The International Context For Healthcare Policy Social Work Essay

This assignment is done to explore the international context for healthcare policy and orgs of healthcare. It also helps us to understand contemporary issues and promotion of healthcare. The political, cultural and social issues that help to determine healthcare policy are also analyzed in this assignment. Our 1st task is to analyze approaches to healthcare policy formation in some international context and here the National Drug Preference Alliance organization is chosen for assessment. The goal of this organization is to save the addicted ones and to promote effective policies, preventing, giving education and knowledge regarding the drugs consumption and its problems caused in society. This organization’s track contains how to approach the study of health care organizations from different angles of theoretical perspectives, levels of analysis, and methods. Organizational theory tries to create a healthier nation and is seen as involving the whole of the community, basically it is an interdisciplinary course of study. Rooted in sociology and social psychology, these healthcare policy approaches developed different variety of theories and methods for the study of organizations. Considering approaches, social and political science provides theories to analyze power relations and decision-making in all kinds of organizations that are held in United Kingdom.

Next task is to assess the influence of funding on policy formation in NDPA organization. Within any of the health policy field, there are chances for formation of healthcare policy. Without creation of a policy, the organization is not worthy enough for the society. A growing literature is trying to understand the various responses of policy makers to research; they explain why certain research findings pave their way into policy and why some others are effectively ignored. It is necessary to fund the policy formation. Else the formation of policy will simply be a dream or just in theoretical papers. The members of the organization must be ready to fund the policy formation. They have to get the help of politicians, social workers, the public, technicians, etc. and they must have some members among themselves who are able to fund for the policy formation. They can also provide fund from the public, can take loans, charity funds, etc. for the formation of healthcare policy. The government is always interested in funding for NDPA organization as it has taken a great role in saving the society from drug addicts and NDPA organization has become a crucial organization for the both the society and the government.

Next task is to evaluate healthcare policy in NDPA organization. With the awareness spread by NDPA organization, the government of the country has made drugs as illegal. It has been declared that the use of drugs is illegal and can lead to the imprisonment of the user along with penalty.it has been estimated that 22% of passengers and 18% of drivers who have been involved in fatal accidents have taken illegal drugs. This statistics shows the importance and urgency that is required for the formation of policy in England. The police in the nation are always engaged in testing policies. It is also declared by the government that drug takers harm no one but themselves. The legislature is spending much part of their time for freeing the nation from the addicts. They have led the focus of government towards drugs. In today’s life the impression is that everyone is into drugs. Nowadays drugs have been considered as a style of living and Britain is leading in this style. It is considered as today’s style accessory. The government has taken many policies to reduce the consumption of drugs. Many awareness programs have been conducted in each and every part of the country. Retreat centers are open throughout the nation for helping the drug victims.

In this assignment next we have to assess the impact of culture on healthcare. Culture can be defined is the way people live. It is natural that culture affects everything we think and do, from how we look after our elders, to whom we are allowing to be a healer, and to what we do when our children are not feeling well. Culture plays an important role in our lives. Like our genes shape our health, so does culture does. The way we define ourselves culturally influences what we will do for others health. So it can be understood that a good health care provider recognizes all these facts and tries to learn about the different cultures of his or her patients. It is not possible to summarize the cultural behavior of patients. It varies from one patient to other. Culture is a vast area. There is a variation that exists among individual members of a cultural group. Learning about general health beliefs and customs of an area would prove to be good while dealing with the patients of that area. It also provides the health cares with experience.

Next is assessing the impact of society with healthcare. Society and healthcare are related deeply together. Any society with ill people won’t lead to development of society. If the society consists of healthy people, then they can lead the society and their nation towards development. Even though Britain is one of the greatest developed nations in the world, it is now the biggest drug user in Europe. Due to this addiction towards drugs different kinds of social and economic disaster can happen. For those drugs which no remedial measures were taken. Reducing its effect requires commitment from the area such as social, political, and economic across industries and governments and also through unique public-private partnerships. These three above mentioned factors force the governing and relevant non-governmental authorities on stream of continual decisions. Not depending on if the need for decisions is adequately there or addressed, unnecessary issues can promote the growth of drug addicts. Nowadays strategies were developed with regard to the research and development that is for preservations of pathogens and how they preserved. To the enhancement of preservation the wellbeing of researchers and the peoples around them these steps were taken and also to ensure the integrity of the surrounding environment.

Next we have to analyze the attitudes towards healthcare. The organization also deals with other important aspects like providing care for older patients, teamwork in teaching process and making awareness and giving training to new comers in the organization. They provide motivation to the drug addicts to live in a normal way and they motivate them to join the organization and save other victims of the drug. To determine the attitudes of healthcare and healthcare workers baseline surveys are conducted. As a result they obtain attitudes of public towards healthcare and they can assess and analyze the progress of their work. Most students in each group of the organization profession agreed that the disciplinary teamwork approach benefits patients and tries to effectively utilize the time for any productive purpose. Several studies conducted have estimated that physician’s attitudes towards prevention, cure and barriers to the delivery of preventive health strategies are effective. All that they require is the cooperation of the people, so that they can change the face of the drowning world. A standard can be considered as a level of quality against which performance can be measured. These are essential in healthcare sector to ensure safe and effective practice. Developing and maintaining the quality of services provided by the organization is a major objective for those involved in the planning, provision, delivery and review of health and social care services since there exists unacceptable variation in the quality of services provided, including timeliness of delivery and the ease of access.

Next we have to evaluate the cultural and social impacts on and attitudes towards healthcare in NDPA organization. The organization is highly influenced by cultural impacts. They study the different cultures that exist in the current society and work accordingly to save the society from the hands of drugs. Learning about general health beliefs and customs of an area would prove to be good while dealing with the patients of that area. It also provides the health cares with experience. In case of social impacts we have to consider a variety of facts. Drug addiction the cause for most of the economic and social disruption or disaster. Factors such as political, social and economic make governments and relevant non-governmental authorities upon continuous stream of decisions. NDPA organization has held a great attitude towards healthcare sector. They have taken the initiative to save the people of the nation from dying. They have always held appositive attitude towards healthcare. Depending upon the interest of public that makes some way into social organization and decision policy are made. All that they require is the cooperation of the people, so that they can change the face of the drowning world.

Net we have to analyze how healthcare policy is translated into practice in the organization. Translating the healthcare policy clinical practice is a valuable initiative for services for health so that the care given to the patient is efficient, cost-effective, and improves patient satisfaction. The studies show that on implementing and disseminating protocols, clinical practice guidelines. The objective is to identify the factors that influence healthcare and to present key international studies on them. Existing system for healthcare was examined to the formation of a plan for the research in future. As a result, various methods of healthcare policy translation are described like clinical pathways, clinical practice guidelines and protocols, a model for incorporating research based on normal and usual questions, partnerships between organizations, and implementation strategies that allow the translation of policies to practice. A lot of fund is required in translating policies to practice which are acquired by the organization in various ways as discussed above. Future research is needed on translating health care policy in the different areas like the best theoretical approaches, barriers, good strategies for nurses , the quality of empowerment approaches, the consequences of international collaboration, the mentor’s value etc.

Next task is to analyze the organizations involved in health care in a national and international context. One of such an organization is the NDPA organization. Finance needed for the health care in developing countries is created by the countries themselves. International health organizations in the developed countries only provide less than 5% of the total needs for healthcare in the developing world. It is important to find that the percentage of costs needed for the healthcare donated by the developed world is greater than the 5% average in the countries which are very poorer. Local health professionals are getting expert technical advice and training from international health organizations. These organizations produce the major documents in tropical health they also produce the most important guidelines for health care workers. Other international organizations in healthcare sector are World Health Organization (WHO) which is the premier international organization for health. The Pan American Health Organization (PAHO) works as the regional field office for WHO. The World Bank is the next major “intergovernmental agency related to the UN” related to healthcare. The United Nation Children’s Fund (UNICEF) spends the most of its program budget on health care. The United Nation Development Programme (UNDP) allocated $141 million, out of a total budget for field expenditures of $1 billion, to “health, education, employment.” Its major health concerns are AIDS, maternal and child nutrition, and excessive maternal mortality. Medecins Sans Frontieres (MSF) gives health aid to war and natural disaster victims.

Next task is to analyze the structure of healthcare delivery in NDPA organization. How health care is organized and delivered in a national context is dealt with the structural delivery of healthcare system. It includes many practical barriers like accessibility in terms of social and transport issues, funding issues, private health insurance cost, cost of treatment, safety issues, for example, in war, conflict or natural disaster areas. The organization has a chief member or director who controls all the functioning of the organization. He will be having subordinate that control sub organizations. All together they function effectively in a practical manner to achieve their goals. It exists within all levels of healthcare organizations. Beyond directives importance is given to improving health status.

Next task is to assess the practical barriers that are found in any health organization like NDPA for their health care policy. Healthcare delivery systems are filled with barriers to health communication in all the levels. Linguistic and language barriers in health communication sectors must be overcome. It exists within all levels of healthcare organizations. Language barriers influences mostly while access within a healthcare delivery system that is access, quality of care, health outcomes and self-efficiency especially. Studies that try to create standards and methods for developing information of the patients which is usable by most patients are needed. The studies must address both the written information and the simplification so that it can match the reading skills of patients and also its cross-cultural application. The major health communication loophole in the structure of care as it feels to patients lies in what is incorrectly termed ‘linguistic appropriateness’ which always takes into consideration translation of language and other elements of health communication are not taken. There are mainly cultural barriers that include health beliefs and behaviors and practitioners beliefs and behaviors. Next are geographic barriers that include rural health professional shortage areas. Then comes organizational barriers. Another barrier is socioeconomic barriers that include poor education, lack of health insurance, inability to pay money out of pocket.

The national and international socio political issues that are always present in promotion of health care is discussed here. They are considered as crucial issues, since sometimes they oppose the functioning of healthcare organization. Political factors deal with public health access and allocation of resources, prevention program’s access, treatment related topmost-exposure interventions and prophylaxis. Impact is made by international political factors in including some educational programs to detection of support, evaluation and response, also limited to information technology and telecommunications infrastructure to create links with highly risky places of the world. Migrations of people, increased trade and travel, food consumption patterns, sexual practices, new medical practices, human conflict, and the deliberate use of pathogens for hostile purposes includes the social factors, these are behavioral activities. Economic factors arise from lack of financial investment in research and development of processes; produce certain tasks such as training, procedures, technology etc. . Factors that related to economy constitute lack of support for a large number of programs that are beneficial such as public-private partnerships, market incentives to development of interventions.

Next task is to ass’s impact of international campaigns and national policies on the demand for healthcare. Various international campaigns are conducted in United Kingdom to secure the creation of a universal health care system. Campaign organizers used a framework to organize thousands of people in support of universal health care. In response to this effort, the state legislature passed health care legislation that incorporates human rights principles. It provides a framework for universal health care. By forming international campaigns it is possible to make people aware about the international issues that are possible in health care area. International campaigns and national policies allow the natives to understand the importance of health care and they make people work against the activities that affect the health of people. The organization has adopted international human rights policy for the betterment of the people. It has been the main topic of their campaign. They also analyses the health care reform bill. Healthcare Is a Human Right Campaign (HCHR) was a campaign conducted in association with the organization. By framing health care as a human right, the center organized thousands of states that had no prior involvement with political campaigning. This led the center making it possible to change the political environment and force the state legislature to enact rules that will lead to universal health care.

Next task is to evaluate the role of health promotion in determining healthcare service demand in a national setting. Health care industry takes the nation’s major financial resources. For facilitating evidence of quality controls and improvements it has come under immense pressure. Current health care consumer is now better educated and the best informed with increased knowledge. Impact of patient perception is the one aspect of health care quality that is mostly being recognized. Even though it depends more on healthcare’s service aspects it also correlates very well with health care quality objective measures. Ultimately delivered quality of health care can be dependent on ability of the health care organization to satisfy demand of the customer for convenience and information. The health care service sector is complex with multiple faces and different phases of organization. Health care system management has been relatively not sufficient before, making customers on the outside of the design of the product, incoherent and supply driven, development and also the delivery process. Many physicians think that the current emphasis on quality is not really aimed at improving health of the patient. Nowadays there is a change to an organization model in which the customer has importance and they influences every function and managers must look forward and make use of it and be instrumental in establishing a change within the entire system to focus on the quality.

