Category: Free Essays

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.

Empowerment can be defined in general as the capacity of individuals, groups and/or communities gain control of their circumstances and achieve their own goals, thereby being able to work towards helping themselves and others to maximise the quality of their lives. In health and social care empowerment means patients, carers and service users exercising choice and taking control of their lives. It is not that one is empowered means he or she become all powerful like God. Even if we are empowered still we have limitation. Actual meaning of empowerment is that one feels that he or she able and feels powerful enough in certain situations to take part in decision making. I also will explain how politics played a part in disempowering women in health and social care services. It is a greatest challenge in health and social care to achieve progress with the empowerment of carers and people who receive services.

Beginnings of twentieth century women were disempowered because of politics played a part. Emancipation is a commonly used word in other western European countries to refer to what in the UK mean by empowerment. The word emancipation has is useful because it has overtones of the struggle for votes for women in Britain at the beginning of the twentieth century, so it reminds us that empowerment in the health and social services has a political aspect. When carers and people who use services experience being disempowered and excluded, this is a form of political disenfranchisement. In other words, it is as though they have no vote and are not treated as full members of society. In contrast, when people become empowered, they can exercise choices and have the possibility of maximising their potential and living full and active lives.

There is a tension between enabling people to take control of their lives and recognising that workers may need to intervene and take control sometimes, in order to protect other people. This applies to both empowerment and advocacy.

Empowerment for people with learning disabilities is the process by which they develop increased skills to take control of their lives. This will help them achieve goals and aspirations, maximising their quality of life.

A key feature in empowering people is giving them a voice and actively listening to what they have to say. Empowerment is, therefore, closely linked to the concept of advocacy.

Empowerment in learning disability can be described as a social process, whereby people who are considered as belonging to a stigmatised social group can be assisted to develop increased skills to take control of their lives. This increased control will help them to achieve their goals and aspirations and thus potentially maximise the quality of their lives. The concept has connections with assertiveness and independence and is clearly linked to the various forms of advocacy.

When considering the current climate it is somewhat an indictment on our times that the Government sees the need to name the White Paper regarding its vision for learning disability services as ‘Valuing People’. The title alone inversely suggests that as a society we are ‘not valuing people’. The content presents the evidence on levels of exclusion, disempowerment and lack of valued social roles facing those with a learning disability and how services should be planned to address this. (A similar Scottish Executive Review of Learning Disability has the title ‘The Same As You’.)

For the individual with a learning disability, the subjective experience of empowerment is about rights, choice and control which can lead them to a more autonomous lifestyle. For the professional, it is about anti-oppressive practice, balancing rights and responsibilities and supporting choice and empowerment whilst maintaining safe and ethical practice.

Education is often seen as the main engine of empowerment, equality and rights of access. Thus, as a group, people with a learning disability can be at a particular disadvantage. They may have to be enabled and supported to perhaps overcome social obstacles and can be dependent on others to make important information accessible to them, assist them with advocacy and help safeguard their rights.

A key feature in empowering individuals is giving them a voice and then listening actively to what they have got to say. Person Centred Planning with its focus on placing the individual at the centre of the process and using techniques to obtain meaningful participation can be a major contribution to finding out what people have got to say. Empowerment will bring along with it rights and responsibilities plus also potential risks for people. It is often the fear of physical risk which can inhibit empowerment processes for people who see themselves as responsible for vulnerable people. They may fear a blame culture if things go wrong. Surprisingly, as recently as 1998, the Social Services Inspectorate noted there were no systematic approaches for risk assessment and management in the field of learning disability.

The Foundation for People with a Learning Disability set out to identify good practice in how to reconcile the tension between ensuring the safety of an individual with a learning disability and empowering them to enjoy a full life in the community. A report was produced called Empowerment and Protection (Alaszewski et al, 1999) which suggested that organisations needed to develop risk policies which embrace both protection and empowerment issues at the same point. The definition of risk should look at consequences and probability. Procedures should also include, from the start, the wishes and needs of the person who has the learning disability and involve them throughout, including the decision making stage.

Such comments about organisations developing appropriate risk strategies show that empowerment is not there just as a concept for front line staff, but should penetrate the strategic planning levels. ‘Valuing People’ states (Section 4.27) that people with a learning disability should be consulted for their views on services and these views utilised at a corporate planning level.

In Mrs Ali case she is empowered by Muslim religious faith to take of her bed-bound husband although in contrast her care taker Jean believes that Mrs Ali should be empowered. This indicates religion also empower some people to take care vulnerable people.

We live in an era in which crisis-inducing events and acute crisis episodes are prevalent. Each year, millions of people are confronted with crisis-inducing events that they cannot resolve on their own, and they often turn for help to crisis units of community mental health centers, psychiatric screening units, outpatient clinics, hospital emergency rooms, college counseling centers, family counseling agencies, and domestic violence programs (Roberts, 2005).

Crisis clinicians must respond quickly to the challenges posed by clients presenting in a crisis state. Critical decisions need to be made on behalf of the client. Clinicians need to be aware that some clients in crisis are making one last heroic effort to seek help and hence may be highly motivated to try something different. Thus, a time of crisis seems to be an opportunity to maximize the crisis clinician’s ability to intervene effectively as long as he or she is focused in the here and now, willing to rapidly assess the client’s problem and resources, suggest goals and alternative coping methods, develop a working alliance, and build upon the client’s strengths. At the start it is critically important to establish rapport while assessing lethality and determining the precipitating events/situations. It is then important to identify the primary presenting problem and mutually agree on short-term goals and tasks. By its nature, crisis intervention involves identifying failed coping skills and then helping the client to replace them with adaptive coping skills. It is imperative that all mental health clinicians-counseling psychologists, mental health counselors, clinical psychologists, psychiatrists, psychiatric nurses, social workers, and crisis hotline workers-be well versed and knowledgeable in the principles and practices of crisis intervention. Several million individuals encounter crisis-inducing events annually, and crisis intervention seems to be the emerging therapeutic method of choice for most individuals.

Crisis Intervention: The Need for a Model A ”crisis” has been de¬?ned as An acute disruption of psychological homeostasis in which one’s usual coping mechanisms fail and there exists evidence of distress and functional impairment. The subjective reaction to a stressful life experience that compromises the individual’s stability and ability to cope or function. The main cause of a crisis is an intensely stressful, traumatic, or hazardous event, but two other conditions are also necessary: (1) the individual’s perception of the event as the cause of considerable upset and/or disruption; and (2) the individual’s inability to resolve the disruption by previously used coping mechanisms. Crisis also refers to ”an upset in the steady state.” It often has ¬?ve components: a hazardous or traumatic event, a vulnerable or unbalanced state, a precipitating factor, an active crisis state based on the person’s perception, and the resolution of the crisis. (Roberts, 2005, p. 778) Given such a de¬?nition, it is necessary that crisis workers have in mind a framework or blueprint to guide them in responding. In short, a crisis intervention model is needed, and one is needed for a host of reasons, such as the ones given as follows. When confronted by a person in crisis, clinicians need to address that person’s distress, impairment, and instability by operating in a logical and orderly process (Greenstone & Leviton, 2002). The profetional, often with limited clinical experience, is less likely to exacerbate the crisis with well-intentioned but haphazard responding when trained to work within the framework of a systematic crisis intervention model. A inclusive intervention allows the novice as well as the experienced clinician to be mindful of maintaining the ¬?ne line that allows for a response that is active and directive enough but does not take problem ownership away from the client. Finally, a intervention should suggest steps for how the crisis worker can intentionally meet the client where he or she is at, assess level of risk, mobilize client resources, and move strategically to stabilize the crisis and improve functioning.

Crisis intervention is no longer regarded as a passing fad or as an emerging discipline. It has now evolved into a specialty mental health ¬?eld that stands on its own. Based on a solid theoretical foundation and a praxis that is born out of over 50 years of empirical and experiential grounding, crisis intervention has become a multidimensional and ¬‚exible intervention method.

However, the primary focus of crisis literature has been on giving aid and support, which is understandable given that the first concern in the aftermath of a crisis is always to provide assistance (McFarlane, 2000), not to conduct systematic research (Raphael, Wilson, Meldrum, & McFarlane, 1996). Experts in crisis intervention have focused on practical issues such as developing intervention models that manage postcrisis reactions (Paten, Violanti, & Dunning, 2000), with little attention being given to the development of theory (Slaikeu, 1990). Slaikeu stated that crisis theories are more like a cluster of assumptions, rather than principles based on research that explain or predict the effect of crises on individuals. Ursano et al. (1996) agreed, stating that clinical observations and implications derived from mediators of traumatic stress have guided interventions, rather than theory. Although these efforts have increased the understanding of the nature of crises, a need exists to mold these assumptions and observations into theory.

The field of crisis intervention is predicated upon the existence of the phenomenon of psychological crisis. Because crisis intervention is the natural corollary of the psychological crisis, this review begins with a definition of the crisis phenomenon.

Definition of crisis

by Caple

“Crisis occurs when people encounter an obstacle in achieving the important objectives of life. This obstacle and cannot be overcome by means of customary methods used dealing with difficulties. This results in a state of disorganization and confusion, in which made numerous unsuccessful attempts of solutions.

Moreover, the crisis resulted from the problems on the road practically important in achieving objectives, obstacles where people feel that they are not able to overcome through the usual choices and behavior”. (1964)

by CARKHUFFA and Berenson

“Crises are crises so that the affected people do not know any ways of dealing

themselves with the situation” (1977)

by Belkin

“Crises of this personal difficulties or situations that deprive people of ability and

prevent conscious control of his life” (1984)

by Brammer

“Crisis is a state of disorganization in which man is confronted with the destruction of important objectives of life or profound impairment of their life cycle and methods of dealing with stressful factors. The term crisis typically refers to a sense of fear, shock and experienced difficulties in connection with the disorder, and not to the same disorder” (1985)

by MARINO

“Crisis develops in clear stages:

a) the situation is critical, which controls whether the normal mechanisms for dealing

deal with difficult enough;

b) the mounting tension and disorganization accompanying this situation excess capacity

it affected people to cope with difficulties;

c) the situation requires reaching for the extra resources (ex. professional

counseling);

d) may prove necessary referral to a specialist who will help in removal of

serious personality disorder ” (1995)

by Badura-Madej

“The crisis is transitional state of internal imbalance, caused by critical

event or life events. This condition requires significant changes and decisions.” (1999)

The Chinese word for crisis presents a good depiction of the components of a crisis. The word crisis in Chinese is formed with the characters for danger and opportunity. A crisis presents an obstacle, trauma, or threat, but it also presents an opportunity for either growth or decline.

Crisis is self-defined , because crisis is any situation for which a person does not have adequate coping skills. Therefore, What is a crisis for one person may not be a crisis for another person. In mental health terms, a crisis refers not necessarily to a traumatic situation or event, but to a person’s reaction to an event. One person might be deeply affected by an event, while another individual suffers little or no ill effects. Crises may range from seemingly minor situations, such as not being prepared for class, to major life changes, such as death or divorce. Crisis is environmentally based. What is now a crisis may not have been a crisis before or would not be a crisis in a different setting.

Basic Crisis Theory: Since Lindemann’s (1944, 1956) seminal contribution of a basic crisis theory stemming from his work in loss and grief, the development of crisis theory has advanced considerably. Lindemann identified crises as having: (1) a period of disequilibrium; (2) a process of working through the problems; and (3) an eventual restoration of equilibrium. Together with the contributions of Caplan (1964), this work evolved to eventually include crisis intervention for psychological reactions to traumatic experiences and expanded the mental health field’s knowledge base in applying basic crisis theory to other types of crises experienced by people.

