Category: Free Essays

‘The public outdoor world is rarely conceived of as an appropriate setting for a person with dementia’: Critically discuss this statement with reference to your reading and practice or caring experience. Use at least one case study or vignette of up to 350 words taken from your practice or caring experience. This should support your argument and illustrate either the opportunities and/or the challenges of accessing the outdoors.

Assignment to be: 2500 words

People with dementia have the right to a dignified, healthy, safe, and friendly environment where they are treated as equals regardless their increasing age or diminishing capabilities. (Mitchell et el., 2004). They can still maintain their abilities to cope independently throughout the early or mild stages of dementia. They still have the desire to stay independent and have control over their own lives. It is essential for people with dementia to experience regular mental and physical exercise to keep their minds and bodies active and to maintain social contact. If the streets in their neighbourhoods are not designed to meet their needs they will be trapped in their homes, because their previously safe and secure neighbourhood changed into a harmful and dangerous environment. There is an increasing need improve urban design through the Local Planning Authorities, as such urban planners should take in consideration the implication of not only normal ageing but they should enable individuals with various types of cognitive impairments to maintain their independence (Burton & Mitchell, 2006).

Effects and challenges of dementia

Physical, mental, and psychological changes are due to the ageing process, and can encompasses several slight impairments in hearing, vision, ability, mobility, and memory. These affect elder individual’s ability to live in their surroundings with ease. This is even more difficult for individuals with dementia because they have to cope with both the normal ageing effects and the challenges of dementia that cause a threat to their personhood and result in the loss of identity (Burton & Mitchell, 2006, Chaudhury, 2008). Dementia pose a number of behavioural, personality, and cognitive changes for example restlessness, agitation, depression, and anxiety. There is a typical decline in physical and mental abilities. They develop a typical style of mobility in the form of an unsteady shuffling pace with a stooped posture, always looking down and as such they are not aware of their surroundings. Dementia also result in sensory impairment which can include hearing and vision. Colour agnosia is often intensified by dementia, dark colours and combinations thereof is difficult to distinguish. There might also be impaired depth perception, sharp colour contrasts or patterns on the ground will be interpreted as steps or holes, shiny or reflective surfaces looks slippery and wet, buzzy designs or repetitive lines will cause dizziness and that can result in trips or falls. The mental decline in dementia is permanent and incurable, it might progress gradually and result in unpredictable physical deterioration. During the mild to moderate stages their short-term memory is very fragile and their long-term memory remains acute (Burton & Mitchell, 2006).

Negative feelings

The statement, ‘The public outdoor world is rarely conceived of as an appropriate setting for a person with dementia’ said it all. “There are currently over 750,000 people with dementia in the UK and this is predicted to rise to about 870,000 by 2010 and over 1, 8 million by 2050”. (Burton & Mitchell, 2006, p. 27). But people with dementia is disabled and disempowered by the unfriendly and unsafe environment, it does not meet their cognitive impairment needs, which is ignored. Accessibility for these individuals have become a huge problem, there is positive transformations for normal disabilities but not effective enough to take into consideration the different barriers for individuals with dementia and their unique impairments. Burton and Mitchell (2006) found that individuals with dementia experience negative feelings that include fearfulness and anxiety. This is due to the fear associated with their decline in mobility and vision. Burton and Mitchell also indicated the complications and risks presented by existing city environments for instance irregular paving, poor seating, no shelter, steep inclines, a lack of signposting, and bicycles on footpaths. The psychological and social difficulties are also serious obstacles for example, poor bus services, inaccessibility of local shops, insufficiency of toilet services, and the possibility of getting lost. Constant noise of heavy traffic flow disturbs the person with dementia’s hearing and has an influence on their concentration. Unexpected, loud sounds often frighten them. Another ‘no-go’ facility is the moving stairways in any public building, it hinders a person with dementia who suffers vision-impairment to judge the stairways distance and speed. (Blackman et al. 2010)

Vignette

The above findings support the caring experience in my practice in that the public outdoor world is not an appropriate setting for a person with dementia, they do experience obstacles and challenges on a daily basis when accessing the outdoors as proven in my vignette:

One of the residents, Mr X, in my care setting has been experiencing Schizophrenia for many years and he has also diagnosed with Vascular Dementia. He was from the local area and very familiar with the neighbourhood and community and is well known by some of the locals. He had free access in and out of the Care Home for many years but recently we received a phone call from a local shop that informed us that Mr X had lashed out towards one of their staff members who approached him to support and guide him. At one stage Mr X entered a private property without consent. He also developed some injuries on his lower legs and hands and also got on the wrong public transport.

It was not very pleasant to involve the police to locate Mr X and to guide him back to his own home. After observing Mr X’s change in behaviour we determined that there was a deterioration in his physical and mental functioning, for example he could not remember where a toilet facility was available and used the ally of the local shop. He also entered a private property because that was his previous home. Due to the uneven walkways he also tripped and fell, injuring his legs and hands. Furthermore, Mr X could not read or understand the electronic screen at the bus stop causing him to use the wrong public transport.

We had to involve Mr X’s General Practitioner to review his medical treatment and according to the legislation we had to redo his risk assessments. Out of experience and observation we are aware that a person with dementia experience bad days and good days, and it can be problematic to specify at what stage their dementia has developed. But Mr X still has the capacity to make his own decisions and as such he decided to continue with his daily visits to the local neighbourhood as normal. We understand and support his decision, because this daily routine ‘walk about’ was very vital to maintain his self-respect, independence, and his quality of life. However, Mr X agreed to inform staff when he is leaving the facility and when he can be expected back, following the internal home policy to keep him safe and secure.

Positive transformations

As mentioned above there was positive transformations for normal disabilities, the UK Disability Discrimination Act updated in 2005 affected a change in attitudes towards design for disability in order to meet the needs of anyone with disability. Accessibility has become the most important problem because of the increasing population of older individuals and more positive attitudes towards disability in general.

Recently the mission for dementia friendly communities received an enhancement from the Prime Minister’s Challenge on dementia: a national challenge. In his challenge the Prime Minister highlighted three key areas (see Prime Minister’s Challenge, 2012, p.5)

Driving improvements in health and care.
Creating dementia friendly communities that understand how to help.
Better research.

Mitchell (2012) identified only six projects that have addressed the dementia-friendly design of neighbourhoods. That includes a three year research project, which was sponsored by the Engineering and Physical Sciences Research Council (EPSRC). Individuals with dementia and older people in the community were directly involved, through escorted walks around their own neighbourhoods and in depth interviews. During the research the neighbourhoods were measured, mapped, and evaluated by using a developed checklist of environmental features. This research identified six key design principles that are necessary and required to make the streets and neighbourhoods more dementia friendly. The streets need to be safe, comfortable, accessible, familiar, legible, and distinctive (Burton & Mitchell, 2006).

Familiarity

The roads and outdoor environments and features should be recognisable and easily understandable by older individuals, especially for the person with dementia who experience confusion, spatial disorientation, and memory difficulties. Individuals with dementia do not recognise modernistic unfamiliar designs, they are used to traditional designs with the main entrance facing the street with normal swinging doors and not revolving or sliding doors. They also fail to recognise modern designed street furniture, for example modern bus shelters, telephone boxes, or an automated ‘Superloo’ (Burton & Mitchell, 2006, Mitchell et el., 2004).

To achieve familiarity in the outdoor environment the following can be done. Long-established streets can be maintained, local styles, materials, and forms should be used for new developments, and any changes should be incremental and on a minor-scale (Burton & Mitchell, 2006, Mitchell et el., 2004).

Legibility

Legible roads refers to an easy to recognise network of directions and junctions with simple, obvious signs and noticeable, unmistakeable features. Some individuals with dementia sub-consciously use various techniques to find their way. These include visualising their route through mental maps, route planning by using the same route every time, and they can follow symbols that are realistic and clear. Most individuals with dementia find it difficult to follow or understand the outdoor signs. A cluster of signs is very confusing and difficult to read and understand. People with dementia prefers straightforward, simple signs fixed to the wall. For example the post office sign is familiar and the colour is acceptable for people with colour agnosia. Another technique they tend to use in order to find their way is familiar landmarks and environmental features, such as the letterbox at the corner or a street cafe. It can happen that individuals with dementia get lost at times, that is due to confusion, disorientation, or distractions like sudden loud noise that causes a break in concentration (Burton & Mitchell, 2006, Mitchell et el., 2004).

To achieve legibility in the outdoor environment, streets should be laid out on an irregular grid pattern, staggered and this will allow the connection of routes that is easy to understand. Forked and T-junctions decrease the amount of routes and offer focus points at the end of the roads (Burton & Mitchell, 2006, Mitchell et el., 2004).

Distinctiveness

Distinctive streets replicate the community’s character through the use of a variety of features, colours, forms and materials that provide the buildings and streets with their own character and identity. It is essential for people with dementia to follow a route with a variety of local styles, shapes, sizes, and colour that will help them maintain concentration. They prefer a visit to the parks that presents them with mix activities such as enough seating, greenery, and public art (Burton & Mitchell, 2006, Mitchell et el., 2004).

To achieve distinctiveness and to help dementia people find their way in the outdoor environment it is important to provide interesting and understandable places, use landmarks, and environmental features. Firstly, make use of aesthetic features such as water pumps, attractive gardens, hanging baskets, fountains, and trees. Secondly, use practical features for example street furniture that includes familiar letter boxes, red K6 telephone box, bus shelters, and safe public seating (Burton & Mitchell, 2006, Mitchell et el., 2004).

Accessibility

Accessibility states to which degree the local streets empower people with any physical, mental, or sensory impairment to reach, enter, and walk to places they wish to visit. Older people, including people with dementia are no longer able to drive on their own or to use any public transport. Their trips are limited, due to their personal capabilities, to local places within walking distance for their homes. With the decline of their mobility they cannot walk fast or far distances and they struggle to cope in crowded places because they need enough space on the walkways. Level changes also create barriers for frail people, similarly ramps or steps are a challenge for people with mobility problems (Burton & Mitchell, 2006, Mitchell et el., 2004).

To attain accessibility for frail people, they should preferably live no more than 125m from the nearest post box or telephone with 2m wide pathways and no more than 500m from crucial services and facilities. There should also be public seating every 100m to 125m (Burton & Mitchell, 2006, Mitchell et el., 2004).

Comfort

Comfort for older people and people experiencing permanent incapacity can include streets that allow them to visit places of their choice without any mental or physical agitation, it provides them with a welcoming and calm feeling (Burton & Mitchell, 2006, Mitchell et el., 2004).

To achieve a comfortable environment the streets must be designed in a way that it is welcoming, quiet, open, and accessible by providing enough public seating, shelter, and toilets. The seating must preferably be a wooden seat with arm and back rests. Bus stops should provide shelter, with transparent sides and flat seats of non-slippery material that do not conduct cold or heat (Burton & Mitchell, 2006, Mitchell et el., 2004).

Safety

Safety is a critical characteristic of a friendly environment for dementia people, they have to be able to move around without fear of tripping, falling, being run-over, or attacked. Safe streets will be well-lit, wide, plain, level, non-slippery, non-reflected, and smooth footways with isolated bicycle lanes and in front of building entering ways (Blackman et al., 2010, Burton & Mitchell, 2006, Mitchell et el., 2004)

The above principles outline the design guidelines to a more outdoor friendly environment for people with dementia. Burton and Mitchell (2006) also provides 65 recommendations and by using these it will support the design and re-design of an easy to use and welcoming neighbourhood.

To summarise, it is clear that people with dementia, at least during their mild to moderate stages, can still maintain their ability to cope independently and any regular mental and physical exercise is essential to maintain their self-respect, independence, and their quality of life as seen in the vignette.

That is why it is so important to us to ensure that the outdoor environment is accessible, open, and safe for people with all stages of dementia. If this cannot be achieved the environment out there becomes a scary and frightening world for people with dementia.

Although, the neighbourhood environment is not dementia friendly at present there is positive improvements and pressure from Government, through the Prime Minister’s Challenge on dementia. Importantly, the research project identified six principles of a dementia friendly environment that can be used for future planning and implementations. This will ensure that all new developments that take these principals into consideration will be in line with suggested and prescribed rules that cater for a safe and accessible environment for people with dementia.

“Assessment is the foundation of the social work process with service users” (Walker and Beckett, 2003:6). Why is assessment a crucial aspect of the social work process and what makes an effective social work assessment? What might be some of the barriers to an affective assessment and how can the worker overcome these? In your answer, you will be expected to refer to relevant research regarding social work assessment.

Social workers are expected to carry out an initial assessment of situations they encounter before taking action. These are important because they provide the foundation for any plans to support, protect, manage or provide aid for a client. In a nutshell, an assessment is simply gathering information about people, their situation, factors deemed relative to that situation, and integrating this into a formal report, which will be used to look back on when carrying out a review. This will not only provide a helpful way for the social worker to quickly reacquaint themselves when looking back on a family, but it will also allow other work staff to get a gist of the situation if they are coming into it for the first time.

For an effective assessment it takes someone with an organised, rational and open minded knowledge base, using these to compliment a number of unique skills they will hold, enabling them to come to grasps with the varied number of situations they will face and an ability to be sensitive to those involved.

It is expected of social work graduates to understand all the legal documentations issued by work bodies (such as the Department of Health), for these will include necessary guidelines on assessment and how and when to act. However, simply knowing these will not cut it, and those who are inexperienced will simply be able to regurgitate back what they have learnt without knowing the true art of carrying out their work.

An assessment is more than simply making notes on ones observations, for it includes the worker’s opinions, beliefs and ideas, which will be essential when carrying out interventions. They are not to be confused with evaluations, although they do contain evaluative sectors, for example determining a client’s needs. Unlike evaluations however, assessments are open to more probing and study, which make them more effective tools for making a decision.

For the social worker to be able to make their assessment successful, they will need to ensure they can fully appreciate a) all factors that affect the client and b) which of the client’s needs are not being met. To do this they will need to establish the type of person their client is, for example how they communicate with others, how they react to stress, how they deal with problems etc.

It is important for the social worker to know which bits of information are relevant, and rather than find out everything they can (scatter gun method) they pick out those bits which will serve to help them later. If they ask too many questions it will lead to general misinterpretations, often a common mistake in those just starting social work practice.

