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The Welfare state in Britain as we know it was formed in the twentieth century but its origins can be traced back to mediaeval times; welfare was delivered collectively, free of the state many local churches ran hospitals; however the word hospitals should not be understood in today’s terms. In mediaeval times these places were communities. Were the sick, frail and elderly in particular were looked after. Back then Parishes in Britain had a responsibility to their poor, In 1598 Elizabeth I, passed an Act for the Relief of the Poor, this is known as The Elizabethan Poor Law. It offered the poor some protection, and less sturdy beggars were sent back to their parish of origin for help, every parish appointed overseers of the poor who were responsible for setting up parish houses for those unable of supporting themselves and finding work for the unemployed. Around the time the industrial revolution came, the rapid population growth and development of the towns, and the first experience of modern unemployment, along with this came increasing poor rates, In 1833 Earl Gray Prime Minister, set up a Poor Law Commission to scrutinise the working of the poor Law system that had been put in place in Britain. In his report published in 1834, the Commission made several recommendations to Parliament. As a result, the Poor Law Amendment Act was passed. (The poor Act of 1598 continued till 1948)

This Essay will discuss the theories in social policy, which underpin welfare provision and to what extent have these theories influenced the delivery of welfare services and met the demands of a changed and changing society this essay will also examine the welfare provision of Community care and Health.

The Poor Laws were very much disliked, a great deal of the development of social services in the 20th century including means tests, health care and national insurance were designed to avoid having to rely on them and in many industrialised societies social exclusion and poverty are alleviated to some degree by the introduction of a welfare state. The majority of industrialised and industrialising countries in the world today are welfare states, this means that the state plays a central role in the provision of welfare; it does this through a system that offers benefits and services to ensure that people’s basic needs such as Income, Housing, Education and Healthcare are meet.

The welfare state has a daunting task of managing the risk faced by people, over the duration of their lives such as: Job loss, old age, sickness and disabilities, the level of welfare services and spending vary from country to country, a number of countries have a highly developed welfare systems and allocate a large proportion of their national budget to them, over the years there are many theories and Political views on welfare and are often divided into right and left wing views over the welfare state and some have shaped the policies that we have in place today.

The right wing: is against public provision of welfare and are for residual welfare They are seen as individualist on the other hand the left wing: is for public provision of welfare and residual welfare and are seen as collectivist, however this is not so straight forwards as it first seems this might also be dependent on The positions that might be held by people. There is an individualistic left wing, and a collectivist right wing. Many right-wingers accept the principle of institutional welfare, and many left wingers are uncomfortable about institutional measures, like student grants or earnings-related pensions, which favour richer people over poorer ones, Left-wingers however support social security (which enable people to buy food in the private market) rather than soup kitchens (which are more of fern than not publicly provided). The main political perspective of welfare positions are: The Marxist, The Conservatism and The Liberal individualism.

The Marxist:

Marxist core beliefs are that welfare concentrates principally on its relationship to the exercise of power. Marxist argues that welfare has been developed through the strength of working-class resistance to exploitation they further argue that the state can be seen as an instrument of a complex set of systems which reflects the contradictions of the society or as a ruling capitalist class or at least a pert of it.

The Conservatism:

Conservatives core beliefs lie in the importance of the social order. This is reflected in a respect for tradition, an emphasis on the importance of religion, and a stress on the importance of inequality – such as inequalities of caste or class – Conservatives believe that Welfare is a secondary issue and the basis for structured social relationships.,

The Liberal individualism:

Liberalism believes that the premise that everyone is an individual, and that individuals have rights. They mistrust the state and they also believe that society is likely to regulate itself if state interference is removed. The liberalism central core belief is freedom. All freedoms are not equally important; their main values and concerns are with certain particularly important freedoms, such as freedom, of worship, of speech, and. of assembly.

The welfare state stretched further under the pre First World War, from the outset the Liberal government’s principle emerged that the state should eliminate the worst causes of poverty and introduced a number of policies these included: Health, Housing, Education, Pensions and unemployment insurance and minimum wage boards and other measures on a strictly limited scale, these minimum standards had been introduced to give a basic level of assistance which was assumed no one would be allowed to fall below, the principle of a national minimum standard of life looks very different today form how the legislations and public policy was originally formulated, it was an attempt to prevent destitution and to deal with poverty. In 1911 the first National Health Insurance Act was passed, Lloyd George, Liberal Chancellor of the Exchequer assured employers it would ease the unsettled workforce and in turn would raise productivity by reducing sickness absence. World war one put a temporarily halted workers’ growing militancy. With the women’s work force increased the factory workers produced an even greater mood for change and with the horrific suffering soldiers coming home from war blind and with out limbs other suffering from mustard gas poising, In 1917 Lloyd George, by now prime minister, warned: that the Russian revolution has already inspired workers across Europe. Lloyd George Argued “The working class will be expecting a really new world. They will never go back to where they were before the war”. He promised a “land fit for heroes”, he was hoping to convince workers that life would improve without them following their Russian cousins.

In today’s society we have been increasingly aware of the many diverse needs of people needing help from a partly or non finical kind these would include: the blind, the deaf, long term sick and the handicapped, single parent families, unmarried mother, and newly arrived emigrants est. Although the principle of a national minimum standard of life is still in place it has immensely improved in comparison over the last 90 years.

The British political history of social policies since 1940’s have been many and varied, before the 1945 elections some new social policies had already been put in place there were three critical developments that took place during the second world war, the early drive towards the establishment of a national health service, the Beveridge Report and the Butler education act of 1944.

The Beveridge Report one of many efforts to plan for the forthcoming peace, it was widely acknowledged within Coalition Government that after the war Brittan would need to rationalise and improve its income maintenance policy; the report itself was a combination of detailed proposals for a comprehensive social insurance system and significant needs for future social policy.

Beveridge” described the road to social reconstruction after the war as involving ‘Slaying the five giants’ of’ Want, Disease, ignorance, squalor and idleness”.

The report had set down, had three conditions that were necessary to the development of a satisfactory system of income maintenance. The introduction of setting up a comprehensive health and rehabilitation service, a system of family allowance and the maintenance of full time employment, at the time these accompanying conditions made more political impact than the social insurance proposals.

The Beveridge Report (1942) The Beveridge Report launched the introduction of the Welfare State. The core reforms included:

The Education Act 1944 – provided free secondary education for all children.

The Family Allowances Act 1945 – provided universal benefits for families with two or more children.

The National Health Service Act 1946 – provided free and universal health care.

The National Insurance Act 1946 – provided unemployment and sickness benefits.

The Children Act 1946 – gave local authorities to set up social work for children.

Beveridge social insurance proposal involved flat rate benefit payments to the unemployed, widows, pensioners and the sick. This was a fixed amount for individuals with additions made for dependants with no graduation In relation to past earnings however this was to be funded by flat rate contributions from the insured, their employers and the state.

Health

On the 5 July 1948, The National Health Service started (The National Health Service Act 1946) The NHS was based on principles unlike anything that had gone before in health care. It was a historic achievement; however at that time majority of doctors were opposed to the idea, they believed that they would lose money as a result of it. Their belief was that their professional freedom would be jeopardised i.e. Doctors believed they would treat fewer private patients and the outcome meant they would lose out financially. Added to this was a strong belief that the NHS would not allow patients to pick their doctor however this was not to be the case and 95% of all of the medical profession joined the NHS. Others countries at that time still tended to rely on insurance based schemes

Before the introduction of the National Health Service (NHS), family doctors (General Practice) charged for their service. The majority of families that were Low-paid asked for a GP as a last choice, often they had to borrowing money from their families, neighbours or the pawnbroker to pay the bill. However more affluent workers paid into ‘Friendly Societies’ as insurance. In some parts of Brittan, workers joined together to pay a doctor with a weekly stoppage out of their wages. The trade unions also organised clubs like this were the worker could see a GP when they were sick the trades unions realised that keeping a healthy work force was more hands on tools. Some cottage hospitals were built with workers’ contributions, particularly in mining areas like South Wales.

However the NHS was to be financed almost 100% from central taxation. Bevan regarded this as a crucial part of the scheme that the rich should pay more than the poor for comparable benefits and People could be referred to any hospital, local or more distant also everyone was eligible for care, even people visiting the country or temporarily resident. Care was entirely free at the point of use. This proved to be a costly mistake as the government underestimated the demand on the NHS with most people it proved to be extremely popular as it quickly found that its resources were being used up from NHS earliest days it seemed to be short of money the annual sums that had been set aside for glasses and for treatment such as dental surgery were quickly used up. The ?2 million put aside to pay for free spectacles over the first nine months of the NHS went in six weeks estimates of the cost of the NHS were soon exceeded and within three years some although prescription changes and dental charges were subsequently introduced a charges of one shilling (5p) and a flat rate of ?1 for dental treatment. This was a small amount if you compare the price of a prescription in the United Kingdom today is ?7.20 per item. The cost of NHS dental care most courses of treatment cost ?16.50 or ?45.60. The maximum charge for a complex course of treatment is ?198. The government had estimated that the NHS would cost ?140 million a year by 1950. In fact, by 1950 the NHS was costing ?358 million.

Over the years the NHS went through many rough periods over finances and in the 1970s things managed to go from bad to worse, Brittan was in the gip that can only described industrial unrest It was the decade of strikes, piles of rotting rubbish on the street and electricity shortages for thousands of people the 70s was a time when people were just trying to make ends meet in difficult economic conditions, when industrial action hit the NHS and Financial problems also hit the service in 1978 and 1979 as oil shortages in the ‘winter of discontent’ took hold. This was not help when the consultants went up in arms over the proposals to reduce the amount of private work they undertook.

The 1970s started the ongoing debate on the best way for the NHS to evolve. With this in mind GPs introduced the first charter to encouraging the growth of primary care in the UK match local health authority boundaries with the new boundaries created in local government. A new system of distributing the resources of the health service more evenly was also implemented in 1974, a few months later a Royal Commission was appointed to look into the problem.

The NHS was slowly changing its mind set looking at people as customers and not as patients and turning towards private investors to help fund and shape the NHS; however before the introduction the first wave of 57 NHS Trusts came into being in 1991and By 1995 all health care was provided by trusts. The majority of family doctors were given budgets to buy health care from NHS trusts and they could also buy health care from the private sector this scheme was called GP fund holding. Patients of GP fund holders were often able to obtain treatment more quickly than patients of non-fund holders. Becoming a NHS trusts this was the new future was to be a ‘provider’ in the internal market, health organisations, independent organisations with their own management, competing with each other.

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Community care

Community care as we know it today came in the 1950s and 1960s; this was the result of political realism and progress in the understanding of mental health and the treatments now available this also includes social changes civil rights campaigns and a rise in the patients’ rights movement, moving away from the isolation of the mentally ill in old Victorian asylums towards their re-integration into the community.

The 1959 Mental Health Act encouraged the development of community care and abolished the distinction between psychiatric and other hospitals. This was seen as the biggest political change in mental healthcare in the history of the NHS, During the 1960s the populist continued to move against the big hospital institutions Psychiatrists questioned traditional treatments for mental illness, with the introduction of new psychotropic drugs also meant patients could be more easily treated outside of an institution.

Enoch, the former health minister was dubbed by some as the Father of Community Care; he argued that mental hospitals were effectively prisons, preventing the patients return to normal life. Powell also belief that community care would be cheaper than hospital care the new district general hospitals contributed to the reduction in the number of beds in mental hospitals from 150,000 in the mid-1950s to 80,000 by 1975.

The Mental Health Act 1983 set out the rights of people admitted to mental hospitals, the introduction of legislation would give the mentally ill more rights allowing them to appeal against committal.

In 1984 Sir Roy Griffiths led a government inquiry into community care, after the murder of social worker Isabel Schwarz she had been killed by her former client. In 1998 Sir Roy Griffiths report outlined the Community Care: Agenda for Action’ was the forerunner to the Community Care Act of 1990, major legislation which sets out the basis for community care as we know it today.

The government invested an extra ?510m in mental health services in England, Frank Dobson the then Health Secretary said the extra ?510m for NHS mental health services over the following 3 years would add to the ?180m announced for social services care of the mentally ill. This would include a revision of the controversial care in the community policy. He also told the House of Commons that mental illness was not “an obscure, minority concern”, but affected one in six people at any one time.

The ?700m will be broken down with at least ?500 million being ear-marked within for targeted change in the way services are delivered, around ?120 million will be spent on new and effective drug therapies and ?70m will go towards training mental health nurses and psychiatrists, and other care and clinical staff.

The government’s drive to Modernising Mental Health Services strategy document included a new national service framework it laid out guild lines on how they can best treat people and it clearly spelt out the range of services needed for the mentally ill.

The new strategy included: More mental health beds, more supported housing and hostels, More training for health workers, Improved services for adolescents and young people Access for the mentally ill to the NHS Direct helpline Access to new mental health drugs More day centres for the mentally ill and more outreach teams and a 24-hour crisis teams.

In the last five years mental health services in England is going through an unprecedented change. A Government programme has been launched to improve on the quality of mental health care, and improve the mental well-being of people in England; the policy has implementation guides and good practice examples.

New Horizons: a shared vision for mental health is a comprehensive initiative that will be delivered by ten national Government departments.

New Horizons forms an alliance of, local communities and individuals and the voluntary sector and professionals, to work towards a society that values mental well-being as much as physical health and it outlines the benefits of unlocking the benefits of well-being in terms of physical health, educational attainment, employment and reduced crime and in turn reducing the burden of mental illness.

Conclusion

As the population continues to age, it is becoming increasingly important to focus on policies and practices that support and enhance the wellbeing of the older population in later life. One sad reality for many seniors in later life and an increasing cause for concern is elder abuse. Elder abuse is one of the most disturbing and rapidly growing areas of crime throughout the global. It is extremely difficult to exactly quantify the extent of elder abuse because many such cases go undetected and under-reported.

The World Health Organization reported that it is generally agreed that abuse of older people is either an act of commission or of omission or neglect, and it may either be intentional or unintentional (Krug et al., 2002). It results in unnecessary suffering, injury, the loss of violation of human rights, and a decreased quality of life for the older person. Like any other form of domestic violence, abuse of the elderly initially remained as a private matter hidden from public view. It was initially seen as a social welfare issue and latter on a problem of ageing, but now has developed into a significant public health and criminal justice concern. The value of loving family institution has been tarnished by greed, position-struggle and impatience.

Despite elder abuse is not entirely a new issue; it is time to find out the prevention ways to be implemented and effective interventions to emerge. There are a few welfare needs that will be highlighted after so that the young generation have a strong sense of love and care towards the senior citizen.

Elderly

Nowadays, Malaysians are living longer; they are on an average of 74 years for men and 78 years for women. In others words, their life expectancy has increase. With the advances in medical care and better nutrition, older people are living longer, they are more visible, more active and more independent than ever before and they are in better health. Therefore there is a growing concern regarding the global phenomenon of aging. A decline in the birth as well as death rates has resulted in an increase in the elderly population. Given that the elderly population is on the rise, it is of paramount importance to examine the care of the older persons.

2005
(%)
2010
(%)

Total Population

26.75 m

28.96 m

65 and above

1.15 m

4.3%

1.36 m

4.7 %

This table shows that the total population and the aged of 65 years or above in Malaysia between the year of 2005 and 2010. In 2005, the total population of Malaysia was 26.75 million, and which 1.15 million or 4.3% was aged 65 years and above. Moreover, in 2010, Malaysia currently has a population of approximately 29 million, and aged 65 years and above has increased to 1.36 million or 4.7%. With the projected population growth of 2% annually, it expected that the total population in 2020 will rise to 34 million, of which 3.2 million or 9.5% will be the age of 65 years and above. In the year 2035, the country is expected to have a total population of about 46 million of which 6.9 million or 15% will be the aged 65 years and above. This is evident that Malaysia’s demographic ageing pattern is emerging. Based on the figure showed in this table, the real numbers of older person have increased lately, which also means that the number of elderly will continue to grow over the coming year. As the populations of older Malaysian grows, so there has a hidden problem of elder abuse. Further, the number of elderly with chronic illness is likely to increase. This can pose an increased burden on their caregivers such as family members, and it could lead to a higher risk of elderly abuse.

