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A profession means a group of people that are specialised in a particular occupation. For example, an individual that is a doctor can be specialised in children, therefore their occupation would be called paediatricians. Profession consists of professionals that have the same interest, skills based on theoretical knowledge. Therefore it is important that professionals should have extensive period of education to influence the competency of their profession. Hodson and Sullivan (2005, p. 258) implies that profession is a ‘high status and knowledge-based occupation that is characterised by the ‘Hallmarks of a profession’. The hallmarks of profession suggest profession is split into 4 main components that are based on abstract, specialized knowledge, autonomy, Authority over subordinate occupational groups and a certain degree of altruism.

Specialized knowledge consists of theoretical, practical and techniques. The theoretical knowledge would focus on theoretical guidelines as to what is expected by professionals. In relations to social work, theoretical knowledge is a crucial element to their profession as putting theory into practice; it helps socials workers develop to think critically and analytically. Oke (2008) suggest that one way of linking theory into practice is known as issue-based approach to learning (IBL). IBL encourages meaningful learning as for example, processing information from a source can help encourages a reflexive process of thinking as it explore further on about ideas and speculate in ways you can put the theories into practice. By means of social workers applying the IBL effectively, it would enhance social workers to work proactively as they would be capable of empowering strategies support the needs and wishes of the service users. The competence of knowledge is a key to profession as Payne (2005 p. 185) suggests professionalism, associated with increasing organisation alongside increasing knowledge and power. Therefore, this may link to entry of qualification, the higher the qualification the more competent on their understanding of putting theories into practice. Learning new information constantly develops the self-knowledge and enables to go in-depth of understanding.

Harris (2003 pp.133-4) argued that social work training helps social workers become a ‘competent and accountable professionals’. This may be a combination of educational institution and social work agencies. The Central Council for Education and Training in Social work (CCETSW) supported the training scheme financially through the central government. Before the mid-1980’s when the CCETSW introduced the certificate in Social Services (CSS), the tendency was students that obtained the CSS were more likely to become social workers. Higham (2006, p. 16) argued that this meant people that worked within social care didn’t fit in with the framework with social workers in the 1970’s. This is because obtaining the qualification became demanding between social work and social care, therefore the CCETSW was worried if there was suitable amount of training resources available for social care staff that was desired to become a qualified social worker. Corresponding to Horner (2009 p.94 -5), he signified that since the emergence of the Diploma in Social Work (DipSW) in 1989 there has been an increase of social workers. This could relate to the discontinued of the CSS qualification in 1992 ended and the start of training courses including worked-based vocational qualification emerged such as National Vocational Qualification (NVQs). In 1992 the National Standards for Training and Development introduced the Worked-based vocational qualification which was made with a difference as there was no set curriculum, specified programmes or examination- it was assessment based. Before there were social care workers that were already employed but did not achieve a formal qualification as it was not regarded at that time. Higham (2006) argued that statistics shows in the year 2000 around 80% of the workforce didn’t not obtain a qualification or had qualification that was not related to their occupation. This shows there was lack of competency within social care professions which may have compelled issues associated with inadequacy of reporting and recording procedures, maintaining confidentiality, accuracy of information and taking into account of the current policies and procedures. The DipSW does not exist any longer; people that are training to become social workers would now need The Social Work degree course to become a qualified social worker. Primarily, the formalisation of training based on social work emerged from social care. Traditionally, society viewed social work and social care as a synonymous profession. Steadily social work had developed recognition in relation to their profession which had gained them distinctive characteristics than the social care profession. However, both professions overlap each other and form a relationship together to facilitate people with their quality of life.

Autonomy is another part of a ‘profession’ according to the four hallmarks. It is common that professionals have a tendency to control their own affairs based on their professional skills and knowledge. Social work values autonomy in terms of decision making. For example, social workers may demand autonomy in terms of building a relationship with the service users more than the heavy caseloads they may encounter as the inequitable caseloads can prevent social workers from tackling effectively the issues that may lead to risk upon service users. Roe (2006, p.15) report emphasises with social workers because he argues that they are ‘… constrained by line management arrangements that require escalation of decision making up a chain of command in order to manage budgets or risk’. This argues that social workers are refrained from professional autonomy as the result of pressure of their line management; this suggest that line managements’ main priority in terms of decision making is to insure appropriate decision making takes place (taking into consideration manageable budgets and the prevention against risk towards service user). Others may argue that there is lack of professional autonomy within social work because of the restriction from the public and within the service demands. Social workers are perceived as authorised professionals that are entitled to autonomous decision making in order to meet the needs of service users; Harkness and Kadushin (2002, p 468) suggest that professional autonomy is about having responsibilities to themselves and the services they offer. Therefore, if there was a deficiency of autonomy within the social workers, this would strongly broad services and social workers would consequently feel greater pressure from the public and other agencies of delivering their full potential due to the boundaries of what they may encounter. An issue that may arise for a social worker is it acceptable to follow their instinct to protect and meet the needs of the service user, even though it may be unacceptable within the rules and regulations of the profession. Sustaining autonomy in a social work profession is imperative as it promotes social workers to actively engage with other multi- agency professionals which would boost their self-confidence and helped them reach their full potential.

In relation to a degree of altruism, there are codes of ethics for professionals within any occupation that are put in place for professionals to seek guidance through competency, practice and acknowledging the complexity of situations. In other words, it is recognised as a systematic framework as to what is ethically acceptable. On the other hand, code of ethics within professionals offers guidance for every believable situation, which means it can be perceived as generic and not the use of specific rules. Despite the codes of ethics being generic, it plays a role for the social work provision. The British Association of Social Workers (BASW) introduced the codes of ethics for social work, values and principles that established the five main key principles such as human dignity and worth, social justice, service to humanity, integrity and competence; they were put in place to ensure that in relations to conflicts and disclosure is honest, fair and accurate. Also to make sure professionals are compliant with the legislations and regulations. Despite, codes of ethics can be misinterpreted or ignored by professionals; not only may the risk of disciplinary action, but this as a result put the service users at risk. However, it is important within the social work profession for social workers to make mature decision as well as understanding and taking into account the value of issues that social workers may face. It is crucial for professionals to adopt the knowledge and skills gained through experience and qualifications in order transfer the skills achieved to help promote new roles and approaches to meeting the needs of the service users.

Within a profession there are codes of practice which is expected by employees to follow and put into practice; it usually consists of the outlines of behaviour. The significance of the codes of practice would ensure high standards of their job roles are being met. This would not only benefit the profession as a whole but also the employees, employers and the wider society. Comparison to the social work profession, they have a similar concept as a range of organisations had been put in place to ensure that it promotes high standards within the profession. To maintain the assurance, regulation within the service (including education and training) and matters of misconduct was a high priority according to the UK government. These organisations included The Social Care Institute for Excellence, 2000 (SCIE), The Commission for Social Care Inspection, 2004 (CSCI), The General Social Care Council, 2003 (GSCC) and Skills for Care – this was known as ‘the big four’ Horner (2009, p 118). Each of regulation has their own purpose to ensure high standards of care were priority. The SCIE main responsibility is to ensure that social care professionals are able to identify and widen knowledge about good practice such as guidance and developing professional standards. The CSCI main duty is ensure that inspection and monitoring services within the health and social care services were affirmative quality of protecting service users or patients from potential risk of the service users or patients needs. Moreover, The GSCC regulates social workers including social care professionals by situating them onto a register. The register ensures only professionals with the required qualification and adhered the occupational standards are genuine to working with service users especially the vulnerable. Furthermore, the Skills for Care regulate the training processes within the social sector. This may include developing qualifications and assessing the social sector training needs to ensure competency within knowledge is constant throughout the training that is supplied to the social care and social work professionals. Overall, the regulatory frameworks may have different missions but they all form a relationship that supports and promotes quality standards to the staffs, services and training within the social care provision. Regulations are important within a profession to ensure professionals are fulfilling the roles satisfactory and sensitively according to the public interest. It is important that the Social work profession should be able to identify when the standards are to some extent failing, it should take instant action as it is their responsibility as a profession to take the leading role in professional governance. This will prevent drastic dilemmas which can damage the profession status.

To conclude, to an extent social work can be said to be a professional as compare to a profession with a social work profession there are similarities. In relation to knowledge, the social work professionals would have some degree of theoretical knowledge. For example, according to Payne the power of professionalism involves the competence through knowledge. This may argue that social workers who obtained a social work degree would have higher qualification alongside increasing knowledge and authority as they more understanding of putting theoretical claims into practice. In relation to training profession require training to keep up to date with current skills, legislations and knowledge so that they can provide a better service to their clients. Social work profession has a history of different approaches to training and development to a point of needed a degree instead of a diploma to become a social worker. Professional autonomy within profession is about professionals dealing with their own affairs. Corresponding, social work is between decision-making and taking into consideration ethical views as to what is acceptable. To a degree of altruism professionals would seek guidance through competency, experiences and understanding complexity of dilemmas. This concept is the same factor for a social work profession as social workers would need to follow their code of practice coherently. To ensure that the profession is meeting the codes of practice, regulation is maintained through organisations including the SCIE, CSCI, GSCC and Skills for care. In general, social work can be recognised as a profession. Furthermore, throughout the years Social work profession reputation has been damage to extent as qualified social workers leaving the profession as they feel it is demanding profession.

The aim of this assignment is to discuss the contribution of medical, sociological and psychological models to understanding emotional health and examine the impact of race, class and gender on emotional health. Furthermore the assignment will discuss appropriate theories to understanding the emotional health linking them to race in case study one.

According to World Health Organisation, 2005 “Mental health and mental well being are fundamental to the quality of life and productivity of individuals, families, communities and nations, enabling people to experience life as meaningful and to be creative and active citizens”. Hales ( ) defines emotional health as the ability to express, acknowledge how one feels, their moods and be in a position to adapt to situations and be compassionate to others.

The medical model views the diseases as coming from outside and invading the body, causing changes within the body. It can also originate as internal, involuntary physical changes caused by chemical imbalances and can also be genetic (Nolan 2009). This model considers the mental malfunction of schizophrenia to be a consequence of chemical and physical changes in the brain. Environmental factors may be the causation of illness, but the disorder might still be influenced by hereditary factors (Tyrer and Steinberg 2008). The abnormal behaviour in an individual is a result of physical conditions such as brain damage, meningitis and others. The treatment given is aimed at controlling the root cause of the disease by changing the individual’s biochemistry. This approach does not account for the occasions this evidence can be found in mental disorders such as such bipolar and unipolar depression and schizophrenia.

The sociological model of health places more emphasis on the individual’s environmental, social and economic causes of disease rather than solely focusing on the biological aspect (Duggan 2002). The socio-cultural aspect refers to the role socio-cultural environments play in a given psychological phenomenon such as parental and peer influence in the behaviours or characteristics of an individual. “Social factors encompass a discrete subject matter because, as collective representations, they are independent of psychological and biological phenomena, although we have individual actions, thoughts and feelings we tend to live our lives through institutions: family, corporation, church, school and nights” (Hadden 1997 p 105).

The Psychological model suggests that human behaviour is strongly affected by experiences from childhood and also that behaviour is the result of interaction between the conscious and the unconscious (Nolan 2009). Mind (2010) points out that cannabis may cause psychological effects that lead to psychotic experiences such hallucination, depersonalisation and paranoid ideas. Rack (1982, p. 124) points out that Cannabis is readily available throughout the Caribbean and the northern parts of the Indian subcontinent its use is not restricted to any particular age-group. In support of this point Cockerham (2007) observes that living in a household with both parents who smoke or having a spouse who smokes can promote smoking behaviours. A psychological model is based on the assumption that conscious thought mediates an individual’s emotional state or behaviour in response to stimulus. The model suggests that people may create their own problems through interpretation.

The psychological model will look a lot deeper into the individuals and not merely the symptoms in which they are showing. It suggests that our thought may cause the disturbances or it may indeed by the disturbances causing our thought. The model refers to the role that cognition and emotions play in any given psychological phenomenon, such as the effects of mood, beliefs and expectation on an individual’s reaction to the event. The biological aspects refer to the role of the prenatal environment on brain development and cognitive abilities or the influence of genes on individual’s dispositions (Rogers and Pilgrim 2000).

Hatty (2000) in Barack (2006) observes that Gender refers to nature and the psychological, social, and cultural components that summarizes the leading ideas about feminine and masculine characteristics and behaviours dominating in any society at one time. According to Pilgrim (2009) gender is a social description. Rogers and Pilgrim (2005) points out that men are prone to be involved in antisocial behaviour and can be categorised as dangerous and criminally deviant, which leads to their removal. The idea of danger to society is always attributed to men than women. There is evidence to propose that men are often sectioned under Mental Health Act 1983 and referred to psychiatric hospitals by the police under section 136 removal to a place of safety. Men are more likely to be hand cuffed and detained in cells more than women (Rogers (1990) cited in Rogers and Pilgrim 2000).

Gove (1984) in Rogers and Pilgrim (2005) shows that there is now a general consensus among social scientists that women experience more psychological distress than men and that this is largely due to aspects of their societal roles. Another view point is that, throughout the life span women report greater psycho-social malaise than men and the gap between sexes increases in older people with self-reported factors like depression, worry, sleep disturbances and feelings of strain. There have used the societal role to explain why women experience psychological distress than men. Women’s unstructured roles tend to be more domestic than men which contribute to their vulnerability to mental distress because they have time to dwell on their problems (Blaxter (1990) cited in Rogers and Pilgrim 2005).

Women’s natural disposition is known to be maternal, caring, passive and home centred. Their inferiority, instability and lack of control are increased as their biology takes over (Jones 1994). WHO (2010) states that while childbearing and motherhood are often positive and fulfilling experiences, for many women these are associated with suffering, ill-health and even death. The estimation of illness is different between men and women, the peak age for men is 15-24 and for women is between 25 and 34. According to Rogers (1990) cited in Rogers and Pilgrim (2000)

Class remains a predictable correlate of mental ill health. Basically the poorer a person is the more likely they are to have a mental health problem. A class gradient is evident in mental health status across the bulk of the diagnostic groups but it is not a neat inverse relationship. For example affective disorders are not diagnosed evenly in all social classes whereas a very strong correlation exists between low social class and the diagnosis of schizophrenia. In the case of depression and anxiety the underlying assumption has been clearer cut, perhaps because minor morbidity is less strongly identifiable as biologically derived illness (Jones 1994). They found a complex relationship of social class to anxiety and depression linked to changing employment status they furthermore examined three different ways of describing social position: income; social advantage and lifestyle; and social class.

Poor accommodation produces stress reactions in inhabitants (Hunt 1990; Hyndman 1990). Social and environmental causes are those factors around us such as where we live, whether we have strong family support networks, our place of work and how and where we can relax (Royal College of Psychiatrists, 2004). Social class is one of the determinants of health which includes; wealth, culture, background, family, financial constraints, accommodation and lifestyle WHO (2010).

According to Barak et al race is socially defined by a collection of traits such as; physical characteristics, culture and religion, national origin and language. King et al (1994) and other authors cited in Kaye and Lingiah (2000) states that there is evidence that, with the intervention of the police and social services, African -Caribbean people are more likely to be admitted to psychiatric hospitals compared to whites. There is a belief that African-Caribbean people are not provided with preventive and supportive measures before there is a crisis, but when the crisis starts and escalates the emergency services get involved which leads to compulsory admission (Bhuil et al (1998) and other authors cited in Kaye and Lingiah 2000). Rogers 1990 in (Rogers and Pilgrim 2005) states that Afro-Caribbean people are found to be less frequently referred by relatives or neighbours but by strangers and passers-by of other ethnic groups. In support of the above statement Reiner 1996 in Rogers and Pilgrim (2005) suggests that there is a process of transmitted discrimination in the way in which black people’s behaviour is viewed which is interpreted in a more negative way. Furthermore the Department of Health (DH 2005) states that the black and minority ethnic groups who live in England are deprived of the quality of mental health care that they need. Black and minority ethnic patients are more likely than the white British to be detained compulsorily, to be admitted to hospital rather than treated in the community, to be subject to measures like seclusion in hospital, and to come into contact with services through the criminal justice system. This leads to a vicious circle of BME people refraining from seeking care early in their illness. According to Rogers and Pilgrim (2005) most blacks including African-Caribbean people who live in the inner cities suffer from recurrent racism and are over represented in psychiatric records.

Looking at what the medical model says and comparing to Daniel’s behaviour, it may be suggested that he was suffering from schizophrenia which is more dominant in African Caribbean people, which could have been caused by substance abuse. Royal College of Psychiatrists (2004) states that there is a causal relation between substance misuse, particularly alcohol, cannabinoids, hallucinogens, and stimulants (such as amphetamines), can produce psychotic symptoms directly without mental illness. They may also precipitate psychotic disorders among people with a predisposition. Kaye and Lingiah (2000) points out that African Caribbean people have a higher rate of admissions for schizophrenia and effective psychosis compared to their white counterparts.

Hales (2010-2011) states that social health refers to the ability to interact effectively with other people and the social environment in order to develop satisfying interpersonal relationships and fulfil social roles. Looking at the changes in Daniel’s behaviour it may be suggested that it was down to living on his own, lack of support, change of environment and financial problems. Frederick 1991 in Rogers and Pilgrim (2005) observes that the various factors identified by Afro-Caribbean mental health users are; coping with adolescence and education system; building up relationships and then dashes their expectations; growing up in a hostile environment with few positive images of black people, parental and with British white cultural input leading to confusion and conflict over identity. Argyle (1994) states that there is a theory that failing to learn correct social skills during the early stages of life can contribute to social rejection there by cause one to fail to cope with life events and can cause anxiety, depression or other symptoms.

