Multi Disciplinary Approach Case Study
Based on the information provided, what needs, risks and strengths can you identify in relation to the individual or family in the case study? How would you plan the assessment, including consideration of theneed for a multi disciplinary approach?
Case study E:
James Downing is 16 years old, white andlives at home with his mother, Sarah, her same sexpartner, Teresa, and his younger sister Joanne, who is 13 years. Jameshas no contact with his birth father, who left Sarah when she was pregnant withJoanne, but he does have a close relationship with his paternal grandparents,who live nearby. James has been in trouble with the police since he was 13years old, and has numerous convictions for care theft, possession of cannabisand ecstasy and for house burglaries.
Sarah has asked a social worker to visither, since she feels that she can no longer cope with the situation and feelsthat the whole family is in danger of `fallingapart’. Joanne is beginning to stay out at friends all the time and clearlydoes not want to be at home, where there are frequent arguments. Teresa worksin a very demanding job, involving a lot of travelling, and Sarah feels she isspending less and less time at home because of James’s behaviour.
Research published in Child Protection:Messages from Research (Department of Health, 1995 cited in Horwath, 2001)states that families often feel they lack control and autonomy when dealingwith social services departments. This becomes particularly problematic whenassessments focus on family weaknesses and disadvantages. Hence a holisticapproach utilising strengths and identifying need is required. This approachforms the crux of the Framework for the Assessment of Children in Need andtheir Families.
Sarah has identified the family difficultiesand has requested support – this is encouraging, suggesting commitment to thewell being of the family, and to change. It is important to highlight thisstrength to the family and emphasise that together we will work to build uponthis. James has a close relationship with hispaternal grandparents, adding to the family resilience and acting as animportant resource during periods of difficultly. Hence grandparents should beengaged with the planning of the assessment.
The family’s economic status is not clear;however there is at least one family member in employment. Traditionally thisis interpreted as a familial resilience factor. Awareness of differingperspectives is essential – the nature of Teresa’s work and the effect of theemployment on the family as a whole is currently unknown and hence couldequally be viewed as a risk factor by the family.
James has established offending behaviourand has been involved with illegal drugs in some capacity. Family and professionals will generally view this as risky behaviour; however it must beconsidered that criminal activity could be viewed as a strength within somesocial groups, hence it is essential to ascertain all points of view, withoutprejudgement and then consider ways forward together.
There maybe risk linked to the lessening orloss of James’ attachment to Teresa as she is spending less and less time athome. Equally, there could be risk attached to the potential loss ofattachment between Joanne and James, as Joanne is stay(ing) out withfriends.and clearly does not want to be at home. The family is under a greatdeal of strain, and it seems Joanne and Teresa are coping with this by shiftingaway from the household. This gives some insight as to how the family functionsunder stress; this will need to be explored further with Sarah and Teresa to identify the processes that will ensure the family achieve theirdesired outcomes when faced with difficulties.
James has no contact with his father, raising concerns around paternal attachment and possible negative life events/experiences due to separation. The assessment will need to explore how James and his family view this separation; again each may hold conflictingviews and this must be sensitively addressed.
One must consider that the immediate family unit, the extended family and professionals may all have differing perceptions of families with same-sex caregivers; some view this as strength whereas others will see membership of a minority group as a risk. Family members themselves may negatively discriminate on the basis of sexuality. Prior awareness of the possibility of conflicting opinions will enable the worker to react thoughtfully and mediate effectively. The social worker should critically evaluate their own practice continuously, checking for assumptions, stereotyping and cultural bias.
Preparation for the assessment should begin with ensuring an appropriate social worker is allocated. The team manager should consider the field workers knowledge and understanding of the issues pertaining to this particular family (for example youth offending, discrimination/oppression based on sexuality/gender, attachment issues etc), as well as ensuring the worker is an appropriate match in terms of race and gender.
Once a suitable worker is allocated thecase, he/she will need to refer to all information gathered previously. This will prevent the family repeating sensitive information again, and will enable the social worker to identify gaps in information that need to be filled during the assessment.
