Category: Free Essays

SOCIAL WORK: Contribute to care of people in a residential setting

TASK 1: Explanation of Te Tiriti o Waitangi and its application in the social services

The Treaty of Waitangi is an agreement signed between the Maori and the Crown in the year 1840. It has four principles that are being applied in the social services of today, and these are: partnership, protection, participation and permission. These principles are applied when social workers work together with the whanau and the client in the decision-making with regards to the kind of care the client needs. It is also applied when client’s cultural rights are kept safe and allowing them to practice their traditions if pleased.

These principles are applied in contributing to the care of people in a residential setting based on these following examples:

1. PROTECTION – A Maori resident who wants to keep his traditions such as removing shoes upon entering his room must be observed by the staff to show their respect of his cultural rights.

2. PARTNERSHIP – Social worker, client and whanau could organize a hui to discuss about the best alternative education courses to arrange for a Maori child who has been admitted at a CYFs residential home due to criminal offense.

3. PARTICIPATION – Client and social worker may have a regular weekly meeting to discuss about the effectiveness of being admitted in a residential home for the client. Client can work together with the social worker to develop a plan on how the activities and programs in the facility could be helpful to him.

TASK 2: Manage admission to residential care

Context/Setting

Hoani Waititi Marae

Individual/Group

Age Group

Summary of reason for admission to residential care

R.W.

teenager

R.W. is a 15 year old Maori female who has been arrested and admitted to CYFS residential care due to failure to abide by her set curfew time. R.W. was first sent to youth court due to robbery. She was sentenced to 3 months community service, required to attend Maori alternative education and was set a curfew until 7pm. However, on their latest visit to court, her grandma raised an issue to the judge that R.W. has been coming home past her curfew time in more than a few times, and when asked where she has been, she just walks straight to her room and not answer the question. She was given a police warning, but on her third offense, the police came and picked her up and set her to the residential home.

(Task 2) Placement Diary – (Student to Complete)

Student Name

Hannah Marie N. Manlangit

Workplace

Hoani Waititi Marae

Meetings and Communication (related to admission process)

Date

Notes/key points of information provided to the residents

16 Sept 2014

Nature of the alternative care placement where the client will be admitted to.

17 Sept 2014

List of recreational activities and alternative education that will be provided to the client once admitted in the residential care.

Summary of information gained to determine individual placement needs in the residence

Cultural and spiritual practices – Client is a Maori and has close relations with her whanau

which should be considered in her residential home. She should be able to have an open

communication with her whanau when needed.

Health and dietary requirements – Client needs to do karakia before meals as part of her

culture.

Support people:
Friends and family – Open communication with whanau and friends.
Government and community agencies – Client’s social worker should still be involved in the assessment process during her stay in the residential home.
High risk assessment – harm, failure to abide by set rules or run away etc.
Hobbies, activities – Client loves music and enjoys playing the piano. This can be integrated in

Her care plan and alternative education.

Notes/key points of how you managed admission in accordance with your workplace standards/ requirements

Our placement’s standards and procedures primarily focus on considering the client’s safety and well-being. Firstly, informed consent is gained before the admission process is conducted. The resident is informed of all expectations and a meeting is organized so that both parties are agreeable that the placement is appropriate.

Once a definite plan has been made and the client has agreed to be admitted in the placement, residential rules and procedures are laid down to her before she starts his stay in the facility. She is also informed of the residence programmes and resources that could help her in getting back on the right track. Resident rights and responsibilities are also discussed, as well as grievances procedures, should she not abide by the policies and procedures of the facility.

Client is also assessed before admission to allow the residential facility to obtain important and relevant information from the client sufficient for the purpose of determining individual placement and needs within the residence.

Other notes/reflections on the admission process

Admission procedures are completed in accordance with service provider standards.
Agencies will have different procedures when admitting a new resident.
The way one agency admits a resident may be very different from another agency. They may have

different protocols and procedures.

TASK 3: Contribute to planning for residential care of the resident

(Task 3) Placement Diary – (Student to complete)

Student Name

Hannah Marie N. Manlangit

Workplace

Hoani Waititi Marae

Contributions to planning for care of the resident

Date

Notes/key points of any meetings or other communication, details of actions related to planning for the care of the resident

16 Sept 2014

Social worker arranges a whanau hui with the family members, the client, her support person and a representative of the residential care to discuss about their plan of action to support the client.

17 Sept 2014

All agreed upon plans during the meeting will be written down in a minute of the meeting and sent to all parties involved in the hui by email or by post.

What factors were relevant to the planning of residential care for the resident?

Objectives for admission to the residence
Integration of the individual into the residence
Outcomes of the admission assessment
Ethical practice
Keeping information confidential
Following legislation
Encouraging self-determination
Reviewing the plan
Followed SW profession’s code of ethics
Followed agency’s code of conduct
Observed cultural practice
Service provider standards
Follow Social Work profession’s code of ethics
Follow agency’s code of conduct
Observe cultural practices

What were the essential features of the resident’s residential care plan?

Matching of the resident’s needs with the services provided by the residence
Objectives of the plan
Resources that are available to achieve the objectives of the plan
A time frame that is consistent with the use of available resources
The roles and responsibilities of people in the plan
Methods of evaluating progress

Other notes/reflections on the admission process

Before an alternative placement happens, the appropriate parties may meet several times to discuss and share relevant information, issues and needs of the client for their safety and well-being.

Legislation
Gender
Residential Rules

TASK 4: Contribute to residential care of the resident

(Task 4) Placement Diary – (Student to complete)

Student Name

Hannah Marie N. Manlangit

Workplace

Hoani Waititi Marae

Contributions to care of resident

Date

Notes/key points of any meetings or other communication, details of actions related to care of the resident

16 Sept 2014

During the whanau hui, client’s interests and hobbies will be taken in consideration to help make the alternative care stay would be beneficial to the client.

17 Sept 2014

During the stay in the alternative care, client’s cultural rights will be practiced at all times.

Outline your role and the main responsibilities you have in the residential care plan

Ensuring the safety and well-being of the resident (and other residents) as their first consideration at all

times.

The social worker has fulfilled all their allocated responsibilities in accordance with the social worker’s

role in the residential care plan.

What contact was arranged for the resident to have with their family/whanau?

Ongoing contact of the resident with their whanau throughout the period of residence is facilitated in

accordance with the plan.

Telephone
Mail
Visiting
Planned joint meetings with residential staff

What are the supervision and custodial care requirements of the resident?

Supervision and custodial care of the resident is carried out according to the plan and residential requirements:

Physical and behavioural boundaries
Legislative requirements
Health and safety management
Behavioural management

How does the residential care plan encourage self-determination of the resident, and discourage dependency on you, other social workers and the social service provider?

Part of the role of facilitation is to encourage self-determination of parties to the plan. This means encouraging all parties to the plan to fulfil their identified roles, and to take ownership of these roles. Dependency on the social worker or social service provider needs to be discouraged.

Encouraging self-determination:

Outlined agency’s objectives and appropriate legislation, backing up agencies mandate/kaupapa.
Informing client and whanau of the parameters and scope of the meeting, and allowed them to

define the best options.

Work collaboratively with the family to find a middle ground where agency mandate and whanauchoices aren’t aligning.

Discouraging dependency on social services:

Give space so the whanau can define their own possible solutions
Where possible the agency steps aside, so the family can step up.

Other notes (Reflect on the decision making process)

Social worker could give the client and whanau assistance in the best way she could but at the same time, give them options to allow them to make a decision on what they think would best suit the client’s needs.

TASK 5: Contribute to evaluation of the residential care plan

(Task 5) Placement Diary – (Student to complete)

Student Name

Hannah Marie N. Manlangit

Workplace

Hoani Waititi Marae

Contributions to evaluation of residential care plan

Date

Notes/key points related to the evaluation of the residential care plan

16 Sept 2014

Schedule a regular monitoring of the client’s progress in the residential care, for example, have the social worker visit her weekly.

17 Sept 2014

Make a care plan for the client and refer to the care plan and her progress in the residential care.

How did you assist parties to identify progress in achieving the objectives of the residential care plan?

Throughout the implementation (and at the conclusion) of the alternative care plan, progress against plan objectives needs to be determined, and documented.
Keeping an open communication with the client and asking her about how she feels about being in the residential facility. If she is happy with her stay and if she thinks if it has been helpful to her.
Encourage the whanau of the client to keep their support and assistance with the client and keeping the connection between them intact throughout the whole process.

How did you assist the parties to evaluate the safety and well-being of the resident and other residents?

The monitoring of progress also needs to specifically include monitoring of progress in terms of the safety and well being of the individual who is the subject of the placement.
Keeping in touch with the facility staff and asking for their observation on the progress and improvement of the client.
Discussing with the whanau of the client on how they think their connection with the client improved during the whole process of alternative care.

What further options (if any) were identified following a review of the resident’s care plan?

When implementation of the plan is complete, the plan needs to be reviewed. In some cases the

review will result in further options being identified. The review may also determine some different outcomes in terms of achievement of objectives and these also need to be recorded in the plan.

Plans can be reviewed as necessary: either weekly, monthly, every three months depending on

clients’ circumstances.

How did you keep all communications confidential?

Communications were kept confidential by ensuring that whanau huis are held in closed rooms with only the people who are closely involved in the case are present. I also ensured that all documents concerning the client are kept in a secured place that are only accessible to the social workers working in the client’s case and are not left lying around for people to see.

Outline the legislation that was relevant to this resident/situation, and how it impacted on your contribution to the resident’s care.

The most important legisltation applied in this process was the Privacy Act. The client’s personal information was kept safe by the residential care placement. As students, we were asked to sign a confidentiality form to ensure that we will be liable in case of information being exposed to parties not involved in the process.
Human Rights were kept in place throughout the whole process by ensuring that client’s cultural, physical, mental and spiritual rights were kept in consideration at all times. As a Maori, their tikanga were kept intact at all times and whanau involvement was highly encouraged.

Other notes (Reflect on the decision making process)

The relationship between client and social worker does not end once client is placed in a residential care. Monitoring of client progress once released from residential care is also vital and important to ensure that client does not go back to her old ways. Especially for young clients, social worker must assist the client on activities and hobbies that will help her divert her attention and not go back to her old ways and lead the straight path.

TASK 6: Application of social service theory

In this particular case, the social work theory on Working with Particular Client Groups was taken into consideration because we were dealing with a teenager. A client at this age has different needs and interests as compared to an adult client. Social worker must ensure to gain the attention and trust of the client to ensure her cooperation in the process. Gender is also taken into account, since the client is a girl, the social worker gave her residential care options that are friendly to her needs and in where she will feel safe and secure. Cultural rights were also taken note of. Client is a Maori thus, she was referred to a Maori organization to protect her tikanga and let her know more about her whakapapa. During her youth hearing the judge encouraged her to recite her pipiha to remind her of her whanangataunga and to practice their te reo which was very helpful to the client as it also encouraged her to get connected with her cultural roots.

Hannah Marie N. Manlangit13160103

Continuous professional development (CPD) A case study to examine why we need to have set criteria as to what constitutes continuous professional development.

This paper sets out a proposal to establish the means by which certain hypotheses around Social Work CPD may be tested, through primary research. It does so substantively through a limited, ‘pilot’ survey of the views of Social Workers themselves, focusing on the value and nature of their own current – and previous – CPD experience. The latter were also invited to comment on proposals for alternative frameworks for SW CPD. The objective of this process was to evolve specific lines of enquiry and areas of interest for wider research. As recent research by Doel et al. argues, ‘At an individual level there is clear evidence that professional development is highly valued, and that participating in these opportunities is more likely to increase confidence, but not for everyone.’ (Doel et al., 2008: p.563) The question is, what kind of CPD is most valued by practitioners themselves, and who determines the types of development paths they follow? Does the element of choice determine the utility of particular CPD for individual practitioners? How far does the current atmosphere of assessment and ‘managerialism’ impinge upon self-determination in professional development?

The issue of self-determination is a theme from the secondary literature which is embedded in this research. As MacDonald et al. argue, ‘…social work as an activity can be understood as an integral part of the modernist project of governance developed and institutionalised in the nineteenth and twentieth centuries…’ (MacDonald et al., 2003: p.195). Whilst this can be readily accepted, it arguably masks the dynamic of client age which government maintained, not only over social work, but other professional groups. The latter were invariably involved in some form of campaign to exert leverage on official circles for recognition in institutional terms. ‘In Britain, social work looked directly to the state for its legitimization…Accordingly, the political opportunity provided by the publication of the Kilbrandon and Seebohm Reports was seized by proponents of the professional social work project, who campaigned for the implementation of the Reports, for example through the Seebohm Implementation Action Group.’ (MacDonald et al. 2003: p.198). As this suggests, Social Work was liable to be co-opted into the social projects of the state on a utilitarian basis, with reciprocal implications for the independence of the profession. As Jordan and Jordan point out, ‘In essence, social work is not a means of implementing policy formally and directly, but of mediating the local conflicts generated by new programmes, and engaging with service users over how to fit new measures to their needs.’ They further argue that, ‘It is a waste of its potential for these tasks to treat it as a crude instrument for the imposition of government rules or the quasi-scientific application of research findings.’ (Jordan and Jordan, 2000: p.10).

What are the implications of this tension for CPD in SW? Potentially considerable, it is argued here. The debate around Social Work education has become focused on whether …‘there has been the supplanting of education by training: the sequestering of discourses of depth by those of surface: the setting aside of knowledge for skills, and the general triumph…of ‘competencies’ over the complexities of abstraction.’ (Webb, 1996: p.186)

It follows from this that the definition of ‘useful’ CPD represents a continuation of such debates through other means: another area through which to contest who exactly defines what is relevant, or ‘best’ practice, in terms of developing solutions for practitioners and service users. How far, for example, do such resources merely reflect the ideas of Lisham, that official ideas about practice ‘…tend to be externally imposed and based more on the requirements of managerial control and less on the professional responsibility to evaluate practice and policy and thereby increase their effectiveness.’ (Lisham 1999: p.4). Subsumed within this is a more subliminal question, which is, where is the space in which SW practitioners can express their views or develop dialogues about professional issues? It would appear that we now have a situation where the parameters defined by the GSSC represent the only ‘legitimate’ channels for debate.

Methodology and Research Issues

In essence the research enquiry followed two themes, one evaluative, one predictive. Within both, it was intended to elicit views without any leading or rhetorical influence, although current conditions in public sector SW may make this difficult to achieve, as will be discussed below. The specific evaluative enquiry offered practitioners the opportunity to briefly assess their own level of satisfaction with their current and previous CPD. The specific predictive proposal made was that CPD be more focused, through the establishment of an agreed range of activities, designed to augment and enhance SW practice. The overall theme of this was to explore the idea that CPD could be more relevant to SW practice, in the perception of practitioners themselves.

This proposal acknowledges the necessity for inclusion of both positivist (quantitative) and phenomenological (qualitative) elements in the enquiry. These labels are arguably less important than the characteristics they represent however. These will explored in more detail below, but it is important here to identify the positivist paradigm as supposedly value-free, and the phenomenological as (in relative terms) value bearing. Obviously, these two model absolutes represent the research ideal, and should not, in any case, be assumed to correlate with the parallel categories of objectivity and subjectivity. Research paradigms in either category would arguably rely on objectivity for their integrity and utility. It is here that the design and operation of a particular model will attract the most stringent scrutiny, especially from its assessors or counter-theorists. Also, when ascribing the different paradigm labels to particular research strands and evidence, it is perhaps important to consider Collis and Hussey’s idea of an unavoidable symbiosis between the two. ‘Although we have identified two main paradigms, it is best to regard them as the two extremes of a continuum. As you move along the continuum, the features and assumptions of one paradigm are gradually relaxed and replaced by those of the other paradigm.’ (Collis and Hussey 2008: p.48). In other words, the quantitative and qualitative paradigms become less discrete and more difficult to distinguish, once the process of interpretation begins. Absolute objectivity is maintained with difficulty, even in the context of an exacting statistical survey: meanwhile purely qualitative work starts to move along the continuum, as soon as repetitive patterns are sought for collateral in phenomenological terms. Various interpretations are possible in any statistical model, whilst even the clearest qualitative conclusions are arguably subject to bias, as soon as a possible conclusion begins to frame subsequent enquiries. As Patton argues, ‘A paradigm of choices rejects methodological orthodoxy in favour of methodological appropriateness as the primary criterion for judging methodological quality.’ (Patton 1990: pp.38-39).

