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Drawing on research and theory critically discuss the effects on young children’s health and wellbeing of being poor in a rich country such as the UK. How can such health inequalities be addressed?

The health and wellbeing of children within the UK has become a controversial topic amongst policy makers, due to the major health inequalities surrounding children in the UK. A report submitted by the Department of Health (1980) concludes that on the whole, health within the UK has improved since the introduction of the welfare state; however there is still widespread health inequality which has resulted in a vast number of children living in poverty.

Poverty is defined as a circumstance characterised by severe deprivation of basic human needs, including food, safe drinking water, sanitation facilities, health, shelter and access to education and information. (United Nations, 1995) Poverty has further been defined in literature in terms of relative and absolute poverty. Relative poverty is where individuals are living in a rich country such as the UK, where there are higher minimum standards which no individual should fall below. These standards should continue to rise as the country expands economically. On a higher scale, the concept of absolute poverty includes anyone deemed to be living below the minimum standards of the above essentials. It is important that individuals do not fall below this standard as it can have devastating consequences. Although poverty has numerous definitions, it must be remembered that child poverty is the poor circumstances experienced throughout the duration of childhood by children and young people. It differs from adult poverty due to the diverse causes and effects. The impact it has on children during childhood can be everlasting. (CHIP, 2004;UNDP, 2004).

Social exclusion is where families have limited access to good health, adequate diet, the ability to participate in the community (Smith 1990). In this sense, poverty and social exclusion are directly related, since families living in poverty often do not have access to the above necessities. The health statuses of various groups of people are dependent upon numerous factors, one which is social status. A person’s social status is almost directly related to the person’s health and social group that they belong to, thus has a potential effect on the health and life chances that one may encounter. Categorically, socio-economic groups in the community vary from the high class to the working class, with geographical location being a primary factor. For example in Britain, those that live in affluent areas are more likely to live a healthier and more productive life than those who live in a deprived location on a low income. The social status element has broadened the gap between communities, allowing poverty to continue to dominate the lives of children. Children are vulnerable to deprivation; even when it is only for a short period in their lives. It can still have long term implications on their growth.

I aim to critically discuss these effects and look at ways in which health inequalities can be addressed.

Childhood is a very vulnerable stage for children, as they are dependent on their parents or guardians to fulfil their needs. Children require basic resources and services to develop mentally, physically and emotionally. To develop into a healthy adult, necessary requirements include educational facilities, vaccinations, healthcare, security, nutrition, clean water, and a supportive environment. Due to their sensitivity during this “critical stage of life, children are particularly vulnerable to exploitation and abuse” (CHIP, 2004: pg. 2).

Furthermore, children living in poverty face numerous deprivations of their rights: survival, health and nutrition, education, participation, and protection from harm, exploitation and discrimination. “Over 1 billion children are severely deprived of at least one of the essential goods and services they require to survive, grow and develop” (UNICEF,2005b: pg. 15)

Children growing up in poverty are more likely to experience emotional and behavioural problems both of which have a negative effect on their wellbeing. Additionally most problems encountered throughout childhood continue into the adolescents and adulthood years. Antisocial behaviour can be due to cultural and social factors which can have an immense influence on the individual. Living in inadequate and overcrowded housing conditions on estates which are associated with crime increases these risks.

Bronfenbrenner’s ecological theory suggests that human behavioural development is shaped by one’s environment. The theory acknowledges that a child affects as well is affected by the settings in which they spend time in. The time spent by children in negative surroundings will have a detrimental effect on their personal behaviour. He states that as the child develops, the interaction and relationships formed with others around them become more complex, and that this would continue to arise whilst the child’s physical and cognitive formation was to grow and mature. A study conducted by Clark in 1996 found that children suffer socially from frequently being re-housed in to more affordable housing. These children felt that they lacked stable friendships and had difficulty forming friendships due to the frequent school changes, schools hence became a place of social deprivation rather than a place where friends could be gained. Moreover, Oppenheim (1996) and Dunn (2000) both argue that children feel excluded because they cannot afford to socialise with their peers leaving them segregated from those around them.

Furthermore Smith (1995) indicates that failure to fit in with their peers’ results in profound effects on children’s behaviour. Blackburn (1991) goes on to argue that poverty affects psychological and behavioural processes which diminish life choices. This can lead to increased feelings of powerlessness and low self esteem as a result. In some cases this can cause the individual to form coping strategies which include alcohol or illegal drugs.

Gilman et al (2003) highlights that childhood adversity extensively increases the risk of depression, as well as long term negative effects on children’s health and wellbeing. The health and well-being of children is interrelated to the quality of housing, the appropriateness of the location and affordability. Housing is a key component of both the physical and social environments in which children are exposed to, and plays a direct and indirect role in the achievement of positive development. A study undertaken by the Board of Science 2003 found that stable, safe and secure housing is a fundamental aspect in the healthy development of a child (Board of Science and Education, 2003). Faulty structure and inadequate facilities, for example heating, can cause accidental injuries (English House Condition Survey (EHCS), 1996). Factors affecting the health of children include the cost, quality, occupancy and the stability of the housing, along with the neighbourhood environment in which the child resides. Moreover, affordable accommodation for poverty-stricken families is frequently restricted to housing with substandard physical properties (Dunn, 2000), and is often in surroundings with socio-environmental problems which provide further disadvantages to physical and psychological well-being. Potvin et al (2002) argues that the housing tends to be in specific locations, resulting in segregation of low-income communities, when combined with poor access to employment opportunity, this can lead to socially deprived neighbourhoods. Klitzman et al (2005) confirms that these neighbourhoods are inclined to be unsafe, with limited access to essential facilities and services. This inevitably leaves fewer opportunities for social integration, and also poses health risks to the community, particularly for the vulnerable groups, residing within these environments.

Curtis 2004 argues that inadequate housing may further influence individuals’ health and mental well-being through increasing their level of stress. This can put a tremendous strain on a child, as the child distinguishes the atmosphere within the home as being depressing. He goes on to acknowledge that crowded living conditions can result in easier transmission of infectious diseases i.e. tuberculosis and increases the likelihood of acquiring respiratory illnesses such as asthma and bronchitis particularly if family members are smokers. Excessive noise levels also result in sleep deprivation, which can affect the growth and psychological wellbeing of a child, as they may experience tiredness and low energy levels whilst at school, which would lead to poor concentration. Similarly this can also have adverse affects on adults and children alike and lead to negative psychological effects, including aggression, depression, irritability, and frustration with others in the family. This is reported to contribute to family issues and potential violence. (Curtis, 2004)..

The English House Condition Survey confirmed that 1,522,000 UK residences did not meet the mandatory standards set (EHCS, 1996). For many deprived communities, the only housing available is unsatisfactory. The World Health Organisation (WHO) advocates that, during the cold weather, the average room temperature should remain at a constant 18-20C (WHO, 2005). However, in the EHCS survey it was estimated that 40% of the UK population resides in temperatures below these guidelines. 19% of housing in the UK is cold, and damp compared to the 9% recorded in Germany (EHCS, 1996). Despite specific measures adopted by local governments, housing policies continued to remain inadequate in many regions. For example, insulation of properties is a major government initiative at present. This is recognised as a cost effective intervention that could increase room temperatures whilst decreasing fuel costs for poverty-stricken families. However, The Warm Front scheme, which provides funding for insulation, is not available to pregnant women and young children, unless they are in receipt of specific social security benefits. Despite repeated evidence of the effects of poor housing, and associated lack of heating, public health interventions remain insufficient.

Economical accommodation for poorer families can be excessively expensive, and the payment of rent or mortgage costs can result in minimal disposable income for fuel, food and other basic necessities (EHCS, 1996). Obesity is a known health issue associated with poverty; a consequence of low incomes and inexpensive inferior foods, which result in high fat and high salt diets. Consequently, it has been determined that people with serious health issues are more likely to occupy the least health-promoting segment of the housing market, which in turn, aggravates health problems.

Children born into poor circumstances also tend to have fewer educational opportunities than children are born into families where parents have been educated, or there is more disposable income available in the household. Hetherington et al (1991) argues that poor parents find it increasingly difficult to provide intellectual, stimulating tools or resources, such as toys, books, and technologically advanced equipment to their children. The complexity of their circumstances also prevents them from increasing the child’s opportunity of receiving a pre-school education, giving them the opportunity of a positive foundation which is essential during the ‘critical period’ of learning and development. Failure to attend pre-school can result in low academic attainment at a later stage. (www.surestart.gov.uk) Furthermore, since many social peer relationships form during the early years, children who do not have these experiences tend to lack confidence and self-esteem (Hetherington et al (1991), When placed within the classroom environment at an older age, these children are more likely to choose to remain segregated rather than participate within class discussion as they feel stigmatised due to the life they lead and have poor confidence when interacting with their peers. They feel that children that live in affluent areas have greater confidence and should be the speakers.

In the mid 1990s, there was an extremely high rate of relative child poverty in Europe, and the UK at present still has a high rate of poverty and the worst birth weight in deprived areas in comparison to any other Western European country (Sandwell-Smith, 2003). Therefore in 1999, Prime Minister Tony Blair made a pledge to eradicate child poverty by 2020, halving it by 2010, and making a difference by 25% in 2005. In order to do this, several changes were put into place such as the implementation of a taxation system, changes in benefit eligibility and the way it is paid, the introduction of the tax credits and the investment in children’s services. Around the same time, the Millennium Cohort Study (2000) established that babies being tracked were already showing larger differences in their health status at the age of three, according to their family conditions. Among children in families with income below ?10,000 a year, 4.2% suffered chronic illnesses at this age, compared to just 1.7% among wealthy families on over ?52,000. This significant difference highlights the importance of living above the poverty line. Such evidence has paved the way for numerous Government initiatives that attempt to close the gap on health inequalities in the UK.

According to the UK’s statement to the United Nations General Assembly Special Session on Children in 2002, the UK is restructuring the machinery of government to put the welfare of children and young people at the heart of policies and services, to ensure that children’s and young peoples voices shape the priorities and practices of the government, and to bring together the government, the voluntary sector, businesses, local communities and families with a vision for young people. (United Nations 2002)

Ten years on research shows that the government still holds a strong will to tackle child poverty and has always had it on the agenda, and is continuing to be a key aspect in the battle against child poverty. In a response to the recent release of poverty figures, the government insisted that the ?1 billion already committed in this years budget with help to lift a further 250,000 children out of poverty, however they believe an additional ?3 billion will be needed to invest in tax credits and benefits in order to meet the 2010 target set by former prime minister Tony Blair. (End Child Poverty HBAI Report 2008).However in a policy briefing on education and child poverty released in March 2008, The Child Poverty Action Group (CPAG) condemned the government for not addressing this issue properly and claimed that the educational gap between disadvantaged children and their peers would continue to increase and that part costs incurred should be claimed through local charging polices ( End Child Poverty 2008).

Although some of the government’s policies and strategies have not achieved their full potential there is still room for improvement with the ideas already formed. This can only take place if there is a major transformation in the way policy makers address the issue and implement strategies. For example the existing tax credits system consists of a working element for parents who are on a low income and a child based element on the number of children under the age of eighteen in full time education. This currently needs to be reviewed and updated; the combined value of child tax credit and child benefit needs to be increased in line with inflation and earnings. The reformation on the administration of tax credits and benefits is also essential as in previous years there has been discrepancies on the amounts paid and the overpayment of these allowances.(www.hmrc.gov.uk)

In conjunction with the above, the benefit entitlement system needs to be reassessed for all UK residents irrespective of immigration status as at present those that are not UK nationals are not entitled to specific benefits.

Another significant aspect is that the government has made various attempts to work towards creating more jobs, and getting people off benefits into work however; it needs to be that the jobs created are enhanced and beneficial, financially for those that are qualified and have the relevant experience.(www.jobcentre.plus.gov.uk)

Conclusion:

There is conclusive evidence that living standards and housing conditions are interrelated and poor socio-economic situations during childhood negatively influence the health status once a child reaches adulthood. The exposure of the young to these situations contributes to long-term ill health. This is worsened due to diminished immune systems and the greater exposure to negative environments which they have little or no control over. (Klitzman, et. al., 2005). Insufficient facilities and the overcrowding of properties are very much a major concern with infectious disease, while damp and mould can cause various respiratory problems (Bornehag, et. al., 2005). Nevertheless, the debate around housing and health and wellbeing is inclined to be concerned with the discourse of poverty. (Dunn, 2000). However, looking at research there seems to be much less consideration of the indirect effects of poor housing upon health, such as social exclusion (Curtis, 2004) and depression, and psycho-social effects are repeatedly overlooked. Moreover in recent years, socio-economic determinants of health have returned to policy debates, and housing conditions are, once again, recognized as a critical influence upon public health (Board of Science and Education, 2003). Recent studies have shifted focus in the direction of a broader-ranging perspective with regard to poverty, and health and quality of life, which presents the possibilities of enhanced understandings of the determinants of health status.

The General Assembly of the United Nations 1948 states that everyone has the right to a standard of living sufficient for the health and wellbeing of himself and his family. This Includes food, clothing, housing and medical care.

As with many health determinants, the quality of housing is directly related to income. Trying to reduce these adverse effects of poor accommodation remains a major challenge. Health inequalities are not reducing in the UK, and the worst health is experienced by those who are most socially and economically deprived (Stanwell-Smith, 2003). As in the nineteenth century, there is a profound need for a rigorous public health reform. Essential to this must be enhanced living standards and prevention of ill health, so as not to become trapped in the inevitable cycle of poverty many children still find themselves in today.

Although the government has evidently reaffirmed its commitment to meeting its child poverty targets, and has developed both the organisational competence and the political drive to do so, there still seems to be a vast majority of children living in poverty and it is highly unlikely that the 2010 target is to be met, based on current spending levels. However it is not too late to improve the strategies enforced to provide a healthier future for the children who will be the new generation of the workforce for years to come.

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Social policy incorporates the provision of basic services – healthcare, education, water and sanitation and other and social protection. Social security includes three principle parts: social insurance, social assistances, labour market intervention and community based or informal social protection. Social protection covers contributory projects covering life course and work-related contingencies. Social assistance contains tax financed programmes managed by government agencies and addressing deprivation and poverty. In the labour market it provide active and passive labour market policies securing basic rights while enhancing the employability.

1. Social assistance

There are various diversity in designs of social assistance in developing and developed countries. In developed countries social assistance depends on an income maintenance design, and providing income transfers that aimed at filling in the poverty gap.