Assessments and subsequent care plans are more effective if the child and family feel empowered and involved throughout the process (Department for Education and Skills, 2001). Indeed this is a duty of any professional working with children as outlined in Article 12 of the United Nations Convention on the Rights of the Child:
the child who is capable of forming his or her own views (has) the right to express those viewsfreely in all matters affecting the child, the views of the child being givendue weight in accordance with the age and maturity of the child
The social worker must engage with James and his family at the outset, establishing how and where theassessment will be carried out, exactly what help is requested and identifying desired outcomes.
As outlined in the Framework for theAssessment of Children in Need and their Families, the social worker andfamily should identify the relevant agencies to be involved in the assessment and ensure it is clear to all professionals and the family the precise role andpurpose of each professional. Advice and information will be sought by identifying all key informants, recording their details and organising aschedule to collect information from these people or organisations. The following would be a minimum essential list of informants:
FamilyGP and other relevant health professionals
Youth Offending Team
James’school/college
Paternal grandparents
Joanne’s school
Prior to any interviews taking place, a list of essential questions should be drawn up to give structure and purpose to the meetings. Following these initial discussions, further interviews may beneeded with Connexions, local police, wider family, or other community groups, in order to build a comprehensive picture of the family.
In planning any assessment, there should be a clear statement of intent, outlining the purpose, limitations and timescales of the assessment. This must be shared with the child and their family. For all assessments this will include the main principles of the Children Act 1989. The particular focus for this assessment should only be decided upon after further consultation with the James and his family.
In what ways does the information provided in the case study raiseissues of power, disadvantage and oppression? You are asked to carry out an assessment of need? How would you attempt to work in an anti-oppressive way?
Case study C:
Razia Akhtar is a 26-year-old single woman, of South Asian Muslim origin, (although born is Britain) who is currently in hospital, following a rapid deterioration in her physical health. She has now been given a diagnosis of Multiple Sclerosis. Razia lives alone in a small terraced house, and is very keen to return home as soon as possible. Her older brother and his wife, Mohammed Khan and Shanaz Begum, who live on the next street, have suggested that she moves in with them, but she is very reluctant to do so. The hospital staff feel that Razia is being very unrealistic about her future, and that she needs to come to terms with the fact that she willbe dependent on others for the rest of her life. Her present condition is such that she will need quite a high level of personal assistance, with someone to get her up in the morning and help her to bed at night.
The hospital based social worker is asked to carry out an assessment to determine Razia’ needs once she is discharged from hospital.
Power describes the capacity to influence or control people, events, processes or resources (Thompson,2003, pg 152). If utilized in a negative fashion, power can be a significant barrier to equality and lead to oppression and disadvantage. Imbalances of power can manifest in a variety of social work situations; in this case study there are potentially a multitude of disparities of power, which require critically reflective practice to ensure equality and empowerment are promoted.
When debating issues of oppression and disadvantage, we must consider the process leading to it – negative discrimination. Negative discrimination is defined by the identification of negative attributes with regard to a person or group of people (Thompson 2003). Generally negative discrimination relates to social and biological constructs and can be based upon sexual orientation, gender, class, race, disability, age and so on. Negative discrimination creates the circumstances that give rise to oppression, which is defined by Thompson (2001) as:
inhuman or degrading treatment of individuals or groups; hardship and injustice brought about by one group or another; the negative and demeaning exercise of power (pg 34)
In relation to Miss Akhtar, we should consider the power that is implied through hospital staff having superior medical knowledge, skills and expertise in relation to Miss Akhtar. From the case notes provided, it appears that current thought relating to Miss Akhtar’s long-term care is based upon the medical model; the impairment is seen as the problem and her dependence is emphasized (Adams et al, 2002). Thompson(2001) says social work should take a demedicalised stance and look past thepathology, utilizing the social model of disability as described by Adams et al (2002). The social model suggests Miss Akhtar’s needs should be considered in a much wider context, ensuring her social and mental health are given equal consideration to her medical needs. Viewing societal constraints as the problem and not the individual creates the frame of mind to consider how to remove barriers to mainstream social, political and economic life. The social worker should liaise with Miss Akhtar and look towards an solution-focused (not impairment-focused) care plan where by within the assessment, barriers are identified and solutions sought collaboratively, utilizing Miss Akhtar’s strengths.
