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Attraction- selection attrition framework; In Attraction, everyone is different, people are differently attracted to a career for different reasons, this could be their passion, helping and/or looking after people could make them happy and fulfilled, even if they just want to try different job, and this is depending on their personality to choose the organization they want. In Selection, in organization the Manager chooses who she thinks will qualified for the job, with the same interest, goals, and personal reasons. Attrition, this is the complete opposite of attraction, where the people who didn’t qualify, or found that they are not happy with the organization, management, job tend to leave, only those people who have the same ideas, interest, fits in the job chose to stay. A very good example is in the residential home I used to work, I’d chose that residential home to apply because of a good reputation. The manager hired me because she thinks have got the qualification they are looking for, and I can contribute to the organization. I and the other lady started working as a Induction carer, 3 days after the manager talked to me, and told me my colleagues are happy working with me and I can start working as a regular carer, working on my own. The sad part was, the new lady didn’t appear two days after.

http://www.utwente.nl/cw/theorieenoverzicht/Theory%20clusters/Public%20Relations,%20Advertising,%20Marketing%20and%20Consumer%20Behavior/Attraction-Selection-Attrition_Framework(ASA).doc/

There are many types of organizational communication. Individuals communicate with peers, superiors, and subordinates within the organization. Managers manage through communication. Employee communication departments attempt to inform and/or secure “cooperation”; from employees. Labour relations specialists deal with labour unions. Formal and informal communication takes place between departments and role occupants throughout the organization. Public relations specialists communicate to external audiences about the organization in general,and advertising departments communicate to consumers about the organization’s products and services. Change agents; and other organizational representatives communicate with clients and community representatives. Finally, organizations communicate with other organizations which generally share common problems or values. In groupthink or team work, a manager or team leader should be sensitive, open to accept suggestions from your subordinates in order to meet the target goal. Working in groups are building blocks for meeting organization goals. Managers should also consider ways to develop leadership in team members. Training for versatility in leadership styles through workshops could encourage this growth. Encouraging self-growth through concept of motivation.

Task 2 – Report

Catherine Lodge is a residential care home that aims to provide continuous professional care to all its residents within a safe, friendly and relaxed environment. It caters up to 39 elderly residents providing each individual with a personal form of service derived from a carefully formulated care plan that meets their needs. This is provided both in short and long term basis depending on each individual. Since each resident has specific needs that range from physical, psychological, social or spiritual needs on a 24 hour basis it requires a certain level of personnel to facilitate this.

“Show me the money!” Well, that’s what financial data do. They show you the money. They show you where a company’s money came from, where it went, and where it is now.

There are four main financial data. They are: (1) balance sheets; (2) income statements; (3) cash flow statements; and (4) statements of shareholders’ equity. Balance sheets show what a company owns and what it owes at a fixed point in time. Income statements show how much money a company made and spent over a period of time. Cash flow statements show the exchange of money between a company and the outside world also over a period of time. The fourth financial statement, called a “statement of shareholders’ equity,” shows changes in the interests of the company’s shareholders over time.

A balance sheet provides detailed information of company’s asset, liabilities and shareholders’ equity.

Assets are things that company owns that have value. They can either be sold or used by the company to provide services that can also be sold. It also includes physical property of the residents that can/can’t be touched but nevertheless exist and have value.

Liabilities are amounts of money that a company owes to others e.g. all kinds of obligations like borrowed money from a bank,payroll a company owes to its employees, environmental costs, taxes owed, and obligations to provide good quality of services.

Shareholders’ equity or capital

Income statements is a report that shows how much revenue a company earned over a specific period, it also shows the company’s net earnings and losses.

Cash flow statement report a company’s inflows and outflows of cash. This is important because a company needs to have enough cash on hand to pay its expenses and purchase assets. While an income statement can tell you whether a company made a profit, a cash flow statement can tell you whether the company generated cash. It shows the net increase or decrease in cash for a period.

In Residential home, we have enough staff to work in the morning, in the afternoon and at night. We have a monthly staff meeting to raise our concern at work, problems with our colleagues, and suggestions on resident/s care plan, and we also have a separate Senior Carers meeting, the Manager/Owner and the Deputy Manager always presents the Carers the needs of good communication, and team work. We have supervision every 3 months, the manager is giving feedback to identify our strengths and weaknesses, and if they think the staff needs to be trained, and appraisal every 6 months in which we rate ourselves, and the Deputy Manager is rating the staff as well in our performance, we can voice out our own opinion, about the job, colleagues and if we are getting support from the Managers. The company also provided us mandatory training, manuals, booklets, presentation from the lecturer and a questionnaire that we need to answer at the end of the training. Catherine Lodge has a seasonal newsletter where they introduce new staff member, residents who celebrated their birthday, and about the achievements of the company. A good communication skill is very important, specially working in care settings. Working with vulnerable adults requires more understanding, must have different techniques and strategies use in supporting communication between the individual with specific communication needs. Good communication with vulnerable adult is essential. This includes identifying behaviour triggers, by means of visual prompts and speaking in short, clear sentences. I considered that the social workers used verbal and non-verbal forms of communications and applied the principles of active listening. Some people with disabilities are not able to use speech as their principle means of communication. They may however be able to use an alternative method of communication such as symbols and symbolic languages. It is vital to recognise that symbols are different from pictures. Pictures generally convey a lot of information at once but their focus is often unclear. Symbols, on the other hand, are often designed to convey a particular meaning. Symbols or symbolic languages can be applied to signify many aspects of verbal communication. Symbols can be presented through visual, auditory and/or tactile media and can take the form of gestures, photos, manual signs, printed words, objects, ‘reproduced’ spoken words or Braille. Symbols help understanding which can increase involvement, choice and confidence. It helps support creativity and self expressions. Using mobile phones at work is strictly prohibited, as it may interfere in whatever the carer is doing or it may cause accident e.g if the Carer is feeding, doing morning care. Some residents may have challenging behaviour that sometimes affects the carer itself, they best react in a calm, quiet environment, Carer must consider the Residents preference, cultural difference, language and environment, assumptions, judging, noise, and distraction.

The use of technology helps the care workers by having an easy access by just typing the resident’s name all his/her information daily report will come out in one click, comparison graph of residential’s weight incomparable from past to present will easily available in one click, not unlike if it is just written and filled you have to search for it and check the book where you filed it. Make work a lot easy, report will neat and tidy, because it is easy to edit if you accidentally misspelled.

Disadvantage of it is if the computer got virus and/or the system got hacked all the information will wipe out, that will give an extra work for the manager, care workers, and andmin.

Code of Practice sets out the minimum standards and guidelines for hygiene, fire building safety, and the level of care required , which aims at ensuring that residents in the homes receive services of acceptable standards that are of benefit to them physically, emotionally and socially. (http://www.swd.gov.hk/doc/downsecdoc/code_rchpd.pdf)I will assess the workplace strategies, policies and procedures that should be in place to ensure good practice in relation to all forms of communication in health and social care setting. The health and social care industry mainly focuses on the heart of care. Since it involves people, communication takes a very important role. Effective communication is not only significant to the health care professionals in ensuring the improvement of clients’ quality of life by addressing their needs. It is also the client’s and support systems’ right in the promotion of their equality and diversity as people.

Workplace strategies, policies, and procedures for good practice in communication focus on ensuring privacy, and confidentiality, disclosure, protection of individuals, rights and responsibilities, and equal opportunities. Moreover, a practice on disciplinary procedures, complaints policy, and flexible working also benefit the entire health care team. If all these flow efficiently, there will be no hindrance in the system of communication. For example, one of our residents had a GP appointment and I escorted her. When we arrived in the GP surgery, the receptionist asks the residents loudly for the reason that I am in the GP surgery in which other patients can hear, there is a break in the policy of ensuring privacy. Whenever I start expressing my concerns at her pace, then I will definitely not have my privacy. It establishes a barrier between us personally and professionally. As a patient, I might start complaining with regards to her action.

Effective communication is a key factor in success may it be in work or association. It is always a part of personal and professional progress. Therefore, to master communication skills and techniques is a very important area to develop in each individual. In the given scenario its implication is to render a quality health care service which benefits the service providers and the service users.

Data Protection is designed for person responsible for safeguarding the confidentiality of information and of the person giving his or her own information. One of its purposes is to safeguard “the fundamental rights of individuals”.

This act governs the right storage and processing of personal data held in manual records and on computers. Under this act, the rights of the individual are protected by forcing organisations to follow proper and sound practices, known as data principles (DPP). Reporting and recording of information is a vital form of communication needed to ensure the safety of vulnerable adults. Parts of a carer’s daily routine should include making notes in a care file, as well as using communication books, forms and documents. Make sure that the writing is legible and clear, that is signed and dated, and that where necessary copies are made.

http://transparency.dh.gov.uk/dataprotection/information-charter/

Health and Safety inspections are an important monitoring tool to help ensure that workplace hazards are controlled and that risk to employees and others are eliminated or minimised. Inspections should be carried out regularly. Carers must inspect the equipment/s before using it, report and record all faulty equipment/s to the Manager e.g. heating, lightning, and ventilation. Charter is for anyone who has dealings with the Department of Health whether through correspondence, involvement in public policy consultations or if for any other reason we hold personal information about the resident.

Communication and listening gives clues to a better understanding of an individual’s preferences and wishes. Gathering information about an individual will lead to creative and supportive ways of providing care. Carers must exercised active listening and having the ability to empathise with the residents by paraphrasing what the others saying to her and understand it. So that, she will increased the trust and gain more information from the individuals. Communication itself is influenced by individual’s values and culture. Carers should always make sure of eye contact; focus on what they are saying and acknowledged what is being said to her by paraphrasing or nodding her head. Carers must also use different technique to enhance their social culture, beliefs and values. Like for instances, I usually greets and chat with the individuals by smiling , Carers must apply the sense of touch in her communication. I believes that by means of touch can be a very positive form of communication in that it can provide comfort and re-assurance when someone is distressed making them feel safe and secure, it can also be a signed of love, respect and affection to somebody or it may calm someone who is agitated. In this case carers show that they met the desires of the human beings to their client which are love, purpose and self expression.

Carers should be warm and caring in nature and she has the ability to connect well with others. Fine qualities and having a good communication skill plays important role in the delivery of care in whatever ethnicity, sex, education or social care they may be.

Saving face is saving your credibility, dignity and ethics by means of being honest, getting out of the situation by means of good explanation.

Theories of Organisational communication

Attraction- selection attrition framework; In Attraction, everyone is different, people are differently attracted to a career for different reasons, this could be their passion, helping and/or looking after people could make them happy and fulfilled, even if they just want to try different job, and this is depending on their personality to choose the organization they want. In Selection, in organization the Manager chooses who she thinks will qualified for the job, with the same interest, goals, and personal reasons. Attrition, this is the complete opposite of attraction, where the people who didn’t qualify, or found that they are not happy with the organization, management, job tend to leave, only those people who have the same ideas, interest, fits in the job chose to stay. A very good example is in the residential home I used to work, I’d chose that residential home to apply because of a good reputation. The manager hired me because she thinks have got the qualification they are looking for, and I can contribute to the organization. I and the other lady started working as a Induction carer, 3 days after the manager talked to me, and told me my colleagues are happy working with me and I can start working as a regular carer, working on my own. The sad part was, the new lady didn’t appear two days after.

http://www.utwente.nl/cw/theorieenoverzicht/Theory%20clusters/Public%20Relations,%20Advertising,%20Marketing%20and%20Consumer%20Behavior/Attraction-Selection-Attrition_Framework(ASA).doc/

There are many types of organizational communication. Individuals communicate with peers, superiors, and subordinates within the organization. Managers manage through communication. Employee communication departments attempt to inform and/or secure “cooperation”; from employees. Labour relations specialists deal with labour unions. Formal and informal communication takes place between departments and role occupants throughout the organization. Public relations specialists communicate to external audiences about the organization in general,and advertising departments communicate to consumers about the organization’s products and services. Change agents; and other organizational representatives communicate with clients and community representatives. Finally, organizations communicate with other organizations which generally share common problems or values. In groupthink or team work, a manager or team leader should be sensitive, open to accept suggestions from your subordinates in order to meet the target goal. Working in groups are building blocks for meeting organization goals. Managers should also consider ways to develop leadership in team members. Training for versatility in leadership styles through workshops could encourage this growth. Encouraging self-growth through concept of motivation.

It is very important to have an effective communication at shift turnover; Care workers should give this a high priority. Shift turnover should be included in the safety-critical topics supervised and audited periodically by management. They should identify its importance in policy and procedures, assign responsibilities and set minimum standards. A description of how to conduct an effective handover should be available so individuals can assess and improve their own practice. High risk handovers needing extra attention should be flagged up.

The importance of effective communication skills during shift handover and throughout other work activities suggests this attribute should be amongst the selection criteria for key posts. Furthermore, opportunities should be available for existing staff to develop their communication skills if required.

To be able to motivate a care worker is to identify his strengths and weaknesses, and by giving him feedback. Being open to accept negative feedback is the key for being productive by improving, and being eager to learn, and update skills. Team work and good communication with one another will make each other’s work easy.

Task 3 – Interpersonal communication

How the use of ICT in health and social care benefits service users? The Information Communication Technology aims to the efficiency of the health care services. This means to b a better outcome for the same or a lesser use of resources. ICT also helps and empowers the health and social care staff, it improves positive patient’s experiences and facilities research and development relevant to health and social care, the legal consideration in the use of ICT is the Health and Safety. How the ICT supports and enhances the activities of care workers and care organisations? As aforementioned, the ICT supports and enhances health and social care activities of care workers and care organisations. It is through administrative, financial, clinical, infrastructure applications, etc. That the needs of staff are met; and there is a high regard innovation in business administration, efficiency and quality of service. It also helps in meeting requirement of other agencies, accountability, and audit. For example, the use of a computer screen is an indication of a patient’s arrival makes the work of the receptionist lighter and easier. Imagine if there was no such thing then the receptionist will have to entertain every person coming in a queue. She will not have enough have time to do other things.

Working with vulnerable adult, Professionals must shows different techniques and strategies used in supporting communication between the individual with specific communication needs. Good communication with people with vulnerable adult is essential. This includes identifying behaviour triggers, by means of visual prompts and speaking in short, clear sentences. I considered that the carers must use verbal and non-verbal forms of communications and applied the principles of active listening. Some people with disabilities are not able to use speech as their principle means of communication. They may however be able to use an alternative method of communication such as symbols and body language. It is vital to recognise that symbols are different from pictures. Pictures generally convey a lot of information at once but their focus is often unclear. Symbols, on the other hand, are often designed to convey a particular meaning. Symbols or body language can be applied to signify many aspects of verbal communication. Symbols can be presented through visual, auditory and/or tactile media and can take the form of gestures, photos, manual signs, printed words, objects, ‘reproduced’ spoken words or Braille. Symbols help understanding which can increase involvement, choice and confidence; it helps support creativity and self expressions.