Next task is identifying contemporary issues in health care of the organization. Nowadays whooping cough cases rises in England. As ministers pass the buck and applications for taking children into care continue to rise, councils’ problems just keep growing. There were volunteers translating health messages from English into local languages and thus providing a vital service for Non-Government Organizations and freeing up thousands of extra dollars to be used for medical aid. There are many policy issues that are contemporary in the financing and delivery of health care services. The role of bureaucratic agencies, legislative committees, interest groups and major health care policies are analyzed for obtaining information such as how to deal with the issues of the health care sector. Problems that related to quality of death and life gets its importance. This is broadly classified to include infant mortality, AIDS policy, occupational safety, government regulation of consumer products, and fiscal issues such as national health insurance, prospective payment, and the rationing of health care. More attention will be given to the legislative and political aspects of these various policy areas, ethical issues will also be considered because they are unavoidable.

Next task is evaluating the impact of these issues on national and international policy discussed above. There are growing dependence between security, health policy and foreign policy so that with developments in these fields having much importance for health in the United Kingdom and globally. The major issue in foreign policy was always health so as its prominence increases, the need of assessment is important if it is appropriately prioritised and how on the national basis the government interacts with business and civil society. Efforts to improve preparedness for acting against all the activities that affects the health of society and policies for tobacco control provides examples where health is highly mixed with high politics. Since 1th September 2001, health and development agenda has also been widely linked with the international policy priorities of preventing state failure and improving global security. The main security issue was become the health and foreign policy for a range of actors both inside and outside government. Policy-makers before think that rather distant fields of security, health and foreign policy must try to consider each other’s work as they are met by the play of issues at the global level. Implications of globalisation for health now are considered as the international issue.

Next task is to evaluate practical responses to contemporary issues that are discussed above. The main method to avoid all the issues is to create public awareness among people. They must be aware of the hazards that might occur due to activities that lead to lesser health of people in society. They must try to make other people aware about the problems that might occur due to careless living of their lives. Health care policy managements must be created in every area of the nation to administer the health aspects in those areas. Current international and national healthcare issues are identified and they must be treated accordingly for the betterment of the society. The current health care consumer is now better educated and the best informed with increased knowledge. International political factors can have an Impact made by international political factors includes limited or non-existent educational activities to support identification and verification, detection, and response. In this assignment a research related to the organization in health care sector is conducted. The political, social and cultural issues are identified. Analyzed the importance of health care policy. It helped to critically assess the policies and aspects of the organization.

The Influences And Decisions Of Social Workers Social Work Essay

As a social worker, having an awareness of how my philosophy may influence my decision-making in a professional setting is important for future practice. In order to give my clients the most beneficial advise. I must be aware of my responsibilities in following the value practices of social work. Know my position in the helping domain According to the Association of Australian Social Workers, social work practice should aim to help individuals achieve success in both personal and social endeavours in order to encourage wellbeing of the individual (aasw 2002,p 5). My self-evaluation will analyse how personal philosophy compliments or contradicts the value set out in social work practice. I will explore my values in relation to individual relationships and speak about my hopes for the future of the world I shall also explore the origins of my philosophies, the pillars that sustain them and the events in my life that have shaped my beliefs. I will then examine the steps I would take to prevent conflicts of interest between my client and me

Personal life Philosophy

Human beings irrespective of gender, race, or status govern their lives according to a series of rules that show the way to behave among family, friends, and the wider community. These are called values and are signals that give direction about right and wrong (Dolgoff et al, 2009, p20, Beckett & Maynard, 2005, p5). Values stem from a variety of areas, as children we are raised in communities that influence our behaviour Beckett and Maynard (2005) refer to these as value systems. The ideals we take from our societies can be static and others can change overtime. (Beckett & Maynard, 2005) Culture has a major impact on our value systems; it influences our professional lives, as well as our private lives. (Otima Doyle, Shari E. Miller, F. Y. Mirza, 2007). I also govern my actions according to values learned as a child and my philosophy has been shaped by a cross-cultural upbringing, I was raised in Papua New Guinea where I received a western education that encouraged individualism and in Uganda, I received a Catholic education where I learned the values of community. I experienced the liberal lifestyle in university. These diverse environments have contributed to how I view the world today. I value people above all other beings because of the way I was raised in Uganda with family members that supported each other economically I did not experience great hardship. However I knew that my parents did. This awareness taught me to respect hard work and value integrity, because my parents despite their struggles resisted the pressures of the government to sacrifice personal integrity for wealth. I value honesty and for me that includes being open about my abilities to take cases that may cause me great distress and I consider credibility in matters pertaining to worker client confidentiality valuable Compassion and charity are also important to me because I believe that in order to be an effective helper, a charitable nature goes along way towards understanding the needs of a client. I am aware however that emotional distance must be exercised. I need to be careful not become emotionally attached to the client In order to prevent my imposing my values upon my client.

I believe in being committed to all my relationships, and feel that in order to achieve success in either my personal or professional life I must be faithful in keeping private details in confidence. Finally I believe that in order for a relationship to grow there needs to be acceptance for differences in all aspects of life, from how someone behaves, to the opinions they hold. Therefore if I choose to interact with people regularly I should be able to accept them completely. I may not like their actions but I should acknowledge that my clients come from different backgrounds and as a social worker my duty lies in not judging them, but rather I am there to help them work through their problems.

Hope for the future and the world

The future is truly an unknown that holds a lot of uncertainty for me; at present I can not clearly picture what my hopes and dreams are. However there are some things I would like to see change in the next ten years: The first area of concern for me is the climate change debate, instead of the constant rhetoric from the major world leaders like the United States, Russia, Great Britain, and China. I would like to see concrete steps being taken to reduce greenhouse gas emission coming from industries around the world. Secondly I wish that in the next few years the millennium development goals (MDGs) are achieved before the dead line in 2015 so far very limited success has been reported according to the United Nations MDGS report of 2009 progress has been noted in only four goals of the ten goal program. The report outlines the progress made in reducing infant deaths, from its 1990 figure of 12.6million to 9 million in 2007; the report also cites progress in the areas of education, poverty and reduction of pollutants. They however admit that more progress is needed in order to meet the 2015 deadline. Finally I hope that more pharmaceutical companies will join the global initiative to find cheaper alternative solutions to the medical needs of the world. I hope the companies like Glaxo smith Kline and its many rivals dispense with the need to make money and consider saving lives as their priority

Origins of values and reinforcement

My philosophy comes from many experiences. As a child I grew up with cataracts that affected my vision. The condition over the course of my education has caused me great frustration. However, the love and strength of my mother ensured that I had the best possible start. She taught me never to give up; the support of my educators also showed me that despite the presence of obstacles, if I worked hard I would achieve my goals. The challenges due to my visual impediment have taught me to be compassionate towards all people who have challenges in their own lives, I have experienced the hardship of trying to live and work with people who have few physical limitations. Reading is a skill that I love but at times I dislike it because the fonts used in books are often too small and cause me to be slower these seemingly minor worries cause me some frustration. I however find great inspiration from men like the Australian born Nick Vujicic who was born with no limbs and with only a tiny foot lives life to the full. With a double degree in accounting and financial planning He speaks with strength about his journey “I found the purpose of my existence, and also the purpose of my circumstance.” (Nick Vujicic 2010). His ability to succeed in the way he has despite his obvious challenges, amazes and humbles me into the realisation that I can achieve any goal if I truly want it.

My life philosophies are sustained by my belief in God to whom I turn to for guidance; guidance I find in the writings of the Old and New Testament of the Bible. In the Old Testament writings, especially in the book of Deuteronomy, I find the moral values by which I govern my life. Set out in The Ten Commandments (NIV Bible, Duet; 5:1-32) that guide me on how to live my life in accordance to Gods wishes.

Other values that have contributed to who I am come from other books I have read. Books by Charles Dickens such as Oliver Twist and Hard Times have painted harsh pictures of poverty in industrial England during the 19th and early 20th century these stories sparked an interest in perusing solutions to human suffering. Before coming to Australia I had completed a degree in International relations with the hope of leading my nation towards finding solutions to our domestic problems in the International arena these aspirations however have not been achieved so far

Personal values in relation to Social work

After reading the Australian association of social workers code of ethics I have found parallels to my own philosophy of life. The association has five core values that provide social work professionals with guidelines that inform their practice. These values are:

Human dignity and worth

Social justice

Service to humanity

Integrity

Competence

(AASW, 2002, 1999, p 8)

At this stage in my live I can appreciate and accept that these values are essential for every day life. However, I must express some reservations in saying that I would adhere to these values completely. The major problem that I can foresee is that I am an individual with mixed ideals in some situations for instance where the question of life is posed I am fairly mixed I do not believe in the death penalty, yet I cannot fully disagree about the abortion questions. I can cite a specific time in my life when I was 22 and a friend told me she was dating a married man and had become pregnant. She wanted to have an abortion and I tried to talk her out f it however she went ahead and had the abortion, my first instinct when I got the news was to be critical of her and I see now that my distaste regarding infidelity and abortion prevented me from being more considerate, as a social worker I must learn to suppress my own views in order to be more receptive to my clients

In situations where my values may conflict with those of a client Ralph Dolgoff etal says clashes occur in many client worker dynamics (Dolgoff etal 2009, p112) mainly because social workers tend to give greater value to social harmony, equality, free choice and social justice. These values differ from culture to culture and may change over time. An example is the question of a woman’s right to choose between an abortion and not having one in the early 20th century women in Europe and North America could not get safe access to abortion services and as a result many died in back alley clinics in the attempt. However as laws around the world have changed so have values and in many societies having an abortion is now just another alternative to a woman who may have no choice but to seek such services.

These differences according to Dolgoff etal may cause problems for the social worker and the client In the initial stages of therapy, however in order to ensure that my point of view does not conflict with my clients values, Dolgoff suggests that social workers need to peruse knowledge relevant to the cultural requirements of clients, this information can be compiled through interviews of clients (Dolgoff etal 2009). As social workers we need to be knowledgeable about the various issues pertaining to cultural or religious beliefs (Dolgoff, etal, 2009, 113).Although I may need to have a better understanding of where my client position on certain values comes from, it is vital that I maintain a clear impartial reserve Dolgoff emphasises the dangers inherent in identifying too closely with the clients he points out that bias will most likely result and affect the success of an intervention. However having a similar background to my client can enable a better rapport to develop between my client and myself.

Further gaps that may arise and cause me problems as a social worker deal with the matter of power; in the social work profession I have assumed power over the client. And because of this assumed power, the client is likely to feel unequal to me by virtue of my knowledge, and the client’s position of service user. This power dynamic can be detrimental to the success of a social worker in trying to gather helpful insight into a clients problem, if not channelled correctly In the text Ethical decisions for social work practice Ralph Dolgoff etal suggest a number of ways in which I can ensure that my client feels comfortable enough to let go of the fear that may hamper the helping exercise. They suggest that as a social worker I need to find out what the clients values are and decide whether conflict of interests exists, and if there is conflict I must next approach the client in a way that does not mention the value in order to understand the nature of my client’s problem.

In order to maintain a professional standard I must remember the reasons I chose to join the helping profession, according Lesley Chenoweth and Donna McAuliffe (2005, p 6) the reasons some people enter the social work profession stem from experiences had ether in child hood or early adulthood. These experiences can sometimes provide a person with a passion to join the social work field because they were helped by a social worker and wanted to inspire others, as they were inspired. For some the experience with social services could have been negative and fostered a desire to bring change to the profession. No matter how we joined the profession it is important that we do not lose sight of the reasons why we chose social work these reasons will sustain me and keep me motivated to continue to work with clients even those who are difficult and hard to help.

Acknowledging personal bias before hand can often reduce the chances of having value conflicts with clients. Chenoweth and McAuliffe regard this as “effective use of self” By letting my supervisors know where I stand on certain issue can ensure that I am less likely to be assigned a case that I cannot properly deal with. Maintaining a value neutral stance is another way to avoid creating value conflicts (Weick as cited by Dolgoff etal) suggests that in order to properly understand the client the social worker needs to listen carefully to what the client truly wants and should suspend all judgement, values, and personal principles in order to provide effective help to the client (Dolgoff, 2009,p, 114).

