The Safeguarding Of Children By The Government Social Work Essay

‘The process of protecting children from abuse or neglect, preventing impairment of their health and development, and ensuring they are growing up in circumstances consistent with the provision of safe and effective care that enables children to have optimum life chances and enter adulthood successfully.’ (Source: Working Together to Safeguard Children, 2006).

It is essential that children are safeguarded from maltreatment and impairment of their health and development not only to prevent the terrible day-today suffering some children are subjected to, but also to ensure that children are safe from these abuses to protect their long-term well-being (Combrink-Graham, 2006: 480). Deliberate and sustained maltreatment, which includes physical, emotional and sexual abuse of children, is not confined to any particular group or culture; it pervades all groups, classes and cultures.

So as practitioners it is our professional duty of care to ensure that every child has the same amount of safeguarding as the next. It is also vital that as Early Years professionals we understand the roles and procedures of the services available for children and families so that we may offer the best advice possible. There are two areas of guidance statutory and non-statutory.

LOC1- analyse the role of statutory, voluntary and independent service in relation to children and families.

A service which is defined as statutory is one that the Local Authority have a legal duty to supply. The Local Authority is obliged by statute to provide some services, for example, social services, NHS hospital, health professionals, the police and probation service, youth offending teams, secure training centres, childminders and schools. They all have a duty under the Children Act 2004 to ensure that their actions are clear with regard to the need to safeguard and promote the welfare of children. (Source: Working Together to Safeguard Children, 2006).

Safeguarding and promoting the welfare of children is the responsibility of the local authority (LA), working in partnership with other public organisations, the voluntary sector, children and young people, parents and carers, and the wider community. (Source: Working Together to Safeguard Children, 2006).

The role of statutory services in relation to children and families is to employ professionals who are committed to the cause of helping children to stay safe. The services need to employ staff that understands their responsibilities and duties in these difficult situations, so any organisation that deals with safeguarding children needs to make sure that all members of staff are safe to work with children and young people by providing a thorough identity check. Also the organisation that provides this service needs to be equipped to deal with any allegations including ones made against staff by having clear procedures in place. All staff have to have regular up to date training and understanding of the subject while working in this environment and they also need to understand the correct procedures if working with partner organisations.

The voluntary sector is undertaken by organisations that are not for profit and non-governmental such as charities like Childline, the NSPCC and churches. This sector plays an important part in providing information and resources to the general public who may be unable or afraid to contact other sectors about the welfare of some children. They may also specialise in a particular area of abuse and may have greater and better understanding of the subject as their members of staff have experienced more in-depth training. Like the public sector their staff paid or volunteers need to go through the same process as the staff from the public sector that is stated in paragraph 2.8 in Working together to Safeguard Children 2006.

Like the voluntary sector, the independent sector also has to abide by the regulations that come with working towards safeguarding children. The Independent sector is not financed through the taxation system by local or national government, and is instead funded by private sources. Such independent services are private schools, boarding schools, private counsellors and private charities such as UNICEF. A non statutory service is one which may or may not be supplied, at the discretion of the authority concerned.

LOC2- Evaluate the legislation framework and procedures for child protection at national and local level.

There are several legislative frameworks/laws and procedures for child protection at national and local level which are continually being amended, updated and revoked. One of the significant pieces of legislation is The Children Act 2004 which led to a considerable change in the way services are directly concerned with serving children and families. As a result of consultation with children and families following Lord Laming’s enquiry into the terrible and tragic death of Victoria Climbie, the government announced its plans to restructure children’s services to help achieve five outcomes for well-being. The government outlined these outcomes in its Every Child Matters (ECM) agenda, stating that to achieve well-being in childhood and in later life children and young people want to:

be healthy;

be safe;

enjoy and achieve;

make a positive contribution; and

achieve economic well-being (DfES, 2004b).

These five outcomes for well-being are now the goals for Every Child Matters and all services that are concerned in the education and welfare of children and young people are bound to ensure these outcomes are achieved.

The Every Child Matters Outcomes Framework (DCSF, 2008b) for enabling children and families to be safe requires that Early Years settings and primary schools must demonstrate that they are enabling children to be safe from maltreatment, neglect, violence and sexual exploitation, and from accidental injury and death, and that children and young people have security, stability, are cared for and are safe from bullying and discrimination. This is a very complex area for those who work with children, or intend to work with children, in part because of the amount of legislation that is attached to these issues.

The Education Act 2002 places a duty on Early Years settings and schools to safeguard and promote the welfare of all children, including ensuring they provide a safe environment themselves and take steps, through their policies, practice and training, to identify ‘child welfare concerns and take action to address them, in partnership with other organisations where appropriate’ (HM Government, 2006:13). The Education Act 2002 also places this duty on childminders and any organisation that provides day care for children – of whatever age.

Locally the group of people responsible for co-ordinating what is done by organisations in Essex to safeguard and promote the welfare of children and to ensure the effectiveness of this activity is the Essex Safeguarding Children Board (ESCB).

Despite all of the legislation and policies, preventable tragedies like Victoria Climbie and Baby P continue to happen. It is vital therefore that child protection agencies learn from these terrible events and continue to amend their policies. Legislation is also put in place not just to protect against harm to children but also to give protection to the professionals working with children and their families.

LOC3- Debate theories of abuse such as medical, feminist, social and psychological models.

The general public’s usual opinion of an abuser is that they are abnormal, sick or criminal. The reasons for abuse may be deep and complex. The actions of an abuser are definitely wrong but why did they take them? There are lots of different theories as to why abusers abuse. Some of the more widely held theories are:

The social model definition is where it is believed that a child copies the behaviour of adults around them. Albert Bandura (1977) referred to the social learning theories of other important professionals in child development such as Vygotsky and Lave. This theory includes aspects of behavioural and cognitive learning. He believed that behavioural learning assumes that people’s environment cause people to behave in certain ways. Also he believed in cognitive learning which is when someone experiences or acquires knowledge, he presumed that psychological factors are important for influencing how people behave.

Another theory is the medical model. John Bowlby (1969-80), is recognized as one of the most prominent theorists in researching social effects on child development, in particular he is famous for his ‘attachment theory’ (Flanagan, 1999). When Bowlby first began discussing this theory his work focused on the importance of the attachment a child has with its mother. The present accepted theory is that children can form a number of attachments with adults other than their biological mother, what is important is that children need caring and nurturing relationships in order to thrive, and not simply the basic needs of food and shelter (Foley et al., 2001; 211).

Bowlby believed that there was a critical period of bonding in the first year of life. Much research has been done that suggests a strong correlation between mothers who have not formed a strong attachment to their children and child abuse and neglect. If not treated conditions such as postpartum depression (or post-natal depression as it is more commonly known) could lead to the mother having a negative attachment with the child developing into neglect which is a form of abuse without the mother realising.

Another influential theorist in the area of child development is Erikson (1902-1994) who in the 1960s devised a model of human social development that focuses more on the impact of background and environment on development, rather than genetic determiners. This is known as a psychosocial model (Miller, 2003). The importance of this theory is that it explores how the beliefs, attitudes and values we grow up to hold are shaped by our genetic predisposition towards incentive acts and how the environment we grow up in impacts on those natural characteristics. Therefore, Erikson maintains, we are distinctly shaped by our formative experiences. If this is so, then the experiences a child will have while they are young will impact on their life as an adult, including on their attitudes, beliefs and values.

A different opinion as to why abusers abuse is the psychological model. Psychological theories focus on the instinctive and psychological qualities of those who abuse. This theory believes it is abnormalities within the individual abuser that are responsible for abuse, for example, abusive parents may themselves have been abused in childhood (Corby, 2000). Although the flaw is that psychologists have failed to establish a consistent personality profile for a child abuser when compared to another form of abuser.

Feminists believe that the Feminist model may be the answer to the actions of an abuser. The feminist model suggests that child abuse like domestic violence is a result of unequal power in the family. Cossins (2000) believes that abuse is done by man to women and is about male masculinity and power. But this does not take into account female abusers. Professor Lynne Segal suggests that the ideas of masculinity emphasises control and power. This assumes that all men have power and women and children do not have power (Bell, 1993). This theory also needs to include not just gender and power issues but to consider race, class and culture as well (Reavey and Warner, 2003).

The Cycle of violence is another model, it is based on the view that children who live with domestic violence will learn that abuse is acceptable and will become either an abuser or a victim. While experiencing or witnessing domestic violence can have a serious impact on children and young people, they will respond in various ways depending on their age, race, sex, culture, stage of development, and individual personality. By no means do all children who have lived with domestic violence grow up to become either victims or abusers. Many children exposed to domestic violence realise that it is wrong, and actively reject violence of all kinds. There is not much evidence to support this model.

Although all these models give some insight into why an abuser would abuse there is no one type of abuser, so there can be no one model. What we would consider a child abuser in this country is not the same standards as other countries. Not one of these models can solely explain the actions of a child abuser. Finkelhor (1986) understood that and was a critic of single factor models. He also believed that women were just as capable of abuse as men are.

LOC4- Describe the categories of abuse and the possible effects on the child, family and workers.

What comprises abuse is open to wide debate, because some researchers will state that what one group in society deems to be abuse, another will claim is a ‘normal’ part of child rearing practice. For example, the smacking debate. Is it acceptable to smack a child? There is a legal acceptance that where a smack doesn’t leave a lasting mark it is not abuse, but if it is continuously done and escalates then this would be classed as abuse. The point at which any practice becomes abusive is the point at which it becomes ill-treatment, likely to impair health or physical, emotional, social or behavioural development (DfES, 2006).

The categories of child abuse are physical, emotional, sexual abuse and neglect. Most often if a child is suffering from one of the categories like physical or sexual abuse they are likely to be suffering from emotional abuse as well, as the categories link into one another.

As Early Years practitioners we need to keep an eye out for any signs of physical abuse, which are usually visible to the eye, such as unexplained injuries, bruises or burns. Other signs of physical abuse are if the victim refuses to discuss injuries, gives improbable explanations for injuries, has untreated injuries or lingering frequently recurring injuries. If the parents administering of punishment appears excessive, if the child shrinks from physical contact, or they have a fear of returning home or of the parents being contacted, or a fear of undressing, or a fear of medical help these could also be a sign of physical abuse. Physical abuse can lead to the child becoming aggressive towards other children and bullying. An abused child may display over compliant behaviour or a ‘watchful attitude’, have significant changes in behaviour without explanation, their work may deteriorate and they may have unexplained patterns of absences whilst bruises or other physical injuries heal. In some cases the child may even try to run away.

Another form of abuse is emotional abuse; this is one of the hardest types of abuse to recognise as there are often no outwardly visible signs. Emotional abuse is about messages, verbal or non-verbal, given by a care giver to a child. Almost all children are subjected to emotional abuse to some degree. Even the most caring of parents will at some time give children quite negative messages, this is why it is hard to detect emotional abuse.

Examples of emotional abuse are deliberately humiliating a child, making a child feel ashamed for not being able to do or understand something which they, in fact, are developmentally incapable of. Other signs of abuse are expecting a child to put the needs of other family members before their own. Persistently verbally abusing a child, or constantly threatening to leave a child on their own as a punishment is abusive whether or not the threat is carried out. Making threats of other cruel and excessive punishments and/or carrying them out, telling a child that he was not wanted, was a mistake, or was the wrong gender, isolating a child, preventing them from socialising with their peers and continually putting a child under unfair moral/emotional pressure is abuse. Some adults may also not realise that exposing a child to age-inappropriate activities such as television, films and computer games is also classed as emotional abuse.

The DfES (2006) What to Do if You Are Worried a Child Is Being Abused document defines sexual abuse as:

Sexual abuse involves forcing or enticing a child or young person to take part in sexual activities, including prostitution, whether or not the child is aware of what is happening. The activities may involve physical contact, including penetrative or non-penetrative acts. They may include non-contact activities, such as involving children in looking at, or in the production of, sexual on-line images, watching sexual activities, or encouraging children to behave in sexually inappropriate ways. (DfES, 2006: 9).

The definition of neglect is ‘the persistent failure to meet a child’s physical and/ psychological needs, likely to result in the serious impairment of the child’s health or development’ (DfES, 2006: 9).

Some examples of neglect are failure to feed a child adequately, not providing appropriate clothes or bedding, giving inadequate basic physical care, the child having no boundaries or consistency, the child not being safe, not attending to a child’s medical needs and failure to meet or recognize a child’s emotional needs.

The definition of neglect clouds with shades into the definition of emotional abuse. While both these definitions make sense, they are somewhat blurred around the edges. When we talk about ‘severe’ actions it can be difficult to decide whether, and at what level, to intervene.

There have been studies that show evidence that neglect, physical abuse and sexual abuse are all associated with reduced intelligence in children (Carrey, 1996). While this study shows an example of the effect abuse can have, sometimes a child can grow up with a positive attitude and have a successful life. But this is not to say that all survivors are successful in life and obviously some people suffer terrible ongoing issues related to their experience of abuse. Such as being able to trust anyone or in the case of sexual abuse never being able to let anyone touch them and the damage is permanent. Abuse can also affect the family by breaking it apart and separating the abuser from the abused.

LOC5- Evaluate ways of enabling children to protect themselves, and ways of supporting children who have been abused.

We can’t expect children and young babies to protect themselves. So the government and schools try to communicate a universal message to children to try to protect them. Such as bullying is wrong, to be nice to one another, to eat well and look after each other and to promote a positive environment. We should always take children seriously and listen to what they are saying, as this is a way of improving our ways of providing support.

There are four methods that are used with children in need and their families, each of which needs to be carried out effectively in order to achieve improvements in the lives of children in need. They are assessment, planning, intervention and reviewing (DfES, 2006).

As an Early Years professional you should be aware of the local procedures to be followed for reporting concerns about a particular child. If you have any concerns about a child, they must be reported to the school’s designated senior member of staff or a senior member that is appointed child protection supervisor. This may be where your involvement may end or you may need to be involved further. The practitioner will discuss with a manager and/or other senior colleagues what they think the appropriate action should be, then if there are still concerns a referral to the Local Authority children’s social care team will be made, followed up in writing within 48 hours. The social worker and manager then acknowledge receipt of referral and decide on the next course of action within one working day. An initial assessment is required to decide if there is any concern for the child’s immediate safety.

The initial assessment should continue in accordance with the assessment framework which is a chart that states what the needs of a child are. If there is reasonable cause to suspect the child is suffering, or is likely to suffer significant harm, children’s social care should arrange an immediate strategy discussion. The purpose of the strategy discussion is to agree whether to initiate section 47 of the Children Act 1989. It is also to identify the appropriate tasks and timescales for each involved professional and agency, and agree what further help or support may be necessary. If the child is likely to be harmed then the police and other relevant agencies are called.

Next there would be a child protection conference and the results from that would determine whether a core assessment is made which is where the family and other professionals agree a plan for ensuring the child’s future safety and welfare. If the results are that the child is in sufficient harm then the child becomes the subject of a child protection plan, which is where the difficulties of the child will be made known to partner agencies. This will be followed by giving the child a key worker and a child protection review conference, the purposes of the child protection review is to review the safety of the child.

Usually, the decision to keep a child’s name on the protection register is reviewed every six months, depending on the circumstances. A child protection review conference can decide that a child’s name should be removed from the register. This decision will only be made when the child protection review conference is satisfied that the child is no longer at risk of significant harm. A young person will also be removed from the register once he or she turns 18. Obviously the worst case scenario is when a child dies due to abuse and nothing was done to help them. As Early Year professionals it is extremely important that situations like this never happen and that is why these procedures are put into place.

Professionals can intervene by working with children and families to help protect them. There are support systems in place for children and their families provided by local government and sometimes connected to the school. Sure start is one such system. Sure start is a government programme which provides services for children and their families. It works to bring together early education, childcare, health and family support. Services provided include advice on health care and child development, play schemes, parenting classes, family outreach support and adult education and advice. If there is a case of suspected abuse but it is decided that there is no need to remove the child or the parent following the families’ assessment, Sure start can be recommended to the family as a place for family development.