Theories of Interpersonal Communication

Uncertainty reduction model People have an urge or need to reduce uncertainty about individuals that they find attractive and this motivates them to communicate In Social network theory closeness develops if people proceed in gradual and orderly fashion from superficial to more intimate levels of exchange. People consciously and deliberately weigh the costs and rewards associated with a relationship and seek relationships that reward them and avoid those that are costly. People connect with others because they believe that rewards or positive outcomes will result. Expectancy value model People believe according to their expectations, and evaluation. The behaviours they perform in response to their beliefs and values are undertaken to achieve some end. However, although expectancy-value theory can be used to explain central concepts in uses and gratifications research, there are other factors that influence the process. Attribution theory is significantly driven by motivational drives, looking at how the person constructs the meaning of an event based on the person’s motives to find cause on person’s surroundings.

Personal development planning is the lifelong process of nurturing, shaping, and updating person’s knowledge. It is about allowing individuals to improve and develop in line with the industry in which they engage or aspire to engage. It is about widening or broadening their knowledge and skills in order that they will continue to have a place in the flatter structures of today’s organisations.

The benefits of personal development planning are that it provides a schedule to work to motivate the individual and suggests a framework for monitoring and evaluating achievements. A good example is If you are currently working as a first line manager or senior administrator and aspire to the position of your manager, you may need to acquire new skills or develop your lower level skills to a higher level in, for example, budgeting, managing people, performance review, report writing and chairing meetings. You would need to planhow you are going to acquire these skills and over what time frame. Personal development planning can also be the basis for: Assessing where you want to be and how you can get there ,keeping skills up-to-date through meetings, trainings, reading the record book of the residents, updating it via computer, particularly in IT and technical areas, Continuous learning, gaining satisfaction from achievements through feedback from colleagues and management whether it is formal or informal, Building up transferable skills, such as time management, adaptability to change, self-awareness, and supporting future employability. You have to set yourself a SMART objective; they must be attainable, viable and realistic time-frame.

A good example of SMART objective is;

Within the next 12 months (time-bound), I will devise and implement a system (specific) which will enable the team to communicate more effectively with each other (achievable and realistic) through monthly group meetings and three-monthly one-to-one meetings (measurable).

There are many different theories as to the causes of domestic violence (abuse). These include psychological theories that consider personality traits and mental characteristics of the offender, as well as social theories which consider external factors in the offender’s environment, such as stress, social learning and drug and alcohol abuse.

Psychological theories focus on personality traits and mental characteristics of the offender. According to this theoretical approach, characteristics associated with individuals who abuse their partners include low self-esteem, isolation from social support, a manipulative nature, and a desire for power and control (Suman Kakar 1998). These individuals are likely to be unwilling to take responsibility for their own actions, have extreme feelings of jealousy and possessiveness, be overly dependent on the victim, and/or have certain mental or psychological disorders.

An important aspect in the psychological theory is power and control. In some relationships, violence arises out of a perceived need for power and control. This is where the abuser may use violence as a strategy to gain or maintain power and control over the victim. Abusers may feel the need to control their partner because of difficulties in regulating anger and other strong emotions, or when they feel inferior to the other partner in education and socioeconomic background. For instance, in our society today, women have moved away from being just a “housewife” and taken up the role as a “career woman”. No longer are women staying home and tending to the house while men go out and work. In fact, a lot of women have taken over jobs that were previously held my men (women politicians). This has brought about a power struggle in the family which often leads to domestic disputes and abuse: Some men with very traditional beliefs still think they have the right to control women, and that women are not equal to men, while women on the other hand, are vying for power and control.

Stress may be increased when a person is living in a family situation, with increased pressures. Social stresses, due to inadequate finances or other such problems in a family may further increase tensions. Violence is not always caused by stress, but may be one way that some (but not all) people respond to stress. Families and couples in poverty may be more likely to experience domestic violence, due to increased stress and conflicts about finances and other aspects. Some speculate that poverty may hinder a man’s ability to live up to his idea of “successful manhood”, thus he fears losing honor and respect. As a result of him not being able to economically support his wife, and maintain control, he may turn to violence as ways to express masculinity.

Social learning theory suggests that people learn from observing and modeling after others’ behaviour. With positive reinforcement, the behavior continues. If one observes violent behavior, one is more likely to imitate it. If there are no negative consequences (e.g. victim accepts the violence, with submission), then the behaviour will likely continue. Oftentimes, violence is transmitted from generation to generation in a cyclical manner. According to Faith St Catherine of the Women’s Resource and Outreach centre in Jamaica, “there is a culture of abuse, especially among the inner city poor…” Studies have found that nearly one half of abusive men grew up in homes where their father or step father was an abuser. An environment where violence is either taught, by example, or accepted as “normal” will imprint upon a child’s psyche. For instance, a young boy may see his father come home from work drunk and angry, screaming at his mother. He watches his mother attempt to please and placate his father’s drunken behaviour. The young boy is being taught that violence gets results. He is developing his own ideas about what makes a man.

http://books.google.com/books?hl=en&lr=&id=BPT0HelrVcMC&oi=fnd&pg=PA201&dq=Social+theories+of+Domestic+Violence&ots=9iVvl8_Tpr&sig=C9P8UBogyad2RePEnpeTk5JYs7Y#v=onepage&q=&f=false

Drug and/or alcohol abuse may be a precursor to domestic violence. Substance abuse leads to out-of-control behaviour. A drunk or high person will be less likely to control his or her violent impulses. However some have argued that abusers use drug and alcohol as an excuse for their action. Yet, alcohol is an important risk factor for partner abuse. According to University of the West Indies professor and gender expert in Trinidad, Rhoda Reddock: in Trinidad, many of the most gruesome murders and sexual violence are linked to mental disease brought about by drug and alcohol addiction, respectively. Since alcohol decreases control and raises the potential for acting on impulse, it is not surprising that some feel it can be a catalyst for abuse. Often a person is able to maintain control of violent emotions when he is sober, but after a few drinks, he becomes abusive. The alcohol has dulled his wits and diminished his ability to control his temper.

In the Caribbean or more specifically in Barbados, domestic violence is becoming more and more apparent in the society. Domestic violence is seldom reported in the island, hence why the true incidence of domestic violence is unknown. In November of 2005, according to The World Health Organization (WHO) one woman in every three (3) women are reported to be sexually abused during childhood or adolescence. The study revealed that the most common forms of violence is meted out by loved ones. As mentioned earlier, domestic violence is also known to be closely linked with drug and alcohol abuse. According to Tessa Chaderton-Shaw , manager, of the National Council of Substance Abuse (NCSA), “There are many cross-cutting issues with substance abuse and domestic violence…” She also stated that, “It can lead to isolation, shame, guilt, initial denial, loss of support, low self-esteem and a potential for criminal involvement.” People then became more aware of Domestic Violence in the country, and the awareness has constantly been growing. Even the Barbados Police Force has taken domestic violence under more serious consideration and had devised a strategic plan to address domestic violence and reduce its occurrence, according to Sergeant David Wiltshire. Wiltshire said that officers were sent to the United States and England for training to respond to domestic violence issues.

References
Theories – http://social.jrank.org/pages/210/Domestic-Violence-Causes-Domestic-Violence.html
http://en.wikipedia.org/wiki/Domestic_violence#Psychological
http://wost201h_domviol.tripod.com/groupactionproject/id4.html
Suman Kakar – Criminal Justice Approaches to Domestic Violence (1998).
Rhoda Reddock & Faith St Catherine – http://www.jamaicaobserver.com/magazines/AllWoman/html/20061203T000000-0500_116180_OBS_CARIBBEAN_FACES_DOMESTIC_VIOLENCE_CHALLENGE_.asp
Barbados & Domestic Violence – http://archive.nationnews.com/archive_results.php?mode=allwords&IncludeStories=1&numPer=20&start=0&keyword=Domestic+Violence&smartText

Reflection on group task

This essay is going to reflect on learning gained from a group task carried out in the unit lectures. I will explore the theories which inform group work, inter-disciplinary and collaborative working and the application of these theories in relation to the group work. I will also identify how I will develop my practice in relation to my current skills and areas for development. Finally, I will also reflect on how I have developed my self-awareness, professional values and professional development, in relation to group work task and how this will inform my future professional practice.

Toseland and Rivas (2008) define group work as a goal directed activity aimed at accomplishing tasks. Members of the group have the opportunity to share ideas, feelings, thoughts, beliefs, engage in interactions and also share experiences. The group members develop feelings of mutual interdependence and a sense of belonging. Martin and Rogers (2004) define inter-disciplinary working as a team of individuals with different professionals working collaboratively with a shared understanding of goals, tasks and responsibilities. This collaborative working is needed when the problems are complex, a consensus decision is required and also when different competencies are needed. According to Cheminais (2009), the approach to the collaborative working requires clarity on roles, power, accountability and strategic planning.

Salas et al. (2012) states that, group work was developed from a philosophy of people working together for mutual gain and theories later emerged to provide clarity regarding the dynamics of groups and to provide an understanding of human behaviour. A group or team can be understood by looking at Tuckman and Jensen’s (1977) model of group formation which comprise of forming, storming, norming, performing and later adjourning. According to Tuchman and Jensen (1977), the forming stage of a group involves clarifying common interests and roles to be played. Martin and Rogers (2004) states that, in an inter-disciplinary team this is the stage where membership is established, team purpose is clarified, roles and boundaries are decided and interpersonal relationships begin. According to Tuchman and Jensen (1977), the storming stage may involve the problem-solving processes and this is usually where conflict emerges. If the conflict is unresolved, it can inhibit the team’s progress. The norming stage usually involves the clarification of the task and establishing the agenda. This stage involves belonging, growth and control. The performing stage involves the allocation, implementation, and evaluation of the task. Finally, the adjourning stage can include the celebration of task completion.

Reflecting on the unit group task, I think my group went through Tuckman and Jensen’s (1977) model group formation which included the “forming”stage in which the group purpose was clarified. The group went through the “stormimg” stage and at that point, there were disagreements on what should be included and how the task will be presented. One of the group members suggested that a role play was ideal for the presentation and I was not comfortable with the idea, as I thought that all of the information was not going to be included in the role play. I was anxious, as I had not get the general picture of exactly what the role play was about. I alsofeltanxious as other members elected me to take the lead role as I had experience in working with psychiatrists. At that time I felt that the team wanted me to do most of the task and I rejected their ideas they were putting forward. I think I did this unconsciously because I realised my actions later on when my group members gave feedback. The group also decided that we give ourselves time to research on the topic given (norming stage) and then meet the following week. I was very frustrated to find the following week that some of the group members did not bring the material they had researched. As I have worked with psychiatrist before and had researched I took on the lead role and shared the information I had.

Belbin’s (2010) work identified roles in teams which each offer positive contributions to team working. The roles include innovator, implementer, completer, evaluator, investigator, shaper, team maintainer, co-ordinator and expert. Reflecting on Belbin’s (2010) group roles, each team member brought strength and perspectives grounded in their discipline and experience. During the group work task, I had the experience and knowledge in relation to the task and I found myself leading the group on sourcing information. I got positive feedback from my group colleagues such as, “goal oriented, researched well on the topic, contributed well and very good ideas on the role play”, however I was criticised for being inflexible with ideas of others. I think I took the role of an implementer who turns ideas and decisions into tasks and actions but inflexible and reluctant to change plans. However from my previous placement I think I took the role of an investigator in a proposed group project of working with young mothers to enable them to gain independent skills. The project failed because I lost interest as a result of constraint in obtaining the resources.

In Belbin’s (2010) model, an investigator explores opportunities and resources from many sources however can jump from one task to another and lose interest. Looking back at it, I think this was because I tend to do things in a structured way and task oriented. The resources in the organisations did not allow me to do the task in time and I end up losing interest. I later understood the situation of working in an organisation team by looking at the group system theory.

According to Connors and Caple (2005), group systems theory provides an understanding and working with teams or groups in an organisation as it goes beyond a focus on the individual or interpersonal exchanges. They suggested that, a group systems theory is influenced by the interactions within the group and by the external environment. All the group members influence group dynamics however, the organisation in which the group work may impacts the group work with its boundaries, power structures that make decisions and the resources it allocates for group work. The environment impacts the group and the group can impact the larger social environment. I abandoned a project which was going to benefit the young mothers and in a way the community as well. In group systems theory, a change in any part of a system creates change in that system and in the other systems in which it is embedded.

Another form of group theory emerged from Bion (1989) who viewed the group working as a collective entity and was concerned with overt and covert aspects. Bion (1989) suggested that overt aspects are the task and purpose of the group. The covert aspects are the unconscious emotions and the basic assumptions of group functioning. Bion (1989) also proposed three basic assumptions in group working. He suggested that there is the dependency group, which assumes that security and protection can be obtained from the group leader. Members expect the leader to have all the answers. As a result, individuals may act helpless and incompetent in the hopes that the group leader will carry the responsibilities. This was evident in my group as they assumed that as I am a mental health nurse and had worked with psychiatrist before, I will have all the information at hand. When this did not occur, group members become angry or expressed their disappointment by acting incompetent and not doing enough research. Bion’s (1989) other basic assumption is the fight-flight group. Examples of flight include absences and fight is demonstrated by resisting reflection and self-examination. In inter-disciplinary working, flight is demonstrated by blaming management for the failure of team work. The final basic assumption identified by Bion (1989) is the pairing group where two group members form a bond. The rest of the group may become inactive as the pair rely on each other and exclude other group members.

Salas et a.l (2012) state that, it is necessary to develop a theoretical framework to guide group practice and to support my techniques and interventions. I am responsible for formulating my own theoretical framework that is derived from the synthesis of theories and that is aligned with my natural views and inclinations. To achieve this it is imperative that I be self-aware and grounded in theories of small group work, including the strengths and limitations of the theories. Only then I can select theories and interventions that are advantageous and appropriate fit for the client. The Health and Care Professions Council (HPCP) (2012) also states that, I should understand the key concepts of the knowledge base relevant to social work so as to achieve change and development.

Gilley et al. (2010) suggested that the purpose of a group is to accomplish the task and for the practitioner to develop problem-solving skills. As a social work student, in order to work collaboratively, I need to develop skills, knowledge, and attitudes in conflict resolution, problem solving, communication, organisational understanding, decision making, and task coordination. This is imperative as I will be working in teams with other professionals or agencies.

From the unit group work, I have learnt that co-operation is vital for effective teamwork. Acknowledging and respecting other opinions and viewpoints while maintaining the willingness to examine and change personal beliefs and perspectives are some of the skills I have learnt. I also now have an understanding of the importance of accepting and sharing responsibilities, participating in group decision-making and effective communication. I have also developed skills in exchanging of ideas and discussion and also how to relay and support my own viewpoint with confidence.

As a future social worker, specific leadership skills are required to manage an inter-disciplinary team, so I need to develop skills in the ability to recognise the challenges inherent not only in group dynamics, but in trying to blend the different professional cultures represented in the team. According to Crawford (2012), to work effectively and confidently with other professionals, I need to understand my own professional identity as a social worker. The HCPC (2012) states that, I need to be able to engage in inter-professional and inter-agency communication and work in partnership with other agencies as part of a multi-disciplinary team. It is also vital that I develop self awareness of my behaviour and values. According to Hall (2005), values are internalised, therefore they can create obstacles that may actually be invisible to different team members. Therefore the professional values must be made apparent to all professionals involved.

Through experiences in group work feedback received from other group members and self observation, I have learnt about my maladaptive style of interacting with others and perceptual distortions. I have also learnt that I need to acknowledge and appreciate the differences and adjust, adapt, and mirror interpersonal interactions when interacting with others. If faced with the same situation again I would try to take into consideration other people’s ideas and also take into consideration that, as people we are different and we have different approaches to tasks.