In addition to recognizing that a crisis is accompanied by temporary disequilibrium, crisis theorists identify the potential for human growth from the crisis experience and the belief that resolution may lead to positive and constructive outcomes such as enhanced coping abilities. Thus, the duality contained in a crisis is the co-existence of danger and opportunity (Gilliland & James, 1997). One part of the crisis state is a person’s increased vulnerability and reduced defensiveness. This creates an openness in people for trying different methods of problem-solving and leads to change characterizing life crises (Kendricks, 1985).

Expanded Crisis Theory: While expanded crisis theory, as we understand it today, merges key constructs from systems, adaptation, psychoanalytic and interpersonal theories (Gilliland & James, 1997), the advent of systemic thinking heralded a new way of viewing crisis states. By shifting away from focusing exclusively on the individual in crisis to understanding their state within interpersonal/familial relationships and life events, entry points and avenues for intervention significantly increase. Systems theory promotes the notion that traditional cause and effect formulations have a tendency to overlook the complex and difficult to understand symptomlogy often observed in people in crisis. Especially with younger populations, crisis assessments should occur only within the familial and social context of the child in crisis.

More recently the ecological perspective is gaining popularity as it evolves and develops into models of crisis intervention. From this perspective, crises are believed to be best viewed in the person’s total environmental context, including political and socio-economic contexts. Thus, in the United States, mobile crisis teams primarily responding to adult populations use an ecological model. Issues of poverty, homelessness, chronicity, marginalization and pervasive disenfranchisement characterize the client population served (Cohen, 1990).

Ecocsystem Theory: Most recently an ecosystem theory of crisis is evolving to explain not only the individual in crisis, but to understand those affected by crisis and the ecological impact on communities. For example, the devastating rate of suicide and attempted suicide in Inuit youth reverberates through their communities on multiple levels. Ecosystem theory also deals with larger scale crises from environmental disasters (e.g. oil spills) to human disasters (e.g. Columbine school shootings).

Applied Crisis Theory: Applied crisis theory encompasses the following three domains:

Developmental crises which are events in the normal flow of human growth and development whereby a dramatic change produces maladaptive responses; Events such as birth, which is a crisis both for the mother and the infant, the onset of puberty and adolescence, marriage, the menopause, and so on as we progress through the biological stages of life, are known as developmental crises, These differ from “situational crisis” in that they necessarily occur at a given point in development and everyone has to pass through them. This goes along with Erikson’s theory of personality development, in that personality continues to develop through life, changing radically as a function of how an individual deals with each stage of development.

There are several causes of developmental crisis. One cause is a deficit in skills that can keep a person from achieving developmental tasks or turn a predictable transition into a crisis. For example, if a parent does not have the skills to be a parent, having a baby could become a crisis situation. Developmental crisis can also occur when the individual is not prepared for milestone events, such as menopause, widowhood, etc. Another cause is when one of life’s developmental transition is perceived by the individual as being out of phase with society’s expectations. Examples of this could be leaving home, choosing a partner, marrying, having kids, and retiring.

Situational crises which emerge with the occurrence of uncommon and extraordinary events which the individual has no way of predicting or controlling; Traumatic events which might or might not happen at a given time. These could either be major catastrophes such as earthquakes, floods, etc., which could affect a whole section of society. In other words – occurs in response to a sudden unexpected event in a person’s life. The critical life events revolve around experiences of grief and loss. like loss of a job, divorce, abortion, death of a love one, severe physical or mental illness, or any other sudden tragic event.

One characteristic of situational crises is their sudden onset and unpredictability. While a struggle with developmental issues usually builds over time, situational crises strike from nowhere all at once. Unexpectedness is another factor of situational crises. People generally believe “it won’t happen to me,” and are blind-sided when it does happen to them. Emergency quality is another characteristic of situational crises. When a situational crisis hits, it needs to be dealt with immediately. Situational crises also impact the entire community. These events usually affect large numbers of people simultaneously, requiring intervention with large groups in a relatively short period of time. The last characteristic of situational crises is the presence of both danger and opportunity. Reorganization must eventually begin. This reorganization has the potential for the individual to emerge on either a higher or lower level of functioning.

Existential crises which refer to inner conflicts and anxieties that relate to human issues of purpose, responsibility and autonomy (e.g., middle life crisis).

It is a stage of development at which an individual questions the very foundations of their life: whether their life has any meaning, purpose or value. An existential crisis is often provoked by a significant event in the person’s life – marriage, separation, major loss, the death of a loved one; a life-threatening experience; psycho-active drug use; adult children leaving home; reaching a personally-significant age (turning 30, turning 40, etc.), etc. Usually, it provokes the sufferer’s introspection about personal mortality, thus revealing the psychological repression of said awareness

Each person and situation is unique and should be responded to as such. Therefore, it is useful to understand the crisis from one or more of these domains in order to understand the complexities of the individual’s situation and to intervene in more effective ways. One would also tend to see a younger population with developmental and/or situational crises (Gilliland & James, 1997).

Due to the duration of the crisis, we may distinguish

– Acute crises

– Chronic crises

Stages of a Crisis

In order to articulate the elements of a responsive mobile crisis service a conceptual framework of the stages of crisis is presented. There is agreement in the literature that most crisis interventions should last about one to six weeks (Caplan, 1964; Kendricks, 1985). This suggested time frame is based on identifiable stages of a crisis. Frequently cited in the literature (Gilliland & James, 1997; Smith, 1978) is Caplan’s four stages of crisis:

Phase I – The person has an increase in anxiety in response to a traumatic event; if the coping mechanisms work, there’s no crisis; if coping mechanisms do not work (are ineffective) a crisis occurs.

Phase II – In the second phase anxiety continues to increase.

Phase III – Anxiety continues to increase & the person asks for help. (If the person has been emotionally isolated before the trauma they probably will not have adequate support & a crisis will surely occur).

Phase IV – Is the active crisis – here the persons inner resources & supports are inadequate. The person has a short attention span, ruminates (goes on about it), & wonders what they did or how they could have avoided the trauma. Their behavior is impulsive & unproductive. Relationships with others suffer, they view others in terms of how can they help to solve the problem. The person feels like they are losing their mind, this is frightening – Be sure to teach them that when the anxiety decreases that thinking will be clearer.

While others have proposed slightly varying stages, there are commonalties in understanding that crises are time-limited, have a beginning, middle and end, and that intervention early in a crisis can produce stabilization and a return to the pre-crisis state. No intervention, or inadequate intervention, can result in chronic patterns of behavior that result in transcrisis states (Gilliland & James, 1997).

Transcrisis: the original crisis event becomes submerged into the unconscious and

re-emerges when anxiety is re-experienced. A woman who experienced rape will

re-experience problems with being sexually intimate with a man and experience problems in intimate relationships.

Crisis stages can be distinguished from mental disorders in that the person in crisis can be described as having normal and functional mental health before and after the crisis. Additionally crisis tend to be of limited duration and after the crisis is over, the client’s turmoil will frequently subside. There however persons who can stay in crisis state for month or years. Such individual is described as being In transcrisis state. It’s also possible for transcris state to lead to the development of anxiety and other tipes of mental disorder (ex.PTSD).

Crisis Intervention

Crisis intervention is the form of psychological help, that is focused on therapeutic contact, concentrated on the problem, that caused the crisis, limited in time, when the person is confronted with the crisis and has to solve it. That kind of help lets us reduce the crisis response and minimize functional impairment. (Badura-Madej, 1999)

Crisis intervention is emergency first aid for mental health (Ehly, 1986). Crisis intervention involves three components: 1) the crisis, the perception of an unmanageable situation; 2) the individual or group in crisis; and 3) the helper, or mental health worker who provides aid. Crisis intervention requires that the person experiencing crisis receive timely and skillful support to help cope with his/her situation before future physical or emotional deterioration occurs.

Crisis intervention provides the opportunity and mechanisms for change to those who are experiencing psychological disequilibrium, who are feeling overwhelmed by their current situation, who have exhausted their skills for coping, and who are experiencing personal discomfort. Crisis intervention is a process by which a crisis worker identifies, assesses, and intervenes with the individual in crisis so as to restore balance and reduce the effects of the crisis in his/her life. The individual is then connected with a resource network to reinforce the change.

HISTORY Crisis Intervention

Origins of crisis intervention, should be found in the topics related to the suicide prevention, the development of environmental psychiatry, as well as a vocation to life services dealing with emergency psychotherapeutic assistance for victims of traumatic events, such as: war or natural disasters (Badura-Madej, 1999).

The roots of crisis intervention come from the pioneering work of two community psychiatrists-Erich Lindemann and Gerald Caplan in the mid-1940s, 1950s, and 1960s. We have come a far cry from its inception in the 1950s and 1960s. Speci¬?cally, in 1943 and 1944 community psychiatrist, Dr. Erich Lindemann at Massachusetts General Hospital conceptualized crisis theory based on his work with many acute and grief stricken survivors and relatives of the 493 dead victims of Boston’s worst nightclub ¬?re at the Coconut Grove. Gerald Caplan, a psychiatry professor at Massachusetts General Hospital and the Harvard School of Public Health, expanded Lindemann’s (1944) pioneering work. Caplan (1961, 1964) was the ¬?rst clinician to describe and document the four stages of a crisis reaction: initial rise of tension from the emotionally hazardous crisis precipitating event, increased disruption of daily living because the individual is stuck and cannot resolve the crisis quickly, tension rapidly increases as the individual fails to resolve the crisis through emergency problem-solving methods, and the person goes into a depression or mental collapse or may partially resolve the crisis by using new coping methods. A number of crisis intervention practice models have been promulgated over the years (e.g., Collins & Collins, 2005; Greenstone & Leviton, 2002; Jones, 1968; Roberts & Grau, 1970).

The goals of crisis intervention are relatively limited, relate to the immediate crisis situation and are the following:

Reduction in disequilibriurn or relief of symptoms of crisis

Restoration to precrisis level of functioning

Some understanding of the relevant precipitating events

Identification of remedial measures which the client can take or make available through community resources.

Connecting the current situation with past life experiences and conflicts

Initiating new modes of thinking, perceiving feeling and developing new adaptive and coping responses which are useful beyond the immediate crisis situation, leading to an emancipated maturation and empowerment.

Basic Principles

While there is no one single model of crisis intervention (Jacobson, Strickler, & Mosley, 1968), there is common agreement on the general principles to be employed by EMH practitioners to alleviate the acute distress of victims, to restore independent functioning and to prevent or mitigate the aftermath of psychological trauma and PTSD (Butcher, 1980; Everly & Mitchell, 1999; Flannery, 1998; Raphael, 1986; Robinson & Mitchell, 1995; Sandoval, 1985; Wollman, 1993).

1. Intervene immediately. By definition, crises are emotionally hazardous situations that place victims at high risk for maladaptive coping or even for being immobilized. The presence onsite of EMH personnel as quickly as possible is paramount.

2. Stabilize. One important immediate goal is the stabilization of the victims or the victim community actively mobilizing resources and support networks to restore some semblance of order and routine. Such a mobilization provides the needed tools for victims to begin to function independently.

3. Facilitate understanding. Another important step in restoring victims to pre-crisis level of functioning is to facilitate their understanding of what has occurred. This is accomplished by gathering the facts about what has occurred, listening to the victims recount events, encouraging the expression of difficult emotions, and helping them understand the impact of the critical event.