In developing countries, it includes a variety of programme design, including pure income transfers as in non-contributory pensions or child grants and allowances; income transfers combined with asset accumulation and protection as in human development conditional transfer programmes or guaranteed employment schemes; and integrated anti-poverty programmes covering a range of poverty dimensions and addressing social exclusion There is also diversity in scale, scope and institutionalisation in social assistance across countries, and across programmes within countries. (Pellissery, Barrientos, 2013)

Various social assistance whether cash transfer or employment or kind etc. is being implemented around the globe. The efficacy of the policy and programme depends upon the implementation and the impact that it create on the society, I this view the later part describe about the various form of social protection either promotive, protective, preventive or transformative.

1.1 Cash transfers

“Although cash transfers are not a panacea, they have been demonstrably effective and are seen as a viable mechanism in both developmental and humanitarian contexts. Conditional Cash Transfer (CCTs), implemented in Latin America with great success, are seen to be a way of mitigating the risk of cash transfers being misused. CCTs yield rapid, positive impacts (poverty alleviation, improved health and education outcomes) and break the ‘vicious cycle’ of intergenerational poverty in the long-term. However, CCTs are criticised for having high administrative, monitoring and enforcement costs, being too reliant on targeting, having a disempowering effect on recipients and negatively affecting overall levels of consumption amongst both beneficiaries and non-beneficiaries.” (Scott, 2012)

1.2 Cash transfers in emergencies

Cash transfer can be effective during emergency or crisis while offering a protective mechanism which has immediate effect on the person through various means either innovative like mobile banking etc or tradition by cash in hand or in bank. It support when the formal institution of protection is failed and there is no other alternative for social protection.

1.3 Social Pensions

It is a non-contributory pension which include a targeted cash transfer by age or widow or people with disability. Various study shows that the cash transfer in the context of social pension gave confidence and support to the targeted person or household. In general the literature suggests that social pensions have been employed particularly successfully in southern African context.

1.4 Public works programmes

It is a type of conditional transfer where cash or food is given in exchange for work on public infrastructure projects, such as road building. During recent times these social protection measure is widely applied around the globe due to consequence of food and financial crisis. This measure create assets, produce jobs and somehow targeted as it be unattractive to the non-poor due to low wages or ration are paid. Though the sustainability of this measure is till when the state is willing to provide because it creates a dependency on state. Available study indicate that while short term public works create and promote consumption and demand during the market failure but the long-term social protection function is likely to be limited unless guaranteed employment is introduced.

1.5 In-kind transfers

“In-kind transfer’s non-cash assets went to vulnerable or deprived individuals and households, often with the aim of modifying or influencing the behaviour of recipients. There is considerable debate over whether in-kind transfers should be favoured over cash transfers, despite the latter being popular for providing beneficiaries with choice in accordance with needs, as well as providing an opportunity for investment”. (Zoe Scott, 2012)

1.6 Food

There has been numerous debate on food vs cash transfer around the globe since and prior to 1970s, on whether food transfer can be used as an alternative to cash or both are complementary to each other, whether food transfers are a nutritional or economic intervention, whether they aim to only ‘feed people’ or aim to support livelihoods.

It has been thought that when there will be food crisis either by market failure or shortage due to lack of supply, or there be a crisis when food are needed, food transfer are preferable, beside other protective measure.

1.7 Utility subsidies

Protection in the form of utility such as housing, electricity and water are provided to lessen the burden of expenditure on these items by people, though despite having the provision of Indira awas yojana along with various scheme, it has been widely accepted that the benefits of utility subsidy doesn’t reach the target people or communities living in an area withought electricity and water. It has been seen as more costly to implement than other form of social assistance. Despite being costly housing subsidy runs with less risks of excluding the most vulnerable.

1.8 Health fee waivers

There is large debate going on Universal health care and targeted health care. One provide a system through which everyone are eligible for health care while contributing up to the fiscal budget whereas targeted has its own flaw of selection and implementation and reach to the targeted people. Though it has been inferred that health service waivers or health fee waiver or exemptions will only be effective if there would be a nationwide policy which effectively monitored and enforced at local and national levels

1.9 In India context

In India the introduction of social assistance were introduced since the British period but it was only for the employee in formal sector and a large portion of population, those who were employed in informal sector were excluded from this. And again after independence until the 1990s the main focus of central government were rural development and social protection didn’t get much attention. There were many rural development program such as integrated rural development program or anti-poverty program, which aimed to provide food and nutrition, basic services like education, healthcare, and housing and employment generation came. In meantime many state introduced various program such as +pension for agricultural landless labourer, maternity benefits, disability benefit etc. depending upon the need but very often these program were introduced as electoral instruments to gain votes. It is important to notice the welfare regime in India could be classified as clientelist or populist.

In the last two decades, there has been a reversal of the story.” The central government has enacted a number of social assistance measures by enacting court enforceable right-based promises to the erstwhile directive principles (such as right to education, right to employment and others) enshrined in the Constitution of India. From the point view of social assistance, three developments are important. First, in 1995 the central government introduced the National Social Assistance Programme (NSAP) under which five different benefits were provided. They complemented existing provision by federal states. These benefits were the Old-Age Pension Scheme (reaching 8.3% of elderly households), Widow Pension Scheme (6.2% of widow households), Disability Pension Scheme (reaching 14.1% of disabled households), Family Benefit Scheme (onetime relief for the families where main breadwinner accidently died) and Annapurna (food for the elderly households” (Pellissery, Barrientos, 2013)

The second and third development took place when the Congress Party-headed United Progressive Alliance government assumed power in 2004. A clamour for food security were supported by civil society movement along with right to employment boost the fillip of decade in the context of social protection. Later the UPA government put forth the social security program for unorganised sector workers, Rashtriya Swasthya Bima Yojana, designed particularly for the workforce in the unorganised sector. That has already provided insurance against hospitalisation to 40 million households. Along with other social protection scheme or program there come various rights which insures social security but the reality seems different. One of the most interesting and effective social assisistance in the developing world is the Brazil’s Bolsa Familia. The Brazilian constitution enshrined a right to social protection and that led to consideration on the role and scope of social security and on the role of government to providing it is based on the citizenship principle and for all Brazzilians.

2. Social insurance

.“Social insurance schemes are contributory programmes in which beneficiaries make regular financial contributions in order to join a scheme that will reduce risk in the event of a shock. Because health costs can be very high, health insurance schemes are a popular way of mitigating risk from illness. However, some people argue that they are too expensive for the

Poor and should be complemented with social assistance. Other types of social insurance schemes include contributory pensions, unemployment insurance, funeral assistance and disaster insurance. Social insurance is strongly linked to the formalised labour market, meaning that coverage is determined by number of formal workers in a country. The informal labour market therefore presents a strong challenge to the success of social insurance programmes”. (Scott, 2012)

3. Labour market interventions

Labour market interventions give protection to poor people who are able to work. Interventions are both active and passive. The active programmes or policy in the context of social protection include training and skills development and employment counselling, whereas passive interventions include, income support, unemployment insurance and changes to labour legislation, for example in Establishing a safe working conditions or minimum wage. Labour market social protection provide various social assistance and cash transfer programmes and can be integrated into longer-term development strategies

4. Community-based social protection

Formal social protection framework do not offer complete coverage and exclude a section of society. “A variety of conventional or ‘informal’ ways of providing social protection to households, groups and networks fill some of the gaps left by formal social protection interventions and distribute risk within a community. There is also considerable interest in the potential for community-based mechanisms to be scaled up in order to undertake wider development activities, and in how to create links between social security schemes and community-based approaches with the aim of extending coverage to meet the challenge of providing adequate health services to the developing world.” (Zoe Scott, 2012)

2. Residual and institutional social welfare

Residual idea of social welfare says in the distribution of social welfare, government should have a limited role. The underlying assumption is that the individual is free to do anything unless it doesn’t harm other and majority of population will find their sustenance and assistance by their own, either by market mechanism, family or social network. So the state only intervene when they fail to support themselves and unable to find any support system. Whereas the institution school of thought describe state as protecting individuals from the social cost of capitalist economy.

does Social protection a residual social welfare

The “Directive Principles” of the Constitution give obligation to the government and its policy to lay down goals and direction for the realisation of the rights. Article 41, 45 and 47 gave a sense of social protection but for the nuanced understanding of the rights and its realisation we have to look at the reality of its content and implementation.

Article 41. which directs the state to “within the limits of its economic capacity and development, make effective provision for securing the right to work, to education and to public assistance in cases of unemployment, old age, sickness and disablement, and in other cases of undeserved want”;

Article 45. by which “the State shall endeavour to provide, within a period of ten years from the commencement of this Constitution, for free and compulsory education for all children.”

Article 47. by which “the State shall regard the raising of the level of nutrition and the standard of living of its people and the improvement of public health as among its primary duties. (Constitution of India, ministry of law and justice)

Society exist because it is in everyone interest to have peace and peace can only prevail if there is sovereign authority to punish those who breach it. There are various indication and updates about the failure of government machinery in india.in the context of social protection the policies and programme that are intended to reach the beneficiary doesn’t reach to them and in the lack of proper institution mechanism the policy itself became a residual in approach. Be it old age pension scheme or MGNREGA. The dominant logic is that the poor are the ward of the state and the state have the responsibility of taking care of its citizen especially poor. But the other school of thought says that the bigger the size of government the larger the burden on the populace. The more government subsidies the resources for the poor the more likely to vulnerability during the failure of support system by the state because of their dependency on the state.

A key challenge faced at the time of introduction of all social assistance programme is from the right-wing that social assistance expenditure is both ineffective and wasteful. What been effective to counter such a position has been the discourse on inequality? The growth story of India has widened inequality rather than bridge the gap. Therefore, introduction of social assistance was seen as helping to act as an inclusive instrument for the poorer sections. Pellissery, Barrientos, 2013). The presence of institutional mechanism but the delivery of services create an atmosphere where the social protection turn up as just a residual kind of thing to the people.

There are around 300 different type of anti-poverty scheme in India that is spread over 13 different ministries. But the integration among them is hardly seen visible. In the name of financial inclusion the still “Krishna get the credit but nobody think about Sudama”. The millennium development goal vow for eradicating poverty but still some part of the globe still suffering from hunger and malnutrition and chronic poverty

Motivation is an intangible human asset which acts as a driver that pushes humans to be willing to perform certain actions. In just about everything we do there is something that moves us to perform the action which involves some motivation allowing us to perform tasks or actions which produces some type of personal benefit as a result. The general theory would be that, the greater the personal gain in performing the task for the individual, the more motivated they are to try at the task to achieve the best outcome. Motivation is usually stimulated by a want where there is a gain to be had as a result of performing a certain task. As Todes, McKinney, Ferguson, Jr. (1977) p.223 states, ‘A person is a wanting being – he always wants, and he wants more.’ Therefore if there is nothing that an individual wants, there would be no need for them to perform a certain task as there is nothing they can gain from it. Over time there have been many motivational theories developed to try and explore what motivation is and how different levels of motivation can be achieved with different inputs. Two of the most widely recognised motivational theories come from Abraham Maslow (hierarchy of needs) and Fredrick Herzberg (two factor theory). Managers in businesses would use these theories in an attempt to motivate staff to provide them with job satisfaction and in return receive better task performance.

Through extensive research Maslow and Herzberg developed their own theories which are now used in businesses all around the world. Both differ in how they are applied but in the modern world they are ‘seen as being totally true by many although they should be perceived as being an interesting problematic set of observations about what motivates people’ (Finchman & Rhodes, 2005) p.199. This is due to the lack of evidence to say that they are completely true despite applying to the overall majority. Each is very similar in the way that there are certain requirements that must be fulfilled before high levels of motivation can be obtained.

Abraham Maslow sets out a ‘hierarchy of importance’ where human needs are arranged in a series of levels (Todes et al. 1977). Like Herzberg’s two factor theory, the needs in Maslow’s hierarchy can be split into two levels. The first set being the basic needs, contain physiological and safety needs. The second set can be seen as the motivators consisting of social, esteem and self actualizing needs. In comparison to Herzberg, basic needs would be the equivalent of hygiene needs consisting of: salary, colleagues, supervision, policies and environment. Herzberg’s second set (motivators) includes: recognition, promotion, achievement, responsibility and intrinsic job aspects, all of which are individually quite self-explanatory and fairly interlinked (Finchman & Rhodes, 2005). As the structure of Maslow’s hierarchy suggests, the higher motivators are harder to achieve than the previous and there is an order to which they must be acquired. If the previous motivator has not been reasonably satisfied then there will be no desire to try and obtain the next. The physiological needs ‘are reflected in the human need to eat, breathe, rest, drink and engage in active endeavors’ (Todes et al. 1977) p.244. These needs can be seen as essentials for survival making it logical to be place at the bottom of the hierarchy and as the lowest motivator (Todes et al. 1977). Safety needs come in the form of feeling secure in the job that you have which means that there is a requirement of: shelter, a strong feeling of job security and as Todes et al. (1977) states, a need for protection against physical dangers along with the need to earn a fair salary that can satisfy a given standard of living which is an element in Herzberg’s list of hygiene factors. A manager would be able to fulfill the basic needs by giving suitable amount of time for breaks in which the physiological needs can be easily met. Safety would derive from supervision and policies of the company where they act as a guide, helping the employee’s progress giving them a feeling of being well supported. The environment that they work in would also help with employees feeling safe as long as there is the avoidance of physical dangers. Also there is the conflict of whether or not salary is a motivator. Managers may think that employees would work harder for a raise whereas others believe it is ineffective. Although necessary, hence it being placed in the hygiene factors and incorporated in the safety needs, it is not a motivator. The reason for this may be that although one receives more money for what they do, they will not necessarily work harder having acquired the raise. This therefore links salary to the motivator, promotion which would be the reason for why there is a sudden increase in an individuals income.

The motivators, beginning with social needs, (Maslow’s third need which could be seen as being at the base of the motivational hierarchy) cannot be achieved unless the basic needs prior to it are in place and adequately satisfied. Social needs can be seen as the desire for interaction, acceptance and a sense of belonging with associates and personal acquaintances (Todes et al. 1977. With Herzberg, it can be argued that the social motivator is split between both the categorical factors contradicting Maslow’s perception of it. As the hygiene factors of colleagues and to an extent, supervision, fulfill the social need for interaction, the motivator recognition would lead to meeting the need for acceptance and belonging. Herzberg’s motivator of recognition combined with promotion, responsibility and perhaps achievement would also be linked with Maslow’s fourth need, esteem. This, a more personal, perhaps egotistical need, is much harder for a manager to incorporate into the working environment due to ‘the managerial trend of reducing most jobs to their lowest level of job content’ (Todes et al. 1977). Being noticed for good performance through praise and recognition, which could lead to the achievement of a promotion where responsibility is increased, can all be contributors towards fulfilling esteem but never effectively satisfying it entirely. Even if it does, it will only be temporarily and perhaps not enough for the peak need of self-actualisation to start being met. It therefore acts as a constant motivator to work harder or continue working to meet the higher needs (Finchman & Rhodes 1977).

