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The following essay will identify and describe key takepu principles that are an integral part of social work and the development of relationships with all culturally diverse individuals within the social work practice. The main focus for my essay will lay around 6 main takepu which are Ahurutanga – Safe space, Kaitiakitanga – Responsible stewardship, Taukumekume – Positive and negative tension, Te Whakakoharangatiratanga – Respectful relationships, Mauri ora – Pursuit of well-being and Tino Rangatiratanga – Absolute integrity. (Pohatu, 2004:1). These takepu are guidelines that social workers should use to allow an open space that encourages and supports a healthy relationship between social worker and client and vice versa. When contextualized, and internalized, they assume a central place in how people should engage in kaupapa. (Pohatu, 2004:1). This essay will also discuss how I incorporate Nga Takepu into my social and professional life.

Nga Takepu principles are grounded in the social work professions philosophy, values, ethical prescriptions and an obvious way of living. They are not supported by empirical verification nor are they compiled in one single document supported by the government. Yet at Te Wananga o Aotearoa these principles are taught as if there is an agreed upon set of practice guidelines that all social workers should follow. To the contrary, social works practice principles are largely unwritten, learned life experiences and typically are passed on informally from seasoned workers to those who are entering the profession, or in my case from teacher to student. I feel that the takepu principles I have learned at Te Wananga o Aotearoa have enabled my conscious mind when it comes to forming and maintaining relationships with people. Social workers must be consciously aware of how their own beliefs, perceptions, and behaviors may have an impact on their professional relationships, as these personal attributes will surely affect the ability to be helpful to clients. (Sheafor, Horjsi & Horjsi, 2000).

Te Whakakoharangatiratanga (Respectful relationships) for me occurs in every aspect of our lives whether it is mother – daughter, brother – sister or student – teacher. There is always that acknowledgement of respect for each other and it is something that I have learned to appreciate throughout my life. In the Tongan culture Whaka’apa’apa (respect) takes on a lot of forms. Showing respect could be not looking your elders in the eyes, which in the European culture can be seen as disrespectful. Respect for me and Te Whakakoharangatiratanga go hand in hand. Respectful relationships cannot thrive without respect from all parties involved. All the positive outcomes that benefited Tongan people in the past were said to result from the acknowledgement, recognition and appreciation or faka’apa’apa for the roles played by deities in the people’s welfare and livelihood. (Havea, 2005).

Good helping relationships result from a conscious effort on the part of the worker. It is necessary for the social worker to make conscious use of what is naturally themselves – to use all of themselves and not just their analytical or technical skills – to achieve a purposive relationship with someone else. (O’Connor, Wilson and Setterland, 1998). A lot of what I am learning at Te Wananga is being consciously aware of my surroundings, being able to absorb all that I can from not only my kaiako but fellow peer’s also. I feel as though I’ve grown up with all these Takepu – I’ve just not known them by there Maori words, they are phrases and values I hold dearly. For me it was all to do with recognizing these principles and knowing when to apply them. My family created a safe space for me at home (ahurutanga), I care for my nephews and nieces when needed (kaitiakitanga), having faith in what I believe in and having the strength to back it up (tino rangatiratanga), I engage in respectful relationships with people I meet at Te Wananga o Aotearoa (Te Whakakoharangatiratanga), resolving disagreements within the family and acknowledging good behavior with younger members of my family (tau kumekume), and last but not least the constant need to better oneself, love more, give more, understand more and even further my knowledge base here at Te Wananga o Aotearoa is all in the pursuit of overall mauri-ora (wellbeing).

“Values are concerned with what is good and desirable whilst ethics deal with what is right and correct”.

(Loewenberg & Dolgoff, 1992)

While understanding when these principles should be used and being able to identify them we cannot steer away from the fact that there is always a deeper meaning to what we learn and what these principles mean to us. If we cannot control the definition we cannot control meanings and the theories which lie behind these meanings (Smith, 1995). This quote reminds us of the importance of Maori frameworks. The fact that I have been fortunate enough to learn about Nga Takepu straight from Matua Taina Pohatu himself just reaffirms the fact that Maori should be teaching all things Maori. His definitions of the meaning therefore mean more to me than if I had read them in a book at school. Being a great social worker to me is when you reach a point where you already know the guiding principles, when to use them, how to use them, and doing so, so much that you subconsciously use all of yourself to engage in relationships with people.

The social work profession promotes social change, problem solving in human relationships and the empowerment and liberation of people to enhance Mauri-ora (well-being). Utilizing theories of human behavior and social systems, social work intervenes at the points where people interact with their environments. Principles of human rights and social justice are fundamental to social work. Incorporating Nga Takepu Principles encompasses social workers duty to tangata whenua – Members actively promote the rights of tangata whenua to utilize tangata whenua social work models of practice and ensure the protection of the integrity of tangata whenua in a manner which is culturally appropriate (ANZASW Code of Ethics, 2008). Tino rangatiratanga (absolute integrity) is not just an important part of my learning here at Te Wananga o Aotearoa but it is an important part of who I am as an individual, how I hold myself and how I appreciate difference and strive to learn more.

All cultures have a special way to define time and space. Understanding how cultures do it differently increases our understanding and communication cross-culturally. (Inglis, 2000). It is through knowledge that we are able to gain an understanding of how people are defined by there culture, or cultural differences. Understanding Ahurutanga (safe space) allows social workers an environment where they are able to freely engage in discussion, an environment where all parties involved are able to open up and truly be in a space that is free from prejudice and any other outside influences. Ahurutanga (safe space) is the first step social workers take when first establishing a relationship. Ones ability to build and maintain positive helping relationships with clients is fundamental to social work practice. (Sheafor, Horejsi & Horejsi, 2000). Knowing when to create Ahurutanga encourages a greater thinking on the social workers behalf, and encourages a healthy relationship.

Creating a safe space to engage in is one of the steps taken to ensure the basis of the relationship is comfortable and an open environment is thus created. The well-being of the client(s) should be present throughout. Mauri-ora is as explained by Matua Taina Pohatu is the pursuit of well-being (Pohatu, 2001). Mauri-ora for me is knowing and having clarity of the past and of your purpose here on earth. Having the ability to grow from these strengths and flourish as an individual all in the pursuit of an ultimate well-being. Mauri-ora is being fully aware of transformative possibilities, responsibilities, accountabilities, guide practice and respectful relationships. From a social workers point of view Mauri-ora would come in the final stages of empowering a client, or fulfilling their needs.

In conclusion interpreting and reshaping take pu to inform and guide our practice in each new activity, give time and place for the active re-engagement with the thinking and voices of earlier generations. The possibilities are immense and boundless if there is the will to respectfully ‘engage’. (Pohatu, 2003). The fact of the matter is there are hundreds if not thousands of principles that we can use to shape how we engage in relationships with people from different cultures. Knowing what principles you already have, and are constantly learning throughout your life help us to respectfully engage with people. Nga Takepu for me are Maori principles that I can incorporate into my studies to help me engage with tangata whenua. All my life experiences add to who I am as a person and how I treat others. All through school I have engaged with people from all different cultures, I have always gone in with an open mind and a willingness to understand more about the true character of a person. Take pu for me is a vital part of my learning towards becoming a social worker, using all of them will surely help how I engage in all relationships now and in the future.

The needs of older people are rarely considered outside of their age-related ailments. Community services remain geared towards the younger generation more specifically children and young people, while older people’s needs tend to be looked at peripherally. A question that springs to mind is how risk is assessed in an older person with mental health issues.

A starting point could be to look at a definition of risk. Risk can be defined as ‘the possibility of beneficial and harmful outcomes and the likelihood of their occurrence in a stated timescale’ (Alberg et al in Titternon, 2005). Risk is also a common feature in assessment frameworks by agencies and policies in social care and health. Hence the need to attach significance to risk issues in several public inquiries. However, these seem to be primarily related to child death inquiries where risk assessment and risk management are seen as the ongoing needed requirements to improve best practice. Most available research studies of risk and older people seem to focus on falls and other everyday risks they might encounter when seeking to return home after a hospital admission.

Langan & Lindlaw (2004) comment that mental health service users have become increasingly defined in terms of risk and dangerousness, despite consistent research evidence that their contribution to violence in society is minimal. They further stipulate that continued focus upon risk means that there is a danger that people so defined will be excluded from decision-making about their lives. This could be related to theory and research evidence that suggests that although older people with mental health needs are at increased risk of admission to long-term care, staff tend not to be well informed about their mental health needs (Nicholls, 2006). This could be related with mental health issues coexisting with other medical conditions in later life, leading to this client group being commonly treated in mainstream settings rather than mental health related institutions.

In regards to legislation and policy that incorporates risk assessment, we have the NHS and Community Care Act (1990) which spells out the duty to assess those in need of community care services. More specifically to risk related interventions, these should be the least restrictive and clients ought to be encouraged to use their own resources or develop new ones as per Mental Health Act (1983), Mental Capacity Act (2005) and Safeguarding Adults. Moreover in context of the National Service Framework for Older People (2001) ‘person-centred care’ is key, where the aim is for older people to be treated as individuals and receive appropriate and timely packages of care which meets their needs as individuals, regardless of health and social services boundaries (DH, 2001). The No Secrets guidance (2000) encourages services users to have greater control of their lives by being given the opportunity to take and manage risks. There is also the Risk and Choice Framework (2007) which provides guidance on risk assessment and tools.

However, current policy and legislation seems to hold long-held ageist assumptions about capacity and capability. For instance, the NSF for Older People (2001) and Essence of Care (2003) require service providers to ensure that care for this client group is fully integrated and holistic in nature. Hence the intended use of the FACS (Fair Access to Care Services) criteria to ensure equality. Yet, these eligibility criteria can prevent an important focus on an older person’s biography in terms of the strengths and abilities they gained over their transitional experiences. In this instance, policy relating to risk assessment needs to consider the impact of age and life course stage.

Moreover, has concluded by McDonald (2010) legislation alone will not change the way in which professionals respond to older people and further analysis is needed in regards to the factors that influence decision making in the context of risk.

Through our lifespan risk can be perceived as beneficial and part of everyday life as it enables learning and understanding. However, one cannot dismiss the negative consequences of risk and subsequently the need for it to, at times be monitored and restricted. Thus risk assessment becomes a significant element of many frameworks.

Risk assessment has been defined as ‘the process of estimating and evaluating risk, understood as the possibility of beneficial and harmful outcomes and the likelihood of their occurrence in a stated timescale’ (Titterton, 2005: 83).

In that context, such process should look at a situation or decision, identify the risk and qualify/rate it in terms of likelihood, harmfulness or even low, medium or high risk. Thus, a risk assessment will only identify the probability of harm a risk may have to the related client and others. Subsequently, intervention strategies should aim at reducing harm. Irrespective of this a risk assessment cannot prevent risk (Hope and Sparks, 2000) and most models of risk assessment recognise that it is not possible to eliminate risk, despite the pressure on public authorities to adopt defensive risk management (Power, 2004).

This defensive risk management is perhaps in response to some of the high profile cases dominated in the media over the recent years, which has directed the focus of community care policy to minimise risk. Also the government current emphasis on risk when it comes to mental health related incidents/cases conveys a highly misleading message to the public which in turns seems to contribute to the defensive nature found in the professionals that carry assessment and are meant to support this client group.

As commented in the Health Select Committee (2000) the current “blame culture” risks driving away much needed staff from mental health services. The parallel concern becomes what are acceptable risks and how these might conflict with the agenda of person-centred assessments and user empowerment. As put in Carr (2011) defensive risk management or risk-aversive practice may result in service users not being adequately supported to make choices and take control, hence being put at risk.

Risk assessment is not only about negative labelling with adverse consequences. It has the value of promoting safety and, where necessary, identify appropriate intervention and support for service users. The methods most used in assessing risk in social work are: actuarial and clinical methods. Adams, Dominelli and Payne (2009) state that the actuarial method involves statistical calculations of probability where an individual’s behaviour is predicted on the basis of known behaviour of other in similar circumstances; clinical assessment employs diagnostic techniques relating to personality factors and situational factors relevant to the risk behaviour and the interaction between the two. This latter is the more familiar method in social work practice. Both methods have limitations in terms of generalising behaviour (actuarial method) and risk assessment being a subjective process (clinical methods), i.e. influenced by assessor’s background, values and beliefs. As such, it is central for professionals to be aware of the limitations of risk assessment tools.

Thus far, risk and its assessment seem to vary which reinforces the need for partnership and collaborative working as a way forward in integrating health and social care to provide a person centred support to mental health service users. Alaszewski and Alaszewski (2002) found that users, families and professionals had differing views about risk and safety. Nicholls (2006) refers to the Green Paper on Independence, Well-Being and Choice, which found that service users believe that professionals are too concerned about risk, and that this gets in the way of enabling service users to do what they want to do.

In relation to older people, the Single Assessment Process stipulates the need for a coordinated approach by which health and social care organisations work together to ensure person-centred, effective and coordinated care planning (Nicholls, 2006). This entails sharing information, trusting one another’s judgement, reducing duplication, and together ensuring that the range and complexity of an older person’s needs are properly identified and addressed in accordance with their wishes and preferences.

Such collaborative working between professionals and service users can address potential conflict, evaluate strengths, needs and risk where the effectiveness of intervention is likely to be improved and the outcomes for service users more positive (Adams, Dominelli and Payne, 2009).

The implications for social work practice is that the needs for service users with mental health issues frequently cross organisational and professional boundaries. For example, professionals working with older people with mental health issues are more than likely to work alongside a range of practitioners from different health and social care disciplines and organisations. Thus, one needs to consider how organisational cultures may impact or influence on how risk is perceived as subsequently assess. As put by Neil et al (2009, p.18) risk decision making is often complicated by the fact that the person or group taking the decision in not always the person or group affected by the risk.

Waterson (1999) further suggests that professionals and users tend to disagree on the levels of risk, not least because risk is subjective and can apply to environments as well as to people. Alaszewski and Manthorpe (1998) equally argue that risk is perceived differently by different professionals and allocating blame is one of the main concerns of public enquiries into failures of community care interventions.

As current society develops into a culture of blame and risk-aversion, there is an emphasis on the need to minimise uncertainty about risks and attribute individual culpability. As put by Parton (1998) ‘blaming society’ is now more concerned with risk avoidance and defensive practice than with professional expertise and welfare development. This defensive form of social work in risk assessment put at risk effective and open collaborative and partnership working. Today’s dominance of individual accountability (or culpability) might make social work lose sight of their traditional values where service users are meant to be empowered to make informed decisions about the risks they are prepared to take and the support they feel they might need. As stated in Carr (2011) practitioners are less able to engage with individuals to identify safeguarding issues and enable positive risk tasking. As a result issues of discrimination, inequality and anti-oppressive practice start emerging with a client group that is already vulnerable.

Both stigma and discrimination against older people is further accentuated by a diagnosis of mental health. It is reported that older people with mental health needs are at greater risk of abuse than other groups of older people (Nicholls, 2006). In regards to risk assessment, literature stresses the need for mental health service users to be included in that process, to have choice and opportunities to take risks towards maintaining their independence and self-determination, as put by Lawson (1996: 55) ‘risk taking is choosing whether or not to act to achieve beneficial results in an awareness of potential harms’.

As mentioned before risk taking is part of life, but too often for older people the presence of an element of risk results in the prescription of care solutions or admission to residential care which may not be the older people’s own wishes. For example, in placement experience when older clients were admitted to hospital the local authority primary goal was to ensure clients remained at home for as long as possible however the package of care was delivered in accordance with the local authority’s interpretation of these client’s needs such as dictating bedtime routines and dismissing the need for social interaction. In this instance, the risk assessment tended to focus on the worker’s interpretation of perceived need. This could relate to the findings of Langan & Lindlaw (2004) study where service user involvement in risk assessment was variable and depended upon individual professional initiative. The concern here is that being overpreoccupied with risk can be to the detriment of assessing needs suggesting a primary concern with organisational procedures and resource-allocation over service user’s wellbeing. As put by Munro (2002) social work should be much more than minimising risk, it should be about maximising welfare. Carr (2011) further suggests that this also impacts of practitioners’ ability to engage with service user to enable positive risk-taking, leaving clients unsupported in taking control.

Discrimination may also occur has a result of the level of risk attributed to a service user. Whereby over-estimation can lead to unwarranted labels and under-estimation lead to inappropriate service provision and/or risk to others (Langan & Lindlaw, 2004). Inflexible labelling is both unhelpful and often stigmatising. As found in research, people with mental health problems are a far greater risk to themselves than they are to the general population and while there are instances where intervention is required this should not be done in a way that pigeonholes this client group as if the category of “dangerousness” (Tew, 2011) is solely related to mental heath issues.

In an attempt to answer the initial question, of how risk is assessed in an older person with mental health issues, risk assessment of older people with mental health issues is more likely to take place in crisis situations. Hence interventions might be more reactive rather than proactive, where professionals’ focuses on weaknesses and inabilities rather than strengths and abilities. Professionals may ‘play safe’ by minimising risk at the expense of user empowerment.

To better understand how risk, strengths and difficulties are assessed in regards to risk assessment in older people with mental health needs (and other mental health service users) we need to put it in the context of current political and social perception. The latter being significant given that research into causes and effects of mental health in older people are limited, also there is limited research on how mental health service users manage risk. Therefore, it is essential that risk assessment moves from a “one-size fit all” approach or a sort of tick-box exercise to being an inclusive process where the individual involved brings expert knowledge that needs to be incorporated into the assessment of risk. As found in Langan and Lindlaw (2004) few service users were fully involved in risk assessment. Similarly, Stalker (2003) makes reference to the omission from research of services users who are perceived to be at risk or a risk. Littlechild & Hawley (2010) suggest that little is known about how social workers actually assess risk and that judgements made by individual professionals can vary when using the same risk assessment tools. Petch (2001) adds that overemphasising the importance of accurate risk assessment may lead to misleading conclusions about the level of risk posed by someone and as such expose this group to unnecessary restrictions.