In this country there are 11 million children, 4 million have been identified as vulnerable (disabled), 400,000 have been identified as ‘children in need’, 32,000 are on the child protection register and 63,000 are ‘looked after’ (in foster care). These statistics have gone up since the terrible tragic death of Peter Connelly (Baby P) in 2007. (http://www.statistics.gov.uk/cci/nugget.asp?id=348).

We live in a highly complex and diverse society and as professionals it is part of our responsibility to ensure we are not confusing what we think is the case, or what we would like, with what is really the case. As Early Years practitioners we need to approach individual children and families with an open mind. While we believe we know what, a perfect world is, we also know that families come in all shapes and sizes, and that all families are likely to need support to help them.

To make sure that all children get the correct and full treatment/service needed to make sure that they are safeguarded against abuse all practitioners/professionals should work together and communicate to achieve this goal.

Effects of Stigma on Drug Users

In this essay I will demonstrate my understanding of stigma and labelling. There are certain people who are stigmatised and substance users often have a negative stereotype. This negativity will often not allow the substance user to seek the help and medical treatment that they need due to the stigma and labelling. I will be discussing the research around the impacts of stigma and labelling that will affect not only their treatment but in housing and employment.

The term stigma originates from the ancient Greek word and signifies that he or she could be a slave, criminal or traitor and was used as a sign of disgrace and shame. It is now used to describe people who are stereotyped because of their social identity (Pierson & Thomas, 2010). According to Goffman, when a person is not able to meet expectations because their behaviour or attributes are undesirable or unacceptable, then stigma disqualifies a person from social acceptance. Goffman suggests that stigma is, “an undesirable attribute that is incongruous with our stereotype of what a given individual should be” Goffmam (1963:3). Stigma is a use of negative labels and is about disrespect. It is not just a matter of using the wrong word but labels that person who has the substance use disorder. Stigma results in discrimination and abuse and is damaging to the lives of many people. The fear of stigma discourages families and many individuals from getting the support and treatment that they may need to lead normal healthy lifestyles. Stigma deprives people their full participation into society which then reinforces negative stereotypes (Goffman, 1968). The way of coping with stigma is to conceal behaviours and internalize these negative views and as a result will be subject to discrimination and exclusion within many areas. Drug problems will remain entrenched if substance users are seen as “junkies”. Landlords will be reluctant to let out their properties and employers will be wary of giving them jobs. Employment and housing are important to substance users as it can be vital in establishing themselves back into society (UKDPC, 2008). Research studies show that 80% of drug users are unemployed. Being employed is shown to be an important component into the reintegration into society. Once in work, it will help in building their self-esteem and back into normal life (UKDPC, 2008). Family members feel shame and stop trusting them and in some cases, disown him/her. Community’s will “finger point”, try to avoid contact and will gossip about them. Many would argue that society’s disapproval of drug use; especially cannabis and heroin will say stigma is necessary to demonstrate disapproval (UKDPC, 2010). Stigma can also make the substance user stigmatize themselves, make them feel alone, rejected and destroy their self-esteem. Seeking help is very difficult for the substance user and will prevent them from doing so. They will often feel that quitting would be no use and returning to normal life would be impossible because people in society will no longer trust them and so will join in with other drug users, start criminal activities to pay for their use and accepting the blame of society (UKDPC, 2010).

Stigma discourages families and individuals from getting the support and treatment they require. Families suffer the impact when another family member has a drug use (UKDPC, 2009) and it alters all their social invitations and friends that they once had. Other family members will often withdraw and children will often be targeted by bullies. Stigma deprives people of their full interaction into society. The UK Drug Policy Commission (UKDPC) suggests that 1.5 Million people in the UK are affected by a relatives drug use. Supportive relationships are key to a successful recovery. Carers UK commissioned a study which estimated that carers in the UK made a contribution of ?87 billion in total economic value in one year. This may have excluded many who have not come forward with coping with a relative who has a drug problem but this gives us some indication of the social contribution likely to be made by the supporting families (DrugScope/Adfam, 2009). The drug user must have determination and faith in reaching their goals and there will probably be setbacks and barriers but with the support and contribution of social workers, support groups, family and friends, this will help towards the recovery process (HM Government, 2010). Families and relationships are key issues for recovery and drug users improve when their family is behind them. They are more than likely to complete treatment and maintain their new lifestyles (Best & Laudet, 2010).

DrugScope published research in 2009 by interviewing a random sample of over 1000 people aged 18 plus. The research published showed that one in five adults had a personal experience of drug use, either direct or indirect. The findings where:

19 % have “personal experience of drug addiction” either directly or among family or friends;

1 in 10 adults have a friend who has experience of drug addiction;

1 in 20 have experienced drug addiction in their family;

1 in 50 has personal experience of drug addiction.

77 % agree investment in drug treatment is “sensible use of government money”.

The poll found that 19% either had direct or indirect personal experience of a family member or knowing someone within their circle of friends. 11% were likely to have a friend who has experienced drug addiction. 6% had family members who were drug dependant, yet 2% experienced the drug dependency themselves. These figures do suggest that drug misuse and the dependency do affect many people’s lives and is a social problem (DrugScope, 2009).

Stigma to substance users will possibly make addiction recovery and treatment more difficult. Substance users often manage in secret and would rather not seek out the treatment and live in denial. The University of Nevada studied 197 drug users on the affects of stigmatization. This research identified that because of the use of stigma they would become more dependent on their drug use due to the perceived negativity that the society had on drug users. 60% of drug users in this study felt that they were treated differently after people knew that they were a drug user. 46% felt that others became afraid of them once they found out and 45% felt that their families gave up on them and wanted nothing more to do with them. 38% of their friends had rejected them and finally, 14% of employers paid a lower wage (Addiction, 2010). Users have no good reason to stop using when you look at this research study. This research identifies that stigma is conceptuality unique. Drug users also had a more difficult time in treatment at succeeding when there were higher levels of stigma. The study also showed that drug users often cope in secret due to their inability to openly discuss their addiction; this caused poor mental health and decreased their chances of recovery. By reducing shame the society could help in driving forward in helping the treatment of drug users who are not coming forward due to stigma (Addiction, 2010).

Stigmatising is not only found amongst the public but also by the professionals who may be working directly with them. Professionals, such as doctors and nurses, who work directly with drug users, will have a greater insight into the problems that drug users face on a day to day basis. Miller et al (2001) mentioned in UKDPC (2010:30) summarised research from the USA which showed an increase in negativity towards drug users. Two studies of the treatment of problems with drug users and drinkers both in the inpatient care and ‘safety net emergency department’ showed that negative views during training, continued when they became qualified and working within their practice (UKDPC, 2010). Stigma between health professionals and the drug user will prevent them from seeking help and may be one of the reasons as to why the drug user will not seek out the help or medical treatment that they require (Kelly & Westerhoff, 2010).

Everyone knows that it is wrong to discriminate, whether it is because of their race, culture or religion. Substance use is very common and is widely misunderstood. It is essential that we learn about the person and treat with dignity and respect. This will then help in emphasizing their abilities (Mental Health and Recovery Board, 2009). Public attitudes to drug addiction were explored in the UK in 2002 (Luty & Grewal, 2002). Results showed that 28% regarded drug users as having a mental health problem. 38% assumed that drug users were criminals and 78% to be deceitful and unreliable. 30% said that they deserved the misfortune that fell upon them. 62% thought that the law were too soft on drug users and 40% believed that their children should be taken into care. It was concluded by Luty and Grewal, 2002, “the results clearly indicate a negative view of drug addicts” (Luty & Grewal, 2002:94).

Yet, DrugScope in 2009 wanted to find out the attitudes of the public towards drug users and drug treatment. They commissioned a poll and the findings suggest that the public to be very sympathetic than sometimes often assumed. 80% of the people surveyed agreed that ‘people can become addicted to drugs because of other problems within their life’. 35% agreed that it was the individuals fault for drug use and that there is no excuse. A large amount of respondents 88% agreed that for the drug user to get back on track, they needed help and support and 77% agreeing that the investment of government money towards drug treatment is sensible. This research showed a sympathetic response of the majority of the people surveyed.

Drug users are the most marginalised people in society where discrimination and stigma are key into the barriers of receiving recovery. Two thirds in a recent poll showed that employers would not employ anyone with history of drug use, even though they were suitable for the job. Stigma and discrimination still remains a barrier to recovery and will clearly impact of them finding work. It will also affect being housed appropriately and accessing the healthcare that they need (DrugScope, 2009)

The things that we can do as practitioners in helping to overcome the stigmatisation is to have a better understanding of how difficult it is for people to change who may have low self-efficacy. First impressions count and for a substance user, coming through the door is hard enough. The substance user will have come because they are in a crisis and has realised it is time for change (Lecture Notes, 2012). As social workers we have to realise that engaging with the substance user will help in the first steps to recovery and help in building relationships. Building respect and trust will prevent misunderstandings that may lead to conflict. Having good communication skills is effective and at the heart of social work. It is only through our communication skills that we are able to understand the knowledge of others and work effectively (Trevithick, 2009). It is important to communicate as it helps in exchanging our thoughts and feelings and in forming the foundation of a good relationship. Communication allows you to help the substance user to be more receptive to the new ideas by creating an environment that they can trust and help in developing resolutions. To have an open and honest relationship, trust is important in succeeding this. An agreement ideally should be met with the substance user about confidentiality. They have a right to know who will be able to access any information about them (Koprowska, 2010).

Motivational Interviewing is a well known model developed by William Miller in 1982. It is a model used with people to evoke change, especially people who have problematic substance misuse. Motivational interviewing is a client-centred counselling style and helps the service user to reach their decisions about potential behaviour change (Nelson, 2012). This model helps in identifying and understanding the substance user’s motivation to change and highlight to the client their perceived negatives and benefits of change. The principles of motivational interviewing are to express empathy, develop discrepancy by helping the client in increasing their awareness of the consequences of their behaviour. Avoiding argumentation as it is them who are the expert. Roll with resistance by encouraging the client to develop their own arguments. Resistance is normal if you are uncomfortable about something and lastly self efficacy by highlighting the skills and the changes they have already made (Lecture Notes, 2012).

Assessing motivation with the substance user and finding out at which stages they may be will help in me identifying where the substance user is in their dependency. A well known model called the cycle of change developed by DiClemente and Prochaska (1982) represents the point at which the substance user passes during their change in behaviour. The different stages are:

Pre-Contemplation, this is where the service user has no desire to change.

Contemplation, this is where the service user may be considering their situation and is more aware of it.

Preparation is where the service user makes a decision to change their substance misuse.

Action and this is where the service user takes steps in bringing about change.

Maintenance is where they have stopped using the drugs and moved to a more controlled and less harmful way of using and is maintaining that change.

Relapse is where the service user will go back to their old behaviour and will have to start the Cycle of Change again (Teater, 2011:122).

The substance user may slip back or relapse in to their old behaviour because permanent behaviour is very difficult to change, particularly with people who want to make change in substance misuse. This is very difficult and may take several attempts (Nelson, 2012). Motivational interviewing will help the substance user move through the stages of change.

Having good active listening skill is important and will help in making the substance user feel that he/she is being helped. Many people will feel encouraged when they have been truly listened to without interruption and will often become encouraged and empowered (New Jersey Self-Help Group Clearinghouse). A good listener allows the person to get their own stories and opinions across, which active listening will allow them to do so. If you interrupt, the person will feel that they may not have been listened to. They will not feel respected and may hold information through being cautious. It is important to allow them to know that you were listening and will help in encouraging them to continue talking. Leaning forward, maintaining eye contact will also show them you are interested in what they have to say (MindTools, 2012). You have to remember to not let environmental factors distract you as this could make you lose focus. Giving the substance user your undivided attention and acknowledge what they are saying. Using body language either by nodding occasionally, smiling and encouraging the speaker to continue by saying verbal comments, such as ‘yes’ and ‘go on’ will encourage the speaker to continue by knowing you are listening. Giving positive feedback by paraphrasing e.g. “What I am hearing is” and “It sounds like you are saying”, are good ways of reflecting back and help in clarifying certain points that the substance user may have said and helps towards getting more background information. Paraphrasing also helps in allowing yourself to really understand what has been said and helps the substance user know that they have been heard und understood correctly (Koprowska, 2010). Having the three core conditions of counselling of empathy, respect and congruence will help to enhance the substance user’s motivation to change. Empathy allows putting you in another person’s shoes and having a better understanding of their feelings and emotions. You must ignore your own perception of the situation and accept their feelings and thoughts. By doing this does not mean that you accept the behaviour they are doing but means that you understand them. Congruence allows you to be yourself and that you are only human and a real person. This will help in reducing the stress the substance user may have. Having respect is accepting the person for who they are regardless of what the person says or does. When others have possibly made that person feel negative, it is very hard for them to feel positive. Showing the substance user respect will show willingness that you want to work with them, which will allow them to grow confidence (Trevithick, 2009).

Change is difficult, so it is normal for the substance user to feel ambivalent. Using the Decisional Balance will help in identifying the positives and negatives of their behaviour. If you are going to change, you need a reason to and people change when the positives outweigh the negatives. We always have to be aware of the short term or long term risk factors including their level of usage and what type of drugs they are using (Miller & Rollnick, 2002). Motivational interviewing helps the substance user in identifying the importance of their behaviour change and also helps the practitioner help in doing so by enhancing their motivation. This model works well alongside the ‘cycle of change’ as it is useful to assess where the substance user may be in their cycle of change and help in identifying the strategies you may use (Nelson, 2012).

In conclusion, if a person does not conform to social stereotypes, they are more than likely to be marginalised and bear stigma. People with substance misuse are of all types and come from different backgrounds (Pycroft, 2010). Working with individuals who are experiencing substance use, it is important to remain focussed. Providing constant feedback and offering support will help in engaging the drug user towards solving the crisis the substance user may have. Having a non-judgemental attitude underpins social work along with empathy and advocacy (Trevithick, 2009). People with substance misuse are often viewed as less worthy and deserving. Stigmatisation can cause prejudice, marginalisation, discrimination and oppression and is often reinforced by the media and even our own families (Theory and practice, 2011). People who substance use are often stigmatised and feel shameful of it and can happen if the substance user has had several attempts. When you are ashamed of something and you disclose it, it is very hard especially if you’re unsure as to how the other person is going to respond. It is important for myself to reflect upon my own value base and prejudices that I may have.

Referances

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(accessed 18 November 2012)

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The Role Of Multidisciplinary Working

This essay will relate to an observation of professional social work practice in a Crisis Centre, for people with mental health issues who require support, and short-term accommodation, with the goal of returning home or to a new environment. This essay will focus upon the role of multi disciplinary collaboration regarding the Crisis Centre staff, and Crisis Resolution Home Treatment Team (CRHTT), and to discuss why collaboration appears to play an important and fundamental role within social work practice. The essay will also aim to demonstrate good practice and possible strengths and weaknesses of multidisciplinary working.

Within the field of social work practice it does seem evident that ‘multidisciplinary working is work undertaken jointly by workers and professionals from different disciplines or occupations’ (Pearson & Thomas, 2010:342) and has evolved at varying speeds over the past 30 years, in response to imperatives of central government. (What evidence)?Evidence suggests that the area mental health was among the first professions to adopt teams of workers from different professions, and the Community Mental Health Team is widely regarded as the model for multidisciplinary working (Community Care, 2010). It seems that , in relation to social work, the distinctive quality that has to be demonstrated is anti discriminatory practice and a holistic approach, by working with a range of situations and people having an attribute for developing multidisciplinary and partnerships (Higham,2006:).

The Crisis Centre that has been observed is run by a Local Council????,Can u not say Liverpool and is a National Health Service Trust based in the community. The centre also corresponds (look up meaning in dictionary)does this word apply here??.-The centre works within the— or to the guidelines set down in the with the 1975 White Paper entitled ‘Better Services for Mentally Ill’. This highlight’s the importance of professions, working together to provide a community based service (Social Care Institute for Excellence (SCIE), 2010) demonstrating that collaboration is fundamental to social work. The Crisis Centre provides beds for adults suffering from mental health issues who have been referred to them from the CRHTT, for instance by referral from their Doctor or health department. The next step is to complete an assessment in line with local authority guidelines and procedures, then produce a care plan and risk assessment. If they decided the service user is in crisis and cannot return home contact will be made to the Crisis Centre. Average sentence length is 15/20 words long.Have a look at your’s.