Hales (2010-2011) points out that those who are psychologically fit normally share the following characteristics: they have high self-esteem and aim towards happiness and fulfilment, they establish and maintain close relationships, they accept their own limitations in life and they feel a sense of meaning and purpose of life. Daniel started neglecting himself and acting on the voices that he heard, which may be suggested he had a problem with his psychological well-being. African Caribbean people are likely to be offered physical treatments, strong medication and not likely to be offered psychotherapy and counselling.

In conclusion analysing approaches to health and illness in terms of medical versus a social model henceforth the medical model is a key concept in both medical sociology and medical anthropology (Chang and Christakis 2002). A lack of social support also can be due to social stigma which is the main reason why mental people’s social network becomes narrow. Also because of schizophrenia’s pervasive effects on daily functioning a range of psychosocial approaches has been developed to improve emotional and psychological well-being.

Introduction

Social work is an established professional discipline with a distinctive part to play in promoting and securing the wellbeing of children, adults, families and communities. As an established professional discipline, social work has its own theories and knowledge. The essay will begin by defining what a theory, models and method is, with reference to different authors. I shall then explain how I applied the particular model or method to practice as well as providing a critique. I will then conclude by relaying this to my practice development.

Theories in social work are often set out as a list of different approaches, including, for example, person-centred counselling, family therapy, task-centred work, cognitive-behavioural therapy, networking, group work, psychoanalytical theory, anti-discriminatory/oppressive practice and feminist theory (Davies, 1997). Alternatively: crisis intervention, the psychosocial approach, behavioural social work, working with families, etc. (Coulshed and Orme, 1998). What they have in common is that the approaches and associated theories do not originate from and are not specific to social work.

Practice theories are relatively discrete sets of ideas prescribing appropriate social work actions in particular situations. Psychological or social explanations of human behaviour are applied to social work situations, and actions are prescribed, based on the worker’s assessment of the situation. Practice theories are usually informed as separate, relatively complete and coherent sets of ideas. However, aspects of them are often used eclectically, in combination (Payne, 2000, p. 332-3).

Models describe what happens during practice in general way, in a wide range of situations and in structured form, so that they “extract certain principles and patterns of activity which give practice consistency” (Payne, 1991). Models help to structure and organise how to approach complicated situations. Methods represent the more formal written accounts about how to do the job of social work (Sibeon, 1990). This occurs when theory or a combination of theories, is made concrete and applied in practice. Pincus and Minahan (1973) argue that models should avoid conceptualizing social work practice in such terms as person-environment, clinical practice-social action. They believe that strength of the profession lies in recognizing and working with the connections between these elements. In the social sciences theoretical knowledge is highly contested because different theories offer competing explanations. Very important question here would be about the nature of the explanation, why something is as it is, according to Thompson, this is what distinguishes a theory from model. “A model seeks to describe…how certain factors interrelate, but it will no show why they do so” (Thompson, 2000, p. 22).

Case study

GC is a 43 years old man who suffers with severe learning difficulties and Autism. GC moved into residential home for people with learning disabilities in 1993. Before that he lived with his parents. For the past 13 years he attended Day Centre 5 days a week. GC has parents and a sister who he remains in contact with and family relations towards GC remains positive. GC participates in different sorts of activities in the residential home as well as in a Day Centre where I am on placement. There are times when GC is agitated, hyperactive and very vocal. He has difficulty in accepting change and demands regular routines with his lifestyle. There are lots of behavioural issues around GC. This can fluctuate in relation to the onset of epilepsy. He can become agitated and hyperactive prior to a seizure. He needs regular monitoring as seizures can be life threatening. GC lacks awareness of danger; these include road safety and strangers. Apart from seizures he also suffers from high blood pressure, asthma and insomnia. However, the last one might have been caused by the recent change of his medication to control his seizures more effectively. Recently, the local authority decided that the Day Centre GC attends will be closed and all clients, including GC, are going to be moved to different Day Centres.

I am a student on placement at this very Day Centre and during my placement I was assigned to be GC’s key worker. In order to work effectively with him I decided that the theory I would use will be systems theory. In the next part of my essay I will justify the reasons for choosing this theory.

Systems theory and implications for practice

Systems ideas in social work originated in general systems theory developed in 1940s and 50s in management and psychology, and were comprehensively formulated by Bertalanffy in 1971. This biological theory sees all organisms as systems. Bertalanffy says, that human being is part of society and is made up of, for example, circulation systems and cells, which are in turn made up with atoms, with are made up with smaller parts. The theory is applied to social system, such as groups and families, as well as biological systems. Hanson (1995) argues that the value of systems theory is that it deals with wholes rather than with parts of human or social behaviour as other theories do. Mancoske (1981) shows that important origins of systems theory in sociology lie in the social Darwinism of Herbert Spencer. Systems perspectives are important to social work because they emphasise its social focus, as opposed to counselling, psychotherapy or many caring professions, whose importance is on individual patients or clients.

The “broadest possible definition of a systems is that it is ‘anything’ that is not chaos” (Boulding, 1985, p. 9). Conversely, a system could be defined as “any structure that exhibits order and pattern” (Boulding, 1985, p. 9). The common definition of a system, is that a system is “an aggregate of elements considered together with the relationships holding among them” (http://wikipedia). In this sense, a system may be considered “as any entity, conceptual or physical, which consists of independent parts”

Systems theory has been developed in to models by Germain and Goldstein, but above all by Pincus and Minahan, which is centred on the individuals systems. Preston-Shoot and Agass (1990) argue that systems theories showing how the public and private interact, how various change agents might be involved, and that workers and their agencies might themselves be targets for change. National Occupational Standards also stresses an “ecological approach”- ‘an individual must be located within the context of the family & the groups/networks to which they belong, & of the wider communities in which they live’ (Key role 1, Unit 1- Key Concept).

The focus of social work practice is on the communication between people and systems in the social environment. People are dependent on systems for help in obtaining the material, emotional or spiritual resources and opportunities they need to realize their goals and help them cope with their daily tasks. The concept of life tasks was highly structured by Harriett Bartlett who states:

“As used in social work, the task concept is a way of describing demands made upon people by various life situations. These have to do with daily living, such as growing up in the family, learning in school, entering the world of work, marrying and rearing a family, and also with the common traumatic situations of life such as bereavement, separation, illness or financial difficulties. These tasks call for response in the form of attitude or action from people involved in the situation. They are common problems that confront many people. The responses may differ but most people must deal with the problems in some way or other” (Bartlett, 1970, p.96).

Hearn (1958) made one of the earliest contributions, applying systems theory into social work. However, the greatest impact came with two interpretations of the application of systems ideas to practice, one from Goldstein (1973), who describes his theory as unitary, and the other one from Pincus and Minahan (1973) who describe it as an integrated theory.

In my essay I will mainly discuss the model that was formulated by Pincus and Minahan (1973). They identify three kinds of resource systems. First, informal or natural system: family, friends, neighbours, fellow workers. The help given by such informal relationship includes emotional support, advice and information. Second, formal systems, consist community groups, trade unions, membership organisations. And the last one is societal system: day centres, hospitals, schools, etc.

In terms of social work and in relation to systems, social work is concerned with the interactions between people and their social environment, which affect the ability of people to accomplish their life tasks and realise their aspirations and values. Pincus and Minahan talk about the purpose of social work in this aspect, which is to enhance the problem-solving and coping capacities of people, link people with systems that provide them with resources, services and opportunities, promote the effective and humane operation of this system and contribute to the development and improvement of social policy.

As social workers we must decide on purpose and relationship, in working with various people. The activities of the social worker can be viewed in relation to four types of systems according to Pincus and Minahan: these are the change agent, client, target and action. In most cases there is a one primary change agent who carries out major responsibilities, though two change agents might share the same responsibility. According to Pincus and Minahan, the change agent is a helper who is specifically employed by the system and pays the salary for the purpose of creating planned change. This differs from view of Roland Warren (1971) who defines a change agent as “any person or group, professional or non-professional, inside or outside a social system, which is attempting to bring about change in this system”.

The client system is about people, groups, and families, communities who seek help and engage in working with the change agent system. They believe that change agent should attempt to obtain sanction and a working agreement or contract from the expected beneficiaries of his change efforts. They also say that people have the right to self-determination and participation in decision that affect them. Warren (1971, p.51) argues that “social workers not only are constrained by agency controls…they are constrained by their own attitude towards the client; they identify with him as a person who needs help and not like citizen demanding his legal rights”.

The target system talks about people whom the change agent system is trying to change to achieve its aims. An important aspect here is to establish the goals for change and then determine the specific people-the targets-that will have to be changed if the goals are to be reached. Some of the targets may agree to make changes and some of them might not or might be resistant. Pincus and Minahan discuss two important aspects in such a situation. First, the client system is not always the target to reach change goals. Second, it cannot be assumed that the target system always will be resistant to the change efforts. Client and target system often partially overlap. e.g, GC who is a target, and mother who is client’s system. The last, but not least social work system by Pincus and Minahan is the action system. It describes those whom the social worker deals in his efforts to accomplish the tasks and achieve the goals of the change effort. An action system can be used to obtain sanctions and a working agreement or contract, identify and study problem, establish goals for change or influence the major targets of change. Roland Warren was one of the first who used the term “action system” to describe new systems created to perform community action tasks. Depending on a situation, the action system could be a new system so members of that system can directly interact between each other.

When talking about a change it is very important not to forget the issue of values and ethics. It is impossible to structure an effective change effort in which an implicit or explicit imposition of values is totally absent. Thompson (2005) says that “values are an important influence in our actions and attitudes, they will encourage us to do certain things and to avoid certain others (…) they are very strong force in shaping people’s behaviour and responses to situations”. Values are beliefs, preferences or assumptions about what is desirable. Values like those that call for the worker to respect the client, maximise client’s self-determination, maintain a non-judgemental attitude, observe the confidentiality of the client’s communications and be honest in dealing with client can be seen as primary social work values. Knowledge and values serve different functions, technical and ethical issues are often complexly interrelated in practice, and separating them is a difficult job. The distinction between knowledge and values should keep social worker aware of their own values. The awareness is an important first step in coping with the value dilemmas that are inherent in the change agent role. To cope with ethical doubt of the change agent role, the social worker must maintain a balance between flexibility and integrity. Self-awareness, technical expertise and tolerance will help in this task.

Case study- Implementing Theory to Practice

As a social worker I need to decide on purpose and relationships in working with GC and his surrounding network. GC’S natural system would be his mother who lives nearby and visits him every Sunday to take him out for a day, his father who lives in Scotland comes to see GC every three months and his sister who currently lives in Australia keeps up to date with news via e-mails and post. He also has a niece, who sends him photos and cards. His societal system is a Day Centre he currently attends.

My role was to link GC with systems that would provide him with resources, services and opportunities. GC is a very active person and there are days when he can hardly sit down. He likes to walk around the unit. My idea was to find him some sort of walking club where he could go out for a day and do some walking. Luckily, there was a local club, which organizes “walking activity” every other week. I thought it could be a good idea to sign him in and link him with a new formal system in order to help him with a new experience. I then discussed this with GC as well as his mother and we all decided that it would be a good idea for someone from his current network system to join him for the first session. It was thought that this might minimise stress and anxiety of being in a new environment. In this task I acted as a change agent, as a person inside a social system, who attempts to bring about change in this system. I deliberately described myself as a person “inside” the system, because immediately when I started to work with GC, his family and other professionals, I became a part of GC’s system.

About a month ago I found out that the Day Centre GC attends will be closing this summer. It will be a very stressful experience for GC as well as his natural system, which will be disturbed. I contacted GC’s mother and father and informed them about this matter. We had spoken about different possibilities and other day centres that may be available for their son. New informal systems may not provide the help that GC needs. After being moved to the new Day Centre, he may lack an informal helping system e.g. being new in a community and not to having any friends around him. Also, societal systems might be disrupted. GC might stop going to the walking club because of the location of the new day centre and distance between those two resources.

In general informal, formal and societal systems may not provide resources or services or opportunities, because the needed resource might not exist or may not provide appropriate help. People also might be unaware that such a resource exists or might hesitate to turn for help. The question was: what tasks GC will face in making the transition from one environment to another? In an attempt to answer this I note that he has informal helpers, such as family, who can support him throughout the process. Major change in GC’s societal system (Day Centre) is largely influenced by his natural, informal system. There will be a significant change to GC’s existing system and the new Day centre will become his new system, a system where members are not engaged in direct interaction with one another but whom a worker will coordinate and work with to change a target on behalf of a client. Therefore change agents may work with a number of different types of action systems at different steps in their change efforts. I advocated on behalf of GC to keep him in a current walking club, he attends and enjoys the most (formal system). Therefore, the first dimension of the social work frame of reference directs attention to the tasks people are confronted with, within social situations and the resources and conditions necessary for facilitating the performance of these tasks. This is the reason I used systems theory for GC. I also mentioned above about the target and client system overlapping. GC’s medication has been recently changed and his behaviour dramatically altered. He started showing aggressiveness and indifference towards his mother. Ms C asked me to somehow help GC to deal with the changes in his medication. I discovered that her behaviour contributes to GC’s problem. She was very sad and anxious recently and GC clearly noticed that. Before starting to work with GC I had to explain to Ms C that her negative emotions have a negative impact on GC’s behaviour and possibly she could use some help as well. In this case she became a target. It is also important to work with GC’s GP and community nurse who are part of his system. I urged medical professional to work closely with the family and myself to ensure everything is going well.

There is also number of criticism around systems theory. In social work interpretations of systems theory, however, and particularly that of Pincus and Minahan, Evans (1976) argues that there is a hidden assumption that all systems are independent. Devore (1983) argues that the life model is better at dealing with social class, ethnic and cultural differences and lifestyle than many other theories, but still lacks specificity in dealing with issues affecting black people.

Siporin (1980) criticise systems theory for not taking into account incompatibilities of class interest in capitalist societies and how these prevent any integration in such a society. The theory itself was also criticised for providing a framework of understanding that does not specify clearly the level and type of interventions required in particular circumstances.

System theory tends to assume that conflict is less desirable than maintenance and integration, which may not be true in practice (Leghninger, 1978). He also says that not everything is relevant and many things may not fit into a general plan, deciding on boundaries could be complex or even impossible, and it may be assumed that things are related in a system without checking to see if they actually are.

Nevertheless, Mancoske argues that in its social work formulations, the criticisms of systems theory as ‘static’ are weak, because usually considerable attention is given to change both individual and social.

Conclusion

I have to admit, that at the very beginning of my work with GC I was very apprehensive about using systems theory. After reading Pincus and Minahan’s “Social work practice: model and method” I found some of the aspects very complex and terminology used by them, difficult to remember and sometimes to understand. Surprisingly, Germain (1979) shares my anxiety and thinks that systems theory and technical language very often alienates social workers from using this theory as a result.

Payne (2005) argued that systems concepts were brought into social work as a reaction against psychodynamic theory, which focused on the human mind. In my opinion systems theory is very holistic framework, which helps social workers to view their workplace, agency in much wider concept. I think that out of all concepts that constitute general systems theory, the concept of boundaries is the most useful for social work practitioners. Boundaries are defining limits within this theory. They signify what is inside and what is outside system. GC has lots of emotional issues which could have been much more resolved with different approach, e.g. like task centred approach. I also observed that system theory has a number of limitations, for example it does not adequately deal with things like class, race, gender, power relations or conflict. I learnt that no single theory can explain a person’s situation. System approach also helped me to understand how families act and what the dynamics within the family are. On GC’s case I also learnt how important environmental changes can affect family dynamic. Social work is about having knowledge of a wide range of theories which gave me a more holistic understanding and how to be eclectic in my approach. I am finding very important drawing upon multiple theories, styles, or ideas to gain complementary insights into a subject, or applies different theories in particular cases. Applying systems theory into practice has also added dimension to my personal and professional values and have had a major impact on my work within my practice placement.

Social work involves working in profoundly emotional events in people’s lives, its practice is demanding and challenging and perhaps one of its most unique qualities is the balance it holds between understanding and working with the internal and external realities of service users (Bower, 2005).

In 1935, Charlotte Towle, a pioneering social worker, deeply influenced the profession recognising that social workers needed to secure knowledge of human behaviour to understand service users. She distinguished between knowing people and knowing about people, suggesting the core of social work to be the interaction between the service user and the social worker (Towle, 1969). More recently, literature has expressed a continued relationship based approach to social work, which emphasises the importance of the social work relationship and the quality of the social work experience provided (Trevethick, 2003, Howe, 1998). Understanding how to best facilitate relationships and work with service users requires acquisition of knowledge from a range of disciplines, theories and skills (Strean, 1978, Hollis, 1964).

Trevithick (2000) discusses that the insight derived from psychoanalysis, the psychodynamic approach and its theories on the unconscious can assist the social worker in offering a framework for understanding complex human relationships. The approach has had a major impact on social work’s development as theories on the unconscious have impacted on ways of working with service users (Pinkus et al, 1977)

The psychodynamic approach derives from Sigmund Freud’s psychoanalysis, a method of inquiry, theory of mind and body of research. Contrary to the prevailing thought at the time, where the assumption of psychology was that human behaviour was rational and the key to understanding human behaviour was to focus upon human consciousness, Freud (1936) believed that human behaviour was irrational and much of our personality, motives and behaviour were unconscious. Central to Freud’s theories was the idea that certain experiences during childhood that are too painful to remember and are unconsciously repressed. According to Freud, these repressed thoughts give rise to states of anxiety or depressions which can be expressed in physical symptoms (Freud, 1986).

In the 1920’s social work practice shifted dramatically as they began working in hospitals and clinics, extending their exposure to psychiatric thinking (Goldstein, 1995). In a publication in 1940, Annette Garret became one of the first social work authors to comment on the impact of Freud’s work on social work theory and practice, advocating for psychoanalytical ideas to be used by social workers (Brandell, 2004).

