases their self confidence and skills and allows them to socialise. Todd (2002) demonstrates this in his report ‘planning a new future’ where an agency worked with a young man with autism whose goal in life was to be an airline pilot, even though this goal was unrealistic. The support worker involved in his person-centered plan, suggested and arranged a visit to Heathrow airport once a week. The idea was to find out what interested the young man about being a pilot, was it the flying, planes or uniform? After visiting the airport for a couple of months it became apparent that the baggage carousels captivated him. The young man was then supported to get a part time job as a baggage handler. (Todd, 2002) enabling the person to become part of the community. In a way that values their human rights, gives them independence and choice.

Person centred planning has a particular approach that can be used for different individuals in different situations. The four main tools that can implemented include: McGill Action Planning System (MAPS), this process is a useful tool for gathering information in the early stages of planning, helping to identify the person talents and needs. ELP (Essential Lifestyle Planning) is more commonly used to plan for people who are moving out of instititionalised care. Personal Futures Planning is less service based, tending to be used for building relationships with family, friends and fitting into the wider community. PATHS (Planning Alternative Tomorrows and Hope) is used to develop an action plan for the individual. (Stalker and Campbell, 1998, Sanderson, 2000)

People with learning disabilities can have communication problems and should not be disregarded from having person centred planning for that reason. There are various techniques that can be used allow a person with a learning disability to communicate in their ideas for the plan, such as Makaton, talking mats, sign language and picture banks. (Grove, 2005) the plan can be done any format that is accessible to the person such as a written document, a drawing or mind map with images or an oral plan recorded on to a compact disc. Plans are the updated when the person wishes to make a change or when they have achieved their goal.

Person centred planning is for eveyone, not just for people who can communicate. As it can engage participants personally by allowing them to hear of deeply felt hopes and dreams and fears, even if the person feels they are silly. As the planning process allows the person to break free from the misconceptions and conventions that can harness their future. Some examples of peoples dreams were a young man wanted a trip to Mexico as part of his vision. Another is taking guitar lessons as a way to achieve his goal of being a country and western singer. An older woman, in her plan, decided to retire. Another is taking art classes and learning to paint watercolours. Starting a business, going to college or university, buying a house, these are all things that are possible through person centered planning. (ne-pdd.org)

Person centered planning has helped people achieve empowerment is their choice to form relationships, get married or have children. People with learning disabilities have the same need for love and relationships as do all human beings. However this need is not being met for people with a learning disability. Literature on the subject provides information about sexuality in regards to learning disabilities, however it seems to focus on disability and sexuality from the perspective of it being a problem. (Parritt, 2005.)

This negative view of people with learning disabilities and sexuality stems from the historical perspective of learning disabilities, where people with disabilities were placed in institutions and segregated (Potts and Fido,1991)

This level of control can still be seen today with professional’s and families trying to discourage intimacy and relationships, viewing the person with a disability as vulnerable, seen as the ‘eternal child’ (McCarthy, 1999)

Mrs Susan Hurst and Mr Frank Hurst tell their story of ‘Our Wedding, Our Dream’ where person centred planning enabled them to get married. Mrs Hurst states, “some people felt there wasn’t a need for us to get married but we wanted what every one else hadaˆ¦Getting married had always been our dreamaˆ¦.” (csrpcp.net)

Mr. and Mrs. Hurst describe how the tools of person centered planning enabled them to identify both their ‘hopes, goals and dreams for the future’ this enabled them both too make all the decisions in planning for their wedding. Mr and Mrs Hurst explain that they even planned their honeymoon and travelled to their honeymoon destination without the aide of support workers, as person centered planning had enabled them to plan ahead of the difficulties that might occur and how the couple would resolve them when on holiday. Without Person centered planning Mr and Mrs Hurst would never have been able to get married or go on honeymoon. Mr and Mrs Hurst felt that person centered planning helped them to achieve their goals enabling them to feel in control of their lives, allowing them to choose their human right to get married and respect for private and family life. (csrpcp.net)