4. Focus on problem-solving. Actively assisting victims to use available resources to regain control is an important strategy for EMH personnel. Assisting the victim in solving problems within the context of what the victim feels is possible enhances independent functioning.

5. Encourage self-reliance. Akin to active problem-solving is the emphasis on restoring self-reliance in victims as an additional means to restore independent

functioning and to address the aftermath of traumatic events. Victims should be assisted in assessing the problems at hand, in developing practical strategies to address those problems, and in fielding those strategies to restore a more normal

equilibrium.

The practice of crisis intervention, typically consist of the following (Badura – Madej, 1999):

Providing emotional support to facilitate the reaction to emotion;

Confronted with the reality and countering tendencies to deny and distorted to form at the moment the most important problem to solution;

Assess the current ways of coping in terms of their adaptive nature;

Referring to good coping strategies or creating new strategies;

A plan of assistance.

Characteristics of a crisis intervention (Badura-Madej, 1999):

– Assistance as soon as possible after the critical event, preferably at the time, when the existing ways of coping are exhausted with crisis, and new constructive behaviors yet not created – to provide the support reduces the risk run adaptive ways of coping;

– Focus on the situation and the current problem associated with the crisis (the “here and now “), taking into account the individual history of man (analysis of this story helps to understand the nature and depth of the crisis reaction)

– Emotional support, often also material support (accommodation, shelter, food,

drinking, etc.) to ensure a sense of security to the person in crisis;

– A large intensity of contacts (depending on the situation) – and sometimes even daily;

– Time limit (6 – 10 meetings)

– flexibility in assisting interactions – from the directive operation, client collaboration, to the non-directive action;

– Mobilizing the natural support system for people in crisis, cooperation with other institutions, providing possible support from institutions to holistic approach to people in crisis (eg, OPS, police, etc.).

Crisis Intervention Models

(Gilliland and James, 2005)

Practice and intervention literature indicate the usefulness of certain general theoretical models for the construction of concrete measures for persons in crisis. Belkin (1984) proposes a classification includes equilibrium model, cognitive model and psycho-social model of transformation (Gilliland and James, 2005).

Equilibrium model

Equilibrium model indicates a basic fact of the continuum balance – imbalance,

which differentiates functioning non-crisis and crisis. Persons in crisis, experiencing

state of disorganization, lack of balance of basic psychological functions, are not able to effectively use their customary ways of coping and methods of solving problems.

The aim of the intervention from the point of view of equilibrium model is to assist the client in regained pre-crisis equilibrium. therefore the use of this approach is the most

justified in the initial stages of intervention, when a person has no sense of control over himself and course of events is confused and unable to take adequate

decisions and appropriate action. Until the client does not recover even though part of the capacity to coping, the main effort should be directed to stabilize the condition of the person. Only then it is possible to use his abilities to cope, and other internal and external resources to solve a crisis problem. Equilibrium model considered

is the “cleanest” model of crisis intervention (Caplan, 1961; for: Gilliland and James, 2005).

Cognitive model

The cognitive model of crisis intervention is based on the premise that crisis are rooted in faulty thinking about the event or situations that surround the crisis – not in the events themselves or the facts about events or situations (Ellis, 1962). The goal of this model is to help people become aware of and change their views and beliefs about crisis events or situations.

The basic tenet of the cognitive model is that people can gain control of crisis in their lives by changing their thinking, especially by recognizing and disputing the irrational and self-defeating parts of their cognitions and by retaining and focusing on the rational and self-enhancing elements of their thinking.

The messages that people in crisis send themselves become very negative and twisted, in contrast to the reality of the situation. Dilemmas that are constant and grinding wear people out, pushing their internal state of perception more and more toward negative self-talk until their cognitive sets are so negative that no amount of preaching can convince them anything positive will ever come from the situation.

Crisis intervention in this model can be compared to work on rewriting your own “program” by the client, which on a positive Coupling back and repeat the exercise in self-assessment of the new situation, be able to change emotions and behavior in a more positive and constructive. Cognitive model can be used in practice when the client has already regained some sufficient level of psychological stability, allowing where appropriate perception, drawing conclusions, making decisions and experimenting with new behaviors.

Basic concepts of this approach are fond in the rational-emotive work of Ellis (1982), the cognitive-behavioral approach of Meichenbaum (1977), and the cognitive system of Beck (1976).

Psychosocial transition model

Psychosocial transition model is another useful approach to intervention in

crisis. This model is based on the assumption that man is the result of the interaction between the genetic equipment, and the learning process, setting the social environment. Both people and their environment and social influence processes are subject to constant change. Therefore, crises may be related to both internal and external (psychosocial, social and environmental) difficulties.

The purpose of crisis intervention, as seen from this perspective, is to help, cooperation with client in an adequate assessment of both internal and external circumstances influencing the emergence of the crisis, as well as assist in the selection of effective alternatives to the (client’s) existing, inefficient behavior, inappropriate attitudes and inefficiencies how to use the resources of the environment in which I live. To obtain a stand-alone control over his private life customers can be needed for obtaining adequate internal mechanisms to deal with difficulties, as well as social support and environmental resources.

The Psychosocial transition model does not perceive crisis simply an interal state of affairs that resides totally within the individual. It reaches outside the individual and askes what system need to be changed. Systems such as family, peer group, work environment, religious community are examples who can also support or interfere with the psychological ada

Groups may be defined in many ways, indeed providing an absolute definition of a group, as with much of the theory around group work, is highly problematic and contestable. However for the purposes of discussing groupwork within a context of working with young people we may define a group as a small gathering of young people. Group work may simplistically be described as the study and application of the processes and outcomes experienced when a small group comes together.

Konopka (1963) defines groupwork as a method of social work that is utilised in order to `help individuals to enhance their social functioning through purposeful group experiences, and to cope more effectively with their personal, group or community problems`. This definition shows a tradition within groupwork of helping individuals with problems. Brown provides a modernised and more comprehensive definition of group work (1994, p.8). He states that `groupwork provides a context in which individuals help each other; it is a method of helping groups as well as helping individuals; and it can enable individuals and groups to influenceand changepersonal, group, organisational and community problems` (original emphasis). He goes on to distinguish between `relatively small and neighbourhood centred` work and `macro, societal and political approaches` within community work, explaining that only the former may be properly classified as groupwork.

Thus the role of groupwork can be seen as one which places emphasis on sharing of thoughts, ideas, problems and activities.

Roles within Groups

Each individual within a group has a role to play in the development of that group to a greater or lesser extent. Through observation, understanding of difference, awareness of personal resourcesand effective communication(Douglas, 1995), each member may affect group processes and individual emotions. Roles develop within groups both through formal appointment and because of the personal characteristics and interpersonal relationships that develop between members. Roles which develop can be constructive and support the group and its members in achieving its goals, or can be destructive and work against the overall group aims. Individuals within the group can develop several roles and at times these may conflict. For example a PTV member who was designated as leaderfor a specific task, also played a clownand was fond of practical jokes. The fooling around led to a lack of trust from other group members creating a conflict with the leadership role.

As the group begins to develop an understanding of four things can be observed:

Observation: the way we behave is based upon what we observe of ourselves, and what we make of others and their reactions to us.

Differences: personally and socially generated; the effects they have on behaviour and understanding.

Resources: frequently stemming from difference but are the source of potential power for a group and an individual.

Communication: considered to be natural but subject to many barriers that remain largely unknown unless a conscious effort is made to find them:

(Douglas, 1995, p. 80-97)

Through supportive roles, groups may play a part in reducing oppression generated externally to the group. Groupwork can be used as a medium for oppressed groups to `help these groups adjust in society`, and moreover to help society to adjust towards these groups. This can be achieved by `individual rehabilitation` in which we can `help individuals to adjust to social life and manage aˆ¦ tension aˆ¦ gain confidence, high self esteem`, and in `getting and keeping employment etc.`. `Societal or community rehabilitation` involves `helping the society to have meaningful contact` with individuals and groups which are discriminated against and oppressed (Osei-Hwedie, Mwansa, and Mufune, 1990, p. 188).

Preston-Shoot describes groupwork creating a `sense of belonging and mutual identity` encouraging `the formation of relationships which foster mutual identification and influence`, thus feelings of isolation and singularity with issues of difference and oppression may be reduced. Also, the group may be encouraged to use its internal resources to move towards individual or group `problem-resolution`, reducing feelings of helplessness, building self worth, and discouraging worker dependency (Preston-Shoot, 1987, p. 6-28). Smith concurs with this view of the suitability of groupwork, stating `Groups are obvious sites of interaction and within them a sense of connectedness or community with others can be fostered` (Smith, 1994, p.111). This `connectedness` is a valuable tool with which to challenge discrimination and oppression, for as Piven and Cloward argue, it is only when we act collectively that change can begin (Piven and Cloward, 1993).

Conclusion: Group Work – Double Edged Sword?

To state that group work is not an exact science is something of an understatement. As we have seen, it is problematic to even define what is meant by a group as no absolute definition exists. Similarly most, if not all, concepts within group work theory can be, and are, contested.

Groups are extremely important in the lives of all individuals. Johnson and Johnson (1975, p1-2) state `many of our goals can be achieved only with the cooperation and coordination of others`.

However `the success of any group depends on the ability of its members to exchange ideas freely and to feel involved in the life and decisions of the group` (Massallay, 1990). All groups within youth work have goals, i.e. a future state of affairs. It is important that short term and long term goals are set realistically if the group is to develop and function effectively. These functions are achieved through the direction of leadership and the development of individual roles within each group.

A group is said to be successful if it:

1. accomplishes group tasks

2. maintains the group internally, and;

3. develops and adapts to improve effectiveness.

(Massallay, 1990)

Groupwork can be used as an effective tool for many youth work situations, not least of which is as a medium for challenging oppression both within groups and individuals. Thus, we have seen the emergence and development of girls issue groups and black young people’s projects that offer mutual support as well as working to challenge oppression. Yet we have seen that through the development stages of a groups life there are many opportunities for individuals to develop and focus oppressive behaviour internally within a group.

A grasp of theoretical understanding of group behaviour and functioning can help to explain individual and group behaviour, and help us to achieve our ultimate aim as youth workers, that of informal education. It is important not to treat group work as an exact science with definitive answers. Indeed many of the questionswe must ask ourselves are unclear, thus the answersare a best guess, or a benchmark that we can develop on and work around.

Finally, let us consider briefly the historical context of group work development and the purpose it has not only within youth work, but society at large. As Taylor reminds us `A moment’s reflection shows that the social groupwork beloved of liberalism is the product of the American capitalist concern to develop more sophisticated management techniques` (Taylor, 1987, p. 140). Let us be careful to use group work to promote democracy and not fall into the trap of using group work as yet another tool for promoting social control in a capitalistic state.

© Student Youth Work Online 1999-2001 Please always reference the author of this page.