Self-actualization is where an individual grows towards a firm understanding of their abilities and utilises these skills at an optimum level (McGregor. 1964). This final need however, is rarely met, hence it being at the top of the hierarchy as the idea of: as you progress up the hierarchy, the peak of each need that must be passed is higher than the need before it. Not only is this an important factor, there is also the requirement that the previous needs, although less dominant in focus, must remain active and acceptably satisfied before the next factor can be of any interest to the individual (Krech, Crutchfield & Ballachey cited in Todes et al. 1977). Due to this and the general fact that self-esteem is satisfied in small quantities and not regularly, it does not make acquiring self-actualization an easy task due to the previously described theory rule. Although Herzberg’s theory operates similarly, there is not as strict an order to follow as to whether a specific factor must be met before another one can become of any interest other than working on the basis that all hygiene factors must be adequately satisfied before any motivators can begin to be of any relevance to the individual. In this aspect the model is more lenient and due to not having a strict order of how they must be met, any factor within their respective categories can be acquired in any order making it easy and ready to be tested. Not only this but each factor is very much interlinked and compliments one another in the way that when one is achieved, other factors can be acquired in quick succession. Managers could then incorporate this into the way that tasks are delegated so that when an employee completes one task they obtain a certain amount of need satisfaction. On the next task performed, more needs could be fulfilled and unknowingly, employees would be progressing through the fulfillment of either Maslow or Herzberg’s needs where they attain either more self-actualisation or job satisfaction.

What needs to be kept in mind is that although the two are very similar, Maslow’s hierarchy can be applied almost any situation with the aim of exploring psychological progression. Whereas Herzberg’s theory outlines more of what factors must be in place before job satisfaction can be achieved relating more specifically to motivation and its impact within the work place (Finchman & Rhodes. 2005). The intrinsic job aspects would be the closest motivator related to personal accomplishment as this need involves the employees feeling that through working they are benefitting and developing as an individual. This therefore means that a manager would need to try and identify which of the two theories they think would be most effective and achievable in developing employee motivation. Do they want their employees to acquire job satisfaction through Herzberg’s motivators or to be self actualizing being more willing to work understanding themselves and what they are capable of. A combination of the two could be possible in Maslow’s basic needs and Herzberg’s hygiene factors but the acquisition of both does not necessarily mean that motivation or job satisfaction would be obtained, it just means that job dissatisfaction would be likely to develop without it (Finchman & Rhodes 2005). Another point to remember is that not all individuals are the same in what they want hence the models not being universally accurate. A situation where either model would not be fully applicable is where one is happy with their current position and the tasks that they perform. As a result of the fulfillment of an unwanted need such as promotion, that particular employee may underperform as they have lost the job satisfaction they had prior to the acquisition of that motivational need. Whereas another who may have wanted such a need would be discouraged due to them not receiving the promotion and as a result de-motivated the employee. As mentioned, everyone is different in their levels of satisfaction and motivational priorities, some of which would be unknown to the individual. Even if known they may not know what to do to obtain them. From this a manager would have to find a way of being able to ‘match the needs of people with appropriate incentives’ (Todes et al. 1977) p.165. Of course for a manager to fulfill all these needs they would have to be able to relate to the motivational needs of the employees beneath them and incorporate them into their strategy so that employees would be able to achieve them through the tasks they perform. As these motivational needs are met, employees may be more motivated to work and unknowingly develop other motivational needs that are fulfilled through the manager’s task setup. A very important factor for a manager to remember according to Finchman & Rhodes (2005) p.266, is that the principle of behaviour that is rewarded tends to be repeated and that which is punished, avoided. From this, it can be seen ‘that managers have a strong ability and influence on their employees behaviour.’

Therefore both motivational theories are not total opposites of each other but are in fact very similar. Both focus on the motivators as being contributors to psychological growth and development (Finchman & Rhodes, 2005). Each has certain requirements which must be met before someone can progress onto achieving motivational needs, such as in Maslow’s case the basic needs and the hygiene needs in Herzberg’s both are seen as being needed to be in place before there can be any progression onto the next set of motivators. This also expresses how both are similarly split into two groups. A big difference would be how Maslow’s theory can apply to any situation but Herzberg’s is more applicable in the workplace and set out in a way that made it easy to prove correct, whereas it was more difficult with the former despite being taught as true (Finchman & Rhodes, 2005). Managers could effectively incorporate the motivational techniques into developmental strategies by designing a work environment where employees would be able to develop personally as they work, in turn they could unknowingly acquire motivation (Todes et al. 1977). This way employees would be more willing to perform their tasks and develop needs encouraging them to work harder, becoming more motivated to meet these new needs. But perhaps the most obvious and important similarity is that although they are taught as being true, a manager would need to keep in mind that they are not. Even though they apply to the majority, different people have different needs and levels of satisfaction therefore either model cannot be totally relied on for a manager to try motivate employees (McGregor. 1964).

Reference List:
Finchman. R & Rhodes. P, Principles Of Organisational Behaviour, 2005 P.199, P.233
McGregor. D, The Professional Manager, 1964 P.11, P.75
Todes. J.L, Mckinney. J, Ferguson Jr. W, Management & Motivation, 1977 P. 165, P. 223-227, P.244

C is a 14 year old boy who has a diagnosis of autistic spectrum disorder and learning disability. C is a very active young boy. His mother is a P.E teacher and has him involved in many outdoor activities. C loves being outdoors and doing practical ‘hands on’ things such as cooking and outdoor activities. Although C is involved in various activities, these are all organised by his family. Mrs F feels that C constantly seeks reassurance when doing tasks etc. She would like to develop his dependence by involving him in activities which are not organised by the family. Furthermore Mrs F felt concerned that if anything were ever to happen to her or her husband, she would like to know that C has some experience within a different type of home care setting. I completed a UNOCINI assessment on C and a carer’s assessment on Mrs F. From that I felt that C would benefit from some time spent apart from the family. After completing the carer’s assessment with Mrs F, I determined that although the main reason for the parents was to develop C’s independence now that he is 14, I felt they would also benefit from these few hours of respite. The need for respite was not initially an issue however when I got Mrs F to think about her caring role and the level of caring responsibilities and how this impacted on her socially and emotionally, she acknowledged that yes, these few hours would act as respite for her as she care for C full-time when she comes home from work on weekdays and at the weekends. This option would help to develop his independence and get him more socially integrated in activities not organised by the family. I also identified two other services called ‘Enable’ and ‘Charis’. The family were informed of these services and given the appropriate information. I left this information with the family so that they could make an informed decision. Mr and Mrs F agreed that they would definitely want to consider the option of the respite unit for C to attend for a few hours every week initially, with the view that they may want to increase this at a later date.

The purpose of this piece of work is to carry out a risk assessment prior to C commencing the rest bite unit. This will need to consider any risks there are with C, how C may behave, what the triggers etc are and how the staff at O can best deal with these risks. Because there are significant behavioural problems with C, the risks are mainly centred around outdoor safety as he has a significant fear of dogs, his dislike of loud noises and consideration of his speech difficulties which will most likely result in communication difficulties. These factors all present risks to C and this meeting is an opportunity for C’s parents, a staff member from the unit, C’s teacher and I to come together, identify the risks, discuss how they are a risk to C and identify the best ways the staff can manage these risks.

Legislation that will guide my practice

As a student social worker I have a duty to practice in a professional and legal manner and it is important that I am aware of the legislation related to disability, which provides the mandate for the intervention.

The Health and Personal Social Services (NI) Order (1972) sets out the role of social workers in Article 4 as having a duty to promote the well being of all the public.

The Chronically Sick & Disabled Persons Act 1978 legally obliges Personal Social Services to disseminate information, assess need, collect and maintain confidential information and provide Social Welfare Services to meet the needs of any person defined as chronically sick and/or disabled. Under this piece of legislation disabled people have the right to live in the community and be provided with appropriate support services. Under section one, authorities have a duty to inform themselves of the number and needs of handicapped persons in their areas and a duty to publicise available services. Section 2 lists various services which should be provided to meet the needs of disabled people including; social work support to families, adaptations to the home and including special equipment, holiday arrangements and meals (Oliver&Sapey, 2006). An opportunity for C to develop his independence has been identified as a need for C. I have enquired into the services available and signposted the family to these services. It is now their decision as to whether they want to avail of them or not.

The Children (NI) Order 1995 is the main piece of legislation associated with the Children’s Disability Unit. This piece of legislation sets out the powers and duties of the Trust in relation to Children in Need and others. The Trust sets out clear assessment procedures for children in need which take account of any special needs. The order outlines that children with a disability will, in many cases, require continuing services throughout their lives therefore the assessment process needs to take account of any special needs and to take a longer perspective than for other children in need. A holistic assessment is needed to determine what is best needed for that child, taking into account the child and family’s strengths, weaknesses and capacities. I have assessed the needs of C and his parents and from that I feel that I strongly feel this service will be of benefit to both C and his parents.

Article 17 (c) defines a ‘child in need’ as a child with a disability; C has a diagnosis of autism and learning disability and therefore is considered a child in need due to this disability. Also I am aware that in accordance with this legislation (Article 17 a & b) I have a responsibility to ensure C achieves or maintains a reasonable standard of development or health through the provision of services. I will bear in mind Article 18 which sets out the trusts duty to support children in need. I had a duty to support C by carrying out an assessment of need which will allowed me to determine what type of support C required. Support may be provided in terms of providing services, signposting, referral to other agencies or the worker may provide emotional support, 1 to 1 work, advice, a listening ear etc. In this instance I have provided the appropriate support through signposting the family to two other services for C and I am in the process of providing them with a respite service.

Within my work with children I am conscious that the welfare of the child is paramount and that this supersedes all else (Article 3 (1). To ensure I achieve this I have knowledge of and will make reference to The Welfare Checklist Article 3 (3) (Children NI Order 1995)

The Disabled Persons Act (NI) 1989 also gives the mandate for the intervention. It gives individuals more control over their lives by providing them with the right to; representation, consultation, assessment, information this I consider to be my role. Carers also have the right to request an assessment and the ability to care is taken into consideration during the assessment process and when decisions are made. The legislation ensures that disabled people have equal opportunities in terms of services amongst other things. I have already completed a carers assessment with Mrs F which indicated that this service would also be of benefit for her as C’s carer.

United Nations Convention on the Rights of the Child (1991) set out for the first time, the rights of the child. Article 2 states, ‘Whereby appropriate measures should be taken to ensure that the child is protected against all forms of discrimination or punishment on the basis of the status, activities, expressed opinions, or beliefs of the child, parents, legal guardians or family member and under article 6 whereby all children have the right to life and to the greatest possible opportunities to develop fully. It is hoped that through C spending some time away from his family, it will develop his independence. Under article 3, whereby in all actions the best interests of the child shall be a primary consideration. In assessing the risks associated with C, we will be able to identify what the risks are, what the level of risk is, are there any triggers, what primary preventative strategies can be used to avoid these behaviors and reactions occurring, what secondary measures should be introduced if the behaviors become apparent, what reactive strategies should be required, specify any unmanaged risks and determine what should be the response following a behavioral incident.

The Human Rights Act 1998 brought the European Convention of Human Rights into domestic law. Human rights are universal legal guarantees protecting individuals and groups against actions and omissions that affect their freedom and human dignity (SHSSB, 2004: 42). Every child has rights under the United Nation Convention on the Rights of the child 1989. Every child has a right to survival, developmental, protection and participation rights. Article 23 of the UNCRC states that a disabled child should enjoy a full and decent life, in conditions which ensure dignity, promote self reliance and facilitate the child’s active participation in the community.

I am mindful that the Data Protection Act (1998) must be adhered to at all times in order to ensure that information is accessed only by people who have a right to access it. This ensures that service user confidentiality is respected and that relevant and accurate information is stored. This legislation safeguards personal data i.e. personal information that is stored on computer and on relevant manual filing systems under eight principles.

Policies and Procedures

It is imperative that as an student of the trust I have knowledge of the Trust Policies and Procedures and how they inform my practice. It is important that I inform Mrs F about the complaints procedure and provide a leaflet advising individuals of how to make a complaint and express their views about the Trust services. It is important for the Trust to have feedback from service users as this enables the Trust to change and improve standards of services were appropriate. Furthermore it is important service users are aware of the confidentiality policy. I will explain to Mrs F that the information discussed within the meeting will be kept confidential.

Theoretical Considerations

Risk became a dominant preoccupation within Western society towards the end of the 20th century, to the point where we are now said to live in a ‘risk society’, with an emphasis on uncertainty, individualization and culpability (Beck, 1992). Social workers frequently have to deal with risk. Obvious examples would be when there are concerns about the safety of children. The process of assessing risk highlights the complexity of the social work role. The fact that decisions have to be made seems to require an element of control in people’s lives and this can cause conflict for some workers. The question often arises about the obvious power imbalance between the worker and the service user and issues can surface around care versus control.

Burke and Cigno (2000) pose the question as to what degree of vulnerability in children reaches the degree of threshold for intervention, and what should be done to minimize the risks to children. These are difficult issues to reconcile. All parties concerned should be aware that allowing children to take a certain amount of risk is recognition of human beings to fulfill their potential. Denial of risk-taking greatly reduces steps towards independence and decreases quality of life. Trying to balance between parental and organisational protectiveness and acceptance of the child’s need to take risks can be a difficult undertaking. There is also the problem of communicating effectively with children their wishes and needs. In the case of children and young people with learning difficulties, professionals are likely to have to learn additional ways of ascertaining the child’s wishes and assessing his or her situation.