CRHTT use numerous ways and methods of contact to inform social workers, such as, E-mail, telephone calls and home visits. This can demonstrate collaboration through good practice and communication which is essential to social work. Effective collaboration between staff at the ‘front-line’ is a crucial ingredient in delivering the government’s broader goals of partnership between services’ (Whittington, 2003). Also, in the audit commission 2002 it seemed evident that service users who seem to require social workers, will, and can, collaborate with other professionals to provide appropriate service.

During this observation multidisciplinary working was witnessed between the Crisis Centre staff, and the CRHTT regarding a service user in the centre through a telephone call. The CRHTT seemed to be following the National Occupational Standards key roles section three, by ‘supporting the individual, representing their needs, views and circumstances by acting as an advocate’ (Higham 2006: 98) and had been informing the Crisis Centre of what was happening. The Crisis Centre staff asked questions in a way that was treating the service user as an individual, by listening to their individual case, respecting and maintaining dignity by only asking questions relevant to the Crisis Centres needs and criteria. Staff spoke clearly and discussed the dynamics of other service users (respecting confidentiality) already in the centre, declaring any conflict or positive interactions that had arisen since their last visit (General Social Care Centre (GSCC), 2010).These skills are seen as fundamental to social work practice as they are valuing the individual and provide a holistic approach. This will also ensure the social worker is not using their power in an inappropriate way.

Furthermore, in the 1990’s the New Labour government recognised that problems cannot be addressed by people and organisations working in isolation. As a result the Department of Health (DH) (1998) intruded the White Paper ‘Modernising Social Services’, which had multidisciplinary working as a key objective (Wilson, et al. 2008:388). The DH (2000) No Secrets legislation actively promoted that multidisciplinary teams will empower, and promote, well-being of vulnerable adults through the services they provide and the ‘need to act in a way which supports the rights of the individual to lead independence’ (DH, 2000).

DH No Secrets (2000) legislation was carried out by the service user, Crisis Centre and CRHTT via staff communicating throughout the day, and providing an environment where service users can come and go freely, yet still have support during their crisis. An example of encouraging independence was allowing the service user to cook and clean for them selves. Ryan’s (2010) evaluation of Crisis Centre and CRHTT asked service users what they valued best about their stay. Their responses included ‘I was on the lowest rung of the ladder in terms of depression and self esteem’. ‘Now I can cook and iron’. It has restored my ‘get up and go’ and ‘it is given me a sense of life back and helped me to find myself. I could not have gone on any longer’. ‘Staff have taught me to cope better and manage my panic attacks.’ This seemed to demonstrate partnership working with the service user and multidisciplinary working. The 2006 White Paper Our Health, Our Care, Our Say emphasises the importance of people having more control over their lives and access to responsive, preventative services by working together in multidisciplinary teams (DH, 2006). The Crisis Centre appears to fulfil this.(Empowerment) u could mention this if u think it would help

Throughout the day through discussions, and observations, it appeared that the Crisis Centre staff and CRHTT encouraged emancipatory practice by involving the service user in their support. This shows good practice and also that staff were not routinized as each day was different, for example, they discussed how each individual was unique. If social workers become oppressed by working in routines this does not always benefit the service user, it is not good practice and is not fundamental to social work values.Who says this?? An example of this was observed when a member of the CRHTT came to the Crisis Centre and completed a visit with a service user. During her visit she was contacted from her office through telephone calls, one of which was a new service user needing to be assessed urgently. She had to re-evaluate her cases as the new referral seemed more of a priority. She did this by speaking to her manager on the telephone and re -arranging for another colleague to see her service user, then asked the office to let the service user know about this change showing collaboration, good practice.

This commitment demonstrates multidisciplinary working and partnership working with the service users are fundamental and collaboration is needed for social work and the interpretation from the staff involved demonstrates good practice. ‘Collaborative working is required by government. To show partnership working with service users in the Crisis Centre, Ryan (2010) Is this reference in the right place or should it be after-required by Government ???. asked service users how they felt about staff. Service user’s responses included ‘any questions or anything you are upset over, you can go and ask the staff’ and ‘staff are very supportive and helpful.’ Social work is about working with people to help them sort their own problems out. Kaggs read this highlighted part again, does it sound right, were u sleepy ????

This essay has aimed to demonstrate positive multidisciplinary working through observation at the Crisis Centre. However, it appears that multidisciplinary working can be negative and dysfunctional. When a group of diverse people with varied skills come together into a team, things do not always go accordingly (Community Care, 2010). Cree (2003) cites ‘multidisciplinary working can also be positive, but also frustrating and isolating (Dalrymple & Burke, 2006). Wilson, et al. (2008) agrees multidisciplinary working does not always work effectively and as a result failures have been documented, such as, Victoria Climbie enquiry and Baby Peter. In addition Thompson (2005) believes multidisciplinary can also appear to do more harm than good and can make situations worse.

During the day it was bought to attention through a staff handover that one of the service users in the Crisis Centre had experienced a negative experience of multidisciplinary working. Consequently, this seemed due to the breakdown of communication between, his social worker, CRHTT, Crisis Centre staff and medical staff. According to Thompson (2009) without effective communication the notion of multidisciplinary becomes unobtainable. Staff at the Crisis Centre believed it was due to lack of budgets and lack of communication. During this handover reflective practice was witnessed and as a team they spoke about what, why and how things had gone wrong for the service user and how they could approach the situation to get the best outcome. Staff at the Crisis Centre spoke about how they valued supervision meetings as it gave them chance to voice any concerns they had and gave the manger chance to deal with any systematic practice that was leading staff to become unfocused (Thompson and Thompson, 2008). Supervision meetings demonstrate good practice and are part of social work codes of practice to develop through opportunities to strengthen skills and knowledge.

This essay has demonstrated through observation the important of working with other professionals as one person cannot solve another person’s problems alone (Thompson and Thompson, 2008). Also that multidisciplinary working is integral for social workers and many other professionals. This essay has aimed to provide a balanced outlook on multidisciplinary working as it demonstrated positive points, as working with other professional’s by pooling skills together is essential. Correct use of legislation and commitment to social work practice can all enrich a service user’s life. Problems do occur though when multidisciplinary teams do not always communicate effectively and this can be frustrating. Through observation it became apparent that lots of people contributed to multidisciplinary teams and showed that collaboration, good practice and communication were not always ideally used within practice.

The role of family power structure

Family Power structure plays a critical role in family health functioning. Power has been defined as the ability to control, influence or change another person’s behavior (Friedman, 1998). Power is related to resources. Control over resources (eg. money) infers power. In most families, parents control these resources. There are three types of family power namely chaotic power, symmetrical power and complementary power (Hanson, 2001).

The power structure in my family is complementary power. It is defined as requiring dominion-submission dynamic within the family structure. In this family-power type, healthy families are characterized by parents having a clear family advantage that their children recognize and accept. Although my father brings home the bacon every month, power is mainly shared between my parents. The decision-making in my family is highly dependent on my parents. Although my sister and I are involved in the decision-making, my parents are mainly responsible for making all sorts of decisions in the family from purchasing household furniture to deciding on a holiday destination to the meals we have together.

Family power structure is not fixed. As I turned 18 this year, my parents recognize me as an adult and would listen to more to what I have to say and how I feel. My parents are not as power-dominant as they were 10 years ago.

1.2 Subsystems

All families develop networks of co-existing subsystems formed on the basis of gender, interest, generation or function that must be performed for the family’s survival. Each member of a family may belong to several subsystems. Each subsystem can be thought of as a natural coalition between participating members. Subsystems in a family relate to one another according to rules and patterns.

There are three types of subsystems in my family namely spousal, parental and sibling subsystems.

For example, the spousal subsystem educates children about male-female intimacy and commitment by providing a model of marital interaction. Ways of accommodating one another’s needs, making decisions together and managing conflict etc.

Another example, my parents define the boundary of a parental subsystem by telling me as the oldest child to not interfere when they are reprimanding my younger sister. Parental subsystem also includes child guidance, nurturing, limit-setting and discipline.

1.3 Boundaries

Boundaries are invisible barriers that keep subsystems separate and distinct from other subsystems. They are maintained by rules that differentiate the particular subsystem’s tasks from those of other subsystems. Boundaries may either be rigid, diffuse or clear. Disengaged families have rigid boundaries which leads to low levels of effective communication and support among family members. Enmeshed families have diffuse boundaries which make it difficult for individuals to achieve individualization from family. Clear boundaries are more of a balance as they do not fall on either extreme ends of rigid or diffuse. Clear boundaries are firm yet flexible, permitting maximum adaptation to change.

The boundary in my family is clear. For example, my parents temporarily redefine the boundaries of the parental subsystem when she tells me to be in-charge of the house when they are away from home. Many years ago, my parents would ask my aunt to come over to care for my sister and I while they are away. This shows that the parental subsystem is flexible enough to include other people temporarily.

1.4 Triangulation

Triangulation is used to describe a situation in which one family member will not communicate with another family member unless a third family member is present, forcing the third family member to then be part of the triangle.

In this triangulation, the third person will either be used as a messenger to carry the communication to the main party or as a substitute for the direct communication. Usually this communication is an expressed dissatisfaction with the main party.

For instance, my family used to be very united until a year ago when my sister who was one of the top PSLE students in her primary school dropped out from secondary school at secondary two suddenly. She stopped attending lessons and was extremely rebellious towards my parents and me. My parents having high expectations from my sister were absolutely furious and upset when she decided to quit school. Numerous attempts to persuade her to attend school failed again and again until a point when my parents gave up convincing her. However, they still talk about my sister to me all the time, mentioning how stubborn/ignorant she is and that she would regret her decision later in life.

2. Communication patterns

McLeod and Chaffee (1972) came out with a scheme to analyze family communication patterns (FCP) to examine the role of family communication. In this model, the family communication environment is characterized by the extent to which the family emphasizes on socio-orientation and concept-orientation. Socio-orientation stresses the importance of harmony in the family and avoidance of conflicts. Concept-orientation encourages children to think about and discuss political and social issues. In a highly socio-oriented family, children should not argue with parents and should not express opinions different from other family members’ so as to maintain social harmony. On the other hand, in a highly concept-oriented family, parents believe that children should look at both sides of issues and talk freely about these issues.

Using these two dimensions, McLeod and Chaffee (1972) introduced a four-fold typology of family communication patterns as seen in Figure 1.

Figure 1

High on both dimensions of socio-orientation and concept-orientation, the communication pattern in my family is consensual. Consensual families emphasize both relational harmony and free communication exchange. Every member in my family is able to express our ideas freely as long as internal harmony in the family is maintained. Since young, my parents have encouraged both my sister and I to voice out displeasures in the family openly but stresses the importance of logical reasoning behind it.

Like most traditional Asian families, my family tends not to express affectionate behaviors in the form of hugging or kissing towards or saying mushy words to one another. Instead, my parents would constantly ask me questions regarding about my school life, the friends that I go out with, among many others that revolve around my daily life. I suppose these are ways of displaying affectionate behaviors in my family.

There are few conflicts in my family. Nevertheless, whenever one arises, we tend to face each other openly and voice out our concerns. My father would always play the middle-man whenever I had an argument with my sister and he would always ensure both parties are treated fairly and just.

3. Family environment

Based on Olson, Russell and Sprenkle’s (1979) Circumplex Model, the Circumplex Model assumes that the difference between functional and dysfunctional families is determined by two interrelated dimensions: cohesion and adaptability.

Cohesion is defined as the degree of attachment and emotional bonding among family members. There are four various degrees to the cohesion dimension namely disengaged, separated, connected, and enmeshed. Families that are disengaged lack family bond and loyalty, and are characterized by high independence. On the other hand, families identified as enmeshed are characterized by high levels of closeness, loyalty, and/or dependency.

Adaptability is the ability of the family to change power structure, roles, and relationships in order to adapt to various situational stressors. It too has four degrees namely rigid, structured, flexible, and chaotic. Families with low levels of adaptability are considered inflexible or rigid. Rigid family types are characterized by authoritarian leadership, infrequent role modification, strict negotiation, and lack of change. Families with high levels of adaptability are considered chaotic as it is changing too frequently. Chaotic family types result from a lack of leadership, dramatic role shifts, erratic negotiation, and are characterized by frequent change.

Based on the Circumplex Model, my family environment is balanced. It has moderate level of both adaptability and cohesion. Power structure is not fixed and there are times when there is a temporary shift in power to adapt to various situations. For example, I am responsible for taking care of my sister when my parents are out. Another example is when an deciding on a holiday getaway, power is shared among each family members to be involved in decision making.

4. Family Rules

Family rules help family members to get along better, and make family life more peaceful. Effective rules are positive statements about how family members want to look after and treat one another. I have become so accustomed with my own family rules that sometimes I do not even realize that some of my daily activities are actually in fact, family rules.

“Dos and don’ts rules regarding family members’ safety, manners and daily routines were set up in my family since I was young. Of course these rules are constantly changing as my sister and I grew older with more responsibility in our hands. Rules such as “be home by 10pm” and “do not lock the doors at home” are a thing of the past when I was much younger. Today, the rules are much more flexible. For instance, if I were to return home late or spend the night at a friend’s house, all I have to do is to call home to inform my parents.

There are also fewer family rules as my sister and I are expected to be able to care for ourselves. Moreover, rules set when we were young are already deep-rooted in our daily life.

5. Family values and attitudes

Family values are political and social beliefs that hold the nuclear family (parents and children) to be the essential ethical and moral unit of society.

5.1 Money

From a very young age, my parents have taught me the importance of saving up money and spending them wisely. Every week, I was to slot in leftover coins in a piggy bank. Years passed by and today I still have the habit of keeping all my loose change in a piggy bank and when it became full, I would then deposit the money into the bank. My parents are prudent in spending money; they only buy what is deemed necessary and seldom splurge on luxury goods.

However, there are times when my parents think that it is worthwhile to spend more money such as holding birthday celebrations or Chinese new year celebrations at home.

5.2 Religion

My family is a little religious. My parents are Buddhists and they made an effort to pay their respects to the deities at temples annually. However, my sister and I do not have a religion but our parents do not force us to join a religion too. There are no altars at home and my parents do not carry religious charms either like a pendent or a talisman with them.

5.3 Education

Like most parents in Singapore, my parents take education very seriously. My father stresses that education is the key to survival in Singapore and this is especially more true since Singapore has been ranked the most competitive country in the world in 2010 by Time. Although my parents view education as important, they also know that each individual has their own limitations towards studying. My parents want my sister and me to have a positive mindset towards studying but yet at the same time not to overwork ourselves. The ideal model is to strike a balance between work and recreation.

5.4 Success/failure

My parents are rather reasonable and they know that success and failure are part and parcel of life. My parents view success as achieving one’s goals. For instance, one of my goals in secondary school was to get into Singapore Polytechnic (SP) and I did well enough during my O levels to enroll in SP. My parents were very happy and proud of me. On the other hand, I did not get into the course of my choice so I felt disappointed because it felt like I had succeeded and failed at the same time. My parents told me that one couldn’t always get what we have aimed for and as long as I have tried my best, that’s all that counts.

6. What I have learnt from my parent’s relationship

What I learnt about marriage from my parent’s relationship is to treat your partner as a friend. Marriage is a lifelong process full of ups and downs. My parents are both committed to overcome obstacles and being the best spouse and friend to each other. My parents are always joking around. My mother loves my father’s sense of humor and they always laugh at the silliest things. This taught me that being playful is a crucial part of marriage and nothing should be taken too seriously in a family.

My parents also speak kindly of each other. My mother always told me that my father was a good father and a hardworking man. In addition, they also give each other nicknames as some term of endearment.

I learnt the significance of having interests/hobbies different from your spouse’s too. My father and mother have different interests. My father enjoys watching detective crime television programs while my mother loves watching Korean Dramas serials. My mother would never last an episode of detective crime programs but that seems okay because they respect each other’s alone time as well. This also taught me that it is fine to have a degree of independence in a marriage too.