Elder abuse

Elder abuse is a single or repeated act or lack of appropriate action occurring within any relationship where there is an expectation of trust which causes harm or distress to an older person (Action on Elder Abuse 1995). The “wilful infliction of injury, unreasonable confinement, intimidation or cruel punishment with resulting physical harm or pain or mental anguish, or the wilful deprivation by a caretaker of goods or services which are necessary to avoid physical harm, mental anguish or mental illness” (1985 Elder Abuse Prevention, Identification & Treatment Act). According to the Swanson (1999), elder abuse refers to the mistreatment of older people by those in a position of trust, power or responsibility for their care. This is a global problem that is likely to intensify in view of the increasing number of older people and the changing socio-economic and environmental conditions worldwide (Randel et al. 1999). Further, Hazzard (1995) described elder abuse as cruel and inhumane treatment of the elderly. Kapur (1997) defines it as a kind of harassment or an injustice done to the elderly by the family members themselves. In fact, there is too many definition of elder abuse but despite this, most would agree with this definition “an action or inaction by someone in a position of trust; often a family member or unrelated caregiver”. Normally, more than two-thirds of the abusers are their family members and are typically giving their basic needs or care support such as food, shelter, personal care or transportation. In others word, someone who commits elder abuse usually has control or influence over the older person. The older persons often know and trust the abusers. Some victims of elder abuse depend on the people who hurt them, sometimes for food, shelter, personal care, or transportation. Therefore, the abusers could be their family members, friend; someone the older people relies on for basic needs or staff in group residential settings such as care homes or in long term health care facilities.

The Prevalence of Elderly Abuse in Five Developed Countries
Country
Prevalence (%)

USA

3.2

Canada

4.0

Finland

5.4

Netherlands

5.6

United Kingdom

5.0

The accepted prevalence rates of abuse of older people are drawn from five community surveys carried out in developed countries, which are USA, Canada, Finland, Netherlands and United Kingdom. The prevalence of the elderly abuse in USA with percentage is 3.2%, in Canada is 4.0%, in Finland is 5.4%, in Netherlands is 5.6% and United Kingdom is 5.0%.

But in Malaysia, the information and data of elderly abuse is scarce. There are no reported cases of elder abuse to the Department of Social Welfare as well as no agency keeps proper records of the incidence of elder abuse in this country. Although this ‘epidemic’ is virtually unheard of in Malaysia, we are challenged to be aware of the many faces of elder abuse in our own society and this issue is much more common than societies admit.

Types of elder abuse

Elder abuse referred to an inappropriate action that causes harms or distress to an elderly which the older person has expectation trust onto the person. Elder abuse can take in several forms. Elder abuse may take form in physical, psychological, financial, sexual abuse, neglect and abandonment that cause distress to a person who is past retirement age.

Physical Abuse

Physical elder abuse is non-accidental use of force against an elderly person that results in physical pain, injuries, or impairment (Ellen, Tina, Jeanne, 2008). This abuse includes not only physical assaults such as hitting or shoving but the inappropriate use of drugs, restraints, or confinement. The physical acts of violence commonly include slapping, hitting, and striking with objects. Indicators of potential physical abuse are broken bones, sprains, or dislocations, unexplained signs of injury such as bruises, welts, or scars, especially if they appear symmetrically on two side of the body, signs of being restrained, such as rope marks on wrists (Elder Abuse.com, 2009). Diagnosis may be difficult even at autopsy as findings may be subtle and invariably some chronic or debilitating disease would be present. The case of an elderly lady from a nursing home referred to the police for suspected physical abuse. Investigations showed that osteomalacia and spontaneous fractures could have accounted for her injuries. However, recognition of physical abuse may not be straightforward, as injuries may be secondary to falls to which the frail elderly are more prone.

Emotional abuse

Emotional abuse is defined as the infliction of anguish, pain, or distress of elderly. Emotional abuse also referred as an act with the intention that causing emotional pain or injury which often accompanies physical abuse. This abuse may be happens in verbal or nonverbal acts. Verbal forms are included humiliation and ridicule, intimidation through yelling or threats and habitual blaming or scapegoating. Nonverbal emotional elder abuse can take the form of ignoring the elderly person, isolating an elder from friends or activities and terrorizing or menacing the elderly person (Ellen, Tina, Jeanne, 2008). Therefore, an elderly person who shows fear, passive, withdrawn, low self esteem, reluctance to talk openly, insomnia, fatigue and listlessness or behave mimics dementia, such as rocking, sucking, or mumbling to oneself may be abused in the form of emotional abuse.

Financial Abuse

Exploitation of the elderly is also considered as an abuse which includes acts of material or financial exploitation. Financial or material exploitation is defined as the illegal or improper use of an elder’s funds, property, or assets (Elder Abuse.com, 2009). Elder financial abuse is one of the most difficult types of elder abuse to recognize due to its lack of obvious symptoms. Some of these include misuse an elder’s personal checks, credit cards, or accounts, steal elder’s cash, income checks, or household goods. Most common example case is the announcements of a “prize” that the elderly person has won but they need to pay money to claim (Ellen, Tina, Jeanne, 2008). Besides that, theft of pension checks, threats to enforce the signing or changing of wills or other legal documents, and coercion involving any financial matters also consider as the example of the financial abuse. Indicators of potential financial abuse may include unusual bank account activity, sudden changes in the elder’s financial condition, or worsening medical conditions due to lack of follow up or unfilled drug prescriptions. Exploitation may also occur in the form of fraud schemes; someone may persuade the elderly person to withdraw their life savings in a “get rich quick” scheme, or ‘contractors’ convincing the elderly that the house needs repairs which in reality might be unnecessary. Financial abuse is one of the most difficult types of elder abuse to diagnose as the victim may not be aware of its occurrence or may not know how to seek help.

Abandonment and Neglect

Abandonment is defined as the desertion of an elderly person by an individual who had physical custody or otherwise had assumed responsibility for providing care for an elder. It also referred to the action of withdrawing a person or a thing entirely; putting aside all care for him or it. Neglect of the elderly is also a form of abuse and is often referred to the refusal or failure to fulfil any part of a person’s obligations or duties to an elder. This may be intentional or unintentional neglect. Active neglect is the intentional withholding of basic necessities or care, while passive neglect is not providing basic necessities and care because of a lack of experience, information or ability. Another area to consider is self-neglect where older adults, by choice or ignorance, live in ways that disregard health or safety needs, sometimes to the extent that the disregard also poses a hazard to others. For example, the caregiver may be unable to perform care giving duties such as bathing or changing an incontinent elderly person. Therefore, an elderly person with unusual poor hygiene, loss in weight, poor nutrition, skin breakdown, unsuitable clothing, unsafe and unclean living conditions such as no heat or running water, faulty electrical wiring, other fire hazards and smelling of urine may be neglected either intentionally or unintentionally.

Sexual Abuse

Sexual abuse is defined as non-consensual and unwilling sexual contact of any kind. This includes all unwanted sexual activity, such as verbal or suggestive behaviour, fondling, sexual intercourse or a lack of personal privacy. Besides that, activities such as showing an elderly person pornographic material, forcing the person to watch sex acts, or forcing the elder to undress are also considered sexual elder abuse. Indicators of potential physical abuse are unexplained venereal disease or genital infections, bruises around breasts or genitals, unexplained vaginal or anal bleeding and torn, stained, or bloody underclothing (Ellen, Tina, Jeanne, 2008). Sexual abuse usually implies a physical sexual relationship with an elderly person without that person’s informed consent, though this is not restricted to sexual intercourse but includes other forms of intimate sexual contact. It is often difficult to establish whether sexual abuse has occurred, unless the individual has cognitive impairment.

Signs and symptoms of elder abuse

Signs and symptoms of elder abuse should be taken seriously. It is vital that we are alert to the possible indicators of abuse. In assessing any situation, it is important to realize that an indicator may be present for reasons other than abuse or neglect. However, if a combination of the following indicators is present there is a need to further explore why those indicators are present. Increase awareness of abuse signs and symptoms as well as monitor the progress in suspected cases of abuse. Home care community nurses can play a critical role in detecting suspected cases of elder abuse. However, in Malaysia, we do not as yet have a health care system in place for such purposes, although these types of services are only now slowly emerging. Hence the only opportunity for detecting abuse is when the older adult visits a primary care setting or an emergency department.

Characteristics of the Abused Elder

Most victims of elder abuse are mentally competent and able to make decisions for them. Most of them able to taking care of their own health needs and do not need constant care. Although some victims of elder abuse are generally dependent on their abuser in some way, their dependency is not necessarily because they are mentally incapable or physically frail (Al Loney, 2006). However, if the older people who having mental or physical disability, they may be more vulnerable to be abused. Those at risk are most likely to be female, widowed, frail, cognitively impaired, and chronically ill. The older adults who poor in physical health, highly dependence on the abuser, functional or cognitive impairment and a living arrangement shared with the abuser are consider as risk factors for elder abuse. Normally, older women are more vulnerable to abuse than older men and are burdened with a lifetime of experiences and beliefs that may increase their susceptibility. In most instances, violence and abuse against older women can be sexual, physical or psychological and also can include material or financial abuse and neglect. It can occur in the home, in institutions or as a result of harmful cultural practices that specifically target older women (Breatheinspirit, 2006).

There are various studies have looked at factors associated with elder abuse. In the NEAIS report, females and those aged 80 and above were more likely to suffer abuse, family members were the most likely perpetrators and victims of self-neglect were usually depressed, confused or extremely frail. Other studies have similarly reported vulnerable elderly as those with physical and mental weaknesses, advanced age, women, those with previous abusive relationships in the family, financial strain and caregiver stress and burnt out.

Characteristics of the Abuser

The abuser is most likely the person with whom the elderly person stays with. More often, the abuser is a close relative; 80% being spouses and children of the victims, or a close relative. In some cases, elder abuse may be caused to abusers’ over use of drug or alcohol, history of anti-social behaviour, or mental illness problems. Abuse is more likely to happen when the abuser is going through a period of high stress. It may be the stress of looking after the older person due to old age is a time of weak health, low income, meaningless role, or the death of loved ones (Al Loney, 2006). These problems may be creating great unhappiness for older people and then damage the relationships with their family. In extreme cases, this may lead to abuse.

Elder abuse often happens because of the abuser’s power and fully control over an older person. Family members who depend on the elder for financial, housing, or other necessities have a higher risk of become an abuser. A caregiver’s inexperience, a history of family violence, economic dependence on the elder or a blaming personality and unrealistic expectations often contribute to elderly abuse. The abuser may be lack involved in community activities, social services, and even contact with other family members. Besides that, they may lack of family support, facing marital conflict, overcrowding and the high burden of care placed on the caregiver. In most of elder abuse cases, the abuser may not allow people to visit or talk to the older person alone.

On the other hands, staff in long-term care homes, such as homes for the aged and charitable institutions, might involved in abuse the older people in physically or mentally. Abusers are more likely to be staff members who are not able to do their jobs properly (Al Loney, 2006). This may due to poor of training, low salary, over-work without pay, or under-staffing. Besides that, it also could be the staffs have personal problems that influence their services to older people which under their care. But, there is no excuse for abuse. The personal circumstances or problems of the caregiver can’t be an excuse of elder abuse. These problems may be factors in the abuse, but they do not try to recognize it. It is unmoral because the older people are fully trusted and relies on the caregiver, but the caregiver misuse the trust of the older people to do something that threaten to the older people.

Common Reasons Elder Abuse Is Not Reported

The actual and prevalence of elder abuse is unknown and difficult to measure. Elderly abuse exists in our society but it is seldom reported, and perhaps even less so in an Asian society where filial piety and respect for the elderly is traditionally highly regarded. This problem often remains undetected because of poor public awareness and lack of knowledge among health care personnel. This is because it can cause some adverse effects on the health and quality of life of the elderly. Due to their mental capacity, they are unaware of the help available to them. Therefore, elder abuse is seldom reported. In most situations, elderly are unlikely to report that they are abused as they are fear of embarrassment and fear of losing care support. They are mostly completely under the control of the abuser and depend on the abusers for food, shelter, clothing and health care. Furthermore, they also fear of harm by the abuser. Some of them are lack of awareness; they are only suspect but uncertain that is abuse, therefore, the cases of elder abuse is hardly to report and also seldom reported.

Risk Factors for elder abuse

Abuse of older adults is such a complex issue with no single explanation. However, there are many factors seem to contribute to these critical issues and each case has its own unique mix of factors.

One of the most obvious factors is the family dynamics. The habits, values, emotional and coping skills are learned early in life and largely through family interaction. In other words, if unhealthy or violent behaviours go unchecked, abuse may continue when roles are reversed. Therefore, if a child who was previously abused becomes a primary caregiver, there is a probability that the cycle of abuse will continue and be inflicted on a dependent parent.

Besides that, inability to cope with stress especially for those non professional caregiver such as spouses, adult children, other relatives and friends find taking care of an elder would caused many responsibilities. This may be extremely stressful to cope with the demands of elder care giving. As a result, the stress of elder care can lead to mental and physical heaths problems that caused caregivers impatient, burned out, and sometimes are unable to keep from lashing out against elders in their care.

Next, problem of elderly abuse may also happen in the nursing home when the staffs who worked are those lacks of experience and training. This is because even caregivers in institutional settings can experience stress at levels that can lead to elder abuse. The nursing home staff may be prone to elder abuse if they lack training, have too many responsibilities and are unsuited to care giving, or they are work under poor conditions.

Social isolation can also conceal and perpetuate abuse or neglect. An older person may become isolated due to physical or mental illness, or through the loss of friends and family members. Therefore, isolation does not just conceal abuse and neglect; it perpetuates the problem. The result of this isolation can make it easier for an abuser to exploit, neglect or abuse an older person. There is a significantly higher risk for elder abuse if without a caring support network. In addition, if a caregiver imposes isolation to avoid uncovering the abuse, this is also a form of abuse.

In addition, sometimes caregivers who are unable to cope with the long term care giving may react to the stress of too many responsibilities in appropriate ways. These unusual releases way are such as abusing, neglecting the older adults in their care. Also, most of the caregiver’s perception is that taking care of the elder is burdensome and without psychological reward. Thus, many of them choose to neglect the older adults.

The society’s acceptance towards violence can also be a form of factors in contributing the elderly abuse. For example the Canadians see violence in the news, movie and television shows. This wide exposure often leads to a general acceptance or tolerance of violence as an acceptable way of venting frustration or anger. Thus, this tolerance creates an environment which can contribute to abuse and neglect of older adults.

The welfare needs of elderly

Welfare needs are necessary for elderly in order to stop the growing elder abuse issue. The government, law and legislation, mass media, school education, health care providers, family and also elderly have the responsibility to give support the rights of old persons.

The government

The National Service Program or Program Latihan Khidmat Negara (PLKN) was established since started in 2004 as a response to the Malaysian Government’s desire to inculcate the spirit of patriotism in the hearts and minds of Malaysian youths. Besides to develop the spirit of patriotism, it instils a spirit of caring and volunteerism among members of society as well as to develop positive characteristics among younger generation through good values. The three-month program is aimed at shaping young people into disciplined, independent and resilient citizens capable of advancing the nation.

From this programme, the young generations could learn how to respect the elderly.

Welfare pension should be introduced in Malaysia. If elderly do not have the ability to claim maintenance from their financially-able children, they have the pension as a security. It is seen as a way to eradicate poverty. The senior citizens are still able to take care of themselves in spite of they are abandoned by their merciless children.

Abuse prevention programme could be introduced by Malaysian government as well. Its purpose is to provide and arrange for services to protect adults who are unable to protect themselves from abuse and provide older adults with information about their rights. For example, Abuse Prevention Programme (APP) in Australia which supports older adults who are being abused, or who are at risk of being abused, by someone with whom they are in a relationship of trust, such as family and friends. APP advocates work in consultation with the older adult, either directly, or with someone else the older person has chosen (their representative). APP can assist them to identify and understand the issues related to abuse of their rights as well as discuss information about options which they can implement to assert their rights. Besides, it suggests action they can take to stop abuse of their rights and give them with appropriate advocacy support that enables them to have their rights met.

In addition, the government can launch adult day care programme, which it enables the caregivers to get time off during the day. Adult day care is a planned program of activities designed to promote well-being though social and health related services. Adult day care centres operate during daytime hours, Monday through Friday, in a safe, supportive, cheerful environment. It not just provides older persons an opportunity to get out of the house and receive both mental and social stimulation but also gives caregivers a much-needed break in which to attend to personal needs, or simply rest and relax.