Freud and his colleagues came to realise that symptoms, such as depression, anxiety and other psychological disorders could be expressions of unconscious conflicting impulses and unresolved issues (BPS, 2007). They explored the idea of transference, the projection of unconscious feelings of unresolved issues from the service user onto the worker. The issues were connected to significant others in their past. The service user experiences the worker through this lens and sees the worker as if he or she is the person from their past. The unconscious remembers feelings from the past and projects them into the present. The feelings from service user to the worker are the transference and the workers feelings towards the service user are the counter transference. Freud noted that transference and counter-transference were experienced in the therapeutic relationship (Freud, 1986). This notion has implications for social work in that it allows the social worker to be aware of his/her unresolved issues that may impact on the working relationship with a service user and also allows the social worker to be mindful of hoe the service user is viewing the working relationship. Payne (1991) discusses how a social worker’s unconscious feelings can be awakened while working with a service user who perhaps reminds him/her of an experience or time in his/her own life.

Freud’s theories relating to the unconscious show that rational human choice may be overridden by our unconscious inner conflicts (Brandell, 2004) and can aid us in understanding human behaviour. The theories encourage social workers to have an open mind when working with distressed service users, enabling them to individualise the person in their environment, suggesting that each service user is unique in personal experience, strength and weakness (Strean, 1993). Transference and counter transference recognise that both service users and social workers are human beings and that to work effectively together involves acknowledging the emotions associated with all relationships (Trevithick, 2000).

Schon (1983), Fook and Gardner (2007), Thompson and Thompson, (2008) advocate the importance of being a reflective practitioner. I feel that the psychodynamic perspective can assist social workers in acquiring the self knowledge it takes to become reflective. Trevithick (2003) describes this self knowledge as being what we learn about ourselves over time, including practice wisdom, our ability to be honest with ourselves about strengths and qualities while at the same time accepting our limitations.

However, Freud’s theories have their limitations in respect of social work practice. As Freud used non scientific methods in his research, it is difficult to prove or disprove his ideas. Freud did not have any concrete data, but undertook many individual assessments, mainly with older upper class women and for this reason, his work is considered sexist (Mitchel, 1974) and also euro and ethnocentric (Robinson 1995, Trevithick, 2000) as the studies on white populations. Fernando (1991) suggest that Freud saw other cultures as primitive in comparison to western white society implying a racist slant and Strean (1979) goes further to state that Freud had limited cultural assumptions and deviations from this cultural norm were considered abnormal and worthy of his treatment. However, in spite of this, Cameron (2006) points out that the psychodynamic approach has been taken up in many cultural contexts, most notably in Latin America, India and Japan.

In light of criticism, however, the psychoanalytical concepts put forward by Freud and developed by later analysts have enriched our knowledge of mental functioning and human relationships and informs the relationship aspect of social work. It not only assists in informing the social work/service user relationship but also the relationships that service users have had in the past, experience in the present and will have in the future. Social work is about working with people and the psychodynamic perspective brings an extra skill of awareness into the mix.

Freud began to understand, through this stage development theory for children, that the child’s relationship to parental figures is the prototype for all subsequent relationships in the child’s life (Freud, 1986). These can involve emotions such as rivalry, jealousy, guilt, love and hate. Freud felt that our sexuality began at a very young age and developed through various fixations. If each stage was not completed, we would develop an anxiety and late in life a defence mechanism to avoid that anxiety (Freud 1986). Freud developed the first stage development theory which acknowledges the issue of attachment between mother and child, a theory which later would be developed by other psychoanalysts and disciplines. The traumatic effects of prolonged separation between mother and infant are widely recognised today and this has led to radical changes in the management of children in hospital (BPS, 2007). Later followers of Freud, such as, Erik Eriksen and John Bowlby, came to realise, particularly through their work with children, that experiences of early infancy, though lost to the conscious mind in adulthood, nevertheless live on in the unconscious and continually affect and shape relationships and behaviour in everyday life (BPS, 2007).

Bowlby (1951) developed Freud’s theory, agreeing with Freud’s emphasis on the importance of the child’s attachment to the mother as a basis for later emotional relationships. His attachment theory describes how our closest relationships begin in infancy and set the stage for subsequent development. When the relationships are secure, they promote self reliance, confident exploration of the environment and resiliency in dealing with life’s stresses and crises. Lack of secure attachment can lead to emotional problems, difficulty relating to others and a vulnerability to psychological distress (Sable, 2004, Bowlby 1951).

Bowlby believed that a mother inherits a genetic urge to respond to her baby and there is a critical period after the baby is born during which the mother and baby form an attachment. One of the most controversial aspects of Bowlby’s theory was the claim that babies have an innate tendency to become attached to their primary caregiver, usually the mother, and that this attachment is different from other attachments. Any disruption of this bond in this period can have serious long term consequences. This has been criticised by other theorists who state that the attachment does not have to lie with the mother, it can be with any care giver (Schaffer & Emerson, 1964).

Mary Ainsworth, a psychologist devised a laboratory experiment called the “Strange Situation” (Ainsworth, 1978) which showed that Bowlby’s evolving ideas could be tested and given a research base. A baby was observed in a set of seven situations, with the mother, with the mother and a stranger, with just a stranger and on its own. The baby’s reactions were observed (Ainsworth and Bell, 1970). Ainsworth found that psychological health is related to the positive quality of these attachment experienced, both present and past and the personal meaning attributed to them. Psychological distress is perceived as a distortion of the attachment systems and symptoms of anxiety, depression or anger reflect the internalisation of adverse affection experienced resulting in dysfunction (Sable, 2004). The behaviour of the parents towards the child, whether they are sympathetic and respond to the child’s needs is important and according to Ainsworth, the more parents accept the child on the child’s terms, the more securely attached the child is (Ainsworth and Bowlby, 1965).

In applying Bowlby’s theory to social work, we can see how social workers can construct an understanding of service users’ early lives and guide managing the relationship in the future (Sable, 2000). Bowlby (1982) proposed that children internalise the relational experiences with their primary care givers during their first year and develop internal working models, which help to predict and understand our environment. The bond that we create with our primary care giver shapes how we respond to others in later life (Bowlby, 1982). Studies from Ainsworth (1967) and Ainsworth et al (1978) support this theory. In social work with children, it is common to see a child’s challenging and disruptive behaviour being understood as an attempt to test whether adults are reliable or consistent than previous ones (Payne, 2005). The psychodynamic approach offers an explanation for relationship behaviour in the service users we work with.

Bowlby’s attachment theory and the concept of resilience has also been used in social work with children to achieve positive outcomes for looked after children where care provided to looked after children aims to provide a secure base, self esteem and self efficacy (Gilligan, 1998). The policy document, Caring for children away from home (DoH, 1998) explains that children in the care system will often have had a long history of family problems and an emotionally turbulent life, leaving their personal development damaged and their capacity for basic trust in people severely compromised. This document highlights that social workers will have to work with service users who display patterns of insecure attachments. The ability for carers to provide secure attachment and emotional warmth is part of policy guidance in the Framework for the Assessment of Children in Need and their families (DoH, 2000). Bowlby’s attachment theory allows social workers to make the link between emotional development, behaviour and the quality of relationships with their carers (Trevithick, 2000). Howe (2000) states that attachment theory can guide and inform social work interventions with children. It can act as a framework of theory and patterns of thinking.

Bowlby’s attachment theory can also help social worker’s make sense of the way in which service users engage with services. Most social workers have worked with service users who say that they would like support but cannot make use of the services on offer. This difficulty can indicate experience of distress in early childhood and can be understood in terms of their history of attachment bonds (Howe, 1999). Some service users seek to exert control in the relationship with a social worker, perhaps refusing support or making unrealistic demands. Social workers could view this as the service user being difficult or alternatively with consideration to attachment theory this could be understood in terms of the service users previous experience of rejection from their carers which has left them cautious of accepting help (Trevithick, 2000).

In critical analysis of attachment theory, Schofield and Beek (2006) explain that although attachment theory can offer assistance, service users lives need to be considered uniquely, drawing on their wider environment, education, experiences of racism and economic background. For example, attachment to carers is central to working with looked after children but must be understood within a range of other factors (Schofield and Beek, 2006).

It can also be argued that attachment theory does not incorporate enough consideration of issues of oppression that result from differences of race, gender, culture, sexuality and social-economic factors (Milner and O’Byrne, 2002). In a society where due to globalisation, colonisation, immigration and asylum seekers, families are having to travel great distances to secure attachments, Bowlby’s eurocentric theories do not go far in explaining cultures or social work from a black perspective (Robinson, 1995).

This highlights again that psychodynamic thought should not be used in isolation. Human nature is such that no one theory can account for the infinite range of difference amongst individuals. For example, difference in learning abilities and other problems in development such as autism can be mistaken for attachment disorders if examined in isolation (Rugters et al, 2004)

The central ideas of the theory used today are that the quality of close relationships (or attachments) has a bearing on personality, emotional and social development not only in childhood but across the lifespan (Howe, 2001).

In conclusion, it is evident that there are weaknesses to a psychodynamic approach in social work. Theories of the unconscious can partly explain human behaviour but it fails to take into account environmental, social, economic factors and issues of culture and race. It is also deterministic in its approach and does not leave much room for agency and change. However, there is not just one body of knowledge used in social work practice. Social work knowledge is derived from different approaches but what they all have in common is that they do not originate from or are specific to social work itself, recognising that social work theory is a political and social process (Payne, 1997). Briggs (2005) states that the overall the contribution of psychodynamic research is to bring in another point of view which enhances the reflective psychosocial space in which social work takes places. Psychodynamic insights can in part assist the social worker in the difficult and complex human situations in which they are involved.

As a core component of social work, the ability to respond to people’s emotional needs, to their impulse for emotional development and to the difficulties they experience in forming or maintaining relationships, the psychodynamic perspective can assist in giving us another point of view.

In terms of recent policy, high profile investigations since 2000 have highlighted the importance of effective relationship building in social work ( Laming, 2003 and Laming, 2009) These cases have caused nationwide concern beyond the professions and services involved, causing a frenzy of media comment and public debate, putting the social work profession under the microscope. Social workers need good observation and analytical skills in order to be able to understand the nature of the relationship between a parent and child, to understand signs of noncompliance, to work alongside a family, and to come to safe and evidence-based judgements about the best course of action (Laming, 2009).

As social work continues to be very much under society’s microscope, it is essential that it encompasses a body of knowledge from a wide variety of disciplines, always remaining open to new theory and knowledge while considering perspectives from other professions.

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The field of psychology has vast areas of interest, and Human growth and development is one of the most popular topics being studied by social workers today. The purpose of this report is to show how essential it is for a trainee social worker to attain a firm understanding of human growth and development, and to ultimately achieve a foundation of knowledge in this area. This report will show that, with practice, preparation, assessment, reflection and finally application, this foundation of knowledge can be effectively used in positive intervention methods. (Crawford 2006)

There have been many great theorists over the years, all of who had different ideas on human growth and development. This report will highlight and discuss 3 theories based on the work of Erikson, Bowlby and Bronfenbrenner. Furthermore, the report will also throw light on the pros and cons of these theories, identifying and discussing potential issues that may arise from failure to mature, as described in each theory.

Finally, the report will identify the role of social workers in relation to their intervention with a client or family.

The outcome of this report will be a sum-up of the key identifying points of each of the 3 theories. Using practical examples, the report will explore the effects of the theories and outcomes that may arise from failure to mature.

The practical examples used will aid, guide and shape the discussion by highlighting the life span of the individual problems or issues, and will provide an underpinning reason for using each of the theories. Each theory chosen in this report is taken from a different discipline of social science; psychodynamic, sociological and psychosocial. These three disciplines all have a different emphasis, but structured in all of them is the core principle of determining what can potentially influence life course development.

The first theory outlined in this report is Bowlby’s ‘attachment theory’. This theory fundamentally sees the earliest bonds formed between children and their caregivers as a key factor in human growth and development, having an immense impact on progression and continuing throughout life.

This theory will be examined, using social work examples with infants. There will be an explanation of how the theory is vastly important for attaining a firm understanding of the foundational relationships infants build for a healthy development.

The second theory discussed in this report is Bronfenbrenner’s ‘theory of ecological development’. Bronfenbrenner’s theory describes the influences of further environmental factors on children, and their positive or negative development.

For this theory, social work examples will be chosen from older adults in order to help attain an understanding of how environmental factors, at micro and macro levels, can influence social workers in relation to the stages of development.

The final theory discussed in this report is Erik Erikson’s ‘model of life stage development’. This theory addresses identity as an individual moves through the stages of life, and how they negotiate crisis points in a successful or unsuccessful progression, this effecting healthy development.

For this theory, examples of middle-later stages of life will be discussed, and how progression through the life stages can successfully or unsuccessfully result in a healthy or unhealthy development of the individual.

So, what can human growth and development be determined as? Before we discuss in depth the main theories, it would be appropriate to give a definition of human growth and development, and highlight why it is so fundamentally important for social workers to have a firm understanding of the various theories.

According to Baltes cited in Crawford (date), human development is multi-dimensional; it is made up of biological, cognitive and social dimensions. Physically, from the moment we are conceived till the moment we die, we are developing biologically. Our bodies are consistently moving from one biological change to another. Subsequently, the growth of our intellectual and social development comes. This begins from very early stages in the course of life and continues across the span of each life. (Thompson)

Both Freud and Erikson agree that every individual is born with a number of basic instincts, that development occurs through stages, and that the order of these stages is influenced by biological and sociological maturation (Sigelman, and Shaffer 1992).

The Requirements for Social Work Training state that all social work programmes must: “Ensure that the teaching of theoretical knowledge, skills and values is based on their application to practice.” (Department of Health 2002)

Theorists, such as Bowlby, Bronbenfrener and Erikson, have different perspectives on life span development stages and the individual’s evolved behaviour as a consequence or a response to developmental milestones crises. These theories are rooted in the disciplines of sociology, biology and psychology. Each theory provides an explanation, in line with development, for arising issues and problems that individuals face and are all relevant to an understanding of the life course development. (Thompson)

Social work practitioners need to have a wide range of knowledge from a span of theoretical disciplines to ensure that all aspects of an individual’s make-up are considered and appreciated when working with them. (Crawford and walker) Using theory can give an explanation as to why an action resulted in a particular consequence. This can help us review and possibly change our practice in an attempt to make the consequences more effective. (Beckett)

Developmental theory provides a framework for ordering the lifecycle and accounts. For factors that may shape development at specific stages. It discusses the multiple. Bio-psycho-social factors impacting development, explores the tasks to be accomplished. At each stage and considers successes and failures in light of other stages. Developmental theories also aim to recognise individual differences in development. Journal

The course of life is different for each individual, and is influenced by the events and experiences that people go through throughout their lives. (Crawford and Walker, 2003) Understanding the impact of transitions within a person’s course of life is important for social work practice, as it aids the social worker in attaining a firm understanding of other people’s lives, so they can effectively intervene with appropriate measures. Using theory can help justify actions and explain practice to service users, carers and society in general. The aim is for this to lead to social work becoming more widely accountable and ultimately more respected. (Beckett )

The use of theories in social work practice underpins how social workers approach their tasks. As social workers, we need to recognise the opportunities to work with people through transitions as an opportunity to grow. We need to try to enable people to use these events to trigger change, move on and develop. (Crawford) When a social worker works with an individual, utilising theories which may relate to a specific situation, will give us more direction in our work. It is clear then that theory is important in practice – both for work with service users and for social work to be more valued in society. (Beckett)

After the definition of human growth and development and the brief discussion of why a theory is important in social work practice, this report will now discuss the attachment theory and will explain why it can be positively used in approach and effectively in practice.4

So, what is the ‘attachment theory’? To start with, let’s define the word attachment; it means a strong emotional bond between two people.

Forming an attachment is based on a two-way interaction. The behaviours from an infant, such as crying, reaching, grasping and making eye contact, and the response of the caregiver both work as a reciprocal process to develop and strengthen attachment. (Woods) According to (Crawford), children use the people they are attached to as a safe base to explore, a source of comfort and a source of encouragement and guidance.

According to (Fahlberg, 1991, cited in Howe), attachment aids children in attaining their full intellectual potential, sorts out what children perceives, assists them in logical thinking, helps them develop a conscience, teaches them to become more self-reliant, aids them in coping with stress and frustration, helps them handle fear and worry, assists them in developing future relationships and helps reduce jealousy.

In 1953, a psychoanalyst named John Bowlby wrote the book Child Care and the Growth of Love. In this book, Bowlby put forward his theory that the relationship between a mother and her child, during the child’s first year, is of vital importance and can greatly affect the development of the child in later life.

This theory is known as the attachment theory, and it is still being used and discussed today, although it has been altered and adapted to suit the modern day economic environment and the change in the family unit over the past 50+ years. (Jeremy Holmes, 1993)

Bowlby believes that attachment begins at infancy and develops throughout an individual’s life, and that there are many distinctive behavioural control systems needed for continued existence and proliferation. The attachment and exploration systems are the main central points in Bowlby’s attachment theory. (Elliot & Reis, 2003)

(Crawford) Bowlby’s “Maternal deprivation Hypostasis”, the forerunner of the attachment theory, believes that if an infant was unable to develop a warm, intimate and continuous relationship with his or her mother or permanent mother substitute, then the child would have difficulty forming relationships with other people, and would be at the risk of behavioural disorders. Bowlby says: “Mother’s love in infancy and childhood is as important for mental health as vitamins and proteins are for physical health.” (Cardwell)

(Bowlby 1988) goes on to say that without a secure base of first attachment relationships, children will not be able to cope with separations of normal life. For Bowlby, the impact of prolonged separation on children is viewed as maternal deprivation. Bowlby describes this as being the temporary or permanent loss to children of their mothers’ care and attention. Bowlby believes that prolonged separation of children from their mothers, especially during the first five years of their lives, is a major cause of delinquent behaviours and mental health issues. (Crawford)

Mary Ainsworth developed a method, whereby a child’s behaviour is observed when reunited with his or her mother after a short separation. This is known as the ‘strange situation’, and it has become widely used to determine whether the attachment was secure or insecure. Ainsworth’s strange situation is used to measure Bowlby’s hypotheses that early relationship experiences affect later adult functioning. The strange situation procedure consists of eight three-minute episodes that have been arranged so as to create increasing levels of stress for a child that will activate attachment behaviours that researchers can then observe.

