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There is a lot of discussion of how disability is described. The literal meaning of disability is “difficulty with ability”. This implies some form of mental or physical impairment that can manifest problems with mobility or awareness. According to the Disability Discrimination Act 1995, disability impairments can include sensory impairments such as hearing or sight, mental impairments such as depression or learning difficulties and physical impairments such as wheelchair users.

People with disabilities may face problems, and not only because of their particular impairments but by social factors such as attitudes, stigma and physical obstructions, for example, ease of access to buildings or transport. The description of disability has varied over the years but the Disability Discrimination Act 1995 describes it as,

“he/she has a physical or mental impairment which has a substantial and long term adverse effect on his/her ability to carry out normal day to day activities”

Thompson and Thompson (2008) state that historically, people with disabilities were considered “tragic, different or in some way devious”. They were not allowed to work, mix with others or travel and many were placed in asylums. Ingstad and Reynolds, (1995) claims that, media representation of disability often relates to insanity and evil. This is evident in such things as super hero movies, where the bad character is often portrayed as physically deformed or mentally unstable.

However, throughout history there have been people with impairments that in today’s society would have been viewed as disabled, Franklin D Roosevelt, four times president of the United States, had polio. The poet Lord Byron (mad Lord Byron), who was born with “talipes”, known then as a club foot, and whose name today is still synonymous for someone dashing, “Byronic”. Admiral Nelson, known for his great naval victories against the Napoleonic French and particularly the battle of Trafalgar, he is not viewed as disabled although he was blind in one eye and only had one arm. In today’s society he would have been seen as a disabled seaman. But when we look at these people we do not see their disabilities, we see heroes, great leaders and writers. Did society just look past their impairment and just see their achievements?. (Ingstad and Reynolds, 1995).

According to Finkelstein (1980), people with disabilities have existed in comparatively large numbers throughout the world and in different societies for centuries. What is also evident is that the cultural understanding and responses to impairment and disability have varied and still do. There is a real cultural stigma towards people that have any sort of physical or mental difference to the “norm”. This can be traced back to ancient Greek and Roman times.

Finkelstein (1980) goes on to say that, all though the degree of bias has varied from time to time, people’s perceptions of impairment and disability have remained much the same since the industrial revolution in the nineteenth century. The start of the industrial revolution introduced the concepts of urbanization and paid labour. This brought new problems for people who were unable to compete for work. After being scrutinised and labelled by doctors and other professionals, these people were put in to hospitals or asylums where they remained for very long periods and sometimes indefinitely. This kind of treatment carried on throughout most of the western world and all through the first half of the twentieth century.

Drake (1999), states that the Eugenic legacy, which looked at the assumptions of human mental characteristics, was in some way influential in forming a different outlook on impairments. Drake continues, the Eugenic legacy came to a logical conclusion during the systematic murders in the Nazi death camps of thousands of disabled people considered undeserving of life, worthless and a burden on society.

In the 17th century impairments or disabilities were seen as punishments from God, and explained by using religion, superstition, or myths and legend. Some of these beliefs remain to this day such as the belief that a disabled person must have been evil in a previous life and is now being punished. (Campbell and Oliver 1995)

I remember in 2003 former England manager, Glenn Hoddle was sacked from his position for saying that disabled people are paying for sins they committed in a previous life. But in other religious cultures in societies, disability may be seen as being chosen by god. (Campbell and Oliver 1995)

Cultural values and Society can be responsible for imposing disability on someone with impairments. This is mostly done unintentionally or by misinterpretation but it results in excluding people with some form of impairment from participating in society. Therefore it is understandable that disabled people will see themselves, as an oppressed group. To understand this, there has to be a definition between the person with the impairment and the social construction, called disability. (Oliver 1996) What this means is that today’s society defines the impairment as it is seen, i.e. the lack of a limb or limbs, organism or motor functions of the body that are not working properly, and the disability as the restrictions and disadvantages that go with it. Oliver, states that,

“We see disability as the disadvantage or restriction of activity caused by a contemporary social organisation which takes little or no account of people who have physical impairments and thus excludes them.” (Oliver 1996, p22)

The common view today, according to Campbell and Oliver (1995) is that a person’s impairment is the cause of their disability and that their disability is a medical problem that has to be overcome. This refers to the ‘medical model’ approach which focuses on prevention and cure. In many countries this has caused a growth of prosperous and costly industries involved with disability comprising voluntary organisations, drug companies, private businesses, charities and government institutions. These will be staffed by an army of professionals including support workers, doctors, nurses, occupational therapists and social workers. This attitude can have a negative effect on the way society see people with impairments and will result in stigmatisation. In addition to this, if society sees the impairment as the problem, surely it is logical to see that these problems must be cured or fixed in order for them to fit in to “normal society”. The outcome is that, people with disabilities are labelled as “disabled people” this may look like a play on words but what this shows is that the disability is seen before the person. Society sees people with disabilities as, “not normal”, this implies “abnormal”, and further reinforce the stigmatisation and stereotyping of people with disabilities being seen as inadequate and dependant.

Are some people with disabilities more vulnerable than others

According to Hales (1996, p152)

“Prejudice is a negative attitude towards particular groups of people based on negative traits assumed to be uniformly displayed by members of that group”

Hales uses the example, that it is commonly assumed, that younger people with learning disabilities have no interest in forming long term relationships, an adult sex life or having children. Hales describes this as issue as being “social attitude” rather than the physical disabilities faced by the people themselves.

It is difficult to say if some people with disabilities are more vulnerable to discrimination than others as there are so many factors to consider. Cost for example. Barnardo’s (2011) state that, the costs involved in bringing up a child with a disability is much greater than raising non disabled children. Barnardo’s also state that, it may not just be the higher cost of living, no qualifications and unemployment that are causing discrimination. But the fact that living in deprived communities where the understanding of disability is lower than the more affluent areas.

One fifth of children with disabilities live in poverty stricken areas, resulting in social exclusion, discrimination and causing multiple oppressions. (Barnardo’s (2011).

Marginalisation and exclusion refers to people with disabilities not being included in everyday life. This includes non equality in the work place. (Barns and Mercer 2003) state that, while some benefits such as disability living allowance (DLA), are in place to help people cope financially with social and work factors, it can also have an adverse effect by highlighting a dependency on benefits. This again can lead to stigmatisation and oppression. New labour recognised this problem and developed the “welfare to work policy” in 1997. The government documented that unemployment for people with disabilities was far higher than it was with non disabled people. A high percentage of people with learning disabilities live in poverty. 24 % of working age people with disabilities do not have formal qualifications. (HM Government 2011)

The government recognises a link between unemployment and social exclusion. In 1989 the government set up the social exclusion unit (SEU) to improve the educational prospects for children with disabilities. Although this was a step in the right direction, it is worth noting that the minister for education at this time was David Blunkett, who is classed as a person with a disability. (Dan 2005)

When people think of disability they think of the obvious such as wheelchair users. There are some things put in place for people with physical disabilities. Examples of these are wider doors, ramps, higher power points, lower light switches, audio and visual aids, lowering busses and disabled parking (Hales 1996). But in my opinion people with learning disabilities seem to be less understood. Therefore, I feel that, it can be argued that people with learning disabilities are more vulnerable to discrimination than other.

Why do some people reject the disability label and some accept it?

According to Barnes (1991), some people will accept the disability label, feeling that they are not able to cope in society and they are in a sort of limbo, waiting for a cure and the hope that one day they may get fixed. This may be because they have been conditioned by a non disabled society to accept their lot in life; they are broken and need a cure. Some disabled people will obviously want a cure and will actively help in working to find one, thus giving their life some meaning and a reason to belong.

“Some need to succeed in order to belong, some need to belong in order to succeed.” (Hill Country Disabled Group)

According to Clapton & Fitzgerald (1997) this stems back to the medical model of disability that perceives impairment as something that has to be fixed, i.e. a person is disabled because of their individual impairment so consequently they will require medical interventions to give them the skills to adapt in our non disabled society.

There are disadvantages to being labelled as disabled. But there can also be advantages. In my experience, in having dyslexia, (which was discovered while I was at university), I am classed as a disabled student. I do not see myself as being disabled as there are no physical signs of dyslexia and it is something I have lived with all my life without knowing. Initially, I resented the disability label, but in accepting it, I received the help I need to complete my course. Some of my fellow students see such a label as stigmatising, and even though they have similar pattern of difficulties, they did not want to seek help for fear of being labelled.

There are the people who see disability as a social problem put on them by a non disabled society that impairs physically disabled people. It is argued that no one has made a specific distinction between biological impairment and social disability. (Clapton & Fitzgerald (1997)

This is seen as the key to the British ‘social model’ of disability and was originally devised by disabled rights activists in the 1970s. This move forward was developed by disabled people and their own experiences of living with impairment in Western society

(UPIAS 1976)

The social model has been widely acknowledged and developed by disability rights groups all over the world. It is now the foundation and the principle way of thinking in regard to policy-making for countries as diverse as Japan, South Africa and the USA. The social model of disability is not complicated; it just highlights the cultural, economic and environmental barriers experienced by people who are seen by others as impaired. According to Barnes (1991), these barriers can include: education problems, communication issues, problems within the working environments, insufficient disability benefits, social support services, inaccessible transport, housing and public buildings and the devaluing of people labelled ‘disabled’ by negative imagery and representation in the media such as films, television and newspapers.

From this viewpoint it is easy to see why some people will reject the label of being disabled and see their disability as a failure by society to accommodate their personal and combined needs within the confines of conventional society.

(Barnes 1991)

What can be done to effectively counter discrimination?

Oliver (1990).explains that, people’s perceptions of disability and rehabilitation are changing. The 1960s saw the start of this change with politicians, policy makers and social workers realising that the world can no longer look at the disability issue as an individualistic medical problem, (Barnes and Mercer 2003).

One of the reasons for this is that people with any form of impairment, be it cognitive or physical, are seen as abnormal and labelled as “disabled”. The fact is, that these people represent a growing segment of the global population and must be treated as equals.

In brief, this means that the social model of disability is a tool to help us recognise the disablement caused by society’s preconceptions of people with disabilities and help improve policy making. (Oliver 2004)

Ten years ago, Glasby and Littlechild (2002), stated that, what is needed to effectively counter discrimination is to move away from government run professional services. They foresaw a need for greater investment in “user led” initiatives, especially regarding direct payments. This should give thousands of disabled people across the UK a better chance of achieving real independent living.

Glasby and Littlechild go on to say that this could be achieved by setting up a new national body working directly with the National Centre for Independent Living (NCIL).

Along with the distribution of direct payments, this new organisation could produce a standardized assessment for direct payments, reducing mistakes and making it easier for service users.

Barns (2004) explained that, such an organization could also monitor local user groups that provide services for direct payment users. This would also give this new organisation the opportunity to benefit from a wealth of experience and expertise that has been developed by disabled people for over twenty years. (Barns 2004)

The problem at this time was that, the government authorities were reluctant to implement direct payment policy for a number of reasons.

Nowadays, direct payments are offered as a matter of course. During my third year placement in social services, It was actively encouraged to offer this service, in fact, I could not complete a unified assessment without doing so.

We also recognise organisations such as the Rowan. This is a registered charity that provides direct Payment and Personal Budget support for service users. The Rowan has a vision of,

“A society that is fully inclusive in which the barriers, whether environmental, attitudinal or institutional, that prevent disabled people from having equality of opportunity have been removed.” (The Rowan Organization 2012)

As social workers we have the training to act in a non discriminatory way. We follow guidelines in our codes of practice such as, upholding public trust in social services and not unlawfully discriminating service users. Anti discriminatory practice is fundamental to the practice of good social work. It is important not to assume what difficulties people have with their disabilities. This in itself is a form of oppression, as only people with disabilities will know what it’s like to face disability discrimination.

I feel that one of the most important roles as a social worker is advocacy. This will ensure that the voices of peoples with disabilities are heard.