In order for my future social work practice to be effect I must cultivate and continually strengthen my knowledge base and seek networks to keep me motivated. Self-awareness is key to understanding my role, as a professional helper, and critical reflections about my self in relation to my values is valuable. As the American author Daniel Coleman said,

“If your emotional abilities aren’t in hand, if you don’t have self-awareness, if you are not able to manage your distressing emotions, if you can’t have empathy and have effective relationships, then no matter how smart you are, you are not going to get very far.”(Coleman, 2010).

The Inequalities In UK Mental Health

Introduction and definitions:

The World Health Organization (WHO) has defined the mental health as:

i??A state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her communityi?? (1).

According to NHS website every year in the UK, more than 250,000 people are admitted to psychiatric hospitals and over 4,000 people commit suicide (2).

Mental health inequality is a long standing problem that has been tackled for decades by epidemiologists, sociologists and health professionals.

And because this problem has both strong social and medical aspect there is no unified approach to identification and resolution.

From Sociologists viewpoint inequality with mental health is a problem that has two main explanations: people are poor because they have mentally illness that makes them unable to keep work probably (social selection), or they become mentally ill under the stress of being poor (social causation). However, in modern psychiatry other factors are believed to involve in the etiology such as genetic factors, diet, and hormonal disturbance which interact with personality disorders or emotional state to produce mental illness.

The problem of inequality is not only about the present of a true mental illness but it is possible to expand the definition of mental health inequality to include everyday feelings which is considered by United Kingdom Department of Health to be a public health indicator:

How people feel is not an elusive or abstract concept, but a significant public health indicator; as significant as rates of smoking, obesity and physical activity (3)

The table below gives examples of those factors that promote or reduce opportunities for sound mental health (4):

PROTECTIVE FACTORS

INTERNAL EXTERNAL

i?? Good physical health

i?? High self esteem

i?? Learning ability

i?? Good conflict management

i?? early and positive bonding and attachment experience

i?? make relationships and ability to maintain or break them

i?? acceptance feeling

i?? good communication skills i?? Availability of the basic needs such as shelter and food,

i?? validation by the community

i?? support from surrounding social network

i?? present of role models

i?? job security

i?? good education level

i?? feeling secure

i?? political stability

VULNERABILITY FACTORS

INTERNAL EXTERNAL

i?? congenital diseases or disability

i?? low self-esteem or social status

i?? sexuality problems

i?? relationships problems

i?? feeling of isolation

i?? institutionalisation

i?? lack of essential needs food , heat , housing ..

i?? loss and separation experience

i?? violence or abuse experience

i?? substance abuse

i?? psychiatric disorder runs in family

i?? discrimination

i?? unemployment peer pressure

i?? pressure from value systems

i?? poverty

Table 1: factors that affect good mental health

What is the evidence on mental health inequalities?

Socio-economic status:

Many Community-based epidemiological studies showed an inverse relationship between Socio-economic status and rates of schizophrenia. Saraceno found that the current prevalence (calculated up to one-year prevalence) of the schizophrenia among low-SES is higher than people of high-SES with a ratio of 3.4, and when calculated to lifetime prevalence it is 2.4i?? (5), and in Britain, suicides rates among people from lower SES nearly double that of high-SES (6).

There are five hypotheses to explain this relation (7)(8):

1: Economic stress. The mental illness is a speci?c outcome of the stress related to economic problems, such as unemployment, poverty, and housing unaffordability.

2: Family fragmentation. The inverse SESi??mental illness correlation is a function of the fragmentation of family structure and lack of family supports.

3: Geographic drift. Individuals movement from communities of subsequent to their initial hospitalization leads to inverse SESi??mental illness correlation (8).

4: Socioeconomic drift. Low employment rate related to initial hospitalization of lower SES communities.

5: Intergenerational drift. Can be explained as following i??The inverse SESi??mental illness correlation is a function of declines in community SES levels of hospitalized adolescents between their ?rst hospitalization and their most recent hospitalization after turning 18i?? (8)

Age:

i?? In elderly:

In a report for NIMHE (National Institute for Mental Health in England) (9 cited by 21) .the following point regarding mental health problems in elderly has been noticed:

i?? The number of older people with symptoms of mental problems in the UK is about 3 millions.

i?? 10-15% of older people could be diagnosed by depression when applying the approved clinical criteria.

i?? About 5% of people aged over 65 and 20% over 80 are affected by dementia

i?? The economic cost of dementia in elderly is about i??4.3 billion per year , this is more than the cost for heart disease ,stroke, cancer combined

i?? the above numbers are expected to rise by a third in the next 15 years

Mental health problems in elderly are more likely to go undiagnosed. Even where they are recognized, they are often poorly managed (10).

The UK inquiry into mental health in later life (11) listed five factors that affect the mental health of elderly: relationships; contribution in meaningful activity; physical health (capacity to do everyday tasks); discrimination (by age or culture); and poverty.

i?? in children :

WHO states that the building an effective mental health policy for child and adolescent requires first deep understanding of mental health problems among children and adolescentsi??(12)

There is an evidence that levels of distress and dysfunction during childhood are considerably high between 11 per cent and 26 per cent, while the severe cases that require interventions are around 3i??6 per cent of people under 16 years of age (13,14).

Emotionally disturbed children are exposed to abuse or neglect in their family of origin, with estimates up to 65 per cent (15).

Gender:

i?? Women and Mental Health

It is proved that mental health problems are more common among women than men with a higher incidence rates of depressive disorder than men (16).

There are many factors to explain this, first: Socio-economic problems such as poor housing conditions and poverty cause greater stress and fear of future amongst women. lack of confidence and self-esteem may be the results of educational factors such negative school experiences , Living in unsafe neighborhoods cause stress and anxiety amongst women , another common problem is addiction on prescription medications (for depressive and sleeping disorders) leads to more stress and anxiety. (16).

i?? Men and Mental Health

In today world Men tend to be more susceptible to mental health problems than ever before especially suicide, some possible reasons for this are (17):

i?? Men in general are less likely to discuss their feelings or problems or even to admit that they may have depression.

i?? Comparing to women, fewer men look for help when having mental problems.

i?? The impact of unemployment on men is deeper in general.

Some mental disorders are more serious in men. For example suicide is considered to be a leading cause of mortality among young men age group(18). Suicide rate is especially high in poor communities for men from age group 10-24 comparing to the same age group in wealthy communities. It is known also that the onset of schizophrenia is earlier in men and the clinical outcomes are poorer (18).

Risk groups for mental illness in men include (19):

i?? Older men: many of them are less willing to benefit of provided health services because of the perception that these services are for older women.

i?? Divorced men i?? because of the lack of support available from their families, and services directed to meet the needs of this group.

i?? Male victims of domestic abuse i?? especially boys in rural areas.

i?? Gay and bisexual men i?? few services are available to assist this group to deal with problems such as homophobic bullying and harassment.

i?? Sexual abuse victims, again insufficient support is provided for males of this group.

i?? Fathers i?? this is mainly due to stresses of parenthood combined with less support services when comparing to those available to mothers.

i?? Mourning men i?? With no or very few appropriate services specifically designed to men who have undergone bereavement.

i?? Men living in rural areas i?? obviously due to difficulty in getting access to proper support services.

i?? Offenders of young age group i?? less psychological services are available in juvenile justice centres in spite of the fact that there are high numbers of young Offenders who actually have mental health problems needed to be taken care of.

Ethnic group:

The i??Count me ini?? report by Commission for Healthcare Audit and Inspection ( 20) noted differences in admission rates among different ethnic groups for example that rates were lower in white British ,Chinese and Indian comparing to the national average , while in Bangladeshi and Pakistani group the rates were around the national average , the highest rates (more than three times higher than average) were found in minority black groups (African and Caribbean) and in Mixed groups (White/Black African or White/Black Caribbean).

Employment Status and Mental Health

It is well-known that getting a job is a protective factor regarding mental illness (21).

But this is not always true. As Wilkinson (22) noted that jobs which are insecure or do not achieve the required level of satisfaction could have negative effects equal to that of unemployment. The main factors that cause this are (21): stress associated with fear of job loss, feeling of imbalance between effort and reward and inability to control job circumstances, stressful relationship with colleagues and bosses, cases of harassment or bullying. All this factors can lead ultimately to serious mental health illness.

On the other hand, According to OSC Health Inequalities Review (23) people with a mental illness have five times lesser chance to get a job, and if they are already working they become more likely to be fired, financially this group has in general lesser income (twice times chance than the general population) and more likely to depend on invalidity benefits. It is noticed that among mental disorders psychotic illness has the worse impact on employment rates which decline in this group to only one in four.

Geographic variation:

Studies result on geographic variation of mental illness are inconsistent , for example Hollie (24) has concluded that regarding mental problems it is possible to see notable variation at the household level but this variations do not exist in postcode units , and there is no proven connection with geographical accessibility or quality of residential environment

Hollie noticed also that in common mental illnesses the psychosocial environment has greater importance than the physical environmenti??

Another example comes from a recent Swedish study of 4.4 million adults found that with increasing levels of urbanisation; there was a notable rise in the incidence rates of psychosis and depression (25).

Another study by Royal Commission on Environmental Pollution shows that people from densely populated areas had a 68-77% and 12-20% higher risk of developing any psychotic illness and depression respectively when compared to a control group in rural areas. Within urban areas the rates for psychoses map closely those for deprivation and the size of a city also matters; in London schizophrenia rates are about twice those in Bristol or Nottingham (26,27).

Disability and Mental Health:

Definition: According to Disability Discrimination Act (1995) (DDA) (28)

i??A person has a disability if he has a physical or mental impairment which has substantial and long-term adverse affect on his ability to carry out normal day to day activitiesi??

In the light of this definition we can focus on mental health inequality of three groups of people (21):

i?? People suffer socio-economic disadvantage caused by stigma and discrimination associated with their mental health problems.

i?? People with both physical disabilities and mental health problems.

i?? People with physical disabilities, whose experience discrimination and stigma because of their physical impairment and become mentally ill because of this experience.

Disabled people are more likely to experience stress and emotional instability than those who are not disabled.

a report by the Equality Commission for Northern Ireland (29) had found that when surveyed 52% of disabled people had experienced high levels of stress in the last 12 months comparing to 34% of people who are not disabled , and when it comes to depression disabled women have a higher rate of depression than disabled men with 44% comparing to 34%

Conclusion:

Inequality in mental health is as important as any other form of health inequality, however the interaction between social and personal level in mental illness makes it more difficult to address different kinds of mental health Inequalities associated with it.

Question 2: word count (2000)

Tackling inequalities in mental health

Introduction:

Many researchers agree that mental illness could be considered one of the fundamental social and health determinants, and it is difficult to separate these both sides because in most cases social exclusion and social inequalities are both cause and consequence of mental disorders (30)

Some studies refer particularly to two characteristics that distinguish mental illnesses when it comes to public health problems (30): first they are the recent high rates of incident and second is the early onset which affect much younger age group comparing to other health problems

Mental health diseases have two distinct characteristics as a public health problem: first very high rates of prevalence; secondly : onset is usually at a much younger age than for other health problem , Mental health diseases effects all aspects of peoplei??s lives : personal relationships, employment, income and educational performance. (31,32)

Who is at risk for mental health problems?

Defining risk groups enables policies makers to determine how to manage available resources to achieve better health equality. Furthermore, these groups are the main targets for health equality promotional programs.

A review of recent evidences on mental health inequalities can help to define the large groups at risk (33):

i?? People living in institutional settings: such as care homes or those in secure care or subject to detention.

i?? People living in unhealthy settings and who may not be reached by traditional health care such as veterans or the homeless.

i?? People with physical and/or mental illness, people misusing drugs, people with alcohol problems, people who are victims of violence and abuse.

i??children whose parents have problems with alcohol or with drugs, children whose parents have a mental illness and looked after and accommodated children,

i?? People from groups who experience discrimination.

Key policies:

These policies can be long term policies focusing on deep change over a long period or short term seeking fast results such as health promotion.

Long term aims:

Inequalities in mental health are not only about equality of access, but also about the quality of access.

In the year 2009 Mental Health Foundation has published a report on resilience and inequalities in mental health (Mental Health, Resilience and Inequalities) (30, 34)

This report mentioned four points that should be consider as priorities:

1- Factors that support the life of the families mainly the Social, cultural and economic conditions:

This can be done by reduce child poverty , parenting skills training and high quality preschool education , providing secure places for the children to play in particularly outdoors, and cooperation between the different governmental agencies to compact violence and sexual abuse.