Miss Akhtar has an autoimmune degenerative disease and again, it is well documented that individuals with physical disabilities are more likely to be subjected to oppressive practices. Dehumanizing and medicalised language can result in a loss of esteem and a sense of disempowerment for the physically impaired service user. This can be prevented by avoiding jargon and providing lots of opportunities for questions and open discussion when working through the assessment with Miss Akhtar. Professionals should continually check themselves for use of infantilizing language andensure they engage in mature, adult discourse with Miss Akhtar.
Miss Akhtar’s religious and cultural needs should be explored and understood as central part of the assessment. These needs must be identified as quickly as possible, to ensure the worker can besensitive to Miss Akhtar’s Islamic or other customs, without making cultural assumptions. Karmi (1996) examines the Islamic emphasis on modesty; hence the worker should consider with Miss Akhtar the extent to which her modesty should be preserved throughout the assessment. It should be explored if Miss Akhtar would prefer female medical staff and social care professionals only to be involved in the assessment and clear guidelines should be established around preservation of modesty and the practice of physical examinations.
It is accepted in many Muslim communities that the most senior male of the family will take responsibility for a female relative’s care. Hence it is possible there may be an imbalance of power between Miss Akhtar and Mr. Begum, dependent on their personal beliefs and how far these correlate with each other’s religious and cultural ideals. If there is a difference in these ideals, the social worker should strive to empower Miss Akhtar by discussing choices and involving a culturally matched advocate if Miss Akhtar desires, in order to mediate within the family. This must be managed sensitively, as Miss Akhtar, Mr. Begum and the social worker may all hold very different views regarding patriarchal hierarchies. The diversity of these views should be acknowledged and respected within the assessment. It is important to be aware of ethnocentrism, as described by Thompson (2003), whereby situations are viewed from the norms of a majority culture and those values projected onto the minority. This can be countered by critically reflective practice, which will promote consciousness of power and oppression, leading to a decreased likelihood of the worker making inaccurate ideological inferences.
Discrimination and oppression can arise through an imbalance in the distribution of financial or other material resources. This is a concern in this case study as Miss Akhtar’s economic status prior to her illness is not clear. Miss Akhtar may experience barriers in accessing the same level of financial resources as previously. Hence the social worker and potentially Mr. Begum could be in positions of power as they are likely to have control over the allocation of resources. This should be countered by being very open with Miss Akhtar and avoiding closed decision-making and mystery. Again, this promotes equality as it avoids welfarism, whereby it is assumed the Miss Akhtar requires welfare services dueto her disability (Thompson, 2003).
Due thought must be given to use of language and culturally biased humour throughout the assessment. Miss Akhtaris an ethnic minority in the UK; as such Thompson (2003) states discriminationcan occur at personal and cultural levels. It is the role of the social workerto critically reflect on their personal prejudices, which could lead to discriminatory stereotyping. Personal discrimination is enveloped by inequity at a cultural level, whereby ethnic minorities, and hence Miss Akhtar, maybe subjected to a general felling of not belonging and polarization, by the use of culturally-specific language and humour.
A central theme throughout these case studies is the need to put the service user at the heart of all planning, decision-making and reviews. Care packages imposed upon users will be ineffective; users must be enabled to help themselves, whilst the social workertakes every opportunity to stand in the users shoes and see life from thetheir perspective.
References
Adams, Robert et al (eds) 2002 CriticalPractice in Social Work. Basingstoke, Palgrave.
Great Britain (1989) Children Act 1989(C41). London, Stationery Office
Department for Education and Skills (2001) Learningto Listen: Core principles for involvement of Children and Young People. Availablefrom: www.dfee.gov.uk/cypu
Department of Health (2000) Frameworkfor the assessment of children in need and their families London, TheStationary Office.
Horwath, Jan (eds) 2001 The Child’sWorld: Assessing Children in Need. London, Jessica Kingsley Publishers.
Karmi, Ghada (1996) The EthicalHandbook: A Factfile for Health Care Professionals. Oxford, BlackwellScience LTD
Thompson, Neil (2001) Anti-discriminatoryPractice 3rd Ed. Basingstoke, Palgrave.
Thompson, Neil (2003) PromotingEquality: Challenging Discrimination and Oppression 2nd Ed. NewYork, Palgrave
United Nations (1991) United NationsConvention on the Rights of the Child (online). Available from:http://www.unicef.org/crc/fulltext.htm
