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Day by day the safety and well being of some children across the nation are threatened by child abuse and neglect. Child abuse is doing harm to child intentionaly or not provides the essential needs for the child. Abuse child can be in physical, emotional, sexual in form or neglect. Each form has its different characteristics. Causes of child abuse can be parents causes, ecological causes or child problems. Parents causes involves parent who have background of emotional deprivation, unaware of difference between discipline and abuse, and isolated from the community. Teenage or single parent also can harm their children because they lack experience in raising children. Ecological causes which are related the environment surround the child. For example, poverty, overcrowding, substance abuse, and problems in marriage. Child causes include child disability and requirement of special needs. Child abuse has great impact on child’s life, damaging a childaa‚¬a„?s self esteem, ability to have healthy relationships, and ability to function at home, at work and at school.

The Causes and Effects of Child Abuse

Child abuse is one of the major issues that bring the attention of entire nation. Several organizations formed because it is not just an individual or familial problem. It takes different forms, physical or psychological maltreatment of children. According to the Centers for Disease Control and Prevention (CDC) define child abuse as “any act or series of acts of commission or omission by a parent or other caregiver that results in harm, potential for harm, or threat of harm to a child” (http://www.cdc.gov/violanceprevention/pdf/CM-FactSheet-a.pdf)

The Federal Child Abuse Prevention and Treatment Act (CAPTA) define child abuse and neglect as “any recent act or failure to act on the part of a parent or caretaker who result in death, serious physical or emotional harm, sexual abuse or exploitation” (What is Child Abuse and Neglect, 2008, para.2).

Every year millions of children suffer from different type of child abuse. Most child abuse results from attempt to punish or control the child. Parents try to punish their children when they are doing something wrong and to avoid spoiling the child, but these attempts will increase to produce physical harm to the child. Therefore we have to distinguish between physical discipline and physical abuse. The most common way to distinguish physical punishment from abuse is by the presence or absence of physical injury. “It is important to recognize that most parents do not want to beat their children. Virtually all parents feel regret after such an incident and most believe physical punishment is not an effective route to increase compliance, learning or respect for the parent” (Durrant, 1996, p.186).

“In 2001, an estimated 3 million children were reported to state Child Protective Service (CPS) agencies as suspected victim of abuse and neglect. One million children were confirmed victim of maltreatment (physical abuse, neglect, sexual abuse, medical neglect, psychological abuse, other abuses), with another 4 million involved in referrals to Child Protective Services (National Clearinghouse on Child Abuse and Neglect Information, 2003a;2003b). Three fourths of the perpetrators were caregivers, and an additional one tenth were relatives. However, only about one half of the child abuse and neglect report are investigated nationally, and on average only about one-third of the investigation find evidence of child abuse and neglect” (Potts & Mandleco, 2007, p 1208). Some people believe that the child abused by stringers only, but the truth that the child can be abused by parent, a friend of parent, neighbourhood, or even a family member.

This essay paper on the causes and effects of child abuse will include types of child abuse and clinical manifestation can be seen in each type, causes and effects of child abuse.

There are four forms of child abuse that is neglect, physical abuse, emotional abuse and sexual abuse. The most common form of child abuse is neglect. According to Longman dictionary “neglect is pay insufficient attention to, or ignore ”. It means parents or caregivers fail to provide the important needs for their children. Neglecting the child can be noticed if the child lacks of hygiene, dresses clothes which is dirty, old, and inappropriate for age and weather, frequently absents from school, always sick and no medical assistance provided, malnourished and isolated from others. These signs of neglect are mostly observed by people who are always with close contact to child like the teacher, doctors, nurses and neighbours. They are frequently the ones who notice, suspect and report child neglect. Neglect has three forms which are physical neglect, emotional neglect and educational neglect. Physical neglect is the most abuse noticed among children. Physical neglect can be seen in many ways for example if the parent not provides supervision, repeat shuttling of child from one household to another for a day or week at a time, not providing adequate food for their children, clothes, house, not seeking medical care for a serious health problem or not giving the child his treatment. Emotional neglect includes inattention to child’s need of affection and emotional support, expose child to extreme spousal abuse, permitting the child to use drugs and drink alcohol, refuse of medical assistance for child with psychological problems and applying high expectation that is inappropriate for child’s age and level of development. Educational neglect can be if the parent refuses to enrol the child in school, failure to provide the essential learning needs and allow frequent absence from school.

The second type of child abuse is physical abuse which is the most clear and has a huge physical effect on the child. “Physical abuse should always be suspected when there is an injury that cannot be explained, or when the history provided is incongruous with the physical findings or the child’s developmental level. Suspicion should also be aroused when the caregiver claims the injury was self-inflected, inflected by a sibling or when there is a delay in seeking medical services” (Potts & Mandleco,2007, p 1211). There are certain clinical manifestations can be observed in children who are abused physically which is “unexplained bruises or welts that appear in various stages of healing often in clustered patterns that reflect the shapes of the articles used to inflict injury, unexplained burns especially on the soles, palms, back, or doughnut-shaped (on buttocks or genitals), unexplained fractures to the skull, nose, or facial structure; multiple or spiral fracture; or dislocations and numerous fracture in various stages of healing and bald patches on the scalp” (Ashwill & Droske, 1997, p 1287).

A third type of child abuse is emotional abuse. Among all different child abuse, emotional abuse is the hardest type to identify. According to American Humane, ‘Emotional abuse of a child is commonly defined as “a pattern of behaviour by parents or caregivers that can seriously interfere with a child’s cognitive, emotional, psychological, or social development” (http://www.americanhumane.org/aboutus/newsroom/fact-sheets/emotional-abuse.html). Emotional abuse occur when parents ignoring and humiliating the child, isolating the child from the family, verbally assaulting the child, threatening the child, rejecting child’s value and request, putting higher expectation on the child and exposing the child to family or community violence. The clinical manifestations which can be observed on a child who is emotionally abused are speech problems, lags in physical development, failure to thrive and hyperactive or disruptive behaviour.

The last type of child abuse is sexual abuse which is the least frequently reported of child abuse. According to (Potts & Mandleco,2007) “Sexual abuse is defined as exploitive sexual act(s) imposed on a child who lacks the emotional, cognitive, or maturational development to deal with the actions (Giardino, Brown, & Giardino, 2003)”. Sexual abuse can be in different ways which are pressuring the child to engage in sexual activities, exposing the child genitals, sexual contact with the child, incident exposure of genitals to a child, and physical contact to child genitals. Everybody believes that the girls are more often abused sexually, but the fact that both girls and boys are sexually abused. Studies have shown those sexual abuse victims are usually between 6 and 9 years of age. Ashwill made it clear that children will show some physical signs such as ”difficulty walking or sitting, torn, stained or bloody underclothing, pain, swelling or itching of genitals, pain on urination, bruises, bleeding or lacerations involving the external genitalia, vagina, or anal area and excessive masturbation” (Ashwill & Droske, 1997, p 1289).

Understanding causes of child abuse is important to address the problem in order to prevent it. Specialists and experts who evaluated a bused child’s environment and family background have come out with three causes for child abuse which are parental causes, ecological causes and child problems. Parental causes include parents who are very young and lack of experience of taking care for children are more likely to neglect child’s need. For example; teenage parent or single parent never learned the skills necessary for good parenting. Although, parents who suffer many problems and they cannot control their anger which will inflict their children by abusing them physically. On the other hand, parents who were abused when they were children are more likely to abuse their own children too. It is like cycle of violence and abuse. Also, some parents raise their children same the way as they rose even if parents were abused. Some parents not differentiate discipline from abuse which lead to physically abuse their children in order to teach them the right things. Parents who physically abuse their spouses can also abuse their children. At same time, parents who suffer from mental disorder, anxiety or depression cannot take right decision for themselves, either for their children.

Ecological causes involve abusing drug and alcohol by parents. Parents who are drunk they cannot think properly for the needs of their children. Also they are unrealistic in their behavior which can lead to abuse their children without even feeling that they are doing so. Some studies show that poverty play major role in abusing children. As the parents face financial difficulties, they cannot provide child’s need. Also, those parents usually isolated and lack of social support. On the other hand, if couple have problem in their marriage that may inflict their children emotionally.” Some parents are aware they are mistreating a child but are unable to stop. Other abusive parents literally hate children or are disgusted by them. The child’s need, sloppiness, crying, or dirty diapers are unbearable to the parent. Abusive mothers tend to believe their children are intentionally annoying them. In many cases, troubled parents expect the child to love them and make them happy. When the child cannot meet such unrealistic demands, the parent react with lethal angry. Such parents are more likely to physically abuse their children” (Coon, 2004, p 154).

Child problems include handicapped children. Caring of child with special needs is difficult and need family and community support. Some parents ignore the needs for the child which lead to abusing child’s rights.

All types of child abuse regardless the causes; affect the child by some way. The effects of child abuse vary depending on the type of child abuse. Some of these effects are physical and other are emotional or psychological. Studies show that sexual and emotional abuse has the major impact on child. Effects can be classified to short term effects and long term effects.

Short term effects can easily detect and the signs of abusing show in short period. For example; wound, burns or fracture that occur after physical abuse, which healed after seeking medical treatment. Child will show some sexual behaviors include sexual play with dolls. Child will be aggressive, fear of parents, fear to go home, and isolated from public. Child will fight to other student in class. Child may have difficulty in speech and cannot express feelings. Child who has been abused by his parent will not trust them to provide physical and emotional needs, which eventually lead to lack of trust to other people in the community.

Long term effects are signs that difficult to detect at beginning of abusing incidents and will progress with the developmental process of the child which lead it to occur after long time. Almost it will occur in adult age if child did not seek medical assistance. For example; the adult will have difficulty to establish normal relationships with other. Adult survive from child abuse, can have unexplained signs of fear, anxiety and depression. Adult survivor of sexual abuse can abuse other children which is the cycle of abusing. Also the adult may suffer from sexual transmitted disease. The adult will have difficulty to express feeling, and may turn to substance abuse (alcohol or drugs). The adult may attempt to suicide.

To sum up, child abuse is worldwide problem affecting children from birth to 18 years of age. There are different types for child abuse which is neglect, emotional abuse, physical abuse, and sexual abuse. There are three main causes for child abuse which is parent causes, ecological causes, and child problems. Based on causes many effects can be observed on the child which affect child emotionally, physically and social development.

In my opinion detecting the early signs of abuse will end further harm to child, better chance for recovery, and appropriate treatment will be provided for the child. Since the family is the core of love and care for the child, it is important to bring their attention and highlight the causes and effects of child abuse, so they can play significant role in stopping the matter. Therefore, proper awareness of the community plays an important role in preventing this problem from going further.

You will need to introduce the situation, explain the rationale behind your intervention, and analyse the skills and process you have used, reflect on the impact of your work and discuss future action. In addition to discussing the process and its application in practice you will need to show that you understand its theoretical underpinning. and reflect on its effectiveness in relation to social policy and anti oppressive issues.

You will include in the appendix the ‘Case study’ this is the description of what happened

You will need to:

Show ability to apply theory to practice

Analyse your skills and processes in relation to working with an individual.

Apply the theoretical background to the intervention.

Be Critical explain the limitations to the intervention and the positive aspects to the intervention.

You will need to analyse your skills, explain the process you have used drawing from theory, assess possible impact and evaluate the intervention. You may want to discuss the practice in relation to your understanding of risk, resilience, social and cultural aspects and government policy. You should show how you analyse your practical work against theory. That you can analyse reflect on your intervention,

You could reflect on such questions as

Has the environment had an impact?

How did I engage the client?

How did I show empathy?

What did I do to develop the relationship?

Why did I choose a particular intervention?

What is the effect of this on practice?

You will need to:

Read and research around the chosen topic. There is an expectation that you will use and reference at least 6 texts and that at least 4 are from recommended reading provided. In addition evidence of wider reading, field research and learning from the teaching should be documented. Please evidence reading to show you can relate theory to your intervention i.e. humanist approaches/cognitive etc

Anti Oppressive Approaches Show that you have considered this topic in the light of anti oppressive practice.

Presentation Structure your work in a coherent, clear and engaging manner. Clear referencing to appendix evidence

. Submission arrangements
Please submit your assignment together with the appendix to the Faculty Student Advice Centre on the 12th February no later than 10.00am, together with cover sheet marked for the attention of J Flett. Please remember to retain a copy of your assignment and the receipt to prove that you have submitted the work on time. Please ensure that the word count does not exceed the limit by more than 10% as there will be a penalty. Please ensure that the assignment is also submitted through Turnitin or else it will be marked as fail non submission.

Reading List

Highly recommended reading

Geldard K (edt) 2009 Practical Interventions for Young People at Risk: Sage Publications

Buchroth I and Parkin C Using Theory in Youth and Community Work Practice: Learning Matters

Wood J and Hine J (edts) 2009 Work with Young People Sage Publications.

Foley et al (edts) 2001 Children in Society Contemporary Theory Policy and Practice

Palgrave MacMillan/Open University

Sayer T (2008) Critical Practice in Working with Children Palgrave MacMillan

Furlong A and Cartmel F (2nd ed) 2007 Young People and Social Change OU Press

Robb M (edt) 2007 Youth in Context: frameworks settings and encounters OU Sage

Mcleod J (1993) Fourth Edition An Introduction to Counselling McGraw Hill: OU Press

McLeod J (2007) Counselling Skills McGraw Hill: OU Press.

France A (2007) understanding Youth in late modernity Open University Press

Kemshall H (2008) Risk, Rights and Justice: Understanding and responding to youth risk, Youth Justice 8 91) 21-37

Mizen P (2004) The Changing state of Youth, Basingstoke :Palgrave

Pearce N and Hillman J (1998) Wasted Youth IPPR

Thom Bet al (Eds) (2007) Growing up with Risk, Bristol :Policy Press

Dunhill a et al (eds) (2009) effective Communication and engagement with Children and Young people, their Families and Carers, .Learning Matters ( chapters 1-3)

Egan G (1994) The Skilled Helper 5th Edition Brooks: Cole

Heron J (2001) Helping the Client 5th Edition London: Sage

Kidd JM (2006) Understanding Career Counselling Theory Research and Practice London: Sage

Koprowska J (2nd edition 2008) Communication and Interpersonal Skills in Social Work Learning Matters

Lindon J and Lindon L (2008) 2nd edition Mastering Counselling Skills Palgrave Master Series

MacDonald A (2007) Solution Focused Therapy Theory Research and Practice Sage Publications

Miller L (2006) Counselling Skills for Social Work London: Sage

Miller WR and Rollnick S (1991) Motivational Interviewing Guilford: The Guilford Press

Reid H and Fielding AJ (2007) Providing Support to Young People A guide to interviewing in helping relationships London: Routledge

Roberts J (2009) Youth Work Ethics Learning Matters (chapters 2, 6)

Rogers C (1961) On Becoming a Person Boston: Houghton Mifflin

Schon D.A (1983) The Reflective Practitioner New York Basic Books

Thompson N (2002) People Skills 2nd edition Palgrave McMillan

Websites

Informal Education Website www.infed.org

Psychology Theories www.ship.edu/~cgboeree

Assignment 1: Case Study
Introduction

For the purpose of this investigation I shall use a case study from my work placement at a supported housing project in Nottingham.