One must understand that views will be different, and that other work forces, agencies or even individuals will draw out their own conclusions for a case. This makes it difficult to assume any kind of truth in an assessment, since “what one sees depends on where one looks”. (Jones 1983)

Another problem assessor’s face is that there is often the case of clients scapegoating or stigmatising based on a negative assessment. Social workers are aware that they are held accountable for any action they make, and so if they make an error in the assessment that could prove costly to a families support, then they may be faced with court proceedings.

In actuality, assessments are by no means a quick process. It is often the case that work staff are met with the stress of having to cope with busy offices, numerous phone calls and masses of paper work. Stress can affect workers in any number of ways, but the biggest concern is that it can lead to negligence such as making quick, inaccurate assessments because there is no time to meet the demands of the office.

There is, however, a way of preventing these difficulties and that is to employ a method referred to as triangulation. This is done by drawing comparisons from other groups to find similarities between information gathered. In addition to this, it may prove helpful to discuss the assessment with clients themselves, for this will not only improve the accuracy of the assessment but will also create a sense of trust and warmth between client and worker.

In spite of triangulation mistakes are still inevitable. Possibly the most common mistake would be to apply a one sided attitude towards people and/or situations. An example would be of a social worker looking at an argumentative couple; seeing things only from either the controlling wife point of view, or the unfaithful husband point of view. For this reason it is essential for the social worker to bring in other colleagues so as to form a multidisciplinary assessment. Rather than relying on one man’s opinion, by working as a team, members may gain further insight into the task at hand and observations may be brought to the table that otherwise would have gone unnoticed. However, the use of multiple assessments is problematic in that the social worker will have to deal with multiple theories. This may lead to conflicts and confusions over the correct path to follow.

Because of the time constraints on social work practice, alternative methods have been introduced to take away some of the pressures. Self assessments for example are often carried out when dealing with younger children. It is seen as a fun learning experience and will tell staff workers much about that child. Self assessments will compose of numerous exercises, such as multiple choice questionnaires, rating scales, producing stories, drawings of themselves, and/or their families. Adults often prefer this method as it allows them to use their own words rather than being misinterpreted.

Another alternative is computer aided assessments. These have long been used in other fields such as medicine in order to make quick diagnoses. They are helpful in that they save time, and unlike humans do not forget or make errors. It is as simple as loading in all the variables, and allowing the computer to calculate the most likely outcome and therefore the best form of action. However, computers are unable to process social, emotional, or psychological factors and so can often fail to spot key issues. The use of computers is therefore limited.

Recently, there have been movements in practice theory, the most important of which is a larger emphasis on the influences of powerlessness, prejudicial views, discriminatory acts and oppression. In addition, workers are starting to develop a more constructionist way of thinking. This includes seeing beliefs and ideas not as relying on the influence of the environment around those who hold said beliefs and ideas, rather them being “constructed” by individual people whilst they converse and respond to one another’s presence.

It is this constructionist way of thinking where many theories on assessment begin.

In the past 3 years it was found, through reviews from service users, that many were unsatisfied with the assessment process. One rising concern was that a large number of social workers were failing to conduct reassessments. It seems that they only look at certain information in order to confirm their theories and therefore neglect many important items. This is a critical point because assessments are the basis for all further work. An error here would be damaging for the whole investigation.

Even when a reassessment is made, there still remains the problem of prioritising key areas of importance. If this is done shoddily then there is risk of the assessment giving off misrepresentations when conducting an evaluation. To prevent this, there are three areas that it is suggested the social worker start by looking at. These are:

“Starting where the client is”, focussing on meeting the client’s needs; “legal considerations”, which should be made known to the client; and “health or safety concerns”, for if there are any risks to the client then they must be informed. (Hepworth and Dean 2006)

Another important issue relates to the production of a culturally competent assessment. The social worker must therefore demonstrate knowledge of “cultural norms, acculturation, and language differences, the ability to differentiate between individual and culturally linked attributes, the initiative to seek out needed information so that evaluations are not biased and services are culturally appropriate; and an understanding of the ways that cultural differences may reveal themselves in the assessment process.” (Hepworth and Dean 2006)

There are numerous differences between cultures when it comes to forms of, for example; disciplining younger family members, selecting the most dominant group member, aiding those unable to manage for themselves, how to address one another, and many others. And because of these differences, the social worker must be wary when considering things such as; what is seen as normal behaviour in children with autism? What is seen as a healthy amount of sex in afro Caribbean tribe members? At what age is a child believed to reach maturity in China, Africa, Asia etc? The list is endless. Patterns of behaviour which may appear dysfunctional in one culture may be considered normal to another. It is important that social workers have knowledge of their client’s background and if not then research it. For an error made may aggravate or offend them.

It can be hard to define exactly what an assessment is, who it is intended for, and the reason it needs to be carried out. Pincus and Minaham (1973) therefore developed a model framework with the specific aim being to help social workers recognise; the reasons for their involvement, the expected goals and outcomes, which persons fit the role of agent and which fit the role of client, what needs to be maintained and what needs to be managed.

“Pincus and Minaham labelled three kinds of resource system which people will have contact with during their lives and four mapping systems which summarise what is occurring”.

The advantages of a systems approach are many. Firstly, it helps the social worker to understand a situation in such a way it gives clear definitions of those involved and how they are linked to one another. Secondly, aims and goals are clearly established early on, which helps them create a formal plan with their client and also helps both parties follow any progress made. Thirdly, it removes some of the burden of work off of the social worker’s back, knowing that not everything depends on their selves. It also helps them to see which areas may take the most work, and which may be met with more conflict. This will help them plan their time and resources irrespectively, know when and where they should be, and how much of their attention is required at any time. By doing this, the social worker is less likely to exclude important responsibilities, or focus too much on only one aspect. Upon evaluation of the system, if for any reason another worker sees something they wish to add, remove or change, then this can be easily done with little time consumption. It is not unlikely that things may change at a later date, for example new clients may need to be added to the system, or new targets to be met. People’s needs are not immutable and are always changing. The social worker must recognise this and be able to identify any changes, and adjust so as to fit them into the system.

There are also certain disadvantages of a systems approach. Firstly, although it helps to maintain the flow of activities, it will not provide enough understanding of a person’s life without the addition of other approaches. Alone, the model is too general, and does not include a great deal of information about the relevant difficulties being assessed. Secondly, despite all its hype about ordering data, the systems approach does not maintain that data should be collected to begin with. Furthermore, it fails to recognise the importance of existing beliefs about human behaviour, so is basically starting from scratch each time. Thirdly, the natural urge to focus primarily on the client’s illness, with little attention being paid on their wellness can often lower their sprits and remove their hopes of ever finding a solution to their problem.

As a social worker making an assessment, it helps to understand that, “since external problems become internal, and the internal affects the external, looking at just the social aspects will prove inadequate, just as looking at just the psychological aspects is inadequate”.(Milner and O’Byrne 1998) We need to look at both, and use various approaches to complement one another.

Assessments need to draw in help from psychiatrists and psychologists, those skilled at exploring the unconscious. For it may be the case that the client has certain unresolved issues that may be of relevance. A problem workers face is that the id is like a cavern, in that it is made up of large numbers of interrelated passages. Some will affect others, while others will come to a dead end. And everything inside that cavern is hidden away from the outside world and is immune to any happenings beyond its entrance.

Applying a psychodynamic approach as it were is advantageous because it is able to explain away what appears to be irrational behaviour. As I explained, many of a person’s difficulties may not be explicit and observable. Many individuals use defence mechanisms as a way of hiding their emotions. And so by combining aspects of psychology (cognitive, psychoanalytic, humanistic etc.) it will allow the worker to delve deep into their client’s personality and learn more about their associations with the world around them.

This approach has imposed a caring, considering, communicative attitude amongst assessment workers and gets them to gain more of an emphatic relationship with their clients. Rather than applying a tick box assessment and using the same set of questions for each person, the worker now has a set of guideline questions allowing them to go off on a tangent basing each new question on the previous answer.

The psychodynamic approach does indeed contribute greatly to the advances in social work assessment; however it has a number of issues of concern. First and foremost, the main interest is on the individual and so social factors are often neglected or disregarded. Secondly, abnormal human behaviour or behaviour that does not fit with the norms of society is grounds for a referral. Homosexuality for example is put down to Oedipal conflicts, homosexuals are not treated as a typical male and this causes much oppression and discrimination. Furthermore, the guidelines for communication are based on a middle class Caucasian male. Although certain groups will see equal gain from this method of practice there are many from other cultures that will react differently. And so to make an effective assessment the social worker must be able to relate their skills across cultures.

Thirdly, when dealing with children, psychoanalysis may prove ineffective or even destructive. For example in cases of child abuse the sexual wants of an adult are transferred into the child’s want for their parents. The child becomes the culprit and the blame is put towards the mother for being neglectful.

When it comes to the ideas of Freud, the population of workers is split, half of them opposing entirely and half of them supporting entirely. As with all other approaches, the psychodynamic approach works best when in conjunction with others.

An assessment which includes a descriptive evaluation of client behaviours will prove more effective than one without because the worker is then able to look at how those behaviours have come to be part of their client’s being and why they continue to exist. Behavioural assessments see behaviours as being learned, and therefore can be unlearnt through training. All behaviours have an underlying cause; the point of the assessment is to therefore find the route of the problem and find ways to negate its effects. There are often however misinterpretations. For example, what is a negative reinforcer? (strengthening a particular behaviour by removal of something undesirable). Punishment is not a negative reinforcer although it is associated with something undesirable. But rather than extinguish the problematic behaviour, it is often the case that it causes resistance. And so the behaviour has become strengthened.

The problem is that there are no clear definitions of positive and negative reinforcers, seeing as what is considered desirable or aversive will vary between people. What may be pain to one man may be seen as a challenge to another who will welcome it. To work around this social workers must ensure they work with their client to determine what they perceive as basically good or bad. It is important the worker be consistent when making visits (reassessments), for example if they always turn up at a foster home when they get a call the child is misbehaving, yet they rarely turn up when the child is behaving reasonably they may inadvertently be making their misbehaviour more appealing.

Many behaviours, be they positive or negative, helpful or hindering, are learned during the course of life and are influenced by our life experiences. Behaviourists believe that when conducting an assessment it is important for the worker to understand where problem behaviours have come from and what reasons there are for their manifestation. Once the underlying routes have been established the worker then helps the client to unlearn those behaviours and get back on track to healthy living. An effective assessment is therefore one that considers the ABCs; the antecedents, behaviours and the consequences. Anything that causes the unwanted behaviour should be removed, whereas anything that promotes desired behaviours should be encouraged. The client should then learn to associate these positive behaviours with pleasant experiences; this way they will want to repeat them. Assessments should look at a client’s history thoroughly. It is easy to miss parts out, yet everything needs to be examined for even something seemingly irrelevant may hold the key to a person’s problem. Of course it is unrealistic to look at absolutely every aspect of a person’s life, especially the elderly who have an extremely long history to cover. And so it has been argued that behavioural approaches lack validity and are unattainable.

This aside the behavioural approach is still useful because it provides clear definitions of; the aims, goals and the plans for intervention. Furthermore, the approach, more so than other approaches motivates the client to have a say in the overall structure of the assessment. Sheldon (1982) believes there is the advantage that it does not manipulate the data in any way so that the client can be placed in a particular category or theory. People are seen as individuals, individual factors are considered, and client perspectives are used to shape the approach.

Task centred theory makes a good starting point for new workers because it is possibly the simplest approach. Assessments can at times be overcomplicated and so it may do workers good to sometimes go back to basics and look at the most obvious action to take. Actions should depend upon one’s values rather than any policy one is obligated to follow. Previous experience should be used to improve practice, even the negative ones. Difficulties are inevitable but they will only get worse if the worker continues to make the same mistakes again and again. When there is time pressure to get a job done, rather than crumble the worker should use the pressure as motivation to get things done efficiently. That way they will have to make fewer reassessments.

The first task is to determine their client’s needs (what it is they want). The next step is convincing the client to accept ones help, firstly recognising they have needs and secondly wanting to do something about it. Epstein (1988) calls this the “Start up phase”, as it gets the ball rolling so to speak. Next, the wants require their own assessment, to determine what should to be done to meet them, how long it will take and who should be involved. The assessment process is a time to give order to the person’s needs, generally up to three of them. It would be helpful to consider not only what changes need to be made, but also what might get in the way of these and what further changes could be done to make the initial changes possible. It would also be helpful to find out how individual problems relate to one another, if at all. If they are then able to tackle the main problem, others may follow suit accordingly with little/no effort on the social workers account. A useful strategy for social workers is to get their clients to firstly write down their problems and secondly assign them a score ranging from no problem at all to highly serious. It is vital that needs are set out from the start and fully understood by both worker and client. Failure at this stage will lead to difficulties come the evaluation. When conducting an assessment on two or more people (such as two partners in a relationship) the worker would be advised to look toward the Want Sheet for support (Masson and O’Byrne 1984). This gives detailed descriptions of different wants and can be used to help service users explain what they feel. So far, no approach has come up with a solution to this problem, making the task centred approach unique. The Want Sheet can be administered to couples/groups and this way can be used to compare different ideas. Through this stage alone, it is possible for a group to resolve any issues without any need for an intervention scheme. This is most unlike other approaches, which see the social worker as an agent coming in to help the needy, an approach not unlike the medical model of mental health.

It is important when assessing individuals, not to mistake the clients as abnormal people just because their behaviour may suggest so, or because they appear difficult or un-cooperative. Doel and Marsh (1992) call this “shooting the reflective parrot” for what they are doing is making false judgements based on observation, without getting down deep to the underlying issue.

Before any interventions, it is important for any decisions to be met together, all other options have been considered, and the client is satisfied with how things are being dealt with. Once a decision is reached, there is still time for one final review. This is a useful step because at this late stage, it is still possible to change one’s mind; nothing is yet set in stone. If no changes need be made, the review is still beneficial as it helps to reduce any doubts or anxieties before progression.