7. Attitude towards authority

I have a positive attitude towards institutional authority (parents, teachers, police, and the law). I tend to respect the rules and abide by it. I held many student leader positions in schools too. Positions such as class monitor in primary school, student counselor and National Police Cadet Corp (NPCC) non-commissioned officer (NCO) in secondary school and class chairperson in my polytechnic life. This is mainly due to my strict upbringing from early childhood. My father was a very strict man. I still remember the times when my father would cane me whenever I got into trouble in primary school. Furthermore, I would have to write a reflection about my wrongful actions. I used to be very afraid of my father when I was very young. However looking back in time, I realized that my father just wanted me to grow up to be a good person and I am grateful for what my father had done to make me the person I am today.

8. Attitude towards sibling

My relationship with my sister has definitely seen better days. We used to be very close and play with each other a lot. However in recent months, my sister’s attitude has grown worst. She became very temperament and gets annoyed very easily. We had a lot of quarrels with each other and soon grew distant. Nowadays, we seldom speak to one another.

9. Level of differentiation from family

Level of differentiation refers to the degree of one’s ability to distinguish his own thoughts and emotions from that of his own family. Individuals with low level of differentiation are more probably to become reliant on others’ approval and acceptance. They either conform themselves to others in order to please them, or attempt to force others to conform to themselves. Thus, they are more vulnerable to stress and they struggle more to adapt to life changes.

Individuals with high levels of differentiation recognize that they need others, but they rely less on other’s acceptance and approval. They do not only adopt the attitude of those around them but take into account their principles thoughtfully. These enable them decide significant family and social issues, and resist the feelings of the moment. Thus, despite conflict, criticism, and rejection they can stay calm and clear-headed to differentiate thinking rooted in a careful assessment of the facts from thinking clouded by emotion. Well differentiated individuals choose thoughtfully and act in the best interests of the group.

I think my level of differentiation from my family is balanced. I have my own thinking and my own point of view. I am not afraid to have a different mindset from my family members. My parents also encouraged my sister and I to become more independent, to be ourselves and not conform for the sake of pleasing others.

10. Family strengths
10.1 Caring and Appreciation

I think I am very fortunate to have a family who is caring and appreciative. Even if a family member makes mistakes, other members would to encourage and support one another. My parents notice and share positive qualities of each other. For example, they pay attention to another person’s polite behavior or something nice he or she did or said. They notice the characteristics, skills, achievements and special qualities that make the other person unique.

My father would write encouragement messages on his red packet during Chinese New Year. These messages are inspirational and reassured me that my family members do care about me.

10.2 Good Communication

Furthermore, there is communication between me and my parents. We talk and share our feelings, hopes, dreams, joys, sorrows, and experiences. I would tell the daily happenings in school or with my friends just to update my parents about what’s going on in my life. My parents take the time to listen and respond to what I have to say.

10.3 Openess to change

There is a set of family rules in my family. These rules are ways to deal with daily life. Some of the more obvious rules consist of who does the cooking, who washes the dishes, who does the laundry or who clean the toilet. Other less obvious forms include: Who has the authority to make what decisions? How are differences of opinion handled? How are anger, affection, or other emotions expressed at home?

10.4 Working together

Most of the time, my family make decisions, solve family problems, and do family work together. Everyone participates. Parents may be in charge of the decision-making at home but the children’s opinions and efforts are invited, encouraged, and appreciated. For example, whenever my parents decided to buy a new television set, they would always ask for opinions about which television is suitable for the family. It makes my sister and I involved in the shopping as well and let us know that what we say counts.

I learnt that if parents allow their children to make real decisions, it enables children to grow up to be responsible adults. Children need opportunities to make decisions, to be involved in family decisions, and to observe the parents’ decision-making process and outcomes.

Children are more motivated to carry out their responsibilities if they have some say as to what those responsibilities are and can see how these particular activities help the family. Teenagers are keener to go along on a family vacation if they help decide the destination and itinerary.

11. How has my family affected my personality? What are the weaknesses you want to improve and what are the strengths you want to maintain in yourself.

Based on a study on more than 100 children conducted by psychologist Diana Baumrind, she identified four important dimensions of parenting which affects the child’s personality. They are disciplinary strategies, warmth and nurturance, communication styles and expectations of maturity and control.

Based on these dimensions, Baumrind suggested that the majority of parents display one of three different parenting styles. Further research by also suggested the addition of a fourth parenting style (Maccoby & Martin, 1983).

The four parenting styles include authoritarian parenting, authoritative parenting, permissive parenting and uninvolved parenting.

My parents’ parenting style suit authoritarian the most. My parents establish house rules and guidelines and expect my sister and I to follow them. However, my sister and I were also involved in the rules setting so we were able to find them realistic. This parenting style is much democratic. When children fail to meet the expectations, authoritative parents are more nurturing and forgiving rather than punishing. Although my father punished me whenever I broke the house rules; he would always end it off with nurturing and kind words. My parents are assertive, but not intrusive and restrictive. Their disciplinary methods are supportive, rather than punitive.

I think I grew up to be a socially responsible and cooperative person. I tend to avoid conflicts with people and adopt the “make more friends than enemies mindset”. I lean more towards the extrovert scale as I enjoy the company of my friends. My friends told me that I am a good-tempered person too. They don’t see me get angry because I am not bothered by the slightest issues.

Another strength that I have is being persistent and committed. Once I set my mind on a target or a goal. I would thrive to achieve it. My parents have been teaching me the importance of goal-setting since young. I also gain a huge sense of pride and satisfaction whenever I accomplished my goals.

One weakness that I have is being perfectionist. I am very attentive to details and would not be satisfied unless I get the exact results that I wanted. Most of the time striving for perfection is tiring and time consuming. My project members would sometimes find me a pain in the neck when I was not satisfied with their research work.

Another weakness I have is laziness. I think I have been too pampered from young. I seldom do household chores because my mother is a housewife and she does all the housework. Well, almost all, my father did his part too. As such I became reliant on my parents to do my own laundry, to wash my dishes etc. I have been trying to increase my contribution to my family by doing some household chores but it’s hard to do so especially since I have done almost no housework since young but I’m not giving up easily.

In summary, family relationships are one of the longest relationships we would ever have in our life. We should never take our family members for granted but should cherish them instead.

The Role Of Family In Mental Health Social Work Essay

During mental health rotation I came across the scenario, which forced me to reflect on it. A 30 years old male patient diagnosed with schizophrenia since four to five years and has multiple admissions during past years. During examination and history taking I came to know that he is being admitted since two year back in Civil Hospital with the complaint of aggression, hallucination and suspiciousness. He was admitted by his sister who wanted to get rid of the responsibility of taking care of him. Furthermore he belongs to low socioeconomic background from the outskirts of Karachi. He is married and has 4 children, his elder brother and all other relatives are supporting him menially. According to his sister he should be restrained with “Zanjeer”. They think that he is putting up an act. His elder brother has left him because of his disease. He has left taking his medications since six months and with nobody realizing it. After six month when he became very aggressive and his family was unable to control him, he was brought for admission in Civil Hospital.

Looking at my patient’s scenario I believe that there were multiple factors which led him to mental illness. Most severe of these were poverty, illiteracy, low socio-economic status, stigmatization and eventually all of they evolved family support from him. If we just see what family is: according to Shomaker (2006 )

“aˆ¦A group of individuals who are bound by strong emotional ties, a sense of belonging and a passion for being involved in another’s lives.” (pp.163)

Therefore it could be said with substance that families live in different compositions including nuclear, extended, multigenerational, single-parent and same gender families. According to B.A.Marry(2005): “aˆ¦so either they are connected emotionally or by blood or in both ways”. Hence family is composite institution where every member is mentally and emotionally affected by the existence of other members. Also that, the presence of family members in healthy state influences the metal health of rest of the family members. In Pakistan, the extended family system is most common family system. In such family systems, individual autonomy is equivalent to group autonomy and the group is the complete family unit. People in Pakistan dearly follow the joint family system and live their life along with their folks. (Naeem, 2005).In other words, it can be said that extended family system has many advantages, it is also of harm in some cases to the members. Due to the sheer size of the family, the members are denied individual attention and care that is so required for any patient. The same happened to my patient who was left alone by his extended family.

According to De Sousa(2009):

“The family is both a system and a unit in society, a primary multifunctional institution into which all human beings are born, brought up and nurtured by various interpersonal relationships. Thus family serves as the basic architect of the individual’s personality. The relationship between the individual and the family members determines the disposition to illness and health in every stage of life right from infancy to old age. He further says that the family is strategic centre to understand human emotions and relationships that play pivotal roles in both positive health and disease. It is the major support system for the patient that is mentally ill but at times the patient is often deprived of psychiatric treatment due to family burdens that exist”.

Family support and role of each member starts since the time of birth as parents as brother as sister and many other different roles which shows their care and affection through bodily gestures, verbal and nonverbal communication and provides a sense of security to the infant and it go on throughout the life. De Sousa(2009) share that the individuals who receive a lack of support early in life remain at an increased risk of experiencing poor health later in life”. If one has lack of family support than he/she might be not able to withstand of normal stressors and ultimately the person will end up in mental illness. It would thus be apt to say that our lives are closely in need of support from other people, without which our existence may not be possible.

Family members of person with mental disability can play a critical role in enhancing the care and treatment of their ill family members; however the ability of family to fulfill their caregivers’ role- is negatively affected by numbers of barriers alike. Lack of family support it can be due to social stigma and this is the main reason that mentally ill people’s social network becomes narrow. Gotlib and Feely (2000) supports that the notion by saying that “over time, due to social stigma associated with serious mental illness, developing and maintaining relationships can be difficult”. A support system is vital for people living with mental illness yet at the same time the illness places relationship at risk. The negative effects are at risk of being exacerbated in case of family not being present and poor prognosis and relapse may be the result.

According to Naeem (2005)”While the attitudes people hold towards mental illnesses has been studied to some extent in Europe. Nothing is known about what people think about mental health problems in Pakistan. Still we are far behind to know the role of family in mental health.” as we did not have enough literature to support and, thinking ahead for the roles of family to contribute will take time.

In our society mental illness is taken as a stigma and still people are not clear about the causative factors of the disease, rather they are connecting it with supernatural forces as cited by Karim.S. et al(2004) “it is widely perceived that mental illness is caused by supernatural forces such as spirit possession, punishments for one’s sins. “if we connect these believes with literacy status of our country then it is quite evident that the lower the literacy rate the greater the force of these believes will be . He further says “the literacy rate was 47.1% in 1997-2000” not only low literacy rate but low socio economic status which is letting people to strive for their basic needs. Though in Pakistan living together family is our culture but the trend lacks definitive approaches. For example, the family members do not realize the roles they are expected to play. This breeds in confidence among the family members preventing them from leading mentally healthy lives.

Family support is required at every age of life, family support and social network shows positive effect on health and well being. Mustafa (2005) suggests that support of family is important to maintain the mental health of individuals. As he mentioned in his work that “Social net work communicates love and affection to them who are in their network’ though patient has a social network (family) despite of them he is left alone. There is a process of social support which includes; (family, friends, neighbors etc) and social climate. In this process first” need” is identified than emotional and instrumental support is delivered through family network and when all parties combine together than a social climate is made for each other’s need. After each type of support is provided outcome appears in a form of mental health promotion. Need is about identification of need of family support, willingness of receiving support, and willingness of giving support in different circumstances.:

If I relate this stage need with my patient then his need was attention, caring attitude from his family however he was fail to receive it. No positive supports identified and if it was identified than it was the only physical part of his care, they were taking care of his physical need however nobody was realizing what actually his need was? This deficit of supportive family role leads to ending patient in the withdrawal of all his medication. So the effects of family presence and mental health problems play a major positive role during the treatment like increase chances of early rehabilitation and prevent relapse.

David.T(2006)” distinguishes between two facets of family involvement-family involvement with the client (apart from treatment) and family involvement specific to the client’s treatment because they may have different antecedents and consequences and because families may be involved in one way, but not the other. For example, a family member may provide financial assistance to the client but not be involved in the client’s treatment. Both types of involvement are operational zed in terms of the quantity, nature, and perceived quality of the involvement. Like although his mother was present with him but most of the time she was worried about his physical need

Calgary Family Intervention Model (CFIM): One way to think about change.CFIM is an organizing framework conceptualizing the intersect between a particular domain (i.e., cognitive, affective, or behavioral) of family functioning and a specific intervention offered by a health professional (Wright, Lorraine & Leahey, 1994). This model emphasis on early involvement of family in patient’s cares where positive and negative feedback can be given to encourage and improve dealing. Families are required to be involved in every level of interventions. As family education and awareness about disease, its management and prognosis is very important. In keeping above scenario in mind for group level interventions one can refer to Gravois, Paulsson and Fridlund (2006) grounded theory model of mental health professional support (MHP). It is based on the needs of families with a member suffering from severe mental illnesses. In this model researcher give four category of MHP support that being present, listening, sharing and empowerment.

In this model ‘Being present’ refers to the early contact, early identification o f role changing and giving early information about coping and disease management. Listening plays very important role in mental illness management. In this model assessment is based on active listening of patient and family experiences. After assessing the burden and worries of family and patient .Health care professional can do intervention that can help family to understand patient needs and learn effective coping skills to deal with the patient. They can also form support groups for family so that they can share their feeling and motivate each other to take better care of patient and relieve pain of stigma. Sharing in this model means maintaining coordination with family and as team could take decisions for the patient. Interaction with shared responsibility will create sense of security in family that will lead to open communication between MHP and family .Thus leading to good prognosis of patients.

Lastly, the empowerment which implies that when the family members cope with the situation and obtain a deeper understanding of mental health/illness, they seem to have gained empowerment. Thus, MHP counseling about mental health/illness, in a group or individually, empowered the family” (Gravois,Paulsson & Fridlund(, 2006.)

At individual level, I actively listened to the patient After through assessment of patient, data were organized and those areas were highlighted which need change .This is the very important step as in the scenario the main problem with the patient was disease process which was aggravated due to lack of support .As with good family support patients can live better life. So I focused the family as well as the individual to deal with the problem. Firstly I planned to give patient education about disease process, developing insight and dealing with delusion, as due to withdrawal of psychiatric medication since six months he was very aggressive and his grandiose delusion were very strong indeed, so I tried to give awareness about himself so the co-operation from his side could make family support easier for him. Secondly I involved patient in different activities to improve her social network and beside this I have planned patient teaching for the family that include awareness about mental illness and discharge teaching. “To improve the quality of life, psychosocial intervention with the family and the mentally ill person e.g. family problem solving, drug compliance, crisis management, training of social skills and cognitive behavioral strategies are suggested”. (Gravois & Fridlund, 2006). But unfortunately I was not able to interact with client’s family. Interventions were carefully planned in keeping culture and educational level of client in mind .

Support groups can be made for better coping. Perese and Wolf (2005) say, “The primary goal of a support is to increase members’ coping ability in the face of stress, to strengthen ‘the central core’ of individuals” beside this supporting family functioning and cohesiveness via acknowledging their values, and advocating for maintaining sense of self worth. Support groups will also give a sense of friendship. Moreover psycho education sessions could be done to help the families. In addition, school plat forms could be utilized to deliver health education to increase awareness and to build support groups. Moreover, I will plan this strategy with the help of psychotherapist in identifying the same patients who are suffering from lack of family support. In implementation I will make them share their life experiences; this will help them learn through each other’s experiences. To evaluate a mini survey could be done to compare the social support system before and after the involvement with support group and beside this I have planned patient teaching for the family that include awareness about mental illness and discharge teaching. “To improve the quality of life, psychosocial intervention with the family and the mentally ill person e.g. family problem solving, drug compliance, crisis management, training of social skills and cognitive behavioral strategies are suggested”. (Gravois & Fridlund, 2006). As cited by Gotlib &Feely (2000)” an approach to developing strengths is to help families develop knowledge or competencies that can enable them to cope and develop. Families can be assisted to locate and access experiences or materials to augment their knowledge.” But unfortunately I was not able to interact with clients. Institutionally health awareness sessions can be done to make people aware of life needs and importance of mental health promotion. Media can be utilized for Speeches to convey our messages to the government to resolve some psychosocial factors: poverty, lack of parental support. Some steps should be done to improve poverty as this is the common factor for mental illnesses. Could work with NGO’s to conduct different seminars for mental health promotion, this will enhance education level of the population and they themselves will take step to overcome factors contributing to mental illness. To plan a seminar at institution level I would make a plan of what need to be discussed in this seminar, I will discuss the target population with directorial level. In this seminar psychiatrists can be included for broadening the horizon of knowledge. After this I will make sure that on implementation media coverage is there. To evaluate this, small research could be done to see the prevalence of mental illness in the community. In addition, small questionnaires can be used to compare the knowledge level before and after seminar.