I work a support worker/project worker ina supported housing unit with places for 13 young people between the ages of 16 to 25 years. All service users are female and are usually referred from Housing Aid. The service users are homeless, some have come from a background of domestic breakdown and the rest have come out of the care system.

The basic needs of the service users have also been addressed in an interview at Housing Aid before being referred to the project.

When the young person has been with Housing Aid they have undertaken an initial assessment of need. The assessment covers several different needs. Physical and wellbeing needs such as any medication or health concerns. The young person may smoke or even have drug or alcohol issues and these will be on the referral. Next the young person’s mental health will have been looked at. Sometimes there may be additional reports from social workers or schools. High risk service users such as ex-offenders may be referred and these cases may have probation workers involved.

Introduce your case study eg “MARY”

Mary is 18years; they are both Portuguese parents and separated. Mary’s father lives in West Midlands; mother lives in Nottingham. She was living between mum and dad for a while; deciding to live with dad. On school holiday stayed with her mum. Father assaulted her at an early age of 10 years old; hit her with a belt and with a metal bar. She was placed in care after police and social services involvement. Her close contact lives in Wales; does not see her regularly. She has friends whom she avoids now ; are getting into criminal behaviour and friends who are not into trouble.

The rationale behind the project intervention

The needs of young women arriving at the project are further assessed through another informal interview. Each young woman is welcomed. The care package offered to young women who arrive at the hostel is to sign up to a tenancy agreement giving them their accommodation in the project. Each young woman gets a self-contained flat within the project. The flat has a bedroom, kitchen and bathroom. Usually all accommodation costs are met through housing benefits. (This may be set to change or be affected by the introduction of Universal Credits in April 2013.) If the young person is working they pay part of the service charge after assessment.

The educational needs of the young person are also looked at. Basic needs in numeracy and literacy are assessed. Personal , social development and health are also taken into account and the young person’s ability to budget their money.

QUOTE

Without this type of project’s intervention, many young people would be homeless and at great risk of exploitation and/or bad health.

An analysis of the skills and processes used in the intervention.

One of the most important skills for this type of intervention is for project workers to be able to listen. Active listening is vital. Verbal and non-verbal skills are needed in order to establish a rapport and good relationship between worker and service user. In a person-centred approach listening skills are the most vital skills.

As a practitioner, is asking the sort of questions that helped the service user’s clarify own thought; avoid authoritarian language, treating people as equal encouraged to think and act for themselves.

QUOTE Rogers here

Any personal feelings in the project worker are left outside the workplace in order to be professional and keep boundaries.

Empathy skills are also very important. ROGERS QUOTE AGAIN-

General people skills, and knowledge of drugs and alcohol and their effects on the body and well being are important and also understanding youth and self-image, personal awareness and personal development in terms of physical, intellectual, emotional and social.

Social power

Values

Values are in essence a set of beliefs, ideas and assumptions that both individuals

and groups hold about themselves and the society they live in.

Values are a part of the culture and societal norms that guide people’s daily

lives’ (Eby, 2000: 118) and are used in everyday language to refer ‘to one or all

of religious, moral, political or ideological principles, beliefs or attitudes’

(Banks, 2001: 6).

Values and principles of being a youth worker are present in all areas of their work especially as an educator delivering lessons. Harrison and Wise (2010 p17) states

“Youth work is informed by a set of beliefs which include a commitment to equal opportunity, to young people in learning and decision making and to help young people to develop their own set of values”

Anti-oppressive

For us, anti-oppressive practice encompasses a number of ‘identifiable values’, principles or value statements, such as social justice and personal caring (Lynn, 1999); compassion (Simey,1996); respect for the individual, valuing uniqueness and diversity, promotion of user self-determination (Banks, 1995: 92); and challenging discrimination and oppression (Burke and Harrison, 1998).

Practitioners will in this situation be required to critically reflect on the different value positions, which will enable them to understand how different discourses impact on their decision-making.

QUOTE

How did I engage the client?

How did I show empathy?

What did I do to develop the relationship with Mary?

Why did I choose a particular intervention wit Mary?

What is the effect of this on practice?

The intervention’s application in practice

Aims and objectives of your project.

Key session (see Appendix 2)

NAOMI

The NAOMIE framework is used to identify the needs of the young people (Ingram et al, 2001). This tool is used to identify the young people’s need and works well. This has identified some of the barriers in anti- discriminatory practice on working together on issues of inequality, discrimination and oppression (Thompson, 1994). So they need to be openly clear to discuss issues

The theoretical underpinning of the intervention

Thompson’s Model: Person, Culture, Structural talks about anti-oppressive practice (explain)

Personal (P) level
Individual actions that I come into contact with, for example service user.
Cultural (C) Level
This analysis is related to the ‘shared values’ or ‘commonalties’. For example, shared beliefs about what is right and wrong, good or bad, can form a consensus.
Structural (S) Level
This analysis demonstrates how oppression is ‘sewn into the fabric’ of society through institutions that support both cultural norms and personal beliefs. Some institutions such as sections of the media, religion and the government can cement the beliefs.
Example: homeless young person
P: Young person 16 years old sharing at her friend’s home. She has been expelled from her mother’s home due to an argument over her mother’s boyfriend. There is no communication between them and she is not attending school but is staying at her friend’s home where she feels safe.
C: being homeless within the community she is sharing her thoughts and feelings with different groups.
S: Network of divisions, social services, health, local authority
There are barriers in relating to ethical practice to identify form group- based approaches to anti-discriminatory practice to work together on issues of inequality, discrimination and oppression (Thompson, 1994). Practitioners will support her with learning tools that transform to challenge oppression Challenging practice with young people engages them into ways. The first is by engaging by using wider policy objectives due to the fact that it is a person centred base. Learners will openly discuss and debate issues within a safe environment amongst their peers and focus on building one’s confidence and reassurance within a group, as well as maintaining the learner’s concentration.
The effectiveness of the intervention in relation to social policy and anti-oppressive issues.

In terms of social policy, the housing project, as an intervention, is in some ways effective.

Current social policy is underpinned by legislation to protect and uphold rights and responsibilities around the vulnerable service users at the project. Acts like Welfare Reform Act DATE, Housing/Homelessness Act DATE, Equal Opps legislation, Race Relations Act DATE, Disability Discrimination Act DATE

This legislation which forms social policy is outworked through the project’s policies and procedures. In terms of Mary’s experience at the project she has been mainly served well. She was homeless and had experienced sexual assault by a close male relative. This caused her to be brought under the care of the local authority and aˆ¦..list how

ANY OTHER THEORISTS THAT NEED MENTIONING HERE?

In terms of anti-oppressive practise Mary has had a positive experience by going through the project. List how

The impact of the project’s intervention

(reflect on the impact of your work for Mary) In reflecting on the experiences Mary had at the project, I believe her experiences have been largely positive and effective for her Explain how

Be Critical explains the limitations to the intervention and the positive aspects to the intervention.

What worked?

What didn’t?

What should be changed?

discuss the practice in relation to risk,

resilience,

Social and cultural aspects and government policy.

Has the environment had an impact?

Future action.

Appendix: Case Study

.

This essay will outline and analyse the Care Programme Approach (CPA), a social policy which was introduced in England in 1991. it will critically analyse and evaluate how and why this policy (CPA) was introduced. In doing so, it will attempt to explore the social problems with which the policy was concerned, its ideological origins, its aims and its nature. Finally, this essay will assess the effects of the implementation of the CPA based on issues of access and outcome.

What is social policy?

According to one website I’ve consulted: The name ‘social policy’ is used to apply to the policies which governments use for welfare and social protection; to the ways in which welfare is developed in a society, and to the academic study of the subject. In the first sense, social policy is particularly concerned with social services and the welfare state. In the second, broader sense, it stands for a range of issues extending far beyond the actions of government – the means by which welfare is promoted, and the social and economic conditions which shape the development of welfare.

http://www2.rgu.ac.uk/publicpolicy/introduction/socpolf.htm

Social problems with which the policy (CPA) was concerned

There are several social problems with which the CPA was concerned and some of them are: The 1984 murder of social worker Isabel Schwarz by a former mental health client as cited by Sharkey (2000) prompted a government inquiry that was led by Sir Roy Griffiths in 1988. His report “Community Care: Agenda for Action” was the forerunner to the National Health Service and Community Care Act of 1990 (NHSCCA) which sets out the foundation for present day Care Programme Approach in England. The care programme approach was also instigated by the Christopher Clunis’ unmet needs as noted by the Ritchie Report in 1999. The report criticised the demeaning failures of the health and social services to work together in relation to the needs of people with mental health problems and to protect the public. The emergence of advocates groups such as MIND, the Mental Health Foundation and Informal Carers’ pressure group in the 1980s were also major social factors that led to the development of the CPA (Morris (1993). Those groups raise fundamental civil liberty issues surrounding the legal rights of people returned back into the community from psychiatric hospital and the need for appropriate services. Another major concern according to Means and Smith (1998: p48) was “the official report on Ely Hospital, Cardiff, which confirmed staff cruelty to patients at this mental handicap hospital.” They argued that “The level of media publicity generated by these incidents became so high that a policy response became inevitable (ibid)”.

CPA’s ideological origins

There are several factors that affected the development and establishment of the Care Programme Approach (CPA). However, the key factors that influence the implementation of the CPA are: political, economic and social. From the earliest stages of the Poor Laws through to the present day social security system, political factors have influenced welfare provision. Like most other policies, the CPA emerge as a result of the conservatism New Right ideology of minimum state intervention, privatisation, the idea of justice and the emergence of global market forces. The conservative government lead by Margaret Thatcher from 1979 through to the 1990s believed, politically, in reducing the power of the local authority and local government with the notion that “care in the community must increasingly mean care by the community (Lavalette and Pratt 1998: 237)”. Mrs Thatcher expressed the view that the sacrifices which the family and voluntary organizations have played in community care from the Victorian era to present day should not be seen as second best or degrading. Her philosophy was built on the importance of mixed economy, choice and given power back to the users of services. Mrs Thatcher was politically concerned with the political structures of the local labour government and the need to give more power to the market forces (private sector) to energize the economy.

The care programme approach policy was also partly motivated by economic factors. The New Political Right regards the free market as the best way forward for organising society. They believed that a competitive market and a mixed economy of welfare is vital in encouraging competition which inspires innovation and efficiency which will inevitable provide better and cheaper services than a nationalised and bureaucratised services. This was a move away from the accepted orthodoxy of the Keynesian economics which sees government intervention in the provision of social care as necessary for the stability of the economy. The mixed economy is therefore seen by the New Right as not only promoting equality and choice but also cost effective. Many believed that the political underlying principle of giving service users choice would cover up the huge spending on the uncoordinated health and social care budget. As a result, both health and social care services were forced to introduce financial and management systems in relation to the purchase of care. For example, social workers became care managers and the purchasers rather than the providers of care.

Regarding social ideology concept, the major social ideology was that, people with mental health problems, were expected to be integrated back into the community with clear and structured care plans. The fatal attacks by dangerous mentally ill people such as Christopher Clunis’s who was misdiagnosed and prematurely discharged then ended up killing an innocent person, were major social factors which affected the development of the CPA. The case of Clunis raised significant social issues of the risk and danger posed by people with mental health problems, especially those not receiving proper care. The case also raises major trans-cultural social issues in relation to the significant number of black men placed on supervision register.

The aim of the policy

The Care Programme Approach was introduced in order to provide a clear framework for the care of people with mental health problems outside hospital (Means and Smith1998: p156)”, which Thompson et al (2000:573) said this include: “Systemic multidisciplinary assessment, planning, monitoring, and reviewing a care plan, the inclusion of users and carers in the formulation and delivering of care and identification of a lead person or key worker” and that, “all of this is undertaken within a framework that is flexible and responsive to the client’s changing needs (ibid)”.

Nature of the CPA

According to Thompson et al (2000) the CPA was introduced in 1991 and is intended to be the cornerstone of the government’s mental health policy. This process applies to all people that are experiencing severe mental health problems who are clients of mental health services, whether on an informal or formal basis. The policy outlined four stages which should be applied to all clients in all cases. The First stage is, to carry out an assessment based on the circumstances of the client, including any support needed by carers. Secondly, to negotiate the care package in agreement with the client, carers and relevant agencies that are designed to meet the identify need within available resources. The third stage is to implement and monitor the agreed package by the appointment of a key worker now known as “care co-ordinator”. The care co-ordinator is responsible for the assessment and planning process. He or she could be a mental health nurse, social worker or occupational therapist. The last stage is, to review the outcomes of the care plan and if necessary undertake revision of services provided.

The policy is based on person-centred approach and one that has been important for health and social care to develop integrated policies and procedures around models of assessment, diagnostic evaluation, integrated working relationships around care plans and monitoring people in care and community by means of integrated budgets. Whereas, practice under previous systems were not person-centred instead, they involved offering people limited number of inflexible choices which were more or less organised to meet requirements of service providers rather than the service users and their carers. With mental health placed in psychiatrist hospitals or prisons these residents are controlled and manipulated by those in charge.

The effects of the CPA

The policy helped services maintain contact with service users, stressed the need for service users involvement in decision making; ensures that there is coordination and communication between all the professionals that are involved in the assessment and delivery of the patient’s care needs, but failed to provide comprehensive co-ordinated care. This lead to several criticism been made about the policy for example, it has been criticised that working together often leads to role insecurity and role ambiguity, thus creating a major hindrance to working together. The policy has also been criticised for mostly being used for inpatients instead of people in the community. This was referenced by Sharkey (2000) as an important point citing the Christopher Clunis’ case due to the failure to offer culturally sensitive services to meet his needs and citing the example of Lavallette and Pratt (1998: 104) in which they commented that ” mental health policies and practice based upon white European, middle-class norms of behaviour can result in a system which does not understand that people from other cultural backgrounds may express symptoms of mental health or ill health in different ways”. This is useful in enabling the understanding of how Christopher Clunis was failed by all the professionals who saw him. For example, Sharkey (2000: p83) refer to the Ritchie Report that “A GP whom Clunis had visited had struck him off his list because he was abusive and threatening”.

The Mental Health Foundation carried out a recent studies which aim was for respondents to talk openly about their mental health issues in relation to employment. They sent out about 3,000 questionnaire and those who replied , 86% were white UK, 3% Black African Caribbean, 2% Black Asian and 4% were other European white including Irish. What the findings has shown is that ethnic minority are uncomfortable to talk about their mental health problems for fear of discrimination and oppression. They also highlighted 85% of those with long term severe mental health problems are unemployed. These can contribute to the stress and anxiety experienced by users, carers, friends and families. For example, living with someone with serious ongoing mental health problems can cause increased strain, worries and distress together with loss of friends and social contracts (example intimate relationships), social isolation (due to stigma attached) and difficulties in coping with particular symptoms. At the same time, the protection of the public from the risk of harm is of paramount importance because patients discharged without adequate supervision or the provision necessary to meet their housing, social and health needs would increase risk to themselves and members of the public as evident in the case of Christopher Clunis. The CPA has also been criticised as a policy that it is largely dominated by medical module of treatment and social issues are neglected by practitioners and this has been highlighted by Thompson (2009) that spirituality is very important component of a person’s well-being and despite this concern, people’s spiritual needs are often seen to be neglected during treatment or in developing and managing care plans for day-to-day activities. In some cases, as noted by rethink.org, a charity campaigning for mental health awareness, spirituality is even seen as a manifestation of the individuals’ psychosis or delusions by some members of society. Even though the policy was introduced so that people with severe mental health problems could be assessed and assigned a care coordinator so they don’t present a risk to themselves or the public, there have been some problems with users of services “slipping through the net” and ending up either homeless or causing ham to themselves or others (sometimes even committing fatal attacks). For example, Taylor (2010) wrote on the Metro Newspaper about a man with mental health problem who hadn’t been offered treatment on several attempts ended up killing a pregnant woman.

Conclusion

Even though this policy has helped people with severe mental health issues to be integrated well into the community and live supported or independent lives, some people with mental health problems are still seen by the policy makers as a burden and stigmatised as a threat to the community. They are routinely being denied the human rights of freedom of movement, family life, and equal access to paid jobs and adequate financial support which may then lead to homelessness and readmission in institutional care.

The biological perspective of ageing believes that the process of aging is a biological fact which is universal and affects all people. It takes the view that aging is a fundamental, progressive process which continuous throughout life (Lymbery, M 2005). The biological approach believes that as a person ages there is a decline in function as cells degenerate. Therefore, this approach views age as connected to a state of dependency and weakness with no possibility for improvement (Crawford, K and J, Walker 2004). However, in contrast there are other perspectives which take into account other elements such as the social construction of old age. For example, the introduction of retirement meant that clear boundaries were created which defined the point at which a person enters older age. Also, other developments in the welfare system such as the provision of pensions, have further defined the concept of old age. Therefore, the end of employment and the start of retirement can be seen as a major influence in the way older age has been socially constructed (Lymbery M 2005).

Crawford and Walker (2004) believe that the way in which older age has been historically constructed impacts upon the current view and treatment of older people in today’s society. They note that during the Middle Ages, older people were cared for by either charities or religious institutions. The Poor Law Act, introduced in 1601, transferred the responsibility of the care of older people within the family, to care within the community. This meant that older people were now cared for by their local parish, as families were unable to support them due to the financial risks of agricultural based society.

Workhouses were then introduced for individuals who were seen as needy and unproductive members of society. This included groups such as older people, the sick and those who were disabled. As there were no welfare system in existence, this meant that older people had to reside in workhouses as they had no other means of support. As the demand for care rose, the Poor Lawn Amendment Act in 1834 was introduced in attempt to cut costs by eliminating outdoor relief, this meant that older people were no longer able to receive support in their own homes and those in need of welfare were institutionalised in workhouse. This resulted in older people being viewed as a burden on society as they no longer had power, choice or control over they way they lived their lives (Crawford, K and J, Walker 2004).

According to Phillipson (1998), the concept of old age being a separate group within society only surfaced during the end of the nineteenth century. As highlighted by Slater (1930 cited Phillipson, C. 1998) up until this period both the welfare provision for the sick, and the welfare provision for the elderly, were classified in the same way with no distinction between the two groups. Slater believes that it was at this point that societies found it necessary to end sickness benefit when an individual reaches 65, and to replace this with old age pension.

The Old Age Pension Act was introduced in 1908 and provided all citizens who were over the age of seventy with up to five shillings a week if their income was under ten shillings a year. However, although this provided support for older people, the view held by society was to remain in work until they were unable to do so due to physical difficulties. Therefore, this resulted in older people who did not work being viewed in a negative way, as they were looked upon as ‘useless’ due to the belief that they were either too stupid or too weak to work (Crawford, K and J, Walker 2004).

It was during the twentieth century when older people began to be seen as different in they way they experienced and held an inferior status within society. It was found that through this period in time, one in five people who had reached the age of seventy were very poor and were a recipient of state welfare, and the likelihood rose significantly for those who were seventy-five, to a chance of one in three. This meant that circumstances such as being in poverty and experiencing marginalisation were seen as inevitable as an individual entered later adulthood, which provided the basis for which the concept of older age was constructed.

What are the consequences for people in terms of social disadvantage?

Older people face social disadvantage in many ways, such as infantilisation. This refers to a process in which adults are treated as though they were a child. This is a form of oppression as it demeans older people by assuming that they are fundamentally different from other adults and are therefore less worthy of respect (Thompson, S 2005). For example, the desexualisation of older age plays a key role in infantilisation. This is because old age is seen as a second stage of childhood, with an inappropriate link with sexuality, which further reaffirms the idea that older people are not adults. However, as sex is seen as an action of the healthy, this also reinforces the idea that older people are unwell, dependent and frail and further excludes them from sexuality. This illustrates they way in which older people are seen to be in need of support and reliant on others, similar to the conventions of childhood (Gott, M 2005). Also, by referring to older people by names such as ‘dearie’, it can be degrading as the person using the term automatically assumes that the individual does not mind being referred to in this way, which can be seen as disrespectful and inconsiderate of their feelings. (Thompson, S 2005)

Marginalisation is also another way through which older people face social disadvantage. Marginalisation is a form of social exclusion, and is used to describe the way in which people are pushed to the margins of society, which then prevents them from taking part in activities (Thompson, S 2005). When referring to older people, this is the process where older people are excluded from society due to preconceived ideas that they have no use, and are therefore a burden to society (Thompson, N 2006). There are many ways in which older people can experience marginalisation within society. For example, Thompson (2005) highlights the lack of suitable transport for many elderly people. This can mean that they are isolated from the rest of the community as the public transport is either inaccessible or unsuitable. This shows how older people can be marginalised due to factors they are unable to control, such structural problems within society.

Dehumanisation is also another factor of social disadvantage in older people. This is because it gives older people a label of being ‘elderly’, to which the individual is then viewed in terms of this label and not as a person with unique thoughts, emotions and needs. Dehumanisation can have adverse consequences as it fails to identify that each person is different, which can cause discrimination and oppression due to its impersonal and stereotypical viewpoint

Abuse of older people is a further way in which people of an older age may face disadvantages in society. Abuse in elderly people can be physical, psychological, sexual, emotional or financial. The underlying factor in this type of abuse is the exploitation of a comparatively vulnerable group within society. The people who carry out this abuse believe that older people within society are inferior with no requirement for respect (Thompson, S 2005). The ‘No Secrets’ document (DoH 2000 cited in Crawford, K and J, Walker 2004) was created as guidance on how to implement and adhere to procedures to help protect vulnerable adults from abuse, and also clarify definitions, which would enable authorities to carry out good practice. According to Hothersall and Mass-Lowit (2010), older people who are isolated, reliant on others, have poor health, or who are considered disabled are more likely to be abused. They believe this abuse can take place in any environment, such as hospitals, residential homes or even the individuals own home.

What multiple disadvantages can impact on people’s lives?

Ethnicity within older age can be seen as a significant influence on the life a person leads. This is because there is a belief that older people, who are of an ethnic minority background, face a ‘double jeopardy’ in society, as they are oppressed by both age and their ethnicity (Thompson, S 2005). Ray, Bernard and Phillips (2009) argue that services are institutionally racist. This is because they tend to be directed towards the majority population, which can mean that people are doubly disadvantaged. This can occur as they are not recognised within the service, and instead they are they are overlooked and treated as though they are invisible. Thompson (2005) states that the common feature of racism and ageism is that they are often susceptible to dehumanisation. This is because it is easy to categorise people as ‘elderly’ or ‘Asian’, however, in reality, these terms incorporate a vast amount of people into one group who experience different religion, culture and way of life. This leaves little manoeuvre for individuality and therefore these categories should be avoided, as the person is then seen in terms of this labels and not as a unique individual. Consequently, social work should seek to recognise the barriers which face ethnic minorities who are of an older age, and attempt to work with them to overcome their disadvantage (Phillips, J, M, Ray and M, Marshall. 2006).

Gender can also be seen as a key issue which can further disadvantage older people within society. Phillips, Ray and Marshall (2006) support the idea of a ‘feminisation of aging’, as older age is now seen as a predominantly female world due to the fact that women live longer than men. This can mean that women are widowed for a greater time than men, which can lead to women having to enter residential care due to being unable to support their own needs without the help of their partner (Arber and Ginn, 1991, cited in Phillips, J, M, Ray and M, Marshall 2006). Women are also seen as less likely to have private pensions compared to men, which means that they are forced to depend upon state pension (Hunt, S 2005). This can be increasingly difficult for women living alone as it becomes the only source of household income which can leave them deprived and subjected to poverty (Phillips, J.M, Ray and M, Marshall 2006). Gender stereotypes within older age can also cause detrimental effects. Women can be seen to be oppressed due to pressure to conform to gender roles, such as to be caring and supportive, which can mean that they are undervalued as it is seen as ‘normal’ and not something which needs to be commended. However, the caring role when displayed in men receives a higher status, as it is not seen to be a typical responsibility of mans stereotypical gender role, therefore they receive greater praise and support in fulfilling the role (Rose , H and E, Bruce, cited in Thompson 2005). It is important to note that not all gender related disadvantages in older age are associated with women, as men also experience undesirable situations. For example, the male gender role is surrounded by the belief that they are the dominant, providing and protective sex. However, this expectation may come under threat in older age as work is replaced by retirement and their health declines. This can then lead to lower self-esteem as they experience a loss of role within society (Thompson, S 2005).

Multiple oppression can also be experienced in regard to ageism and economic disadvantage. Social class can be an important factor within old age, as those who belong to a lower class are significantly more likely to have a lower income and to live in poverty. Being in poverty affects a vast amount of older people, and can have negative consequences as a sufficient income is a required to be able to meet a persons fundamental needs (Crawford K, and J, Walker 2001). According to Thompson (2005) if an older person has a low socio-economic status within society then they are more likely to suffer from a state of poor health. Crawford and Walker (2001) point out that this may be due to being unable to afford to heat their home or to buy nutritional food, which increases the risk of contracting an illness as well as being able to properly recover. Also, they believe that other socio-economic factors act in a way in which reinforces multiple oppression. For example, older people may be afraid to seek medical help when it is needed due to a fear of disapproval from people of a higher and professional status, such as doctors. This can mean that an older person tolerates their condition for a longer period of time, during which it could cause their health to deteriorate. Phillips, Ray and Marshall (2006) believe that it is becoming increasingly important in modern day society to contribute to an occupational pension. This is because there is a growing inequality between older people who rely on a public pension and those with the benefit of private pension schemes. Consequently, as state pensions are low, they have to be supplemented by means-tested top up benefits in an attempt to enable older people to remain above the poverty line.

What do social workers need to think about when working with these service users with particular reference to anti-discriminatory practice

One crucial factor in which social workers need to think about when working with older people is to avoid ageist assumptions. For example, Thompson (2006) proposes that older people are often subjects of sympathy as they stereotyped as being lonely. However, it is important to realise that people of all ages can be lonely, it is not something reserved for the elderly. Also, many older people have good social relations, and although they live alone, this does not mean they are lonely. Therefore, within social work practice, each case needs to be assessed individually to avoid stereotypical assumptions about older age.

Another aspect which social workers need to think about when working with service users is to challenge the concept of ageism. This is because there are many negative stereotypes surrounding old age, which can be seen by the disproportionate media coverage when an older person is abused and dies, and when the same happens to a child. This means, that to actively challenge the concept of aging a social worker needs to perform roles such as assessing the strengths of an older person and what they are able to do, rather than focusing on their problems and inabilities. As well as other positive functions such as advocating on the behalf of the service user, to enable them to gain access to services to improve their standard of living. This will allow the service user to overcome the discrimination and oppression which they may face (Phillips, J. M, Ray and M, Marshall 2006)

To conduct good social work practice when working with older people there should be support for the service user, individual personal care tailored to their needs, and also physical assistance, especially when offering help to those who have long term illness or disabilities. There are also other factors which constitute good social work practice such as values, skills and knowledge which enable social workers to carry out anti-discriminatory practice. A value base is needed to recognise the common issues amongst older people when trying to protect their independence. Skills are needed such as being able to empower people to remain in control of their lives, to advocate on behalf of the service user, to manage risk, and to be able to communicate effectively with both the service user and their carer. And also a knowledge base, that is derived from evidence based practice, policies and similar past experiences (Ray, M. M, Bernard and J, Phillips 2009)

An important factor that social workers need to consider when working with older people is the language that is used. This is because terms such as ‘the elderly’ can be seen as demeaning as they have negative connotations which can be seen as disrespectful. Also referring to service users as ‘old dears’ or similar names, although it is not meant to be intentionally offensive it can be seen as patronising. This can then mean that the person feels inferior due to the lack of respect shown through the language used towards them and make them feel as though they are not being taken seriously. Therefore, the language used to refer to older people needs to be carefully considered to try fight ageism, rather than reinforce it. (Thompson, N 2006)

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Explanation of Te Tiriti o Waitangi and its application in social services

Te Tiriti o Waitangi can be used in the social services through the application of four principle of the treaty, which are Partnership, Protection, Participation, and Permission.

Partnership – in this principle the social service providers ensure that all the services they provide are bi-cultural in perspective. Also, the social service organizations ensure that the needs of Maori clients are taken into consider in terms of interaction with them and creation of policy that may affect Maori.

For instance, before engaging with a Maori client, the social worker should build rapport and trust through effective and therapeutic communication. The social worker must provide consultation to the Whanau of the client then include them in the decision making of the client.

Protection – in this principle the social service organization needs to respect the rights of every Maori client to enjoy their treasured resources. Maori clients have the right to make their own choices with regard to their cultural traditions and customary practices. Their rights should be acknowledge in order to protect them all the time.

For instance, Maori clients are ensured that they are safe at all times like in consultation. They are given the freedom to speak Te Reo Maori.

Participation – in this principle, Maori clients are ensured to participate at all times. They should be consulted with regard to the important matters that can impact their well being and life.

For instance, the social service providers must ensure that they have consulted the whanau of the client before implementing any plan for the client.

Permission – Maori client should be asked for their permission if they wanted to speak Te Reo Maori and if they wanted to participate in any Maori spiritual and cultural practices.

For instance, the social service providers must ask permission if the Maori clients and their whanu would like to practice their culture like karakia, kai, powhiri and mihi when organizing a whanau hui.

TASK 2

Summary of reason for family meeting or whanau hui

Youth – a youth court judge required a family meeting for KJ, a 16 years old Maori, due to criminal offense, victim of family violence and low parental supervision.

(Task 2) Placement Diary – (Student to complete)

Student name

Anne Miriam Roces Mercado

Workplace

Salvation Army

Meetings and Communication

(Related to family meeting / whanau hui)

Date

Notes / key points of information provided to the family / whanau

21 / 08 / 14

The client and his whanau was ensured to maintain their information confidential and kept safe. The social service provider builds a therapeutic relationship with the client and whanau.

22 / 08 / 14

The whanau and the client were asked for their permission to provide cultural practices in the whanau hui.

Notes / key points of how you received and recorded the referral. What service provider guidelines did you follow?

The social service provider received a referral from the youth court justice. Upon receiving the referral form, whanau needs to fill-up certain forms from the social service provider as per accordance to the guidelines and policies of Salvation Army. After completing the form, I recorded the information in their system records in their computer with the use of one of the employee’s username with password. All the encoded information of client was secured in the system and treated with safe and confidential. Moreover, the cultural practices of KJ and his whanu were acknowledged and treated with respect throughout the process. Also, the client and his whanau signed the form as their consent for any disclosure of information within the Salvation Army organization.

Notes / key points of how you assessed the referral for relevance to the service provider.

The referral was assessed for relevance to Salvation army prior to acceptance of the case. If the Salvation Army can provide services for a certain client, the social service provider accepts the case but if not, the referral will be referred to other service provider that can be suitable for the client. In terms of referral back to other social service provider, the client and his whanau must be consulted. In the Salvation Army, they provide assistance and support to clients with family violence, criminal offence and low parental supervision.

Notes / key points of how you processed the referral through the service provider systems. What service provider guidelines did you follow?

The referral was processed through the service provider systems by ensuring the wellbeing and safety of KJ and his whanau. The service provider received referral from the youth court judge for whanau hui. The service provider assessed the referral whether it is relevant to their services. Since it is relevant, all of the relevant information were recorded and documented in the computer then forwarded to the social worker. I ensure that confidentiality and privacy were observed and respected through out the process. Moreover, the cultural practices of the client and his whanau were acknowledged and allowed to apply during the process.

Other notes / reflections on the referral process

The service provider assessed the relevance of the referral. The safety and wellbeing of the client and his whanau were ensured at all time. Their rights were provided to ensure safe practice. The gathered information was recorded in the computer system with the use of the staff’s username with password to ensure that the information of the client and his whanau was maintained confidential and private. Confidentiality and privacy were ensured through not disclosing the information to unauthorized personnel. Moreover, I with other staff members of the Salvation Army, worked professionally by the provision of services in a non-biased and non-judgmental approach to clients. Lastly, the social service provider follows their services guidelines and policies to every case.

TASK 3

(Task 3) Placement Diary – (Student to complete)

Student name

Anne Miriam Roces Mercado

Workplace

Salvation Army

Coordination of planning for the family meeting or whanau hui

Date

Notes / key points of information provided to the family / whanau

29 / 08 / 14

The client and his whanau were contacted in order to gather details for the whanau hui such as appropriate venue, agenda, cultural / other protocols, facilitator, time, proposed duration and date.

29 / 08 / 14

Key memebers identified by KJ and his whanau that were important in the whanau hui like his father, kaumatua, aunts, uncles, cousins etc. were contacted through phone calls.

Notes / key points of how you received and recorded the referral. What service provider guidelines did you follow?

The key memebers of the whanau were identified thorugh the consultation with KJ that need to be included in the whanau hui. The following key members are as follows:

KJ’s father, TJ, even if KJ’s father physically abuse KJ, his opinion and decision making about KJ’s wellbeing because KJ’s mother died when he was 6years old.
Kaumatua (MK)
Auntie (KC)
Uncle (EP)

Who is the facilitator for the meeting / hui and how was the person identified?

The facilitators for the whanay hui were identified by KJ, which were the social worker and the kaumatua. The social worker and the kaumatua worked together I the facilitation of the whanau hui. The lead social worker was identified since she handle KJ’s case and kaumatua who was the elderly leader from KJ’s Marae was identified to respect and acknowledge KJ’s cultural practices and traditions.

If there were participant who had essential information for the meeting / hui, how did you identify these people to the facilitator?

The father of KJ had information for the hui with regard to the condition and situation. KJ’s father is considered because KJ’s mother had passed away. The participants who had essential information for the whanau hui such as kaumatua, EP (uncle), auntie (KC) were identified to the facilitators by respecting their opinions and encouraging their involvement in the whole process.

How did you notify the plan for the meeting / hui to memebers of the family / whanau and any other attendees?

The plan for the whanau hui was notified to the key members attendees of the whanau hui. They were initially consulted in order to build trust and rapport so that there can have good relationship as well as coordination with the key members were ensured to be involved in the whole process. The whanau hui details were sent through email, post, and phone calls to all the attendees.

Other notes / reflections on the planning process

In the planning process of the whanau hui, the wellbeing and safety of KJ and his whanau were ensured at all times. The cultural practices were considered and allowed to apply in the whanau hui. The opinions of the key members of the whanau hui were listened, acknowledged, and respected to ensure non-biased and non-judgmental approach. In addition, whanau involvement was provided to promote cooperation, participation, coordination and collaboration to everyone involved in the whanau hui.

TASK 4

(Task 4) Placement Diary – (Student to complete)

Student name

Anne Miriam Roces Mercado

Workplace

Salvation Army

Coordination of welcome and hospitality for the family meeting or whanau hui

Date

Notes / key points of information provided to the family / whanau

04 / 09 / 14

KJ’s cultural practices of welcoming and hospitality were acknowledged and provided like kai, karakia, karanga, mihi nad powhiri. These were provided to ensure that all of the participants of the whanau hui were welcomed appropriately.

05 / 09 / 14

The agenda was prepared in advance and was given to all the attendees so ensure an organized hui. In addition, attendees were asked for any special dietary requirements needed such as allergies or preferences.

What cultural forms of welcome were required and who was responsible for these (for example kai, karakia, karanga, mihi , powhiri)?

The whanau hui was facilitated in the Marae
Powhiri was arranged and conducted by the kaumatua as soon as all of the attendees arrived at the Marae
Karakia means offering prayer was done before the start of whanau hui as well as before kai by the kaumatua
Mihi and karanga means ceremonial greetings were observed in the whanau hui
Kai or food and drinks were provided during the hui by the kitchen staff.

What resources did you arrange (eg fares, kai, kaikorero, kaikaranga, venue)?

The whanau hui venue was arranged while considering the location of each attendees and accessibility of the venue
Kai was prepared in advance considering the preferences and dietary requirements of each attendees
The transport / fares of the attendees were arranged and provided to ensure convenience

How did you carry out the coordination of the family meeting / whanau hui in line with criteria (ei. Legislation, ethical practice, service provider guidelines)?

Principles of Te Tiriti o Waitangi – the four principles were observed and applied during the whole process of whanau hui through consultation, whanau involvement, protection of their rights and allowing cultural practices.
Privacy act – confidentiality and privacy were applied at all times in the whanau hui. All information were treated with respect, private and confidential by not disclosing any information to other personnel who were not involved in the case.
Ethical practice and service provider guidelines were followed at all times
Salvation Army services policies and procedures regarding family violence, low parental supervision and criminal offence were followed accordingly.
Safe and secure environment was rendered to vulnerable clients and his whanau which was the major concern in the whanau hui.

Other notes / reflections on the coordination of welcome and hospitality

Partnership between the client, his whanau and the service provider was ensured with regard to coordination of welcome and hospitality. Everyone participated and cooperated in the whole process of whanau hui. Preparations were done that resulted to an organized and successful whanau hui. Moreover, the safety and wellbeing of KJ and his whanau were the primary focus and considered at all ltimes. Therapeutic communication was observed during the whanua hui. Opinions of every participant were listened, acknowledged and considered during the whanau hui. The cultural practices and traditions of KJ and his whanau were allowed and respected during the whanau hui. In addition,

Other notes / reflections on the planning process

In the planning process of the whanau hui, the wellbeing and safety of KJ and his whanau were ensured at all times. The cultural practices were considered and allowed to apply in the whanau hui. The opinions of the key members of the whanau hui were listened, acknowledged, and respected to ensure non-biased and non-judgmental approach. In addition, whanau involvement was provided to promote cooperation, participation, coordination and collaboration to everyone involved in the whanau hui. In addition, legislations, ethical practices, and social service provider’s policies and procedures were followed always during the whole process of whanau hui to ensure safety.

TASK 5

Application of social service theory

Te Tiriti o Waitangi

The social service provider committed, observed and practiced their services with regard to the four principles namely Partnership, Protection, Permission and Participation. These principles helped me build a strong relationship while working together with a Maori client, empowering and protecting Maori Tinorangatiratanga.

For instance, social worker must observe and consider cultural practices, values, and beliefs of a Maori client and his Whanau when conducting whanau hui. The rights of Maori client must be observed and respected in terms of the services available and decision-making process to encourage autonomy of every Maori client.
Social work service Users

Clients were given the essential information with regard to their rights as a client thus, equality, fairness and quality services can be provided. This can build trust and rapport to clients in which I and the social worker established to have with the client and whanau.

For instance, social service provider ensures that the rights of the client and his whanau are being acknowledged and practiced during the whanau hui. In addition, the gathered information about the client and his whanau must be treated as confidential and safe through documentation and avoiding open disclosure to other personnel not involved in the case.
Social work ethics

This serves as a guidelines and principles for social work practice to act and to work professionally and ethically to client and his whanau. This ensures boundaries and accountability of the social worker to every clients and whanau involved.

For instance, social worker is well equipped and knowledgeable about ones role whenever rendering services to client and whanau. Social worker is aware of the responsibilities and obligations in the social work practice. In addition, social worker must maintain veracity and honesty to all clients and whanau in order to deliver safe social work practice.

Reference:

Aotearoa New Zealand Association of Social workers: Social Work Practice. (2012). Backgorund of the Code of Ethics. Retrieved from http://anzasw.org.nz/social_work_practice/topics/show/157-background-of-the-code-of-ethics

Hayward, J. (n.d.). Appendix: The principles of The Treaty of Waitangi. Retrieved from http://www.justice.govt.nz/tribunals/waitangi-tribunal/treaty-of-waitangi/tribunals/waitangi-tribunal/documents/public/treaty-principles-appendix-99

Te Ara. (2013). Story: Kaumatua – Maori elders and their role. Retrieved from http://www.teara.govt.nz/en/kaumatua-maori-elders/page-1

Te Ara. (2013). Story: Maori feasts and ceremonial eating – hakari. Retrieved from http://www.teara.govt.nz/en/maori-feasts-and-ceremonial-eating-hakari

Introduction

This essay deals with the circumstances and challenges faced by 22 year old Betty, who became pregnant when she was 15, and now lives with Candy, her six year old daughter. Betty has been referred to the social services cell of the local authority for appropriate social work intervention. She has been engaging in bouts of bingeing and has in the recent past been suffering from vomiting, weight loss and amenorrhoea.

A brief case overview is provided below, followed by its analysis and its various implications for social work intervention.

Case Overview and Analysis

Betty’s mother left her father and her sisters when they were very young because of problems in dealing consumption of alcohol. The child and her sisters were thereafter sent to a home for children, where they lived for many years. Whilst the children did not have any further contact with their mother, they would occasionally receive visits from their father, who worked in a brewery and also suffered from alcohol related problems.

Betty and her sisters spent their childhood in the children’s home, from where they first attended the children’s village school and thereafter went to a comprehensive secondary school near the residence of her father. Betty began to develop truancy tendencies in her early teens and became pregnant from her relationship with an African Caribbean person, when they were both 14. She decided to keep her child who was named Candy, rather than give her up for adoption, and was placed in a foster home situated at a distance from where she had lived for many years. With the children’s home closing down, Betty’s sisters, followed by Betty and Candy, came to live with their father. All the children, including Betty and Candy, lived with their father for the next 6 years.

Betty first met a social worker when she was 22. She thereafter moved with her daughter to a small flat, which she liked and made efforts to make nice and homely. Whilst shifting to her new home proved to be beneficial for both Betty and candy, the death of her father, which occurred soon after she moved out of his home, traumatised her severely. She suffers from bouts of speaking difficulties, weight loss and vomiting and amenorrhoea. Her social service records reveal that she suffered from speech disorder episodes in her childhood as well. Betty has also spoken to her social worker about her difficult relationship with her daughter Candy. Whilst the child is doing well in school and is liked by people, she behaves very badly with her mother.

An investigation of Betty’s history reveals that she may well have been neglected during her childhood. Both her father and mother had alcohol related problems. Her mother left home when Betty and her sisters were very young, following which she was placed in a home for children. Child neglect can be defined to be a condition, wherein individuals responsible for taking care of children permit them, either deliberately or because of inattentiveness, (a) to experience suffering that is avoidable, and (b) otherwise fail to provide the environment required for the development of their physical, emotional and mental capabilities. Neglect can be physical, emotional or educational (Butler & Gwenda, 2004, p 76). Betty and her sisters were taken in the care of social services when they were young and placed in a children’s home. Whilst their physical needs were met adequately and they were sent first to the village and later to secondary school, it is very possible that they suffered from educational and emotional neglect (Grinnell & Yvonne, 2008, p 46). They certainly did not have anybody to provide them with emotional or psychological support or to help them with their school work.

Educational neglect includes the failure of care takers to acknowledge and correct acts of truancy by children, even as emotional neglect can arise from inattention to the requirement of children for emotional support and sustenance (Ghate & Ramella, 2002, p 66). It is evident that conditions in homes for children are unlikely to have emotionally or educationally enriching environments (Ghate & Ramella, 2002, p 66). Neglect during childhood can have adverse effects on the physical, social, intellectual and psychological development of young people (Ghate & Ramella, 2002, p 68). Studies reveal that neglected children are prone to development of insecure, anxious or disoriented attachments with their care givers (Howe, 2009, p 37). Such lack of security in attachment can lead to hyperactivity, lack of attention and involvement in class and lack of initiative and confidence to work on their own (Howe, 2009, p 37). Child neglect is also associated with greater incidence of substance abuse, delinquent behaviour, and early pregnancy (Howe, 2009, p 37).

Betty developed tendencies for truancy, both in her school and in her children’s home, and became pregnant when she was 14 from her relationship with a boy of her age. Teenage pregnancy is widely prevalent in UK, with the country having a highest rate for such pregnancies in all of Europe. Studies reveal that girls from social class V are at greatest risk of becoming teenage mothers. Research evidence also reveals higher incidence of teenage pregnancy in (a) young people in care, (b) young people leaving care, (c) homeless young people, (d) truants and (e) young people involved in crime.

Whilst parenthood can certainly be a positive and enriching experience for normal people, it can also bring about many negative consequences for teenage mothers (Duncan, 2007, p 307). Such problems include (a) adverse physical and mental health outcomes, (b) lesser chances of completing education, (c) greater likelihood of living in the households of others, and (d) greater probability of being lone parent (Duncan, 2007, p 307). Teenagers who become parents are known to suffer from greater socio-economic deprivation, low self esteem and greater incidence of sexual abuse (Duncan, 2007, p 307). The children of such parents tend to have lower birth weights, lesser likelihood of being breast fed, greater chances of growing up in lone parent families, and greater probabilities of experiencing poverty, poor quality housing and poor nutrition. Such people also show greater tendencies for smoking and alcohol abuse (Duncan, 2007, p 307).

“Common problems amongst teenage mothers include depression and anxiety during pregnancy, financial, social and partnership problems and more negative life events (relationship break-ups, parental separation and lack of community and family support). Teenage mothers are more likely to diet or to smoke during pregnancy. The high smoking prevalence amongst people facing social and economic deprivation suggests that smoking may be used as a stress coping mechanism. However, there is a close association between smoking during pregnancy and adverse outcomes such as low birth weight, infant mortality and delays in child development”. (DHSSPS, 2004, p 1)

Betty, whilst she has lived in a designated children’s home, and has been educated in standard schools, may have suffered from neglect during her childhood and has experienced pregnancy in her early teens. Both these experiences can result in adverse physical, emotional and psychological outcomes. A social work report reveals that she was prone to suffer from speaking difficulties in her childhood, which could well be the outcome of an emotional and mental distress at being separated from her parents. This speech disorder surfaced again when she was 22, very possibly on account of her emotional traumatisation at the death of her father, who had provided her with shelter for 6 years after the closure of her children’s home. Her other ailments namely bingeing, vomiting and amenorrhoea could also be related to her disturbed upbringing and her psychologically disturbed state, which appears to have been aggravated by the death of her father.

Methods of Intervention

Betty is emotionally and mentally disturbed because of the death of her father and the behaviour of her child, Candy, towards her. Such emotional disturbances appear to have resulted in eating disorders, vomiting and weight loss. Apart from these ailments, Betty is also suffering from amenorrhoea. She needs medical and possibly psychiatric help and should be referred to mental health professionals and the local GP for appropriate support. Betty’s basic vulnerability arises from her status as a single parent, her past of a teen mother, her lack of earning capacity and her difficult relationship with her daughter. Such problems could lead to reduction of self esteem, depression and consequent mental and physical ailments.

Social work practice in such circumstances should first focus on understanding her case and her background and thereafter formulate appropriate intervention strategies. Social workers must in the first case adopt appropriate anti-discriminatory, anti-oppressive and person centred approaches in dealing with her case (Nash, et al, 2005, p 23).Thompson, (2001, p 7), advances the theory that anti-discriminatory approaches essentially arise from personal, cultural and social (infrastructural) influences that are experienced by individuals over the course of their lives. These influences affect the socialisation of individuals and result in deeply entrenched attitudes that surface unconsciously and influence their actions and behaviour (Thompson, 2001, p 11). Social workers, many of whom come from affluent and educated backgrounds, are very likely to have developed entrenched discriminatory attitudes towards disadvantaged segments of society and could well approach the problems of service users, from different racial, ethnic, social and income backgrounds, with preconceived notions and attitudes (Butler & Gwenda, 2004, p 83). Dominelli (2005, p 41) has also time and again emphasised that discrimination is pervasive in UK society and its social work infrastructure.

Modern social work theory and practice also recommends the adoption of person centred approaches towards service users. Service users, it is now widely accepted, should be placed at the centre of the social work process; with due regard given to their need for dignity, independence and self determination (Howe, 2009, p 48). Social workers, whilst dealing with Betty, with her history of living in a children’s home, teenage truancy, and teenage pregnancy, can very likely (a) have preconceived notions about her background, upbringing, education and attitudes, (b) take little cognisance of her helpful nature, her love for her father and her affection for her child, and (c) adopt attitudes of “I know best” condescension in their assessment and intervention practice. It is thus imperative for the social worker dealing with her case to consciously overcome discriminatory attitudes, adopt a person centred approach, communicate with understanding and empathy and involve Betty in all intervention suggestions.

The social worker should in these circumstances engage Betty with open ended questions about her problems and difficulties. Betty should be allowed to express herself as completely as possible without interruption in order to obtain a more complete realisation of her physical, emotional and mental strength (Brachmann, 2010, p 1). She should be asked to explain the ways and means in which she has coped with the various crises in her life and asked to explore and discuss her various strengths and weaknesses (Brachmann, 2010, p 1). Such discussions can well help in alleviating her feelings about the difficulties and hopelessness of her situation, enable her to think about positive lines of action and formulate suitable exit strategies (Grinnell & Yvonne, 2008, p 55).

Betty should be asked to choose the different reasons for her crises, focus on one issue at a time, and thereafter sequentially explore and analyse the different challenges confronting her. Such a strategy will help her to address the different crisis factors and find effective ways to address the diverse challenges (Adams, et al, 2009, p 107). It would thus be possible for her to individually focus on her physical and emotional difficulties, her problems with bringing up her child, and her financial challenges. The social worker should lead Betty in conversations that emphasise non-directive exploration of the various crisis issues (Adams, et al, 2009, p 107). Encouraging her to open up by asking different types of open-ended questions may help in obtaining revelations or in greater realisation of the various issues, which in turn can help her and the social worker in the making of informed choices (Brachmann, 2010, p 1). The social worker, once she expresses something specific or something that she would wish to alter, can become more direct in asking her to implement such changes (Howe, 2009, p 53).

Betty is now 22 and has brought up her child for 6 years as a teen parent, doing her best at the same time to help as a non earning member in her father’s family. Whilst Betty can no longer be technically classified as a teen parent, she continues to suffer from the vulnerabilities of such people, who are considered to be among the most vulnerable members of British society. Studies consistently reveal that children born to teenage mothers are more likely to have comparatively worse outcomes in terms of physical and mental health and education. Adolescent births are also related to higher levels of mental health difficulties, violence with partners and social exclusion (Coley & Chase-Landsdale, 1998, p 152). Contemporary teenage mothers have lesser likelihoods of competing in the job market. With teenage child bearing being automatically disruptive for secondary education, it is far more difficult for such people to complete their education in the more expensive contemporary day environment (Clemmens, 2003, p 94). The children of teenage parents are thus more likely to be economically deprived and socially excluded. When adolescents become parents, their education is likely to be delayed and even discontinued. Their employment opportunities are lesser, their incomes are likely to be low and they are less likely to develop long lasting relationships. Such people often require welfare support for prolonged periods (Duncan, 2007, p 307).

Betty, it is evident, suffers from physical and emotional problems. Adequate medical attention needs to be provided to her physical and mental condition in order to ensure that she recovers from the traumatic experience of her father’s death, is able to overcome her eating disorders and develops a stable, enriching and rewarding relationship with her daughter.

The UK government’s social work policies and infrastructure for teenage mothers provide for a number of intervention programmes (Asmussen & Weizel, 2010, p 2). Social workers provide case management support by visiting teen mothers and members of their families in their homes. Such visits help in promoting problem solving behaviours, identifying personal difficulties and challenges and in finding ways and means for overcoming them (Asmussen & Weizel, 2010, p 2). They encourage mothers to find jobs and pursue their education further. Case managers also plan and hold meetings with such mothers and their family members, wherein all participants work towards developing appropriate support plans (Asmussen & Weizel, 2010, p 2).

Social workers help teen mothers by the development of mutual assistance groups, where such people can receive and give assistance between each other. Young mothers like Betty can also be appropriately educated and trained in developing and managing small businesses (Asmussen & Weizel, 2010, p 2). They are, after the completion of such training makes them ready to run their businesses, assisted to develop and formulate business plans for their projects. The funding for start up costs for such project is provided after project plans are approved by trainers (Asmussen & Weizel, 2010, p 2).

Social work programmes also provide education in life skills, which is delivered over 8 weeks in group formats (Asmussen & Weizel, 2010, p 7). Such sessions promote the enhancement of knowledge and skills in various areas associated with parenting, social understanding and behaviour management. Leadership development amongst such mothers is promoted by giving them various responsibilities and roles in different types of group activities like planning of social events and development of committees (Asmussen & Weizel, 2010, p 9). Studies on these various projects reveal that their use leads to increase in the educational achievements of mothers and lessens the chances of repeat pregnancies. It also enhances their sense of well being and reduces utilisation of illegal substances. Studies on these programmes are however yet to reveal their impact upon child outcomes (Asmussen & Weizel, 2010, p 9)

The various techniques that can be used by the social worker to make Betty open up and focus on her various challenges have already been discussed before in the course of this essay. The social worker should, in line with such techniques, encourage Betty to think and discuss about her specific challenges, namely (a) overcoming her present physical and mental difficulties, (b) establishing a stable and rewarding relationship with her daughter, (c) furthering her education, (d) increasing her earning capacity and (e) leading a more enriching and socially inclusive life. Open ended questions and discussions over different sessions on each of these issues can help Betty in becoming emotionally more positive and in finding appropriate exit strategies for her different challenges (Butler & Gwenda, 2004, p 92).

The social worker can help her in discussing various alternatives like (a) medical and psychological health, (b) counselling sessions with her daughter, (c) formulation of programmes for completion of education and / or increase of earning capacity and (d) greater inclusion in social and community life. Appropriate intervention plans can be made after obtaining taking Betty’s active agreement on specific action plans.

Conclusion

This essay concerns the social and economic and challenges faced by 22 year old Betty, who became pregnant at 15 and now lives alone with her six year old daughter. Betty has been engaging in bingeing bouts and is suffering from vomiting, weight loss and amenorrhoea.

Betty’s mother left the family when the children were very young because of alcohol related problems. She and her sisters were sent to a home for children, where they would occasionally receive visits from their father. Betty and her sisters first attended the children’s village school and thereafter went to a comprehensive secondary school. Betty began to develop truant in her early teens and became pregnant from a relationship with a boy when both of them were 14. Deciding to keep her child, Betty, her child, Candy, and her sisters spent the last 6 years with their father, following which she moved out with her child to their own small home. She was severely traumatised by the death of her father and is concerned about the negative attitude of her child towards her. She now suffers from eating and speech disorders, is losing weight and experiences episodes of amenorrhoea.

An analysis of Betty’s history reveals that she may well have been neglected during her childhood. Childhood neglect can adversely affect the physical, social, intellectual and psychological development of young people. Early parenthood can also bring negative consequences like adverse physical and mental health outcomes, lesser chances of completing education, greater probability of living in the households of others, and more chances of being lone parents. Such people suffer from greater socio-economic deprivation, low self esteem and greater incidence of sexual abuse.

Social work practice, in such circumstances, should first focus on understanding her case and thereafter formulate suitable intervention strategies. Social workers must adopt appropriate anti-discriminatory, anti-oppressive and person centred approaches in dealing with her case. It is imperative for the social worker to deliberately prevail over discriminatory attitudes, adopt a person centred approach, communicate with understanding and empathy and involve Betty in all suggestions. The UK government has a number of social work policies and intervention programmes for young mothers. The social worker should engage Betty with open ended questions about her challenges and difficulties. She should be allowed to express herself freely in order to obtain a fuller understanding of her challenges as well as her physical, emotional and mental strengths.

The social worker should discuss different options like (a) her medical and emotional status, (b) engaging in counselling sessions with her daughter, (c) formulation of programmes for completion of her education and / or increase of her earning abilities and (d) ways and means for increasing her inclusion in social and community life. Appropriate intervention plans should be made after obtaining Betty’s active agreement on specific intervention programmes.

The problem of teenage pregnancies in the UK led to the development of a National Teenage Pregnancy Strategy (NTPS) to combat it. Despite efforts put into this strategy, the UK still ranks as the highest in Europe and the lofty targets of 50% reduction is yet to be met as recent statistics show only an overall of 4.9% in reduction in rates since inception of the programme (ONS 2009).

The NTPS highlighted four key areas to be used as the basis for LA programmes which include; the use of mass media and campaigns to increase awareness, Sex and Relationship Education (SRE) in schools and community settings, easily accessible services and information on sexual health and improved assistance to young parents to reduce social exclusion (DCFS 2009). On this note, The last 10 years have seen the implementation of different programmes in the local authorities (LA) in an attempt to reach the national target of halving the rates of teenage pregnancy in the UK as well as providing means to increase by at least 60% the number of teenage mothers returning into gainful employment or education as the case may be (DCSF 2009).

Different LAs have experienced both negative and positive changes in the teenage pregnancy rate with areas characterised by social and educational deprivation having a steeper rate of decline than others (DCSF 2005). Despite this steep decline, the Spearhead areas which face the greatest challenges in terms of health inequalities still have higher rates of pregnancies than others (DCSF 2009b) and Southwark belonging to this group has been worse-off than other areas in Britain. This essay attempts to highlight the process of impact assessment of the SRE programme adopted by Southwark and is intended to map the needs and examine demands of the teenagers and assess services providing SRE so as to check the gaps between these factors which are responsible for the high teenage pregnancy rate in this area despite the strategies applied in keeping with the NTPS.

SRE Programme Summary and Analysis

In 2000, the Department for Children, Schools and Family (DCSF) issued guidance on all schools to improve and ensure effectiveness of SRE in schools which is targeted at influencing young people to make responsible and well-informed choices about their lives (DCSF 2009c). SRE is meant to educate young people on sex-related issues and on making conscientious choices about their lives thereby reducing risky behaviour which might lead to unintended pregnancy. It involves mainly schools, the parents and the community at large. This is meant to be with support from the LA to ensure inclusion of comprehensive SRE programmes into PSHE in all schools (DfES 2006).

Southwark LA took the following approaches towards administering SRE which would raise the ambition of teenagers in the LA. It extended the services of sexual health professionals to beyond clinical settings to include schools and community settings. Programmes were developed outside school settings to teach teenagers about the realities of parenting and the advantages of wise choices for example: Choose your Life, L8R, Body Tool Kit, Teens and Tots, Virtual Doll Programme. Diverse needs of different ethnicities, religions and abilities were considered with programmes to meet them. In the school settings, the schools were made to develop SRE guidelines which involved parents, teachers, school nurses and teachers and vanguard staff especially those working with high risk teenagers in the schools and community were trained (NHS Southwark 2007). By this means, the Southwark LA seeks to improve the knowledge of young people on early pregnancies, direct them to making credible decisions and in turn reduce the rate of teenage pregnancies (Fullerton et al 1997).

The measures taken were in line with the aims and objectives of the programme as studies have shown that teenagers appreciated a forum to discuss sex and relationship issues and these forums were advantageous as they reduced the chances of earlier intercourse (Allen et al 2007; Fullerton et al 1997) however some local disputes existed that interfered with optimal delivery of SRE in the schools in Southwark. Not all schools had included SRE in the teaching curriculum, some of the teachers were unclear of the extent to teach and were either embarrassed or awkward about young peoples sexual issues, some schools had a curriculum that did not include social or emotional issues which play a significant role (Chambers 2002), mixed gender classes discouraged the teenagers especially females from asking questions (Stephenson et al 2004) and some parents were not totally cooperative as they withdrew their children from SRE classes (Lanek 2005).

In response to these problems recommendations by Health & Social Care Scrutiny Sub-Committee (2004) were made. The committee advised that the obligation of all schools especially faith schools towards inclusion of SRE into school curriculum should be encouraged and advocated for further training of teachers on undertaking sexual health issues with teenagers and use of different techniques that will include social aspects. They also recommended that schools attempt to increase parents’ awareness on the proactive nature of sexual health education (NHS Southwark 2004).

Health Impact Assessment Process

A Health Impact Assessment (HIA) is a blend of processes through which a project , policy or programme can be evaluated and assessed so as to identify the influence it has on the health of the population (WHO, 1999). It is a systematised way of assessing the effectiveness of a project involving different stakeholders in order to make evidence-based decisions towards improvement of the project where necessary (Lock 2000). A HIA is the ideal approach to use in assessing the effect of the SRE on Southwark teenagers as it identifies the health and inequality impacts (NHS Southwark 2004) considering the diverse nature of the young people in Southwark. Bearing in mind that this programme has been on-going, this process is regarded as a concurrent health impact to expose strengths and weaknesses in the project while making recommendations in tune with the gaps to further enhance its progress in the most cost-effective way (Bos 2006; WHO 2002).

The process of HIA involves a stepwise approach and has five core steps which would be applied towards the SRE in Southwark and any other HIA (Cameron 2000; WHO 2002). These steps which include; screening, scoping, appraisal, report and recommendation, and monitoring and evaluation may be adapted to suit the community or project being assessed (Breeze et al 2001; WHO 2010).

Screening

This process which is the first step in a HIA is aimed at exploring the feasibility and importance of the assessment, the department of health instructs on some questions to be answered to check viability of the HIA process, and the questions put into consideration the wider determinants of health which play a role in the problem of teenage pregnancy in southwark (DH 2007).

Based on the screening tool, a HIA is necessary on the SRE as Southwark LA ranks highest in teenage pregnancies in Britain despite its adoption of the programme like other LAs. In accordance with the NTPS, Southwark LA goals were to reduce teenage conception by 15% in 2004 and 60% by 2010 (NHS Southwark 2004) however the rate is still at 76.7 per 1000 and a change of 12% only has been seen since the start of the programme in 1999 (DCSF 2009a). Like the rest of Britain, Southwark included the SRE programme in its teenage pregnancy strategy and as the general consensus holds sex education has contributed greatly to the reduction of teenage pregnancies. The impact assessment will provide information and evidence on category and substance of change of the SRE programme where needed for policy makers to guarantee set targets of reducing teenage pregnancy rates are met (NHS 2007) .

Scoping

A steering group is appointed to supervise the process and also to set the geographical boundaries and profile of the population affected by the programme in agreement with the stakeholders. (Cameron 2000; Metcalfe et al 2009). As the HIA is based on Southwark SRE the geographical boundary is limited to Southwark borough and the population profile consists of about 20,000 teenagers with 37% from Black and Minority Ethnic groups (BME), blacks make up 26%, 4% are Asians, 3% are Chinese, 4% mixed (ONS 2004; Southwark Vital Statistics 2007). Issues relevant to the needs of young people in Southwark in relation to the SRE are identified and discussed to direct the appraisal step of the HIA (WHO 2002). Background information on SRE in Southwark showed the problem with the programme was multifaceted (NHS Southwark 2004). Using this information in addition to information on the SRE in other LAs where successes have been registered, proposals can be set towards addressing the issues (Joffe et al 2005).

Appraisal

“Appraisal is the ‘engine’ of health impact assessment, moving the whole process along towards practical outcomes” (Cameron 2000). This appraisal can be regarded as intermediate as the method of information collected is based on a collaboration of stakeholders, health care professionals, the teenagers and a semi-extensive literature review on the effects of sexual education on teenagers. The negative and positive impacts of the SRE on reducing teenage pregnancies in Southwark is explored by this process (Parry et al 2001) using both qualitative and quantitative data for completeness. Considering this is a concurrent HIA the past impacts are evaluated with a vision to enhance future progress. It is a multidisciplinary step as it involves all the people involved in the SRE programme (WHO 1999). Workshops organised should include the health workers, school-teachers, school nurses, community programme co-ordinators, peer-health educators, youth representatives from schools and community programmes, representatives from faith-based organisations and representatives from the LA who will provide local views of the programme (Mindell et al 2004) . The information collected from this exercise will help define the understanding of SRE amongst the different groups, inequalities existing between these groups may also be recognised and aspects of the programme which are not advantageous may be brought to light. It will also help to assess long and short-term impacts of the programme (Joffe et al 2005). Considering that data collected from this exercise are likely to be biased, robust methods are needed to contribute validity to the predictions derived from the data (Parry et al 2001). Other information should be collected by secondary analysis of existing data from the youth centres, school reports, NHS Southwark databases, and Office for National Statistics. This data collected will supply the sociodemographic and health profile of the teenagers in Southwark, and also report on already experienced impacts of the SRE.

Some challenges are expected in this stage as evidence-based information regarding the determinants of health for the different groups of teenagers may not be readily available or easily accessible. This may be daunting but should not deter continuation of the assessment rather the best available data should be used while recognising the significant gaps in the evidence used (Joffe et al 2002, Mindell et al 2003).

A sexual health needs assessment conducted on Southwark showed that high levels of need exist in relation to teenage pregnancies in Southwark and it is evident from the high teenage conception rates, high termination and repeat termination rates (NHS Southwark 2004). Another major finding which can be related to the SRE is that these high rates are disproportionately distributed as the Black and Minority Ethnic groups have higher rates (Berthoud 2001). The needs of this group are peculiar as teenage pregnancy is viewed differently with regards to the culture or religion. Teenagers of Muslim faith had different views from the wider community as younger marriage and parenthood is regarded as the norm (DCSF 2008). It is of importance to note that the ethnic inequalities in teenage pregnancy is an outcome of socioeconomic disparities (Nazroo 2003) which is evident in their representation in number looked after by LAs and in school exclusions (DCSF 2008). On the other hand, the teenagers considered sexual health services aligned to schools with some scepticism which was based on confidentiality issues (NHS Southwark 2007). Some studies carried out on the effects of sex and reproductive education on young people showed that most young people were more satisfied when the education was peer-led than teacher led and females had some inhibitions about discussing sex related issues in the presence of males (Stephenson et al 2004; Seamark et al 2005; Ross 2008). Also, despite the addition of SRE into school programmes, most teenagers cited places other than school as main source of sex related information (Allen et al 2007).

Putting all the information into consideration, the basis for the HIA can be addressed towards the different ethnicities, faiths and socioeconomic groups (Fullerton et al 1997) considering that this has been recognised as the bane of the challenges faced in maximising the impact of SRE to teenagers in Southwark. Appraisal done can relate these needs to the services available and identify the gaps where they exist to make recommendations towards satisfying the needs in the future.

Report and Recommendations

In view of the fact that the problem of teenage pregnancies in Southwark is on-going with about 289 pregnancies in U-18s yearly ( NHS Southwark 2009), it is essential that this process of report writing which will influence decision-making by the stakeholders is not delayed so as to ensure early adaptation of recommendations where implied (Joffe et al 2005). A high level of assiduousness must be assumed by the steering group to guarantee thoroughness in the recommendations proposed.

The Dahlgren and Whitehead (1991) rainbow model of health integrates biological, social and environmental factors into defining the general well-being of an individual. These factors are not constant and the degree of influence each of these determinants of health play varies for different population groups. The decision-making step of the HIA should put this model into consideration while proposing recommendations on the SRE which would adjust the proposal to take full advantage of already established positive impacts while curtailing the negative health impacts (Parry et al 2001).

Consequent upon the findings during the appraisal step of the HIA recommendations towards improving the SRE may include: establishing ethnic and faith -based SRE programmes, which will relate better with the different beliefs held by the diverse groups found in Southwark, stronger collaboration of the community, health sectors and schools in promoting SRE and further training of more peer-educators to increase the impact of the programme and thereby reduce the rate of teenage pregnancies. In addition to this, consideration of same-sex SRE classes should be made (Fullerton et al 2001) There should be a recommendation for future monitoring of the impacts seen after implementation of the revised project which would allow for necessary action towards unexpected outcomes and also contribute to the evidence base for later use (Metcalfe et al 2009; WHO 2002).

Monitoring and Evaluation

The fact that recommendations have been put forward does not guarantee implementation thus monitoring is of necessity to ensure that decision-makers put into effect agreed changes as different factors like lack of resources or political shifts could influence decisions (WHO 2010; Joffe et al 2005). The indicators which should be used in assessing the revised SRE would include rate of teenage pregnancies recorded, teenagers knowledge of sex related issues and ability of teenagers to make well-informed choices to name a few. This can be gauged using qualitative and quantitative methods (Scott-Samuel et al 2001). Long term monitoring can be used to assess accuracy of predictions made during the appraisal and recommendation (Taylor et al 2003; WHO 2002).

Three different forms of evaluation are essential. These include; evaluation of the process which acts as a mechanism of quality assurance (process evaluation), evaluation of acquiescence and execution of recommendation (impact evaluation) and outcomes of subsequent proposal (outcome evaluation) (Parry et al 2001; Scott-Samuel 1988). It is important to note that notwithstanding the extensive nature of the appraisal, the outcome may not be as predicted especially for the groups which have been identified as vulnerable groups which in this case are the BME thus the impacts in this group may be assessed and compared with other groups for more clarity (Joffe et al 2005). Other possible challenges in this stage may be budget related or due to the seemingly endless need for evaluation of a project however a defined stop-point at the onset will help to eliminate this difficulty (Thorogood et al 2000; Taylor et al 2003).

Conclusion

The concept of HIA is fairly new but then its effectiveness is extensive as it has been used in different sectors realeting to health issues and otherwise. The advantages of carrying out a HIA Can be used prospectively, concurrently or retrospectively;

_ Values a social model of health and well-being;

_ Aims for equity;

_ Uses a multidisciplinary and participative approach;

_ Works towards sustainable development;

_ Makes use of qualitative and quantitative best available evidence;

_ Encourages openness and transparency to public scrutiny;

_ Demonstrates health gain as an added value;

_ Responds to public concern about health;

_ Provides an opportunity to develop effective partnerships

The aim of this study or discussion is to analyse and discuss the impact of the labour government policy on teenage pregnancy and social exclusion in the United Kingdom, to what extent has the policy achieved its aims and objectives and if the objectives have not been met, why and how it may be improved, what are its shortcomings and constraints in the implementation process or if the policy itself was not well put together.

Barry (2002) argues that social exclusion occurs when individuals or groups are not given the opportunity to participate in society, whether or not they desire to participate.

The British Government in 2001 defined social exclusion as “a shorthand term for what can happen when people or areas suffer from a combination of linked problems such as unemployment, poor skills, low incomes, poor housing, high crime, bad health and family breakdown”.(Cabinet Office, 2001)

Burchardt, Le Grand and Piachaud, (2002) identify consumption (the capacity to purchase goods and services, including health services), production (taking part in economically or socially valuable activities including voluntary work), political interaction or participation (involvement in local or national decision-making) and social interactions (integration with family, friends and the wider community) as the four key elements of social participation. These elements individually can represent an outcome measure for social exclusion or inclusion. Teenage pregnancy is a risk factor for social exclusion. Social disadvantage refers to a range of social and economic difficulties an individual can face such as unemployment, poverty, and discrimination and is distributed unequally on the basis of socio-demographic characteristics such as ethnicity, socioeconomic position, educational level, and place of residence (Wellings and Kane, 1999).

Social exclusion can happen to anybody but is more prevalent among young people in care, young people not in school and among teenagers growing up in low income households , or those growing up with family conflicts and people from some minority ethnic communities are disproportionately at risk of social exclusion. people are also most vulnerable at periods such as leaving home, care or education.

Teenage birth rates in the UK are the highest in Western Europe and pregnancy among girls under sixteen years of age in England and Wales have increased since 2006, more than four in ten girls still get pregnant before the age of twenty. Two-thirds of all students have sex before graduating from school and are exposed to pregnancy and sexually transmitted diseases. (ONS, 2009).

Social exclusion Unit (2001) in their report to cabinet said that In England, there are nearly 90,000 conceptions a year to teenagers; around 7,700 to girls under 16 and 2,200 to girls aged 14 or under. Roughly three-fifths of conceptions – 56,000 – result in live births. Although more than two-thirds of under 16s do not have sex and most teenage girls reach their twenties without getting pregnant, the UK has teenage birth rates which are twice as high as in Germany, three times as high as in

France and six times as high as in the Netherlands.

Teens that get pregnant are less likely to complete their education therefore risks making their future worse. They are more likely to be single parents and are more likely to contract sexually transmitted diseases including HIV. Every year there are new entrants into teenage world.

The risk factors that affect early teenage pregnancies are economic disadvantages, peer pressure, emotional distress, sexual beliefs, attitude and skills, family structure, community disadvantages, sexual risk taking and poor contraceptive use. (Kirby, 2007).

The main policy initiatives (750)

New Labour (1997) introduced policies that aim to reduce young people’s risks of low educational attainment, poor or no job prospects, criminality and offending, teenage pregnancy and sexually transmitted infections (STIs).

Tony Blair (PM, 2001) in a foreword to the Report by the Social Exclusion Unit on Preventing Social exclusion said “Preventing exclusion where we can, reintegrating those who have become excluded, and investing in basic minimum standards for all and we have worked in a new way – developing partnerships around common goals with the public services, communities and charities, businesses and church organisations that have been struggling with the causes and symptoms of poverty for so long.”

The policy used risk management approaches as a way of reducing risks of teenage pregnancy and sexually transmitted diseases amongst young people by using strategies that gives the individual choices , responsibilities and make them part of the solution. New Labour’s policies on teenage pregnancy centres around teenage pregnancy and sexuality using Knowledge Acquisition, Shifting Blame and Constituting Knowing Active Welfare Citizens as strategic Risk Management options.

The New Labour government set up a Teenage Pregnancy Strategy overseen by the Teenage Pregnancy Unit and the strategy centres on reducing the rate of teenage conceptions, with the specific aim of halving the rate of conceptions among under 18s by 2010.

Getting more teenage parents into education, training or employment, to reduce their risk of long term social exclusion.

The Social Exclusion Unit was setup by the New Labour government to co-ordinate policy-making issues like school exclusion and truancy, rough sleeping, teenage pregnancy, youth at risk and deprived neighbourhoods through,

preventing social exclusion happening in the first place – by reducing the numbers who go through experiences that put them at risk or targeting action to compensate for the impact of these experiences ,

reintegrating those who become excluded back into society, by providing clear ways back for those who have lost their job or their housing, and missed out on learning and

getting the basics right by delivering basic minimum standards to everyone in health, education, in-work income, employment and tackling crime.

Critically analyse policies-SID,RED,MUD
Critical analysis of the Policy, (2000)

Action to prevent social exclusion is delivering results:

the proportion of children in homes where no-one is in work has fallen from 17.9 per cent in

1997 to 15.1 per cent in 2001;

over 100,000 children are benefiting from the Sure Start programme to ensure they are ready to

learn by the time they reach primary school; school exclusions have fallen by 18 per cent between 1997 and 1999; under-18 conception rates have fallen in four out of the last five quarters;

more 16-18 year olds are staying on in education;

the Care Leavers strategy has been introduced;

the Rough Sleepers Unit is piloting new approaches to end the fast track to homelessness from

prison and the Armed Forces;

Summary

Stakeholder Pensions will help moderate earners build up better pension entitlements from this

April. Some 18 million people stand to gain from the State Second Pension, providing more

support than under the State Earnings Related Pension Scheme (SERPS) for modest and low paid

workers, and for carers and the disabled; and

the personal tax and benefit measures introduced over this Parliament mean that by October

2001, a single-earner family on half average earnings and with two young children will be ?3,000

a year better off in real terms compared with 1997. Families with someone in full-time work will

have a guaranteed minimum income of at least ?225 a week, ?11,700 a year. And families with

children in the poorest fifth of the population will on average be ?1,700 a year – or around

15 per cent – better off.

And programmes to reintegrate people who have become excluded are recording successes:

since 1997 more than 270,000 young unemployed people have moved into work through the

New Deal for Young People;

over 6,000 people have found work through the New Deal for Disabled People and over 75,000

people had found work between October 1998 and December 2000 through the New Deal for

Lone Parents;

all Local Education Authorities (LEAs) have increased provision for excluded pupils, a third already

do so, and two-thirds plan to offer them full-time education in 2001;

between June 1998 and June 2000, the number of rough sleepers fell by 36 per cent; and

the proportion of teenage parents in education, employment or training has increased from 16 to

31 per cent between 1997 and 2000.

And changes in basic public and private services are focusing improvements on the poorest:

higher standards than ever before in Key Stage 2 English and maths with a ten and 13

percentage point improvement in each subject respectively between 1998 and 2000;

44 Local Education Authorities (LEAs) in the 88 most deprived areas2 improved their Key Stage 2

maths results by 14 per cent or more between 1998 and 2000. The most improved area was

Tower Hamlets, with an increase of 23 per cent;

24 LEAs in deprived areas improved their Key Stage 2 English results by 11 per cent or more over

the same period;

between 1998 and 2000 children from most minority ethnic communities saw a rise in

achievement of GCSEs. This includes an eight percentage point increase in the number of black

pupils achieving five or more GCSE grade A*-C, against an average for all pupils of three

percentage points;

unemployment has fallen faster than the national average in 19 of the 20 highest unemployment

areas;

the combined effects of Minimum Income Guarantee (MIG), Winter Fuel Payments and free

television licences for those aged 75 and over mean that from April 2001 around two million of

the poorest pensioner households will be at least ?800 a year better off compared with 1997 – a

real terms rise in living standards of 17 per cent.

together with tax and benefit reforms, the national minimum wage has helped to make work pay

and encourage individuals to move from benefits into work; and

by the end of 2000, all the high street banks offered a basic bank account available to all.

Preventing social exclusion

These improvements are a good start. Trends on literacy, school exclusion, post-16 participation and

rough sleeping are on track. Incomes for the poorest pensioners and families, and for low-paid

workers, have risen substantially. Where programmes have been slow to deliver results, for example

on truancy, the Government is intensifying action. But many of the programmes in this document

are only in their infancy, and are on course to deliver more substantial results over time. At the same

time, policy innovation has been accompanied by new structures and new ways of working within

Government. These have created clearer accountability for cross-cutting subjects such as rough

sleeping, neighbourhood renewal and youth policy; set the basis for a new relationship of

Partnership with groups outside Government; organised services around the needs of the client;

and helped people to help themselves

Policy can exacerbate and not alleviate
Conclusion (500)

The 1999 UK government’s report on teenage pregnancy concluded that the following were risk factors for pregnancies among teenage girls: socioeconomic disadvantage, having been oneself the child of a teenage parent, poor communication with parents, not being in education, training or work after age 16 years, peer pressure to have sex early, educational problems such as low achievement and truancy, alcohol use, low knowledge about sexual health, and learning about sex from sources other than school

However, these conclusions were based on evidence that was rather old or from cross-sectional studies, which are not the best guide to current trends

Social Work Approaches

The social work profession promotes, encourages and elicits social change in those they work with and society. This essay will examine two approaches used to support change in social work today, Task-Centred Practice and Cognitive-Behavioural Therapy, and compare and contrast these two. The essay will achieve this by applying these two interventions to Case Study Two, analysing the advantages and limitations of each method. Finally the essay will discuss any anti-discriminatory issues raised in the application of the discussed social work approaches.

Cognitive-Behavioural Therapy (hereon CBT) is a psychological approach based on a combination of theories of learning: social learning, operant and classical conditioning (Teater, 2010 p.141). The approach is a composite of behavioural and cognitive therapies, involving assessing and changing behaviours, thoughts and feelings together. CBT suggests that service user problems or difficulties are a result of thoughts, feeling and behaviours being unescapably linked, therefore how a service user views themselves or situations affects their behaviour and emotions (Vonk and Early, 2009). However, CBT only focuses on presenting problems and their current causes. The goal of CBT is to change service users’ existing faulty or negative thoughts feelings or behaviours and replace them with more socially acceptable and positive thoughts, feelings and behaviours that decrease the problem. The use of CBT derives from criticisms of Psychodynamic theory for not being evidence-based and not being effective in creating change (Howe, 2009). However CBT is not the only evidence-based approach.

Similar to CBT, Task-Centred Practice (hereon TCP) is based on strong research evidence; studies by Reid and Shyne, Reid and Epstein and Reid demonstrated planned short-term treatment using task-centred model was effective (Payne, 2005 p.99). In contrast to all other approaches TCP was developed within social work for social work practice, and is commonly used in social work today. TCP is focused on problem-solving; a versatile approach, TCP is used in a wide range of problems (Stepney and Ford 2012 p.102) including interpersonal conflict, dissatisfaction with social relations, problems in social transition, financial problems and behavioural difficulties (Ford, 1978 as cited in Stepney and Ford 2012 p.103). Doel (1991 as cited in Teater, 2010) states that TCP uses key values related to social work, for example partnership and empowerment: clients are seen as the experts in their problems; the approach builds on service users’ strengths rather than weaknesses; and finally that the Social Worker is providing help rather than treatment. TCP’s assumption of client as expert is another point of contrast to CBT. However CBT has its own assumptions.

CBT holds three basic assumptions: firstly, an individual’s cognitions mediate emotions and behaviours (Trowel et al, 1988; Vonk and Early, 2009 as cited in Teater, 2010 p.146); secondly, faulty or distorted cognitions lead to psychological distress and dysfunction (trowel et al, 1988 as cited in Teater); finally, diminishing or alleviating psychological distress and dysfunction requires modification and change to the faulty or distorted cognitions and behaviours (Trowel et al, 1988; Vonk and Early, 2009 as cited in Teater, 2010 p.146). CBT takes these assumptions and creates a structured approach to working with service users. Coulshed and Orme (2006 p.181-182) describe the CBT approach in eight clear stages; engagement, problem focus, problem assessment, teaching cognitive principles, dispute and challenge assumptions, encourage the client’s self-disputing, set behavioural homework and finally, ending. This extremely structured approach is another point of comparison with TCP.

TCP, similar to CBT, is built around a clear model, and progresses through set stages. Firstly, ‘identifying the problem’; TCP is a collaborative approach which works to tackle problems the service users acknowledge and understand (Doel, 1991 as cited in Teater, 2010 p.178). In addition the service user must express a wish to work on the problem alone or with the help of worker (Reid and Epstein as cited in Teater, 2010 p.179) Next, ‘exploring the problem’ in detail, selecting the problem that is causing the client most distress. From the problem ‘define a goal’ which diminishes or removes the problem, ‘establish tasks’ for the worker and service user towards reaching the goal, and finally ‘evaluate’ if the goal has been met and if the problem is removed (Reid and Epstein, 1972 as cited in Teater, 2010). The essay will now examine how these approaches could be applied to Case Study Two.

Case Study Two presents many key issues. The service user, Neil, is facing many difficulties at one time, which include problems with family, aggressive behaviour which has resulted in his homelessness, and lack of money, food, bedding, and household items. In addition he is also worried about moving GP. Many of Neil’s problems could be tackled using either CBT or TCP; selective eclecticism allows social workers to choose which approach would best suit each problem. The problems of homelessness, money and the want of a job are better suited to TCP; they are problems of living that may also include some social factors which CBT would not account for. The problem of behaviour where Neil is swearing in the family and the anxiety toward the change of GP would be best suited for CBT intervention, as this is proven to help with problems of behaviour and anxiety (Sheldon, 2011).

In Neil’s case, the first stages of TCP, identifying problems, exploring problem and setting goals, would need to be applied in the early meetings between Neil and the social worker. The collaborative period needs careful discussions and mutual agreement on problems and goals. A possible outcome may be tackling the problems such as homelessness, lack of money, food and unemployment in order; however, other factors may make this unrealistic. The ‘SMART’ method for goal setting is commonly applied, stating goals must be: specific, measurable, achievable, realistic and timely (Marsh and Doel, 2005 p.36). The assessment phase of CBT mirrors this early approach of TCP. During CBT’s assessment phase the service user and worker examine the links in thoughts, feelings and behaviours using the ‘A-B-C model’, as well as measuring intensity, duration and frequency of the problem (Teater, 2010 p.145). After assessment both approaches then move to intervention phases.

TCP uses tasks as an intervention. The task should be planned carefully, asking: what is the task, the reason for the task, and what the person needs to be able to achieve the task. These stages can be simplified to what, why and how (Marsh and Doel, 2005 p.55). The tasks are performed by either the service user, the social worker or by both parties in session. In contrast, a CBT intervention is classified into distinct categories of intervention including cognitive restructuring, relaxation techniques, social skill training, assertion training, problem-solving skills, aversion therapy, systematic desensitisation, reinforcement and modelling (Teater, 2010 p.149-150). The actual intervention that is selected is dependent on the problem faced. In the case of Neil, cognitive restructuring may be suitable to approach the anxiety and his false belief that his doctor is the only one who can understand him. This is done by challenging the assumption, reinforcing self-challenging and homework. Next both approaches move on to the ending phase.

The ending or evaluation phase is critically important in both CBT and TCP. Both approaches use close evaluation of the goals and progress made in the intervention; this evidence-based practice is seen as a great benefit of both these approaches. CBT uses data collected in the assessment phase as a tool for evaluating the outcome of the intervention. This is done by comparing intensity, duration and frequency of thoughts or behaviours before the intervention and after, giving a measure of success or failure in the intervention (Sheldon, 2011). TCP uses a similar process of evaluation: firstly regular assessment of the outcome of the tasks set measures change in capability; secondly, TCP monitors whether the service user’s goals have been met or the problem solved. This measurability of evidence-based approaches finds them favoured by funders and managers in social work (Payne, 2005 p.101). These are not the only benefits of these approaches.

TCP has many other qualities that result in it being commonly used: it is generic, can be used in many settings and with many different clients groups (Teater, 2010 p.189). TCP can be used easily in combination with many other approaches, such as motivational interviewing to help someone who may be unsure about change (Teater, 2010 p.189). Both CBT and TCP are highly structured and easy to use (Payne, 2005). Furthermore both interventions are brief and time-limited while remaining effective (Stepney and Ford, 2012). However these approaches have some limitations.

TCP requires that service users can make connections between problems, tasks and goals; this is not possible with all service users, as some may be unwilling or experience difficulty in making connections (Marsh and Doel, 2005). CBT also faces similar difficulty with service user commitment the approach relies on equal involvement from the social worker and the service user in changing faulty learning process or behaviours (Teater, 2010 p.155). In addition, Payne (2005) suggests another weakness in TCP is its failure to tackle the long-term individual or social problems. This is especially pertinent in Neil’s case, in which he and his family have had previous social service interventions. Another criticism of CBT is that it only focuses on the individual: oppression, discrimination, racism and poverty are not addressed in the approach (Teater, 2010 p.155). Furthermore, by not accounting for oppression and discrimination, TCP and CBT may inadvertently exacerbate both.

Thompson (2012) defines anti-discriminatory practice as an approach to social work practice which seeks to eliminate discrimination and oppression, and argues it is fundamental to social work. However, a social work intervention often places power and influence in the hands of social work, and there is scope for discrimination and oppression in social work practice, whether intended or unintended. CBT focuses on changing behaviour from inappropriate to appropriate. What is ‘appropriate’ behaviour is culturally relative and a misinformed social worker may attempt to change acceptable behaviour thus creating oppression. However, cultural sensitivity must be balanced with ability to challenge behaviour that causes discrimination in itself (Tanaka-Matsumi et al., 2005 as cited in Teater, 2010 p.156). Marsh and Doel (2005 as cited in Teater, 2010 p.191) suggests that TCP is allied with empowerment-based approaches and anti-oppressive practice as TCP takes account of power and oppression in a wider social context. The approach emphasises partnership and transparency, highlighting any power imbalance should be made explicit from the beginning of the intervention (Teater, 2010 p.191). Doel and March (2005) further argue that the client should be informed and as involved as possible. However, TCP relies on the service user accepting that there is a problem; this point may become a point of oppression whereby the social worker may force their perspective of the problem upon the service user, particularly in mandated work (Doel, 2002 as cited in Teater, 2010). However, good practice in TCP sees the service user as the expert in their problem and the social worker as helper, rather than prescriber of a course of action (Teater, 2010 p.191).

In conclusion, supporting and eliciting change is a difficult job for social work. Numerous factors play a part in a service user problem or want. No one approach will consider all the factors all the time, therefore being eclectic in choosing an intervention is a key social work skill. As shown, both TCP and CBT are very practical approaches: each has a clear structure, a strong evidence-base and uses evaluation to show the efficacy of an intervention. However each approach has weaknesses: TCP fails to address long-standing problems and asks service user to have good insight into their problems. CBT does not account for oppression, discrimination, racism and poverty, instead focusing on the individual. Like all interventions in service users’ lives, both CBT and TCP can be oppressive and discriminatory used casually or incorrectly. However, handled with care, collaboration and transparency, both TCP and CBT can be used to support service users to empower themselves into making the changes they want to make.

Reference List

Adams, R, Dominelli, L and Payne, M. (2009) Critical practice in social work, 2^nd edition, London: Palgrave.

Coulshed, V and Orme, J. (2012) Social Work Practice, 5^th Edition, Basingstoke: Palgrave Macmillan.

Marsh, P and Doel, M. (2005) the Task-Centred Book, Abingdon: Routledge.

Howe, D. (2009) a Brief Introduction to Social Work Theory, Basingstoke: Palgrave Macmillan.

Payne, M. (2005) Modern Social Work Theory, 3^rd Edition, Basingstoke: Palgrave Macmillan.

Teater, B. (2010) Applying Social Work theories and methods, Berkshire: Open University Press.

Thomson, N. (2012) Anti-discriminatory practice, 5^th edition, Basingstoke: Palgrave Macmillan.

Sheldon, B. (2011) Cognitive-Behavioural Therapy, 2^nd edition, Abingdon: Routledge.

Stepney, P and Ford, D. (2012) Social Work Models, Methods and Theories, 2^nd Edition, Dorset: Russell House Publishing Ltd.

Vonk, M, E & Early, T, J. (2009) Cognitive-Behavioural Therapy, New York: Oxford.

“Write a case study illustrating a social work intervention with an individual or family drawn from your current practice placement. The case study should illustrate the application of a social work method / approach (such as crisis intervention, systemic approaches, solution focused approach, CBT etc) to a practice situation and should contain a critical analysis of the chosen methodology.”

Within this assignment I will discuss a case that I am managing within my placement by providing details of the case and other professional bodies that are currently involved. In relation to this case I will discuss the relevant theories and methods that I have used with this client and critically analyse my choice of method. I will also mention other methods or approaches that I feel may have been beneficial to my work with the client. In order to provide evidence of this session with my client I will also attach a process recording to illustrate my chosen method.

Michael is a 47 year old male that is a service user of the Mental Health Team in Ballyfermot. Michael has been diagnosed with schizophrenia and a mild intellectual disability. He currently lives alone in the community with the support of the Mental Health Team. I am managing this case with the supervision of my practice teacher. At the moment Michael has the support of the outreach team in which they manage his medication and food shopping, whereas the social work department manage his finances in regards to his bills and give Michael a daily allowance each week. I am currently working one to one with Michael on a weekly basis in regards to the goals he has set for the following weeks. Each week Michael and I meet to discuss relevant issues that may have arisen for him during the week. Michael and I worked in partnership to complete the recovery star and made a plan to tackle some of the areas in his life that he would like to improve on. An example of this would be attending literacy classes, learning how to text and learning how to cook at home and also finding a job. I am working in partnership with Michael to achieve these goals.

For this session, I planned to discuss and start the recovery star with Michael in order to understand his lifestyle at this present time. In order to complete the recovery star I used a task centred approach. The theory that I used for this session was behaviourism. Behaviourism is based on the theories of Pavlov, Skinner and Watson (Trevthick.P, 2005). According to Trevthick.P (2005) it was seen that through observable and measureable responses that behaviours are learned and in result behaviours can also be unlearned (Trevthick.P, 2005). According to Trevthick.P (2005) it also states that there are four types of techniques which are systematic desensitization, aversion therapy, operant conditioning, and modelling. In regards to working with Michael in this session, I used one of these techniques which were operant conditioning. “Operant conditioning is a technique where ‘the environment has been specifically programmed to support certain behaviours and discourage others’ (Sheldon, 1995) by altering the consequences that follow” (Trevthick.P,2005:P.96). While working with Michael and arranging to have our sessions in the civic centre every week it is evident through our sessions that the environment around him would have an effect on his behaviour. For example if the civic centre was busy Michael would sometimes seem a little anxious, whereas if the centre was quiet, Michael’s mood would be quite calm. Through operant conditioning it also discusses the possibility of reinforcements in regards to behaviours. Through this it is evident that through our weekly sessions, Michael would understand his reinforcement by participating within the session would be his daily allowance. This has become clear on a number of occasions as Michael has become quite engaging in regards to the sessions that would take place on a weekly basis. Whereas before if Michael received his daily allowance before his weekly sessions he would become disengaging and would abandon the session. Through this theory I then decided to use the method of task centred work with Michael.

According to Adams, R et al (2002) “Task centred casework was described as a method to help people with problems of living.” (Adams.R et al, 2002). According to Payne.M (1997) task centred work looks at problems with the client and ensuring that the client accepts and acknowledges the problems that they have. Also understanding that their problems can be resolved by their actions outside the ongoing work they may have with the social worker and that the problems can be defined clearly. While also having certain issues in the clients lives that they feel that they can change and that these problems are realised by the client and not others that are in the client’s life (Payne. M, 1997). It is also discussed that it should be assessed of the “direction and strengths of clients wants” (Payne. M, 1997), this is explained in regards that the clients want can start an action, although the clients belief system can shape the want while also providing an acceptable way of accomplishing those wants. In result according to Payne. M (1997) a belief can steer an action and by completing certain cognitive therapies these beliefs can be changed. According to Payne. M (1997) this was called a point of leverage. A point of leverage is accuracy, scope and consistency. Accuracy is when a social worker would discuss how accurate a client’s belief is then discuss the scope in which they discuss the range of beliefs that client has and explored with the client when they think these beliefs are limited. And lastly consistency in which the social worker would tackle misrepresentations due to a disagreement between one belief and another in which the social worker would be able to remove these and discuss it with the client. Through this emotions can arise for the client when there is a collaboration of their belief and want. This can then follow onto an action which would be shown by a behaviour which would be carried with intent which then follows on to a plan (Payne. M, 1997). A plan is a portray of intentions which is formed from the interaction of the belief, want and emotion (Payne. M, 1997). Through this a plan can be set in regards to exploring alternative options that may not have been tried by doing so this can give feedback to the client and social worker to understand if the method was successful or not. Through this method it also allows the client to resolve any problems they may have while also providing them with the skills for situations that may arise in the future. In result the client would be able to tackle a future issue that may arise without the need of the social worker.

As cited in Payne. M (1997), Reid (1978) discusses the various stages of task centred practice. These are as follows step one “identify potential problems” (Payne.M, 1997) identifying specific problems the client is having and allowing them to express these problems in their own words in order to gain a full understanding of the situation. Step two is “reaching tentative agreements” (Payne.M, 1997), by doing this you can explore the main problems the client may be facing. Step three is “challenge unresolvable or undesirable problems” (Payne.M, 1997) by completing this with the client the social worker can challenge these problems so the client will not be encouraged to obtain an unrealistic goal. Step four is “raising additional problems” (Payne.M, 1997), through this step the social worker can challenge and allow the client to realise other problems they may be having. Step five is “seek others involvement” (Payne.M, 1997) through this it may be beneficial to seek others that can be supportive or can contribute to finding a solution. Step six is “jointly assess the reason for referral” (Payne.M, 1997); in this step it would be useful to discuss the reason why the client was referred to the service especially if the client was forced to do so. Step seven is “get precise details” (Payne.M, 1997), it would be very important for the social worker to get accurate details into when and where the problems are occurring for the client. Step eight is to specify the problem for the client, step nine would be to identify the clear baselines and lastly step ten would be to decide on the changes the client would like to make (Payne.M, 1997).Throughout this process it is vital that the client and social worker have a similar understanding of what needs to be achieved and also provide feedback at the end of each session in order to understand if certain aspects of their work is not proving successful. Adams. R et al (2002) discusses this that task centred work is a systematic model which examines what works well for the client and what doesn’t work so well in regards to achieving the desired goals that are put in place (Adams.R et al,2005).

In regards to this the main reason why I used this approach with Michael was because he has a mild intellectual disability and it can be difficult to engage Michael in activities for a long period of time. So when starting the recovery star I explained to Michael that we would complete three sections and then continue the rest the following week. Throughout this session Michael became agitated and annoyed as he wanted to receive his daily allowance and leave. Although when continuing to proceed with the recovery star and using the task centred approach it became clear to myself and Michael what improvements he would like to make in the different areas of his life. With this new knowledge, Michael and I were able to set a basic map. While working in this session with Michael, I decided to use the basic map of task centred practice that is discussed by Trevthick.P (2005). The reason I used this specific map instead of the other process described by Payne.M (1997) was because the basic map overall described four basic steps that would be beneficial to the sessions I had with Michael. According to Trevthick.P (2005) a basic map of a task centred approach consists of four steps. These steps are as follows, step one would be targeting three main problems the client has. Through the recovery star there were certain areas Michael wanted to improve on, which was his living skills i.e. cooking and cleaning and also his literacy skills. Step two consisted of a contract which was setting up a plan to achieve these goals successfully and set a time frame for when these would be completed. This was competed by researching the resources that were in the community in regards to the literacy classes and possible cooking classes and looking at the time scale of when Michael would like to accomplish these goals. Step three consists of problem solving which would be solving any problems that would arise for me or Michael in regards to the sessions that take place. For example while working towards improving Michaels literacy skills it was evident that Michael would need one to one tutoring and this wouldn’t be possible for several months, although Michael was adamant to start in which he decided to start in a group. In result as the student social worker I know I will have to support, encourage and motivate Michael in this process as he may find it challenging to be part of a group of sixteen. Finally step four is termination in which will commence when I start to finish up in my placement and hope that Michael will continue with his goals with his own social worker. At this present time because of Michael’s background and his diagnosis this method has been successful to date. I have also been able to use a person centred approach along with the task centred approach with Michael throughout this process in order to allow Michael to open up about his feelings and be honest about what is going on for him at that time and in result has allowed Michael to achieve positive outcomes within our daily sessions.

In regards to the task centred approach that I have undertaken with Michael, at present it has been successful as it looks at the three main problems that he would like to improve on within the short space of time that I will be working with him. By using this approach it was evident that Michael felt motivated to complete these goals as he focused on the three main issues he had in his life. According to Trevthick.P (2005) it can be very difficult to engage in the underlining issues that may be present. In my opinion and the evidence from conducting sessions with Michael this is quite accurate as it can be difficult to engage Michael in certain difficult conversations from his past from a task centred approach. Although by using a person centred approach when discussing these difficult conversations can be suitable as this approach allows him to discuss these issues calmly and reflect on the situation that he may find difficult. For example by using this approach, it allowed Michael to open up about his daughters and the relationship he has with them and how he wants it to improve. He was also able to realise that he wanted to do something about his literacy skills and how this issue could be a barrier for him when searching for a job. By conducting a task centred approach and completing the recovery star I discovered this about Michael and was able to use the person centred approach to discuss it in more depth. Although even though it is discussed that a task centred approach is chosen because it allows the goals to be achievable, it can be difficult for those who may suffer from a mental health illness. Some individuals may find it difficult to achieve the goals that have been set, although at that time it is important for the social worker and client to be able to feedback any difficulties that have arisen and be able to change in accordance with the individual. For example while working with Michael it can be difficult for him in regards to his mental health, so throughout our sessions I ensure that near the end of each session Michael is able to understand what was discussed and his understanding and ensure that he is still motivated in regards to the goals that he has set for himself.

In conclusion, it is evident that the ongoing weekly sessions with Michael have been beneficial in regards to a task centred approach. The reason for this is that Michael can concentrate on three specific goals at a time and doesn’t feel overloaded. From working with Michael on a one to one basis, his history and mental health status, this approach is working in a positive way in regards to what Michael wants to achieve. From previous case notes it has been noted of other methods that have been tried and failed to motivate and encourage Michael. This approach does have its limits for example it doesn’t allow the client to discuss their issues in detail, although that is when the social worker can incorporate other approaches into their work with the client. Throughout my work with Michael this approach has been favourable as with this client it has achieved positive results, while I am also aware that this may not be the case with every client that I encounter. Although while managing this case I plan to continue with this method and incorporate various approaches as needed in order to work in partnership with Michael to achieve his goals while anticipating a positive outcome.

References

Adams. R, Dominelli, Payne.M (2002). Social Work: Themes, Issues and Critical Debates. 2nd ed. Hampshire: Palgrave. P191-199

Teater. B (2010). An Introduction to Applying Social Work Theories and Methods. Berkshire: Open University Press, McGraw – Hill Education. P178-193

Nelson – Jones. R (1992). The Theory and Practice of Counselling Psychology. London: Holt, Rinehart and Winston LTD. P107-120

Payne. M (1997). Modern Social Work Theory. 2nd ed. Hampshire: Palgrave. P104-112

Trevithick. P (2005). Social Work Skills: A practice handbook. 2nd ed. Berkshire: Open University Press, McGraw – Hill Education. P95-98, P275-277

Recovery Star