From some of the literature review and research available risk can be viewed as a social construction, perception of risk differs between professionals (and service users) and society has its own normative views on risk and it’s overtly concerned with the consequences of risk behaviour in relation to mental health. Moreover, the role of the media in shaping and, one could argue, amplifying some of these concerns must also be acknowledged. Nonetheless, this does not make risk inexistent. The key seems to be for the needs and risk of mental health service users to be assessed from a holistic approach, avoiding judgements, placing the service user at the centre and valuing their perspective as a contributing expert while at the same time recognise that risk is contextual as well as its fluid, i.e. risk can change.

Risk assessments need to be comprehensive and build on a bigger picture of the service user by drawing on their strengths and aspirations. Tew (2011) reiterated that the dominant discourse around risk tends to pathologise service users where social and environmental context is not considered. Also that this leads to a paternalistic practice where service user’s needs are provided for without considering their rights.

The concept of ‘risk’ is complex, making its assessment challenging. This is reflected in the different ideas and approaches to risk assessment as well as the inkling that we are moving to a risk dominated society. As a result, the attitudes and behaviours of such society are weighed in policy and practice in relation to service users with mental health issues whereby isolated incidents involving people with mental health issues become exaggerated to generate perceptions that such client group are inherently dangerous and need to be controlled and confided (Gould 2010). Undisputedly, it is a major challenge to get the right balance when making difficult risk decisions.

On the other hand, risk assessments are needed to improve the validity and reliability of decision making particularly where there may be concerns about an individual’s capacity to make informed judgements. However, risk can never be eliminated altogether, and occasionally decisions will be made in good faith, on the best evidence available.

As proposed by Stalker (2003) more studies are needed to address the complex nature of risk as well as positive-risk taking in regards to service users with mental health needs. This in addition to the need for research to include services users perspectives as well as other variables such as race and gender.

In regards to older people, if as a social group they tend to be institutionally marginalised then it might be equally easy to negate the views of people with mental health problems who equally challenge society’s assumptions of capability in regards to managing risk. Risk assessment is central to social work practice; however it must not depersonalise the service user and merely identify them through a compilation of risk variables. Additionally the discourse around risk assessment needs to move from a concern about risk adversity to a probability of negative and positive risks. Equally antagonistic is the use of the term “dangerousness” to define vulnerable service users. Such language can impact on collaborative and partnership work between professionals and service users. Moreover, as put in Tew (2011) the ongoing rituals of risk assessment may impact further on service user’s sense of self and undermine their capability to manage risky situations. Also, as stated in Petch (2001) there will always be people in the community who pose risk, whether or not they suffer from mental health, and singling out or blaming a particular group of professionals will not change this.

Thus, a risk assessment is made on a balance of probabilities rather than exact conclusions. While striving for uniformity within risk assessment is a move towards equity, flexibility is also important given the subjective contexts of risk and mental health needs. People’s lives involve many changing and interrelated variables which will always create some difficulty in balancing risk assessment. In the end, life cannot be without risk and risk-taking is part of the process that makes us who we are, complex beings.

The second part of the report concentrates on to understand process of ageing. It will then assess the role and function of social work within wider socio-political policy context especially in terms of poverty and inequalities. Finally it will be demonstrated how the identified issues may inform the policy and organisational context and the points raised will be summarised in the conclusion.

According to World Health Organisation, most developed world countries have accepted the age of 65 years as a definition of “elderly” or older person. (WHO: 2012) However, in the United Kingdom the Friendly Societies Act 1972 S7(1)(e) defines old age as, “any age after fifty”, where pension schemes mostly are used age 60 or 65 years for eligibility. (Scottish Government: 1972) Ageism can be defined as process of discrimination and stereotyping against people because of their age. It affects many institutions in society and has a number of dimensions such as job discrimination, loss of status, stereotyping and dehumanization. Ageism is about assuming that all older people are the same despite different life histories, needs and expectation. (Phillipson: 2011) According to Erikson (1995) psychosocial stages of life older age has been defined as the period of integrity versus despair. This stage involves the acceptance and reflection on one’s life.

The authors describe older people as a group of marginal concern that has moved to one of central importance in social work profession (Phillipson: 2011) This is caused by the speed of demographical change that is most remarkable in its expand. The number of older people is increasing both in absolute numbers and as a proportion of the total population. The ageing of the population indicates two main factors such as the downward trend in the birth rate and improvements in life expectancy. (Phillipson: 2011) In Scotland in 2010 there were an estimated 1.047 million older people age over 60, where older people are one fifth of Scottish population. (Age Scotland: 2012) In the last hundred years Scotland’s life expectancy has doubled from 40 in 1900, to just over 74 for males and just over 79 for females in 2004. By 2031 the number of people aged 50+ is projected to rise by 28% and the number aged 75+ is projected to increase by 75% (All our future: 2007) It has been estimated that in the UK in 2005, 683,597 people suffered from dementia, the number is expected to triple by 2051 to 1,735,087 people. (Alzheimer’s research trust: 2010)The issue require to be deeply analysed in terms of how society will be able to respond effectively to the complex needs of older people.

“Look beneath the surface” the needs and issues of older people

The policy All our future (Scottish Government: 2007) indicates the age over fifty as a stage where life circumstances start to change in ways that can be significant for the future. An example of this can be; children leave home, change in working patterns, people have less work and more time for themselves and perhaps more money. It is worth pointing out that caring responsibilities for elderly relatives at this stage can also increase. The time fifty upwards is a time when physical health can deteriorate causing possible health problems such as osteoporosis, osteoarthritis or coronary heart disease. What is more, the state of health after that time decrease substantially and become greater in its extend. People must face changes in appearance such as wrinkles, hair lost or change of hair colour to grey. In addition, they physical state deteriorates and they are not as fit as they used to be. Form psychological point of view this must be difficult to accept it. However, ageing can also concerns some psychological effects such as changes in memory function, decline in intellectual abilities or even memory loss. As a result of a degenerative condition of brain’s nerve cells or brain disorders many people may suffer dementia, Alzheimer or Parkinson disease. Wilson et al. (2008) who draws attention to physical, biological and psychological effects of the ageing, pointing out that ageing is not itself a disease but some specific diseases may be associated with this process. (Wilson: 2008)

Social work underwent fundamental changes from the 1960s following broader ideological, political and economic developments. To understand the current role of social work within society and wider policy framework, particularly with older people, it is important to analyse the past socio-political and economic trends that have reflected on contemporary practice. By the 1960s, more attention was beginning to be paid to the social consequences of capitalism that started to be seen as the economic order of an unequal and unfair society. The strong critique of that system is known as radical social work that grew on the ideology of Marxism. (Howe: 2008) The publication of the Kilbrandon (1964) consequently led to introduction of Social Work (Scotland) Act 1968, which embedded social work firmly within state sector with the voluntary sector as complementary. (Ferguson & Woodward) Social work wanted to be seen as unified profession that offered generic services, to overcome earlier fragmentation and overspecialisation of services. Social workers were obligated by law to assess needs and promote social welfare by providing services. However, the government of Margaret Thatcher began to weaken state welfare responsibilities to help people in need leading to the major ideological shift in 1980s called neoliberalism. As a result Barclay Report (1982) intended to clarify the role and task of social workers employed within statutory or voluntary sector, the later Griffiths Report (1988) were similar to Barclay Report in terms of promoting greater choice, participation and independence of service user and carers. However, neoliberalism undermines the role of welfare professionals, allow the rich become richer and marginalise the poorest and most vulnerable individuals. Woodward and Ferguson (2011) argue that neoliberal trend has been continued under New labour government, leading to managerialism and bureaucratisation. Therefore, contemporary practice is drawn by extreme pressure through the forces of marketisation, managerialism and consumerism, that led to profession dominated by stress, frustration and strongly focus on meeting deadlines. The labour government has also been driven by the development associated with consumerists ideas such as personalisation that place service user at the centre of service design and delivery or direct payments that emphasise independence and individual choice through giving service user their own money to buy own services. For a long time neoliberal economic and social policies in the UK speculated a very different concept of what social work should be about. The Changing Lives report of the 21st Century Social Work Review (Scottish Government: 2006) has brought significant shift within social work polices through an expression of dissatisfaction of social work that was mainly caused by lack of opportunity for relationship based work with service user.

The policy has reshaped social work practice towards providing social workers with additional space to develop good social work practice. There have been initiatives to improve recruitment and increase professionalism and standards within workforce as well as improve integration in the planning and provision of social work services. Integration has been developed through Modernising Community Care: An Action Plan (1998) and Community Care Joint Future (2000) that introduce Single Shared Assessment (SSA). In Scotland Joint Future is the driving policy on joint working between local authorities and the NHS. The other key policy themes are personalisation, self-directed support, early intervention and prevention as well as mixed economy of care on the grounds of more effective partnership. (Scottish Parliament: 2008) Another significant report that brought about change in policy and later in Scottish legislation is the Sutherland Report (1999) that provided free personal and nursing care on the basis of assessed needs. (Petch: 2008) The above review of social work policy framework is a good illustration of constantly changing role and function of social work. Social work operates within socio-political framework of constantly developing policies and legislation of health and social care. The reality and ideology constantly has changed people and society faceing new challenges. Social work makes a key contribution to tackle these issues by working with other agencies to deliver coordinated support and to increase the wellbeing of older people.

The critical analyse of needs of older people and current issues in the delivery of social work services.

The first issues when working with older people is partnership of health and social care within four main areas: assessment, care management, intermediate care and hospital discharge. (Wilson: 2008) The main problem is tight budget this is in particular importance especially in statutory setting. (Wilson: 2008) The problem increases when local authority must, as normally is a case, work in collaboration with other bodies. This raises an external question who are going to pay for services? That causes unnecessary delays and constraints. One might expect that new Integration of Adult Health and Social Care Bill (Scottish Government: 2012) will resolve problem by the joint budget and equal responsibilities of Health Boards and Local Authorities. Wilson et al. stresses the importance of rationing services in social work due to low budget that lead to delays in provision of services and lack of time to develop more creative forms of practice.

The next issue is the assessment process that is seen as balance between needs and resources. A major element during assessment is the relationship with service user and appropriate methods of communication to understand and be understood. Practitioner must take the time to get know the older person and resist pressure from other professional to do a quick assessment. (Mackay: 2008) The problem of autonomy and protection is the other one in relation to work with older people. This raises the question of capacity, consent and the deprivation of liberty of older people. This group of service users is often a subject of legislation that deprives their rights and liberty, this is because they are likely to be affected by cognitive disorder such as dementia. The term dementia include Alzheimer’s disease, vascular and unspecified dementia, as well as dementia in other diseases such as Parkinson’s. It has been estimated that in the UK the number of patients diagnosed is 821,884, representing 1.3% of the UK population. (Alzheimer’s research trust: 2010) The assessment of incapacity or mental disorder is not straightforward and ethically and morally difficult for both service user and social worker. Social workers have to manage the balance between acting in accordance with the wishes of the individual and their best interest. It has been suggested by policy and legislation that the views and wishes of people expressed through self-assessment would remain at the heart of intervention. (Department of Health: 2005)

The another issue is abuse of older that may have many forms and can be very severe in its extend. Older people are vulnerable to abuse or to not having their rights fully respected and protected. The problem came to public awareness not as long as few years ago. Despite the fact that legislation came into force through Adult Support and Protection (Scotland) Act 2007 it is estimated that elder abuse affects 22,700 people in the Scotland each year. (Age Scotland: 2012) Older people are a subject of physical, psychological abuse, neglect, sexual or financial harm, that normally takes place at home, in hospital, residential care or day centre.

Age discrimination is next issue to consider around 24 per cent of older adults in the UK report experiencing age discrimination. (Age Scotland: 2012) The new NHS policy that came to force 1st of October this year, states that it is unlawful for service providers, policy makers and commissioners to discriminate, victimise, or harass a person because of age. A person will be protected when requesting and being provided with services. If anybody will be treated less favourably because of their age, they will be able to take organisations or individuals to court and may be awarded compensation. This mainly relates to health boards individual clinicians such as consultants, GPs or other health professionals. (Department of Health: 2012)

Older people are disadvantaged based on the relatively low socio-political and cultural status in contemporary society. They are repeatedly presents as a drain on resources as they no longer actively contribute to grow of society. They do not work and do not pay taxes anymore. Older people are systematically disadvantaged by the place they occupy within society. Wilson et al. (2008: p. 620) rightly suggests that old age is “socially constructed”. A good example of this is retirement that makes people officially old and unavailable to work, despite factual physical and emotional state of the individual. Other forms of social construction that significantly affect the experience of old age is class, gender, race and ethnicity. (Wilson: 2008) An illustration of this can be statement that older people have much more in common with younger people from their class then they do with older people from other classes. (Philipson: 2011) Disadvantages and inequalities experiences during life can magnified the process of ageing through differences in access to health facilities, health status and lifestyle that may influence life expectancy. There is no doubt that experience of ageing is subjective and depends on many factors but it seems to be a matter to consider class, gender and race at first place. When discussing poverty and inequalities the things that have to be in mind are issues of discrimination of older women who are less likely to have as a great pension as male due to the fact many women are paid a lower wage then men. Moreover, women tend to live longer than men so they are more vulnerable to live alone and in poverty. (Age UK: 2012) There are many forms of disadvantage associated with older people in poverty such as; low income, low wealth and pension, debts or financial difficulties, feel worse off, financial exclusion, material deprivation and cold home. The first three are experiences by around 20% of older people, half of older people experienced at least one of the nine forms of poverty described above, and 25% had two or more. A minority 3% suffered from three or more forms of poverty. (Age UK: 2012) In terms of ethnicity and race there are significant inequalities in the process of ageing. An illustration of this can be the black community of older people who are more likely to face greater level of poverty, live in poorer housing. In addition, they are more susceptible to physical and mental illness due to often heavy manual work, racism and cultural pressures. (Phillipson: 2011)

Most of older people want to say at home as long as possible this is supported by policy All Our Future (Scottish Government: 2007) that helps people through services such as free personal care, telecare development programme, care and repairs services or travel scheme free bus passes. The policy aims to improve opportunities for older people, foster better understanding towards this group of service user, create better links between generation to work together and exchange experiences, to improve health and quality of life: promote well being and active life within community, improve care support and protection, housing and transport as well as promote lifelong learning.

The role of social work in working with older people is described by Marshall’s text (1990) and cited by Scottish Government (2005) It has been suggested that a key issues are: communication, including sensitive listening and awareness of non-verbal communication, taking time to assess needs always in the presence of service user. Supporting people in managing crises that arise through loss or change such as bereavement, mental health issues or physical constrains like illness or disability. Offer practical help and organise resources. Working with other professionals and people involve in the process of intervention and together combat ageism.

Ageing can be defined as discrimination against older people m

The current trends in adults social care have began through Green paper Independence, Well-being and Choice (Department of Health: 2005) and the subsequent White Paper , Our Health, Our Care, Our Say (Department of Health: 2006) these documents set out the agenda for future. This is based on the principle that service users should be able to have greater control over their own lives, with strategies that services deliver will be more personalised than uniform, this is referred to as personalisation. Personalisation enables the individual to participate and to be actively involved in the delivery of services. Personalisation also means that people become more involved in how services are designed by shaping and selecting services to receive to support that is most suited to them (Scottish Government: 2009) Personalisation is a wide term covering a range of approaches to providing individualised services, choice and control. The programme directly response to wants and wishes of service user regarding service provision. Personalisation consists of person centre approach, early intervention and prevention, is based on an empowering philosophy of choice and control. It shifts power from professionals to people who use services. (Department of Health: 2010) However, it could be argued that approaches extending service user control in realty can be seen as transferring risk and responsibilities form the local authority to the individual service user (Ferguson: 2007)

Another option recently promoting by government is Self Directed Support (SDS), a Bill has been introduced into the Scottish Parliament last year and recently has passed stage three. The bill seeks to introduce legislative provision for SDS and the personalisation of services and to extend the provisions relating to direct payments. (Scottish Parliament: 2012) The SDS approach before has been brought into Parliament were reflected in many reports and policy initiatives such as: Changing Lives, Reshaping Care for Older People. SDS let people to make informed choices about the way support is provided, they can have greater control over how their needs are met, and by whom. Social worker working on behalf of local authority will have a duty to offer SDS if the individual met eligibility criteria. The four options to consider are: direct payment to the individual in order that that person will arrange own support, the person chooses the available support and local authority will make arrangement for services on behalf of that person, social worker will select support and make arrangement for provision, the last option is a mix of the above options. (IRISS: 2012) There is no doubt that the ideas of SDS are glorious because express a great opportunity for service user to expand their control over services provided. However, this raises a question of how many people will be ready to utilise option one of SDS, if a ordinary person who use services will have skills and knowledge to take responsibility for own care such as to employ own carers or personal assistance and to buy own services. One could envisage that it could be possible if the role of social worker will change from care management to brokerage and advocacy. The new model of care requires also to support communication, have experience in employment practice, manage record keeping and pay roll services. A potential care broker will provide assistance to obtain and manage a support package, drawing on individualised funding. It can be questioned if social workers who are mostly employed by local authority and accountable to statutory agencies are reliable to perform this task working across three sectors.