When I visited the psychiatric hospital I was upset by looking at patients’ condition. I was amazed that how this disease has took hold of patient and how this is done all of a sudden. It was my prejudice that genetic and biochemical factors are the most prominent ones, to cause any disease however it is not true psychosocial factors can be the most influencing one to have a disease as it is in my patient’s scenario. I assumed that the lack of family support only exists in Pakistan however through literature search I came to know that it is global issue. It is also very important to keep this fact in mind that family members and mental health care professional frame the role of family members in the care process. After analysis my patient’s life with the present condition I felt that I am blessed by God by having the supportive family, friends, and the community.

The Role of Child Death Inquiries

Recently the benefits of child death inquiries and serious case reviews have come under particular scrutiny (Corby, Doig and Roberts, 1998). This assignment will use evidenced based information and practice to find other approaches or how to improve the form of the inquiry so its benefits outweigh its limitations.

The United Nations estimate that every week two children in the United Kingdom die from abuse or neglect (UNICEF, 2003). The United Nations Convention, article 3 on the rights of the child places a duty on countries to protect children from abuse or neglect, the best interests of the child must be the primary concern when making decisions which may affect them, article 6 focuses on the importance of safeguarding their right to life (United Nations Convention on the Rights of the Child, 1992).

There are two types of child death inquiries; serious case reviews and public inquiries. A serious case review takes place when a child dies and abuse or neglect is suspected. They also take place in other circumstances where serious situations have occurred for example where a child has suffered from serious sexual abuse. The purpose of child death inquiries according to Working Together, 2010 is for agencies and individuals to learn where problems have arisen and to learn from these to improve their practice. The lessons learnt should be given to all individuals who work in this area to ensure they safeguard children in the correct way. When agencies already know where certain problems lie they should improve upon them before the serious case review is finished. A public inquiry for example The Colwell Report (1974), The Climbe inquiry (2003) is a inquiry ordered by the government to review events, in this case child deaths. To conclude where practice could be improved upon, recommendations can be given and lessons can be learnt.

Under regulation 5 of the local safeguarding children’s board requires that the local safeguarding children board undertakes reviews of serious cases. Serious case reviews must establish lessons to be learnt, identify which lessons are within agencies and which between and how long they have to act upon the changes to be undertaken. The reviews must also improve upon inter and intra agency working to promote and safeguard the wellbeing of children (chapter 8, Working Together, 2010). Laming (2009) states that serious case reviews are an important tool for learning lessons. Currently there is debate regarding the approach used in serious case reviews some believe that there are different approaches to take to learn from poor social work practice. Effective safeguarding practice is an approach considered, to learn from what is already proven to work.

The obvious aim of child death inquiries is to try and avoid future tragedies. There is a repetitive circle within child protection. Families collide with professionals and most of the outcomes involve protection. The tensions involved between families and professionals involve competition of rights. The Human Rights Act, 1998 article 8 stipulates the family’s right to a private family life and to be able to conduct their lives according to their culture and understanding. The opposite to this argument is to ensure all children are protected. When should professionals become involved? Parton (1991) describes the dilemma of how can the state establish the rights of the child and still promote the family to be an independent body in which to raise their children how they see fit and not intervene in all families and consequently reduce its autonomy.

Depending on the theoretical viewpoint the professionals and current Government takes would impose when the state should intervene. A laissez-faires government would have little intervention. State paternalism is a perspective which favours more involvement of state intervention to protect children from abuse. This theory regards the child’s welfare as more important than family autonomy. This perspective was reflected in the Children Act, 1989 as it introduced the expression likely for the child to be in significant harm. If there is a likelihood of significant harm there are possibilities of child protection orders being produced, and in other extensions of state power.

Tensions between the duties that social workers have to safeguard children, the family’s right to a private family life, the rights of the child, working in partnership with the parents and understanding when the state should intervene cause problems within social work practice. Knowing when to intervene has always been a problem for social workers within this area. Malcolm Hill (1990) found that published child abuse inquiry reports identified working with parents as a common problem. He found that papers noted access difficulties, in a number of cases parents didn’t cooperate when the social worker needed to see the child at risk. Hill (1990) concluded that papers found social workers were too ready to believe parents. Hill (1990) concluded that the Colwell report (1974) found that social workers should focus on parents demonstrating their parenting skills and not to assume all was well because the parents said so.

Social workers also need to look at the care the child is receiving holistically not focus on single areas of the family where they are showing positive steps, for example social workers may be satisfied as the family are participating in counselling but they need to still look at their parenting at home whilst this continues. Thus depending on the theoretical viewpoint the social worker takes decides when they should intervene. This assignment will adopt a state paternalism perspective, this perspective although draws conclusions that the child is likely to suffer significant harm which may affect the family relationships and autonomy it’s better to intervene now then wait until abuse or neglect has taken place and then safeguarding the child. This perspective takes a view that children have a high priority in society, they have rights to high standards of care and using this approach ensures that they are protected at all costs by the force of the law (Fox Harding, 1997).

Child death inquiries are seen as an important tool used to improve local practice and implementing wider community health approaches to improve upon infant mortality rates. Bunting and Reid (2005) found that there numerous benefits to serious case reviews taking place. These included; more effective multi agency working, improved communication between agencies, they found that death certificates had become more informative they also found that from participating in serious case reviews practitioners had more knowledge surrounding child death and the causes of them ensuring a further focus on preventative measures of child death rather than focusing on child abuse.

Corby et al (1998) have found that there is a growing concern on the impact of child inquiries on professionals especially social workers. They found that whilst inquiries were taking place social workers face continual criticism. The Maria Colwell case made social work practice public and put it under great scrutiny. Professionals within this case became points of focus of criticism, their work was scrutinised in incorrect contexts focusing on training of social workers affecting their morale significantly (Corby et al, 1998).

The impact of child death inquiries on social workers and other professionals in this area can be psychological and emotional. Corby et al (1998) argues both sides of the case that child death inquiries can highlight poor practice and the need for the public to know why children already known to social services and other departments can still go on to be abused and killed. However the emotional and psychological effects on social workers can be so detrimental because of the scrutiny they are under, their work will be affected, and affecting further work they do.

Corby et al (1998) investigated child abuse cases and inquiries and how useful they are and what changes have been made by using child death and abuse inquiries as an approach. Of the seventy inquiries they investigated between 1945 and 1997 they all produced similar recommendations in areas of improving inter agency co-ordination, training of professionals, improving child protection systems and using more experienced staff. Corby used this information to highlight that changes made between 1945 and 1997 have not been substantial as inquiries continue to make the same recommendations.

Child death inquires do have their place in the public eye specifically when practice goes wrong, nevertheless they have a number of limitations. Child death inquiries affect personal confidence of the social workers and other professionals when they become embroiled within the investigation. Due to the nature of the child death inquiries the public only see the negatives of social workers, social workers fear the association of such inquiries. Practice will not change when inquiries focus solely on the structure of children and families department. If social workers feel like the target when involved in inquiries their work will be affected therefore affecting the work they do further on for example other children may be more at risk because social workers have no confidence in the work they are practicing.

To use child death inquiries as a vehicle for policy development may not be the most effective approach to take. Child death inquiries are very expensive. If a more effective approach was to be taken and social workers and other professionals were able to learn more from this different process it would be more beneficial to take this approach than to carry on using money and concluding the same issues. Parton (2004) has found that the same issues have been identified on numerous times without any obvious changes in social work practice. Devaney, Lazenbatt and Bunting (2010) found that child death inquiries can still be effective but more emphasis needs to be on recommendations, implementing and acting upon them. Devaney et al (2010) also argue that policy makers need more understanding of the difficult situations in which children are at more risk from abuse or neglect. Devaney et al (2010) argue that this can help the policy makers express what social workers can do and make a distinction between that and what should be done.

Child death inquiries make assumptions that something has gone wrong and that the inquiry can find out what and give recommendations to learn from the mistakes. It assumes that practice will change because of the recommendations given and many inquiries don’t focus on acting upon the recommendations, if they did then future inquiries wouldn’t produce the same recommendations. Inquiries assume that the method they use is sophisticated. However, research into inquiries and literature has shown that other approaches could be more effective and less intrusive in practice and less strain can be put on professionals. Inquiries assume that multi agency working will be more effective, though if tensions between professionals are problematic then these will be difficult to resolve. Inquiries cannot assume that these tensions can be worked at by the professionals they need a superior management style to overlook the different professionals to be able to work effectively together.

As well as the implications for social workers individually and for policy makers regarding the process of child death inquiries, organisational structures will be also be impacted upon when changing child welfare policy. Due to changes within organisations, for example changes in roles of professionals involved in child death inquiries the foundations of interprofessional multi agency work are not secure, concluded because inquiries focus excessively on the role of social workers rather than the antecedents of child death or abuse. With regards to the case of Maria Colwell (1974) the Secretary of State Barbara Castle concluded that social workers alone cannot solve the underlying problems. All professionals in this field of child welfare need to understand their role but if child welfare policy continues to change constantly the role cannot be undertaken as professionals have poor ideas of what their role is and how they should practice. All professionals need to work effectively together and have an understanding of delivering comprehensive services to diverse communities so no children are lost in the system or ignored. The importance of effective interprofessional multi agency work is such that until there is a balance of role and practice then the safeguarding of future children may be affected.

Contemporary social work values may be affected, social workers have their own values personally and from learning from experience. Social workers must focus on human rights and social justice as their motivation for social work. Some critiques may argue that depending on the theoretical framework for example state paternalism some social workers may not be able to justify their motivation to impose this framework in their practice by not letting the family have a right to private family life (Human Rights, article 8) and be too quick to intervene. To ensure anti discriminatory practice social workers must understand different cultures have different behaviours when it comes to parenting. The social worker may think it is not appropriate, the family however may believe differently. This can lead to the social worker to not act at all. The social worker must ensure anti discriminatory practice, they need to see things from the perspective of the culture the family employs. Though still maintaining the values and knowledge they have regarding child abuse and when they should intervene. They must keep each case individual and make judgements based on evidence, not on their assumptions.

To evaluate how useful child death inquiries are as a vehicle for policy development evidence needs to be considered whilst investigating journal papers to gain an understanding of where bias may occur. Using a wide range of sources gives a broader idea of what has been proven to work in social work practice (Roberts and Yeager, 2006). Research evidence is more valued than other sources, those papers that are repeatable and use a large amount of participants are more likely to have less prejudice in concluding how useful child death inquiries are as a vehicle for policy development. Higgs and Jones (2000) propose that evidence is knowledge derived from various sources, which has been tested and found credible.

Having read all the information the weight of evidence suggests that changes need to be made to the approach of child death inquiries. The limitations and implications to practice are too substantial to ignore. Professionals and public haven’t seen any major changes because of the recommendations give by the inquiries. Corby et al (1998) found that of seventy public inquiries between 1945 and 1997 the main focus of recommendations was on improvements on inter agency co-ordination and improving the training of staff. The gap between the time of the death of the child and receiving the results of the inquiry is detrimental to social workers. Corby et al (1998) also argue that the cost of inquiries and the negative impact on social workers affecting their future practice may create more risk to other children they are safeguarding because they don’t have the confidence to practice anymore. The most effective approach to take would be one that focuses with less scrutiny on the social workers so their confidence is not affected and acts upon the recommendations it has made. Policy can develop by using a different vehicle instead of child death inquiries. At the minute the impact of changing child welfare policy on social workers and organisational structure is considerable. An improved approach to child death inquiries can be more effective in changing policy than the constant changes that are currently happening because of the results from child death inquiries.

The Role Of Assessment In The Workplace Social Work Essay

In this assignment I will discuss the role of assessment in collaborative learning. It will also discuss service-user involvement in practice-based educational processes.

For the practice teacher an essential responsibility of this role is to assess whether the student has developed a satisfactory level of competence in their practice within their placement. The assessor’s responsibility is to measure the student’s performance against the national occupational standards.

I would agree with Harden and Crosby (2000 in: Walker et al, 2008, p.61) that the role of an assessor is to contribute to a student’s development in a number of ways, i.e.: facilitator, role model, information provider, resource developer, supervisor, planner and assessor.

This was my first opportunity to formally assess a Social Work student. Before this I have mentored the students however this particular role of being work based supervisor was different to my previous experiences. I felt it was essential to develop an open and honest relationship; from our first initial meeting prior to the placement starting. It was explained to the student that the students are assessed on their ability to respect, understand and support the roles of other professionals involved in health and social care. It is recognised that each member of the group brings with them relevant/different experience and skills.

Research confirms that a collaborative partnership, which allows the student the sharing of power where possible, is important and that a supportive and nurturing approach enables the development of trust and safety. These features are thought to also facilitate more accurate assessments. (Walker et al, 2008, p.83). I offered my student opportunity to be open about her expectations from me considering that this was my first time to be a work based supervisor as I was a student too. It was a challenge to take on this responsibility due to the work load we had at that time, the amount of cases which were complicated and the whole team was going through lots of changes. I had less support from my practice teachers due to his sickness. Social workers often deal with some of the most vulnerable people in society at times of greatest stress and there can be tragic consequences if things go wrong. I was mindful of this. My line manager supported me to take on this challenge in a more positive way and enabled me to be effective in my role as a practice assessor.

Following the Lord Laming Report one of the significant changes for Social Workers was the introduction of The General Social Care Council on 1st October 2001. This set out a code of practice and National Occupational Standards for employers and Social Workers. This was the first time that such standards have been set out at national level.

I attended a ‘Safeguarding’ conference recently held in our department for social workers. We were encouraged to follow a ‘SMART ‘tool. ‘SMART’ is a useful way of measuring what is needed, a simple tool to use in the work place, supervision and completing direct work. An assessment plan should be: Specific, Measurable, Achievable, Realistic, and Targeted. This gives a precise explanation to the way social worker should carry out an assessment work. Social workers need to work to the core values of social work outlined by the General Social Care Council in their Code of Practice for Social Care Workers. Students during their placements need to demonstrate that they know and understand these values, which they will also be assessed against.

The assessment of students is central to the role of practice education. The relationship between a practice educator and their student and how it is perceived is important for learning between them both. (Knight, 2001, Kolevzon, 1979 in: Walker, Crawford and Parker, 2008, p.82).

The student will need to meet the six key roles set out in the National Occupational Standards for Social Workers:

Prepare for work with individuals, families, carers to assess their needs

Plan, carryout, review and evaluate social work practice

Support individuals to represent their needs, view and circumstances

Manage risk to individuals, families, carers, groups, communities self and colleagues

manage and be accountable, with supervision, for own social work practice within the organisation

Demonstrate professional competence in social work practice

(TOPSS 2002)

As the work-based educator/ practice assessor, my aim was to give the student the opportunity to gain an understanding of working for a statutory agency and to put their academic learning into practice. As the assessor my role was to link theories to practice for the student and for the student to use the framework for assessment and to link the national occupational standards for social work to the framework for assessment. Following some shadowing my student was gradually offered to gain practical experience of handling situations through co working as well as individual pieces of work.

As social workers, we all have responsibility to safeguard the child. The inquiry into the death of Victoria Climbie, recommendation 14 (Laming, 2003) stated that all national agencies for children and families should require each of the training bodies covering the services provided by: doctors, nurses, teachers, police officers, housing departments and social workers to demonstrate that effective joint working between each of these professional groups features in their national training programmes.