References

Belbin, R. M. (2010) Management teams. 3^rd edn. Oxford: Elsevier Limited

Bion, W. R. (1989) Experiences in groups and other papers. New edition. London: Routledge

Cheminais, R. (2009) Effective multi-agency partnerships : putting every child matters into practice. Dawsonera [Online]. Available at: https://www.dawsonera.com/readonline/9781446203514/startPage/38 (Accessed: 13 January 2014)

Connors, J. and Caple, R. (2005) “Review of group systems theory”,Journal for Specialists in Group Work, 30(2), pp. 93-110, SocINDEX [Online]. Available at: http://0-ehis.ebscohost.com.brum.beds.ac.uk/eds/pdfviewer/pdfviewer?vid=5&sid=a5e06866-f590-4862-bcbb-3dea9991c6f0%40sessionmgr4005&hid=4108 (Accessed: 30 December 2013)

Crawford, K. (2012) Interprofessional Collaboration in Social Work Practice. London: sage Publications Limited

Gilley, J.W., Waite, A.M., Coates, T., Veliquette, A. and Morris, M.L. (2010) “Integrated theoretical model for building effective teams”,Advances In Developing Human Resources12(1) pp. 7-28.SCOPUS [Online]. Available at: http://0-ehis.ebscohost.com.brum.beds.ac.uk/eds/detail?sid=a5e06866-f590-4862-bcbb-3dea9991c6f0%40sessionmgr4005&vid=10&hid=4108 (Accessed: 30 December 2013)

Hall, P. (2005) “Interprofessional teamwork: professional cultures as barriers”,Journal of Interprofessional Care19 pp. 188-196. CINAHL [Online]. Available at: http://0-ehis.ebscohost.com.brum.beds.ac.uk/eds/pdfviewer/pdfviewer?vid=13&sid=a5e06866-f590-4862-bcbb-3dea9991c6f0%40sessionmgr4005&hid=4108 (Accessed: 12 January 2014)

Health and Care Professions Council (2012) Standards of proficiency. Available at: http://www.hpc-uk.org/assets/documents/10003B08Standardsofproficiency-SocialworkersinEngland.pdf (Accessed: 20 January 2014)

Martin, V. and Rogers, A. M. ( 2004) Leading interprofessional teams in health and social care. Dawsonera [Online]. Available at: https://www.dawsonera.com/readonline/9780203505359/startPage/139 (Accessed: 10 January 2014)

Salas, L. M., Roe-Sepowitz, D. and Le Croy, C. W. (2012) “Small group theory”, in Thyer, B. A., Dulmus, C. N. and Sowers, K. M. (eds) Human behavior in the social environment: theories for social work practice. Dawsonera [Online]. Available at: https://www.dawsonera.com/readonline/9781118227251/startPage/363 (Accessed: 15 January 2014)

Toseland, R. W. and Rivas, R. F. (2008) An introduction to groupwork practice. 6^th edn. Harlow: Pearson Education Limited.

Tuckman, B. W. and Jensen, M. A. (1977). “Stages of small group development revisited”, Group and Organizational Studies, 2(4) pp. 419- 427. Available at: http://www.freewebs.com/group-management/BruceTuckman(1).pdf (Accessed: 30 December 2013)

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Theories are used to explain the characteristics and circumstances of individual. Theories look at human growth and development; managing loss and change; managing stress and behaviour

AQA. (2017). The Humanistic Approach | AQA B Psychology. [online] Available at: http://aqabpsychology.co.uk/2010/07/the-humanistic-approach/ [Accessed 4 Feb. 2017].

The aim of this essay is to use knowledge of human growth and development to critically discuss the theories a social worker might employ to assess a family and better understand their behaviour. A family profile will be provided and two family members selected for further discussion and the application of appropriate theories. These theories will be critiqued in terms of how they might assist social workers in making informed assessments, as well as where the theories are limited in their application.

Sylvie and Greg met when they were 19-years of age. They had been together for 5-years when their daughter Molly was born. They split up when Molly was 1-years old, but got back together 6-years later when Molly was 7-years of age. Greg said that they split up because he was unable to handle Sylvie’s total lack of trust in him. This caused huge arguments between them, with Sylvie constantly questioning where he was and his commitment to his family. Sylvie said that she was devastated when Greg left, but knew that it was going to happen. During their time apart Sylvie turned to alcohol and drugs, but sought counselling and support for this and the issues in her past. As a result, she has been drug and alcohol free for over 4-years.

Greg always maintained a good relationship with Molly during the 6-year separation and she lived with him and her paternal Grandparents at different points when Sylvie was not coping. Molly said that she was happy that her parents got back together.

Mason was planned and both Sylvie and Greg felt they had resolved historic issues and were committed as a family unit to having another child. Mason was born with Global Developmental Delay, which is a condition that occurs between birth to 18-years of age and is usually characterised by lower intellectual functioning and significant limitations in communication and other developmental skills. Sylvie blames herself for Mason’s condition, believing that it must somehow be linked to her ‘wild’ years of drinking and drug binges. Despite being reassured to the contrary by medical professionals and a social worker, she remains low in mood and feels that she has let everyone down. Sylvie has found bonding with Mason difficult and she feels frustrated by him not meeting his developmental milestones. Mason is in nappies, he is not yet talking, he is very unsteady on his feet and he lacks co-ordination. As a result, he still requires feeding at mealtimes and has not begun to develop independent skills. Sylvie has said that she feels like ‘sending him somewhere.’ Greg, on the other hand, feels very attached and protective towards Mason and Sylvie feels that he ‘lets him get away with anything.’ Conflict has developed between Sylvie and Greg, resulting in Greg staying at work longer and meeting up with his friends more in an effort to avoid the arguments and tension at home.

Elsie, mother to Greg, owns the large family home in which they all live. Sylvie and Greg decided that they would move in with her shortly after they got back together, as Greg’s father died very unexpectedly. The plan was that they would all support one another financially, practically and emotionally. Elsie is very involved with the children as both parents work. However, recently Elsie has been forgetting things, such as collecting Mason from the specialist childminder and this has caused tension between the adults.

There have been some difficulties with Molly at school. Sylvie was called in to Molly’s school last week as a result of Molly using racist language towards another student. The school state that Molly is very close to being excluded, as a result of her angry and disruptive behaviour. Sylvie broke down upon hearing this and explained about her low mood, feelings of despair and worries about Greg’s mum. Sylvie cannot understand the change in Molly’s behaviour and said that she and Greg need help.

Applying Human Growth and Development to Social Work

As part of this essay, there will be a focus on two members of this family: Molly and Elsie. The two theories of human growth and development to be applied to Molly are Attachment Theory and Life Course Theory. The two theories of human growth and development to be applied to Elsie are Ecological Theory and Disengagement Theory.

Anti-oppressive practice will underlie the critique and has been defined as “a form of social work practice which addresses social divisions and structural inequalities in the work that is done with ‘clients’ (users) and workers” (Dominelli, 1993, p. 24). Anti-oppressive practice is a person-centred approach synonymous with Carl Rogers (1980) philosophy of person-centred practice. It is designed to empower individuals by reducing the negative effects of hierarchy, with the emphasis being on a holistic approach to assessment. Practising in an anti-oppressive way requires valuing differences lifestyles and personal identities. This goes against common sense socialisation which portrays differences as inferior or pathological and which excludes individuals from the social world and denies them their rights.

MOLLY
Attachment Theory

Attachment Theory is a psychological theory based on the premise that young children require an attachment relationship with at least one consistent caregiver within their lives for normal social and emotional development (Bowlby, 1958). Attachment is an emotional bond between an individual and an attachment figure, usually the person who cares for them. Psychologically, attachment provides a child with security. Biologically, it provides a child with survival. Ainsworth et al. (1978) formulated four types of attachment that provide a tool for social workers to assess and understand children’s emotional experiences and psychosocial functioning: secure; insecure, ambivalent; insecure, avoiding; and disorganised.

Molly appears demonstrates insecure, ambivalent attachments, where parental care is inconsistent and unpredictable. This type of attachment is characterised by parents who fail to empathise with their children’s moods, needs and feelings. Indeed, Sylvie cannot understand the change in Molly’s behaviour, indicating an inability to empathise with Molly.

Children with insecure and ambivalent attachments often become increasingly confused and frustrated. They can become demanding, attention seeking, angry and needful, creating trouble in order to keep other people involved and interested. Feelings are acted out, as Molly has been doing at school. This is because insensitive and inconsistent care is interpreted by the child to mean that they are unworthy of love and unlovable. Such painful feelings undermine self-esteem and self-confidence and an understanding of this can ensure that social workers resist stereotypes of the moody, anti-social teenager, and instead explore the underlying reasons for changes in mood.

For Molly, the development of an attachment figure was likely to have been compromised during her early developmental years. In particular, when Molly was between the ages of 1 and 7-years old, her mother was addicted to drugs and alcohol and thus was emotionally and physically unavailable. Despite living with her father and paternal grandparents for a period of time, the overall insecurity within her family unit is likely to have impacted her ability to attach to others. If Molly did develop an attachment figure it is most likely to have been with her father or maternal grandparents, who were not unavailable due to drug or alcohol abuse during this vital developmental phase of Molly’s childhood.

Taking this into consideration, there are a number of significant changes that have occurred in Molly’s life and that involve potential attachment figures who have provided Molly with much-needed security and safety. For example, Molly’s father, whom Molly has remained close to throughout drama within the family, is no longer at home as much in an effort to avoid arguments with Sylvie. When he is at home, the tension is likely to impact the duration and quality of time spent with Molly. Indeed, marital conflict has been found to influence adolescents’ attachment security by reducing the responsiveness and effectiveness of parenting (Markiewicz, Doyle, and Brendgen, 2001). Strained marital relationships can also lead to increased marginalisation of the father who can become distanced from their children, as has been the case within this family (Markiewicz, Doyle, and Brendgen, 2001).

In addition, Molly has recently lost her grandfather, which her grandmother is also trying to come to terms with. Not only has Molly lost her grandfather, but her grandmother’s behaviour is likely to have changed as she comes to terms with her own loss. All of the key attachment figures in Molly’s life are either emotionally or physically unavailable at present. It is important to consider this within the context of Molly’s current developmental stage, which is that of adolescence.

Attachments to peers tend to emerge in adolescence, but the role of parents remains vital in teenagers successfully achieving attachments outside of the home. It is a time when parents are required to be available if needed, while the teenager makes their first independent steps into the outside world (Allen and Land, 1999). Molly’s recent problems at school could be the result of this lack of availability from adults in her life. She might also be anxious about losing her father again, creating anticipation and fear about separation from an attachment figures. The anger she expresses at school could be transference of the anger and fear created by her unstable circumstances at home. The fact that she has become racially abusive might suggest that her anger lies with her mother, who is of dual nationality.

The main critique of Attachment Theory has been in the guise of the nature versus nurture debate, the former being genetic factors and the latter being the way a child is parented. Harris (1998) argues that parents do not shape their child’s personality or character, but that a child’s peers have more influence on them than their parents. She cites that children are more influenced by their peers because they are eager to fit in. This argument is supported by twin studies showing that identical twins reared apart often develop the same hobbies, habits, and character traits; the same has been found with fraternal twins reared together (Loehlin et al., 1985; Tellegen et al., 1988; Jang et al., 1998). It is likely that nurture plays a greater role in the younger years, when parents and caregivers are the child’s primary point of contact. On the other hand, when a child enters adolescents and engages with society more, nature might take over.

Another limitation in Attachment Theory is the fact that model attachment is based on behaviours that occur during stressful separations rather than during non-stressful situations. Field (1996) astutely argues that a broader understanding of attachment requires observation of how the caregiver and child interact during natural, non-stressful situations. It is agreed that behaviours directed towards the attachment figure during separation and reunion cannot be the only factors used to define attachment.

Despite these limitations, the theory does provide valuable information regarding relationship dynamics and bonds, which social workers can use to better understanding the individual being assessed. It is, however, important to remember that what is seen as healthy attachment will vary culturally. Consideration of this is crucial to anti-oppressive practice.

Life Course Theory

Life Course Theory has been defined as a “sequence of socially defined events and roles that the individual enacts over time” (Giele and Elder, 1998, p. 22). Within this theory, the family is perceived as a micro social group within a macro social context (Bengston and Allen, 1993). According to Erikson’s 8 stages of human development, Molly is in stage five, which is characterised by a conflict between identity versus role confusion. Being of dual heritage might cause issues within this stage and within Molly’s search for identity. Evidence within the literature has shown that adolescents of dual heritage report more ethnic exploration, discrimination, and behavioural problems than those of single heritage (Ward, 2005). Indeed, this could explain why Molly is being racially abusive, in an effort to determine her own thoughts and feelings on ethnicity and the confusion it can cause. The racial abuse directed at other children might even be representative of her own anger at being of dual heritage.

Adolescence is difficult to define, but it is traditionally assumed to be between 12-18 years of age and characterised by puberty (i.e. the transformation from a child to a young person). During this time, hormones strongly influence mood swings and extremes of emotion, which might explain Molly’s difficulty controlling her anger at school. Adolescence is also when an individual starts to develop socially, increasing their independence and becoming more influenced by peers. During this time, according to Piaget’s (1964) theory of cognitive development, an individual enters the ‘formal operational stage’ and starts to understand abstract concepts, develop moral philosophies, establish and maintain satisfying personal relationships, and gain a greater sense of personal identity and purpose (Santrock, 2008). Risks to social and cognitive development include poor parental supervision and discipline, as well as family conflict (Beinart et al., 2002), showing this to be an important time to intervene with Molly.

It is these biological and social changes during adolescents that can create the stereotype of the moody, anti-social teenager. It is important that social workers do not allow negative stereotypes to influence their expectations of Molly. Instead, they need to take a holistic approach and examine where she is on the life course as well as what the character and quality of Molly’s behaviours and relationships tell them about her internal working model, defensive inclinations, emotional states and personality. This ant-oppressive approach will also allow social workers to identify links between past and present relationship experiences.

ELSIE
Ecological Theory

Bronfenbrenner’s (1977) Ecological Model of human development posits that in order to understand human development, an individual’s ecological system needs to be taken into consideration. According to the theory, an individual’s ecological system comprises five social subsystems:

Micro-system – comprising activities and social roles within the immediate environment.

Mesosystem – processes taking place between two or more different social settings.

Exosystem – processes taking place between two or more different social systems, at least one of which does not involve the individual but indirectly affects them.

Macrosystem – includes ideology, attitudes, customs, traditions, values and culture.

Chronosystem – change or consistency over time in individual characteristics and environmental characteristics.

Ecological Theory is, overall, a model of how the social environment affects the individual, with these five systems interacting and thus influencing human growth and development.

Elsie’s ecological system has been continually changing for many years. At one point she was living with her husband, son, and her granddaughter. This was followed by living alone with her husband. On losing her husband, Elsie’s son moved in with his wife and two children, one of whom has a disability. There has been very little environmental stability within Elsie’s life, at least over the last 7-years or more. It is perhaps understandable that her health has started to deteriorate. She has recently lost her husband, experienced continually fluctuating environmental conditions, and is now living in a tense atmosphere due to issues within her son’s marriage. It is also important to note that, children’s behaviour and personality can also affect the behaviour of adults; Elsie’s behaviour might be negatively affected by her granddaughters struggle through adolescence and her grandson’s disability. Taking into consideration Elsie’s ecological system highlights the importance of not making assumptions that Elsie’s increased forgetting is a sign of dementia; her symptoms may be the result of stress within her ecological system.