“All forms of risk need to be acknowledged in any assessment or evaluation” (Trevithick, 2003: 115). A risk assessment is only valid for the situation which it has been carried out in and needs to be an ongoing process as the child develops. It is important to recognize that the situations of children and families are not static they are fluid and changing. Each individual risk has a lifespan and needs to be constantly monitored and reviewed. However, it is important not to give the concept of risk more weight than is needed by becoming too focused on controlling risks. Questions should be asked about whether or not the level of risk is acceptable, sometimes risk is inevitable and to try and control everything a person can or cannot do can be a breach of a person’s basic human rights. The Bamford’s Review of Mental Health and Learning Disability Equal Lives Group argued how service users want the chance to make their own choices in life and to be supported by the professionals around them, not simply told what they can and cannot do. Hope and Sparks (2000) suggest that a risk assessment can only identify the problem of harm, assess the impact of it on key individuals, and pose intervention strategies which may diminish the risk or reduce harm. They do not believe that assessments can prevent risk completely. This is something which I would be inclined to agree with.

Beckett and Maynard propose that control may be used to protect service users, staff and other members of the community and that by controlling the extent of potential risks that we are ensuring that the best possible care can be delivered. They feel that “control” used appropriately is not the opposite of care, but on the contrary is an expression of care. We should not fall into the simplistic idea that the use of statutory powers is necessarily ‘oppressive’ or that working in other ways is necessarily anti-oppressive.

There has been a concurrent growing mistrust of professionals in social work and an increased reliance by the profession on complex systems of assessment, monitoring and quality control (Stalker, 2003). Parton (1998) proposes that the ‘blaming society’ is now more concerned with risk avoidance and defensive practice than with professional expertise and welfare development. However, risk is a normal and often beneficial part of everyday life. While it enables learning and understanding, in the case of potentially destructive consequences it may need to be monitored and restricted.

The Southern Health and Social Care Trust (2008), define risk as “the chance, great or small, that damage or an adverse outcome of some kind will occur as a result of a particular hazard. It is the threat that an event or some action will adversely affect the Trust’s ability to successfully execute its strategies and achieve its objectives. It is a process of continual improvement which requires the identification, assessment, analysis, evaluation, treatment, monitoring and communication of risk.” The Southern Trust ‘Risk Management Strategy’ recognizes the need to reduce and eliminate or reduce all identifiable risk to the lowest practicable level. The trust is committed to achieving this through a holistic approach based on the principle that “risk management is everybody’s responsibility”.

There are two important models to consider when assessing risk, that of Brearley and that of Greg Kelly. Brearley’s analysis of risk talks about predisposing hazards, which are factors that cannot be changed or are difficult to change before decisions are to be taken. He talks about situational hazards, which are factors specific to the situation that can be changed. Brearley also takes into account the strengths of the situation as factors that decrease the possibility of a poor or ‘loss’ outcome. This is a positive step which may encourage families if their strengths are acknowledged. The Children’s (NI) Order 1995, promotes the welfare of the child and risk assessment and risk management are now a central part of the social work role and should acknowledged accordingly.

Greg Kelly’s model is designed for use when there are serious concerns for the welfare of the child. It is designed to help clarify the issues in relation to the protection of children, to address key questions in decision making in situations where risk is present, ‘what is the problem and how serious is it?’ The development of a non-technical language (strengths and weaknesses) has made the model useful in sharing and discussing issues with parents. What is very useful about this model is that it categorises risk. Thus to agree on the degree of risk is to agree on the harm that is more likely (high risk) or less likely (low risk) to occur in the absence of preventative measures. It inevitably involves a degree of predicting future events. Almost by definition taking decisions in situations of risk means taking them not in ideal circumstances and with less knowledge than we feel we need. Despite the dangers, however, children’s circumstances sometimes require that we take decisions based on our best estimate of the risk of harm to them in a particular situation and at a particular time.

The risk assessment pro-forma used at O respite unit is based on Greg Kelly’s model in that it categorises risk as high, low or medium. High Risk would be recent and regular occurrence of behaviour, for example in the past 3 months. Medium risk would be recent and only occasional occurrence in the past 3 months. Low risk would be seen as having happened in the past but would only have occurred very minimally in the past 3 months. The assessment here is not just the potential of risk of harm to the children, but also the individual measures staff can take to prevent the likelihood of the risk actualizing and any steps that management may need to take.

Person centred planning is rooted in the belief that people with disabilities are entitled to the same rights, opportunities and choices as other members of the community. Person centred planning has been around for about twenty-five years and its principles are about sharing power with service users and community inclusion. This way of thinking insists that people with disabilities have the same quality of life and position in society which is equal to people without disabilities. It challenges the idea of grouping people together on the basis that they are perceived as needing the same level of assistance. Person centred planning asks how the client wants to live their life and ways that they think could make this possible and if they require any support with this. Person centred planning has five key features:- The person is at the centre, family members and friends are partners in planning, the plan reflects what is important to the person, their capacities and what support they require, the plan helps build the persons place in the community to welcome them. It is not just about services and reflects what is possible, not just what is available. The plan results in ongoing listening, learning, and further action. Putting the plan into action helps the person to achieve what they want out of life.

Person centred planning is about the social worker facilitating the service user to take control of his or her own lives and move forward as much as is possible. Coulshed and Orme (2006) illustrate how it focuses on the individual as unique and special in their own situation. It is important for the social worker to develop a good relationship with the service users for this approach to be successful. “It encourages the development of an equal, non-authoritarian relationship where both service user and social worker work together to establish a significant and meaningful relationship.” (Trevithick, 2006: 271)

It is important in person-centred planning to work out what is important to the client but also what is important for the client, which can sometimes be difficult. This can even be simple things such as pen pictures which illustrate the things which are of most important to our clients. This can include information such as favourite foods, colours, clothes, possessions, people, activities or place. It is important to remember these principles when I am completing the risk assessment and ensuring that it is a personalised account of this child.

Previous knowledge

My knowledge of risk assessment is initially very limited. Although I have completed various UNOCINI assessments, and within that you are thinking about risk and identifying potential risks for that child or family if certain support networks or services etc are not put in place, this is not as extensive as this specific ‘risk assessment’ I am to undertake with C. I read around the topic of risk assessment and took into account the different models, especially the Southern Trusts Risk Management Strategy. I also considered number 4 of NISCC objectives which was to “manage risk to individuals, families, carers, groups, and communities, self and other colleagues. This increased my sense of purpose and direction in which the risk assessment was to take.

I have good knowledge around C and the family as I had completed the initial assessment. I have previously met with C’s teacher which gave me an insight into Cs daily routine at school and explained the best way to communicate with C. Further to this I read a completed risk assessment which used the same pro-forma to gain a better understanding of how the information gathered should flow.

It is important to have an understanding of what autism is and how it can impact on a person and their family as C has autism. Having shadowed the autism support worker few home visits to see children who have autism, I already had an insight into the importance of the schedule and routine for children who have autism. I had also previously increased my knowledge base by talking to the autism support worker within the team about the disorder and its effects. My first degree in Psychology also looked at autism and its effects on development so I have refreshed my memory and read my notes again.

Tuning into my own feelings as a worker

I feel a little nervous as I will be facilitating this meeting. I feel nervous about the fact that there will be other professionals such as C’s teacher and the social worker and manager from the respite unit. Furthermore, Mrs F is also a teacher. Considering Mrs F’s profession, she may have standards and I hope I am able to effectively facilitate the meeting in a professional manner which meets her standards. In saying this, I have met with Mrs F on a few occasions and I feel very comfortable with her. I want to be able to facilitate this meeting as effectively as possible in ensuring everyone gets an opportunity to contribute, all opinions are considered, all risks are identified and a plan is set in place which will effectively manage these risks. I feel slightly more confident in that I have met with the social work manager and C’s teacher before and feel I have built up a good rapport with Mrs F.

Tuning C’s feelings

C is unable to contribute to the meeting due to his learning disability.

Tuning into parents feelings

This is a new experience for Mrs F as she is C’s main carer and the only time they are ever apart is when C is away at school. She may be feeling anxious about considering the risks there are with C. She is placing a lot of trust in the staff at O in order to be aware of these risks and manage them. However this is an opportunity for Mrs F to inform the staff on how to best, most effectively manage the risks associates with C. In turn this meeting may consequently lessen Mrs F’s anxieties in knowing that we have identifies the relevant risks and we are fully aware of how to most appropriately manage these risks. This will hopefully provide reassurance for Mrs F in knowing that the relevant safeguards will be put in place prior to C commencing the unit.

Skills

It is important that I am able to analyze the information from the O assessment in order to determine if there are any risks, what they are, how they are currently managed and how they could be best managed by staff members. I have already analyzed what the risks are. I have determined that C’s communication is a risk as there is a risk he may become distressed if the staff at O do not understand him. I thus felt inviting C’s teacher to the meeting was important. I felt this could also act as an information sharing meeting whereby the people that C spends most time with such as his mother and teacher would be able to give input on how best to communicate with C. C’s teacher previously informed me that use of the PECS and super symbols would be essential to apply in order to effectively communicate with C, until such times as the staff familiarise themselves with C. The ability to analyze involves breaking a situation or issue down into its component parts so that the inter-connections and patterns can be uncovered (Thompson, 2005). I need to be able to analyze the information gathered to determine what the risks are, to determine the level of risk and determine what safe guards need to be put in place in order to try and reduce these risks.

Communication has been defined as, ‘the verbal and non verbal exchange of information, including all the ways in which knowledge is transmitted and received’ (Barker, 2003: 83). I will be facilitating this meeting and thus I need to communicate in a clear and concise fashion in explaining the purpose of the meeting, what I hope to cover, why and what I hope to achieve. I will explain the relevance of inviting Miss V, C’s teacher and explain how I hope she will be able to contribute to the meeting. This will reassure Miss V of her role, purpose and prepare her for what she may want to say with regard to how the staff can best communicate with C. I will similarly explain the relevance of why C’s parents are there also, in that they know C best as his parents and carers and their input and advice will be most valuable with regards to identifying any additional risks I may have missed, and how to manage these and give any input they wish throughout the meeting. This is also an opportunity for C’s parents to ask any additional questions, be reassured that we are aware of the risks involved with their son, the appropriate safeguards will be put in place to try and minimize the risks and what plan they have in place if something does happen to C.

Negotiation skills are vital as a result of this Risk Assessment. I have invited the relevant persons to this meeting so important information can be shared with regard to how certain risks can be most effectively managed. Miss V, C’s teacher has a good insight into effective communication exchange techniques which will allow the staff and C to effectively communicate with each other and understand what C is communicating. This is vital in order to prevent C from feeling frustrated if noone understood what he was saying or what he wanted etc. I will be looking upon Mr and Mrs F are experts in their own family lives. Noone will know C better than themselves and thus their input is vital in indentifying any additional risks, how they can best be managed. Before we end the discussion, in order for the risk assessment to be effective I feel it is necessary that everyone negotiates on how the risks can most effectively be managed.

Trevithick (2005) proposes that listening provides a creative opportunity to demonstrate our commitment and care. The essence of good listening is learning about how to reach the emotions and thoughts of others; it requires active involvement and engagement with the client. I am confident in my ability to convey that I am valuing Mrs F’s contribution as she is the expert her family life with C and Mrs V’s contribution as C’s teacher.

Values

I am committed to anti-oppressive practice and Thompson’s PCS model of discrimination helps me to be mindful of this. Thompson analyses discrimination in terms of three levels: the personal, which highlights the feelings and attitudes at an individual level; the cultural which refers the social “norms”, and the structural level which is the way that oppression and discrimination can be institutionalised in society.

Biesteck value principles are principles of the social worker-service user relationship which are deemed to be effective forms of practice. The principles are:- individualization, purposeful expression of feelings, controlled emotional involvement, acceptance, non-judgemental attitude, service user self-determination and confidentiality.

I think these value principles have a lot to offer professionals. I think in terms of this risk assessment I will be aware of the importance of individualisation. This is a specific piece of work which directly impact on the care and support that C will receive while he is at O for respite. It is vital that the work is an accurate representation of C and his individual needs. Biesteck’s value principles are a useful checklist to ensure that we are practicing in an anti-oppressive manner.

One of the core values that I believe to be relevant in all of my work is respect for the person I am working with. Valuing Ms F and treating her with dignity is fundamental to a good working relationship. This should be a part of my everyday practice, part of empowerment, participation and choice (Payne, 1998). Thompson acknowledged the importance of respecting persons and “not treating them in a way that you would object to if other people treated you like that” (Thompson, 2000).

In order to build trust and a positive working relationship with Ms F, Roger’s (1961) core conditions of empathy, congruence and unconditional positive regard are vital. I need to be able to convey to Mrs F that I understand their situation and their feelings. In order to do this I need to be open and honest and convey warmth and a non-judgmental attitude to Mrs F. If my work is to be effective it needs to be based on partnership. I hope to convey to Mrs F that she will always will be the expert on herself and C and their family situation. Within a social work context, it is the service users who should define their own needs and dictate wherever possible how their needs should be met (Parker & Bradley 2003). Useful pointers in developing a relationship based on partnership include: do not do most of the talking, do not put words into peoples mouths, help everyone feel comfortable, particularly Mrs F.

Empowerment involves seeking to maximise the power of clients and to give them as much control as possible over their circumstances. It is the opposite of creating dependency and subjecting clients to agency power (Thompson 1993:80). I will be reminding Mrs F of the importance of her contribution in identifying any risks and advising on how she best manages those risks at present as no one knows C better than herself. Hopefully this reassurance will empower Mrs F to contribute as much as possible to the sharing of information.

The book, And Still We Rise: The Trials and Triumphs of Twelve Gifted Inner-City Students, offers valuable insight into the lives of inner-city youth in Los Angeles and throughout the country. Inner-city students are frequently subjected to poverty, violence, gangs, and drugs in their schools, homes, and communities. Yet, many of these students manage to survive and thrive despite their volatile environment. The book provides school social workers with a unique opportunity to understand the challenges presented to inner-city students, and the power of resilience to overcome adversity. Let us now examine how various psychosocial and environmental factors contributed to the development and success of the students discussed in the book.

Developmental Tasks, Systems, and Resilience

Adolescence is arguably one of the most difficult and challenging stages of development for an individual. It is a time of great social, psychological, emotional, and academic growth that poses many challenges for youth surrounding identity, self-esteem, and self-efficacy (Zastrow & Kirst-Ashman, 2007). According to Erikson’s psychosocial theory of development, adolescence is a time of exploration and experimentation in relation to peers and social roles in order to establish a sense of identity (Zastrow & Kirst-Ashman, 2007). The students in the book are each facing various identity challenges and demands within their environment. They are exposed to gangs, drugs, poverty, and teen pregnancy in their everyday lives, and they must each make the difficult decision of who to be and how to reconcile various role demands. Sadi, for example, had to make the difficult decision of whether to maintain his gang lifestyle which provided a sense of power, protection, and family for him or to explore his intellectual abilities as a student in school. Fortunately, with encouragement from Ms. Little and Mr. Braxton, Sadi chose to join a different kind of family, one that offered promise and hope through academic achievement.