Law and legislation

Malaysia law and legislation also play a vital role in overcoming the elderly abuse problem. Malaysia law can establish a legislative “Elder Protective Act” which is warranted to protect our vulnerable elderly from untold suffering. They have the right to live with dignity and security. For example in all 50 US states have specific adult protection legislation within which issues related to elder abuse and/or neglect are addressed. This legislation is influenced by child welfare models, and is characterised by legal powers of investigation, intervention and mandatory reporting. In the absence of federal mandates, states have been developing their own responses to adult abuse, neglect and exploitation. Legislative “Elder Protective Act” should be implemented by the government to safeguard the rights of our vulnerable elderly.

Suggestion has been made for the government of Malaysia to adopt a law which allowing the elderly parents to claim maintenance from their financially-able children. This can be learned from the country of Singapore where the Maintenance of Parents Act enables parents above 60 years old who cannot support themselves to seek legal action forcing their children to provide maintenance for them.

The government of Malaysia should also tighten the law and can used country of India as an example. In India, children could be imprisoned or fined or be subjected to both if they abandon their elderly parents. The Tamil Nadu government is set to notify rules for the Maintenance and Welfare of Parents and Senior Citizens Act, 2007, to help tribunals in each district decide on the order of maintenance for elderly citizens, who complain about being neglected by their children. Therefore, the government is committed to develop such services and formulate policies against elder abuse in Malaysia.

Malaysia, being one of a few countries that uphold Syariah Law has Islamic Law that governs the welfare of family matters including the ageing parents, following the case in which a couple sued their daughter for not providing sufficient maintenance as what they have agreed.

Elder abuse is a national problem with far reaching consequences for individuals, families, communities, and institutions. The state courts must play a critical role in addressing the needs of victims of elder abuse. The court’s ability to assist older persons essentially determines whether individuals live their remaining years with respect and dignity, or are further alienated from the justice system with personal safety.

Mass Media

Mass media also plays a quite significant role in minimizing the problem of elderly abuse in Malaysia. The media was often blamed as one of the sources of the negative images of older adults in society. It was seen as important to work with the media to change these negative images, to raise awareness and to educate the population about elder abuse. They are able to inspire the public to be aware of this social issue by utilizing mass media such as televisions, radio networks, internet, newspaper, magazines, etc.

Nevertheless the problem often remains undetected because of poor public awareness and lack of knowledge among healthcare personnel. Therefore, the print as well as electronic media are to play active roles to increase the society’s awareness of the elderly.

Media coverage of elder abuse cases can make the public knowledgeable about-and outraged against-abusive treatment in those settings. Due to most abuse occurs in the home by family members or caregivers, there needs to be a concerted effort to educate the public about the special needs and problems of the elderly and about the risk factors for abuse. Within mass media cultures, social issues such as elder abuse, have key reference points which can attract concentrated coverage of the topic and carry influential associations in public perceptions. For example, in USA, the Indochina Sino-American Community Centre formed a coalition called “Chinese Americans Restoring Elders”, they used mass media to encourage the public to contact the Community Centre for matters related to elder abuse; provided some individual counselling sessions; and conducted a press conference and distributed brochures and flyers in Chinatown to commemorate World Elder Abuse Awareness Day.

The television networks always played the advertisements that have the influence on the public over the caring of the elderly. Like the PESTRONAS during religious or cultural holidays (namely Aidilfitri, Chinese New Year, Deepavali) are often accompanied by touching advertisement that convey the message to show love and care to our parents.

School Education

Education is the cornerstone of preventing elder abuse. This education needs to start very early, in primary school.

The students need to be educated to perceive to older adults more favourably as positive contributors to society. The elderly do not necessary mean burden to the family or society. With their wealth of knowledge and experience, they can still contribute to economic development and wealth creation. They have contributed to the development of the nation in their earlier years and they can still continue to be productive in their golden years. The students should consider senior citizens are an important and integral part of our society.

Students need to understand the interpersonal dynamic of care-giving. For example, they need to be award of the value placed on the dependency and inter-dependency in care-giving; role reversals in care-giving; and how unresolved emotions between the elderly and the care-giver influence the care-giving process.

The school curriculum is to include education on the family to enable the younger generation to understand and appreciate the elderly. They need to be encouraged to form closer relationships with older adults. The general population also needs to be aware that elder abuse happens and is a problem. Students need to understand the subtle difference between abuse, neglect and abandonment theoretically as well as operationally. The moral education teachers not just teach theoretically but also operationally. What is more, the schools should organise a numbers of the activities like visiting old

The Case Study: The Webster Family, A Family In Crisis?

This assignment requires me to outline what model of assessment I will use when working with the Webster family. I will also give a description on how the family was referred to social services for a Section 47 (S47) investigation. There will be a strategy meeting and the details of this meeting will be outlined along with instructions given. There will be a case conference held to discuss whether the children are at risk of significant harm or the likelihood of significant harm. There will be a clear recommendation as to whether I will register these children on the child protection register, justifying my decision. Whilst working with the Webster family I will explain what legislation I used, my research into the theories involved and also I will provide details of any anti-oppressive practice and any anti-discriminatory practice whilst working with this family.

Ms Webster and Mr Webster have lived together for twelve years. They have three children, Faith and Hope who are twins and are aged ten and Charity who is seven years old. Charity has Cerebral palsy, is doubly incontinent and is a wheelchair user. Mrs Webster is a teacher and Mr Webster was a probation officer who up until twelve months ago worked full time. Following an accident a work he has taken early retirement on health grounds and is now employed full time as a househusband looking after the children. The family are not known to social services or any other welfare agencies. There have been many tensions building up within the family home since his accident and after a violent row Mr Webster left the family home.

After speaking to the headmaster it appeared there had been an incident of domestic violence in front of the children and staff.

Previous to this incident, the day before Charities class teacher had had reported to Mr Perry that over the last two weeks Charities appearance had deteriorated, her clothes were unclean and her nappies were soiled and Charity smelled of urine. Charity had also began being aggressive to her friends and to the staff. A staff member had also discovered pressure sores on Charity. When Charities teacher telephoned Ms Webster to tell of their concerns, Ms Webster was frosty in response.

After the incident outside the school Mr Webster explained that Ms Webster had attacked him on two other occasions and these incidents again where witness by the children. On both occasions the police were called, however Mr Webster was concerned about social services and did not press charges.

After the incident, later that afternoon The Education Welfare Officer (EWO) Ms Murray, went to visit Ms Webster at home but was refused entry. Ms Webster was verbally abusive. Ms Murray then tried to speak to Charity but she refused to talk to her. Ms Murray then went to visit Mr Webster where the twins were staying. The twins seemed fine but a little subdued. Mr Webster stated that he would be looking after the twins and he would like custody of all three children.

Following the visit a strategy meeting was formed. A strategy discussion will take place if there is reasonable cause to suspect that a child is suffering or is likely to suffer significant harm. This will involve The Local Authority Social Care, the Police and other bodies as appropriate for example, a headmaster or a teacher (Working Together to Safeguard Children, 2006). Present in the meeting was myself (duty care social worker), Ms Gold (my team manager), WPC Bond (family protection unit), Mr Perry (headmaster) and Ms Murray (EWO). A strategy discussion is to share information regarding the situation at hand and another aspect is to plan how the S47 enquiry, if there is to be one, should be carried out. We can also agree action is required immediately to safeguard and promote the welfare of the child. The Domestic Violence Unit reported they did not refer these incidents to Social Services as they did not see the children to be at any risk, however Working Together states that children may suffer directly and indirectly if they live in households where there is domestic violence and domestic violence is likely to have a damaging effect on the health and development of children. It is often appropriate for such children to be regarded as children in need S17.

Mckie (2005) makes some interesting observations on the terms ‘perpetrator’ and ‘victim’ in an analysis of domestic violence. The policies and practices connected with domestic violence become gendered in so far as women are conceptualized as those who should act. Mckie (2005).

Working Together also says that children who witness domestic violence have been shown to be at risk from behavioural, emotional, physical, cognitive functioning, attitude and long term developmental problems.

We do know that Charity has become aggressive and abusive.

After the strategy meeting and because of the concerns regarding Charity, It was agreed after a discussion with my team manager that I would visit Ms Webster to discuss the referral from school. From this I would then make an assessment as to whether the child/children are at risk of significant harm or the likelihood of significant harm. The overall decision was that a S47 enquiry should proceed with immediate effect.

Some children are in need because they are suffering or likely to suffer significant harm. Concerns about maltreatment may be a reason for a referral of a family to social services. In such circumstances, the Local Authority is obliged to consider initiating enquiries to find out what is happening to a child and whether action should be taken to protect a child. This is set out in Part V S47 of The Children Act 1989 (Protection of Children).

The Framework for the Assessment of Children In Need and Their Families (2000), section 1.28 states that the LA has a duty to respond to children in need to provide services to minimise the effects of disabilities, this applies to Charity. We also have to take steps to prevent neglect or ill treatment. There does appear to be in this, in relation to Charity’s case.

Section 17 of the Childrens Act says that services may be provided to assist a child in need. This would refer to Ms Webster if she is agreeable because the needs of parent carers are an integral part of an assessment because providing these services which meets the needs of the parents is often the most effective means of promoting the welfare of children, particularly disabled children. My role now is to recommend which route we proceed down.

When I went to visit Ms Webster, She was hostile towards me. Ms Webster said she had never been violent to her husband before and denied the incident outside school. Ms Webster claimed she had no problems looking after her children but showed a negative attitude towards Charity. She spoke about Charity as if she was not there and referred to Charity as “she” instead of by her name. Ms Webster said Charity was hard work and was always soiling her nappies, shouting and crying. Ms Webster seemed angry as she was explaining this. Whilst we were talking, Charity did not say anything but looked as if she wanted to cry. Charity’s appearance was unclean and she smelled of urine. Ms Webster was clearly upset about her husbands’ sexuality, more than for the safety of her children. When entering Charity’s bedroom which Ms Webster had reluctantly agreed to, I found bed clothes stained with urine and stools. The en-suite and bath were both unclean. The rest of the home however was clean and tidy. I spoke to Ms Webster about my concerns and told her that she would be entitled to help if she would accept it. This empowered Ms Webster and allowed her to feel there was help if she wanted it and she was not alone. Ms Webster did say that she thought Charity may have been affected by witnessing the recent arguments and she would make sure Charity was not further stressed that day. It was discussed that Charity had pressure sores; from this Ms Webster became ‘frosty’. Reluctantly she agreed to take Charity to see her doctor and I arranged to visit the next day.

The following day on the 20th January 2008 I visited Ms Webster, but there was no answer. When I tried to telephone her there was still no answer. As a result from this, there were concerns regarding the domestic violence and the condition of Charity and it was decided that a Child Protection Case Conference was to go ahead.

I will explain this model of assessment I used in this case before I go on to the case conference. The model of assessment used is The Framework for The Assessment of Children In Need and Their Families (DOH 2000) more commonly known as the assessment framework. The assessment framework will be integrated into the revised Working Together to Safeguard Children. A key principle of this framework is that it is child-centred; this means that the child is seen and kept in focus throughout the assessment. The child or children are my main priority as a child social worker. It is also rooted in child development which includes recognition of the significance of timing in a childs life. Calder, M and Hackett, S (2003).

This particular assessment model is dynamic, fluid and continuous, this helps the intervention because as changes occur in a person’s life, it can adapt to the changes and my care plan can also be adaptable. A criticism of this model is the timescales can force social workers towards a procedural model whereas the Exchange Model offers an empowering dialogue with parents.

Smale et al (2000) identify a weakness in this model in that this approach may not work if the service user is not engaging in the process or are unable to articulate themselves. It also denies that workers have a professional responsibility and can be time consuming, which may create difficulties given the time constraints of The Assessment Framework. It also overlooks the need to adopt a procedural approach given the various questionnaires/scales utilised.

Changes have appeared to have happened over the last two weeks for Ms Webster and her family. Domestic violence, with both parties blaming each other and the deteriation of Charity’s appearance and her temper towards others. This leads me onto another concept of my assessment, which is parenting capacity. This is done using the assessment triangle, which includes child developmental needs, family and environmental factors. The DOH dimensions of parenting capacity has six core dimensions of parenting capacity, three of these provisions suggest that Charity is not receiving emotional warmth, Charity’s needs for secure, stable and an affectionate relationship, appropriate physical contact to provide comfort and warmth and stability of attachments and basic care to provide food, drink, warmth, appropriate clothing and personal hygiene. Ms Webster’s capacity concerns me because of her response to Charity and her circumstances involving her cleanliness and her appearance, the way she speaks about Charity, whilst Charity can hear her mother, and her reaction to use support and accept help and the relationship between Ms Webster and Charity.

Children’s chances of receiving optimal outcomes will depend on their parent’s capacities to respond appropriately to their needs at different stages of their lives Calder, M and Hacket, S, (2003).

Some of the above factors are included in the integrated model for assessing parenting capacity. The parenting style I would suggest of Ms Webster is neglectful parenting as she is neither responsive nor demanding of Charity. Ms Webster lacks the monitoring and the supervision duties surrounding Charity at the moment.

Neglect is the persistent failure to meet a child’s basic physical and/or psychological needs, likely to result in the serious impairment of the child’s health or development. Working Together To Safeguard Children (1999).

From my assessment I would put forward in my opinion and recommend that Charity to be put on the child protection register S47 but not her two twin sisters, but would offer support under S17. This is because of the declining condition of Charity’s physical condition and appearance, due to her persistent soiled nappies, the urine smell on Charity, her dirty clothes, her pressure sores and her aggressive nature toward others. Charity has suffered some the physical neglect of because of the delay of being taken to a doctor by her mother. Charity also suffered abuse due to witnessing the domestic violence and therefore there is a h3 possibility of emotional abuse.

Research shows that ‘prolonged and/or regular exposure to domestic violence can have a serious impact on the child and/or children’s development and emotional wellbeing and can lead to serious anxiety and distress and in some cases the repetition of violent behaviour. Department of Health (2006).

All these factors could lead to significant harm. These are the categories for registration. The twins will not be registered as they are not in any immediate danger as they are both cared for by their father and his partner at the moment, a police check has been carried out and neither is known, the EWO has no concerns regarding the twins. However this situation needs to be monitored and regularly reviewed to safeguard the children as this situation may change. My reasons for recommending registration are the three incidents of domestic violence over the last three months, one known to have been witnesses by the children. Ms Webster’s reaction outside school when she was verbally abusive, erratic and aggressive. There are neglect issues. We also need to take account of Charities additional needs.

A definition of disability is children and their families whose main need for services arises out of the children’s disabilities or intrinsic condition (DOH 2000). This applies to Charity as she falls within the category and she has a medically diagnosed condition, which is Cerebral Palsy.

Both parents are blaming each other for the domestic violence issues. There are concerns by school staff regarding Charity’s decline in appearance and her aggression. There is also the issue of family attachments which I noted earlier in parenting capacity.

After making a recommendation to register Charity an Initial Child Protection Case Conference was set for 28th January 2008. Ms Webster was informed of the decision by telephone and I arranged with her to visit and give her a copy of the notes before the meeting, this will empower Ms Webster and give her some idea of what will happen. I will also keep the family fully informed throughout, invite parents to meetings and explain procedures in an open and honest way. But I will ensure the parents are fully aware of my concerns regarding the risks towards Charity.

The function of a case conference is to bring together the child (where appropriate), family members and those professionals most involved with the child and family, following a S47 enquiry. One purpose of this is to decide what future action is required to safeguard and promote the welfare of the child and how action will be taken and what the intended outcomes are. The core group members are I, Ms Webster, Mr Webster, Ms Gold (team manager), WPC Bond (family protection unit), Mr Perry (head teacher) and Ms Murray (EWO). All the above people involved will all play a part in monitoring and safeguarding the surrounding concerns for Charity. During the case conference I will be looking at recommending the following care plan:

Behavioural support, some schools have these implemented by way of school mentor, this could help Charity with her aggression.

Anger management counselling for Ms Webster due to the domestic violence issues.

Family Resource Centre for Ms Webster and Charity, this could help them both have contact with other families experiencing similar issues.

Counselling for mum due to loss and separation and the children.

Counselling for Charity to give her a chance to talk to someone about her experiences and how she feels.

Charity spending quality time with her father and sisters.

With the care plan identified, this can only go ahead if Ms Webster will give her consent as she has parental responsibility.