The task centred approach to assessment seems full proof. Reid (1978) commented that it holds particular value in situations whereby the service user is able to contribute to a moderate degree. It holds the advantage over other approaches because it considers not only the client, but their interactions with the outside world. They get a fair hearing, and communication between them and the social worker is mutual, leading towards a more accurate evaluation.

There have been arguments that giving too much leeway can leave the worker vulnerable to misinformation. More so with children, there are cases where the client is not responsible or trustworthy enough to be given a shared role in the assessment.

In conclusion, there are numerous positives and negatives of any approach to assessment. Every worker will have a preference on how they will deal with a situation; however it need be emphasised that no two situations are alike. And so workers must be able to “think on their feet” if they are to become competent social workers. Those who are open minded will reap the most success, for the key lies within managing all the different approaches, integrating them into a whole. Care should still be taken, for within the approaches lie numerous contradictions. There will always be a degree of uncertainty, but what makes the difference between good and average work, is the confidence to give an opinion, whilst at the same time welcoming the views of others.

In conclusion, why is the assessment process vital? Because it forms the foundation for understanding one’s client, and gets the ball rolling when planning actions for change. It forms a record which can be referred to when evaluating said changes, and can also be used as evidence in court.

What makes an effective assessment? One which investigates all relevant factors rather than stick to anything specific, which matches with individual’s aims and goals, which is centred on the tasks at hand, which draws from multidisciplinary agencies, which forms a partnership between agent and client, and which is anti oppressive or discriminatory.

What barriers do workers face? They can be time consuming, workers are under pressure to get through their work load and may be unable to spend time getting to know their client, groups who are often the target of oppression may seem uncooperative and resistant to change, and all assessments are in some part vulnerable to bias.

How can these be overcome? It is imperative that when conducting an assessment one shares thoughts and ideas with not only other workers, other agencies and welfare authorities, but also with the client themselves, thus spreading out the work load, and reducing the likelihood of any errors going unnoticed. Furthermore it helps to be self aware. This way one picks up on any fool hardy assumptions they may be making. One should not be afraid to challenge higher authorities and understand that personal values and the law will often conflict. And finally, every assessment should be instigated with care and precision, frequently asking “why” one has come to that conclusion and “what” other alternatives are there.

References

Ahmad, A. Practice with Care, London, Race Equality Unit/National Institute for Social Work, 1990

Challis, D., Chessum. R., and Chesterman, J., Luckett, R. and Traske, K. Case Managementin Social and Health Care , Cantebury, Personal Social Services Research Unit, 1990.

Department of Health. Protecting Children: A Guide for Social Workers Undertaking a Comprehensive Assessment, London, HSMO, 1988.

Doel, M. and Marsh, P. Task Centred Social Work. London: Ashgate, 1992.

Epstein, L. Helping People; The Task Centred Approach. Olumbus, OH: Merrill, 1988

Forder, A. Concepts in Social Administration: a Framework for Analysis, London Routledge & Kegan Paul, 1974.

Hepworth and Dean, H. Direct Social Work Practice: Theory and Skills, p. 179-205, London: Thomson/Brooks Cole, 2006

Jones, C. State Social Work and the Working Class, London , Macmillan, 1983

Masson, H and O’Byrne, P. The Family Systems Approach: A Help or a Hindrance, in Violence Against Children Study Group. Taking Child Abuse Seriously. London: Unwin Hyman, 1990.

Milner, J., & O’Byrne, P. Assessment in Social Work: Chap 7; Psychodynamic Approaches, Macmillan Press LTD, 1998

Pincus, A. and Minahan, A. Social Work Practice: Model and Method. Itasca, Il: Peacock, 1973.

Reid, W. J. The Task Centred System. New York: Columbia University Press, 1978.

Sheldon, B. Behaviour Modification, Theory, Practice and Philosophy. London: Tavistock, 1982.

Thoburn, J. Child Placement: Principles and Practice, Aldershot, Wildwood House, 1988

Advocacy, Rights and Partnership

This reflective report contains my experience and understanding of advocacy and explains the types of advocacy and its methods and models, I will explain the theories and relate it to my practice and finally discuss the strengths and weakness of my area of practice and discuss the conflicts of interest implication up on the service user.

DEFINITION OF ADVOCACY

Advocacy is defined as a key concept in social work practice. It is defined as exerting influence on behalf of organisations and groups within legal power and political structure.

” Advocacy involves either an individual or group, or their representatives, pressing their case with influential others, about situations which either affect them directly or, and more usually, try to prevent proposed changes, which will leave them worse off” .(Pardeck, 1996).

Gates (1994) cites four variations of advocacy: legal advocacy, the representation of the user in a formal context, for instance a health-review tribunal; self-advocacy, where the individual or a group of individuals speak up for themselves, a form of empowerment; collective or class advocacy, the large organisations who speak for the interests and rights of a category of people; and citizen advocacy, the representation of the user’s interests by a competent advocate (eg a Social worker).

Advocacy is a concept embraced by social work and advocating for clients is vital for the social work profession. The primary goals of advocacy are achieving social justice and people empowerment. In achieving these goals, a proactive, responsive and participatory approach is necessary (Pardeck, 1996). My role as an advocate during my placement was to speak on behalf of my clients and to empower them to advocate on their own behalf, whenever their rights have been denied; for example in accessing state benefits or demanding repair work from local Housing departments. The advocacy role, from a social context, includes the redistribution of power and recourse to an individual or group, guarding their rights and preserving their values, conserving their best interests and overcoming the sense of powerlessness (Pardeck, 1996. pg 151).

RESOURCES AVAILABLE WITHIN PLACEMENT

My second year practice placement was with a charity organisation, in the London Borough of Newham called RAMP (Refugee And Migrant Project). RAMP is one of The Renewal Programme projects and is registered with the Home Office – Office of Immigration Services Commission.

RAMP works to enable refugees and migrants (including asylum seeker) to realise their potentials and facilitate their integration into society. The focus of the organisation is to provide advice and advocacy and support on welfare benefits, housing and education and NASS – National Asylum Support Services.

RELATING THEORY TO ADVOCACY

When I began working with migrants, refugees or asylum seekers, I took a very holistic and Person Centred Approach that allowed me to work in partnership and give them the opportunity to go through their own problems and find their own solutions to them. Carl Rogers was the founder of Person-Centred therapy. As a psychologist in the 1950’s and 60’s he studied the process of counselling and came to the conclusion that a number of basic principles were required in order for there to be a positive relationship and outcome between the client and the therapist. These are also known as ‘core conditions’:

. Unconditional positive regard that involves the therapist being non-judgmental and accepting the client and their experiences.
. Congruence, which means that the therapist displays their true thoughts and feelings during the session.
. Empathy, where the therapist shows understanding towards the client’s experiences without oppressing them.

When engaging with my clients, I demonstrated unconditional positive regard by not judging them as individuals or for the needs they had; I wanted to find out what it is that they wanted/needed. I was congruent in that I acknowledged the fact that I was a student and I was also learning myself, and therefore I may not be able to answer all questions immediately. Finally, I showed empathy by acknowledging similarities that I may have with them such as coming from a minority ethnic community.

As well as the core conditions, I used the Exchange Model of communication to engage in my meetings with my clients. Smale and Tuson (1998) point out that the exchange model believes that the client has an equally valid perception of their problems and that they themselves can contribute to finding the solutions. This also facilitates partnership between the worker and the client. The exchange model was effective because English was the second language for all my clients therefore enabled me to ask them simple, open-ended questions that were free from professional jargon, compared to Procedural model that has pre-set questions to conform to the requirements of the agency.

I used two main theories to look at situations during my practice placement: Systems theory and Muslow’s Hierarchy of Needs. Systems theory originates from Bertalanffy’s (1971) biological theory that all things are part of a system: sub-systems that make up super-systems (in Payne, 1997). The theory is also known as ecological perspective; family theory and networks theory depending on what context it is used. Systems theory allows you to look at the whole picture and not just one aspect of a particular case. The concept of ‘circular causality’ is also significant in this theory and it suggests that: if something happens in one part, it affects the other. I therefore did not analyse clients’ situations in isolation, I looked at their surroundings and their systems to understand their situations better. Pincus and Minahan (1973) describe 3 systems in which people depend on (in Payne, 1997 p.141):

Societal systems

(housing, social security and schools)

For some of my clients, their housing department was part of their societal systems that they may have been experiencing problems with. On top of this, some of their main informal systems – their families – may be missing from them (i.e. still in their own countries). This had a detrimental effect on their self-confidence and achievement as it left gaps in the systems that are supporting them. Maslow’s hierarchy of needs highlights that the family is a very important factor in meeting basic needs for example, security. By being estranged from their families, clients are already at a weak point and according to systems theory; this also affects their formal and societal systems. As a social worker, in order to promote and enable my clients and to empower them, it was important that I was able to maintain as many systems around them as possible. This was important for their confidence and future development.

When carrying out my work with asylum seekers, refugees and migrants I was very much open and holistic in the way that I looked at the multiple forms of discrimination and oppression that this client group may face. For example I did not only focus on the obvious forms of oppression. Such as race, religion and gender, I also looked at underlying issues such as relationships with partners and domestic abuse. I ensured that I did not ignore the oppression and discrimination that they may face within their own communities.

Other theories, models and methods which I used included Crisis Intervention, Task-Centred work, Loss & Bereavement amongst others. I found that being able to study, understand and relate these to my practice guided me immensely in my practice. They provided me with the knowledgebase, which I could use to eclectically and effectively in order to work with the many different situations that I worked with.

THE IMPORTANCE OF WORKING IN PARTNERSHIP WITH SU

Adams (1998 p314) sees advocacy as a form of empowerment which, “involves representing a person’s interests in circumstances where they are not able to do so themselves”. It strives to promote social inclusion by empowering marginalised people and therefore, has a direct relationship to anti-oppressive practice in social work. The ethical principles underlying advocacy reinforce working in partnership with users and carers, a key concept in social work practice and community care. Furthermore, the skills required for successful advocacy reflect core skills of social work practice (Bateman, 2000p17).

Professionals get involved in people’s lives most of the times to help, but then oppress them by making decisions for them. Oppression is:

“Inhuman/degrading treatment of individuals/groups; hardship And injustice brought about by the dominance of one group over another; the negative and demeaning exercise of power. Oppression often involves disregarding the rights of an individual/ group and is thus the denial of citizenship” (Thompson 1997 p31).

In a situation where the Social worker made a decisions without consulting him, his needs and interests were not considered. As Adams (1998p301) affirms “remedies to problems encountered lie primarily with experts and thus undermines self determination and authenticity”. Most professionals take it upon themselves to make decisions for people as they assume that they cannot make choices for themselves, yet the Mental Capacity Act 2007 argues that almost all including the most severely disabled are capable of making choices and expressing their views and preferences. Therefore it is the Social worker’s role to “challenge the abuse of power for suppression and for excluding people from decisions which affect them” as stated by Stanford (accessed 5/01/2009) in the code of ethics.

People requiring access to services should not feel that they are beggars, their welfare needs should be met as a right and dignity and respect should be maintained all the times.

STRENGTHS AND WEAKNESSES OF ADVOCACY

To assist service users, advocacy may be appropriate to protect the rights of the service user. An advocate will inform an individual of their options, and talk with other services on their behalf, if required to. The role of an advocate is to allow the service user to make their own self-determinations by ensuring they have all the relevant information, whilst at the same time not imposing their own views on the situation (Coulshed and Orme 1998).

Difficulties with advocacy arise if the advocate tries to impose their own opinion on the service user, who may be vulnerable, and open to suggestion. The lack of statutory advocacy means that most services are provided by those who have already experienced similar situations, and who may have a biased view or are not trained to deal with difficult situations (Adams et.al. 2002)

Anti oppressive practice (AOP): Looking at the structure of oppression developed by Thompson (1993) called the PCS model. I can illustrate how oppression is occurring, because this model is used to ‘develop our understanding of discrimination and the oppression that arises from it’. (Thompson,1998:12). It operates at three very separate levels, which are inter-related. These levels being personal, cultural and structural ‘(the term PCS model)’. (Thompson,1998:12).

‘Oppression itself is a powerful force. On a personal level it can lead to demoralisation and lack of self-esteem, while at a structural level it can lead to denial of rights’.

(Dalrymple and Burke,1995:57)

This statement proves to be true because at the personal level, because the majority of the community that come to our organisation are feeling oppressed by themselves because of not being able to access facilities and not receiving the advice in maintaining their health, hygiene and environment.

At the cultural level oppression is coming from other communities because they feel that they are superior to them, due to the fact that they are more familiar with the services and maybe able to speak English, therefore demoralising the community .

At the structural level, institutions such as schools, hospitals, social security offices, advice centres the list is endless do not provide a facility whereby individuals from the community can access them, whereby denying them their rights.

As an advocate it was my duty to challenge what the service users where feeling and going through, whereby I would empower them to access necessary services and direct them to attend relevant courses in order to tackle there problems and emotional feelings.

CONFLICTS OF INTEREST WHICH MAY ARISE IN ADVOCACY

The most common conflict of interest that I was faced with whilst advocating was the language barriers between service users and advocacy staff , In reflection throughout the advocacy I noticed the significant difference that language plays throughout society. It made me realise that not having the language skills can be very oppressive to a person and can leave them marginalized from the rest of society.

Communication is a skill in itself and it is central to the role of social work (Thompson, 2000). Communication can come in many different forms; this can include verbal, non-verbal, listening and writing skills.

Conclusion

In conclusion to the finding throughout research and practice, it shows a huge importance in working in partnership with service users and other professional, good partnership helps social workers and other professional to delivery an effective service.

Social workers are helping to promote change; even though they are working within statutory agencies their role can have a huge influence from advocacy.

New World Enclopedia (2012) defines foster care as full-time substitute care of children outside their own home by people other than their biological or adoptive parents or legal guardians.]

History of foster care

Placement of children in foster homes is a concept which goes as far back as the Old Testament, which refers to caring for dependent children as a duty under law. Early Christian church records indicate orphaned children lived with widows who were paid by the church. English Poor Laws in the 1500s allowed the placement of poor children into indentured service until they became adults. This practice was imported to the United States and was the beginning of placing children into foster homes. [1]

The most significant record of fostering was in 1853, a child was removed from a workhouse in Cheshire and placed in a foster family under the legal care of the local government.At the beginning of the 1900s only orphaned or abandoned children under the age of 11 years were fostered, and they had to have a demanding psychological profile – well adjusted, obedient and physically normal.