In terms of this study, the methodological issues are basically two-fold. In the first instance, we have a very small sample of data in proportion to the overall scale of what is potentially a national issue. The sample employed here was obtained from one area, and so is immediately vulnerable to the charge that it fails to analyse possible regional variations in both strategy and best practice. Although it reflects differentiated levels of satisfaction with the CPD process, it does not incorporate the views of those who might express – with varying objectivity – the most exacting critiques: i.e., those who have left the profession due to dissatisfaction with the career structure, or CPD possibilities. In the second instance, we have three discrete form of data to integrate, i.e. binary yes/no questionnaire responses, written answers, and more in-depth, qualitative interviews, as well as information from secondary sources. The necessary fusion of these sources in a cogent form inevitably becomes an editorial process, vulnerable to charges of subjectivity and bias. This is arguably what Ely refers to as the ‘teasing out’ what is considered the ‘essential meaning’ of the data obtained. (Ely, 1991,p.140). (Quoted in Wright et al 1995). This, arguably, is especially pertinent because we are researching a matter of public policy, where positivist data tends to be adapted to value judgements by governments, and governing bodies. As Denzin and Lincoln point out, ‘Qualitative research is inherently multi-method in focus…However, the use of multiple methods…reflects an attempt to secure an in-depth understanding of the phenomenon in question. Objective reality can never be captured. We know a thing only through its representations.’ (Denzin and Lincoln, 2005: p.5).

In term of representation, the specific enquiries made here are designed to produce data at micro level, although their collective implications may have a meso function in terms of the local negotiation of control over CPD standards and access. Only a numerically wider and more varied study could produce data which might function at macro level. However, the eventual connection between micro and macro is implicitly accepted here: as Strauss and Corbin point out, ‘…the distinction between micro and macro is an artificial one.’ (Strauss and Corbin, 1998: p.185). The point is though that this limited sample cannot establish such tautology in absolute terms, only suggest ways in which it may be researched further.

To these two empirical issues may be added more complex ethical issues around confidentiality and contractual obligation. To employ the current parlance of Human Resources Management, all employees have a ‘psychological contract’ with their management, wherein informally agreed tenets of ‘fairness’ operate. As Williams indicates. ‘..this interpersonal aspect to fairness reminds us that there is a social basis to the exchange relationship between employer and employee and we might expect this to be part of the psychological contract.’ (Williams, 1998: p.183). It has to be conceded that any debate engendered around CPD has the potential to impinge upon the either side of the psychological contract, a fact which may influence and limit the format of questions.

30 brief questionnaires were sent out, of which 22 were returned: three of these respondents agreed to be interviewed, and the same interview pro-forma was employed in each context. There were 14 female respondents and 8 male: in keeping with contemporary guidelines, age was not elicited. The criteria for subject selection was that the respondent should be an established practitioner, i.e. have at least two years service, but no managerial responsibilities. The interviewees were invited to participate and the customary protocols followed in terms of permission to use the material, based on anonymity and the right to withold use of the material.

Analysis and Findings

The mode of analysis employed was substantially one of triangulation. The binary responses were tallied and are expressed as percentages. In Question 4 the written responses were sorted into those supportive, unsupportive and uncomitted with regard to the proposal (of an agreed ten-part choice of CPD activities). Based on this polarisation, qualitiative responses were then taken from the interview transcripts to illustrate and expand upon the themes identified.

22.75 per cent of respondents agreed that 90 hours of CPD was sufficient for SW’s over a three year period: 18.2 per cent thought it insufficient, whilst a majority, 59.15 per cent thought the whole idea of a prescribed amount of hours too arbitrary. 18.2 per cent considered that the current SW guidelines were effective, with an equal amount disagreeing with this proposition. A majority – 63.7 per cent expressed the view that some kind of change was necessary. Only 13.65 per cent of respondents thought that the CPD options available to them personally had been sufficient for their needs as a practitioner. 27.3 per cent meanwhile thought such resources had been insufficient. 22.75 per cent thought the available CPD had at least been consistent, whilst 36.4% disagreed with this idea.

The written responses still produced a fairly polarised set of information. 35 per cent of those who answered supported the idea of being able to select their own CPD activities from a ten choice range. Of the latter, a majority gave some kind of indication that they saw within such a development the opportunity for gaining more control over their own professional development. This was evident from responses such as ‘Yes, great idea, assuming practitioners are involved in drawing it up’, and ‘Yes, perfect. If we get to choose what’s on the list, otherwise its just another form of management control, and we already have too much of that.’ (Appendix 3). Interestingly, the same concern underpinned the rationale of the 55 per cent who did not support the idea. As one respondent put it, ‘I don’t think it could work because CPD is all about standardisation, this idea involves too much individual choice for the ‘powers that be’ to accept it.’ This was expressed more directly in the views of another, who remarked that No. CPD just ticks a management box, it doesn’t really help me, so I don’t want four or ten or whatever it is boxes to tick.’ (Appendix 3). The 10 per cent who were uncommitted raised concerns about relevance and the numbers of available options. (Appendix 3)

The twenty two tallied responses to Question 5, about practitioners preferences for CPD areas, produced an overwhelming choice for a specific vocational focus in the form of Multi Agency Working, at 36.4 per cent. All of the nine other activities suggested scored 9.1 and 4.5 per cent respectively. (Appendix 3)

As might be expected, the interview questions produced the most detailed qualitative data. When asked to evaluate the personal importance of CPD for them, two respondents identified pressure of work rather than management imposition as the main impediment to their pursuing more professional development. The first respondent stated that it was

‘Very Important. I know I don’t spend enough time doing it very often, but that’s just the nature of the job at the moment, where we are all running to stand still. It’s very difficult to commit a worthwhile timetable of CPD when you know for a fact that you won’t actually do half of it, due to unforeseen commitments.’ . The second respondent meanwhile acknowledged that it was ‘…Not as important as it probably should be. It’s a box I know I should tick, but in a department where we can’t even recruit at the moment, it’s not a priority. Sorry.’ (Appendix 5). The third respondent explained their lack of commitment to CPD in terms of their lack of control over it: ‘I know it’s vital, but who is it for exactly? If it’s just stuff they think I should be doing, rather than what I want to do, then I could well live without it.’ (Appendix 5).

In terms of the specific proposal, i.e. that of providing practitioners with a framework of choice for CPD, the responses were varied. Respondent 1 replied, ‘I can’t think of ten….for me personally at the moment, it would be team-building, and risk assessment, plus maybe multi-agency working.’ (Appendix 5). Respondent 2 indicated ‘Communication, risk assessment, leadership, policy development’ as their preferred foci. Respondent 3 indicated interest in ‘IT skills, communication, multi-agency working, risk assessment’, adding that ‘….the list is endless!’ (Appendix 5)

Provisional Conclusions

Concerns about who would take responsibility for more liberal and diffuse CPD should be noted here, as in the response , ‘Who would supervise it? I’ll bet it would just be an extra job dumped on somebody like me.’ (Appendix 3) Such objections reflect trends in management which have already been highlighted in the related literature. As Watson points out, ‘The drive for local and central government to modernise and become more accountable has led to a rise in responsibilities of managers for performance management and transparency in decision making.’ (Watson, 2008: p.330)

The extent of interest in multi-agency working as a useful area for practitioner CPD, is something which has already been noted in the related literature. As Farmakopoulou has indicated, ‘The main inter-organizational inhibitory factors were related to structural difficulties and lack of joint training. Education and social work departments embody different statutory responsibilities…’ (Farmakopoulou 2002: p.1064). Whilst this specific point is obviously vocationally limited, a wider one about inter-professional cooperation may arguably be abstracted from it.

In terms of generalisability, it has to be acknowledged that this research and its findings is vulnerable to usual charges of subjectivity which may be levelled at triangulation. As Denzin and Lincoln concede, ‘Triangulation is the simultaneous display of multiple, refracted realities. Each of the metaphors “works” to create simultaneity rather than the sequential or linear. Readers and audiences are then invited to explore competing visions of the context, to become immersed in and merge with new realities to comprehend.’ (Denzin and Lincoln 2005: p.6).

However, in terms of putative research questions, enough areas of potential interest have arguably been identified to warrant further investigation. Themes would be…

Involve a larger cohort of respondents.
Involve local management as respondents, to obtain views from both sides of the ‘psychological contract’.
Involve the GSCC on their views about possible change.
APPENDIX ONE:

Questionnaire. Are you male ….. female…..

For each question, please indicate the statement with which you agree most by ticking it.

Question 1.

a. 90 hours CPD is sufficient for a SW Practitioner over three years.

b. 90 hours CPD is insufficient for a SW Practitioner over three years.

c. 90 hours is far too arbitrary an amount of CPD for a SW practitioner: it should be varied for individuals.

Question 2.

a. Would you agree that the current SW CPD guidelines are effective?

b. Would you disagree with the idea that the current SW CPD guidelines are effective?

c. Do you think that changes are necessary in current SW CPD?

Question 3.

a. Has the available SW CPD been sufficient for your needs as a practitioner?

b. Has the available SW CPD been insufficient for your needs as practitioner?

c. Has the available SW CPD been consistent? Inconsistent? iˆ

Question 4 : Please explain why you would support OR not support the idea of a ten-criteria list from which to select SW CPD activities?

………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

Question 5 : Which areas of professional competence would you include in a ten-criteria list?

………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

APPENDIX 2:

Tables of Questionnaire Results.

Question 1.

90 hours CPD is sufficient for a SW Practitioner over three years.

90 hours CPD is insufficient for a SW Practitioner over three years.

90 hours is far too arbitrary an amount of CPD for a SW

practitioner: it should be varied for individuals.

5

4

13

Question 2.

Would you agree that the current SW CPD guidelines are effective?

Would you disagree with the idea that the current SW CPD guidelines are effective?

Do you think that changes are necessary in current SW CPD?

4

4

14

Question 3.

Has the available SW CPD been sufficient for your needs as a practitioner?

Has the available SW CPD been insufficient for your needs as practitioner?

Has the available SW CPD been consistent?

Has the available SW CPD been inconsistent?

3

6

5

8

APPENDIX 3

Question 4 : Please explain why you would support OR not support the idea of a ten-criteria list from which to select SW CPD activities?

Why ten? It should be about relevance, not a number.
Yes I would, but only if I got to choose them, so they were relevant to my needs.
No, because it would expand what is already a drain on my time.
I don’t think it could work because CPD is all about standardisation, this idea involves too much individual choice for the ‘powers that be’ to accept it.
No: who would enforce or administer it?
Yes, although why settle on that number?
Yes, great idea, assuming practitioners are involved in drawing it up.
Yes, perfect. If we get to choose what’s on the list, otherwise its just another form of management control, and we already have too much of that.
Yes, if we can get everyone to agree on it.
No. It sounds to me like the thin end of a very large wedge which I’ll have to fit into my diary.
No. I’m still trying to catch up with my existing CPD, so I definitely don’t need any more.
No. One CPD target is enough, I wouldn’t want any more than that.
Yes, if it happens, but I can’t see it.
No. Wouldn’t this just be more ‘big brother’ stuff from the GSSC?
No. I imagine the bureaucracy the government would create around it.
No. Who would supervise it? I’ll bet it would just be an extra job dumped on somebody like me.
I like the idea in principle, but I think a smaller number of options would be more helpful.
No, because I think the current system is OK, and manageable within realistic constraints of time.
No. CPD just ticks a management box, it doesn’t really help me, so I don’t want four or ten or whatever it is boxes to tick.
Yes, its just what we need to give us more of a voice in our own professional development.

The 20 written responses obtained for Question 4, though qualitative in nature, have been sorted into three categories: supportive, unsupportive, and uncommitted.

Supportive: 35%

2.Yes I would, but only if I got to choose them, so they were relevant to my needs

6. Yes, although why settle on that number?

7. Yes, great idea, assuming practitioners are involved in drawing it up.

8. Yes, perfect. If we get to choose what’s on the list, otherwise its just another form of management control, and we already have too much of that.

9. Yes, if we can get everyone to agree on it.

13. Yes, if it happens, but I can’t see it.

20. Yes, its just what we need to give us more of a voice in our own professional development.

Unsupportive 55%

3. No, because it would expand what is already a drain on my time.

4. I don’t think it could work because CPD is all about standardisation, this idea involves too much individual choice for the ‘powers that be’ to accept it.

5. No: who would enforce or administer it?

10. No. It sounds to me like the thin end of a very large wedge which I’ll have to fit into my diary.

11. No. I’m still trying to catch up with my existing CPD, so I definitely don’t need any more.

12. No. One CPD target is enough, I wouldn’t want any more than that.

14. No. Wouldn’t this just be more ‘big brother’ stuff from the GSSC?

15. No. I imagine the bureaucracy the government would create around it.

16. No. Who would supervise it? I’ll bet it would just be an extra job dumped on somebody like me.

18. No, because I think the current system is OK, and manageable within realistic constraints of time.

19. No. CPD just ticks a management box, it doesn’t really help me, so I don’t want four or ten or whatever it is boxes to tick.

Uncommitted 10%

1.Why ten? It should be about relevance, not a number.

17. I like the idea in principle, but I think a smaller number of options would be more helpful.

Question 5 : Which areas of professional competence would you include in a ten-criteria list?

Team Building skills 2
Leadership skills. 2
Multi-Agency Working. 8
IT skills. 1
Risk Assessment. 2
Intercultural Skills. 2
Communication Skills. 1
Policy Development. 2
Strategic Development. 1
Self-Reflection: being a reflective practitioner. 1
APPENDIX 4:

Interview Pro-Forma.

Time in SW………… Current Post………

Question 1. How important is CPD to you as a Practitioner?

………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

Question 2. Would you change any aspect of current CPD practice?

………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

Question 3. What do you see as the principal issues in current SW CPD practice?

……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………….

Question 4. Could you identify some of the areas you would include in a ten-item range of activities for SW CPD?

………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

APPENDIX 5:

INTERVIEW TRANSCRIPTS.

Question 1. How important is CPD to you as a Practitioner?

Respondent One:

Very Important. I know I don’t spend enough time doing it very often, but that’s just the nature of the job at the moment, where we are all running to stand still. It’s very difficult to commit a worthwhile timetable of CPD when you know for a fact that you won’t actually do half of it, due to unforeseen commitments.

Respondent Two:

Not as important as it probably should be. It’s a box I know I should tick, but in a department where we can’t even recruit at the moment, it’s not a priority. Sorry.

Respondent Three:

I know it’s vital, but who is it for exactly? If it’s just stuff they think I should be doing, rather than what I want to do, then I could well live without it.

Question 2. Would you change any aspect of current CPD practice?

Respondent One:

Not all of it, as some of it can be very good. I would definitely give people more choice, and the group/team learning idea is a very good one.

Respondent Two:

Personally, I think it’s all about resources: I mean, I’d let people timetable for it, and relate it closely to what they needed as practitioners…but…that would cost money: money which, as far as I can see, we just don’t have at the moment.

Respondent Three:

Yep…I’d I either get rid of it….or do it properly…I can’t see either happening at the moment though.

Question 3. What do you see as the principal issues in current SW CPD practice?

Respondent One:

Time. All the time it’s an add-on, when it really needs to be a practice-centred activity which you could timetable for, and really concentrate on.

Respondent Two:

For me its all about relevance and real value. I can spend any amount of time becoming a more reflective practitioner, but that doesn’t help me if my case-load is increasing while I’m doing it.

Respondent Three:

Well, I can only comment on what they are for me….the real issue is, a lot of what I get given – or I should say, is inflicted upon me – as CPD, has very little to do with my case-load and the real problems I face. Maybe its because I’m old-school, pre-graduate and all that. Yes it’s all very interesting, but, well, I’m not an academic! There, I’ve said it! This is what I do, and no amount of CPD seems to change that.

Question 4. Could you identify some of the areas you would include in a ten-item range of activities for SW CPD?

Respondent One:

I can’t think of ten….for me personally at the moment, it would be team-building, and risk assessment, plus maybe multi-agency working.

Respondent Two:

Communication, risk assessment, leadership, policy development.

Respondent Three:

IT skills, communication, multi-agency working, risk assessment….the list is endless!

Bibliography

Brown, K., and Keen, S., (2004), ‘Post Qualifying Awards in Social Work (Part 1): Necessary Evil or Panacea?’ Social Work Education, vol. 23, No 1: pp.77-92.

Bryman, A., (1998), Doing Research in Organisations, London Routledge.