Service User Involvement

Dalrymple and Burke (2006) discuss issues that influence contemporary social work such as social justice, empowerment, partnership and minimal intervention. The service user participation has began in 1990 through NHS and Community Care Act. (Ray, 2012) There is still increasing acceptance that people who receive services should be seen as own experts in defining their own needs. This is in accordance with exchange model of assessment presented by Smile and Tuson et al. (1993), where social worker view the individuals as experts of own problems. The role of practitioner is to help service user to organise resources in order to reach goals that are define by the service user. Government policy addressing to older people highlights the importance of developing services that focus on maintaining independence, encouraging choice and promoting autonomy such as Independent living in Scotland (2011), Reshaping Care for Older People (2011), All our Future(2007). The policies highlights the importance of user participation in risk management and risk taking within independent community living for older adults. One of the action enhance independent living is direct payments. This has been seen as a way of improving choice and autonomy of older people. Social workers have a moral obligation to ensure that direct payment, when offered, do in fact provide better opportunity for this group of service user to meet their needs in creative way. (Ray: 2009) One may expect that active involvement and participation in service provision will have a crucial role not only in exercise more control and choice but also in challenging social exclusion. Shaping our lives is a notional independent user network that aims to make sure the voice of older people are heard so they have equal chance in defining outcomes in social care. (Crawford & Walker: 2008)

It could be argued that one of the main needs of older people is the importance of active listening of this group of service user, who are often because of age ignored or disregard. This is supported by Kydd (2009) who highlights how important it is for older people to feel that they are being listened too.

In social work there is constant need to evidence based practice on the grounds of empirical knowledge that guide decision making process. An example of this can be three stages of theory cycle presented by Collinwood and Davies. (2011) There is no doubt evidence based practice is important but the view undermine relationship based practice that is equally important. Rightly Wilson (2008) refers to relationship-based as a main feature of social work practice that shape the nature and purpose of the intervention. It is a unique interaction between the service user and the practitioner that help to obtain more information and define the best way of intervention.

A fundamental part of working with older people is to recognise and respond to the way in which they may be marginalized. An example can be the role of social worker as advocate that seek; to provide accurate information in relation to the services the individual is entitled and to enable the person to live where she/he wants to live. (Dalrymple & Burke: 2006)

New World Enclopedia (2012) defines foster care as full-time substitute care of children outside their own home by people other than their biological or adoptive parents or legal guardians.

According to The Adoption Foundation (2012) Foster care means placing a child in the temporary care of a family other than its own as the result of problems or challenges that are taking place within the birth family.

Johnson (2004) defines Foster care as a 24-hour substitute care for children placed away from their parents or guardians and for whom the State Agency has placement and care responsibility.

To summarise the Foster Care aim is to provide the opportunity to children victims of abuse and/or neglect to live in a substitute family on a temporary basis. The role of the foster parents is to give support to the child and help him to grow physically, emotionally, socially and spiritually.

3.2 History of Foster Care

The Children Aid Society (2012) stated that placement of children in foster homes is a concept which goes as far back as the Old Testament, which refers to caring for dependent children as a duty under law. Early Christian church records indicate orphaned children lived with widows who were paid by the church. English Poor Laws in the 1500s allowed the placement of poor children into indentured service until they became adults. This practice was imported to the United States and was the beginning of placing children into foster homes. The most significant record of fostering was in 1853, a child was removed from a workhouse in Cheshire and placed in a foster family under the legal care of the local government. At the beginning of the 1900s only orphaned or abandoned children under the age of 11 years were fostered, and they had to have a demanding psychological profile – well adjusted, obedient and physically normal.

Jeune Guishard-Pine (2007) identified that in 1969 research was carried out on the foster care system and it was found that foster families required training on how to deal with the foster children and make them fill secure in the placement.

3.3 Foster care as a global concept

Johnson (2005) emphasised that foster care is most likely the most widely practised form of substitute care for children world-wide, depending on the needs of the child, the culture and the system in place. According to Askeland (2006) there are many different kinds of fostering and definitions of ‘foster care’ vary internationally. It can be short -term, a matter of days ,or a child whole childhood. A review of foster care in twenty-two countries found considerable diversity in the way of fostering in both defined and practised.

Mannheim (2002) stated that kinship foster care, which is the most common form of fostering in African countries, is not called ‘foster care’ in all countries. ‘In Ireland for example only children placed with no relatives are said to be fostered’. According to Colton & William (1995) in some countries foster care is only seen as a temporary arrangement.

Johnson (2005) stated that the procedures to be registered as foster parents in different countries such as United Kingdom, Australia, Uganda and South Africa are similar. In some countries foster care programme is managed either by the government or an agency, and each country has their own basic criteria that should be fulfilled, such as; being physically and mentally fit and healthy, having a room for the child ,having time to spend with the child. According to Blatt (2000), the process to be registered as foster families can take approximately six months or more. Individuals who are willing to become foster families must make their applications to the agency. A home study is conducted by a social worker to assess the capability of the applicants for taking care of a child. The assessment form is then forwarded to a panel who gives the approval.

3.4 Placement in Foster care

According to (Blatt 2000; Zuravin & Deponfilis 1997), children are removed from their homes to protect them from abuses. These children have suffered physical, sexual abuse, or neglect at home, before they are transferred to a secure milieu. Some children are abandoned by their parents or legal guardians, or have parents or legal guardians who are unable to take care of them because they have financial difficulties, some are alcoholics, others are irresponsible. These children are then placed into foster care until the parents or guardians are capable of taking the parental responsibility.

Elisa et al (2010), states that in all foster care cases, the child’s biological or adoptive parents, or other legal guardians, momentarily gives up legal custody of the child. The guardian gives up custody, but not necessarily legal guardianship. A child may be placed in foster care with the parents’ agreement. In a clear case of abuse or neglect, a court can order a child into foster care without the parents’ or guardians’ consent.

Duncan and Shlonsky (2008) emphasizes that before any placement the foster care family is screened by the Government or agency through a psychologist or social worker that assess the foster care families under certain criteria such as emotional stability, motivation, parental skills and financial capabilities. Elisa et al (2010) states that the government provides foster families with an allocation taking in foster children. The foster parents are required to use the funds to buy the child’s food, clothing, school supplies, and other incidentals. Most of the foster parent’s responsibilities toward the foster child are clearly set in legal documents.

According to Blatt (2000), foster placements may last for a single day or several weeks; some continue for years. If the parents give up their rights permanently, or their rights to their child are severed by the court, the foster family may adopt the foster child or the child may be placed for adoption by strangers.

3.3.1 The Aim of Foster Care System

According to Hayden (1999), the aim of foster care system is to protect and endorse the security of the child, while providing foster parents and biological parents with the sufficient resources and available services needed to maintain the child’s healthy development. Foster care environments are proposed to be places of safety and comfort, and are monitored by several welfare agencies, representatives, and caseworkers. Personal caseworkers assigned to a foster child by the state or county are accountable for supervising the placement of the child into an appropriate foster care system or home. The National Conference of State Legislatures (2006), states that the caseworker also carries out regular visits to the foster care family home to monitor progress. Other agents involved in a child’s placement into foster care may include private service providers, welfare agencies, insurance agents, psychologists, and substance abuse counselors.

3.3.2 Types of Foster Care

Ambrosino et al (2008), emphasis that parents may voluntarily place children into foster care for various reasons. Such foster placements are monitored until the biological family can provide appropriate care for the child, or the biological parental rights are terminated and the child is adopted. Legal Guardianship, is a third option which can be used in cases where the child cannot be reunited with their biological family and adoption is not a suitable option. The Guardianship option most commonly occurs for older children aged 10years old onwards, who are strongly bonded to their biological parents.

Geen (2003) mentions that voluntary foster care can be utilised when the parents are unable or unwilling to care of a child; a child may suffer from behavioural or psychological problems and requires specialized treatment. Involuntary foster care is applied when the child is in danger and should be removed from the family to be put in a secure place.

(Blatt 2000; Bath 2010;Moe 2007) mention different types of fostering:

(i) Foster family home, relative – ‘A licensed or unlicensed home of the child’s relatives regarded by the state as a foster care living arrangement for the child’.

(ii) Foster family home, non-relative – ‘A licensed foster family home regarded by the state as a foster care living arrangement’.

(iii)Group home or Institution – ‘A group home is a licensed or approved home providing 24-hour care for children in a small group setting that generally has from 7 to twelve children. An Institution is a facility operated by a public or private agency and providing 24-hour care and/or treatment for children who require separation from their own homes and group living experience. These facilities may include child care institutions, residential treatment facilities, or maternity homes’.

Associated Problems with Foster Care System

According to Mannhein (2002) stated that in the United States, placement success rate was 40% and failure rate was 60%.From previous studies carried out, Children and Family Research Center (2004), Proch & Taber (1985), there are many associated problems with the foster care system that leads to the removal of the child from the foster care home such as time of placement in the foster care family, characteristics of home, foster parents characteristics and child characteristics.

According to a study carried by Mannhein (2002) in the United States, placement success rate was 40% and failure rate was 60%. Fernadez and Bath (2010) states,that foster children face a number of problems both within and outside the foster care system. Foster children are more exposed to neglect, abuse, family dysfunction, poverty, and severe psychological conditions. The trauma caused to a child when removed from their home is also severe and may cause depression, anger, and confusion. Psychological conditions of abused and neglected children are required to improve when placed in foster care, however the separation from their biological parents cause traumatic effect on the child.

3.3.4 Time of Placement in Foster Care family

According to Bremner & Wachs ( 2010) many studies which has been carried out show that behaviour of the child is the strongest predictor of placement disruption and is one of the main reasons foster parents request removal the children from Foster Families. Newton et al (2000) confirms that children showing sign of behaviours such as disruptive, aggressive or dangerous behaviour in the foster homes are requested to be removed from Foster Families. Zandberg & Van der Meulen,(2002) study show that behaviour becomes a critical issue for foster placements for children over the age of 4 years.

Webb et al, (2010) states, that children are more prone to experience insecurity in the foster home during the initial phase of placement and the first six months of a placement are crucial as 70 % of removal of foster children occur within this period. According to Whittaker et al (2010) older children experience more placement instability during the initial phase compared to infants and older girls are at the highest risk of placement disruptions than boys.

3.3.5 Characteristics of the Home

Berridge & Cleaver, (1987) stated that children have difficulty to adapt in foster home when they are placed with other children who are roughly the same age or if they are placed in foster homes where the foster parents have children of their own. Foster Children placed with other children may feel insecure and start competing for affection and materialistic objects eventually this leads to conflicts in the foster care family.

3.3.6 Foster Parent Characteristics

According to Walsh & Walsh (1990) to deal with a child’s problem behaviour is mostly related to the Foster Parents character and sense of understanding. Doelling and Johnson (1990) states that ‘the other most predictive characteristics of foster parents is their “goodness of fit” with a child including a match temperaments and having a relationship that is described as close’. Butler & Charles (1999) also state that a mismatch in temperament between a foster parents who is inflexible and a child with negative mood will eventually lead to disruption.

Walsh and Walsh (1990) study also shows that for a placement to be successful the foster parents should be motivated, they should accept the child, they should feel the desire to parent the child and they should be motivated by their own childhood experience. According to Fine (1993), Social Support in foster family is important to prevent placement disruption and foster parents who have good relationship with their family and friends are more likely to be successful.

3.3.7 Child Characteristics

According to Children and Family Research (2004), the behaviour of a child is closely linked to placement disruptions. As stated by Lindheim & Dozier (2007) foster parents do not understand the behavioural problems of the child and finally they request removal of the child from their custody. The behaviour of the child is a result of the child characteristics i.e the background of the child. Foster children are more exposed to neglect, abuse, family dysfunction, poverty, and severe psychological conditions. The trauma caused to a child when removed from their home is also severe and may cause depression, anger, and confusion.

Psychological Trauma in Children

Psychological trauma is a type of damage to the mind that occurs as a result of a severely distressing experience. When that trauma leads to disorders , damage possibly will involve physical changes inside the brain and to brain chemistry, which modifies the person’s reation to future stress.

A traumatic event involves a single experience, or an enduring or recurring event or events, that fully surmount the individual’s capacity to deal with or integrate the ideas and emotions involved with that experience. The sense of being overwhelmed can be delayed by weeks, years or even decades, as the person fights back to cope with the abrupt situation. Psychological trauma can lead to serious long-term negative consequences that are often overlooked even by mental health professionals:

Trauma can be caused by a wide range of events, but there are a few general aspects .There is, putting the person in a state of tremendous puzzlement and lack of confidence. Psychological trauma may accompany physical trauma or exist seperately of it. The usual causes and dangers of psychological trauma are sexual abuse , domestic violence, being the victim of an alcoholic parent, particularly in childhood. Long-term exposure to situation such; as extreme poverty or milder forms of abuse, such as verbal abuse, can be traumatic.

Psychological trauma may happen during a single traumatic event or as a result of repeated (chronic) exposure to overwhelming stress (Terr, 1992). Children exposed to chronic trauma normally have considerably worse effect than those exposed to severe accidental traumas. In addition, the failure of caregivers to satisfactorily protect a child may be experienced as betrayal and further supply to the adversity of the experience and effects of trauma. Acute psychological trauma causes impairment of the neuroendocrine systems in the body. excessive stress triggers the fight or flight survival response, which activate the sympathetic and suppresses the parasympathetic nervous system. Fight or flight responses increase cortisol levels in the central nervous system, which enable the individual to take action to survive (either dissociation, hyperarousal or both), but which at extreme levels can cause alterations in brain development and damage of brain cells. In children, high levels of cortisol can disrupt cell differentiation, cell migration and critical aspects of central nervous system integration and functioning. Trauma affects basic regulatory processes in the brain stem, the limbic brain (emotion, memory, regulation of arousal and affect), the neocortex (perception of self and the world) as well as integrative functioning across various systems in the central nervous system.

Traumatic experiences are stored in the child’s body/mind, and fear, arousal and dissociation associated with the original trauma may continue after the threat of danger . Development of the capacity to control affect may be destabilized or disrupted by trauma, and children exposed to severe or chronic trauma may demonstrate symptoms of mood swings, impulsivity, emotional irritability, anger and aggression, anxiety, depression and dissociation. Early trauma, mainly trauma at the hands of a caregiver, can distinctly modify a child’s perception of self, trust in others and perception of the world.

Children who experience severe early trauma often develop a foreshortened sense of the future. They come to anticipate that life will be dangerous, that they may not survive,and as a result, they give up hope and expectations for themselves that reach into the future (Terr, 1992).

Among the most demoralizing effects of early trauma is the disruption of the child’s individuation and differentiation of a separate sense of self. Disintegration of the developing self occurs in response to stress that overwhelms the child’s limited capacities for self regulation. Survival becomes the focus of the child’s interactions and activities and adapting to the demands of their environment takes priority. Traumatized children lose themselves in the course of handling with ongoing threats to their survivalI?they cannot afford to trust, relax or fully look at their own feelings, ideas or interests. Characterlogical development is shaped by the child’s experiences in early relationships (Johnson, 1987). Young trauma victims often come to believe there is something naturally wrong with them, that they are at fault, unlovable, hateful,helpless and unworthy of protection and love. Such feelings lead to poor selfimage, self abandonment, and self destructiveness. Eventually, these feelings may create a victim state of body mind spirit that leaves the child/adult vulnerable to subsequent trauma and revictimization.

Acute trauma in early childhood affects all area of development, including cognitive, social, emotional, physical, psychological and moral development. The pervasive negative effects of early trauma result in significantly higher levels of behavioral and emotional problems among abused children than non-abused children.In addition, children exposed to early trauma due to abuse or neglect lag behind in school readiness and school performance, they have diminished cognitive abilities, and many go on to develop substance abuse problems, health problems and serious mental health disorders. Serious emotional and behavioral difficulties include depression, anxiety, aggression, conduct disorder, sexualized behavior, eating disorders,somatization and substance abuse. Early childhood trauma contributes to negative outcomes in adolescence, including dropping out of school, substance abuse, and early sexual activity, increasing the occurrence of sexually transmitted diseases, early pregnancies and premature parenting. Early childhood trauma contributes to adverse adult outcomes as well, including depression, posttraumatic stress disorder, substance abuse, health (Harris, Putnam & Fairbank,2004).

Although the effects of child abuse and neglect vs. family environmental and

genetic factors have been debated, recent twin studies confirm a significant causal

relationship between child abuse and major psychopathology (Kendler, Bulik, Silberg,Hettema, Myers & Prescott, 2000). Acute trauma in early childhood seems to set in motion a chain of events , a negative path that places those children who have the highest exposure and a less positive mediating or ameliorating factors at greatest risk of significant debilitating effect on development and increased occurrence of psychopathology (Perry, 1997, 1999, 2001I? Eth & Pynoos, 1985I? Pynoos, 1994).

The Adverse Childhood Experiences Study (1998)carried a study where researchers mailed questionnaires to over 13,000 people who had freshly had medical workups at the Southern California Permanente Groupin San Diego. These patients were asked about their experiences with any of seven categories of childhood trauma: psychological, physical, or sexual abuseI? violence against the motherI? or living with household members who had problems with substance abuse, mental illness, were ever imprisoned or committed suicide. Over 9,000 patients responded. Among those who reported even one such exposure, there were substantial increases in a awful range of disorders, together with substance abuse, depression, suicide, and sexual promiscuity, as well as increased incidences of heart disease, cancer, chronic lung disease, extreme obesity, skeletal fractures and liver disease.

In summary, experience to extreme traumatic stress affects people at many levels of functioning; somatic, emotional, cognitive, and behavioral (e.g., vander Kolk, 1988I? Kroll, Habenicht, & McKenzie, 1989I? Cole & Putnam, 1992I? Herman,1992b, van der Kolk et al., 1993). Childhood trauma sets the stage for a variety of disorders, such Post traumatic stress disorders,eating disorder,Attention deficient hyperactivity disorder,oppositional defiant disorder,pervasive disorder,attachment disorder.(Herman, Perry, & van derKolk, 1989I? Ogata, Silk, Goodrick, Lohr, Westen & Hill, 1989

3.4 Disorders with the Foster Child

The Northwest Foster Care Alumni Study (2012) on foster care children showed that foster care children, were found to have double the incidence of depression, and were found to have a higher rate of post-traumatic stress disorder (PTSD) than combat veterans. In long term the foster care children suffer from psychopathology and cognitive disorders.