2- Establishing an educational system that can effectively support children on both emotional and economical scale by:

i?? Schools health promoting programs, involving teachers, pupils, parents and working with families to enhance the home learning environment (HLE).

i?? Taking steps to encourage sport activities and social events beside academic performance.

3- Reduce unemployment and poverty levels to reduce their negative effect on mental health, and while this is not an easy goal but the steps that could be taken my include:

i?? Supporting efforts to improve pay, work conditions and job security.

i?? Taking advantages of workplace based support by early detecting and caring of personal problems or psychiatric symptoms before developing into serious stages.

.

4- Tackle economic and social problems, which cause the psychological distress. Such as housing/transport problems, isolation, debt, beside that art and leisure centres can help to reduce stress too.

However, these strategies take a long time to be effective, that means the need for more rapid actions or short term aims.

Short term aims: Mental health promotion:

To build an effective strategy to promotion for health equality the following points should be achieved (30,35).

i?? Comprehensive: promotion of mental Health is not only the responsibility of health services alone; other sectors of society should join that effort.

i?? Based on evidence

i?? Responding to the needs of the local communities, and with the agreement of these communities.

i?? Under continuous assessment: The strategy should undergo critical evaluation and can be changes should be made when necessary.

A good example of such strategy is the Mental health national evidence based standards which have been issued by The National Service Framework for Mental Health (36). The idea of these standards is to deal with mental health discrimination and compact social exclusion in patients with mental illness. And that can be achieved by promotion:

i?? Increase the awareness about the importance of mental health in the society

i?? Take strong position against discrimination affecting individuals with mental illness, and promote the steps that make the social inclusion possible for them.

Tackling inequalities for special risk groups:

The Suicide prevention strategy:

One of the best example is the strategy based on work by The NSPSE (National Suicide Prevention Strategy for England), the report was the result of literature review of suicide prevention programs around the world and has reached the following goals (38):

1. To identify and work on people with the highest suicidal risk.

2. To raise the awareness about mental well-being in the society .

3. To target common suicide methods and limits the possibility to get access to such methods if possible.

4. Work with the media for better coverage of suicidal behaviour and its dangers.

5. Support the research for better understanding of suicide and the possible way to reduce it.

6. To evaluate the steps taken to achieve lower rates of suicide.

Women and Mental Health: Preventing:

The results of UK-based survey (38 cited by 21) shows that mental health services for women:

i?? Do not respond to special need of mental health in women.

i?? Can be unequal.

i?? Sometimes prove to be unsafe for women.

i?? May not reflect to the gender effects on social inequalities, which present in deferent levels such as class and race.

However, in their response to a survey conducted in England and Wales (38), women said that they services should:

i?? Provide Sense of Security for them.

i?? Encourage the feelings of independence and ability to make choices and control their life again.

i?? Try to identify and deal with the real causes beyond the stress and the problems they face not only the symptoms of these problems.

i?? support motherhood by directly address this group problems, such as suitable accommodation, jobs opportunities, education.

i?? Embrace their inner strength and potentials of recovery.

These points are crucial to build a need-based action plan for better equality in health services.

Men and Mental Health: Preventing:

The Equal Minds conference workshop which had special focus on men and mental health listed some changes to the support services that make these services more related and directed to solve men mental health issues: (21):

i?? the services should be designed especially for men and with easy access in mind , this include both the place and timing of the selected service , for example choosing places that men usually meet in , or including sport activities or introducing programs that run only by men

i?? Holistic approach, works on the person as a whole, not just on mental health.

i?? Early intervention to prevent anxieties and concerns build up, especially in stress and anger management.

i?? Trust and confidence are vital to solve problems of identity and role which can cause a lot of stress and self-image problems in men.

Ethnicity and Mental Health: Preventing:

One of the main problems in this group is the accessibility to the mental health services due to many factors such as:

i?? Linguistic communication.

i?? Stereotypic approach to their problems.

i?? Ignorance about the importance of mental health.

Sashidharan in his report titled: i??Inside Outsidei?? (39 cited by 21) discussed the mental health services provided for black and minority ethnic groups in England and Wales. And he noticed that these services are different when comparing to services provided to the majority white population in some aspects:

i?? Patients are less likely to receive specialist mental care.

i?? Patients are more likely to undergo obligatory admission (there are differences exist between different ethnic groups and different age groups).

i?? Patients are more likely to be wrongly diagnosed.

i?? Patients are more likely to be treated with psychiatric drugs and Electroconvulsive therapy (ECT), more than receiving talking therapies.

i?? To have higher readmission rates and stay for longer in hospitals.

i?? To be admitted to secure care/forensic environments.

i?? Their social care and psychological needs are less likely to be addressee within the care planning process.

i?? To have worse outcomes.

A strategic approach in Ethnicity and Mental Health:

In England and Wales a framework has been developed for action for i??delivering race equalityi?? in mental health (40 cited by 21)

The framework introduces three points which are essential to reach the targets of better services and results in mental health problems in minority ethnic groups, these points are:

i?? Providing high quality Information services.

i?? To insure that the provided services are easy to access and can respond quickly to minority groupsi?? needs.

i?? Involve the community in the efforts toward better mental health.

In other words any approach should take in consider both quality of health services and the already existing socio-economic inequalities that ethnic groups may face.

Some suggested steps for this approach may include (21):

i?? Providing interpretation and translation services beside mental health service to insure highest possible quality.

i?? Adopting equalities practice in mental health services, that mean better understanding for cultural identity, the impact of racism, and culture differences in the ways people express of mental stress.

i?? Researching better tools and assessment measures that can better assess patients from different backgrounds and ethnicities.

i?? Ensuring that services understand and respect spiritual requirements for different cultures.

i?? Ensuring access equality to services that more culturally accepted including, counseling, psychotherapy and advocacy.

i?? Addressing common problems of black and minority communities, such as housing, employment, welfare benefits, and child-care.

Disability and Mental Health:

people with disabilities may experience high levels of socio-economic disadvantage due to discrimination and stigma , this group need a special interest regarding mental health services , they are liable for what Rogers and Pilgrim (41) described :i??inequalities created by service provisioni??.

Mental health services for disable people should be customized to their needs, some recommendations for such services may include:

i?? Promotion for well-being, mental health, and living with disability.

i?? Early intervention: for people who show symptoms for possible mental illness.

i?? Personalised care based on individuals’ wishes and needs.

i?? Stigma: work for better social inclusion and try to deal with problems associated with stigma and discrimination associated with some disabilities.

Elderly and mental health:

In order to achieve better equality for this group, policy makers should insure better access to mental health services in the first place.

In the year 2005 the Department of Health introduced a report titled i??Securing Better Mental Health for Older Adultsi?? (42) to launch a new program to enhance the levels of services provided for elderly suffering mental illnesses or problems, this report promoted for a new policy that depends on two important steps:

i?? Ensuring equality in the provided mental services; that means that the availability of these services should depend on the actual need for it not on selective age groups.

i?? The approach of these services should be Holistic and personalized to meet both mental and physical needs for older age group.

Here, it is essential to emphasis the importance of specialist mental health service for older adults.

Sexual Orientation and Mental Health:

In this group health promotion plays a prominent role to address the mental problems associated with sexual orientation.

PACE organization has published practice guidelines for mental health services working with lesbian, gay and bisexual people (43 cited by 21).

The guidelines suggest that these services should especially designed to meet the needs of LGB people, examples of such services include particularly counseling and advocacy.

In response to these guidelines and other studies about LGB such as (44 cited by 21). Mental health services for LGB people should:

i?? Deal with the problems of heterosexism and homophobia that this group frequently faces.

i?? Raise the community awareness about the problems that this group suffer especially social exclusion and discrimination.

i?? The services directed to LGBT people should be able to interact effectively with this group i??culturally competenti??.

Preventing in Mental Health Problems:

People with mental health problem are in need for i??resilience factorsi?? which may be the only way to heal from mental distress and to fight the stigma and discrimination they frequently face (21), we can name some of these factors such as confiding relationships, social networks, self-determination, financial security, however, support health services are essential for individual recovery and to achieve socially inclusive i??accepting communitiesi?? (45).

Examples for these services can be found in i??report on Mental Health and Social Exclusioni?? which has been introduced by Social Exclusion Unit. The report included a 27-point Action Plan especially designed to deal with discrimination and stigma (21).

In this action plan the health and social care services play an decisive role to fight the problem of social exclusion and provide the proper support for community and families, this support may include help to find better accommodation, and provide financial (46).

Beyond this report, it is essential that policy makers be aware of connection between inequalities and mental health as a result and a cause, this will encourage more holistic approach that aim prevention at the long run.

Conclusion:

It is essential to put the different recommendations on mental health inequalities into everyday practice , for example a recent study by Glasgow Centre for Population Health found that policies are not driving practice for effective reduction in inequalities levels in mental health within primary care, and the primary care organization studied is not Contributive to tackle inequalities in mental health. (47).

For that reason, it is the responsibility of government, health services and health professionals to put these strategies and plans into action to insure a better and healthier society.

The Importance Of Personal Networks Social Work Essay

Personal networks are an important factor in people’s daily lives. People who are embeded in a network of personal relationships experience a higher level of well-being than those who are socially isolated.The following is a critical reflection analysis about themes that I found to be most meaningful during the course of the term. The themes include the importance of a social network for the older adult, as well as how this type of network can impact their quality of life. An exploration of these themes will be provided using literature along with my own personal experience. This reflection will highlight the insight that I have gained from this analysis as it relates to my future nursing practice. In addition this reflection will address nursing implications for providing superior client relations.

Exploration of Themes

Social relationships of older adults along with their access to social support networks can influence the general health and well being of this population ( ). The existences of social support networks are important for the older adult’s identity, self-respect, social integration, feeling of security, companionship, as well as practical and emotional support. For example, my grandparents live alone, however, at the same time they have a network of friends, relatives and inter-faith community members on which they can depend on. On the other hand, my neighbour who is 76 years and widowed, is isolated from meaningful and supportive social relationships. My insight into the plight of the elderly, combined with my compassion towards this vulnerable population, compels me to visit her home and spend prolonged time in conversation. We talk at length about her day, her baking, and her fond memories. My neighbour often expresses a deep sense of appreciation for my frequent visits and I feel satisfacation that she allows me to participate in her enthusiasm and happiness.

A social network can stimulate the mind of the older adult as well as increase their level of energy and motivation. If the older adult lacks the support of a social network, it can often lead to isolation and depression ( ). There are a variety of social factors that contribute to an older adult being socially isolated. This includes being female, having a low income, being widowed or divorced, are experiencing family conflicts, and lastly who are experiencing ageism (BC article). According to these criteria, my neighbour is definitely at risk of being socially isolated. Evidence suggests that there are health promoting effects of social relationships. Socially isolated older adults have a two-fold increase in mortality from all causes (Jeannette, 2009). A lack of social support among the older adult population has been associated with a variety of adverse health outcomes in older age, ranging from depression and self-harm, to deteriorating physical health. (Jeanneate) (Dennis et al., 2005). Research supports that various types of social support from different sources are associated with positive health outcomes. Social relationships are also thought to be a key factor in psychological health including an individual’s happiness and subjective well being (tomaka).

In a study that looked at the ranking of importance of different aspects of life for adults over the age of 65, they consistently ranked their relationships with their family and friends as the second most important factor after their health (Kobayashi, Cloutier-Fisher & Roth, 2008). Among the older adult population, the social integration and overall participation in society are considered vital indicators of productive and health ageing ( ). According to the World Health Organization (2003), social support for the older adult population has a strong protective effect on overall health and can influence their quality of life (QOL). The QOL for the older adult that have chronic illnesses and who live at home are highly influenced by the presence of and the accessibility to social networks. Therefore, finding ways to help older adults engage in social networks that are productive and enjoyable is an important aspect of ageing.