There is legislation that supports the rights of people with learning disabilities to have fulfilling relationships and sex lives if that is their choice. (Article 8) states that every human being has a right to respect for private and family life. The Disability Discrimination Act (1995) gives people the right to access family planning clinics and advice centers. People with learning disabilities should be accepted as people who have the same capacity for loving as others in society.(Lesselliers, 1999)

Loneliness and isolation may occur through the lack of opportunity to have loving relationships. Therefore person centred planning can enable people with learning disabilities to be empowered by allowing them to make these decisions and choosing how they want to live their lives.

person centred planning improves the person quality of life. Increasing the persons right to empowerment through the right to work where they want, where they would like to live and increasing their social network by letting them choose how they would to socialise. (Whitney-Thomas et al., 1998).

Relationships improve for the person at the centre of the planning, as they became more motivated and goal oriented. As the participation process allows friends and family to join in the planning and help the person achieve their goals. Parents also reported that person centred planning had such an impact on their family’s lives, that they choose to become involved in training other families in the importance of person centered planning.

As person centred planning is designed to focus on one person at a time, it increases the potential to broaden opportunities for people with learning disabilities in gaining the life they choose. As Person centred planning allows the person to choose how, when and where they want support or services delivered rather than the standard ‘one size fits all’ approach. (O’Brien & Lovett, 1993).

However there are limitations to person centered planning for people with learning disabilities. Insufficient funding and resources can hinder the planning process persons and their opportunity to achieve their goals, leaving people disillusioned with the process.

Person centered planning requires trained and well equipped staff who are knowledgeable about inclusion, rights of people with learning disabilities and how to help empower people by directing them. As people can lose trust in centered planning if these values are not upheld. (Kinsella 2000),

Person centered planning can take time to achieve targets, it is not suitable for people who require emergency planning where action needs to take place in a few days. The process is not a “quick fix” (O’Brien & Lovett, 1993).

In conclusion people with learning disabilities have suffered from disempowerment in the past as a result of institutionalised care. However person centered planning has enabled people with disabilities to become empowered by allowing them to make their own choices and be fully supported about how they would like to live their life. By allowing people with learning disabilities to choose their right to employment through what job they would like to work, this in turn empowers them by gaining fiancial independence and increased self confidence, as well as learning skills and getting to meet new people. Person centred planning has allowed people to gain their right to family life and marriage, by allowing people to plan their own wedding and honeymoon giving them independence to start married life.

Therefore person centered planning creates positive effects that go beyond effective planning. In that it allows people to be listened to and what is important to them. However this is only effective if what is recorded on the plan is acted on, as people will lose faith in person centered planning if no action comes from their choices.

Traditionally, people experiencing mental health problems were removed from society and placed in asylums across the country, indefinitely (Thornicroft and Tansella, 2002, pp. 84-90). Patients within the mental health system were expected to take a compliant role in the management of their care and leave the decision making to the professionals. In today’s society that is not the case. In this assignment the writer will begin by exploring the publication ‘Vision for Change’ while discussing the main theme of this publication which is ‘the importance of service user involvement and the importance of empowering the service user in the mental health system of Ireland’ (Ireland, Dept of Health & Children, 2006). To empower the service user requires the control of power to be transferred from the professionals to the now known “Service User”. The writer will discuss the effect of this change and the importance of this change within the mental health system. The Mental Health Act 2001 requested the closure of many asylums and the move towards a community based model of care. The deinstitutionalisation of many patients and relocation back into the community required changes in the way the psychiatric nurse and service user operate.

Evidence has shown the importance of service user’s participation in research, education and in practice through out the mental health care system. The writer in this assignment will discuss the importance of service user participation in the delivery of psychiatric nursing care, focusing on the nursing assessment using a holistic approach.

Finally, the writer will discuss the importance of service user participation in the remaining stages of the nursing process; the nursing diagnosis, outcomes, planning, implementation and evaluation while exploring the need for a therapeutic relationship between service user and psychiatric nurse to complete the nursing process successfully.