References &Recommended Reading

Adair, J. (1988) Effective LeadershipLondon: Pan

Barker, L. L., Cegala, D. J., Kibler, R. J. and Wahlers, K. J. Groups In ProcessNew Jersey, USA: Prentice-Hall

Bond, T. (1986) Games for Social and Life SkillsLondon: Hutchinson

Brandes, D. and Phillips, H (1977) Gamesters’ HandbookGreat Britain: Stanley Thornes

Brown, A. (1994) Groupwork 3rdEditionGreat Yarmouth: Ashgate Publishing

Dearling, A. and Armstrong, H. (1994) The New Youth Games BookGreat Britain: Russell House Publishing

Douglas, T. (1983) Groups: Understanding People Gathered TogetherLondon: Routledge

Douglas, T. (1995) Survival In Groups: The Basics of Group MembershipBuckingham: Open University Press

Dynes, R. (1990) Creative Games in GroupworkGreat Britain: Winslow Press

Garland, J. Jones, H. and Kolody, R. (1968) `A model for stages of development in social workgroups` in Bernstein, S. (Ed.) Explorations in GroupworkBoston: Boston University School of Social Work

Heap, K. (1977) Group Theory for Social WorkersGreat Britain: Pergamon Press

Konopka, G. (1963) Social Group Work : a Helping Process Englewood Cliffs, N.J. : Prentice Hall

Leech, N. and Wooster, A. D. (1986)Personal and Social Skills – A Practical Approach for the ClassroomGreat Britain: RMEP

Massallay, J. L. (1990) `Methods, Techniques and Skills of Youth and Community Work: Community Action and Group Work` Chapter 4. In Osei-Hwedie, K., Mwansa, L-K. and Mufune, P. (Eds.) Youth and Community Work PracticeZambia: Mission Press

Osei-Hwedie, K., Mwansa, L-K. and Mufune, P. (1990) Youth and Community Work Practice: Methods, Techniques and SkillsZambia: Mission Press

Piven, F. F. and Cloward, R. A. (1993) Regulating the Poor : The Functions of Public Welfare USA: Vintage Books

Preston-Shoot, M. (1987) Effective GroupworkHampshire: Macmillan

Rogers, C. R. (1967) `The process of basic encounter group` In Bugental, J. F. T. (Ed.) TheChallenges of Human PsychologyNew York: McGraw-Hill

Sessoms, H. Massachusetts, D. and Stevenson, J. L. (1981) Leadership and Group Dynamics in Recreation ServicesUSA: Allyn and Bacon

Smith, M. K. (1994) Local Education: Community, Conversation, PraxisGreat Britain: Open University Press

Taylor, T. (1987) `Youth Workers as Character Builders` Chapter 9. In Jeffs, T and Smith, M. (Eds.) Youth WorkBasingstoke: MacMillan

Tuckman, B. W. (1965) `Developmental Sequences in Small Groups` in Psychological BulletinNo. 63 p. 384-399

http://youthworkcentral.tripod.com/sean3.htm

Professionals get involved in peoples to protect then and promote social justice , yet oppress them for example, by making decisions for them or the structure of an organisation can oppress on individual. Oppression is:

The central circle P represents the personal, psychological, practice and prejudice. Here we are considering the individual’s thoughts, feelings and actions. The way in which each practitioner interacts with service user and the “aˆ¦inflexibility of mind which stands in the way of fair and non-judgmental practice.” The P level is embedded in the C level, as values and norms are internalised through socialisation. C refers to the cultural, sphere where people share “aˆ¦ways of seeing, thinking and doing.” Commonailties and consensus about right and wrong and conformity to shared norms are found here. Social inequalities are thus legitimated through culture. Our culture is supported by structures such as the economy, society and the nation state. The C level is immersed in the S level. Discrimination is part of the fabric of society. Socio-political and social divisions describe the “aˆ¦interlocking patterns of power and influence” (Thompson 1997).

Therefore, at the P and C level we can see that anti oppression and values are interlinked. they are both socially constructed moral code that assist and control our actions within society; as social work practice recognises the complexity of interactions between human beings and their environment, it has drawn some of its knowledge from anti-oppressive practice and values in order to influence individual change. This knowledge helps the social worker to make informed judgements in addressing the inequalities and injustices that exist in society (Stanford 2005).

Issues and risk factors from the case study.

A referral form the Child and Adolescent Mental Health Service (CAMHS) was sent to the organistion on be half of David, requesting service from the Adult Community Mental Health Team (CMHT). David is 17 and half years old has got a history of mental health. Clinical depression (quotion) and self harm. and has been involved for 3 and half years with The Child and Adolescent Mental Health Service(CAMHS). His condition is medicated and he been taking this on a regular basis as well as receiving counseling. Due to his age his current Social worker his referred him to the Adult Community Mental Health Team. However, the CMHT made clear that David could receive service from the organisation as he not 18. This could have a negative effect on his condition. for example, it may further the risk of self-harm and potential risk of accidental suicide. According to (Rutter, 1995 and Steinberg, 2004) adolescent are particularly vulnerable to self- harm and suicide if they are already suffering from depression. Therefore, coping strategies such as counselling and the resources centres are important to his well-being. However, at the moment it’s not Cleary as to where David will receive support. according to the Menatl Health Act he is sitll a child mental health Act

Both organisation were in a dilemma as the both shifting to blame on his age however the Menatal Health Act points out…in this case Daivd may need an independent person to speak out for him because the professional are able to support.

I found this very demoralising and questioned the CAMHT’S decision; had she thought about, the remaining mouths of his age, was this helping David to lead a fulfilling life like any other citizen and had she thought of any other ways to support David attend a resource centre without stopping him completely? I wondered whether the whole notion of “working together”,” partnership “professionalism”, and “commissioning” meant anything at all to the both social workers. I thought that the CAMET’S social worker decision based on a social model.

This decision deprived to David to gain a resource that will enhance his well-being. For the reason, his complex needs where not being met. Since both organisations where not working in partnership. There are two types of partnership working, one working with the service user and the other working with other professionals as part of a multi-disciplinary approach. Coulshed & Orme (2006:230) states “Multi-disciplinary work or inter-agency work is carried out to ensure that a range of service is accessed to provide a holistic approach to meeting the needs of service user”. In this case, I believe the CAMHT did not carry out a holistic approach clearly his/ her approach was to simply transfer David to the AMHT. As Thompson (2000) stress partnership working with service users involves working with clients, as opposed to making decisions for them. This view is also shared by Hatton (2008) and Trevithick (2000) who points out positive practice must involve service user if it is to achieve agreed objectivesaˆ¦within this process, service user must be seen not only in terms of “problems” they bring, but as “whole person” and “full citizens.” Therefore, in partnership working, the service user is seen as the ‘expert’ on themselves and therefore it is essential to involve them in all of the processes. Hatton(2008) goes on to say, if social work is to make a real impact on live of people like David… it needs to develop a frame of reference which values, hears and works in partnership. This is in contrast to for example, the medical model, where the professional is regarded as the expert on the service and the service user’s health.

redard of his he should fall ut of this frame referneces. in constarn with ths social modle as it is concerned with experience of vulnerable people at risk of oppression and social devaluation.

The whole notion of ‘working together’ and ‘joined up thinking’ is now embedded in social work and social care discourses in the United Kingdom (DOH 1998, Payne 2000)

Partnership working with other professionals is highly important in order for services to be delived well. The relationship between different agencies can sometimes be difficult as both parties are likely to operate on different levels. For example, referring to level S or Structural-organisation level of the PCS model in David’s case both professional where clashing or the case. Therefore, services are not co-ordination. This will have an effect at the C level or the “professional-culture level”. As Wilson (2008) highlights effective cooperation between different profession groups is possible but they is a range of difference between them; for instance, their goals, the nature and peace of their work. Therefore, professionals have different priorities, expectations, obligations and concerns, as this is the underlying message in the case of David as a result it is important that these are shared from the beginning to enable understanding. This then allows any issues to be dealt with in a positive and open manner (Thompson, 2000). In doing so, professionals should A, recognise and accept the need for “partnership”. b, develop clarity and realism of purpose. c, ensure commitment and own ship. d, develop and maintain trust, e, create clear and robust partnership arrangements. F, monitor, measure and learn.(Nuffield cited from class notes)

According to the “working together” It is considered as high-quality practice when a service has partnership working with both the service user and other professionals. According to aˆ¦

Keeping clients informed and aware of any issues and changes in the situation empowers the client and provides autonomy.

In order to work in partnership, it is important to keep communication channels open, by involving the service user and other professionals in decision making processes, for instance, in the case David the CAMHT’S social worker should have communicated with the AMHT’s social worker in advance about the transfer. Therefore, it would have been clear that the AMHT would not be able to take on Daivd, therefore, he/ she would have thought of an alternative such as commissioning service. Commissioning means that “services a available so that identified needs can be met” c and 0()This suggests that he/she was accountable to the supplier of the resources and the service user . This is supported by the GSCC code of practice as it requires social workers to “be accountable for the quality of their work”. In the case of David there was lack of commissioning and partnership the case was closed both social workers did not think about the next step. .. to carry out an assessment and plan therefore , Partnership working promotes a jointed accountability for resolution of the condition, making sure that all parties consider that their contributions are important (Thompson, 2000). Plans must be supported on negotiated agreement and not on the prejudices or assumptions about client’s feeling or thoughts.

,

Introduction

Using course materials from Death and Dying, I will discuss the idea that death is something to be feared. I will use course material from Block 1, The Social Context of Death and Dying, focusing on units 1 and 2. I will provide evidence of arguments for and against this notion and consider other attitudes of how these views are formed by society. I will also illustrate my answers using materials form the course website, reader and audio activities. I have also incorporated some personal and professional experience. in an attempt to illustrate my points.

Death is portrayed and discussed in various ways by people from all walks of life, their upbringing and religious views can have an impact on how they perceive death. As discussed in Block 1, one indicator that death is something to fear is our use of language. This anxiety is demonstrated in the euphemisms individuals use when describing or explaining a death. For example when undertaking activity 1.1, Explaining the meaning of death, (Block 1, unit 1, pg 1). I discussed my first experience of death. I recall having to explain to my youngest sibling that our mother had died. My sister was 8 years old and I sat her down and spoke firstly about angels and the stars. I went on to tell her that God had decided he needed mum to be an angel. I couldn’t bear to use the word dead as I was struggling with mum being dead and was of the view that using the word ‘dead’ would have been too painful and therefore spoke about angels to make it less emotive. Since then I have experienced the death of other relatives and friends and find that I will use euphemisms such as, “passed away” or “gone to a better place”. I have also heard myself use phrases such as “kicked the bucket, however, this is usually when referring to someone I didn’t really know.

A number of examples are provided in block 1 in relation to euphemisms used to describe what occurs after death. Spiritualist and Mediums use words such as “crossing over” or “passed over” as they see the death as the beginning of a journey from this world to what they describe as the ‘spirit world’. Komaromy (2005) spoke of how she found that whilst exploring how death and dying were managed in care homes, was “frequently met with difficulty over the use of words ‘death’, ‘dying’ and ‘dead’” (Block 1, unit 1, section 1.2, pg 13). It would appear the fear of using these words were not necessarily from the residents themselves but by those who cared for them.

The beliefs instilled in people from a young age from their family, educational professionals and religious sources as well as their personal experience of death can often have a profound impact on how they perceive death and dying. Roman Catholics appear comfortable when speaking about death as they see death as a momentous event that should not be feared. Catholics believe in life after death, stating the soul leaves the body and will normally spend a period in Purgatory and when the soul is cleansed of the temporal consequences of sin they will enter heaven. However some anxiety remains, as for many, there is uncertainty of how long their soul will remain in purgatory. “They do not fear the next world, but rather the passage, the crossing over……..” (Toscani, et al(2003), OU course material, website).