Bryman, A., (2007), Social Research Methods Oxford, Oxford University Press.

Bryant, A., Charmaz, K., (2007), The Sage Handbook of Grounded Theory, London, Sage Publications.

Collis, J and Hussey, R., (2003), Business Research: A practical guide for undergraduate and postgraduate students, London, Palgrave Macmillan.

Crombie I 1996 Pocket Guide to Critical Appraisal London BMJ Publication Group

Department of Health (1998) Modernising Social Services London H.M.S.O www.doh.gov.uk Accessed 19-01-2006

Department of Health, (2000), Strategy for Social Car,e H.M.S.O., London www.doh.gov.uk Accessed 01-11-2006

Denzin, N.K., and Lincoln, Y.S., (eds), (2005), The Sage Handbook of Qualitative Research, Thousand Oaks, California, Sage Publications.

Doel, M., Nelson

In order to consider how child protection policy and practice has been shaped, a definition of child protection and significant harm and abuse is required. The Department for Education (DFE, 2011) defines child protection as the action that is carried out to safeguard children who are suffering, or are likely to suffer, significant harm. Furthermore the Children Act (1989) defines harm as ill-treatment including neglect, emotional, sexual and physical abuse. Interestingly, Parton et al (2012) suggested that determinations of what should be considered child abuse are socially constructed, and are therefore reflective of the culture and values at a specific moment in time.

To begin, childhood is a status that is documented worldwide and throughout history, which sometimes sees the child as innocent ,vulnerable, a consumer, a worker alongside other household earners, a threat to society and it is a construction that changes over time and place (Prout, 2005). Historians of childhood have argued over the meaning, such as Aries (1960) cited by Veerman (1992, p5) stated the concept of ‘childhood’ didn’t exist before the seventeenth century; therefore children were mini adults with the same rights, duties and skills. This idea was supported by the poor law (1601) which was a formalised system of training children in trades to contribute to society when they grew up (Bloy, 2002).

Another example came from Locke (1632-1734) and the ‘Tabula Rasa’ model. This proposes that children were morally neutral and were the products of their parents (Horner, 2012). The nineteenth century showed it was the parent’s responsibility to offer love and pertinent correction, to bring out the good in their nature thus helping them to become contributing members of society. This could easily lead to blaming the parents as good or bad based on the behaviours of their child, since the child was not considered as his own agent. The 1834 Poor Law Reform Act would support Locke’s idea and children who were sent to workhouses, would participate in schooling to imprint knowledge. Although this incurred a number of scandals, for example inmates eating the rotting flesh from bones, the government’s responded by introducing sterner rules for those operating workhouses, along with regular inspections (cited by Berry 1999, p29). Fox Harding (1997) described this era as ‘laissez faire’ which was based on family privacy and minimal state intervention that allowed families lives to remain private and behind closed doors.

An alternative concept from Rousseau (1712) suggested the idea of innocence; a child was born angelic until the world influenced them. This was significant in terms of child protection with the implementation children’s charities such as Save the Children (founded in 1919). They portrayed children in a variety of adult situations and as poor victims worthy of being rescued (Macek, 2006) using contemporary ideas of childhood. Interestingly the Children and Young Person’s Act (1933) was introduced to protect the welfare of the child, including any person legally liable to have neglected them in a manner likely to cause injury to his health. Nonetheless it could be argued that the cause of injury may not have been fully understood considering caning in schools was common until 1987. However some may argue this was legalised abuse, and in direct contradiction to legislation put in place to protect children.

Moving into the twentieth century took a wide shift from the laissez faire approach and along with the concept of childhood, became the notion of state paternalism. Child protection practice was based on extensive state intervention to protect children from poor parental care (Fox Harding, 1997). These changes led to a sharing of blame with their parents for children becoming anti-social (a demon) or a great achiever (an angel) in society. The demonic model illustrated by Pifer (2000) was already seen in childhood construction but blamed society, not the child, when as Rousseau noted “is the romantic discourse that becomes tainted with the corrupt outside world”. These historical concepts still dictated that children should be seen and not heard and every aspect of the child’s life should be determined by their parents or guardians. Although the shift is evident, it could be argued that the laissez faire and paternalist perspective shared a common view of children having limited capacity for independence and decision making. Pollock (1983) would argue that children were not miniature adults as Aries (1960) claimed, but actually were at a significantly a lower level of development and so had distinctive needs from adults. This suggests as immature people they could make mistakes and be excused from full responsibility for their actions.

Given the current high profile debates on children, it is public outrage and moral panics in the media that frequently changes the way things are seen. The research into child deaths has prompted changes in legislation (Parton et al, 2012). Key events such as the death of Maria Coldwell (1974), led to specialist workers instead of generic workers who dealt with the elderly. They were specific to the child and encompassed the needs of the whole family. Serious case review’s in to a child’s death was undertaken as a way of discovering how the tragedy occurred, who was responsible, what professionals were involved, rationalising individual actions and learning lessons for future practice (Rose and Barnes, 2008). The public’s perception of social workers placed more pressure on the notion of identifying risk before the child died which developed many theories and models for the professional to practice.

In contrast to the numerous child deaths, the Cleveland case in 1988 evidenced the over enthusiasm of state intervention. Children were removed from their families based on an anal reflex test to diagnose sexual abuse. The inquiry recommended greater rights for parents and children and suggests the separation from families was seen as abuse itself (Ashden, 2004). This, and proceeding enquires into the deaths of children, offered dilemmas for social workers representing the most visible agencies within the child protection system, in terms of whether a child should be removed or not. This event was a major policy driver and is reflected in the Children Act 1989, where parent’s rights have been replaced with responsibility in ensuring children turn out to be good citizens of society. However it could be argued that in practice today the Cleveland event still carries stigma with parents believing their children are going to be taken into care.

Given the models of childhood outlined in previous paragraphs it is quite predictable that children appear to fit within a particular construct. However children such the murderers of Jamie Bulger in 1993 were children carrying out unthinkable, far from innocent acts. These children had a dual status; they committed a crime as an adult yet still a child in need of protection. Society wanted to look at their background to decide if watching horror movies or having divorced parents or poor discipline made them kill a little boy. The thought in the media flowed from born bad, to being made bad which is the nature nurture debate. Moral panic through media fed into this case and although historically the view had been to protect children, society shifted to the concept of demonising children, newspaper headlines branding them as wicked and evil (Bracchi, 2010). It is interesting that throughout history, legislation was implemented to protect children yet it conflicts with criminal law, as it does not recognise them as children over ten years of age (Molan, 2008). It could be argued that criminal law agrees with Aries and children are mini adults, yet social workers guidance refers to children up to the age of seventeen. One could question how professionals can work in a multiagency way when conflicting legislation cannot agree what age a child is.

Further spotlight cases such as Victoria Climbie (2003) highlighted failings of multi-agency workers (Lamming 2003) and facilitated to shape the next change in legislation. The Every Child Matters green paper which outlined five outcomes to be achieved by all children was enshrined in law as part of The Children’s Act (2004). These were defined as, stay safe, be healthy, enjoy and achieve, achieve economic wellbeing, and make a positive contribution (Knowles, 2006) which gave professionals direction on the minimum requirements for every child, and allowed social workers to intervene to meet these needs in child protection practice. Nonetheless, the coalition government in 2010 abolished this agenda (McDermid, 2012) suggesting that families are not as important, even though it has underpinned social work practice for a number of years.

Nevertheless child deaths continued to be a growing problem, the Baby Peter case (2008) indicated that individuals are failing children and again multi-agency communication is poor in assessing risk. Another case that followed approximately a year later was the Edlington boys (2009) who tortured two young boys. Society then blamed foster placements and care systems suggesting they do not work and foster placements are as bad as the families they were removed from. Cases such as these developed blame culture, where children were perceived as being failed by the government workers; usually the social workers less often the police and the politicians (Community Care, 2012). The public outcry and criticisms of social services which followed high profile cases of child abuse make social workers practice to err on the side of caution. This suggests the romantic concept of childhood (i.e. protection of innocence), came to the forefront and children were seen as vulnerable and in need of protection. It appears that each disaster that happens the social construct of children changes.

Indeed, researchers into twenty-first century childhood such as Sue Palmer (2006) refers to a ‘Toxic Childhood’ which is the harm society is causing to children through a competitive, consumer driven, screen-based lifestyle. The media and internet evidence how much it has made it possible for children to consider adult ideas and behaviours, alcohol, sexual activity, drug use and teenage violence that show that distinctions between adulthood and childhood are fading. Nevertheless it could be debated that contradictory attitudes remain commonplace with children being constructed as innocent little angels and little devils, innately capable of the most awful types of crime until the adults in society influenced them.

Despite these criticisms the families that children live in are also judged to be secretive and deliberate abusers. As a result children may grow into poor citizens due to not being protected from their families. There is a notion of good families and bad families and very often poor families are classed as poor parents and certain constructions take place without the family even being assessed. To exemplify Tucks (2002) identified a connection between all forms of abuse and social deprivation, but a possible explanation for this is that perpetrators target vulnerable children or women to secure access to children; socially deprived neighbourhoods are characterised by relatively large numbers of lone parents. Through the pressures of their circumstances and in family crisis, parents had become caught up in a child protection system that was more attuned to assessing risk than to bringing out the best in parents struggling in adversity (DoH, 1995).

Moreover Owen and Pritchard (1993) identified the difficulties in classifying ‘at risk’ in terms of the criteria for assessing the levels of risk and what constitutes abuse. The role of professionals holding varying opinions and attitudes towards what constitutes abuse and risk could be argued that this in itself reduces the identification of risk to a child. Nonetheless professionals are still expected to protect children by the Children Act 1989 which outlines ‘significant harm’, but is very ambiguous and there is broad scope for authorities to further define what constitutes a child in need (Brandon et al 1999). The Munro report (2011) on Child Protection agrees that social work involves working with this uncertainty and not able to see what goes on in families which suggests little shift . The defensive practice comes from workers who are expected to manage this uncertainty and the issue is that evidence of abuse and neglect is not clearly labelled.

Since the implementation of the Children Act 1989 more emphasis was placed on the child’s rights but has become very controversial. The idea of protecting children and giving them rights may become problematic for adults in terms of taking children’s rights seriously. This could be that children have been under-represented in social theory and policy for many years). It could also be, that adults may be reluctant to relinquish power to the children because they still assume they know what is best for children as the early historians suggest. Franklin (2002) suggests a conflict between adult’s rights and children’s rights could offer explanations for ‘demonization’ of children. Another idea could be that giving children rights takes away a child’s ‘childhood’. This may have been viewed from the idealistic construction of childhood as a time of innocence where they consider that children should not be concerned with important decision-making and responsibility.

To further support children’s rights, the children Act 2004 updated the legislation to include the abolishment of physical punishment (NSPCC, 2012). However, Owen and Pritchard’s (1983) idea of ‘cultural relativism’ whereby specific behaviours in some families is attributed to cultural practice, question the concept of what how significant harm can actually be measured. In cases of child abuse, black and ethnic minority children are therefore at a higher risk because warning signs that would otherwise have been picked up are ignored and accepted to cultural practices and norms. For instance Rogers, Hevey and Ash (1989) state that the beating of West Indian children can be viewed as traditional use of chastisement within that culture, rather than observed as physical abuse of children. Owen and Pritchard (1983) propose this aspect to ‘racist beliefs’ and stereotyping, where culture is considered deviant rather than the actions of a caregiver.

Conversely Munro (2008) considers Effective Child Protection and points out the significance on the value of relationships between families and the worker and suggests this leads to better outcomes by understanding the families and cultures. An effective assessment and intervention in child protection draws from having good interactions and in turn aids parents to disclose information and collaborate with authorities. It could be argued if a worker does not believe in certain cultural practices that children could become at risk when maybe they are not.

Another point to consider is the risk posed by professionals that work with children; previously society has created an assumption that the rich, social workers, teachers and other professionals that work in child focused roles follow the legislation on protecting our children from significant harm. Yet through the power of trust professionals appear to abuse ‘safe’ spaces designed for children. For example the police report in to the murder of Jessica Chapman and Holly Wells by the school caretaker in 2002, identified ‘significant failings with regard to police vetting procedures’ (HMIC, 2004). The Sexual Offences Act 2003 which included offences of grooming and abusing positions of trust was incorporated with a vetting and barring system to adults working with children and introduced into the safeguarding vulnerable groups Act 2006 (NSPCC, 2012).

Equally Nursery manager Vanessa George in 2009 abused children in her setting. The review found a systemic failure in communication throughout and highlighted a common theme of assumption provided a fruitful environment in which to abuse, a point that has been proficiently highlighted by the mainstream press. The child protection policies and procedures were inadequate and rarely followed, as she feared children would be moved to other settings. The report highlighted how culture had within the nursery preventing staff from challenging George’s inappropriate behaviour.

Cases such as this called for a review of vetting adults who work with children and formed a piece of legislation, the protection of freedoms Act (2012) which focuses on roles working closely with vulnerable groups. Some children related posts such as governors and school inspectors were being removed from the lists although they require having contact with children (Kelly, 2012). Additionally supervised volunteers will no longer be classed as working in ‘regulated activity’. Therefore, individuals barred from working in ‘regulated activity’ can still volunteer at your school, as long as they are supervised. It could be argued that although the government is keen to scale back the cost of vetting, it does not take into account the risk of grooming which is not negated by supervision. Furthermore, the new process does not allow schools to check the barred list when recruiting volunteers which suggests it is providing a false sense of security for all.

A further report into child protection by Munro A child centred practice in 2011, established that a universal approach to child protection is preventing the main focus of the child. Munro recommended that the Government and local authorities should continually learn from what has happened in the past, however this could be difficult when cases such as Jamie Buglers that buried the hatchet to protect the boys. One could question what professionals can learn from such secretive cases. Additionally, it could be argued that Munro’s child centred approach offers a potential negative impact on children and professionals. For instance, if the government removes the prescriptive practice that professionals may be using as guidance, this could create the potential to miss the signs of a child being abused based on judgement alone.

Having considered this idea, future risks assessment needs to change a theoretical and practical model for possible state intervention in cases where a caregivers ability to care for a child is questioned. The British government will be pivotal to play a major role in reforming existing legislation and constructing new strong legislation to allow involvement by care services in the most high risk cases of child abuse. This request upon the government is an outcome of the philosophy of risk now prevalent in the UK, where it is assumed that the government has the ability to foresee and prevent abuse and maltreatment which holds the government when this does not happen.

In conclusion, the historical views of childhood can be seen throughout the numerous ideological discourses and demonstrate how society’s constructions of childhood can, has and will carry on to influence laws and legislation regarding the ways in which child protection is shaped. Although it is recognised that childhood warrants some degree of protective status, socioeconomic and cultural circumstances do affect young children’s behaviour and the way professionals practice. Those changed conditions also influence adult beliefs about rearing children and how protecting children should be. The emphasis on risk and assessing risk has changed over time, what was a risk in the 1980’s is very different to what is a risk today.

As outlined there are some recurrent issues such as the recognition of significant harm, taking appropriate action, effective communication and achieving an appropriate balance between supporting families and disruptive intervention to safeguard and promote children’s welfare. Nevertheless child protection has been around for a number of years and indicates that there is a correlation between legislation, society and the construct of childhood which continually mirrors each other.

Social policy is about social well-being and its policies are designed to promote this, social well-being is for everyone and it’s to ensure that everyone gets treated impartially and according to their needs. This may include areas such as housing, education and social care. According to the HM Treasury’s spending review 2010-11 the vast majority of money was spent on Welfare and Health this illustrates that these two sectors especially welfare are major factors within our society and are a priority. However some political ideology can have impact on social policy in regards to how money is spent and in what ways.

Social welfare and policy is provided by the government and social policies are developed for the public and certain groups who need them. Social welfare on the other hand is given to people who are seen to be in need and may be seen as people who need a public service. Welfare services and healthcare are the key services in social policy. Social services and the healthcare system are in place and are provided to give a service to help aid with people’s well-being. For example these include people who are going through a crisis or serious personal issues to do with their health or personal lives. Social policy is incorporated with social welfare provision; social welfare provision is about the needs of the people. The government plays a big part in social welfare because they decide on what to spend on such as housing and education. Social Policy is made by the government which are made up of party’s politicians and parties that deliberate and decide on how to manage the country and its political needs. Politically speaking Social policies work together with employees of social welfare such as social workers as well as healthcare and the law. All these organisations help to make up social policy and work on and for the state. Local Government are councillors which have been locally elected for example a local MP and also local authorities, these may include people such as school governors and members of the community health councils, these selected people work together to govern and implement what key policies are needed locally, and these are tailored policies specifically for their local communities. The local government may make decisions on housing and other local factors such as developments that may be needed and transport. The private sector is made up of businesses individuals, local and central government who purchase welfare services such as private care homes and employ carers privately to care for service users. Social workers as well as the healthcare workers are involved in social policy for the reason that they will be putting whatever is decided in social policy in practice. Central government is the political party who is elected nationally in the UK. At the last national election the conservative party were voted in with this came their own political ideology in running the country and many changes were made.