Within my assessor role I was also required to arrange an induction programme for my student, a component of this was giving the student the time to meet other professionals that she would come into contact with. I helped my student to arrange some visits to the agencies we work most frequently such as local police, child protection units, Behavioural Resource services, family centres. We also arranged slots for my student to observe some Forums where we request different types of work with children and families.

Training together gives people the opportunity to “challenge and reframe established practices, to encourage productive dissention… to encourage new ways of thinking and acting” according to Fay who describes emancipatory personal development. (Fay in Rogers 2009). As part if the induction I arranged my student to attend the training called ‘Paris Training’ this was crucial for her to be able to access and use the software we use to put all the data in the system.

One of my aims in this placement was to give the student the opportunity to help and empower service users to have a better quality of life and to feel safe. Lymbery (2000 in Doel and Shardlow, 2005, p.21) has identified three ways of relating to service users: the traditional view, the market view and the partnership view. The first highlights the traditional power imbalance, the second divides users and providers and focuses on ‘commodity’ and finance; the third is currently the most used approach. There can be problems when there are significant conflicting interests such as child protection or mental health work but using the principles of empowerment and communication can help move things forward more positively.

Involvement of service users in training, as part of learning together and sharing information to a common end; gaining feedback through various means; planning and delivering services, involvement in budget allocation (Doel and Shardlow, 2005, p.21) helps to empower people and gives them and social workers and organisations opportunities to learn from and develop services which use strengths, knowledge and abilities to resolve problems.

Social work has to be seen as one part of the wider field of society’s responsibility for the community at all levels, in the same way that all people within the community and other agencies must. By developing structures within which people work and participate in this wider context, particularly at the starting point of people’s involvement through their education, it should be possible to reduce the levels of differences at a time when everyone should be following the same aims rather than trying to resolve their different perspectives or absolve themselves from their responsibilities.

Bibliography/Referencing

Banks S (2001) Ethics and Values in Social work (2nd ed) Palgrave, Basingstoke

Baldwin M (1994) Social Work Education Vol13, No.2

Department of Health (2004) Children Act 2004 DOH London

Department of Health (2003) Every Child Matters DOH London

Department of Health (2000) Framework for the Assessment of Children in Need and Their Families the Stationary Office, London

Fay in RogersT, Lecture notes, 12.02.09

Fook J (2005) Social Work Critical Theory and Practice, Sage Publications London

HM Government (2006) Working Together to Safeguard Children The Stationary Office, London

Jones-Devitt and Smith (2007) in Rogers T, Lecture notes 12.02.09

Jones P in Lawson H(Ed) (1998) Practice Teaching-Changing Social Work Jessica Kingsley Publishers London

Lawson H (Ed) (1998) Practice Teaching-Changing Social Work, Jessica Kingsley Publishers London

Laming (2003) The Victoria Climbie Inquiry Report, DOH, the Stationary Office, London

National Organisation of Practice Teaching (NOPT) (2006) in: Maclean S, with Lloyd I (2008) Developing

Parker J (2004) Effective Practice Learning in Social Work, Learning Matters Ltd, Maidstone

Payne M (2005) Modern Social Work Theory (3rd ed) Palgrave London

Rogers, T Lecture notes 12.02.09

Rustin, in Ruch,G (2008) Lecture notes

Simmonds in Le Riche and Tanner (1996) in Ruch, G (2008) Lecture notes

Smith D (2005) Social work and Evidence-base Practice (2nd ed) Jessica Kingsley Publishers London

Training Organisation for the Personal Social Services (TOPSS UK) (2002) The National Occupational Standards for Social Work

Social Work in Anti-Discrimination

Explain the role of the social worker and consider the purpose of intervention and service delivery making links with Anti-Discriminatory Practice and Anti-Oppressive Practice and the importance of working in partnership with users of services and other professionals and agencies.

In this assignment I am going to be looking at mental health. In particular mental health affecting older people. I am aware that mental health issues affect people of all ages affecting each individual in a unique way.

A social workers role can be described in many ways and the role can vary depending on the service user. However in general social workers aim to empower people to make decisions for themselves. An essential part of the social workers role is working as part of a multi-disciplinary team and sign-posting service users to all services applicable to them. The fundamental principles of good social work practice are knowledge, skills and value’s, they all go hand in hand. They are useful divisions that can aid understanding. To ensure good practice all 3 need to be used together, making competent social work practice.

Focusing on mental health in older people as your client it is important a social worker to be aware of and work within The Mental Health Act 1983. The Mental Health Act 1983 was established to ensure approved mental health professionals assess and treat people with mental health conditions and to protect the rights of these service users. It provides safeguards for people in hospitals as well.

When looking at the history of mental health what stands out is that through the centuries there has been an accepted way of dealing with people with mental health problems. However the used method in the past is now considered to be inhumane and largely unsuccessful, but also at this time alongside the orthodox practitioners there were others with a more enlightened approach. Most histories concentrate on the gruesome facts rather than the positive aspects, going back as far as Victorian times, for example the Victorian asylums. Historical notes show how there isn’t much that is actually new in today’s approaches, it has all been said before but the issue with their acceptance is that mainstream treatment still retains its hold.

Mental health problems are considered to be more common in older adults. The most common mental health condition among older people is depression.

“Depression affects 1 in 5 older people living in the community and 2 in 5 living in care homes.

-Adults in Later Life with Mental Health problems, Mental Health Foundation quoting Psychiatry in the Elderly (3rd edition) Oxford University Press (2002)”

(http://www.mentalhealth.org.uk/information/mental-health-overview/statistics, 2006)

However another common illness affecting older people is dementia.

“Dementia affects 5% of people over the age of 65 and 20% of those over 80. About 700,000 people in the UK have dementia (1.2% of the population) at any one time.

-National Institute for Clinical Excellence (2004)”

(http://www.mentalhealth.org.uk/information/mental-health-overview/statistics, 2006)

As a social worker upon meeting the client, your initial role is to carry out a carer’s assessment. You need to carry out an accurate assessment to enable you to make the necessary recommendations and referrals. This leads to signposting to relevant services even when the client doesn’t meet the service criteria. For successful signposting you need to have an accurate understanding of how relevant organisations in mental health are MIND. Your assessment gives you the relevant information to be aware of what you need to do for your client. You now need to gain trust and build a positive relationship. However you need to be professional and always be honest, you are not the client’s friend, as being their friend conflicts with personal boundaries. You need to be clear and define your role to avoid confusion. You will be keeping records, discussing secrets and reporting to other professionals.

A successful model of assessment for this type of client is SWOT. This involves looking at the strengths and weaknesses which are the advantages and disadvantages for our client. Then looking at the opportunities which involve looking at all opportunities for change that you can provide. The final part of your SWOT analysis means looking at the threats. SWOT analysis helps you to think through each issue allowing you to look at the problem and lead to possible solutions and prepare for possible threats. A major and vital part of this particular assessment is about what’s happening now. A SWOT analysis provides evidence to explain your actions. It needs to be specific, and will vary dramatically from person to person. It is a helpful tool in helping you to weigh up the pro’s and con’s and help you to balance them out.

With mental health the actual illness is going to have a major affect on the SWOT analysis. The stage of the illness can be an advantage or a disadvantage. A threat with mental health will always be the deterioration of the illness. With older people family can be a major strength if they play an active part in the client’s life. However bare in mind the lack of a family can be a big disadvantage, having affects on the client.

Anti-oppressive practice is a piece of social work jargon, but is based on a very simple yet important idea. Social work is all about empowering others and assisting those who feel oppressed in getting both their needs and rights recognised and met. Anti-oppressive practice is informed by values and always takes into consideration both the views and experiences of oppressed people.

“Practitioners are required to analyse how the socially constructed divisions of race, age, gender, class, sexuality and disability, and the impact of differential access to resources interconnect and interact to define the life experiences of individuals and communities.” (Davies, 2009, p14)

Therefore the practitioner is able to both recognise and challenge all situations of oppression within their work.

Anti-discriminatory practice emphasises the different ways in which people tend to be discriminated against, as individuals and groups, it also highlights the need for professional practice to counter such discrimination. Discrimination can occur due to lots of different types of oppressive differentiation.

“The primary goal of anti-discriminatory practice is the promotion of equality and social justice.” (Davies, 2009, p13)

Anti-discriminatory practice is not a separate social work theory or method, but a value that should under-pin all practice generally. Both anti-discriminatory and anti-oppressive practice theories seek to assist clients to gain awareness into how oppression affects their lives, and to promote different strategies for opposing discrimination and gaining mutual support. It should also prevent different agencies from being discriminatory.

True partnership working can create empowerment. It is a basic part of good practice and of values work. Feeling the need to ‘rescue’ the client is oppressive; you should be working with the service user to ‘rescue themselves’. Helping clients to become more independent and less dependent on the system is a positive way forward, and should have a positive long-term affect on the client. Effective partnership is based on a variety of factors and therefore will vary accordingly. A few of these factors are based on values, beliefs, ideals and even practical factors such as funding and resources.

Social workers have a duty of responsibility to both the client and other family members who play an active role in the client’s life. You should work together with your service user, their family and other agencies, you all need to be aware of difficulties and expect setbacks but remember you can get through it together. When working with other agencies you need to share the responsibility and have open and honest communication. A social workers role is one of both care manager and care co-ordinator.

In mental health you will need to be working with other organisations and as it is a health issue you will be working with medical professionals.

The role of an Occupational Therapist

The following essay will give a critical evaluation of the role of an Occupational Therapist (O.T) within vocational rehabilitation in the private mental health setting. Firstly the essay will describe a critical analysis of vocational rehabilitation and the added value of an O.T within this setting. Secondly it will analyse the trends within vocational rehabilitation and how these relate to O.T philosophy and core tenets, thirdly an examination of concepts of management that relate to vocational rehabilitation and finally a justification of the identification of a model relevant to vocational rehabilitation.

Work can be seen as being an important part of health and wellbeing and also social inclusion. Waddell & Burton (2006) suggest that work is therapeutic, helps promote recovery and rehabilitation. Leads to better health outcomes, minimises physical mental and social effects of long term sickness absence and worklessness, decrease the chances of chronic disability, long term incapacity from work and social exclusion. Also promotes full participation in society, independence and human rights, reduces poverty and improves quality of life and wellbeing. Work can be divided into four different areas: paid (contract, material reward), unpaid (housework, caring, volunteering), hidden (illegal, morally questionable) and substitute (sheltered workshop, work projects, day centres) (Ross 2007).

The demand for work is extremely high due to the amount of people that are living. Compared to other countries, the United Kingdom employment figures are high with people being employed with a health related condition increasing (Department of Health 2008).

It has been estimated that 175 million days were lost in 2008 due to illness with 600,00 people turning to incapacity benefit. (Department of Health 2008)

It has been shown that 40% of medical certificates issued have been related to mental ill health with the average time off working being 15 weeks. (Department of Health 2008)

Work has been shown to be good for your health and employers who adopt a good approach to health, by protecting and promoting it, are important in stopping illness from occurring. This is an area in which O.T’s can provide a key role in supporting and maintaining people back into work or who are already in work to stay there.

Vocational rehabilitation is important. This has been shown in the government’s new mental health strategy ‘No Health Without Mental Health’ (Department of Health 2011). One of the aims is working to help people with mental health problems to enter, return to employment and stay in it.

The application of O.T within this area is important as our core philosophy is to enable individuals to engage in meaningful occupations, therefore there is a key role for O.T’s to play within vocational rehabilitation. The following quote demonstrates that meaningful engagement in occupation can be important, which reflects O.T’s core ethics and philosophies. ‘Not everyone wants to be employed but almost all want to work, that is to be engaged in some kind of valued activity that uses their skills and facilitates social inclusion’ (College of Occupational Therapist 2007 p9).

Currently within vocational rehabilitation, employment specialists are trained in advice and guidance and REC level 3 advanced certificate in recruitment practice. Employment specialities tend not to be mental health professional but have skills in vocational rehabilitation or industry experience (Waghorn 2009). O.T’s already have these skills and also can add a holistic client centred approach from an occupational perspective. O.T’s can also add an educative approach, combine medical and occupational models and use activity analysis. They can assess occupational function/performance, build therapeutic relationships, carry out psychosocial assessments and interventions, cognitive evaluation and training, help with work life balance for the client and work with client’s strengths. (Waghorn et al 2009, Devline et al 2006 & Joss 2001, cited in College of Occupational Therapist 2007 p15)

An O.T can bring seven core skills to vocational rehabilitation: collaboration with the client e.g. building therapeutic relationships, assessment e.g. Model of Human Occupation Screening Tool, enablement, problem solving, using activity as a therapeutic tool, group work and environmental adaptations e.g. graded return to work (Duncan 2006 p45)

Current themes and drivers within mental health are social inclusion, return to work agenda, recovery. Social exclusion happens when people are ‘unemployed have poor skills, low incomes, poor housing, high crime, bad health and family breakdown’ (social inclusion and co-production 2011)

A report called ‘Mental Health and Social Exclusion’ was published in June 2004 by the Office of the deputy Prime Minister. It aimed to improve the live’s of people with mental health problems by getting rid of obstacles to employment and social participation. There are five main reasons why social exclusion occurs for people with mental health problems. Firstly stigma and discrimination, in which an O.T can help by activity speaking to employers about mental health and how reasonable adjustments, could be made. An O.T can help by increasing low expectations, help promote vocational and social outcomes, help provide ongoing support whilst in employment by regular outreach appointments and help access basic services e.g. dry runs on transport, membership to sports centres (Office of the deputy Prime Minister 2004). Overall an O.T can help people remain in their jobs longer and return to employment faster and manage the work environment better by grading work, breaking down activities and rebuilding them step by step and making adaptations to the work environment for example.

Another trend is recovery. Recovery is ‘building a meaningful and satisfying life, as defined by the person themselves, whether or not there are ongoing or recurring symptoms or problems’ (Slade et al 2008). Recovery encourages people to develop relationships which give their life meaning. There are five stages of recovery: moratorium (withdrawal, loss, hopelessness), awareness (realisation), preparation (strengths and weakness regarding recovery), rebuilding (positive identity, goal and taking control), growth (living a meaningful life, self management of illness, resilience, positive sense of self) (Andresen, Caputi & Oades, cited in Slade et al 2008). Satisfying work supports recovery and as such O.T’s can have a great impact here by ensuring clients are in jobs they really enjoy and able to cope with the work demands. By working in a client centred way, listening, help identify and prioritise personal goals for recovery; identify examples of own lived experience. Also pay attention to goals which will enable the service user to get back into work, suggest non-mental health resources (friends, contacts, organisations), encourage self management of problems, discuss what the service user needs in terms of psychological treatment, convey an attitude of respect and continue to support, an O.T can help a service user to achieve their ideal job.

The return to work agenda is about helping people in and/or return to work. O.T’s can aid this by grading work activities e.g. working hours to start with 16 hours per week and gradually increase by 5 hours per week until full time hours are achieved for example. Also by providing support whilst in job by light touch support, setting up group work activities and training the service user. A practice called ‘place then train’ helps increase motivation and confidence by placing someone in work and then training them instead of the other way around. It improves employment outcomes and peoples mental and physical health over a long period of time (Centre for Mental Health 2011). Its philosophy emphases rapid job searching, individualised job placement in work followed by on-the-job training and ongoing support (Twamley et al 2008).

Currently the concepts of management in vocational rehabilitation within the private mental health sector follows the following structure:

Area manager

Service lead

Employment specialists Volunteers

With the introduction of an O.T manager the following structure will be placed:

O.T Manager

Band 5/6 O.T

Employment specialist/ Volunteers

O.T.A

Referrals will either come from people themselves or via the community e.g. mental health teams, doctor surgery’s, job centres. With new referrals the degree of risk, impact of O.T on service user, consequences of service user not receiving treatment, length of waiting time and the appropriateness of skills and abilities will be considered.

To get people on board for the change in management, people will be listened to for their points of views, concern will be shown, the manager must be approachable e.g. leaving door open and using positive body language, change will be promoting in a positive manner e.g. it will benefit the patients and questions will be encouraged, integrity and charisma will be shown, also have a good ability to communicate, set direction and unify and manage change.