Future Nursing Practice and Nursing Implications

Throughout my analysis, I have gained a great deal of insight with regard to the importance of a having a social network and its impact on the QOL of older adults. It has increased my awareness and compassion to the importance of friends, family and community support in creating a social network for the older adult in order to maintain or increase their overall QOL. It is important to reduce the amount of isolation that older adults face – even those that have families. In practice, it is paramount for nurses to be aware of the older adult’s social support networks, along with advocating for the creation of further networks in order to tailor to the complex needs of older adults. Upon reflection, I would use Newman’s theory of Health as Expanding Consciousness as my approach when I consider the importance of ensuring that social support networks are in place for my clients prior to discharge from a hospital. Newman (2004) describes human beings as open energy systems in constant interaction with the environment. Therefore, the way for nurses to understand the health of an older adult is by understanding the individual’s pattern of relating to the environment. Thus being said, the social network of an adult is crucial to reduce dependency among the older adult population by improving time spent with this group and having more interaction with the elderly (Souraya & LeClerc, 2008)

In conclusion, despite the salience of recent studies devoted to ageism that examines social support and well-being, this body of nursing research has paid limited attention to the increasing prevalence of social isolation among older adults in Canada or its relationship with health status. More research is needed in these areas as older adult Canadians are living longer, alone, and with a reduced number of social contacts (McPherson, 2004). Social isolation is not an easy topic for policy. It is a problem that cannot be identified with more familiar social topics as education, economic independence, societal participation and social cohesion. Nurses need to advocate on the importance of gaining emotional, practical and relational support for this population.

This reflection has brought up the issue of mental health among the older adult population. From a personal standpoint, it saddens me to see the lack of interaction that exist among the older adult population suffering from a mental illness. I believe that further attention needs to be focused in this area by creating more social support programs and increasing access to these services for this cohort. As a result of this experience I have become more professionally attentive to my interactions with the older adult client on the units that I am working on. Being empathetic has made me realize that it must be challenging for the older adult to be looked after as they were once independent individuals who could take care of themselves. I can see how nurses can become frustrated with this population combined with a heavy workload, but I do feel that this population carries with them a lot of wealth and wisdom.

Introduction

Identification of theme(s) in your reflective writing.

Exploration and analysis of themes that are most meaningful to you

Significant learning or insights gained from your analysis that will guide your practice

Nursing implications

Choose any 2 topics; use references; combination reflection + scholarly

Jeannette, G., et al. (2009). Loneliness, social support networks, mood and wellbeing in community-dwelling elderly. International Journal of Geriatric Psychiatry,24 (7): 694- 700.

Tomaka, J., Thompson, S., Palacios, S. (2006). The relation of social isolation, loneliness, and social support to disease outcomes among the elderly. Journal of Ageing and Health, 18(3), 359-384.

Kobayashi, K., Cloutier-Fisher, D., & Roth, M. (2008). Making meaningful connections: a profile of social isolation and health among older adults in small town and small city, British Columbia. Journal of aging and health, 21(2), 374.

When measuring the level of access that older adults have to social support networks or the risk of social isolation, it can provide a valuable means to gathering information on their living arrangements (stats can).

Importance of Social Work

Social work involves working with some of the most disadvantaged and vulnerable people in society. It is working with individuals, groups and communities, putting into practice Social Work Values that aid people to overcome possible oppression they face. The actions of Social Workers are to promote social change, help solve problems and empower and liberate people to help enhance their well being. (British Association of Social Workers, 2002) It needs to be understood that Social Workers must be vigilant against the possibility of exploitation or oppression of Service users through ‘unethical Practices.’ (Thompson, 2005: Pg 108)

All Professional occupations are guided by ethical codes and underpinned by Values (Bishman, 2004) and from the very beginning of Social Work, the profession has been seen as firmly rooted in values (Reamer, 2001) (Cited by Bishman, 2004) ‘Every person has a set of beliefs which influence actions, values relate to what we think others should do and what we ought to do, they are personal to us.’ (Parrot, 2010:13) Although society may been seen as having shared values we are all brought up with different personal values bases, this is an important point to consider when working with others, because our values can influence the way we behave. It would therefore be seen as foolish to underestimate the significance of values within the Social Work Profession. (Thompson, 2005: 109)

Our Personal Values can change over time, and our behaviour can alter as a result of the situation we are in. From a young age one of the most important values instilled in me by my parents was to have respect for others, this should be carried throughout life as we should treat others the way in which we would expect to be treated.

‘The importance of having a value base for Social Work is to guide Social Workers and protect the interest of Services Users.’ (Parrot, 2010:17) As a practising Social Worker it is important to recognise personal values and to be able to understand, situations will present themselves were personal and professional values can conflict. It was only when we had the speakers in that I began to question my own values.

NISCC outlines a code of Practice for Social Workers to adhere to, from listening to the speakers in class one issue that was highlighted was that of partnership. Partnership is now a very evident part of everyday language of people involved in the process of providing care. (Tait and Genders 2002) However it is not always put into practice. Mr Y referred to being ‘kept in the dark’ about his illness, he was eventually given a diagnosis, but it was never explained to him what the meaning of this diagnosis was or how it would affect his life. Social Workers have to exercise professional discretion, due to the nature of their work; judgements have to be made which involve values and consequences that make the worker accountable for their actions. (Thompson 2009)

Partnership working is very important for people with a disability, I was able to recognise a conflict with my personal values when one of the Mr X spoke about a visit to the GP, where the GP was asking the carer how the Service User was feeling rather that asking them, from listening to this I was able to recognise that this is something that I have done in the past and possible infantilises the individual with comments such as referring to them as ‘we dote’ or ‘wee pet’ and I never thought that there was anything wrong with using these statements, however from the experience gained I can recognise that my personal values and the professional values are in conflict at this point. It is a way of oppressing this individual, and failure to promote their rights as an person.

When viewing this in conjunction with the NISCC Code Of Practice, it was clear that there was a conflicting of values. NISCC states that as a Social Care worker we must protect the rights and promote the interests of service users and carers as the Disabled Movement states ‘Nothing about us, without us.’ We need to consider the Service User perspective, one of the speakers stated ‘effective partnership working should include the professionals and the Service user.

‘Partnership is a key value in the professional value base underpinning Community Care.’ Braye and Preston-Shoot 2003’43) Partnership should be promoted in several ways such as keeping an open dialogue between professionals and Service Users, setting aims, being honest about the differences of opinion and how the power differences can affect them and providing the Service User with information that helps to promote their understanding. (Braye and Preston-Shoot 2003) In the case if the speaker who was not given a diagnosis for a long time and was just put out of the consultant’s office this key areas did not apply.

Another issue that was striking was that of independence, initially my personal view was not of someone with a disability being independent, my personal experience in the past had led me to believe that people with a disability required a lot of help and were dependant on a carer to provide that help, I didn’t view them as being in employment. Some of these values were quite dormant until I began working in the Social Care Field. The Speakers that we had in from Willow bank explained that they all have jobs and aim to be as independent as possible. This highlighted the conflict between my personal and professional values which I need to be aware of. The NISCC code of practice states a Social Worker should promote the independence of Service Users, this is one conflict that I can acknowledge with my personal values, I need to look at the bigger picture an view the service users as individual people with unique traits and interests it is important that they are not labelled due to their disability, It is viewed that it is society which disables physically impaired people, disability is something imposed on top of impairments by the way we are unnecessarily isolated and excluded from full participation in society. (Oliver 1996) My Personal view was that I believe that we should aim to do things for people with disabilities, I have often found myself carrying out tasks for them that I know they are able to perform themselves, when the speaker from sixth sense spoke about how she had been spoon fed and pushed around the playground as a child had gave her a sense of learned helplessness, it made me acknowledge my own actions. Again this is another area where my personal values conflict with the professional values. Respect for persons in an extremely important values, although I believe I was brought up to show respect for others by creating dependency in a way is disrespectful to the individual.

The promotion of independence is important, it is crucial to see those with a disability as individual people. The NISCC code of practice highlights As a social care worker, you must respect the rights of service users while seeking to ensure that their behaviour does not harm themselves or other people. Keeping in line with the NISCC Code of Practice I need to actively challenge my own prejudices in order to ensure that I am promoting anti-oppressive practice.

Being able to understand the value conflicts in practice can prove to be very beneficial. It can help us acknowledge the differences in the power structure, which can oppress the service user. Social Workers aim to empower the Service User, to help them help themselves. It is important that Professional values are always at the forefront to promote anti-oppressive practice. Social Work Practice is underpinned by laws, policies and procedures.

It is important to always be aware of the Service Users perspectives, this will help ensure more effective and efficient practice.

Both our personal and professional values need to be acknowledged for effective and efficient practice. It is of little use if Social Workers have a professional value base which doesn’t inform or influence their practice, Social Work ethics can be understood as Values put into actions. (Banks, 2006)

The Importance Of Core Communication Skills Social Work Essay

According to Nelson (1980) social work was one of the first professions to recognise the importance of communications skills and the link to effective practice. Communication skills can be essential to the task of assessment, interviewing and later decision making for social workers. In practice, communication tends to be defined primarily as: ‘The verbal and nonverbal exchange of information, including all the ways in which knowledge is transmitted and received’ (Barker, 2003: 83 in Trevithick, 2005, p 116). The latter elements of communication, which can often translate the emotional content of the communication, are also referred to as interpersonal skills. According to Thompson (2002) social workers use such skills to communicate “ethically sensitive practice” (p.307). The purpose of this essay is to highlight the role and importance of verbal and non verbal communication skills involved in social work practice.

According to Koprowska (2008) communication is both interactive and context related. Therefore, careful consideration needs to be taken when communicating. There may be several barriers involved in communication, such as: authority; language; ability; personality; gender; age; and class (Thompson, 2009). True communication can only be achieved if the barriers are identified and removed. This can be attained by the practice of an anti oppressive and anti discriminatory approach to communication on the part of the social worker.

Verbal Communication

In practice good communication skills, practically listening and interview skills, are crucial for establishing efficient and respectful relationships with service users and lie at the heart of best practice in social work (Trevithick, 2005, p116). Social workers must demonstrate several skills while assessing or interviewing a client. Verbal communication is a key skill in social work practice and “refers to face to face interactions and involves the impact of the actual words we use in speaking” (Thompson, 2009, p100). It is importance for social workers to be aware of how and what they say in certain situations; for example, in regards to the issue of formality. If the social worker does not access the situation correctly they may be conceived as being too formal or informal and thus will inevitable create barriers. Further, many service users tend to come from vulnerable sections of society. It is possible that their involvement with social workers may invoke feelings of shame or fear. It is likely that this will then leave them vulnerable to feeling misunderstood and not listened to. It is therefore fundamental that social workers treat each client as an individual and assess their situation as a unique case. In order to build a good relationship with each client the social worker must demolish any power or untrusting issues that may be present. This power may be either perceived or real in certain situations. For that reason, congruence plays an important role during the interview process. It may not be completely possible to eradicate the power imbalance but it is a key skill to be aware of the need to achieve congruence. This can be active by using the appropriate language so that the client can fully understand and be listened to. It is through such skills that social workers can convey genuine warmth, respect and non-judgement for the service user. Indeed, verbal communication skills also play a major role when working with other colleagues and professions, and are essential for decision making and assessments (Cournoyer, 1991).

Non Verbal Communication

Non verbal communication is a major component for interpersonal skill repertoire and includes posture, facial expression, proxemics, eye contact, and personal appearance (Kadushin and Kadushin, 1997, in Trevithick, 2005, p120), and it can support or contradict verbal communication. The importance of non-verbal communication is not a new concept in the social work field, in an article by DiMatteo, Hays, and Prince (1986) maintained that there are two dimensions of nonverbal communication, firstly decoding or sensitivity and secondly encoding or expressiveness. According to DiMatteo et al “nonverbal decoding refers to the capacity to understand the emotions conveyed through others’ nonverbal cues such as facial expressions, body movements, and voice tone. Nonverbal encoding refers to the capacity to express emotion through nonverbal cues” (p 582).For example, much of the understanding of non verbal communication can be gathered through using observation skills. Observation skills can be vital for social workers interviewing a client. According to Kadushin and Kadushin (1997) “there are five thousand distinctly different hand gestures and one thousand different steady body postures so precise observation of non-verbal behaviour is important”(P 315). The client may tell the social worker they are coping fine and don’t need any help but by observing their facial expression or lack of eye contact they may contradict this. Sheldon stresses that social workers must be aware of their own “capacity for self-observation, although always somewhat limited, provides us with an opportunity to analyse our own role and impact.” (Sheldon 1995: 132-3 in Trevithick, 2005, p123).