Until World War II, foster care was recognized as a charitable service. Two important events that pushed the state to look at the foster care system in a different angle was the first mass evacuation of millions of children and then the death of a child in a foster care in 1945.

In 1969 research was carried out on the foster care system and it was found that foster families required training on how to deal with the foster children and make them fill secure in the placement. (Jeune Guishard-Pine, 2007)

Foster care as a global concept

Foster care is probably the most widely practised form of substitute care for children world-wide, depending on the needs of the child, the culture and the system in place. There are many different kinds of fostering and definitions of ‘foster care’ vary internationally. It can be short -term, a matter of days ,or a child whole childhood. A review of foster care in Twenty-two countries found considerable diversity in the way of fostering in both defined and practised.(Hannah Johnson, 2005).Kinship foster care ,which is the most common form of fostering in African countries is not defined as ‘foster care’ in all countries. In Ireland for example only children placed with no relatives are said to be ‘fostered’. In some countries foster care is seen only as a temporary arrangement ,whereas in others the norms is for long term and quasi adoptive placement.(Colton &William ,1995)

Hannah Johnson (2005) stated that the process to be registered as foster parents in different countries such as U.K , Australia, Uganda and South Africa is practically the same. In some countries foster care programme is managed either by the government or agency, and each country has their basic criteria that need to be fulfilled ,such as being physically and mentally fit and healthy, having a room for the child ,having time to spend with the child .The process to be registered as foster families can take approximately six months. Individuals who are willing to become foster families must make their applications to the agency. A home study is conducted by a social worker to assess the capability of the applicants for taking care of a child. The assessment form is then forwarded to the final panel who will decide whether the applicants are fit to become foster carers.

Placement in Foster care

According to zuravin & Deponfilis (1997) children are removed from their homes to protect them from immediate abuses.

In many situations, these children have suffered physical, sexual abuse, or neglect at home, and therefore they are placed in a safe environment. A small percentage of children are in foster care because their parents feel unable to control them, and their behaviour may have led to delinquency or fear of harm to others. Some children have been neglected by their parents or legal guardians, or have parents or legal guardians who are unable to take care of them because of substance abuse, incarceration, or mental health problems. These children are then placed into foster care until the parents or guardians are capable of looking after them.[1]

In all foster care cases, the child’s biological or adoptive parents, or other legal guardians, temporarily give up legal custody of the child. (The guardian gives up custody, but not necessarily legal guardianship.) A child may be placed in foster care with the parents’ consent. In a clear case of abuse or neglect, a court can order a child into foster care without the parents’ or guardians’ consent.

Before any placement the foster care family is screened by the Government or agency through a psychologist or social worker that assess the foster care families under certain criteria such as emotional stability, motivation, parental skills and financial capabilities.[2]

The government provides foster families with an allocation taking in foster children. They are required to use the funds to buy the child’s food, clothing, school supplies, and other incidentals. Most of the foster parent’s responsibilities toward the foster child are clearly defined in a legal contract.

Foster placements may last for a single day or several weeks; some continue for years. If the parents give up their rights permanently, or their rights to their child are severed by the court, the foster family may adopt the foster child or the child may be placed for adoption by strangers.[3]

The Aim of Foster Care System

According to Hayden (1999), the aim of foster care system is to protect and endorse the security of the child, while providing foster parents and biological parents with the sufficient resources and available services needed to maintain the child’s healthy development. Foster care environments are proposed to be places of safety and comfort, and are monitored by several welfare agencies, representatives, and caseworkers. Personal caseworkers assigned to a foster child by the state or county are accountable for supervising the placement of the child into an appropriate foster care system or home. The caseworker also carries out regular visits to the foster care family home to monitor progress. Other agents involved in a child’s placement into foster care may include private service providers, welfare agencies, insurance agents, psychologists, and substance abuse counselors.

Types of Foster Care

Parents may voluntarily place children into foster care for various reasons. Such foster placements are monitored until the biological family can provide appropriate care for the child, or the biological parental rights are terminated and the child is adopted. A third option, known as guardianship, is sometimes utilized in certain cases where a child cannot be reunified with their birth family and adoption is not a suitable solution. This generally includes some older foster children who may be strongly bonded to their family of origin and unwilling to pursue adoption.

Voluntary foster care may be utilized in circumstances where a parent is unable or unwilling to care for a child; a child may have behavioural or psychological problems requiring specialized treatment, or the parent might have a problem which results in a temporary or permanent inability to care for the child. Involuntary foster care is implemented when a child is removed from their caregiver for his or her own personal safety. A foster parent receives monetary reimbursement from the placement agency for each foster child while the child is in his or her home to help cover the cost of meeting the child’s needs

(Dorsey et al 2008) stated that in many countries ,most of the children enter the foster care system due to neglect. Children may join the foster care system via Voluntary or involuntary means.

Voluntary placement may happen when the biological parents are facing difficulties to take care of the child.

Involuntary placement occurs when the child is being at risk under the care of the biological parents.

Adoption and Foster Care Reporting System recorded , different types of fostering such as:

(i) Foster family home, relative – A licensed or unlicensed home of the child’s relatives regarded by the state as a foster care living arrangement for the child.

(ii) Foster family home, non-relative – A licensed foster family home regarded by the state as a foster care living arrangement.

(iii)Group home or Institution – A group home is a licensed or approved home providing 24-hour care for children in a small group setting that generally has from 7 to twelve children. An Institution is a facility operated by a public or private agency and providing 24-hour care and/or treatment for children who require separation from their own homes and group living experience. These facilities may include child care institutions, residential treatment facilities, or maternity homes.

Problems in Foster Care System

[1]Foster children face a number of problems both within and outside the foster care system. Foster children are more vulnerable to neglect, abuse, family dysfunction, poverty, and severe psychological conditions. The trauma caused to a child when removed from their home is also severe and may cause depression, anger, and confusion. Studies have shown that psychological conditions of abused and neglected children are required to improve when placed in foster care, however the separation from their biological parents causing traumatic effect on the child.

Children with histories of maltreatment, such as physical and psychological neglect, physical abuse, and sexual abuse, are often at risk of developing severe psychiatric problems and may be described as experiencing trauma-attachment problems. The trauma experienced may be the result of abuse or neglect, inflicted by a primary caregiver, which disrupts the normal development of secure attachment.

Associated Problems with Foster Care Child

In long term the foster care children suffer from psychological, cognitive and epigenetic effects. The Northwest Foster Care Alumni Study on foster care children showed that foster care children, were found to have double the incidence of depression, and were found to have a higher rate of post-traumatic stress disorder (PTSD) than combat veterans.

Tarren-Sweeny (2010) reported that Children in foster care have a higher probability of having Attention Deficit Hyperactivity Disorder, and deficits in executive functioning, anxiety as well as other developmental problems.

Neurodevelopmental Disorder

A neurodevelopmental disorder is an impairment of the growth and development of the brain or central nervous system. It refers to a brain disorder of brain function that affects emotion,learning ability and memory and that unfolds as the individual grows.

Most foster care children are placed in foster care families at a very young age which is a critical period for the children as the development of mental and psychological processes occur during early childhood. According to kristen Rollins, the human brain does not develop fully until the age of 25, and one of the most critical periods of brain development occurs in the first 3-4 years. Therefore, the human brain is influenced by negative environmental factors such as emotional neglect, poor nutrition and exposure to violence in the home and any type of abuses.

The study by McCrory E et al ( 2010) states that the negative environmental factors influences all areas of neurodevelopment: neurogenesis (creation of new neurons), apoptosis (death and reabsorption of neurons), migration (of neurons to different regions of the brain), synaptogenesis (creation of synapses), synaptic sculpturing (determining the make-up of the synapse), arborization (the growth of dendritic connections, myelinzation (protective covering of neurons), and an enlargement of the brain’s ventricles, which can cause cortical atrophy including decreased activity of the prefrontal cortex.

Harden BJ (2004) reports that Foster children have elevated levels of cortisol, a stress hormone in comparison to children raised by their biological parents. Elevated cortisol levels can decrease the immune system.

Post traumatic stress disorder (PTSD)

According to Dubber (1999) 60% of children in foster care who were sexually abused had post traumatic stress disorder ( PTSD). 18% of children who were not abused faced PTSD just by witnessing violence at home. These children then suffer from intrusive memories, flashbacks, avoidance, and psychological and physiological reactivity.

Eating Disorders

‘ Eating disorders refer to a group of conditions defined by abnormal eating habits that may involve either insufficient or excessive food intake to the detriment of an individual’s physical and mental health’. Hudson, JI; Hiripi, E; Pope Jr, HG; Kessler, RC (2007).

According to Hadfield Sc (2008), Obesity in all age groups of children has become an increasing concern in recent years. Children in foster care are more prone to become overweight and obese, and in a study done in the United Kingdom, 35% of foster children experienced an increase in Body Mass Index (BMI) once in care.

The children also suffer from Food Maintenance Syndrome which is a pattern of excessive eating and food acquisition and maintenance behaviour without concurrent obsesity. The syndrome is said to be caused by stress and maltreatment of foster care children.

Tarren-Sweeney (2006) study states that children in foster care also suffer from Food Maintenance Syndrome which is characterized by a set of aberrant eating behaviors of children in foster care. It is “a pattern of excessive eating and food acquisition and maintenance behaviors without concurrent obesity”; it resembles “the behavioral correlates of Hyperphagic Short Stature”. It is hypothesised that this syndrome is triggered by the stress and maltreatment foster children are subjected to.

Northwest Foster Care Alumini study (2011) reports that Bulimina Nervosa is seven times more prevalent among former foster children than in general population.

Epigenetic effects of environment

According to Weaver (2004) negative environmental influences, such as maternal deprivation, child abuse and stress have a profound effect on gene expression, including transgenerational epigenetic effects in which physiological and behavioral (intellectual) transfer of information across generations-not-yet-conceived is effected.

Neighh GN et al (2009) states that the effects of abuse may be extended beyond the immediate victim into subsequent generations as a consequence of epigenetic effects transmitted directly to offspring.

Suicide -Death Rate

Charles (1991) states Children in foster care families are at a greater risk of suicide. Children from foster care families as compared to general population have a risk ratio of suicidal attempts of four to five time greater.

A study conducted in Finland have indicated that children in foster care have a higher mortality rate compared to the general population due to incidence of acute and chronic medical conditions and developmental delays.(Kalland M,2001)

Academic Prospects

According to Neild Ruth et al (2006) foster care children tend to underachieve academically with many never completing high school. The children have low concentration in class and perform poorly in exams. Very few children attempt University and obtain a degree.

Barriers in foster care System
Timing in Placement

Children are more prone to experience insecurity in the foster home during the initial phase of placement, especially in the first six to seven months.(Mary Bruce Webb et al, (2010)

Peter J Pecora, James K. Whittaker et al,(2010 )suggest that older children experience placement

Stability during the initial phase compared to infants. In order to decrease the chances for placement disruption which children normally experience during the initial phase of placement, it is recommended that children develop trust and not feel lost in the system.

Characteristics of the Home

(Berridge & Cleaver, 1987) stated that children have difficulty to adapt in foster home when they are placed with other children who are roughly the same age or if they are placed in foster homes where the foster parents have children of their own. Foster Children placed with other children may feel insecure and start competing for affection and materialistic objects eventually this leads to conflicts in the foster care family.

Children’s mental and behavioral health

According to J.Gavin Bremner & Theodore D.Wachs (2010), Child behaviour problems is among the frequent reason that foster parents request the removal of a child in their care.

Children over the age of four (4) are more prone to experience placement instability due to behavioural problems. (Strijker, Zandberg, & van der Meulen, 2002)

Foster Parent Characteristics

Training and support for foster parents are of a paramount importance to avoid children experience disruption in their foster homeFoster parents who have bigger support system such as extended family are more possible to provide a secure placement for the child. .(Walsh &Walsh 1990;Redding et al 2000).

Furthermore, foster parents who seize suitable hope and understand causes and reason for a child’s behaviour is predictive of placement stability.(Butler & Charles 1999)

Counselling in the Foster Care System
Definition of counselling

Counselling often described as ‘ talking therapy’, is a process aimed at providing clients with the time and space to explore their problems, understand their problems, and resolve , or come to terms with their problems, in a confidential setting. The Royal College(2006 a) defines counselling simply as ‘a type of psychotherapy which helps people address and resolve their problems and work through their feelings’.(Jan Sutton &William stewart ,2008)

Counselling involves the development of a relationship between the client and a trained professional that focuses on the client’s concerns and difficulties . it is a process in which individuals have the opportunity to improve upon their understanding of themselves ,including their patterns of thoughts ,behaviours ,feelings and the ways in which these may have been problematic in their lives. Counselling is a collaborative effort as it involves the client and the counsellor working together to identify goals. Throughout the counselling process the client is encouraged ,supported and empowered to look at himself/herself from a different perspective . The aim is not only to help the client cope with a current issue of crisis ,but to do so in a way that produces learning for the future ,so that the client can feel more in charge of his/her life.(M.Ravi 2008)

3.4.1 Foster Child Counselling

Williams (1994) ,Children in foster care have often suffered abuse, neglect or maltreatment. Trauma will affect children in different ways, depending on age, family support, developmental level and basic temperament.

The objective of child counselling (taken from Children and Trauma) include:

aˆ? The safe release of feeling

aˆ? Relief from symptoms and post traumatic behaviors

aˆ? Recovery of a sense of mastery and control in life

aˆ? Correction of misunderstanding and self blame

aˆ? Restoration of a sense of trust in oneself and the future

aˆ? Minimizing the scars of trauma

aˆ? Development of specific skills or coping tools

The Therapy is meant to be a process to work through trauma and help a child understand what has happened to him/her. It also aims to help a child function better in the world around him /her.

3.4.2 Foster Family Counselling

(Fernandez Elizabeth, 2010) Therapy does not change family dynamics. Placing a child in therapy will help the child but will not fix the problems in the family. Family counselling offers a better chance at successful family reunification.