Legislation is main area that can help fight discrimination and oppression. The Equality Act 2010 enforces a duty on employers to make adaptations that will aid disabled people in the work place. This act also makes it illegal to treat people differently because of their disability.

According to Barns (2003), the equality movement and looking into the problems of disablement has brought forward the concept of independent living. This concept was first used in the United Kingdom during the 1970s, after being adopted by disability activists in the USA. These activists called themselves the “ILM” or independent living movement. This movement was partly developed within campuses of American universities and partly from the on-going efforts of the disability activists who were attempting to influence, not only US disability legislation in the 1960s. But also, people’s discriminating perceptions of disabled people.

Disability Wales ran a campaign from April 2010 to March 2011. This was called “independent living now”. This highlighted six main “calls to action” that disabled people had deemed essential in further development of Independent Living. These are:

1. “Improved access to information, advice, independent advocacy and peer support services for all

2. Availability of accessible and supported housing to meet individual requirements

3. A comprehensive range of options and genuine choice and control in how personalized care and support is delivered

4. Improved access to Person Centered Technology (aids & equipment)

5. A barrier free transport system, including all modes of transport

6. Enabling access, involvement and social, economic and cultural inclusion for all disabled people”.

This concept of independent living is a broad one and is usually associated with younger and middle aged people with physical and sensory conditions. But this concept does apply to everyone in the disabled population. This includes people with high support needs and people with cognitive conditions such as learning disabilities and mental illness (Barnes 2003). Because of this, independent living does have some criticisms. My own experience of working with a young man who had learning disabilities was not very successful. This person was granted independent living and was given his own flat. The problem was that all his “friends” did not have any kind of impairment. This was causing real problems as they were encouraging him to spend his disability allowance on alcohol and having parties at his flat. In turn this was causing problems with the neighbours because of the constant noise. This also resulted in him not having any money for food and being drunk most of the time. This was causing him to have health problems, which resulted in him being returned home to his parents.

Conclusion

In concluding this assignment, I have discussed why there is disability discrimination both from an historic and societal point of view and how people are disabled by these views. I have also discussed the different levels of vulnerability and who I feel are the most vulnerable in our society. In addition, I have covered why some people accept the disability label whilst others reject it, and what can be done in the hope of effectively countering disability discrimination.

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Acts

Disability Discrimination Act 1995.

Equality Act 2010

For my final year I have been assigned to produce a dissertation on a topic of my own interest. During my second year of this course I was at a placement in a Supported Housing organisation. Whilst working there I came across a lot of child abuse issues, in particular child sexual abuse and this is where my interest in seeking more knowledge about the subject came about. I have chosen to focus on the issues regarding the sexual abuse of children and how this affects their life as children and as adults. The topic itself is quite a complex one to define and understand. The issue of sexual abuse began to attract widespread attention as a social issue in the late 1970s. However, the extent of child sexual abuse has only been fully recognised over the last 20 years or so. But exact figures depend on how sexual abuse is being defined. The term child abuse refers in this dissertation to the physical or emotional mistreatment and neglect of children or their sexual exploitation, in circumstances for which the parents can be held responsible through acts of commission or omission (cited in Doyle, 2006). The possibility of child sexual activities taking place arouses feelings of disgust and horror; it is condemned by society as a violation of what is normal sexual behaviour.

I have chosen to structure this dissertation into 6 sections. In the first chapter I will start of by defining and explaining what child sexual abuse is. The second chapter will consist of describing who the perpetrators of child sexual abuse are. I will explore further into their reasons for committing such an offence and if it is linked with their past. Most people who have suffered sexual abuse when they were younger do not grow up to abuse. Jones (2002) states that, a significant minority of those who sexually abuse children have themselves suffered physical and sexual abuse in their own childhood. The most potent predictors of who is likely to commit the most serious and prolonged sexual abuse are childhood family violence, loss of a carer, and family breakdown. Sex offenders are noted for their invisibility. When people think of a sex offender they may visualize a stereotypical image of a man filthily dressed, hanging around street corners though in truth the sex offender appears in many forms and in all walks of life. When people hear of a sex offence, they generally associate total strangers to be the ones who carry out the crime, what they don’t realise is that sex offending itself takes many forms. In some cases the abuser may be diagnosed as having serious mental health problems. For example, a woman drowns her twin 6 month old daughters. Another mother throws her daughter off a bridge into icy water. A father has sexual intercourse with his 6 month old daughter. These descriptions are often enough to convince most people that only someone who is mentally disturbed or truly psychotic would inflict such grievous harm onto a defenceless child (Gelles & Cornell, 1990).

The third chapter is based on the victims of child sexual abuse. Children who are sexually abused generally find it harder to talk directly and clearly about their experiences. Although some children disclose, many do not. Many children assume that, if their parents mistreat them, it is because every parent behaves in that way (Doyle, 2006). Children can become attached to abusing parents. They often want the abuse to stop but crave the abuser’s love. Every child has a right to receive a good standard of care and protection, and parents have a duty to provide this, however, this is not always the case.

Sexual abuse victims may protect their self-image by convincing themselves that there is nothing wrong in sexual relationships between adults and children. Wyre (1986) noted that many men who had raped children had been sexually abused as children and had incorporated their experiences of abuse into their own sexuality. Findings from Trickett and Putnam (1998) show that about a third of sexually abused children who have been sexually abused are at specific risk of developing sexual problems and sexualised behaviour. For some children, being inappropriately sexual with other people is the only way they know to love and get close to people. As adolescents, some boys who have been sexually abused show an increased likelihood of exposing their genitals to women, or being sexually coercive. Some girls become sexually, and often indiscriminately very active. Sexual promiscuity can get both young boys and girls into social difficulties. In the case of early sexual activity amongst sexually abused girls there is the risk of teenage pregnancy (Trickett and Putnam 1998, cited in Howe 2005).

The fourth chapter outlines the long term and short term effects child sexual abuse has on victims. I will describe the extent an abused child’s developmental stage is impaired. The more forceful and violent the abuse, the more the individual is likely to suffer trauma. The most crucial period of a child’s life is when assumptions about the world, others and the self are being formed. Unlike adults, children’s lives are affected and traumatised during this period. REFERENCE These posttraumatic reactions can easily collide with a child’s social and psychological maturation, which leads to a potentially typical dysfunctional development. The amount of damage caused to the victims is unpredictable. Survivors of sexual abuse are often described as having a number of emotional, cognitive, and social difficulties. The child perceives the self as unworthy of being loved or protected. This leads to low self-esteem.

Chapter 5 illustrates a case study in relation to my second year work placement at a supported housing organisation intended for individuals who are just released from prison. Whilst working there, my main interests were within the YOT team. During my first few days I read a particular client’s file, who was part of the Program X scheme. I found his file very interesting as there were serious issues of child sexual abuse associated with his life, which later led to extreme depression and suicide attempts.

Last but not least, the next stage is to determine how these issues can be addressed and if victims find a way to escape the nightmares associated with the abuse. Do they ever live a normal life again? This can prove difficult at times as many abuse survivors inappropriately assume responsibility for what was done to them as children and are often believed to have provoked it in some way, REFERENCE some deny that abuse ever occurred in the first place, and underestimate their personal rights to self-determination and safety. There are many agencies and organisations that provide help and support to individuals suffering from child sexual abuse. Getting help through therapy allows the survivor to find closure.

Finally, I will end the dissertation with concluding comments regarding the issues discussed throughout the dissertation.

Chapter 1 – What is Child Sexual Abuse?

Sexual violence and childhood sexual abuse are two of the most serious and damaging crimes in our society. for victims, these crimes represent a violation which can have a significant and ongoing consequences for health and wellbeing. REFERENCE Many patients who have been abused do not talk about sexual issues with their health care providers. REFERENCE They often feel disconnected from their bodies and health needs. REFERENCE

Sexual abuse is defined in the Department of Health 1999 guidelines as:

‘Involving, forcing or enticing a child or young person to take part in sexual activities, whether or not the child is aware of what is happening. The activities may involve physical contact, including penetrative (e.g. rape or buggery) and non-penetrative acts. They may include non-contact activities, such as involving children in looking at, or in the production of, pornographic material or watching sexual activities or encouraging children to behave in sexually inappropriate ways.’ (Department of Health 1999: 6, cited in Corby, 2006).

The above definition states that the sexual abuse of a child does not necessarily need to involve physical contact. It provides examples of such non-contact abuse but does not mention intra-familial abuse or anything about the age of the perpetrator. Another definition used is:

‘Any child below the age of consent may be deemed to have been sexually abused when a sexually mature person has, by design or by neglect of their usual societal or specific responsibilities in relation to the child, engaged or permitted the engagement of that child in any activity of a sexual nature which is intended to lead to the sexual gratification of the sexually mature person. This definition pertains whether or not it involves genital contact or physical contact, and whether or not there is discernible harmful outcome in the short-term.’ (Glaser and Frosh 1988: 5)

The issue of defining sexual abuse in practice is both problematical and complex. In some cases, there are overlaps and connections between the different forms of abuse. For example, a child might be sexually and physically abused, neglected and physically abused and so on. Very young children as well as older ones are affected by sexual abuse and now it is a crime thought far more common than it was previously. Sexual abuse is harmful at all stages but Corby (2000) suggests it is considered to have greater effects, where the abuse is carried out by a father figure; if it is accompanied by threat, force or violence; where the sexual act involves penetration; where the abuse has continued for some time and finally where the family responds negatively regarding the abuse (Howe, 2005).

History

There is little evidence about sexual abuse of children in antiquity and medieval times. Growing up in Rome or Greece frequently involved being sexually abused by older men (de Mause 1976: 43). In Scotland 1757, incest was given the death penalty (Corby, 2006). By contrast, in England during the twentieth century, incest became a legal offence. . By the beginning of the Second World War, under the 1908 Incest Act the number of prosecutions for incest gradually increased reaching 100 a year (Corby, 2006). The definition of incest in the Sexual Offences Act of 1956 is as follows:

It is an offence for a man to have sexual intercourse with a woman whom he knows to be his grand-daughter, daughter, sister or mother….it is an offence for a woman of the age of sixteen or over to permit a man whom she knows to be her grandfather, father, brother or son to have sexual intercourse with her by her consent (Smith & Hogan, 1983: 419, cited in Howitt, 1992).

In 1937 the state of Michigan enacted a sexual psychopath legislation. In the same period of the 1930s there is also evidence that the public became more concerned about sexual offences. REFERENCE By 1960 there were some 27 states and the District of Columbia with a version of a sexually dangerous person law. From the late 1930s onwards to the early 1960s there was emphasis on the treatment of offenders through involuntary civil commitment procedures rather than punishment after conviction. Reasons for jurisdictions over such offenders varied among 27 states. Beginning in the late 1950s and continuing for nearly two decades, there was a panic over sex crimes, sexual deviance and sexual behaviour generally. By the late 1980s almost half of the states with sexually dangerous persons legislation had revoked the statutes. In 1994 a provision entitled the ‘Jacob Wetterling Crimes Against Children and Sexually Violent Offender Registration Act’ was included in the omnibus 1994 crime bill. In 1997, the Wetterling Act [1] was amended to allow for community notification, which permitted law enforcement personnel to disclose registry information to neighbourhood residents about sex offenders who live in close proximity. REFERENCE

The NSPCC began to tackle child sexual abuse within the family, which was previously ignored as an issue. The NSPCC did not bring sexual abuse to public attention, in the same way as it had publicised physical abuse and neglect, despite its awareness and recognition. This response reflected a general attitude to the issue, which was one of not wanting to know, a conspiracy of silence. Many parents keep their child’s abuse a secret even if they know of it. By contrast, however, child prostitution received far more public attention.