The legislation I have used is Childrens Act 1989/2004 with S47-Duty to asses risk and S17-Duty to assess need. I have also used Working Together to Safeguard Children, this sets out clear guidelines for multi-agency working to protect children from abuse and neglect, this was needed in relation to Charity.

I will now move on to theories and research. Neglect can have major long term effects on all aspects of a childs health, development and well-being. Maltreatment is likely to have a deeper on the childs self image and self esteem. Difficulties may lead on into adulthood and the experience of long term abuse could lead to difficulties in forming or maintaining close relationships, one of the skills needed to be an effective parent (DOH 2000). DOH 2000 also says that the child could have feelings of isolation and the feeling of being unloved. Stress could affect the parents’ capacity to respond to their childs needs. This relates to this case as Ms Webster is very stresses since her husband left her for another man. In relation to physical abuse and Charity witnessing this, this could be the reason as to why Charity is showing aggression towards people. Physical abuse has been linked to aggressive behaviour in children, emotional and behavioural problems (Working Together).

Further research that relates to the case is the Attachment Theory because of Charity’s relationship with her mum and vice versa. Bowlby believed that the primary caregiver is the mother. He said that children deprived of maternal care would nearly always be affected in some way. Bowlby (1953). However Ainsworth identified three types of attachment, securely attached, insecurely attached (avoidant) and securely attached (ambivalent). As its core, attachment theory is about the way that childhood needs are met and the long term effects of needs being met or otherwise. Ainsworth (1970). In my opinion I would say Charity is negatively attached. A criticism of Bowlby is that he says that the mother has to be the primary caregiver; this is open to much subjection. Children can have attachment figures other than them receiving it from their mother. In some cultures the childcare is shared, not only by mothers but by fathers, grandparents, aunts, uncles and friends Beckett, C, (2002). Another criticism is that it is sexist, it tends to lead to maternal deprivation rather than paternal deprivation, it excuses absent fathers from any imitation of parenting skills. It ignores gender bias and how family make ups can change. This is significant in this case as Mr Webster left the family home. Theory on domestic violence is gendered natured in that, it ignores the facts that female to male violence is increasing. This is significant in this case because Mr Webster had suffered domestic violence issues with his wife. Charity also witnessed domestic violence. Helping victims and children to get protection from violence, by providing relevant practical and other assistance is one of the considerations to include when involved in a child protection case (Working Together pg 2004).

There are contradictions within the legislative framework. The Children Act 1989 contravenes the Human Rights Act because S8 of the Human Rights act states that in absolute certainty children should not be removed from their family and the Children Act defines harm but not significant harm. The Framework for the Assessment of Children in Need and their Families is not without contradiction. The Joseph Rowntree Foundation 1999, points out that it would be helpful to strengthen the assessment framework by stating that the responsibility of the local authority is not only to promote and safeguard the welfare of the child but also the rights of the child.

Throughout my work I will continue to reflect on my practice and how my own values and assumptions may unconsciously affect my decisions.

This essay will look at the ethical considerations present for a social manager faced with budgeting decisions. This essay will consider evidence on social care management priorities and ethics as well as any available guidance on budgetary decision-making in order to complete the assignment. Theoretical perspectives on social care priorities will be examined to see if these provide any additional insight into making difficult decisions about priorities of care. The practice context will be considered in order to see if there may be other previously ignored factors at work here.

The case study is about a social care manager who is faced with having to reduce their service’s spending. Budgeting options may include the rationing of care, the priority of preventative services, the assessment of needs to determine resource allocation and other possibilities. The manager must take ethical considerations into account when making their decision as well as theoretical perspectives and practical realities.

A consideration of ethical factors is a wide-ranging remit including the consideration of all factors that have some moral bearing on the situation. In the case of social care, this is likely to be almost any aspect of the services as much of the service’s activities affect the wellbeing of vulnerable people: this is the reason for the services in the first place. Anything that does not have a direct impact on service users is likely to affect the work conditions of staff or the economic cost of the service to the taxpayer. So ethical considerations in this context are really the moral factors to consider in any change of social care services.

When looking at changes to budgets and cutting, the social care manager is relatively limited in the scope of what they may be able to do. Guidelines about which groups can be considered to be the most vulnerable and about priorities and responsibilities for services are centrally devised. Basic standards are set and money provided in the expectation that certain provisions will be made. In order to avoid ‘postcode lotteries’, the government makes quite a lot of aspects of care services centrally proscribed. However, there are within this many aspects of local decision-making such as the categorisation of care needs, which is one way local authorities may adjust their definitions in order to manage their costs. The day-to-day running of services and the potential for efficiencies in this area is also in the hands of the local authority, as is the pooling of resources with other services and the training and support of staff.

Much of what the social care manager will have to do in order tackle budgetary changes is an assessment of the priorities of their local service and an analysis of how the current reality of service meets these priorities. It is considered to be common sense that when resources are scarce (money, time or physical and organisational resources) then they should be used in order to do as much good as possible (Williams, 1998). This is the ages old motto of housekeeping and the modus operandi of many public services in times of lean.

Before making decisions about budget changes, the social care manager must make an assessment of the service’s priorities, which will include the health and wellbeing of services users. Yet it is appropriate to question whether the social care manager has the moral authority to make decisions about the best interests of service users and the right to decide what is in the best interests of other people (Seedhouse, 1989). They are likely to assume that health is a good thing and that the promotion of health is also a good thing. However, even such a basic concept as this cannot be assumed in the case of other individuals who may have competing rationales. For example, this becomes a particularly difficult question when working with older people, who may for example prefer to retain their independence at a lower level of health than experience higher levels of physical health but lose the ability to care for themselves in their own home.

Rationing is an emotive term, and describes the inability to give all things to all people all the time and so the need for decision-making about where to focus resources. Most often in social care services, rationing comes about as a consequence of a financial limitation, but there may also be rationing as a result of staff shortages or a lack of other resource such as cars for home visits. Rationing may often be described as “priority setting”, “resource allocation” or other similar euphemisms, particularly by those who seek to limit the blow of its reality (New, 1996).

Theoretical frameworks

Many of the decisions that a manager needs to take can be considered ethical decisions. Improving efficiency can be seen as an ethical decision taken in the interests of the society as a whole, applying service objectives universally and fairly can be seen as an ethically justified decision, and a consideration of the relative benefits of different groups from services is an ethically justifiable process as long as it is undertaken to ensure the most ethical distribution of resources (New, 1996).

Many managers would adopt management theoretical techniques to enable them to develop an overview of the context in which their decisions must be made and to better prepare them for reporting and justifying their budget decisions. Theoretical perspectives can enable a more objective view of the context and the tools to make cooler and more balanced assessment of the decision to be made. Examples of frameworks include a SWOT analysis of the service’s strengths, weaknesses, opportunities and threats that allows a strategy for improvements or changes to be developed (Gill, 2006). A SWOT assessment may help the manager in their assessment of how to balance budget changes with the maintenance or even the improvement of standards. Identification of the strengths and weaknesses of a service may allow a focus to be given to the thrifty improvement of weaknesses while maintaining the strengths of the social care provision.

Individuals can be seen to be under obligation to provide certain healthcare steps in order to reduce their burden on others and are morally obliged to make certain, usually public health, decisions in order to ensure their minimal use of resources. The most common example given is that of vaccination, where herd immunity for all can be obtained once individual levels of protection exceed a certain point. The obligation could also apply to the economic costs to society as a whole of poor health and so the requirement to maintain a good level of health, or to retain personal independence for as long as possible as a way of reducing dependence upon others. There may therefore be wider ethical considerations for the prioritising of certain types of care over others, particularly where difficult questions arise of which individuals have made the most effort to reduce their burden to society as a whole and whether they should be somehow rewarded (Dawson, 2007). Many would argue that it is not the place of the social care manager to make such moral judgements and that any such decisions can only be made with the backing of society as a whole through political mandate.

Priority setting is one of the most preoccupying roles of management (Dracopoulou, 1998) and this decision about priorities is usually taken with the assumption that all service users will be treated equally in terms of the assessment of their financial and care needs. It is important when a manager is setting priorities for services that this is done with the input of those whose professional responsibilities lie with the best interests of the service user. There should be no moral gulf between practitioner and manager. If there is, this implies either a misunderstanding of the objectives of the service by the manager or a failure to consider the best interests of the service user by the management. An assessment of priorities must take into account the reality that changes to the balance of costs spent on one aspect of services also imply the sacrifices that will be made by other potential service users whose needs were then either not treated, not treated for free, or not treated in the same way (Williams, 1998).

Effective decisions will often rely on the application of evidence-based knowledge in order to conclude. For example, the provision of effective treatments relies on an independent and reliable assessment of their relative efficacy in order to make cost-benefit assessments and decisions. Much of this work, particularly for the clinical aspects of care, is carried out by the National Institute for Health and Clinical Excellence (Nice) who use scientific evidence in order to make judgements about the value of a particular therapy or treatment. To a large extent, the existence of a national body such as Nice allows the problem of a postcode lottery to be overcome and assists managers in managing their scarce resources better. However, there maybe instances where the evidence is inadequate for the types of decisions being made when the manager will not have the assistance of a Nice guideline in making the best decision, such as where the process of decision-making itself may be important in terms of encouraging and developing user involvement in care, autonomy and self-sufficiency (Hunter and Marks, 2002).

There are standard measurements of priorities, particularly those related to clinical activities, which have been developed in order to assist with the kind of decision-making being indicated here. For example, QALYs (Quality Adjusted Life Years) are used in order to measure the benefits of health care against a scale of cost. These scales may seem stark to the casual observer: “For the purpose of priority setting in health care, being dead is regarded as of zero value” (Williams 1998, p21). Other, less nuanced, measures include survival rates and illness incidence rates as well as service user satisfaction measures.

Decisions such as this have been criticised as really a kind of paternalism. Some have said that health policy must always be considered from the perspectives of power as well as processes (Walt, 1994). Regarding power balances enables a proper consideration of the influence of government and other institutions over the lives of individuals and a conscious assessment of whether such power is justified in particular instances and always in the best interests of the service user.

Some have sought to tie down all the ethical factors a manager must take into account when making health or social care decisions. Seedhouse’s Ethical Grid (see fig 1) is one such example. This diagram displays the layers of ethical factors that may be taken into account. The blue layer describes the purposes of health care, the red layer looks at duties and motives, the green layer is consequences and priorities of proposed outcomes, while the black layer is the external environment and practical considerations. Such a model may be helpful to a social care manger in order to help them order priorities and ensure that all factors have been taken into consideration.

Fig 1: The Ethical Grid (Seedhouse, 1989, p209).

The subject of rationing of services is probably the most emotive part of a manager’s decision-making role and there has been and continues to be huge debate about this issue. One of the main contentions of the debate is whether care can and should be explicitly rationed, or whether decision-makers must come to the best professional decisions they can without expecting or even seeking consensus or approval at a societal level. Hunter (1997), for example, believes that even if explicit rationing delivering public and stakeholder consensus were desireable, it would not be realistic to implement because of the inevitable lack of consensus and frustration of service users are being unable to impose their view on the services they are being offered and were told they had a voice within. Many have sought to set the priorities for rationing in a clear way, but the conclusion of most is that while a system of principles may help to guide the professional, decisions can only really be made on a case-by-case basis, for whoever the care worker is making the decision: the time poor practitioner, the cash-strapped manager or the capacity-scarce administrator (Klein et al, 1996).

Many believe rationing in public sector services such as health and social care is inevitable and that the decisions of the manager are constant and integral to budget management rather than exceptional and significant in relation to cost savings (New, 1996).

Practice context

In a practice context, the most important thing in an assessment of the distribution of resources and the management of costs is that the decision-maker should have a clear understanding of the objectives of the service and so the criteria relating to these objectives (New, 1996). Many see it as a relatively easy task for the well informed public sector manger to ration the service they provide, because of the close central control operated by government and the routine focus on a multitude of factors aside from profits. These decisions and the implementation of them are a different matter when the inputs of private sector organisations must also be taken into account and the demands of customers satisfied or risk loss of loyalty (Payne, 2000).

In a practice context, there are ways in which money can be prioritised in order to have least impact on services for users. For example, the reduction of waste is the first, most efficient, effective and least painful step towards working within a budget set centrally rather than according to profit margins (Dracopoulou, 1998). Waste reduction would be for example the cessation of a treatment that is not effective. In practice, however, there are unlikely to be enough areas of waste reduction to be made in order to cover a significant budget shortfall, and inevitably the manager will have to look at service reductions, which are in practice usually closely related to management priorities. These priorities may include preventative working, personalisation and multi-professional working.

Preventative working, which may include practices such as the support of older people to enable them to continue living in their own home, are an important aspect of managing care budgets in the longer term. The effective addressing of preventative working such as support for independent living requires a multi-disciplinary approach with the same goal in its sights (Dawson and Verweij, 2007). Multi-disciplinary working may in itself also save money and there have been suggestions that the poling of budgets between services, such as the NHS and social care agencies, can help to release savings and ensure better coordination of care (DH, 1998).

Previous research has found that some counter-intuitive methods of practice can be the most beneficial for patients, such as teaching them coping skills, health education and stress management upon diagnosis which has been seen to lower the incidences of depression, fatigue and confusion in cancer patients as well as to increase the vigour of the individuals and may even have an impact on their demonstrable health and survival (Buckley, 2002). New research such as this must be welcome to the social care manager attempting to balance improvements in care quality with reductions in cost.

Personalisation of care and the focus on the individual which is now such an important part of the working of care services (DH, 2006) may become more of a challenge when looking at budget restrictions and wanting to be fair. Health care practice encompasses ideas of the empowerment of individuals to control their own destiny, as a healthy life may include all kinds of medically sub-standard conditions, such as ageing and death (Illich, 1975). The important thing is how the individual adapts to changing environments and not how ‘healthy’ they are objectively assessed to be. This awareness that health and wellbeing may not be the same for all individuals and that many individuals want to have control over the priority setting of their own health care has been a huge cultural change that is still ongoing in health and social care services. The Department of Health has said that the providers of services are now less important in the consideration of care than the user, and that the quality of services from a user’s perspective and the levels of independence that they are able to maintain should be a primary indicator of the success of caring services (DH, 1998).

If it becomes impossible for the social care manager to reduce spending in a way that does not seriously impact on the welfare of individuals or on the equity of services, there may be other factors they can consider in order to manage budgets. The most likely but perhaps least palatable of these is a reassessment of the sources of funding for services. By taking a look at the potential opportunities for changing the balance of contributions made by service users at various levels of need and wealth, the manager may be able to demand more contributions and so better balance their budgets (Care Quality Commission, 2010; Bryans, 2005). There are minimum standards set, such as the level of free care set at an asset level of around ?23,000 or less, but most other rationing decisions are left to the discretion of the local authority provider.

Conclusion

In the field of social care, ethical decisions must influence all management decisions. In our specific example of the need to reduce service spending, it has been seen that almost any decision made in this regard could be observed to be a value judgement or a moral or morally condemnable decision.

Budgets are a constant battle for health care managers, even when cuts are not being demanded. This is because there are constantly rising levels of expectation and significant increases in the user population, eg because of changing societal demographics (Bryans, 2005). Decisions on the rationing of care, changes to focus on preventative methods and alterations to patterns of contributions from service users are very unlikely to reach unanimity, both among society and even among different professionals. This reality should be known and accepted, and the decision-maker therefore empowered to make whichever fully informed decision they believe to be best (New, 1996).

While lists of service priorities are a useful tool for social care managers, the most beneficial next step for research is likely to be a better assessment of the cost-efficacy of personalised services and the best ways to approach the delivery of messages about preventative behaviours and the moral burden upon each individual to carry them out.

In the context of Shona and her family, this assignment will firstly review the powers and orders necessary to bring the children to be looked after by the local authority along with the governing principles. It will then discuss relevant areas for review and the required order to ensure good care for the children, including how and when these should be reviewed. Finally, looking at the significance to the case study of s17 of Children Act, 1989 along with considering the different services presented to each sibling whilst in care.

Police Powers

Shona’s case is discovered by police officers under-taking ordinary duties when social services departments and the courts are closed (Masson, 2001). CA, 1989 s46(1) gives the police power, without going to court, to remove or detain children for 72 hours if they have reasonable cause to believe that the children are likely to suffer significant harm (Brammer, 2010; Powell, 2001).