Professor Douglas Davis’ research highlighted that gender plays a significant role in the belief in life after death in contemporary British Society. He states that women are far more likely to believe in an afterlife, than men, with a ratio of almost 2:1. He informs 30% of the population with a similar gender imbalance believe the dead remain among us and have had contact in one form or another with their loved one. (Audio1, activity 1.8, Identity and Belief). This I would argue is based on a person’s knowledge of the deceased and is linked to their sense of identity and the need to continue the link with their loved one, which in turn may offer comfort and peace of mind to those who are bereaved. People also seek comfort through contact with the dead via spiritualists and mediums, in an effort to communicate with loved ones. Justine Picardie describes this as attending a social gathering of the dead (Picardie in Making Sense of Death and Dying and Bereavement: An Anthology, pg 198, Earle, et al).

Research and studies regarding the beliefs and views of individuals in life after death vary from person to person depending on their religious or non-religious beliefs. For example the article “Life at the end of Life: beliefs about individual life after death and “good death” models – a qualitive study” Toscani, F., et al, highlights two different models and arguments regarding death and what would be classed as a “good death”. The attitudes and assumptions depend on whether the individual is a believer or non-believer but even then there can be conflicting opinions between faiths.

Tibetan Buddhism describes in great detail the process of death and the passage over. Tibetan Buddhists are encouraged to read “The Tibetan Book of the Dead” and when an individual is dying, there is a common conception that it is good to read this book to the dying person. “By understanding the death process and familiarisingour self with it, we can remove fear at the time of death and ensure a good rebirth” (Death and Dying in the Tibetan Buddhist Tradition, Hawter; V.P – internet source: Buddahnet.com). In contrast, Seventh-day Adventist beliefs regarding death are totally different from those of other religions. Adventists believe that people do not die nor do they go to Heaven or Hell. It is their belief that the individual “goes to sleep and will rise again on the Day of Judgement”. (Kormaromy, 2005, Block1, unit 1, section 1.2, pg13). By this they mean the person will remain unconscious until the return of Christ.

The views of atheists vary, although the consensus is that there is no life after death, that when we die, we die, and that is it. “If I am, death is not; if death is, I am no longer: why, then, fear death?” (Toscani,et al(2003), OU course website, pg 8). This does not mean that atheists do not have a fear of death, like believers there are similarities with regards to how they will die and where they would like to die. I worked with a family whose child was dying. When trying to support the family through this difficult period they spoke of feeling angry at individuals who had questioned why they were not in church praying. They informed me that as far as they were concerned that when their child died that was the end. They stated their only fear was that their child would die alone if they left his side.

The management of death and dying has changed over time. French Historian, Phillipe Aries claimed that in the Middle Ages people appeared more optimistic with regards to death, as they acknowledged death as part of life, as it unavoidable. The death affected not only the family of the deceased but the community as a whole. With individuals being assigned particular roles, for example, preparing the body for burial, announcing the death and it was customary to view the body of the deceased. Death was a common occurrence and this may explain why death was seen as inevitable and therefore not feared.

Aires argued that after the 19th century death in western society was hidden and following the First World War, death became a taboo subject and was no longer seen as a natural process of life. (Block 1, unit 2.2, pg 38). The explanation for this could be that it was due to what we know as the ‘nuclear family’ era? Norbert Elias (1985) would argue that in today’s society the role of preparing the deceased has been taken over by funeral directors who offer a wide range of services to the family. This includes collecting and preparing the body for burial or cremation. In my own recent experience of the death of my son, the only duty the funeral director could not undertake was to register the death. Elias argument “is that dying people are now more isolated than in the past” (Block 1, Unit 2.2 pg40).

It should be noted that some traditions continue, for example, the viewing of the deceased remains within many faiths be it within a church setting or funeral directors chapel of rest, although this is usually by family and close friends. This could explain why Aires theory that death after the 19th century did not have an overall impact on the community but rather than on a smaller network, family and friends. German Sociologist, Norbert Elias (1985), (Block 1, unit 2.2, pg 40) challenged Aires ideas, that in the past, death was accepted as being a natural process. Elias claimed death was painful as life was much shorter and more dangerous.

Conclusion

Perhaps the idea of life after death allows us to cope with what can only be seen as a natural fear as the alternative, non-existence is unimaginable and we are psychologically inept to deal with this. Therefore we need to ask the question is death something feared by all? Is this a hypothesis or could it be that for many individuals, especially, those in old age or with a terminal illness that death could be the beginning of something better. It can therefore be argued that whilst individuals and society have diverse opinions regarding death and what happens to them when they die, the majority do have a fear of how they will die. For example being alone, suffering pain, dying young or, being forgotten.

This article critically analyses ‘cultural competence’ as a theoretical construct and explores the need for a framework that will assist social workers to carry out culturally competent assessments of children in need and their families. It is argued that the necessary components of a framework for practice in this area are a holistic definition of culture, an ethical approach to difference, self-awareness, an awareness of power relations, the adoption of a position of complete openness in working with difference and a sceptical approach to a commodified conception of ‘cultural knowledge’. The approach must avoid the totalisation of the ‘other’ for personal or institutional purposes. It is argued that the Furness/Gilligan Framework (2010) reflects these concerns and could be easily adapted to assist with assessments in this area.

Key words: assessment; children in need; children and families; culture; cultural competence
Introduction

The purpose of this paper is to critically analyse ‘cultural competence’ as a theoretical construct and to explore the need for a framework that will assist social workers to identify when aspects of culture are significant in the lives and children in need and their families. The 1989 Children Act places a legal requirement to give due consideration to a child’s religious persuasion, racial origin, and cultural and linguistic background in their care and in the provision of services (Section 22(5)). This provision established the principle that understanding a child’s cultural background must underscore all work with children. However, there has been a longstanding concern that services to children are failing to be culturally sensitive. Concern over the disproportionate number of ‘children in need’ from ethnic minorities led to their specific mention in The Government’s Objective for Children’s Social Services, which states that “the needs of black and ethnic minority children and families must be identified and met through services which are culturally sensitive” (Department of Health, 1999a: para 16). Government policy documents increasingly recognise the multicultural reality of Britain. Yet, government assessment guidance provides practitioners with little assistance in terms of establishing ways in which cultural beliefs and practices influence family life.

Social work has acknowledged the need to respond respectfully and effectively to people of all cultures, ethnic backgrounds, religions, social classes and other diversity factors in a manner that values the worth of individuals, families and communities and protects and preserves the dignity of each (BASW, 2009). There are many indications that culture is significant in determining the ways in which some people interpret events, resolve dilemmas, make decisions and view themselves, their own and others’ actions and how they respond to these (Gilligan, 2009; Hunt, 2005). Practitioners may not, therefore, be able to engage with service users or to facilitate appropriate interventions if they take too little account of these aspects of people’s lives or consider them on the basis of inaccurate, ill-informed or stereotyped ‘knowledge’ (Gilligan, 2009; Hodge et al., 2006).

Culturally competent practice is so fundamental to assessments of children in need that one might expect a well developed literature on the subject. This would act as a robust knowledge base to underpin excellence in service delivery. Thompson (2006, p. 82) admits, “there is a danger that assessment will be based on dominant white norms without adequate attention being paid to cultural differences. Failure to take such differences into account will not only distort, and thereby invalidate, the basis of the assessment but will serve to alienate clients by devaluing their culture.” However, the literature in this area is surprisingly sparse. Almost two decades ago it was described as a “void of published information” (Lynch and Hanson, 1992, p. xvii) and Welbourne (2002) argues that progress is still slow. Boushel (2000) argues that despite the government’s stated concern to know more about the impact of ‘race’ and ethnicity on child welfare, the limited extent to which research reflects the experience and needs of culturally diverse children fails to support a true evidence base for policy or practice. There is evidence that aspects of culture can all too easily be underestimated, overlooked or ignored, sometimes with extremely serious consequences (Laming, 2003; Gilligan, 2008; O’Hagan, 2001). Many mainstream childcare and child protection texts make little reference to culture (O’Hagan, 2001). Not one of the twenty pieces of research into differing aspects of child protection work considered in Messages From Research (Dartington, 1995) explore the cultural aspects of any of the cases dealt with.

There is now a growing body of literature written for health and social care professionals about the importance of developing and incorporating cultural sensitivity and awareness in their work with others (Campinha-Bacote, 1994; CHYPERLINK “http://bjsw.oxfordjournals.org/cgi/content/full/bcp159v2?maxtoshow=&hits=10&RESULTFORMAT=&fulltext=social+work+religion+and+belief&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT#BCP159C4?andHYPERLINK “http://bjsw.oxfordjournals.org/cgi/content/full/bcp159v2?maxtoshow=&hits=10&RESULTFORMAT=&fulltext=social+work+religion+and+belief&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT#BCP159C4?a HYPERLINK “http://bjsw.oxfordjournals.org/cgi/content/full/bcp159v2?maxtoshow=&hits=10&RESULTFORMAT=&fulltext=social+work+religion+and+belief&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT#BCP159C4?andHYPERLINK “http://bjsw.oxfordjournals.org/cgi/content/full/bcp159v2?maxtoshow=&hits=10&RESULTFORMAT=&fulltext=social+work+religion+and+belief&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT#BCP159C4” Furman, 1999; Hodge, 2001, 2005; Moss, 2005; Gilligan and Furness, 2006; Sue, 2006; Laird, 2008). However, despite the apparent emergence of a more general recognition and acknowledgement of these issues amongst many professionals, relevant day-to-day practice remains largely dependent on individual views and attitudes (Gilligan, 2009). A Department of Health (2002) study of 40 deaths and serious injuries to children found that, “information on the ethnic background of children and carers was vague and unsophisticated in that it failed to consider features of the child’s culture, religion and race, as specified in the Children Act 1989” (Department of Health, 2002, p. 26). The failure to conceptualize accurately the cultural and social context within which minority ethnic parents are operating impacts on interventions offered, which ‘… served to reflect and reproduce existing powerlessness. . .’ (Bernard, 2001, p. 3). If, as this suggests, there is a deficit in social workers’ ability to conceptualize minority ethnic service users’ social and cultural context in assessments of children, partly accounted for by a paucity of literature in this area, the implications for practice are potentially a failure to carry out culturally competent practice for many vulnerable children.

In The Victoria Climbie Inquiry Report 2003, Lord Lamming commented that, ‘The legislative framework is sound, the gap is in the implementation’ (2003, p. 13). Report after report has expressed concern over the limited skills of social services staff when undertaking assessments and designing interventions with ethnic minority children (Batty, 2002). While many professionals acknowledge that there is a need to work in culturally sensitive ways, there is evidence that many professionals working with children and families do not always feel equipped to do so (Gilligan, 2003). Gilligan (2009) found that whilst professionals may recognise that service users’ beliefs are very important, there is little consistency in how such recognition impacts on practice. Even within his small sample, there was considerable variation in attitudes and much to suggest that actions and decisions are the product of individual choice rather than professional judgement or agency policies (Gilligan, 2009). Practitioners are able to continue with ‘culture-blind’ approaches without these being significantly challenged by agency policies or by professional cultures (Gilligan, 2009). There is a clear need to look again at what we mean by ‘cultural competence’ and to develop a framework that will assist social workers to identify when aspects of culture are significant in the lives and children in need and their families.