With people experiencing mental health difficulties, who now reside in the community, it is vital that service users become involved in the development and delivery of mental health services, such as self-help services, drop-in centres, and in providing assistance with activities of daily living. The aim of this is to sensitise society to the need of integrating people with mental health difficulties back into community life.

As quoted in a Vision for Change;

“Service users must be at the centre of decision making at an individual level in terms of the services available to them, through to the strategic development of local services and national policy. To use a slogan of the disability rights movement: ‘nothing about us, without us’.

To reduce the stigma attached to people with mental health difficulties the term ‘patient’ was changed to service user, as most of the care they receive is provided in the community. The Mental Health Act, 2001 suggests ‘the term ‘patient’ is used to describe someone who is involuntarily admitted. Patient does not therefore refer to all individuals in an approved centre’. In the Vision for Change it states that ‘the correct way to describe someone with a mental health illness was to see the person before the illness, for example someone with anorexia nervosa was not to be described as ‘an anorexic’ rather than as a person with anorexia nervosa. Stereotyping in mental health is as damaging as any other stereotype (Ireland, Dept of Health & Children, 2006)’. People, who experience mental health difficulties, can be the experts through their own experience (Bee et al, 2008, pp. 442-447).

Psychiatric nurses remain the largest staff group involved in the provision of mental health care, (Bee et al, 2008, pp. 442-447). Therefore, to ensure the mental health care service abides by legislation, it is vital for psychiatric nurses to re-evaluate their role to ensure priority is given to including the service user. An Bord Altranais recommend that a holistic approach is adopted and it is listed as one of the requirements in nurse registration education programmes (An Bord Altranais, 2005). It is fundamental that the service user participates in the nursing assessment especially where the holistic model of assessment is used. The biopsychosocial model uses a holistic view, addressing the biological, psychological and social factors contributing to a person’s mental health problems. According to Boyd (2004, p.190) it proposes a person-centred treatment approach which addresses each of these elements through an integrated care plan agreed with service users and their carers and involves participation of the service user throughout the assessment. This assessment requires the service user to answer a series of questions, some being of intimate nature about themselves. This enables the assessor to obtain relevant information required in making a nursing diagnosis. To ensure accurate nursing diagnosis it is critical that the services user listens carefully to the questions asked and is completely honest when answering the questions. This process also requires the service user to be patient while the assessor records the data received. However, it is important to remember that an initial assessment can occur when a service user is first admitted into psychiatric care. According to Boyd (2004, p.194) the assessor must have empathy and an understanding of how difficult it is for a person to discuss intimate details of ones life’s to a complete stranger, even if it is in the person’s best interest.

Although the nursing assessment is the starting point of the nursing process, the writer feels that service user’s participation remains of equal importance throughout the nursing process. The freedom of information act 1997 requires that all services users can request access to any information stored about them. While, it is now a legal requirement for service users to be involved at all stages of the nursing process, the writer suggests that it is imperative that the service user is informed of the nursing diagnosis. This will empower the service user, by encouraging the service user to find relevant information regarding their diagnosis which can assist in them becoming experts of their own mental illness.

Following the diagnosis it is required by law that the psychiatric nurses discuss all details of the outcome with the service user. The psychiatric nurse needs to ensure that the service user’s values and beliefs are priority when planning the outcome. If any treatment is deemed necessary for the road to recovery, then it is compulsory that the service user is capable of understanding the effects of the treatment proposed, this requirement is stated Under the Mental Health Act, 2001:

“the service user must be capable of understanding the nature, purpose and likely effects of the proposed treatment and the consultant psychiatrist has given the patient adequate information in a form and language that the patient can understand, on the nature, purpose and likely effects of the proposed treatments (Section 56). Factors for consideration include the capacity to comprehend and decide, risks involved, patient’s wishes to be informed, the nature of the procedure and the effects of information on the service user.”