Active listening

Research has verified listening as the most utilized form of communication. “If frequency is a measure of importance, then listening easily qualifies as the most prominent kind of communication” (Adler & Rodman, 1997, p. 283). Listening may appear to be straightforward but active listening skills need to be learned, practised in training, developed and refreshed for effective use in real situations. Active listening describes a special and demanding alertness on the part of the social worker involved in interviewing a client. For Egan, active listening is about being present psychologically, socially and emotionally, not just physically (Trevithick 2005,p.123). By using skills such as paraphrasing, reflective questioning and open and closed questioning the social worker can convey full interest and understanding to a vulnerable client.

Self awareness

The concept of self-awareness is important in social work interviewing. Burnard (1992) defines self awareness as “the process of getting to know your feelings, attitudes and values” (in Thompson, 2009, p.3). A key aspect of self awareness is being aware how we may be perceived by others. In regards to interviewing the social worker may believe they are being laid back, however for the client it may be conceived as being uncaring. Supervision is therefore an important tool to gain feedback and explored any issues. Further importance of self awareness included understanding how possible external factors may affect social workers. Social workers need to aware of concepts such as transference, triggers and blind spots during interviewing process. Thompson stressed that the worker can be affected by a situation without knowing. Therefore, the ‘use of self’ is extremely important.

Empathy

Empathy is another important communication skills involved in social work interviewing. This skill involves “understanding or appreciating the feelings of others, but without necessarily experiencing them” (Thompson 2009, p111). Social workers must show sensitivity and respect to the feelings of the client. There is however a difference between sympathy and empathy. Therefore there is a fundamental skill to achieving empathy not merely expressing sympathy.

It is clear from the above information that the failure to achieve efficient communication between the social worker and client can lead to serious consequences. Poor communication can contributed to the harm and inadequate care clients. For example, in recent times such failures of communication among a range of professionals have been highlighted in the public inquiries into the death of several children known to be in the care of social services.(rewrite)

Personal Learning

The Importance And Significance Of Self Awareness Social Work Essay

Self awareness, according to Wong (2003), means recognition of our personality, strengths and weaknesses and likes and dislikes. As a social worker, self awareness is an essential element to prepare oneself to encounter the clients’ personal matter, their attitudes, thoughts, etc. The essay is going to discuss the importance and significance of self awareness. Then talk about what I have learnt about myself, in terms of my personalities, attitudes, strengths, limitations and how my past experiences affect me. Finally correlate how self awareness can help my professional development as a social worker.

According to Rothman (1999), everyone has its own attitudes or viewpoints towards something. Our thoughts and values are shaped during the time of infancy, childhood, adolescence and adulthood. These thinking may be based on our own experiences, education received or society influences.

It is clear that our past experiences, social norms, values from the others, characteristics, prejudices or stereotypes shape

Knowing how my past experiences influence my own values helps me to be more aware of my own self. Having an uncle who committed suicide that made my family, especially my grandmother, sad and miserable, I personally hate people who have the intention to end up their lives. However, this hatred may make me unable to make the most appropriate decision when a client who has the will to commit suicide seeks help from me. Moreover, as suggested by Biestek (1961), the relationship between the social worker and the client has been called the soul of casework. It may be hard for me to develop appropriate relationship with the client. It is possible that I will have uncontrolled emotional involvement and judgmental attitudes towards the client. Without self awareness and knowing what experiences shape my thoughts, I will experience difficulty in providing sensitive and skillful services to the clients. I may also unknowingly reject the client and avoid talking too much about death unconsciously. However, by knowing what experiences are affecting my values and thoughts, Rothman (1999) suggested that it assists the worker to work with clients, and to control and minimize the influences of personal attitudes and beliefs that may be harmful and prejudicial toward clients.

Prejudices, biases and stereotypes may be great barriers on my professional development. It is common that when come to minorities such as prostitutes, homosexuals or the street sleepers, people may regard their behaviors as unethical. It may due to their personal values, cultural, religious and other beliefs which people take for granted to adopt when facing these issues. I also have prejudices and stereotypes on them and they may be expressed in conversations, acts or behaviours since they are hidden in the subconscious as suggested by Rothman (1999). I may unknowingly have words that harm them and make them defensive or not trust in me. Thus making it hard to develop good relationship with the client and hard to have intervention processes. For example, I have been exposed to a strong heterosexual bias and may incorporate some homophobic reactions such as discomfort or hatred of homosexual people. Without self-awareness and knowledge, I may not be able to provide skillful services to gay or lesbian clients. If a worker has religious belief, he or she may even have a strong belief that homosexuality is a sin. According to Sheafor and Morales (2007), one of the competences required for social work practice is the capacity to engage in ethnic-, gender- and age-sensitive practice. In order to achieve this, it is essential for a worker to find ways and methods to separate their personal belief system from their professional values, ethics and roles.

Knowing my strengths and weaknesses also helps me with my professional development. I am glad and patient to listen to others. At the same time, I am also empathetic to others’ experiences and difficulties. It makes the clients feel being respected and thus it is easier to develop a proper client-worker relationship. It is of utmost importance that the client trust you

Reflecting on our own experiences and developmental stages helps when working with clients. For example, I was shy and not willing to express my care towards others in my childhood. And I would have no opportunity to show my love to my grandmother who died years ago. The losses in my life make me re-think the way I used to be and strive for a change, that is, be more outgoing and caring to others. I can thus draw on my personal experience when working with young people and guide them in the changing process. However, it also makes me consider my limitations, that is, when working with elderly clients. I can relate my experience that is similar to a teenager’s, however, it is impossible for me to have certain difficulties faced by elderly clients such as the aging process. As suggested by Berman-Rossi(2001), a social worker thus must develop aging relevant knowledge, self awareness, sensitivity and skill. Knowledge about aging demographics, age-related changes and developmental tasks is essential.

Although there are limitations to my service provided, there are ways to minimize the inadequacy.

Increased openness to other ways of thinking

My family is a blissful one, sometimes having some conflicts but still harmonious on the whole. I once thought that it is normal to have the kind of family like mine, and at least most of the families are alike. However, it is wrong as there are diversities in family structure. Some families are single-parented, while some may have huge communication problems among family members or having family members that are drug addicts that greatly affects the family.

Sharing own feelings and thoughts among a group of peers helps to make up one’s own viewpoint towards the population. By listening and sharing, one can know more about the peers’ attitudes on the issue, to examine their own attitudes and to exchange opinions in an overview. One can also have a broader view on an issue and

Social workers must confront their own prejudices and stereotypes about minorities.

Making myself known about losses in my own life helps me to understand what past experiences or feelings are affecting my own values and thoughts today.

The Implementation Of Policies And Legislative Social Work Essay

Children are de¬?ned as ‘in need’ when they are “unlikely to achieve or maintain, or have the opportunity of achieving or maintaining, a reasonable standard of health or development”; or whose “health and development are likely to be signi¬?cantly impaired, or further impaired” without the provision of services under s.17(10); o are disabled as defined in s.17(11); or those who are in specific need of safeguarding under Part V of the (CA)(1989).

Ann had recently been separated with her husband due to domestic violence and is currently living in a women’s refuge with her 12 years old daughter. She had reported feeling depressed and lack resources. The development of a definition of domestic violence in Yemshaw v Hounslow LBC [2011] UKSC 3 (SC), decision by the court set a precedent that was used in meeting the needs of families. Children witnessing domestic abuse have now been included in the definition of harm under s.31(9) of the CA (1989).

Section 17(1) of the CA (1989), places a ‘general duty’ on Local Authorities (LA) to “safeguard and promote the welfare of children within its area who are in need”. It is based on the presumption that so far as it is consistent with their duty, children upbringing should be promoted within the family with an emphasis on ‘parental responsibility’ as defined under s.3(1) of the CA (1989). This is complemented and reinforced under s.10(3) of the CA (2004), which requires LAs to have “regard to the importance of parents and other persons caring for children in improving the well-being of children”. LAs are directed through their “specific duties and powers” specified in Part 1 of Schedule 2 to provide services ‘considered appropriate’ to meet the needs of ‘children in need’ with the aim of avoiding the need for care proceedings . This includes homelessness, the psychological effect of witnessing abuse and disruption with school. Under s.17(6) the LA’s can provide accommodation, counselling or as in the cash of domestic violence, assistance in cash.

Social workers are charged with discretion in making ethical decisions and should therefore use case law for additional guidance (Brammer, 2010: 190). In R v Nottingham City Council [2001] EWHC Admin 235, it was established that assessment is not a discretionary duty. Additionally, In R. (on the application of MM) v Lewisham LBC [2009] EWHC 416, it was held that “the consideration given to the referral fell far below the standard required by law”.

The CA (1989) stipulates the legal framework within which Social Work practice with children in need is situated. Its child-centred approach is embodied in the welfare paramountcy principle s.1 and the welfare checklist s.1(3) states factors that must be considered with respect to determining the child’s best interest. This welfare principle is also evident in s.3(5) and s.17. It adopt the principle that any delay s.1(2); “in considering whether to make, vary or discharge” s.31 and s.8 orders, s(1)(4); is likely to prejudice the child’s welfare; and no order should be discharge except it is unequivocally in the child’s best interests.

The complexities and uncertainties of family life have brought about evolving policies and guidelines to complement the legislative framework (Davis, 2009). An understanding of children’s needs requires a multidisciplinary evidenced-based assessment, which is prescribed under The Framework for the Assessment of Children in Need and their Families (DoH, 2000). This is conferred under s.7, LA Social Services Act (1979) and requires LAs to comply with their duties. The Every Child Matters (DfES, 2003) led to the enactment of the CA (2004): it requires LAs under s.11(4) to “have regards of statutory guidance” to cooperate and make arrangements to “safeguard and promote the welfare of children”.

Working Together to Safeguard Children (DCSF, 2010) specifies how agencies should work together: it states unequivocally the proactive early identification of additional needs and the provision of appropriate services. The complexities and tension of multi professional perspective is recognised in The Common Assessment Framework (CAF) (DfE, 2009) and based assessment on consistency and coordination between agencies (Brammer, 2010).

There are potential dissonances between legislative framework and the ethical frameworks, which informs social work practice. Parton (2006) noted the complexities of balancing child empowerment and professional judgement, and suggested that Social workers should advocate for children through their active participation in accordance with s.17(4A and 4B). Graham (2011: 1541) highlighted a substantial cultural shift to include children in planning and decision-making through the construction of the “social model of childhood”. This principle sought to reconcile the concept of child autonomy and right, with professional accountability and responsibility (Williams, 2008). The concept of best interest and the welfare of the child set out in s.1(3) and A8 of the United Nations Convention on the Rights of the Child (1989) is also embodied in decision-making (Butler and Hickman, 2011). In a speech at the Institute of Public Policy Research, Educational Secretary Michael Gove claimed that safeguarding children is inundated with “optimism bias” (Media, 2012).

The law confers both a discretionary and obligatory duties, and the prediction of impairment is given emphasis under s.31 and s.17. It is therefore critical for social workers to have an ethical consideration when discharging their powers and duties, and reflect social work values in their proportionality of intervention under the Human Rights Act (HRA) (1998) which is seen as “an additional scrutiny of practice” (Brammer 2010: 114).

The value of outcome focus needs analysis and multi-agency working is compatible with social work values. It recognise the complexities and sensitivity of domestic violence, and emphasis on the compounding effect of stereotypical assumptions and stigma faced by individual and families (Sheppard, 2006). Social workers’ conceptualisation according to Connolly, et al (2006) is invaluable in promoting social inclusion. This is particularly relevant to Ann’s situation.

Assessment should not be based on a single event; careful consideration must be given the long-term effect of domestic violence (Williams, 2008). It must be conducted sensitively with an emphasis on “respectful uncertainty”, flexibility, openness and honesty about professional involvement (Laming, 2003).

Strafford,et al (2010:13) locates the process of assessment in the context of a “Systems approach”. Social workers need to be aware of the likely impact of any intervention on the family. Social workers are required to adopt a principled approach based on negotiation and partnership.

The CA (2004) requires LAs to coordinate services with relevant agencies: this gained explicit recognition in the Working Together to Safeguard Children guideline and reflects an acknowledgement that disadvantage occurs within a context of multiplicity of interlocking factors and social dynamic of the family (Graham, 2011). Social workers must therefore, integrate best-known evidence to inform professional judgement to accounts for the uniqueness, uncertainties and potential value conflicts (GSCC, 2003).