3.4.1 Psychopathology Disorders with Child

According to Barkley and Mash (1996), child psychopathology is the manifestation of psychological disorders in children and adolescents. Some examples of psychopathology are post traumatic stress, attention-deficit hyperactivity disorder, oppositional defiant disorder, and pervasive developmental disorders.

3.4.1.1 Post traumatic stress disorder (PTSD)

Cash (2006) states that posttraumatic stress disorder (PTSD) is an emotional illness that that is classified as an anxiety disorder and usually develops as a result of a terribly frightening, life-threatening, or otherwise highly unsafe experience. PTSD victims re-experience the traumatic event or events in some way, tend to avoid places, people, or other things that remind them of the event , and are exquisitely sensitive to normal life experiences (hyperarousal). According to Dubber (1999) 60% of children in foster care who were sexually abused had post traumatic stress disorder ( PTSD). 18% of children who were not abused faced PTSD just by witnessing violence at home. The symptoms of post traumatic stress disorder are tabulated below

Table 3. 1 Symptoms Post Traumatic Stress Disorder

Re-experiencing the Traumatic event
Avoidance and Numbing
Increased Anxiety and Emotional Arousal

Intrusive, upsetting memories of the event

Avoiding activities, places, thoughts, or feelings that remind you of the trauma

Difficulty falling or staying asleep

Flashbacks (acting or feeling like the event is happening again)

Inability to remember important aspects of the trauma

Irritability or outbursts of anger

Nightmares (either of the event or of other frightening things)

Loss of interest in activities and life in general

Difficulty concentrating

Feelings of intense distress when reminded of the trauma

Feeling detached from others and emotionally numb

Hypervigilance (on constant “red alert”)

Intense physical reactions to reminders of the event (e.g. pounding heart, rapid breathing, nausea, muscle tension, sweating

Sense of a limited future (you don’t expect to live a normal life span, get married, have a career)

Feeling jumpy and easily startled

Intrusive, upsetting memories of the event

Avoiding activities, places, thoughts, or feelings that remind you of the trauma

3.4.1.2 Attention Deficient Hyper Activity Disorder

Millichap (2010) , defines attention deficit-hyperactivity disorder (ADHD) as a psychiatric disorder and it is characterized by either significant difficulties of inattention or hyperactivity and impulsiveness or a combination of the two. ADHD impacts school-aged children and results in restlessness, acting impulsively, and lack of focus which impairs their ability to learn properly. It is the most commonly studied and diagnosed psychiatric disorder in children, affecting about 3 to 5 percent of children globally.

Robin (1998) has listed some of the symptoms of Attention deficit-hyperactivity disorder are inattention, hyperactivity, disruptive behavior and impulsivity. Academic difficulties are also common signs of ADHD. According to Ramsay et al (2008), the symptom categories yield three potential classifications of ADHD-predominantly inattentive type, predominantly hyperactive-impulsive type, or combined type if criteria for both subtypes are met. The table below shows the Attention Deficient Hyper Activity Disorder Symptoms

Predominantly inattentive Symptoms
Predominantly hyperactive-impulsive Symptoms
Impulsivity Symptoms

Be easily distracted, miss details, forget things,

Fidget and squirm in their seats

Be very impatient

Have difficulty maintaining focus on one task

Talk nonstop

Blurt out inappropriate comments, show their emotions without restraint, and act without regard for consequences

Become bored with a task after only a few minutes, unless doing something enjoyable

Dash around, touching or playing with anything and everything in sight

Have difficulty waiting for things they want or waiting their turns in games

Have difficulty focusing attention on organizing and completing a task or learning something new or trouble completing or turning in homework assignments, often losing things (e.g., pencils, toys, assignments) needed to complete tasks or activities

Have trouble sitting still during dinner, school, and story time

Not seem to listen when spoken to

Be constantly in motion

Daydream, become easily confused, and move slowly

Have difficulty doing quiet tasks or activities

Have difficulty processing information as quickly and accurately as others

Fidget and squirm in their seats

Struggle to follow instructions

3.4.1.3 Oppositional defiant disorder

Matthys W & Lochman J (2010), defines oppositional defiant disorder (ODD) as an ongoing pattern of anger guided disobedience, hostilely defiant behavior toward authority figures which goes beyond the bounds of normal childhood behavior. People may appear very stubborn and often angry.

Freeman et al (2006), also listed some common features of oppositional defiant disorder (ODD) as persistent anger, frequent temper tantrums or angry outbursts and well as disregard for authority. Children and adolescents with ODD often purposely annoy others, blame others for their own mistakes, and are easily disturbed. The table below shows the signs and symptoms of Oppositional Defiant Disorder.

Signs and Symptoms of Oppositional Defiant Disorder (lasting at least 6 months, during which four or more are present)

Symptoms

often loses temper

often argues with adults

often actively defies or refuses to comply with adults’ requests or rules

often deliberately annoys people

often blames others for his or her mistakes or misbehavior

is often touchy or easily annoyed by others

is often angry and resentful

is often spiteful or vindictive

3.4.1.4 Pervasive Developmental Disorder

Waltz M (2003), defines “Pervasive developmental disorders,”( PDDP, as a group of conditions that involve delays in the development of many basic skills, most notably the ability to socialize with others, to communicate, and to use imagination.

Malmone & Quinn (2004) also states that these conditions are usually identified in children around 3 years of age — a critical period in a child’s development. Although the condition begins far earlier than 3 years of age, parents often do not notice the problem until the child is a toddler who is not walking, talking, or developing as well as other children of the same age and four types of Pervasive Development Disorders have been identified; Autism, Aperger’s Syndrome, Childhood disintegrative disorder and Rett’s syndrome.

According to Volkmar (2007), children with autism have problems with social interaction, pretend play, and communication. They also have a limited range of activities and interests. Many (nearly 75%) of children with autism also have some degree of mental retardation.

Malonne & Quinn (2004), stated that children with Asperger’s syndrome have difficulty with social interaction and communication, and have a narrow range of interests. However, children with Asperger’s have average or above average intelligence, and develop normally in the areas of language and cognition (the mental processes related to thinking and learning). Volkmar (2007) also stated that children with Asperger’s often also have difficulty concentrating and may have poor coordination.

Waltz (2003) stated that children with Childhood disintegrative disorder begin their development normally in all areas, physical and mental. At some point, usually between 2 and 10 years of age, a child with this illness loses many of the skills he or she has developed. In addition to the loss of social and language skills, a child with disintegrative disorder may lose control of other functions, including bowel and bladder control.

According to Goldstein & Reynolds (2011), Children suffering from Rett’s Syndrome which is a very rare disorder have the symptoms associated with a PDD and also suffer problems with physical development. They generally suffer the loss of many motor or movement skills — such as walking and use of their hands — and develop poor coordination. This condition has been linked to a defect on the X chromosome, so it almost always affects girls.

The table below summarises the General Symptoms in Pervasive Developmental Disorders

General Symptoms in Pervasive Developmental Disorders

Difficulty with verbal communication, including problems using and understanding language

Difficulty with non-verbal communication, such as gestures and facial expressions

Difficulty with social interaction, including relating to people and to his or her surroundings

Unusual ways of playing with toys and other objects

Difficulty adjusting to changes in routine or familiar surroundings

Repetitive body movements or patterns of behavior, such as hand flapping, spinning, and head banging

Changing response to sound; the child may be very sensitive to some noises and seem to not hear others.

Temper tantrums

Difficulty sleeping

Aggressive behaviour

Fearfulness or anxiety

Eating Disorders

Hudson et al (2007) defines ‘eating disorders refer to a group of conditions defined by abnormal eating habits that may involve either insufficient or excessive food intake to the detriment of an individual’s physical and mental health’. According to Hadfield (2008), obesity in

How do we make ethical decisions in social work? Discuss the process illustrating your arguments with specific case examples.

Ethical awareness is a fundamental part of the professional practice of social workers. Their ability and commitment to act ethically is an essential aspect of the quality of the service offered to those who use social work services. It is an inevitable process that social workers will find themselves within the dimension of ethical issues which will no doubt challenge the individual and bring about some critical reflection of action. Some of the problem areas where ethical issues may arise include;

“The fact that the loyalty of social workers is often in the middle of conflicting interests. The fact that social workers function as both helpers and controllers. The conflicts between the duties of social workers to protect the interests of the people. With whom they work and societal demands for efficiency and utility. The fact that resources in society are limited.” Beckett and Maynard (2006)

This assignment will address some of the areas where a social worker may run into conflict. To begin this assignment will examine the importance of values personal, professional, societal and organizational; it will further examine the vital need for a shared core base of professional values within social work. It will begin to discuss the complex nature of social work and the guidance found in the code of ethics when social workers face ethical dilemmas. It will support this concept with a case scenario. The assignment will then discuss another area where an ethical dilemmas can arise, in risk assessment, and will discuss using a case scenario how risk can be managed ethically. The core of the assignment will briefly outline an approach to how an ethical decision can be made and will draw on two theoretical aspects within ethical decision making. To finish this assignment will look at ethics within partnership working where a brief scenario will support the importance of anti-oppressive practice and ethics within organisations. The assignment will then conclude with a summary detailing the need for ethical awareness within social work.

Every day social workers are faced with stressful, even traumatic situations, such as domestic violence, child abuse, the homeless, family tension, mental illness and suicide. Therefore it is fair to say social workers work with the most disadvantaged groups and vulnerable individuals in society. Clark, (2000) p1 says “The service that is provided is seen as the most contentious of all the human service professions”.

It is because of the nature of the job, social workers often find themselves dealing with tough decisions about human situations that involve the potential for benefit or harm. Whilst underpinning the decision process is the strong expectation that social workers must be able to balance the tension between the rights and responsibilities of the people who use services and the legitimate requirements of the wider public. They must also be able to understand the implications of, and to work effectively and sensitively with, people whose cultures, beliefs or life experiences are different from their own. In all of these situations, they must recognise and put aside any personal prejudices they may have. According to Pinker, ‘social work is, essentially, a moral enterprise’ Pinker, (1990) p14 whilst Beckett and Maynard, (2006) p189 states “Almost all of the important decisions that are made by social workers have a value component.”

According to Banks, (2006) p6: ‘Values are particular types of belief that people hold about what is regarded as worthy or valuable’. Values of the client, profession, organisation and society are an intrinsic part of decision making. Traditional values of social work was first introduced in the early 60s by Biestek. His principles outlined the basics of traditional social work and were constructed of a seven-point scheme. The principles consisted of “Individualism, Purposeful expression of feelings, Controlled emotional involvement., Acceptance, Non-judgmental attitude, User self-determination, Confidentiality”.Biestek (1961). Many of Biestek beliefs were very traditional and were criticised for their diversity in their interpretation. Controversies relating to different principles caused many problematic conclusions, for example individualisation and confidentiality. Individualisation could not be possible in the fast moving modern world, people lose their identity and individualisation is not respected. Confidentiality has its limitations to be enforced for example; If a user shares information where someone will be harmed, the social workers duty is to share it as a right to other individuals. It was clear these key issues had to be developed and advanced to help social workers. Furthermore it was considered that there must be guidance on values and ethics for social workers, as they play a major part in their work.

Banks, (2006) p150 says; ‘There is recognition that personal and agency values may conflict and that the worker as a person has a moral responsibility to make decisions about these conflicts’. Therefore the social work profession is guided by the shared values that underpin its practice set out in the (GSCC 2002) code of conduct. The code is criteria to guide practice standards and judge accountability from social care workers. The work load of social workers deals with individuals who are disadvantaged in some form or another so it is important to have a shared value system to reflect the ethical problems and dilemmas they face. “‘Working from a professional value is a guide to professional behaviours that maintain identity and can protect service users from malpractice’. Parrott, (2006) p17. On their own personal values will be of limited use. Beliefs and good intentions will not give the professional the knowledge and skills they need to make sense of a practice situation and intervene in it. The difference between personal and professional values include, “professional values can be distinguished from personal values, in that personal values may not be shared by all members of an occupational group, for example, a person who works as a social worker may have a personal belief that abortion is wrong, but this is not one of the underlying principles of social work”. Banks, (2006), p 7.

The GSCC codes of practice contain a list of statements that describe the standards of professional conduct and practice required of social care workers. They are as followed; “protect the rights and promote the interests of services users and carers, strive to establish and maintain the trust and confidence of service users and carers, promote the independence of service users while protecting them as far as possible from danger or harm, Respect the rights of service users while seeking to ensure that their behaviour does not harm themselves or other people, Uphold public trust and confidence in social care services and Be accountable for the quality of their work and take responsibility for maintain and improving their knowledge and skills “GSCC (2002)

It is then hardly surprising giving the complex nature of the professional role a social worker may find them self when making decisions within ethical areas facing an ethical dilemma. Theaˆ?ethical dilemma arises when there are; “two equally unwelcome alternatives which involves a conflict of moral principle and it is not clear which choice is right” Banks (2006). When social workers struggle to reach a decision they can be then guided by the code of Ethics. The primary objective of the Association’s code of Ethics is to express the values and principles which are integral to social work, and to give guidance on ethical practice. BASW (2001). Loewenverg and Dolgoff (1996) state that “Ethic are designed to help social worker decide which of the two or more competing goals isaˆ?correct for their given situational” . However alongside ethical awareness you have to be aware of the publicly stated values of your agency and make skilful judgements based upon your accumulated knowledge and experience. Ethical considerations are rarely the responsibility of one worker; however, agencies’ policies and structures of accountability offer both guidance and a standard against which your practice can be measured. “Accountability, therefore, is the process through which employers and the public can judge the quality of individual workers’ practice and hold them responsible for their decisions and actions.” (Derek Clifford & Beverley Burke 2005)

Competing values and multiple-client system are two areas where a social worker may find themselves facing an ethical dilemma. Weather it is the social work values that is competing against agency values or within each a confliction of values, which will leave the social worker in need to decide which value will take priority. Also deciding which role the social worker must take in order to reach the right decision can lead to the dilemma of role confliction. Beckett and Maynard (2006) suggest that the role of a social worker can be put into three groups: Advocacy, Direct Change Agent and Executive. “The advocacy role can be either direct or indirect. Direct change agent being counsellor or therapist, mediator, educator and catalyst, with executive role as almoner, care manager, responsibility holder, co-ordinator and service developer” (Beckett and Maynard 2006 p8).

The GSCC (2002) code of conduct says “As a social care worker, you must strive to establish and maintain the trust and confidence of service users and carers” (s2), which includes “Respecting confidential information and clearly explaining agency policies about confidentiality to service users and carers. Consider the following scenario; whilst on placement a client disclosed sensitive information to a trainee social worker regarding the well-being of her neighbours’ children. After clarification that social worker would have to pass this information on to their manager, the client did not wish to consent to the information being passed on. When the supporting relationship had ended, the social worker had to then make a decision based on where there priorities lay. As they were supporting the client who disclosed, they had a responsibility to uphold the standard of respecting her confidentiality. However they also had a responsibility to the wider society which in this case was the children who were at risk of harm.

When making the decision they assessed all the information and weighed up the outcomes. Do they withhold the information in order to maintain the trust and respect of the client or do they prioritize the needs and risk of the children? They then turned to the agency safeguarding policy and the code of ethics for social workers which clearly states; “we must not promise to keep secrets for or about a child or young person” Agency safeguarding policy, (2010) p10 and further states; “We aim to safeguard children at all times, by delivering our services safely and by sharing information when there is a concern”.p9. Clearly the value of life outweighed the needs and wishes of the client in this circumstance. However to whom did the social worker owe responsibility and which role should they take in this situation. Banks (2006) p48 clarifies this conflict by suggesting : ‘Yet while the social worker may be able to focus largely on one individual service user and take on the role of advocate for the service users rights, often the social worker has to take into account the rights of significant aˆ?others in a situation. aˆ?In the interests of justice it may not always be morally right to promote the service users rights at the expense of those of others’

The social worker if doubting her judgement, would address the BASW (2001) code of Ethics to guide the outcome of her decision, the code states; “Social workers will not act without informed consent of service users, unless required by law to protect that person or another from risk of serious harm”. (4.1.4 p8) Furthermore it guides us by stating; “In exceptional circumstances where the priority of the service user’s interest is outweighed the need to protect others or by legal requirements, make service users aware that their interests may be overridden.” (4.1.1 b p8) As you can see the code of ethics guided the social worker to the right course of action that they should take. They were duty bound by law to act on behalf of the individuals who were at most risk.

According to Parrot (2010) p86 Risk refers to the “likelihood of an event happening which in contemporary circumstances is seen as undesirable.” It is when facing issues involving risk that values become of central importance in enabling practitioners to manage risk. Consider the following scenario; a social worker visits an elderly lady in her home after a referral is made by the ladies niece. The niece is concerned for the safety of her aunt after a recent decline in her aunt’s mobility and health which resulted in a nasty fall. The niece lives quite far away and cannot provide regular care for her aunt. The lady values her independence and does not want to be put in a residential home which her niece thinks would be for the best; however there is a concern able risk that if some form of intervention is not in place the lady is at serious risk of hurting herself further. The social worker is faced with a dilemma. The lady has a right to autonomy and self-determination however there is a risk of potential harm happening. The social worker must risk assess the potential outcomes and measure the risk involved. Which on one hand the individual faces residential care involving losing much personal freedom and autonomy; on the other hand to leave a person in their own home to face social isolation and to be potentially at risk of physical danger may also be unwelcome. Social workers have to look to the consequences of their actions and weight up which action would be least harmful / most beneficial to the user, and which action would benefit most efficiently’aˆ? Parrott (2010) p51 While Kemshall (2002) p128 argues,” risk management cannot guarantee to prevent risk. It can attempt to limit the chances of risky situations tuning into dangerous ones or reduce the consequences of such situations. As she suggests, minimization rather than reduction is the key”.