Political Ideology is a range of ideas and thoughts which can range from social wellbeing to laws being made it is also beliefs on society and social welfare. This can come from a right left wing approach of thinking politically. This affects social policy and how social policy is approached because the decisions that is made effects people’s lives. For example when new labour was elected in 1997 its approach to social policy was a mix and right and left wing perspectives. The new right perspectives to social policy consist of views such as distinguishing between the deserving and underserving poor. What is known as the deserving poor are those who are thought to deserve to receive welfare, an example of this is someone being poor through no fault of their own, while an undeserving poor is someone who may be poor due to their laziness such as not wanting to work. The title of deserving and undeserving varies from one individual to another, this is because everyone’s circumstances are different therefore it is harder to determine who is deserves to receive benefits from who does not. The new right approach suggests that the welfare system was making people depend on benefits and making them lazy. This was also referred to as the nanny state, however those who are welfare such as single parent families struggle and what is given is actually only enough to live on because benefits are accessed on what the government believes is enough for individuals to live off. David Cameron the current Prime minister stated that he wanted to “end the “culture of entitlement” and a bigger debate into welfare would be needed as the wrong signals were being sent out to unmarried and single parent families. This suggests even more cuts for those who are dependent on benefits as a way to get people off benefits and back into employment. Political ideology affects social work because these values affect practice. Ideas of political ideology shape practice and action, these actions can also influence ideas of ideologues which respond to the environmental pressures which surround them. (Marquand 1996,6.)

Marxist had the view that the welfare state was biased and favours the working class to prevent a revolution. For the modern day welfare state this couldn’t be any truer as we have seen with the conservative’s party that the biggest spending cuts have hit the poor the worst.it seems as though especially to those who are worse off, for example families who receive benefits such as tax credits etc. These are the people who are feeling the cuts the most while the rich have had far fewer cuts being made. Last year we saw that most of the changes being made were affecting the poor and working class the most, while the rich had their tax reduced. This is indeed an unfair change in regards to welfare because the changes seem to favour the rich more. The Guardian newspaper online reported that the poorest households would be hit the worst by benefits cuts, in reported government plans and the Department of Work and Pensions. It also stated that in a bid to save 3.1 billion working benefits would rise to 1% hitting the poor hardest.

The guardian online featured a letter by MP Michael Meacher who pointed out that the recent welfare benefits reports bill and its percentages on cuts leaving the rich richer by paying less percentages in tax while the unemployed receiving benefits such as the job seekers allowance were being cut. It also argued ministers had failed to realise that the 20% cut that was going to be imposed would work out as less money for people to live on. The cut was argued to be applied because it was seen to be unfair that those unemployed had had a 20% rise while the lowest paid only had a 10% pay rise. Even so those who are in less paid jobs are still financially better off than those on JSA, so again why are cuts being made to the poorest people in need. It was also pointed out that the richest that are on over ?3000 a year had their income tax cut to almost 3bn a year, also the very richest increased their income and wealth over the last year according to the Sunday Times Rich List. With cuts being made and bills rising how is people going to afford to eat and live? There is a struggle for the currently unemployed to get back in employment due to the lack of jobs. People are being pressured into either living a very poor life financially or working for wage which they may again struggle to live on and then being given a very low pension when they retire. This affects social work practice because more people will be in crisis and in a vulnerable state which may lead to intervention by professionals such as social workers being needed for well-being and support.

The cuts to social care have seen only the ones who can afford to pay for care being able to receive care. The reason for this is budgets being cut for social care leaving those without financial security in need of support. According to ADASS in their budget survey (2011) councils were reducing their budgets by 991 million. They were also reducing their spending by 169 million for support for people. The implications and consequences of these cuts are that some council will have to make cutbacks to services in order to balance out their budgets. For those who cannot afford services this can serious implications as well as on impact on social work practice because of the intervention that may be needed. It also affects social work in the sense of how it is implicated as well as using the best methods for service users. According to this survey it increases more gaps within Social Care funding. The care and Support Bill 2012 abolished the local authorities’ right to remove a person in need from their homes. The reason for this could do with the cuts being made with in social care and as a way to save money have abolished this to save funding which would otherwise be spent on giving care to service users.

The Just umbrella gives an insight into austerity the coalition and policy. The just umbrella pinpoints many actions the government at the moment and the way in which society is handled in regards to spending welfare etc. It also talks about the London riots and how they may have been an underlying factor as to why the riots took place. The riots stemmed from a man of ethnic minority who was shot and killed by the police, as a result the family wanted answers as to what happened and as to why their family member was shot. There was many speculation as to if the victim was armed or not or whether it was to do with racism. A peaceful march began by the family demanding answers which soon escalated to the riots. The riots were blamed on gang culture and people taking advantage of an unfortunate situation. However nothing of unfair treatments of people and tension between the youths and the police were addressed. The riots may have been a cry for help and that may have been the chance for many more deprived members of society to have their say. Also the riots may have been due to frustrations built up as well as other underlying social factors which were not addressed. Such as most of the people who were involved were part of less privileged communities who were worse off in terms of employment and housing. The finding s of the riot research found that over half 59% of rioters were from the 20% most deprived areas in the UK. The riots seem to have had much more of meaning than just that of the shooting of Mark Duggan. According to the Reading the riots report (2011) its findings were very interesting in regards to its contents. The study was to find out what have driven individuals in the riots and who were responsible of which came these findings of the analysis. 87% of the people who were interviewed out of 270 said that policing and tensions between the police and public were to blame because of the treatments they had from officers. This shows that policing and public frustrations were indeed key contributing factors as to why the riots happened. This combined with anger and frustrations in regards with the relationship between the police also added more fuel to the riots.

The Blackwell companion to social work, social work and politics focuses on social work and ideology and the role in which social workers have. It argues that social workers have a power struggle with family and service users and these are due to political ideology and that social service and workers are political activists. Both the Just Umbrella the Backwell companion discuss changes and the state moving away from the neo-liberal economics in regards to Labour and Margaret Thatcher’s approach to politics. Both stated that the new right approach to social policy was focused on making the welfare state in particular better in regards for what works. However Blackwell argues that this gives room for politicians to pass difficult subjects to professionals to suggest solutions. The just umbrella also comments on what is known as the Big Society and that of the effects it has on society as well as the coalition policy. According to the Cabinet Office the big society is about giving more power to the people to help improve their lives, Transferring power from Whitehills to Local Communities. While the just umbrella recognises failings in the big Society and its local ideas, Blackwell points out ideology behind this and how it affects social work practice. It aims to put the point across that social work is heavily driven by politics and ideology.” The social worker who claims to be above or beyond politics is one who has denied him or herself access to a set of conceptual tools which are directly necessary to a properly informed conduct in today’s complex world of practice”. What is exactly meant by this statement is that social workers cannot fulfil their full potential of practice without accepting they are a part of politics. Accepting this gives social workers the knowledge and power to practice effective service. This is a matter of opinion however because it takes away from the social workers individual core beliefs. If a social worker does not agree with some aspects of political ideology this does not mean they do not have the tools to properly practice social work.

Introduction

Public concern over adolescent sexual health and the resolutions to these concerns has over the past three decades generated political debate and academic inquiry the world over. At the core of adolescent sexual health is the issue of teenage pregnancy. South Africa has not been spared from the challenges teenage pregnancy presents. Inquiry into teenage pregnancy in South Africa began in the 1980s. In an effort to control the prevalence of teenage pregnancy, academics and policy makers alike have developed various strategies and policies targeting teenagers. Yet three decades later, teenage pregnancy still remains a topical issue in South Africa.

About 16 million adolescent girls between 15 and 19 years give birth each year worldwide, and 80% of these girls are found in developing countries (World Health Organisation, 2010). In South Africa, 40% of all births involve girls under the age of 19 years, and 35% of these teenagers, give birth before reaching the age of 19 years (Medical Research Council, 2009).According to the Department of Basic Education (2009), in South Africa, a total of 45,000 teenagers were pregnant in 2008, while the number increased to 49,000 in 2009.

This chapter examines literature on teenage pregnancy, and will assist in providing rationale and context for this study. This literature review will deviate from the traditional Knowledge, Attitude and Perception (KAP) literature studies that isolate individuals from social, cultural and economic contexts that influences and shape their lives. The weakness of KAP studies is that they do not acknowledge the effect of cultural, economic and societal factors on human behavior. Jewkes et al. (2001) add that KAP studies on teenage pregnancy in South Africa have mainly been descriptive and do not make an effort to account for the gap between knowledge, attitude and perception. In effort to account for these discrepancies, and come up with gaps in teenage pregnancy research, this literature review has been divided into the following two sections (i) the consequences of child bearing on teenagers, and (ii) factors contributing to teenage pregnancy.

CONSEQUENCES OF CHILDBEARING FOR TEENAGERS

The challenge of unplanned and unwanted pregnancy for a teenager has long-term consequences, not only for the mother, but for society as a whole, with far-reaching implications for economic and social development. Mpanza (2010:66) puts forward that “teenagers who drop out of school due to pregnancy never do well after they return from childbirth”, this can be attributed to divided loyalties between taking care of the child and continuation of school. Because of its usually unwanted and unplanned nature, teenage pregnancy always poses a health and social risk, a point further supported by Edgardh (2000), Genius and Genius (2004), Santelli (2000), and Petiffor et al. (2004). These studies confirm that early sexual initiation is a predictor of risky sexual behaviour and is more likely to be non-consensual, unprotected and to be subsequently regretted, resulting in unplanned and unwanted pregnancy.

While the consequences of teenage pregnancy are varied, it is important to acknowledge that teenage pregnancy is a result of a complex set of varied, but interrelated factors. An understanding of these factors will enable a better understanding of the knowledge, attitudes and perceptions of teenagers towards teenage pregnancy.

Disruption of school

Teenage pregnancy has the potential of limiting a learner’s future career prospects. For the pregnant learner, impending motherhood forces her to drop out of school as she is unable to continue studying (Macleod &Tracey, 2009). Learners are forced to leave school when their pregnancy has progressed as schools are “considerate of their state” (Bhana & Swartz, 2009). The Department of Education’s (DoE) 2007 Measures for the Prevention and Management of Learner Pregnancy “makes it possible for educators to ‘request’ learners take a leave of absence for up to two years” (Macleod & Tracey, 2009:15). Even with legislation in place, pregnant teenagers are sent away from school earlier than they should (ibid). This is probably due to the perception that pregnant learners are a bad influence to other learners.

Vagueness and ambiguity of the education guideline presents a challenge to the educators who are left to interpret it at their discretion. For instance, the document puts the responsibility of parenting firmly on the learner, and states that a “period of two years may be necessary for this purpose. No learner shall be should be re-admitted in the same year that they left school due to pregnancy” (DoE, 2007:5), educators are left to decide how long the learner stays away from school. This ruling may be in conflict with the desires of the young mother who may have sufficient support at home, which enables her to return to school earlier than expected (Bhana & Swartz, 2009).

Young fathers are also affected by pregnancy, albeit differently. It has been reported that impending fatherhood, cultural and societal expectations may force the young father to leave school and seek employment. This is conditional as it depends on whether the boy accepts responsibility or not (Shefer & Morrell, 2012; Bhana & Swartz, 2009).

However, Macleod and Tracey (2009) argue that the level of disruption caused by pregnancy on learners is debatable as learners drop out of school for various reasons of which teenage pregnancy is one. Preston-Whyte and Zondi (1992) concur with this assertion. Manzini’s (2001) study of teenage pregnancy in KwaZulu-Natal (KZN) indicates that more than 20.6% of pregnant teenagers had already dropped out of school before falling pregnant. Apart from falling pregnant, teenagers may leave school due to frustrations associated with the inexperience of teachers, who often are required to teach in areas that are not their expertise, and a lack of relevance of the curriculum and teaching materials (Human Science Research Council, 2007). Among factors within the home that led to drop-out, learners in this study cited the absence of parents at home, financial difficulties and the need to care for siblings or sick family member.

Strassburg et al. (2010) and Fleisch et al. (2010) concur with the 2007 HRSC findings and assert that the reasons teenagers drop out of school are a combination of inter-related factors. As such, Fleisch et al. (2010) note that poverty alone cannot best explain why teenagers drop out of school, because there are other factors such as academic ability of the teenager, teacher-pupil relationship, support from home and school, alcohol and drug abuse and family structure that contribute to school dropout.

Lloyd and Mensch (1995:85) summarise the various reasons why teenagers may drop out of school by stating that,

Rather than pregnancy causing girls to drop out, the lack of social and economic opportunities for girls and women and the domestic demands placed on them, coupled with the gender inequities of the education system, may result in unsatisfactory school experiences, poor academic performance, and acquiescence in or endorsement of early motherhood.

However, pregnancy ranks among the top contributors to school dropout for girls in South Africa (HRSC, 2009).

While pregnancy may not be the reason for leaving school, child care is a reason for not returning to school. Manzini (2001) indicates that young mothers, who have to take care of their babies, and find it difficult to juggle student life and being a mother, ultimately drop out. Various reasons for not returning to school have been explored, among them being a lack of a support structure, financial challenges and access to a Child Support Grant (CSG). Research in South Africa indicates that teenagers who do not have support from their families and struggle financially once the baby is born, usually dropout of school so as to provide for the baby and themselves (Bhana & Swartz, 2009). On the other hand, studies in Brazil and Guatemala indicate that girls are forced to look for jobs to supplement family income and take care of the new family member (Hallman et al., 2005).

Young mothers who have support structures in the form of parents and grandparents have an opportunity of returning to school (Grant & Hallman, 2006). Matthews et al. (2008) concur and maintain that the presence of an older female in the family enables learners to return to school, while the absence of the same forces them to look for alternative ways of making a living. This is the same with teenage fathers who have accepted responsibility and have family that is prepared to support the child (Bhana & Swartz, 2009). The return to school in South Africa is motivated by a desire for a better life. Anecdotal evidence suggests that parents of African teenage mothers usually send the teenager back to school, since she has a higher chance of fetching high bride price in the event that she gets married. In the African belief system, an educated woman is bound to fetch a higher price than that of an uneducated one (Macleod, 2009; Mkwananzi, 2011; Bhana, Swartz & Morrell, 2012). Kaufman, de Wet and Stadler (2000) concur, adding that the fact that the teenager has proven her fertility actually increases her chances of marriage in future. Interestingly, teenagers in Hlabangana’s 2012 study in Soweto (South Africa) indicated that falling pregnant before marriage decreases the bride price, as prospective grooms consider the teenage mothers as ‘used goods’. Reasons for returning to school after pregnancy may vary for both sexes, but the important part is that the teenager is back in school.

Clearly the effects of teenage pregnancy on the teenager vary for the young parents, the difference may lie in the financial circumstances of the teenagers’ family and on the part of the young father whether or not he accepts responsibility of the pregnancy. The consequences of dropping out of school for teenage girls due to pregnancy cannot be overestimated, especially in a continent where the adage ‘when you educate a woman , you educate a nation holds true (Hubbard, 2009: 223). The main thrust of the study is to understand why teenagers continue falling pregnant in the face of efforts by the South African government in trying to manage teenage pregnancy. In an effort to control and manage teenage pregnancy, the government has provided youth-friendly clinics, life skills programmes in schools and is currently on a much opposed drive to supply condoms in schools. Opposition for distributing condoms in schools comes from parents who fear that by distributing condoms in schools, teenagers are given indirect permission to indulge in sexual activities.

In light of the efforts made by the South African government and a decade of spending on teenage pregnancy management, figures still indicate that teenage pregnancy rates are on the increase nationwide. Disruption of school, as a consequence of teenage pregnancy merits scrutiny in this study, as it will enable an understanding of their perceived effect of teenage pregnancy on young girls who are pregnant.

health risks

Research on health risks associated with early childbirth in teenagers is mainly divided into two main camps. One camp argues that teenagers are at risk of health problems due to their socio-economic status. The other camp, which is scientific, argues that age at first childbirth puts young women at risk of health problems as she is not mature enough to push the baby, and this proves fatal to both mother and child. Some young mothers who have assisted births end up having obstetric complications such as hemorrhaging and damage to the womb. Macleod (2009) identifies paucity of research in South Africa in terms of health risks associated with early childbirth.