The resulting behaviour was used to classify the child into one of three categories. These categories are insecure avoidant attachment, secure attachment and insecure resistant attachment. Securely attached children were able to balance their need to explore the environment with their need for comfort and support from their caregiver in relation to their feelings of stress. Insecure avoidant attached children, when stressed, continued to explore the environment, showing minimal need for comfort and support. The children who were classified as having insecure resistant attachments stop their exploration and return to their care giver show the maximum amount of attachment behaviours. Main (1991) has since identified a fourth category that of the disorganised/ disorientated child. (Cardwell)

According to Bowlby a central tenet of attachment is that:

People developmental representations,

Or internal working models, that

Consist of expectations about the self, significant

Others and the relationship between the two. (Bowlby, 1969, 1973)

The main criticism of Bowlby’s attachment theory came from J.R. Harris. It is often assumed that hard working, kind, honest and well-respected parents will have children who will turn out to be like them. On the other hand, in the case of parents who are bad role models, rude, and disrespectful, the children will end up the same when they become adults. According to Harris, this may be far from the truth.

Harris (2008), believes that a parent does not determine a child’s personality or character, and that a child’s external social factors have more influence than anything else. A good example of this taken from Harris is a child from an immigrant family. Although the parents may well pick up a new language, they will still have an accent from their native language. The child, on the other hand, will learn the new language, and will speak it without an accent. Children are more influenced by their peers than their parents. (Harris, 1998).

Criticisms were also levelled at Bowlby’s theories because of his ideas that he concluded from work he had undertaken with juvenile delinquents who had been separated early in their lives from their mothers. The criticism is that the theories are unrepresentative of the general population, and involved too small a sample.

It was also argued that not all maternally deprived children became juvenile delinquents. But in agreement with Bowlby, Stroufe (1979) stated: “We cannot assume that early experiences will somehow be cancelled out by later experiences. Lasting consequences of early inadequate experiences may be subtle and complex.” (Cardwell)

Research has shown that, contrary to Bowlby’s idea of monotropy (one primary caregiver), children can form more than one significant attachment, and these need not be towards the biological parents, and can be of either sex, although there is often a definite hierarchy. An infant’s attachment to his or her father is as strong as the mother’s in the first few days of life. Then the attachment changes because of the different amount of time available for the parents to interact with the infant, given the work commitments. Both the mother and the father are important attachment figures for their infants, but the circumstances that lead to selecting the mother or the father may differ. For example, the father is usually selected for playing. (Schaffer & Emerson 1964)

According to Parke (1981), “Both the mother and the father are important attachment figures, the father is not just a poor substitute for the mother.” (Cardwell)

When looking at how attachment theory is applied to social work practice, Coulshed (1988) proposed that “psychology has been useful in the degree to which you can apply some of the theories, if you are prepared to see theoretical contributions as ways of enriching your thinking and understanding. You will gain a broad framework of information through which you will recognise the complexities and possible causes of human suffering.”

The attachment theory provides a valuable model in understanding relationships of families in need and promoting new and healthy attachments (Daniel et al 1999). The attachment theory has had an impact on many areas relating to how children are cared for, including the legal framework it operates under and how services for children have developed. Some of the areas, where clear links can be made to practice being underpinned by the attachment theory has effected changes, are;

When negotiating contact between children and their families it is undertaken from a child centre perspective rather from the adults involved. This may include having closer links with grandparents, relatives and any other persons who the child considers significantly important to them. (Howe)

Attachment theories underpin the policies that are relevant to the development of children in public care, and form the basis for assessing their needs, such as pre-placement and post-placement support systems. The effects of separation and loss that children have experienced can be taken into account when assessing their needs. (O’loughlin)

Social Work as a profession can promote the needs of children through influencing policy and practice e.g. acknowledgement that delays in placing children may be detrimental to their wellbeing should ensure that the adoption and fostering processes can be as speedy and efficient as possible. Likewise, it is clear from research that children are adversely affected by the loss of familiar peers. Children who maintain friendships over time are seen to have greater social skills and better social adjustment. This should also be promoted. (Aldegate et al)

The attachment theory has allowed optimism to develop towards caring for children, as a less distorted and confused picture of child development has emerged. It is now apparent that a healthy development can occur in many different family environments. There are many ‘right’ ways of meeting children’s needs. (O’Loughlin)

The second theory discussed in this report is derived from the discipline of sociology. Sociological theoretical perspectives explain human development by examining the interactions between people and the society in which they live. Sociologist theorists research this by looking at influencing factors at different levels of society. (Crawford)

Unlike other disciplines of human development theories in which service user’s problems are conceptualized on individual terms, sociological perspectives on human development seek to gain a full understanding by locating the person’s problems within his or her experiences in a broader picture of social and historical circumstances. In other words, rather than directly focusing on the problem and the person’s inability to cope, the problem would be assessed in terms of the impact of the economic and political conditions of the day. (Cunningham and Cunningham).

One theorist whose theory has being particularly influential in the study of human development is Uri Bronfenbrenner 1917 – 2005.

Bronfenbrenner developed a theory to explain how everything in a child and the child’s environment affects how a child grows and develops. His theory is known as the ecological systems theory, and it approaches a child’s development by looking at different levels of interaction, from family, local communities and schools to economic and political conditions that are all influential to the development of the individual in his or her course of life. He uses the terms Microsystems, exosystem and macrosystem. He suggests that there is a reciprocal process of interaction, in that the child is both influenced by and influences his or her environment at each of the levels. (Crawford)

The ecological environment is thought of as:

“Nested structures encircled within and inside the other like a set of Russian dolls. Starting with the most inside to the outside, these networks are described as micro systems, meso systems and macro systems” (Brunfenbrenner, 1994).

The work of Bronfenbrenner has been particularly influential in social work practice and is the model that underpins the framework for the assessment of children in need and their families (department of health, 2000 cited in Crawford). The theory also encourages social workers to grasp the concept and understanding of the sociological imagination, and develop this in relation to service users’ own lives and practice. As social work intervenes at the points where people interact with their environments (NOSS), this approach, therefore, helps social workers to locate service users within an understanding of the bigger picture that underlies their lives. (NOSS)

Applying an ecological approach can be best understood as looking at persons, families, cultures, communities and policies, and identifying and intervening upon strengths and weaknesses in the transactional processes between these systems. A practical example of this in practice would be the use of the ecological perspective when carrying out assessment and for planning intervention for older adults in the community. Although it is theoretical, it is very practical, as it provides a kind of a map to guide us through very confusing terrain Stevenson 1998 cited in aldegate)

The population of the UK is ageing. Over the last 25 years, the percentage of the population aged 65 and over increased from 15 per cent in 1984 to 16 per cent in 2009, an increase of 1.7 million people. (Gov statistics)

Elderly individuals are vulnerable and in need of social services because they often live alone, and can be subject to numerous health difficulties, such as difficulties in functional ability.

As senior adults experience an increased need for care, it is predicted that, in many cases, family caregivers will begin to have a higher level of physical, emotional and financial burden. All of these issues combined warrant an increase in research related to meeting the needs of the elderly and their families living in our communities (Crawford).

EST is an ideal approach for assessing the needs of elderly adults living in communities. Given the rapidly increasing numbers of baby boomers reaching retirement age and beginning to require extended support, it is important for communities and families to address the best fit for the senior adult later in life. EST addresses the micro, meso and macro systems that are an extension of the individual, and works to obtain resources in order to improve support and expand networks necessary to maintain good quality of life for senior adults. (Journal)

The ecological perspective analyzes how well the individual or family fits with their environment, and is based on the assumption that when a person or group is connected and engaged within a supportive environment, functioning improves. In order to determine the best fit, usually for an individual, there is an examination of the difference between the amount of social support needed by the person and the amount of social support available in the existing environment. Once this assessment has taken place, the social worker engages with the individual and works together with him or her to offer the support needed. One unique feature of the ecological model is its distinguished concept of human development within an environmental perspective. (Bekett)

Social work practice has an overarching meta-paradigm that emphasizes the person in the environment. This meta-paradigm is linked with an ecological systems perspective as a focus of attention. EST is compatible with this belief system and helps support a theoretical approach for practice at the micro, meso and macro levels with individuals, families and communities.

Social workers need to be aware of how the changing needs of families will affect psychosocial and emotional factors for the elderly individuals and their family caregivers. Examples of such issues include geographical location of family members when the senior adult is in need of care, role reversal when there is a shift in the family system and a parent becomes more dependent upon an adult child, and the anticipated grief and bereavement as spouses and adult children care for elderly family members over an extended period of time.

The final theory of discussion is Erick Erikson’s eight stages of man. Erikson’s theory is an extension and modification to Freud’s psychoanalytical theory on explaining the development of the personality through childhood stages of psychosexual development. Erikson, however, provides a more comprehensive framework for human lifespan through a series of genetically influenced sequence of psychosocial stages. “The term psychosocial describes an approach that considers the impact of both the individual psychology and the social context of people’s lives on their individual development.”(Crawford) Each stage involves a battle between contradictory resultant personalities, and each stage has either adaptive or maladaptive qualities. To develop into a healthy, mature adult, the adaptive must outweigh the maladaptive. (Richard Gross, 2005). In other words, he suggests that people confront a series of developmental challenges or conflicts, each occurring at particular and predictable times or stages in their lives.

One of the main elements of Erikson’s psychosocial stage theory is the development of ego identity. Ego identity is the conscious sense of self that we develop through social interaction. According to Erikson, our ego identity is constantly changing owing to new experience and information we acquire in our daily interactions with others. In addition to ego identity (Quote), Erikson believes that a sense of competence also motivates behaviours and actions. Each stage in Erikson’s theory is concerned with becoming competent in an area of life. If the stage is handled well, the person will feel a sense of mastery, which he sometimes refers to as ego strength or ego quality. If the stage is managed poorly, the person will emerge with a sense of inadequacy. (Quote)

In each stage, Erikson believes people experience a conflict that serves as a turning point in development. In Erikson’s view, these conflicts are centred on either developing a psychological quality or failing to develop that quality. During these times, the potential for personal growth is high, but so is the potential for failure.

Erikson’s eight life stages:

1. Basic trust versus mistrust

2. Self-control versus shame and doubt

3. Initiative versus guilt

4. Competence versus inferiority

5. Identity versus role confusion

6. Intimacy versus isolation

7. Generativity versus stagnation

8. Ego-integrity versus despair

Erikson suggests that whereas the outcome of moving through a life stage is unfavourable, the individual will find it more challenging to meet the trials of the next stage. Erikson further suggests that if individuals fail to develop through a stage, they may return to unsettled earlier points in their lives. (Crawford)

Stage five is commonly associated with adolescence Erickson 1995 recognised this as the critical crisis of adolescence in the eight stages of development – identity versus role confusion. He believes that a successful transition through childhood would lead to a progressive success to resolve this stage (Crawford). Erikson considers the fifth stage, that of adolescence, in the developmental process to be of particular importance. He considers that by the end of this period of psychosocial moratorium, adolescents should have achieved ego identity, that is the integration of their own ‘self’ perceptions into their core identity which is both psychological and social. But he notes that some young people experience difficulty or find it impossible to commit themselves to adult roles, thus characterizing this as a period of identity crisis. When adolescents fail to achieve ego identity, it is considered to be identity role diffusion.

Applying Erikson’s model to social work can help identify with individuals whether or not they have progressed successfully at previous life stages. It can also help individuals clarify and address their strengths, expectations and limitations, a duty expected of the social worker according to NOSS Key role 1(Crawford).

The psychosocial perspective enables social workers to consider the influences of the relationship between the internal world of the service users and the social environment in which they live. (Howe 1987 cited in Crawford)

However, Erikson’s stages are criticised alongside other psychosocial stage approaches to human development because they do not incorporate difference and diversity. They are culturally specific and differences between sexuality and gender are not easily explained, because the theory was developed from a male perspective. Crawford

Being too fixed and deterministic in real life, it is not possible to divide one’s life into neat stages. The theory also does not consider the significance of social change in different societies and across different cultures. The model suggests there are universal experiences that all people encounter. Anthony Giddens 1991 cited in Crawford argues that modern society is continually changing, and that people pursue many different paths through their lives.

Erikson describes the concept of a life cycle as implying some kind of self completion (Erikson, 1982 p. 9 cited in Crawford). This use of the word cycle can be criticised for implying a circular process whereby, in the later years of life, there is a return to the dependency of childhood. (Crawford)

In conclusion this assignment has looked at

Social workers need to develop an understanding of theories from a range of disciplines in order to take a holistic approach to their practice. (Crawford)

Whilst it is important for social workers to have knowledge of these theories, none of the theories can be easily applied to explain a person’s course of life. One theory may be relevant to a particular person at a particular moment in time. For example, one theory may be useful for child development, but not so useful in explaining the challenges of life events that influence growth and development in later life. (Crawford and Walker, 2003) All people are individuals and deserve the right to be treated as such. To do anything less would be seen as an act of oppressive practice. Social workers need to draw on many different resources and theories available to them in order to truly meet service user’s needs. (Beckett 2007)

The understanding of disability is still unknown to many people. The way people see disability have different meaning to the way society see disability. Different cultures have different meaning to the term disability. There are some people, who consider people with disability are paying for their sins. It is believed that they must have done something bad in their pervious life and are paying for it in this life. Because of some cultural differences, they mostly are labelled to be look through negative perspectives.

Swain (2003) says that what term societies are meant to use? ‘Disable People’ or ‘People With Disability.’ Using the term ‘People with Disability’ is considered more human and more positive compared to ‘Disabled People’ it makes people feel part of the society instead of being left out.

To make people with disability feel more part of the society the government bought laws so that everyone was equally, the DDA Act 1995. However it got change in 2005.

The (Disability Discrimination Act) DDA Act 2005 states that ‘as having a disability for the purposes of the DDA where they have a physical or mental impairment which has a substantial and long-term adverse effect on their ability to carry out normal day-to-day activities.’ (Department of work pension 2005)

Yet what can be considered ‘day to day activities?’ It is not clearly defined correctly as some people with disability could use some part of their body where there are some who can not. Because of this people with disability are often labelled and left out.

Calling someone handicap or dump or deaf and dump is being labelled. Being labelled is quite negative towards people with disability. It makes them feel that the society does not consider them equal. This discourages some people to make friends or go out into the society.

Shakespeare (2006) explains that labelling is viewed negatively in the disability communities. It is because, people with disability do not want to be labelled and ask other people for help. Some people do not want to ask for charity.

If people do need help, how do they come across it? Do they have to provide evidence that they are disabled?

Which moves to the medical and the social model of disability?

The medical model of disability is sees the disabled person as the problem. They are meant to adapt and fit in to the world and if it’s not possible then they are shut away. (Rieser 2002)

The social model of disability the social model is a concept which recognises that some individuals have physical or psychological differences which can affect their ability to function in societies. (Brain.HE 2006)

The medical model is used for those that need help. It is with the medical model that people can get support. If individual needs help from the government and need money or any other support they need to go through a series of process where they would have to under assessment to see if they can qualify for help.

The medical model is used through examination or testing or by professional expert which will then give evidence if you have a disability or not.

The advantage of the medical model is that it can provide support to those that need help. It can provide finical support and can also provide information to those individual that need operation and can also provide guidance to a cure.

The medical model can also share understanding towards others as it can make other people understand the similar dilemmas that they may be facing as well. However, a cure was something that could help in understanding that the medical model and gave people the belief that their disability would go away.

Yet like any other model that have been discovered the medical model has its fault. For example in the medical model the individual is the one that has an abnormality. That the disability is in the person and the only way is to cure it.

Another problem with the medical model was that the environment was ignored. If someone had an accident, it was considered a tragedy yet if someone had been born with impairment, it was considered a disability.

The medical model also considered that they are independent on themselves and will always need help from others or charities. It made them look pitiful and helpless.

However, the problem was that the medical model is still dominated because, to know what is happening to an individual, they need to be asses.

It was also used more as a critique than by the medical professional themselves. It is the job of the professional to find a cure and to help those that need help.

Because of the medical model, people began to think differently and the social model comes into process.

The social model of disability was the ‘big idea’, in the British disability movement. (Shakespeare and Watson 2003 p3

It was a starting point to those who felt that the medical model did not help. It gave those individual the point where they did not need to depend on others.

The social model of disability was there to help people with disability feel part of the community. With the model, it can overcome barriers such as labelling and any other barriers that society can come up with. (Crow 1996) pp66) states that the social model was a means to escape.

It was meant for those individuals who wanted to overcome any issues regarding disability. The people see that being disabled is not a bad thing. That you can do many day to day activity like any other person. It makes a better social relationship with the society.

However, like the medical model, the social model had its fault. Where an individual needs help, now believes that the social model is making them feel that they are too being ‘pitied’ that they can not do anything by themselves.

The model is important because it enables the identification of a political strategy and its main focus was to try and remove barriers, which helped, because the medical model did not try to remove barriers such as external ones.

The social model also focuses on the influence of the family, the income, the education and any other factors as well.