In other words to approach this situation the social worker will identify the social work values that is embedded in the their practice which is; “As a social care worker, you must respect the rights of the service users while seeking to ensure that their behaviour does not harm themselves or other people”. (GSCC 2002 s4). For further guidance the social worker will identify with the code of ethics which states; we may ‘limit clients’ rights to self-determination when, in the social workers’ professional judgment, clients’ actions or potential actions pose a serious, foreseeable, and imminent risk to themselves or others,’ but it also tells us that we are to ‘promote clients’…self-determination’ Code of Ethics (1.02). Weighing up the outcomes of the individual the social worker will be committed to allowing the individual choice and empowerment. And work with the elderly lady to ensure her self-determination remains able whilst also advocating on the ladies behalf to ensure she is able to access services which will allow her to live a safe independent life. Thompson (2005,p170) cited on blackboard says it is the social workers role to enable service users and carers: ” to gain power and control over their own lives and circumstancesaˆ¦..to help people to have a voiceaˆ¦..so that they counter the negative effects of discrimination and marginalization whilst Hatton (2008, p145) cited on(class PowerPoint 2011) “sees social workers role as active change agents to create: ” an empowered and active group of service users and carers who hold us to account, share in our decision making and participate actively in the way we deliver services”

Social work decisions span a wide range from safeguarding through to allocation services and advising clients and families on courses of action to improve their lives. As we can see some decisions may involve a breach of confidentiality and assessment of high risks such as a vulnerable adult in need of services to improve their quality of life and prevent harm even death. It is important therefore for social workers to be able to justify their actions. Social worker therefore must draw upon a variety of professional knowledge – such as law, policy, research, theory, standards, principles and practice wisdom – to inform complex and sensitive judgements and decisions in uncertain situations where harm may ensue. “Much of what social workers do concerns decisions about future courses of action, which puts decision making at the heart of social work as a core professional activity”. Banks (2006) p9

This assignment will now examine how the ethical dilemma can be resolved by discussing an approach to guide the process of ethical decisions in practice. We have identified that social workers are expected to critically examine ethical issues in order to come to a resolution that is consistent with social work values and ethical principles. However how is the social worker able to organize all the components relevant to the decision and outcomes. One example of a model to help assist the social worker reach resolution is Mattison (2000, p.206) His model offers a framework to analyse ethical dilemmas such as: Define and gather information; Once the social worker has identified an ethical dilemma, they begin the process of making a decision by fully exploring case details and gathers needed information to understand holistically the client’s current circumstances. Supporting this is Horner (2005 p97) who says that social workers are to “engage holistically with both the person and their circumstances whilst at the same time recognizing the processes of power dynamics at the play in the helping relationship”

It is then important for the social worker to distinguish the practice aspects of the case from the ethical considerations (so separate practice from how you have learned to think about ethical issues). Identify value tensions The social worker must refer to the professional code of ethics – to help clarify obligations and identify the principles that have a bearing on the dilemma The social worker projects, weighs, and measures the possible courses of action that seem reasonable and the potential consequences of these The social worker after weighing up options must select an action for resolving a dilemma. This involves determining which of the competing obligations are we going to honour foremost (this may mean at the expense of others). The social worker reaches the resolution stage and this means being able to justify the decision.

To further this ideas of influence on decisions It is also vitally important for social workers to take time to reflect on their practice and own values. This is a vital point because although guides and frameworks can be developed to offer social workers a logical approach to the decision making process, to some extent, the use of discretionary judgments is evitable (Mattison, 2000). The value system and preferences of the decision maker ultimately shape the process of working through dilemmas and so it is important for social workers to be ethically aware of their character, philosophies, attitudes and biases. Furthermore, philosophers have argued that elements of deontological and teleological thinking operate in and influences decision making in ethical dilemmas. A deontological thinker is grounded in the belief that actions can be determined right or wrong, good or bad, regardless of the consequences they produce and so adherence to rules is central. Once formulated, ethical rules should hold under all circumstances (Mattison, 2000). On the other hand a teleological thinker is ground in the belief of consequences and so weighing up the potential consequences of proposed actions is central to this way of thinking (Mattison, 2000). So a social worker following a deontological way of thinking will differ in their approach to ethical decision making compared with a social worker following a teleological way of thinking.

As part of the profession social workers often find them self-working collaboratively with other professionals such as doctors, police, nurses, teachers and probation officers to name but a few. Considering the variety of different professions merging to reach possible outcomes it is not surprising that partnership working becomes a complex problem. “Mainly because of the assumptions that we are all working towards a collective aim”. Bates cited in Parrot (2010.) Different values, ideologies, ethics and culture of working can too lead to confliction of interests. Effective partnerships require sustained relationships, shared agendas built up over time and a commitment to shared problem solving. “When different professional groupings come together in collaboration then they bring with them their own ways of working, organisational cultures and attitudes, their particular practice experience and their own ethical codes” Parrot (2010)

Consider the following scenario; a social work student commitment to anti oppressive practice is clearly challenged whilst on placement. The voluntary organisation which they are placed with worked in partnership with the crown court. One day as they were waiting for an expected family, to whom they were supporting, they are then approached by an usher (a worker of the court justice system). He commented on the family jokingly saying; “Oh no not that family again they are low life Jeremy Kyle watching scroungers, they bring the trouble on themselves”. This use of stereotypical language discriminated and negatively challenged the whole purpose of the organisations aims which is to value diversity, whilst also conflicting with section 5 of the core values of the GSCC “You must not discriminate unlawfully or unjustifiably against service users, carers or colleagues” (GSCC 2002 5.5) Parrot (2010 ) suggests “There is no appropriate way at which a social worker can condone such language weather they choose to confront the issue at hand or make a formal complaint”. Parrott (2010) further states; “what is the point in partnership working with fellow professionals only to result in the dilution of the social workers value base and the demeaning of service users”. The point of partnership working is not to deliver appropriate services to service users only to have them undermined by some partners exhibiting discriminatory attitudes.

What if in the scenario discussed above, the discriminatory attitudes and beliefs of the usher, was an unconscious influence to the social workers approach when working with the individuals involved in the scenario. This could result in an already marginalised group becoming oppressed further. Thompson, (2005 p34) describes oppression as; ‘Inhuman or degrading treatment of individuals or groups; in hardship and in justice brought about by the dominance of one group over another; the negative and demeaning exercise of power. Oppression often involves disregarding the rights of an individual or group and this is a denial of citizenship’.

Thompson further suggests that oppression can act at three levels, these levels of oppression offers a framework for looking at how inequalities and discrimination manifest themselves. “Personal level which relates to an individual’s thoughts, feelings, attitudes and actions. Cultural level which looks at shared ways of seeing, thinking, and doing. Structural level relates to matters such as policy.” Thompson (2005 p21 -23) Abramson 1996 cited in Mattison (2000) supports this by saying “The process of the decision making is forged by the prejudice and prejudgement brought to the decision making process by the decision maker”. Therefore social workers as agents of change attempt to alleviate inequalities and oppression within societies and need to be aware of the values underlying their work by referring to the code of ethics. By adopting values and anti-oppressive practice such as advocacy; social workers will be able to make informed decisions in addressing aspects, which relate to the provision of services to individuals who may have differing needs. Parrott (2010 p23) describes Anti oppressive practice (AOP) as “a general value orientation towards countering oppression experienced by service users on such grounds as race, gender class age etc’. AOP are also values of working in partnership and empowerment.”

“Social workers and their employers have an ethical duty to ensure that the organisations they work for operate in a just manner” Parrot (2010) Social work organisations therefore must uphold the portrayal that social work is something worthy and the operation of its organisation will lead to positive outcomes. The commitment to social justice ensures public organisations work under legislation to eliminate unlawful discrimination and to promote equality of opportunity and good relations between persons of different racial groups. Expectations of the social care employee are prompted by the GCSS code of conduct. For example in the case scenario discussed above if the attitudes of the usher was another social worker within an organization the social worker would act on guidance on policy procedure and ensure the commitment to social justice was withheld. If the other social workers attitudes towards service users resulted in unfair treatment and inequality of services than they are not upholding the ethical principles of effective practice stated in the IFSW (1994) “Social workers should recognise and respect the ethnic and cultural diversity of the societies in which they practise, taking account of individual, family, group and community differences.” S4.2.2 Therefore the other social worker would have a responsibility to Challenging unjust practices “Social workers have a duty to bring to the attention of their employers, policy makers, politicians and the general public situations where resources are inadequate or where distribution of resources, policies and practices are oppressive, unfair or harmful.”s4.2.1

If the other social worker is ethically aware and challenges injustice it is their moral obligation to bring to the attention of the organisation the other social workers behaviour. The social worker would participate in whistle blowing Parrot (2010) p154 defines whistle blowing as “The disclosure by an employee, in a government agency or private enterprise, to the public or to those in authority, of mismanagement, corruption, illegality or some other wrongdoing.” The organisation will then deal directly with the moral character of the social workers discriminatory attitudes.

In conclusion social work can be a challenging subject and one that will actively push the boundaries of all social workers on a personal level and professional level. It is agreed within social work that ethics, morals and values are all an inescapable part of professional practice and ‘Ethical awareness is a necessary part of practice of any social work’ (IFSW, 1994).aˆ? However as this assignment has discussed guides can be provided but inevitability it is up to the social workers discretionary judgement of the circumstances. Arguably It is therefore important as a social worker to be aware of the code of ethics, and to talk, discuss, debrief and debate with colleagues and supervisors about dilemmas they may be struggling with. Finally, the onus is on social workers to be reflective about themselves and how ‘self’ influences practice and decision making. To finish we have to be critically aware of personal beliefs and biases, bringing them to light so they do not unconsciously influence our practice decisions, leading to injustice and unfair distribution and access to services. Service users must be put at the heart of social work practice and it is our duty as social workers to take any necessary steps within our organisations to ensure mistreatment and inequality is brought to surface. We can therefore improve public trust within the social service profession and encourage service users to work in partnership to empower their lives.

References

Agency Safe guarding Policy, (2010)

Banks, S., (2006). Ethics and Values in Social Work .3rd Ed. Basingstoke: Palgrave Macmillan,

BASW (2001) The Code of Ethics for Social Work,

Beckett, C. & Maynard, A.,( 2005). Values and Ethics in Social Work: An Introduction, London: Sage

Biestek,F. (1971). The Casework Relationship, 7th Ed Unwin: University Books.

Clark, C. (2000) Social Work Ethics: Politics, Principles and Practice. Basingstoke: MacMillan

Class PowerPoint, Values and Ethics, Blackboard (2011)

Clifford, D & Burke, B, Anti-oppressive Ethics, Social Work Education, Vol. 24, No. 6, September (2005), pp. 677-692

GSCC (2002) Codes of Practice for Social Care Workers and Employers, London: GSCC

Horner, N. (2005) “What is Social Work? Context and Perspectives”. Exeter: Learning Matters

International Federation of Social Workers (IFSW) available at; http://www.ifsw.org/p38000324.html, accessed on 12/05/2011

Kemshall, H and Pritchard, J (1996) Good Practice in Risk Assessment and Risk Management. London: Jessica Kingsley Publishers

Loewenberg, F. and Dolgoff, R. (1996) Ethical Choices in the Helping Professions. Ethical Decisions for Social Work Practice, 5th ed., Illinois: Peacock Publishers:

Mattison, M. (2000) Ethical Decision Making: The Person in the Process Social Work Vol.45(3), pp.201-212.

Parrott, L, (2010) Values and ethics in social work practice 2nd ed, learning matters: Exeter

Pinker, R. (1990) Social Work in an Enterprise Society, London: Routledge.

Thompson, N, (2005). Understanding Social Work: Preparing for Practice. 2nd Ed. Basingstoke: Palgrave Macmillan.

Often, people who seek the help of a therapist are vulnerable in a number of ways, and the unique relationship of client and therapist is built on a great deal of trust and openness where a number of issues are exposed. This situation can often leave a patient or client feeling more vulnerable than ever before, and depression, anxiety, and other mental health concerns can easily cloud a client’s judgment. Because the client-therapist relationship is a relationship of power, it is more important than ever that therapists do not give into seduction or sexual attraction that may exist for a client, and that sexual relationships with clients and patients not be allowed to develop.

Although some studies have been done on the existence of client therapist sexual relationships, it is evident that many of the results of these surveys are unreliable due to the nature of the situation. Even when confidentiality is assured, many therapists are fearful of the repercussions of being exposed and are reluctant to divulge such information. Still, these studies confirm that sexual relationships still often do occur between therapists and clients, more frequently in male practitioners than females. Furthermore, these studies have also revealed that these kinds of relationships can be further detrimental to clients and patients who seek the help of professional therapists.

Sexual relationships between counselors and clients has existed probably since the beginning of time, being noted as far back as the fifth century B.C., when the Hippocratic Oath originated, stating, “In every house where I come, I will enter only for the good of my patients, keeping myself far from all intentional ill-doing and all seduction, and especially from the pleasures of love with women and men.”

However, recent studies and even court cases have confirmed that this phenomenon continues and in many cases, is further detrimental to the mental health of the clients who enter into these types of relationships. For clients who are dealing with issues related to domestic violence, abuse, rape, or incest, the abuse of trust and power that occurs with sexual client-therapist relationships can increase feelings of trauma and psychological distress, often triggering symptoms of post-traumatic stress disorder. Even in clients who are not dealing with these kinds of issues, increased depression and anxiety can occur, and a patient who has been involved in a sexual relationship with a therapist is often more likely to attempt suicide and further resistant to additional treatment.

Also, studies have revealed that sexual relationships between therapists and patients are frequently associated with cognitive dysfunction, feelings of emptiness and isolation, an impaired ability to trust, increased feelings of guilt, confusion regarding boundaries, and suppression of anger. Although these types of symptoms are not noted in every client who has been involved in a sexual relationship with a therapist, many of these symptoms were seen as common in clients who had engaged in this type of relationship. In short, therapy is the most successful when boundaries and trust of the client are not violated and a professional relationship is maintained, and in nearly every jurisdiction, it is the responsibility of the therapist to maintain this professional relationship.

In fact, the legal consequences for therapists who do enter into a sexual relationship with a client can be severe in many states. In order for therapists and other mental health professionals to maintain their professional licenses, most states not only mandate that there be no sexual relationships with clients, but also that there is no sexual relationship with a former client as well. While in some states the requirement is that the client has not been a patient for at least two years, in others the guidelines stipulate at least five years. In addition, the mental health professional may be obligated to prove that the relationship is not exploitative in nature and that the client is fully capable of making their own decisions regarding the relationship.

For therapists and mental health professionals who do engage in a sexual relationship with a client, the penalties can be severe. Not only can a therapist lose their professional license for such acts if the relationship is discovered, but they can also be sued for malpractice and violation of trust in many instances. Maintaining a professional relationship at all times is not only in the best interest of the client and their mental well-being, but also in the best interest of the practitioner and their professional reputation.

In order to consider how child protection policy and practice has been shaped, a definition of child protection and significant harm and abuse is required. The Department for Education (DFE, 2011) defines child protection as the action that is carried out to safeguard children who are suffering, or are likely to suffer, significant harm. Furthermore the Children Act (1989) defines harm as ill-treatment including neglect, emotional, sexual and physical abuse. Interestingly, Parton et al (2012) suggested that determinations of what should be considered child abuse are socially constructed, and are therefore reflective of the culture and values at a specific moment in time.

To begin, childhood is a status that is documented worldwide and throughout history, which sometimes sees the child as innocent ,vulnerable, a consumer, a worker alongside other household earners, a threat to society and it is a construction that changes over time and place (Prout, 2005). Historians of childhood have argued over the meaning, such as Aries (1960) cited by Veerman (1992, p5) stated the concept of ‘childhood’ didn’t exist before the seventeenth century; therefore children were mini adults with the same rights, duties and skills. This idea was supported by the poor law (1601) which was a formal system of training children in trades to contribute to society when they grew up (Bloy, 2002).

Another example came from Locke (1632-1734) and the ‘Tabula Rasa’ model. This proposes that children were morally neutral and were the products of their parents (Horner, 2012). The nineteenth century showed it was the parent’s responsibility to offer love and pertinent correction, to bring out the good in their nature thus helping them to become contributing members of society. This could easily lead to blaming the parents as good or bad based on the behaviours of their child, since the child was not considered as his own agent. Legislation such as the 1834 Poor Law Reform Act would support Locke’s idea as children who were sent to workhouses, would participate in schooling to imprint knowledge. Evidently a number of scandals occurred from inmates eating rotting flesh from bones to survive. The government’s response implemented sterner rules for those operating workhouses, along with regular inspections (cited by Berry 1999, p29). Fox Harding (1997) described this era as ‘laissez faire’ which was based on the family being private with minimal state intervention around children.

An alternative concept from Rousseau (1712) suggested the idea childhood being about innocence and a child was born angelic until the world influenced them. This was significant in terms of child protection with the implementation of children’s charities such as Save the Children (founded in 1919). They portrayed children in a variety of adult situations and as poor victims worthy of being rescued using contemporary ideas of childhood (Macek, 2006). Interestingly the Children and Young Person’s Act (1933) was also introduced to protect these children from any person legally liable and likely to cause injury to their health. What is obvious is that harm was not clearly understood, considering caning in schools was common until 1987 and stopped because of corporal punishment being abused in schools (Lutomia and Sikolia, 2006).