Despite the relevance of this theory to understanding Elsie’s situation, the critique does highlight limitations in its operationalisation (Wakefield, 1996). In particular, since past experiences and future anticipations can impact an individual’s current well-being, lack of inclusion of this element of human growth and development within the Ecological Model is a serious limitation. In addition, the emphasis of the model is on adaptation and thus it has been argued that the theory can be abused and used to encourage individuals to accept oppressive circumstances (Coady and Lehman, 2008). Social workers using this theory in their assessments ideally need to be aware that oppression and injustice are part of the environment that needs to be considered in an ecological analysis. With this consideration, the theory offers social workers a way of thinking about and assessing the relatedness of individuals and their environments; the person is assessed holistically and within the context of their social circumstances.

Disengagement Theory

Disengagement has been described by Cumming and Henry (1961) as “an inevitable mutual withdrawal . . . resulting in decreased interaction between the ageing person and others in the social systems he belongs to” (p. 227). Within their theory, they argue that older people do not contribute to society with the same efficiency as the younger population and thus become a societal burden. In order to function, therefore, society requires a process for disengaging older people. By internalising the norms of society, older people become socialised and take disengage from society due to a sense of obligation. The theory further purports that the extent to which an individual disengages determines how well they adjust to older age. In other words, continued withdrawal from society in later life has been deemed the hallmark of successful and happy ageing.

Applying this theory to Elsie’s situation, it could be that the problems surrounding her forgetfulness in collecting her grandson from school is a step towards social disengagement. Furthermore, it could be theorised that this disengagement was prompted by her husband taking the most extreme form of disengagement, which is death.

There has, however, been much critique of this theory, including the fact that many older people do not conform to this image and remain actively involved in life and in society. Hochschild (1976) has criticised the theory with what has been termed the ‘omnibus variable.’ Hochschild points out that while an older person might experience disengagement from certain social activities, such as retiring from work, they are likely to replace this with something else that is socially engaging such as being more involved in the community or becoming more family-oriented. Indeed, Hochschild’s biggest challenge to Disengagement Theory was the presentation of evidence from Cumming and Henry’s own data showing that many older people do not withdraw from society.

Disengagement Theory creates a picture of older people as lacking freedom to act on their own, thus ignoring individual ageing experiences and describing the ageing process in a purely social context (Gouldner, 1970). Indeed, Estes et al. (1982) argues that disengagement is often forced upon older people, which supports the notion that old age is just as much a social construction as it is a biological process. Older people are, in many ways, socialised into acting ‘old.’ Thus, older age is strongly related to Labelling Theory (Rosenthal and Jacobson, 1968). For example, making assumptions about old age and having low expectations of older people can become a self-fulfilling prophecy. This again raises the importance of not assuming that Elsie’s forgetting is a sign of dementia; despite being seen as a natural consequence of ageing, only a minority of people develop dementia (Stuart-Hamilton, 2006).

In many ways, Disengagement Theory serves to legitimise the marginalisation of older people and is, it could be argued, ageist and discriminative. Ageism is the application of negative stereotypes and includes actions such as categorising older people separately from ‘adults.’ This has created immense debate within social work practice, with it being believed by some that distinguishing older people from adults is oppressive and can exacerbate social isolation. Tackling social isolation is being encouraged in efforts to prevent deteriorating health in older age, suggesting that disengagement is far from the ideology purported by Cumming’s and Henry (DH, 2010). The introduction of the Equality Act 2010, which replaces the existing duties on the public sector to promote race, disability and gender equality, now comprises a single duty to promote equality across eight ‘protected’ characteristics, one of which is age. The Act also includes provisions allowing the government to make age discrimination in service planning and delivery unlawful. This is likely to be implemented in 2012 and thus it is crucial that social workers make anti-oppressive practice in the form of tackling ageism a priority. There needs to be a move away from viewing older people as an homogenous group characterised by passivity, failing health, and dependency, as highlighted within Activity Theory.

Activity Theory (Leont’ev, 1978) is a direct challenge to Disengagement Theory in that it suggests that life satisfaction is related to social interaction and level of activity. Nevertheless, as with all theories discussed within this essay, Disengagement Theory can be applied to understanding Elsie’s situation without being oppressive and without taking the extreme position that originally inspired the theory. More modern approaches to human growth and development clearly show the benefits of social engagement versus disengagement; however, disengagement remains a key factor to consider due to ageist attitudes and the socialisation of old age.

Conclusion

This essay has utilised theory and knowledge of human growth and development to demonstrate how social workers can make an informed assessment of a complex family situation. The strengths and limitations of these theories have been discussed, drawing in particular on their application within anti-oppressive practice. All theories offer a better understanding of human growth and development, with some requiring specific adaptation to encompass the core values of social work practice. Such adaptation is not necessarily a disadvantage if the key strengths of each theory are utilised alongside the knowledge and expertise of the social worker.

2-1- Introduction

In the upcoming chapter, the title will be review of research literature. This chapter considered as the heart of research supervises al the time research stages and is theoretical and performance guidance of research. This chapter consists of three main topics. The first topic titled “review of research theoretical literature” deals with theoretical approaches of the elderly abuse including definition, forms and associated theories. Outlines and former subject researches about the elderly abuse which have been done by different domestic and international researchers in forms of bachelor, master, doctoral theses or research projects were labeled as “review of experimental research literature” and forms the second topic of this chapter. And finally, the last topic which will be discussed in this chapter is “elective theoretical research frame” that we will try to review the former two topics (theoretical and experimental literature) and discuss theories and approaches which will be used regarding the influential factors on elderly abuse in Malaysia and based on them other stages of research will be followed up in future chapters.

Now in this part, firstly theoretical fundamentals of research will be discussed and then the assessment of experimental research literature inside and outside of the country will be covered:

2-2- Review of theoretical literature

The following sentences relates to theoretical dimensions and conceptive environment of research topic. In another word, explanations and theoretical approaches about the elderly abuse including definition and effective factors are issues that will be covered and it will be tried that by exploring these topics, thought and mind environments of research will be clarified and we would be able to provide a background for future chapters, particularly results, conclusion, and suggestions.

2-2-1- The Definition of the Abuse of the Elderly

Although there is an absence of agreed or standard definitions of abuse, commented on by McCreadie (1996) and others, a number of definitions of elder abuse have emerged. Early attempts at defining mistreatment in the UK context were relatively specific as seen, for example, in the following: “A single or repeated act or lack of appropriate action occurring within any relationship where there is an expectation of trust, which causes harm or distress to an older person” (Action on Elder Abuse, 1995)

However, later definitions tend to have been more widely drawn, as in the recent government document, No Secrets, in which the definition is given as: “Abuse is a violation of an individual’s civil or human rights by any other person or persons” (DoH, 2000).

Given the lack of consensus concerning definition, which ultimately may not result in any major difficulty (Penhale, 1993), it is at least reassuring to find that most people concerned with the issue agree on the different types of mistreatment that can happen. The usual types of mistreatment included within most definitions are physical abuse, sexual abuse, neglect, financial abuse (also referring to exploitation and misappropriation of an individual’s property and possessions), psychological and emotional abuse. When considering neglect, separate, stand-alone definitions do not usually appear, with neglect often appearing as a sub-type of abuse. Thus in the Social Services Inspectorate (1993) definition, elder abuse is described as: “. . . physical, sexual, psychological or financial. It may be intentional or unintentional or the result of neglect” (DoH, 1993, para 2.1).

More recently, draft guidance issued by the Social Services Inspectorate indicates that abuse may occur: “. . . as a result of a failure to undertake action or appropriate care tasks. It may be physical, psychological, or an act of neglect . . .” (DoH, 1999, para 2.7).

Neglect and acts of omission are then further delineated as: “. . . including ignoring medical or physical care needs, failure to provide access to appropriate health, social care or educational services, the withholding of the necessities of life, such as medication, adequate nutrition and heating” (DoH, 1999, para 2.8).

To these may be added such categories as enforced isolation and deprivation of necessary items for daily living (warmth, food or other aspects, such as teeth). In general, however, situations of self-neglect by an older person would not be considered within the UK perspective of mistreatment. Although many practitioners work with older individuals who self-neglect, usually this is not considered within an elder mistreatment or indeed an adult protection framework.

Abuse within institutions also encompasses situations that arise because of the regime or system that may operate in the unit in addition to individual acts of abuse that occur. There also may be abusive situations that arise between a resident and a member of care staff, initiated by the older person as protagonist, so there may be dual directionality of abuse, or unidirectional abuse from resident towards staff member (McCreadie, 1996). Neglect within institutions may arguably be more pervasive and insidious, affecting the daily lives of many residents in a myriad of ways, from overt to covert.

According to the American Medical Association Council on Scientific Affairs (1987), with elderly abuse has several forms and definition is as follows: any act of commission or omission that results in harm or threatened harm to the health and benefit of an old people. The Select Committee on Aging defined the following categories of abuse: physical abuse, Neglect, emotional abuse, financial abuse, and self-neglect. In its most common usage, elder abuse is an all-inclusive term representing all types of mistreatment or abusive behavior toward older adults. Abusive acts include the following: striking, burning, threatening, abandoning, starving older adults, or taking their property without consent. If an act of violence, such as a slap, occurs only once, by most standards it is probably not considered to be elder abuse. If it happens fairly often or results in the hospitalization of the victim, the action is deemed abuse; likewise, threatening with a gun, sexual assault, or other markedly violent acts need only occur once (Wolf, 2000).A shocking way for elderly people to spend their final days is in a state of maltreatment known as elder abuse. Although it can occur in institutions, it is most often suffered by frail elderly people living with their spouses or their children (Papalia & aIds, 1995).

2-2-2- Forms of Older Adult Abuse

There are many types of abuse that affect older adults. According to Gray-Vickrey (2001), the five most common types of abuses are as follows:

1. Neglect, whether intentional or unintentional, accounts for 49% of substantiated elder abuse cases. Neglect generally to happen when a care provider to not do what is excepted for an old people with adequate food, clothing, shelter, medical care, or assistance with activities of daily living.

2. Emotional abuse, the willful infliction of anguish through threats, intimidation, humiliation, and isolation, is involved in 35% of cases.

3. Financial abuse is the misuse of someone’s property and resources by another person. Financial or material exploitation occurs in 30% of cases.

4. Physical abuse, the use of physical forces that results in pain, impairment or bodily injury, accounts for 25% of substantiated elder abuse cases. Hitting, slapping, restraining, molesting, biting, burning, pushing, or pulling all qualify as physical abuse.

5. Sexual abuse is another extremely devastating form of the abuse of older adults.

Sexual abuse can be seen as a type of physical abuse (Arbetter, 1995). However, it is often discussed separately due to the different types of harm inflicted upon older adults.

In one study, researchers found that the urogenital injury due to sexual abuse was aˆ¦. Prevalent among elderly people (Muram, Miller, & Culter, 1992). There main sexual abuse behaviors are mentioned frequently in relevant literatures. First activity or activities which are done without any physical contacts. They something are called “Hand – off “behaviors. A common form of hand-off abuse is to make the victim to watch pornographic sceneries, exhibition and voyeuristic activities. The second form of sexual abused is called ” Hand-on ” behaviors involving some physical contact with the victim. The third and most dramatic form of sexual abuse is a kind of painful action on victims sexual or rectal region.(Ramsey, Klawsnick, 1999).

On the other hand, Pritchard (1999) introduced another category of abuse among older people which are commonly seen by health professionals:

History of incest between mother and son.

Husband wife sexual abuse.

Older gay man abused in the community.

Research is mixed concerning the victim-offender relationship in elder sexual abuse cases. Muram et al. (1992) compared the medical record of older sexual assault victims (n=53) to younger sexual assault victims (n=55) and found that older adults were more likely to be assaulted by strangers and to have the assault occur in their home. Johnson (1995) seems to agree, stating, “Most sexual assaults of elderly women occur in the victim’s home by an assailant who is unknown to the victim” (p.221).

Research by Ramsey-Klawsnick (1991) and Holt (1993) suggested slightly different patterns. Ramsey-Klawsnick (1991) asked twenty adult protective service workers to identify and describe cases of sexual abuse among older adults they have seen in the past. The case workers identified twenty-eight cases of sexual abuse, with eighty one percent of the cases reportedly committed by caregivers. Seventy-eight percent of the abusers were relatives, with sons representing the majority of offenders. Research by Holt (1993), studied seventy-seven elder sexual abuse cases in Great Britain and found that fifty percent of the cases were committed by sons of the victims. None of the sexual assaults in Holt’s study were committed by strangers. According to NCEA (1998), sexual assault is a problem that is usually not associated with older adults, often accounting for approximately less than 1% of reported elder maltreatment cases.

There is other dramatic type of psychological abuse. This kind of abuse can be demonstrated in different forms such as threats, bargaining, seduction, stalking or manipulation ( Marshal, Benton, & Brazier, 2000). The most common characteristics of this kinds of abuse is their difficulty to be assessed. Johnson (1995) stated that they psychological abuse are not concrete, so they are hard to be assessed.

According to Quirm and Tomita (1997), psychological abuse is an integral part of other types of abuse. Victims often report being threatened with nursing home placement if they protest physical abuse or if they threaten to tell someone outside of the family, or if they refuse to hand over money. According to NCEA (1998), psychological abuse accounted for approximately 35% of the cases of maltreatment reported in 1996.

A well known form of abuse can be financial abuse which extremely traumatic in nature. In order to recognize financial abuse, it is suggested to have the following items in mind:

Unusual transaction in bank activities.

Older person’s inability to sign other documents such as power of attorney, will or other bank drafts.

Care givers disappear suddenly.

D) There is a lack of amenities, when the estate can afford it (Quinn & Tomita, 1997). Larue (1992) suggests that financial abuse might have been even more common than reports indicate because it is so difficult to detect. Research that relies on interviews with people in their communities instead of abuse complaints filed with governmental agencies tends to support this view. For example, Canadian researchers who randomly sampled citizens at home showed financial exploitation to be more common than neglect (Podnieks, Pillemer, Nicholson, Shillington, & Frizzell, 1990). According to Welfel, Danzinger, and Santoro (2000), the financial exploitation of older adults ometimes experienced through fraudulent telemarketing schemes or through unscrupulous contractors who are strangers are not the primary domains of elder mistreatment laws.