Defining culture

There is a clear recognition that aspects of culture are significant in the lives of children and their families and that this needs to be considered in assessment practice. In order to address the lack of understanding and ineffective practice among practitioners in this area it is necessary to provide clear definitions of ‘culture’ and ‘cultural competence’. Assessing children in need and their families is a complex task. There is evidence of considerable variation between social workers’ definitions of the essential components of ‘good enough parenting’, reflecting the variation between professionals in definition of ‘need’ (Daniel, 2000). When reviewing cases of serious injury or death, the Department of Health concluded that: “. . .areas suggested by this research as ripe for … development [include] reaching common definitions of ”being in need” or ”at risk of significant harm”’ (Department of Health, 2002). It is in this context of ambiguity that ‘culture’ must be defined. The 1989 Children Act uses the wording ‘culture’ as a statutory requirement in addressing the needs of black children, but does not offer guidance about its definition.

Culture is a highly discursive term and the object of an intensive theoretical and political dispute (Benhabib, 1999, 2002). The construction of culture as a theoretical concept has always been affected by entangled perspectives, particularly in social work (Boggs, 2004). Harrison and Turner (2010) found that participants in their study spent considerable time discussing the complex nature of culture and the difficulties in defining it. This means that when looking at the practice of cultural competence as part of assessing need and risk the scope for conceptual ambiguity is vast (Welbourne, 2002).

Eagleton (2000, p. 1) states that, “culture is said to be one of the two or three most complex words in the English language”. O’Hagan (2001) argues that culture is a complex concept, with virtually limitless parameters, which cannot be defined or explained in the two or three sentences usually allocated to them in much health and social care literature. For example, Payne (1997, p. 244) provides a rather ambiguous definition of culture: “a difficult concept. It implies a relatively unchanging, dominating collection of social values, and assumes that members of an identified group will always accept these”. It is possible to examine definitions of culture that stem from anthropology, sociology, psychology and cultural geography (O’Hagan, 2001). The anthropologist Edward Tylor (1871) formulated the most enduring definition of culture: “culture… is that complex whole which includes knowledge, beliefs, art, morals, law, custom and any other capabilities and habits acquired by man as a member of society”. The sociologist Giddens (1993: 31) says that culture “refers to the ways of life of the members of a society, or of groups, or within a society. It includes how they dress, their marriage customs and family life, their patterns of work, religious ceremonies and leisure pursuits”. O’Hagan (2001) defines culture as “the distinct way of life of the group, race, class, community or nation to which the individual belongs. It is the first and most important frame of reference from which one’s sense of identity evolves”. O’Hagan’s definition draws on anthropology and is wide enough to challenge essentialist notions of culture, yet defined enough to be meaningful. It also balances the community and individual aspects of culture. When we consider this definition of culture it can be seen that all assessment of children in need occurs within a cultural context. In fact it is perhaps better understood as taking place within a number of interacting cultural contexts, with the culture of the child at the heart of the process.

The use of the concept of ‘culture’ in developing ‘cultural competence’ and not ‘race’ has been a deliberate shift in terminology from anti-racist theorising. Anti-racist theory, with its emphasis on race, has been criticised for dichotomising ‘blackness’ and ‘whiteness’ which does not permit any differentiation in the experience of racism between different ethnic groups (Laird, 2008). The idea of racial homogeneity has been enduring but this idea must be challenged. White people and black people are not homogeneous groups (Laird, 2008). Culture is a broader term than ‘race’ or ‘ethnicity’ and can include aspects of age, gender, social status, religion, language, sexual orientation and disability (Connolly, Crichton-Hill and Ward, 2005). Using the term ‘culture’ allows for difference of attitude and experience between individuals who are part of the same ethnic or racial grouping. If one considers that culture is learned from generation to generation, it is inevitably person specific and shaped by one’s personal and societal context.

The Challenge of Cultural Competence

There are a variety of paradigms in the study of race, ethnicity and culture which are located in particular socio-historical and political contexts. ‘Cultural competence’ is just one of these and has not escaped criticism in the professional literature. Writers in social work have argued that cultural competence depoliticises race relations and promotes ‘othering’ (Pon, 2009), assumes workers themselves are from a dominant culture (Sakamoto, 2007) and is based on the flawed assumption that acquiring cultural knowledge will result in competent practice (Dean, 2001; Ben-Ari and Strier, 2010). Despite its wide acceptance, the concept remains subject to multiple, often conflicting, views. There is a need to critically analyse ‘cultural competence’ as a theoretical construct in order to make it meaningful to practitioners and to provide a basis for best practice.

Concern with racism emerged in the social work profession in the 1970s and during the 1980s major texts appeared to guide practice (Payne, 2005). The concept of ‘anti-racist’ practice emerged built on the principles that ‘race’ is a social construct that has been used to justify oppression and that it is necessary to critically examine the dynamics of power relationships that produce oppression. Anti-racist theorists have criticised advocates of cultural competence for creating an ‘exotic’ understanding of people from ethnic minorities and for not recognising practice issues of social inequality or racial discrimination (O’Hagan, 2001). Cultural competence has been presented as apolitical and has been criticised for failing to address the power struggles of history (Barn, 2007). Key issues of power are absent from much of the analytical thinking around the paradigm of cultural competence (Barn, 2007). Given that the political, cultural and professional perspectives on race and ethnicity have important consequences for minority ethnic children and families, social workers need to incorporate an understanding of power relations as a key tool for subverting racism. A more sophisticated and nuanced approach is necessary, which will involve a paradigm shift from essentialist notions of race which view culture in rigid and inflexible ways to one in which cultural sensitivity is understood within the context of power relations (Barn, 2007). It is important to widen the debate beyond ‘black’ and ‘white’, to recognise that racial, ethnic and cultural groups are not homogenous, but to not abandon the challenging of racism and other forms of oppression.

Culturally competent practice needs to take account of the tensions between different cultural norms and values within the UK, not only between ethnically and culturally distinct groups of people. Social work norms and values may not be those of the majority of Europeans, or even of the ‘mainstream’ white UK population, as the case of A v UK demonstrates. Writers such as Olsen (1981), Korbin (1981, 1991) and Thorpe (1994) have problematised the notion of a universal standard of childcare, pointing to significant cross-cultural variability. The essence of this challenge is that standardized definitions of child abuse must be contested as they necessarily relate to culturally defined norms. Korbin HYPERLINK “http://bjsw.oxfordjournals.org/cgi/content/full/35/6/901?maxtoshow=&hits=10&RESULTFORMAT=&fulltext=how+and+when+does+athnicity+matter&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT#KORBIN-1991?(1991), in what is now a classic essay, warns against the dangers of both Eurocentric practice and overly culturally relativist practice.

On the one hand, Eurocentric practice serves only to impose one set of cultural beliefs and practices as preferable and therefore reproduce patterns of domination and oppression. In the British literature, concern has been expressed that minority families are too frequently pathologised and stereotyped, with workers over-relying on cultural explanations for their problems and utilizing a model of cultural deficit (Williams and Soyden, 2005; Chand, 2000; Ahmed, 1994). It is argued that they receive more and speedier punitive services than preventative/care services (Williams and Soyden, 2005). Lees (2002) argues from her research that there is a tendency to ‘pathologise’ behaviour that is not culturally ‘normative’, an example being negatively evaluating the act of running away from an abusive home among young black women rather than adopting passive coping strategies.

At the other extreme, Korbin notes “… extreme cultural relativism, in which all judgements of humane treatment of children are suspended in the name of cultural rights, may be used to justify a lesser standard of care for some children” (1991, p. 68). It has been suggested that cultural relativism ‘freezes the status quo’ by making standard-setting according to ‘universal’ norms impossible (Laird, 2008). Barn et al (1997) found that adoption of a position of cultural relativity through fear of being labelled as racist affected statutory provision to children and families. They found that some social workers were reluctant to intervene to protect children because they believed that abusive behaviour was sanctioned by their culture (Barn et al, 1997). The child abuse inquiry reports of Jasmine Beckford (Blom-Cooper, 1985) and Tyra Henry (Lambeth, 1987) concluded that ‘culture’ had impinged upon events leading to the deaths of these children. It was suggested that workers were too optimistic in their assessments of carers and that abusive behaviours were interpreted as aspects of culture.

Whilst these concerns turn on the recognition of aspects of cultural difference as significant in the process of assessment, it has long been noted in the social work literature that practitioners fail at the first hurdle, in as much as they do not recognise at all the importance of culture: a culture-blind approach (Dominelli, 1998; Boushol, 2000; Graham, 2002). The culture-blind approach eschews difference in its search for a universal formula. It suggests that a standard of good practice can be established which fits all. For example, Payne (1997) rejects the argument that western social work theory may be incompatible with some of the core components of other cultures and ignores the fact that it was used extensively in the processes of annihilation of various indigenous cultures (O’Hagan, 2001). Despite being consistently criticised as naive and oppressive, this approach represents a powerful paradigm within social work (Williams and Soyden, 2005; Dominelli, 1998).

Finding the balance between these concerns poses considerable difficulties for those charged with assessments of children in need (Dominelli,HYPERLINK “http://bjsw.oxfordjournals.org/cgi/content/full/35/6/901?maxtoshow=&hits=10&RESULTFORMAT=&fulltext=how+and+when+does+athnicity+matter&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT#DOMINELLI-1998A” HYPERLINK “http://bjsw.oxfordjournals.org/cgi/content/full/35/6/901?maxtoshow=&hits=10&RESULTFORMAT=&fulltext=how+and+when+does+athnicity+matter&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT#DOMINELLI-1998A”1998). What is needed is an approach to practice that can challenge normative stereotypes of ‘appropriate’ behaviour by parents or children while promoting the rights of children to safety and ‘good enough’ parenting. Brophy (2003, p. 674) states “Balancing a respect for differing styles of parenting and guarding against inappropriate inroads into lifestyles and belief systems, while also protecting children from ill-treatment, remains an exacting task. Professionals can be castigated for intervening too quickly or too slowly.” Social workers must operate with cultural sensitivity within the assessment process but at the same time recognize that at the heart of anti-oppressive practice is a commitment to the non-relative core value of human equality.

A Knowledge Based Competency?

Cultural competence as a practice response to these issues has been conceptualised in several ways. There are not one, but multiple definitions of cultural competence and it appears to be a changeable, evolving concept (Harrison and Turner, 2010). The frameworks available to assist practitioners in assessing aspects of culture are predominantly of two types: assessment models that try to aid in the collection of information and the understanding of specific service users’ strengths, needs and circumstances (Carballeira, 1996; Hodge, 2001, 2005; Hogan-Garcia, 2003; Sue, 2006) and reflective models that aim to help the practitioner to develop relevant skills and awareness in general terms (Green, 1999; Connolly, Crichton-Hill and Ward, 2005; Papadopoulos, 2006).

Assessment models of cultural competence frequently refer to the integration and transformation of knowledge about individuals and groups of people into specific standards, practices and attitudes used in appropriate cultural settings to increase the quality of services, thereby producing better outcomes (Davis and Donald, 1997). To work effectively with diversity, practitioners are expected to gain knowledge of different cultural practices and worldviews, to have a positive attitude towards cultural differences and develop cross-cultural skills (Ben-Ari, 2010). Examples of assessment models include the LIVE and LEARN Model developed by Carballeira (1996) which identifies a series of activities which practitioners need to engage in to be culturally competent: Like; Inquire; Visit; Experience; Listen; Evaluate; Acknowledge; Recommend and Negotiate. Another example is Campinha-Bacote’s (2002, pp. 182-3) ASKED model which identifies five dimensions of cultural competence: cultural Awareness; cultural Skill; cultural Knowledge; cultural Encounter; and cultural Desire. In line with this approach Sue (2006) argues that “culturally competent social work practice is defined as the service provider’s acquisition of awareness, knowledge, and skills needed to function effectively in a pluralistic democratic society” (2006: 29).