Nevertheless, steps need to be taken to provide assistance to the child and foster family who are in need of counselling. Thus, counsellors and therapists need to construct a relationship based on mutual trust for the counselling process to begin.

According to Silva (1991), to establish therapeutic mutual trust, there need to be the following requirements:

Accurate Empathy: The therapist conveys his or her understanding of the child’s background and experience;

Genuineness: The therapist is as spontaneous, tactful, flexible, and non-defensive as possible;

Availability: The therapist is accessible and available (within reason) when needed, and avoids making promises and commitments he or she cannot realistically keep;

Respect: This is both gracious and firm, and acknowledges the child’s sense of autonomy, control, and responsibility within the therapeutic relationship. Respect is manifested by the therapist’s general attitude, as well as by certain specific actions

Concreteness: Therapy should, at least initially be goal-oriented and have a problem-solving focus. Foster parents are into action and results, and to the extent that it is clinically realistic, the therapeutic approach should emphasise active, problem-solving approaches before tackling more sensitive and complex psychological issues.

Counselling Strategies and Techniques

Blau (1994) recommends that the first meeting between the therapist and the child establish a safe and comfortable working atmosphere by the therapist’s articulating :

a positive endorsement of the foster parents decision to seek help;

a clear description of the therapist’s responsibilities and limitations with respect to confidentiality and privilege; and

Blau (1994) also delineates a number of effective intervention strategies for foster children including the following:

Attentive Listening: This includes good eye contact, appropriate body language, and genuine interest, without inappropriate comment or interruption.

Empathy: This therapeutic attitude conveys availability, concern, and awareness of the turbulent emotions being experienced by the traumatised children.

Reassurance: In acute bahvioural situations, this should take the form of realistically reassuring the child that matters will be taken care of.

Supportive Counselling: This includes effective listening, restatement of content, clarification of feelings, and reassurance.

In appropriate cases, this therapeutic strategy can stimulate the officer to explore underlying emotional stresses that intensify a naturally stressful traumatic event. In a few cases, this may lead to ongoing psychotherapy (Miller, 2006).

There have always been asylum seekers and refugees going back to the World War but in recent years the United Kingdom (UK) has seen a vast number of asylum seekers coming from different parts of the world in search of security from their troubled regimes. As a signatory to the 1951 United Nations Convention the UK has an obligatory duty to receive and protect asylum seekers until a decision has been made on their individual claim (Hepinstal et al, 2004).

According to the 1951 UN Convention an asylum seeker is defined as,” a person who has crossed an international border in search of safety and refugee status in another country”. To get the refugee status under this Convention a person has to present with;

“A well founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social group or political opinion and is outside the country of his nationality and unable or, owing to such fear is unwilling to avail himself to the protection of that country”.

Too often those seeking asylum travel from their familiar communities to start new life in environments that could be alien to them which makes them vulnerable to social exclusion which is defined by the Social exclusion Unit (SEU),( 2004) as:

“What can happen when individuals or areas suffer from a combination of linked problems such as unemployment, poor skills, low incomes, poor housing, high crime environments, bad health and family breakdown”.

It is a process that deprives individuals and families, groups and neighbourhoods of resources and services needed for their general involvement and their health and well being (Pierson, 2002). Most of these factors affect the asylum population since they face immigration controls on things that shape them as individuals. This affects their engagement with the society towards expressing their individual needs.

For asylum seekers to be socially included in the society certain areas of concern will have to be addressed. This is achieved by firstly understanding what social inclusion means. It is defined by some as, finding ways of preventing and overcoming social exclusion (ncaonline.org.uk). For this to be achieved the following points of views will be discussed on the issues that affect their health and well being, how resources and services from local, regional and national level can support them and the roles and responsibilities of nurses and other health and social care professionals in promoting social inclusion. However the author is going to use different available materials to provide an overview of this diverse group which is often mistaken by the public as a “homogeneous” group. The author is going to focus on asylum seekers (someone who is still in the process of becoming a refugee) rather than refugees (someone who has been granted the refugee status) because refugees just like ordinary citizens have wider choices that can socially include them as compared to asylum seekers who do not have the privilege of choice.

To whatever the destination an asylum seeker flees to, the journey is rather distressing with fears of being discovered, persecuted and arrested which can affects their mental health and physical well being. It is believed that when they arrive some would have been in good health but, the asylum process itself may entail its additional stresses such as conflict with immigration officials, being denied a work permit, unemployment, difficulties registering with GP’s, loneliness and boredom (Hayes and Humphries, 2004). Their mental and physical health may deteriorate within two to three years of arriving due to post-traumatic experiences, unexpected changes, dependency, poverty and poor accommodation (Burnett and Fassil, 2002).

Frequently reported mental health problems experienced by asylum seekers include anxiety, depression, phobias and Post Traumatic Stress Disorders (PTSD) which may cause long term problems if not well attended to. These may have been as a result of domestic abuse, multiple losses, torture, witnessing hostile situations and sexual abuse (Jones and Jill, 1998). Since mental health issues are viewed differently in some cultures, healthcare professionals have to be culturally sensitive towards those presenting with problems related to mental health (NMC, 2004). Those with PTSD will require strong advocacy to ensure that they have access to specialist support.

However, some of the physical health needs usually suffered by asylum seekers are chronic diseases such as coronary heart diseases and diabetes which may not have been detected because of poor health facilities in countries of origin (Burnett and Fassil, 2002). Some conditions may have been acquired en-route to their destinations such as gastrointestinal problems, respiratory infections such as Tuberculosis (TB), malaria and other communicable diseases such as HIV and AIDS. Asylum seekers may present with fear of being seen as disease carriers which means they may suffer in silence, therefore demonstrating sensitivity towards these people will ensure that they are valued and respected regardless of their illnesses. Offering full medical assessments for the benefit of the individuals will help in detecting any unknown problems and find suitable interventions in promoting their health and wellbeing.

Disabilities suffered through torture or war may present health concerns and emotional distress to asylum seekers (Burnett and Fassil, 2002). Those who are disabled will need referrals for assessment of needs where the provision of care may only be granted in regard to their immigration status, which may undermine their basic human needs (Immigration and Asylum Act, 1999). The author argues that this endangers the person with the disability as they will be more vulnerable to social exclusion.

Some women seek asylum while they are pregnant. These may have been as a result of domestic violence, rape as well as prostitution as a result of trying to fend for themselves and their families. They may suffer complications due to late registrations, lack of geographical knowledge and support and poor ante-natal care (McLeish, 2002). In some instances when the woman is being abused her needs may not be identified because men are culturally considered as the main speaker of the family risking misdiagnosis of the illness. It will need tactical nursing skills and knowledge of different cultures for the woman’s needs to be met without disrespecting cultural beliefs and values.

Since April 2004 failed asylum seekers have been asked to pay for their hospital charges which can have a negative impact on their mental and physical health. Since one of the core principles of the NHS towards healthcare is that care is regarded as a universal service for all and a basic human right, therefore service should be provided based on clinical need rather than an ability to pay (Kelly and Stevenson, 2006), it can be argued why asylum seekers are refused treatment and asked to pay for their services when they are not even allowed to work for them to be able to finance this need). If health professionals follow this core principal and exercise empathy it will have a positive impact on those who really need care.

Accommodation is a key resource in the resettlement of asylum seekers. The areas they are dispersed to may be of great impact to their health and well being. The dispersal process may cause long term damage if they are dispersed to areas that are ill-prepared for their unique needs. There is evidence which shows that asylum seekers may be living in substandard housing that is impoverished, overcrowded and with high risks of fire and spreading of diseases (Garvie, 2001). They have no individual preferences and choices of where they want to live and who to share their accommodation with.

While the Immigration and Asylum Act, 1999 makes the care in the community function dependent on immigration status, older asylum seekers who are in need of community care may not be eligible for basic services such as day centre places for those with mental problems, social work support for mental disorders and meals on wheels because they are subject to immigration control which can make their experiences difficult (Cohen, 2001). Okitikpi and Aymer (2000) sited in Pierson (2002) argues that other multi-disciplinary teams such as social workers have an unavoidable political task around the policies of dispersal in order to build broad coalitions in raising local awareness of the legal confinements with which refugee families have to cope.

As granting employment to asylum seekers has been observed as a pull factor for more arrivals, asylum seekers in the UK are not allowed to work until they receive their refugee status, even though there is evidence which shows that unemployment does not have any impact on the number of people seeking asylum (Zetter et al, 2003), they are still not allowed to work and have to live on lower than subsistence levels of income as compared to the general public (Hayes and Humphries, 2004). Unemployment makes them more vulnerable to poverty, as they only receive about 70% of normal income support. Those who have exhausted their claims and being looked after under section 4 of the Immigration and Asylum Act 1999 only receive non cash vouchers which they can only use in certain supermarkerts where-by no change is given back which will further reduce the amount. This stigmatises, discriminates and violates their basic human rights as they will not have wider choices of supermarkets that sell food from their own countries. It is believed that allowing asylum seekers to work whilst awaiting their decisions may reduce negative socio-economic effects on their mental health and enhances their social integration with the society (Hayes and Humphries, 2004).

The United Nations High Commissioner for Refugees (UNHCR) offers international protection to displaced asylum seekers with a well-founded fear of persecution by assuring them of certain clearly defined rights (Loescher et al, 2008). It has a responsibility of monitoring and supporting states’ compliance with the norms, rules and decision making procedures set out primarily by the 1951 Convention.

Nationally in the UK, the National Asylum Support Service (NASS) within the Home Office works to provide accommodation and money for everyday essentials. It provides regional funding to the local councils and registered landlords in the provision of furnished accommodation. Firstly assessments are done following the Immigration and Asylum Act 1999 to check if the person seeking asylum is destitute, so that the level of support needed is clear. NASS can only support those who are awaiting decisions which place those who have been refused status to become destitute and homeless. Voluntary organisations such as Yorkshire and Humberside Consortium for Asylum seekers and Refugees (set up in 2002 co-ordinates with NASS in providing management of accommodation, developing accessible services and promoting integration into new communities (www.harpweb.org.uk). Refugee council provide advice and information in individual languages, emergency accommodation and assistance in different regional areas (www.refugeecouncil.org.uk). Oxfam is also a voluntary or charitable organisation that helps in campaigning for those who are being made destitute by the asylum process to stop them from being deported back to their countries where they may be arrested and persecuted. British Red Cross also help those who are homeless by providing food supplies, clothes and vouchers to buy essentials such as toiletries (www.harpweb.org.uk).

Drawing on material from the module, critically discuss the extent to which theories relating to resilience inform our understanding of an aspect or aspects of contemporary social work. Resilience is described by Fonagy, et al ( 1994) as an ability to achieve a normal standard of development, within a challenging situation. Within contemporary social work practice therefore, support should be provided to enable children and young people to develop and be resilient when faced with adversity and trauma in their life.

Rutter (2000) argues that a child’s ability to be resilient when faced with hardship, is

comparative as opposed to being conclusive. A child or young persons level of resilience is not a predetermined personal quality, individuals are therefore not either weak or strong. The ability to be resilient to trauma subsequently changes in relation to the situation the child is in and the protective factors which may, or may not be, in place. I will explore this further in respect of the psychosocial theories concerning resilience and vulnerability and the defensive aspects which might underpin this. I will also discuss how an increased understanding of these can be constructively applied within modern social work and the need for development of resilience in social workers, practising within a bureaucratic environment.

From a psychoanalytical perspective, Freud (1923, cited in Glassman, 1995) proposes that psychological states are determined in the very early stages of life, arguing that a persons level of resilience or vulnerability may be set in place prior to the Oedipal stage. Therefore, by the end of the childhood development period, reactions such as apprehension and fear, alongside other emotive forces and mechanisms of defence have already been imprinted into a specific individual model (Thomas, 1996). A child experiencing the divorce of his parents for example, may develop polarised split views of each parent for example having positive feelings towards the mother and negative towards the father, as a method of coping with the situation (Rutter, 2000). When a situation as an adult occurs which is causing similar emotive reactions such as anxiety, an individual may fall back on this prefigured defence mechanism of splitting their views very distinctly, without perhaps analysing all of the information fully.

Masten & Powell (2003) argue that primary structures recognised as qualities of human functioning are adaptive and have significant importance in building resilience throughout a diverse range of traumatic and frightening circumstances, for example the forming of attachment relationships which provide a sense of security. Bowlby’s (1969) theory of attachment argues that the establishment of a definite connection to a primary care giver, is a significant and valuable initial relationship. Object relations theory which explores the relationship between mother and child proposes that for a child to feel positive about themselves, a warm, stable relationship is required.

Bowlby (1988) proposes that a secure attachment will support a child to make confident enquiries of the world around them, developed from having a strong feeling of integration within an encouraging social structure. Attachment can be divided into secure and insecure attachments, and contains both empirical and hypothetical implications. Throughout practice therefore, a model of insecure attachment for example, can be applied in observing a child’s behaviour and their possible inability to form relationships. An insecurely attached individual may have a combination of juxtaposed views such as reliance and closeness, alongside an anxiety of possible criticism and dismissal ( Holmes, 1993) . In practice therefore, an understanding of an individuals lack of connection with other people and difficulties in coping with an adverse situation can begin to be understood further within the attachment theory framework.

Henderson et al ( 2007) propose that in respect of young people, the transition from childhood through to adolescence and into adulthood, is greatly strengthened by being part of a group and experiencing a sense of connectedness, as opposed to loneliness. A strong sense of ones own abilities and potential can be bolstered by being part of a social network, and also support a child’s perception of school as being a constructive and positive part of life (Glover, 2009). The theory of attachment can be applied in practice not just from a psychoanalytical approach, through analysis of learned behaviour and unconscious processes, but also from a behavioural perspective which may argue that an inadequate attachment to a primary caregiver, explains the difficulty experienced in forming friendships during school years for example. Practitioners should remain mindful, however, that there are children who with a great deal of family encouragement and wider social support, still struggle to have the ability to endure the adversity and stresses which may occur in their lives (Rutter,1999).