The Lewins stages of change (Mullins 2007) will be adopted where first unfreezing will take place followed by moving and then refreezing. Unfreezing is about getting ready to change by understanding that change is necessary and moving out of comfort zones. It’s about weighing up benefits and negatives of the change.

Moving or change is when people are unfrozen and decide to move toward a new way of working. This is often the hardest for people and support is needed.

Refreezing is stability once the changes have been completed. These changes have been accepted and become the norm. People create new relationships and become comfortable with the new routines.

The O.T manager will provide supervision to the band 5/6 O.T and have supervision from a paid outside O.T at that equivalent level. The Band 5/6 O.T will have supervision from the O.T manager and the Occupational therapy assistant (OTA) / employment specialist and volunteers will be supervised by the band 5/6 O.T. Volunteers will be looked after by the OTA.

Management will be in a democratic style by listen to people opinions and having staff work with the manager, not against. Make sure that management set examples by dressing correctly, not being late for work; develop an image, project self confidence, influence others and establish personal authority (Martin et al 2010). Also address self management by managing time, self and case load e.g. size up task, knowing themselves (need for breaks, strengths and weakness), prioritising and planning control(keeping a dairy, decreasing interruptions). Bad management will be discouraged such as not resolving problems, criticising staff, poor decision making, disorganisation, failing to deal with staff issues, done give recognition, inflexibility, and have an uncaring attitude and poor communication skills (Moore et al 2006)

Management will consider professional duties and responsibilities such as the code of ethics, continues professional development (competence), health and safety (risk assessments) and deal with the present.

A number of factors may influence management style: confidence in staff e.g. their abilities, need for certainty (risks of handing over control), personal contribution and stress (overload, worry, pressure) (Martin et al 2010).

The justification of a model relevant to vocational rehabilitation is the Model of Human Occupation (M.O.H.O). M.O.H.O looks at people’s motivation (volition), routine planning (Habituation) and the influence of environment on occupation (performance capacity). Some of these areas will be affected by the service user.

Volition is the thought and feelings we adopt whilst doing things. This involved three areas: personal causation, value and interest. To change motivation these areas will need to be addressed. By looking at the service users present and potential abilities relating to work and how able they are to bring about work (what is good, right and important) e.g. security, accomplishment and interests, having positive feelings associated with working. Habituation looks at reoccurring patterns of behaviour that make up our daily routines. A service user can change their habits by learning new ways of doing occupations and by changing their perceived role to one of a worker/bread winner. Performance capacity is how the musculoskeletal, neurological, cardiopulmonary and other body systems are used during performance. If there is a problem in performance capacity, the environment must be addressed.

Work is an increasing important aspect in our lifes. Some of us live and breath work spending the majority of our waking hours working. Work gives us a sense of identity, an occupation, money to spend. It also provides us with a role in the community helping others with our knowledge in a particular area.

Work provides us with a purpose, includes us within society preventing social exclusion, increases self esteem and gives us a role/meaning within society.

Definition

Work can be seen as the idea of doing, either mental or physical, giving an economic reward, social interaction, the structuring and organisation of time, opportunity for social interaction, contribution to society and self identity (Baker & Jacobs 2003)

What can Occupational Therapy offer that is different?

Occupational Therapy can offer an approach which looks at the whole of a person by putting the client at the centre of their treatment from an occupational perspective. Occupational therapists can also educate people, focusing on independence and ensuring participation in meaningful activities.

Occupational Therapists are able to combine medical and occupations models. This means they can look at the impact that physical, social and cultural environments have on everyday activities.

Patch Three

The following patch will give a critical evaluation and analysis of social policy, legislation and ethical issues impacting on vocational rehabilitation in a report style.

Legislation

No Health without Mental Health (Department of Health 2011)

The government is helping people with mental health problems to enter, stay in, and return to employment. This can by achieved by using light touch support, increase confidence in returning to and remaining in work, help manage conditions and help the interaction between appropriate work and well being. It consists of six main objectives:

‘more people will have good mental health, more people with mental health problems will recover, more people with mental health problems will have good physical health, more people will have a positive experience of care and support, fewer people will suffer avoidable harm and fewer people will experience stigma and discrimination’ (Department of Health 2011 p6).

Its outcome strategies is to focus on how people can be best empowered to lead the life they want to lead, to keep themselves and their families healthy, to learn and be able to work in safe and resilient communities and how practitioners can be supported to deliver what matters to service user.

Occupational Therapists can provide high quality employment support which will include building confidence in returning to and retaining work, changing employers and service user’s beliefs, that they can perform the job and their condition is manageable. Support Interaction between appropriate work and wellbeing and help employees to make appropriate recruitment decisions and manage workplace health.

New Horizons (Department of Health 2009)

This mentions that work can be good for mental health and wellbeing and support recovery. Those who are unemployed are at an increased risk of developing mental illness and benefit from early support.

Employment should be seen as an important outcome to the treatment of mental illness in health care settings.

O.T’s can help change attitudes to mental health, can improve health and wellbeing in work, provide swift intervention when things go wrong, coordinate help tailored to individuals needs and build resilience from the early years and thought working lives.

Health, Work and Wellbeing – Caring for Our Future (Department of Health 2005)

Suggests that work is recognised by all as important and barriers to starting, returning to or remaining in work are removed. For people to remain in and return to work, that healthcare services meet the needs of people of working age. That health is not affected by work and good quality advice and support is available. Ensure work offers opportunities to promote health and wellbeing and access to the retention of work promotes and improves population, people with health conditions and disabilities are able to optimise work opportunities and people make the right lifestyle choices from an early age.

O.T’s already recognise the importance of work for their patients wellbeing and can provide the assistance necessary to fulfil their key roles in helping patients to remain in and return to work.

O.T’s can help people return to work following and absence by employment advice and helping to find a suitable job by adapting the work place environment e.g. time flexibilities.

National Skills Framework – 5 years on (Department of Health 2004)

Help to prevent social exclusion in people with mental health problems, improving their employment prospects and opposing stigma and discrimination. O.T’s can help prevent social exclusion by building confidence, motivation and skills, speak to employers about mental health and how reasonable adjustments could be made, help provide ongoing support whilst in employment and help reduce stigma and discrimination by educating people.

Working for a healthier tomorrow (Department of Health 2008)

Is concerned with the health of people of working age (females 16 to 59 and males 16 to 64). Identifies factors that prevent good health and changes in attitudes, behaviours and practices.

Three main principal objectives:

prevention of illness and promotion of health and wellbeing

early intervention

improvement in health of those out of work

O.T’s can prevent illness and promote health and wellbeing by using activity as a therapeutic tool, ensuring early intervention and help those out of work by doing group work to build confidence, motivation and reduce anxieties.

Ethics

There are at least five potential ethical issues which may be encountered within vocational rehabilitation in a private mental health charity organisation. These are confidentiality, consent, autonomy and welfare, human rights, issues of power and control (College of Occupational Therapists 2005):

Confidentiality

Safeguarding of confidential information relating to clients, only disclose information when client has given consent, there is a legal justification or it is in public interest to prevent harm. Only disclose to third parties if there is a valid consent or legal justification to do so. Keep all records locked away securely and only make available to those who have a legitimate right or need to see them. Clients can see their records and prior to producing material, issues of confidentiality will be addressed.

Use the confidentiality model: Protect (look after information), inform (ensure service user is aware), provide choice (allow service user to decide if information will be disclosed and improve (look for better ways to protect, inform and provide choice) (Department of health 2003)

Consent

Making sure the client has the capacity to consent. The 2005 Mental Capacity Act makes provision for people who are thought to lack capacity to make their own decisions. It has five key areas: ‘a presumption of capacity’ – every adult has the right to make choices and must be assumed to have capacity to do so unless it is proved otherwise; ‘the right for individuals to be supported to make their own decisions’ – appropriate help must be provided before anyone suggests that they cannot make their own decisions; ‘that individuals must retain the right to make what might be seen as eccentric or unwise decisions’; ‘Best interests’ – anything done must be in the best interest for the service user and ‘Least restrictive intervention’ – anything done should be the least restrictive of service users basic rights and freedoms. (Department of health 2007)

Autonomy and welfare

Respect client’s autonomy and promote dignity, privacy and safety of client. Give patients the right to make choices and decisions about their own healthcare and independence. Provide sufficient information to enable them to give informed consent and in a language that can be understood. Make sure client understands the nature, purpose and likely effect of intervention and acknowledge refusal.

Human rights

A right not to be discriminated against regardless of person’s religion, sex, race, colour or mental health

A right to respect for private and family life e.g. medical record keeping, parental involvement, collection of data

A right not to impact on the individual’s freedom of thought, expression or conscience e.g. spoken language and access to interpreters

Issues of power and control

Respect individuals, enable client to take power and promote partnership

Management of Quality Issues
Quality assurance

The service provided will ensure that it meets the needs and expectations of clients and communities, that there is an understanding of service delivery systems and its key services, that data is analysed, problems are identified, performance is measured and that a team approach to problem solving and quality improvement is used.

Clinical Governance

Involvement

Make sure service users, carers and public are involved within the service by holding focus groups, open days, suggestion boxes, questionnaires, panels e.g. to find out opinions on waiting times, attitudes of staff and the physical environment

Risk management

Establish what could go wrong and rank this. Think how probable it is likely to occur, what can be done about it and what action should be taken if incident happens again (Health & Safety executive 2006). E.g. service users deliberately harming herself in occupational therapy session or a spillage on the floor. The Healthy and Safety at Work Act (1974) states that it is the duty of the employer ‘to ensure so far as is reasonable practical, the health, safety and welfare at work of all his employees (section 2 (1) Health and safety at work act 1974). Although it is the duty of the employee to take reasonable care for the health and safety of him/her and others who may be affected by his/her acts of omission and to co-operate with their employer in regard to any duty or requirements imposed (section7 Health and Safety at Work Act 1974)

Clinical audit

Identify topics relevant to vocational rehabilitation e.g. referral response times, set standard (3 days), collect data (computer package), analyse data (if standard not met then why) and implement change. Other examples may be how the service compares with standards set by other clinical governance activity.

Clinical effectiveness

Ensure that all treatment is up to date and based on evidence based practice, National Institute of Clinical Excellence and National Service Framework guidelines.

Staffing and staff management

All staff recruited have the skills and qualifications needed to do the job e.g. that they are Health Professional Council (HPC) registered, induct them, give supervision and appraisal and deal with poor performance. Also supervision on a regular basis and appraisal once a year. Use an indirect approach which is more centred around the person, talk less and listen more, provide a supportive relationship, ask questions, accept and use ideas, reflect and summaries ideas (Enthwistle 2000)

Education, training and Continues Professional Development (CPD)

Ensure mandatory training is given e.g. fire training, child protection, health and safety. Complete CPD portfolios and HPC audits; provide training and opportunities to enhance CPD such as visits to another vocational rehabilitation service. The HPC (2011) states five standards for the CPD. A registrant must maintain:

‘an up-to-date and accurate record of their CPD activities’

‘demonstrate that their CPD activities are a mixture of learning activities relevant to current or future practice’

‘ make sure that their CPD has contributed to the quality of their practice and service delivery’

‘ensure that their CPD benefits the service user’

‘present a written profile containing evidence of their CPD on request’

Use of information systems

Use information systems to record treatment sessions that service users attend, time spent preparing treatment sessions, time spent on phone calls to service user and time spent in case discussions. Also handling patient identifiable information by applying the data protection act and locking information away. The data protection act implies that anyone collecting personal information must ‘fairly and lawfully process it, process it for limited, specifically stated purposes, use the information in an adequate relevant and not excessive way, use information accurately, keep information on file no logger than necessary, process information in accordance with legal rights, keep information secure and never transfer information outside U.K without adequate protection’ (Direct Gov 2009)

Patch Four

The following patch will provide a reflective narrative of the learning experienced throughout the module utilising the Gibbs reflective cycle. This has been developed from Kolb’s ideas and develops the features of the

experience-reflection-action cycle (Jasper 2003):

Description

Action plan Feelings

Reflective cycle

Conclusion Evaluation

Description

The Gibbs cycle consists of six stages and asks a series of questions about the experience. Description stage is what happened, feelings stage is what where you thinking and feeling, evaluation stage summarises what is good and bad about the experience, description stage involves making sense of the situation, conclusion stage is what else could have been done and the action plan stage asks if the situation arose again, what would you do.

To begin with the whole assignment seemed extremely daunting as I had never participated within a role emerging placement/role before. I had also never completed a patch work text and knew very little of both. As part of the assignment we were asked to discuss ideas with peers. I felt it was a good idea to share information with others and thought that this would be an ideal opportunity to reflect on things I was not sure about and where to go for more information. Whilst discussing ideas with my peers I was thinking how what we had discussed would fit into my assignment and in what patch. It made me feel a little more comfortable sharing with other as we could bounce ideas and thoughts off each other. I feel other peers also felt that group discussions were useful and helpful. From start to finish I felt good about discussing information and still feel that this was of great benefit to all of us.

Exchanging views helped put things in some kind of order and others could help in areas where I had difficulties. I do not feel there was anything negative about this experience in general. Sharing ideas with others went well as we all had views to share. To contribute, I helped others to see what went in each patch and gave ideas about the assignment.

Overall there is not much I would have done differently with this peer review work. The aim was to share and discuss information and this was done successfully. If I were to do peer review work again I would do the same by sharing ideas and information with others.

During my visit to a vocational rehabilitation setting I got to see how the service was run, where referrals come from, meet staff and service users and view leaflets. Upon arrival I felt overwhelmed by information and was intrigued about the service. I was thinking how I could relate this to my assignment and what role an occupational therapist would play within such a service. The service manager, who showed me around, knew about occupational therapy as previously they had worked as an assistant in such a role. This made me feel happier as I could share some ideas with them. I felt the visit went extremely well and it was a positive learning experience. From the start I felt comfortable about visiting the service and knew I would collect lots of relevant information from it. Access to information and ideas was the most significant factor for me.

Actually seeing a vocational rehabilitation service running was a great inspiration and thought provoking for me, as I could see where parts of my assignment would fit in. I feel the whole visit went well and managed to collect a lot of relevant information.

To complete patch work two we were asked to produce a leaflet aimed at our intended service users. I found this patch difficult because selecting relevant information was not easy e.g. font, colours, headings, content, pictures. When I first started the leaflet I had previous knowledge from another module, so had an idea how to construct the framework. I was thinking what type of content would go into the framework of the leaflet and how. Others mentioned that the leaflet should be easy to read and with bullet points, pictures and a calming background. I felt this would be a good idea, by aiming the leaflet at my service user group in particular. I thought that the leaflet was starting to take shape and it was aimed at who it was intended for. To start with I felt a little lost as to what to so but with help from my peer review group I eventual found a way. The most significant thing to me was being able to reflect ideas with other people about the leaflet.

I feel that putting the leaflet together was a good experience as it has taught me how to present information to a targeted audience by using easy to understand phrases rather than jargon. Also working in peer review groups was a good experience as we were able to share ideas with each other and share information. The only thing that didn’t go so well was working out how to transfer the leaflet from publisher to a word document, also slimming down the content without vital information being lost.

I feel the leaflet went well and managed to collect and produce the correct information. Others did help by offering encouragement and ideas which aided me in producing the leaflet.

I realise now that I should have consulted my peer group earlier to starting the leaflet as their ideas helped and guided me.

To complete patch three we were asked to critically evaluate and analyse social policy, legislation and ethical issues impacting vocational rehabilitation. I found writing this patch extremely difficult as I had no idea of legislation, ethical issues and quality issues relating to this subject.