Age at first child birth contributes to a range of complications, including pregnancy-induced hypertension, anemia, obstructed and prolonged labour, low birth weight, preterm labour and delivery, perinatal and infant mortality, and maternal mortality (WHO, 2007). These complications are usually associated with the physical immaturity of teenagers, an assertion that Cameron (1996) supports and adds that limited access to health care services is another contributing factor to the range of complications. He suggests that “complications become more pronounced when the teenager decides to terminate pregnancy” (Cameroon, 1996:83).

In South Africa, the Choice on Termination of Pregnancy Act (No. 92 of 1996) allows minors under the age of 18 years to terminate a pregnancy without the consent of either parents or guardians. Manzini (2001) suggests that due to health personnel attitudes, teenagers are forced to have unsafe abortions, which may lead to death. Lack of support structure before and after termination maybe the reason for teenagers resorting to ‘self-administered terminations’ and this usually leads to irreversible damage to the womb or even death (Petiffor et al., 2005).

Sexually active young fathers face different health challenges from those of the young mother and child. Bhana and Swartz (2009) indicate that young fathers in Cape Town (South Africa), often have multiple and concurrent partners (MCP), and this puts them at great risk of contracting and spreading HIV. However, they are quick to mention that impending fatherhood for those that have accepted responsibility is cause for behaviour change. MCPs are one of the main drivers of the spread of HIV (Halperin & Epstein, 2007). Young men put themselves at risk by practicing unprotected sex with multiple partners who themselves may be part of a potentially sexual network.

Geronimus and Sanders (1992) observe that young African American women who live in conditions of poverty are more prone to problems as they are unable to access pre- and post-natal care. They note that this is different for white teenage mothers who are the bulk of teenage mothers in America. Geronimus and Sanders (1992) suggest that this may be due to the differences in economic status of the teenagers. Macleod (1999) points out that despite their socio-economic status, teenage mothers hardly ever access pre- and post-natal services. This may be due to the ‘stigma’ associated with teenage pregnancy, and may also be due to the attitudes of service providers. While studies may site negative attitudes of staff towards teenagers (Wood & Jewkes, 2003), Ehlers (2003) paints a more positive picture, arguing that youth-friendly services initiated by South Africa’s Department of Health (DoH) have made great strides in addressing the stigma attached to adolescent sexuality.

The Child Support Grant (CSG)

Social grants or assistance can best be described as non-contributory cash transfer programmes set up by the government for the under privileged, aged or vulnerable (Grosh et al., 2008). Social grants are very important as they assist in alleviating poverty, reducing the level of vulnerability of vulnerable groups in society and providing social insurance to the vulnerable groups in society (Neves et al., 2009).

The CSG was first introduced in South Africa in April 1998 as a poverty alleviation strategy for the poorest children (Parliamentary Liaison Office, 2007). Initially restricted to children under the age of seven years, it was later extended to include 14 year olds in 2003. According to Hall (2011), the CSG pay-out in 2011 was R275 per month per child.

A lot of debate surrounds the CSG and teenage pregnancy in South Africa with the media fuelling the opinion that teenagers fall pregnant to access the CSG. Popular opinion states that the CSG has led to a perverse incentive for teenagers to conceive and go on to spend the money on personal goods (Macleod, 2006). In response to the media outcry, the Department of Social Development (DSD) commissioned research into the matter in 2006. The research concluded that there was no direct relationship between CSG and teenage pregnancy (Kesho Consulting, 2006). Other research by Makiwane and Udjo (2006) concluded that there is no evidence that the CSG leads to an increase in welfare dependency in South Africa. Furthermore, during the period in which the CSG has been offered, rates of termination of pregnancy have increased (Macleod, 2009). In 1998, when the CSG was introduced, abortion rates were at 4.1%, a decade later abortion rates were at their all-time high of 8.1 %, and in 2011 they were at 6.3%. Macleod (2009) suggests that the high rate of abortion amongst teenagers, in the face of the CSG, is evidence that there is no relationship between the CSG and teenage pregnancy.

Matsidiso Nehemia Naong (2011) concurs with research that indicates that there is no link between the CSG and teenage pregnancy. In her study of three of South Africa’s provinces (Free State, Mpumalanga and Eastern Cape), Naong’s sample of 302 school principals and 225 Grade 12 learners indicated that there was no relationship between the CSG and teenage pregnancy. Instead, the study concluded that poverty, peer pressure and substance abuse contributed to teenage pregnancy. Naong concludes that teenage pregnancy and CSG are divorced and any influence between the two is negligible.

Interestingly enough, anecdotal evidence suggests that more and more teenage girls are falling pregnant in an effort to access the CSG so as to complement household earning or in some instances the CSG is the main source of income. In such cases teenage pregnancy ceases to be unplanned and becomes planned and unwanted. In a 2005 study of CSG use in KZN, Case, Hosegood and Lund (2005) showed that 12.1% of pregnant teenagers who had conceived cited the CSG as the reason. Tyali (2012) in his study of HIV and AIDS communication in Platfontein (South Africa) found that teenagers were deliberately falling pregnant so as to access the CSG, while others wanted to access the HIV and AIDS grant.

Marsh and Kau’s (2010) study of teenagers’ perceptions and understanding of teenage pregnancy, sexuality and abortion concurs with Tyali’s (2012) conclusion that teenagers deliberately fall pregnant to access the CSG. Using a population sample of 35 teenagers (24 girls and 11 boys), Marsh and Kau (2010) discovered that the CSG was perceived as means of increasing household income, by having a baby, the teenager then contributes towards the household income through access of the CSG. Interestingly, Marsh and Kau’s research population indicated that the influence or pressure to bear children in order to access the CSG came from family. On the other hand other teenagers viewed the CSG as a way of increasing the pocket money for clothes and cell phones.

On the other hand, the CSG has been credited with enabling teenager mothers to return to school. “The CSG is associated with an increase in school attendance and improved child health and nutrition. Thus, the grant can be associated with an improvement in the lives of children whose caregivers receive the CSG on their behalf” (Macleod, 2009:24).

It will be interesting to find out how teenagers perceive the relationship between the CSG and teenage pregnancy. Their attitudes regarding the grant will also be important in the formulation of a communication intervention, and eventually contribute towards efforts to manage teenage pregnancy rates.

CONTRIBUTING FACTORS TO TEENAGE PREGNANCY

The present study does not look at pregnant teenager’s knowledge, attitudes and perceptions towards teenage pregnancy; instead it focuses on non-pregnant teenagers’ knowledge attitudes and perceptions towards teenage pregnancy. Having said that, contributing factors to teenage pregnancy merit exploration as these factors will shed light on knowledge, attitudes and perceptions towards teenage pregnancy. Understanding how teenagers make meaning of teenage pregnancy through their knowledge, attitudes and skills is important in particular if this understanding is viewed through the contributory factors to teenage pregnancy.

Contributing factors to teenage pregnancy are important for this study as they will put the study in context and enable the researcher not to take the revisionist and reductionist approach towards teenage pregnancy. The reductionist and revisionist approaches to teenage pregnancy ignore other non-sexual factors that contribute to teenage pregnancy. The following contributing factors were apparent in this review of the literature and will be dealt with in the following sections:

Family Relations

Family is an important unit for socialisation as it enables the sharing of beliefs and ideals that lead to societal norms. Research indicates that family relations are an important aspect in teenage pregnancy rates. Eaton (2003) and Bhana (2004) found that teenagers with single parents were prone to risky sexual behaviour, and pregnancy compared to those with both parents. This may be attributed to issues to do with shared control and responsibility of both parents, whereas in single family parents control is vested in one parent. Family form becomes a protective condition to young people. Muchuruza (2000) concurs and puts forward that in Tanzania teenagers coming from single parent families have risky sexual behaviour and are more likely to become young parents. Where the single parent struggles to provide for the girl child, the girl is at greater risk of pregnancy as she has to look for means of survival and usually this is achieved through intergenerational relationships. The major reason why teenagers engage in intergenerational relationships with older men and women is that they see them as providers of social status symbols such as flashy cell phones and jewellery, while at the same time taking care of their basic needs. Such relationships jeopardize the health of the two people involved as the teenager is unable to negotiate for safe sex because of fear of losing their economic goals (Leclerc-Madlala, 2008). Most documented research on intergenerational relationships is between girls and ‘sugar daddies’. These ‘sugar daddies’ feel that such relationships are transactional hence there is no need for them to use protection (ibid). Such relationships leave the teenager vulnerable to HIV and AIDS, pregnancy, Sexually Transmitted Infections (STIs) and to sexual manipulation.

Bhana’s (2004) Cape Town (South Africa) study found that 66% of the teenagers reported that family norms enabled them to have people to advise them on how to live a constructive life, while 55% said that availability of family members acted as source of control for their sexual behaviour. This is evidence that family relations play an important part in the behaviour of teenagers and most importantly their sexual behaviour.

The presence of a responsible biological father encourages girls to delay their sexual debut and instils in boys a sense of sexual responsibility. Blum and Mmari (2005) point out that the presence of a male figure in a household and their attitude to sexual behaviour plays an important part in influencing teenagers’ sexual behaviour. They found that girls with father figures who were against premarital sex were less likely to engage in premarital sex and experience unplanned pregnancy, compared to those with father figures who had sexually permissive attitudes and those without fathers. In the same context, Loving’s (1993) investigation into the connection between family relationships and teenage pregnancy in Durban (South Africa), established that warm relationships between fathers and their daughters played an important role in delaying young girls’ sexual initiation.

Mfono (2008) holds the view that teenage girls whose mothers were teenage mothers themselves have a greater chance of being teenage mothers. Arai (2008) observed that in Britain and America, the daughter of a teenage mother is one and a half more likely to become a teenage mother herself than the daughter of an older mother. This, according to Hlabangana (2012) is due to the fact that these teenagers come from communities where it is ‘normal’ to be a teenage mother, since almost everyone has been or is a teenage mother. The HRSC’s 2008 study of perceptions towards teenage pregnancy in Johannesburg, Cape Town and Durban (South Africa) coincides with Hlabangana’s assertion that teenage pregnancy has been normalised. According to the respondents of the HRSC study, non-pregnant teenagers are viewed as the ‘other’, and are asked when they too will be pregnant. Such attitudes make teenage pregnancy a way of life, and teenagers themselves view teenage pregnancy as a reality that forms a part of everyday life rather than an alien occurrence (HRSC, 2008).

This cycle self-perpetuates from one generation to another until it becomes ‘acceptable and normal’ for teenagers to fall pregnant. The intergenerational cycle is a result of a lack of upward mobility; upward mobility is an individual’s ability to rise above their current social or economic position (Hlabangana, 2012). Arai (2008) considers this ‘low expectation’ on the part of teenagers, as one of the reasons that perpetuates the intergenerational cycle of teenage pregnancy. This she attributes to structural factors in deprived communities such as schools that fail to give teenagers a reason to feel entitled to anything. Knowledge, attitudes and perceptions of teenagers towards teenage pregnancy may be rooted in the ‘lack of upward mobility’ that Arai refers to.

Arai (2008) notes that in Britain, the low expectation argument for teenage pregnancy is a powerful one as evidenced by many British researchers (Garlick et al., 1993; Rosato, 1999; Selman, 1998; Smith, 1993; Wilson, 1991). She puts forward that in Britain, teenage pregnancy is very high amongst teenagers who do not have family support, come from broken homes, are raised by single parents, have difficulty with school and who come from socially disadvantaged backgrounds. According to Arai (2008), teenagers from such backgrounds have access to contraception and sexual health information, but display a deficiency in their knowledge of sexual health, proper contraceptive use, are shy to engage in sexual health communication and are wary to access services for sexual health.

In a 1999 study in Northumberland, Britain, it was discovered that teenage parents had low educational achievement and low expectations of their future prior to their parenthood Arai (2009). She notes that these teenagers went on to have low paying jobs where they had to work long hours. In another Scottish study, (Smith,1993 in Arai, 2009) observed that teenagers from deprived backgrounds were six times likely to fall pregnant and then abort than their counter parts from well to do areas. These studies, validate Arai (2009) and Hlabangana’s (2009) notion of upward mobility and entitlement for more on the part of the teenagers.

Interestingly, Rutenberg et al. (2003:5) in their study of attitudes towards HIV and AIDS and teenage pregnancy in KZN (South Africa) discovered that “for some adolescents, increasing opportunities and aspirations for education and employment, in addition to the perceived risk of HIV and pregnancy, results in many adolescents not wanting an early pregnancy”. Rutenberg et al.’s study, validates Arai’s (2008) and Hlabangana’s (2009) assertion that teenagers with a low sense of upward mobility are most likely to find themselves as teenage parents while those with a high level of upward mobility are most likely to prevent themselves from early parenthood. This study will seek to unearth these varying dynamics in an effort to understand teenagers’ attitudes towards other teenagers who fall pregnant.

economic status

Pregnancies among teenagers are related to social problems, and this is predominant in developing countries and in particular poverty stricken communities. Risky sexual behaviours among teenagers are more likely to occur in poor families and those with single families. Lack of resources forces girls to become sexually involved in an effort to get material gains (Jewkes, Morrell & Christofides, 2009). Hallman (2004) found that in South Africa low income families contributed to risky sexual behaviour among young people in both rural and urban areas. The study argues that low income accounts for girls’ decision to engage in risky sexual behaviour in trying to make ends meet. Macleod (2009) and Manzini (2009) concur with Hallman, and further add that young people from low economic statuses are most likely not to use condoms. This is attributed to lack of access to health services, reproductive health information and proper support structures from other social institutions.

Teenagers who find themselves in intergenerational relationships find themselves unable to negotiate safe sex practices in fear of jeopardising their economic goals (Panday et al., 2009; Leclerc-Madlala, 2008). Many young women not only engage in risky sexual activities to meet their basic ‘needs’ such as money, food and clothing, but also to satisfy ‘wants’ such as expensive cell phones, high-class jewellery and rides in luxury cars (Hunter, 2002; Leclerc-Madlala, 2004). Chances of teenage pregnancy become high when the teenager comes from a home without adult supervision and most likely poor economic standing. Mfono (2003) confirms these arguments stating that teenagers are at high risk of pregnancy if they come from financially disadvantaged backgrounds, or if they succumb to peer pressure to engage in sexual activities for economic gain.

On the other hand, teenage girls reject the transactional sex talk and state that they are able to make do with what is available without having to engage in intergenerational and transactional relationships with older partners. Sathiparsad and Taylor’s (2011) study of 335 girls and boys in eThekwini Secondary Schools in Durban (South Africa) revealed that girls view themselves as independent and rational thinkers. These girls suggested that they do not think that sex is synonymous with love, and assert their power as individuals by their ability to say no to unprotected sex. This is indicative of girls resisting manipulation and normative submission (ibid). For the purposes of this study, it will be interesting to find out how teenagers perceive economic status as a contributing factor to teenage pregnancy.

Gender Dynamics

The South African DoH’s Policy Guidelines for Youth and Adolescent Health (2001) locates gender considerations as fundamental to the health of young people. The policy guidelines identify sexual health and sexual exploitation, sexual abuse, gender-based violence, coercive sex and gang rapes as areas of concern that put young women in particular at risk of HIV and AIDS and teenage pregnancy.

Dunkle et al. (2004) in their study of young women attending ante-natal clinics in Soweto (South Africa) discovered that over half of the women aged between 15 and 30 years had been exposed to sexual violence. Another survey, conducted by the Planned Parenthood Association of South Africa (PPASA) in six of South Africa’s provinces, found that 20% of girls reported forced sexual encounters or were sexually assaulted (PPASA, 2003). Similarly, Vundule et al. (2001) found that 33% of girls in South Africa have their first intercourse as a result of force, including rape. Where there is unequal power distribution and lack of negotiation skills, pregnancy ceases to be a matter of choice.