Therefore, whilst psychological theories such as Bowlby’s attachment theory can aid understanding of behaviour each individual is effected by the structural factors impacting on their lives. Skeggs ( 2001) argues a sociological view, postulating that class has a significant impact on access to education for example, due to economic resources and as such restricts an individuals opportunity to develop and move forward with their lives, in a way they might wish to. Giddens (1991), in contrast, argues that people have a great deal of agency and control over their lives and therefore have the ability to make changes within their experienced structure of society. Giddens (1991) argues that we live in a post traditional society in which young people do not fall back on traditional roles which were executed by previous generations. Whilst this level of agency enables greater autonomy it may also add to the vulnerability felt by young adults, some of which may struggle more than others due to factors such as racism, stigma and disability (Banks, 2006). It could be argued therefore, that young people are attempting to move forward in life with very little sense of direction. In a postmodern society the propensity for insecurity of children is almost built into their lifestyle.

Erikson’s ( 1965) theory of development supports this view, arguing that cultural and social circumstances, rather than inner drives, should be evaluated. This will enable an understanding of a individuals behaviour to be gained and issues which are having a damaging effect, to be addressed.

The field of child psychology which is concerned with life events, analyses the context in which the child is experiencing the significant incident. The resilience needed to cope with a life event such as divorce is ongoing. As argued by Rutter (2000) there may be particular turmoil surrounding the life event, but there is a potential for the effects of this trauma to continue throughout all other aspects of life. For example having to move home and therefore change schools, form new friendship groups and cope with the feelings of loss if a parent is no longer maintaining regular contact with the child. Therefore, whilst the divorce if the significant life event the long term loss and vulnerability felt by the child is much broader than this.

A child who is experiencing a difficult home situation because of the breakdown of a parental relationship, can shield themselves from some of the mental and emotional anguish of their home life through the formation of a close relationship with an adult who is external to the immediate family unit. Howe (1995) postulates that extended family members such as aunts or uncles who positively acknowledge and nurture their abilities and unique characteristics will encourage and enable the child to form a confident and positive perception of the self, away from their traumatic situation. Achieving a feeling of ownership and confidence in ones own abilities can support the development of coping mechanisms. Fonagy, et al (1994) concur with this, arguing that in regards to building a level of resilience, the development of a strong, close relationship with a supportive adult provides an effective protective factor.

In respect of contemporary social work, it is the practitioners role to support a child or young person who does not have a stable network of social support (Charles & Wilton, 2004), through enabling access to recreation and social activities as necessary. However whilst this may provide support to form a social network and become part of a friendship group within a structured environment, the provision of encouragement does not have to be as definite or predetermined. The introduction of reliable, regular routines into a child’s life may assist greatly in the formation of a sense of identity and well being, as recognised by Sandler et al (1989). For example, recurring daily practices in home life in respect of stories at bedtime for young children or eating meals together at a regular time. All of which help to form a feeling of stability and organisation, encouraging a sense of belonging, attachment and security. If a practitioner can apply this theory when working with a family experiencing trauma it may serve to provide a sensation of familiarity in a life which may, in all other ways, be in turmoil.

Within adult care social work also, exploration of early childhood relationships, presence of attachment and occurrence of significant life events, can be carried out, in order to fully understand how an individual has come to a particular point in their life. For example, Bowlby’s (1969) study of adults in prison involved therapeutically working back through their lives, to a point in which their childhood attachments could be identified. An understanding of the construct in which the adult is existing, will enable a practitioner to gain deeper understanding, provide appropriate support and to ensure anti-oppressive practice occurs, supporting empowerment of the service user (Dominelli, 2002).

Henderson, et al ( 2007) execute a biographical method in their research carried out with young people regarding their perception of well being, enabling a holistic analysis of their lives to be obtained. The benefits of this study are that the researchers tried to comprehend what the young people really understood as being imperative to their well being, through the discussion of life events which had occurred throughout the research process. Whilst the methods used by Henderson et al ( 2007) could be applied positively within social work practice in order to gain understanding of an individuals specific circumstances, practitioners should be mindful of not overlooking the complexities of situations by using the information disclosed in respect of significant life events as a straight forward method of explanation of why a young persons life has transpired the way it has.

Kenny & Kenny (2000) identify the possibility for patriarchal and authoritarian practice, in the application of psychosocial theories. The notion of resilience itself is subjective and therefore practitioners should be aware of their own opinion of what constitutes ‘sinking’ or ‘swimming’ and ensure that this personal view does not influence their judgement of a situation or an individuals capabilities ( Walker & Beckett, 2003). The level of power, therefore held by social workers is vast and should be applied carefully and with an awareness of and respect for, diversity of family structures and relationships within the assessment process (Dominelli, 2002).

The qualitative methods executed by Henderson et al ( 2007) in respect of gaining a biography of each participant over time, support the view of Giddens ( 1991) who argues that the self is a reflexive project. Giddens (1991) view of late modernity argues that adulthood is constructed and therefore the most significant method of establishing identity as adults, is the development of self narratives. This view is also proposed by Frosh (1991) who argues that through the development and reflexive nature of narrative construction, an individual will form the skills to endure adversities which he argues can persist throughout life. The construction of a personal narrative and the effects of life events on this, is therefore an ongoing process throughout child and adulthood. This is reflected in the research of Fonagy et al (1994) who identify that mothers presenting as resilient, provided an accurate model of the characteristics of their relationship held with their own mother. This capacity to possess a consistent paradigm of their personal maternal attachments, which may be positive or negative, created a higher likelihood of establishing strong, secure attachments with their own children.

Giddens (1991) postulates that ‘fateful’ moments occur in individuals lives which shape the way their lives continue. This may be empowering or destructive dependant on the event, the timing of the event and how capable and resilient the individual is to deal with it. For example if a child experiences illness and as a consequence is unable to attend school the effects of this event can be ongoing. Being unable to sit exams, missing lessons etc, impact on their ability to integrate into friendship groups when they return to school which may result in being bullied and a change in their perception of school. The ongoing effects of this could be truancy and a lack of engagement in studying, in order to obtain qualifications and progress into further education ( Henderson, et al, 2007). In practice, gaining an understanding of an individuals narrative may present details of critical moments in their life enabling a deeper understanding of their experiences and resilience to dealing with difficulties .

To conclude, it is clear that resilience does not represent a distinct personal attribute or quality. Children and young people may demonstrate resilience in regards to particular anxieties and traumas but feel unable to cope with others ( Rutter, 1999). Within social work practice, therefore, it is essential to evaluate how a child is placed within their family unit and also within wider society. As discussed by Gilligan (2004), the presence of other siblings, how the child functions within the family model and their relationship and interactions with family members, are significant, contextual and influential elements of a child’s life and their capacity to be resilient.

The impact of external environmental factors such as positive relationships with other adults, being part of a friendship group and feeling happy at school all act as protective factors in mitigating the negative elements of their life and promoting their resilience ( Werner & Smith, 1992).

Within the practice of contemporary social work therefore, attention should also be paid to the level of resilience held by practitioners, working with individuals in traumatic situations whilst existing within their own personal construct of relationships, family and past life events. It is imperative that practitioners are self aware in respect of their own ability to cope with the situations in which they are practising. This is an element which can at times be overlooked in regards to people working in supportive roles, who are often perceived as being highly resilient to the effects of trauma ( Coulshed & Orme, 2006).

In modern social work there is great emphasis placed on value and proficiency both in respect of time and finances and efficiency of practice (Rogers, 2001). The significance of emotion and resilience can frequently be underestimated within the bureaucratic schema in which social workers practice. Psychosocial theories of resilience therefore, can be applied not just in working with service users but in attempting to maintain resilience of practitioners.

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Reflective Practice was introduced by Donald Schon in his book ‘The Reflective Practitioner’ in 1983; however, the original idea of reflective practice is much older. John Dewey was one of the first American philosophers /psychologists to write about Reflective Practice, with his exploration of experience, interaction and reflection. Other researchers, such as Kurt Lewin, Jean Piaget, William James and Carl Jung were developing theories of human learning and development. Dewey’s works inspired Donald Schon and David Boud to explore the boundaries of reflective practice. Central to the development of reflective theory was interest in the integration of theory and practice, the cyclic pattern of experience and the conscious application of that learning experience. For years, there has been a growing literature and focus around experiential learning and the development and application of Reflective Practice. Donald Schon’s 1983 book introduces concepts such as ‘reflection on action’ and ‘reflection in-action’ where professionals meet the challenges of their work with a kind of improvisation learned in practice. Reflective Practice has now been widely accepted and used as developmental practices for organizations, networks, and individuals. As Boud et al states: Reflection is an important human activity in which people recapture their experience, think about it, mull it over and evaluate it. It is this working with experience that is important in learning. Reflective Practice can be seen and has been recognized in many teaching and learning scenarios, and the emergence in more recent years of blogging has been seen as another form of reflection on experience in a technological age.

Reflective Practice is paying critical attention to the practical values and theories which inform everyday actions, by examining practice reflectively and reflexively. This leads to developmental insight. The importance of reflecting on what you are doing, as part of the learning process, has been emphasised by many investigators. Reflective Observation is the second of the Kolb learning cycle. Reflective practice is an active process of me witnessing my own experience in placement in order to take a closer look the way I progress or where I may be weak at something and to explore it in greater depth. This can be done in the middle of an activity or as an activity in itself. The main thing about reflection is learning how to take a perspective on my own actions and experience. By developing my ability to explore and be curious about my own experiences and actions. Where I can open up the possibilities of purposeful learning. The purpose of reflection is to allow the possibility of learning through experience, whether that is the experience of a meeting, a project, a disaster, a success, a relationship, or any other internal or external event, before, during or after it has happened (Amulya, Joy ‘What is Reflective Practice?’ The Centre for Reflective community Practice). Certain kinds of experiences create particularly different opportunities for learning through reflection. Struggles provide a window onto what is working and what is not working and may often serve as effective tools for analysing the true nature of a challenge that I may face. Some struggles show a problem, which can provide a good source of information about a clash between my values and my approach to getting something done. Reflecting on my experiences of uncertainty helps shed light on areas where an approach to my work is not fully specified. Positive experiences offer good sources of learning. For example, doing and thinking are very helpful in revealing what was learned and how successful it turned out to be. Breakthroughs can also instruct on an emotional level. By locating why and when we have felt excited or fulfilled by an experience, I can gain insight into the conditions that allow my creativity to expand. Now I can become more purposeful not just about my learning but about how to work in more creative and sustaining ways. Reflective practice is simply creating a habit, structure, or routine around studying an experience. A practice for reflection can vary in terms of how often, how much, and why reflection gets done. Reflection can also vary in depth from simply noticing present experience to deep examination of past events. Reflection can be practiced at different frequencies: every day, every week or even months. When on placement I think it would be important for me to have reflection on a weekly basis with my assigned supervisor, as daily would be a lot more repetitive and monthly would be too far apart especially as it my first time in this setting. I can think of many benefits when using reflective practice in my work placement. First, because I’m in the business of protecting young people. I need to be clear that I do protect the young people and myself when I am in my work placement. A bit of thought and planning may now be of huge benefit later. Something that I have found through studying this subject in the last year is that reflection seems to create a certain clarity and sense of safety around this area of work I am going in to. The log I will use is a very safe way of offloading and debriefing I, as well as discussions with colleagues and managers. It enables me to avoid stress and it helps me to move forward from worry and frustration at service users, colleagues and departments. It helps me to understand why I feel this way, why it needs to be this way, and how what I do could potentially change this situation positively. I’d use this to change my negative energy to positive. By doing this I can go a long way toward keeping well at my placement, which can affect the service delivery and ultimately the way in which I do my business with the young people. The constant weight of handling issues and prioritization is a concern as a future youth worker I worry about going in to placement. It is easy to get caught in the overwhelming feeling of loads in paperwork, young people with high needs, and balancing everyday tasks. When I feel this way, I need to down for myself and briefly run through my priorities, I can look at how I can work smarter, maybe delegate tasks to young people or their families, therefore empowering them and including them in planning for the young people. We can look at how we can establish a work-life balance, while still getting through all tasks and complying. A balance is possible with some thought, care and of course the policies in place, which supports work-life balance and understands its importance in terms of overall success and health of its work force and work practices. Instead of finding myself bogged down with constraints, if I’m serious about my role as youth worker, I can truly focus on the young people I will serve and what would be in the best interests for them young, even if what I think would be the best solution is not unlikely. The benefits of reflection in terms of collaborative practice with other agencies and wider communities open many doors to my understanding of roles and responsibilities, and it can be critical in removing boundaries and stopping me from blaming others. It’s my personal responsibility to do my reflection, for speaking up and letting people know what I think and why through this process. Another part of reflection is being able to use the criticism that I may face and utilize it. So I can turn the situation on its head, and learn something positive from it. Instead of being defensive and subjective.

In conclusion, the importance of critical and reflective practice is difficult to measure and often under-estimated, yet it is crucial to our professional and personal development. More important, I feel that reflection helps and prepares me to be accountable and responsible for the very difficult decisions and challenges we often face in child protection and allows us to make good choices and have better outcomes for young people.

References

Redmond, Bairbre. (2004) Reflection in Action Developing Reflective Practice in Health and Social Services. Aldershot, England: Ashgate

Share, P. & Lalor, K. (2009) Applied Social Care (2nd Ed). Dublin: Gill & Macmillan

Thompson, N. (2009) People Skills. Hampshire: Palgrave Macmillan

What is Reflective Practice? Joy Amulya, Centre for Reflective Community Practice, Massachusetts Institute of Technology http://www.learningandteaching.info/learning/reflecti.htm (3/11/10/) http://www.ukcle.ac.uk/resources/personal-development-planning/introduction (7/11/10)

http://www.mftrou.com/support-files/kolb-learning-style-inventory.pdf (7/11/10)

http://www.itslifejimbutnotasweknowit.org.uk (11/11/10)

This essay will be constructed into five parts. It will firstly define what a group is, secondly explore models of group process, thirdly the considerations involved in setting up a group, fourthly it will discuss the benefits and barriers of group work, lastly it will conclude by summarising the key points of the essay.

A definition of a group will be given in the first part of the essay and what the principles of group work are. In the second part some models of group processes will be explored and what their relevance is to the specific group, such as Bruce Tuckman’s model and Dorothy Stock Whitakers Model. Next a discussion will take place on how to set up a group, including what steps to take before setting up a group using a method on that used by Dorothy Stock Whitaker. Benefits to group work will then be discussed and the barriers staff will encounter in establishing groups. Finally a summary of the key points will conclude the essay.