Social Service Managers recognise the value of s46 as an emergency intervention but have criticised its excessive use as a result of police anxiety (Masson, 2001). The principle is that courts should make a decision to remove children wherever possible; therefore, s46 is to be used in exceptional circumstances. The local authority should have in place with the Clerks to the Justices an out of hours Emergency Protection Order (EPO) application process (HO Circular, 2008).

Emergency Protection Order

EPO is a short-term emergency measure, lasting up to 8 days with a possible extension of a further 7 days, whilst the local authority under CA, 1989 s47 investigates the children’s welfare. S44(1) of the act outlines the grounds for applications for an EPO of which there are two forms (‘any person’ and ‘likely to suffer significant harm’). The local authority’s application for Shona and her siblings is on the grounds that they are likely to suffer significant harm due to domestic violence. Although the court may agree that there are grounds for an EPO, it still needs to apply the principles contained in Part 1 of the act.

Principles governing the decision-making
Welfare Principle

CA, 1989 s1 states that, “the child’s welfare shall be the court’s paramount consideration”. The meaning of s1 has been closely examined and criticised due to its wide range of interpretations (Brammer, 2010; Brayne and Carr, 2010). “Decisions based on the welfare of the child are ultimately value judgements” (Ryan, 1998: 8) Therefore, a checklist was added to maintain consistency and provide clear understanding (Ryan, 1998 and Brammer, 2010). For an EPO the court must consider the welfare principle but it does not have to consider the checklist (Brayne and Carr, 2010).

Non-Delay Principle

CA, 1989 s1(2), supported by European Court of Human Rights article 6(1), emphasises that any delay in court proceedings is potentially harmful to the welfare of the child (Brayne and Carr, 2010), therefore, the court needs to have regard to the non-delay principle.

The Public Law Outline (PLO), 2008 attempted to address case management and avoid delays in court proceedings by setting a timetable. Masson argues that “Legislating against delay did not change working practices; adult parties continue to create advantageous delay” (2010; 55).

No-order Principle

CA, 1989 s1(5) directs courts to make no order, even if the harm threshold condition is satisfied, unless it considers that making an order would be better for the child than making no order at all (known as the ‘no-order’ principle). The principle recognises the need for proportionality with three foundational aims: 1) “discourage unnecessary court orders”, 2) “to ensure that the order is granted only where it is likely positively to improve the child’s welfare” and 3) discourage the making of unnecessary applications (DCSF, 2008: 7).

If government guidance ‘discourages unnecessary applications’, this may account for research findings showing a general misunderstanding of this principle amongst local authorities who interpret it to mean that cases should not be taken to court unless it is totally necessary. The recent increase in court applications may demonstrate that the principle is not preventing Social Workers from carrying out their duties (DCSF, 2008; Brayne and Carr, 2010). The majority of court proceedings have resulted in orders being granted, therefore Mason argues, “Neither the public nor the courts themselves have accepted the ‘no order’ principle” (2010, 57).

Areas Needing to be looked at:
Threshold Question

As Shona has been in care for approximately three years, the local authority would have applied for a court order. This cannot be obtained without meeting the threshold criteria of CA, 1989 s31: identifying significant harm, cause for the harm and no order principle (Ryan, 1998; DOH, 1999). Significant harm has to be found to exist before the court will intervene in family life, however, as the term is not defined it causes considerable problems of interpretation. The Adoption and Children Act, 2002 s120 broadened harm to include witnessing or hearing it, which would be relevant in the case of Shona (Brammer, 2010).

Assessment

The children would be assessed under the child protection structure due to the physical abuse Liam endured and his sisters witnessed. This structure has evolved through a series of reports and government circulars. In 2008, the Children Act Guidance Volume One was revised and issued under s7 of the Local Authority Social Service Act, 1970 which provided clarity for what should be completed before making an order application (Brayne and Carr, 2010). Working Together to Safeguard Children, 2010 provides interagency guidance on assessment and investigation. The Framework for the Assessment of Children in Need and Their Families, 2000 provided, under one structured system, a “holistic assessment” and planning tool for all children in need (Thomas, 2005: 83).

Using the framework, the local authority, through the core assessment process, will need to consider both the children’s and parent’s needs along with those in the wider family and community, to reach a decision that an order is necessary to safeguard their welfare. The local authority would also need to seek legal advice and communicate to the parents their concerns (DCSF, 2008).

Care Plan

ACA, 2002 amended s31 of the CA, 1989 so that an order cannot be made until the court has considered a care plan (Brammer, 2010). A separate plan would be required for Shona, Liam and Siobhan so the court can consider their individual needs. The plans should be based on findings from the initial and core assessments with the structure, as guided by Local Authority Circular 99(29), 1999, being: 1) overall aim, 2) child’s needs, 3) views of others, 4) detail on placement and 5) local authority management. The court’s decision on the no-order principle will take into account the care plan for verification as to how the order would be applied (DOH, 2000).

What Orders May Have Been Necessary
Care Order

In having met the threshold criteria, completed assessment and care plan the local authority under s31 would apply for a care order for the children. A care order, rather than a supervision order, involves the children being removed from their home and provides the local authority with shared parental responsibility for the children alongside the parents (Brayne and Carr, 2010).

Reviews by Local Authority

Upon granting an order, the court has no influence in the plan being carried out (Brammer, 2010). ACA, 2002 amended s25(a) CA, 1989 by requiring an Independent Review Officer (IRO) to be appointed to “chair all review meetings of looked after children, ensure the child is involved in the review and will challenge poor practice, and any drift in implementing the Care Plan” (HMG, 2003: 45). If the plan is not implemented the IRO can pass the case to CAFCASS who can now return it to court (Brammer, 2010).

CA, 1989 s26 makes it a legal requirement for local authorities to regularly review the children’s care plans. Reviews “ensure that it [plan] is being effectively implemented and to make any changes that have become necessary” (Thomas, 2005: 76). All involved in the care of the children, including the child, should be involved in the review. The minimum requirements which reflect the no-delay principle, are set out in the Review of Children’s Cases Regulations 1991, amended in 2004. The first review should be held within four weeks of the children becoming looked after, followed by a further review at three months later and then six monthly (Brammer, 2010; Ryan, 1998).

Relevance of s17 to case study
Views of Parents

Under s17 of CA, 1989, the local authority has a general duty to promote the upbringing of children in need by their families and with article 8 of the Human Rights Act, 1989; they would need to justify any interference in family life. Working Together, 2010 re-emphasized the commitment of partnership with parents in making plans for the welfare and protection of their children. There are a number of ways the local authority can work in partnership with Shona’s parents; through consultation, taking into consideration their views, attendance at case conferences and being notified of any public proceedings (Brayne and Carr, 2010).

CA 1989, s17 also makes clear that the first priority is to promote and safeguard the children’s welfare and then try to keep them within their family (Brayne and Carr, 2010). Provided that the welfare and safety of the children is paramount then potentially there should be no conflict between the principles of family support and child protection (Parton, 1997). However, research has shown that full partnership is difficult to reach when risks are high and families disagree with the perceived risks (Bell, 1999). The recent case of Baby Peter has highlighted the importance of Shona’s Social Worker having the skill to recognize when partnership with the parents is failing to protect them (Brayne and Carr, 2010). The father’s violence towards the children could be a reason to exclude him from any conferences but his wishes can be obtained by other means (DCSF, 2010). It is also important to recognise that the children’s views and wishes may be different to their parents.

Child’s wishes

The Children Act, 2004 s53 amended s17 of CA, 1989 making it a requirement that before deciding what services should be provided the children’s wishes should be obtained and given consideration (DCSF, 2010). CA, 1989 s22 by mentioning the child before the parents suggests that the child’s wishes are to be the first consideration (Brayne and Carr, 2010).

The law has also been criticised for assuming that it is possible to know objectively what is in a child’s best interest but instead should give the children themselves a role in determining what happens (Thomas, 2005). However, the emphasis of listening to the child’s wishes has recently been criticised as it undermines the courts authority to make a best interest decision (Times, 2010). “Laws, policies and procedures continue to reflect he tension between these twin goals of safeguarding children and advocating their rights” (Adams, 2009; 304). To ensure that the child’s interests, wishes and rights are upheld in court, CA, 1989 s41(1) contains the duty, if required, for a Children’s Guardian to be appointed from CAFCASS (Brayne and Carr, 2010).

Placement Details

The local authority whilst taking into consideration the views of the children and parents, will have regards for s17 when considering placements for the children. The CA, 1989 s44(a) was amended by the Family Law Act, 1996 giving “power to include exclusion requirement in emergency protection order”. This could have been an option looked at in the case of Shona with the father being excluded from the family home (Brayne and Carr, 2010). Consideration of family members and friends as potential carers for Shona and her siblings should be explored and clearly demonstrated in their care plans before making a court order application (DCSF, 2008). S23(7) CA, 1989 promotes contact between parents and children with local authority, as is reasonably practicable, providing accommodation near to the family home and keeping siblings together. Under schedule 2 of CA, 1989 there are powers given to the local authority to assist in maintaining links between children and their family (Brayne and Carr, 2010).

Options Available to each child
Family Group Conference

There are several methods for compiling the children’s care plans, with one such option being Family Group Conference (FGC) (Thomas, 2005). FGC has been described as a, “realistic methods for merging the needs and interests of children and families and the protection concerns of public child welfare agencies, the courts, and the community” (Chandler and Giovannucci, 2004: 217). Although there is no factual data, reviews of FGCs have implied that it is not a suitable option for domestic violence cases due to the welfare of the child. However, in the case of Shona, FGC may have been a viable option when initially becoming children cared for to help explore the welfare concerns, deciding what services are necessary and to take into consideration the children and parents views when considering permanency so to prevent the children becoming entrenched in the care system (Chandler and Giovannucci, 2004).

Accommodation

The local authority has a power under s20 CA, 1989 to provide accommodation to the three children (Ryan, 1998). From initially coming into care (the sisters going to foster care and Liam to residential care) up until their current situation (Shona and Siobhan different wishes to return home) decisions on the provision of accommodation have been paramount with the options to be explored being: kinship, foster care, residential, reunification, adoption and independence. ACA, 2002 provides guidance on the “timescales for decisions about adoption” with permanence, including adoption, needing to be considered at the second care plan review (Brayne and Carr, 2010: 378).

Education / Crime

Due to the highly publicised statistics of children in care’s educational underachievement, crime rates and employability, the recent government has made a number of changes to legislation. Under s20 of the Children and Young Persons Act, 2008 all three children will have (had) “a designated member of staff” at their school “responsibility for promoting the educational achievement”. The local authority under s22 should provide for under 25 year olds “assistance to pursue education or training” which is relevant to Liam and Shona’s current situation (Brammer, 2010: 356). Although the agenda for change is not without criticism, “Its policy recommendations are framed within a social investment approach which values education as the route out of exclusion and into employability” (Williams, 2004; 423).

Schedule 2(7) of CA, 1989 puts an onus on the local authority to “take reasonable steps designed to reduce the need to bring criminal proceedings against such children” (Brammer, 2010: 369). Therefore the Youth Offending Team (YOT) could be a service considered for Liam. Adams argues that the number of detained children is high in the UK with, “policy and practice regarding children and young people who have committed offences remain stubbornly resistant to welfare principles” (2009; 318).

Legal Requirements

In 2003 the government published Every Child Matters (ECM) which introduced five outcomes for service providers to make arrangements to improve the well being of children: “being healthy, staying safe, enjoying and achieving, making a positive contribution and economic wellbeing” (2003:6-7). CA, 2004 was passed to provide a statutory framework for applying ECM with the five outcomes included in s10(2) of the act (Brayne and Carr, 2010). The act also introduced the requirement for working together of statutory departments and other relevant bodies for achieving the five outcomes (Brammer, 2010). In theory this provides Shona, Liam and Siobham with greater opportunity for services from public, private and voluntary sectors, however, this legislative change did not come with an increase in budget (Williams, 2004). The responsibility of the local authority to provide services to the children is outlined in schedule 2 of CA, 1989. The wording is moderated for example ‘reasonable steps’ or ‘consider appropriate’, therefore the local authority can prioritise services based on what is available rather than having to meet every need (Brammer, 2010). When more than one agency is involved in the children’s care a lead professional will be appointed to “be responsible for ensuring a coherent package of services to meet the individual child’s needs” (HMG, 2003: 9).

Conclusion

In the situation of Shona and her family, this assignment has highlighted the current social and political thinking towards safeguarding children with the balance in the CA, 1989 between welfare and children’s wishes; the emphasis on partnership with parents; the importance of accountability through reviews and the value placed on children remaining with their families. The five outcomes for children in care provide a framework for the provision of services, however, the limitation in budgets does not support the political agenda.

The purpose of this assessment is to identify and discuss the vulnerability issues arising from the scenario. Peter is a vulnerable adult and inclined to be forgetful therefore, reference will be made to the nursing and Midwifery Council’s code of professional conduct in respect of duty of care, safety, respecting client’s dignity, confidentiality, and consent to accept or refuse treatment. This case scenario is not a real client, therefore no consent was needed and no breach of confidence was made. An attempt will be made to explore whether Peter has the mental capacity to consent to the treatment himself. Guidelines on The Mental Health Act 2005 and the legislation will be included to support this. A discussion will be outlined to the nurse’s role in safeguarding vulnerable patients and their families, which will include the government’s policies and procedures, and the Nursing and Midwifery’s Council guidelines. The discussion will also include the consequences of the policies not being followed correctly and the outcome that would have on the nurse. The key vulnerability issues relating to Peter and his daughter within the scenario will be identified such as Peter’s age and his forgetfulness.

This assignment will contain the major role and responsibilities of a nurse in terms of ensuring that the rights of Peter are promoted and maintained and will be specifically around him not to be treated in a degrading manner. Autonomy and advocacy, and the interventions which are available to support Peter for his security to be assured and him needing confidence to increase his mobility. The Human Rights Act (2008) refers to individual’s rights to make decisions for himself and not to be discriminated against. Peter has a specific right of expression of thought and conscience to accept or refuse care. The assignment criteria require students to explain how Peter’s autonomy may be promoted by the nurse to gain the ability to make his own decision, including patient-centred care and acting as an advocate. A final requirement of students is to specify and justify appropriate professional behaviour and interventions for Peter. Reference will be made to therapeutic relationships between the nurse and Peter, highlighting the support the nurse should give to the patient and his family, and to discuss the importance of maintaining professional boundaries. The multi-disciplinary team will also have to assess Peter’s home to see if there were any adjustments needed to support him further with his mobility. Peter would also need further extensive health services if he agrees to go ahead with the surgery.

The paper is presented in accordance in line with the University’s academic guidelines presented as appendix 7 in the Student Handbook 2010. References will also be citied in line with the University’s own version of the Harvard referencing system.

Main Body
Vulnerability – Section 1

According to Rogers 1997, vulnerability is “Liable to damage or harm, especially from aggression or attack”.

Vulnerability is when a person is put into a situation where they are not familiar with, which makes them feel uncomfortable. A vulnerable adult is anyone over the age of 18 who is unable to protect themselves against harm or exploitation. The types of people who may be particularly vulnerable are children, the elderly, adults with visual, hearing or speech impairment. Other types of vulnerable adults include those with learning disabilities, mental health problems or a severe physical illness.

People who require care services may have an increase in their vulnerability as they are entering a new environment with unfamiliar surroundings. Another factor could be their age and if they are unable to take care of themselves. Therefore, they are not in control of the situation and could become fully dependant on a nurse to care for them which to the patient increases their risk of becoming vulnerable. Peter is particularly vulnerable due to him being 85 years old and inclined to be forgetful, also the fact his daughter is trying to force Peter’s decision in going ahead with the surgery yet he is no longer certain he wants too.

“Abuse is a violation of an individual’s human and civil rights by any other person or persons” (Department of Health, Pg 9).

Abuse can consist of a single act or repeated acts. It may be verbal, physical or psychological; it may be an act of neglect or an omission to act. It may occur when a vulnerable person is persuaded to enter into a financial or sexual transaction to which he or she has not consented, or cannot consent. Abuse can occur in any relationship and may result in significant harm to, or exploitation of the person subjected to it.

A nurse’s most important responsibility is to the client first. The NMC (2008), states that “Nurses have an absolute duty to safeguard and protect vulnerable adults from harm.”

The responsibility of a nurse is to promote health, prevent illness, restore health and alleviate suffering. A nurse should take appropriate action to safeguard the individual when their care is endangered by a co-worker or anyone else. Nurses have a right but also a responsibility to act on behalf of the client if they feel he or she is being mistreated.