In the summer of 1987, newspapers reported a child sexual abuse scandal in Cleveland. It emerged that 121 children had been brought into care over a period of six months on place of safety orders on the recommendation of two paediatricians who had diagnosed them as having been anally abused. Up to this time, for child protection agencies in Britain, the issue of child sexual abuse had been a relatively minor concern. Child sexual abuse was beginning to find its way onto the official child protection agenda by 1987, although the response to such abuse throughout Britain was patchy and variable. The Cleveland report had an impact on the passage of the 1989 Children Act through Parliament. Findings from the Cleveland inquiry report confirmed that, child sexual abuse was a more widespread phenomenon than had previously been thought to be the case. Similarly, in 1991 in Clwyd, residential social workers in two children’s homes were prosecuted for serious sexual offences against children in their care. As a result, Clwyd County Council set up its own independent inquiry which commenced in 1996 and reported in 2000. Its findings were that there was evidence of widespread physical and sexual abuse of girls and boys in Clwyd during this period (Corby, 2006).

Concerns about the use of child pornography have risen since the 1990s. Sadly, only a fraction of the sexual abuse of children is ever reported. Silverman and Wilson (2002) reported that in 1995 the Obscene Publications Unit of Greater Manchester Police seized about a dozen images of child pornography during the whole year, but in 1999 the unit recovered 41,000 images and by 2001 so many images were being recovered that they had to stop counting. REFERENCE

Public concern over the sexual abuse of children is a relatively recent phenomenon. It is only recently that the general public in Britain has begun to realise that, far from being an extremely rare phenomenon, the sexual abuse of children is much more widespread. As in the USA, a number of tragic cases in the 1990s in England and Wales have attracted widespread publicity, provoked public outcry and provided a legislative and organisational change. In Britain, media interest in sexual offenders released from prison and allowed to live anonymously in the community created an outbreak in public anxiety following the abduction and murder, of seven year old Sara Payne in July 2000 in Sussex. Here newspaper accounts criticised the probation service for failing to prevent Sarah Payne’s death. REFERENCE. Since then, Britain’s local newspapers have been concerned about the risks to children from sex offenders living in the community. It is seen from all this that sexual abuse of children occurs at all levels of society.

The issue and prevalence of young people (under 18) drinking alcohol in recent years has become a matter of increasing public concern, with current trends ‘amongst the worst in Europe’ (Gunning et al 2010). Drinking during childhood, particularly heavy drinking is associated with a range of problems including physical and mental health problems, alcohol-related accidents, violence, and anti-social behaviour (Gunning et al 2010). Young bodies are still growing, and alcohol can harm their development; regular drinking can lead to cancer, liver disease, and heart disorders in later life (Bateman 2011). Deaths from liver disease have risen vastly in the 25-34 age groups over the last 10 years; thought to be a consequence of increased drinking starting from an earlier age (Thomson et al 2008).

In England in 2007/2008, ‘more than 7600 children under 17 were admitted to hospital as a result of drinking alcohol’ (Gunning et al 2010). It is believed that young people who start drinking alcohol at an early age, drink more, and drink more often than those who delay the onset of drinking until they are older. They are also more likely to develop alcohol abuse/dependence problems in adolescence and adulthood; dependence is also likely to occur from a much younger age (Gunning et al 2010).

A recent survey carried out in 2010 by the National Centre for Social Research (NatCen) to determine the ‘smoking, drinking and drug use of secondary school pupils aged 11 to 15’; (7,674 pupils in 247 schools through the use of questionnaires) interestingly found that the proportion of young people who ‘have drunk alcohol’ had decreased in comparison with earlier findings from 28 per cent in 2001 to 21 per cent in 2006 (DH 2008). However it must be stated that although there had been a marked decrease in the number of ‘young people’ who had ‘drunk alcohol’; many of the 11 to 15 year olds who do drink were described to be consuming larger amounts of alcohol, more often, to deliberately ‘get drunk’ (Bateman 2011). This study also conveyed that ‘18% of pupils had drunk alcohol recently, is equivalent to around 540,000 young people’ (Gunning et al 2010); suggesting that more still needs to be done to reverse these prominent trends, as despite the marked ‘decrease’ alcohol misuse in young people is still a serious problem that is affecting the health of the youth today and greatly impacting the wider community, in that alcohol misuse carries a financial burden; and has been estimated to cost nearly ?11,000 million each year, in terms of health, social welfare and criminal justice resources (Waller et al 2002).

Collecting this type of data can prove difficult, as drug and alcohol misuse are of a sensitive nature and often individuals do not wish to share this information candidly when questioned. It is particularly difficult to obtain from ‘young people’ (under the age of 18), as this often has to be carried out within a school environment, via questionnaires. The extent to which ‘honest reporting’ occurs is again complex, as young people will often exaggerate to peers, and conceal from parents (Gunning et al 2010). Honesty is not the only factor affecting accuracy of responses in young people, precision of estimates and the recall of the amount of alcohol drunk can also be problematic, given that pupils’ patterns of behaviour between the ages of 11 and 15 may be described as ‘experimental’ and ‘sporadic’ opposed to ‘habitual’ and ‘regular’ (Gunning et al 2010). The National Treatment Agency (NTA) has recently stated that young people’s substance misuse is a relatively ‘new area of academic study’ and so research on effective treatment interventions are inconsistent (NTA 2010).

It is widely acknowledged that alcohol misuse in youth is inextricably linked to a number of factors; including the influence of parents/family, peers, environment, culture and socio-economic status (Templeton et al 2006). According to the Acheson report (1999), dependency upon alcohol is ‘significantly correlated with socio-economic position’, suggesting that the problem is one that is beyond the chemical impact of the substance itself (Nacro Youth Crime Section 1999) coinciding with more recent National statistics and research studies that indicate, ‘as well as sex and age, socio-economic status, ethnicity and geographical area of residence are among the factors linked to levels and patterns of harmful alcohol consumption’ (Waller et al 2002).

In order to target the issue of alcohol misuse within young people, these factors needed to be taken into account and have since been the guide by which policies regarding ‘youth’ and ‘alcohol’ are implemented (DH 2008); therefore providing alcohol education in schools; beginning in the primary phase, well before patterns of regular drinking become established, designed to educate and advise young people on sensible drinking patterns and the dangerous effects it may have upon them (DH 2008). Parents and carers also have a responsibility for whether their children drink, at all, and if they do, how much and how frequently they drink. However, for parents to ‘feel confident’ when talking to their children about alcohol and to empower them to set appropriate boundaries they need guidance from the appropriate services (DH 2008).

In terms of government strategies, to target the issue of alcohol misuse in young people; the coalition’s programme for government published in May 2010, outlines proposals designed to restrict the supply of alcohol to young people, less than 18 years of age, by increasing the control given to councils to close outlets that ‘persistently sell alcohol to children’; and to increase the maximum fines for under-age alcohol sales. Additionally, there will be a ‘ban on the sales of alcohol at below cost price’ (Gunning et al 2010), and a review of alcohol pricing and taxation, both policies expected to have particular impact on ‘young drinkers’ (Gunning et al 2010).

Whilst these policies are currently weighted towards prevention, and adopting preventative strategies, recent statistics suggest that the majority of young people accessing services and interventions have ‘problems with alcohol (37%) and cannabis (53%)’ (NTA 2010), thus suggesting that more needs to be done in the ‘preventative’ stages of alcohol awareness in children; as evidence suggests that the problem is clearly still on-going.

The choice and effectiveness of treatment approaches is typically dependent on a range of factors, such as the individual characteristics of the client for example motivation, family life, social circumstances and environment; in addition to the particular drug or drugs that are being used (Crow & Reeves 1994). The National Treatment Agency (NTA) defines young people’s treatment as: “aˆ¦ care planned medical, psychosocial or specialist harm reduction interventions aimed at alleviating current harm caused by a young person’s substance misuse” (NTA 2010).

Young people with drug related needs are supported by interventions and services within a ‘four-tiered model’ of drug and alcohol interventions which consists of a General Frontline service delivery for young people and their families (‘first port of call’) (tier 1), open-access services (such as drop in) (tier 2), Drug treatment within the community (‘Shared care’) (tier 3) and residential drug treatment (‘specialist services’) (tier 4) (NTA 2006).

Young drug and alcohol users are believed to differ from adults as they will typically not have used drugs for a prolonged period of time, in order to have developed a dependency to a substance; and as a result affecting the type of treatment generally provided to young people (Frontier Economics 2010). Young people are most likely to require psychosocial, harm reduction and family interventions, opposed to treatment for addiction, which most adults but only a small minority of young people require (Frontier Economics 2010). Psychosocial interventions are known as ‘non-pharmacological’ interventions typically involving ‘structured counselling, motivational enhancement, case management, and care-coordination, psychotherapy, and relapse prevention’. The intention is to encourage behavioural and emotional change, with the support of lifestyle adjustments and the enhancement of coping skills (Frontier economics 2011).

The most common form of therapy offered for substance misuse is some form of counselling; this may take the form of counselling for the drug problem itself, for example thoughts about using, coping strategies for reducing or counselling concerning the surrounding issues that impact on drug use (Lewis et al 2009). Counselling is a flexible approach and can be used to respond to a wide variety of circumstances surrounding misuse (Rounsaville & Carroll 1992). It is possible to identify two general approaches to counselling in use in community drug services, the first being, counselling to tackle the personal problems, underlying drug misuse and the second being that of support and advice to help manage the consequences of drug misuse (Bryant- Jeffries 2001). The vast majority of young people accessing specialist treatment need and receive counselling, sometimes alongside their families to address the underlying causes and consequences of substance misuse. Such ‘psychosocial’ interventions are the most common form of support accessed by under-18s (Frontier Economics 2011).

The National Institute for Health and Clinical Excellence (NICE) coincides with the idea of the counselling theory, and has recommended that offering brief, one-to-one advice on the harmful effects of alcohol use, and how to reduce the risks and find sources of support, is an effective approach for tackling harmful drinking amongst children and young people (NICE 2007).

The most common counselling approach to drug treatment has been cognitive behavioural approaches. The cognitive behavioural approach relies greatly on getting the user to focus on identifying problems and solutions. Cognitive behavioural counselling can be used to promote abstinence or gradual control of drug use, with an emphasis on teaching cognitive and behavioural techniques to resist drug use and related behaviours. The cognitive element of CBT is concerned with getting users to identify the reasons why they misuse, and in particular getting them to identify ‘maladaptive thought patterns’ that lead them to engage in ‘destructive behaviour’ (Jarvis 1995). The behavioural aspect of CBT is about helping people to look at the signs that encourage them to misuse drugs and to help them develop alternative ways of behaving (Jarvis 1995).

NICE has recommended cognitive behavioural therapy (CBT) as an effective intervention for treating young people’s substance misuse (NICE 2007). Providing CBT in a group setting may help young people to role-play and practice coping with ‘high-risk experiences’. The group setting allows young people to share similar problems, develop social skills, model, rehearse and gain peer feedback (NICE 2007). NICE also recommends that brief interventions using motivational interview techniques can be used as one-off interventions, or to facilitate engagement with more structured specialist substance misuse treatment (NICE 2007). Implying that individuals with social networks supportive of drinking will benefit especially from a programme that encourages attendance at AA meetings, because it is ‘the most effective means of eliminating heavy drinking friends and acquaintances from the social network’ (Connors, Tonigan and Miller, 2001).

Although NICE states that a group setting is beneficial in helping young people overcome their alcohol abuse it may in fact be criticised, as young people, especially ‘troubled’ young people may be ‘overwhelmed by group influences’, either in treatment among peers who are also recovering from chemical dependence or else after leaving treatment, in the form of familiar drug-using groups’ (Peele 1987). And so the most successful types of counselling approach used for young people needs to take into account their age, as being amongst adult’s with alcohol issues would not be beneficial to a young person as adults are often described as ‘dependent’ requiring more intensive forms of treatment; young people will have often not reached this stage of ‘dependence’ and so these adult influences may cause further negative impacts on the impressionable ‘young’ (Geldard 2010). Type of personality needs to be taken into account in order to discover which counselling approach would be most appropriate and successful for them as an individual, as some individuals may respond best to a one-to-one approach, being able to fully open up to one person (the counsellor). Whereas some may find it easier to speak within a group setting with peers, learning from others experiences. Counselling is often described as a ‘flexible approach’ (Rounsaville & Carroll, 1992) and therefore can be adopted to meet the needs of individual cases and respond to a wide variety of circumstances surrounding misuse; in addition utilising ‘a flexible approach’ suggests that it allows for the young person to access this service around other commitments such as school, so as to not jeopardise other important aspects and influences within their sphere of activity, flexibility of counselling will also allow for the involvement of the family, with evidence to suggest that family involvement enhances assessment and intervention and increases motivation in treatment (Kaufman, 1992). As young people are often depicted as ‘not yet independent’, family interventions are believed especially important in addressing the basis of their drug and alcohol involvement; (Kaufman, 1992). Also important is helping the family initiate and support the person’s involvement in an appropriate treatment program (Kaufman, 1992). Within individual treatment, compared to group therapy it is believed that much more time can be spent on issues that are unique to the individual involved, a trait that needs to be evident when working with young people (Rounsaville & Carroll 1992).