However, there is now a shift. Once where the medical model was dominated and was the answer to most questions has transfer to the social model. But, here lies the problem as well. The social model is now considered outdate as well.

Union of the Physical Impairment Against Segregation (UPIAS) called for an alternative model of disability.

Mark, 1999 said that the social model argues that the key issues are that the individual must have a ‘positive identity’ as disabled. With this it showed that unless you have a label, you can not be given help. This shows that, even though the social model is there to help, the medical model still dominates and now the social model is outdated because people with disability do not want to be looked at as needy.

Tom Shakespeare is one of those who believe that the social model is an outdated and that need much more updating. In the journal ‘research in social science and disability’ he wrote an article dedicating that the social model of disability is now outdated. He explains that the model needs to be improved from new direction. It needs to be improving as social cultures are need and different views are need as its more focus on the British people and needs to be view from different culture as well.

The social model of disability is also being criticised by Grabe and Peters (2004) who explain that the social model needs to recognise the significance of bodily experience. That it is not easy to distinguish between people with disability and people without disability. They also explain that the model does not cover everything. The model is there to make a person feel important about them and that they would feel that the model is helping them.

Oliver 2009 (p49) criticise that, there are five important things have come from the social model of disability. The first one is that the model does not consider the realities of impairment, as the model is based on misunderstanding because the model is not based on personal experience.

The second is that the pain of impairment and disability is ignored by the society. The third is that it is unable to incorporate social sates and social division. The fourth is issues of otherness. This is where it is viewed from other person’s perspective, and the final is that the social model is inadequate.

This shows that the social model of disability now is outdated as there are many problems that model is facing.

In conclusion, it is shown that the social model is outdated and the society needs a new view. But there lies that problem. Because where the social model was a new thing now has become outdated, what will happen when there might be a third model. Will they consider the new model outdates when its time will come. It seems to be going in a cycle.

The social model of disability has its fault like the medical model disability. However, unlike the social model the medical model of disability, it is still dominated despite the trend towards the social model, the medical model is needed for those individual who need support finically and support from the government. Yet at the same time they do not want to become dependent on the government as well. This also causes the issues, as the social model of disability is there to support those individual who need to feel that they want to do something for their lives and not just depend on others.

Author such as Liz Crow, Tom Shakespeare and Michael Oliver, all believe that the social model of disability is outdated. Their factors are that the social model of disability does not cover all factors that are necessary and needed. They believe that the model needs to be looked at a new angle or modify or even bring in a new model, as the current one is giving problems.

If the society does bring in a new model will it not criticize the model as well? As all it seems that people do is criticise that this model is not good or that model is not good.

True the social model of disability needs a new change, but despite the model being outdated, the model still helps those individual feel better about them. The model has given encouragement to those individual with disability, the ability to give something back to the society.

The medical model of disability is there for the medical professional as guidance in attempt to find a cure as the medical model of disability gives facts only and the social model is there for support and moral and encouragement and is effective to those people with disability.

There will be some individual that will complain about their situation compared to others, and will say that they need extra support, but what these people need to understand is that they need to stand up and become braver. True, there have been cases where individuals with disability have had hardships and have had no support, but what they need to understand is that the models do not run their lives; they merely are guidance on how they should live morally and finically.

The medical model of disability gives facts and the social model gives support. So despite the social model being outdated, the social model of disability makes it feel to those individual people that they have support that they need, thus the model is still affective.

Word Count: 2000

Professional social workers frequently encounter a thorny situation called client resistance. As resistance is inevitable in the intervention process and will very likely affect the intervention outcomes, study of client resistance is important to social workers and learning how to manage it will be pivotal to achieve expected goals and objectives. This paper will firstly narrate the writer????s personal experience so as to put the issue of client resistance on the agenda and give a brief description of involuntary clients or client resistance, then present the writer????s understanding of them in terms of their several distinctive features, and finally propose tentative strategies of coping with client resistance.

Keywords: resistance; involuntary clients; intervention skills

Introduction

As potential social workers, we probably will be brought into contact with more and more ????involuntary clients???? in the future, like mentally illness patients, deviant behavior adolescents, violent parents, battered children, etc.. Some of them are ????legally mandated to engage with service providers???? (Rooney,1992), while others are experiencing ????social or non-legal pressures, for example, being coerced by family members to seek assistance for a particular behavior???? (Rooney,1992).

These kinds of clients constitute a high proportion of whole clients and display more resistant behaviors than those voluntary ones. Often, they do not seek help willingly and may demonstrate resistant behaviors such as negative evasions, pretended obedience or undisguised hostilities, threats and attacks from the very beginning of the worker????s intervention.

Therefore, how to interact with and intervene in this type of clients has become a tremendous challenge in the field of social work practice and it is important for social workers to get a deeper understanding of involuntary clients.

Case Example

X once was a primary school teacher with a fine income, and her husband Y has been running a factory which creates a great deal of wealth to the whole family. Everything seemed perfect that the couple were devoted to each other and have a daughter C who was in her second year in a satisfactory university.

Unfortunately, X was extensively burnt in an explosion accident three years ago. Since then, she lost self-confidence because of her disfigured face and refused to go out for the fears of being laughed at. The daughter Z tried to took her out for an airing and ease her anxieties and inferiority about the disfigurement but failed. Since a lot of people pointed at her on the street, X felt painful and tended to isolate herself.

To make things worse, not too long after her accident, her husband Y began to make relationship with another woman and was spending a large sum of time and money on that woman. He went to his factory early and back home late every day and seldom had meals at home which was entirely different from what it was before. In addition to Y????s indifference, Z was studying at a university so far from home that she was unable to accompany her mother all the time. Consequently, X always staied alone at home with the feeling of helpless and hopeless. Although sometimes Y would come back home and cook meals for A, he had nothing to talk with X.

Actually, the daughter Z here is me. I was extremely anguished, seeing my originally harmonious family rapidly disappeared. I tried to cope with such a depressing family atmosphere, but found it difficult. However, when I look back and combine the past experiences with what I have learnt in MSW, I have been realized that there were such a lot of unwise actions had been taken to resolve my family problems. Examples are showed as follows:

In that period of time, I tended to communicate with my mother more than with my father and owe this difference to gender similarity and the tragic suffering of my mother. I spent much time on comforting her just because she was the only victim as in my own perception. I constantly teaching my mother how to calm herself down and change her mindsets, so as to survive in a miserable feeling. Unexpectedly, when I suggested her talking more with my father, she just sneered, saying ????he is so obstinate that nothing will change his mind????. It could be inferred that she was still pessimistic and lacked motivation to make changes in spite of my consistent encouragement.

On the other hand, the stereotypes that men are always mentally stronger than women made me totally forgot that my father was suffering pains and he needed care as well. Hardly had I decided to concern for and communicate with my father when I learnt that I should take him into consideration early. The most challenging thing was that he had been greatly reluctant to talk about either his former or current relationship with my mother especially the information about his extramarital love. He even did not admit any fault he had made. I have to acknowledge that I was livid when I found out that my father had been two-timing his wife and was highly emotional and illiberally prejudiced against as a result. Only now did I understand the reasons why I failed to assist my parents in settling their contradiction. My deficient consideration of my father????s personality and the dignity as a man almost turned an equal dialogue into a thoughtless bickering. In fact, my father was defiant in the whole session because he was afraid that his authoritative status in the family would be ruined, however, I did not realize that kind of unwillingness at that time.

No doubt, neither my mother nor my father is my client in the sense of professional, but if they are viewed as clients, it will be a classic case of client resistance.

Definition of Client Resistance

When doing the literature review, I found that the term involuntary is sometimes used interchangeably with resistant, however, the former refers to ????the status of the client????, while the latter refers to ???? behaviors or characteristics that hinder the therapeutic process???? (Chui & Ho, 2006). Usually, involuntary clients show some resistant thoughts and behaviors.

Freud (1914/1957) originally conceptualized resistance as ????the client????s effort to repress anxiety-provoking memories and insights in the unconscious during psychoanalytic free association???? (Freud, 1914/1957).

According to the perspective of social interaction theory, resistance is ????psychological forces aroused in the client that restrain acceptance of influence (acceptance of the counselor’s suggestion) and are generated by the way the suggestion is stated and by the characteristics of the counselor stating it???? (Strong & Matross, 1973). Simply stated, resistance has been defined as ????a process of avoiding or diminishing the self-disclosing communication requested by the interviewer because of its capacity to make the interviewee uncomfortable or anxious???? (Pope, 1979).

Client resistance should not be regarded as ????something that happens within the client, as a response to his or her inner workings, and must be overcome by the counselor???? (Cowan & Presbury, 2000). Rather, resistance should be understood as ????a phenomenon that emerges between client and therapist in the unfolding interaction between their differently organized subjective worlds???? (Cowan & Presbury, 2000).

In a word, resistance is treated as results from the communication pattern of the counselor and the client. In other words, resistance emerges when the intervention strategies are not gear to clients???? willingness to accept the style in which the intervention is conducted.

Typical Involuntary Clients

This part is a personal understanding towards client resistance. Based on an examination of the case example and the literature review, I summarized three types of involuntary clients.

1. Clients Who Have Inadequate Strength or Ability

Some clients do not have the ability to take care of themselves or seek help from others, such as the disabled, the battered children and the abandoned elderly. These clients are normally forced by others to consult an agency and a social worker.

2. Clients Who Have Insufficient Motivation

The clients who fall into the difficult position for a long time may feel mentally exhausted and have no extra will to seek help. Take some battered women as an example, they tend to have a despairing view of the marriage because of the learned helplessness and may find it meaningless to join in the intervention tasks.

Similar to those who have inadequate strength or ability, the majority of the insufficiently motivated clients are not willingly attended the intervention tasks.

3. Clients Who Lack Introspection

Although some people know that they are mired in difficulties because of their misbehaviors, they have insufficient self-contemplation, and self-examination when faced with the problems they have, which, as a result, make the problems relapse again and again. This is also the reason why most drug or alcoholic abusers find it difficult to completely overcome their additions.

Skills of Coping with Client Resistance

For involuntary clients, it is a common phenomenon that they will be reluctant towards self-exposure and conservative to their own experience because they worry about that not doing so would threaten their self-concept. It is necessary for a social worker to learn how to alleviate clients???? excessive anxiety. Social workers are expected to adjust their intervention methods and the styles to the need of clients. Since most involuntary clients pay much attention to self-protection, the workers should not only avoid requesting or anticipating their self-betrayal, but also refrain from any actions that attempting to tear down clients???? mask.

1. To Find Out the Third Party

In general, social workers are required to listen carefully to clients, thus provide clients more opportunities to express their feelings and perceptions and make them feel respected and admitted. However, things are different when confronting involuntary clients. Since it is an issue of power and control that the pouring-out people are usually vulnerable whereas the listening people always have the power to make evaluation and assessment, the involuntary clients tend to crave a sense of empower through the process of resistance and rebuttal.

In involuntary cases, the third party is needed in the course of the entire conversation. If I intake a client like my mother, I should not unilaterally focus on counseling the client changing herself, but on concerning several means to bring the third party into the intervention so that establishing a ????social work ??C client ??C the third party???? triangular communication system. In short, the third party is ones who push clients to seek help or forced them to ask for counseling.

2. To Make the Intervention Process Clear

Apart from understanding about the force that push clients into the intervention, the workers should also enquire about whether the clients have any other confusions. It aims at discovering the problems which clients want to improve. The worker as a listener should do something to give clients a feeling that they are under a clearly planned effective assistance.

In addition, it is very important to make sure that clients know what will the worker do and will not do. For example, summarizing or reflecting clients???? current situation or their main resentment can possibly promote their expectation to the counseling and enhance social workers???? reliability as well.

3. To Alleviate Clients???? Anxieties about Changes

Resistant clients may or may not recognize that they have a problem, and/or may not want to engage in a process of change (Rooney, 1992) so that they will take resistance as an means to protect themselves from the unknown (Yalom & Molyn, 2005). They might be resistant towards the therapeutic process because it involves changing their current maladaptive behavior (Chui & Ho, 2006).

An available method to ease clients???? anxiety about change is to make them feel more sense of control. The less the clients can control the process and results of intervention, the more they will view social workers as the representatives of those who force them to participate in the intervention. Consequently, the degree of resistance may increase dramatically. Such situation requires social workers to discuss with clients about the reasons why they are recommended to have the counseling. If a client is compelled to accept counseling, the social worker may point it out to the client that he could reject the counseling and bear the consequences of such rejection, thus restore their sense of control.

Furthermore, as cultivating new behaviors is much easier than changing old ones, it might be more reasonable and effective that social works try to train the clients to foster some new patterns of communication and behavioral habits, rather than amend their previous habits, thus establish a harmonious relationship with clients. Some more complex intervention, such as teaching clients relaxation skills, or assisting them in analyzing the irrational thoughts, may have immediate utilities to the involuntary clients.

Discussion

The relationship between the social worker and the client is always living no matter what happened in the process of intervention. One of the major responsibilities for social workers is paying enough attention to the quality and the health of rapport-building process. To some extent, clients???? changes or improvements come from an appropriate and valid interaction within a harmonious relationship.

As potential social workers, in addition to understanding of various theories or therapies which provide different approaches to resolve client resistance, we should also learn to ????determine how best to address that relational dynamic in counseling???? (Joshua, 2008).

Self harm in all of its forms is one of the greatest dangers that face vulnerable adolescents, promoting unhealthy cycles, and increasing the risk of suicide and from the perspective of a school nurse, the problem is very evident. Whilst providing duties to young people with, or prone to, psychological, emotional or mental help problems it is clear that self harm is an ever increasing issue. There is evidence that would suggest that the rates of self harm within the UK are the highest in Europe (Mental Health Foundation, 2006, a) and as such, this act should be considered one of our nations significant health concerns. Self harm is a complicated and very challenging problem to face and as such a deep understanding of self harm is vital to combating it.

In reviewing literature we must interpret a comprehensive volume of information relating to a given topic. In this instance the topic at hand is self-harm, and as such we are required to study and absorb as much of the available information in order to digest it into new insights and to provide evidence to inform our practical decisions. In this specific review the aim is to use the available literature to identify the most prominent and prevalent challenges that could face a school nurse in the treatment and management of youths that self harm.

The act of self-harm has become all the more common amongst adolescents (Fortune and Hawton, 2005) (Laukkanen et al, 2009), wherein as many as one in 15 youths undertake self harm at one point or more in their lives (Mental Health Foundation, 2006, a). Self harm involves many types of personal injury, from poisoning to starving, though cutting is the predominant method of self injury (Lakkanen et al, 2009) and because of this, I have ensured to differentiate cutting, from other means of self harm within this review. The primary approach of this review is to attempt to identify the most prominent literature relative to this topic within the UK. Unfortunately there is only a small pool of literature governing the topic of self harm in youths; even foreign literature on the topic is just as underdeveloped and lacking, often using differing terminology, such as “self-Mutilation” (Derouin and Bravender, 2004).

A further category of self harm that requires specific definition is the term Deliberate self harm, otherwise known as DSH. Whilst it is most frequently used in UK literature pertaining to the subject, it has been regarded as controversial, because of the mental connotations behind the disorder. (NICE, 2004). People who commit self harm, tend to not feel comfortable with the use of the word ‘deliberate’, as it disrupts the notion that the act is voluntary, which a lot of sufferers disbelieve (Royal College of Psychiatrists, 2007). In recognising different perspectives on the matter, the term ‘deliberate’ should no longer be used in relation to self harm, to give an enlightened view of the topic within this literature review.

When discussing young people or adolescent in this report, the terms will refer to any young person between 12 and 18 years of age. The average age of onset for self harm is 12 years (mental health foundation, 2006, a), however children as young as five years old have been reported to self harm (Bywaters and Rolfe, 2002). The cases of children that young performing self harm is very uncommon, and the rate tends to increase rapidly with age throughout adolescence (Hawton et al, 2003).

Methodology.

Gathering literary sources was done by utilising a search of CINAHL (Cumulative Index to Nursing and Allied Health Literature), a database for nurising based literature reviews. It is particularly suiting as it relaties specifically to nursing and allied health literature (Aveyard, 2010). In order to get the most comprehensive list of resources, several terms were used within the search; Cut* “self-harm” “self-mutilation”, “Adolescent” and “School nurse” in order to provide a wide range of literature related to the topic. Recent papers, such as those published within the last five to ten years were used. In order to gather enough information, the limit was extended to ten years, as there was simply not enough sources within a five year bracket. When performign these searches, the search terms were often linked in order to provide the best set of results. Other databases were used, using a similar method as this to good results. They included The British Nursing Inde, and PsychINFO.

It is often emphasised how important it is to combine search strategies (Greenhalgh and Peacock, 2005), within literature reviews. Despite the advantage electronic searches provide, it is still possible to miss key sources of literature. (Montori et al, 2004). Every step to ensure the best quality of literature is provided should be taken, and as such within this review, any appropriate cited references have been thoroughly checked and sourced. In following various searches, the extracts from the articles were read for relevance to the review. They were also regarded to see if they met the inclusion/exclusion criteria and for general relevance and importance. The critical apraisal skills programme was used to great effect in ascertaining the quality of certain articles (Aveyard, 2010). Further articles that did not meet criteria at this stage were disregarded from the study. As could be expected, all literature that had been collated showed similarities in their findings and themes. These have been used to link the findings in a systematic manner for the purpose of this review (Pope et al, 2007). Prevelance, rates, reasons to harm, the factors behind harming, suicidal intentions and intervention are all themes which need to be studied and examined for the problems and considerations faced by a medical professional when encountering them.