There are many definitions to what a group is and many different principles or qualities within them. People are part of a group on a daily basis such as a family group. Individuals all have a role in this group such as a mother, daughter, sister or an aunt, a family group is an informal gathering where our personal development is met. Arnold and Boggs describe a group as;

“A gathering of two or more individuals, who share a common purpose, meet over substantial period of time, in face to face interaction, to achieve an identifiable goal.” (Arnold & Boggs, 2007).

For the purpose of the group chosen here, an anxiety management group, it is a group composed for people with similar problems where they can share and gain experience of how to deal with anxiety.

Bruce Tuckman had a model which used five stages of group development, forming, storming, norming, performing and adjourning. This model explains the 5 stages of how a group should develop according to Tuckman.

The first stage is the Forming stage where everyone is getting to know each other maybe even pretend to like everyone. People’s behaviours are generally polite and superficial.

The second stage is the Storming stage here people’s personalities start to show, some conflict may arise in this stage as politeness diminishes, Cliques may form and decisions are hard to make as individuals begin to challenge others, power struggles will be evident in this stage.

The third stage is the Norming stage this is where everyone will be used to each other and trust will have been built between the group. Roles and responsibilities will be defined by this stage and accepted by the other members.

The fourth stage is the Performing stage here the focus is clear the group has a shared goal to achieve, disagreements may arise at this stage but they can be positively and constructively resolved because of the group cohesiveness.

The fifth stage is the adjourning stage this is where the task is complete and the group breaks up and people can move on to new things. This stage is usually discussed throughout the group prior to the ‘end’ so people have the opportunity to prepare and discuss anxieties about the group termination.

(Tuckman 1965)

The relevance of Tuckman’s model to this specific group is that the group leader/facilitator should be knowledgeable about the theories about group development, group process and group dynamics. Using a specific model for groups as a guide allows the staff to assess what appears to be the ‘normal’ behaviour for members as they approach each stage and assess whether the group is progressing towards making their goals, also it allows them to identify any problems or dysfunctional behaviour that arise. Tuckman’s model is relevant to group establishment as every group has a beginning, middle and an end. The beginning being the forming stage where the group starts and introductions are made, the middle being storming, norming and performing where the group gets to know one another, form alliances and start to open up and build trust. The end is the adjournment stage where the group comes to an end. There is no one model that is used in a specific group and they are not always rigid, meaning they will not follow each of these stages as they come but might go back and forth until the stage is complete then they can move to the next stage.

The group that has been chosen is an anxiety management group for people who are recovering from substance misuse. Anxiety Management programmes are for individuals who are recovering from alcohol and/or drug use. The group is aimed at individuals who experience anxiety, including worry, panic and social phobia, which are stable in regards to substance use but still experience symptoms of anxiety. The group is based upon Cognitive Behavioural Therapy and will explore with service users how thoughts, feelings and behaviours can maintain anxiety. National Institute for Clinical Excellence (2004) has produced guidelines for generalized anxiety and phobias recommending cognitive behavioural therapy as the choice of treatment. Before setting up any type of group there are a few tasks and thoughts to take into consideration before introducing a group in to this area, here the considerations will be discussed. These considerations were taken into account while setting up the anxiety management group.

A thorough assessment or preliminary interviews should be carried out of the service users this can determine whether or not the service user has ability to participate in a group and should be evaluated throughout the group term.

Service users should be asked about the type of groups they have been in and what their experiences are of being in them. If they have been in groups/therapy before such as AA or NA explain that this group is different from those groups it is not a self help group, this group enables the service users to identify their behaviours and find ways to change them through the group experience and learn from others about different ways of coping. The group will have different people with different levels of personal experiences, what they found helpful and what was not so helpful and share these experiences with the rest of the group.

Firstly the service users would need to be asked what their views and opinions were on staff introducing groups in the substance misuse area and what groups they would be most likely to attend if it was to go ahead, this can be done by a questionnaire, face-to-face or by having an informal meeting. This is important because the staff do not want to establish a group that is not going to be well attended, so finding out what is important to the service users is a big consideration. The rest of the staff team would then be informed of what might be going to happen and have a discussion on what their thoughts are and if they would be willing to give up an hour or two each week to facilitate the group. This can be problematic for example if the group was a smoking cessation group staff who smoke or people who have never smoked could have different views and may not want to facilitate it.

Secondly the staff member would take the information that they had collected from the service users/patients and come up with the most common group. They would then do the research into that specific group, what does it involve do they need any other members of the multidisciplinary team to take part, for example an exercise group for the older person do they need a physiotherapist to be there or take part.

Once this research has been done the staff member can start to plan the group.

Dorothy Stock Whitaker (2001) used a similar set of principles to that below while setting up a group.

The staff member would have already identified the group population during questioning of the service users/patients at the start, so this will determine whether it will be an all male, female or mixed sex group. The anxiety management group will be heterogeneous members may be mixed in age, gender, culture, and so on. This is because the service users have similar needs, dealing with anxiety so it seems appropriate to have a mixed level of experiences.

The group leader/facilitator would have to decide whether co facilitation or co-working is appropriate, this is a good way for less experienced facilitators to learn from more experienced facilitators, also co-facilitation provides an opportunity for feedback. The proportion of facilitators to members may make the service users feel threatened or outnumbered and may feel reluctant to open up or share things, according to Whitaker (2001) it is a good rule not to have any more than two members of staff present, including student observers, this can be an advantage it provides the group with two people with different experiences. By having two facilitators in the group one may notice things that the other has missed.

It appears that the structure of the group is important for example the anxiety group will be a time limited group that will run for one and a half hours once a week,

the facilitator should remind the members of this at the start of the group and again when they need to wind up, this can aid the group to run smoothly, if the session is shorter it is not enough time for people to settle in and if it is longer t it might cause restlessness and become tiring.

If the group is going to run once a week the service users need to be informed how long the group will run, for instance 12 weeks, this will depend on the number of topics that will be covered. This is important for the service users to be aware of as they could have other commitments such as child care or even work, so they will need to arrange time off or someone to look after their children.

The size of the group may have an effect on the way the group develops, too small a group will lose opportunities to explore or exchange thoughts or feelings, however too large a group can have the same effect. Literature shows some difference in opinions about how big or small a group should be however most studies say that between six and nine people are just about the right amount.

The location of the groups is important, if it is a community based group people do not want to be travelling an hour on a bus to get there. If it is a hospital based group then the room should be of adequate size, if the room is too small for the group size it could become very warm and people may become uncomfortable and agitated, which may result in conflicts with others, appropriate to hold the size of the group comfortably and away from others so that confidentiality can be maintained, a room that can be block booked for future sessions and be available for the time the sessions will run. If service users were to turn up week after week to a different room or a room being double booked it could make the staff look uninterested or incompetent and they may lose interest which may result in poor attendance. The arrangement within the group room for example is the group going to be sitting in an open circle or around tables; ideally an open circle is recommended however most people feel comfortable sitting round a table as they feel less exposed.

Before the group starts inform the service users/patients and staff about the group that is going to be going ahead, when it will start, what time and how long for. This would also be the trial run so they need to made aware of this. This could be advertised through posters or an information leaflet.

For example the group that is going to be run is an anxiety management group it will run for 10 weeks it will be on a Thursday night at 7:30pm and will last for one and a half hours.

Group facilitators find many ways to open groups for example using ice breakers to ease the tension and then maybe introductions from everyone in the group or vice versa. Moreover it is sometimes appropriate to say nothing and let the service users start the group but as it is an anxiety group this would not be appropriate, as this method would stir up feelings of anxiety and may not be tolerated by the service users, hence the reason they are in the group to begin with. The group agreement/rules may be discussed; this is where the expectations of the group, facilitators and service users will be discussed such as confidentiality, time keeping/attendance and participation in the group. These are all important factors as no one in the group will want their feelings and thoughts discussed with others outside the group; it is hard enough for them to open up.

The biggest benefit of group therapy is helping people to realise that they are not alone. Some of the benefits to being in a group that might attract people to a group could be the fact that it is safety in numbers; someone may feel more confident speaking up in a group than in a one-to-one session.

Meeting up with people in similar situations can diminish the feeling of being isolated or the only one with a particular problem they can receive help and mutual support from someone who has similar problems, this can empower the group and individuals. Working in a group can improve people interpersonal skills and identify their strengths and weaknesses. Group work can offer things like trust games, role play and relationship exercises that members may find helpful as it can teach them or enhance their interpersonal skills, that may not be available elsewhere such as one-to-one meetings. This can be an enjoyable experience that is also helpful and informative to the service users. (Lindsay & Orton 2007)

Groups offer the opportunity to share and this can encourage others to learn effective and positive ways to deal with situations as they arise.

However group work will not suit everyone all of the time some people may feel more isolated as they are not getting the undivided attention they would expect to get from 1:1 meetings, this may result in non-attendance or poor attendance.

Group work might be a drain on resources as it will take extra time to plan and facilitate tasks for example extra staff or to provide provisions such as tea or coffee. The group size can be a factor; a large group can produce fewer opportunities for others in the group to communicate. The group may have a certain degree of conflict at times but this shows that the group is functioning well. The facilitator may find that a particular member may not be suited to the group after a few weeks, but do they exclude the person from the group, this could have negative consequences on the person by doing this, it may make them think negatively in the future about group work and not attend anymore (Whitaker 2001). Some members may think that they will be stigmatised as they are attending a group specifically aimed at addressing their issues and it could be problematic if the group is held in an area such as a hospital which in its self could carry stigma. The group may be expensive to set up as the employment of other agencies may be required such as a trained therapist. (Lindsay & Orton 2007)

The essay used Tuckman,s Model however there are various other models that can be used, the point here is that group leaders/facilitators should be aware of these models/theories and use them as a guide models are a useful tool, it will give insight in to how groups should develop and guide them on what the ‘normal’ behaviours are at each stage of development.

From this account we can see that group work has some good advantages for service users and facilitators, it can empower the service users to venture into new things as they gain new skills and coping strategies from others in the group, however this may not be the case all of the time, others may find that this was the worst experience of their lives. Also that by using a feedback system for the groups the facilitators can learn from these experiences too by asking the service users and co-facilitator what could have been done better, what was not done so well, for example, this can be taken on board to make the service better next and a more enjoyable experience.

We considered the barriers of group work mostly for the service user but also for the facilitators and to acknowledge that these exist they will occur from time to time but not to be disheartened by them, instead we can learn from them.

In order to solve the issue of gender discrimination at workplace, gender mainstreaming would be a solution to limit gender inequality. Gender mainstreaming was recognized as an international approach that seeks to achieve gender equality and equivalent rights for both men and women in the Platform for Action adopted at the Fourth World Conference on Women (Hannan 2003, pp. iii).

Gender mainstreaming is classified by the 52nd Session of The Economic and Social Council (ECOSOC) of the United Nations in 1997 as, “Mainstreaming a gender perspective is the process of assessing the implications for women and men of any planned action, including legislation, policies or programmes, in any area and at all levels. It is a strategy for making the concerns and experiences of women as well as of men an integral part of the design, implementation, monitoring and evaluation of policies and programmes in all political, economic and societal spheres, so that women and men benefit equally, and inequality is not perpetuated. The ultimate goal of mainstreaming is to achieve gender equality” (International Labor Organization 2002).

Why Gender Mainstreaming?

Gender mainstreaming composes the social problem of gender inequality obvious and clear for the community. Additionally, it improves the basis of all organization’s projects and procedures and also teaches the organization’s staff about the various effects of women and men’s contribution. Moreover, gender mainstreaming improves transparency and strategic decision making within the organization, as well as making full utilization of human resources by recognizing men and women’s capabilities and opportunities. In a practical mean, gender mainstreaming will persuade any organization’s staff to start on evaluating their organization and its activities on the basis of gender approach. Therefore, makes the organization realize the gaps between men and women and the source of discrimination and its approaches. Moreover, by determining the problem, it would be easier to take the initial important actions to improve the situation and achieve gender equality goals by being involved in the consultancy procedure and policy making. These actions require setting up a new development plan and modifying the organization’s priorities to put them into action. To achieve gender equality goals, it cannot be done individual as much as it needs the whole organization’s team cooperation and coordination (UNDP 2004, pp. 19-20).

Gender mainstreaming enhances the organization’s qualities by focusing on equal rights policies and allocating equal opportunities to both men and women. Moreover, it would also help to allocate financial and human resources to prepare and implement the policy. In addition, it would engender more awareness and knowledge on the autonomy and equity between men and women with the availability of gender expertise. It will also identify the responsibilities and answerability for gender mainstreaming and gender policy (Ministry of Foreign Affairs, Foreign Information and Communication 2002, pp. 3).

Importance of Gender Mainstreaming:

There are several reasons of why our society needs gender mainstreaming for its magnitude on the organizational and societal level.

Gives people the opportunity to get involved in the policy making.

Gender equality and mainstreaming highlights the needs to evaluate policies according to their influence on individuals and social situation, along with their needs. It also contributes to introduce among public opinions, a learning progression of giving more attention of the policies impact people’s life. It is a step forward to a more human approach of development and modern democratic societies. By taking gender equality, policies will be made upon the real needs of men and women.

Gender mainstreaming leads to a better government.

In order to have a better government, then there should be a good formation of policies. Consequently, it will face all obstacles to inequality and lead to a superior transparency in the policy process.

Engage men and women to have full access to human resources.

It is well known that the society depends on human resources and men and women’s experience as well. Therefore, gender mainstreaming adds both men and women’s experience and acknowledges their responsibility to eliminate inequality within the society. Additionally, it might help in reducing any democratic deficits.

Makes gender equality issues noticeable for the society.

Gender mainstreaming gives the opportunity to clear out the idea of the consequences of political initiatives on men and women. Gender equality should be visible for the society and be integrated into the mainstream of the society. Therefore, gender mainstreaming reveals how gender equality is important social matter with implication for the society development. However, gender inequality cannot be combated without full involvement and commitment of the political structure (Council of Europe 1998, pp. 19-20).