Motivational interviewing has a number of similarities with cognitive behavioural techniques but has a somewhat different emphasis in that the role of the counsellor is less directive and the responsibility is very much on the client to identify ways of changing (Bryant -Jeffries 2001). It aims, through the counselling ‘relationship’, to engage clients in a process of change and assumes that an individual’s level of motivation can be influenced by the interaction between the client and the therapist. Motivational interviewing assumes that behaviour is a prospect that can be worked on and developed (Bryant – Jeffries 2001).

It is concerned essentially with working with clients to address the confluence of factors that drug misusers consistently feel about changing their behaviour and hopefully encouraging them towards reducing or abstaining (Jarvis 1995). The theoretical basis of this approach is ‘Prochaska and Di Clemente’s transtheoretical model of behaviour change or, as it is most frequently referred to, the ‘stages of change’ model’ (Turnbull 2000). The stage of change model is a ‘social cognition model’; focusing upon readiness to change a potentially destructive form of health behaviour i.e. drug misuse. The model has been applied to other health behaviours such as eating disorders as well as to substance misuse (Wilson & Schlam 2004). It refers to a five or six stage process that people go through in their thoughts about their readiness to change. A study of alcohol users found that the number of clients motivated to change was increased by 77% when motivational interviewing was used (Miller & Sanchez 1999). Motivational interviewing is believed to increases the effectiveness of more extensive psychosocial treatments; often the chosen method of treatment used in young people (NTA 2010).

Motivational interviewing although successful, in adult treatment programmes, may not be the best choice of treatment to use when young people are concerned. As previously stated they are unlikely to have used drugs for a prolonged period of time, to develop dependencies (NTA 2010) and so readiness to change, or to contemplate change may not be something they have even thought about and so a ‘pre-occupation’ with lifelong abstinence in a young population may not only be unnecessary but unrealistic, and may actually encourage ‘regular relapse episodes’ (Peele 1987). Young people require guidance and cannot often think about the consequences of their actions, or the harm they are causing themselves by ‘heavy drinking’ (DfES 2004). It is suggested that therapy should encourage the assumption of values toward work, accomplishment, family, and social institutions that facilitate the ‘maturation process’ (Peele 1987).

Harm Reduction is one of the key public health approaches to drug use in recent years (Riley et al 1999). The harm reduction approach attempts to define and discuss drug use in terms of the harm it can be said to cause, and respectively to look at ways of reducing levels of harm (Riley et al 1999). Harm reduction is a term that defines policies, programmes, services and actions that work to reduce the health and social economic harms to the individual, the family, communities or society that are associated with the use of drugs (Newcomb 1992) ‘without necessarily reducing drug consumption’ (Wodak 2011).

A harm reducing approach to illicit drug use focuses on attracting users to services, in the realisation of the fact that many people who have problems with their drug use are not in touch with services (Wodak 2011). Thus, harm reduction policies and programs are offered to those not willing or able to cease their drug use in the short-run; aiming to make services more accessible to drug users as a first step towards treatment; however, this philosophy remains compatible with an ‘eventual goal of abstention’ (CAHM 2009); Programs requiring abstinence as an ‘immediate goal’ cannot therefore be considered harm reduction (CAHM 2009). A ‘goal sequence’ produced by the Aids and Drug Misuse report (ACMD 1988) provides a clear example of a harm reduction approach to drug use; firstly to discourage sharing, encourage the shift from injecting towards oral use, reduce the overall levels of illicit drug use and finally abstinence (ACMD 1988).

Harm reduction accepts that some use of mind-altering substances is inevitable and that some level of drug use in society is normal (CAHM 2009), for young people and alcohol use this is most definitely the case, as most individuals have their first experiences of alcohol during their early teenage years (Marlatt & Witkiewitz 2002). Based on the recent evidence young people would benefit from prevention programmes aimed to reduce the amount of harm experienced by ‘young drinkers’ this may be seen as a more realistic and effective method for educating individuals about the possible consequences associated with alcohol consumption as opposed to abstinence within this particular age group (Marlatt & Witkiewitz 2002). This suggests that Harm reduction in this sense is the best approach when looking at young people and alcohol misuse, as abstinence may be described as ‘unlikely’ within this age group, acknowledging that most ‘adolescents’ will drink, speaking of the possible harms may be enough to reduce harmful levels of drinking by the young person (Marlatt & Witkiewitz 2002).

The Life Skills Training Program and the Alcohol Misuse Prevention Study (AMPS) in the United States and the School Health and Alcohol Harm Reduction Project (SHAHRP) in Australia are described as large scale intervention studies that have been ‘systematically designed’ and ‘evaluated based’ on a ‘harm reduction philosophy’ (Marlatt & Witkiewitz 2002). The life skills training programmes is said to adopt a cognitive behavioural approach to drug abuse prevention; thus providing education on the effects of drugs, teaching skills for resisting social pressure to use drugs, and promoting the development of self-esteem and social skills (Marlatt & Witkiewitz 2002). Whilst SHAHRP combines a harm reduction philosophy with ‘skills training, alcohol education, and activities designed to encourage positive health behaviour change’ (Marlatt & Witkiewitz 2002); Results from a study comparing an intervention group of students who participated in SHAHRP with a control group over a 3-year period, conveyed that students in SHAHRP had significantly lower levels of alcohol consumption and alcohol related harms (Marlatt & Witkiewitz 2002).

In conclusion, harm reduction seems the best approach for young people and alcohol use, it must be stated that they are not as advanced as adults who misuse alcohol thus require harm reduction leading to abstinence. Young people will often ‘eventually “mature out” of harmful drinking behaviour’ (Marlatt & Witkiewitz 2002) and so harm reduction at such a stage should be an appropriate practice in order to highlight the harmful effects to young people enough so that it reduces overall consumption.

‘We need to be able to convince children that life is worth living and that they are capable, not only of avoiding drugs, but of achieving a worthwhile existence (Peele 1987); presenting them with the values of achievement and positive accomplishments; of friendship and community; of health and self-preservation; of fun and adventure; of responsibility for self and contribution to others; of consciousness and intellectual awareness; and of a commitment to life that goes beyond personal protectiveness and fear’ (Peele 1987).

Elder abuse and neglect is a critical health care issue that must be brought to the attention of health care providers and older adults family members. Adults older than 65 who live at home or in long-term care facilities may be at risk for abuse. Nurses should be aware of the causes, screening questions, symptoms of abuse, and resources in the community. Armed with information and a better understanding about the issue, nurses can minimize the devastating effects of abuse on older adults and their families.

Every man, woman, and child deserves to be treated with respect and caring. Individuals of all ages deserve to be protected from harm by caregivers (American Psychological Association, 2006). Significant policy developments during the past 20 years have focused on eliminating abuse. However, a deficit in health care providers’ knowledge and clinical skill application remains. The purpose of this article is to define and describe the kinds of abuse, their potential clinical presentations, and theoretical explanations for abuse to enhance nurses’ knowledge and understanding of their role in its assessment and management in older adults.

BACKGROUND

Abuse is defined as the infliction of injury, unreasonable confinement, intimidation, or punishment, with resulting physical harm, pain, or mental anguish (Table 1). It can also be the willful deprivation by a caregiver of goods or services that are necessary to maintain physical or mental health (American Psychological Association, 2006). Elder abuse and neglect has plagued society for centuries but only recently has the issue come to the attention of health care providers, law enforcement agencies, and protective services. Fewer research studies exist about the maltreatment of older adults than about other forms of family violence, including child abuse, rape, and intimate partner violence. The earliest reports of elder abuse and neglect in the United Kingdom in the 1970s dramatized case reports of the phenomenon, termed “Granny battering.” The health care community and the public were shocked and appalled. A decade later, studies confirmed that the problem was common in the United States as well.

In the late 1970s, the U.S. Senate Special Committee on Aging issued a series of reports on abuse and neglect occurring in nursing homes. In 1981, the U.S. House of Representatives Select Committee on Aging conducted hearings in which victimized older adults gave firsthand testimony of their experiences with abuse. In 1986, the Institute of Medicine published recommendations for preventing the maltreatment of older adults in institutions, and several years later, the Elder Abuse Task Force was created by the Secretary of the U.S. Department of Health and Human Services. The task force developed an action plan for the identification and prevention of maltreatment of older adults in their own homes, health care facilities, and communities. The action plan included data collection, research, technical assistance, training, and public education. The National Center on Elder Abuse was established as part of the Administration on Aging’s Elder Care Campaign. Adult Protective Services programs now exist in every state to serve vulnerable adults, particularly older adults, who may be at risk for abuse and neglect. Many law enforcement agencies and Offices of the District Attorney have investigative staff specifically trained to address abuse of older adults and other vulnerable populations, in collaboration with health care and protective service professionals.

Such actions have led to increased public and health care provider awareness about elder abuse and neglect. Researchers have also sought to grasp the full scope and causes of maltreatment among older adults. Laws that require health care providers to report suspected cases have been instituted in nearly every state. The Joint Commission on Accreditation of Healthcare Organizations’ (2006) standards for emergency departments and ambulatory care centers call for improved identification and management of elder abuse, in addition to intimate partner violence and child abuse.

As the U.S. population ages, demands placed on health care systems to care for older adults are increasing. More than 36 million people who live in the United States are older than age 65, and 600,000 older adults will require assisted living (U.S. Department of Health and Human Services, Administration on Aging, 2006). Currently, there are approximately 17,000 nursing homes in the United States, with 1.6 million residents (U.S. Department of Health and Human Services, Administration on Aging, 2004). Unfortunately, older adults are becoming victims of intentional abuse and neglect within their own homes, as well as in assisted living and long-term care facilities.

Each year in the United States, 1 to 2 million adults older than age 65 are injured, exploited, or mistreated by their caregivers (National Research Council Panel to Review Risk and Prevalence of Elder Abuse and Neglect, 2003). One community-based, cross-sectional survey reported that 32 of every 1,000 older adults reported that they had experienced some form of maltreatment at least once since reaching age 65 (Pillemer & Finkelhor, 1988). Underreporting is typical with all kinds of abuse, and it is estimated that only 1 in 14 elder maltreatment cases are reported. Health care providers can expect to see a steady increase in the number of cases of elder maltreatment as the older adult population rapidly increases.

THEORIES OF ELDER ABUSE

Elder abuse is a complex problem with multiple risks and causes. Dysfunctional family lives, cultural issues, and caregiver inadequacies have been implicated as contributing factors. Awareness of such factors may help nurses understand and anticipate situations where maltreatment may be preventable.

Several theories attempt to explain the existence and increasing occurrence of elder abuse. The transgenerational, or social learning, theory asserts that violence is a learned behavior. Individuals who have witnessed or been victims of family violence are more likely to try to resolve challenging and difficult life situations with violent tactics they learned in their formative growth. Although 90% of perpetrators of elder abuse are reported to be family members, this cannot account for all cases (Fulmer, Guadagno, Bitondo, Dyer, & Connolly, 2004).