Moving into the twentieth century took a wide shift from the ‘laissez faire’ approach and along with the concept of childhood, became the notion of state paternalism. Child protection practice was based on extensive state intervention to protect children from poor parental care (Fox Harding, 1997). These changes led to a sharing of blame with their parents for children becoming anti-social (a demon) or a great achiever (an angel) in society. The demonic model illustrated by Pifer (2000) was already seen in childhood construction but blamed society, not the child, when as Rousseau noted is the romantic discourse that becomes tainted with the crooked outside world. These historical concepts dictated that children should be seen and not heard and every aspect of the child’s life should be determined by their parents or guardians. Although the shift is evident, it could be argued that the laissez faire and paternalist perspective shared a common view of children having limited capacity for independence and decision making. Pollock (1983) would argue that children were not miniature adults as Aries (1960) claimed, but actually were at a significantly a lower level of development and so had distinctive needs from adults. This suggests as immature people they could make mistakes and be excused from full responsibility for their actions.

Given the current high profile debates on children, it is public outrage and moral panics in the media that frequently changes the way things are seen. The research into child deaths has prompted changes in legislation (Parton et al, 2012). Key events such as the death of Maria Coldwell (1974) and Jasmine Beckford (1984), led to specialist workers instead of generic workers. The immediate bureaucratic response which reframed child protection practice was no longer intervention into preventative work but became more focused on assessing risk. Serious case review’s in to a child’s death was undertaken as a way of discovering how the tragedy occurred, who was responsible, what professionals were involved, rationalising individual actions and learning lessons for future practice (Rose and Barnes, 2008). The public’s perception of social workers placed more pressure on this notion of identifying risk before the child died which developed many theories and models for the professional to practice.

In contrast to the numerous child deaths, the Cleveland case in 1988 evidenced the over enthusiasm of state intervention. Children were removed from their families based on medical assessments grounded on uncertain scientific knowledge (Hawkes, 2002). The inquiry recommended greater rights for parents and children and suggests the separation from families was seen as abuse itself (Ashden, 2004). This, and proceeding enquires into the deaths of children, offered dilemmas for social workers representing the most visible agencies within the child protection system, in terms of whether a child should be removed or not. This event was a major policy driver to the Children Act 1989, where parent’s rights have been replaced with responsibility and ensuring children turn out to be good citizens of society. However it could be argued that in practice today the Cleveland event still carries stigma with parents believing their children are going to be taken into care. Sexual abuse statistics from the NSPCC (2012) state 20, 758 children in 2009 were subject to sexual abuse with a decline in 2010/11 to 17,727. This result could offer a suggestion that preventative work and forceful criminal justice system in the last two decades is responsible. Alternatively it could be argued there may have been no decline at all and is purely a drop in the number of cases being identified.

Interestingly Child protection: Messages from Research conducted in the early 1990’s (DoH, 1995) examined the role of the Children Act 1989. The document defied the socio-medical model of child abuse and reframed and contextualised the notion of the ‘dangerous family’. This suggested that the responsibility was to be laid on the parents of children that fall out of particular construct in order to combat poverty and crimes. Children such the murderers of Jamie Bulger in 1993 were children carrying out unthinkable, far from innocent acts. However this case offered a different construct as children with a ‘dual status’. They committed a crime as an adult yet they were still children in need of protection. Society wanted to look at their background to decide if watching horror movies or having divorced parents or poor discipline made them kill a little boy.

Given the media’s response the nature nurture debate came to the forefront with notions of being born bad, to being made bad. Fascinatingly the historical view had been to protect children, yet moral panics made society shift to demonising children, branding them as wicked and evil (Bracchi, 2010). The legislation that had previously sought to protect children had also come into conflict with the boundaries of criminal law, as it does not recognise them as children over ten years of age (Molan, 2008). It could be argued that criminal law agrees with Aries (1960) and children are mini adults, yet social workers guidance refers to children up to the age of seventeen. One could question how professionals can work together when legislations cannot agree what age a child is.

Further spotlight cases such as Victoria Climbie (2003) highlighted failings of multi-agency workers (Lamming 2003) and facilitated to shape the next change in legislation. The Every Child Matters green paper which outlined five outcomes to be achieved by all children was enshrined in law as part of The Children’s Act (2004). These were defined as, stay safe, be healthy, enjoy and achieve, achieve economic wellbeing, and make a positive contribution (Knowles, 2006) which gave professionals direction on the minimum requirements for every child, and allowed social workers to intervene to meet these needs in child protection practice. Nonetheless, the coalition government in 2010 abolished this agenda (McDermid, 2012) suggesting that families are not as important, even though it has underpinned social work practice for a number of years.

Nevertheless child deaths continued to be a growing problem, the Baby Peter case (2008) indicated that individuals are failing children and again multi-agency communication is poor in assessing risk. Another case that followed approximately a year later was the Edlington boys (2009) who tortured two young boys. Society then blamed foster placements and care systems suggesting they do not work and foster placements are as bad as the families they were removed from. Cases such as these developed blame culture, where children were perceived as being failed by the government workers; usually the social workers less often the police and the politicians (Community Care, 2012). The public outcries and criticisms of social services made social workers practice on the side of caution. This suggests the romantic concept of childhood (i.e. protection of innocence), came to the forefront and children were seen as vulnerable and in need of protection. It appears that each disaster that happens the social construct of children changes.

Indeed, researchers into twenty-first century childhood such as Sue Palmer (2006) refers to a ‘Toxic Childhood’ which is the harm society is causing to children through a competitive, consumer driven, screen-based lifestyle. The media and internet evidence how much it has made it available for children to consider adult notions and behaviours, alcohol, sexual activity, drug use and teenage violence that show that differences between adulthood and childhood are disappearing. Nevertheless it could be debated that contradictory attitudes remain commonplace with children being constructed as innocent little angels and little devils, innately capable of the most awful types of crime until the adults in society influenced them as Rousseau (1712) noted.

Despite these criticisms the families that children live continue to be judged as secretive with children growing into poor citizens due to not being protected by them. Very often poor families are classed as poor parents and certain constructions take place without the family even being assessed. To exemplify Tucks (2002) identified a connection between all forms of abuse and social deprivation, but a possible explanation is that perpetrators target vulnerable children or women to secure access to children; socially deprived neighbourhoods are characterised by relatively large numbers of lone parents. Through the pressures of their circumstances and in family crisis, parents had become caught up in a child protection system that was more attuned to assessing risk than to bringing out the best in parents struggling in adversity (DoH, 1995).

Moreover Owen and Pritchard (1993) identified the difficulties in classifying ‘at risk’ and the criterion for assessing what constitutes abuse. Indeed professionals hold a variety of opinions towards what constitutes abuse and could be argued that this alone diminishes the identification of risk to a child. Nonetheless professionals are still expected to protect children by the Children Act 1989 which does outlines ‘significant harm’, but it is very ambiguous in terms of definition (Brandon et al 1999). Munro’s report (2011) on Child Protection agrees that social work involves working with this uncertainty and not able to see what goes on in families which suggests little shift . The defensive practice may come from workers who are expected to manage this uncertainty if the issue of abuse and neglect is not clearly labelled.

Since the implementation of the Children Act 1989 the emphasis on the child’s rights has become very controversial. The idea of protecting children by giving those rights may have been problematic for adults in terms of taking them seriously which arguably could be minimal representation they have had over the years. Additionally adults may be averse to handing over power to their children, because as the early historians suggested, the adult knows what is best for their children. Franklin (2002) suggests a conflict between adult’s rights and children’s rights could offer explanations for ‘demonization’ of children. Another idea could be that giving children rights takes away a child’s ‘childhood’. This may have been viewed from the idealistic construction of childhood being a period of innocence where they consider that children should not be concerned with important decision-making and responsibility.

To further support children’s rights, the Children Act 2004 updated the legislation to include the abolishment of physical punishment (NSPCC, 2012). However, Owen and Pritchard’s (1983) idea of ‘cultural relativism’ whereby specific behaviours in some families is attributed to cultural practice, questions the concept of how significant harm can actually be measured. In cases of child abuse, black and ethnic minority children could arguably be at a higher risk, as warning signs that would have been picked up are ignored and accepted to be cultural practices and norms. For instance Rogers, Hevey and Ash (1989) state that the beating of West Indian children can be viewed as traditional use of chastisement within that culture, rather than observed as physical abuse of children. Owen and Pritchard (1983) propose this aspect to ‘racist beliefs’ and stereotyping, where culture is considered deviant rather than the actions of a caregiver.

Conversely Munro (2008) considers Effective Child Protection and points out the significance on the value of relationships between families and the worker and suggests this leads to better outcomes by understanding the families and cultures. An effective assessment and intervention in child protection draws from having good interactions and aids parents to disclose information and collaborate with authorities. It could be argued if a worker does not believe in certain cultural practices that children could become at risk when maybe they are not.

Another point to consider is the risk posed by professionals that work with children. Society has created an assumption that the rich, social workers, teachers and other professionals that work in child focused roles follow the legislation on protecting our children from significant harm. Yet through the power of this trust professionals have abused in ‘safe’ spaces for children. For example the murder of Jessica Chapman and Holly Wells by the school caretaker in 2002, identified ‘significant failings with regard to police vetting procedures’ (HMIC, 2004) and the notion of grooming and abusing positions of trust was incorporated into the Sexual Offences Act 2003.

Considering the Act was implemented in 2003 Nursery manager Vanessa George was found guilty in 2009 of abusing children in her nursery. The review found a systemic failure in communication throughout and highlighted a common theme of assumption provided a fruitful environment in which to abuse, a point that has been proficiently highlighted by the mainstream press. The child protection policies and procedures were inadequate and rarely followed (Community Care, 2009). This suggests that Vanessa prayed on the innocence of children knowing how society views her as a practitioner.

Cases such as this called for a review of vetting adults who work with children and formed a piece of legislation, the protection of freedoms Act (2012) which focuses on roles working closely with vulnerable groups. Some children related posts such as governors and school inspectors were being removed from the lists although they require having contact with children (Kelly, 2012). Additionally supervised volunteers will no longer be classed as working in ‘regulated activity’. Therefore, individuals barred from working in ‘regulated activity’ can still volunteer at your school, as long as they are supervised. It could be argued that although the government is keen to scale back the cost of vetting, it does not take into account the risk of grooming which is not negated by supervision. Furthermore, this process does not allow schools to check the barred list when recruiting volunteers which suggests it is providing a false sense of security for all.

A further report into child protection by Munro A child centred practice in 2011, established that a universal approach to child protection is preventing the main focus of the child. Munro recommended that the Government and local authorities should continually learn from what has happened in the past, however this could be difficult when cases such as Jamie Buglers that clamped the hatchet to protect the boys. One could question what lessons can be learnt from such secretive cases. Additionally, it could be argued that Munro’s child centred approach offers a potential negative impact on children and professionals. For instance, if the government removes the prescriptive practice that professionals may be using as guidance, this could create the potential to miss the signs of a child being abused based on judgement alone.

Having considered this idea, future risks assessment needs to change, a theoretical and practical model needs to be considered to allow state intervention in cases where a caregivers ability to care for a child is questioned. The British government will be pivotal to play a major role in reforming existing legislation and constructing new strong legislation to allow involvement by care services in the most high risk cases of child abuse. This request on the government is a consequence of the philosophy of risk now predominant in the UK, and is assumed that the government has the skill to anticipate and stop abuse and harm which in turn holds the government responsible when this does not happen.

In conclusion, the historical views of childhood can be seen throughout the numerous ideological discourses which determine how constructions of childhood continue to influence laws and legislation concerning the ways in which child protection is shaped. Although it is recognised that childhood warrants some degree of protective status, socioeconomic and cultural circumstances also affect young children’s behaviour and the way professionals practice. Those changed conditions also influence adult beliefs about rearing children and how protecting children should be. The emphasis on risk and assessing risk has changed over time, certainly through media, society and legislation.

As outlined there are some recurrent issues such as the recognition of significant harm, taking appropriate action, effective communication and achieving an appropriate balance between supporting families and disruptive intervention to safeguard and promote children’s welfare. Nevertheless child protection has been around for a number of years and indicates that there is a correlation between legislation, society and the construct of childhood which continually mirrors each other and will probably continue to do so.

This study aims to investigate the conduct of inter-professional practice in areas of social and health care, with specific regard to the involvement of service users in such practice. The case study prepared by the City and Hackney Local Safeguarding Children Board on Child A and Child B is taken up for analysis and review in this context. The case study is taken as read and is not elaborated for the purpose of this essay.

Health and social care in the UK is currently being significantly influenced by a growing commitment towards greater public involvement in the design, delivery and evaluation of services, greater availability and choice of services for all categories of service users, reduction of inequality, greater emphasis on provisioning of services at the local level, (including from the independent and voluntary sectors), the commissioning process, integration of social and health care, and professional roles for delivery of care on the basis of actual needs of service users (Barrett, et al, 2005, p 74).

Such reforms call for the blurring of strict boundaries between the different professionals and agencies working in health and social care (Cowley, et al, 2002, p 32). They also call for greater inter-professional and inter-agency working and for significant alterations in organisational cultures in order to enhance the power base of service users and members of the public in different aspects of social care provision (Cowley, et al, 2002, p 32).

It is now widely accepted that health and social care professionals need to be more responsive to the rapidly changing needs of service users. Such changes call for the development of health and social care practitioners to improve care for clients and service users (Day, 2006, p 23). Such improvement is required to be brought about by more emphasis on person centred care for clients and service users and the greater involvement of such people in different aspects of planning, delivery and evaluation (Day, 2006, p 23).

The increasing contemporary emphasis on user involvement in the policy and practice of social care is however coming in for increasing questioning from disenchanted service users and service user organisations (Branfield & Beresford, 2006, p 2). Service users, whilst highlighting the benefits of their involvement in the social and health care process, are raising various questions about their actual participation in social and health care and the continuance of various barriers that prevent their genuine contribution to the process (Branfield & Beresford, 2006, p 2).

The case study under question details the results of an enquiry into an episode, wherein a mentally disturbed mother killed her two children after (a) being released from institutional surroundings, and (b) being integrated with her children with the full knowledge and approval of an overseeing group of social, health, nursing and mental health professionals. The enquiry raises disturbing issues about the extent of involvement of service users in social and health care processes and in the decision making of the inter-professional group overseeing the care, treatment and rehabilitation of a mentally disturbed and potentially dangerous individual.

The essay investigates the involvement of service users in inter-professional practice in the UK, with specific regard to the case study and the enquiry report. Whilst doing so it takes cognizance of (a) identification of sources for evidence based social work practice, (b) the use of enquiry reports as sources of evidence, (c) the relevance of themes that emerge from such enquiries, and (d) the implications of evidenced based practice for the development of practice in social work. The essay is analysed vis-a-vis the Every Child Matters programme and makes use of legal, political and ethical frameworks.

Inter-professional Practice

Inter-professional practice and inter-agency collaboration aims to ensure the coming together of service providers, agencies, professionals, carers and service users in order to improve the final level of quality of planning and delivery of services (Mathias & Thompson, 2001, p 39. Whilst partnership and collaboration are often considered to be interchangeable, collaboration is the actual foundation for joint working and the basis for all successful partnerships (Mathias & Thompson, 2001, p 39).

The UK has been enacting legislation and policies for the promotion of Inter-professional and inter-agency collaboration (IPIAC) for the last five decades in order to enhance standards and reduce costs in health and social care (SCIE, 2009, p 1 and 2). The development of IPIAC was shaped by the white paper Caring for People in 1989, followed by the enactment of the NHS and Community Care Act 1990. The government has in recent years issued various policy documents for the promotion of collaboration in order to improve efficiency and effectiveness (SCIE, 2009, p 1).

Greater emphasis on IPIAC is expected to improve care because different professional groups like social workers, physicians, teachers and police officers will during the course of such working bring their individual perspectives to the collaborative process (SCIE, 2009, p 1and 2). The IPIAC process will aim to ensure the best ways in which such individual and sometimes differing perspectives can be made to come together, as also the ways whereby respective contributions of different professionals and agencies can be utilised to enhance standards of service and experiences of service users and carers (Freeth, 2001, p 38). Consideration requires to be given to collaboration between organisations, as well as professionals, in the course of IPIAC working. It is also important to consider the differences in the working practices and cultures of the various organisations that are required to work together and to take appropriate action to minimise the impact of such differences in order to make inter-professional practice effective (Freeth, 2001, p 38).

Policy makers and practitioners agree that adoption of IPIAC will result in greater service delivery despite the existence of various personal, individual and organisational barriers that can practically hinder its efficiency and effectiveness (Day, 2006, p 23). It is however also widely accepted that effective IPIAC working cannot take place in the absence of deliberate involvement of service users and clients in all stages of planning, delivery and evaluation processes (Day, 2006, p 23). The white paper Modernising Social Services, published in 1998 clearly states that people cannot be placed in neat service categories and users will inevitably suffer if partner agencies do not work together (SCIE, 2009, p 1).It is now mandatory that social work programmes, as well as nursing and midwifery, embrace the involvement of patients and service users. Contemporary government reforms are based on public involvement in different aspects of service delivery (SCIE, 2009, p 2). Person centred approaches in health and social care recognise the need for valuing the opinions and experiences of patients and service users and the adoption of person centred approaches by social work practitioners (SCIE, 2009, p 2).

Current research however reveals that service users often feel left out of the process of social care, despite the progressive implementation of IPIAC concepts and approaches (Branfield & Beresford, 2006, p 2). Service user organisations state that the knowledge of service users is by and large not taken seriously or valued by professionals and service agencies. Many service users find such attitudes from professionals and agencies to be intensely disappointing and disempowering (Branfield & Beresford, 2006, p 3). Agencies and practitioners do not appear to be interested in the information provided by service users and do not accord the respect to such knowledge that they otherwise provide to professional knowledge and expertise. Service users also feel that the cultures of social and health care organisations continue to be closed to service user knowledge and reluctant to change (Branfield & Beresford, 2006, p 3).