Registered nurses hold a position of trust to the client and this must never be breached, they should also maintain professional relationships with vulnerable clients at all times. A nurse not only has a professional duty to protect vulnerable clients, but also a legal responsibility. If a nurse failed to comply with legal obligations they could be struck off the NMC register, but also it could be classed as a criminal offence.

The Independent Safeguarding Authority is a government policy which helps to prevent unsuitable people from working with vulnerable adults. They assess those individuals working or wishing to work in regulated activity that are referred to them on the grounds that they pose a possible risk of harm to vulnerable groups. The Government ensures the safety of vulnerable adults by integrating strategies, policies and services relevant to abuse within the framework of the NHS and Community Care Act 1990, and the Mental Health Act 1983.

The Mental Capacity Act 2005 and Code of Practice is another vitally important piece of legislation setup by the government. The Code of Practice provides guidance and support to anyone who is working with or caring for adults who may lack a decision making capacity. This includes professionals, carers and families who know the person best. It focuses on those who have a duty of care to someone who may lack the capacity to agree to the care that is being provided.

As the NMC (2008) states, “You must disclose information if you believe someone may be at risk of harm, in line with the law of the country in which you are practising.”

Section 2

The key vulnerability issues relating to Peter is that he is an elderly client of 85 years. He has not yet consented to the treatment as he is feeling apprehensive as there are major risks associated with the procedure. His daughter is very keen for the surgery to go ahead and Peter is seeking help from the nurse as he obviously feels he cannot discuss his fears with his daughter.

Section 3

Article 3 in the Human Rights Act states no one shall be tortured, or suffer inhuman or degrading treating or punishment.

Although there is no absolute right to receive care in the UK, all patients have certain rights in their dealings with health care professionals. In 1995, the government issued the patients charter to inform clients of their rights, it is designed to improve the services people receive and it lays down the level of care that people can expect from the National Health Service. The charter was made public so that clients know the standards they should expect, they can take steps to complain and have things put right if the standards are not met.

Client’s rights include the right to make their own decisions about their own lives and the right to be given appropriate information to make informed decisions. The right to privacy and confidentiality and to be given appropriate assistance in exercising their rights, when they are unable to themselves, such as having an advocate available. Clients also have the right to freedom from exploitative and abusive practice, and the right to have personal beliefs, preferences and choices including religion, culture and political beliefs.

Peter should expect the nurse to maintain his right’s by having his dignity and privacy maintained while care is being given. The right to be included when making his care plan, the right to accept or refuse treatment, and for his patient information to be kept confidential. Also as Peter asked the nurse to help him make the decision and due to him being vulnerable and inclined to be forgetful, the nurse should act as Peter’s advocate for him if needed.

As the NMC (2008) states: “You must uphold people’s rights to be fully involved in decisions about their care.”

Accountability

Accountability is based on three conditions including ability, responsibility and authority. Nurses hold a position of responsibility and to promote efficiency and safety as other people rely on them. They are professionally accountable to the NMC and to the law for their actions. Nurses use their professional judgement, knowledge and skills to make a decision based on evidence for best practice and for the client’s best interests. Nurses need to be able to justify the decisions they make. If you are a professional in charge of a task you can be called by law to account what happened, especially if something goes wrong. This is because if a nurse performs a task, they immediately take responsibility for that task and its outcomes

“As a professional, you are personally accountable for actions and omissions in your practice, and must always be able to justify your decisions” (NMC, 2008).

Duty of care

Any health care professional who undertakes the care of a client owes them a duty of care. A nurse’s duty of care includes managing risk appropriately, work effectively as part of a team, share information with colleagues and delegate effectively. Treat people as individuals and respect their dignity and confidentiality. Nurses should also need to ensure they gain consent, maintain clear professional boundaries, and collaborate with those in your care.

Confidentiality

The most essential element to confidentiality is it must be built on trust. The nurse’s need to know that the client trusts them but also that they trust the nurse’s professional judgement, knowledge and skills. It is also essential that the nurse feels the client will inform the nurse all that is necessary to deliver the most appropriate care. Confidentiality is an integral component of the nurse-patient relationship and a fundamental element of professional conduct and ethical practice. Sharing information with other professionals can only be done on a strict “need to know basis”, and patient confidentiality can only be breached in exceptional circumstances. Nurses must maintain confidence and respect the privacy of a patient’s health information at all times. Professionals must only disclose confidential information with consent from the client, if they are required to by the court of law or where they can justify that it was in the public’s interest.

Section 4 – Autonomy

Autonomy is about independence and the freedom to choose, and about not being coerced into doing something one would not otherwise choose to do. Autonomy has been defined as “the power of self-determination and freedom from alien domination and constraint” (Smith, 1967).

Autonomy involves clients making choices for themselves. As a nurse you should actively encourage clients to be involved in the decision making process and ensure that their voice is heard. Respecting client’s autonomy means to treat them as a person with rights and not as objects of care. This mainly involves discussing their care and treatment with them in an open and honest way and allowing them to make their own decision about what care they want to receive. For a nurse to be able to promote client’s autonomy there has to be a relationship and effective communication between them and the client. If their autonomy is to be respected, then nurse’s have to allow client’s to make decisions and then act upon them.

According to (Hendrick, 2004, pg 95) autonomy is defined as “The capacity to make reasoned decisions, the ability to think for oneself, to make decisions for oneself and to act on the basis of such thought.”

Patient-centred care includes all aspects of how services are delivered to our clients. This includes compassion, empathy, values, preferences and responding to all their needs. A nurse should be delivering this care at all times and make sure they are giving the patient all the information available, communicating to them at all times and educating them about their care and how processes and procedures work, using as little jargon as possible. Emotional support should be provided to help relieve client’s fears and anxieties as this can be important to a therapeutic relationship.

Advocacy

“Promoting and protecting the interest of people in your care, many of whom will be vulnerable and incapable of protecting their own interest” (NMC, 2008).

Advocacy is about acting on behalf of the client in a professional capacity who cannot speak themselves. Anyone could potentially need an advocate as any client may feel vulnerable as they are in unfamiliar surroundings. An advocate is acting as an intermediary between clients and family, significant others, and health care providers. It is a role of support for clients, both speaking and emotionally.

As a nurse you have a duty of care to encourage the client to participate or if they cannot speak for themselves then nurses should become that person’s advocate by putting their needs and views forward, and to ensure their rights are promoted.

“You must act as an advocate for those in your care, helping them to access relevant health and social care, information and support” (NMC, 2008).

Consent

Valid consent must be given by a competent person and must be given voluntarily. Nurses have three professional responsibilities with regard to obtaining consent. They need to make the care of people their first concern and ensure they gain consent before they begin any treatment or care, ensure that the process of establishing consent is transparent and demonstrate a clear level of professional accountability. After they have obtained consent they need to accurately record all discussions and decisions relating to obtaining consent.

“Every adult must be presumed to have the mental capacity to consent or refuse treatment, unless an assessment reveals they lack the capacity to consent” (NMC, 2008).

When a nurse needs to inform a client about proposed treatment or care it is important that they deliver the information in an understanding and sensitive way. It is essential that they are given sufficient information for them to make a decision whether to accept or refuse the treatment being offered. Nurses should also give the client enough time to consider the information and the opportunity to ask questions if they need too. Nurses should not assume that clients know even basic medical information and should explain every aspect with as little jargon as possible in order for the client to make their choice.

There are three different types of consent including verbally, implied and written. Clients can express their agreement by either of these forms. With Peters surgery includes risks associated his agreement should be made by written consent. Written consent is a document which shows the patient’s choice and that discussions have taken place between them and a professional.

There can sometimes be difficulties with gaining consent. There are particular vulnerable groups such as older people, people with mental health problems, people with learning difficulties and children. Nurses need to keep these vulnerable groups at the centre of the decision making process. As Peter is a vulnerable elderly client he is weaker and inclined to be forgetful, therefore an assessment would need to be carried out by a nurse of doctor to assess his mental capacity; professionals should always presume that older people are able to make decisions.

In the same way a client can accept treatment, they can also make the choice to refuse treatment, even if this may harm them or cause death. Nurses should find out why they are refusing and then the consequences of declining the treatment and what will happen to their health if they don’t go ahead. If this happens it is important that you honour their rights and wishes and document fully any decisions made to refuse, and clearly record that this is the client’s choice.

“You must be aware of the legislation regarding mental capacity, ensuring that people who lack capacity remain at the centre of decision making and are full safeguarded” (NMC, 2008).

The Mental Capacity Act 2005 provides a statutory framework to empower and protect people who may lack the mental capacity to make an informed decision for themselves. The Act is underpinned by five main principles, the first one being that everyone is assumed to have the mental capacity to make a decision until proven otherwise. Every individual needs to be supported to make a decision and if a person makes what seems like an unwise decision, they should not be treated as lacking capacity.

Section 5-last bit

In order for a nurse to develop a therapeutic relationship with a client there must be effective communication involved. The very best of care is only achieved if the nurse is committed to getting to know the client in there care through effective assessment as individuals. This involves finding out how best to care for and communicate with them from their perspective, whilst ensuring respect, dignity and fairness are maintained.

This literature review focuses on sports volunteering as part of an investigation into the successfulness of leadership academies. By critically examining existing research and related literature, this review aims to draw up key issues and identify gaps in the current volunteering system. The scope of the searches for relevant literature was restricted to material dated from 1990 onwards, with to enable the literature review to concentrate on the most recent information. Literature was sourced through databases and websites linked to volunteering, sport, active citizenship and leadership. As such, this literature review draws on a variety of subjects which will be identified throughout the review. This paper reviews key literature, focusing on the need for continued involvement in leadership and volunteer opportunities within the school and community context.

Introduction

It is a cherished belief within physical activity and sport communities that participation in leadership and volunteering has the potential to offer young people a range of physical, psychological and social benefits, whilst also as a provider of sporting opportunities and in the development of sport, from increasing participation through to supporting excellence and elite performance. More recently in the UK, this belief has become prominent in government policies, are seeking to engage young people in order to inspire individuals and even though the London 2012 Olympic Games is 3 years away strong planning for volunteering is being put in place as the aspect of major events that has the potential to contribute to social regeneration and the strengthening of social capital.

The phrase ‘volunteering is the lifeblood of English sport’ is often used in todays sporting society. With it being well recognised that volunteers provide the core support for sport in the United Kingdom and without the 2 million adult volunteers who contribute at least one hour a week to volunteering in sport, community sport would simply grind to a halt (Sports Council, 1996). The research, commissioned by Sport England (2003) and carried out by the Leisure Industries Research Centre, provided the hard evidence to support this contention. It demonstrates the breadth and depth of support given by people across the country, who provide their time and rarely look for any reward beyond the personal satisfaction they get from the opportunities they provide for others to participate and achieve in sport. Volunteers also play an incredible role in staging some of England’s most prestigious sporting events. Volunteering in the UK has a long and established history (Ockenden, 2007) and without its volunteer workforce, events simply wouldn’t happen. Such reliance on volunteers in UK sport lead to the production of the government strategy, “A Sporting Future for All”. The policy has a major focus on ensures that volunteers get adequate training, support and strategic management (DCMS, 2000).

Defining volunteering

As suggested by Cluskey, et al (2006) defining volunteering is something that on the surface appears to be relatively simple, but in reality it is actually quite complex. Many researchers have stated that the term ‘volunteering’ is vague, covering different activities and participation at all levels of society, with volunteering traditions being affected by cultural and political contexts (Salamon & Anheier, 1997; Lukka & Ellis, 2002; United Nations, 2001). Although the word ‘volunteer’ may seem to have a common shared meaning, there is not universal consensus about the meaning of the term. It should be highlighted that there is no single meaning of volunteering or of a what volunteer is (Volunteering England, 2008).

Davis Smith (2000) and Nichols (2004) highlight four characteristics of volunteering within a UK context:

That it should be undertaken for no financial gain

That it should be undertaken in an environment of genuine freewill

That there are identifiable beneficiaries or a beneficiary

That there can be formal and informal types

Current context for sports volunteering in the UK

The voluntary sector plays a central role in sports development and the provision of sporting opportunities in the UK. Volunteers are key in the organisation of UK sport and the sector also provides a major economic contribution to the total value added of the industry (Shibli et al, 1999; Gratton and Taylor,2000).

Volunteering in the UK has a long and established history (Ockenden, 2007) and the valuable contribution volunteers make to society is increasingly being recognised. All levels of government are becoming more and more keen to raise active citizenship, and volunteering is promoted as one of the best examples of how individuals can make a meaningful contribution to civil society with volunteering seen as an important expression of citizenship and fundamental to democracy (EFSD, 2007).

There has been two main research documents both commissioned by Sport England, which look into sports volunteering in England. The latest “Active People Survey” (2006) showed that over 2.7 million people put some voluntary time into sport (at least one hour a week volunteering to sport). The “Sports Volunteering in England” (2002) found numerous results some of the headline information from this research is below:

There are 5,821,400 sport volunteers in England.

This represents 14% of the adult population.

26% of all volunteers cite ‘sport’ as their main area of interest.

That makes the sport sector the single biggest contribution to total volunteering in England.

Sport volunteers contribute one billion hours each year to sport – equivalent to 720,000 paid workers.

These results have seen a massive change as results from five years previous in the 1997 National Survey of Volunteering (Davis Smith, 1998) indicated a ‘sharp reduction in levels of participation by young people’. Volunteering by those aged 16 to 24 was down from 55% in 1991 to 43% in 1997, reversing the trend towards higher rates of volunteering in the previous decade (Lynn and Davis Smith, 1991).

Government change over time

Eley and Kirk (2002) identified during the 1990s there became a recognition of the benefits of volunteering which led to greater interest in volunteer activity among young people and the political parties developed strategies to help attract and encourage more young volunteers. The government has now identified engaging people in voluntary work as a key way to reaching out to those most at risk from social exclusion. This was linked with New Labour coming to power in 1997, as numerous initiatives recognised and supported volunteering were established:

Millennium Volunteers – an England wide scheme that aimed to increase volunteering for people aged 16 to 24 year olds. Now been re-branded as the ‘vinvolved programme’, currently funding voluntary organisations and encouraging young people to get involved in volunteering.

The Year of the Volunteer 2005 – a ?10 million campaign funded by the Home Office and aimed at raising the awareness of volunteering, increasing opportunities for people to become involved whilst also encouraging more individuals to volunteer

Although these programmes are generic volunteer programmes they include projects that take place within sport. ‘A Sporting Future for All’ (DCMS, 2000) and ‘Game Plan’ (DCMS, 2002) ensured that volunteering in sport appeared on the strategic agenda. Sport England was made responsible for raising the profile of and promoting volunteering within sport. Given the role assigned to sport in achieving new Labour’s social inclusion and active citizenship agendas (PAT 10 Report, DCMS, 1999), numerous nationally driven initiatives that promote volunteering in a specifically sporting context have appeared.

As stated by Volleyball England (2004) over the past few years leadership for young people within sport has become a hot topic on the Governments agenda leading to specifically targeted policies. The Physical Education and School Sport and Club Links (PESSYP) strategy which came into place in 2003, consisted of 8 strands which covered an array of areas aiming to enhance the take-up of sporting opportunities for pupils five to sixteen year olds. Step into Sport was one of the eight strands which focused on developing leadership. Now, the new PESSYP Strategy which shows the Governments continued interests in improving school PE, added 2 extra strands to the policy with ‘Volunteering and Leadership’ having its own priority.

Current Sport England programmes:

Recruit into Coaching – is part of the wider PE and Sport Strategy for Young People (PESSYP) coaching strand. Recruit into Coaching focuses on the 70 most deprived areas of England as identified through the highest ranked local authorities. It is flexible in terms of the sports it includes as it’s based very much on local need. Which meets to the view of Rochester (2006) of using volunteering for civic renewal and social inclusion.

The Young Ambassador Programme – was born and initiated in the summer of 2006 as a direct response to the promise that London would use the power of the Olympic and Paralympic Games to inspire millions of young people to choose sport.

London 2012 Olympics volunteering – The London 2012 games will depend on up to 70,000 volunteers to make sure they run smoothly and successfully. This has lead to the creation of a number of volunteer schemes, which are aiming to allow for the volunteer spirit spreading wider than the Games themselves by encouraging everyone to give their time to help others.