Situational theory supports the idea that the greater the burden on caregivers, the more likely caregivers are to abuse. Exchange theory addresses the dependence of older adults on their caregivers as a risk of abuse, along with inadequate methods of problem solving as an established pattern of family behavior. Political economic theory addresses the changing roles of older adults. Their loss of independence and income may cause them to look to others for care and support (Fulmer et al., 2004).

Psychopathology of the caregiver theory studies caregivers with severe emotional or mental health problems or addictions that put the older adults for whom they care at risk of being abused. For example, a caregiver with a mental health problem who cares for a frail older adult with cognitive impairment is a dangerous combination and may lead to resistant behavior and maltreatment. Although theoretical frameworks cannot explain all cases of elder maltreatment, they can provide a foundation for nurses to begin to understand the combination of factors responsible for the occurrence of elder abuse and initiate a holistic plan of care.

NURSING ASSESSMENT & INTERVENTIONS

Nurses are in an ideal position to play a significant role in the detection, management, and prevention of elder maltreatment and may be the only individuals outside of the family who have regular contact with an older adult. Nurses are uniquely qualified to perform physical and psychological assessments, order confirmatory diagnostic tests (e.g., blood tests, x-rays), and collaborate with physicians and protective services. They may authorize services, such as home health care, or recommend hospital admission as they initiate further investigation by the appropriate local agencies.

Opportunities for abuse detection and intervention occur daily in health care settings. In institutional settings, nurses may monitor patient health and perform health history interviews and physical, psychological, sexual, and financial abuse assessments that may be crucial to elicit reports, expose or prevent abuse, and intervene for patients’ safety (Wieland, 2000). Nurses and other health care providers are part of an interprofessional team collaborating to ensure appropriate, sensitive, and safe outcomes for older adult patients.

Institutional maltreatment occurs in long-term care facilities, board-and-care homes, and other assisted-living facilities. Institutional medical directors, private practitioners, nurses, and all health care workers in daily contact with older adults have a responsibility to identify, treat, and prevent abuse.

Abuse may be perpetrated by a staff member, another patient, an intruder or a visitor, or a family caregiver. Abuse may include failure to implement a plan of care or provide treatment, unauthorized use of physical or chemical restraints, and use of medication or isolation for punishment or staff convenience. Nurses must be aware of patient diagnoses, medical orders for care, and medications and their side effects to recognize what is suspicious and needs further evaluation or warrants a report to supervisors. However, most elder maltreatment does not occur in institutions but in the home at the hands of a caregiver, often a family member.

Unless nurses are educated about abuse and how to observe suspicious injuries, elder abuse may be difficult to detect. Definitions of the kinds of abuse and their signs and symptoms should be included in the training and education of family members and health care workers who care for older adults. Older adults experiencing abuse may be unable to communicate clearly, their bruises may be attributed to the aging process, or they may be fearful and hesitant to report abuse (Wieland, 2000). Indications of physical abuse should signal health care providers to evaluate for other kinds of abuse, such as sexual abuse.

In addition to inadequate information, training, and the caregiver’s experience of caring for older adults, older adults are at risk for maltreatment due to other vulnerabilities. Older adult residents in institutions are typically dependent and chronically ill and may have cognitive, visual, and auditory impairments. They are usually more frail than are younger patients and may not have regular visitors who monitor their mental status, physical condition, or health care. In older adults, each vulnerability increases their mortality risk (Fulmer et al., 2004).

Co-existing conditions and medical diagnoses may lead to worse outcomes for older adults who are abused. They may have a decreased ability to heal after injury and may experience greater trauma from physical injuries than do younger people. Their bones are more brittle and tissue more easily bruised, abraded, and lacerated with minimal trauma. Injured older adults differ from the younger population in terms of cause of injury, physical and psychological responses to abuse and injury, and outcomes.

Dementia is common in 50% of residents of long-term care facilities (National Center for Health Statistics, 1985), and cognitive impairments often cause older adults to behave in a more resistant manner toward caregivers. Impaired cognition, along with insufficient resources, staff shortages, high staff turnover, and inadequate supervision and training, may increase the risk of elder maltreatment. In addition, societal ignorance about required standards for quality care and victimized older adults’ acceptance of abusive or neglectful behavior can lead to exacerbation of elder abuse in institutions.

Routine questions related to elder abuse and neglect can be incorporated into daily nursing practice. Diminished cognitive capacity does not necessarily negate older adults’ ability to describe maltreatment. It is always reasonable for nurses to ask about abuse or neglect. A brief mental status examination can be helpful in evaluating patients’ cognitive status.

Assessment for elder abuse should include caregiver, as well as victim, evaluation. Nurses should conduct interviews and examinations with the patient first, in a private setting separate from the caregiver.

Clinical settings should have a protocol for the detection and assessment of elder maltreatment. Protocols should consist of a narrative, checklist, or standardized forms that enable rapid screening for elder abuse and provide guidelines for sound documentation that may help disclose patterns of abuse over time and will withstand scrutiny in court. Basic demographic questions should be included and should allow the interviewer to determine the family composition and socioeconomic status. Interviews should proceed from general questions that assess the patient’s sense of well-being to those focusing on specific kinds of abuse. Common signs and symptoms of maltreatment should be evaluated (Table 2).

Elder abuse screening instruments are summarized by Fulmer et al. (2004). Questions recommended by Wieland (2000) for general abuse screening and assessment include:

* Do you feel safe where you are living?

* Who is responsible for your care?

* Do you often disagree with your caregiver(s)? If so, what happens?

* Does anyone scold or shout at you, slap or hit you, or leave you alone and make you wait for care or food?

After general screening questions, more specific questions about kinds of abuse may follow:

* Has anyone ever touched you without your consent?

* Has anyone ever made you do things you did not want to do?

* Has anyone ever taken something that was yours without asking?

* Have you ever signed any documents that you did not understand?

Health care providers do not have to prove that elder maltreatment has occurred. They need to screen and document suspicious verbal and physical findings, which may be as simple as stating that the patient seems to have health or personal problems and needs assistance. Sound documentation may include drawings of injuries on body diagrams or photographs to support written reports. Suspicious claims for abuse and neglect may be difficult to quantify. Diagnosis of elder maltreatment depends on education about abuse and application of that knowledge by the multidisciplinary team of health care providers, law enforcement agencies, advocates, and patients. Protocols for elder abuse screening, assessment of risk factors, and documentation should be posted in all health care facilities.

ABUSE AND THE LAW

National standards for care in nursing homes are based on the Nursing Home Reform Act of 1987. The law is part of the Consolidated Omnibus Budget Reconciliation Act of 1987, often referred to as OBRA 87. The intent of the law is to promote high-quality care and prevent substandard care. The law also seeks to ensure that the rights of nursing home residents are respected. These include:

* The right of protection against Medicaid discrimination.

* The right to participate in health care decisions and to give or withhold informed consent for particular interventions.

* The right to safeguards to reduce inappropriate use of physical and chemical restraints.

* The right for provisions to ensure proper transfers or discharges.

* The right to full access to a personal physician, long-term care ombudsman, and other advocates.

* The right to be free from verbal, sexual, physical, or mental abuse, corporal punishment, and involuntary seclusion.

* The right to be free from physical restraints or psychoactive drugs administered for the purpose of discipline or convenience.

Nearly all states have mandatory reporting laws that require health care professionals and paraprofessionals to report suspected elder abuse and neglect to a designated authority. Some state laws specify that after authorities have been alerted to suspected elder abuse or neglect, an agent of the state must make an onsite investigation in an attempt to corroborate the report. Uniform reporting systems are established, and cases are assigned and investigated by protective services in a timely fashion. Cases are assigned and investigated by protective services in a timely fashion. Nurses may play an important role in preventing and identifying elder abuse, as well as in the subsequent investigation.

CONCLUSION

Elder abuse is a significant problem in the United States and often goes unreported and unrecognized. Elder abuse may be physical, emotional, psychological, sexual, or financial. Immediate care, overnight housing, and care in a safe location, in addition to long-term care and home-delivered food, may be necessary. Elder abuse may be a minor issue that can be easily resolved or it can result in severe and life-threatening debilitation.

The more knowledge health care providers have, the more likely they are to institute strategies for abuse prevention and management. No matter how minor or severe the abuse, nurses have a duty to assess elderly patients according to recommended protocols and report suspected abuse to designated authorities. The multidisciplinary team then works together to help resolve the issue. The application of knowledge about elder abuse includes screening, assessment, and sound documentation in an attempt to enhance the quality of life and maximize the functional ability of older adults.

[Sidebar]

Domestic violence is acknowledged as a significant issue within Malaysia. Historically, women non-government organizations (NGOs) have made violence against women a visible issue and have laws and protection services for victims of gender violence. In the year of 1994, the Domestic Violence Act was finally passed by Parliament, making Malaysia the first Asian and Muslim country to adopt such legislation. Government and Women’s groups have make hard afford in raising awareness around the issues of domestic violence due to Malaysia has a high level of physical abuse of women by husbands and boyfriends. The 1992 WAO/SRM (Women’s Aid Organisation and Survey Research Malaysia) survey revealed that 39 percent of women have experiencing battering. In the year of 1995, there were 1409 police reports of domestic violence. 1n 1997, the first full year of the implementation of the Domestic Violence Act, increase to 5477 reports, representing a 388 percent increase. To sum up, the statistics of domestic violence cases are increasing year by year according to the statistics on marital violence cases of the Department of Social Welfare of the Ministry of National Unity and Social Development (Department of Social Welfare, 1999-2009).

Except the studies on the number of cases reported for domestic violence, there has also been a small body of research conducted in order to recognise the consequential costs to governments in responding to the consequences of such violence. Studies of the prevalence of violence against women indicate that violence is an issue that permeates every corner of society, is widespread and costly. The costs that spend on domestic violence can be found in Justice, Health, Social Services, Education, Business Costs, Personal or Household Costs. Consequently, the costs of violence against women drain resources from many sectors including private businesses and agencies, the government, community groups and individuals. In brief, for the long run, violence against women will impede economic and social development in Malaysia.

Majority of the research on domestic violence tend to place the attention on its causes and consequences as well as short-term crisis intervention such as provision of accommodation, welfare assistance and other emergency support and advocacy services. However, less attention has been given to the long-term impact of intimate partner violence on battered women’s career development and the role of career counselling interventions in empowering battered women to become economically independent. Therefore, this paper aim at exploring a more comprehensive and extended framework by which the focus is given to the importance of long-term planning in areas such as job search and career development. Thus, rather than continues to concentrating on immediate needs, focusing on the area of career development will reduce the overall expenditure spend by the government or society and also provide an opportunity for the victims of domestic violence for long-term independence as more people enter the workforce. According to the Women’s Aid Organization annual report, there is a need for a more long-term approach to the issue of domestic violence in Malaysia.

Since the topic of this paper is to discuss about the domestic violence and career development in Malaysia, thus, firstly, the author will examines the impact of domestic violence on career development. Second, it places the issue of career barrier encounter by battered women, and third it explores the work of Bandura (1989) and Gianakos (1999) to understand career orientation. Finally, by drawing on these concepts builds a framework which provides a pathway for domestic violence victims to attain sustainable employment and independence.

The Impact of Domestic Violence on Women’s Career Development

The impact of domestic violence on women’s career development can be devastating. The constant denigration associated with emotional abuse destroys women’s beliefs in their competence and worth. Physical states and injuries resulting from physical and sexual abuse limit women’s ability to go to work, complete job tasks, and advance in their job positions (CDC, 2003; Chronister & McWhirter, in press). Battered women also may be isolated and as a result, have fewer opportunities to engage in positive learning experiences, observe role models, and build support networks. These factors, considered from a social cognitive career theory (SCCT) perspective (Lent, Brown, & Hackett, 1994), severely restrict battered women’s range of career interests, formulation of career goals, and persistence toward those goals.