However, there is disparity in the literature as to the ‘knowledge’ that is necessary for effective culturally responsive practice. The above models adopt a cultural literacy approach in which culture specific information and practice is categorised under broad ethnic group categories (Connolly, Crichton-Hill and Ward, 2005). For example, Laird’s (2008) book “Anti-Oppressive Social Work” contains chapters entitled “communities with roots in India”, “communities with roots in the Caribbean” and “communities with roots in China”. Similarly, O’Hagan (2001) includes chapters about “Islam”, “American Indians” and “Australian Aborigines” in his book about cultural competence. Laird (2008, p. 156) states “It is only by gaining cultural knowledge, that is, learning to appreciate the variety of ways in which people with different heritages organise their lives, that practitioners from the white-majority community can gain cultural awareness. This is because cultural knowledge… offers practitioners a comparative analytical tool with which to examine cultural influences upon their own lives”.

From this approach ‘knowledge’ is seen as central to the development of cultural competence skills, which are fundamentally knowledge-based learned capacities (Ben-Ari and Strier, 2010). It is widely believed that cultural knowledge is the key to interpreting the code of cultural diversity (Ben-Ari and Strier, 2010). It is argued that without knowledge, one cannot be aware of the presence of biases in professional practices and practice could remain ethnocentric (Adams et al., 2001). There is a tendency to think that if a worker learns about a culture, what Spradley (1994) calls ‘explicit cultural knowledge’, then they will have a framework for working with that culture. Widely existing conceptions of cultural competence assume that the ‘other’ is knowable and that this knowledge is a prerequisite for being culturally competent (Ben-Ari and Strier, 2010).

A radically different stance has been suggested by Ben-Ari and Strier (2010) who examine cultural competence through the lens of Levinas (1969) theory of ‘other’. Levinas (1969) proposes that ethics precedes knowledge. He argues that our humanity is realised through the ‘wisdom of love’ and not through the ‘love of wisdom’ (the literal Greek meaning of the word ‘philosophy’). In other words, ethics precedes any objective searching after truth (Beals, 2007). Levinas’ thesis ‘ethics as first philosophy’ means that the pursuit of knowledge is but a secondary feature of a more basic ethical duty to the ‘other’. Within this framework, the main question becomes what relation to the ‘other’ is necessary in order for knowledge to be possible? He argues that the ‘other’ is not knowable and cannot be made into an object of the ‘self’, as is done by traditional philosophy. By emphasising the primacy of ethics to knowledge, Levinas creates a new framework for working across differences.

This raises fundamental questions with regard to the nature of social knowledge. Laird (2008) argues that the most critical requirement of culturally sensitive social work is to keep open the dialogue between people from different ethnic backgrounds and to ensure that each individual emerges as a unique composite of values, beliefs and aspirations. It is necessary to consider how accumulated knowledge about ‘other’ cultures has the potential to limit our openness in our encounters with people who are ‘other’ to us. Knowledge about other cultures can lead to the experience of totality: something is nothing more than what I make out of it (Ben-Ari and Strier, 2010). When we totalise the ‘other’ we reduce our understanding of it. Levinas (1987) proposes that we should aim for the experience of infinity, that is, the recognition that something is more than what we could make of it. Berlin (2002, p. 144) notes the danger of totalising people from other cultures, stating “classifying people on the basis of group membership only gives us the illusions that we are being culturally sensitive, when, in fact, we are failing to look beyond easy characterisations for the particular and specific ways this person is understanding, feeling and acting”. A knowledge based approach to cultural competency has a tendency to create overgeneralisations of cultural groups and can lead to the worker perceiving themselves as an ‘expert’ despite the likelihood of them being in a position of cultural naivety (Connolly, Crichton-Hill and Ward, 2005).

The implication of this is that culturally competent assessments must come from an ethical standpoint of openness on the part of the practitioner. O’Hagan (2001) states, “The workers need not be highly knowledgeable about the cultures of the people they serve, but they must approach culturally different people with openness and respect”. It must be recognised that thoughts, feelings and actions are influenced by external and internal variables that are cultural in origin and, as a consequence, that each individual who enters the child welfare system is unique (Connolly, Crichton-Hill and Ward, 2005). A consequence of this is that perceptions of the child welfare problem will be unique to each client or family. Understanding how the family perceives the problem enables child protection workers to work in a more culturally responsive way in developing solutions. Cooper (2001, p. 732) states “the meanings in context of a child’s injury are not ‘revealed’ through objective facts or through ‘expert’ objective assessment or diagnosis. An agreed meaning, understanding and potential for change can only be co-constructed, with the service user and their social relationships and networks, within a situated organisation and multi-agency context”. Aligning solutions with the cultural identity of the family provides the potential for family-centred responses. Cultural competence must move away from an emphasis on ‘cultural knowledge’ if it is to provide an ethical framework for working with difference.

A Matter of Reflection?

The second main type of cultural competence model is a reflective model. Reflection has been part of practice discourse for a number of decades (Schon, 1983; 1987). More recently the concept of critical reflection has taken hold (Fook, 2002). A critically reflective response challenges the values and attitudes associated with professional conduct (Connolly, Crichton-Hill and Ward, 2005). An example of a reflective model of cultural competence is the ‘cultural-reflective model’ developed by Connolly, Crichton-Hill and Ward (2005). This model includes the processes of cultural thinking; critical reflection and reflective practice outcomes. A strength of the model is that is recognises the interaction between the ‘self’ and the ‘other’ within interactions between people of different cultures.

Ben-Ari and Strier (2010) argue that the development of the concept of ‘cultural competence’ could benefit from considering the significance of ‘self’ and ‘other’ interdependence in contemporary debates on cultural diversity. They analyse relations between ‘self’ and ‘other’ using Levinas’ theory of ‘other’ and explore the ways in which these relations play a pivotal role in working with differences. A person’s definition of the ‘other’ is part of what defines the ‘self’ (Levinas, 1969). The idea that the ‘self’ requires the ‘other’ to define itself has been expressed by many writers (Brown, 1995; Riggins, 1997; Gillespie, 2007). It has been recognised that the concept of ‘otherness’ is integral to the understanding of identities as people construct roles for themselves in relation to an ‘other’.

The implication of this is that that all cross-cultural encounters between social workers and service users bring into play not only the heritage of the service user, but also that of the practitioner (Laird, 2008). Connolly, Crichton-Hill and Ward (2005, p. 59) note that “assessments of the social world are likely to say more about the perceiver than the persons under study”. Social workers need to discover and reflect upon their own value system and traditions in order to be culturally competent. Reflective models, such as Connolly, Crichton-Hill and Ward’s (2005), recognise that our cultural thinking responses are often automatic and outside of our control. It is necessary to ask where our responses and language come from (Connolly, Crichton-Hill and Ward’s, 2005). The reflective process encourages an examination of values and beliefs underpinning reactions. It involves challenging our assumptions, recognising stereotypes and recognising power and its effects. Without this it is easy to think that it is our way of being is the norm and other people who are “ethnic, idiosyncratic, culturally pe

Introduction

The essay shall explore and analyse the theoretical underpinnings and key elements of critical social work. The account shall then describe assessment in social work practice contexts and consider how critical social work theories like Marxism, Feminism, Radical Social work and Post Modernism have shaped practice. A range of values ranging from personal, professional, institutional, organisational or agency, political, religious and cultural inevitably feature and must be dealt with in practice. Over and above this lies the social justice, emancipatory agenda vehicle by anti-oppressive approaches. Empathy is required and the social worker must be in the clients’ shoes (Egan, 1998). Theoretical bases and approaches enable practitioners to cross social divides and be with the client in a supportive way in an accountable and ethical manner. Vast energy must be invested to dispel and challenge both the personal and the structural dominant forces of oppressive practices. The author shall attempt to demonstrate how theories have shaped the response approaches to service delivery and contributed to professional practice.

Critical Social Work Theoretical Frameworks

The emergence of Socialism, Marxism, Liberalism and Conservativism shaped the emerging ‘social’ professions at the turn of the twentieth century totally and reshaped the manner in which life was understood. How the social, political, economic shaped that reality became core in conceptualising reality and the way humans reacted to the world around them. In most cases socially constructed realities could be explained through the material realities if one was to look at the world through a Marxist perspective. The 1960-70s interpretation of social problems, described as ‘the rediscovery of poverty’. Marxist principles understood the world as socially divided by class, rendering some classes more susceptible to poverty than others as economically determined by having no control of the means of production. Marxist theory locates class struggle as a means of redressing this kind of socio-economic imbalance and the inequality The core elements in this phase were modes of production and power, the equality that came with the package and the desire for change, social change could only be achieved through class struggle.

The human position could thus be understood as driven and controlled by the external, in this case the poor as the oppressed group desired change. Social work’s role involves working with people’s lives, social problems centred on poverty and disadvantage and the core business involves establishing balance, social stability and social justice. Intervention without challenging social exclusion, inequality and poverty has proved to be insufficient yet traditional social work pathologised the individual.

At the early phases social work was more about maintaining public order and suppressing civil unrest and class struggle rather than getting down to the core issues of poverty alleviation and challenging the sources and reasons for the differences that affected the people. Norms of behaviour and lifestyle for the people were determined by the eligibility criteria as the beneficiary elements of philanthropic interventions more than rights driven determinants.

Radical social work emerged to instil that it was in fact a political activity. Social work should be about supporting those in need, challenging inequality and social change, not social control dealing with material realities. With radical social work emerged the community element in social work, conscious raising approach, gradual incremental change in the process and oppositional activism. As the profession developed critical social work begins to understand oppressive forces and work to reconstruct power imbalances (Thompson, 2007; Dominelli, 1988; Braye and Preston-Shoot

Radical social work had been too minimalistic and was criticised for over focussing on class and paying no attention to other forms of inequalities. Bhatti- Sinclair (2011) argues that ‘social workers remain committed to human rights, ethics and values and continuously seek a sharper understanding of how to apply theoretical concepts found in universal humanitarian principles, professional ethics and national law, policy and procedure’. (xii) Inclusivity and citizenship are the main targets in critical social work practice as opposed to viewing people as collective groups (Glaister, 2008). Anti-oppressive practice thereby pursues social justice and challenges practice discrimination and oppression bluntly. Engagement with social reality must involve critiquing of social systems and structures, and set platforms for social change and difference. The approach has an ethical commitment to social justice by exposing inequalities and challenging unequal power dynamics in society. The manner in which society functions has structures that can either oppress or liberate some social groups. As the practitioner works, there is undoubtedly the challenge of professionally compliant.

Social Work Practice Approaches

Critical social work practice at all times engages with how other people on the other social, cultural, religious divide are understood by us. Understanding diversity and how personal views and values are located must be a constant reflective professional commitment. Personal or societal perceptions are shaped over time or driven by historical and socio-political realities/environments must be understood. Where stereotypes have been shaped over time in individuals; a professional operational base must be adopted. Braye, S & Preston-Shoot, M (2003) challenge hypocritical professionalism by arguing that personal values and attitudes will always be there, the issue is that they should not affect effective service delivery. This is the heart of critical social work practice; being able to transcend the personal and being a professional.

Social work can challenge or maintain status quo and that social workers are invested with power to care and control. In the context of what shall be discussed later about assessments, Braye & Preston-Shoot (2003) state that,

‘Preparation for and review of practice requires workers to understand themselves, their relationship with and impact on others, and their strengths and weaknesses in relation to maintaining a professional role’ (2003:135).