The ‘Young Leaders Programme’, supported by BP, is one of the volunteer scheme which is designed to give a group of disadvantaged young people the chance to make positive change to their lives by using the summer games as a catalyst.

Rochester (2006) suggests that within the UK, two broad policy streams encourage voluntary activity within sport and other contexts. These consist of, civil renewal and social inclusion. The aspect of civil renewal is aimed at targeting the increasing amount of people who are becoming disengaged from public life. Disengagement is regarded by the government as posing a threat to democracy and having a harmful impact on community cohesion, with individuals progressively losing their sense of common purpose and belonging within the society (Jochum et al., 2005).

Social inclusion has also become a hot topic for new Labour. The formation of the Social Exclusion Task Force, which was established in 2006 shows the commitment creating inclusive communities. It has been identified that participating in voluntary work as a way to reach out to people at risk of social exclusion and promoting correlative social inclusion (Social Exclusion Task Force, 2009).

Champion Coaching was the first nationwide scheme created to help the support volunteers.

Motives for volunteering

Whilst evidence shows that there is widespread commitment to increase numbers and strengthen the volunteer base, a clear picture of what we know about young volunteers does not exist. Gaskin (1998) created the most detailed and comprehensive information on young people’s attitudes and what they want from participation in volunteer activity. It established that the personal benefits gained by young people through volunteer and community service in sporting (Hellison, 1993) and general contexts (Pancer & Pratt, 1999) which include an increase in confidence, personal development and pro-social identity.

Many researchers have identified that people volunteer for a variety of reasons, both egoistic and altruistic, and the motivation for engaging in volunteer activity can vary greatly from person to person and over time for one person and many volunteers commonly cite multiple reasons for their involvement (Clary et al., 1998; Clary & Snyder, 1999, 2000; Farmer & Fedor, 1999; Wardell et al., 2000; Coleman, 2002; Taylor et al., 2003). Different age groups may also change their motives for volunteering, with younger groups regarding volunteering as a way of using and expanding their leadership skills, learning new skills and helping them with their future career prospects (Davis-Smith, 1998; Eley & Kirk, 2002; Coalter, 2004; Kay & Bradbury, 2009) while older volunteers more commonly mention a desire to fill up ‘spare’ time and cite involvement in volunteering as part of their philosophy of life (Doherty & Carron, 2003; Low et al., 2007). The contribution of young sport leaders takes an added significance because their leadership training in sport not only contributes to their own personal skills development but they also use those skills through volunteering to provide greater sport opportunities for other young people to participate in sport (Elay and Kirk, 2002).

Perhaps one of the most widely adopted theoretical approaches to understand volunteer motives is that of Clary and Snyder (1991) citied in Cluskeley, et al (2006) who argued that people act to satisfy socio-psychological goals and although individuals may be involved in similar voluntary activities, their goals can vary widely. Their perspective identified four key distinct functions which categorise the motives behind an individual’s involvement;

Expression of value – acting on the belief of the importance to help other

Understanding and knowledge – need to understand others

Social – engage in meeting others through volunteering

Ego defensive or protective – relieve negative feeling through service to others

Issues faced by volunteers

Volunteers are under increasing pressures in their roles, as indicated by Sport England studies (Taylor et al, 2003; Nichols et al, 2003; Gratton et al, 1996; Nichols, Shibli and Taylor, 1998). These include societal pressures – such as the constraints of time imposed by the paid workplace and family commitments – and some which are institutional: for example, heavier obligations as a result of legislation (e.g. health and safety, child protection) and greater demands from NGBs and Sport England (e.g. funding requirements, equal opportunities policies, accreditation schemes).

Findings published in Gaskin’s (1998) ‘Vanishing Volunteers’ created the message that volunteering has a poor image among young people. Although they generally approve of volunteering as beneficial to society and to individuals, its appeal to them is limited. An examination by the National Centre for Volunteering of the barriers to volunteering in 1995, for example, identified five obstacles for young people: lack of awareness of the benefits of volunteering, and negative images of voluntary work as boring, badly organised, the preserve of white, middle-aged, middleclass females, and expensive and time consuming (Niyazi, 1995). This view was also highlighted in the Millennium Volunteers scheme which concluded that for the programme to be successful it would need not only ‘to raise the profile of volunteering’ but also to ‘carry images of volunteering which are relevant and meaningful to young people’ (DfEE, 1998).

OLYMPIC VOLUNTEERING CHANGING THE IMAGE
Promoting active citizenship

The British government has been concerned with increasing citizenship and a sense of community spirit in young people for a number of years. In June 1998 the government published a policy framework for a scheme called the Millennium Volunteers. This programme created by the Department for Education and Skills was the one of the first to incorporate aims focused around increasing citizenship and rebuilding a sense of community among young people. Tony Blair, the British Prime Minister at the time expressed his concern about the need to support and recognise community involvement in order to bring about a ‘giving age’ (Heath, 2000).

The government is attempting to increase public engagement in civic institutions and society and respond to societal breakdown by promoting active citizenship and public participation as the responsibility of every individual. The government’s commitment to such policies can be seen by the promotion of volunteering in schools through the introduction of citizenship as a subject in the national curriculum, extra support made available for employee volunteering, the creation of institutions that promote citizenship and, new funding initiatives and policy proposals that link citizenship to volunteering (NCVO, 2009). This change to the national curriculum links closely to the view of Elay and Kirk (2002) who identified the benefits of volunteering are also evident from an educational perspective because it is central to the issue of how young people should be taught about their rights and responsibilities to the community.

Conclusion

This literature review has been able to identify that sport has had a long history on heavily relying on volunteers. It remains one of the most popular fields for engagement for volunteers, with between 13% and 26% of all voluntary work in the UK taking place in a sporting context. Although sport is so reliant on its volunteers it has only started to receive recognition and support from the government or the broader volunteering infrastructure in recent years. The significant difference now however is the substantial funding which is being invested into school leadership programmes designed at creating lifelong volunteers.

Volunteering may well be a catalyst for changing communities with excluded individuals, but there is no guarantee that this will always occur and it isn’t backed up with enough solid information to create a solid case. Although volunteering does have a vast array of people involved the message from young people is that it needs a make-over to gain further participants. By improving its image, broadening its access and provide what today’s and tomorrow’s young people need. Volunteering suffers from outdated associations with worthy philanthropy and conjures up images that do not appeal to the young. However, it is recognised as potentially offering opportunities to young people that are scarcely available anywhere else. The research suggests that there is a vast pool of young people who could benefit from voluntary work, if certain conditions are met. (Gaskin, 1998)

Chanchez M. Smith
Abstract

In this paper, I will discuss generalist social work practice with victims of a violent crime. The following elements will be included: a clearly defined victim population of my choice; the nature of the crime; ethical issues that may affect social work practice or that could impact practice with the population that I chose, or value conflicts that a social worker may experience (such as conflicts between professional and personal values, personal and client values, or professional values and client values). Policy issues that may influence social work practice will also be included.

Violent crime is defined as an action or deed that results to causation of bodily harm and physical injury to another person. Violence has been a part of human history (Garland, 2012). Since the onslaught of evolution when early men settled their scores by means of brawl to the present day when the vice has taken up a widespread and more encompassing concept, it seems that violence will remain a part of human history for the foreseeable future. Previously, violence was used as means of indicating displeasure at a second party’s sayings or deeds. It was also used as a way of marking territory and making conquests. In some communities and groups, violence was used in induction and initiation into certain levels of the society. Today, apart from the factors mentioned above, violence has taken up a different form and is a target of both the defenceless and otherwise. There are different types of violent crime. These include assault, armed robbery, kidnapping, homicide (for instance murder) and sexual assault crimes among a host of others. People from virtually all walks of life can fall victim to these types of crimes. In particular, violence against women and children has become common in today’s society. Women have been on the receiving end of violent crimes of various types, most commonly rape and sexual assault (Stith, McCollum, Amanoraˆ?Boadu, & Smith, 2012). Children on the other hand are more commonly the victims of kidnap and assault.

The role of the society with regard to occurrence of violent crimes is of immense importance when trying to establish the causative factors and means and measures of countering the vice. As social beings, our interactions, thoughts, actions and sayings are largely determined by our environment and upbringing. Thus, the society is largely involved in the making of violent people. Research reveals that most people who exhibit elements of violent behaviour have an underlying problem attributable to the society. This could be due to a troubled childhood in which the parents divorced when the offender was young, or lack of parental care (due to other causes such as being raised up in a children’s home), drug and substance abuse, mental problems or even poverty. Poverty is strongly linked to a number of violent crimes, most commonly robbery, kidnappings and gun violence. The society is also involved in the punishment accorded to such people and the way forward in terms of correction and rehabilitation. Through legislation of laws and making of rules that govern a people, the repercussions of violent crimes are and should be spelt out. In that way, those tempted to engage in such crimes are deterred. This aspect should be two sided such that the correctional aspect should also be factored in. The role of the society in rehabilitation of offenders with regard to violent crimes is immensely important. A system that allows the offender to realize the mistakes he/she made and work towards amending them will serve a greater purpose than that which only highlights the faults made without a clear means of overcoming and changing the violent nature.

Victim Population

This paper highlights women and children as the victim population that bears the brunt of the most commonly committed and the most heinous violent crimes. In the case of children, those aged between five and twelve years have a higher predisposition while in the case of women, all age groups are generally susceptible (Barner & Carney, 2011). Notwithstanding the country or region, violence against women and children is becoming increasingly common. Further, the rate at which such offences are being carried out is alarming with research revealing that in spite of this, most cases go unreported altogether. Take an example of Australia, a country largely considered to be peaceful and exemplary with regard to crime management. A research conducted by the Australian Bureau of Statistics with regard to Personal Safety revealed what was becoming a disturbing trend. The research was carried out in 2005 to measure domestic violence and sexual assault directed towards women. According to the findings, about 5 percent (363,000) of the women in the country experienced some form of violence, either by people known to them or unknown offenders in that year alone. Among the people known to the victims, most cases involved husbands, particularly with regard to domestic violence. Findings from the study also revealed that 1.6 per cent (126,100) of the female population had experienced sexual violence. Further, 33 per cent (2.56 million) of women in the country have experienced physical violence since they were fifteen years old. 19 per cent (1.47 million) have experienced sexual violence since they were 15. From the results, one can draw that one out of every five women has experienced sexual assault since they were fifteen while one out of three has experienced some form of violence (Daly, 2012).

As regards children, kidnapping is arguably the most common type of violence faced by most countries around the world although there are a significant number of cases involving child battery and assault too. A country synonymous with child kidnappings is Mexico. In Mexico, drug cartels have formed a formidable force and combining this with connections in the justice system and money to burn, are causing all sorts of trouble to authorities. However, the people with the greatest headache are parents, particularly rich folks. In Mexico, child abduction is often carried out with the intention of demanding ransom. The money is then used to service and propagate other criminal activities. On the other hand, killing of children is carried out for a more disturbing purpose; to prove to the world their ruthlessness and to exert their authority! Human rights groups in Mexico estimate that between 2006 and 2010, 994 youngsters (below 18 years) had been killed in drug related violence. Adding the number of those abducted and exposed to other forms of violent crime results to the figures multiplying more than 100 fold. Interestingly, when it comes to international abductions, Mexico and the United States have a lot in common. This is highlighted by the fact that most children abducted in the US find their way to Mexico where they can be used as bait to demand ransom or sold to childless couples. In the same way, a good number of kidnapped children in Mexico are moved to the US where they find new families.

Nature of Sexual Assault and Child Abduction

Sexual assault and domestic violence against women is not only demeaning and degrading but also comes with a great deal of emotional turmoil to the victims. There have been cases of women committing suicide after falling victim to sexual assault. In other cases reported, the victims become withdrawn and may develop a negative attitude towards men. It is also common to find women suffering from mental problems such as stress and depression after incidents of sexual assault and violence. In some communities and regions, the blame is usually placed on the woman’s head (Daly, 2012). This makes the recovery process even more difficult as the victim is made to feel like she brought the misfortune upon herself.

Child abduction usually culminates to a whole lot of problems, not only to the victim but also to the society. Many abducted children are used as a bargaining chip for demanding ransom. However, in other cases, child abduction is carried out with a different intention, one of which is child pornography. This has been an emerging issue in which children are kidnapped and forced into engaging into sexual acts. These are then taped, recorded and sold. The business of sexual exploitation of children is becoming common. This is attributable to the high levels of profits made by the people engaging in such outlawed activities. For instance, in Atlanta, children as young as eleven years of age have fallen victim to the activities of unscrupulous people in the name of pimps. To the child victim, the introduction to a corrupted world at such a tender age may change the outlook of their lives and the nature of their future. Such children usually end up becoming drug addicts posing a new challenge to governments and the society. They may become social misfits, who end up engaging in outlawed activities as a way of ‘paying back’ for what they went through. The victims may also become withdrawn and develop psychological problems as a result.

Ethical Issues involved

Most studies reveal that a significant number of cases of violence go unreported. In particular, cases of domestic violence against women are usually hushed up within the confines of the house. Domestic violence and even sexual assault are usually regarded as private incidences that need not be shared with the rest of the world. In some communities and regions in the world, a woman suffering physical violence in the hands of their husbands is quite normal. In others women who fall victim to sexual assault are largely viewed as the orchestrators of their own downfall; they are often believed to be the reason for the assault in the first place. This could be through their way of dressing, mannerisms or other factors. As a result, women in such communities suffer in silence knowing that the community would judge them harshly if they reveal the goings-on. What victims who fail to report cases of violence do not realize is that keeping quiet instead of reporting or talking about it does more harm than good (Garland, 2012).

Failure to report the crimes may pose a challenge with regard to development of strategies and solutions for overcoming the vices. To begin with, it is difficult to point out victims of sexual assault and domestic violence. Even if they could be pointed out, without their willingness and cooperation it would be difficult to come up with a solution. Failure to report the ordeal in the first place amounts to lack of cooperation. In addition, by failing to report the crime, the victims directly and indirectly contribute to the continuation of the crime. For example, in the case of sexual assault, failure to report rules out the chance of tracking and nabbing the offender. This means that any other woman out there is a potential victim. In the case of domestic violence, failure to report denies other victims the courage to speak out and potential victims are also denied justice as they come into a society where the status quo is already predetermined.

A social worker is also likely to come against values that challenge his/her own beliefs. For instance, coming from a more free and liberal society to interact with a community in which violence against women is considered part and parcel of life, the social worker may find it hard to adjust to the new set up. What he/she consistently views as wrong and unacceptable is, on the contrary tolerated.

In Mexico, reporting of crimes is almost certain not to occur. The ruthlessness with which the drug cartels handle their victims is beyond imagination. Reporting such crimes only earn the persons involved a ticket for graver repercussions. Research reveals that even the media, including newspapers are forbidden by the cartels not to report incidences of crime; they have no choice but to abide. More specifically, child abduction is a common occurrence but which occurs right under the noses of the authorities and the society but the cases are hardly reported. In the same way, the activities that the children are made to undertake (such as child pornography) are difficult to report even by those who are not directly involved in the crimes due to ethical concerns. For example, it may appear ethically inappropriate to report cases of sexual molestation and exploitation of children in light of the unspoken taboos that revolve around sex. Even to a social worker, sometimes it may come with a level of discomfort when talking about sexual issues with children as the centre stage. This may directly contradict the values of a social worker who does not believe in premarital sex or any other kind of sex apart from that between married people.

Policy Issues that may Influence practice

Violence directed towards children and women can only be successfully managed with input from all stakeholders. This includes the victims, the society and governments. In particular, governments have a major role to play as they determine much to do with policies and legislations (Garland, 2012). If the government supports and encourages a free and liberal society, it will advocate for measures that provide a platform for reporting and subsequently dealing with offenders. This will serve to give the victims a voice and an assurance that their plight is taken into account. Provision of such an avenue should also be accompanied with measures that help the victims recover from the ordeal. This may include providing counselling programs and keeping the victims under watch to observe their progress and recovery In addition, policies that promote the role of the society and social workers in aiding victims of violence go a long way in aiding the management of the vice.

Social Work Practice with Victims of Violent Crime

The role of social work with regard to helping victims of violent crime cope is vital for their recovery and healing. In most cases, social workers engage victims in talks that though may seem and sound simple yet actually achieve a lot. The experience of sharing alone is enough to take a whole load of burden off the victim’s shoulder (Gitterman, 2013). In the process of sharing, the social worker gets the chance to interact with the victim at a personal level and to empathize. This is very important for the recovery of the victim. He/she needs to feel that someone understands the ordeal they went through, the predicament they are in and that the person is willing to listen and even offer pieces of advice.