The students in the book are also charged with the task of navigating various systems within their environment that impact their lives. On a mezzo level, the students interact with family, teachers, social workers, foster and group homes, and gangs. On a macro level, the students interact with the school, community, social services, and the judicial system. Unfortunately, the students in the book are negatively impacted by a number of these systems. Many of the students lack adequate support at home and are forced to work in order to survive. Some students have been neglected or abandoned by their families and are forced to navigate a cruel and unjust world alone. The students are also exposed to violence and poverty within the community and frequently suffer retribution from the judicial system. Additionally, the social service system did not always adequately address the needs of the students. For many of the students, their only sanctuary was school, a place where they felt welcomed, supported, encouraged, and cared for.

The students in the book survived due to their resiliency. Each student possessed the inner strength, power, and motivation to overcome obstacles in their environment and to thrive in the face of adversity. The incredible power of resiliency allowed the students to maintain focus and motivation despite negative environmental factors. Their resiliency coupled with the support and encouragement of administrators and teachers within the school allowed the students to exceed expectations and claim futures full of hope and promise for a better life through education. Let us now examine how the challenges of adolescence, systems in the environment, and resilience shaped the life of one inner city student.

Olivia’s Story

Olivia’s story provides a unique perspective on the various difficulties encountered in relation to systems in the environment, and how the power of resilience provides motivation and drive to survive and beat the odds despite numerous obstacles. Olivia was affected by various mezzo and macro level factors throughout her childhood. On a mezzo level, Olivia’s interactions with her mother, social workers, and various foster and group homes shaped her life. Olivia was physically and emotionally abused and neglected by her mother, and abandoned by her father. At the age of twelve she entered the world of social services, and began her journey through various foster and group homes that provided little to no financial or emotional support. Olivia’s social worker did not provide her with adequate resources and support either, and Olivia was forced to take matters into her own hands and support herself by working a number of jobs, many of which were inappropriate, dangerous, and illegal.

From a macro level perspective, Olivia’s encounters with the teachers and administrators at Crenshaw High School, the social service system, and the judicial system significantly influenced her life as well. At a time of chaos and uncertainty in her life, school was her only reprieve. It was the only place she felt wanted, needed, and loved. School also provided her the opportunity to show her true potential in the gifted magnet program. Olivia received the support and encouragement she needed at school from Ms. Little and Mr. Braxton, who served as her pseudo parents and family. They provided her with the guidance, nurturance, and impetus she needed to reach her academic potential. Unfortunately, Olivia was underserved by the social service and judicial system. She was in the social service system for many years and was never provided the adequate resources and support she needed to survive. As a result, Olivia was forced to seek alternate illegal sources of support that ultimately landed her jail. If Olivia had been given adequate resources and support from the social service system she would not have had to engage in illegal activities to survive. In this sense, the judicial system was reactive as opposed to proactive with Olivia. For many years, she tried to navigate her way through an unforgiving system trying to attain assistance. Ironically, it was not until she committed a crime that she finally had access to the resources and support she desperately needed throughout her childhood. Fortunately, despite all the hardships Olivia endured throughout her childhood she did not let the social service or judicial system prevent her from attaining her dream of attending Babson College. Her incredible sense of resiliency and drive for a better life helped her to stay positive and maintain focus despite the many obstacles she encountered. Olivia always knew she would prevail, and in the end she did! She relied on the strength and perseverance she had used to overcome past obstacles to achieve the dream that had almost been stolen from her. Her story is a source of inspiration for inner-city students throughout the world, and proves that childhood experiences and environmental systems may influence, but do not define, an individual.

Lessons for a Future School Social Worker

The book provided me with valuable insight into the lives of inner-city students. Prior to reading the book, I was unaware of the various obstacles many inner-city students face in their everyday lives. I now have a new understanding of how various systems in the environment negatively and positively influence students, and how I might be able to assist students in navigating many of these systems as a school social worker. The book also helped me realize how important it is for students to have access to adequate resources and support for optimal psychological, social, and academic development. The book also highlighted the relevant role school teachers and administrators have in impacting student’s lives, and how important it is for social workers to work collaboratively with school staff to ensure that student’s needs are being met. On a positive note, I have learned that inner-city students have incredible potential and that as a school social worker I will play a vital role in identifying and addressing obstacles, providing resources and support, and serving as an advocate and coach to help students reach their full potential. I can, and will, make a difference in the lives of the students I work with! J

A mental health nurses perspective of the issues surrounding the treatment of patients with a dual diagnosis of psychiatric disorder and learning disabilities in mainstream mental health units. This essay is going to explore from a mental health nurses perspective the issues surrounding the treatment of patients with a dual diagnosis of psychiatric disorder and learning disabilities in mainstream mental health units. Including a discussion around prevalence, provision of services, access to services, government policy and whether staff in mainstream mental health units have the knowledge and skills necessary to provide effective care for this potentially vulnerable service user group.

The contemporary concept of learning disabilities focuses on the physical and social difficulties that can occur as a consequence of being labelled a person with a learning disability and how any impairments a person may have affect them (Swain et al, 2004) however it neglects to identify the mental health issues people with learning disabilities regularly and more commonly face

If people who meet the diagnostic criteria for borderline learning disability are included the prevalence of learning disabilities in the UK equates to 12 % of the population or around 8 million people (Hassiotis et al, 2008)

It is generally recognised that people with a learning disability have a higher rate of psychiatric disorder compared with the general population with the prevalence estimated at 40 – 50 % (Raghavan and Patel, 2005). In comparison to 10 – 20 % of the general population (The Office for National Statistics, 2000) Various factors have been cited as being contributory towards this vulnerability including brain damage, sensory impairment, chronic physical ill health, epilepsy, repeated loss or separation issues, poor self-image, coping mechanisms and social skills, communication difficulties and family problems (Fraser & Nolan 1995, Hardy et al, 2007)

Mental health nurses are specifically trained to treat a diverse group of people including children and young people, working age adults, the elderly and new mothers all with mental health problems. Experiences from clinical practice demonstrate an increase in the number of people with learning disabilities admitted to general acute mental health hospitals and the increasing incidence of complications that can often come along with the care of this group of people. These include problems with assessment and treatment, usually stemming from communication difficulties, behavioural issues and barriers to collaborative working between the learning disabilities and mental health teams. They can often lead to an increase in length of stay in hospital and inappropriate or inadequate care being delivered.

Problems arise for the most part when a person with a learning disability develops a psychiatric disorder to the extent that requires acute psychiatric admission. It is now more common to find that they are being admitted to general psychiatric beds under the care of general adult psychiatrists and mental health nurses, many of whom have had little training in the assessment and treatment of mental illness in this group. The communication difficulties people with a learning disability may face can make assessment extremely complex. People with learning disabilities often require a longer stay and may also be vulnerable (i.e. Abuse and exploitation) without additional support on the ward. People with a learning disability may also have unusual presentations of common mental disorders due to brain injury or other long standing conditions such as epilepsy leading to difficulty in diagnosis and an idiosyncratic response to treatment.

Furthermore, people with learning disabilities represent a diverse group with a varied range of complex mental health needs, which mainstream staff may feel ill-equipped to meet. Boundary disputes between general adult and learning disability services frequently lead to a reduced quality of care for people with complex needs

Death by Indifference (Mencap, 2007) highlighted alleged care failings in general hospitals and primary care settings It led to the establishment of an independent government inquiry in England. The inquiry unfortunately did not extend to mental health services It found that there is little evidence concerning the quality of care received by people with learning disabilities in these settings but anecdotal evidence from practice has indicated that it is reasonable to believe mental health services face the same kind of problems as general medical care.

It seems pertinent to tackle these issues head on in order to meet the needs of this client group who have a diverse range of needs that can span across all branches of nursing and whose care can suffer as they seem to be regularly forgotten or pushed to the bottom of the pile

Until 20 years ago, people with learning disabilities did not normally come into contact with mainstream services. Most people with a learning disability who had complex needs including mental illness, were cared for in specialist mental handicap hospitals, and all medical and psychiatric care was provided on site. Deinstitutionalisation has transformed their care and now this group can live in the community and access mainstream health services, regardless of the degree of their disabilities. This process has been guided by the principle of normalisation since the early 1970s, which is a philosophy that remains influential today. Normalisation represents a fundamental statement of human rights stating that patterns of life and everyday living which are as close as possible to the regular circumstances of society should be made available to all mentally ill and learning disabled people (Nirje, 1976).

Closely associated with the principal of normalisation is the concept of mainstreaming, which advocates the use of standard rather than specialised services, for example, schools,

Employment and health care it is now a firmly established principle and features heavily in government policy which supports the use of mainstream services and the interrogation of the learning disabled population back into society but also recognises the need in some cases for specialist services. (The Department of Health, 1992) stated that: “wherever possible people with learning disabilities should be enabled to use ordinary health services as well as specialist assessment and treatment services”.

Advocates of normalisation generally support the mainstream approach; they may argue that specialised services lead to labelling, stigmatisation and negative professional attitudes. The argument for this approach at first glance appears sound and is supported widely by literature. It is, for example, current policy in the UK and USA. However, in practice mainstream community mental health and inpatient teams have found it increasingly difficult to meet the needs of people with learning disabilities and psychiatric disorders (US Public Health Service, 2002).

Each of the four UK countries has its own policy structure addressing how the needs of people with learning disabilities should be met in a mental health environment. England’s policy is set out in the following reports. Valuing People: A new strategy for learning disability in the 21st century (Department of health, 2001), Health Services for People with Learning Disabilities (Department of Health, 1992) and Mental Health: National Service Framework, (Department of Health, 1999), The common themes and issues that underpin this policy structure, include: promoting collaborative working between mainstream mental health services and specialist learning disability services; allowing people with learning disabilities to access mainstream mental health services wherever possible but creating small specialist inpatient services for those whose needs cannot be met by mainstream services, implementing a changing role for specialist learning disability services to providing support and facilitation for mainstream services including providing mainstream mental health and care staff with adequate training on the needs of people with learning disability; applying a care programme approach for people with learning disability and mental health problems and creating mental health promotion materials which are made accessible for people with a learning disability.

Advice is available to help care providers and staff support people with learning disabilities in accessing mainstream mental health care settings (Hardy et al, 2006). The Green light toolkit (Foundation for People with learning disabilities et al, 2004) is one example of a guidance document that demonstrates how policy structure and specific policies are being implemented in practice. It is used throughout England as an audit tool to measure how the National Service Framework for mental health (Department of Health, 1999) is being implemented for people with learning disabilities. The toolkit provides a gold standard that can be used by local mainstream mental health services to measure services against. It offers a traffic light scoring system and provides guidance on how services can be improved, covering areas such as local partnerships, planning, accessing services, care planning and workforce planning. After a green light toolkit assessment, each local area should develop an improvement plan from the action points identified and have a time frame to implement the necessary changes. Anecdotal evidence from observations in practice suggest that the green light tool kit is still being used in practice today but similar areas for improvement are identified time and time again such as access to health promotional materials in understandable formats. This would suggest that although assessments of services are being undertaken the outcomes of these assessments and action points are not being carried forward into practice. The Disability Rights Commission (Disability rights commission, 2006) supports this view by saying that previous guidance documents intended to help people with learning disabilities gain access to mainstream health services have had limited effect.

A working group from the royal collage of psychiatrists (Royal College of Psychiatrists, 1996) acknowledged that enabling people with learning disabilities to access mainstream mental health services can be a complex and demanding task requiring input from specialists in the psychiatry of learning disability. To respond to this statement they have advocated two principles for the mental health nursing of people with learning disabilities: joint working between mental health and learning disability teams with the use of Mainstream psychiatric facilities at every possible opportunity as well as stressing that provisions for specialist services are still to be available if needed.

The independent government inquiry instigated by Death by Indifference (Mencap, 2007), while not extending to mental health services, promoted research into the experiences reported by people with learning disabilities of acute mental health units. This provides a mixed picture. The negative experiences are similar to concerns expressed by other patients. These include: lack of control and information; theft of property; intimidating multi disciplinary meetings; poor food and poor care. However the presence of learning disabilities may alter their significance for example, service users with learning disabilities may find it harder to understand information about their admission and treatment, unless it is shared in a format which is appropriate to their cognitive and communication skills. Psychotropic medication may further impair already poor cognitive functioning and may represent an additional limitation on individuals’ capacity to understand and take an active part in their treatment. Relatives and paid carers are likely to have a much more significant and long-standing role in supporting the service user than would be the case with other adults with mental health problems, Often a person with a learning disability has specific routines that only someone close like a carer would know and following these routines can make nursing them much easier. this is something to which mainstream services in particular seem to pay little attention. Not stressing involvement with carers in particular with a client from this group can lead to either a lack of support for carers or carers feeling pushed away by services and left without a role which in itself can lead to the presentation of depression and low mood in the carer. (Scior and Longo, 2005) Finally, the risk that signs and symptoms of mental health problems will be misattributed to a person’s learning disability (diagnostic overshadowing) is specific to this group. These issues need to be considered by practitioners however, evidence indicates that healthcare professionals often lack the knowledge, skills and experience necessary to meet the healthcare needs of people with learning disabilities. (Fraser, 1999)

The Royal College of Nursing (Royal College of Nursing, 2008) commented that the recent development of an expectation of the mainstream mental health services to respond to the needs of the majority of people with learning disabilities and co-morbid mental illness has often proved an unrealistic goal for the mental health nurse.

It has been proven that special expertise and training as well as the use of specialist mental health teams are required for the assessment, diagnosis and treatment of mental illness in the learning disabled population. Although it is theoretically possible to train staff in mainstream settings, the small number of cases gives little opportunity for staff in the various disciplines to gain the necessary skills. Additionally, mainstream mental health staff often feel that caring for this group of vulnerable people is not part of their role, and the resources of adult mental health services are already stretched (Day, 1988). The funding implications that arose from such a massive shift in service responsibility that came out of the implementation of the mainstreaming approach never seem to have been adequately addressed (Bouras et al, 1995)

Collaborative working between professional groups in healthcare is vital across the board for improving standards of care for patients and their carers (Pollard,2004). In relation to this professional rivalries between mental health and learning disabilities teams are common and the understanding of each other’s role is poor leading to mainly ineffective collaborative working (Bouras et al, 1995) There has also been no apparent or definitive negotiation between the two service teams in the UK to develop clear local operational policies or service agreements and only vague definitions of who is entitled to access which service exist, which can sometimes lead to a patient receiving inappropriate treatment, being bounced between services or, in rare cases, even being denied care altogether as neither team is willing to take responsibility for that patients care.