Respect is necessary both when working with service users and fellow colleagues. As explored in Thompson’s model – PCS, Social work must explore the personal, cultural and structural dimensions of discrimination, and how these come together, and can be challenged in different ways (Dominelli, 2009). Social work must not reinforce oppression, discrimination or any inequality. Social work can reinforce patriarchal and other oppressive systems and power relations.

There are social realities that social work either challenges reinforce, statistically ethnic minority groups generally experience higher rates of unemployment, live in poorer housing, have poorer health, lower levels of academic achievement, higher rates of exclusions from schools and are over-represented in prison statistics. Families who are from black and ethnic minority groups are more likely to be referred to children’s social work services, receive support services later, and children are more likely to go into the care system. There are other forms of prejudice, inequality and discrimination which can intersect, and these can affect people in many different ways. In light of these objective realities, what could be the drivers of such realities? What ideas are generated about the social group and how could this impact on a practitioner’s judgement when dealing with an individual from BME groups.

The same applies when working with Unaccompanied Asylum Seeking Children, awareness of professional responsibility and a social justice approach when conducting an age assessment must be the practice base. The Human rights and child rights must be appropriately accorded without discrimination. Another example is that of mother blaming in a child protection cases. Feminist theory has challenged this gendered approach to problem solving where the female is mostly at the centre of the problem yet ignores the men from the social causal matrix. As a result of critical social work a shift has developed where the whole domestic environment and people must be part of the issue at hand. If all are not challenged this practice reinforces the interests of some groups over others and oppresses women.

Assessment Process

Middleton (1997) describes assessment as part of the planning agenda involving gathering and interpreting information in order to understand a person and their circumstances. It involves making judgements based on information. (Middleton, 1997:5). The process here involves respect for the individual’s values, their core identity and judgements are made without being judgemental. Selective and stereotypical considerations must be avoided, labelling and categorising people and overlooking their individuality and can allow elements of discrimination to permeate the process which must otherwise not be affected by individual values and perspectives. As argued by Clifford (1998) it is important that social workers check their individual biases and ensure that these do not affect the manner in which they undertake assessments.

In direct link with critical social work, assessments must be informed by critical theory to enhance a balanced, just and anti-oppressive assessment process. Personal views held by the social worker must not occupy any space in the assessment process for the sake of justice, fair access to services anti-discriminatory practice.

Parker and Bradley (2005) argue that a balanced approach of an assessment involves wisdom, skills, appreciation of diversity and systematically applied knowledge in direct practice. Service users must feel that they benefit from the assessment process for it to be effective (Addock, 2001) and the social worker and family members must collectively contribute to the process. This involvement enriches the process and eliminates subjective approaches to the assessment.

Social work practice and critical approaches intersect; the worker must be conscious of their personal beliefs and values and strike a responsible, ethical and professional balance in the manner the assessment and intervention is conducted and be honest and explicit with service users. (Parker & Bradley, 2005: 7). Extensive knowledge of the service user’s environmental and living systems and the wider systems that impinge on them must be key determinants in assessments (Parker & Bradley 2005:13) .Service user involvement is empowering and demonstrates citizenship and self driven responsibility as human worth.

Understanding power dynamics in assessments

Power relations inherent in the social work process must be carefully managed and ensure a balanced contributory approach whereby an exchange model would can adopted to acknowledge that the service users are experts of their situations. Service users and social workers exchange ideas, information and ways forward to make a difference and find alternative ways of approaching as collective partners (Parker & Bradley, 2005:14). In terms of skills this involves actively listening to service users being available for them, a professional and non-judgemental or non directive approach, straight and honest talk and social justice pursuit. (Parker & Bradley, 2005).

Child centred assessments must be informed by child development theories, ecological approaches, ensuring equality of opportunity, involvement of families and an interagency approach ensures collective creative interventions. When working with unaccompanied asylum seeking children for example, Culturegrams help in analysing the impact of culture in the lives of those individuals and families being assessed (Parker & Bradley, 2005:50-53). This can be very useful when working with BME groups as well as refugees and asylum seekers in a broader context. Values of the families and individuals are explored and these help shape the nature of the intervention where the individual shapes the course of the intervention as opposed to it being driven by the powerful professionals.

Multiculturalism and social work

Multiculturalism is a 21st Century challenge as citizenship recognition and integration a modern society characteristic. Critical multiculturalism suggests that social workers need to intellectually engage with the issues of difference and citizenship, in a manner that detaches practice from monoculturalist norms’ (Powell, 2001:146). Social workers are practically challenged to interrogate the value assumptions of their approach and assess principles and values they use in practice. ‘If social workers are to avoid narrative repression, they need to be capable of challenging discursive hierarchies of meaning in their practice’. (Powell, 2001:146). This becomes the reflexive component in the intervention. This involves challenging the very systems that they use and lobby for the change in structural elements that could be oppressing the very people they would be working with.

Feminist social work engages in redressing gender inequalities, this could be the mother blaming attitude that it challenges. Critical social work engages a need for awareness by practitioners, a transformation of cultural attitudes around race relations, gay rights and the relationship between sexuality, culture and power and of the need for anti-discriminatory practice (Powell, 2001:149). In order to meet the professional demands of the profession, social workers must seek guidance and close the gap between personal values and professional practice. This must make constant reference to human rights, equality, discrimination and racism (Bhatti- Sinclair, 2011). Fook (2000) argues that expert critical social workers are able to create critical knowledge which challenges and resists all forms of domination.

Anti-racist practice

Dominelli (2008) points out that anti-racist practice beyond that presented in Thompson’s (2007) PCS model by emphasising on its interactional nature. For Dominelli (2008) racism is a multidimensional form of oppression over and above discrimination Institutional and Cultural racism are structurally associated and viewed as less evil than the personal racism which society frowns upon, yet the is no better racism. If practitioners hand over responsibility of BME issues to BME staff this may be problematic as it may result in a lack of obligation by white social workers to anti-racist practice and reinforce difference. Institutional practices must be professionally compliant (Bhatti- Sinclair, 2011:128) at their own level.

Treatment of black families/children hits them every day and there are challenges that the social workers have to deal with in the face of these ingrained stereotypical views of the good white family and the bad black family. Dominelli (2008) argues that ‘challenging how white people perceive black families is only possible within positive trusting relationships. Nomadic settlers fall into the same category where as the minority ethnic groups where stereotypical assumptions exist that can influence the social work process.

To work with individuals on the autistic spectrum requires knowledge and understanding of autism. Knowledge of the condition’s characteristics, the basic understanding of the triad of impairments is necessary for use in the social work process. The individuals must not be viewed as unwilling to engage due their limited social interaction skills but must be understood and appropriate communication systems used. For example, instead of talking through an assessment; picture boards, games of their interest, familiar environments and using their preferred mode of communication would help to involve them, engage them and remove a possible stereotypical view that they cannot make decisions. If this process does not involve them, the likelihood is that anti-oppressive practice would have been failed. Good practice recognises individuality and this permeates through the social work process.

Assessment process in practice

The author’s work experience with a forty year old autistic man in Coventry stands as a unique example of the complexity of service user involvement and creativity aimed at raising the level of positive outcomes in reviewing a care plan. The only established access point for his contributions was when he was away from home, on the bus. During any travel by bus, he livened up and opened up, expressed his views about the service he was receiving and it was the best time to evaluate the support care plan, conversationally in a bus. Working around the individual’s world helped the social care provider to reach out to the very important needs that an office based assessment could not achieve. The bus environment had no powerful/powerless unequal binary dynamic in it. It was his comfort zone. Failure to recognise individual likes, obsessions and sensory issues in autistic individuals can hinders the social work process. Effective assessments can only be achievable when the service user is located at the centre of the process by use of approaches that promote social change and justice.

Challenging discrimination in practice

Children are often described as vulnerable, innocent, in need of protection and lacking experience. If not carefully approached the child may be sidelined from the assessment process and overshadowed by adult ideas. If it is around abuse in the home, it is the child’s experience and not the adult’s experience that must take precedence with the child as the expert. The Lamming Report emphasised the need to see the world ‘through the eyes of the child’. The role of the social worker in practice is to challenge discrimination, exclusion of socially excluded groups like children. Children have been looked at as subjects and the critical approach locates them as able to shape and voice. Failure to recognise children and the social worker’s relatively powerful position practitioners reinforce oppression. The critical practitioner ‘engages service users to facilitate the telling of their stories’ in the assessment process.

Law is used to counter oppressive practice and sets out operational parameters for professionals to deal with racism and be aware that discrimination is unlawful (Race relations Act 1976 & Equality Act 2006, Bhatti- Sinclair, 2011).To overcome the practice challenge, social workers have looked up to anti-racist advocates for guidance on methods and models which respond ethically, effectively and efficiently to daily challenges and dilemmas (Bhatti- Sinclair, 2011).

Training and existing regulatory bodies like the HCPC enable practice to be justice based by requiring professionalism by the workforce through compliance and guidance. The Professional capabilities Framework requires the worker to ‘Recognise and manage the impact on people of the power invested in your role’ (PCF 33) and standards of proficiency calls on the need to ‘recognise the power dynamics in relationships with service users and carers and be able to manage those dynamics appropriately’ (SoPS 2.8). Formalised assessments aid in injecting consistency Crisp et al (2005) argues that the absence of a formalised assessment framework results in subjective assessments. Professionally trained and skilled workers enhance a fair assessment. Assessments must not just look at behaviour, but also the cause of the behaviour in a holistic way in order to make correct judgements and this is achieved through service user participation in the process. Milner & Byrne, (2002) postulate that the assessment there is need for mapping before planning the assessment journey. This involves knowing the child, engaging them and drawing their strengths in order to shape appropriate support (Dominelli & Payne, 2002).

Involvement

Effective anti-racist, anti-oppressive practice must be drawn from practice intelligence, applied research and service users involvement. Empowering practice has an involvement and integration component as opposed to exclusion practice approaches by lack of appropriate language and culture awareness (Bhatti- Sinclair, 2011).Structurally, well planned and coordinated assessments and interventions involve the service user and must respond sensitively to their needs.

Awareness of our own prejudices and past experiences and ideas must be non-threatening to clients (Lindsay, 2010) .Interactive polarisation between the social worker and client can undermine social work effectiveness whereupon families and individuals are pathologised either as unreachable or resistant. Positive communication enhances the relationship building (Kaprowska 2010:5) which is the key to an accurate assessment.

Individuals with disabilities often argue that social workers’ assessments of them emphasise more on impairment and less on being seen as human, instead assessments must explore their individual abilities. In addition when working with individuals who use minority languages it can become a barrier for an accurate assessment hence the need to plan assessments for these individuals with full awareness of this key communication element in order to ensure the service user’s involvement. This could be necessitated by translators or minority language speaking social workers. Similarly, when working with the elderly, assessments must detect abilities and not reinforce ageist stereotypes, shared power and agreed direction principle.

Conclusion

The concept of critical practice locates the social worker as an active participant in a process of interpreting and understanding relationships and communication that must cut across difference. Over and above assumptions, prejudices, personal beliefs, structural frameworks; the critical practitioner must be reflexive and engaged in an empowering way whilst being aware of personal and socio-cultural origins and belief systems and challenging all forms of oppression. Appropriate skills and knowledge must be incorporated for the social work process to be effective.