Anti-discriminatory and anti-oppressive practices are integral to social worker practice and enshrined in law. The GSCC (2003: 1.5) code of practice stresses the importance of “respecting diversity and different culture and values”. Further, s.22(5) requires due consideration to be given to a child’s religious persuasion, racial origin and cultural and linguistic background which is also encapsulated in A.14 of HRA (1998), the right not to be discriminated against. The amendment of parental responsibility by the Adoption and Children Act (2002) to include “adult with real relationship” accounts for value placed on recognition of diversity of families to combat social exclusion (Strafford,et al 2010: 16).

Millar and Corby (2006) highlighted the positive effect of a detailed assessment: Munro (2011) and Wise et al (2011: 95) are however, critical of the bureaucracy and the “prescriptive nature” of the Assessment Framework, which distracts social workers from their core therapeutic function. This presents a dilemma of balancing the need of a more rigorous assessment framework with the CAF (Crisp, et al, 2007).

Social inclusion and integration are intrinsic to social work, however, Palmer (2003) and Goldthorpe and Monro (2005) notes that there is concern amongst social workers that the high eligibility criteria have seen a shift from family support to reactive child protection practice thereby further excluding and marginalising families. This have led social workers to question the concept of ‘needs led’ service provision.

Stafford, et al, (2011) reports on the conflicts and complexities around issues of confidentiality and information sharing within multidisciplinary teams. This posed a dilemma between the welfare of the child and Ann’s right to confidentiality.

Domestic violence occurs within the context of both civil and criminal domain. This present are a wide range of shared and diverse models of knowledge and practice amongst professionals involved with children and families (Graham, 2011). O’Loughlin and O’Loughlin (2008: 41) noted the complexities of balancing the “rights and responsibilities of parents” and the “rights and needs of children”. This present a dilemma between a principled welfare approach and s.8 orders as highlighted in Debbonaire (2012).

Cleaver et al (2010) noted that whist children’s needs occur within the family and environmental context and often interlinked with those of their parent: It is crucial that practice is child-centred and needs considered separately through children’s “active participation” (Mullender 2002: 121). The complexities of parental contact from the perpetrator of abuse might expose the children to witnessing more abuse.

The legislative framework and policies have an enormous impact on social work practice. The complex interplay of skills, values and knowledge; the prevailing social attitudes; and the conflicting and overlapping imperative, have been analysed as the range of dilemmas and conflicts faced by social workers. What is most noteworthy, however, is the need for sound professional judgement and ethical consideration.

The Impact Of Social Divisions Social Work Essay

Social Workers work with some of the most disadvantaged and vulnerable people in Society, those who have been possibly subjected to oppression in their daily lives. ‘Most would agree that Social Work is a diverse and shifting activity’ (Jones 2002’41) in response to the situations presented within society. The society that we live in can be seen as one with many divisions, due to individual difference, people are categorised in due to these differences such as gender, race, class, age and disability. These Social Divisions can result in certain groups being oppressed.

Barker (2003’306-307) defines oppression as

‘The social act of placing severe restrictions on an individual, group or institution. Typically a government or political organisation that is in power places these restrictions formally or covertly on oppressed groups so that they may be exploited and less able to compete with other social groups, the oppressed are devalued exploited and deprived of privileges by the individual or group that has more power.’

Oppression can be fully understood through attention to ‘race,’ gender, class, disability, sexuality and age. Society can attribute to these differences by defining people and their roles based on their different experiences in relation to the power, status and opportunities in society.

Northern Ireland is seen as a multi-cultural society with inhabitants from many different backgrounds and cultures. The roles and expectations that society assumes for different group of people is immersed on a cultural level, thus creating common values about what is ‘normal’ which creates perceptions of social norms. Through these perceptions of ‘social norms’ oppression comes to the forefront.

Recurring discrimination leads to oppression. Thompson (1998’10) says this is: “inhuman or degrading treatment of individuals or groups; hardship and injustice brought about by the dominance of one group over another, the negative and demanding exercise of power. Oppression often involves disregarding the rights of an individual or group and is a denial of citizenship.”

It is important that it is recognise that oppression is not intended solely to refer to situations where a powerful person or group exerts tyranny over others it also refers to the structural injustices that can arise from often unintentional oppressive assumptions and interactions which occur as a result of institutional and social customs, economic practices and rules. (Clifford and Burke 2009)

For the purpose of this assignment I am going to focus on racism and the oppression faced by Travellers as an ethnic minority group. Travellers are an indigenous minority in Ireland and enjoy a distinctive culture, value system and common language. (O’Connell, 2006:4)

Travellers’ nomadic lifestyle follows a routine based on economic practices and religion. According to the Government, Travellers “have shared histories, a nomadic way of life and distinct cultural identity” (Department of Justice 2005; Cited by O’Connell 2006’4)

One notable feature about the discourse of Travellers is the tendency to associate traveller oppression with the terms ‘discrimination’ and ‘prejudice’ and not racism, a tendency which is reflective of a broader resistance among some members of the Irish public and some policymakers and politicians to naming the treatment of travellers as racist. (Exchange House Travellers Service, 2005, www.exchangehouse.ie) (accessed 14/10/10)

The failure to acknowledge traveller oppression as racism may be stemming from failure to acknowledge travellers as a distinct ethnic group. ‘While travellers are visually racialised in society by their normandism, they were also marked through their physical, not structural whiteness. This failure to associate the marginalisation of travellers in Irish Society with racism supports a false understanding of racism as pertaining exclusively or primarily to people of colour’ (Downes & Gilligan 2007’249) despite definitions such as Burke and Harrison’s (2000? 283) who believe:

‘racism is a multidimensional and complex system of power and powerlessness, a process in which powerful groups are able to dominate, which can be seen in the differential outcomes for less powerful groups in accessing services in the health and welfare, education, housing and the legal and criminal justice systems.’

This notion of ‘power’ can demonstrate the segregations in society, and can heighten the oppression faced by those of ethnic minority groups.

‘The development of racial ideology does not reflect the state of knowledge about racial differences but an aspect of social conflict.'(Ely and Denny 1987’4) Racism is a negative term with negative connotations and can be seen as a socially constructed ideology rather than a biological entity. (Thompson 2006) The impact of racism on ethnic minority groups can be detrimental, it can place many restraint on the lives of the individuals such as being restricted in what services they can avail of, the lack of knowledge about the provisions and opportunities available to them. ‘Racism damages those it oppresses socially, economically and politically.’ (Dominelli 2008’65)

Thompson (1993, p19) states that:

“P refers to the personal or psychological; it is the individual level thoughts, feelings, attitudes and actions. It also refers to practice, individual workers interacting with individual clients, and prejudice, the inflexibility of mind, which stands in the way of fair and non – judgmental practice.

C refers to the cultural level of shared ways of seeing, thinking and doing. It relates to the commonalities, values and patterns of thought and behaviour, an assumed consensus about what is right and what is normal; It produces conformity to social norms, and comic humour acts as a vehicle for transmitting and reinforcing this culture.

S refers to the structural level, the network of social divisions; it relates to the ways in which oppression and discrimination are institutionalised and thus ‘sewn in’ to the fabric of society. It denotes the wider level of social forces, the socio-political dimension of interlocking patterns of power and influence.

At the Personal Level Travellers can be seen to be oppressed in many ways, the impressions that Travellers are dirty, criminal

As a minority group, Travellers suffer discrimination and oppression; they are marginalised and excluded by people of the ‘settled community.’ Poverty is seen to be part of daily living within the travelling community and many of the ‘settled’ community feel that it is due to their Normandic way of life and that it could be solved by settling down and getting a job. (De Burca & Jeffers 1999; Cited in Downes & Gilligan, 2007:249)

Rather than offering a structural explanation for traveller poverty, or an understanding of these experiences from the travellers’ point of view, the views and interpretations of the dominant cultural group are usually imposed on travellers. (Downes & Gilligan 2007) However the oppression faced by travellers cannot be seen just from a personal point of view, it needs to be viewed in a broader context. Racism manifests itself in many different ways in society. Thompsons (2006) PCS model provides an understanding to how racism des so; it can be seen to operate at three different levels, the personal, cultural and structural. Clifford and Burke (2009’18) believe that ‘Oppression operates at both structural and personal levels at the same time.’

Since the formation of the Welfare State many changes have come about which have resulted in positive actions in attempting to challenge racism and the oppression faced by people in Society. Social Policy plays an important part in promoting integration in society. ‘One of the functions of the Welfare provision in general, is to promote the integration of individuals in society.’ (Oliver 1996’78) These policies may be interpreted as responses to perceived social needs. The policies evolve within an environment where problems come to the forefronts that are seen to require political solutions and pressures occur for new political responses. (Hill 2009)

Social Work practice is transforming through the creation of social relations, fostering equality and justice in moving toward an anti- racist approach, a political stance against racism is adopted on the personal, institutional and cultural levels within policies, practice, education and Social Work organisations. (Dominelli, 2008)

O’Connell (2006’5) states that ‘Travellers have been victims of violence and intimidation and have been subject to exclusion from services, giving rise to many cases under the Equal Status Act.’ This Act covers discrimination on the grounds of gender, race, age, marital status, family status, religion, sexual orientation, disability and membership of the Traveller Community. ‘Deconstructing power relations and privileging within professional relationships can begin the processes of changing professional and organisational structures.’ Dominelli (2008:77)

The Traveller Education strategy (2006) seeks an end to separate Traveller provision in education to be replaced by inclusive provision in main stream services.

The need to respect Travellers’ rights is a logical element of the new human rights and equality architecture established since 1998: the creation of an Equality Authority to promote equality, an Equality Tribunal to hear discrimination cases, the National Consultative Committee on Racism and Interculturalism (NCCRI) to give expert advice on these issues, and the Irish Human Rights Commission (IHRC) to promote human rights. Ireland has adopted new anti-discrimination legislation (1998 Employment Equality Act and 2000 Equal Status Act), and most recently the State has announced a National Action Plan against Racism (Department of Justice 2005).

Anti-racist initiatives are reflected in Social Work education and practice, many Social work organisations engaged with what is known as Race Awareness Training. These initiative target Social Work education as well as service delivery. CCETSW implemented an anti racist policy which was aimed at looking at ways to educate student and practitioners of anti-racist practices. (Llewellyn 2008)

The Impact Of Living With Chronic Illness Social Work Essay

Families and individuals have to overcome new challenges due to disability and chronic illness. Families have suffer financial burden related to providing health facilities, education and buying appropriate equipment for the disabled or chronically ill member of the family. Some times house needs to modified to accommodate the needs of affected individual. Sometimes families and affected individuals get financial help from social services but getting the whole procedure and paper work done puts an extra burden while caring for the affected family member. Sometimes the situation is more worse when affected families and individuals suffer because they are unaware of the facilities and help they can get from government institutes

Stress:

Caring for the affected member of the family on daily basis puts family members under constant stress, anxiety, and depression and also physical fatigue. Family members and the affected individual become uncertain about the future.

The affected individual also suffers from the frustration of disability and losing function.

Gender:

Disability affects family members differently- female family members tend to be more considerate and affectionate towards the affected person while male family members tend to provide financial support. Most families who are responsible for the care of disabled/chronically ill members of the family find this division of labour according to gender an easy way to manage and cope with challenges.

Gender also affects disabled individual- female and male individual show different attitudes towards physical disability or chronic illness/pain. Women do not feel comfortable outside their home anf find it dangerous while men tend to adapt to their reduced function and still tend to be as functional as is possible. Disabled females tend to be more dependent on family and friends compared to disabled males.

Relationships:

Often relatioships change their meanings within the family responsible to care for a disabled member. The person who is mainly responsible for the care/ entertainment/ diet and necessities of the disabled person tends to take more important position in the family and the rest of the family becomes less involved in decision making. If a mother is more involved in the care of a disabled child this can lead to father being less involved in the care responsibilities and tend to indulge himself more in work or activities outside home- this can sometimes lead to conflicts within the families with one member feeling overburdened.

Lifestyle:

Most of the resources (money, time etc) of a family with a disabled member are spent in the care of the disabled leading to an overall lower quality of life. Families have to give up entertainment plans such as holidays due to lack of resources, facilities and extra responsibility of care.

Friends, neighbors, and people in the community may react negatively to the disability by avoidance, disparaging remarks or looks, or overt efforts to exclude people with disabilities and their families. Despite the passage of the Americans with Disabilities Act in 1990, many communities still lack programs, facilities, and resources that allow for the full inclusion of persons with disabilities. Families often report that the person with the disability is not a major burden for them. The burden comes from dealing with people in the community whose attitudes and behaviors are judgmental, stigmatizing, and rejecting of the disabled individual and his or her family (Knoll 1992; Turnbull et al. 1993). Family members report that these negative attitudes and behaviors often are characteristic of their friends, relatives, and service providers as well as strangers (Patterson and Leonard 1994).