Poverty and employment have been at the forefront of economic and social policy debate in Australia for the last three decades (Saunders 2006). Domestic violence victims not only suffer from a range of physical and mental health problems, but are more likely to have been unemployed in the past and also have higher levels of job turnover (Lloyd and Taluc 1999; Costello et al. 2005). Some work in the USA suggests that women who had experienced aggression from male partners had only one third the odds of maintaining employment for at least 30 hours per week over a six month period (Browne et al. 1999). While some abusers simply prohibit their female partners from working, others take measures to undermine any attempts at employment such as denying them transportation, tearing up clothing, beating them before job interviews and generally demoralising the partner to such an extent that work becomes impossible (Brandwein 1998; Lloyd and Taluc 1999). Such women then have more interrupted work histories, are less likely to seek or achieve promotion and often operate in low paid/low skilled work (Costello, Chung and Carson 2005: Lloyd and Taluc 1999).

In the Australian context unemployment or joblessness as it is now known continues to be the perennial cause of poverty (Saunders 2006). However, there is a lack of Australian research on the links of domestic violence and employment, but what limited work there is has found that training and employment transition services were considered a low priority even though the financial, social and emotional benefits of such interventions were considered significant (Costello et al. 2005, 257). This is very different from Britain and Ireland where the issue of poverty and joblessness has been addressed in a comprehensive way with the setting of anti-poverty targets and long-term solutions (ACOSS 2004).

Domestic violence, no matter whether it be physical, emotional, verbal, economic or social, leads to lower self-esteem and self worth, social isolation, poverty and welfare dependency and poor health for the women and children who are subjected to such abuse (Partnerships Against Domestic Violence 2001, 7; Tolman and Wang 2005, 148). They find they are unable to set short-term goals, have limited information through their social and economic isolation and exist in a climate of fear and these become barriers to seeking full employment and becoming financially independent (Trent and Margulies 2007).

Domestic violence, also known as domestic abuse, spousal abuse or intimate partner violence (IPV), can be broadly defined as a pattern of abusive behaviors by one or both partners in an intimate relationship such as marriage, dating, family, friends or cohabitation.[1] Domestic violence has many forms including physical aggression (hitting, kicking, biting, shoving, restraining, slapping, throwing objects), or threats thereof; sexual abuse; emotional abuse; controlling or domineering; intimidation; stalking; passive/covert abuse (e.g., neglect); and economic deprivation.[1] Alcohol consumption[2] and mental illnessHYPERLINK “http://en.wikipedia.org/wiki/Domestic_violence#cite_note-dutton1994-2?[3] can be co-morbid with abuse, and present additional challenges when present alongside patterns of abuse.

The Ipswich Women’s Centre Against Domestic Violence (IWCADV) is a feminist community based organisation committed to working towards the elimination of domestic and family violence throughout the community. The primary focus of IWCADV is to provide support to women and children survivors of domestic and family violence. This includes telephone information, referral and support services, court support for women, counselling services, group work and children’s work. During my placement experience as a women’s counsellor at IWCADV I first spent a few weeks developing my understanding of the issues involved in domestic violence and the systems that are in place to support women and children who are survivors of domestic and family violence.

My knowledge of the issues affecting women and children experiencing domestic and family violence includes an understanding of the emotional impacts of abuse (such as feelings of grief and loss, anger, guilt, depression, trauma), the loss of personal and physical security, safety concerns, the financial costs, family law and other legal issues, and power and control imbalances in relationships.

I have developed my knowledge of the issues affecting women and children experiencing domestic and family violence in my university studies and my work experience. The understanding that I gained from my University studies was enhanced during my student placement at the Ipswich Women’s Centre Against Domestic Violence. It was here that I developed my understanding of feminist perspectives on domestic and family violence, including the individual, familial, legal and social issues. In this role I was able to develop my understanding of feminist informed practises and techniques. I support this framework for practice as it can empower women and help them find their voice, encouraging women who have experienced the loss of control to make choices about their own life and to take responsibility for their life choices and to take back control. I worked from within a feminist framework to empower the client to find her voice and to discover her worth and make her own choices.

In my role as a student counsellor at IWCADV I provided crisis support and advocacy work to women who have experienced domestic and family violence. During the beginning counselling sessions, I found it was quite difficult to always follow the story and set direction for the counselling. I took a strengths based narrative approach and usually after 2 -3 sessions a clearer picture had developed of the client’s experience with domestic violence, and this continued to unfold throughout the counselling sessions.

One of the most personally rewarding aspects of my counselling experience was the opportunity to explore and experience symbol and sand tray therapy. I spent some time reading Sandplay and Symbol Work – Emotional healing and personal development with children, adolescents and adults by Mark Pearson and Helen Wilson to prepare for my personal experience with symbols and sand tray therapy during my professional supervision sessions. I then had the opportunity to introduce one of my counselling clients to the sand tray. Whilst I did have feelings of uncertainty about my ability to facilitate the process, I did feel comfortable enough with the setting and with my client to create a safe place for self-discovery and self-awareness. She was very open to the process and we both found this to be an enjoyable and meaningful experience. My client reported that this was a very positive experience for her and allowed her to process some of her experiences with domestic violence and that it was a breakthrough for her in terms of learning to accept and value herself. I felt that it was an honour to share this part of my client’s journey.

With another client who was directed by the Department of Child Safety to attend counselling, setting the direction for each session was more difficult. I did not believe that this woman was ready to explore some of the emotional issues related to the trauma that she had experienced as a result of long term domestic violence. I was encouraged by her regular attendance and I believe that this was a result of my increasing ability to develop rapport. I was able to develop good rapport with my clients by being non-judgemental, using open ended questions and appropriate body language. I believe that my skill in developing rapport is reflected by the feedback and regular attendance to counselling sessions by my clients.

I did struggle with ending the sessions on time and frequently found that sessions with some clients were running over 1.5 hours long. I spoke with some of the other workers at the service about this and they agreed that it could be difficult especially when women are exploring very painful issues and that it was important to be sensitive but direct when closing a counselling session.

The group supervision times that I was included in at IWCADV were also very rewarding and inspiring times for me. The other workers at the service were all very passionate women with a strong commitment to empowering women and changing community attitudes about violence towards women. During group supervision there was opportunity and support for workers to reflect on their own feelings of despair and helplessness, and there was encouragement to extend and share your knowledge and understanding of the issues relating to domestic and family violence. The group times were also very rewarding team building occasions and there is a strong commitment at the service to supporting one another. For example, I found that after long phone calls or after a counselling session, another worker would check-in with me to provide any support and to answer any questions that I had.

The following essay examines a case study on a young child that was sexually abused and murdered by a known sex offender, and the serious case review that was written on the case. This essay will also discuss the basic legal policies and the frame work of the Children Act 1989, 2004 and Every Child Matters: National Service Framework. It will demonstrate the understanding of the different types of abuse, an understanding of the child protection system and how it applies to the common assessment frame work. Also the importance of working in a child centred manner will be understood. This essay will criticise the different approaches of multi-professional tactics on child protection. It will take a look at the Lord Laming and Munro reports that were put in place between the death of Victoria Climbie and baby P and safeguarding reforms planned to prevent future deaths.

Zuzanna Zommer was a 14 year old girl who came to live the United Kingdom with her parents and young bother from Poland. Not long after the move, Zuzanna was sexually abused and murdered by a known sex offender named Michael Clark who lived two doors down from the Zommer’s. Unknown to the family and his past history, Clark befriended the Zommer family and would go to family barbeques (Brooke 2008). See appendix 1. Statistics show that nearly a quarter of young adults are sexual abused during childhood, in 2010 and 2011 17.727 children under the age of sixteen were sexually abused in England and Wales (NSPCC 2012).

Several agencies failed in the case of Zuzanna Zommer (BBC News England 2012) due to failed communication between agencies. Michael Clark moved to Leeds after being released from Hull prison prior to meeting the Zommer. Humberside police failed to provide the public protection agencies in Leeds with enough warning that Clark would be moving to the area (BBC News England 2012). See appendix 2

A serious case review was released in March 2012 on Zuzanna Zommer which states that Clark’s childhood was ‘unhappy’. His parents divorced when he was three years old and was brought up by his mother and stepfather, of which he witnessed domestic violence with his mother regularly using physical abuse. Clark was bullied at school and then expelled from junior school before going to a school for the deaf (Cocker 2012). See appendix 3 Over the past thirty years, theories of child maltreatment have shifted from single- cause models (e.g. the transgenerational transmission of child maltreatment, which saw children who grew up with abuse becoming abusive adults) to more integrated and multi-faceted perspectives, emphasising instead a number of interacting factors (Azar et al, 1998; Thomas et al, 2003). Research repeatedly suggests that a history of childhood abuse is associated with low educational attainment and poor physical and mental health in adulthood (Gilbert et al, 2009b;

Safeguarding and protecting children are supported by a complicated system of legislation, guidance, regulation, and procedures (Stafford,Vincent,Parton 2010).

Within the UK, the Department of Health defines child maltreatment in terms of “inflicting harm” and/or “by failing to act to prevent harm” to children (Department of Health, 2006 p26).

“Significant” is not defined in the Act, although it does say that the court should compare the health and development of the child “with that which could be reasonably expected of a similar child”. So the courts have to decide for themselves what constitutes “significant harm” by looking at the facts of each individual case (NSPCC factsheet 2012 p2)

Within the overall category of child maltreatment, four categories of abuse are traditionally recognised (WHO, 2006) World Health Organisation (2006) Preventing child maltreatment: a guide to taking action and generating evidence. World Health Organization and International Society for Prevention of Child Abuse and Neglect. The abuse towards Zuzanna Zommer took 11 months to result in her death during which the sexual abuse of the child went undetected. http://whqlibdoc.who.int/publications/2006/9241594365_eng.pdf [Accessed 25 Feb 2010]

Sidebotham et al (2006) observed that a wide range of factors are associated with child maltreatment, with the strongest risks coming from socio-economic deprivation and parental background, including poor mental health. Community-level variables consistently linked to child maltreatment include lack of social support (including the availability of childcare), neighbourhood poverty and the accessibility of alcohol (Coulton et al, 1995; 1999; 2007; Korbin et al, 1998; Molnar et al, 2003). Social factors, such as beliefs about using physical punishment to discipline children and the portrayal of violence and sex in the media may additionally contribute to abusive behaviour towards children (Belsky, 1993; Straus and Mathur, 1996). Belsky, J. (1993) Etiology of child maltreatment: A developmental-ecological analysis. Psychological Bulletin 114: 413-434.

Following the death of Victoria Climbie, who was known to the social services and many other agencies within the social sector?

Victoria’s parents stated “they had noted that the social worker blames the doctors, front line staff blames the management, mangers blame the council, and the councils blame the government for lack of funding”. Response to the fallings were ‘I am poorly managed’, ‘not my job’, (Laming,2003, evidence 19 February 2002,p97).

Lord Laming was invited to carry out an enquiry looking at the situations leading up to Victoria’s death. His report had a 108 recommendation to safe guard children in the future, this inquiry became known as “the Laming Report” (Laming 2003).

Deryk Mead of Action for Children stated, “I do believe that inquiry reports have made a positive difference to the child protection system, and I have every confidence that Lord Laming’s report will do so too” (Katwala and Ciglerova 2003 p5).

However there was some criticism to his report Caroline Abrahams and Debora Lightfoot from the Action for Children stated the report was looking more at the case of Victoria Climbie and not at children in general in regards to child protection (Abraham and Lightfoot 2003).

.According to Harry Ferguson, a professor of social work at the University of the West of England, “Laming’s report focuses too heavily on the implementation of new structures and fails to understand the keen intuition that child protection work demands”. (Ferguson 2003 p5)

All areas of the UK have policies to safeguard children and young people, to be able to protect them and advertise their general well-being. In 2006 Working Together was re- published on which ideas have been further developed which was again called Working Together to safeguarding Children: A Guide to inter- agency Working to Safeguarding and Promote The Welfare of Children (HM Government 2006).