The study of the case review of the episode involving the deaths of child A and child B appears to reinforce the impression of service users about their continued exclusion from the working and decisions of different agencies and professionals involved in delivery of social and health care (Henderson, p 261). The Every Child Matters Programme requires social work agencies and professionals like social workers, health care specialists, teachers, nurses, doctors and mental health professionals to constantly ensure the safety, security and protection of children wherever they can. Extant legislation and policies like The Children Act 2004 and the Every Child Matters Programme clarify that it is everyoneaa‚¬a„?s job to ensure the safety of children (Henderson, p 261).

The report clarifies that various agencies were involved in the assessment and treatment of Ms. C, the wife of Mr. D and the mother of the two children, child A and child B. The report further reveals that agencies, as well as individual practitioners, failed to consider the views, opinions, and experiences of service users, even as it also contains a number of examples of sound agency and inter-agency practice. There is limited evidence of professional contact with Mr. D, the father of the children, after the contact session in October 2006, and it appears likely that professional networks assumed the agreement of Mr. D with arrangements for Ms. C. Professionals also paid inadequate attention during their provisioning of support to Ms. C, in response to her request for re-housing, and did not communicate with Mr. D to ensure that future arrangements would serve the best interests of the children. Interviews conducted with Mr. D and his parents also revealed significant differences between their expectations of the roles of social workers roles and what was implied by the records kept in the agency. Mr. Daa‚¬a„?s family members, it appears, were clearly under the impression that they had little choice in the rehabilitation process and were furthermore required to facilitate the contact of the children with their mother.

Whilst the report elaborates the role and sincerity of various agencies and professionals in assessing Ms. Caa‚¬a„?s condition and her rehabilitation in society, it specifically refers to (a) the under involvement of Mr. D in the process, (b) the lack of communication with him (Mr D) by social workers and agencies, (c) the differences in perceptions about the role of social workers between Mr. D and his family and the agency, (d) the poor communication of agencies with the parents, (e) the absence of school records of children, and (e) the scope for improvement of involvement of GPs and the police in the social care process.

Although the report makes several recommendations, the specific references to involvement of service users calls for detailed and greater involvement of parents and carers of children in planning of discharge and assessment of risk in order to ensure that actions are based on full information. One of the agencies, the East London and the City Mental Trust has been asked to involve family members and carers of children in all processes, even as the Hackney Children and Young Peopleaa‚¬a„?s Service has been directed to ensure that decisions are not taken on issues that can affect children without communicating carefully and appropriately with current carers.

Emerging Themes and Evidenced Based Practice

The revelations of the enquiry into the report reveal a number of themes in different areas of inter-professional practice, inter-agency working and the involvement of service users in planning, delivery, and evaluation of health and social care, which can be beneficially used to inform future social work practice.

The report specifically refers to (a) the lack of participation of services users in social and health care processes, and (b) the involvement of different agencies in their exclusion, thereby reinforcing the need for greater emphasis by agencies and practitioners on involvement of service users in their care plans. It also becomes obvious that much of the sentiments and ideas about involvement of service users in social care processes continues to remain in the realm of rhetoric and that it will need determined and deliberate effort by practitioners to truly bring services users into the actual planning, intervention and evaluation functions of social work practice.

Enquiry reports serve as important sources of evidence for development of future social work practice. The impact of the enquiry conducted by Lord Laming into the death of Victoria Climbie led to the revelation of evidence on gross inadequacies in the social care system for children and widespread organisational malaise (Roberts & Yeager, 2006, p 19). The publication of the report led to radical changes in governmental policy on social care for children and to the introduction of the Every Child Matters Programme and other important policies for the physical and mental welfare of children (Roberts & Yeager, 2006, p 19).

The utilisation of research evidence for guidance of practice and development of policies in the area of social services and health care is becoming increasingly important for enhancing the effectiveness of social and health care interventions, especially so because of the limited available resources with the government and the pressures to achieve positive outcomes (Johnson & Austin, 2005, p 5). Scholars however feel that much of research based evidence is not absorbed by practitioners and have identified five important requirements for research evidence to practically influence practice and policy, namely (a) concurrence on nature of evidence, (b) a strategic approach to the conception of evidence and the progression of an increasing knowledge base, (c) effective distribution of knowledge along with development of useful means for accessing knowledge, (d) initiatives for increasing use of evidence in policy and practice, and (5) a range of actions at organisational level to increase use of evidence (Johnson & Austin, 2005, p 5).

Conclusions

This study investigates the conduct of inter-professional practice in areas of social and health care, with specific regard to the involvement of service users in such practice. The case study prepared by the City and Hackney Local Safeguarding Children Board on Child A and Child B is specifically taken up contextual review.

Inter-professional practice aims to ensure the collaborative working of service providers, agencies, professionals, carers and service users in order to improve the planning and delivery of services. Policy makers and practitioners also agree that whilst adoption of inter-professional working is likely to lead to improved care, it cannot occur without the involvement of service users in all stages of the care process. Person centred approaches also recognise the importance of considering the opinions and experiences of service users in planning, intervention and evaluation of care. Contemporary research however reveals that service users feel that their knowledge is not valued by professionals and agencies.

The results of the enquiry reinforce the possibility of service users being excluded from the working of agencies and professionals and refer to a number of instances, where the opinions of the service users were not considered for taking of practice and intervention decisions. The report reveals a number of themes in different areas of inter-professional practice that can be beneficially used to inform future social work practice. The use of research evidence for guidance of practice in social work is becoming increasingly important for improving the effectiveness of social and health care interventions.

Enquiry reports serve as important sources of evidence for development of future social work practice. Scholars however feel that much of research based evidence is used by practitioners and that certain specific conditions, which have been elaborated in the last section, need to be met for the improvement and application of evidence based practice.

Word Count: 2530, apart from bibliography

The concepts of ‘partnership’ and ‘collaboration’ have become amongst the most critical themes of ‘new’ Labour’s social policy, particularly in respect of the delivery of health and social care. (Lymbery, M, 2005) This is the reason why a reflective summary will be produced in which concepts of partnership, the philosophies and the reducing of negative outcomes for professional, client and organization will be discussed in greater depth. Proposals for minimising negative outcomes will also be covered.

CONTENT

CONCEPTS OF PARTNERSHIP

The definitions of partnership according to Collins English dictionary, 1991 is equal commitment or the state of being a partner. Partnership is also defined as a shared commitment, where all partners have a right and an obligation to participate and will be affected equally by the benefits and disadvantages arising from the partnership as defined by Carnwell, R. and Carson, A. in 2008. Partnership defining attributes are trust and confidence in accountability, respect for specialist expertise, joint working, teamwork, blurring of professional boundaries, member of partnerships share the same vested interests, appropriate governance structures, common goals, transparent lines of communication within and between partner agencies, agreement about the objectives, reciprocity and empathy. Antecedents of partnership are as follow: individual, local and national initiatives, commitment to shared vision about joint venture, willingness to sign up to creating a relationship that will support vision and also value cooperation and respect what other partners bring to the relationship. Partnership provides a number of benefits such as social exclusion will be tackled more efficiently, service provision from different organisations will be less repetitive, activities by agencies will be less diluted and the chance of agencies producing services that are counterproductive to each other will be reduced. However, there are also barriers in working in partnership for instance, complexity of relationships, representativeness of wider public, tokenism and excessive influence of the vocal groups, desire of individuals not to be involved in making decisions about their care, threat to confidentiality, role boundary conflicts, inter-professional differences of perspective and threats to professional identity. (Carnwell, R. and Carson, A. , 2008)

PHILOPSOPHIES OF WORKING IN PARTNERSHIP

In working in partnership, there are few philosophies that underpin partnership working. The philosophies are empowerment, independence, humanity, equity, trust and respect. Empowerment in the context of health and social care is a process through which people gain greater control over decision and actions that will affect their health. (World Health Organisation, 1998) The reason why empowerment is important in the partnership of health and social care context is because they are the vital foundation of developing an honest relationship between client and professional. They also have become accepted principles in social work practice and have received legislative endorsement as the foundation stones of quality relationships between users and providers of community care services as mentioned by Braye, S. and Preston-Shoot, M., in 1993. Without empowerment, a partnership working will not be effective.

Independence according to Oxford, 2010 is free from outside control; not subject to another’s authority. Independence in terms of partnership in the health and social care perspective is the ability to make decision that will affect the life of a person without the control of others, be it health professional, family member etc. Other than that, it can also be described as a situation in which a person is not under the power of others. An example for independence in partnership is between a patient and a health professional, the patient should be given the autonomy to choose the choice of treatment that he wants to undergo, not chosen by the professional.

Humanity is the quality of being humane according to Oxford, 2010.

Equity means fairness. Equity in health means that people’s needs guide the distribution of opportunities for well-being. (WHO, 1998) Equity in partnership means that every client should be treated and given the access to health services equally. The WHO global strategy of achieving Health for All is fundamentally directed towards achieving greater equity in health between and within populations and between countries. This implies that all people have an equal opportunity to develop and maintain their health, through fair and just access to resources for health. (WHO, 1998)

A commitment to partnership working can only be fostered if the partnership itself displays openness in the way it conducts its affairs, ‘open book accounting’ has to be taken to the extreme if a partnership is to be successful. The reason why trust is important in a partnership is because once distrust enters into a relationship, it is bound to fail. As mutual confidence grows at the individual level so it becomes much easier for the partnership as a whole to become more transparent in its working and thus, encourage trust between partners. (Geddes, M., 2005) Trust in the health and care setting is essential because without trust, it is difficult for a client to be open and honest to the professional.

Respect in partnership is important because in partnership, partners work together to achieve common goals and this relationship is based on mutual respect for each other’s skills and competencies and recognition of the advantage of combining these resources to achieve beneficial outcomes. Partnership in the health and social care context can be linked to the key of successful doctor-patient partnerships in which that patient will be recognised as the experts by the doctor. The doctor is, or should be, well informed about diagnostic techniques, the cause of disease, prognosis, treatment options, and preventive strategies, but only the patient knows about his or her experience of illness, social circumstances, habits and behaviour, attitudes to risk, values, and preferences. Both types of knowledge are needed to manage illness successfully, so both parties should be prepared to share information and take decisions jointly. (Bristol Royal Infirmary Inquiry, 2001)

MODELS OF CARE IN RELATION TO PARTNERSHIP PHILOSOPHIES

Models of care are made up of two models. They are the medical model and social model. In medical model, their thinking is that the disability of a person is of their own fault, their future is on the result of the diagnosis, they also tend to be labelled, their impairment becomes the focus of attention, assessment, monitoring, programmes of therapy are imposed to them, separation and alternative services are the only options, their ordinary needs are also put on hold, they are also only allowed to re-enter the ordinary world if they are normal enough otherwise it is permanent exclusion and society remains unchanged. (BFI, 2009) In this model, the independence of patient is being violated as their therapy is imposed on them, not their own choice. Their equity is also defied as they are being excluded socially.

On the other hand, in social model thinking, the disabled person is valued, strengths and needs are defined by self and others, barriers are identified and solutions will be developed, outcome based programme are designed, resources are made available to ordinary services, training for parents and professionals are also provided, relationships are nurtured, diversity are also welcomed and child is included and society evolves to accept the disable. (BFI, 2009) In this model, the client is empowered such as the NHS ‘Expert patient programme’ in which client take control of their own live without the relying on others. Another strategy that fosters empowerment is the ‘Prosumers’ in which providers (the disabled person) are also the consumers (supporting other disabled person as a support team). (Dickerson, F., 1998)

THE OUTCOMES & RECOMMENDATIONS

As mentioned in the working in partnership concept, partnership offers various advantages to different level of service user be it users, practitioners and organisations. Alas, it also has its own disadvantages which both will be looked into briefly.

In working with partnership, the advantage is that workload between practitioners will be distributed equally according to one’s own expertise. For example, the partnership between family nurses, the supervisor and social worker in safeguarding vulnerable child. If babies and young people who may have been, or are likely to be, abused or neglected. Family nurses will refer a child to social worker as a ‘child in need’, when appropriate, and will act on concerns that the child may suffer or likely to suffer significant harm. Family nurses will also receive weekly supervision and together with the supervisor work closely with social worker with safeguarding responsibilities. (HM Government, 2010) This benefit both the service user (in this case is children) and organisation that the practitioners work for as work will become more efficient. The Working Together 1999 initiative sets out how organisations and individuals should work together to safeguard and promote the welfare of children and young people in accordance with the Children Act 1989 and the Children Act 2004. (HM Government, 2010)

Partnership with other organisations both involving statutory and voluntary will benefit service users as competition will arise. This will enhance the service being offered by the organisations involved. As an example is the British Red Cross as the voluntary organisation and local department of social work as the statutory. The NHS and Community Care Act in 1990 split the role of health authorities and local authorities by changing their internal structure, so that local authority departments assess the needs of the local population and then purchase the necessary services from ‘providers’ such as the Red Cross. Community care ensures people in need of long-term care are now being able to live either in their own home, with adequate support, or in a residential home setting. (UWIC, 2010) This adequate support can be obtained from the Red Cross, such as support after being discharged from the hospital until they are fully empowered of themselves to be independent again. Support is important as seeking help from professional can help client to recover better. This will benefit both client and also organisation.

Albeit partnership offers benefits to everyone, it also has its own challenges. One of the major problems of working in partnership is confidentiality. The more people working together on a case, the chances of information to be breached will increase. Along the way, information could also get lost as well. This is because one party will think specific information is not as important as what other parties will think. To overcome this problem in protecting personal data of a client, the 1998 Data Protection Act is the key legislation which covers all aspects of information processed. Additionally, especially in health and social care, to ensure that this act is put into operation, the Caldicott principle is introduced. (Department of Health, 2010)

In general, working in partnership is a great way to tackle issues effectively. However, the idea of partnership does not usually work as what is expected ideally in reality. Partnership working can be difficult to do well, it can be costly if not properly managed and it may not deliver the desired outcomes if the aims and objectives are not clear. On the other hand, it can be reduced by having plans and strategies as a guidance that must be revised after a certain period of time by local authority. The principal purpose of guidance is to provide a framework against which to ‘test’ potential new partnerships and examine existing ones, to ensure that the Authority can be reassured that the partnership under consideration is one which will contributes positively to its agenda. (Rochford District Council, 2009)

CONCLUSION

Working in partnership in health and social care is beneficial to all service users, inter professional working and organisational that is involved although it has its own negative consequences. These negative outcomes however can be reduced by referring to guidelines and policies that needs to be updated from time to time.

Abstract

The concept of work-life balance has now become centre of attention for almost all companies, political institutions, research institutions, families, individuals and trade unions at both national and international level. Work life balance is an important topic in human resource management that means to combine work and life in a way, that both are achievable. Work life balance is generally related to role overload, time management, time pressure, job satisfaction, job stress, organizational commitment, life satisfaction, turnover, welfare, social security, working time, flexibility, family, fertility, (un)employment, migration, consumption, demographic changes, leisure time and so on. In this paper, work means paid work i.e. a person earns money by providing his/her services to the organization. Both work family balance and work life balance is same thing. Moreover, work life conflict and work family conflict are used interchangeably. We will discuss some relevant definitions, its importance in organization and in life of individual, antecedents and consequences of work life conflict, factors which help in creating work life balance, advantages of work life balance, cost of implementing its policies, some findings from literature, our recommendations and implications and in the end conclusion. From our literature we try to find some quantitative data about condition of work life balance in different countries but we were not able to get it. This paper is done mostly on qualitative data we get from different and renowned journal articles written by different prominent authors.

Introduction

”There’s no such thing as work-life balance. There are work-life choices, and you make them, and they have consequences”, stated by Jack Welsh, former General Electric’s CEO and all-round business guru (Khallash & Kruse, 2012, p. 682). The two most important domains of an individual’s life are work and family and their interface has become centre of attention in the past two decades for researchers in the field of human resource management world-wide. The changing social structures arising out of dual career couples, single parent families, globalization, changes in the demands and patterns of work, an increasing number of parents with children care responsibilities, increasing number of women workforce and ageing parents all have contributed to escalating research in the area of work life balance. There is a need to integrate and balance family and career requirements otherwise work life balance is in jeopardy as a person is unable to perform his roles due to tiredness from work or family responsibilities hamper concentration at work (McCarthy et al., 2010; Valk & Srinivasan, 2011). Work life conflict is opposite of work life balance, that can be either related to strain-based or time-based conflicts between work and life. There are two conflicting areas: (1) how work impacts on family life i.e. work-to-family conflict and (2) how family life impacts on work i.e. family-to-work conflict. But the net impact is same and that is Work life imbalance or conflict. Work-life balance is not primarily a women’s issue as the principles equally apply to men (Pichler, 2008; Crompton & Lyonette, 2006). This concept highly aims to encourage employees to adopt flexible working arrangements that can help them to achieve balance between their professional and private life.

History of Work-Life Balance

In 1986, the term “Work-Life Balance” was first identified, but it’s usage in everyday language was still sporadic for a certain number of years. Although, interestingly work-life programs existed in early years such as 1930, but people did not recognize them. Before the Second World War, the W.K. Kellogg Company created some flexible work hour shifts for their employees who replaced the traditional daily working hours, and the new shift resulted in increased employee efficiency and morale. In 1977, Rosabeth Moss Kanter, for the first time in his influential book, Work and Family in the United States: A Critical Review and Agenda for Research and Policy, raised the issue of Work-Life Balance and brought it to the forefront of organizations and research. This concept forces organizations to follow work-family friendly environment. Therefore, in the 1980s and 1990’s, some organizations began to offer work-life programs who aimed to promote balance work-life. The first waves of these programs were mainly to support women with children (Brough et al., 2008). Now-a-days, many work-life programs have been introduced which are less gender specific and identify other obligations as well as those of family.