Criminal statutes relating to fraud and extortion are probably better suited to deal with such schemes. However, if a person befriends an older person and begins caring for that older adult in order to take money or material goods from him or her, that person would likely be subject to the elder abuse statutes. The most common form of the abuse of older adults is neglect, which involves failure to provide essential physical or mental care for an older person. Physical neglect includes withholding food or water, failing to provide proper hygiene, or neglecting to offer physical aid or safety precautions. Neglect needs not to be intentional; it sometimes occurs when the caregiver is unable to provide the older person with proper care (Lachs & Pillemer, 1995). Overall, 49% of the reports of elder maltreatment involve neglect and maltreatment, either intentional or unintentional (NCEA, 1998). Abandonment is a particular form of neglect. The state of Connecticut defines abandonment as “the desertion or willful forsaking of an elder by a caretaker or foregoing, withdrawal, or neglect of duties and obligations owned an elder by a caretaker or others” (Fulmer, Mc Mahon, Baer-Hines, & Forget, 1992, p. 506). According to the American College of Emergency Physicians (1999), scenarios of abandonment include family members dropping off elderly persons, boarding homes or nursing homes dropping off elderly persons, and, in some cases, elderly persons seeking out care in emergency rooms on their own because they are unable to care for themselves.

There are times when the neglect older adults suffer results from their own actions or inactions. This problem is referred to as self-neglect. Older adults may self-neglect when they fail to take medications, repeatedly skip meals, use alcohol or other drugs to excess, or fail to attend to personal hygiene. Often, such self-neglect is associated with untreated physical or mental health problems, especially depression (Quinn & Tomita, 1997). Tatara (1996) suggested that as many as one third of elder abuse cases involve self-neglect or self-abuse. The NCEA (1997) gathered data about self-neglect and found that self-neglect cases are those that are most often dealt with by protective service employees. Estimates of the extent of self-neglect are likely low because most elderly persons who are neglecting themselves would be unlikely to report their self-neglect to authorities (Hall, 1987). Byers and Lamanna (1993) further note that protective service workers often find these cases the most difficult to handle because efforts to stop the self neglect are resisted by the victim.

2-2-3 Factors that Contribute to the elder abuse

Everitt, O’Malley, and Campion, (1983). (a) Those focusing on the victim’s dependency: That is, there are a variety of factors that may contribute to older adult abuse and neglect. According to Bennett and Kingston (1993) and Biegel and Blum (1990), several factors predisposing elderly abuse by caresr include

: (1) mental and physical dependence to one family, (2) poor communication or a failure of relationship, (3) considerable change in a caregiver’s lifestyle,(4) perceptions of caregivers towards dependence of older persons, (5) frequent visits to general practitioners by the informal caregivers to talk about their problems, (6) role reversal, and (7) isolation of the household. Preliminary hypotheses regarding the cause of elder mistreatment that was based on case reports and early studies were reviewed by O’Malley on physical and mental impairment of an older adult, (b) Those emphasizing the effect of stress on the caregiver, (c) Those concerned with the influence of families who have learned to solve problems by being violent with one another, (d) Those that focus on the individual problems of the abuser, and (e) Effects of a society, which casts older adults in the role of non-persons through ageism, sexism, and destructive attitudes toward the disabled and toward those who are perceived to be unattractive. Several researchers have identified various risk factors that can potentially lead to mistreatment or abuse of older adults. According to Anastasio (1981), risk factors that characterize precipitators are inability to provide care, financial needs and inability to maintain one’s home. For victims, the risk factors include functional impairment and adverse physiological change. There are a variety of probable causes of the abuse of older adults. Most causes of abuse are committed in residential rather than institutional settings, and the most likely culprits are spouses, children, siblings, relatives, or paid caregivers. In older persons, the most common types of maltreatment are neglect, emotional/psychological abuse, and physical abuse (Marshall, Benton, & Brazier, 2000). Other risk factors in abuse are (1) shared living arrangements between the elder person and the abuser, (2) dependence of the abuser on the victim, and (3) social isolation of the elder person.

The typical victim is an elderly person in poor health that lives with someone. Elderly people living alone, whether widowed, divorced, or never married are at low risk. The abuser is more likely to be a spouse than a child, reflecting the fact that more elderly people live with their spouses than with children; and the risk factor is greater when the caregiver is depressed (Pillemer & Finkelhor, 1988: Paveza, et al. 1992). Although many older men are abused, abuse against women inflicts more injuries.

Rates of violence are high in families with an elder person suffering from dementia; in these families punching, kicking, and other violent behaviors are high in both directions (Paveza, et. al., 1992). In the United States, the number of reported cases of domestic elder abuse nationwide, calculated by combining state reports and adjusting for differences in definitions and eligibility criteria, has increased steadily from 117,000 in 1986 to 296,000 in 1996 (Tatara, 1995; Tatara, Kuzmeskas, and Duckhom, 1997).

2-2-4Competing theoretical explanations of elder abuse

Five major theories have been set forth in an effort to understand the causes of elder mistreatment. These theories include (a) the impairment theory, which advances the idea that elderly persons who have a severe mental impairment are most likely to be abused; (b) the theory of psychopathology of the abuser, contending that personality traits or character disorders cause persons to be abusive; (c) the transgenerational violence theory, which holds that violence is a learned normative behavior in some families; (d) the stressed caregiver theory, which examines the burdens a dependent elder places on the family; and (e) the exchange theory, which evaluates the effect of external influences upon the relationship between victim and abuser (Fulmer, 1998).

Lachs & fulmer (1993) reported seven leading theories or conceptual frameworks are used to examine the etiology of elder abuse. Of course, in addition to these seven theories, exchange theory has paid attention to the elderly abuse subject from the view of expenses and rewards that will be pointed out in the following of the seven theories.

2-2-4-1- Psychology of the abuser

The first is psychology of the abuser, which refers to caregivers who have pre- existing condition that impair their capacity to give appropriate care. For example, a caregiver who has mental retardation or alcohol dependency may not be able to exercise appropriate judgment in care giving of older adults. This can ultimately lead to abuser neglect (Lachs & fulmer, 1993).

2-2-4-2 Transgenerational violence

The next Theory is related to transgenerational violence. According to this theory, elderly abuse can be a part of the continuing domestic violence that started with child abuse and elderly abuse will end. Little research has been done to obtain empirical evidence to support this theory, but the same number also emphasized on its importance. Another aspect of transgenerational violence relates to adult children that long time lived with their parents and children were abused then grow up and the elderly parents living with them are being abused. (Lachs & fulmer, 1993).

2-2-4-3- Learning theory

Finally, transgenerational violence has been explained in terms of a learning theory in that a child who observes violence as a coping mechanism may learn it and bring to adult life (Lachs & fulmer, 1993).

2-2-4-4- Isolation theory

National center on elder abuse and the American public human services association (1998) has reported isolation theory espouses that mistreatment is prompted by a dwindling social network. According to the National Elder Abuse incidence study about 25% of all elderly person live alone and even more interact only with family members and have little social interaction with the outside word. Isolated older adults are at the particular risk because there are no outsiders watching out for them, and they may not be identified by the healthcare system or reporting agencies until it is too late (Lachs & fulmer, 1993).

According to Godkin, Wolf, and Pillemer (1989), it is difficult to determine whether isolation is the result of mistreatment (family members or caregivers may be trying to hide the abuse from the outside word) or precipitating factor of abuse.

2-2-4-5- Identity Theory

Other theories are role and identity theories. A synthesis of role theory and identity theory has provides an explanation of the effects of socially constructed roles and identities for the elderly. It assists in understanding how these socially constructed roles and identities may increase the elder’s vulnerability to abuse.

2-2-4-6- Role Theory

In their classic text on role theory, Biddle and Thomas (1986) noted that one of the key characteristics of social behavior is “the fact that human beings behave in ways that are different and predictable depending on their respective social identities and the situation”. Key concepts of role theory includes: the identities that actors assume, the expectations for behavior of the actor that is mutually understood and adhered to by the individuals, and the social behaviors that are characteristic of the particular behavior.

2-2-4-7- Social exchange theory

Another conceptual model that has been used to explain elder abuse has been derived from social exchange theory. Social exchange theory is based on the idea that social interaction involves the exchange of reward and punishments between at least two people and that all individuals seek to maximize reward and perform instrumental services. In fact, with increasing physical infirmities, the individual begins to require more and more in the form of instrumental services. Therefore, when one is old and infirm, violating the law of distributive justice is relatively easy. In addition, because of the losses associated with aging, the individual’s potential to supplement social ties and to extend a personal power base is reduced. As a result, the individual becomes less able to reciprocate rewarding behaviors and less likely to have a choice about continuing unrewarding or punishing social exchanges with those who perform an instrumental service. Figuratively speaking, the elderly individual must begin to live on the credit accumulated over the years because there are few ways to replenish the bank. One outcome of the aging condition that Dowed predicts is that as the imbalance in power increases, the older person is likely to display more passivity and compliance and more withdrawing behaviors in an effort not to alienate the remaining few people who can provide rewards and services.

2-2-4-8- Situational theory

Steinmets (1990) have explained situational theory, which is also referred to as caregiver stress. As care burdens multiply, they outweigh the caregiver’s capacity to meet the needs of the older adult; therefore, caregiver stress can overwhelm the situation. Elder abuse can be outcome.

The situational model is the explanatory base that was the earliest devised to explain elder abuse. It also appears to be the most widely accepted at this time. Derived from the theoretical base associated predominately with child abuse and less strongly with other forms of intrafamily violence, this model has considerable intuitive appeal. In addition, among clinicians, this model has popular support, since its basic premise fit easily within an intervention framework.

Very simply, the basic premise of the situational model is that as the stress associated with certain situational and/or structural factors increases for the abuser, the likelihood increases of abusive acts directed at a vulnerable individual who is seen as being associated with the stress. The situational variables that have been linked with abuse of the elderly have included 1) elder related factors such as physical and emotional dependency, poor health, impaired mental status, and a difficult personality. 2) Structural factors such as economic strains, social isolation, and environmental problems, and 3) caregiver related factors such as life crisis, burn out or exhaustion with care giving, substance abuse problems, and previous socialization experiences with violence.

There is a lot of support to approve the situational model. It is obviofied us that the aˆ¦aˆ¦ burden of stress to caregivers makes more than overwhelmed and older abuse family members. Moreover, psychological model of child abuse and interfamily violence model which are highly related to structural and situational stress. Bring up the problem of older abuse. If gives a strong approval to use situational model for abuse among older people. Finklhor and Pillemer stated that there are some similarity between child abuse and elder abuse. They found this similarity in vulnerability of abuse victim and frustration in caregivers. Moreover, both child and elder abuse share the social context and are identified by healthcare professionals. They believe that the story is true for spouse abuse, too.

Whatever the reason of abuse, it can be prevented. This aˆ¦aˆ¦.that shows that situational model is an applicable model for elder abuse.

2-2-4-9 Physical/Mental Dependence (Impairment)

This theory is based on the belief that elderly persons who have a severe mental or physical impairment are most vulnerable to becoming abused. In relationships where one person is dependent and another person is the helper or caregiver, there is always potential for misuse of power by the caregiver.

Summary of theoretical explanations

To explain the causes of elder abuse, some researchers in developed countries have viewed it as a problem of an overburdened caregiver (situational model), a mentally disturbed abuser (intra-individual dynamics), or a dependent perpetrator and dependent victim (exchange theory). Others have used learned behavior (social learning theory), the imbalance of power within relationships (feminist theory), and the marginalization of elders (political economy theory), or a lack of fit between the organism and the environment (ecological theory).

2-3- Review of experimental literature

Phenomenon of the elderly abuse and its forms and causes are subjects that have been explored by sociologists, social psychologists and hygiene experts to find its visible and invisible dimensions. This part of the draft, as is clear from its topic, is discussing subject experimental literature about characteristics of victims. This literature involves all performed studies and researches in the form of governmental reports, organizational researches, bachelor, master, and doctoral theses that are cited according to the year they have been performed.

No one explanation for the cause of elder abuse exists. Abuse is a complex problem which is rooted in multiple factors (Wolf, 2000). Caregiver stress and burden was once regarded as a major causative factor of elder abuse. However, Anetzberger (2000) discusses the complexity of elder abuse and the results of prior studies, which suggest that the etiology of elder abuse is multifaceted, and that caregiver stress and burden is not the only dominant risk factor. She stresses that the reality of elder abuse demands the development of new explanatory and intervention models (Anetzberger, 2000). A number of socio-demographic factors have been identified as possible contributors to elder abuse. Levine (2003) lists the following factors: intra-family stressors including separation, divorce and financial strain, ageism, increased life expectancy and medical advances that have prolonged years lived with chronic disease (Levine, 2003).

Elders are abused in homes, hospitals, nursing homes and in other institutions (Nelson, 2002). Prevalence or incidence data on elder abuse in institutional settings are lacking despite the vast existing literature on issues of quality of care (Wolf, 2000). Most elder abuse and neglect takes place in the home and is inflicted by family, household members and paid caregivers (Smith, 2002). A survey conducted in one US state reported that 36% of nursing and support staff reported having witnessed at least one incident of physical abuse by another staff member during the prior year and 10% admitted to having committed at least one act of physical abuse themselves (Wolf, 2000). A cross-sectional retrospective chart review of new in- and outpatients

conducted by a Montreal General Hospital Division of Geriatric Psychiatry in one calendar year, studied the prevalence and correlates of four types of elder abuse and neglect in a geriatric psychiatry service (Vida, Monks, & Des Rosiers, 2002) Although this study was limited by a clinically derived and a relatively small sample size of 126 patients, it was reported that elder abuse and neglect was suspected or confirmed in 16% of patients studied. Living with non-spouse family, friends, or other persons in a non-supervised setting, along with a history of family disruptions by widowhood, divorce, or separation were significantly correlated with abuse, while statistically non-significant yet potentially important identifiers included female gender, alcohol abuse, and low functional status.

Elders are most at risk from family members (Nelson, 2002). The perpetrator is a family member in two-thirds of known cases of abuse and neglect and was identified as adult children or spouses (National Center on Elder Abuse, 1998). Despite the popular image of elder abuse occurring in a setting of a dependent victim and an overstressed caregiver, there is accumulating evidence that it is neither ca regiver stress levels nor the dependence level of the victim that are the core factors leading to elder abuse (Wolf, 2000). It is now felt that stress may be a contributing factor in abuse cases but it does not explain the phenomenon (Wolf, 2000). Recent studies on the relationships between caregiver stress, Alzheimer’s disease, and elder abuse suggest that it is the long-term or pre-abuse nature of the relationships which is the important factor in predicting instances of maltreatment (Wolf, 2000). The mental status of the perpetrator which includes emotional, psychiatric, and substance abuse problems, the dependency of the perpetrator on the victim, and the lack of outside the home external support for the victim continue to emerge as elder abuse risk factors (Wolf, 2000).

A cohort of 2,812 community-dwelling adults over the age of 65 from the

Puao-te-Ata-tu (daybreak) was a report requested by the Minister of Social Welfare in 1986, that investigated “the ways in which they could better support MA?ori clients and address the social needs of the MA?ori people” (Hollis, 2005). The report stated that MA?ori were not being consulted on any decisions regarding education, social welfare and justice and that decisions “were being made for, rather than by, MA?ori people” (Ministerial Advisory Committee, 1988, p. 18). It was the beginning of a period of change for the government of New Zealand, which “challenged social workers and Aotearoa New Zealand institutions to examine themselves for institutional, cultural and personal racism” (Nash, Munford, & O’Donoghue, 2005, p. 20).