Social stigma:

Families with disabled member and disabled individual themselves feel isolated from the society. Friends, neighbours and other family might not play their supportive role effectively

Overall, stress from these added demands of disability in family life can negatively affect the health and functioning of family members (Patterson 1988; Varni and Wallander 1988). Numerous studies report that there is all increased risk of psychological and behavioral symptoms in the family members of persons with disabilities (Cadman et al. 1987; Singer and Powers 1993; Vance, Fazan, and Satterwhite 1980). However, even though disability increases the risk for these problems, most adults and children who have a member with a disability do not show psychological or behavioral problems. They have found ways to cope with this added stress in their lives. Increasingly, the literature on families and disabilities emphasizes this adaptive capacity of families. It has been called family resilience (Patterson 1991b; Singer and Powers 1993; Turnbull et al. 1993). Many families actually report that the presence of disability has strengthened them as a family-they become closer, more accepting of others, have deeper faith, discover new friends, develop greater respect for life, improve their sense of mastery, and so on.

While there are many commonalities regarding the impact of disabilities on families, other factors lead to variability in the impact of disability on the family. Included in these factors are the type of disability, which member of the family gets the disability, and the age of onset of the disability.

Disabilities vary along several dimensions, including the degree and type of incapacitation (sensory, motor, or cognitive); the degree of visibility of the disability; whether the course of the condition is constant, relapsing, or progressive; the prognosis or life expectancy of the person; the amount of pain or other symptoms experienced; and the amount of care or treatment required. John Rolland (1994) has outlined a typology of chronic conditions based on some of these factors and has described the psychosocial impact on families based on these factors. His argument, and that of several others (Perrin et al. 1993; Stein et al. 1993), is that the variability in the psychosocial impact of chronic conditions is related more to characteristics of the condition than to the diagnosis per se.

Consider the course of the condition. When it is progressive (such as degenerative arthritis or dementia), the symptomatic person may become increasingly less functional. The family is faced with increasing caretaking demands, uncertainty about the degree of dependency and what living arrangement is best, as well as grieving continuous loss. These families need to readjust continuously to the increasing strain and must be willing to find and utilize outside resources. If a condition has a relapsing course (such as epilepsy or cancer in remission), the ongoing care may be less, but a family needs to be able to reorganize itself quickly and mobilize resources when the condition flares up. They must be able to move from normalcy to crisis alert rapidly. An accumulation of these dramatic transitions can exhaust a family. Disabilities with a constant course (such as a spinal cord injury) require major reorganization of the family at the outset and then perseverance and stamina for a long time. While these families can plan, knowing what is ahead, limited community resources to help them may lead to exhaustion.

Disabilities where mental ability is limited seem to be more difficult for families to cope with (Breslau 1993; Cole and Reiss 1993; Holroyd and Guthrie 1986). This may be due to greater dependency requiring more vigilance by family members, or because it limits the person’s ability to take on responsible roles, and perhaps limits the possibilities for independent living. If the mental impairment is severe, it may create an extra kind of strain for families because the person is physically present in the family but mentally absent. This kind of incongruence between physical presence and psychological presence has been called boundary ambiguity (Boss 1993). Boundary ambiguity means that it is not entirely clear to family members whether the person (with the disability in this case) is part of the family or not because the person is there in some ways but not in others. Generally, families experience more distress when situations are ambiguous or unclear because they do not know what to expect and may have a harder time planning the roles of other family members to accommodate this uncertainty.

In addition to cognitive impairment, other characteristics of disabilities can create ambiguity and uncertainty for families. For example, an uncertain life expectancy makes it difficult to plan future life roles, to anticipate costs of care, or to make decisions about the best living arrangements for adults requiring assistance in the activities of daily living. For example, from 1970 to 1991, survival for children with cystic fibrosis increased 700 percent, to a life expectancy of twenty-six years in the United States (Fitzsimmons 1991). These young adults now face difficult family decisions, such as whether to marry and whether to have children. In more extreme cases related to severe medical conditions, persons may have their lives extended by using advances in biomedical science and technology. When this happens, families can be faced with very difficult decisions about what techniques and equipment should be used, for how long, with what expected gains, at what cost, and so on. Society is facing new issues in biomedical ethics, but there is no social consensus about how aggressively to intervene and under what circumstances. Family members who bear the emotional burden of these decisions do not always agree on a course of action and, furthermore, may be blocked by hospitals and courts from carrying out a particular course of action. While these kinds of cases may not yet be widespread, they have sparked intense debate and raised the consciousness of many families about issues they may face.

In addition to type of impairment, there is variability in the severity of impairment. The degree to which a person with disability is limited in doing activities or functions of daily living (e.g., walking, feeding oneself, and toileting) can be assessed and is called functional status. The lower the person’s functional status, the more assistance he or she will need from other people and/or from equipment and devices. Family members are a primary source of this needed assistance (Biegel, Sales, and Schulz 1991; Stone and Kemper 1989). Providing this assistance can create a burden for family caregivers, which may result in physical or psychological symptoms of poor health. For example, parents, especially mothers, experience more depression when their children with disabilities have lower functional status (Patterson, Leonard, and Titus 1992; Singer et al. 1993). For elderly caregivers, physical strain may be a limiting factor in how much and for how long assistance can be provided for the disabled individual (Blackburn 1988).

The age of the person when the disability emerges is associated with different impacts on the family and on the family’s life course, as well as on the course of development for the person with disability (Eisenberg, Sutkin, and Jansen 1984). When conditions emerge in late adulthood, in some ways this is normative and more expectable. Psychologically it is usually less disruptive to the family. When disability occurs earlier in a person’s life, this is out of phase with what is considered normative, and the impact on the course of development for the person and the family is greater. More adjustments have to be made and for longer periods of time.

When the condition is present from birth, the child’s life and identity are shaped around the disability. In some ways it may be easier for a child and his or her family to adjust to never having certain functional abilities than to a sudden loss of abilities later. For example, a child with spina bifida from birth will adapt differently than a child who suddenly becomes a paraplegic in adolescence due to an injury.

The age of the parents when a child’s disability is diagnosed is also an important consideration in how the family responds. For example, teenage parents are at greater risk for experiencing poor adaptation because their own developmental needs are still prominent, and they are less likely to have the maturity and resources to cope with the added demands of the child. For older parents there is greater risk of having a child with certain disabilities, such as Down syndrome. Older parents may lack the stamina for the extra burden of care required, and they may fear their own mortality and be concerned about who will care for their child when they die.

The course of the child’s physical, psychological, and social development will forever be altered by the chronic condition. Since development proceeds sequentially, and since relative success at mastering the tasks of one stage is a prerequisite for facing the challenges of the next stage, one could anticipate that the earlier the onset, the greater the adverse impact on development (Eisenberg, Sutkin, and Jansen 1984).

There are many ways in which the accomplishment of development tasks is complicated for persons with disabilities. This, in turn, has an effect on their families as well as on which family roles can be assumed by the person with disability (Perrin and Gerrity 1984). For example, in infancy, disability may frighten parents, or the infant may be unresponsive to their nurturing efforts such that attachment and bonding necessary for the development of trust are compromised. The parent may feel inadequate as a caregiver, and parenting competence is undermined. For a toddler, active exploration of the social environment, needed to develop a sense of autonomy and self-control, may be restricted because of the child’s motor, sensory, or cognitive deficits. Parents, fearing injury or more damage to their young child, may restrict their child’s efforts to explore and learn, or they may overindulge the child out of sympathy or guilt. If other people react negatively to the child’s disability, parents may try to compensate by being overly protective or overly solicitous. These parent behaviors further compromise the child’s development of autonomy and self-control.

As children with disabilities move into school environments where they interact with teachers and peers, they may experience difficulties mastering tasks and developing social skills and competencies. Although schools are mandated to provide special education programs for children in the least restrictive environment and to maximize integration, there is still considerable variability in how effectively schools do this. Barriers include inadequate financing for special education; inadequately trained school personnel; and, very often, attitudinal barriers of other children and staff that compromise full inclusion for students with disabilities. Parents of children with disabilities may experience a whole set of added challenges in assuring their children’s educational rights. In some instances, conflict with schools and other service providers can become a major source of strain for families (Walker and Singer 1993). In other cases, school programs are a major resource for families.

Developmental tasks of adolescence- developing an identity and developing greater autonomy-are particularly difficult when the adolescent has a disability. Part of this process for most adolescents generally involves some risk-taking behaviors, such as smoking and drinking. Adolescents with disabilities take risks too, sometimes defying treatment and procedures related to their condition, such as skipping medications or changing a prescribed diet. Issues related to sexuality may be particularly difficult because the person with disability has fears about his or her desirability to a partner, sexual performance, and worries about ever getting married or having children (Coupey and Cohen 1984). There is some evidence that girls may be at greater risk for pregnancy because of their desire to disavow their disability and prove their normalcy (Holmes 1986). Teens with mental impairment may be subjected to sexual exploitation by others.

When disability has its onset in young adulthood, the person’s personal, family, and vocational plans for the future may be altered significantly. If the young adult has a partner where there is a long-term commitment, this relationship may be in jeopardy, particularly if the ability to enact adult roles as a sexual partner, parent, financial provider, or leisure partner are affected (Ireys and Burr 1984). When a couple has just begun to plan a future based on the assumption that both partners would be fully functional, they may find the adjustment to the disability too great to handle. The development of a relationship with a significant other after the disability is already present is more likely to lead to positive adjustment. Young adulthood is that critical transition from one’s family of origin to creating a new family unit with a partner and possibly children. When disability occurs at this stage, the young adult’s parents may become the primary caregivers, encouraging or bringing the young person home again. The risk is that the developmental course for the young adult and his or her parents may never get back on track. This is influenced in part by the extent to which there are independent living options for persons with disabilities to make use of in the community.

When the onset of disability occurs to adults in their middle years, it is often associated with major disruption to career and family roles. Those roles are affected for the person with the disability as well as for other family members who have come to depend on him or her to fulfill those roles. Some kind of family reorganization of roles, rules, and routines is usually required. If the person has been employed, he or she may have to give up work and career entirely or perhaps make dramatic changes in amount and type of work. The family may face a major loss of income as well as a loss in health and other employee benefits. If the person is a parent, childrearing responsibilities may be altered significantly. The adult may have to switch from being the nurturer to being the nurtured. This may leave a major void in the family for someone to fill the nurturing role. If the person is a spouse, the dynamics of this relationship will change as one person is unable to perform as independently as before. The partner with the disability may be treated like another child. The sexual relationship may change, plans for having more children may be abandoned, lifestyle and leisure may be altered. Some spouses feel that their marital contract has been violated, and they are unwilling to make the necessary adjustments. Children of a middle-aged adult with a disability also experience role shifts. Their own dependency and nurturing needs may be neglected. They may be expected to take on some adult roles, such as caring for younger children, doing household chores, or maybe even providing some income. How well the family’s efforts at reorganization work depends ultimately on the family’s ability to accommodate age-appropriate developmental needs. In families where there is more flexibility among the adults in assuming the different family roles, adjustment is likely to be better.

The onset of disability in old age is more expectable as bodily functions deteriorate. This decline in physical function is often associated with more depression. An older person may live for many years needing assistance in daily living, and the choices of where to get that assistance are not always easily made. Spouses may be unable to meet the extra caretaking needs indefinitely as their own health and stamina decline (Blackburn 1988). Adult children are often in a position of deciding where their elderly parent or parents should live when they can no longer care for themselves. Having their parents move in with them or having them move to a nursing home or seniors’ residence are the most common options. However, each of these choices carries with it emotional, financial, and social costs to the elderly person as well as to his or her adult children. This responsibility for elderly parents is not always shared among adult children. Adult daughters are more likely than adult sons to be involved in providing direct care for their elderly parents (Brody 1985). The many decisions and responsibilities can be sources of tension, conflict, and resentment among extended family members. This period of disability in old age can go on for a very long time, given the medical capability to sustain life. While the practice is still not widespread, more elderly people are preparing a living will, which is a legal document preventing extraordinary means from being used to prolong their lives.