Sexual violence alters the power relations in any relationship, and in most cases women are vulnerable and unable to negotiate safe sex. Teenagers may avoid negotiating contraceptive usage, in particular condoms, for fear not only of violent reactions, but also of emotional rejection, of being labelled unfaithful or HIV positive (Wood, Maforah & Jewkes, 1998). Furthermore, women attempting to use other ‘invisible’ contraceptive methods, such as the injection, may be accused by their partners of causing ‘infertility, ‘disabled babies’ and vaginal ‘

Conflict of personal and professional values

Introduction:

It has always been acknowledged that social work practice raises ethical dilemmas on a regular basis. These dilemmas occur due to a conflict of professional and personal values. Social work is involved with the support of people who have a variety of needs, with relationships within the family, with needs ascending from structural influences; such as poverty and conflicts with society. These are individually moral concerns which are integrated into the tradition of society, and are therefore laden with social values. This is where the problem lies, because the views in which are regarded as being acceptable in society, are then accepted by the mass population. They say “what ought to be the case” (Shardlow, 2003, p.3), consequently initiating the potential for conflict between individuals on bases of belief and conceptualisation. Therefore, social work will always reflect values and will often be disputed because society may not necessarily agree with the aim of social work. The following assignment will look at values at a professional and personal level, while considering the possible conflicts which could arise within practice, why this can happen and what needs to change.

The word ‘value’ means the “Principles or standards of behaviour; one’s judgement of what is important in life” (Oxford Dictionaries, 2014). Every individual has a set of beliefs which influence their actions, some are personal to us, while others are shared beliefs. Our own moral code defines what is of value to us in life and therefore, identifies part of who we are. As a social work student, we are taught to be aware of our own personal values and how they might be different to people of a different culture. Professional values are based on a code of ethics presented by the British Association of Social Workers (BASW). These are split into: human rights, social justice and professional integrity (BASW, 2012). Therefore, social workers are expected to respect all individuals and protect vulnerable people. Likewise, the Northern Ireland Social Care Council (NISCC) issued a code of practice for social care workers to abide by. These highlight standards such as; protecting the rights of service users and carers, maintain trust, promote independence, respect and accountability and responsibility (NISCC, 2002). There are also agency policies, procedures and legislation which governs the way in which a social worker must practice.

One dilemma which could prove to be conflicting for a social worker is balancing confidentiality with the duty to protect versus the right to self-determination. A central question with relation to ethics in social work is how a social worker should behave towards a client. What are the boundaries of a client-worker relationship? Let’s say for example, you are a social worker working with a female client, Miss Smyth, within a mental health facility. You have been working with Miss Smyth for three months and she has a son, aged six, who has some behaviour problems. Over the past few months, your relationship with Miss Smyth has strengthened and she now feels she can confide in you and trust you, talking to you about some of her personal problems such as; financial issues and her battle with depression. Working together, you have taught Miss Smyth different ways with which to deal with her son’s behaviour problems and from this, there have been a great deal of improvements. However, one day during your visit with her, Miss Smyth confides in you about an incident she had with her son, when he was acting out and she pushed him because she was frustrated, but this caused him to bang his head as he fell over; leaving him with a bruise. Miss Smyth pleads with you not to tell anyone, but the problem here is that the law requires you to report what has happened. You understand that Miss Smyth and her son have improved greatly and continue to make progress, however, if you report this incident, then your progress with both Miss Smyth and her son will likely be permanently affected. What do you do?

The above case highlights some of the difficulties social workers face: a dilemma of social work values. Values such as respecting the client’s right to self-determination and confidentiality, can be a complex process, since there are particular circumstances where breaching confidentiality is sanctioned by the law and professional values. For example, “…confidentiality may be breached with or without the client’s consent in order to report instances of neglect and abuse” (Saxon et al. 2006). This is a conflict of personal and professional values, referred to as an ethical dilemma. An ethical dilemma is “..a situation in which professional duties and obligations, rooted in core values, clash” (Reamer, 2006, p.4). ‘Confidentiality’ in terms of social work means “…a system of rules and norms applied to information given by clients to social workers…social workers will not divulge this information to others except in certain circumstances” (Hugman and Smith, 1995, p.67). As established, it is clear that the majority of professionals agree that it is acceptable in particular situations to break confidentiality, yet, the principles surrounding the importance of maintaining confidentiality are considered as significant in gaining the clients trust.

Jonathan Coe, chief executive of Witness, states “I don’t think anyone has got the boundaries right in all circumstances. Things will always come up and people need to be able to articulate these challenges and discuss them with supervisors and managers..”(Sale, 2007). He added “You cannot have an absolute list of do’s and don’ts when it comes to professional boundaries…you would end up with a situation where workers become so remote and distant from clients they would be unable to engage with them…” (Sale, 2007). As a result, there is no perfect solution. However, it could be highlighted that the BASW code of ethics fails to provide sufficient guidance for social workers in the day to day conflicts of values and their responsibilities.

Additionally, another conflict which could be highlighted is social work valued based practice versus core value, such as; working with sex offenders. A characteristic of social workers is personal resilience, and this is particularly fundamental for those working with sex offenders. This profession requires a practitioner to help empower people, to see an individual’s strengths and build on them. There have been many conflicting debates on the view of sex offenders, especially paedophiles. Naturally, societies view has been that paedophiles are ‘monsters’ while fuelling fear into parents over the safety of their children, with the media hyping up public speculation by releasing stories such as; “Warning over paedophiles ‘grooming’ primary school children..” (Harris, 2012). Further stories involving respected individuals within the public, shocked society with articles featuring; “Irish Catholic church child abuse: A cruel and wicked system” (McDonald, 2009). Therefore, strengthening society’s negative view of sex offenders.

However, in recent years, there has been an increasingly oppositional view of these offenders. Sarah Goode, published by Damian Thompson, in the Telegraph (2013), states “Adult sexual attraction to children is part of the continuum of human sexuality; it’s not something we can eliminate…if we can talk about this rationally…we can maybe avoid the hysteria”. Likewise, a recent television documentary: ‘The Paedophile next door’ (Channel 4, 2014) showed a rise in public debate. The documentary attempts to discover why legislation has failed to protect children from sexual abuse, and investigates drastic and controversial alternatives. Peter Saunders, founder of the National Association of People Abused in Childhood, told Metro “We have to tackle these sordid issues head on and if someone is seeking help, better we do that before they offend rather than after” (Binns, 2014). Statements like these reinforce the fact that awareness has increased and that there is more evidence in support of assistance for sex offenders to change. Therefore, viewing the offender as a person and not focussing on their offence.

As a result, there are ways in which a social worker can control the conflict of values and dominate the mixture of feelings which are triggered by these offences. These include; not labelling, recognising and validating experienced trauma, understanding attachment difficulties and understanding the pathway an individual has undergone to get where they are (Hebb, 2013). This approach can help to encourage the individual to believe that they can lead a purposeful life and achieve goals without posing a threat to others.

As a social work student, I know I will find some situations more challenging than others. My personal beliefs have been instilled into me from a young age, therefore, training to be a social worker and having to learn new values which I have to take into account will be difficult. The code of practice clearly states that all “social workers must protect the rights and promote the interests of service users and carers” (NISCC, 2002), therefore it is important to recognise that the appropriate action is to assess someone’s needs while working at a professional level. Furthermore, social workers operate from a ‘Framework for Theory and Practice’ (Dalrymple and Burke, 2006) that understands the presence of inequality and oppression that exists in society. Therefore, using this framework will help to develop the skills required within practice without causing oppression or inequality. These skills will also help to improve working relationships with multi-agency and multi-disciplinary groups. These can be applied to my practice and will strengthen my ability as a social worker. .

Conclusion:

As previously stated, social workers regularly make difficult decisions, where there is no ‘right’ or ‘wrong’ answer. This essay supports the argument that social work values, such as, client self-determination and sustaining confidentiality can create an uncertain process, causing confusing between values and process, therefore resulting in the inability to find the ‘correct’ response. A clients concerns are often complex and have many aspects, therefore, it could be suggested that the greater the knowledge and skills that a practitioner is able to develop in ethical decision making, the more effective this would be for a social worker in practice. Additionally, the foundations of good social work practice is knowing your values and principles, how you’ve learned to interact with people, your knowledge and skills learned. I have always considered myself to be an empathetic person, who listens well, does not judge others and is sensitive to the feelings of others. But, I am aware that there are still some areas I need to strengthen. For example; the ability to work with a person that has abused a child, I have always focused on the areas I would like to work and never considered being placed with a person or group of people I might struggle to accept or work with. This will be a conflict of my personal and professional values, however, through consistent training and development, I will be able to further develop in the profession of social work based on a commitment in practice to key values and principles.

Word count: 1806

Reference Section

BASW (2012) The Code of Ethics for Social Work: Statement of Principles. [pdf] BASW. Available at cdn.basw.co.uk/upload/basw_112315-7.pdf [Accessed 13 November 2014]

Binns, D., (2014) Paedophile to out himself in channel 4 documentary. Metro. [online] Available at metro.co.uk [Accessed 28 November 2014]

Dalrymple, J., and Burke, B., (2006) Anti-Oppressive Practice: Social Care and the Law. McGraw-Hill Companies, Inc.

Harris, S., (2012) Warning over paedophiles ‘grooming’ primary school children on Club Penguin and Moshi Monsters website. Daily Mail Online [online] Available at www.dailymail.co.uk [Accessed 21 November 2014]

Hebb, J., (2013) ‘Social work values are essential in my work with high risk offenders’. Community Care. [online] Available at www.communitycare.co.uk [Accessed 30 November 2014]

Hugman, R. and Smith, D. (1995) Ethical Issues in Social Work. United Kingdom: Taylor & Francis, Inc.

McDonald, H., (2009) Irish Catholic Church child abuse: ‘A cruel and wicked system’. The Guardian [online] Available at www.theguardian.com [Accessed 22 November 2014]

NISCC (2002) Codes of Practice for Social Care Workers and Employers of Social Care Workers. [pdf] NISCC. Available at www.niscc.info/files/Codes/2002Sep_NISCCCodesOfPracticeWordVersionEnglish_Publication_Approved_AFMCK.pdf [Accessed 15 November 2014]

Oxford Dictionaries: Language Matters (2014) Oxford Press. [online] Available from www.oxforddictionaries.com [Accessed 13 November 2014]

Reamer, G. F., (2006) Social Work Values and Ethics. New York: Columbia University Press.

Sale, A. U., (2007) How to maintain proper relations between practitioner and service user. Community Care. [online] Available at www.communitycare.co.uk [Accessed 30 November 2014]

Saxon, C., Jacinto, A. G., and Dziegielewski, F, S., (2006) ‘Self-Determination and Confidentiality: The Ambiguous Nature of Decision-Making in Social Work Practice’. Journal of Human Behaviour in the Social Environment, 13 (4) p. 56.

Shardlow, S., (2003) The Values of Change in Social Work. Routledge.

The Paedophile Next Door (2014) [TV programme] Channel 4, 25 November 2014 21:00

Thompson, D., (2013) Guardian: Paedophiles are ‘ordinary members of society’ who need moral support. The Telegraph [online] Available at http://blogs.telegraph.co.uk/news/damianthompson/100196502/guardian-paedophiles-are-ordinary-members-of-society-who-need-moral-support/ [Accessed 23 November 2014]

1

Basically, is a pointer to the sensitivity nature of the profession and the methods that is required to proffer acceptable and correct care service to accommodate and embrace individual’s beliefs, values and culture and of course practitioners among other things must take cognisance of individual background to facilitate anti discriminatory practice in service delivery.

When implementing prevention programs to curb any form of discriminatory attitude ,some of the cogent factors that should be considered as sub set of cultural diversity are, ethnicity, socioeconomic status, sexuality, spirituality, and some other areas. Both the internal and external parts of human life can be considered as the understanding of culture. Among diverse of lots of ways to define culture, it can be viewed from the angle of experience, values, knowledge, attitudes, skills, ideas, tastes, and techniques which are transfer from one experienced person in the community to others.

Transmitters of culture are now families both immediate and nuclear, religious group, peer groups social groups, neighbours and professional organisations. Essentially it should be noted that element of culture and diversity are numerous, some cultural experiences could be are biological related factors, like physical stature and colour of skin, whereas others could be sociological related factors, like socioeconomic status and religious connection. Based on these variables it will be wrong and illogical to draw a conclusion regarding people based on the way they appear externally.

It has become imperative for social care practitioners to be very competent cultural, apart from the fact that this could improve the service delivery standard it will help immensely to help in the quest for anti discriminatory practice in this profession. Some of the importance of this anti discriminatory practice in this regards is that it will help to facilitate a serene atmosphere whereby social workers will be able to see it as a matter of responsibility to engage in proper conduct, effective ethical services and decision making. This will enable them to be more conscious about the value base of their service users and of course it will help to maintain an ethical standard that could ultimately serve as a platform on which a professional relationship that can facilitate and improve service delivery can be attained in the long run.

Civilization according to Obama can be described as equal respect for everybody without exception and a way of living a method of living. Obama B. (2006). In a similar vein, in a speech that was delivered by M. Martin in Dublin (2001) in regards to solving the problems of cultural diversity facing the health care sector in republic of Ireland. Martin stated in his speech that, diversity gives social care practitioners the privilege to develop their knowledge, mental know-how and the understanding of the problems associated with health sector diversity from two angles of both the clients and the staffs.

He also identify awareness and sensitivity training workshop for staff as a bench mark to resolving issues related to diversity in population. He suggested that such training should be projected towards enhancement of knowledge based development and skills in other to render effective services that are sensitive to cultural disparities.

Diversity according to Thompson, (2001: 34), is a term hugely being used to lay emphasis on the disparities between people, set of group or individuals, and the fact that such disparities can be viewed as a valuable asset that can be exploited rather than a challenge to be surmounted. Such disparities if not properly managed could result to discrimination and thus oppression can take place.

Moreover, social care workers do confront with lots of difficulties and barriers in the course of engaging with the young, aged, and the physically challenged as well. Ireland as a country is fast becoming a much more multi-cultural society where people are coming from diverse cultural and ethnical background obviously people’s ideas thought and expectations based on service delivery will definitely be conflicted , but it is expected that social care practitioners will manage all these issues as a matter of cultural competency. In recent times, it is now not unusual for a practitioner to work with a black or coloured people or somebody from eastern bloc. Nor is it unusual to work with a child from an ethnic minority in residential care.

Another important of anti discriminatory practice is that it will enable practitioners to have an insight to how human life and experience is characterise by diversity and how is germane to identity formations. Diversity as it may, can be viewed from intersectionality of different dimensions, these factors consist of gender, age, colour, religion, sexual orientation, class differences, culture, sex, physically challenged, immigration status, ethnic background, political ideology and national origin.

Social workers need to understand and placed ultimate premium of the fact that as a result of individual differences, somebody somehow might have experience or suffered from exploitation, marginalisation, oppression, poverty, exclusion and stigmatisation. Understanding this fact will not only help a practitioner to manage and deliver good service but will greatly assist to be able to deal effectively in handling individual’s need individually.

According to Worman, (2005) diversity can best be described as, the disparities that exist between people that ranges from both visible and non-visible. He identifies three different types of diversity: Social diversity which includes age, race, ethnicity and gender, Value diversity such as psychological differences based on personality and attitudes and Informational diversity which includes organisational differences in education, tenure and function. Rather than seeing this as the beginning and end of one the greatest challenges been faced by this profession it should be seen as a means to an end towards achieving a better service delivery.

Perhaps, one of the possible fruits of the challenges of cultural diversity is that it could chrysalises to discrimination talking about the client and the service deliverer. According to Laird, (2008) concerns with racism first emerged in the social-work profession back in the 1970s and during the 1980s major social-work texts emerged to regulate practice (Payne, 2005: 277). Thereafter, a new Diploma was introduced as a prerequisite which include antiracism practice a core module to be part of the prospectus.

Thompson’s advanced work on the ‘PCS analysis’, (1998, 2006) refers to the personal, cultural and structural levels at which discrimination can occur, as a means of identifying and combating oppression against ethnic service users. As a result of his research Thompson would say that the combination of personal and cultural predispositions can create an ethnocentric outlook. Ethnocentrism results in judging other distinctive groups of people according to the norms of one’s own group. This of course can create more problems rather than solution that ought to be the central major target of the carer and invariably it can lead to frustration on the part of the carer.

Practically, over time it has been proven that problems that arises from discrimination in service delivery if properly addressed and managed will ultimately enhance performance and this to a large extent will help to improve the lives of the clients. Some the discriminatory acts from recent research have their source from language and culture. Ireland for instance is now a cross multicultural country whereby we have huge number of people from Africa and Eastern bloc. This factor can make or mar service delivery effectiveness depending on how is applied. As observed by Share (2009), that practitioners and service users be aware that language and cultural barriers can mar the provision of effective and meaningful social care.