Historically Puao-te-Ata-tu was “the MA?ori perspective for the Department of Social Welfare and the Children and Young Persons Act 1974” (Keddell, 2007). The report states “throughout colonial history, inappropriate structures and Pakeha involvement in issues critical for MA?ori have worked to break down traditional MA?ori society by weakening its base-the whA?nau, the hapA«, the iwi” (Ministerial Advisory Committee, 1988, p. 18). It was initiated due to the high amount of MA?ori children in the care of the state, and because it was felt at the time, that the social welfare system was not inclusive of whA?nau (Cram, n.d.). Cram states “at the heart of the issue is a profound misunderstanding or ignorance of the place of the child in MA?ori society and its relationship with whA?nau” (Families Commission, 2012). The Puao-te-Ata-tu report was delivered to the Minister in 1988, made thirteen recommendations which focused “upon the need for the department to function in a bicultural manner and to share responsibility and authority for decisions with appropriate MA?ori people” (Waitangi Tribunal , 2012, p. 107). New Zealand had an obligation to the Te Tiriti O Waitangi (Treaty of Waitangi), which “protects the rights of MA?ori (tangata whenua) and provides validation for tauiwi (all those who have settled in this land after the arrival of MA?ori) to live in this land” (Nash et al., 2005. p. 160-161). With focus on bicultural practice, the government was duty-bound to make changes so that MA?ori could be involved in decisions regarding MA?ori, resulting in MA?ori being involved in “planning and service delivery at the tribal and community level” (Ministerial Advisory Committee, 1988, p. 18). A review of the Children, Young Persons Act 1974 was necessary.

The Children, Young Persons, and Their Families Act 1989 relate “to children and young persons who are in need of care or protection or who offend against the law” (Harris & Levine, 1994, p. 75). It was established to regulate how the government responded toward children that had been abused or neglected or who were at risk of being youth offenders (Ministry of Social Development, n.d.). The Act “introduced principles that changed the way decisions were made about children and young people, enabling family to become partners in the decision-making process to resolve family issues” (Ministry of Social Development, n.d.). New Zealand’s obligation to the Te Tiriti O Waitangi has led to more culturally aware policies and practices.

Historically the Children and Young Persons Act 1974 was thought to reinforce institutional racism, and didn’t take into account the culture of the differing minorities throughout New Zealand (Keddell, 2007). MA?ori felt their cultural values, that encompass the collective not the individual, were not being considered leading to unhappiness with the governmental institutions. (Keddell, 2007). The Puao-te-Ata-tu report had caused a “paradigm shift in social work thinking” (Nash et al., 2005. p. 20) and the New Zealand government had to make changes to recognise this. A change to policies caused a change in practice, therefore, the Code of Ethics became inclusive of MA?ori culture and the Bicultural Code of Ethics was established.

The Aotearoa New Zealand Association of Social Workers Code of Ethics was “founded on the guidelines enumerated by the International Federation of Social Workers” (ANZASW, 2008). Its purpose is to: provide a definition of ethical social work, offer guidance, inspire and promote professionalism, guide social work students, underpin everyday practice and development and incorporate bicultural practice (ANZASW, 2008).

Historically the ANZASW Code of Ethics was first developed in 1964, where the ANZASW was called NZASW and Code of Ethics was the ‘Interim Code of Ethics’ (ANZASW, 2008). In 1976 after a conference in Puerto Rico it was decided to adopt the International Federation of Social Workers code, this transcended the ‘Interim Code of Ethics’ (ANZASW, 2008). In 1993 a new code of ethics was developed, this was the first ‘ANZASW Code of Ethics and Bicultural Code of Practice’ which recognises Te Tiriti O Waitangi “to foster equitable collaboration between the diverse realities of its membership who are Tangata Whenua and Tauiwi” (Aotearoa New Zealand Association of Social Workers, n.d.).

The Puao-te-Ata-tu report was the foundation for bicultural practice in social work practice with MA?ori and wider communities. Ruwhui (as cited in Nash et al., 2005) maintains biculturalism as being “the relationship between cultures co-existing alongside one another” (p.97). The advent of biculturalism caused government agencies and social workers to reflect on the practices they employed and the ones they reproduced from overseas to see if they demonstrated the same cultural principles that New Zealand now practiced (Nash et al., 2005).

Social workers are now guided by new principles that recognise family as being an integral part of MA?ori culture, the Children, Young Persons and Their Families Act 1989 states “the principle that the primary role in caring for and protecting a child or young person lies with the child’s or young person’s family, whA?nau, hapA«, iwi, and family group” (New Zealand Legislation, n.d.). The Act has introduced family group conferences where family, extended family and community representatives meet together and discuss the consequences for care and protection cases or when the child has been involved in illegal behaviour so that the court is not necessarily involved (Levine, 2000). This has proved worthwhile and Maxwell and Morris (2006) state “both the philosophy underpinning this system and the use of family group conferences exemplify a restorative justice approach that has now been adopted in many other countries” (p. 239).

The ANZASW Code of Ethics and Bicultural Code of Ethics has impacted the development of social work practice in MA?ori and wider social work communities by incorporating the Te Tiriti O Waitangi and its commitment to creating a more anti-racist practice (ANZASW, 2008). Social workers now are responsible for the promotion of change in mono-cultural agencies and organisations therefore assisting in the “protection of the integrity of Tangata Whenua” (ANZASW, 2008, p. 7). Webster and Bosmann-Watene (as cited in Nash, et al., 2005) state “the challenge for practitioners is to provide appropriate interventions that meet the cultural and clinical needs of MA?ori” (p. 20). The ANZASW uses bicultural practice “to foster equitable collaboration between the diverse realities of its membership who are Tangata Whenua and Tauiwi” (Aotearoa New Zealand Association of Social Workers, n.d.).

According to Barker (as cited in Sheafor and Horejsi, 2008) social justice is “an ideal condition in which all members of a society has the same basic rights, protection, opportunities and social benefits” (p.22). In order for the fair and equal treatment of MA?ori in New Zealand the Puao-te-Ata-tu report recommended that the Department of Social Welfare improve its training methods of practitioners in the social work field (Ministerial Advisory Committee, 1988). The Department of Social Welfare needed to “identify suitable people to institute training programmes to provide a MA?ori perspective for training courses more directly related to the needs of the MA?ori people impacted social workers commitment to social justice” (Ministerial Advisory Committee, 1988).

The Children, Young Persons, and Their Families Act 1989 impact social workers commitment to social justice, in how they advocate for children and their families. As a social worker one needs to be able to challenge governmental policies and structures that are ineffective. The social worker must be aware of not only “the individual experience to the broader structural issues” but how the individual and the social structures relate to one another (O’Brien, 2011, p. 71). The Children, Young Persons, and Their Families Act 1989 could be considered an example of social justice as it publicised the racism that was thought to be in government institutions and practice, which made anti-racism towards the minority cultures part of the objective.

The ANZASW Code of Ethics has impacted social workers commitment to social justice in that they now “advocate social justice and principles of inclusion and choice for all members of society” (ANZASW, 2008, p. 8), particularly minority races and the disadvantaged. Social workers must recognise and value clients, integrating anti-discriminatory practice, the practice in which a social work practitioner strives to “reduce, undermine or eliminate discrimination and oppression” (Thompson, 2006).

In conclusion key principles like the Puao-te-Ata-tu report, the Children, Young Persons and Their Families Act 1989, and the ANZASW Code of Ethics have introduced biculturalism by honouring the Treaty of Waitangi. The Puao-te-Ata-tu report has brought about the inclusiveness of MA?ori with regard to decision making in policies that involve them. Similarly, The Children, Young Persons, and Their Families Act 1989 have included whA?nau, hapA« and iwi in decision making while the ANZASW Code of Ethics focuses on anti-discriminatory practice to provide fair bicultural service to clients of all cultures. This has impacted social work in New Zealand by creating a more accepting culturally aware practice. Social workers now consider MA?ori as a collective rather than as individuals and through training and commitment can provide a more encompassing and holistic service.

In this essay I would like to give a clear definition of the neglect of children and explain what goes on in families where children are neglected. I would like to explain the typologies of neglect and how these can impact on the child developmentally.

The most common form of child maltreatment is child neglect (Child Neglect: A Guide for Prevention, Assessment and Intervention. 2006). Neglect is very much complex in many ways but is paradoxically quite simple. Life can be pretty miserable for the child whose needs are not being met. The neglect can be so profound that they die because of accidents or starve to death (Daniel et al, (2011). Failure to provide a child’s basic physical health, nutrition, emotional nurturing and education is child neglect. In order for a child to develop it is necessary for the caregiver to provide physical, social and emotional warmth. In terms of research and policy, little attention has been paid to neglect and it has been challenged by recent research that neglect is not as serious as other forms of child maltreatment and the least understood (NSPCC, 2007). Defining neglect has not been straightforward as there are no clear, cross-cultural standards for bringing up a child adequately (Gaudin, 1999).

It is shown by research that neglect often co-exists with other forms of abuse and adversity (Daniel 2005; Claussen & Cicchetti 1991). “Working Together” (DfES, 2006Bb) defines neglect as:

‘The persistent failure to meet a child’s basic, physical and/or psychological needs, likely to result in the serious impairment of the child’s health or development. It may involve a parent or carer failing to provide adequate food, shelter or clothing, failing to protect a child from physical harm or danger, or the failure to ensure access to appropriate medical care or treatment. It may also include neglect of, or unresponsiveness to, a child’s basic emotional needs.’

In the last 10 years, child neglect has been the most frequently reported form of maltreatment (Moran, 2009). Up to the end of March 2010, 43.5% of children registered in England where on the register for neglect and this is rising by 1,000 children per year. These figures are to be treated with caution as a new method of collecting statistics has been bought in this year. 375,900 children are ‘in need’ at March 2010, which 39% were referred for the reasons of being abused or neglected (DfES, 2011). It is unsure as to how many children are affected in the UK due to neglect. There are still many who suffer neglect which is not recognised. Studies have suggested that up to 10% (1.5 million) of children in the UK have experienced neglect in some form (NSPCC, 2011).

Child neglect has numerous negative impacts developmentally. Neglected children are at risk of emotional withdrawal, anxiety symptoms, low self-esteem and delays in their cognitive and language development. Neglected children are often unpopular and bullied. They have problems in forming and maintaining close attachments. Academically, a child neglected have lower grades and to not attend school on a regular basis. Extreme forms of neglect can lead to failure to thrive, developmental delays and death. Neglect has been shown to be damaging to a child either in the short or long-term than other forms of maltreatment (Erickson & Egeland, 2002). Children born prematurely, with disabilities, children in care, adolescents, refuge children and children from black and ethnic minority are especially vulnerable to neglect (NSPCC, 2007).

The most common form to be subject to child protection or put on the child protection register in the UK, is neglect. Radford et al, (2011) interviewed 1,761 young adults aged between 18-24 years; 2,275 children aged 11-17 years and 2,160 parents of children aged under 11 for a major piece of research for the NSPCC. Based on the interviews of the 1,761 young adults aged between 18-24 years, 16% (one in 6), during their childhood where neglected at some point and 9% (one in 10 young adults) of the young adults were severely neglected. Based on the interviews with the 2,275 children aged between 11-17 years, 13.3% (one in 7) have been neglected at some point and 9.8% (one in 10 children) where severely neglected. Based on the interview with the 2,160 parents with the children under 11, 5% (one in 20) of children under 11 have been neglected at some point. 3.7% (one in 30) had been severely neglected (Child abuse and neglect in the UK today, 2011).

Horwath (2007) identified different categories of neglect as:

Medical neglect. Where the carer denies a child’s illness. This includes optical, dental, speech and language therapy.

Nutritional neglect. Not providing the adequate food for normal growth which can lead to a ‘failure to thrive’. Providing an unhealthy diet which can lead to obesity, which can also increase the risk of health problems in adulthood.

Emotional neglect. Having a hostile indifferent parental behaviour which damages the child self-esteem and diminishes their sense of belonging.

Educational neglect. Showing an interest in the child’s education and providing a stimulating environment. Making sure that any special educational needs are met.

Physical neglect. The state of the home. Lack of heating, furniture and bedding. This can include inadequate clothing, which will mark them differently from his peers resulting in bullying and isolation. This can also refer to the lack of safety, exposure to electric wiring and sockets.

Lack of supervision and guidance (Horwath 2007, p.27). Failing to provide guidance and supervision in ensuring the child is protected from harm and is physically safe.

It has been acknowledged that most parents with the support of their family and friends care for their children really well. Some parents do require extra support from services to help in caring for their child adequately. Depending on the complexity and seriousness of the families circumstances will depend how comprehensive the support the services will offer in ensuring that all their needs have been met (Child Neglect Practice Guidance, 2008). The causes of neglect are varied and there are studies to suggest that substance misuse and mental health problems, domestic violence, unemployment and poverty experience a variety of these factors which will increase the likelihood of neglect (NSPCC, 2007).

One of the most influential factors to child maltreatment could be related to the family dynamics. These factors help in dictating who or what is available or unavailable and constitutes the exact circumstance in which the children live. From the moment the child enters the house, the household will condition and shape the person in who they will become. Family dynamics include the age of the parents, parental relationships and the family living arrangements (Beahn, 2009).

The impact of child neglect is often compounded by other detrimental influences such as intrapersonal, an inter-personal/family and socio-ecological level. From a socio-ecological perspective, the current theory on maltreatment states that consideration should not only be taken from the parent’s role but also from environmental and societal role which help in contributing to the parent’s inability to provide the child’s basic needs (Erickson & Egeland, 2002). This model helps in identifying the shared responsibility amongst the communities and the society, which therefore helps in targeting interventions on a more constructive approach (Gershater- Molko & Lutzker, 1999).

At an intra-personal level, primarily focuses on the characteristics of the neglectful parent and focuses on the mother having the inability to plan, has difficulty managing money and have no confidence for the future. Mental health problems have also been linked with the inability to cope with the child’s needs (Minty, 2005). Substance misuse plays a crucial role in being able to manage parental responsibilities. While this level focuses on the mother, the role of the father has been unexplored in neglect and there is still not enough evidence to determine whether fathers neglect differently to mothers and how this will affect the children (NSPCC, 2007).

At an inter-personal/family level the majority of the families that are neglectful are either by lone parents or have a transient male (Stevenson, 1998). The increase of child neglect is often caused by abusive and unstable relationships. Children are often forced to witness abuse or live with domestic violence, which is damaging to the child (Radford & Hester, 2006). If a child is seeing an abusive relationship, it is the parents who are failing to protect their child from emotional harm. It has been shown that recent research on domestic violence has shown that supporting the non-abusive is good at child protection (NSPCC, 2007).

The factors to be looking for when considering looking at neglect from a socio-ecological perspective are social isolation and poverty. It is also important to take into consideration that a person’s fail to provide are not always considered as neglectful. Factors relating to the parents health such as domestic violence, mental health issues often contribute to neglect and these need to be taken into consideration when any intervention is for neglect is needed. Parents who are poor may not have the inability to provide the appropriate amount of food. It is important to identify the factors that may contribute to the inability to provide, for example mental health problems. If it becomes consistent that a family fails to obtain support or use the information of the services that is available to them, an intervention maybe required. Having an understanding of what may contribute to neglect can help in identifying the appropriate interventions that will help in addressing the child’s basic needs (Gelles, 1999).