Distinguishing between psychiatric disorders and behavioural issues in people with learning disabilities is not always a straightforward process. Both empirical and conceptual issues relating to the nature of such behavioural disorders question both the validity and reliability of a diagnosis of mental illness in a person who has a learning disability (Krose et al, 2000) This raises the question what does a nurse treat first? As with dual diagnosis of a drug addiction and mental illness, in many cases the drug problem needs to be tackled first before the full extent of the mental illness can be seen (Drake,2007).However, with a learning disability this is not a possibility as a learning disability is a long standing condition that cannot be treated. The question is therefore, is the behaviour being exhibited by a patient due to their mental health problems or the learning disability?

When a person with a learning disability requires admission to hospital due to a psychiatric illness, the first objective is to agree on whether the general or learning disability psychiatrist acts as the responsible clinician. The admission of a person with learning disability often happens as a last resort in response to an emergency that cannot be managed elsewhere such as in the community or via the use or respite services. The community learning disability team should be able to offer some training to nursing staff or even carry out specific pieces of work directly with the patient.

The allocation of a named nurse is extremely important and, if available, someone with special skills or interest should be appointed in order to develop a more effective therapeutic alliance with the patient. The increased vulnerability of people with learning disabilities to abuse even during admission should be considered and protection from this potential risk given. This may need to be in the form of separation from ‘high-risk’ patients or an increased level of nursing observation such as is policy with under 18s admitted to adult acute psychiatric units. In all cases, the importance of collaboration with the learning disability team should be stressed. This becomes particularly important during discharge planning. In the scenario of an admission under a Mental Health Section, people with learning disability and mental health problems are entitled to all the provisions of the Care Programme Approach and Section 117 after-care.

It is also essential that mental health nurses have a good working knowledge of mental health law and legislation. Experiences from clinical practice have demonstrated that often mental health legislation is misused or disregarded for people with co morbid learning disabilities which denies them the safeguards and protection of the law that legislation such as the mental health act was designed to put in place (Mental Health Act, 1983). The relevant legislation should be applied to this group of people if and when it is appropriate to do so and the same categories of detention used as for other individuals experiencing mental ill health. Although it is important to note that a person with a learning disability can still be sectioned if it is deemed they behave abnormally aggressively or seriously irresponsibly, without any signs of mental illness it is therefore important to determine that that there be actual mental health problems present if a person is admitted under section to a mainstream mental health hospital.

Assessment is a specific part of the nursing process where mental health nurses can struggle when dealing with people with learning disabilities For example, The Mental State Examination, which constitutes an essential component of the formulation process and is essential for assessing risk and formulating a treatment plan, may be problematic. This could be for a number of reasons, including high rates of compliance or an eagerness to please in certain interview situations (Sigelman et al, 1982). Moss argues that people with learning disabilities are also less likely to complain or approach members of staff to ask for help which may further complicate the Assessment and risk management process. (Moss,1999) Simple language and direct questioning including communication and in depth discussion with carers could be a way to overcome this difficulty. Higher levels of nursing observation may also be useful, not only in ensuring a person’s safety on the ward but also in giving vital information regarding a person’s mental state (Appleby,1999)

(Gibson, 2007) highlighted some key factors that nurses without specialist training may find complicate effective assessment and intervention The two main factors that affect mental health nurses are: intellectual distortion, which may result from cognitive deficits in areas such as memory and concentration which can make comprehension and communication of thoughts and feelings difficult; and Cognitive disintegration, which can occur in situations where the person is overwhelmed by the anxiety of the demands being placed on them, resulting in an inability to martial thoughts and bizarre behaviour

Communication is central to making a sound and accurate assessment. It is estimated that upwards of 50% of people with learning disabilities have significant communication difficulties (Matson, 1998) A nurse needs to address the particular communication needs of each individual as each will vary in their abilities, This is another point in which collaborative working becomes very important as if the person is involved with a learning disabilities team, that team may be able to provide the nurse with accurate information about the levels of a person’s communication and how best to manage these issues.

Many of the problems in relation to management of people with learning disability by mental health nurses relate to the lack of knowledge skills and training (Lennox & Chaplin, 1995). Evidence suggests that qualified nurses regularly feel out of their depth and unsupported when dealing with this client group and observations in practice indicate a certain amount of avoidance tactics from mental health nurses when it comes to volunteering for the named nurse roll which could be due to a lack of confidence in this area.

The current pre-registration nurse education programme for mental health nurses was originally validated by the English National Board (English National Board ,2000), and the curriculum follows the Nursing and Midwifery Councils’ Fitness For Practice Guidelines (United Kingdom Central Council for Nursing, Midwifery and Health Visiting ,1999), which states that students undertaking pre-registration programmes must have certain other specialities included. However, learning disability, as either a practical or theoretical component of the branch programme, is not one of them. With government policy (Department of Health, 2001) stating that people with learning disabilities should wherever possible access generic services, there would appear to be the need for a more specific and in-depth approach to learning disability education for all students throughout their pre-registration education.

Experiences from local preregistration nurse education show that currently nursing education provides a 12- month common foundation programme for nurses who intend to train in all areas of nursing including Adult, Mental health, Midwifery, child and learning disability nursing. Although not required by the NM, Learning disability theory is taught but placements in this area are not common. After common foundation period of training, student nurse education in mental health has little or no further opportunities to gain learning disability experience.

Comparisons with learning disabilities mental health can be made to both child and adolescent mental health, as well as to older people’s psychiatry in that they are both specialist groups with their own issues and mental health nurses are expected to study these client groups in detail during their branch training in order to become familiar with the complexities of this type of mental health nursing. As these areas are mandatory specialities in order to meet the requirements of qualification as a mental health nurse (English National Board, 2000) and, coupled with the government’s policy for people with learning disabilities to access generic mental health services, it would appear essential that mental health nurses address the speciality of people who have learning disabilities and additional mental health problems during their pre-registration education as they do with other specific patient groups.

Many senior mental health nurses have received no learning disability training at all. This lack of training may result in problems with communication and understanding, as well as negative attitudes toward people with learning disability. On the flip side, nurses in learning disability have similarly limited training in the area of mental health, although there are newly available post-registration courses. One such course gives an experienced nurse from either branch a six month secondment to the other nursing discipline which is backed up by 2 modules of theory. Anecdotal evidence gained from speaking to a mental health nurse who has recently completed this course has shown that general nursing skills that every nurse should be competent in upon qualification can be transferred across the board to other branches of nursing. The feeling of this nurse is that currently, mental health mainstream services see only those with mild or borderline learning disabilities coming into the service and the assessment and treatment process for these people is not much different to that of non learning disabled people. Currently specialist services provide the majority of care for the patients with more complex needs. (Scior and Longo, 2005)

In conclusion the evidence presented in this essay suggests a number of issues that need to be addressed if mental health nurses are to meet the needs of their clients with a co morbid learning disability effectively. There are: pre and Post registration training for mental health nurses, collaborative working between the mental health and learning disability teams and provision and access to services.

It seems that specialist learning disability in-patient units with a mental health focus offer a more positive experience for the patient than mainstream mental health units, and therefore should be developed further(Scior and Longo, 2005). However, realistically mainstream services are highly likely to continue to provide care for this group, if only because of the resource limitations in specialist services and the fact that 30% of NHS trusts provide no specialist admission facilities (Bailey & Cooper, 1997). There seems a need now for major changes to be made to the structures and day-to-day practices in these services. Such changes should include initiatives to promote more positive attitudes and behaviour towards individuals with learning disabilities through training and regular input from specialist learning disabilities services. Closer attention must be paid to the need to make information about diagnosis and treatments accessible, in media such as leaflets using simple language videos and audio information (Forster et al, 2001) and the need for stronger involvement of and co-operation with service users’ regular carers.

Current practice experience has shown however that in the most part mental health services in this area only seem to come into contact with patients who have a borderline or mild learning disability as there is a bountiful supply of specialist beds. Currently only in rare cases would mainstream mental health units be admitting a person with severe or profound learning disabilities whereby small alterations to practice and transferable nursing skills would not be enough to give that patient the best care available.

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Sigelman C.K., Budd E.C., Winer J.L., et al. (1

Tony is a 14 year old boy who is out going and boisterous adolescent. June His mother describes him as “out of control” and says he never does as he is told June say’s “he is going to end up like his father terry” who is currently serving a prison sentence for a violent assault.

Discuss how an understanding of human development from a life course perspective assists you in understanding this child’s situation
Consider how your understanding will influence your work with the child and family social worker.

Human development from a life course perspective is a way of considering all contributing factors of an individual life and incorporating them with growth, development and change. It is often referred to as the lifespan or cycle, theorists use the different perspectives in order to understand and interpret different experiences and how these impact on an individual. The biggest debate throughout the centuries has been the nature nurture debate. There has been differing perspectives for example the

psychological and sociological perspectives to define exactly how much of personality, characteristics, behaviour and feelings derives from nurture or how much is in our genes and therefore innate. I will look at some theories in order to explain the case of Tony, a fourteen year old boy, who is described as an outgoing and boisterous adolescent.

Tony’s mother describes him as “out of control” she feels that he is unruly and states “he is going to end up like his father Terry” who is incarcerated for a violent assault. In order to fully understand Tony’s situation you must look further than the facts. There is likely to be various underlying issues within parental relationships, his environment, poverty and education, which will contribute considerably to his situation, therefore as a social worker I would consider a holistic approach in order to obtain a full and accurate understanding of his situation. To do this I will be incorporating theories on various aspects of his Tony’s life from a psychological, biological and psychosocial perspective.

Obstructions vary and can be hereditary such as a disability or health problems or environmental such as education unemployment and living conditions. According to the Behavioural Perspective, the individual may mimic or learn behaviours through: their environment, their peers, television, internet and media but more importantly role models. These behaviour patterns are underpinned by positive or negative rewards for the behaviour which in turn determine which behaviours are chosen to mimic Gross (20??). Tony’s father may have been a strong role model for him within a disadvantaged area where he may not have felt safe or secure. (Elaborate from violent night book).

There is a pattern throughout many perspectives which link the importance of stages in determining human development, like the lifecourse, such as; Piage’s stages of moral development, Freud’s psychosexual stages and Erikson’s eight stages of man. Erikson considered the developing stages of the life span as eight individual tasks and suggested these, depending on how successful the completion, would result in a positive or negative outcome. The eight stages of man is considered to be a Freudian based model of the psychosexual stages, as both see the relevant stages and the importance of completing them in order to successfully move on to the next. However Freud was not as flexible as Erikson, as he did not consider the ability to repair uncompleted tasks, where as Erikson suggests that more often than not there will be unresolved issues, but which may be overcome in later life. In Erikson’s adolescent stage, where the individual is thought to go through a process of identity v role confusion, searching for a coherent personal and vocational identity. The desired result of this would be for the individual to consider themselves as a consistent and integrated person.

However in Tony’s case there may have been an interruption of the stages, for example if his father has had an inconsistent relationship with Tony through a number of prison sentences from reoffending, then there may be confusion as to ‘what or who he is’. This outcome is considered to be a pattern for any individual who does not successfully complete this stage within the psychosocial model. Beckett (20??). Vitaro et al derived a theory based on Erikson’s eight stages that an individual who has a best friend or role model who is a delinquent, has a higher chance of them too developing such behaviour. However this model tends to take a somewhat individualistic approach and does not consider free will or the humanistic approach which would say that human beings have the ability to overcome adversities and choose the path in which they want to take. Gross Psychology (2008).

We can assume that there is a problem with finances which may suggest that there are some aspects of poverty. According to Perry (2004), children largely reflect their upbringing; positive and negative life experiences will determine behaviour. Therefore an understanding of early experiences and how they impact on the human brain is vital in order to understand the individual. The more enriched the early experiences of the child, the better the outcome and chance to reach their full potential is thought to be.

Du Plessis suggests, DATE the only innate features human beings are born with is reflexes such as blinking, breathing and sucking. Everything else is thought to be learned through the environment in which they live which then in turn will then determine the adult they become. She gives an example of a person given the wrong directions would never reach the desired destination, just as a child not given the necessary emotional support, love and affection will never reach their full potential, therefore the parents as the primary educators.

“The destiny of children’s lives lies in the hands of their parents”. Du Plessis (19..)

Mills suggests that people develop differently depending on the culture and environment in which they live as this affects the opportunities which they may have, or lack, through their life span. REFERENCE Income has a direct effect on children’s development for example; poor housing conditions such as: damp, cold and poorly nourished have a direct emotional and physical effect. There is also an indirect effect through the parent’s suffering hardships, parents and caregivers may not fully accomplish their parenting tasks unless living within ‘permitted circumstance’. Children’s development and well being is said to suffer through inequality as financial deprivation is probably the most common and wide spread stress factor faced by families within society. Algate, etal (19??).

“Poverty means staying at home, often bored, not seeing friends, not going to the cinema, not going out for a drink and not being able to take the children out for a trip or a treat or a holiday. It means coping with the stresses of managing on very little money, often for months or even years. It means having to withstand the onslaught of society’s pressures to consume. It impinges on relationships with others and with yourself. Above all poverty takes away the tools to create the building blocks of the future-your ‘life chances’. It steals away the opportunity to have a life unmarked by sickness, a decent education, a secure home and a long retirement. It stops people being able to plan ahead. It stops people being able to take control of their own lives. Taken from Aldgate – (Oppenheim and Halker 19996 p5)

Behaviour which is collectively considered unacceptable or maladaptive behaviour is thought to derive from distorted thought cognitions. These can often be self defeating thought processes not feeling good enough or in Tony’s case being constantly told he will never amount to anything positive. Gross Psychology (200??). Piaget’s theory of cognitive development emphasises the understanding of how a child’s cognitive ability varies by age, this too is a stage theory of cognitive ability. Such theories have given an insight into how a child is able to understand, or make sense of, their environment or a given situation and enabling professionals to consider such factors to guide their approach. (advanced psychology reference)

It may be argued that Tony is merely a product of his environment (look at book on environmental issues)…

However environmental factors, although have a vast impact, do not consider the individual will or the ability of human resilience to overcome obstacles, for example: the Humanistic Approach which emphasises individual choice. There is the thought that a person chooses whether or not to submit to oppressive circumstances and, has the ability, to overcome disruptions in order to reach full potential Gross (2008). Psychosocial is considering both individual psychology and social context of people’s lives on their individual development Walker (2008). It focuses on the importance of illiminating obstructions which may be preventing self actualisation, like the Humanistic Approach, emphasis on the will of a person and their ability to overcome adversities.