In 2004 England and Wales were the first to deliver the policy frame work Every Child Matters and recognised the five outcome for children and young people. This was a response to the Laming Report (2003) and to safeguarding children (Department of health 2002). From this the Common assessment framework (CAF) was implemented and used when assessing children and family’s Suffolk County Council (2012)

Every Child Matters was planned to be put in place in 2008, however before it was due to be released the tragic death of baby P happened and the medias response was very critical to all the services involved in his case (Stafford,Vincent,Parton 2010). The system had failed again baby p there had been over sixty visits with the family different health and social care professional he died after 48h of being in hospital (Stafford,Vincent,Parton 2010).

Criticism has been made regarding Every Child Matters and the Children Act 2004 on what should have been a positive social policy programme, is that it only relates to England.

Hilton and Mills (2006) Stated that Every Child matters invades the rights of children’s privacy under article 8 of the European Convention Rights. The loss of space the officer of the Information Commissioner found that children themselves were worried about the invasion of their own privacy (Hilton and Mills 2006).

“While they create a way of seeing and suggest a way of acting, they also tend to create ways of not seeing, and eliminate the possibility of actions associated with alternative views of the world”.(Morgan, 1986, p 202)

Other criticism has been made regarding Every Child Matters and the Children Act 2004 on what should have been a positive social policy programme, is that it only relates to England (Hoyle 2012)

All areas of the United Kingdom are committed to promoting all areas of the national frame work for young people and children. (Stafford,Vincent,Parton 2010).

There is no separate legislation for child protection but legislation covers child’s welfare, including support for children in need and children in need of protection (Lindon 2008). While all parts of the United Kingdom have had some restructuring in recent years to the child protection policy, not much change has been done to the legislation. The children Acts which was put in place the 1980s and 1990s these acts are an intervention in family life to help protect children from abuse and neglect ,and the definition of ‘significant harm’ and ‘children in need’ theses have not been amended (Owen,2009)

The 1989 Children Act still remains, but the Children act 2004has made some amendments. “The Children Act 2004 is primarily about new statutory leadership roles, joint planning and commissioning of children’s services, and how organisation ensure their functions are discharged in a way which safeguards children and promotes the welfare” (Owen 2009 p.17). Section eleven enforced agencies that are working with children and young people to safeguard and promote their welfare, another change was that the Child Protection Committees were replaced by Local Safeguarding Boards ((Stafford,Vincent,Parton 2010).

In 2010 the Government- commissioned Professor Eileen Munro to evaluate the safe guarding practice one of the recommendation was to ask that the ministers establish a national chief social worker whom will advise minister and that the council should be obliged to ensure “sufficient provision such as sure start and other support schemes”.(Butler 2010)

“The report found that safeguarding had indeed become overly dependent on procedures and paperwork, with frontline professionals spending over 60% of their time in front of computer screens”(Butler 2010 p4)

Munro said: “A one-size-fits-all approach is not the right way for child protection services to operate. Top-down government targets and too many forms and procedures are preventing professionals from being able to give children the help they need and assess whether that help has made a difference.”( Munro review 2010)

Some key weakness were found in with the Munro Review this was from social workers, stating that the review states what is being done but dose “not offer the path to a better child protection system” in the future? (Parliament 2012).

In Conclusion this essay has examined an horrific news report on the sexual abuse and the death of Zuzanna Zommer and the back ground of her perpetrator it has looked at how the system failed to protect her from such an ordeal. It has also

The interrelationship between theory and practice is to analyse the client’s strengths based of theory and practise. The important concepts are empowerment and resilience the sources are a big factor in social work because they are the cultural and important stories that are to do with the client. Empowerment can play a big impact on the individual as this can influence their health from their emotions to their beliefs. This is the best way to help the client overcome these certain needs. For example they may need positive thinking and to ignore the negative feedback. (apa psycnet, 1996) Although theory is easy to follow it is also essential to put the theory into practice and to connect with the client.

Whereas (lennarto.wordpress.com, 2009) states that the interrelationship between theory and practice is to analyze the issue non-empirically we could proceed in one of the following two ways: either we could hypothetically take one stance and see what follows from that (e.g., say that there is a close relation between theory and practice, how can we account for that and what would be the – theoretical as well as practical – consequences); or we could make it a normative issue. It is the environmental philosophy there has been a strong suggestion that we should minimize the gap between theory and practice. Shifting the focus from value theoretical issues towards practical real-world why do we need theory in the first place? These issues could be widely extended

This is a demonstration of understanding the use of theoretical paradigms in social work. A paradigm is a group of collective idea’s it is a set of systems which is based on a topic or theme (dictionary, 2012). For this topic I will write about Bandura’s theory behaviourism as a paradigm.

Banduras theory is related to the bobo doll that the children won’t know how to react towards things until they see how their role model acts and then they will take on this behaviour. (experiment resources, 2012) As a social worker and you help the case before it gets out of hand this is changing the behaviour they have modelled to prevent other people won’t pick up this type of behaviour. Bandura’s paradigm can be used in social work because it relates to people’s behaviour. This is important to understand because if a client comes into see you, you need to understand that the client does have history of being violent and with knowing this paradigm you will know what questions to ask to what causes this behaviour. Changing the behaviour to what is considered to be the social norms. Bandura then considered that the personality has relations between three modules: the environment such as where the person lives, behaviour through aggression and the psychological development which is the ability to divert images in the mind and through language. (learning theories, 2012)

As a social worker you have to have an excellent understanding of how practise shapes theory and theory shapes practice. A Theory is a day to day basis to show us how to use practise works effectively. Theory that is evidenced based can impact the theory drastically every day. Through theory you can get the best outstanding models to use in the felid of social work from Te whare tapa wha to code of ethics that are used in practise. (How does theory shape practice in social work, 2010) Te whare tapa wha is a method that is used in social work that illustrates the four walls of MA?ori well- being. The four walls are Taha wairua (spiritual), Taha tinana (physical), Taha hinengaro (mental) and Taha whaanau (family health). (health, 2012)The use of this method is to write down questions in each section to ask your client when they come to see you. Theory shapes practice because theory is a guideline of what the social worker needs follow in order to understand the client. When the social worker is having a session with the client this is the basic needs the social worker will need to know about the client in order to have a successful conversation about what is happening currently with the client. This is where Te whare tapa wha will come in place. This gives the social worker the opportunity to ask the client the questions that they have previously written down according to the notes they had previously received. For instance if the client was a violent person and preformed violent actions towards an object or human, a question under mental health could be “tell me why you feel angry and what kind of thoughts do you have when you feel angry?”. A series of questions can be asked in order to get the right amount of information out of the client in order to help the client recover. They could feel that they have to be violent because that’s what their parents had shown them when they were younger. With this in mind you are able to relate to the client and understand where they are coming from. The Reflection cycle is important because this is what helps get the client on the right track with what they are trying to succeed. This area there are 6 elements to this area’s these are Description (to explain what has happened?), feelings (how the client is feeling and what their thoughts are?), Evaluation (What are the good points and bad points about what is happening?), Analysis (What can you tell me about this situation?), Conclusion (what else do you think you could have done) and finally the Action plan (what would you do if it was to happen again?). (brookes.ac.uk, 1998) This is a good strategy to help a client reach their goals. Each time a social has a meeting with the client the strategies have to be different but still following the format and then the cycle is to start all over again. This is a good way for the client to tell the social worker about what has been going on in their life and in their environment. With the social worker knowing these answers it then give the social worker the appropriate time to ask the client any questions to go further in depth for why they might need your help. You may then need to ask the client about what is going on and how the situation can make the client feel. Another view is that if the client was violent you would be able to trace back to when this first happened and strategize a way with the client of how they can fix this habit in their own way and own pace.

Another form of reflection is the Layers of reflection. These contain: The Reflection-on-experience which is to reflect after the event/ situation has taken place and understanding what has happened in a positive manor. Reflection-in-action to understand the experience and take the information gained towards new goals. Reflection-within-the-moment becomes aware with what is going on with the thinking and understanding of the situation and to respond in discussion. And finally Mindful practice is aware with what is happening throughout practice. (Becoming Reflective, 2004) This is also a good model for a social worker to follow to get a full understanding of their client and also the client will be able to see the progress they are making for extra encouragement if they feel that they are close to giving up.

Conclusion:

In conclusion I will have explained and demonstrated my knowledge of the relationships between social work and theory and how the theory and practise link together. I then explained what theoretical paradigms and how Bandura’s behaviourism fits into place with the paradigm and social work theory. And finally I would have linked behaviourism into Te whare tapa wha in the areas of has practise influences theory and how theory influences practise in a clear pattern with examples of reflective is important in social work theory.

This essay will outline and explain why inter professional collaborative practice in social work is important. It will also examine key factors that help or hinder effective inter professional collaborative practice. It will explain why it is important that professionals work together and effectively as a team and the consequences that can occur when professionals fail to collaborate successfully.

There has been a great deal of political and professional pressures for the development of inter professional collaborative practice. From the late 1990’s onwards there were vast amounts of official documents to promote the importance of collaborative working within the health and social care sector. The 1998 social services White Paper Modernising Social Services (DoH, 1998) and The NHS Plan (2000) devoted entire chapters to the subject. It has been argued that inter professional working has advanced further in relation to services for older people than it has in relation to children and families. The Green Paper Every Child Matters (DfES 2003) recognised this and one of the main elements of this paper focused that improved collaboration was required so as not to repeat the tragic events of the Victoria Climbie case (this case will be discussed in further detail later in the essay). Government recognition suggests that many social problems cannot be effectively addressed by any given organisation acting in isolation from others. That is, when professionals work together effectively they provide a better service to the complex needs of the most vulnerable people in society. Inter professional collaborative practice involves complex interactions between a range of different professionals and is when professionals work together as a team to reach mutually negotiated goals through agreed plans. It is a partnership that can be defined as a formal agreement between the different professions who agree to work together in pursuit of common goals. Collaborative is defined as putting that partnership into operation or into practice. It involves the different professions working together and using their own individual skills instead of working in opposite directions to meet the needs of particular service users. It is suggested that when social workers and other professions work collaboratively the service user gets a better deal. ‘Willing participation (Henneman et al, 1995, cited in Barrett et al, 2005, p.19) and a high level of motivation’ (Molyneux, 2001, cited in Barrett et al, p.19) have been stated as vital aspects of effective inter professional collaboration.

Social workers have certain ethical obligations to society that they must follow and this comes in the form of The British Association of Social Work (BASW) Code of Ethics and the National Occupational Standards for social workers. The Code of Ethics follow five basic values, Human Dignity and Worth, Social Justice, Service to Humanity, Integrity and Competence whilst the National Occupational Standards outline the standards of conduct and practice to which all social workers should adhere to. Whilst working in collaboration with other professionals, social workers should follow these Codes and Standards to ensure that the best possible outcome is achieved for the service user.

In the past inter professional collaborative practice has been difficult with many disadvantages and that this has caused problems between the different professions involved. This has in the past led to catastrophic tragedies as in the case of Victoria Climbie. Shared accountability is important for effective collaboration and all professionals should be accountable. Each profession should support one another, not be seen as self interested and that no one profession is higher than another. Some of the problems that can occur are when there is not a logical distribution of power. ‘Unequal power distribution can be oppressive’ (Payne, 2000, cited in Barrett et al, 2005, p.23) and can limit participation for some group members. Struggles for power are rooted in professional tradition and social difference. It is believed by some critics of social work that ‘social workers have often been located in settings where they were considered as subordinate to other more established professional groups’ (Brewer and Lait, 1980, cited in Wilson et al, 2008, p.401). Traditionally there have been difficulties within the medical profession and Cooke et al, (2001, cited in Barrett et al, 2005, p.23) suggests that ‘general practitioners felt threatened by a redistribution of power and had problems letting go of their traditionally held power base’. Social work in the past has been described as a semi profession and similar to nursing and teaching and not comparable to the ‘learned profession of medicine or law as it does not have the required features of those professions’ (Freidson 1994). Payne (2000 cited in Barrett et al, 2005, p.23) identifies this as ‘people’s capacity to get what they want’. Power in inter professional collaborative practice should be shared and distributed and no hierarchy of power should exist. If some professionals see themselves as more powerful than another they are not meeting the needs of the service user. Being territorial and not sharing information and knowledge has long been a problem in inter professional collaborative practice. Molyneux (2001, cited in Barrett et al, 2005, p20) ‘found that professionals who were confident in their own role were able to work flexibly across professional boundaries without feeling jealous or threatened’. ‘Professional adulthood’ was an expression used by Laidler (1991, cited in Barratt et al, 2005, p.20) to describe professionals who were confident in their own role to share information and communicate effectively with other professionals. These professionals do not feel territorial about relinquishing their knowledge and understanding to further enhance good inter professional collaborative practice. Stapleton (1998, cited in Barrett et al, 2005, p.20) suggests that ‘a combination of personal and professional confidence enables individuals to assert their own perspectives and challenge the viewpoints of others’.