Socio- economic factors will define the standards in which we live in, not only where we live but where we work and how stressful we become. Each family has different dynamics whether educationally and will have different employment skills. It has been concluded through research that families who have been identified as being neglectful and abusive have similar socio-economic characteristics to one another. Families that have lower employable skills, education levels and poor employment histories will affect in how the families live or how comfortably. Families will often have to live with one another due to financial strain and can sometimes lead to homelessness. These situations can become distressing cause anxiety and constant worry which will often lead to poor ability to deal with problems effectively on a daily basis (Beahn, 2009).

It is useful to practitioners if they know about the factors associated with neglect. The better the practitioner knows and recognizes the situations will help in situations where the parents may require more help. Studies have shown that mothers who neglect will often have low self-esteem (Cash & Wilke, 2003), mental health problems (Carter & Myers, 2007) and poor knowledge of parenting. Mothers will have less empathy for their children and poor connection (Daniel et al, 2011). Information about earlier stages of neglect is less available because most studies are taken when neglect is substantiated. There are some interesting pointers when the approach is taken from a different direction. A study was undertaken in the US while mothers were still in hospital, which measured any concerns the parent may have. Combs-Orme, Cain & Wilson, (2004) conducted a research study on 246 mothers of new born babies. The mothers completed a measure of concerns that they may have about their parenting. 1.4% had concerns that they might neglect and 25.7% were worried they may not provide enough care while, 8.2% were concerned the father may neglect the new born (cited in Daniel et al, 2011: 37). Practitioners are likely to experience parents from many different cultural variations and consideration must be taken when some parents are not prepared to speak to practitioners due to shame and stigma that may be attached to various concerns (Daniel et al, 2011).

Compared to other areas of child maltreatment, the effects of neglect is still very limited. What is known about the effects of neglect is often found from studies that are conjunction with other forms of abuse. Neglect can cause much distress and can bring poor outcomes for the child in the short and long term. The child may suffer mental health problems, low educational achievements and difficulties in forming attachments and relationships. The risk of neglect in childhood will have an impact in their parenting responsibilities later in their lives (NSPCC, 2007).

The child’s developmental of the brain can have an effect when they have suffered emotional neglect. Children grew up to be cognitively underachieving and socially withdrawn when their mothers were found to be emotionally unavailable and neglectful (Erickson & Egeland, 2002). A study of 25 children, aged between 23 to 50 months who are being raised in an orphanage in Romania showed that cognitively and their social functioning were seriously delayed (Kaler & Freeman, 1994).

The early theories and models that explained maltreatment focused on intra-individual factors. Other models proposed that the abuse of illicit drugs, alcohol and mental illness caused maltreatment. Later on there were theories added which included social, cultural and environmental factors. These multidimensional models include:

Social learning theory. This theory proposes that people are shaped through the environment in which they live in and through the learning processes in which they see. It also proposes that if the parent has suffered neglect and abuse they are more likely to maltreat their children to those who have not suffered abuse and neglect. The children who are most likely to be violent when they grow up are more than likely to have witnessed violence with their parents. The family is a place where much is learned and where roles are supposed to be. The home is where you are taught how to deal with different levels of stress and crises. The home is where much is learnt and in many in stances violence is often seen first inside the home (Smith & Fong, 2004).

Ecological theory. Garbarino (1977) and Belsky (1980) proposed that the ecological model explained the nature of the maltreatment. This model proposes that violence arises from the mismatch of the parent to the child to the neighbourhood. Parents who have poor coping skills and suffer a great deal of social stress may find it difficult in meeting the needs of their child. If the child has developmental problems such as a disability or social handicaps then the risk of abuse and violence is increased especially when parents are under stress (Garbarino, 1977).

Attachment theory. This theory proposes that a strong and emotional bond with the primary caregiver who is able to offer the security of feeling safe (Bowlby, 1973). Early attachments are important and have a clear pattern of the bonds that will appear during your lifetime. Adult relationships when you are older will feel secure attachments if you have formed strong secure attachments during childhood from your primary caregiver. If there has been an insecure, ambivalent and anxious attachment earlier on, their behaviour will be replicated during adulthood (Bowlby, 1973).

Some professionals who want an explanation for child maltreatment still go down the psychopathological route. These models soon gave way to a more multidimensional approach which considered the environment, social and cultural factors but still included psychopathology (National Research Council, 1993).

The definition of neglect is still comprehensive and still remains challenging to practice. Research shows that practitioners still have various understandings of neglect and is still unsure as to when a referral has to be made (Howarth, 2005). The practitioner can feel overwhelmed at the enormity of the neglectful families needs. The Munro review (2011) called for more social workers to be empowered in having the confidence to act within the best interest of the child. It is suggested that if parents are not able to meet the needs of the child, then it is the professionals who must take action in promoting to safeguard the well being of the child (NSPCC, 2012).

There are much early intervention programs such as family group counselling and parenting programs which help in enabling positive parenting. Most of the neglectful families will be experiencing multiple problems and have lack of resources, skills and knowledge. If parents are educated and given the proper and appropriate resources it could possibly help in the decrease of children being neglected (National Institute of Health, 2006).

The United Kingdom is ageing fast. In common with much of the rest of the world the population of older people is increasing (HM Government (HMG), 2010; Nolan, 2001, Improvement and Development Agency (IDeA), 2009) and their prevalence in the population is predicted to rise to 29% by 2031 (Association of Director of Social Services (ADSS), 2003). For the first time, the number of pensioners will outweigh numbers of those under age sixteen. In 1980 it was suggested that men aged 65 could expect to reach 78, however, predicted life expectancy today would extend to 85 and by 2050 it is expected to stretch to around 89 years. This should no longer be looked upon as exceptional as older people can now expect to live over a third of their lives above pensionable age (HMG, 2009) and the advance in life expectancy can be seen as a major accomplishment for public health (Gillam et al, 2007) though it is also a major challenge.

In 2001 the Department of Health (DH) launched an ambitious policy aiming to set standards for older people’s care in all health and social care settings. The National Service Framework for Older People (NSFOP) was established to set national standards that would improve services, drive up quality and eradicate disparities in care. It was, state Williams and Webster (2002), a “key vehicle for ensuring that the needs of older people were at the heart of health and social services reform.” This essay will discuss the development of the NSFOP, and it’s progression since 2001, in a political context with particular reference to the inequalities experienced by older people associated with social exclusion.

Discussion

Life expectancy in 1856 was only 40 years and early reports recognised how the inequality of socioeconomic conditions impacted hugely on health (DH, 2008). The historical association between age and ill health is widely acknowledged. Under the Elizabethan Poor Law of 1601 the elderly were cared for in poor houses, often referred to as the feared ‘workhouses’ (Donaldson and Scully, 2009). The responsibility of the Poor Law transferred to local government and was then replaced by the National Assistance Act in 1948, just as the National Health Service launched.

Recognising the link between poverty and inequalities The Black Report (1980), commissioned by the previous Labour government in late 1970’s, saw social isolation coming under close scrutiny for the first time. It was published as the Conservatives claimed power in 1979 despite their attempts to restrain its completion, then not endorsing its findings as it disclosed a noticeable gradient between social class and disease prevalence implying the association between income and health (Lewis et al, 2008). Black et al (1980) also noted that any health improvements on the part of the impoverished could not match those experienced by the more affluent in society. On re-election of the Labour party in 1997, a further report reaffirmed the existence of the inequalities previously reported on by Black, adding that those gaps between the poor and the affluent had, if anything, widened (Acheson, 1998).

The fact that some individuals are more or less susceptible to poor health has notable ramifications for public health (Donaldson and Scally, 2009) and health inequalities experienced earlier in life have been found to continue in later life (Acheson, 1998). The term ‘health inequality’ refers to the difference in health experienced by one group above another due to one group’s advantage of the other, with the difference being noted as avoidable and unfair (Flowers, 2006). Marmot notes that this reflects New Labour’s ideology that any health inequalities which could be avoided are unjust (Marmot, 2010). Such differences may be economical, demographical (age, gender, ethnicity), social (class) or geographical (Acheson, 1998; Gillam et al, 2007; Lewis et al, 2008). Historically, older people experience more ill-health, relying on health and social care services more so than other groups in society yet often falling foul of ‘The Inverse Care Law’ which states that those in greatest need are least likely to receive support services (Tudor- Hart, 1971). This is generally due to factors such as pre-disposition to certain disease, poverty-related illness and death, the common treatment of older people and their social isolation (Lewis et al, 2008).

There is substantial evidence showing that social isolation and loneliness can be detrimental to older people’s health, well-being and quality and life (Abbott and Freeth 2008) affecting one in seven people over age 65 (Greaves and Farbys, 2006). Social isolation (and exclusion) causes inequality since it prevents people from participating in

normal activities within their society as a result of factors outwith their control (Le Grand, 2003). Marmot (2010) declares that the social characteristics of a community and how healthy behaviours are promoted and facilitated habitually can contribute to social inequalities in health. He describes the link that connects and binds older people to each other, their families and friends within and outwith their communities, as having a major impact on the effects of such inequalities as “social capital”. Muntaner et al (2000) describe social capital as “all types and levels of connections among individuals, within families, friendship networks, business and communities” and, since the 1990s, it has been widely considered to have an influence on health (Almedon, 2005; de Silva et al, 2005; Pearce and Davey Smith, 2003;Coulthard, Walker and Morgan, 2002 ). Thus, Wainwright (1996) promotes the possibilities that social capital may offer a public health policy alternative to “large scale government redistribution” such as diminishing the welfare state post World War 2. The social networks that build social capital create civic participation, trust and “reciprocity” (Gillam et al, 2007; Pearce and Davey Smith, 2003). These indicators of social capital have been strongly related to rates of mortality (Pearce and Davey Smith, 2003) as social networks are affected as people age. Losing spouses, partners and friends reduces social capital, leading to depression, loneliness and a loss of community participation (Office of the Deputy Prime Minister (ODPM), 2006). Putnam (1993) declared the following on his findings on social capital:-

“Of all the domains in which I have traced the consequences of social

capital, in none is the importance of social connectedness so well

established as in the case of health and well-being.” (Putnam, 1993)

The fact that health is generally dependent of factors such as diet and lifestyle make it somewhat beyond Government control. Increasing social capital to reduce inequalities such as social exclusion may, therefore, be an easier target for governments as they consider it to be something they can have greater control over. Hence, in 1989 Thatcher’s Government published the White Paper ‘Caring for People’. Deemed to be the starting point for considering the community care strand of policy around social exclusion it set principles to assist with social integration in later life. When New Labour came to power in 1997 with their ‘Third Way’ policies based on “rhetoric of community, partnership & strong government” (Klein, 2001) claiming they would look after the poorest first, Blair made tackling social exclusion one of his priorities (ODPM, 2004), recognising that older people sometimes get ‘lost’ between health and social care services.

The well-being of older people is not only attributable to income, but also involves housing, health, care, transport and social contacts. Recognising this the Local Government Centre directed the driver against social exclusion resulting by launching a two-year research programme, Better Government for Older People (1999), aimed at developing strategies to provide a seamless and more accessible service for older people. One result of this was the launch of the NSFOP (2001) that would set standards to reduce variations in care which result in equalities including exclusion. Blair’s Secretary of State, Alan Milburn declared, in his forward, that Labour were “determined to deliver real improvements for older people” and their priorities lay with looking after the poorest in society. The NSFOP was expected to deliver improvements in both health and social care for all older people over a set timescale of ten years.

With older people’s prevalence in the country rapidly increasing as discussed, and the subsequent costs rising substantially, the agenda was set for the development of the NSFOP. The policy making cycle continued with formulation of an External Reference Group of actors including the Professor of Health Care for Elderly People, the Chief Inspector of the Social Services Inspectorate, the Director of Social Services, and other practitioner and management groups working in the field of care for older people such as Help the Aged and the Carers National Association. Policy development also included those in Primary and Secondary Care with specific disease management knowledge and from Community Care including those forming the User Reference Group. Proposals were agreed based on evidence-based expert opinion and consideration of the values which underpin care services (NSFOP, 2001). Evidence included systematic reviews, individual intervention case studies and also fundamental experiences of older people themselves and their carers. Further input would be required across the implementation period of the policy from health and social care by forming Local Implementation Teams tasked with disseminating the policy’s objectives.

Policy implementation would be continual over the 10 year period and was based around eight ‘Standards’ of care targeting progess towards improved service provision, One and Eight being most pertinent to reducing exclusion. Standard One (Rooting out age discrimination) fit neatly with New Labour’s agenda to reduce age-related stigma and increase fair access to services based on need (Baldwin, 2003) so is perhaps predictable. It promised to audit all age-related policies, assessing service patterns across the country to establish examples of best practice with a view to setting benchmarks on which to measure future improvements arising from the NSFOP. Standard Eight (The promotion of health and active life in older age) aimed for a joint NHS/Council approach to increasing fair access to services to help people stay well and independent, hence discouraging exclusion. Health promotion initiatives for older people have been shown to provide early returns in improved health, independence and wellbeing making them economically sensible investments for any Government (DH, 2006a) particularly when promoting healthy ageing is central to the health inequalities agenda (DH, 2003).

Since the cycle of the NSFOP was set until 2011 the final stage of evaluation remains incomplete. However, several papers have been published analysing its progress and considering the next steps to be taken to meet its aims (Baldwin, 2003; DH, 2003; Commission for Healthcare Audit and Inspection (CHAI), 2006; DH, 2006b; Cornes et al, 2008; ODPM, 2006). Whilst noting that there was still a long way to go, each report agreed progress had occured and made reference to some significant development in Government policy as a result of the NSFOP including: Opportunity Age (HMG, 2005); Independence, wellbeing and choice (DH, 2005); and Our health, our care, our say (DH, 2006b). Such progress includes increased breast cancer surgery for the over 85s, 39% more hip replacement operations for the over 65s and an increased coronary artery bypass procedures for the over 65s. Although, an increasingly ageing population would logically result in increased necessity of these operations with or without the NSFOP. Other services have not faired so well. Older People’s Mental Health initiatives have focused specifically around those who are still of working-age, irrationally since many older people suffer reduced mental health after retiring due to the loss of focus and a feeling of no longer being of worth, often resulting in depression and isolation from the rest of society (CHAI, 2006). The “deep-rooted attitude to ageing”(CHAI, 2006) is still evident in some services and only 15% of older people have been found to be in contact with health and social care services at any one time. Whilst the CHAI report that spend on these services for the over 65s has increased – 40% of the NHS budget in 2001 increased to 43% for 2003/2004 and ?5.2 billion of social services budget increased to ?7billion in the same period – it is unclear whether this increased service delivery results from the NSFOP framework or is simply due to the amplified demand of an increasingly ageing society. Many of the initiatives stemming from the NSFOP designed to improve older people’s health and wellbeing whilst reducing social exclusion have been found to be inconsistently accessible to older people, resulting in continuance of the exact problem they aimed to remedy. Baldwin (2003) agrees, believing the NSFOP to be ideologically sound yet found it to ironically increase age-related exclusion in relation to some health services.

Many initiatives aimed at improving older people’s health and social care have their roots based predominantly in a top-down medical model in which the primary objective is to ensure that care is provided. Jack (1995) argues that it is vital to recognise the need for empowering older people since they are amongst the most disempowered in society, often being regarded as a problem by service providers due to their increasing numbers resulting in rising costs. Nusberg (1995) agrees and is quoted by Thompson and Thompson (2001) as stating:

“Older people are one of the last groups with which the notion of

empowerment has become associated. Yet the privilege it represents –

the ability to make informed choices, exercise influence, continue to make contributions in a variety of settings and take advantage of services – are

critically important to the well-being of elders.”