Prevelance

One thought that is unanimous within studies concerning self-harm is that the act itself is much more than simply attention seeking behaviour. (Mental Health Foundation, 2006, a). This is supported by the instances in which youths attempt to hide their attempts behind long sleeved tops, or by cutting in areas of the body that are hidden from view, such as the inner thigh or the axilla (Freeman, 2002). Because of this, many acts of self-harm do not come to the attention of the healthcare services, so it is almost impossible to discern the true scale of the matter.

However in one study 13 .2% of adolescents reported to have purposefully harmed themselves within their lives (Hawthorn and Rodam, 2006). There have been many studies on the matter, but it is difficult to compare results due to varying age groups and conditions. Two facts seem t o be agreed upon however, and they are that cutting is the most prevalent type of self-harm (Laukkanen et al, 2009) and that in all likelihood the true scale of the problem goes unrecorded. The latter could be due to several reasons; between youths hiding the fact they perform self-harm and that parents who have no fears in regards to their children, are less likely to give consent to permit these studies recording data. (Hintikka et al, 2009).

With all reports agreeing that the situation as a whole reflects merely the tip of an iceberg, and that findings do not cover the majority of acts that go unnoticed by the medical services, health professionals require a greater understanding of the topic, in order to tackle the problem when they do encounter it. As School Nurses are often the first to contact youths who self harm (McDougal, 2003), it is even more vital to provide an understanding and means to address this problem. Whilst establishing a professional where pupils feel comfortable in disclosing their behaviour , it is also vital to promote awareness in the school and community at large of the dangers of this self-harming behaviour (Hackney, 2009). However the root of the problem lies in identifying those who are prone to cutting and other acts of self harm, and understanding why they choose to take this step.

Why Adolescents Self-Harm

There appear to be many reasons offered as to why adolescents choose to harm themselves including to feel more alive, to distract from the reality of their situation, and to even gain relief from the pressures that surround them (Mental Health Foundation, 2006, a). It can be used as a means of dealing with emotional extremes of anger, sadness or depression (Mental Health Foundation, 2006, a), or even as a means of expressing negative emotions such as self-loathing or loneliness. Whatever the cause, the reason behind it is often that the adolescent’s mind finds it easier to deal with physical pain and trauma than the emotional pain that is the root of the problem (Medical Health Foundation, 2006, a). Physically, there are endorphins released during the act of cutting which serve as to calm the person down (Starr, 2004). In doing this, the anxiety is reduced and not only is the adolescent satisfied emotionally, but also potentially addicted physically. Adolescents often feel that between studies and their family, they have no control over their own life; and as such cutting can be a means of exerting control over themselves physically. (Derouin and Bravender, 2004). However in certain circumstances, it can be used to exert control of those around the youth, such as friends, family, and other loved ones. (Freeman, 2002).

With this in mind, it is understandable why youths take to self harm as a means of resolving their emotional issues, as it has been recorded that most youths who have undertaken the act, hold it in a positive light (Griesbach, 2008). However it is only a temporary solution and an often dangerous one at that. Any gratification gained from the act itself does nothing to relive the underlying problem (Mental Health Foundation, 2006), and as such cannot be expected to resolve itself. Those who choose to self harm, tend to do so because of a complex combination of reasons and experiences, rather than a single, governing event (Fox and Hawton, 2004). As such, it can often be difficult for a Nurse to address these issues as a collective when dealing with those who self-harm.

Factors associated to Self Harm

Girls are more prone to internalise their problems than boys and as such, certain pieces of literature believe that girls are far more likely than boys to resort to self harm (Hawton et al, 2002). In contradiction to this, certain texts would state that in a study of admissions to an accident and emergency department, almost as many boys were admitted as girls, for the act of self harm (Lilley et al, 2008). As such, it is important to acknowledge that the differences between genders, may not reflect the likelihood of cutting as any greater than the other.

There a re also emotional factors tied to self harm, tha t include feelings of loneliness, isolation, depression, frustration and worthlessness (Griesbach, 2008). These feelings in and of themselves often a re enough to cause concern that a youth could self harm, however combined with other factors such as separation from loved ones (through arguments or neglect), bullying or even abuse could amplify the risk of self-harm (Griesbach, 2008). It is just as important when considering these factors, that not everybody who has suffered neglect or abuse will self-harm, and that those that have will often handle things in a less destructive manner (Turp, 2002).

Other behavioural factors have been linked to those who self-harm, which include aggressive tendencies, poor educational performance, substance abuse, and most commonly depressive moods (Laukkanen et al, 2009). There are also those who suffer from stress, or who feel as if they have little control over their life. (Griesbach, 2008)

Family and Relationships

Whilst behavioural problems can be tied to the reasons behind self-harm, often it is those closest to the adolescent that promote these issues, knowingly or otherwise, such as a parental figure providing either overprotection, or a lack of care (Marchetto, 2006). There are many psychosocial issues that may impart negative emotions, stress, or pressures upon a youth, with serious family and relationship problems being the more common (Laukkanen et al, 2009). With this to consider, a school nurse must realise that even the most superficial act of self harm could be linked to a very deep and complex series of psychosocial problems. Young people often feel uncomfortable opening up about such backgrounds, regardless of family circumstance (Griesbach, 2008) and consequently it can be difficult for a school nurse to uncover the true cause of self-harm with a patient. This difficulty in opening up must be considered when assessing a youth suspected of self harm in order to best establish a relationship with the patient and thus a level of trust (Griesbach, 2008).

Mental concerns.

A high proportion of children can be diagnosed with mental disorders. With mental health problems such as anxiety, depression and even eating disorders being strongly linked to those who self-harm (Hintikka et al, 2009), these high proportions become all the more concerning. According to The Mental Health Foundation (2006, b) One in ten children have a mental health disorder, coupled with the strong links between self harm and these disorders gives cause for concern as to how much goes unrecorded. Depression has even been recognised as a major factor behind self harm (Derouin and Bravender, 2004), which is becoming even more common with girls who choose to cut. (Hintikka et al, 2009). However there is often a stigma attached to mental health issues that a school nurse will have to overcome when addressing these problems. Often establishing a heightened awareness of these disorders within the community will remove some of the stigma related to these disorders, and in turn will encourage youths to be more open and healthy with their thoughts (Hackney, 2009).

Some adolescents however, have been discovered to have self-harmed for years by successfully hiding their injuries, and have shown no signs of a mental disorder (Derouin and Bravender, 2004) that stimulates the necessity to cut. Even if mental problems are not to blame however, the act of self harm is a sign that something is wrong within the youth’s life; self harm often being the outward response to unfavourable circumstances (Griesbach, 2008).

Social Circumstances

Peer pressure is an all too common part of adolescence. In regards to self-harm, this combined with curiosity and risk taking behaviour will often act as encouragement to “try it” (Derouin and Bravender, 2004). It is important for a school nurse to understand the presence of peer pressure, and be mindful of it when assisting those who have to overcome self-mutilation. Indeed it is necessary to be mindful of all outside social developmental issues when a school nurse attempts to break the cycle of cutting with a patient. (Derouin and Bravender, 2004).

Suicide.

Whilst those who choose to self cut or self mutilate often are not intending to attempt suicide, there can often be a risk. Often they are simply attempting to release extreme anxiety or inner pain, (Derouin and Bravender, 2004). However, there are difficulties when addressing this problem as a school nurse. Those who choose to cut are often less likely to be at risk of suicide than those who harm in a different manner; often their only aim is to release tension, and they are more in control of the damage they are inflicting than other methods. (Griesbach, 2008). However, evidence supports the notion that those who self-harm, will repeatedly self-harm, and in turn this increases their risk of suicide, intended or not (Cleaver, 2007).

It is important to remember that in general young people will see suicide, and self-harm as two very separate things. Unfortunately for a school nurse, the characteristics of those who self-harm and those who intend to commit suicide are often shared (Hawton and James, 2005). Thus it can be a very challenging experience for a School Nurse to identify pupils who self harm who are at risk of suicide in a medium or a short term. It is vital for School Nurses to recognise the differences between the two, and intervene at the earliest possible opportunity, for every case of self-harm. Whilst Suicide is a rare event (NICE, 2004), it is still the third most common cause of death in the adolescent age group. As such any discovery of self-harming should be fully assessed for needs, emotional, psychological and social factors that are specific to the individual case (NICE, 2004) so as to better assess the problem at hand.

Interventions

There is some debate as to the best method to stop repeated self-harm, and unfortunately there is a lack of good evidence to support one method over another (NICE, 2004). Randomise Control Trials (RCT) are often the premier choice of researching and comparing differing interventions (Harner and Collinson, 2005). There had been positive results found within the realm of group therapy. Wood (2001) found promising results from a study into developmental group psychotherapy, recording a clinically significant difference to favour group therapy above other forms of aftercare and upon this evidence a first line of treatment should be prescribed as group therapy. Unfortunately in contrast to this a recent repetition of the study failed to yield any positive results to suggest that group therapy was a superior treatment (Hazell et al, 2009). As we can see there is a great difficulty in assessing the value of any research into treatment, and the importance of repeating the tests for grounded evidence.

Young people say that they wish to be helped in a way that feels comfortable for them. This is understandable, as they are often discussing a private matter. Private support groups, one on one sessions and drop in services are viewed as particularly helpful (Griesbach, 2008). One of the most important factors is overcoming the negative attitude associated with the disorder; something that is even possessed by the nurses who treat it (Cleaver, 2007). As such it is important to treat the patient with respect and to listen to their problems, even if their roots do not stem from self-harm, but from daily, or emotional issues. Many who have self harmed state that had this service been available to them in the first place, they would not have started their disorder (Mental Health Foundation, 2006, a)

Preventative measures must be taken to address self-harm in all of its forms. A school nurse is positioned at the forefront of these preventative measures, and often can find themselves in the best possible position to assist the youth. However; self harm is a very large, and very complex problem for a school nurse to address, with evidence suggesting nurses to feel overwhelmed and under supported when tackling the issue (Cook and James, 2009). With this in mind, the further education of school nurses to equip them to deal with these issues cannot be disregarded (NICE, 2004).

When preventative measures fail it is good practise to advise people who repeatedly self injure with management techniques such as, how best to deal with scarring, alternative coping strategies, and harm minimalisation techniques (NICE, 2004). This concept is well established in health promotion and has been applied in recent years successfully to both sexual health education and in a reduction of teenage pregnancies (Lesley, 2008). Adolescence is a time for striving for independence, experimenting and taking risks (Lesley, 2008) and this approach of minimising self harm can often be the best approach to tackling those who have already self harmed.

Evidence to suggest an effective treatment is not abundant (NICE, 2004) but to focus on minimising the damage is a pessimistic approach. Certain voluntary organizations advocate the thought “If you feel the need to self harm, focus on staying within the safe limits” (Mind, 2010). Young people want a range of options for self help best suited to them, even if it is something as simple as something to distract themselves from self harm for just a short period of time (Mental Health Foundation, 2006, a). Successful distraction techniques have been known to include using ice instead of cutting, or even marking with a red pen; other means involve simply venting pent up frustration such as by punching a punch bag (Mental Health Foundation, 2006, a) not all reliefs have to be physical, however, and often creative pursuits such as writing, drawing and painting can have a very positive effect (Griesbech, 2008). Often, it is much more constructive to engage in creative rather than destructive behaviour and is even more likely to change behavioural response to self harm (Norman and Ryrie, 2004).

If unavoidable, it is advocated that those who cut use clean, sharp instruments and avoid areas that include veins and arteries (Pengelly, 2008). When advocating this a nurse must consider both the legal and ethical arguments of endorsing any form of self harm (Pengally, 2008). Many do not feel comfortable discussing these minimalisation techniques over the concern that this could be construed as encouragement and leave the nurse vulnerable to backlash (Pengally, 2008). That said, often self harm may be the only control that a young person feels that they have over their lives (Derouin and Bravender, 2004) it is essential for a nurse, when supporting adolescents, to make effective clinical decisions. Ethical dilemmas and diverse situations often arise in this field of medicine and must be balanced with the needs of the patient and community (Bennet, 2008).

Ultimately, when undertaking these decisions, practitioners must consult with the rest of the clinical team and maintain in depth records. Similarly, the decision whether or not to inform the parents raises another ethical question. Inititally, it can damage trust between the nurse and patient in future consultations, however, should a youth be considered mature enough they should be treated as adults and thus given the same level of confidentiality (Hendrick, 2010).

Limitations.

The majority of sources of information within this review is qualitative research which is related to the desire to obtain the opinions of individuals alongside their experiences (Watson et al, 2008). The benefits of qualitative methods are that often a greater wealth of information is obtained, in terms of social and personal experiences and insights than would otherwise be available (Hall, 2006). Unfortunately, there are many criticisms that beset qualitative studies. For instance, many disregard the findings as they are not ecologically valid due to the small sample size (Parahoo, 2006) as such, findings of many studies often only reflect the characteristics of that particular sample as opposed to the diverse population that engage in the act of self harm. Furthermore, it is difficult to justify evidencing qualitative research as often its results are interpretative (Aveyard, 2010) of course, findings can also be affected by the differing assessment methods used to collate the information, such as whether the assessment was done autonomously or if it relied on parental consent.

Recommendations.

Harm minimalisation techniques need to be widely available to adolescents who self harm with recognization of the ethical dilemmas, in order to support school nurses within this field of practise. Future literature on the subject also needs to choose its terminology carefully and focus upon one form of self harm rather than generalising. This is the only manner in which a specific treatment can be formulated to address each individual form of self harm allowing nursing to develop appropriate preventative interventions. School nurses should also refer all youths who harm to CAMHS. The presumption that young people that cut are not suicidal or that they do not have mental illness is too high a risk to consider and even though the majority hold neither of these disorders, they can not be overlooked due to the minority that do possess them.

Conclusion.

The true extent of self harm or self cutting is very difficult to determine due to the inconsistencies and definition and underreporting that often it goes unnoticed. What can be agreed upon, is that self cutting is an increasing and serious problem among adolescents. School nurses hold a vital role in the management of this disorder and are often at the forefront of any prevention, treatment and education. An understanding of why adolescents self harm and all linked factors are vital for undertaking treatment of a patient. However, this challenge is complex and requires a large amount of training and support; it is very important to avoid any stigma attached to self harming when treating youth, they are often not attention seeking and frequently posess a lot of problems in their lives. Self harm masks underlying emotional, psychological and social trauma and can simply be a youths only outlet to relieve stress and emotional tension. It is undeniable that self harm is a rapidly expanding area of research, however upon reviewing this literature many questions are still left unanswered. There is still the underlying moral and ethical difficulties that a school nurse must consider when supporting those who self harm

In day to day life abuse activities are growing rapidly and the measures to prevent them are also getting more specific .The exercise of power by the state on this sector is the most important thing to solve this problem. The government bodies are making different plans, policies to prevent abuse and create a healthier society and the nation. Mckibbin et al (2008) states that range of legislation and policies are designed to protect individual, groups, and vulnerable adults from abuse these are-

“The Care Standard Act 2000”
“Confidentiality policy”
“Whistle Blowing Policy”
“Physical Intervention Policy”
“Complaint Procedure in Care Home”

Confidently and disclosure

Trust is an integral part of our ability to provide consistent high standards of care and such it must not be broken.

A person’s trust is not a right but a special privilege, which means you must exercise care and thought in your handling of confidence. You must never divulge a confidence placed in you by a service user, colleague, relative etc.

Only where the nature of the confidence may have a detrimental impact upon the standard of care should consider passing it on and then only to the registered Manager, never anyone else.

Due to the nature of the work that is conducted within the home, and the confidentiality of information passes between residents, medical staff and statutory agencies and workers, all staff are required to sign a confidentiality agreement whereby you agree not to disclose any information relating to any resident without first obtaining permission from the resident and their assigned worker.

Physical intervention policy

Working with people who can behave aggressively has always presented management difficulties for staff.

Some of the people that we work for occasionally behave in a way that leaves us no option but to intervene physically for their own or other’s safety.

Every effort must be made to ensure that potentially volatile situations are avoided using non-confrontational approaches aimed at enabling the resident to take responsibility for his/her actions and consequences that follow.

As a staff team we work together to reduce risks around violence and look at ways in which we can do this. Primarily, this is done by writing with Care Plans. The Care Plan needs to outline the aims and methods to be used with residents to gain achievements and life goals.

When writing Care Plans, Risk Assessments will be a functional part of this process. Both Care Plans and Risk Assessments need to reflect the principles of O’Brien and Wolfensberger regarding the provision of normalizing services.

Once a comprehensive Care Plan package is in place the staff team are able to work with a clear and defined approach offering consistent care and support to the people we work with.

The recording of incidents is a vital process in the safety of the staff.

All episodes of violence must be recorded. Staff are made aware of these procedures and the following must always be completed:-

Accident Book

Incident and Violent Episodes Forms

By the correct recording of Violent Episodes (VE) staff can look at the antecedents to behaviours in relation to the consequences. Often it is possible to develop strategies for reducing incidents in relation to this.

Incident and Violent Episode Forms give the staff team the opportunity to reflect and access.

Feedback and support is given in the form of supervision. All staff receives regular supervision every two to three weeks. This allows staff the opportunity to access their actions and reflect on work practice.

When looking at violence toward staff, there are a number of preventive measures that need to be considered and put into practice.

These are:-

Ensuring the staffing levels is appropriate to the task. If there is a high risk, evaluate whether levels are adequate and if not have the flexibility to have extra staff on one given shift.
Rotating high risk jobs thus ensuring the same person is not always at risk. The team should also have the ability to evaluate a task and decide what action if any is necessary.
Make sure a senior member of staff on duty can make quick decisions if necessary.
Ensuring the whole staff team is aware of particular guidelines, Risk Assessments and Care Plans.
Making available the appropriate information for a particular task to be understood so that this can be undertaken with minimal risk.