Women represent half of the society; therefore, development should be based on the contribution of both men and women. Nonetheless, gender inequality directly and indirectly affect the impact of development strategies, hence, the overall achievement of the development gaols. The empowerment and sovereignty of women and the improvement of their social and political prominence is important for achieving a transparent and accountable government, in addition to sustainable development in various life areas. Therefore, achieving equality goals to involve both men and women in the decision making process will reflect a more accurate image of the society composition as there is a high need to reinforce democracy and promote its appropriate functioning (OSAGI 2001 pp. 1).

Gender Mainstreaming in Organization’s:

Even though gender mainstreaming is an International strategy to promote gender equality, there is still a long way before gender perceptions are consistently incorporated in all development fields. Specific knowledge and capacity is required to bring the realities of both men and women as well as their contribution, perspectives and needs to put up with accurate data collection and analysis, regulation development, implementation and monitoring in all fields of development (Hannan 2003, pp. 14-15).

Governmental or non-governmental organizations policies on gender equality are not effective or implemented properly due to the traditional domination of men’s role over women’s within the organization. Therefore, leading to low number of females, lack of rural women’s needs projects, low allocation of budget related to women activities, and unbalances decision making. Organizational change efforts include training between genders, gender mainstreaming and organizational development. The most fundamental components to achieve progress on institutionalizing gender equality obligations are to focus on senior managers. The management role is still a pre-requisite to assure the availability of adequate resources to work on addressing the gender issues and for the organizational systems and practices to require accountability to gender equality policies (WOCAN 2006, pp. 1-2).

For the organization to respond to the gender quality matter, it should identify the factors that create and increase gender biases within its atmosphere such as the vision and objectives, structure and policy, practices, programs and services, beliefs and attitudes as well as the practices of the staff members. However, the organization should adopt some measure to eradicate the causes of gender equity throughout some changes in the vision and objectives, reforming the policies, organizational restructuring, conduct gender awareness seminars, and improve physical capabilities to enhance safety and security (Sobritchea 2008, pp. 2-3).

A gender responsive organization should ensure programs and plans are being guided by the gender equality principles by taking affirmative actions when necessary to limit the gap between male and women concerning the access of benefits. In addition, practicing gender equality in decision making and opportunities (Sobritchea 2008, pp. 6). Nonetheless, the organization should eliminate any biases in the hiring, firing and promotion of male and female staff. Additionally, promote gender equality in educational and training decision and participate in the decision making as well as adopting non-sexist practices and developing structures and personnel services that address gender issues such as harassment and coordination between work and family life (Sobritchea 2008, pp. 7).

Difficulties of Gender Mainstreaming:

On of the constrains to gender equality law is the lack of awareness on national and International law on equal opportunity of both women and men (International Labor Organization 2003, pp. 83). Most of the problems can be endorsed by the misunderstanding of the existing procedures, techniques and means or the lack of political determination. The following are some difficulties that might accompany gender mainstreaming:

U­ Misunderstanding the concept of gender mainstreaming.

U­ Need for a wider concept of equality.

U­ Existing approaches to policy making and the need of mainstreaming for procedural changes.

U­ Lack of adequate tools and techniques.

U­ Lack of adequate knowledge about gender equality issues.

U­ Danger of talking about gender mainstreaming without implementations (Council of Europe 1998, pp. 17-18).

Procedures to Address Gender Mainstreaming Problems:

Organizational development in terms of illustrating tasks and duties, create accountability methods, developing guidelines, employing gender specialists and granting competence development for all workforces and human resources is required and essential to support gender mainstreaming. Full responsibility to implement mainstreaming strategies should be based on the highest level within the governments and organizations. Management levels should be responsible for putting mainstreaming mechanisms to monitor the progress with mainstreaming. The way to guarantee mainstreaming is to allocate clear indicators on the progress that can be monitored over time by the management (Hannan 2003, pp. 16).

To address the problem of gender mainstreaming, integrating genders issues with policies and programmes so that the civil society and the community efficiently respond to significant needs of women. The gender mainstreaming components are:

Establishing commitment and ability by creating and strengthening gender central points in local and nation development composition thought advocacy with senior decision makers.

Influence policies to be more responsive to gender issue by advocating gender legal reforms, organize policy forums and reinforcing women’s forum.

Increase women’s participation in the national and local level by providing leadership training to become role models in their societies.

Improving the capacity for gender monitoring and evaluation by expanding the information more effectively in advocacy.

Raise public awareness by establishing gender focal points in the structure of local and national development (Hannan 2003, pp. 10).

Clear definition of equal opportunities policy and on women and development within the organization.

Organizations’ executives and seniors should devote attention on the issue of equal opportunities.

Organizations’ employees should contribute to gender equity based on their policy field.

Gender experts should take a sufficient part in the policy decision making procedure.

Allocate enough money and human resource for the policy making and functioning.

Assessment and accountant of policy at a specific stage. (Ministry of Foreign Affairs, foreign Information and Communication, the Netherlands 2002, pp. 2).

My understanding of professionalism is having the discipline to be aware of and work to a set of values made up of legal statutes, of professional body frameworks and guidelines and of employer policies, frameworks and guidelines, which together detail expected conduct. Those statutes, policies, frameworks and guidelines should be used to identify roles and responsibilities which in turn define boundaries. The British Association of Counselling and Psychotherapy (BACP), of which I am a student member, is the largest professional body in the UK for counselling and psychotherapy and lays down what standards of conduct counsellors, service users and the public expect at a national level.

‘If a counsellor or therapist is a member of a professional body, he or she will be bound by a code of professional ethics framework or in the case of the BACP, the ethical framework’…’it recognises that choices are often not clear-cut, and that sometimes difficult decisions need to be made that, even when taken in good faith, may have unpredictable and unwanted outcomes’ (Merry, 2002:11)

Professionalism and ethics both relate to proper conduct. I view the ethical framework as a list of qualities for how the counsellor should ‘be’ and a list of behaviours for what the counsellor should ‘do’ and ‘not do’. Examples of the desired attitudes include possessing empathy, sincerity, integrity, resilience, respect, humility, competence, fairness, wisdom and courage. Examples of the desired behaviours include fidelity, autonomy, beneficence, non-maleficence, justice and self-respect.

The BACP produced the ethical framework to protect both the client and counsellor through good practice in counselling and psychotherapy. It sets out a series of professional and personal values, underlying principles and moral qualities which reflect my attributes as a trainee counsellor in order to promote a safe and professional environment, one where I could enable clients to allow trust to develop within our relationship. I abide by the BACP guidance on good practice which is concerned with client safety, counsellor responsibility and accountability, clear contracting and my competence as a trainee counsellor. It provides information for what counsellors are expected to do and sanctions for consequences of malpractice.

I have chosen a hypothetical ethical dilemma, albeit a realistic one, relevant to my chosen placement at The Truce YMCA in Lancaster.

A sixteen year old female client presents with news of her parents having separated two weeks previously. She lives with her mum who is drinking excessive amounts of alcohol and who is not coping with the day to day duties of looking after the client’s nine year old brother, who is now mostly in the client’s care. No other meals are being provided other than school dinners and no money is being allocated to them for food. Last night the client’s mum pushed the client against the wall and the client has a head injury. The client asks me not to tell anyone.

The ethical dilemma here is that my client has disclosed a Child Protection issue and asked me to maintain the confidentiality aspect of the contract. There are several implications, professionally I must breach confidentiality as there would be no way that I could hold that information, my integrity would be conflicted. I would have a professional obligation that would be impossible for me to ignore. However, by breaching confidentiality this could have severe consequences for the client, myself (our relationship), and the client’s family. A question I need to ask myself is:

What are our statutory duties and responsibilities?

We have a duty under the Children Act 1989 to safeguard and protect children who may be suffering from abuse. This may be physical, sexual, emotional or as a result of neglect http://www.tameside.gov.uk/childprotection/parentinfo#t2 date accessed, 21st April 2010

The YMCA has put together a procedure flow chart and as part of my training I have been made aware of it. It is a clear example of my role, responsibilities and boundaries.

Safeguarding means doing everything you can to protect children and young people from harm. A safeguard is a measure to help reduce the risk of children and young people being harmed. http://www.nspcc.org.uk/Inform/trainingandconsultancy/consultancy/cst/safe_communities_toolkit_english_wdf70126.pdf date accessed, 19th April 2010

The disclosure demands to be sensitively, sincerely and respectfully explored in order to honour the principle of non-maleficence because every child matters. As a trainee counsellor I have ‘an ethical responsibility to strive to mitigate any harm caused to a client even when the harm is unavoidable or unintended’ (BACP, 2007:03)

There are several implications:

I am aware that the principle of fidelity requires a responsibility to honour the trust that has been placed in me as a trainee counsellor and that how I move the process forward from this point could alter how the client and I may or may not work together in the future. Without confidentiality and empathy there is potential to harm the relationship, and as Bond (1993:46) states that, ‘responsibilities to the client are the foremost concern of the counsellor. The justification of counselling rests on this work being undertaken in a counsellor-client relationship’.

Where as a trainee counsellor can I find guidance on consent and disclosure?

I could check against the BACP guidelines, with my casework supervisor, my managerial supervisor, the agencies codes of practice and policies, my tutors and Social Services. To avoid the possibility of prosecution I need to respect my role and abide by the BACP guidance on good practice which is concerned with client safety, counsellor responsibility and accountability, clear contracting and my competence as a trainee counsellor.

‘Professional accountability is also key in ensuring public protection and allows the Profession to move forward enjoying the public confidence in the services provided’

http://www.bacp.co.uk/prof_conduct/ 4th February 2010

The principle of beneficence involves acting in the client’s best interest and maintaining the standards of competence and knowledge expected for members who continue to both personally and professionally develop by using supervision for support. As I am working within an agency I am expected, as a member of the BACP, to have ongoing regular supervision for my work with a clinical supervisor and with my managerial supervisor. Supervisors, managers and counsellors have a responsibility to maintain and enhance good practice, to protect clients from poor practice (promoting their wellbeing) and for the counsellor to acquire the attitudes, skills and knowledge required for each of their roles raising awareness and ensuring the fair treatment of all clients and the uniqueness of individual people regarding culture differences, gender or disabilities which involves the principle respect of justice.

When considering what action to take the first step I would take would be to explore what the client had told me by clarifying what had been said in order to check out my understanding with the client. It is important to identify that there is a problem and if so I would then work out whose problem it was and in this case it would be the client’s. Yet I would be responsible to her, myself and accountable up the chain of command within the organisation.

By setting the contract provided by The YMCA clearly so that it is understood by the client there is less chance of misunderstandings and more chance of boundaries being clear at the onset. The agreement of a contract protects both the client and the counsellor. It proves that each party has agreed their responsibilities and boundaries and that they each know where they stand in the counselling process in relation to their obligations to each other. I would need to refer back to the initial contract to remind the client about our agreement that would be in place between us. I would have competently explained at the time that should harm to self or others be disclosed to me that I would need to breach confidentiality. I would use appropriate language for a sixteen year old to understand and include her in the process. I would respect the principle of respect for autonomy by discussing the necessity of safeguarding her, protecting her and her younger brother and, with her consent, checking whether the child protection officer would be available to enter the room to work it through all together by understanding my job roles and responsibilities and working within my training and experience competently I could deliver a professional level of service that promotes safety and both at the same time being fully aware that she has choices and human rights too.

Although I could have a conflict of interest in that I would have to breach confidentiality…

Human Rights Act 1998

Article 8.1

Everyone has the right to respect for his private and family life, his home and his correspondence.

Article 8.2

There shall be no interference by a public authority with the exercise of this right except as such as in accordance with the law and is necessary in a democratic society in the interests of national security, public safety or the economic well-being of the country, for the prevention of disorder or crime, for the protection of health or morals, or for the protection of the rights and freedoms of others (Bond, 2010:158).

…I would protect myself from litigation as I have a duty to observe the Code of Professional Conduct and the other guidelines issued by the BACP. Not all laws are perfect, the problem is that laws are often generalised and open to some interpretation and that’s where they can be exploited. The law regarding sixteen year olds (child versus Gillick competent versus adult) and the obligation of Social Services to look after somebody until eighteen years of age is not black and white. Somebody planning to go to the Dignitas clinic in Switzerland to end their life is within their own rights and it would be an example of a case where a counsellor could respect the client’s dignity.

At the first available chance I had I would follow the example of a child protection form, from my safeguarding policy and guidelines provided by the organisation and make very clear, accurate, brief, factual notes of who said what, when it was said, where it was said and the nature of the concern. I would bear in mind that the notes could be read by the client herself and if I was required to write a report for court I would be aware that I have not been trained to write such a report and seek advice.

According to Pollecoff, et al. (2002:58)

‘Counsellors and psychotherapists are in a unique position when asked to give evidence’…’…unlike other professionals, they do not necessarily keep detailed notes of each session held with a client’…’Problems can arise regarding client confidentiality in the context of presenting reports or giving evidence’.

I would file the notes confidentially and each client has a code to be used for anonymity purposes, store for six months, once the case is closed, then they are destroyed.

Bond (2010:158) suggests ‘The Data Protection Act 1998’…’…covers a wide range of requirements to do with record-keeping’.

I would call my case supervisor and I would explain what has happened, what I did (discussed with line manager and or referral to Child Protection Officer etc.) and ask him if there is anything else I should have done or could do.

Working within a multi agency can be useful as it can meet the needs of young people more effectively. Confidentiality procedures are in place and consent must be given by the person concerned and must be present when consented information is shared. There are exceptional circumstances.

At the same time how I present myself and interact with people (language, appearance, actions and interactions) influence impressions. There are informal expectations and continuing with both professional and personal development (supervision).

Questions like ‘What does the BACP say about this?’ are what I need to ask myself in during my evaluation in order to do the ‘right thing’ and knowing how important it is to not do the ‘wrong thing’ because that could cause damage to more than the client in the room. I hope that I have demonstrated that I understand that there is a need to act within the law at all times but in a way that provides as much support and protection as possible towards the client first and foremost, towards myself and towards the organisational structure and the profession itself. It is not always a case of knowing what to do to as an expert, but it seems to be a case of knowing what to do next and who to go to in order to get the answers needed.