(Look at Darwin for biological explanations)…

Sociological explanations on deprivation- Bronfenbrenner (1979) influenced social work practice as he derived a series of systems to explain deprivation in depth which were: The microsystem which is the immediate environment such as people and events in the home, this is said to have the largest impact as it is direct, the mesosystem, which is a social and cultural factor and the way in which two or more Microsystems interact, the chronosystem which is the history of growth and development of time, the Ecosystem is beyond the immediate environment, for example the neighbourhood in which the child lives, and finally the macrosystem which is social factors, economic conditions and cultural values. Each of these systems interacts with each other to form the complexity of each individual’s life. Crawford and Walker (2008)

Look up examples of psychosocial theories-psychological theories is developmental psychology, cognitive and behavioural approaches which are already in essay but need to relate to eachother and state as such.

Conclusion To gain an understanding of each individual, as an individual, there must be an understanding of the interaction between various factors such as: the genes we inherit, physical characteristics, environmental factors, the impact of culture and response of others for example social class, the way we are brought up and choices made, random or unexpected events, opportunities and the impact of others on and in our lives Crawford and Walker (2008). As a social worker I would take a life course perspective, in order to ensure that I could incorporate this theory into practice, I would take a narrative approach. This is a way of working with individuals that focuses on the importance of their experiences and the meaning they attach to them, how the individual may have interpreted experiences within their lifespan to get to this point and therefore possible approaches or interventions to fit.

For ADP being careful of discriminatory language like youth culture which is linked to hoodies culture, talking about anti social behaviour is again linking the individual to a label based on age and assumptions. Also not using jargon therefore ensuring language is clear and targets are clearly understood, not abusing power by ensuring the individual has a right to input on how they feel and what they want despite them being a minor. Not making assumptions based on class or the environment in which they live that may be linked to high drug and crime rate. Not assuming the behaviour is innate and therefore there is genetics which will determine the behaviour of Tony to be exactly like his father. Ensuring all legislation and procedures are met as he is a minor with regards to objectives and choices given. Making sure you’re using resources available to the best of ability as you will more than likely be working within a budget. Assessing time scale trying to improve the situation before there is a crime committed, therefore assessing whose needs are to be addressed first. Looking at what agency you are working with and the approach that they take therefore being accountable for any choices you make within this restriction and having awareness of poverty, adolescence, the effects of incarcerated parents on their children and local agencies that you may incorporate to deal with practical problems.

Children’s whose parents are incarcerated are often overlooked when considering adversities faced by families and support structures which are put in place after such an event. According to Barnardo’s report, children of those in prison are more likely to experience mental health difficulties, poor housing conditions and poverty, yet are less likely to offered help and support for these. There is said to be over two hundred and eight local authorities and health boards spread across the United Kingdom and yet only twenty make reference to children whose parents are imprisoned in their children’s plan. (According to Linda Wilson director of bernardo’s Northern Island).

In today fast-paced society, finding a perfect balance between work and daily living is a very challenging task that every worker must face. Particularly, it is most affected to families lives, as some couples may prefer having more children, yet cannot see how they would afford to working lesser or stop working in order to look after their kids; while some other families satisfy with the number of kids they have, but still prefer working more to support their life styles. This typical problem somehow raises difficulty to the government in a sense that if parents could not achieve their desired work-life balance, it could affect their welfare and so directly impacts on the development of the country as a whole. As a matter of fact, it is said there is no such thing called ” perfectionism ” in this world.

Even so, Work life balance is still very important for the healthiness of everyone – employees and employers, so as for the good sake of the organization; presently it has also received attention from researchers, governments, management teams and employee representatives (Pocock, Van Wanrooy, Strazzari & Bridge, 2001; Russel & Bowman, 2000). In fact, most of us have all heard the term and simply complain that we do not have enough of it in our lives; so what is work-life balance, exactly? According to Kathleen Gerson, Sociologist, young people are searching for new ways to define Work-life balance that do not force them to choose between spending time with their children and earning an income. Yet, it is generally believed that parents should make more time to support their kids both economically and emotionally, as well as sharing labor equally, at the same time. Indeed, Work-life balance is not simply about working less or starting a family; it is also about learning how to truly live and enjoy our lives. In this paper, I would like to address the importance of work-life balance in the workplace; also, the challenges and solutions upon work-life balance.

II. Body
2. a. Benefits

Work-life balance describes an individual’s work and personal life. It tries to prioritize between work (career and ambition) and life styles (health, pleasure, leisure, family and spiritual meditation), so that people can maintain their leisure times with families and friends, and at the same time improving their potential performance at work. On that account, three main benefits are given to both employers and employees when organizations agree to adopt Work-life balance; firstly, embracing Work-Life balance helps attracting and retaining top talent staffs. Otherwise, negatively changing work environment like increasing working hours or lack of support and guidance from new employers are likely to force them to leave the place. Due to the fact that Work-life balance is compulsory toward the growth of company, The Yamaha Group, for example, is known to actively cooperate with labor for many years in its efforts to promote Work-life balance – shortening total work hours and providing support for both work and family. The company then started introducing employee benefit programs and systems ahead of statutory requirements. Besides, The Yamaha also introduced childcare leave followed by a system of nursing care leave, hopefully eliminating the negative outside forces of their staffs while working for the company (” Initiatives for a Better Work-Life Balance ”, 2011).

Secondly, work-life initiatives helps employees to reducing absenteeism, health costs, and stress even though they may have some distractions by family issues at work; it is known that people who are free of worry about what is going on at home can be more productive at work. According to the Australian data from the 2010 National Work/Life Benchmarking Study (Barbara Holmes, Work/life Balance International) found that thirty-seven percent (37%) stated that their work-life balancing strategy contributed to a reduction in absenteeism, while seventy-nine percent (79%) reported a positive impact on work productivity.

Thirdly, work-life balance also allows changes in working flexibility. New research from Families and Work Institute (FWI) has found out that employers and employees benefit, when both partner in finding flexible ways to work. Working flexibly means due to shortages of talent and skills, many knowledge workers have the bargaining power to negotiate their working conditions, including working hours preferences and space available, as long as they can ensure the job will be done. That is to say, working flexibly can not only help employees to manage their work and personal responsibilities, but it can also enhance an employees’ effectiveness on the job, and thus benefiting employers as much as employees themselves.

b. Challenges

We live in stressful times, and each of us has to deal with stress everyday. In a society that filled with conflicting commitments and responsibilities, work-life balance is known to be a predominant issue in the workplace; thus, having better understanding the interface between work and family relation, it directly and indirectly affects the daily living and performance in the workplace. Regardless of above benefits, three major challenges of work-life balance are described here. Firstly, global competition describes the outside forces that bring about the work-life balance tensions. These days, due to the various demand of the national and international workplaces, employment experience is changing – to get the jobs within today’s business environment, workers need to obtain higher skills to compete with overseas workers, it is somewhat weaken the relationship between work and family life. Also, in this new global trend, in order to decrease the company’s cost, most employers are searching for lower costs workers, resulting in pushing the wages lower and income insecurity higher for the individual workers. According to A Work-Life balance survey in 2009, it was stated that seventy percent (70%) of more than one thousand and five hundred (1500) respondents said they do not have a healthy work-life balance.

Ageing population, secondly, impacts the staffs’ benefits directly. According to Joseph Rowntree Foundation, Older workers are those men and women who continue their employment after reaching age 50, or who during their fifties or sixties are seeking to re-enter the labor market. Therefore, to stabilize their job in old age, an individual has to work longer hours, thus forgoing personal leisure time as well as neglecting their health, to meet the excessive demands of work and life. In the United States, for example, healthcare does not provide to all citizens. Statistically, Berg disclosed that 15.7 percent out of a population of 46 million is said to have no access to healthcare, because it is mainly covered by their employers and for the expenditures on this healthcare have just rose by 40 percent. Likewise, since their society takes it as a private matter, there is no federal assistance for this child rearing and sickness, causing it to be very expensive for most workers to afford. Additionally, Berg also added that starting from 1997 until today, dual-earner couples has been increasing in US – causing them to work by 10 hours per week and thus personal time has been dramatically reduced to an hour or less for men and women respectively.

Thirdly, technology is said to have facilitated employees from pressuring and keeping themselves at work more than home; however, the increased technology allows individuals to work anywhere and at anytime. Berg again raises that men nowadays have less time off but working more, which pushing them to face higher levels of intensity at workplace. An increasing in ill health, both mental and physical, and stress then have become troublesome problem in the modern workplace as much for office staff, managers, and even shop floor workers, due to over-work.

c. Solutions

Since work life balance is rising to the top of many employers’ and employees’ consciousness, in today high-tech society, human resource personnel seek alternatives to positively impact the bottom line of their companies – improve employee morale, retain employees with valuable company knowledge, and at the same time to keep pace with workplace trends. There is no particular strategy of one size fits all; yet three possible solutions are given to deal with above challenges. To begin with, On-the-Job Training should be provided. Being able to take part in lots of seminars and training might allow employees to challenge themselves in a global market. Besides, it is also enabling them to learn how to better manage their workloads, eliminate unproductive work habits, get enough exercise and bargain for more flexible work conditions, which meet their needs.

On top of that, it is important for line manager to be aware of overwork, because only managers are able to manage the error rates, absenteeism and stress-related burnout of their employees, by simply offering employee-assistance programs. Moreover, a manager should also guide them on how to prioritize their works in case lower level workers do not have related-knowledge; otherwise workload and stress are likely to exist amongst them.

Next, both men and women in ageing society mainly like in US, are found to be very crucial for the development of organization in terms of the knowledge they have, the role they can play in mentoring or coaching younger colleagues, and for the experiences they offer; so organization should consider creating strains on retirement pension budgets and education on retirement healthcare, prompting governments to encourage older employees to remain in the workplace with flexible time contracts. Otherwise, those young talented staffs will urge to retire more and enjoy early retirement stage, while other older and experiential senior workers insisting on retirement due to the need of spending more time with family and friends. Plus, government also plays important role in eliminating age discrimination in the workplace either upon promotion or recruitment. According to Margaret Collins from Bloomberg.com/news, once they lost their jobs, older workers in the age of 55 years old tend to stay out of work longer about 41 weeks on average in 2010, compared to 35 weeks of those age 25 – 54 years old.

Last but not least, with unlimited access to information and technological advances, it seems to serve both of our personal and business matter at the same time, faster than expected. However, when technology could be accessed everywhere people seem to be busier than they used to; it is suggested that if one is really addicted to web surfing, so to better balance this typical work-life, an individual should limit their working time (checking email, and work on it) and start focusing on family life, while getting some other times for leisure, as well. Besides, it is suggested that all workaholic should adopt the single idea of ” work will never be finished ”. It is true that there are some certain people, who try to please everyone (boss, customers, family) by holding multi-tasking at the same time, but they may forget that it could make them less productive and inefficient if they still continue with their workloads. People are not computer, there are times to be productive and times to be not, so entertainment is a must in this sense, to help them relax or re-focus on their job after a short while.

III. Conclusion

To sum up, in today’s sophisticated life, although money is not everything, people have to work harder to support their infinite demands. Meanwhile, they have to distinguish between working and family time while earning money. So it is the responsibility of all the managerial levels of organizations to ensure that they provide positive working environment for their employees by taking Work-Life Balance into consideration. Employees tend to feel more motivated when they feel appreciated and respected, thus boosting up their morale and productivity levels. In my opinion, efforts should be made to balance personal life and professional life, for the reason that if employees tend to pay more attention on personal life, then professional life will be more disturbed which resulting in losing the job and income. Nonetheless, if employees would give more importance to professional life, it is more likely to affect their nerve causing higher stress levels and thus negatively affecting their work performance.

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

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

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

Elderly

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

2005
(%)
2010
(%)

Total Population

26.75 m

28.96 m

65 and above

1.15 m

4.3%

1.36 m

4.7 %

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

Elder abuse

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

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

USA

3.2

Canada

4.0

Finland

5.4

Netherlands

5.6

United Kingdom

5.0

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

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

Types of elder abuse

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

Physical Abuse

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

Emotional abuse

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

Financial Abuse

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

Abandonment and Neglect

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

Sexual Abuse

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

Signs and symptoms of elder abuse

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

Characteristics of the Abused Elder

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

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

Characteristics of the Abuser

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

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

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

Common Reasons Elder Abuse Is Not Reported

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

Risk Factors for elder abuse

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

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

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

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

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

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

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

The welfare needs of elderly

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

The government

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

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

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

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

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

Law and legislation

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

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

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

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

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

Mass Media

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

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

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

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

School Education

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

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

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

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

The rationale behind this assignment is to highlight restorative justice and the aspects of it, in terms of how it differs from the traditional legal justice system. This will include a critical analysis of restorative justice while evaluating its strengths and weaknesses as a different approach to crime control. I will identify underlying theory, legislation and policy that brought restorative justice to the forefront of opinion, and specifically relate it to the Northern Ireland criminal justice system. The aim is to identify if it is a meaningful system to all parties involved and why/if it is necessary in the present criminal justice system.

Introduction

In an age of “hoodie culture” and prison overcrowding, questions are being asked over the efficacy of the criminal justice system and how much of a deterrent from crime it really is. Following a long period of differing regimes, such as retribution, rehabilitation and restructure, all competing to be the dominant influence in the criminal justice system, there has emerged a ‘new’ approach to crime control, that of restorative justice (Hughes, 2001, p247). The aim of this approach is to provide an opportunity for the rehabilitation of the offender, as well as punishment of the criminal behaviour, with a central role in regards to the rights of, and provision of justice for the victim (Hughes, 2001, p248). The commonly accepted definition of restorative justice is; ‘Restorative justice is a process whereby parties with a stake in a specific offence collectively resolve how to deal with the aftermath of the offence and its implications for the future’ (Marshall, 1999, p5). According to Hughes (2001) Restorative justice aims to bring the process of criminality back into the ‘community’, enabling all parties affected by criminal behaviour to be involved in working towards resolution and future planning (Hughes, 2001, p248). This is a new concept, as traditionally criminal justice was retributive and aimed only to address the offence by punishing the offender.