Also, anti discriminatory practice can necessitate the quest for knowledge and information to improve learning. To be effective at their job, Social Care Workers need to acquire the skills in dealing with culturally different co-workers, subordinates peers and clients. Powell (2004) points out that organisation are now very conscious of the pressing need to understand and respond to demographic trends in the modern employment force. Carer need to gain an awareness and understanding of the environment around them in order to provide effective supports to service users based on individual needs. Discrimination could be as a result of inability to understand or insufficient knowledge.

In sufficiency of knowledge is as good as being ignorance or lack of awareness of the needs and choices of an individual this can lead to complications and frustration on parties. This information may include dietary requirements and religious practices, cultural differences and language barriers or personal rituals.

Thomas (1991), observed that workplace diversity transcend beyond gender and race. It cut across people lifestyle, age, sexual preference, functional speciality and geographical location. The diverse nature and the methods to manage challenges that are coming from it has become a major priority for communities and organisations generally. Wilson (1997) observed that the new workforce is the changing workforce. For instance, today’s workforce comprise of more dual family earners, an older work force, more people of colour and ethnic minorities, more people with disabilities and more homosexual practitioners.

These set of new workers that falls within the groups earlier mentioned are more demanding and their expectation about the employee’s involvement is so great, Provision has to be made for better work and balance family and making information more accessible, legal frameworks should be in force in order to encourage the Irish workforce to acknowledge and appreciate diversity.

The Employment Equality Act 2004 and the Equal Status Act 2000forbid by law on different nine grounds the act of discrimination including race and membership of the travelling community. Section 24 of the Employment Equality Act 2004, states that it is projected towards the implementation of the principle that embrace treating people equally treatment irrespective of race and ethnic background, establishing a general framework for equal employment and occupation and equal treatment for men and women in regards to employment, vocational training and promotion.

As a social care worker, working in a diversity workforce, it becomes paramount to take cognisance of and respect such differences. Cultural diversity and ethnicity are not a new occurrence in Ireland. The Irish Travelling Community is synonymous with a long history of a strong cultural background and unified identity group that is peculiar to their clan. Only when these differences are acknowledged in a respectable manners and informing ourselves with regard to them can we be rest assured that these differences has been addressed.

Basically, understanding and valuing of differences are what equality and diversity are all about. It is about the creation of a suitable working atmosphere that acknowledges respects and harnesses difference. A fair environment allows everyone to contribute and gives the opportunity to all to fulfil their potential. Practitioners face many challenges in their everyday work environment. In stressful situations it is important to have support, for example, from the team a carer work with, the supervisor or even an individual co-worker.

Consistency is an important tool for any practitioner so as to provide the best service for the people that they work with. Powell (2004) explains that ignoring diversity may limit a team in its work to reach a required goal.

According to Powell, practitioners benefit from working in a multicultural environment as it teaches them a culture of inclusion and they can benefit from the range of skills and values that are present in wherever section they find themselves. This will eventually result to an environment that is devoid of discrimination and prejudice and ultimately both client and staff relationship will be greatly strengthened. In the present times of highly increasingly mobile and diverse modernised society the key requirement for social work practice to be effective is to imbibe the culture of adequate educational training and practice code of conduct that includes an understanding of minority ethnic cultures and sensitivity to inter-cultural perspectives.

The National Association of Social Workers (N.A.S.W) describes the responsibilities of social workers as to ‘act to expand choice and opportunity for all persons, with special regard for vulnerable, disadvantaged, oppressed and exploited people and groups.’ These standards heighten the acceptance and respect for diversity as a fundamental social work value. Share et al (2009) points out that many third level institutions providing social care courses integrate inter-cultural training as part of the prospectus.

Many organisations adopt diversity programmes to combat exclusion in the work place. “Social workers have a professional mandate to identify and challenge organisational systems and individual practices that compromise client service, choice and general well-being.” (Maidment et al, 2002: 399).

Constant rising in Ethnicity and social heterogeneity has been identified as one of the greatest and essential challenges militating against modern societies, and in the same way, one of the most significant opportunities in almost all the advanced countries of the world. One thing that is very certain that can be said about virtually all the modern societies is that is generations are going to be more diverse than ever in a foreseeable future.

According to Putnam (2007). He described in the theoretical tool kit of social science two diametrically opposed perspectives about the effects of diversity on social connections. One of those, he labelled the contact hypotheses which argues that diversity fosters interethnic tolerance and social solidarity.

The more we associate and make more contact with people who are different from us, it will enable us to overcome our initial hesitation and ignorance and come to trust them more. This is true in social care an example can be that the first time a service user would have had a black worker as a carer there could or would have being name calling because they did not know any better. In some cases this has improved as the client and carer have gotten to know each other and come to realise that the only difference is their culture and not what colour they are.

CONCLUSION

This essay has been able to observe and established that in order for social care work to be effective and fair, social care workers need to acknowledge differences and embrace them so as to reap the benefits of a diverse workforce. Racism has no place for the social care worker in the work place. Working with clients who have diverse needs can only serve to further teach a social care worker and enrich their practice, which in turn promotes their standard of professionalism and experience.

What is recommendable is that there are two sides to a coin, diversity as it may, in totality could be a blessing in disguise because it can propel a society towards achieving or providing the best and the most effective service delivery in the context of social care practice through all the possible learning and training processes that ranges from competency to ethical conducts for all the social care workers.

This essay has shown just what diversity is and what types of diversity challenge social care workers could encounter on a daily basis. It has also emphasised how important training and development is in order to give potential social care workers a prepared insight into how diversity can be managed and respected.

The world is a small place and social care workers need to recognise and embrace all cultures and their respective differences in order to further enhance their ability to help all service users in multicultural society like ours. Emphasis has been laid on some the importance of anti discriminatory practice in the context of this profession like better service delivery, enhancing good relationship, improve professionalism and help to facilitate cultural competence and ethical standard amongst others. All this factors put together will ultimately underpinned the future and best practice for this profession.

“Psychiatrists are increasingly churning out new syndromes at the behest of their funders in the pharmaceutical industry”. The above quotation, drawn from a news feature from the Independent news paper, highlights an issue of concern associated with mental health diagnosis. According to the (Social Exclusion Unit, 2004), approximately one in six people in England experiences some form of mental health problem at some point in their lives and the estimated annual costs of providing services is ?77 billion. Wrong diagnosis affects not only the patient being diagnosed, but also the patient’s support network. In communities where mental health is not well understood by the vast majority and where people tend to get embarrassed by it, wrong diagnosis can make it difficult for those diagnosed to seek help. Additionally, people with mental health illnesses have to contend with a number of social issues such as: stigma, acceptance from friends and family, employment challenges and adjusting to losing their independence as a result of the effects of illness and / or the side effects of medication, (Sheppard, 2002; Elder et al, 2009). While these issues affect all mentally ill people, research shows that for black and ethnic minority groups, being diagnosed with a mental illness compounds social challenges and perpetuates poverty, deprivation and social exclusion, (Hocking, 2005; Ndegwa and Olajide, 2003). The challenge for social work is to advocate for clients in a field where social work expertise might be challenged by the medicinal nature of mental health diagnoses.

As a background to the research proposal, this paper will briefly evaluate the effect that wrong mental health diagnosis has on black and ethnic minority families. In selecting the objectives, my starting point is that wrong diagnosis affects people’s lives regardless of their race or ethnicity. Therefore, the proposed research will aim to identify whether and, if so, how black and ethnic minority families are affected by being wrongly diagnosed with mental illness.

Introduction:

According to Hocking (2005), culture and race have an important role to play in the likelihood of someone being diagnosed with mental health problems. Her findings are mirrored in the results of recent psychosis studies which indicate that there are disproportionately high numbers of people from black and ethnic minority groups diagnosed with severe mental illness, (Count Me in, 2010). Citing Bhui (1997)’s review of (Lloyd and Moodley, 1992)’s research, (Bhui and Bhugra, 2002) also state that there is a substantial body of evidence that highlights disparity between the experiences of people from black and ethnic minority groups in comparison to white groups, when it comes to accessing mental health services. They argue that white people, who are mentally ill, stand a better chance of being given a diagnosis and appropriate treatment.

Data from a mental health and ethnicity census conducted by partnership between the Healthcare Commission, the Mental Health Act Commission and the National Institute for Mental Health in England, found that almost 10% of mental health inpatients were black or mixed race. Analysis of the findings also concluded that compared to the rest of the population, black people were three times more likely to be admitted to psychiatric hospitals in England and Wales and stood a 44% chance of being detained under the Mental Health Act, (Care Quality Commission, 2005). The findings also indicated that black men experienced high rates of control and restraint from staff within psychiatric services and were more likely to be put into seclusion or in medium or high secure wards, (Bhugra and Gupta, 2010; Kaye and Lingiah, 2000).

It is with this background that this paper evaluates the impact of wrong mental health diagnosis on black and ethnic minority families. In terms of methodology, the proposed research will take a similar form to this paper i.e. I will use the same key terms, research objectives, search terms and data collection methods. A paragraph on the proposed methodology follows the literature review.

Defining Key Terms:

In addition to cultural differences and subjective assessments of mental capacity, definitions of mental health are influenced by perspectives from various disciplines. In order to conduct a robust research, definitions of the key terms are explored below:

Although the Mental Health Act (2007) does not give a definition of mental health, it describes mental health in terms of mental disorders and refers to mental health as any condition that disorders or disables the mind, (Bartlett and Sandland, 2007).

Psychological perspectives define mental health as a level of cognitive or emotional wellbeing which includes a person’s ability to enjoy life by balancing the demands of everyday routines to achieve psychological resilience, (Shaw et al, 2007).

According to the World Health Organisation (WHO), mental health is a state of wellbeing in which an individual realises that they can cope with life’s normal stresses, can work productively and fruitfully and contribute to their community, (WHO, 2005).

Definitions of mental health that are based in evaluating the positive signs of health, such as how an individual copes with environmental stressors, are still under debate as scholars, practitioners and policy makers consider the importance of factors such as religion, individual aspirations, social class, race, gender and lifestyle choices impact on mental health, (Clarke, 2008; Kay and Lingiah, 2000, Heller and Gitterman, 2011).

The English dictionary describes diagnosis as the identification of an illness or a discovery about what is wrong with someone who is ill or something which is not working properly, after examination. It implies identification of the nature and cause of a thing.

However, diagnosing mental illness seldom involves a set of specific or straight forward tests. Rather, psychiatrists diagnose based on their observation of symptoms and comparison with a diagnostic schedule, (Elder et al, 2009; Arrigo and Shipley, 2005). As a result it is often difficult for mental health problems to be diagnosed and sometimes patients can feel that they have been misdiagnosed. Detailed discussion follows later in this proposal.

The Research Question:

This paper briefly reviews mental health literature in order to set the background for a proposed research into the extent to which wrong mental health diagnosis affects Black and Ethnic Minority families in Britain.

Research Objectives:

The objectives set prior to writing this paper and indeed proposed for in-depth research are:

Reviewing the literature that is available on mental health diagnosis and how mental health impacts families in general.

Exploring the role of social workers in working with people that have been diagnosed with mental illness.

Identifying any discernable differences in how diagnosis affects Black and Ethnic Minority families in comparison to their white counterparts.

Highlighting the impact of wrong mental health diagnosis on families in general and on Black and Ethnic Minority families in particular.

Identifying any gaps in practice and in the literature in order propose areas for future study.

Rationale:

I first became interested in studying this area because four of my relatives had been diagnosed with severe mental illnesses and three were later found to have been wrongly diagnosed. In the three months prior to being told that the diagnoses were wrong, our family relationships had been tested to the extreme as we tried to adjust to the challenges of caring for loved ones whom we thought were mentally ill and in denial. The relief that came from hearing the news that three of them had been wrongly diagnosed was quickly replaced with feelings of injustice towards professionals, because of the strain that had been put on the family relationships.

Search Terms, Databases Used and Linguistic Clarifications:

When researching literature to review, I used several on-line catalogue systems which included: EBSCOHost, InfoTrack, ProQuest, Ingenta, eLSC, CareData, academic journals, mental health action group websites and read various newspaper articles reporting on multiple mental health related issues. My initial searches produced a lot of literature, which I narrowed down by browsing subject indexes and reading abstracts. The search terms included: “Diagnosing Mental Health in England”, “the impact of Mental Health diagnosis on families”, “Mental health diagnosis and minority ethnic families”, “The role of social workers in mental health cases”, “the impact of wrong mental health diagnosis on black and ethnic minority families”, “community mental health” and “coping with mental health at home”. My decision to use online catalogue systems has more to do with my lack of knowledge in how to use manual cataloguing systems. Additionally, I was aware of my own limitations as a researcher and did not want to add any more complications to my task.

Literature Review:

Prior to commencing discussions about how diagnosis, right or wrong, impacts on families, it is important to note that diagnosis infers illness. Therefore, the extent of the impact on families is not determined by the diagnosis, but by how the inferred illness affects day-to-day activities directly or indirectly. The impact will vary depending on factors such as the severity and duration of the diagnosed illness, the family composition and the extent to which the illness affects aspects of family life, (Clark, 2008: Heller and Gitterman, 2011). For example, where short term illnesses can be treated by the family’s general-practitioner and where the members are older or resilient, families will cope better with a mental health diagnosis.

For many black and ethnic minority families, being diagnosed with a mental illness adds to stigma, as these communities tend to have many myths and misconceptions about mental illness, (Ray et al, 2008; Bhugra and Cochrane, 2001; Bhugra and Gupta, 2010). This can affect families’ social interaction as they worry about the unpredictability of the diagnosed member’s public actions and reactions. The result is that individuals within the family or the entire family can easily become isolated, thus perpetuating a cycle of social exclusion, (Beresford, 2004). However, this view is widely contested as some scholars argue that mental health problems are not derived from social injustices or oppression nor are patients any more likely to experience social exclusion and discrimination as a direct result of their difficulties, (Sheppard, 2002). Scholars acknowledge that people with mental health problems can experience vicious circles of social isolation, poverty, unemployment, poor housing and scarce social and support networks but that these are neither causal nor circular factors.

In 2010, the Care Quality Commission published a psychosis study which tested the theory that psychiatrists, wittingly or unwittingly, allowed their professional judgement to be influenced by the colour of their patients’ skin, (Count Me In, 2010). The study, which tracked year-on-year results from 2005 to 2009, was aimed at highlighting inequalities in access and outcomes that affect patients from Black and Minority ethnic communities, how hospital stays are managed, national debates about mental health and guide positive action, revealed that at 53.8%, black people represented more than half of the people detained under the Mental Health Act. These finding are consistent with other studies, which highlights that black men were more likely to be diagnosed with psychotic illness than whites and to be detained under the Mental Health Act, (Ray et al, 2008).

Additionally, knowledge about mental illness, like many other aspects of human life, has undergone paradigm shifts over time. For instance, conditions such as sadness, anger, or disappointment, which were once considered to be in the normal spectrum of human behaviour, are now seen as psychiatric or psychological disorders, (Beam, 2001). This, coupled with the fact that there are no specific or straight forward ways of diagnosing mental illness, makes mental health diagnosis challenging. In order to diagnose a mental illness, psychiatrists observe a client’s symptoms and match them to a diagnostic schedule. Prentice (2010) reports that in recent history, research has shown that even seemingly simple changes in the description of conditions such as attention deficit disorder, autism and childhood bipolar disorder, captured many patients who would have been better off not entering the mental health system.

One of the initial challenges that families have to overcome when a loved one is first diagnosed with a mental illness is the feelings of denial as they come to terms with what the illness will mean for their loved one and for themselves. This combined with having little or no knowledge about the diagnosed illness, causes panic, (Beresford, 2004). When, as in our case, families later find out that the diagnosis was wrong the relief can easily be replaced with anger as they recount the toll of strained inter family relationships that were a result of their caring responsibilities. In such circumstances, guided by professional values and ethics, a social worker would be duty bond to empower the family by ensuring that the family have all the information they need in order to understand the implications of the illness. This includes advocating for those for whom English may not be a first language and being creative with working partnerships, (Beresford, 2000).

Wrong mental health diagnosis often means that the patient will be prescribed medication to stabilize the “illness”. Consequently, the family may have to not only deal with the challenges of caring for a loved one whose behaviour may be unpredictable but also come to terms with the medication’s side effects such as apathy and a lack of motivation, (Ray et al, 2008). In her review of a number of qualitative research publications on how families cope with mental health, (Bhui, 2002) found that family members were fearful that the constant stress and concern for their loved ones created family problems that may never be over come.