The service user must be informed of the benefits of taking the medication prescribed, for what duration the medication is to be taken and what side affects may occur when taking the prescribed medication. Forcing an unwilling inpatient to receive medication has been considered an unnecessarily coercive, traumatic, and even punitive assault on a person’s privacy. It has been stated that the patients’ refusal of medication is indicative of a gap between their experience and understanding of the medication and the intention of the prescribing physician. (Kaltiala-Heino et al, pp. 290-295) In today’s mental health care system, many service users receive treatment in the community; therefore, it is critical that services users listen to information regarding their prescribed medication while raising any concerns they may have.

Planning and the implementation stages of the nursing process are not possible without the involvement of the service user. Communication and agreement between the service user and the psychiatric nurse is necessary. Potential obstacles need to be pointed out, and methods of overcoming these obstacles, discussed. Potential risk areas for the service user needs to be discussed and a therapeutic risk assessment carried out by the psychiatric nurse to ensure the service user is not at risk or danger of harming themselves or others. Awareness of patients perceptions of their impaired quality of life gives psychiatric nurses important information for planning individually tailored interventions (Pitkanen, A. et al, 2008, pp. 1598-1606).

Finally, the evaluation stage evaluates client progress and reviews plans in accordance with evaluated data in consultation with the client. Evidence shows that the evaluation of a services users experience is of vital importance in shaping the future of service user’s outcomes within the mental health service. It also enables the psychiatric nurse to take the necessary steps required to ensure that the individual service user is satisfied with the service received. The Department of Mental Health, UK stated that the experience of service users, including those from black and minority ethnic groups, is a recognised national marker in the performance of the UK mental health services. In 2006, the UK National Service Framework (NSF) in line with the Mental Health Unit of the Regional Office for Europe carried out a systematic review of empirical service user views and expectations of UK-registered mental health nurses. Feedback from this review was both positive and negative, with service users holding mental health nurses in high regard. However; feedback also reveals that there was a strong need for nurses to be more effective in interpersonal communication and relationship building, whilst spending more time with the service user (Bee et al, 2008, pp. 442-447).

Throughout the nursing process it is necessary for a therapeutic relationship to exist between the service user and the psychiatric nurse to. Relationships are central in fostering and maintaining hope (Byrne et al 1994). Psychiatric nurses are required to have a genuine interest in services users, listening in a non judgemental way to what is being said. In a user-led study evidence has shown service users identified the importance of therapeutic relationships and how they inform patient experiences. Communication was highlighted by all participants as necessary. One participant in the survey quoted; “As soon as you come they can see that you are angry. Then someone will say, sit down, let’s talk about it, make a cup of tea.” Failure to establish a therapeutic relationship between the service user and the psychiatric nurse can result in negative patient experiences. Participants identified coercion as the main reason for failure to establish a therapeutic relationship (Gilburt, H. et al, 2008).

Conclusion:

The writer in this assignment briefly exposed the treatment of patients within the mental health care prior to the introduction of the Mental Health Act 2001 and the publication of ‘Vision for Change’. Then, the writer discussed the major changes within the Mental Health Services as a result of this act and publication. The Mental Health Act 2001, focused on the closure of many asylums and a community based model of care to be adopted, however, both the Mental Health Act and the Vision for Change also focus on the importance of service user involvement and empowering the service user. The writer demonstrates how a new psychiatric and service user role was required to adapt to policy changes within the Mental Health Service and to ensure all parties were adapting to policy requirements that aims at service user involvement at all stages, thus; empowering the service user. The writer reports how the publication ‘Vision for Change’ also hoped at reducing stigma by aiming to involve services users in developing and delivering mental health services. The writer mentioned the importance of service user involvement in research, education and practice, while focusing on the practice area by exploring the nursing process, starting with the assessment. Evidence is clear that it is not possible for a psychiatric nurse, even with the necessary skills required to proceed with the nursing process without the participation of the service user at all stages. The writer concluded this assignment by exploring evidence which reveals that service users regard a therapeutic relationship and good communication between the service user and the psychiatric nurse of high importance.