In recent years, restorative justice has been a process that has been adopted by an international audience, particularly the USA, Australia and New Zealand, each employing it to address some of the traditional concerns of the formal justice system (O’Mahony and Doak, 2004, p484) i.e. the effectiveness of prison acting as a deterrent for crime, or victims lack of inclusion in the criminal justice process. The ‘new’ restorative justice system aims to move away from the traditional notions of retribution into a new context of restoration. Most international practices are supported by Braithwaite’s (1989) theory of reintegrative shaming, which exerts the idea that the offender should be encouraged to experience shame for their actions and work towards absolution (O’Mahony and Doak, 2004, p484). The process attempts to ‘repair the relationship’ between the victim and the offender and begin a ‘healing process designed to meet the needs of the victims, whilst also reintegrating the offender into society’ (O’Mahony and Doak, 2004, p484). Braithwaite’s theory is based on the proposal that the process of restorative justice will address the needs of the victim materially, emotionally and psychologically, whilst also helping them emerge from the process with more respect for the system (O’Mahony and Doak, 2004, p484).

Another theory of restorative justice was first introduced by the New Zealand Maori and their principles of collective responsibility, where restorative justice seeks to decentre the state’s status as the responsibility of dealing with crime (Tauri and Morris, 2003, p44). Instead, operating by drawing together all those involved in an offence to an environment, promoting equal power relations, while discussing the harm caused, and jointly agreeing on how reformation can be made (Tauri and Morris, 2003, p44). A central component to restorative justice is that the community is seen to be a key stakeholder in the offence (Zehr and Mika, 2003, p41). This can take a variety of forms, from the vicinity in which the offender and victim live, or their wider social networks of family, friends and colleagues (Zehr and Mika, 2003, p41). This allows for comprehensive information sharing beyond that of only the offender and victim, so that the scale of the harm caused by the offender can be explored. This is the main difference between the formal justice system and that of restorative justice, where all parties can contribute information of the offence and the harm caused, while also having an involvement into meaningful reparation.

Restorative Justice in practice

Restorative justice in practice is a relatively new concept in the UK, having elements such as reparation orders in the Crime and Disorder Act (1998), and referral orders in the Youth Justice and Criminal Evidence Act (1999) (Crawford and Newburn, 2002, pp476-478). Within Northern Ireland it was the Criminal Justice Review (CJR) (2000) which provided recommendations to involve victims in the criminal justice process and develop restorative justice approaches for juvenile offenders. The review concluded that restorative practices for adult offenders and young adult offenders (aged 18-21) be piloted and evaluated before whole schemes are introduced (Criminal Justice Review, 2000, p203).

Since then, within the UK and indeed internationally, there are the three common practices of restorative justice used within the criminal justice system, these are; 1) Victim-Offender Mediation (VOM) – a face-to-face meeting with a trained mediator, the offender and the victim to discuss the offence and reparation. VOM is predominantly offered to incarcerated offenders. 2) Family Group Conferencing (FGC) in Youth Justice – is open to a wider number of participants including the offender, victim, victim’s family and professionals who are linked to either party, where the aim is to resolve conflict or behaviour, and discuss reparation. Specifically used within youth justice as an alternative to formal prosecution, encouraging offenders to achieve empathy towards their victim, while also assuming responsibility for their behaviour. 3) Restorative/Community Conferencing – Open to a wider circle of participants including the offender, victim, both families and members of the community who discuss the offence and how to repair the harm caused. Conferences hold the offender accountable, but also offer reintegration into the community.

(Extracted from www.restorativejustice.org.uk)

FGC in youth justice is seen as one of the most successful models of restorative justice, widely used internationally in New Zealand, Australia and parts of the USA, and gaining momentum in the UK (O’Mahony and Doak, 2004, p485). FGC aims to be an alternative to formal prosecution, providing the offender, victim and families with an opportunity to understand the offence and the implications of it. The main aim of FGC as a form of restorative justice seems to exist to prevent younger people becoming implicated in the adult criminal justice system, having countless disadvantages for their future. FGC specifically seems to be effective as it uses a holistic understanding of the offence. It incorporates collaboration between the offender, victim and community i.e. friends and family, to find suitable resolution to the offence. This perhaps creates a more ‘person centred’ justice system realising each person’s needs are different but equally important. A reflection of this on a wider scale is that – should the reparation fit the people rather than the crime? Restorative justice practice shows that it is necessary to meet all parties’ needs, and not just the offenders. This relates to changes in policy which recognises the victim as a central aspect of the criminal justice process.

In other areas of the criminal justice system, such as with adult offenders and serious crimes, restorative justice only operates within the already established systems of punishment. Restorative justice is not used to substitute traditional measures, i.e. retribution, but to work alongside them. Restorative justice for serious crimes is not used unaccompanied without formal justice, as legislation and policy do not currently permit it. Marshall (1999, p7) claims restorative justice should be used with serious offences as there is more to gain in regards to victim benefits, and also crime prevention. However, it remains to be seen if this could be functional as the only form of justice, and without punitive measures would the behaviour be negatively reinforced?

Within Northern Ireland restorative justice is a relatively new concept which has been introduced under different circumstances and will be discussed below.

Restorative Justice in Northern Ireland

As mentioned earlier restorative justice in Northern Ireland was a result of the recommendations made from the Criminal Justice Review (2000), and the Justice (NI) Act (2002); each identifying that the victim should be central in the criminal justice process. This became the state led restorative justice approach, but a community based restorative programme was unique to Northern Ireland and the ‘Troubles’ at that time. Restorative justice and theory became prominent during the Northern Ireland peace process as an alternative to paramilitary violence (McEvoy and Mika, 2002, p2). First introduced from the Good Friday Agreement (1999), community projects were established, in part, to remove ‘paramilitary policing’, while reflecting the desire for community-based justice (Gormally, 2006). Projects were established in both communities – Northern Ireland Alternatives on the Loyalist side and Community Restorative Justice Ireland on the Republican side (Gormally, 2006). Both projects now operate successfully throughout Northern Ireland, each having numerous locations. The main agenda for the projects are to provide victim-offender mediation and reparation of the communities, with the community playing a significant role in each. It is also indicated that beyond the non-violent alternatives to paramilitaries, the projects now extend into ‘broader mediation and conflict work’ (McEvoy and Mika, 2002, p7). Critics of the community-based projects claim that paramilitary violence still occurs, only under the ‘respectable cover’ of these schemes (www.mediationnorthernIreland.org) leading to questions being asked about its legitimacy. However, evaluation of the projects show punishment violence related to crime and anti-social behaviour has decreased dramatically within each community (McEvoy and Mika, 2002, p8).

As well as the strengths of restorative justice and the benefits it provides it is also necessary to discuss possible draw-backs in order to be fully aware of the system. This will be discussed below.

Critical Analysis of Restorative Justice

Restorative justice, as mentioned earlier, has a strong theoretical basis and practical application. However, as it is a relatively new concept it is imperative to discuss potential shortcomings as well as benefits in relation to retributive forms of justice. The four main criticisms that will be discussed below will relate to the offender, community, victim and retribution in relation to restorative justice.

Offender:

The principles of restorative justice are about redefining crime as harm and giving stakeholders a share of power (Marshall, 1999, p6). The benefits of this are well documented in practice, especially within youth justice, with the young offender more likely to complete reparation plans if they themselves have helped construct them. However, it remains to be seen if this practice is completely ethical. When facing a victim, in a room full of strangers and perhaps their own parents, a young person is likely to comply to any measures, without dispute, in order to hasten proceedings (Daly, 2002). The victim may also be revengeful or unforgiving and want a harsher punishment with pressure on the young person to agree, creating a power imbalance similar to punitive measures. The young person may then regret volunteering for the restorative process, aiding the break down of restorative plans, making the process ineffective and meaningless.

Community:

Possibly one of the biggest critiques of restorative justice is its reliance on community relationships, with the community playing a large role in the reintegration of the offender back into society. Marshall (1999) claims that communities are not as integrated as they once were, with many individuals wanting greater privacy and self-sufficiency. Leading to questions; who are the community and how can they play a significant role in the rehabilitation of the offender? According to Zehr and Mika (2003) the community can take a variety of forms, for example, the neighbourhood where the offender and victim live, or their closer social networks of family, friends and colleagues. Braithwaite’s (1989) theory of reintegrative shaming claims that strong relationships within the community helps limit wrong-doing because of conscience and anxiety. For those offenders that commit crime ‘shaming’ then is an integral part, not only for reintegration, but for crime prevention. Restorative justice then needs community and family relationships to be effective, if the offender does not take responsibility for their crime or feel shame, then they cannot be rehabilitated correctly or reintegrated into society. Does restorative justice then have its downfall if there is no bond to society?

Victim:

Another criticism of restorative justice is that it is open to offender manipulation and other symbolic implications. Is it seen as an easy option? Perhaps it is all too easy for an offender to say sorry and ask for forgiveness, without actually being punished appropriately for their actions. Daly and Stubbs (2006) claim that without treating offences seriously, the wrong message can be conveyed to the offender e.g. that their behaviour is acceptable, and therefore reinforced, leading the victim to feel injustice and therefore re-victimised. This is one of the major downfalls when it comes to adult restorative justice; if it was the only form of justice it is open to manipulation and coercion of the offender.

Retribution vs. Restoration:

The main question that needs to be addressed is ‘can restorative justice exist without retribution and the formal justice system?’ In regards to juvenile court it is possible to exist alone, if the offence is minor. But for adult offenders, with major offences, the process is not so simple. According to Mead’s ‘psychology of punitive justice’ (cited in Daly, 2002, p59) there are two contrasting methods responding to crime. 1) ‘The attitude and hostility toward the law breaker, which brings attitudes of retribution, repression, and exclusion’ which identifies the offender as the ‘enemy’, and 2) Outlined in youth justice, is the ‘reconstructive attitude’, which tries to ‘understand the causes of social and individual breakdown’ & ‘not to place punishment, but to obtain future results’. It is a contrasting method which identifies differing views, which is fundamentally what restorative and retributive justice represent. The question that needs to be addressed is ‘can restorative justice exist alone as a justice system for all crimes?’ According to Morris (2002, p601) it shouldn’t have to meet the standards of conventional criminal justice, but just consider what it has already achieved, and what it can still achieve.

It is now accepted that restorative justice should be used to integrate with traditional forms of justice, to provide an effective service to all those involved & to offer a ‘whole’ justice (Marshall, 1999, p8). Marshall (1999, p8) claims both forms of justice should now support each other to become a single system in which the community and formal resources can work in partnership. Nevertheless, without current legislation or policy that governs restorative justice practice, this leaves the projects that do exist in Northern Ireland, and the rest of the UK, operating in an informal basis with a lack of safeguards, resources and support to gain proper momentum.

The criticisms of restorative justice practice are negative, but research nationally and internationally can show us just how successful it can be, with victims and offenders experiencing greater satisfaction with the processes and outcomes of restorative justice compared with attending court (Ashworth, 2003, p175 and Daly, 2002, p208). Properly done, restorative justice can have many benefits to not only the offender, but to the victim and community as well, providing a balance that is surely the way forward for the criminal justice system.

Conclusion

The question for this assignment was ‘restorative justice aims to address the consequences of offending for victims, offenders and communities in a meaningful way’? Evidence shows that restorative justice works within the youth justice system, but due to restraints on policy and legislation it is limited in the adult justice service. When restorative justice is implemented properly, it is effective at meeting the needs of offenders and victims, but to decide if this is meaningful is based on an individual experience, which I do not possess.

On the theory of restoration vs. retribution – to combine them, rather than separate them provides all stakeholders with a ‘whole’ justice, capable of meeting physical, emotional and social needs, while also considering all parties as equal.

There are many criticisms of restorative justice, but evidence shows that it is effective and provides reformation far beyond that of retribution. It provides explanation of behaviour, which in itself is meaningful, and is more than traditional methods provide. Restorative justice is an internationally respected system, and identified as a person centred form of justice, representing all parties equally, while balancing reformation with understanding.

References:
Ashworth, A. (2003) ‘Is Restorative Justice the Way Forward for Criminal Justice?’ in McLaughlin, E., Fergusson, R., Hughes, G. and Westmarland (eds) (2003) ‘Restorative Justice: Critical Issues’, London. Sage Publications. The Open University
Braithwaite, J. (1989) ‘Crime, Shaming and Reintegration’, Cambridge, Cambridge University Press
Crawford, A and Newburn, T (2002) ‘Recent Developments in Restorative Justice for Young People in England and Wales’. British Journal of Criminology, 42:3
Daly, K. (2002) ‘Restorative Justice: the real story’, Punishment and Society, 4:1, 5-79
Daly, K. & Stubbs, J. (2006) ‘Feminist engagement with restorative justice’. Theoretical Criminology, 10:1, 9-28.
Gormally, B (2006) ‘Community Restorative Justice in Northern Ireland – An Overview’: http://www.restorativejustice.org/editions/2006/april06/gormallyarticle – Accessed 22/10/09
Hughes, G (2001). ‘The competing logics of community sanctions: welfare, rehabilitation and restorative justice’. In E McLaughlin and J Muncie, ‘Controlling Crime’, London. Sage Publications. The Open University.
Marshall, T. (1999) ‘Restorative Justice: An Overview’. London. HMSO
McEvoy, K & Mika, H. (2002) ‘Restorative justice and the critique of informalism in Northern Ireland’. British Journal of Criminology. 43:3, 534-563
Morris, A. (2002) ‘Critiquing the Critics: A brief response to critics of restorative justice’. British Journal of Criminology, 42:3, 596-615.
O’Mahony, D. & Doak, J. (2004) ‘Restorative justice – is more better? The experience of police-led restorative cautioning pilots in Northern Ireland’, The Howard Journal, 43: 5, 484-505
Tauri, J., & Morris, A. (1997). ‘Reforming justice: The potential of Maori Processes’. Australian and New Zealand Journal of Criminology, 30:2, 149-167.
Zehr, H and Mika, H (2003). ‘Fundamental concepts of restorative justice’
In E McLaughlin, R Fergusson, G Hughes and L Westmarland (Eds). ‘Restorative Justice: Critical Issues’. London. Sage Publications. The Open University.

Web sources:

http://www.mediationnorthernireland.org/documents/BrendanMcAllisterEuropeanRestorativeJusticeConferenceJune2006.pdf – Accessed 22/10/09
http://www.psni.police.uk/index/updates/index/updates/consultation_zone/eqia_of_youth_diversion_scheme.pdf – Accessed 19/10/09
http://www.restorativejustice.org.uk/index.php?What_is_Restorative_Justice%3F –