When the diagnosed family member is a parent, the inferred illness will have a profound impact on family life. Research shows that when a parent is diagnosed with mental illness, children are especially vulnerable, as their coping strategies tend to be dependent on the adults in their lives, (Heller and Gitterman, 2011). Parental mental illness compromises the parent’s ability to care for their child and in some cases, especially where there is no other adult to take responsibility, children can become their parent’s carers, (Ritter and Lampkin, 2010: Arrigo and Shipley, 2005). A wrongly diagnosed parent who keeps insisting that there is nothing wrong with them, can easily be seen as being in denial thus escalating welfare concerns. The dilemma for social work lies in their dual role of control and care.

Depending on the nature of the diagnosed illness, the risks to a child’s welfare can be severe even when the child’s physical safety is not at risk. Social workers would need to give consideration to issues such as how the illness affects the child’s emotional, behavioural and mental development. There is a vast body of research which indicates that children of psychotic parents are themselves particularly vulnerable to psychiatric problems, (Heller and Gitterman, 2011; Bhugra and Gupta, 2010; Ndegwa and Olajide, 2003;).

In order to explore this topic in detail, I propose to conduct research that addresses the objectives set in this paper, using methodology that focuses on reviewing secondary data. The intended research process is as detailed in the question, objectives, rationale and search terms of this paper. The proposed research will have relevance for policy and practice in that it will enable better service provision for black and ethnic minority families as a result of understanding not only the causes of wrong diagnosis, but also why minority groups are disproportionately over represented within mental health services. It will also evaluate how national and international legislation, current studies on mental health and user involvement initiatives, impact on service delivery for minorities.

In conclusion, I have shown that by inferring illness, mental health diagnosis does impact on families regardless of their racial or ethnic backgrounds. However, while the issues discussed here are not necessarily unique to black and ethnic minority families, research indicates that people from black and ethnic minority groups are disproportionately over represented in mental health services in England. Complex and multifaceted factors such as a lifestyles, social stressors, genetic predisposition and lifecycle transitions, make diagnosing mental illness difficult. This can present challenges for social workers as they perform their dual roles of control and care. Professional ethics and legal responsibilities mean that they must advocate for the marginalised groups while continuing to work in partnership with medical professionals without having the expertise to make a judgement call on the accuracy of diagnosis. These issues require deeper exploration in order to understand how wrong mental health diagnosis affects people from black and ethnic minority families.

‘Indigenous Australian Cultures’
The Dreaming

The English language has no exact word or phrase that depicts The Dreaming and each Indigenous Australian language groups has its own term to refer to this epoch. In Western Australia Ngarinyin people refer to it as Ungud, the Central Australian Aranda people as Aldjerinya, the Pitjantjara of north-west South Australia as Tjukurpa, while in the Broome region it is Bugari. While the English word suggests fantasies or vague recollections of the real world the Indigenous Australian translation see’s The Dreaming as inherent reality (Edwards, 1998).

The Dreaming is how Aboriginal people explain how their world came to be. Clarke (2003, p.16) suggests culture and lifestyle in traditional Aboriginal culture are shaped by their values, beliefs and the relationship between Indigenous Australians and every feature of landscape and living creature. The spiritual beings that feature in The Dreaming accounts are the spiritual Ancestors of the present day Aboriginal community and continue to influence the beliefs and values of Aboriginal Australians (Clarke, 2003, p. 16).

The Dreaming tells of the creation of land, trees, plants, rocks, waterholes, rivers, mountain, stars and animals and the journeys the Aboriginal Ancestors travelled. The spirits of these Ancestors whom often resembled people and or animals continue to inhabit these features of the world today. Both consequences and punishments are depicted in The Dreaming and form life lessons that are shared throughout generations. For example the Dhuwa shares The Dreaming of a hunter who abducts a young girl and traps her in a cave with him. While he sleeps she transforms into a butterfly and escapes. In his anger he transforms into a bat and is trapped in the prison he made forever (Abc.net.au, 2015)

Kinship

For Aboriginal Australian’s kinship is more than family genetics or blood ties. Kinship is a complex system based around social organisation, which outlines responsibilities within Nations, clans and family groups. (University of Sydney, 2005-15)Kinship and family are especially important to Indigenous Australians. As it guides responsibilities to their ‘kin’ and environment. Kinship is so dominant for the Wiradjuri people they speak of kin as their ‘whole world’ (MacDonald, 1998 p. 303).

Kinship in the many Aboriginal Nations shares common components as well as differences. The all-embracing systems have been handed down through generations from Ancestors of The Dreaming and are based on reciprocal actions, such as giving of privileges in return for similar privileges. Rights and obligations are determined by an individual’s kin, and such influences include who you may marry, share food and resources with, who will look after an individual and who might educate them.

Kinship systems consist of Moiety, Totems and skin names. Moiety is a form of social organisation meaning ‘two halves’. Each individual is assigned a moiety group from either the matrilineal (mother) or patrilineal (father)’s line. Moiety governs where partners are chosen from. For example a marriage partner must come from the opposite moiety. Each nation has their own names for each half of moiety. Arnhem Nation refer to it as Dhuwa and Yirrity while Wiradjuri as Dilbi and Kuputhin. Each individual belongs to a totem dependant on when they were conceived. Aboriginal totems can be animals or plants, they hold special meaning to a group of individuals (Bani, 2004). They are filled with the spirit of their ancestors. Individuals become the generational custodians of their particular sacred places, ceremonies and dreaming stories. A person has four totems that represent Nation, Clan, family and a personal totem that recognises their strengths and weaknesses, this totem maybe given at birth or later in life (University of Sydney, 2005-15).

Economic organisation

Goodall (1996, p. 2) has suggested Indigenous Australians have been practicing sustainable land and economic management for thousands of years. Long before European settlement Aboriginal Australians “have used techniques to increase the numbers and growth of plants and animals”. Clearing trees and creating grasslands for grazing while maintaining patches of forest for shelter are examples of these techniques (Australian National University, 2011).

While The Dreaming and kinship organisation describe Aboriginal men as hunters, and women gatherers, Women are more reliable food suppliers than men due their sources being more plentiful, whereas hunting cannot be guaranteed (Dingle, 1988 p. 13).

Aboriginal people created trade routes across the country and exchanged food, shells and psycho-active drugs such as Pituri. Individuals would not travel the entire distance, they would meet at waterholes, where exchanges would be made and then return to their Nation.

Resource management is critical to the sustainability of the Aboriginal culture. Seasonal calendars impact the strategies used to ensure effective methods were utilised, including hunting animals at the time of year they are at their fattest therefore providing maximum nourishment. Ensuring animals weren’t hunted during breeding season or carrying their young was another resource management strategy used. (Anon, 2015)

References

Abc.net.au, (2015) DustEchoes. (online) Available at: http://www.abc.net.au/dustechos/dustEchoesFlash.htm, (March 11, 2015)

Anon, (2015). 1st ed. [ebook] Available at: http://www.larrakia.csiro.au/pdf/MingayoorooSeasonsCalendar.pdf (Accessed 15 Mar, 2015).

Australian National University. (2011). Bill Gammage discusses ‘The Biggest Estate on Earth’ http://www.anu.edu.au/vision/videos/5001/, (March 9, 2015).

Bani, E. (2004). Torres News, the voice of the islands: What is a totem? In R. Davis (ED.), Woven histories, dancing lives: Torres Strait Islander identity, culture and history (pp.151). Acton A.C.T: AIATSIS.

Clarke, P. (2003). Where the ancestors walked: Australia as an Aboriginal landscape. Sydney: Allen & Urwin.

Dingle, T. (1988). Aboriginal economy and society: Patterns of experience. Melbourne: McPhee Gribble and Penguin Books.

Edwards, B. (1998). Living the dreaming. In C. Bourke, E. Bourke, & B. Edwards (Eds.), Aboriginal Australia: an introductory reader in Aboriginal studies (2^nd ed.) (pp.77-99).

St Lucia, QLD: University of Queensland Press.

Goodall, H. (1996). Invasion to embassy. St Leonards: Allen & Unwin

MacDonald, G. (1998). Continuities of Wiradjuri tradition. In W.H. Edwards (ED.), Traditional Aboriginal society: An introductory reader in Aboriginal studies (2^nd ed.) (pp. 297-312). South Melbourne: MacMillan.

University of Sydney. (2002-15). The kinship module. http://sydney.edu.au/kinship-module/ (March 10, 2015).

Cant remember if I used this one

Aboriginal art and culture centre – Alice Springs

http://aboriginalart.com.au/gallery/gallery_intro.html

The remit of this essay is to explore and discuss the concept of therapeutic relationships in mental health and what is involved in building these relationships. The question is in two parts, so in the first part of the essay, the author wishes to explore the meaning of a therapeutic relationship and discuss what is needed from the nurse and service user to maintain this. In the second part, the author will choose two key elements that contribute to a therapeutic relationship in mental health nursing and discuss the importance they have. The two key elements that have been chosen is communication, both verbal and non verbal, and the importance of these elements in a relationship between a nurse and a service user. To achieve this goal the author will use various resources available, for example the internet, literature from class and appropriate reading materials.

Main Body

“Building relationships is central to nursing work…,” (Nursing Times) and extremely important in mental health nursing. A therapeutic relationship involves respect, empathy and genuineness (Callaghan and Waldock 2006). Both the nurse and service user should show respect for each other and the nurse should respect the beliefs of the service user, even if they do not agree with these. The relationship should be person centred, allowing the service user to be at the core of their care plans etc, their beliefs and wishes must be respected at all times. Service users must be at the centre of their care and recovery. Choices and decisions should be made by them. If there are any changes to be made to a care package, the service user must be informed and have their say. In a therapeutic relationship the nurse will support the service user in all aspects of their care and recovery. With reference to the quote in question, “…did it at my level and pace all the time…,” (Brown and Kandirkirira 2007) this is vital in recovery and for a therapeutic relationship. The nurse must work alongside the service user and support them in aiming for the goals that the service user has made and not what the nurse expects them to be able to do. The service user should always remain at the centre of their recovery and to develop such a relationship, the nurse should share their knowledge of the illness, which gives the service user an understanding of what they are experiencing and some control on the situation and both will be able “to take an active role in the management of the illness,” (Owen 2004).The nurse should be able to show empathy, being able to put themselves in the service users’ position and imagine how they would feel and how they would wish to be treated, “accurate empathy is always empowering, since it represents an understanding and acceptance of the speaker’s feelings” (Millenson 1995). This skill shows the service user that the nurse has taken on board what has been said and that they can put themselves in the individuals’ situation. Those involved in the therapeutic relationship should always show genuineness and hold non judgmental attitudes towards each other. “Genuineness is based on the ability of the practitioner to be open with his patient…It will help to reassert the patient as the centre of the treatment and promote the patients trust in the practitioner and his treatments,” (Owen 2004). The nurse should want to work alongside the service user and offer support when needed to achieve and maintain this relationship.

“The people have the right and the duty to participate individually and collectively in the planning and implementation of their health care,” (World Health Organisation 1978).

A therapeutic relationship does not occur overnight, it takes time and a great deal of trust is essential between the nurse and the service user. Trust is very important for the relationship to develop and if this is achieved the service user will accept the nurses support and advice on treatments available and also work alongside each other instead of the nurse suggesting that they know best as they are the professional. “…patients themselves value therapeutic relationships which offer respect, trust and care and it seems that such relationships may in themselves prove to be healing in the broadest sense.” (Mitchell and Cormack 1998). If trust is maintained throughout the development of the relationship the service user will begin to realise that the nurse does in fact care about their situation and does wish to support them on their road to recovery offering support and advice when necessary. The trust gained from both people should help each other to begin feel at ease the more they meet with each other and the service user may slowly begin to open up to the nurse and enable them to talk about how they are really feeling, what may scare them and accept their advice and support. It will also show the service user that they are at the centre of their care and that they will work at their own pace and when they are ready to take that one step further down their path to recovery, they will.

A key element that contributes to a therapeutic relationship in mental health nursing is the use of verbal communication. One very important aspect of this is asking open questions, which the service user is unable to reply with a simple yes or no answer. This will allow the nurse to gain a deeper understanding of how the service user really feels (Burnard 1992). This also shows the service user is at the centre of their care and maybe they will begin to talk openly and freely about their true feelings as this type of questions show the nurse does care for them and wants to support them in the best possible way, it allows the nurse to empathise, if they can get a true account of the feelings the service user has. The empathy shown may encourage the service user to talk openly more often as they know that they will not be judged for having some of these feelings and thoughts.

Another important aspect of verbal communication is reflecting and clarifying what has been said by the service user. Reflection requires the nurse to say back to the service user what they have said to ensure they understand fully. Clarifying is required by both the nurse and service user. The nurse may ask a closed question, which allows the service user to answer simply yes or no, or a single answer to be definite, to ensure they get the true meaning of what the service user is saying and in turn the nurse can explain their understanding of the illness or situation that the individual finds themselves in and what support and services are available and how they can go about setting these up, together, enabling the service user to make decisions after being given the choice to do so. When the nurse gives their views to the service user, any specialist language, for example jargon, should be avoided as this may act as a barrier within the therapeutic relationship as the nurse is not taking into account if the service user understands what is being said to them. This binds in with the core elements of a therapeutic relationship as the nurse will show empathy, genuineness and trust will increase working at the level and pace of the service user.

The nurse must be aware of their “tone of voice,” (Stickley and Freshwater 2006) when speaking to the service user, to make sure they don’t come across as patronising or uncaring. This may create a challenge in maintaining the relationship as the service user may feel belittled by the nurse and in turn may close up and not speak about how they are truly feeling therefore the relationship will not develop and there won’t be any trust. Another element of verbal communication is the nurse should “not be quick to problem solve,” (Stickley and Freshwater 2006). Allowing the service user to think of approaches of overcoming the problems that may occur during their recovery process highlights that they are at the centre of their care and shows that they have the final decision in their care and or treatment. If the nurse moves in quickly to try and help the service user, it may come across as patronising and that they are trying to take control of the situation as they have not took the time to ask what the service user wants and may cause a barrier between the nurse and the service user.

The second key element that contributes to therapeutic relationships in mental health is the use of non verbal communication. This element is extremely important in maintaining a therapeutic relationship and being aware of the skill involved is vital. The most important skill is sitting in a mirrored position, not sitting face on in front of the patient but to the side and leaning slightly in showing they are ready and willing to listen (Stickley and Freshwater 2006), sitting behind a desk can act as a barrier and come across as authoritative (Burnard 1992) and may cause the service user to feel uneasy, deterring them from opening up and feeling unable to trust the nurse. The nurse should be sitting comfortably and in a way that does not make the service user feel uncomfortable in any way. The use of eye contact is paramount in maintaining a therapeutic relationship but knowing when and how to use the skill is the key. Too much eye contact may cause the situation to intensify and both the nurse and service user may feel uncomfortable. Not enough eye contact may convey a lack of interest in what the service user is trying to tell them and may cause the therapeutic relationship to come to an end and the service user may not show what they are truly feeling or thinking at this time.

Another important aspect of non verbal communication is listening, “The role of the listener therefore is a privileged one and one that can promote healing,” (Stickley and Freshwater 2006). Listening is probably one of the greatest skills a nurse can achieve. Listening is, the nurse hearing what the service user is saying and understanding what is being said, not what the nurse thinks they are saying. “…effectiveness largely depends on the nurses ability to listen and detect cues for therapeutic enquiry,” (Stickley and Freshwater 2006). Thus again shows the nurse has picked up on the detail of the statement from the service user and can reflect back to the service user what has been said to clarify their understanding and to reassure the service user that they are being listened to. This will help the service user to build trust in the nurse as they will have a feeling of acceptance and that someone is listening to them.

Conclusion

It can now be seen that there are many key elements that contribute to a therapeutic relationship and the list is endless. A therapeutic relationship requires a lot of time and trust on both parts and the core skills required from a nurse is empathy, trust and genuineness. As the author stated she was only looking at two key elements that contribute to this relationship and feels further investigation may be required into other elements to fully understand the importance and why such skills are acquired to build a relationship with a service user and the difficulties they may come across in maintaining a therapeutic relationship. One thing the author has achieved is the importance of person centred care and how essential it is to involve and listen to the service user in all aspects of their care.