Having choices and being able to maintain control over decisions about their own health is of great importance to older people and unless the medical model is challenged, older people will continue to be social excluded and considered a minority group, being treated by service providers and policy-makers as recipients of care, rather than simply as older adults with the same range of problems as younger ones. The NSF Next Steps (DH, 2006a) recognises the potential that older people can contribute to their local communities, in turn improving their own health, independence and well-being. Through consultation with older people, the Public Service Agreement 17 (HM, 2010) acknowledges their diverse needs and aspirations noting their contribution to society as “an important factor in well-being, independence and connectedness in later life”. New Labour aimed to support older people to contribute more to society by taking forward their plans from the HM Treasury Final Report (2007) to promote and support best practice in volunteering and mentoring. Renewal of civil society formed a component part of Blair’s ideology and many policies on health inequalities developed during New Labour’s reign refer to the role of society, encouraging Wanless’s statement that ultimately everyone is responsible for their own health and that of their families (Wanless, 2004). This ideal has been reflected in some of the NSFOP progress reports, almost using older people’s lack of engagement in inequality-reducing initiatives as a ‘get-out’ clause for the timescales not having been reached. This swing towards passing the responsibility of reducing inequalities such as social exclusion over to society under the banner of ‘civil participation’ is set to continue through Cameron’s ideology of ‘The Big Society.’

Conclusion

In their 2010 manifesto, the Coalition announced that they would safeguard age-related entitlements, free travel and increased opportunities for work, all of which would move towards reduced inequalities for older people. The fact that reducing the current deficit displaces all other planned measures has quickly altered the Governments’ promises. Already the swingeing public spending cuts are causing concern for older people. Age UK (London Evening Standard, 30/9/2010) suggest the poorest will be hardest hit losing an average income of between 29% and 33.7%, yet only 12 months ago in ‘Building a society for all ages’ (HMG, 2009), Gordon Brown stated pensioners were now less likely to be in poverty than other groups with benefit changes enabling the poorest households to be on average ?2100 per year better off. Brown also boasted more employment opportunities for older people. However, unemployment rates for the 50-65 age group are higher than the rest of the working population (Audit Commission, 2008). The Coalition state one way they will tackle loneliness and encourage older people’s social interaction is through promotion of digital technology. Many older people remain connected to friends, families and social sites through internet use in venues such as libraries yet the new Government plan to close many local libraries. They also plan to alter free bus pass privileges by increasing eligibility age to 65, yet a third of over 60s used a bus at least weekly as their only form of transport throughout 2007 (Audit Commission, 2008). Such changes inevitably exclude older people further and are only likely to increase isolation. The substantial demographic shift requires a radical change in the way the Coalition Government now proposes to support its older people. Attitudes and expectations need to change across society, stereotypes should be shed and the assumptions about what growing older means must be challenged to tackle the inequality of being older along with the social exclusion that often accompanies it.

The Centre for Policy on Ageing report (2010) cites approximately 75 policy documents developed with an aim to improve older people’s services since March 2005. Even the very recent publication, ‘Building a society for all ages’ (HMG, 2009), starts by discussing the prevalence in ageing and proposing a programme to “end age discrimination and promote age equality”. ‘Equity and excellence’ (DH, 2010a), aiming to liberate the NHS, claims it will create a service which will “eliminate discrimination and reduces inequalities in care”. However, in a very unstable financial climate, NHS Primary Care Trusts (often the drivers behind the NSF’s) will struggle to achieve the NSFOP 10 year targets. Facing the prospect of huge debt, job losses and imminent abolishment any aspirations of developing further initiatives needed to meet the NSFOP final objectives will inevitably be crushed. Marmot (2010) states: “Even backed by the best evidence and with the most carefully designed and well resourced interventions, national policies will not reduce inequalities if local delivery systems cannot deliver them”. Evidence-based or not, in his 1997 manifesto TB said “What counts is what works” (Klein, 2001), however what ‘counted’ has not made any major improvements since the NSFOP launch according to the considerable body of evidence and consultation papers delivered subsequently which basically all make the same already recognised statements – that the population is ageing quickly and older people remain isolated from many essential health and social care services – yet not appearing to move forward in what is being done to address the situation.

Understanding how policy affects older people can be seen as challenging, particularly in view of the changing demographics. A key challenge in implementing policy is the need to engage older people in the process by putting their needs at the centre of policy development. Elbourne’s 2008 report to Government advises that “policy makers and service providers will be better prepared to plan & deliver policies that really do meet the needs of older people when they begin to welcome the rich diversity of views and experience owned by this group”. Likewise, Cattan et al (2005) advocate the importance to policy and practice of involving older people in planning, developing and delivering activities that prove most effective at reducing inequalities. Older people often believe their contributions are not valued and their voices go unheard only exacerbating the very problems of discrimination, poverty, isolation and social exclusion (ADSS, 2003) which the NSFOP aims to reduce. With ‘fairness as its cornerstone’, Equity and Excellence (DH, 2010b) promises to involve ‘patients, service users and the public’ in all service developments. Politicians often acknowledge the wealth of experience that older people have to offer within White Paper rhetoric – perhaps this is the time to actually listen and value that experience and then adhere to their promises and not use them simply for votes. After all, the new Coalition’s mantra is “No decision about me, without me”.

This research proposal concerns the investigation and analysis of the impact of parental misuse of alcohol on children. The perceptions of policy makers and members of society in the UK have for many years acknowledged the negative consequences of excessive alcohol consumption on health, behaviour and public safety. Such perceptions have in turn resulted in curbs on sale of alcohol to young people and to restrictions on driving under its influence. Social workers along with professionals in areas like health, medicine and law and order are also working towards reducing domestic violence and disruption on account of alcohol misuse (Bancroft, et al, 2005, p 47).

The impact of parental alcohol misuse on children has however been largely ignored, even in the midst of growing concern about increasing alcohol consumption; especially amongst young people (Murray, 2005, p 7). Recent reports highlight that children numbering more than 2.6 million in the UK live with dangerous drinkers, even as more than 8 million children are adversely affected by alcohol misuse of family members. Families where parents misuse alcohol are by and large characterised by poorer functioning. Such families are perceived to lack cohesion, ritual and routines; they have (a) lesser levels of verbal and physical expression, display of positive feelings, and caring and warmth, and (b) greater degrees of unresolved conflict (Murray, 2005, p 9).

Misuse of alcohol by parents is seen to be causal in (a) adverse physiological and physical outcomes for children and (b) fostering of environments that are unfit for children, both for development and for living. Such environments are marked by numerous incidences of neglect and direct or indirect violence (Harwin & Forrester, 2002, p 84). There is a great deal of evidence to show that parental alcohol misuse can harm children in diverse ways and lead to behavioural difficulties in early and later life. Children exposed to domestic conditions of parental alcohol misuse are less likely to do well in the classroom and appear to be more prone to mental health problems in later life (Harwin & Forrester, 2002, p 85).

Evidence also suggests that a huge majority of alcohol dependent people in the UK had alcohol misusers for parents and work towards perpetuating the cycle for future generations (Kroll & Taylor, 2003, p 25). There is also disturbing evidence to reveal that parental misuse of alcohol is significantly associated with deaths and serious abuse. Studies of adults, who are homeless, imprisoned or have substance misuse problems show significant association of such people with parents who misuse alcohol (Kroll & Taylor, 2003, p 27).

1.2. Aims and Objectives

The proposed research study aims to study the impact of parental misuse of alcohol in detail, with specific regard its relevance for social work theory and practice. The objectives of the dissertation are as under:

To investigate the short and long term consequences of parental alcohol misuse on children?

To investigate the relevance of the issue in current social work theory and practice?

To assess the rationale, validity and effectiveness of current social work approaches in improving the situation, with regard to both results and costs

To provide recommendations on improving policy and practice approaches towards improving outcomes for children of parents with alcohol misuse problems.

2. Literature Review
2.1. Short and Long Term Consequences of Parental Alcohol Misuse on Children

Research reveals that children of parents who misuse alcohol consumption can suffer from a variety of physical, psychological and behavioural problems with short and long term outcomes. As alcohol problems differ in character, severity and time period, their impact upon children also varies (Murray, 2005, p 4). It is however clear from national and international studies that the children of families in which one or both parents engage in alcohol abuse have greater problems than others. Seven important features of the family lives of these children, namely (1) roles, (2) rituals, (3) routines, (4) social life, (5) finances, (6) communication, and (7) conflict could be adversely affected (Murray, 2005, p 5).

Whilst parents with alcohol abuse problems cannot certainly be equated with bad or uncaring parents, research does suggest that alcohol problems adversely affect parenting quality. Excessive drinking can make individuals emotionally unavailable, unpredictable and inconsistent and result in passive, neglectful or even harsh parenting (Grekin, et al, 2005, p 15). With children learning from their parents about who they are, particularly in relation to others, children of parents who engage in alcohol abuse are likely to get ambiguous and inconsistent information, mainly because of the unpredictability on the behaviour and responses of such parents (Grekin, et al, 2005, p 18).

Whilst inconsistency occurs mainly on account of the unpredictable way in which such parents behave, such impulsiveness and irresponsibility in their behaviour results in the imposition of responsibilities on children that are excessive and beyond their years, which in turn affects their education, their family life and their relationships with their peers (Murray, 2005, p 9). Such children also face high risks of social exclusion because of their urge to conceal their parental drinking from their friends. Such children sometimes carers of their parents, especially in circumstances of domestic violence and can ally with the drinking parent or against him or her. Psychologists and behavioural specialists state that children of problem drinkers could fail to internalise their feelings of worth and trust and often learn not to trust, feel or talk. They may also be worried about the abilities of their parents to safeguard them and thus find it difficult to trust others (Murray, 2005, p 9).

Children of parents with alcohol problems are at significantly greater risk of witnessing and experiencing verbal, physical, and sexual abuse, as well as neglect. Excessive alcohol consumption plays a major role in 25 to 33 % of known child abuse cases (Kroll & Taylor, 2003, p 29). Children of problem drinkers are also extremely likely to blame themselves for the difficulties experienced by their families in naA?ve attempts to make their environment become better able in supporting them. Such children are also likely to carry their experiences of childhood into adulthood. Unborn children of mothers engaged in alcohol abuse during pregnancy can develop Foetal Alcohol Syndrome (FAS), involving a variety of mental and physical health problems (Kroll & Taylor, 2003, p 34).

2.2. Resilience among Children of People with Alcohol Consumption Problems

Whilst many of the problems described above place significant demands on social workers, especially when they continue through generations, it is also true that some children of parents with drinking problems do not seem to face as many difficulties as others. They appear to have greater resilience (Murray, 2005, p 5). Contemporary research reveals that certain protective processes and factors can reduce the adverse effect of parental alcohol difficulties on children, in the short as well as the long term. Such protective factors include high degrees of confidence and self esteem, self efficacy, ability to handle change, good problem solving skills, strong and positive family functioning, close and positive bonding with one or more caring adults, and good support networks beyond the family (Murray, 2005, p 7). Protective processes on the other hand include planning on behalf of children to make their lives less disruptive by (a) reduction of the impact of risks by altering the exposure of children to such risks, and (b) development and maintenance of self efficacy and self-esteem and self efficacy, and (c) improving the care provided by parents (Murray, 2005, p 7).

2.3. Social Work Policy and Practice for Children of Parents with Alcohol Related Problems

The national policy for dealing with adults with alcohol related problems is fragmented and approaches the issue from different angles. The main components of the governmentaa‚¬a„?s national policy towards containment of alcohol misuse are as under (Galvani, 2006, p 3-7):

The National Alcohol Harm Reduction strategy for England focused upon the requirement for services in the area of alcohol and domestic abuse to function together to address the issue.

The guidance document for the delivery of alcohol strategy acknowledges the requirement for assessment of consequences of alcohol problems on children.

The guidance document on alcohol misuse intervention focuses on the ways in which PCTs, along with local authorities, criminal justice agencies and voluntary agencies should understand and implement their roles in dealing with alcohol related crimes.

The Drug and Alcohol National Occupational Standards appreciates the requirement for workers to be able to safeguard and reduce the risk of abuse, both by and to their clients.

The vision for services for children and young people who are affected by domestic violence guides commissioners on (a) the important aspects of support for children and young people experiencing domestic abuse, (b) assessment of gaps in local services, and (c) their priorities for action.

The Children Act 1989 and its subsequent amendments incorporates the witnessing or hearing of bad treatment of children by other persons to be included in parameters for assessment of harm.

The National Service Framework for children, young people and maternity services focuses upon relationship conflict and alcohol and drug use as important areas where parents could require early intervention as well as multi-agency support.

The 2009 Task Force Report in response to Lord Lamingaa‚¬a„?s Report states that many children continue to be at risk of harm on from the people they should otherwise be rely on for care and love and that the government is responsible for doing everything possible to safeguard such vulnerable children (HM Government, 2009, p 29). The 2011 Munro Report on child protection states the need for abandoning the old standardised and bureaucratic approach to child protection and customising services on the basis of the experiences and needs of children Monroe, 2010, p 1).

The recently elected coalition government is in the process of assessing and reshaping national policy towards social work and some refocus of attention of policy makers on the consequences of impact of parental alcohol misuse on children is expected.

2.4. Research Questions

The aims and objectives of the proposed research, along with the information obtained from a brief review of literature have resulted in the formulation of the following research questions.

Research Question 1: What are the short and long term consequences of parental misuse of alcohol on children?

Research Question 2: How is current social work policy and practice dealing with this problem?

Research Question 3: What is the rationale of existing policies and practices for improving the lives of children threatened by excessive parental consumption of alcohol?

Research Question 4: What is the validity of such policies and practices and what is the extent of their effectiveness?

Research Question 5: How can current policies and practices be improved for bettering the life outcomes of children at risk from parents who engage in excessive alcohol consumption?

3. Research Method
3.1. Choice of Research Method

Social research is by and large conducted with the use of positivist and interpretivist epistemologies, which in turn largely call for the respective use of quantitative and qualitative methods of research (Bryman, 2004, p 43).

With the issue under investigation being extremely complex and multifaceted, the use of quantitative methods is hardly likely to yield any substantial or new results. Quantitative surveys on the issue have already revealed the various problems that can stem from excessive alcohol consumption by parents on their children. The use of interpretivist methodology and qualitative research techniques should help in the investigation and analysis of the subject under issue.

It is proposed to obtain relevant information on the subject from appropriate primary and secondary sources, whilst information from secondary sources will be obtained from the substantial amount of information and research findings on the subject that is publicly available. The researcher proposes to obtain primary information through the conduct of detailed one-to-one interviews with three social workers who have been closely involved in providing services to the families and children of people suffering from alcohol misuse problems. The interviews will be conducted carefully with the use of a range of open and close ended questions and will hopefully lead to interesting and relevant information.

3.2. Ethics

The researcher will take all measures to follow appropriate ethical codes of conduct, with regard to informed consent, confidentiality, absence of coercion, and freedom to answer or not to answer questions. Efforts will be made to ensure that the research is totally original and devoid of any form of plagiarism (Creswell & Clark, 2006, p 69).