Staff training is essential for all aspects of our jobs and can give staff some of the necessary tools for coping with and lessening violence. This should encourage a more positive body language and this in turn should lessen violent episodes within the service. We clarify with all residents that violent behaviour is not acceptable however we shall not judge or condemn their behaviour.

You must acquaint yourself with and abide by all and each of the issues current for the time being of the Company’s Using Physical Intervention Policy. The Company revises all such policy and procedural documents on a regular basis responding to

changes in contemporary care practice, the needs of the Company and the needs to ensure continued efficiency. The responsibility to maintain awareness of and act upon on-going revision of such documents remains wholly that of the individual staff member. Although these various statements and procedures are not formally expressed terms of your Contract of Employment, compliance is regarded as important by the Company and failure to abide by the same way lead to disciplinary action.

Other policies

Legislation implements by the “Care Standard Act 2000” and the CQC aims to ensure that care home operates in a legal way in the release of care to the customers. “Health and Safety at work Act 1974” is to give and preserve safe and healthy working conditions in workplace. “Data Protection Act 1998”, it is applies confidentiality. “Disclosure Act 1998” about abuse and whistle blowing. “The Human Rights Act 1998” shows a whole range of rights and freedom of people. DOH (1998)

Strengths and weaknesses in current legislation and policies: In every policies and programmes there can be strength and weakness side so it s the important factor to identify which one is strength and weakness factor . We can make our strength more stronger and decrease or eliminate the weakness when we are well known about these factors. Here are some of the strength and weakness factors in current legislation and policies;

CRB Check (Adult protection): CRB and POVA will give that the employee (candidate criminal offence report) but it is doing only in the UK. When candidate from abroad did crime there in his back home country, CRB in UK wont show those crimes, in that case its better to check the foreign police clearance certificate as well.

Whistle Blowing Policy: It’s the way to Improve the legislation practices and is a democratic option to build a healthier policy. But in some cases whistle blowing can create misunderstanding between the staffs and can decrease the motivation and security of the employees and can lead to worse condition as well.

Complaint Procedure: It will improve the service at the same time most demented people wont be able to complaint due to their disability

Residential Care Home Manager

Managers may direct workers directly or they may direct several supervisors who direct the workers. The manager must be familiar with the work of all the groups he/she supervises, but does not need to be the best in any or all of the areas. It is more important for the manager to know how to manage the workers than to know how to do their work well. Annie Phillips (2003)

Manager should have sufficient qualification and experience and no bad remark in Criminal record Bureau (CRB) records. (Frances 2004). Customers may be various and to meet the variety of their requirements, as a manager we have to be clear about what exactly each is seeking, what is needed is a way of thinking about the array of customers of residential care home.

Social care council

The general social care council is responsible for registration of all social care workers. The council regulates their conduct and their training. It will support for the setting and maintaining good practice standards. (Frances 2004). With having higher powers of operation in this sector social care council should be highly responsible for the better conduct and operation of the activities.

Care Assistant

These group of people are the direct responsible groups who cafe the target group so they should be well trained, and to be as per the standard set by the council. Workers should free from CRB and required to register with the council and need to be appropriately qualified (minimum NVQ 2) Should be able to give personal care, followed best practice, allow the residents to maintain their dignity, privacy and respected their individuality through out. (Frances 2004)

Working practice and strategies used to minimise abuse
Answer 3
Approaches To Adult Protection

There are many working practices implemented to minimise abuse in Health and Social Care Sectors the practices follows

Adams (2007) states that “in England, multiagency codes of practice aiming to tackle and prevent abuse of vulnerable adults developed in the light of the publication of the official guidance No Secrets (DOH and Home Office,2000)”.

Protection of Vulnerable Adults (POVA)

Adams (2007) states that “The protection of vulnerable adults (POVA) scheme was introduced in England and Wales in a phased programme from 2004,as required in the Care Standard Act 2000”.This formed a list of persons considered not fitting to with vulnerable adults in England and Wales.

People considered harmful to vulnerable adults could be referred by health and social care setting managers or employers of care for enclosure on the inventory These providers also could request for checks alongside the POVA list as part of an application for a CRB disclosure regarding persons apply for vacancies in care work. National minimum Standard were introduced for residential care

Under the POVA actions ‘safeguarding adults’ partnership have been set up from 2005 in each CQC area. Alerts may be triggered by inspectors, sometimes when inspecting or investigating a complaint. Safeguarding inspectors will deal with any safeguarding adult’s matters arising from this. Where there are concerns about the fitness of the manager of an establishment, registered person, or service or a breach of the Care Standard Act 2000, the CQC could be the main investigating agency. A safeguarding plan should be produced through a case conference, normally reviewed within six months.

Complaint Procedures

Registered providers of health and social care services are bound by law to produce a complaints procedure, specifying how service users, carers or patients can complain about the services. The procedure normally involves the complaint being investigated or responded to first by the service provider, although if the complaint is made to CQC inspection. The CQC may decide itself to carry out an investigation.

Whistle blowing

This usually involves a person making public some aspect of a group or organisation which they feel is wrong, dangerous, deficient or otherwise needing putting right through public attention. It is the activity of telling a third party, apart from colleagues or the employer, about malpractice. It will be unusual if any worker in the health and social care services does not come across some aspect of whistle blowing. This can arise directly or indirectly in three major ways, where:

You are the whistleblower: you notice practice you feel is not acceptable and you consider telling a third party, outside the line management, about it.

A colleague is the whistleblower: you see another person ‘blowing the whistle’ on practices they consider unacceptable.

The whistle is blown about practice involving you: where someone complains about, or ‘blow the whistle’ on, some practice with which you’re connected.

Case Conferences

Pritchard (1996) states that Case conference is very imp[ortant in to prevent abuse. A case conference brings people together to share their views and to discuss their work.It should be a forum where people can discuss their concerns,vent their feelings and anxieties and support each other. It is also a tool for organising future intervention. In summary the main purposes of a case conference are to:

Exchange information in a multi disciplinary forum
Assess the clien’s situation and the degree of risk
Make decidion and recommendation which are to be implemented

Participants attending a case conference have several tasks to perform, namely:

To give and share information

The information given must be accurate.the participants gives factual information about the people they know( victim,abuser,or other important personnel). Obviousely participants voice their concerns,but they must also highlight the strength of a situation not just the negatives. Any gaps in information should always be identified and acknowledged.

To assess the level of risk

While handling a case of suspected abuse always need to do a risk assesment it is very important in case conference.

Decide on registration

Few authorities have ‘at risk’ register for adults.where they do exist conference participants must know what know what the defined criteria are for putting a person name on the register.

Co – ordinate future intervention

This will involve the formulation of a plan,which will state the tasks and responcibilities of everyone who will be involved. The keyworker will be responcible for ensuring that the plan s implemented and reconvening the case conference if there are difficulties in implementing the plan.

Following are some suggestion for further improvements in working practices to minimise abuse in health and social care context

When any one going to works for health and social care setting thet must check against POVA and CRB. POVA they can check new staffs with the provisional body whether they are free from Abusive offence in the United kingdom but here there is a drawback in case if the new employee is from outer United kingdom it will be harder to find whether the employee had any Abusive offence in their country.

So we can ask particular employee to give references and police clearance from their own country. So as employer of the organisation get a full detail of the new employee further more every employee must have a proper relevant training such as Manual handling, Adult protection and many more so as manager of the organisation make sure all the staffs are well trained for the job and the manager must do supervision and appraisal the the employee.

Whistle blowing is a good practice and it also got some disadvantages for an example in a residential care home all employees are from a certain country and in this team no one whistle blow about their country people to prevent this the manager always employ different ethnicity employees to the organisation and manager educate their staff about abuse. Communication and working in partnership is very important in minimising/preventing abuse in health and social care if not there are many more cases like Baby P,Victoria Climbie can happen future.

1 identify and review exiting working practice and strategies designed to minimalism abuse in health and social care context

As we know abuse is a violation of an individual’s human and civil rights by any other person or persons. So these violations should be restricted and some of the strategies to limit the abuse are being implemented everyday. Its very important to identify the practices and strategies to minimise abuse in health and social care sector. Some of the practices and strategies are as follows.

Safeguarding vulnerable adults: These special group of people need support from the society and nation and it’s the responsibility of the nation to protect them and help them to live.

Domestic violence: Domestic violence has remained as a chronic problem in social sector. Strong support of family, friends and society are the base for preventing this problem. Government has also made strict rules regarding the domestic violence.

Racial harassment: Any type of behaviors that makes you feel distressed, alarmed or afraid can be categorized as harassment. This can include:

verbal abuse, such as name-calling, insults or racist jokes
vandalism and racist graffiti
nuisance phone calls, texts or emails
bullying, intimidation and threats
Physical abuse or violence.
Working practice

Verbal and oral communication

Communication both with the service provider and user, involved in their care and support is necessary if any potential for harm and abuse is to be minimised. Care must be taken when communicating information, verbally to ensure it remains confidential. For example that is not overheard by others. Written records must be kept in secure place and only accessible to that person who need to know or are responsible for those communications.

Use of IT in sharing information between professionals

Now day’s mostly health and social care organisation use computer to keep data about service user. It is important to make sure that data remains protected under the Data Protection Act 1998. Important information specially documents of abuses which are highly sensitive and disclosure of this information can be occurred harm for victims, should be stored by using password. Any kind of data share between professional must be informed individual’s before sharing.

Anti-oppressive practice

In relation to supporting and protecting adult from abuse important information should not be withheld from those who have a right to that information. According to the British Law a person is innocent until it is proved that is guilty and it is important therefore that worker and other do not jump to conclusion or make assumption about a person’s guilt. Adult Protection procedures are in place to make sure that no one is treated in oppressive manner which is abuse itself. So before knowing the abuser its not legal to assume them.

Anti-discriminatory practice

Everybody should take care in avoiding any kind of discriminatory practice when identifying, reporting and acting to protect individual from abuse. Individual legal right is that when investigating any case of abuse involve with them, they should free from any kind of blame and miss judgment.

Frame work of assessment

The aim of framework of assessment is protecting vulnerable people. There are different types of framework can save people from being abused. To minimise abuse in institutional care recruiting is so important. Proper selection of employee can reduce abuse in many ways, the process of selecting POVA employee can be clarified as follows;

Is it a care position set out sub sec. 80(2) &(c) of the Care Standard Act?

Continue with recruitment/selection process including CRB disclosure where Appropriate

Conduct recruitment /selection process including CRB check

No

Yes

Await CRB disclosure and conformation of POVA check.

Is it a care position set out sub sec. 80(2) &(c) of the Care Standard Act?

Yes

No

Apply for POVA first check as waiting would put provider of care breach of statutory staffing requirements

POVA first check shows that a person with the same name and date of birth is on the POBA list

Yes

No

No

Do not offer employment in a care position in a care home or with a domiciliary agency

No

Offer employment subject to CRB disclosure and conformation of the POVA check

Await CRB disclosure and final POVA check.

Offer (or confirm) employment in a care position in a care home or with a domiciliary care agency

Does CRB disclosure indicate that person should not be employed in a care position?

Does conformation shows that applicant on the POVA list

Strategies

Working in partnership with service user

Care sector agencies working in partnership is only part of the overall strategy to protect vulnerable adult from abuse. Enabling service users to recognise abuse and knowing how to alert others to this another important strategy.

Decision making process and forums

Local authority social service departments are responsible for adult protection and has set adult protection forum. If not then the local policy and procedure will describe the decision making process in situation where suspected or actual abuse require investigation.

Strategy between professional and within organisation

Working in partnership is also crucial, especially when the service user is accessing a number of different services. Effective communication between professional and organisation is important to ensure that the service user is protected. Communicating information about changes, significant event and action ensures that all those involved with supporting the service user are monitoring their well being so that they shouldn’t be abused.

Effectiveness of policies and strategies

Use of IT in sharing information is protective and secure than traditional paper work besides to make quickest service use of technology is also important. Oral communication between care professional is remain confidential which means this information is not overheard by other people. Anti- oppressive practice and anti-discriminatory practice decrease chance of further abuse and frame work of assessment shows how to assess service user or assess employee before entering care work (POVA framework, diagram 1.1)

Working in partnership within service user helps to stay closer with service user and give the opportunity to know their needs and demand. Multi agency working is very crucial to protect vulnerable adult from abuse which lacks in only one agency.

Implications

To do further improvement in care profession to protect vulnerable person from being abused local authority should closely monitor proper implementation of legislation. Care organisation shouldn’t send care worker to the work, before making sure that they are skilled enough to work otherwise the same thing will happen what was happened in the case of Victoria climbie and Baby p. Those two children died in their early age under the same authority because of lack of experience of care worker.

Conclusion:

Abuse has very bad impact in the society. Without preventing abuse activities in the society its very hard to develop and development and civilization may get worst. It should be removed from our society by making sure the proper implementation of rules and legislation. We have to consider that abuse destroys individual’s hopes, desires and interest of life and finally leads to a great social problem in the community and a nation.

Recommendation

Changing individual’s mentality is most important to minimize abuse. Besides. working in partnership is also a way to diminish it. Step of government and help of Non Government Organisations (NGOs) is extremely needed to remove it and make it a permanent result. Thus as we know abuse is a social problem and cannot be solved through one’s effort only so every members of society should play active roles in preventing abusive activities.

Anglo-Saxon society has traditionally entrusted parents with the responsibility of bringing up their children. Parents, under such societal traditions, are required to look after the physical, emotional and mental needs of their children, provide them with a warm and comfortable family atmosphere, educate them to the best of their ability, and ready them for future adult responsibilities.* Birchall The overwhelming majority of people in the UK try to follow these tenets to the best of their abilities. Social changes like the increased incidence of divorces, live-in relationships, and single parenting, whilst significantly changing the social and economic structure of UK society, have not affected basic child rearing responsibilities. Modern day parents remain as committed to their children as their predecessors.

Whilst the overwhelming majority of members of British society think of children as precious, both in the individual and in the collective context, some parents exhibit significantly deviant behaviour and subject their children to neglect and various forms of mental and physical abuse. *Arthurs Children are also vulnerable to physical and other forms of abuse outside their domestic environments for a variety of reasons.

The social services infrastructure of the UK, which came into being as an integral component of the welfare state after the closure of the Second World War, has always emphasised the need to safeguard and protect children. Policy makers of different governments, both conservative and labour, have consistently made efforts to bring about laws and policies for the safeguarding of children, adolescents and vulnerable young adults. The social work infrastructure of the country also provides high priority to protecting children from different forms of abuse. Brandon

A significant number of children in the country, despite the presence of a plethora of protective laws and policies and the existence of a huge, nationwide, protective social service infrastructure, are subjected to various degrees of emotional, mental and physical abuse.CReighton Incidents of child abuse and death continue to regularly be reported in the national media. One such episode, which ended in the tragic death of 8 year old Victoria Climbie in 2000, led to the institution of The Laming Commission and to significant changes in social welfare policy. *

The formulation and implementation of the Every Child Matters (ECM) programme, which constitutes the overarching structure for child care in the country, places immense emphasis of the safety and security of children.*

The country’s social care policies and social services infrastructure contain specific policies and processes for the identification of children at risk, followed by mandatory need assessment, and the provisioning of adequate security to them through planned interventions. The continuance of physical abuse against children, some episodes of which lead to substantial physical injury and even death, is a cause of intense distress to the people and policy makers of the country. Much of media debate and discussion on the issue assigns the responsibility for such continued violence against children, despite the existence of extensive preventive infrastructure, very squarely, on inadequate managerial leadership and decision making skills at various levels of the social services and social work infrastructure, as well as in other public services like health, education and policing. Learning Lessons Ofsted, Lord Laming Whilst incidents of violence against children have in the past led to intense criticism of individual social workers and of the social services system, contemporary nationwide soul searching over child safety is bringing up concerns regarding managerial control, leadership and decision making, across the ambit of the concerned public service organisations. Laming

The Serious Cases Review, a national fact finding process that among other things investigates episodes of serious violence against children, has time and again provided details on reasons behind individual child abuse cases, the learning to be taken from such episodes, and the actions needed for the prevention of recurrence of such horrific incidents. U/LL

The continuance of such episodes, despite the presence of extensive preventive machinery and the availability of such significant information has created confusion and concern over the ability of public service organisations to control and reduce child abuse and related deaths. Observers and analysts feel that a number of causes have combined to produce, stagnation, inefficiency, and ineffectiveness in the decision making of public sector agencies, and in their ability to work in cooperation and in collaboration with each other.

This study takes up the investigation of child abuse in the UK, the findings of the serious case reviews, and the learning obtained from such reviews. This is followed by an exploration and analysis of the factors that limit the role of such learning in the actual decision making processes of various public agencies that are associated with and are responsible for the safety of children in the UK.