Definitions of Work-Life Balance

Now-a-days, the concept of Work-Life Balance is not new; because of its importance it has been discussed extensively. It has been conceptualized as an individual’s orientation across various life roles and inter roles phenomenon. Different scholars have given different views on how they perceive the concept of WLB. Some of the important definitions are: (1) Kofodimos has defined it as ‘a satisfying, healthy and productive life that includes work, play and love, that integrates a range of life activities with attention to self and to personal and spiritual development, and that expresses a person’s unique wishes, interests, and values’ (Valk & Srinivasan, 2011, p. 40). (2) Kirchmeyer has viewed Work-Life Balance as ‘achieving satisfying experiences in all life domains, and to do so require personal resources such as energy, time, and commitment to be well distributed across domains’ (Greenhaus et al., 2003, p. 512). (3) Clark views work life balance as ‘satisfaction and good functioning at work and at home with a minimum of role conflict’ (Greenhaus et al., 2003, p. 512). (4) ‘Work life balance is the term used to describe the organizational initiatives aimed at enhancing employee experience of work and non-work domains’ (Darcy et al., 2012, p. 112). (5) ‘Work life balance is experienced when demands from the domain of work are compatible with demands from other domains, e.g. family’ (Pichler, 2008, p. 3). These definitions share number of common elements for example; all highlights the balance between work and non-work domains and equality of inputs and outcomes.

On the other hand, work life conflict is ‘a form of inter role conflict in which the demands of work and family roles are incompatible in some respect so that participation in one role is more difficult because of participation in the other role’ (Voydanoff, 2004, p. 399). In short, work life conflict is conflict between work and family responsibilities.

Significance of Work-Life Balance
Literature has shown that concept of Work-Life Balance is worth for discussion as it aims to create a balanced work-life. Work life balance is becoming an important issue as people deals with shrinking workplace and time pressure. Many studies have highlighted that work-life initiatives offer a win-win situation to both employees and employers and affect business progress and performance in many ways as improving work life balance practices increase productivity, employee well-being, reduces costs, lead to improve retention and recruitment and better motivation and morale for employees (Maxwell, 2005). Various theories have revealed that work life balance policies try to minimize stress and add to a healthier and safer work environment. Work life balance has been associated with greater employee commitment, job satisfaction and organizational citizenship behavior and its policies are beneficial for individuals, their families, physical health, mental health, relationships, creativity, organizations, and society (Brough et al., 2008 & Grzywacz & Carlson, 2007). Employees expect their employers to recognize that in addition to job they also have a life that includes their family, friends and social gathering. Studies have shown that a workforce that is out of balance faces stress and dissatisfaction which reduces family and work engagement. Work life balance issues are one of the main reasons which forces workers to quit their jobs. Therefore, work life balance is an important and increasingly hot topic because it’s about improving people’s quality of life and aims to widen access to career opportunities and paid employment. Firm size is also the next best predictor of the presence of work life balance policies; because its size affects the extent and type of work life balance policies a firm can offer. Large companies are more likely to offer longer and paid parental leave and flexible working hours (Beauregard & Henry, 2009; Kucharova, 2009). In short, firms have recognized that creating a balanced work and family life of employees is the only solution of all problems. Now, senior management has become more proactive about their employees health and they are introducing and implementing work life strategies.
Measurement

There is no as such one measurement tool for work life balance in literature. But most widely used tool is questionnaire and surveys. Most companies do questionnaires and survey to their employees to find out how balanced is their work and life is. One such questionnaire is discussed here. Employee has to select one option and each option is assigned different point. Options were based on a 5-point rating scale that ranged from never to always. Questions are: I have come home from work too tired to do the chores which need to be done? It has been difficult for me to fulfill my family responsibility because of the amount of time I spend on my job? I have arrived at work too tired to function well because of the household work I had done? I have found it difficult to concentrate at work because of my family responsibilities? Keep worrying about work problems when you are not working? Feel too tired after work to enjoy the things you would like to do at home? Find that your job prevents you from giving the time you want to your partner or family? Find that your partner or family gets fed up with the pressure of your job? If employee faces these problems quite often it means he/she is facing work life conflict (Pichler, 2008). Higher scores indicate imbalance rather than balance of work and life. (Other surveys and questionnaires are mentioned in appendix).

Antecedents Which Cause Imbalance Work-Life

In many researches both men and women has reported that they face difficulties in keeping a balance between family and work life, therefore, their lives suffer because of this imbalance. One of the main reasons for this difficulty is lack of support and help from their better half or spouse. In addition to this, work life (im)balance highly depends upon on job role, project-based job and nature of industry. For example, project-based work with unpredictable work pressure and requirement to deliver project consistently with predetermined time, often requires extensive travel disturb family relations. Additional working hours and working outside normal hours at expense of home and family time with high work intensity and pressure may result in bad health, stress, anxiety, fatigue and adverse/unpleasant psycho-physiological consequences that can have dreadful affect on quality of family and work life. Some researches has indicated that despite of an overall decline in weekly working hours across Europe over the last decade, the increased stress level, insecurities and competition at work-place are considered to be additional factors which are relevant in creating disruption of balance in life (Valk & Srinivasan, 2011; Pichler, 2008). Literature has also highlighted that fact that highest level of stress occurs when job demands are high whereas work life balance practices and policies are low. There are also some barriers which restrict organizations to implement work life balance policies that are job requirements, commitment and loyalty, cultural values, and change (Chiang et al., 2010). According to Voydanoff (2004), work demands expected to be highly associated with work-to-family conflicts which are of two types i.e. time based and strain based. Long paid working hours restrict an individual’s time that can be spent with friends and family. This lack of time may create difficulties for employees in maintaining family relationship and performing family orientated task or duties. Sometimes, strain-based demands (job insecurity or concern over losing a job) threaten the economic well-being that is necessary to quality of life and stability. The stress related with job insecurity decreases interpersonal availability and restricts effective participation in family life. Sometimes, family responsibilities also restricts person to perform his/her work duties effectively but researches have been more focused on work to family conflict rather than family to work conflict.

Consequences

Conflict between family and work has real and worth discussing consequences which extensively affects quality of life and career success for both women and men. Stressfulness, lower productivity, low employee morale, decreased job satisfaction, absenteeism and sickness are some common consequences which are caused by work life conflict. The consequences for women may comprise serious career choices and constraints, limited career advancement opportunity and success in their work role and need to choose between an active satisfying career or marriage and children. Most of the men face tradeoff between career and personal values when they tries to find out ways to make dual career families work that often requires them to hold family roles that are far different and open. Other serious consequences of imbalance work-life are alcohol-drug abuse, negative physical and mental health effects, poorer outcomes for dependants and other household members, a lesser work contribution, a diminution of social citizenship and community participation, depression, financial and marital problems, distrust, tardiness, cheating and violence in workplace, task avoidance, embezzlement, organizational sabotage, compulsive eating disorder and burnout (Voydanoff, 2004; Pocock, 2005). Because of these serious consequences organization faces with the prospect of losing talented men and women who because of imbalance between work and life become unable to cope with dual family and work demands. That is why; organizations reconsider personnel policies and expectations.

Factors Which Help in Creating Work Life Balance

The role of social/family support and supervisor/co-worker support has consistently emerged in literature as an important factor that influences work family balance in a positive manner. Social support includes support from an employee’s parents, siblings, spouse or partner, children, friends and extended family. Of particular importance is support from the spouse who contributes in a variety of areas including moral, domestic and childcare support, earnings and personal financial management, home and family responsibilities, career management and interpersonal support. Family support also includes the exchange of support among relatives. The personal social support can be further conceptualized as emotional and instrumental support, thus suggesting that it positively influences the individual’s functioning at work. The role of workplace support, i.e., the support received from supervisors and co-workers is another critical element of work family balance. Organizational and supervisor understanding of family duties are positively related to satisfaction with the balance between work and family life. Workplace support via an organizational approach involves the implementation of family friendly policies, which are associated with integrating work and family responsibilities and achieving a healthy work and family balance. Organizations offer a wide range of work family benefits and programs to their employees (these are discussed in appendix). Through research it is found that flexible work arrangements allow individuals to maintain a balanced life. There is also importance of supportive supervisors, peers and colleagues in managing their work family balance. Literature recognizes that all of the above mentioned variables have a greater impact on women. An emerging category appeared to achieve work life balance that is self-management or reinvention: reconsidering not only the kind of work one wants to do but also the kind of person one wants to be and the sacrifices one is prepared to make to grow into that new self (Valk & Srinivasan, 2011; Wayne et al., 2007; Voydanoff, 2004). Communication about work life programs to employees and providing proper resources and rewards to them also contribute towards work life balance.

Advantages of Balanced Work and Life

Researchers are now focusing on how family and work can benefit each other and this concept is known as work life facilitation. This facilitation may take place when gain from one domain can be transferred to and improving the functioning in the other domain. Work life balance can serve as a guide for organizations to address family work balance issues by redesigning the HR practices and policies for facilitating family work balance. This will help further help in enabling workers to be more committed to the organization, perform better work, and contribute to growth of economy and positive impact for society as whole (Valk & Srinivasan, 2011). Work-Life programs promotes improve productivity and employee commitment, lower rate of turnover, thus result in fewer employee relation challenges and reduced likelihood of unethical business practices. Moreover, implementation of work life balance policies can result in less loss of knowledge workers to competitors, reduced staff turnover, lower training and recruitment costs, reduced absenteeism, improved quality of workers, reduction in work stress, reduced use of sick leave, high self-esteem, confidence and loyalty, better performance and high morale and satisfaction. Some vital benefits that employer gains from work life balance includes employees feel valuable and work harder, maximized available labor, more loyal and motivated workforce, less stressful workplace, high employee involvement, organizational effectiveness and positive employee attitude and behavior (Beauregard & Henry, 2009). Work life promotes happiness and better relations among employees and employers.

Costs of Implementing Work Life Balance Policies

The cost of implementing work life balance policies is another vital issue which organizations take into account. These costs include direct cost e.g. parental leave payments, childcare subsidies, cost of extra space associated with increased facilities like breastfeeding rooms or childcare facilities, providing equipment to telecommuters and indirect costs such as temporarily filing absentee’s post and reduction in productivity from temporary disruptions (Darcy et al., 2012; Brough et al., 2008). It has also highlighted that manager’s role plays a critical role in policy development and implementation. Poor managers/supervisors skills and behaviors in work life balance practice can lead to increase costs (Maxwell, 2005). According to Roberts (2008) a reduction in worked hours is perhaps the most obvious route for employees to improve their work life balance despite the connected costs in terms of income, career and status.

Managerial Implications/Recommendations

Based on feedback from family and co-worker a person can evaluate whether he/she fulfilling both family and work responsibilities (Grzywacz & Carlson, 2007). Work life balance support and practices promotes a mean by which workers may alter their work hours and condition in a way which can reduce stress. When employees enjoy high degree of freedom and flexibility, sense of job control will increase, thus alleviating job stress (Chiang et al., 2010). Work life balance practices can have positive impact on employees and competition at firm level. These are some suggestions to promote work-life policies and program: (1) Use questionnaires to find out what workers feel about work life balance. (2) Review HR strategy and see if they support company’s mission. (3) Develop work-life reward programs by using non-cash incentives associated with business objective. (4) Align HR strategy (e.g. employer of choice) with work-life initiatives (McCarthy et al., 2010). Work-life initiatives also create positive employer branding, promote organizational citizenship; endorse being an employer of choice and support diversity programs. To start work-life programs, managers should consider these key areas: employee retention, absenteeism, employee time save, increase productivity and motivation and decrease stress related illness and health care costs. However, the entire work-life programs cannot be told firmly by only quantitative measurements. HR professionals must consider four significant questions: (1) do supervisors and managers aware of the impact work life balance and its policies has on their employees, (2) does a firm culture and environment truly support work-life benefits, (3) does the company’s management philosophy sincerely promotes work-life benefits, (4) are workers aware of and do they recognize company’s work-life policies and programs. If a company is already in practice of offering work-life benefits, then the next step for it would be to re-communicate and repackage them so employees can see how such benefits may find them ways to reduce or manage work-family conflict. Moreover, creating a HR strategy that clearly comply with company’s mission will exhibit that how committed the company is to its employees needs. Organizations may need to adopt more modified work life balance programs, initiatives and have the courage to go beyond from a one size fits all approach (Darcy et al., 2012; McCarthy et al., 2010). In other words, Companies may need to re-think work life balance more specifically and need to pay more attention on it. Work life balance programs are not reduced hours, flexible delivery, but it is about assisting people to match their behavior to their values (Reiter, 2007). According to Grawitch et al., (2010) it’s not about balance, it’s about resource allocation (in appendix, it is discussed in more detail). Companies should tailor its HR and work life balance policies according to the need of the employees and should implement it effectively to get desired results.

Discussion & Findings

From the literature we found that younger employees and employees in professional and managerial positions account higher levels of work life conflict. Singles are generally more balanced than people whose partner is in paid work. Long working hours, high levels of job insecurity, a lack of power in deciding when to start or finish work and demanding jobs result in higher imbalance in work and life. Women with children also report high level of work life conflict (Pichler, 2008). But it was revealed by Emslie & Hunt (2009) that there is no clear relationship between work life balance and gender. It is definitely clear that women is considered to do the home related work, on other hand men is also supposed to fulfill family responsibilities. There is also no clear relationship between work life conflict and age of employee’s children, but there is some evidence about those employees whose children are below three faces more work life imbalance. A ‘one size fits all’ approach used for the development of work life balance programs is costly and ineffective to meet the needs of different type of employees. Job involvement was negatively related to work life balance whereas, perceived managerial support was positively related to work life balance (Darcy et al., 2012). It was found by Kucharova (2009) that there is no clear relationship between work life balance and economic condition of the different countries. It was found that sometimes flexible working and working from home increase work life conflict and part time work and job sharing also sometimes increase work pressure. There was no clear relationship found between flexible working arrangements and working conditions such as pay, promotion opportunities and employee commitment (Russell et al., 2009; Moore, 2006). Through study of Reiter (2007) it was clear that organizational development field is struggling with the apparent lack of success of work life balance programs in many organizations and this is caused by lack of investment by companies and government in work life balance initiatives. Furthermore, to gain real value from investment in work life balance, organizations need to recognize it as a complex issue and apply much more holistic solutions than has usually been the case.

Conclusion

In conclusion, we like to say that people who combine all aspects of their life in a balanced manner should therefore be the most satisfied and happiest one. In short, work life balance is part of the general well-being. The higher work-life imbalance, the lower are life satisfaction, happiness, subjective health and emotional well-being. Work life balance programs have the potential to extensively reduce absenteeism, improve employee morale and keep hold of organizational knowledge, particularly during hard economic times. In such a marketplace where there is increasing globalization and companies aspire to reduce costs, it depends upon human resource expert to comprehend the serious issues of work life balance and become of winner work life programs. It will cost some money, but in the long run, the company will benefit from this. If properly introduced and implemented then work life balance programs can be win-win situation for employee, family and organization. Flexible working arrangements are important but it should be catered according to employees’ needs, resources, time and demands to get more improved results. Work life balance is associated with quality of life and is not only a moral issue – it is productivity and economic issue, a workplace issue and a social issue, and needs to be addressed as such.

We can also measure by using some other questions and that are, how successful do you feel in balancing your paid work and family life? Are you satisfied or dissatisfied with the balance between your job or main activity and family and home life? I am satisfied with the balance I have achieved between my work and life? I am able to balance the demands of my work and the demands of my family? I experience a high level of work-family balance? I am satisfied with the balance I have achieved between my work life and my family life? How successful do you feel in balancing your paid work and family life? Are you satisfied or dissatisfied with the balance between your job or main activity and family and home life? Responses were based on a 5-point rating scale that ranged from ‘strongly disagree’ to ‘strongly agree.’ (Allen & Kiburz, 2011; Kucharova, 2009; Reiter, 2007).

Factors Which Help in Creating Work Life Balance

Organizations offer a wide range of work family benefits and programs to their employees such as job sharing, staggered hours, compressed working hours, telecommuting, job protected parental leave, part-time return to work options, shift swapping, flextime, resource and referral services, unpaid family leave, dependent care assistance, shorter standard work weeks, improvement in job conditions, breaks from work, work for home, on-site childcare, support groups for working parents, sports facilities, day-care facilities, laundry facilities, and canteen facilities (Valk & Srinivasan, 2011; Wayne et al., 2007; Voydanoff, 2004).

It’s not about Balance, It’s about Resource Allocation

Literature has re-conceptualizes the frame work of WLB. Previous researches have given more emphasized on the ways in which work and non-work life affect each other, but now new studies has introduced the concept of Personal Resource Allocation (PRA) framework which considers that all life demands forces an individual to make choices about where, when, how to allocate personal resources across the life domains. This Framework has four main central components which include personal resources, demands, resources allocation strategies and the individual outcomes. It suggests that effective work-life balance is an effective personal resource allocation across all life pursuits. It allows researchers to move beyond the old assumption of WLB, in which work life is considered bad and family life considered as good, to person-environment interactions that brings positive individual outcomes. According to PRA framework, individuals bring their personal resources to their daily lives, and because they come across repeated demands (anything that competes for personal resources) on their resources so, these demand forces them to make choices where to allocate these resources. Once the resources are allocated, then individuals are left with fewer resources to meet additional demands (Figure1, in appendix shows the PRA framework). Therefore, positive outcomes can only be achieved if (a) perceives that they have necessary resources to respond to their demands of life, (b) when they believe that they have adequate control to allocate their resource according their preferences, (c) when they feel satisfied with the way they have managed their resources (Grawitch et al., 2010). This Framework has presented the rethinking concept of WLB interface by de-emphasizing the negative role that work plays in life and emphasizing a resource allocation strategy. This theory incorporates person-environment interactions that bring positive outcomes, instead of, simply those that decrease or increase outcomes.