When I started this patch I felt very nervous and worried as to how I would find such information. I was wondering how I would go about doing this patch and what was involved. When I was looking for information I found a vast array. I had to sieve through relevant legislation and apply it to

Cause and Effects of the Rise in Cohabitation

Recent decades have witnessed a dramatic rise in cohabitation in much of Western Europe including the United Kingdom (Ermisch 2005; Ermisch and Francesconi 2000a; Haskey 2001; Kiernan 2001; Murphy 2000). This rise has taken place against a dramatic decline in marriage rates. A so-called “golden age” of marriage that prevailed in the United Kingdom from the 1950s up to the 1970s (Festy, 1980), has been eroded. Marriage is no longer the exclusive marker of first union nor the pre-eminent context within which children are born; (Kiernan, 2001). The decline in the popularity of marriage indicates that ‘no longer is marriage seen as the only organizing principle for relationships’ (Hall, 1993: 8) and therefore legal marriage has ‘given way to a variety of optional non-traditional forms of ”living together” (Boh, 1989: This essay will seek to examine whether the rise in cohabitation will witness a decline in marriage to a point where marriage is a rare phenomenon. This will entail an analysis of statistical evidence on both cohabitation and marriage and the explanations that have been provided. These include notions of selfish individualism (Morgan, 2000), notions of the democratic, consensual and “pure” relationship (Giddens, 1992; Beck-Gernsheim, 2000), Becker’s (1973, 1981) model of marriage, the common-law marriage myth, commitment in cohabiting partnerships, and the use of ‘lived law’ to create a DIY variety of marriage (Duncan et. al. 2005).

The 1960s and the early 1970s was a golden age of marriage in the United Kingdom during which marriage was highly popular among the young ages (Kiernan & Eldridge 1987) and a record peak of 480,285 marriages was recorded in 1972 (ONS, 2008). However, since the 1970s there have been considerable changes amounting to a structural shift in individuals’ demographic behaviour and societal norms (Haskey, 2001) and among these are increases in divorce and in cohabitation, that is, in couples who live together in intimate relationships without being legally married. Similarly, Ferri et al. (2003) have documented several demographic changes which led social commentators to lament the ‘end of marriage’. These include significant rises in cohabitation, divorce, lone parent families, single parent households, children born out of marriage and age of marriage.A These changes, it was assumed, led to the disintegration of traditional structures and codes and ultimately to the end of marriage.

Statistical evidence indeed shows that there has been a long-term decline in marriage rates and a significant rise in cohabitation. From 1971 to 1995 first marriage rates fell by 90% for teenage women and 80% for women aged 20-24. Median age at first marriage rose from 23.4 to 27.9 yrs for men and 21.4 to 26.0 years for women (Murphy and Wang 1999). The decline in remarriage rates has been even more pronounced. For divorced men, the remarriage rate has fallen by 75% since 1971 (Murphy and Wang 1999). There were 311,000 marriages in the UK in 2004 and this figure fell to 270,000 in 2007. This represents almost half the number of marriages that took place in 1972 when marriage peaked (ONS 2009).

On the other hand, cohabiting is the fastest growing family type in the UK (with the proportion of cohabiting couple families increasing from 9% to 14% between 1996 and 2006), (ONS, 2009). Among single women marrying during the latter part of the 1990s, 77% had cohabited with their future husband, compared with 33% of those marrying during the late 1970s, and only 6% of those marrying in the late 1960s (Haskey 2001). During the 1960s, 40% of remarriages were preceded by a period of cohabitation; and this figured had soared to around 85% in 2000. (Murphy 2000). The 2001 Census recorded just over 2 million cohabiting couples in England and Wales (a 67% increase from 1991). When the new form of cohabitation arrived in the 1970s it was mainly a child-free prelude to marriage. Increasingly, children are being born to cohabiting couples. In 2006, 56% of births in England and Wales were outside of marriage compared with 8% in 19z71. (ONS, 2009). Between 1996 and 2006, the number of cohabiting couples in the UK increased by over 60%, from 1.4 million to 2.3 million, ONS, 2009). The number of cohabiting couples in England and Wales is projected to almost double to 3.8 million by 2031 (which will be over one in four couples on this projection). (ONS, 2009).

Social theorists have conceptualized these trends in terms of individualization theory. The theory which includes notions of the democratic, consensual and “pure” relationship (Giddens, 1992; Beck-Gernsheim, 2000) and notions of selfish individualism (Morgan, 2000), has emerged as the dominant contested theoretical approach in explaining whether the rise in cohabitation means ‘the end of marriage.’ According to the former, modern society is viewed as having entered a ‘late modern’ epoch of ‘de-traditionalisation’ and ‘individualisation’ in which traditional rules and institutional frameworks have lost ground, only to be replaced by more modern and rational rules (Beck, 1992 and Giddens, 1992, 1994). Institutional forces such as education, the modern economy and the welfare state have freed individuals from externally imposed constraints, moral codes and traditional customs, a development which Beck (1994) says is a disembedding of individual lives from the structural fabric of social institutions and age-specific norms.

According to Brannen and Nilsen (2005), social class no longer has the same structuring role that it once had.A Individuals who used to have a standard biography no longer have pre-given life trajectories but are instead compelled to reflexively make their own choices and hence create their own biographies. At the same time, the ‘project of self’, with an emphasis on individual self-fulfillment and personal development, comes to replace relational, social aims. This results in ‘families of choice’ which are diverse, fluid and unresolved, constantly chosen and re-chosen (Weeks 2001) and which Hardill, (2002) refer to as the ‘postmodern household’. In ‘families of choice’ all issues are subject to negotiation and decision making (Beck and Beck- Gernsheim1995, Beck-Gernsheim 2002). Individuals are seen as preferring cohabitation to marriage because they wish to keep their options and their negotiations open ( Wu, 2000).

The individualisation theory sees modern relationships as being based on individual fulfillment and consensual love, with sexual and emotional equality, replacing formal unions based on socially prescribed gender roles. Sexuality is largely freed from institutional, normative and patriarchal control as well as from reproduction, producing a ‘plastic sexuality’, which serves more as means of self-expression and selfactualisation rather than as a means to reproduction and cementing institutionalized partnership (Giddens, 1992). Giddens argues that that such plastic sexuality as part of the ‘project of self’ is realized in ‘pure relationships’ an ‘ideal type’ that isolates what is most characteristic for intimacy in reflexive modernity, ‘Giddens (1991, 1992).A This is ‘pure’ because it is entered into for its own sake and for the satisfaction it provides to the individuals involved. The pure relationship must therefore be characterized by openness, involvement, reciprocity and closeness, and it presupposes emotional and sexual democracy and equality, ‘Giddens (1991, 1992). According to Cherlin (2004:853), the pure relationship is not tied to an institution such as marriage or the desire to raise children. Rather, it is ‘free-floating’, independent of social institutions or economic life’.

The individualisation theory asserts that these changes in relationships contribute towards the ‘decentring’ of the married, co-resident, heterosexual couple. It no longer occupies the centre-ground statistically, normatively, or as a way of life (Beck-Gernsheim, 2002; Roseneil and Budgeon, 2004). Instead other forms of living such as cohabitation, living alone, lone parenting, same-sex partnerships, or ‘living apart ‘ have become more common and are both experienced and perceived as equally valid.

However, most English-speaking commentators (e.g. Morgan, 1995, 2000, 2003; Bellah et al., 1985; Popenoe, 1993; Dnes and Rowthorne, 2002) have developed a pessimistic view of family change. In cohabitation they have seen a moral decline and its harmful effects on society, a loss of family values, individual alienation, social breakdown, rise in crime and other social ills and social, emotional and educational damage to children. For them, the trend in statistics is clear evidence of selfish individualism and have thus advocated for ‘turning the clock back’ by promoting marriage among other things. Morgan (1995) for instance, argues that without the traditional family to socialize children and in particular to provide role models and discipline for young men, delinquency and crime will escalate and society as a whole will be at risk. To avoid this social policy should seek positively to support marriage and promote traditional gender roles for men and women. According to Morgan (2003), cohabiting relationships are fragile. They are always more likely to break up than marriages entered into at the same time, regardless of age or income. On average, cohabitations last less than two years before breaking up or converting to marriage. Less than four per cent of cohabitations last for ten years or more. She also believes that cohabitation should be seen primarily as a prelude to marriage but increasingly it is part of a pattern which simply reflects an ‘increase in sexual partners and partner change’ (Morgan, 2003:127). Morgan (1999) also argues that cohabitation is concentrated among the less educated, less skilled and the unemployed.

The individualization theory in its various versions, has been seen as having its merit in terms of indicating trends in post-modern societies, but has been criticized for lacking reliable methodologies and for lacking empirical and historical evidence. According to Thernborn (2004), individualisation theory should be seen as a geographically and historically limited exaggeration among the variety and long durees of socio-sexual systems. Individualisation theory is seen as largely resting on the evidence of qualitative work using purposive samples of particular social groups in particular contexts and localities. They do not often use representative samples or total population figures which can accurately portray overall social patterns. According to Sayer (1992) individualization theorists have used ‘intensive’ research design which are indeed in-depth and able to access social process more directly, and understand its context but points out that such work needs to be complemented by ‘extensive’ research on patterns and distributions, using representative survey for example. Duncan and Edwards (1999) share the same view that the use of both intensive and extensive research designs will enable generalizations to be made. In addition intensive work will enable better interpretation of the representative patterns revealed by extensive work and to link process to pattern directly rather than depending upon post-hoc deduction, (Duncan and Edwards 1999).

Critics of the individualisation theory have argued that the theory underplays the significance of the social and geographical patterning of values and behaviour and neglects the importance of local cultural and social contexts. According to Duncan and Irwin structures of economic necessity, social groups and moral codes have not gone away, although they may have changed. Family forms are still deeply influenced by local structural conditions or contexts and although people might be less constrained by older traditions, this does not necessarily mean individualisation. The ‘traditional’ structures of class, gender, religion and so on have a continuing importance, (Duncan and Irwin, 2004, 2005).

Individualisation theory assumes that individuals can exercise choice and shape their lives. However, the theory has been criticized for taking insufficient account of the context in which individuals make their choices. Critics of individualisation have pointed out, people’s capacity to make choices, for example in respect of separation and divorce, must depend in large measure on their environment, whether for example, on the constraints of poverty, social class and gender, or, more positively, on the safety net provided by the welfare state (Lasch, 1994; Lewis, 2001a). In addition, the context in which people are making their choices is constantly shifting. Thus the meaning of what it is to be married, or to be a parent has changed and continues to change. Actors will in all likelihood be affected by these changes over their own life course and must expect to have to re-visit the decisions they have made, for example in respect of the division of paid and unpaid work, especially at critical points of transition such as parenthood. Charles and Harris (2004) have argued that choices regarding work/life balance are different at different states of the lifecycle.

The individualization theory in its various versions, has been seen as having its merit in terms of indicating trends in post-modern societies, but has been criticized for lacking reliable methodologies and for lacking empirical and historical evidence. According to Thernborn (2004), individualisation theory should be seen as a geographically and historically limited exaggeration among the variety and long durees of socio-sexual systems. Individualisation theory is seen as largely resting on the evidence of qualitative work using purposive samples of particular social groups in particular contexts and localities. They do not often use representative samples or total population figures which can accurately portray overall social patterns. According to Sayer (1992) individualization theorists have used ‘intensive’ research design which are indeed in-depth and able to access social process more directly, and understand its context but points out that such work needs to be complemented by ‘extensive’ research on patterns and distributions, using representative survey for example. Duncan and Edwards (1999) share the same view that the use of both intensive and extensive research designs will enable generalizations to be made. In addition intensive work will enable better interpretation of the representative patterns revealed by extensive work and to link process to pattern directly rather than depending upon post-hoc deduction, (Duncan and Edwards 1999).

Critics of the individualisation theory have argued that the theory underplays the significance of the social and geographical patterning of values and behaviour and neglects the importance of local cultural and social contexts. According to Duncan and Irwin structures of economic necessity, social groups and moral codes have not gone away, although they may have changed. Family forms are still deeply influenced by local structural conditions or contexts and although people might be less constrained by older traditions, this does not necessarily mean individualisation. The ‘traditional’ structures of class, gender, religion and so on have a continuing importance, (Duncan and Irwin, 2004, 2005).

Individualisation theory assumes that individuals can exercise choice and shape their lives. However, the theory has been criticized for taking insufficient account of the context in which individuals make their choices. Critics of individualisation have pointed out, people’s capacity to make choices must depend in large measure on their environment, whether for example, on the constraints of poverty, social class and gender, or, more positively, on the safety net provided by the welfare state (Lasch, 1994; Lewis, 2001a). According to Lupton and Tulloch, (2002), people’s choices may depend in part on the consideration they give to the welfare of others, and on how far others influence the way in which they frame their choices. In addition, the context in which people are making their choices is constantly shifting. Thus the meaning of what it is to be married, or to be a parent has changed and continues to change. Charles and Harris (2004) have argued that choices regarding work/life balance are different at different states of the lifecycle.

Scholars have examined public attitudes towards marriage and cohabitation in order to assess whether the trends in statistics confirm the deinstitutionalisation of marriage (Cherlin, 1994), in which an increase in the acceptability of cohabitation can be interpreted as evidence for weakening of the social norms.

Using data from a number of British Social Attitude Surveys, Barlow et. al. found clear evidence of changing public attitudes. More and more people in the United Kingdom were accepting cohabitation both as a partnering and parenting structure, regardless of whether it is undertaken as a prelude or alternative to marriage. In 1994, 70 per cent agreed that ‘People who want children ought to get married’, but by 2000 almost half (54 per cent) thought that there was no need to get married in order to have children; cohabitation was good enough. They found increasingly liberal attitudes to pre-marital sex, with the proportion thinking that it was ‘not wrong at all’ increasing from 42 per cent in 1984 to 62 per cent in 2000. By 2000 more than two-thirds of respondents (67 per cent) agreed it was ‘all right for a couple to live together without intending to get married’, and 56 per cent thought it was ‘a good idea for a couple who intend to get married to live together first’.

Studies by Dyer (1999) and Barlow et al. (2005) found there was a clear difference in attitudes towards cohabitation from young and old generations, indicating a shift in social viewpoint to an acceptance of cohabitation. The younger age groups were more likely to find cohabitation acceptable than older age groups, but all age groups had moved some way towards greater acceptance of pre-marital sex and cohabitation. Barlow et al. argue that over time there is a strong likelihood that society will become more liberal still on these matters, although particular groups, such as the religious, are likely to remain more traditional than the rest. This change in public attitude is echoed by former Home Secretary, Jack Straw who was quoted in the Daily Mail as saying ‘the important thing is the quality of the relationship, not the institution itself’ (Daily Mail, 16th June, 1999). This acceptance in politics as well as in society is probably one reason why people drift into cohabitation. Barlow et a!. suggest Britain will ‘probably move towards a Scandinavian pattern, therefore, where long- term cohabitation is widely seen as quite normal, and where marriage is more of a lifestyle choice than an expected part of life’.

Barlow et al, however, do not interpret the public attitudes to indicate the breakdown or ‘end of marriage’ as a respected institution. In the 2000 survey, 59 per cent agreed that ‘marriage is still the best kind of relationship’. A mere 9 per cent agreed that ‘there is no point getting married – it is only a piece of paper’, while 73 per cent disagreed. Despite the increasing acceptance of cohabitation, Barlow et al. therefore argue that, ‘overall, marriage is still widely valued as an ideal, but that it is regarded with much more ambivalence when it comes to everyday partnering andA parenting’. While only 28 per cent agree that married couples make better parents, just 40 per cent disagree – figures virtually unchanged since 2000, (Barlow et al, 2005)

According to Barlow et al. (2005), there is a body ofA qualitative research that shows that for many cohabitants, living together is seen as a form of marriage rather than an alternative. Moreover, just as the majority think that sex outside marriage is wrong, the same applies to sex outside cohabitation: the large majority of cohabitants, over 80 per cent, think that sex outside a cohabiting relationship is wrong, (Erens et al., 2003). These findings give little support to the notion that many people cohabit outside marriage because cohabitation is more congruent with a project of the self, as individualisation theory would have it (Hall, 1996). Instead research seems to indicate that many traditional norms about relationships still hold true and cohabitation is seen as the equivalent of marriage. According to Barlow et al, (2008), cohabitation is socially accepted as equivalent to marriage and whilst marriage is seen as ideal, social attitudes show great tolerance to different styles of partnering and parenting relationships.