2. Commentary
Legislation and Public Policy on Child Protection

Abuse against children can occur in numerous different circumstances and across social and economic segments. Children are specifically vulnerable in circumstances or environments that concern family violence, bullying, substance misuse, learning inadequacies, mental health problems, and social and economic difficulties; also when children are unplanned, unwanted, premature or disabled. Vulnerable children may again be open to threats from more than one type of neglect or abuse. CPG

The occurrence or possibility of “significant harm” provides the trigger for initiation of child safety and protection measures in the UK. The occurrence of significant harm depends upon a range of issues like the extent of abuse, its impact on the child, and the circumstances in which the abuse took or can take place. Whilst even a single traumatic episode may constitute significant harm, the term is more representative of a cumulative pattern of episodes that adversely affect a child. CPG

The Children Act 1989, as well as The Children (Scotland) Act 1995, state that all local authorities must act jointly to safeguard children in need. The Children Act 2004 subsequently introduced a statutory structure for local cooperation for protection of children in England and Wales. All organisations that are responsible for providing services to children, including those that are engaged in education and health care, need to necessarily take steps for safeguarding of children in the discharging of their normal functions. CPG The English, Scottish and Welsh Executives have published detailed guidelines on inter-agency working on protecting children, which are available on their websites. CPG

The Social Services is the lead child protection agency. It is statutorily responsible for making enquiries into all issues concerning child protection and is the main contact point for child welfare. The police are also empowered to intervene in all circumstances that could concern the safety of children. Local Safeguarding Children Boards (LSCBs) and Child Protection Committees (CPCs) are responsible for outlining the ways in which relevant organisations in individual local areas must cooperate to provide safety and security to children. CPG

All organisations responsible for providing services to children are required to have clear structures and practices for child protection in place. These include (a) specific lines of accountability for work in child protection, (b) arrangements for suitable checks on new volunteers and staff, (c) procedures for handling of allegations of abuse against volunteers and staff members, (d) suitable programmes for training of staff, (e) a policy for child protection, (f) appropriate procedures for whistle blowing and (g) a culture that encourages the addressing of issues related to safeguarding of children. CPG

Health care professionals who have apprehensions about neglect or abuse should adhere to local child protection procedures and should have access to required support and advice. CPG NHS organisations must have a doctor and nurse with requisite expertise in child protection. Private hospitals also need to compulsorily have child protection policies as, well as named professionals who possess expertise in child protection.

It is also mandatory for all professionals dealing with children, as well as members of the general public, to bring apprehensions or fears about the vulnerability of any child in their domain of knowledge, (who is or could be under physical threat), to the attention of the local social services department.CPG It thereafter becomes mandatory on the social services to take such reference into account, carry out detailed assessments of the needs of the child under threat and plan and implement appropriate interventions. CPG

Serious Case Reviews and their Findings

The social service in the UK has been rocked by instances of child abuse, some of which have led to death. Two year old James Bulgar was brutally murdered by two ten year olds, Thompson and Venables, in 1993. JB The incident, which attracted immense publicity and public outrage and led to the imprisonment of the two perpetrators for many years, increased awareness of the dangers faced by children and young adults and the need to bring in policies and procedures for improving their safety.

The tragic death of 8 year old Victoria Climbie, in 2000, at the hands of her carers, led to the institution of a public inquiry, the severe indictment of social workers for being negligent towards their duties and responsibilities, and to a number of positive developments in the area of child protection. The publication of the Laming Report, in 2002, led to the formulation of the Every Child Matters programme and the enactment of The Children Act 2004.

The death of 17 month old baby P, in 2007, which occurred out of injuries suffered at the hands of his carers, (his mother and her boyfriend), during a period in which he was repeatedly seen by social workers brought home the fact that children continued to be unsafe despite the introduction of legal enactments and policy reforms, and the strengthening of the social services sector. *

The neglect, abuse, or death of a child being a matter of immense national concern, UK public policy calls for the undertaking of serious care reviews in circumstances (a) where a child has been seriously injured or harmed, or has died, and (b) abuse is suspected or known to have been a factor in the occurrence of the incident.

Chapter 8 of the Government Document Working Together to Safeguard Children (1999) states that a LSCB must necessarily carry out a serious case review in all circumstances where a child dies and neglect or abuse is suspected or known to be a factor. Learning All LSCBs are also enjoined to consider the conduct of a serious case review in the following circumstances.

“(a) a child sustains a potentially life-threatening injury or serious and permanent impairment to health and development through abuse or neglect, (b) a child has been subject to particularly serious sexual abuse, (c) a child’s parent has been murdered and a homicide review is being initiated, (d) a child has been killed by a parent with a mental illness, (e) the case gives rise to concerns about inter-agency working to protect children from harm.” (Learningaˆ¦, 2008)

The same document defines three specific aims of a serious case review, namely (a) the establishment of whether any lessons about inter-agency working can be learnt from the case, (b) the clear identification of the nature of these lessons, the ways in which such lessons will be acted upon, and the change that can be expected to result from such working, and (c) improvement of inter-agency working and the institution of better safeguards for children.

“when a child dies and abuse or neglect are known or suspected to be a factor in the death, local agencies should consider immediately whether there are other children at risk of harm who need safeguarding (and) whether there are any lessons to be learned from the tragedy about the ways in which they work together to safeguard children.” (Sinclair & Bullock, 2002)

Serious case reviews, it is stipulated, should be conducted by individuals who are independent of all involved agencies and professionals, and should be submitted within a period of four months of the decision for carrying out the review. LSCBs are obliged to send each completed review for evaluation to Ofsted. The results of the Ofsted evaluation are shared with LSCBs and constitute an integral part of the information used for the yearly performance assessments of local areas. Learning

The Ofsted study of the 50 serious case reviews received by the agency from April 2007 to March 2008 provides significant information on the nature of child abuse, the reasons for such abuse, and the working of different agencies who are entrusted with the responsibility of preventing such abuse. *The study reveals that children aged less than one year formed the largest group of the total surveyed population. This segment, which comprised of 21 children, was followed by the 11 to 15 age segment (14 cases), the 1 to 5 age segment (8 cases) and finally the over 16 segment (6 cases). The majority of these children died from the abuse that was inflicted upon them. In the case of children aged less than one year, the commonest cause of injury or death was physical assault by a parent, or the partner of a parent. Amongst the children and young people in the age group 11 to 16, 9 killed themselves, 3 were murdered by other young persons, and 1 died of anorexia.

The key issues that arose from the evaluation of 50 serious case reviews concerned drug and alcohol misuse, domestic violence, mental illness, and learning difficulties or disabilities. In the case of drug and alcohol misuse, reviews found that the concerned agencies did not suitably evaluate and access the risks that could come about from such misuse, particularly in the case of very young babies.

Domestic violence also featured in a number of serious case reviews, often in conjunction with drug and alcohol misuse. Agencies were again found to be inadequate in understanding, accepting and assessing the effect of domestic violence on young children. In some of these cases the history of domestic violence in the family was known to outsiders and police intervention had occurred in the past. Agencies, particularly the police, did not follow policies and procedures, with identified issues including poor levels of police training and inadequate attention to recording and reporting of domestic violence occurrences.

Mental illness came across as an issue of concern in a number of reviews. In many cases the health visitor and the midwife were unaware of the histories of the mental health of the mother, or of the learning difficulties of the father, which otherwise would have influenced their assessments. A number of delays occurred in the assessment and treatment of people in need of assistance from mental health services. A few cases involved issues related both to mental health and to learning disabilities.

The serious case reviews repeatedly point to specific inadequacies on the part of agencies in dealing with child abuse problems. The various agencies were found to be limited in their understanding of basic signs, symptoms and factors concerning child protection risks. Agencies tended to respond reactively to a particular situation rather than by perceiving the situation in the context of the history of the case. Agencies, by themselves, did not have complete details of the involved families or records of their concerns. The agency staff accepted, on a number of occasions, standards of care that in the normal course would not be acceptable by most families. Very little direct contact was established with the children in order to find out their thoughts and feelings about their situations. In many cases professionals tended to be uncertain about the importance of child protection issues, more so in complex and chaotic family environments, and placed inordinate trust on the statements of parents.

Families on the other hand often expressed hostility to establishment of contact with professionals and engineered numerous strategies to keep them at a distance. Very few assessments contained evaluation of the quality of relationships between children and parents. In many cases multiple assessments were carried out on families, which were followed by the establishment of plans that did not contain any clear expectations of the changes that were needed for the sake of the children, and the likely consequences, if such changes did not occur.

Many of the reviews reveal a number of lost opportunities on the part of universal services for suitable intervention and prevention of abuse. Such agencies included schools, health services and other services like housing, Connexions and Surestart. The majority of reviews pointed out that whilst policies and procedures were by and large appropriate and adequate, there was poor practice in the implementation of basic procedures, including in assessment, planning and decision making. With the understanding of the signs, symptoms and risk factors of child protection being inadequate, agency staff continued to be unaware of the possibility in the situations they were handling. Communication, both between and within agencies, was found to be poor; and specifically so with health agencies. Record keeping was essentially poor across agencies and particularly so in health services and schools. All agencies failed in seeing children in person, recording how they were, how they looked and what they said or noticed alterations in appearance or behaviour.

Management oversight was identified in practically 50% of the evaluations, mostly in connection with social care managers. The absence of the management overview was common in cases concerning chronic neglect. Managers in such cases, instead of trying to see the larger picture, tended to react and make their decisions in response to specific incidents, as and when they arose.

“One manager decided it was not appropriate to remove four children on the basis of one minor injury and that instead a full assessment should be undertaken, without taking into account the catalogue of previous incidents and concerns, and the fact that the family had already been assessed four times.” (Learning…, 2008)

Individual staff errors, in connection with social care staff, as well as members of police and health agencies were mentioned in a few cases as being instrumental in the lack of prevention of child abuse. Whilst staff capacity and resources were by and large not felt to be a major reason behind the failings, the requirement for additional staff training was mentioned in the majority of serious case reviews. The lack of basic awareness of indicators of abuse in important staff groups like teachers, health visitors, GPs, midwifes and emergency and accident personnel was felt to be a matter of great concern.

Poor assessment and planning was a concern in most evaluations. Issues like parenting abilities, drug and alcohol dependence, and mental health problems were not addressed in decisions concerning the need for assessments. Universal services were felt to be inadequate in undertaking risk assessments for purposes of deciding whether specific cases should be referred to social care agencies. Members of universal services did not appear to have competencies in listening to children, in questioning what was presented to them, and in being open to the chances of abuse. With the prevalence of a “rule of optimism”, it was hard for such people to be curious about what the children were facing.

Social care services were found failing in acting in accordance with their procedures, both with regard to assessment and planning. Assessments were not made in a number of cases, without such actions being supported by adequate reasons. Assessments, in other cases, were poorly done, often failing to take account of the wishes, feelings, or situation of the child, or of information available with other agencies.

A number of reviews revealed agency neglect. Agencies, in such cases knew the families for considerable periods. The common themes that emerged in areas of neglect concerned (a) the failures of individual agencies to possess complete pictures of families, situations, and records, (b) agency tendencies to respond reactively, (c) resigned acceptance of otherwise unacceptable standards of care (d) failure to make direct contact with children and (d) not taking children seriously, when they try to tell agency representatives about their situations.

An important message that arose from one of the reviews related to the issue of family support obscuring the need for child protection. It also was felt that (a) agencies should be more alert to the possibility of unintentional collusion by professionals in the continual abuse of children and that (b) decisive action needed to be taken when evidence of change with regard to circumstances of children was insufficient. The evaluation also takes note of poor record keeping, especially in the case of schools. Schools, in more than 60% of the cases, did not have comprehensive records, either of families of children, or of their attendance or non attendance.

The Lord Laming Report on The Protection of Children in England, 2009, also makes a number of negative observations about management skills, leadership, and quality of decision making in the agencies responsible for directly and indirectly safeguarding children. Laming The report specifically calls upon the relevant Cabinet Subcommittee to ensure the adoption of comprehensive and collaborative national strategies for delivery of local strategies by all government departments involved in safety of children. The report calls upon Directors of Children Services, senior service managers, police area commanders and chief executives of PCTs to frequently review referrals in cases concerning the safety of children and ensure a sound approach in terms of multi-agency working, risk assessment, onward referral and decision making. DCSs without direct experience in protecting children are required to appoint senior managers with required skills and experience.

The Laming Report further calls for effective leadership at the national, regional and local level in involved public agencies in order to provide the support or expertise required for adequate child protection. It places great emphasis on the role of the Directors of Children Services in protecting children and places the onus of responsibility squarely on their shoulders.

“The time is long past when the most junior employee should carry the heaviest burden of accountability. The performance and effectiveness of the most senior managers in each of these services should be assessed against the quality of the outcomes for the most vulnerable children and young people.” (Laming, 2009)

Managers, the report says, need to lead from the front and take personal interest in delivery of frontline services. They need to ensure that the stipulations regarding referral and assessment in “working together to safeguard children” are being adhered to comprehensively. Managers are also called upon to ensure that communication, information sharing and decision making between the local services and within each local service are capable of keeping children safe, even in times of pressure. They should value and support frontline managers, ensure rigorous management control of decision making and improve and shorten communication lines between senior managers and child protection staff.

Management and Decision Making Issues in Public Service Agencies

Study and analysis of the material available in serious case reviews reveals a number of issues of concern.

At one level the concerns of policy makers, individual experts and monitoring agencies like Ofsted are very obvious. Such concerns have led to the enactment of child protection law and to the introduction of nationwide policies within the overall ambit of the Every Child Matters programme; which work towards ensuring the safety of children through the combined multidisciplinary efforts of the education, health, police and social services. Changes in attitudes towards increasing the effectiveness of working of government agencies have resulted in the introduction of managerialism and much stronger accountability among the executives and staff of these agencies. Structures have been put in place and procedures introduced to ensure better coordination and closer involvement between different agencies in delivery of services in various areas related to child protection. Members of the NHS, individual GPs, managements of schools, and members of the social services have repeatedly been told about and are aware of their need to work together, and take proactive steps on their own, without waiting for instructions or approval in any circumstance where the safety of a child has come or can come under threat. The extent of media discussion and public outrage that followed the deaths of James Bulger, Victoria Climbie and Baby P indicates the expectations of the nation from these services, with regard to protection of children and vulnerable young adults.

The continuance of brutality and abuse towards children, resulting in injury and death, despite the introduction and implementation of numerous multi-dimensional and holistic measures, whilst being a matter of concern, primarily points to ineffective management and decision making at the level of service delivery in these various organisations.

The key learning that emerges from the serious case reviews relates to (a) basic lack of understanding in agencies regarding the signs and symptoms of child abuse, (b) under establishment of meaningful contact with the children at threat, (c) credence to the views expressed by parents, (d) inability to counter the engineered hostility of parents, (e) poor quality assessments, (e) inadequate coordination between critical services like the police, the NHS, and schools with social services, (f) a high degree of management oversight, (g) the tendency of managers to ignore the larger picture and react to specific situations, (h) poor assessment and planning, (i) lack of alertness to the possibility of unintentional collusion by professionals in the continuance of abuse on children and (j) absence of decisive action in the presence of evidence relating to abuse of children.

Lord Laming, in his comprehensive report also takes up the issue of management at the agency level very strongly. His comments indicate (a) the need for recruitment and retention of workers engaged in child protection, (b) undue emphasis on targets and processes, (c) bureaucratic, lengthy, and over complicated tick-box methods for assessment, (d) lack of coordination between different agencies responsible for child protection, (e) inadequate training and support for frontline workers in the police, social services and health care, (f) poor staff morale, (g) inadequate and low quality supervision, (h) high workloads and (i) the need for some resource augmentation, both in the police and in the social services.

Such circumstances are exceedingly common in poorly managed organisations in the private sector, and are also reflective of many adequately resourced but inefficiently managed public sector organisations. Whilst sustained poor management in private business firms mostly leads to economic losses and organisational closure, similar situations in publicly funded government enterprises or agencies lead to continued inefficiency and poor product and service quality. Such situations in public service organisations entrusted with vitally important responsibilities can have literally tragic consequences; as is seen by the continuance of episodes of child brutality and child deaths. The continuance of such a situation is also absolutely unacceptable. Lord Laming, in a candid aside, remarks that he has often been tempted to tell managers of ineffective agencies to “just do it”, even whilst realising that such impatience was unlikely to lead to any constructive results. Laming

The essence of management, both in the private and public sector lies in the making and in the quality of decisions by organisational managers. Managers in the course of their work are continuously required to assess alternatives and take decisions, on a broad range of issues, which can have both long and short term implications. Strategy, Proctor

Extant management literature is awash with different decision making styles, which range from immediate and instinctive reactions to the use of complex statistical models and decision trees. Whilst decision making involves consideration of numerous factors, it is also subject to the influence of different obvious and latent forces. It involves both quantitative and qualitative analysis, even as it is affected by rational (objective) judgement and non-rational (subjective) factors like organisational environment and culture. Numerous subjective issues like the personality of decision makers, relationships of decision makers with other organisational members, peer pressure, expectations of seniors and juniors and personal agendas of decision makers influence decisions. Individuals engaged in social services are additionally bound to act in accordance with clear and strong codes of ethics and against oppression and discrimination. Professionals in other services that are associated with child protection, like schools, health services and the police are also influenced and controlled by their particular codes of conduct, their professional ethics, and their organisational norms. Decision making in such environments, which are likely to be chaotic rather than stable is essentially a complex issue and obviously subject to various degrees of success. Sources on Decision Making

Whilst the possibility of decisions being wrong is normal in all human situations, the possibility of extremely unfortunate consequences of wrong decisions in areas of child safety make the institutionalisation of sound, rational and essentially ethical decision making processes in concerned necessary. Peter Drucker identifies eight decision making practices followed by successful executives

“Ask “What needs to be done?” Ask “What is right for the enterprise?” Develop action plans Take responsibility for decisions Take responsibility for communicating Focus on opportunities rather than problems Run productive meetings Think and say “we” rather than “I” (Decisionaˆ¦, 2010) Drucker

Drucker’s suggestions go to the heart of the decision making process with fundamental questions on the need for the decision, followed by creation of focus on areas of improvement, rather than on problems, the development of collective action, and finally the need for responsibility and communication.

Ralph Keeney (1998), states that decision making failures often occur because of decision makers tending to consider too few alternatives in their decision making process. Decision makers, Keeney states, need to assess their problems carefully and decide upon objectives by questioning goals, objectives, aspirations, interests and fears. They also need to carefully assess the consequences of different alternatives before choosing routes of action. Modern day managers are told to devise different alternatives through imagining of different options and use of brainstorming techniques.

Limitations in Decision Making Practices of Managers of PSOs

Managers in business settings tend to look at issues differently from those engaged in public service organisations. They have