Open and honest communication is a vital and probably one of the most important aspects of inter professional collaborative practice. It requires professionals to take into account each other’s views, be respectful, dignified and to listen to each other without being highly critical of one another. Constructive criticism needs to be undertaken alongside constructive suggestions and encouragement and should take place at a time when other professionals are receptive. Active listening is an important skill. To be able to recognise and respond to what is being communicated is a fundamental skill. Professionals working collaboratively should demonstrate this verbally and non-verbally to each other. This is greatly helped if all concerned put aside the typical stereotyping of each other’s professions in order to hear and listen to what the speaker is saying. Keeping good eye contact and having good body language is just as important. ‘It is estimated that approximately two-thirds of communication is non-verbal, i.e. something is communicated through ‘body language’ – by a body movement, a posture, an inflection in the voice’ (Birdwhistell, 1970, cited in Wilson, 2008, p.297). A breakdown in communication and the lack of sharing of information between the professions in the past have been major failings in inter professional collaborative practice for example in high profile child protection inquiries and this has led to tragic consequences. Effective systems of communication and knowing what information should be shared are essential not just between the professions but also between the service users.

Trust, mutual respect and support are key features to inter professional collaborative practice. Trust was highlighted by many professionals as one of the most important factors in successful collaboration. When trust is absent professionals may feel uncomfortable and insecure in their role and this in turn can lead to defensive behaviour to counteract their insecurities. Stapleton (1998, cited in Barratt et al, 2005, p.22) suggests that ‘trust develops through repeated positive inter professional experience and develops gradually over a period of time’. Trust cannot be gained overnight so it is important for professionals working collaboratively to give one another time for trust to develop. When professionals feel valued, they feel respected. This can be achieved by actively listening to each other and having an insight into one another’s professions.

Conflict between the professions can have a huge impact on the different professionals and service users. Loxley (1997, cited in Barrett et al, 2005, p.24) suggests that conflict is ‘interwoven with collaborative practice’. To counteract some of the problems associated with conflict it may be beneficial to all concerned to form ground rules. These ground rules could go some way to prevent and help the management of conflict and could include; open discussion and the obligation to be able to give each other honest feedback. Most importantly these ground rules need to benefit all parties involved.

A great deal of emphasis is placed on social workers to critically reflect their practice. It literally means that social workers reflect on their practice before, during and after, thinking through tasks carefully. Other professionals may not do this in line with social workers beliefs of critical reflection or in the same way or see that reflection on their own practice is an important aspect of successful inter professional collaborative practice.

To illustrate the above points a practice example will now be explained. The inquiry into the death of ten year old Victoria Climbie highlights the disastrous consequences when communication in inter professional collaborative practice fails. This child death case was fraught with communication breakdowns across the range of professionals associated with the case. In Lord Laming’s report (2003) he draws attention to and illustrates lack of communication as one of the key issues. Victoria Climbie was failed by a system that was put into place to protect her. Professionals failed in this protection by not communicating with each other or with Victoria herself. One of the criticisms in the Laming Report (2003) was that none of the professionals involved in the case spoke to Victoria about her life or how she was feeling and suggests that even basic service user involvement was absent. There was an opportunity which is highlighted in his report that a social worker missed an opportunity to communicate with Victoria by deciding not to see or speak to her while she was in hospital. It could be argued that if basic levels of communication with Victoria herself had been implemented, then more could have been achieved to protect her. It was not only a lack of communication with Victoria herself but a lack of communication between the professions that were investigated in the Laming Report (2003). Communication is equally important between the service user and the different professional bodies. Professionals are less effective on their clients’ behalf if they cannot communicate precisely and persuasively’. (Clark, 2000, cited in Trevithick, 2009, p.117). For successful inter professional collaborative practice to work a combination of personal and professional skills are required, together with competent communications skills to enable the different professions to challenge the views of others. Recommendation 37 of the Laming Report (2003) states ‘The training of social workers must equip them with the confidence to question the opinion of professionals in other agencies when conducting their own assessment of the needs of the child’. On at least one occasion, this did not happen when a social worker did not challenge a medical statement which turned out to be professionally incorrect which in turn led to the tragic eventual death of Victoria. Had the social worker challenged the medical opinion in this instance then it could be argued that more efficient communication and less confusion in the case may have saved Victoria. Alan Milburn (Hansard 28 January 2003, column 740, cited in Wilson et al, 2008, p.474), the then Secretary of State commented when introducing the Children Bill in the Commons that ‘Victoria needs services that worked together’ and that ‘down the years inquiry after inquiry has called for better communication and better co-ordination’. Communication lies at the heart of high quality and successful inter professional practice and Victoria is just one case of when there is a lack of communication between the professionals and the devastating consequences that can arise.

In conclusion, successful inter professional collaborative practice has many elements and all these different elements require that the different professions adopt them. Although inter professional working practice has been around for many years and is not new, it still needs to be continued, developed and incorporated into the daily work of all professions. When health and social care professionals from different disciplines truly understand each other’s roles, responsibilities and challenges, the potential of inter professional collaborative practice could be fully realised and many of the barriers alleviated, giving a more successful outcome to the service user.

“Social work practice seeks to promote human well-being and to redress human suffering and injusticeaˆ¦..Such practice maintains a particular concern for those who are most excluded from social, economic or cultural processes and structuresaˆ¦.Consequently, social work practice is a political activity and tensions between rights to care and control and self-determination are very much a professional concern”(O’Connor et al, 2006, p.1)

The Brown family case study will be referred to throughout the essay in an attempt to explore and discuss the lived experiences of service users. With such an array of difficulties faced by the family, in order to be able to provide analysis and critique, many of these difficulties and their correlation within social work practice will not be explored. The essay will begin with examining the political background from Margaret Thatcher to the current Coalition government and emphasize their continued functionalist ideologies. It will also discuss sociological constructions of the family, poverty, power, and managerialism.

The prolific cases of the deaths of Victoria Climbie and Baby P led to such media scrutiny and a downward turn in public perception of social workers. As a result, this has led to changes in social work practice with children and families.

Due to the current austerity measures, social workers gatekeeping of resources and having to meet stringent thresholds often result in limitations being put on families and creating what aˆ¦aˆ¦aˆ¦aˆ¦aˆ¦..describes as a revolving door syndrome. The Brown case study refers to there being intermittent involvement from social services over several years, which supports the suggestion of a revolving door syndrome. Although the case study is not explicit, I think it would be safe to assume that issues faced by the Brown family may have suggested that they meet the section 47 threshold set out in the Children Act which would have triggered social work involvement with the family. However, if the involvement has been intermittent, this would suggest that once significant risk had diminished the involvement with the family was stopped which suggest risk led practice was employed rather than a needs led (Axford, 2010).

Munro’s recent review of child protection (2011) included 15 recommendations. There is not scope to discuss each recommendation but she urges the government to accept that there will inevitably be an element of uncertainty, to allow professionals to have a greater freedom to use their professional judgement and expertise, and to reduce bureaucracy. The response from government is to accept 9 out of the 15 recommendations (DfE, 2011)

Poverty

The case study highlights that the Brown family are dependent on welfare benefits and that they find it difficult to manage their finances. Therefore, they are essentially living in poverty. Poverty can be described as a complex occurrence that can be caused by a range of issues which can result in inadequate resources. It impacts on childhoods, life chances and imposes costs on society

“Child poverty costs the UK at least ?25 billion a year, (equivalent to 2% of GDP) including ?17 billion that could accrue to the Exchequer if child poverty were eradicated. Public spending to deal with the fallout of child poverty is about ?12 billion a year, about 60% of which goes on personal social services, school education and police and criminal justice”. (Hirsch, 2008: Joseph Rowntree Foundation,p.5)

Cross national studies have suggested that child poverty is not a natural occurrence. Moreover it is a political occurrence, the product of decisions and actions made by the government and society. Attention concerning a dependency culture has filtered through different political parties and have been utilised with renewed enthusiasm since the formation of the coalition government in 2010. These assertions of dependency create propaganda about the attitudes of the workless and they give the wrong impression of the previous efforts of the Labour government to tackle child poverty who focus was to direct increased welfare payments towards those people who are working in low paid jobs. The coalition is currently reducing benefit payments to families in work. As a result of these cuts, many children will evidently be thrust back into child poverty (aˆ¦aˆ¦aˆ¦).

A possible contention is that the coalition government argue that they seek to treat the symptoms of poverty, rather than the causes. However, their analyses of the causes are at best partial or incomplete. While in-work poverty is acknowledged, it is often buried beneath the rhetoric of welfare dependency (ESRC, 2011). The suggestion that previous methods to tackle child poverty have inevitably robbed people of their own responsibility and therefore led them to become dependent on the welfare state that simply hands out cash is absurd (Minujin & Nandy, 2012).

Work is frequently referred to as the favoured route out of poverty. Although the government have introduced numerous policies to ‘make work pay’ there are countless families that still do not earn enough money to attempt to lift their family out of poverty (Barnardos, 2009). More than half of all children currently living in poverty have a parent in paid work (DWP, 2009). The Brown family have both parents out of work, with Anne having never been in paid work and Craig struggling to find regular employment since leaving the Army 8 years ago. Both parents have literacy difficulties and so require a complex package of support to enable them to improve their life chances of gaining employment that pays above the minimum wage in order for their family to no longer be living in poverty.

According to the code of practice (HCPC, 2012) social workers are required toaˆ¦aˆ¦aˆ¦aˆ¦aˆ¦aˆ¦aˆ¦aˆ¦aˆ¦aˆ¦aˆ¦aˆ¦aˆ¦aˆ¦aˆ¦aˆ¦aˆ¦aˆ¦aˆ¦aˆ¦aˆ¦aˆ¦aˆ¦aˆ¦aˆ¦aˆ¦

As mentioned previously, successive Neo Liberal governments uphold a functionalist ideology that frequently locates poverty in terms of personal responsibility and deficits.

Managerialism

As mentioned previously, services have changes over the past 20 years and this can be explained by the emergence of a managerial approach to how services are being delivered. Intrinsically, managerialism is a basic set of ideas that transpired from the New Right criticisms of welfare and is founded on the notion that public services need to be managed in the same way as profit-making organisations (Harris & Unwin, 2009). In the UK there has been a rise in managerialism which can often lead to weakening the role and autonomy of social work practice. In the pursuit of becoming accountable and impartial, managers are attempting to control or prescribe practice in increasing detail which inexorably leads to reducing the opportunity for practitioners to implement individual reasoning. As a result, this leads to policies that represent rules that can often be described as inept and insensitive for the service user. Therefore, the tussle between the managerial and the professional control in social work practice is often a contested issue (Munro, 2008). As managerialism takes more control, then a shift towards defensive practice develops which results in procedures that are insensitive to the needs of families. In essence, the professional role of a social worker can be progressively reduced to a bureaucrat with no possibility for expertise or personalised responses

In addition, a managerial approach causes conflict, as it emphasises the need for targets that will assess performance and the delivery of services (Brotherton et al, 20120). Furthermore, there is a correlation with an apparent distrust or autonomy of professionals. This has led to an upsurge in scrutiny by a variety of inspection bodies such as Ofsted and this has been extremely significant in the area of child protection following the high-profile cases of the deaths of Victoria Climbie and Peter Connolly.