Social work may also act as an eye-opener to the goings-on in the society. Through knowledge, skills and experience, the social worker may be able to unearth facts about the community that were previously unknown. Facts to do with their beliefs, values and culture may offer insight into their way of life (Gitterman, 2013).

Conclusion

Violence against women and children is not a problem restricted to particular countries or regions. Rather it is a global menace (Barner & Carney, 2011). According a 2013 global review of data, 35 per cent of women all around the world have experienced some form of violence. In some countries, the findings are even more alarming with reports of up to 70 percent of women having fallen victim to violence. Research also reveals that of all women who were killed in 2012, about half died in the hands family members or better halves. With this information in mind, it is important that communities and countries around the world demand for more from their governments and from themselves in the fight against violence directed towards women and children. The causes and the outcomes of violence against women and children stem from and affect the society at the end of the day. Therefore, the solution should come from the society in the first place.

References

Barner, J. R., & Carney, M. M. (2011). Interventions for Intimate Partner Violence: A Historical Review. Journal of Family Violence, 26(3), 235-244.

Daly, K. (2012). Conferences and Gendered Violence: Practices, Politics, and Evidence. Conferencing and restorative justice: International Practices and Perspectives, 117-135.

Garland, D. (2012). The Culture of Control: Crime and Social Order in Contemporary Society. University of Chicago Press.

Gitterman, A. (Ed.). (2013). Handbook of Social Work Practice with Vulnerable and Resilient Populations. Columbia University Press.

Stith, S. M., McCollum, E. E., Amanoraˆ?Boadu, Y., & Smith, D. (2012). Systemic Perspectives on Intimate Partner Violence Treatment. Journal of Marital and Family Therapy, 38(1), 220-240.

Introduction

Management of a violent or aggressive client plays an important role in health care setting. This is very critical in mental health sector and as well as the prevention of violence and aggression is very essential since the main concern of the modern world has been directed towards preventive measures rather curative and therapeutic actions.

Researchers have found out that violence and aggression are common among mentally disordered clients than community controls. It is more common among schizophrenic and drug addictive clients than other mentally disordered clients. Furthermore this article reveals that the number of homicidal events for last few decades remains constant in UK although the technology has been improved. (Davison, 2005)

Furthermore some articles reveals that hundred percent of nurses who are working at mental health settings have experienced some kind of violent behavior from clients towards them. The more important thing is these behaviors vary from verbal threat to sexual harassments. And also this article reveals that nurses and health care workers who directly work with such clients are getting assaulted more often than doctors who visit them periodically. (Richter & Whittington, 2006) These facts prove the important of developing more effective strategies to manage violent and aggressive clients.

Since they are not completely independent and since they seek care it is very essential to plan strategies to cope with and to prevent or minimize such incidences while maintaining clients’ rights and dignity as health care workers.

The other important aspect of this discussion is to minimize or prevent injuries or harm to the coworkers while managing such clients in a dignified and well accepted manner.

Before look in to the management and the prevention it will be useful to be familiar with technical terms.

What is violence?

Violence has been defined as an intentional behavior towards any person or a property to damage, Injure, hurt, abuse or kill with a physical force. (Dictionary, 2012)

What is aggression?

Aggression is a set of behaviors which can cause physical and psychological injury, damage of harm to oneself, others or properties. (Cherry)

What causes aggression and violence?

It is critical to figure out the reason or the cause, why violence and aggression occurs in health care setting. Despite clients mental health condition or the physiology of the disease the environment and the way staff approach the client is important. Most of the articles reveals that clients with antisocial behaviors, schizophrenia, drug addictives and clients who are having problems with the insight may become aggressive than other traits. But it is important to notice that apart from above conditions the environment which is discomforting to clients and actions of outsiders may play a role towards clients’ violence and aggression. This may be common among health care settings the onset of aggression due to certain actions taken by staff members which can justify due to lack of systematic techniques and understanding even though it is unethical. Because with the more often aggression and harassment towards staff make their mind to take aggression and violence as a job related threat or hazard and make them helpless during a such incident. This will make their mind to be more focus on safety rather clients rights and dignity.

Prevention of Aggression & Violation
Identify your client

It is essential and critical to know your client very well before you approach your client. This includes the condition of your client, medical, social history & violent history. Knowing you clients medical & social history may help you to recognize what makes you client aggressive while violent history will reveal lot of important facts about you behaviors. Simply you should know likes & dislikes of your client, what makes them aggressive, how they express when they were above to behave aggressively & what would they do when they become aggressive. So you can anticipate & get prepared if you know above information about your client.

Pay your attention to aggravating factors

If you know your client, you can figure out what makes them aggressive. May be certain topics, actions, words or behaviors will make them aggressive. You need to avoid them as much as possible when you approach a client. This will help a healthcare worker to prevent such incidents.

Take precautions

Once you identify your client properly, you should take necessary precautions. Based on above assessment firstly you need to rule out factors which makes them aggressive. Secondly you should pay your attention and find out a way to identify such incidents before it occurs by your client’s expressions, specific behaviors, or gestures. Then you should know what they would do when they are aggressive or violent. Based on that information you should take necessary precautions. You may keep your coworkers informed before you approach your client, & keep an emergency communication system ready such as a call bell to use in case.

Arrange the environment

It is very essential to arrange your client’s environment. That should be calm, comforting environment with no clutters & threats. The surrounding should not posses any sharp objects, ropes, wires, tubes which can be use to harm self or others.

Managing Aggression & Violation

If your client become violent or aggressive; by using following measures you can try to control the situation.

Talk on behalf of your client

Always show your client that you agree with him or her and always take you client’s side though you strongly disagree with him or her. Because, your client becomes aggressive or violent since they are not fully mentally competent at the moment. Realize that this is not the best moment to discuss & prove your client is wrong or his or her actions are unacceptable. Talking on behalf of your client will help you to gain your client’s trust & faith which will be useful to calm down your client. Send victims or opponents out immediately while you are having someone around to assist you. Because seen his or her opponent would make your client more discomforting.

Try to calm down you client

Once you gain faith of your client you can control you client up an extent. Don’t try to over control your client. Calm down you client by giving them suggestions while listening to him or her. Offer him or her a seat to make your client comfortable. Give your client enough time without rushing.

Remove aggravating factors from your client’s sight

If aggression or violation has being occurred due to a person, send him out, the factor may be a picture, word which has being used or any behavior or can be any minor thing. You must avoid them & remove them immediately if it is possible to support him to calm down.

Keep supportive measures ready all the time

All the time the emergency alert system, urgent medicines such as sedatives, supportive staff should keep ready when you deal with such a client. This will help healthcare workers to minimize the damage if an incident occurs.

Go with a crowd

When you approach a client who is highly possible to become violent or aggressive it is preferable to go with one or more coworkers. In case if client becomes violent supportive staff can help you to restrain at least until medications has being administered. And it is very important that you should keep your eye on your client and should be at your sight whenever you are at your client’s room or area. This will provide your safety. By having your client at your sight all the time, you can see what they are doing & for what they are getting ready for. Your client may try to harm you since he is mentally incompetent. If you do not pay your attention to your client; it will make it easier for your client to harm you.

IM rout is preferable for emergency medicines

Always intramuscular route is preferable to administer medications such as sedatives during an violent or aggressive situation. The reason is you don’t need much of coordination to administer IM injections as IV. Even though IV act fast administering as IV medication will be difficult with a non cooperative client unless they are restrained or an IV canula has being inserted.

Do not Criticize

Once an incident occurred do not label your client since that will lead you client to become more aggressive when people treat them differently as well as that will help to recur the same situation. Treat them similarly as for the others & do not show them a difference.

Conclusion

Aggression and violence is common in health care related to mentally incompetent people such as patient with anti social behaviors, schizophrenia, personality disorders & drug addictives. Poor techniques, protocols and systems to deal with them put both clients and health care workers at a risk. Furthermore this will cause breaching client’s dignity, rights & health status while healthcare workers consider them as a job related risk. Proper education and awareness of healthcare workers would improve healthcare workers coping with such incidents & proper management of incidents. Knowing you client & being prepared is the best way to minimize aggression & violence in healthcare.

Outline:

I. Introduction:

1. What is violence?

2. Children in daycares.

3. Violence against children in daycares.

II. Situations:

Violence against children in Vietnam.

2. The consequences of the violent using.

3. Parents’ responsibilities.

III. Problems:

Public daycares overload.
Risks of private daycares.
The careless of parents.

IV. Solutions:

Increase the nannies’ knowledge in teaching and caring children skill.
Enhance daycares’ facilities and infrastructure.
Increase inspection and supervision of the authority at private daycares.

V. Evaluation

1. Advantages

2. Disadvantages

VI. Conclusion

Nowadays, violence against children is become one of the most alert issues; especially in Vietnamese daycares. The children are physically and mentally ill-treated. Firstly, violence means using physical force against people and an act of aggression against a person who resist or not (definitions.net). In that sense, toddlers, children aged from two to four years old are the victims of violence in daycares. Using violence against toddlers is seriously violating the human rights, especially the children rights. According to UNICEF, “ Governments should ensure that children are properly cared for, and protect them from violence, abuse and neglect by their parents, or anyone else who looks after them” (Article 19,unicef.org). In recent years, Vietnamese daycares are facing a lot of doubtful legal cases. Many of these daycares are caught in the act of hitting and persecuting small kids. The government, especially the child-care organizations also takes a part in this alarming issue. One of the first responsibilities belongs to Vietnamese Ministry of Education and Training (MOET). The issue which has been originated from the insufficient skills of management operation in children-care centers has led to a lot of severe and social and educational consequences. As a result, the Vietnamese government and local organizations are now making the revolution in the child-care system to calm parents’ mind.

II. Situation

First of all, the toddlers have the right to learning and growing with love. They are not deserved to be ill-treated that some adults have done. For example, the case which causes a tide in Vietnamese public opinion happens in Phuong Anh daycare in Thu Duc District. The scene was based on the video clip which people living around the daycare have been recording; the babysitters hit and forced small kids with violent actions. Although they were crying, the babysitter still throttled and slapped them. This is just one of cases which involve the violence against children in daycares. “The violence against children phenomenon is not popular however it’s not so rare”, said Ngo The Minh, the Deputy Chairman of Committees of cultural and educational youth and children of Congress (24h.com.vn). However, Vietnam is not the only country having the violence against small kids. This phenomenon happens everywhere in the world, especially the developing and poor countries. Below is the statistics showing the percentage of children from some countries experiencing violent discipline, psychological aggression or physical punishment (unicef.org):

Children are the future of every country. They make the world become a better place and more complete day by day. If they were treated badly in the past, they would become the one who will treat their children the same in future. Particularly in daycares, the kids begin to learn and understand about the world. Therefore, when they grow up, they remember how the adults rose and taught them. The fact that nannies apply violence with kids just makes them more hard-headed and stubborn. As a result, parents are the people who suffer the most because of the kids’ misbehaviors and inappropriate attitudes. Parents also take important responsibilities in this issue. They don’t have time with their children because of their busy works. In Vietnam, the parents who don’t have time to take care of their children such as workers, office staff or even doctors having some busy jobs usually send their children to daycares. Some of them even send their kids to the not-officially-certified daycares. As a consequence, this carelessness leads to a lot of unfortunate accidents which have been written a lot in various newspapers.

III. Problems

In recent years, the violence against children is the most concern issue in Vietnam. There are a lot of toddlers being abused in illegal daycares. Some of them are badly injured and the others are dead because of nannies’ brutal act. Thus, there are many reasons for these tragic accidents which happen every year. The first reason is public daycares are having an oversupply of kids. Families who have toddlers living in the big city or the capital are having difficulty in finding public daycares, especially families with low income or don’t have city household. The Vietnamese daycares are oversupplied with kids because the population growing faster in recent years. Every mother and father wants their children sent to the place with good education and skillfully teacher. Consequently, the late ones don’t get the chance to send their children to public daycares so they must take their children to private daycares.

Secondly, the percentage of using violence against children in private daycares is usually high. Private daycares were opened to help the children who didn’t get a place to study because of the public daycares’ overload. However, most of the private daycares fail to meet the requirements in the facilities, infrastructure and teaching qualifications. Moreover, normal people even can open the daycares at homes without officially-certified papers. As a result, there are so many accidents happen at home daycares such as the story happen at Thu Duc district. The nanny name’s Nho who is the criminal for killing the eighteen-month kid name’s Long. “When Nho was getting the breakfast for Long, she saw the kid cried. Then she yelled at Long and threatened him to eat the food. However, Long still cried which make Nho became angry and lost control. Therefore, she lifted up the boy and threw him in the air without catching the boy back. The falling make Long got badly injured then he cried out loud which was the reason make Nho stomped on the baby’s chest and head two times. Unfortunately, the kid didn’t survive the thrashing of the nanny” (vtc.vn). Thus, this issue also takes a part in the responsibilities of parents.

Thirdly, the careless of parents are one of the reasons that make children being ill-treated. They didn’t learn carefully about the daycares where they entrusted their children. Parents absolutely trust in the babysitters. If something happen to their children, they will often ask the babysitters instead of finding the reasons from their kids. Some parents give nannies that take care of their children some extra tips on special events. For this reason, low-income families may have disadvantages with the nannies even so their children. Which means parents know that violence is exist in daycares and they accept that by bribing the nannies. Consequently, when the violence is finding out, they take all the blame on the daycares as well as the nannies. Besides, people who live around the daycares also be the accomplice in most of the violence issues. They knew what happened in these illegal daycares everyday but they are indifferent with that. If they have a parent’s heart, they should tell the abused children’ parents as well as the newspaper office to accuse the illegal daycares. In this manner, the unfortunate events could be prevented.

IV. Solutions:

The child abuse phenomenon can’t be stop immediately; it requires time and lots of solutions. Therefore, there are many possible solutions being proposed to stop this phenomenon. Accordingly, the first solution is “Increase training and periodic retraining to improve professional skills in the work of nurturing, caring and education for young nannies”, said Trinh Viet Then, lecturer of psychology at Van Hien university (vnexpress.net). Small children such as toddlers are very hard to teaching and caring which lead to many acts of violence. Even the well-trained nannies sometimes think about using violence to kids. Toddlers don’t conceive things right or wrong which make the nannies sometimes become furious and cannot control the behaviors. Consequently, if the nannies have both of these skills, the child abuse in daycares will decrease dramatically. According to Thuy Nguyen Radio Station, Dong Son daycare has applied this solution in 2014. The daycare gives the nannies the opportunities to learning and training. In present, most of the babysitters in Dong Son daycare meet the requirement of teaching qualifications (haiphong.gov.vn).

In addition, daycares should enhance the infrastructure and as well as the facilities to serve for the teaching purpose. Pham Hien, psychological expert said: “Daycares must have cameras to help parents easier to observe their kids every day” (youtube.com). Better equipment and infrastructure, the more effective in teaching and caring children. Moreover, daycares having cameras in the classes make the nannies have more self-conscious in their behaviors towards toddlers. This solution also helps parents and researchers easier to keep an eye on kids and avoid problems for the daycares itself. Additionally, daycares with good equipment make kids feel comfortable and easily learning the lessons. For example, the Vietnam Women’s Union (VWU) has donated a large amount of money to enhance the facilities and infrastructure of two kindergartens at Long An province and Binh Duong province (baomoi.com). As a consequence, children studying at these kindergartens are prevented from the violence using of nannies.

However, the authority’s inspection and supervision at kindergarten is indispensable. In addition, private daycares without officially certificates must be banned and stop working. Nguyen Thi Loc, vice-director at Hoa Mai semi-public kindergarten said: “The authority should permanently increase the inspection toward the nannies such as examine the employment records or the nannies’ license” (mamnon.com). Besides, the MOET should investigate and total up the documents of violent victims such as toddlers. Based on the documents, the authority proposes solutions to prevent the violence. Furthermore, people should using banners of anti-violence against children near daycares. People who live near the daycares should encourage others to find out the illegal one and report to the nearby authorities. For example, the Women’s Union at District 8 has made a monitoring at three daycares in November, 2014. The reason is through the monitoring, they can raise awareness and sense of responsibility for those who have the responsibility of raising children, and to prevent and promptly handle those who abuse children (gov.vn).

V. Evaluations: