toptermpaper.com

Introduction

Mr X is a 78 years old gentleman who has been admitted to a busy dementia unit six months ago. He was admitted from home following increasing lethargy, depression and reduced mobility. Prior to the admission he was diagnosed inter alia with Vascular Dementia. He communicates verbally with no difficulties, using very wide vocabulary however can mix up words and situations. He was assessed as lacking capacity to make informed decisions. Mr X has one daughter who is of the opinion that her father lacks insight into the difficulties he was having at home believing that he was managing fine. Mr X’s wife (Eva) died few months ago, in a hospital suffering from breast cancer. Mr X was very involved into her care throughout the illness and cannot accept the loss.

Problem assessment

Mr X, does appear to have an understanding of the sourroundings albeit he is very quiet most of the times almost like having no intrest of what is happening around him. He appears unable to generate any enthusiasm.

Mr X remains independent in terms of personal care, use of facilities, eating and drinking and requires minimum assistance and maximum encouragement and prompting. He is able to mobilize with a zimmer frame, though seem to feel best sitting in a chair in his room, even at “meals or activities times”.

In relation to the above three main problems that interlock have been identified

1. Depression and its effects

Mr X cannot reconcile yourself to the loss of his wife, changes in life his physical and mental health resulting in depression and progress in dementia. He appears isolated, lost a lot of weight; apathy and withdrawal are present affecting seriously his ability to perform everyday tasks.

According to him, to his daughter and to the information gained on assessment using Initial Dementia Assessment (IDA) he used to enjoy reading books, travelling and had an outgoing personality. The IDA indicated that the dramatic change and deterioration in his condition was noted when his wife passed away and he was told that he is having dementia. On the Mini-Mental State Examination (MMSE) Mr X scored 20/30 which could suggest that his dementia is not severe and that there may be other reasons for his withowal. His score could have been slightly inflated because well educated people like Mr X find thequestions “easy” to answer (Marshal at al 1983) but he could be described as “ mildly confused”.

One of the MMSE questions related to language skills was about writing a sentence about anything. Mr X wrote a short statement “Eva is not here and I have dementia”.

Research show that coping and getting along with the diagnosis of dementia is a time-consuming process often related to a range of emotions such as: fear, shame, guilt, sadness, bitterness, isolation and helplessnes. (Alzheimer Europe, 2009) Mr. X appeared to feel overwhelmed by those emotions.

Paying attention to non verbal signs of Mr X bevaiour helped staff to investigate his case further. He often avoided eye contact, showed no inattentiveness his appetite decreased and his posture expressed “tiredness of living”. Studies of nonverbal behaviour indicators in show that this type of signs are often related to post traumatic stess disorder ( PTDS) and that men are more likely to show depression in a form of isolation and withrowal (Stratou at al, n.d.).

2. Upset family relationships

Assessment tools demonstrated that family was very important to Mr X.

When communicating with the daughter lack of understanding dementia, depression and PTDS were identified as an important factor contributing to Mr X situation. Evidence show that above named health issues have an impact on family members; relationship difficulties are common and it it not easy to understand the “loved one”. ( Alzheimer’s Society, 2013). The main concern was no communication with the father and unwillingness to spend time with him to enable him to accept his chalanging situalion. She could not imagine that her normally happy and sociable father was so depressed, and in addition diagnosed with dementia which meant he became “a stranger” to her.

3. Challenging behaviour

Whilst staff members were doing their best trying to motivate and encourage Mr X to get more involved into his care and the care home life, Mr. X refused everything or simply ignored them. The efforts had a negative impact on him and caused reactions such as pretending to be dependent and irritating staff. These types of reaction have been identified by Wallbridge as types of aggression called “ active resistance” ( Wallbridge, n.d.). Staff then presented negative attidude and disaffection towards Mr X. Evidence suggests that behaviours, including uncooperativeness, staff find difficult to cope can lead psychological stess amongst staff and discourage them to deepen knowledge related to the health problem of the patient. ( Brodaty at al, 2003)

Planning

From the above assessment a list o goals have been created in order to improve the quality of life for mr X which is aimed to be archived through:

creating an environment where Mr X could feel emotionally safe, supported and understood
helping him understand, manage and accept his condition .
Lowering the level of lethargy and depression and stimulate functional ability, social contact and activity by encouraging him to talk and listen to what he is saying
Stimulating and motivating Mr X to create new habits related to maintain his physical independence, eating and help him use his potential
involving Mr X’s daughter into care and help her understand the complexity of her father’s condition to make the psychosocial interventions better and improve Mr X behaviour and mood as well as increase his acceptability of the care home settings. Encourage her to let Mr X know that she cares about him and to stay in contact with him by visiting him, taking him out, calling etc to minimise the isolating experience
training for staff in relation to challenging behaviour and dementia awareness, communication, behaviour and work related stress management

The desired outcome is partially based on the outcomes from the research done amongst people with mild dementia and suffering on depression that have successfully managed to improve their lives, that was done was done by the social work department of University of Stirling for the Scottish Executive. (Scottish Executive Social Research 2005)

Implementation

In relation to problem 1

Assessment using IDA and MMSE indicated that Mr X condition is affected by depression. Further investigation has been done. GP and the Liason Psychiatric Nurse have been contacted and involved.

Mr X scored 23/30 in the Geriatric Depression Scale (GDS) indicating severe depression. (Yesavage et al, 1982)

It has been decided that his depression should be addressed first because it was the major factor preventing Mr X from enjoying life similarly to like he used to. It is known that the effects of depression go far beyond the mood ( Smith at el. 2014).

In Mr X case this had an impact not only on his energy, appetite, and physical activity but also on his relations with family and staff.

In relation to the weight loss Malnutrition Universal Screening Too (MUST) (BAPEN, n.d.) has been used. Initial MUST score was 0 with healthy BMI but due to his poor appetite the score rose to 1 within 3 months. Therefore his dietary intake was documented in a form of Food and Fluids Record Chat ( Care NHS UK, n.d) and his weight was monitored every two weeks.

In relation to diet intake Mrs X was offered meals according to his likes suggested by his daughter and accepted by himself which significantly increased the likehood of an “ consumed meal” .

After 2 months his weight stabilised. He remains “ poor eater” and therefore his meals contain more calories. His weight is currently monitored once a month and is not a concern anymore. Changes are documented in his care plan that is evaluated every month.

Studies show an association between depression and increased mortality in older adults. Factors identified in Mr X case included poor adherence , lack of physical activity, cognitive impairment. ( Gallo et al 3013)

From the point of his medication, a rviewd was requested by the GP and and it has been suggested to discontinue Paroxetine(Seroxat) and commence on Amitriptyline. Both belong to antidepressants but vary in side effects. ( NHS Choice, 2013). In addition it has been requested to commence Mr X on regular laxatives as episode of constipation have been noted. Currently Mr X bowels are monitored and documented on bowels chart on daily basis. No concerns have been noted.

In relation to problem 2

Reduced sense of purpose was identified as the main co-existing factor

To help Mr X overcome this problem (which he expressed clearly during the MMSE mentioning the loss of his spouse and dementia diagnosis) his daughter was asked to participate and although she was initially sceptical she brought meaningful memoralia and small pieces of furniture to help him feel like home. Staff gave her assistance and explanation in relation to dementia and depression. She was also offered help and given reassurance in a form of Family Support Meetings organised by the home. The initial scepticism disappeared with gaining awareness of the illness. She became Mr X advocate and currently holds medical and financial power of attorney for him. ( Office of the Public Guardian, Scotland, n.d.) Furthermore her two sons come regularly to visit Mr. X, they often take him out for a meal or call him to find out how he is.

Staff has also managed to discuss one the most sensitive matters related to Mr. X’s End of Life such as DNACPR certificate that is present in Mr X file in the event of need. Mr. X’s relationship with his daughter and grandsons appears happy. The daughter stated that this helped also her to resolve personal problems she feels acknowledged by her father and therefore valued. There is a Family/Relatives Communication part in Mr X care plan and a book in Mr X room where any suggestions, complaints or comments can be made by staff members or by the family .(U.S National Library of Medicine, 2011)

The relation with staff can be defined as very good. A person’s family is often the most important, long-standing connection in their life. Therefore, the ability of staff to work positively and inclusively with families and carers is a core staff skill.

In relation to problem 3

Most of the staff required training to help them understand the nature of behaviour that challenges. The importance of the training this became so vital that it is now one of the mandatory trainings every member of staff has to attend. Skills that were aimed to be improved included addressing challenging behaviour, person centred approach and communication skills (Skills for Care, 2013) Many staff showed the need to be trained in related to stress management (Wallbridge, n.d.) The future aim is to create a team that focuses on people’s assets and life outcomes. A team that is confident of their roles and impact on Mr X and any other client, willing to contribute and encouraging new members of staff to learn.

Evaluation

Summarising, Mr. X case has been an example of mostly successful process of assessment and implementation of the planned actions. There was and so called “multi agency” approach to Mr X needs. Assessment tools helped in the identification and articulation of the needs and contributed to positive changes leading to holistic, personalised approach to them. Recent changes to the social care management and the need to comply with the Public Services Reform Scotland Act 2010 contributed to the awareness in relation to staff due to the accent on the importance of systematic and sensitive assessment.

Mr X’s continuing care did not require up to now any specific nursing interventions.

The difficulty consisted of identifying the roles and the division of work.

Mr X’s case proved that there are different functions staffs have to complete that contribute to the optimum health and overall wellbeing of older people such as:

psychosocial and emotional support enabling life review – where the family support was crucial but required time to function
work aimed at maintaining his independence and functional ability that continues to be improved through the aspiration of a well functioning team work.
educative – teaching self-care activities by encouraging physical activity
managerial- directions in terms of who and when undertakes the administrative and supervisory responsibilities could have been improved.

All the above reduces to good knowledge, awareness, and experience, will power to change things for the better and to a well functioning team work. Many things would have been done sooner or could have been dealt with better if we were aware of the need and knew how. This is why it would be recommended to pay more attention to training needs in relation to new regulations, staff assessments, achieving and evidencing outcomes, person-centred care planning.

References

Office of the Public Guardian( Scotland)( n.d.) http://www.publicguardian-scotland.gov.uk/whatwedo/power_of_attorney.asp

Care NHS UK ( n.d.) Food and Fluid Record Chart http://www.glos-care.nhs.uk/images/Food_and_Fluid_chart_-_attachment_31_copy_copy_copy.pdf

(BAPEN, n.d.) Malnutrition Universal Screening Tool http://www.bapen.org.uk/pdfs/must/must_full.pdf

Skills for Care (2013) Supporting staff working with people who challenge services Guidance for employers http://www.skillsforcare.org.uk/Document-library/Skills/People-whose-behaviour-challenges/Supporting-staff-working-with-challenging-behaviour-(Guide-for-employers)vfw-(June-2013).pdf

U.S National Library of Medicine (2011) no author Communicating with families of dementia patients Can Fam Physician Joulrnal Vol 57(7): 801–802 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3135450/

NHS Choice ( 2013) Antidepressantshttp://www.nhs.uk/conditions/Antidepressant-drugs/Pages/Introduction.aspx

Melinda Smith, M.A., Lawrence Robinson, and Jeanne Segal, Ph.D. Last updated: February 2014. Depression in Older Adults & the Elderly http://www.helpguide.org/mental/depression_elderly.htm

Gallo, J., Morales, K.H.,Bogner, H.R, Raue, J.P, Zee,J, Bruce M.L and Reynolds C.F(2013) BMJ Helping doctors making better decisions Long term effect of depression care management on mortality in older adults: follow-up of cluster randomized clinical trial in primary care http://www.bmj.com/content/346/bmj.f2570

Scottish Executive Social Research (2005) Effective Social Work with Older People http://www.scotland.gov.uk/Resource/Doc/47121/0020809.pdf

Wallbridge, H. ( n.d.) When pushed to the limit:Moving beyond a difficult situation http://www.alzheimer.mb.ca/handouts/When%20Pushed%20to%20the%20Limit…Moving%20Beyond%20a%20Difficult%20Situation.pdf

Alzheimer Society (2013) Understanding and respecting the person with dementia file:///C:/Users/GEORGE/Downloads/Understanding_and_respecting_the_person_with_dementia_factsheet.pdf

Stratou,G., Scherer,S., Gratch,J. and Morency, L.P. (n.d) University of Southern California, Institute for Creative Technologies, Los Angeles Automatic Nonverbal Behavior Indicators ofDepression and PTSD: Exploring Gender Differences http://ict.usc.edu/pubs/Automatic%20Nonverbal%20Behavior%20Indicators%20of%20Depression%20and%20PTSD-%20Exploring%20Gender%20Differences.pdf

Alzheimer Europe (2009) no author Facing the diagnosis Diagnosis of dementia http://www.alzheimer-europe.org/Living-with-dementia/After-diagnosis-What-next/Diagnosis-of-dementia/Facing-the-diagnosis

Marshal F. Folstein, MD; Lee N. Robins, PhD; John E. Helzer, MD (1983) The Mini-Mental State Examination JAMA Network Journal Archives of General Psychiatry Vol 40, No. 7 http://archpsyc.jamanetwork.com/article.aspx?articleid=493108

National Chronic Care Consortium and the Alzheimer’s Association (2003) Tools for Early Identification,Assessment, and Treatment for People with Alzheimer’s Disease and Dementia http://www.alz.org/national/documents/brochure_toolsforidassesstreat.pdf

Introduction

Every society in the human history confronted the question of how disputes should be resolved. Independence of the judiciary is the principle that the judiciary should be politically insulated from the legislative and the executive power. Courts should not be influenced by the other branches of government. Different nations deal with the idea of judicial independence through different means of judicial selection. An independent judicial branch is one of the main guarantees of democratic system of government and it ensures the rule of law so that it is free from outside influences and judges can render cases only due to the law and facts.

The importance of the independent judicial system in England were established in the beginning of 11th century, when William The Conqueror come to throne in 1066 and had started settling new laws in the whole England (today is known as Common Law) and also had fixed by The doctrine of the “separation of powers”. Whereas, In Kazakhstan legal system the Judicial power as the legal category is rather new. On 30th August 1995 on the basis of the Declaration of Independence the Constitution of The Republic of Kazakhstan had been accepted and it covered the initial principles and appointments of independence of judges (The Constitution of The Republic of Kazakhstan, 1995).

Firstly, I would like to return to the past of the UK to observe the formation way of the power structure, which we have today.

The ideas based on a modern principle of division of the authorities, for the first time was expressed by Aristotle, in his fourth book named, “Politician”. He formulated the idea of separating the power in the state on three parts: legislative, official, judicial; each of the authorities should be represented by the separate ‘body’.

The further development of the theory of division of the authorities is bound to John Lock and Charles Louis Montesquieu, who have carried out the most thorough working out of this principle. Later on, by the end of 18th and the beginning 19th century, the principle of division of the authorities was recognised in many states.

Next paragraph separately exposes the origin ways of each power branch in the UK.

The Parliament

The British Parliament is one of the oldest parliaments in the world. It is often named “foremother”, but in my opinion it would be more exactly to call it “forefather” of all parliament systems in the world, and it continues to function throughout the whole political history of the country since the second half of 13th century.

Formation and development of The British Parliament occurred during XII and XV centuries. Considerable value of this long process traditionally was attracted by a crown of the higher nobility to the decision of the state, affairs monarchy going back to its origin. Meetings of the King’s vassals, from the middle of XII century, became an obligatory part of the state life and they were the historical beginning of the class representations.

The ancestor of legislative system of England was the Curia Regis (the council of tenants-in-chief) it was created by William The Conqueror, who brought to England the feudal system from his native Normandy after the Norman conquest in 1066, and was granting land to his most important military supporters, further the supporters were granting that land to their own supporters thereby creating feudal hierarchy of England. Eventually this council has developed into the Parliament of England, and now includes the head of the state (monarch), chamber of lords (historically – chamber of the nobility and the higher clergy) and the House of Commons (historically – chamber of commoners).

The Monarch and Government

Formation of strong English government begun in the beginning of 12th century when English people were victims of intestine wars and feudal anarchy. This severe historical experience had definitively convinced English people that nothing but the strong central power and the wide state organisation can serve for them against those harms.

Reducer of the reeled English state order was Henry II Plantagenet (years of board 1154-1189). During Henry’s reformatory activities people against feudal lords joined him and it can be said that absolute monarchy formation in England begun with him.

The restrictions of the monarchs’ power began being introduced in the beginning of the 13th century, when the English nobility forced King John to recognize the certain document named, Magna Carta. The constitutional monarchy in that way we see it today, has developed and has become stronger in 18th and 19th centuries when function to administer the affairs of the state has passed to the Cabinet which were appointed from elective parliament.

The Cabinet has arisen before the bourgeois revolution of 17th century on the basis of secret council, as the narrow board helping the king to quickly solve the important problems of the government.

At first this body completely depended on the monarchy. Further, by the end of 18th century and the beginning of 19th century, it was ceased to be a subsidiary organ of the Royal management and should lean against Parliament support. As the result by that time it started being recognised that the Cabinet should have the majority of voices in Parliament and the head of it should be the Prime minister.

The Legislative

If the legislative and executive powers are assigned on the exactly higher state body then the judicial power is much more difficult. It is assigned to set of judicial bodies from the local Supreme. Each judicial body is independent and it has own place in the system, resolving concrete affairs absolutely independently.

The today’s judicial power of England has arises from 1178, when Henry II appointed five members of his personal household “to hear all the complaints of the realm and to do right”, however the role of the Lord Chancellor was still formal and judgements were a prerogative of the King. Such situation had been existing till “Glorious Revolution”, the acceptance of the Bill of Rights in 1689 and the Act of Settlement in 1701. After those changes the power of the monarch was essentially limited and courts received independence and leadership of the law.

The doctrine traditionally demands “separate of powers”, that the state system of the power must be divided into three branches and each branch is not only supplemented by two others, but also could be balance.

As I said above, the judicial power became independent from executive, legislative and Royal powers when The Bill of Rights 1689 was introduced. According to the Bill the monarch was deprived to a duty to support and supervise judicial system, and the right of the Queen was only to dismiss judges on ministerial council. However, until recent time the principle of “separate of powers” in the Great Britain was not completely observed. So that the Lord Chancellor being the head of the judicial power in the Great Britain simultaneously was the member of the Cabinet and a member of Lords’ chambers. Moreover, the Lord Chancellor was appointed to the post by the Queen on representation of the Prime Minister.

In July 2003, Tony Blair’s government tried to make radical changes to a judicial branch of the power and declared plans to cancel a post of the Lord Chancellor to abolish the system of Law Lords and to replace it with separate Supreme Court. These plans caused considerable contradictions, and finally, Prime Minister decided to change, instead of cancelling an ancient role of the Lord Chancellor. Reform of the role of the Lord Chancellor has started the process of separating his various duties making clear distinction between the government, Parliament and the judicial power.

Kazakhstan

16 December 1991, the Parliament of the on the Republic declared the independence of the Republic of Kazakhstan and the Republic Kazakhstan was formed.

During the period 1991-1995, the political system and Constitutional legislation of the Republic were formed. The first Constitution of sovereign Kazakhstan was adopted in January 1993. Being to some extent a compromise between the old and new political systems, reflecting attempts to introduce into the post-Soviet context a western democratic model, this Constitution initially contained some contradiction which occasionally took the form of unnatural opposition and resistance of power.

As a result of the Referendum held on 30 August 1995, a new Constitution of the Republic of Kazakhstan was adopted, eliminating the shortcomings of the former constitution. The new Constitution established a Presidential Republic, and solved rationally the problem of divided responsibilities among different branches of power, while also welcoming changes to the market system.

According to Article 3 of the Constitution states that the state power in the Republic of Kazakhstan is unified and executed on the basis of the Constitution and laws in accordance with the principle of its division into the legislative, executive and judicial branches and a system of checks and balances that governs their interaction.

The legislative branch comprises Parliament of the Republic of Kazakhstan (the Senate and the Majilis).
The executive branch comprises the Cabinet of Ministers, state committees, others central and local executive bodies of the Republic.
The judicial branch comprises the Supreme Court and Constitutional Council and local courts (regional, district and others).

The President of the Republic of Kazakhstan is the head of state, its highest official determining the main directions of the domestic and foreign policy of the state and representing Kazakhstan within the country and in international relations. He shall ensure by his arbitration concerted functioning of all branches of state power and responsibility of the institutions of power before the people. (Art. 40 of the Constitution). The President is elected every seven years on the basis of universal suffrage. One and the same person may not be elected the President of the Republic more than two times in a row.

Nursultan Nazarbaev has been the President of the Republic of Kazakhstan since 1 December 1991.

Parliament

The highest representative body of the Republic of Kazakhstan is the bicameral Parliament. According to the President’s Decree having force of Constitutional Law «On elections in the Republic of Kazakhstan» (1995) the parliament will consist of two chambers the Senate and the Majilis and work on professional base.

Parliament at a joint session of the Chambers: introduces amendments and makes additions to the Constitution; adopts constitutional laws, approves the republican budget, the reports of the Government, and the Accounts Committee about its implementation, and introduces changes into the budget; conducts a second round of discussion and voting on the laws or articles of the law; hears the report of the Prime Minister on the Government’s program and approves or rejects the program and annual messages of the Constitutional Council of the Republic on the state of the constitutional legality in the Republic or reports on the activity of the commissions; decides issues of war and peace; adopts a decision concerning the use of the Armed Forces of the Republic to fulfill international obligations in support of peace and security at the proposal of the President of the Republic; puts forward an initiative calling for an all-nation referendum; exercises other powers assigned to Parliament by the Constitution.

The Government

The Government is appointed by the President and accountable to the Parliament. It implements the executive power in Kazakhstan, heads the system of executive bodies and exercise supervision of their activity.

Judicial Authority

Justice in the Republic of Kazakhstan is exercised only by the court. The judicial system in the Republic consists of the Supreme Court Republic of Kazakhstan, the highest judicial body, and regional, district, town, and city courts. (Art.75)

The Supreme Court of the Republic of Kazakhstan shall be the highest judicial body for civil, criminal and other cases which are under the courts of general jurisdiction; exercises the supervision over their activities in the forms of juridical procedure stipulated by law, and provide interpretation on the issues of judicial practice.

The chairman of the Supreme Court is the judge and is appointed to the post by the President with the consent of the Senate of Parliament of the Republic of Kazakhstan.

Independence of the judicial power in Kazakhstan completely based on the Constitution and the Constitutional Law named, “About courts and the status of judges”, and the guarantor of the constitution is the President. However, the theory of division of the authorities does not assume creation of “the Chinese wall” between various branches of the power. That is also impossible, as their interaction and interdependence are the questions of uniform institutes and the government shall be necessarily differentiated from its branches, generating an interlacing of some elements.

The general meaning of the modern legal doctrine are the connection of ideas of unity and division of the authorities, their interactions and system of controls and counterbalances. Such understandings are reflected in the newest constitutions. The most distinctive expression is the point 4 of article 3 of the Constitution of Republic Kazakhstan of 1995 which says: “the Government in Republic Kazakhstan is uniform, is carried out on the basis of the Constitution and laws according to a principle of its division into legislative, executive and judicial branches and their interactions among themselves with use of system of controls and counterbalances”.

Basically the Kazakhstan’s and English models of the judicial power are very difficult to compare moreover they are based on various legal foundations. English system of the Right is based on judicial precedent and actually courts of England create laws. In Kazakhstan the system is based on the code system of the right, such as the constitution, the constitutional laws, codes etc., and the Kazakhstan courts in contrast to English courts do not have the legislative initiative.

It is believed that the judicial power is the weakest branch and it does not lean against wish of voters as the legislature, has no power for compulsion as the Executive. The force of the judicial power is in respect from the civilised society to the right and court. Here again we can see considerable distinctions. In that number, and in relations of other branches of the power both judicial in England and Kazakhstan.

The execution institute of court decisions in England is so accurate also punishment for default so serious, that the practical excludes concept «default of the decision of court» and communication with what, the authority of the judicial power is indisputable.

Since independence Kazakhstan has undertaken huge efforts for a raising of courts authority, however corruption and a principle of “the telephone right” create for this purpose very big obstacles.

Also I would like to stop in detail on the status English of judges put in English statutes. According to this statutes judge are appointed for life. In Kazakhstan the similar norm of the law does not exist. And although the legal judge is appointed to the post and dismissed by the President of Republic, the nonflexible system of estimations of activity of the judges allow to the chairman of courts easily release the judges who was not undesirable to him.

Although the term empowerment is frequently used, the availability of high-quality research which demonstrates its success for improving the wellbeing of communities is fairly minimal (Woodall et al. 2010). There is, however, some evidence that shows that empowerment programs can lead to improve outcomes for participants. For example, in examining the effectiveness of interventions using community development approach, the Migrant Resource Centre of South Australia, which provides programs that targets particular community groups, including women, younger people, has recorded some promising ability to impact the lives of young refugees (MRCSA Annual Report, 2009). In fact, this essay argues that while community development interventions are difficult to measure, the migrant Resource Centre of South Australia has registered significant gains in the area of youth empowerment.

This essay will highlight the various intervention programs implemented by the Migrant Resource Centre of South Australia (MRCSA). However, case study will focus on its youth empowerment component and to evaluate the overall effectiveness of community development approach of the organisation. To achieve this task, the essay is partitioned as follows. The first part will examine the definitions of empowerment. The next section will discuss about community development as a strategy and a model of practice by the Migrant Resource Centre of South Australia (MRCSA). The third section discusses the impact and challenges of this intervention. The final part of the essay will evaluate the impact of MRCSA’s youth empowerment program among a number of interventions.

Background and definition of the Concept of Empowerment

In the 1990s the term empowerment began to replace community participation (Rifkin, 2003). Empowerment according to Rifkin has conceptually evolved from the idea of lay participation in technical activities to a broader concern of improving life situations of the poor. This evolution can be traced historically in the areas of policy and in community activities. In the policy area, Rifkin proposes that three theoretical constructs can be identified to trace the changing view of participatory approaches from consensus building to empowerment. These Rafkin stated correspond to the political and political environment of the time.

The historical development of the concept of empowerment helps explain why there is no universally accepted definition of empowerment (Rifkin, 2003). However a number of scholars defined it as a process (McArdle, 1989; Laverack, 2005; Werner, 1988; Kilby, 2002). McArdle (1989) defines empowerment as a process whereby decisions are made by the people who will wear the consequences of those decisions. Similarly Werner (1988) and Laverack (2005) describe the concept of empowerment as a process by which people are able to gain or seize power to control over decisions and resources that determine their lives. Moreover, Kilby (2002) describe a process by which disadvantaged people work together to increase control over events that determine their lives. Expansion of individual’s choices and actions, primarily in relation to others aˆ¦ fundamentally a shift of power to those who are disempowered.

From a public health perspective, empowerment involves acting with communities to achieve their goals (Talbot & Verrinder, 2005). This implies working with disadvantaged individuals or groups to challenge structural disadvantaged (on the basis of class, gender, ethnicity or ability) and influence their health in a positive way. The application of the concept into the field of health promotion as outline by Laverack and Labonte (2000) is categorized in two folds; the bottom-up programming and the top-down programming. The former more associated with the concept of community empowerment begins on issues of concern to particular groups or individuals and regards some improvement in their overall power or capacity as the important health outcome. The later more associated with disease prevention efforts begin by seeking to involve particular groups or individuals in issues and activities largely defined by health agencies and regards improvement in particular behaviours as the important health outcome. Laverack and Labonte (2000) thus viewed community empowerment more instrumentally as a means to the end of health behaviour change. They argue that community empowerment which is defined as a shift towards greater equality in the social relations of power is an unavoidable feature of any health promotion efforts.

On a much broader scale empowerment promotes participation of people, organisations and communities towards the goals of increased individual and community control, political efficacy, improved quality of community life, and social justice (Wallerstein, 1992). The next section is a case example of how this approach is applied by an agency in dealing with question of social inclusion.

Community Development: A case of Migrant Resource Centre of South Australia (MRCSA)

By reviewing the previous definitions of empowerment and examining MRCSA’s framework, It is clear that the worker in (MRCSA) understand and adopt empowerment concept similar to which all of McArdle (1989); Laverack (2005); Werner (1988); Kilby (2002) and WHO (1986) do understand and adopt where empowerment is a matter of giving people the right and the opportunity to exercise power and control regarding making decisions that affect their health promoting.

In addition, in order to empower migrant people and communities, the (MRCSA) provide and still providing number of interventions based on community development model of practice. According to Tesoriero (2010), community development is the use of a set of ongoing structures and processes which enable the community to meet its own needs. Similar to Tesoriero (2010), Community Development is understood and implemented by the (MRCSA) as a multifaceted program of activities that concentrated on supporting the need of new arrivals and their new and emerging communities to understand their rights and obligations, to link into training and employment pathways and to develop networks of support within their local and in the broader community (www.mrcsa.com.au). In fact, The MRCSA has adopted Laverack and Labonte’s (2000) bottom-up approach in implementing their programs by consult sing and working closely with leaders and key representatives of new and emerging communities, including women and young people, to support them in gaining the knowledge and skills that they need to further their independence as well as their capacity to support and provide assistance to their members. Moreover, beside community development programs, MRCSA is providing number of women’s advocacy programs, youth leadership and participation and employment advocacy programs, As well. The programs also include Refugee Men’s Talk, an initiative supporting men to adapt to their new social environment.

To ensure and facilitate the participation of new and emerging communities in their local areas and in regional areas where they settle, or resettle, the program includes local government and regional initiatives. MRCSA believes that new and emerging communities require a place in which to implement their own activities. The organisation provides these through its own community centres and through linkages with other community facilities.

Also, Given that community development as an approach require working across divergent spheres, the Migrant Resource Centre of South Australia (MRCSA) maintain link with a number of stakeholders. These include the Commonwealth Government, the state of South Australia and the NGO community.(www.mrcsa.com.au). At the level of the Commonwealth Government, the links include; Department of Immigration and Citizenship, Centrelink, Employee Advocate, Department of Families, Housing, Community Services and Indigenous Affairs and Australia Council for the Arts. At the level of the State Government the links are; Multicultural SA, Department of Health, Department of Families and Communities, Department of Education and Children’s Services, Skills SA, English Language Services – TAFE SA, Arts SA, Office for Women, Women’s Information Service, Women’s Health State Wide, Local Government Association of SA and Be Active. The links within the Non-Government Sector includes; Settlement Council of Australia (SCoA), Refugee Council of Australia, Federation of Ethnic Communities’ Councils of Australia (FECCA) LM Training Specialists, SA Council of Social Service (SACOSS), Service to Youth Council (SYC), Working Women’s Centre, Migrant Women’s Support and Accommodation Service, Youth Affairs Council of SA (YACSA), Anglicare SA, African Communities Council (ACCSA), Middle Eastern Communities Council (MECCSA), Volunteering SA and Northern Territory. Analysing this web of networks from Labonte’s, (1992) community development continuum, the MRCSA’s programs deal with individuals which transcend to small groups, community organisations, coalition advocacy and political action. With this wide array of networks, the organization has been facilitated to maintains a huge amount of social capital and through careful co-ordination, it stands a lot to gain in achieving its primary objectives (Butter et al. 1966)

The next section will focus on one of its many programs in the area of youth enhancement.

Youth Empowerment Program

The Migrant Resource Centre of South Australia (MRCSA) works closely with the leadership and key representatives of its client communities, including women and young people to support them in acquiring the knowledge and skills that they need to further their independence and self-determination, as well as their capacity to assist their members with their settlement and participation (www.mrcsa.com.au)). These goals are achieved through a number of programs including ethnic leaders’ forum, adult migrant education, community management and leadership forum by way of funding and leadership training. This section focuses on its youth empowerment program with emphasis on the Newly Arrived Youth Settlement Services (NAYS). The primary objective of this program as outlined in the MRCSA Annual Report (2008-2009) is to empower young people to develop their own programs and to become advocates for themselves, their families and communities.

In partnership with TAFE SA, the MRCSA conducted a number of training programs for young people who were not engaged in school or work. Specific training includes Certificate II in Information Technology, Productively Places Program Certificate II, Volunteering, work experience capacity building, apprentiships and traineeships (MRCSA Annual Report (2008-2009).

Through its new arrival humanitarian settlement program, the MRCSA has been an advocate and a voice for the inclusion and participation of young people of refugee background (www.mrcsa.com.au). According to the 2010 MRCSA Youth Empowerment Program Annual Report, the program has since 1998 addressed the needs of young people from new and emerging communities in South Australia through a multi-faceted program. The program provides young people with a range of services that aim to further their resilience, leadership skills and pathways to employment and independence. The MRCSA Youth Empowerment Program for 2008-2009 provided assistance to five hundred and twenty-nine (529) young people of refugee background, most of them recent arrivals to South Australia, to achieve some of their goals (Annual Report 2009-2010). These achievements were based on strong foundations upon which MRCSA operate. The next section will discuss the guiding principles which form the basis of MRCSA’s operations.

MRCSA Guiding Principles

The Migrant Resource Centre of South Australia’s philosophy and approach in working with young people from refugee backgrounds outline a number of guiding principles (Annual Report, 2008-2009). The principles discussed below indicate that MRCSA operates Laverack and Labonte’s (2000) bottom-up approach of community development. The guiding principles include the following:

Firstly, any youth programs, initiatives or activities are shaped and driven by the young people themselves through consultation with their peers. Secondly, young people are encouraged and supported to speak for themselves to drive their own development; the role of the MRCSA is that of mentor and advisor only. Thirdly, the importance of young people’s connection to family and community is recognized, valued and supported. Fourthly, the ethnic, religious and cultural identity and heritage of young people is affirmed and respected. Fifthly, respect for gender differences and how these impact on the planning and delivery of the youth program. Also, young people are active decision makers. Finally, an action research approach informs continuous service improvement and best practice.

These guiding principles are based on the premise that empowerment strategies focus on what people can do to empower themselves and so deflect attention from social issues (Keleher et al. 2007; Keleher, and Murphy, 2004) . However, Labonte (1990) warns that unless national and international trends are taken into account, the decentralization of decision-making may shift from victim blaming of individuals to victimizing powerless communities. In view of such warnings, Wilson et al (1999) suggest that effective primary health care as in the case of public health functions depends on efforts to link local issues to broader social issues. Intersectoral action can be used to promote and achieve shared goals in a number of other areas, for example policy, research, planning, practice and funding. It may be implemented through a myriad of activities including advocacy, legislation, community projects, and policy and programme action. It may take different forms such as cooperative initiatives, alliances, coalitions or partnerships (Health Canada http://www.hc-sc.gc.ca)

What are the Barriers?

In achieving their goal of empowering communities, the Migrant Resource Centre of South Australia (MRCSA) faces a number of challenging issues.

When young refugees arrive in Australia they face a number of challenges. They need to begin a new life, establish new friends and networks and find pathways that link them into mainstream community (MRCSA Annual Report, 2008-2009).

Some young people may also be at risk and need to deal with issues around language, religious identity, grief and loss, the justice system, consumer culture and intergenerational tension (MRCSA Annual Report, 2008-2009). Young people also need ways of dealing with race, racism and their identity (MRCSA Annual Report, 2008-2009).

There are fewer opportunities for young women from new and emerging communities to participate in sport due to the barriers they experience from within sporting environments and their own communities (MRCSA Annual Report, 2009). These barriers can be based on cultural, religious, and gender expectations of young women and their roles in their community. The report (MRCSA, 2009) also highlighted other factors affecting young women participation in sports. These include; lack of parental support, perceived fear of racism, lack of knowledge about the structure of sport in Adelaide and high cost of membership and registration fees.

On the other hand, community development approach can pose barriers to Public Health Practitioners in a number of ways. Epidemiological, sociological, and psychological evidence of the relationship between influence, control, and health, provide a rationale for a community empowerment approach to health education. For example, studies show an association between powerlessness (or similarly, learned helplessness, alienation, exploitation) and mental and physical health status. Examining the application of community empowerment approach to health education, Israel (1994) identified a number of limitations and barriers to this approach. Firstly, situations where community members’ past experiences and normative beliefs result in feelings that they do not have influence within the system (powerlessness, quiescence) and hence, they may feel that getting involved in an empowerment intervention would not be worthwhile. Secondly, differences in, for example, social class, race, ethnicity, that often exist between community members and health educators that may impede trust, communication, and collaborative work. Thirdly, role-related tensions and differences that may arise between community members and health educators around the issues of values and interests, resources and skills, control, political realities, and rewards. Fourthly, difficulty in assessing/measuring community empowerment and being able to show that change has occurred. Fifthly, the health education profession does not widely understand and value this Approach. Next, risks involved with and potential resistance encountered when challenging the status quo, for the individual, organizations, and community as well as the health educator. Seventhly, the short time-frame expectations of some health educators, their employers, and community members are inconsistent with the sustained effort that this approach requires in terms of long-time commitment of financial and personal resources. Finally, the collection and analysis of extensive amounts of both qualitative and quantitative data to be used for action as well as evaluation purposes may be perceived as slowing down the process.

Inspire of these barriers, community development is still relevant to Public Health Practitioners. Epidemiological, sociological, and psychological evidence of the relationship between influence, control, and health, provide a rationale for a community development approach to health education (Israel, 1994). For example, studies show an association between powerlessness (or similarly, learned helplessness, alienation, exploitation) and mental and physical health status (Israel, 1994).

The challenges posed by community development approach also extend to the wider arena of state level. The demand on government and competition for resources by professionals is a major obstacle. Similarly, Inter-professional distrust and reluctance to share information also remains a major obstacle. The way in which governments fund departments can be an obstacle to collaboration (Baum, 1993). It is therefore argued that Stability of an organisation and its staff is important for interagency agreements and establishing trust (Walker et al. 2000). Walker (2002) further argued that Competition for resources can affect trust and intergroup conflict can occur when there is a lack of adversaries. However, insecurity brought on by political and economic uncertainty can facilitate political coalitions (Weisner, 1983).

Overcoming the barriers

Overcoming the barriers will require a concerted effort from communities, concerned organisations and government. The Proceedings of 2008 the Conference on Social Inclusion for New and Emerging Communities, outline some of the areas that need urgent interventions are discussed below.

Racism and discrimination

Identified as a major area of concern, combating discrimination requires coordinated and targeted social inclusion and human right measures. The focus should not be limited to what occurs in a social context (e.g. schoolyard, public places etc.) but also the systemic racism that supports discrimination, the perpetuation of racial stereotypes, and institutional inclusion e.g. within the justice system, the employment sector and in the blocks to the recognition of overseas qualifications and experience as well as the registration and utilization of these.

Women and safety

Women should have the right to feel safe in their homes as well as the broader community, to access culturally appropriate services for themselves and their families (e.g. health, childcare, education etc ), to learn English without it compromising their chances at finding a job and to undertake training that prepares them for work and improve their employment potential.

Empowering young people

The voices of the diversity of young people rather than a token representative from new and emerging communities must be listened to and give strong credence in the advance of a national or state framework for social inclusion. Supporting the empowerment and participation of young people as future citizens and leaders of Australia will serve the country culturally, socially and economically.

Base on the above discussion in the case of challenges to MRCSA operations, solutions to barriers could be summarized therein; Barriers can be overcome through integrated structures, developing responsibility – within structures

Support of local leaders, developing leadership skills for negotiation and collaboration. Enhancing Regional networks/structures, established processes and relationships are important for collaboration.

Conclusion

From the case studies, it was found that the Migrant Resource Centre of South Australia (MRCSA) utilize community mobilization approaches to improve equity of services, reduce institutional barriers within the society, enhance participation in new and emerging communities, strengthen civil society associations and create healthy social policies. The programs demonstrated that opportunities for community ‘voices’ to be heard had been increased and this had raised community capacity to maximise their needs and create change.

This study also found that empowerment can have a positive impact on participants’ self-efficacy, self-esteem, sense of community and sense of control and, in some cases, empowerment can increase individuals’ knowledge and awareness and lead to behaviour change. These findings were particularly apparent on youth empowerment approaches and those programmes concerning young women.

A theory of service delivery that focuses on the individual strengths instead of weaknesses.

This model is based on the understanding of the individuals’ deep internal resources and ability. The purpose of this model is to help survivors identify this strength and build life upon them. During the treatment, the clients must participate in the process of their recovery which controls the direction and pace of healing efforts. Each client helps his or her own plan for personal wellness. The plan is based on the client’s psychological, medical, or legal needs. Together, the client and case manager regularly review the progress, discuss achievements and changes, and modify goals based on the client’s evolving situation and needs. When a client is granted asylum, the case manager continues to provide assistance to satisfy the client’s needs. This may include helping the client find information on educational or employment opportunities.

Assessment:

The strength based model focus mainly on developing and finding the client’s strengths and abilities and makes a plan based on this. As this model considers the wellbeing of the clients, so the participation of the client in the treatment is very important. The client must figure out their needs of any aspects and give feedbacks of the current treatment. According to this point, the model is very adaptable to individuals as the diversity of their different situations. But this kind of model just encourage the client to live life as what they want and they can so the disability part has been left over which is very important in making progress.

Planning:

The strength based model needs a very detail and flexible service plan at the beginning which carried out mainly depends on the client’s own abilities and needs because the client will live a life based on the plan. And the plan will be change over time because during the treatment the client and the case manager have to review the changes and progress that the client has met so the goals will be modified based on the reality and the process of achievement.

Coordinating:

The strength based models require a high standard of the coordinating between the client and the case manager. The case manager will give the client professional suggestions and make plans according to the client’s condition which maybe not very consistent with the client’s imagination and needs. But the client should be considerate since the accessibility and the efficiency. And the case manager should also have a regular contact with the client and be ready to make any changes to make sure the plan is always suitable and updated.

Strengths and weaknesses of the strength based model:

The strength of the strength based model is that it is easy to be carried out because it is based on the client’s needs and ability so the client will be very cooperative during the treatment. And the psychological needs of the client are easily to be met so the confidence will be built to the client. It is very good to the client’s mental health. Besides, the client’s strengths are well maintained and developed. But the weaknesses of this kind of model are also obvious. It is because this kind of model only concerns about the strength so the weakness of the client has been ignored. But at many times the weakness plays the main role of whether the treatment is successful or not so the weaknesses can’t be improved.

Perspectives of the disability people:

The strength based model is very practical for the disabled. Client empowerment is a central theme to this approach. To empower a client, the evaluation must be made to the disabled person and thus the achievable goals will be made along with the evaluation so a well-organized plan will be carried out to achieve the goals and the possibility of the success will hopefully be very high. Critics of the strength perspective suggest this is simply reframing problems in a better light. No one will succeed while being convinced that they will fail.

Summary of the expected outcomes for the disabled:

For the strength based model, the expected outcomes is that the mental health of the client is strengthened and many the disabled can joint well to the society like the normal people without much mental barriers. In addition, the client may develop certain advantages to a high level and gain some achievement better than normal person. But the disabled part can’t be improved.

Case management Model

A collaborative process of assessment, planning, facilitation and advocacy for options and services which is aim to meet an individual’s holistic needs through communication and available resources to promote quality cost-effective outcomes.Case Management has been used to a wide range of issues including community care for the aged, and people with disability and mental health issues; acute health settings; injury management and insurance related areas; correctional services; court systems; in the management of chronic health conditions; child and youth welfare; at risk populations in schools; managed care and employment programs. The case management model requires the organization deliver a range of services based on the comprehensive assessment that is used to develop a case or service plan. The plan is developed in collaboration with the client and reflects their choices and preferences. Case Managers provide the coordinating and specialist activities that flow from the particular setting, program and client population. However it is usual to identify the following process as core to Case Management: screening, assessment/risk management, care planning, implementing service arrangement, monitoring/evaluation and advocacy.

Assessment:

However the case management model is a bit similar to the strength based models as they both respect the needs of the clients. But the case management model focus on the hobbies of the client and encourage them to attend relative activities so that the purpose of treatment is achieved during the community time. So that this model is also based on the client’s abilities in some degrees and can maintain the client’s past lifestyle and an active mind and body as much as they can. But there will be many potential barriers hidden behind like the decrease of the client’s health condition or the bad weather. So there will be many uncertain situations so the achieving of certain goals will require a long time and patience.

Planning:

Comparing with the strength based model, the case management model plan is relatively fixed because the client’s hobbies and preference are stable. Based on this a long term plan is worked out and the plan will be seldom changed. But the plan is not very detail because it’s just an optional orientation.

Coordinating:

The case management requires coordination between the activity coordinator and the client as well as the relationships among different clients who participate in the activities. And the coordinator also has to consider the clients’ physical ability and other element like the economy and the climate and so on make sure the arrangement is made in advance.

Strengths and weaknesses of the case management model:

Like the strength based model, the case management model is also very easy to be executed since it is based on the priority of the client’s to the activities according to their interests. This model is good for both the mental and physical development of the clients. But the weakness is that it is easy to be influenced by the uncertainty elements like the natural disasters and the client’s health conditions and any personal issues of each part. Also this model can’t be updated with the time going on along with the aging and the decrease of the client’s health. So at the end, the client does maybe have no ability to participate or the quality of the participation is going down.

Perspectives of the disability people:

The strength based model is very practical for the disabled. Client empowerment is a central theme to this approach. To empower a client, the evaluation must be made to the disabled person and thus the achievable goals will be made along with the evaluation so a well-organized plan will be carried out to achieve the goals and the possibility of the success will hopefully be very high. Critics of the strength perspective suggest this is simply reframing problems in a better light. No one will succeed while being convinced that they will fail.

Perspectives of the disability people:

The case management model is widely used in our lives and it’s easy to be carried out. The perspective is that this model will be continuingly development and improved during the practice in reality. It will play a main role in the recovery or dealing with the disability problems. The potential ability and interests will be found during the process of the treatment so there will be a bright future of this model.

Summary of the expected outcomes for the disabled:

For the case management model, the client’s life is fulfilled and interesting than before. Also this is very good for the psychological development like the strength based model. And it will be a big contribution to the arrangement of the arrangements of the physical therapy. But this model is not good for finding an occupation for the client and it is easy to make the client depend on others.

Comparisons of the two models

The strength based model focus mainly on developing and finding the client’s strengths and abilities and makes a plan based on this. However the case management model is a bit similar to the strength based models as they both respect the needs of the clients. But the case management model focus on the hobbies of the client and encourage them to attend relative activities so that the purpose of treatment is achieved during the community time. Comparing with the strength based model, the case management model plan is relatively fixed because the client’s hobbies and preference are stable but the strength based model is very flexible and keep changing with the client’s condition. The two models also have difference with the coordinating part. The strength based models need a high level of coordinating between the client and the case management however the case management model requires a good relationship between the activity coordinator and the client as well as the relationship among clients. If the clients have mental goals we suggest that they choose the strength based model but if the client has the needs of physically requirement then we’d better use the case management model for her.

Review of databases on social care, psychiatry, and psychology revealed various strategies for preventing sexual abuse in people with intellectual disabilities. These procedures generally seem to fall into one of three broad categories: therapeutic measures, designed to minimise the effects of abuse; education and training for staff, victims and/or family members (e.g. parents); and multi-agency information sharing.

Kroese and Thomas (2006) tested the value of Imagery Rehearsal Therapy (IRT) for treating sexual abuse trauma in learning disabled people experiencing recurring nightmares. The intervention produced a statistically significant reduction in distress. Furthermore, these positive effects seemed to endure even when participants were awake. Several studies have evaluated the merits of ‘support groups’ for victims of abuse (e.g. Singer, 1996; Barber et al, 2000). For example Singer (1996) organised ‘group work’ for adults living in a residential home. The aim was to teach these individuals how to respond assertively in situations of abuse. Assertiveness is an essential skill for victims who often fail to challenge authority, due to low self-esteem, fear, dependency and lack of awareness of their rights (MENCAP, 2001). Participants learned to respond more assertively when role-playing situations that involved sexual abuse. However, role-play scenarios often lack the stressful conditions of real-life that may prevent an individual from speaking out. Nevertheless, support groups may provide a valuable therapeutic resource for victims of abuse (Barber et al, 2000).

The National Association for the Protection from Sexual Abuse of Adults and Children with Learning Disabilities (NAPSAC^[1]) identifies the sharing of information between protection agencies as a valuable prevention strategy (Ellis & Hendry, 1998). Based on data from a survey of individuals and organisations involved in social care, Ellis and Hendry (1998, p.362) emphasised the need for a “foundation level of awareness” between specialists in learning disability and those involved with child protection. Lesseliers and Madden (2005) report the establishment of a ‘knowledge centre’ to encourage systematic exchange of sexual abuse information, which is accessible to both victims and specialists (also see Stein, 1995). The problem with information sharing schemes is that they primarily benefit service providers (e.g. expanding their knowledge of available therapies), rather than the victims themselves. Finally, several studies have tested the efficacy of education and training programmes, targeted at staff, victims, and/or family members (e.g. Martorella & Portugues, 1998; Tichon, 1998; Bruder & Kroese, 2005). Bruder and Kroese (2005) reviewed clinical studies that evaluated the value of teaching protection skills to learning disabled adults and children. Findings revealed that adults could be successfully taught such skills, although the generality and longevity of these abilities was questionable. Martorella and Portugues (1998) conducted workshops with parents, based on the premise that prevention is best achieved by making family members aware of sexual issues concerning their children. Parents were provided with printed materials and videos on puberty, childhood sexual fantasies, and other related topics. Following these sessions many parents re-evaluated their children, and demonstrated a renewed urge to support and protect their children. Overall, training and education schemes seem to have immediate albeit short-lived psychological benefits, for both the victim and their families.

Discuss the Similarities in “Vulnerable Adult Sexual Abuse” and “Child Sexual Abuse”

There are similarities in terms of the reasons why disabled people are susceptible to abuse (MENCAP, 2001), psychopathological and social effects of abuse (Sequeira & Hollins, 2003), consent issues, and protection requirements (DOH, 2002a, 2002b). The MENCAP (2001) report identifies seven reasons for increased vulnerability in adults, most of which may equally apply to children; they include low self-esteem, long-term dependency on carers, lack of awareness, fear to challenge authority, powerlessness to consent to sexual relationships, inability to recognise abuse when it occurs, and fear of reporting incidents of abuse. These concerns are compatible with factors the National Society for the Prevention of Cruelty to Children (NSPCC, 2002) implicates in child vulnerability. They include: children’s lack of awareness and education; a learned reluctance to complain; dependency on carers, which can make it difficult for a child to avoid abuse; and general disempowerment. Whereas factors such as fear of authority and low self-esteem may be ambiguous, and hence difficult to detect, long-term dependency on a care giver is a much more tangible characteristic that increases susceptibility to abuse, in both adults and children. The risk may be higher in children because their level of dependence is usually more extreme. However, severely impaired adults may also be highly dependent on another person for their day-to-day care (MENCAP, 2001).

In their review of the literature on the clinical effects of sexual abuse in intellectually disabled people, Sequeira and Hollins (2003) found that both children and adults exhibited behavioural problems, sexually inappropriate behaviours, and various forms of psychopathology. However, some evidence suggests that children may be more ‘overwhelmed’ by the experience of sexual abuse, often with long-term and harmful consequences for mental health (Green, 1995). Moreover the damaging effects of sexual abuse may be compounded in both adults and children when the abuser is known to the victim (e.g. family member). However, Sequeira and Hollins (2003) warn against drawing conclusive inferences regarding the clinical impact of abuse on disabled populations. Firstly many studies rely on ‘informants’ (e.g. family members) for their data, many of whom may be ignorant of the internal psychiatric and cognitive trauma that a disabled person might be experiencing. Thus, any apparent similarities between children and adults in how they respond to sexual abuse may not reflect less obvious discrepancies in psychopathology. Sequeira and Hollins (2003) emphasise the need for more reliable diagnostic criteria.

The MENCAP (2001) report stresses the issue of consent. Both children and adults often lack the ability to give consent albeit for different reasons. Children may simply not have any understanding of sexual activity, its consequences, and how to distinguish sexual behaviour from other forms of physical contact (e.g. hugging) and personal care (e.g. bathing). Although most adults will have a better grasp of sexuality, some may be unable to give consent if their learning disability is extremely severe. Regardless, adult and child sexual abuse denotes a lack of consent. Furthermore, both forms of abuse may require similar safeguards. There is a mutual need to create more awareness amongst the general public about the vulnerability of people with learning disabilities (NSPCC, 2002). Community building, staff training, and other protective measures will benefit both children and adults (Ellis & Hendry, 1998; Barter, 2001; Davies, 2004).

Can the “Keeping Safe” Child Protection Strategy Work with Adults with Learning Disabilities?

The Department of Health has made various recommendations for “keeping children safe” (DOH, 2002a). These include: having a sound statutory framework; encouraging professionals from different specialities/agencies to work together; assessing children’s needs and the range of support services provided by organisations and community groups; considering the impact of strategies designed for vulnerable adults on children; involving both children and family members in making decisions about what services the child needs; monitoring how well councils are delivering the system; and recruiting, training, and supervising adequate care staff. These proposals are a direct response to the Victoria Climbie Inquiry report. Overall they emphasise risk assessment, recognition of abuse, and information sharing, consistent with other published literature (e.g. Ellis & Hendry, 1998; Lesseliers & Madden, 2005). By contrast, the Department of Health prescribes a different set of guidelines for adults, referred to as the Protection of Vulnerable Adults Scheme, or POVA (DOH, 2004). Central to the scheme is the POVA list: “Through referrals to, and checks against the list, care workers who have harmed a vulnerable adult, or placed a vulnerable adult at risk of harm, (whether or not in the course of their employment) will be banned from working in a care position with vulnerable adults. As a result, the POVA scheme will significantly enhance the level of protection for vulnerable adults” (DOH, 2004, p.5). The POVA system is supposed to complement other schemes, such as MENCAPS “behind closed doors” plan (MENCAPS, 2001).

The child protection scheme can be adapted to work with adults. Many child safety measures focus on staff performance (e.g. working together, recruitment, training). For example, it is a requirement that staff are trained sufficiently to recognise “whether a child’s injury or illness might be the result of abuse or neglect” (DOH, 2004, p.7). By implication, it should be possible to modify training protocol so that staff can also identify sexual abuse in vulnerable adults. For example, Lunsky and Benson (2000) identify some issues to be considered when interviewing developmentally disabled adults about sexual abuse, notably the appropriateness of using detailed drawings and dolls used in assessing children (Martorella & Portugues, 1998). Proposals designed to help identify the need for protection and facilitate information sharing, such as community “neighbourhood watch” arrangements, can be extended to adults. What modifications would be required? MENCAPS (2001) highlights the need for a suitable mechanism for establishing consent between adults. Vulnerable adults have the same sexual rights and privileges as the general population, and these rights have to be accommodated within any protection strategy. Staff training on child protection can include guidelines for identifying adults who are able to give consent to sexual relations (e.g. suggesting appropriate tests to use), and protecting those who can’t. Additionally, MENCAPS (2001) emphasises the need to “tighten standards for people who work with adults” (p.16). The POVA scheme is set up precisely to address this issue, albeit retrospectively, after abuse has occurred (DOH, 2003). Improvements in staff recruitment, training, and monitoring can be implemented that benefit both children and adults.

Bibliography

Barber, M., Jenkins, R. & Jones, C. (2000) A survivor’s group for women who have a learning disability. British Journal of Developmental Studies, 46, pp.31-41.

Barter, K. (2001) Building community: a conceptual framework for child protection. Child Abuse Review. 10, pp.262-278.

Bruder, C. & Kroese, B.S. (2005) The efficacy of interventions designed to prevent and protect people with intellectual disabilities from sexual abuse: a review of the literature. Journal of Adult Protection, 7, pp.13-27.

Davies, L. (2004) The difference between child abuse and child protection could be you: creating a community network of protective adults. Child Abuse Review. 13, pp.426-432.

DOH (2002a) Safeguarding Children: A Joint Chief Inspectors’ Report on Arrangements to Safeguard Children. London. DOH.

DOH (2002b) No secrets: The Protection of Vulnerable Adults from Abuse: Local Codes of Practice. London. DOH.

DOH (2004) Protection of Vulnerable Adults (POVA) scheme in England and Wales for care homes and domiciliary care agencies: A Practical Guide. London. DOH.

Ellis, R. & Hendry, E.B. (1998) Do we all know the score? Child Abuse Review. 7, pp.360-363.

Green, A.H. (1995) Comparing child victims and adult survivors: Clues to the pathogenesis of child sexual abuse. Journal of the American Academy of Psychoanalysis and Dynamic Psychiatry. 23, pp.655-670.

Kroese, B.S. & Thomas, G. (2006) Treating chronic nightmares of sexual assault survivors with an intellectual disability – two descriptive case studies. Journal of Applied Research in Intellectual Disabilities, 19, pp.75-80.

Lesseliers, J. & Madden, P. (2005) European Knowledge Centre for the Prevention of and Response to Sexual Abuse of People with a Learning Disability. Learning Disability Review, 10, pp.18-21.

Lunsky, Y. & Benson, B.A. (2000) Are anatomically detailed dolls and drawings appropriate tools for use with adults with developmental disabilities? A preliminary investigation. Journal-on-Developmental-Disabilities. 7, pp.66-76.

Martorella, A.M. & Portugues, A.M. (1998) Prevention of sexual abuse in children with learning disabilities. Child Abuse Review, 7, pp.355-359.

MENCAP (2001) Behined Closed Doors: Preventing Sexual Abuse Against Adults with a Learning Disability. London. MENCAP

NSPCC (2002) Disabled children and abuse [online]. London, NSPCC. Available from: [Accessed 10 March 2006].

Sequeira, H. & Hollins, S. (2003) Clinical effects of sexual abuse on people with learning disability: Critical literature review. The British Journal of Psychiatry, 82, pp.13-19.

Singer, N. (1996) Evaluation of a self-protection group for clients living in a residential group home. British-Journal-of-Developmental-Disabilities. 42, pp.54-62.

Tichon, J. (1998) Abuse of adults with an intellectual disability by family caregivers: the need for a family-centred intervention. Australian Social Work, 51, pp.55-59.

1

Identify and reflect on potential strategies for addressing oppression and unfair discrimination encountered in community care for adults. Examine the implications of this process for a social worker value base.

The Audit Commission report of 1986 and the Griffiths report 1988 emphasised the need for care to become consumer-led; traditionally state run services were quickly contracted out to private and voluntary sector providers. Value-for-money became key, and community care became the favoured option over and above residential care (Blakemore, 2003). Some argued that social work values became secondary to resource-led decision-making (Banks, 1995).

Negative discrimination can be defined as the attribution of negative traits or features with regard to an individual, or a group of people (Thompson 2003). Generally negative discrimination relates to social and biological constructs and can be based upon a multitude of characteristics, such as gender, race, sexual orientation, disability, class, age and so on. Negative discrimination creates situations that can lead to oppressive practices, which is defined by Thompson (2001) as:

“Inhuman or degrading treatment of individuals or groups; hardship and injustice brought about by one group or another; the negative and demeaning exercise of power” (pg 34)

The core principle of the NHS & Community Care Act 1990 was to give people the choice, where possible, being cared for in their own home (Blackmore, 2003), and the social care field was opened to market forces; services users became consumers. However, the purchasing power of service users is disparate, dependant upon social, economic and individual variables. Adults partaking in community care are particularly vulnerable to oppression where there is an imbalance in the distribution of financial or other material resources; economic status can create real disparities in the standard of care received. Service users will often find their financial resources are controlled by their carers, placing the carer in a powerful position and disempowering the service user. This can be countered by being very open with the service user and avoiding “closed” decision-making and mystery (Topps, 2001). The service user should be involved at all levels of decision-making regarding resources. The Community Care (Direct Payments) Act 1996 is encouraging as it allows local authorities to make direct payments to service users, enabling them to arrange and pay for their own care package. This is a positive step forward in empowering community care service users.

It is also important for practitioners and carers to consider their use of language and its potential effects. Dehumanizing and medicalised language can result in a loss of esteem and a sense of disempowerment for the any service user, particularly those with intellectual impairments who maybe less able to understand medical terms. This can be prevented by avoiding jargon and providing lots of opportunities for questions and open discussion. Carers and social services staff should continually check themselves for use of infantilising language and ensure they engage in mature, adult discourse with service users. An example of dehumanizing language that is still used regularly in care setting is the term “manual handling”. Many physically impaired service users have reported this term as degrading (Elder-Woodward, 2001), as the implication is that the person is an object to be handled. The term “moving and assisting” is more widely accepted now.

We should also consider the power that is implied through the assumption that “professionals” have superior medical knowledge, skills and expertise in relation to the community care service user. Often, care plans are based upon the medical model; the impairment is seen as the problem and the service users dependence is emphasized (Adams et al, 2002). Thompson (2001) says social work should take a “demedicalised” stance and look past the pathology, utilizing the social model of disability as described by Adams et al (2002). The social model suggests the service users needs should be considered in a much wider context, ensuring their social and mental health are given equal consideration to their medical needs. Viewing societal constraints as the problem, and not the individual, creates the frame of mind to consider how to remove barriers to mainstream social, political and economic life. Social workers should liase with service users and look towards a solution-focused (not impairment-focused) care plan whereby barriers are identified and solutions sought collaboratively, utilizing strengths.

Social workers are trained to critically reflect on their practice to ensure they continually monitoring their reactions to, and engagement with, service users. Critically reflective practice is crucial in anti-oppressive and anti-discriminatory work. Until recently, community carers were not trained in such practice and therefore were more likely to repeat oppressive practices over and over as they maybe not be aware of the implicit discriminatory messages of some behaviours. The issue is tackled by new regulations, which require all paid carers to hold an NVQ qualification. The NVQ requires carers to consider issues of discrimination and oppression, and look at significant elements of their own identity. It is important this training is followed up by regular supervision and support (Thompson 2003). Care can be stressful, and it is crucial that steps are taken to minimise pressure, where possible, and for managers/social workers to take the opportunity to debrief with carers as necessary.

The ability to identify and promote non-discriminatory and anti-oppressive practice and procedure is a focal point of the social work value base (Training Organisation for Personal Social Services, 1989). Social workers must maintain awareness of the value base by using a variety of strategies to ensure service users are not discriminated against. The aforementioned strategies mean the social work value base is referred to, and reflected upon on a regular basis; it makes it a working, “live” document. All of the aforementioned strategies are referred to within the value base as issued raised by service users.

Anti-discriminatory and anti-oppressive practices are once again key focus areas for social workers and carers alike. It is encouraging that all workers are required to consider such issues within their training and as part of their value base, and steps are being taken to empower service users by facilitating the co-ordination and funding of their own care package. It remains the case that many care-receivers live with friends/family, who ultimately are in a position of considerable power over the service user, which can lead to oppression and discrimination.

References

Adams, Robert et al (eds) 2002 Critical Practice in Social Work. Basingstoke, Palgrave.

Banks, S (1995) Ethics and Values in Social Work. Macmillan Press LTD, London

Blackmore, k (2003) Social Policy: An Introduction. 2^nd Ed. Buckingham, Open University Press

Elder-Woodward, J (2001) Making Sense of Community Care – Recent Initiatives: A service user’s perspective; or, Farewell to Welfare – The perspective of an ungrateful bastard. Retrieved 16^th August 2005 from: http://www.leeds.ac.uk/disability-studies/archiveuk/elderwood/CCPS paper3 (Times12).pdf

Thompson, Neil (2001) Anti-discriminatory Practice 3^rd Ed. Basingstoke, Palgrave.

Thompson, Neil (2003) Promoting Equality: Challenging Discrimination and Oppression 2^nd Ed. New York, Palgrave

Training Organisation for Personal Social Services (2001) National Occupational Standards for Social Work. Topps, Leeds

Schizophrenia is a mental illness with symptoms like delusions, hallucinations, disorganized speech and behaviour, and inappropriate emotions (Barlow & Durand, 2009). These symptoms would distort an individual’s living to a certain extent. For example, the irrational thoughts may result in communication problems. In fact, not only do the symptoms of schizophrenia affect an individual, stigmatization of people with schizophrenia also has profound effects on those people with schizophrenia.

Stigma is the general negative attitudes towards a certain group of people (Schneider, 2004). Many scholars suggested that people with schizophrenia are highly stigmatized (Chang & Johnson, 2008; Gingerich & Mueser, 2006; Prior, 2004). They are generally described as depressed, unpredictable, violent, dangerous and aggressive (Chang & Johnson, 2008; Schneider, 2004). Although these may be true for some cases, it is believed that there is overgeneralization of the situation. The situation would also be worsened by the media (Chang & Johnson, 2006), which sometimes connect schizophrenia to violent acts. For example, a person with schizophrenia would be more likely to be a murder. These negative views would trigger discrimination on people with schizophrenia.

Schneider (2004) suggested the labeling theory to explain why people with mental illness behave in the way that the general public describes as dangerous and violent. He explained that they act as dangerous and violent just because they are stigmatized and play out their assigned roles. Therefore, it can be seen that they may actually be socialized to behave in those ways instead of behaving naturally.

It should be noted that people are not only stigmatized while they are suffering from schizophrenia. A research was done by Cheung and Wong (2004) with 193 people in Hong Kong on the perception of stigmatization on people with mental illness. The result shows that the majority agrees with the fact that “most people believe that someone with a previous mental illness is untrustworthy and dangerous”. Schizophrenia, being one of the mental illnesses, is of no exception. The implication of this research is that stigmatization on people with schizophrenia is a life-long issue, from the onset of the disorder until the end of one’s life.

Gingerich and Mueser (2006) suggested that stigma on people with schizophrenia may make others feel fear of and avoid interacting with those people. This fear and avoidance would in turn reduce the interaction between people with schizophrenia and the public and there would be less opportunity to change the stigmatizing beliefs (Gingerich and Mueser, 2006).

Holmes and River (1998) introduced the concept of social stigma and self-stigma. The aforementioned are social stigma as the general public stigmatizes those with schizophrenia. Chang and Johnson (2008) suggested that there are social messages delivered in the stigma which may lead to self-stigmatization of an individual. This further stigmatization would cause even more negative effects on oneself.

Effect of stigmatization on people with schizophrenia

As suggested by Tsang, Tam, Chan and Cheung (2009), stigmatization prohibits mentally ill people from recovery. Regarding situations in Hong Kong, Tsang et al. (2009) found from a survey that 80% of respondents thought social stigma has negative consequences towards mentally ill people. Compared with the high percentage, much less respondents considered social stigmatization unacceptable. Which means quite a number of people tolerate or accept stigmatization even though they know the impact brought. Other figures found by Tsang et al. (2009) also revealed the severeness of stigmatization in Hong Kong. For example, one fourth of respondents are hesitate to accept people with mental illness and about 30% of respondents oppose mentally ill elderly into elderly home. These thoughts and stigmatizations contribute to the effects brought by schizophrenia and make it more serious in Hong Kong.

There is no doubt that stigmatization poses negative consequences on people with schizophrenia throughout their life. Chan, Mak and Law (2009) confirmed the point above after reviewing a lot of literatures. Firstly, it imposes constraints in daily living on those with schizophrenia. Moreover, it may lead to lower self-esteem, reduced life satisfaction and social adaptation. It also hinders help-seeking behavior. Apart from the above impacts, Corrigan (1998) also suggested that stigmatization would lead to discrimination, followed by loss of social opportunities as members of society withhold the chances related to work or income. Thus lead to poor quality of life.

It should be noted that the psychological, social and biological aspects cause the negative consequences and they are interrelated. Socially, negative attitudes towards people with schizophrenia inhibit the employment opportunities (Corrigan, 1998). The claim is also supported by the finding by the Equal Opportunities Commission (1997) in Hong Kong. It stated that the mentally ill people’s employment rate is low (around 30%). The unemployment problems may trigger a lot of other problems. It is obvious that unemployment causes financial problems. It also places burden on clients’ relatives. Moreover, as stated by Mowbray, Bybee, Harris and McCrohan (1995), “employment offers opportunities for social interaction, builds self-esteem and identity, and is the best predictor of recovery and social integration”. However, without a job, there may be disappointment and self-blame of being a burden to the family or being incapable to earn a living. The psychological aspect of the people is thus affected and may reduce life satisfaction.

Tsang et al. (2003) also suggested that stigmatization not only affect the individual but also his family or social network. An example illustrated is that a large number of people would change seats in public transport when sitting next to people who appear to have mental illness. When going out with the mentally ill people, their relatives or families would feel embarrassed. Thus their emotions are also affected. And because of the stigmatization of experiences that irritate the mentally ill people, they may isolate themselves. The family is also likely to conceal their illness because they feel ashamed of the schizophrenic people. This is particularly true in Hong Kong as Chinese stresses the importance of collective representation of families (Tsang et al., 2003). This further prohibits the individual from interacting with other people. Because of the isolation, the individual is not quite possible to seek help from other. Without social support and social resources, the schizophrenic people are hard to adapt to the environment. This forms a vicious circle and the situation may become worse.

Biological aspects may also increase the seriousness of stigmatization. Age of onset of mental illness may be an important factor. If a person is mentally ill since he/she was young, his/ her social network would narrow down as there may be discrimination and isolation. Thus the support is limited. Moreover, if the person suffers from schizophrenia during college or secondary school, his/her education is not competitive enough in Hong Kong as there are more and more students receiving tertiary education (Census Department, 2005). With the mental illness and lower than average academic achievement, they face a lot more difficulties in employment.

Interventions

It can be seen that stigmatization causes many negative effects on people with schizophrenia. Therefore, it is necessary to reduce the stigma on them. However, there should be some consideration when intervening in the situation. Chiu, Chui, Kelinman, Lee and Tsang (2006) pointed out that those interventions which focus on changing public’ attitude towards schizophrenia are actually isolating those stigmatized to be a group that deserves special treatments. This in turn reinforces the stigmatization. Chiu et al. (2006) also stressed that there may be the possibility of making those stigmatized more aware of the fact that they are being stigmatized. They may become hopeless about changing the current situation and just conform to the stigmatization.

Hong Kong has actually taken some actions to intervene in the stigmatization on people with schizophrenia. However, it seems that the actions taken are not quite effective in reducing the stigma. For example, “psychiatrists changed the Chinese term for schizophrenia from “splitting of the mind to “perceptual disorder”” (Chiu et al., 2006, p. 1694). However, Chiu et al. argued that the new term was re-stigmatized quickly after a short period of time.

Besides changing the name, there have been anti-stigma programmes which promote a sense that “schizophrenia is an illness like any other” (Davies, Haslam, Read & Sayce, 2006). Davies et al. (2006) pointed out that these programmes failed to reduce the stigma as they deliver the message that individuals cannot control themselves when they are suffering from schizophrenia. This makes the public feel that those with schizophrenia become even more unpredictable and thus increasing the stigma.

As it has been mentioned, stigma on people with schizophrenia can be divided as social stigma and self-stigma. Therefore, interventions at both community and individual level are needed to reduce the stigma on people with schizophrenia.

For the community level, Gingerich and Mueser (2006) suggested letting people understand more about the situation instead of changing how they think about the situation directly. One common but effective way is education (Gingerich & Mueser, 2006). Education allows people to develop a better understanding on schizophrenia, for example, the cause, effects and treatments. They may be able to view psychiatric symptoms as understandable psychological or emotional reactions to life events, thus reducing the fear on people with schizophrenia (Davies et al., 2006). A research done by Chan et al. (2009) discovered that it is more effective in reducing stigma on schizophrenia if there is a lecture about schizophrenia followed by a video show which includes real cases of schizophrenia. They explained the effectiveness of the education-video model as allowing participants to get enough information and background before having deeper processing of the video.

It is suggested that there was little or no organized advocacy by psychiatric patients to strive for their own interest (Chiu et al., 2006), like legislation and resource allocation on people with schizophrenia. Besides, it is suggested that poor treatment of schizophrenia may intensify the stigmatization of schizophrenia (Prior, 2004) because people may over-generalize those small group who are poorly treated and have adverse symptoms as the majority of people with schizophrenia. Advocating for the improvement of services for people with schizophrenia can thus help to reduce stigma by allowing better recovery. Besides, services like employment assistance can help integrate them in society and allow them to develop a social network (Prior, 2004).

For individual level, treatments like medication, psychosocial education (Chang & Johnson, 2008). In addition, family cares and supports are important to reduce stigma on an individual with schizophrenia (Chang & Johnson, 2008; Gingerich & Mueser, 2006) as it is the first system that the individual would situate. If the family is a supportive one, it is more likely that the individual would be less self-stigmatized.

In conclusion, stigmatization poses great impacts on individuals with schizophrenia and their families. These impacts included reduced life satisfaction and social adaptation. Unemployment is also an important factor that affects social and psychological functioning of people with schizophrenia. On the other hand, interventions should not focus on changing public’s attitude towards people with schizophrenia. Instead, it should focus on letting people understand more about schizophrenia and providing supports to people with schizophrenia. In the community level, there can be education and advocacy. In the individual level, there can be medication, psychosocial education and family support.

The Stigma of Mental Illness in Developing Countries

Seeking treatment for mental illness can be a daunting task. Even in the United States, where medical care is relatively easy to obtain, there is a stigma surrounding mental illness. In my own experience of living in a small, close-knit community, I found it nearly terrifying to talk to my primary care physician about the anxiety and depression I was experiencing. In my town, parking my car at the counseling center was like admitting that I couldn’t take care of myself. The common perception in the community was that people need to ‘suck it up’ and not rely on doctors or therapists to get through life. With this clear and prevalent stigma against mental illness and treatment, it took me years to finally get the help that I needed. This issue of stigma was still on my mind when I started looking for a topic for this research project. I was curious about how non-Western and developing countries viewed the issue and what was being done to help lessen the stigma of mental illness worldwide.

What is Stigma?

In order to take a close look at mental health stigma in cultures around the world, we first need to understand exactly what is meant by ‘stigma.’ The dictionary definition of stigma is ‘a mark of disgrace or infamy; a stain or reproach, as on one’s reputation’ (Dictionary.com). This is a good place to start, but it does not accurately define the measurable aspects of stigma, which is necessary for researchers to be able to study it. Link et al. (2004) discuss several theoretical perspectives for stigmatization in general and the stigma of mental illness in particular. Most useful for the purposes of this paper is the framework laid out by Link and Phelen (2001) and discussed and elaborated upon by Link et al. (2004) that suggests several interrelated categories: labeling, stereotyping, separating, emotional reactions, status loss, and stigma’s dependence on power structure. Labeling is a natural way that humans categorize differences, and many labels (shoe size, favorite foods) are not socially salient. Other labels, such as sexual preference or nationality, are much more relevant. ‘Both the selection of salient characteristics and the creation of labels for them are social achievements that need to be understood as essential components of stigma’ (Link et al. 2004). In the stereotyping component, the researchers suggest that the labeled differences are linked to negative assumptions about the labeled person or others with similar characteristics. The next aspect of the ‘stigma process’ is separating, which is the ‘us versus them’ mindset. Link et al. (2004) suggest that one place the initial conceptual framework about stigma is lacking is in the underrepresentation of emotional reactions: ‘We believe that this underrepresentation needs to be corrected, because emotional responses are critical to understanding the behavior of both stigmatizers and people who are recipients of stigmatizing reactions.’ Status loss and discrimination can be overt, like refusing employment to someone with a mental illness, but it can also be much more insidious and pervasive. Link et al. (2004) gives the example that considerably less funding exists for schizophrenia research and facilities for schizophrenia treatment are often located in less desirable locations. The final aspect of the stigma framework is its dependence on power structures ‘ Link et al. (2004) state that this aspect is very important because without social, cultural, economic and political power the concept of stigma would be much less useful.

Now that we understand at least one way in which stigma can be defined, we must next go about looking at the ways stigma is measured. Link et al.(2004) state that there is a considerable lack of study of mental illness stigma in the developing world ‘ they reviewed a large number of studied conducted worldwide, and found only a few in Asia and Africa, though the researchers did clarify that this might have been because their review was restricted to English language journals. This paper will focus on a few key studies, but it is certain that more study in this area is needed to get an in-depth look at differences between cultures and the relative stigma of mental illness.

Some studies focus on the stigma of the general population towards those with mental illness, while others focus on the opinions of people who suffer from mental illness. One survey I found to be particularly interesting and useful is the World Mental Health Survey, in which subjects with mental health issues were asked about their perceived stigma (Alonso et al. 2008). For this survey, stigma was considered to be present if respondents reported both embarrassment and perceived discrimination related to illness. Among people with significant activity limitations (i.e., at least moderate difficulty with cognition, mobility, self-care, or social), the perceived stigma rate was highest in the Ukraine, with 32.1% of respondents reporting stigma. The lowest rate was 3.2% in Germany. The average rate of perceived stigma in developing countries was 22.1%, compared to 11.7% in developed countries (Alonso et al. 2008, Table 1). The researchers’ finding was that perceived stigma associated with mental disorders is universal, but considerably more frequent in developing countries; however, the implications of this finding were not discussed, though they suggest ‘it may be of interest to investigate social, cultural and health service characteristics that differentiate countries in which patients feel less excluded from countries in which patients are more likely to report perceived stigma (Alonso et al. 2008:312). The researchers also found that ‘perceived stigma is strongly associated with common mental disorders, particularly with comorbid mood and anxiety’ (Alonso et al. 2008:306). The implications of this survey are twofold: first, developing and developed countries have different ways of associating stigma with mental illness, although the reasons for this are not clear. Second, people with mental illness are much more likely to perceive stigma relating to illness than, for example, people with chronic physical ailments. Most interesting to me is the fact that the statistics from Alonso et al.’s (2004) study shows that developing countries have nearly double the rate of perceived stigma as developed countries.

Studies of Stigma in Developing Countries

Lauber and Rossler (2006) conducted a review of literature that summarizes results of research on the stigma of mental illness in developing Asian countries. They state that this research is very important because ‘The stigma of mental illness and discrimination against mental patients are believed to be a significant obstacle to development of mental health care and to ensuring quality of life of those suffering from mental illness’ (Lauber and Rossler 2006: 158). They provide a clear discussion of how they defined developing and developed countries:

‘A developing country is a country with a low-income average, a relatively undeveloped infrastructure and a poor human development index when compared to the global norm’Development entails developing a modern infrastructure (both physical and institutional), and a move away from low value added sectors such as agriculture and natural resource extraction. Developed countries usually have economic systems based on continuous, self-sustaining economic growth’ (Lauber and Rossler 2006:160).

This definition helps clarify some of the general differences between developing and developed countries.

Lauber and Rossler’s (2006) review of literature found that people in developing countries in Asia are generally afraid of those with mental illness. They also found that many studies reported respondents who felt that mental illness symptoms were a normal reaction to stress; this finding suggests that awareness of mental illness and the need for medical intervention is lacking in these cultures. However, the results of these studies are similar to the results in Western countries (Lauber and Rossler 2006). Another finding of this study was in regards to help-seeking behaviors: it is much more likely for those seeking help for mental illness to rely on family members instead of professional mental health services (Lauber and Rossler 2006). I found it interesting that the researchers suggest the differences in mental health care in developing Asian countries is due not only to ‘a different cultural understanding of health and health care,’ but also the stigmatizing attitude of health care professionals as well (Lauber and Rossler 2006).

Gureje and Lasebikan (2005) studied the use of treatment services for mental illness in the Yoruba-speaking part of Nigeria through face-to-face interviews with nearly 5,000 adults. They found that fewer than 1 in 10 people with mental health disorders over the past 12 months had received any treatment whatsoever, compared with 25% in the United States (Gureje and Lasebikan 2005). They also found that respondents who did receive treatment were much more likely to be treated in the general medical sector rather than by a mental health specialist; these results are similar to those found in other developing countries as well as developed nations. Another significant finding was that people with mental illness were considerably less likely to use ‘complimentary health providers’ than those with other non-mental disorders: ‘This observation flies in the face of the common belief that traditional healers provide service for a high proportion of persons with mental disorders in developing African countries’ (Gureje and Lasebikan 2005:48). The authors suggest that many of the problems with mental health utilization in Nigeria result from its inadequate health service personnel and facilities, financial constraint, as well as ‘poor knowledge of and negative attitude to mental illness (both of which are rampant in Nigeria)’ (Gureje and Lasebikan 2005:48). This suggests that in addition to the need for better health systems in developing countries, we also need to address the issue of stigma towards mental health treatment.

Another study in 2005 attempted to look at the existing attitudes towards mental illness in the same Yoruba-speaking part of Nigeria. Gureje et al. (2005) studied over 2000 respondents and found widespread stigmatization of mental illness. The researchers found that respondents were often misinformed about the cause of mental illness with 80.8% stating that mental illness could be caused by drug or alcohol abuse, 30.2% claiming possession by evil spirits as a cause, followed by about equal responses of trauma, stress, and genetic inheritance (Gureje et al. 2005; Table 2). The researchers add that only about one-tenth of respondents ‘believed that biological factors or brain disease could be the cause of mental illness,’ and 9% felt that ‘Punishment from God’ was a possible cause (Gureje et al. 2005).

In addition to the misunderstood causes of mental illness, the researchers found that many Nigerians have generally negative views towards people with mental illness: fewer than half of respondents believed that the mentally ill could be treated outside of hospitals, and only ‘ thought that mentally ill people could work at a regular job. The researchers found that these negative attitudes were equally spread across the socioeconomic spectrum (Gureje et al. 2005). The stigma associated with mental illness in Nigeria is evident in the responses that show ‘most respondents were unwilling to have social interactions with someone with mental illness,’ including fear of having a conversation with or working with a mentally ill person (Gureje et al. 2005:437). 83% of respondents would be ashamed of people knowing that someone in their family was mentally ill, and only 3.4% responded that they could marry someone with a mental illness (Gureje et al. 2005: Table 4). These results support the findings of the World Mental Health Survey that the stigma of mental illness is considerably higher in developing countries than in developed countries, but the research still does not show any distinct variables that could be identified in order to help reduce the associated stigma.

Griffiths et al. (2006) performed a comparison of stigma in response to mental disorders between Australia and Japan, and found some interesting results. This was the only research I found that used similar methodologies to survey the public in two different cultures. Though both Japan and Australia are developed nations, the cross-cultural comparison is relevant to this study. Griffiths et al. (2006) found a significantly higher proportion of the Japanese respondents held ‘stigmatizing attitudes and social distance’ towards mental illness. The authors give several possible reasons for this difference. First, conformity is more highly valued in Japan, so people who deviate from the norm because of mental illness would be more negatively impacted. Secondly, the treatment options in the two countries differ: in Japan, long-term institutionalization is common, while in Australia, community and rehabilitation services are emphasized. The implication is that even among developed countries, significant differences in the rates of stigma and the way it affects a society occur; therefore, any push to combat stigma needs to take into account these cultural differences. The authors suggest that this study may ‘point to ways in which interventions programs for reducing stigma might be tailored for each country’ (Griffiths et al. 2006).

Attempts to Reduce Stigma Associated With Mental Illness

Many countries and cultures have made attempts to reduce the stigma associated with mental illness. Lauber and Rossler (2006) discuss the attempts in some Asian countries to rename schizophrenia in order to reduce the stigma associated with the disease; however, results show that a less pejorative label has little effect on the stigma associated with schizophrenia. Stein and Gureje (2004) suggest the approach of medicalization of suffering, or training healthcare providers to recognize the depression and anxiety that are often related to violence, chronic illness, and poverty ‘ in order for this to be successful, however, overcoming the stigma related to mental health issues is of primary importance. Lauber and Sartorius (2007) states that work towards reducing the stigma of mental illness is very important as a human rights issue: ‘Societal or structural discrimination finds its expression in jurisdiction that restricts the civil rights of people with mental illness in, for example, voting, parenting or serving jury duty, inequities in medical insurance coverage, discrimination in housing and employment, and the reliance on jails, prisons and homeless shelters as the way of disposing of people with mental illness’ (103). They discuss the importance of the normalization paradigm in which people with mental disorders are seen as ‘similar to and not different from other people’ and medicalization, the idea that mental illness is a treatable medical condition rather than a personal defect, in the anti-stigma endeavors (Lauber and Sartorius 2007).

Form (2000) suggests that one important aspect of reducing mental health stigma is to increase what he calls ‘mental health literacy’ or knowledge about mental health disorders: he outlines several education programs that were widespread in the 80s and 90s in the United States ‘ the Depression Awareness, Recognition and Treatment Program and the National Depression Screening Day. These programs received widespread media attention, but their effects have not been studied. Form suggests that one good way to help improve mental health literacy is to target specific populations, such as high school students. However, Form’s research says little about how these ideas would work in developing countries.

In conclusion, a look at the research on stigma associated with mental illness shows significant differences in developing and developed countries, but the reasons for this are still unclear. I had hoped to conclude this research with a set of key differences between high-stigma and low-stigma cultures, but this information, if it exists, was not found. I believe that research on identifying causes for and reducing incidences of the stigma of mental illness is a very important topic in medical anthropology and one I believe will see continued advancement in research in the future.

References Cited

Alonso, J., A. Buron, R. Bruffaerts, Y. He, J. Posada-Villa, J-P. Lepine, M.C. Angermeyer, D.

Levinson, G. de Girolamo, H. Tachimori, Z.N. Mneimneh, M.E. Medina-Mora, J. Ormel, K.M.

Scott, O. Gureje, J.M. Haro, S. Gluzman, S. Lee, G. Vilagut, R.C. Kessler, M. Von Korff, the

World Mental Health Consortium.

2008 Association of perceived stigma and mood and anxiety disorders: results from the world

Mental Health Surveys. Acta Psychiatrica Scandinavica 118:305-314.

Griffiths, Kathleen M., Y Nakane, H. Christensen, K. Yoshioka, A. F. Jorm, and H. Nakane.

2006 Stigma in response to mental disorders: a comparison of Australia and Japan. BMC

Psychiatry 2006, 6:21.

Gureje, Oye, and V. Lasebikan

2005 Use of mental health services in a developing country: results from the Nigerian survey

of mental health and well-being. Social Psychiatry & Psychiatric Epidemiology 41:44-49.

Gureje, Oye, V. Lasebikan, O. Ephraim-Oluwanuga, B. Olley, and L. Kola

2005 Community study of knowledge of and attitude to mental illness in Nigeria. The British

Journal of Psychiatry 2005 186:436-441.

Jorm, A. F.

2000 Mental Health Literacy: Public Knowledge and Beliefs About Mental Disorders. The

British Journal of Psychiatry 2000 177:396-401

Lauber, Christopher and N. Sartorius

2007 At Issue: Anti-stigma endeavors. International Review of Psychiatry. April 2007;

19(2):103-106.

Lauber, Christopher and W. Rossler

2007 Stigma towards people with mental illness in developing countries in Asia. International

Review of Psychiatry, April 2007; 19(2): 157-178.

Link, Bruce, L. H. Yang, J. C. Phelan, and P.Y. Collins

2004 Measuring Mental Illness Stigma. Schizophrenia Bulletin 30 (3):511-541

Stein, Dan J., O. Gureje.

2004 Depression and anxiety in the developing world: is it time to medicalise the suffering?

The Lancet Vol. 364.

stigma. (n.d.). Dictionary.com Unabridged. Retrieved December 1, 2010, from Dictionary.com

website: http://dictionary.reference.com/browse/stigma

The whole world urbanized day to day because of globalization. Every person can go one state to another simply moreover the reason of work, or study. While a person from one different environment or nation work together with another people from a different surroundings, that time they both takes their own social status, culture, nature, believes with them, which are dissimilarity between each other (Google question) As a result, discrimination arises within a people in their working place because every people have different attitude towards the person which may be positive or may be negative. The purpose of this assignment is to discover the problem arise in male dominating workplace which especially faced by women and also analyse the issues and build recommendation for taking action by company as well as provide better solution. This briefing paper focuses the case study of Ms. Rosina Chamar, employee of Dynamic Power Supply International Pvt. Ltd. The business of this company connected to not only in Nepal also running in European countries too. After overview the situation of case, SWOT and PEST analysis has been discussed to solve the problem. At last of the paper, outcomes plus forecasts has been granted for better suggestion.

In this briefing paper, to make clear the difficulties on workplace, Hofstede Cultural Theory and SWOT (Strengths, Weaknesses, Opportunities and Threats) analysis could support a lot to overcome the problems or to meet the best results. Also external factors PEST (Political, Economic, Social and Technical) helps to analyse the Situation and find suitable result.

Terms of Reference

There are many people around the world, who think they are more powerful and superior than other people. This is not result of today’s condition because this happened from the beginning when there were kings and servant, where the very strong people were respected and worshipped while the weak ones were became servant ( Lisa Gayagay, 2009:1). The aim of the assignment is based on the problems which face by the person especially women who are working in place in a male dominating country like Nepal. At first, we all must have to know that stereotypes absorb generations regarding the typical features of the people. Same as prejudice is a manner of the people which can be positive or negative that they show without knowing of the fact. In the case of the sex stereotyping which occurs when persons are judged according to traditional typecast based on gender. Either developed countries or undeveloped counties people have to deal with these types of problems (Prejudice, chapter: 5).

Who I am:

I am a senior counsellor Kritika Gautam. I am working in BK Legal Advice Consultant Pvt. Ltd since 2005. During my working period I have got many knowledge and experience every day. I have got degree from University of Bedfordshire, England in Law and Human Resource Management. So my degree and my working experience help me to get right decision and solve problems. As an advisor, my duty is to take out her in that situation. It’s very essential that an advisor have to solve the client’s problems. During my experience, I have got chance to learn the different problems faced by people because of cultural dominating, traditional dominating. And badly have to say that women are the main target of those kinds of problems.

Who my client is:

My client is Ms. Rosina Chamar. She is working as a financial officer in Dynamic Power Supply International Company in Nepal. She is coming to a multinational company to work from rural community. Because of her talent and graduation level educational certificate she got an opportunity to work with a multinational company. In our Hindu culture, women were blessed as ‘Shakti / Devi’ or power to achieve everything. People were worshipped her vision, sympathy power and even her justice. I have serious difference of opinion with Rosina Chamar’s issues. After hearing her words once, her words struck me. According to my client, in our society we weather treated women like goddess or servants. There are so many examples which show that women have been demoralized, neglected and exploited since the days of caveman. In her case, the first issue is that she has to struggle to stand in male dominated culture where bad languages and sexist jokes which may be norm of man and she needs to consider those types of things. Next point is that a male ego also makes difficult for him to accept a woman from lower cast as his senior even she has the right educational background and credentials (Pushya S, 2009).

What helps my client wishes?

She has come to me for support because she has faced many problems. My client Ms. Chamar, she wishes to get relieve of these problems. To win a male dominating society, she must have to settle in her company. That’s why after facing many difficulties she still working in that company. Either my client is a well educated woman and has 3 years experience in relevant field but unfortunately she has to face problems in her work. And lastly she has to come to me to get idea and advice to solve the problems.

Overview of the situation

In the present situation of our country Nepal, the culture and behaviour of people of town is totally different from countryside. Town become a more modernized and practical. Working in an office is more stressed and have to practical knowledge to do. Also people of the town are totally different from their behaviour, language, outlook and attitude. They have given more priority in group assignment but she has a problem to work together with men. Because she is from low cast and medium family background, her colleagues have negative thinking toward her culture and believe and main thing she is woman. Even town is a place of educated people but the behaviour and thinking of their still same like an ancient period. So, this is a vital problem she has to face. My client first should have to be awake all these situations before taking decision that she will do continue the job or not.

After understanding her all problems, the main problems she faced everyday in her workplace are like the given below and she has to be prepare to get rid from these trouble.

Attitude: – The problem of attitude of men about her is very negative because she is middle class women and she always like to be reserve. That’s why may be her workmates thought that she is unfriendly and self-righteous.

Wages gap: – In every enterprise, women still earning less than their male co-workers. Not only my client, many women around the world had very few rights and also could be sacked from job simply because of their family and social problem like: women had to play a role of mother, housewife. So they have to problem to be a full professional. That’s why even they work hard and active still they get less salary than other equal men. Ms. Chamar also faced same problem of less salary.

Cultural difficulty: – When a woman comes in different society to do something for her future she has to face many problems and the cultural difficulty is one of them. In village most of the families are not allowing to women to work outside the own society, but while coming in town she has to work with different types of men where they have open thinking, culture and environment.

Male dominate: – For better organizational future, company must have to use many type of technique to work. And male and female both are part of good decision making. So my client has to come to work in male dominated society where the male consider as a superior as compare to the female. So it is very hard for man to work with the talented and active female staff. She has a good work experience and knowledge but the man who has top position in the society so they have comparatively hard to follow behind the female.

Social and family connection: – In our Nepalese society women has many social barriers and restricted. She must have to follow social rule and morals. But in city life all have freedom to do anything. And she has problem to accept suddenly this condition in her life because it takes few more time to understand.

Harassment: – The last and serious problem she faced is harassment either sexual or languages. About the cases of sexual harassment (Farler, 1978), it mentions examples of many groups of working women: young/old, professional/labour, and rich/poor. It is endemic but very critical issue to workplace. In the case of my client her co-workers and senior managers wanted to take sexual relation with her and they always try to behave badly and mislead. So she is always afraid from that situation and tried to keep safe self from them.

Geert Hofstede Cultural Dimension:

This prejudice problem is not individual problem because the whole society and world faced these types of problems. Not only had women from Nepalese society, all women around the world directly or indirectly beard this problem. Geert Hofstede recommends a theory to understand the cultural differences between peoples, genders and countries (Prentice Hall-Financial tine, 2002). There are five aspects which help to clear the differences between male and female discrimination in workplace and society.

1. Power Distance Index (PDI)

2. Individualism (IDV)

3. Masculinity (MAS)

4. Uncertainty Avoidance Index (UAI)

5. Long Term Orientation (LTO)

To illustrate above phases of cultural differences the graph of Asian and European countries show these briefly:

Five dimension theories of Professor Geert Hofstede
Power Distance Index:

PDI demonstrate the imbalanced allocation of power between the people. This is a level towards which the less powerful members of organization have to accept and seniors of company distributed this unequally. In this graph, Asian countries have highest PDI with a ranking of 70% compare to European countries average of 40%.The power distance between Asia and Europe indicate the high of inequality of power and wealth between genders within the society and culture and even in organizations.

Individualism:

IDV depends on self ego. In above graph, Asian countries have 55% individualism where as European countries have 80%. These huge difference figures indicate that European people were free minded and self dependent than others. Asian people and European people both have different culture, believes, ethnic and behaviour. Women have social boundaries in Asian countries.

Masculinity:

MAS represents the space between the men`s value and women`s value. In above graph Asian countries have MAS as the lower Hofstede dimension of culture with a ranking of 60% and European average just slightly higher at 70%. It surprisingly shows that not only Asian countries have more men’s value because women of European countries also faced this situation. There is not a huge dissimilarity between Asia and Europe.

Uncertainty avoidance Index:

UAI deals with a people and society towards patience for uncertainty and doubt. It represents that a traditional program its associates to think both comfortable and uncomfortable in open conditions. Where uncertainty is escaping in people of those countries has full of power. In above graph, the uncertainty in Asian countries is 50% and in European countries, it is in 40%.

Long Term Orientation:

A higher LTO could be indicative of a culture that is economical and perseverant on the other hand the short term orientations are deference for believes, rewarding social commitments. The LTO score of Asian countries is 60% and European is 30%. That’s shows the result is Asian are short orientated and European are long term orientated.

Analysis of the situation
SWOT Analysis

After the overview of the situation, it is better to analysis the case through strength, weakness, opportunity and threats condition of my client. Starting from analysis of internal factors:

Strength(S):

– Positive sense on skills and attitude

– Work hard in any situation and strong emphasis on decision

– Power to choose own career path

– Experience on work and optimistic

Weaknesses (W):

– Lack of patient

– Weak communication and fearful mind

-Too trustworthy and always shy

-Soft hearted and never say ‘no’ to others

Other external factors:

Opportunity (O):

-Power of leading staffs and company

-Promotion in very high position

-International working

-Possibility of being example of successful women in society

Threat (T):

-Dissimilarities between genders

-Traditional mind of people and social cultural barriers

-Criticism and prejudice in work

-Issues of cast and fear of self identity

All above mention points clear that she has a good opportunity to take defence on prejudice but her weaknesses stopped her to face challenges. Lack of power and support affect her. That’s why after analysis her internal and external weak points and possibilities, she has more positive points which help to support in her future success and stand for defence of imbalance condition of workplace.

PEST Analysis

It is usually used to build the strategies to search external environment. It helps to evaluate the problems created by external surrounding issues. PEST identifies Political, Economic, Social and Technological factors of macro environment.

Political area has a huge influence upon the regulation of business, society and countries as well. Government has many policies regarding the case like more information and awareness about harassment, gender gap, wages facilities in workplace. Government reinforce and upgrade the systems for monitoring equality in employment (Eurofound, 2009).So, my client has to clear knowledge about government policies and rules.

Economic Factor (E):

In present, women are a large part of the employment. They are involving in every kind of work same as men. Either they both work same kind of work or also women do better than men but women get less benefit and wages than men. But today many human rights- national and international agencies and government policies came aware of that situation. They made rights against discrimination and also granted other minorities protection in the workplace. Therefore, she has to talk with her directors about her problem.

Social Factor (S):

In our Nepalese society, women has treated like second class citizens in work and most those people who are from lower caste. Many people either educated or illiterate have same thinking that the community of ‘Dalit’ (Lower caste) which is not considered part of human society. That’s why these community members generally perform the most menial and degrading jobs. My client Ms. Chamar, she is also from Dalit community. Stereotyping about this cast is they must handle dead animals and also consume their flesh. So this is very critical for her to faced bad thinking of people about her and her caste. Under the Nepalese constitution act (1990), caste discriminations were made a criminal offence and there are many rules about stereotyping and discrimination.

Technological Factor (T):

In worldwide, women tend to have less access to education, training opportunities so prejudice and stereotyping still placed in our society. In the case of Ms. Chamar, she has to develop her communication skills more and try to interact with other social literate persons also developed consumers relation. Because of science and technology covers the entire world so she must has to get more information about universal achievement in science, politics, economy and society.

Solution and Recommendation

After analysis all situation, it could be said that this is not a very big problem to solve. Her internal weaknesses and outside issues, cultural differences in society as well as differences between Asian and European culture, after discussing all these areas I would like to suggest to my client to move towards these recommendation. As an advisor, I came to the solution of her case like these ways:

Improve interpersonal skills and power to face challenges.

It is better to make a union of co-workers for equality rights at workplace.

Planning before taking every action regarding safety and power.

Try to avoid behaviour of tolerance everything.

Interact with diverse professional contacts which help to learning about different culture in company.

Try to know about office policies to determine how to handle harassment.

Ensure that the area which create around you help to keep safe in workplace.

Never tackle the harasser. If they threaten and you fear for safety, go directly to management and directors.

Expand your sensitivity and keep an open mind to diversities.

Make it your goal and exercise commitment and patience to remove stereotyping and type casting in workplace.

Apply effort to challenge to learn from things that hard to understand.

Forecast and Outcomes

Stereotyping and Prejudice is a norm of every people in our culture. It takes still more time to move bad thinking about faiths, castes, cultures, and believes of peoples. It would not be change from effort of one person whole society and nation has to do full exercise to keep safe self from stereotyping and prejudice case.

Here in the case of Ms. Rosina Chamar, she is either well skilled and broad minded but after facing these problems she become more weak, frustrate and helpless. These all happened not by her mistakes because these all came from society, government’s weak policies as well as people’s ancient thinking. There is also fault of Management of Dynamic Power Supply Co. because if they take her problems seriously, she would not be in trouble now. If she will try to be bold and motivate self to avoid her challenges, these problems will be no more. Her threats will decrease automatically. There are so many opportunities she has, so she has to develop her strengths more. And it is better for her if Dynamic gets her problem seriously and take action regarding her problems. If she will get positive support from management no doubt that she will obviously do better work for company.

We live in a culture where families are challenged with problems all the time. Regardless of what the problems may be, families need help developing skills to communicate effectively and strengthen their relationships. While most individual can recognize that their families need help, they frequently are not adequately prepared to help their families make needed changes. Obtaining a Masters of Arts in Family and Consumers Science- Family Studies Concentration will help me to help others prepare for change and ultimately achieve both my short-term and long-term goals.

In the short term, I hope to work my way up to become the Lead Housing Resource Specialist at Community Rebuilders. Currently, I’m a Housing Resource Specialist. This experience has created a passion in me to work in the family studies field and learn more about it. A key component that I have found common among all of my clients is that they all wish they could have been prepared for their problems. That tells me that if my clients had prevention methods in place, their problems may not have been a major problem to begin with. Family Life Education works from the prevention model because it teaches individuals and families how to improve family life and to prevent problems before they occur. Family problems, when they can be addressed through prevention, are less damaging for people and less expensive for society.

My long term goal is to help educate families as an Executive Director of a non-profit agency. While studying for the Masters program, I hope to develop the education and skill-set in order to reach my goals. I want to become an effective and innovative professional who can provide effective education and prevention services for families through services my agency can provide. I want to become an individual of high moral and ethical standards whose agency can function as a change agent in my community.

Studying for the Masters of Arts in Family and Consumer Science- Family Life Education is a wonderful opportunity because I will be able to learn the different parts of the family and learn to see how they function as a whole. The Fundamentals courses should give me the framework, while the advanced courses will provide a more specific training. During study, I will also look to take an internship and/or supplemental classes to help further my experience. It is the ability to understand the many different aspects of the family that will prepare me to accomplish my long-term goal of becoming an Executive Director. Equally important, I hope to learn from my fellow students and share with them some of the lessons I have gained from my experience. The best lesson I have learned while working at Community Rebuilders is to step out of the box and think of new solutions to old problems. These creative moments are what will move a family forward during hard times. I expect that graduate work at Western Michigan University will be demanding, challenging, and exciting, and I look forward to attending. During my time in graduate school, I expect to receive the opportunity to learn, grow, and evolve as a person and a family life educator. I am prepared and look forward to investing myself, my time, and my energy toward earning that degree. I hope I will be allowed to do so at WMU.

TOMARA L. MITCHELL
____________________________________________________________________________________

3841 Yorkland Drive NW Apt. No. 9

Comstock Park, MI 49321

(616)337-1852

[email protected]

Profile

Seeking a position which will enable me to utilize interpersonal and leadership skills to positively impact social issues affecting families. Interact effectively with people of varying cultures, backgrounds and professional levels. Committed to establishing connection and building strong relationships with all people. Skilled at identifying strengths and weaknesses in strategies and in creating compassionate and non-judgmental solutions to problems. Proven to be highly motivated and hard working. Possess excellent time management skills.

Education

Bachelor’s Degree in Sociology/General University Studies- April 2009

Western Michigan University, Kalamazoo, MI

Minor: Social Work

Related Coursework:

Crises and Resilience in Families

Social Work Services and Professional Roles

Social Welfare as a Social Institution

Intro to Culture, Ethnicity, and Institutionalized Inequality in Social Work Practice

Social Work Research Methods

Human Behavior and the Social Environment

Group Community and Organizational Behavior

Child Psychology

Global Ecology of the Family

Employment Experience

Community Rebuilders, Grand Rapids, MI February 2010 -Present

Housing Resource Specialist

Operate assigned rapid re-housing and prevention programs

Assist participants in locating and securing housing of their choice

Assist participants in development of strength-based goal and action plans that promotes permanent housing

Provide counseling and advocacy to participants

Facilitate and coordinate supportive service activities for participants

Serve as an ongoing liaison between property managers and participants

Hope Network, Grand Rapids, MI October 2009 – March 2010

Community Living Support

Provided direct supervision to individuals in residential programs.

Displayed appropriate behavior and teaches life skills to residents.

Provided evaluation and instruction in areas of daily living skills or independent living skills to enhance the residents’ ability to reach his/her highest level of independence.

Muskegon Heights Public Schools, Muskegon Heights, MI, September 2009 – February 2010

On-Call Substitute Teacher

Followed lesson plans, left by the permanent teacher.

Created and maintained a climate of respect and fairness for all students.

Used classroom instructional time appropriately and wisely

Tax Connection Worldwide, Muskegon, MI, January 2009 – March 2009

Seasonal Tax Preparer

Prepared customers federal and state returns

Provided customer service by quickly and effectively processing transactions to ensure return business and customer satisfaction

Answered multi-line phones, greeted customers and performed light clerical work

MOKA Inc., Grand Haven, MI, July 2006 – January 2008

Resident Support Staff

Supporting small groups of developmentally disabled and/or mentally ill individuals in residential setting

Teaching skills with the goal of independent living.

Heritage Community, Kalamazoo, MI, September 2005 – December 2005

Personal Care Assistant

Provided comprehensive, quality patient care in the area’s top retirement community

Used acquired formal knowledge and skills

Represent the concerns of the resident and their family

Collaborate with team members towards the development and achievement of optimal resident goals.

Family and Children Services, Kalamazoo, MI, February 2005 – July 2005

Respite Care Worker

Managed small group home-like setting for children 4 – 17 with severe emotional and/or developmental disabilities

Served as role model, encouraged and supported personal behavioral growth and helped develop professional and life skills

Maintained healthy environment, inventoried and ordered supplies, and complied with local and state regulations

Lowe’s Home Improvement, Portage, MI, July 2003 – December 2004

Customer Service Representative

Provided customer service by quickly and effectively processing transactions to ensure return business and customer satisfaction

Informed customers of new items and promotions that were available to improve the customer shopping experience

Completed paperwork, handled cash, answered phones, and transferred calls when needed.

Muskegon Heights Public, Muskegon Hts., MI, September 2001 – July 2002

Office Assistant/ Summer Program Tutor

Answered multi-line phones, greeted customers and performed light clerical work

Acquired high level of communication skills and learned to quickly assess and expedite customer needs.

Ran tutoring sessions on daily basis for elementary aged kids during summer school program

Graded work weekly and tracked individual progress