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Social Work and Criminal Justice: Victims of Violent Crime Analysis

Abstract

This report explores many factors of sexual abuse, specifically sexual exploitation of children. Ethical and policy issues that may affect practice with this population as well as the nature of the violent crimes are some of the factors explored in this report. The sexual exploitation of children is widespread and exists worldwide. Many of these children have long-term effects from sexual abuse that follow them into adulthood. In order to provide the adequate and appropriate treatment to sexually abused and exploited children, one must understand the magnitude of this heinous epidemic that is steadily increasing.

Introduction

The role of a generalist social worker who works with victims of violent crimes is of extreme importance. This is significantly true for social workers working with children who are victims of sexual exploitation. When generally recognized standards do not exist with respect to an emerging area of practice, social workers should exercise careful judgment and take responsible steps to ensure the competence of their work and to protect clients from harm (Reamer, 2010). A generalist social work base provides an existing foundation on which direct intervention, policy formation, advocacy, and networking may be implemented (Herrmann, 1987). Social workers confront child sexual exploitation as school social workers, at runaway shelters, at counseling agencies, and within the court system. The history of the profession provides the precedent for social work’s involvement in ending child sexual exploitation.

Sexual abuse is any sexual activity with a child where consent is not or cannot be given. This includes sexual contact that is accomplished by force or by threat of force, regardless of the age of the participants, and all sexual contact between an adult and a child, regardless of whether there is deception or the child understands the sexual nature of the activity (Zastrow & Kirst-Ashman, 2013). The sexual exploitation of children includes sex trafficking, child pornography, and child prostitution. Exploited children carry the effects of sexual abuse for many years in an agonizing struggle with sexual dysfunction, depression, insomnia, suicide attempts, and self-mutilation.

The population mostly affected by child exploitation is usually children from infancy to adolescence. These children often live in poverty or live in low-income environments. Often, these children lack parental guidance or have parents who are involved in substance abuse. This population is usually the target of sexual abuse. Because of the anxiety most people harbor about sexuality in general, children have little information about sex. They have limited life experience upon which to base judgments. Thus, children can be easily misled or tricked (Zastrow & Kirst-Ashman, 2013). Those who sexually abuse children are referred to as pedophiles. Many pedophiles report a history of sexual victimization as adolescents. Occasionally, many children find themselves blackmailed into adulthood by their exploiters. Not all victims become victimizers. All, however, may experience guilt, confusion, shame, and anger as a result of exploitation (Herrmann, 1987).

Risk Factors of Child Sexual Abuse

Risk factors associated with sexual abuse and the exploitation of children includes the facts that suggest that girls are more likely to be victimized than boys. However, boys are equally as vulnerable as girls. The average age for the abused is between ages 4 and 6 years for boys and ages 11 and 14 years for girls. Children who have disabilities are at greater risk for sexual abuse. These children are more vulnerable and less likely to defend themselves (Zastrow & Kirst-Ashman, 2013).

Nature of Violent Crime

The nature of this particular crime can be heinous. This includes physical abuse, sexual abuse, and power of manipulation. Often, children are profiled and sought for their openness to trust others. The children are misled and manipulated into thinking the perpetrator will provide conditions that are better than their current situation. Children are often beat and drugged then sold into human trafficking. These children are forced in prostitution and forced to participate in horrible sexual acts. This includes intercourse, fondling, pornographic photography, and other unthinkable acts.

Scenario

Angel is a 14 year old African-American girl living in an inner-city neighborhood. Angel has four siblings and both parents are incarcerated for substance abuse. Because of the absence of her parents, Angel and her siblings are cared for by their elderly grandmother. The family does not have much money and often goes without basic needs such as food and clothes. Angel dropped out of school due to the constant judgement and bullying from other students. Without anywhere to go, Angel would often walk the streets to pass away the time.

While hanging out in the neighborhood, Angel was approached by an older man who mentioned he had taken an interest in her. He complimented Angel on her looks and told her that she should not be walking the streets, but pampered instead. Daily, the man would complement Angel and showered her with gifts. She had never been shown this kind of love before and felt she was in love. She was invited to the man’s home for dinner. Although the man was much older, Angel was eager to receive his charm. She agreed to dinner at his home.

On the following evening, Angel met the older man around the corner from her family’s home. She was instantly swept off of her feet. The man arrived in a shiny, red convertible sports car with a bouquet of roses in hand. When she arrived to the man’s home, she was greeted with more flowers, candles, and wine. Although she had never had wine before, Angel felt a sense of maturity and drank the wine. During the dinner, the man told Angel that he was aware of her conditions at home. He promised her that he would make all of her sorrows go away if she allowed him to take care of her. He promised to provide all of her needs and that she will never have to go without any of her basics needs anymore. He promised to shower her with gifts and to show her the world. Angel felt all of her prayers had been answered and that she had met her knight in shining armor. Although the room began to spin and she felt slightly ill, Angel agreed to spend the night with the man. He insists that she should not go home in her condition.

The next morning Angel awoke feeling very ill and confused. She could not remember where she was. Angel’s clothes had been removed and she was chained to a bed at her wrist and ankles. She is in a lot of pain and begins to cry out for help. Angel is aware that her body has been violated and wonders who could do this to her. Although she has been crying for hours, no one answers her cries for help. Eventually, a man she does not recognize enters the room and begins to yell and curse at her. He tells her that no one is going to help her and threatens to hit her if she does not stop crying. Although she tries to control her sobbing, Angel continues to cry. The man kept his promise and began to violently beat her. The violent beating left Angel unconscious and she never saw her knight in shining armour again.

On the following afternoon, again, Angel awoke dazed and confused. She noticed that she was chained to a radiator and had been moved to another location. She was later approached by two men who informed her that she now works for them. She was promised shelter and protection in return for following their orders. Daily, Angel found herself in different locations servicing men for money. Often, Angel would be transported from state to state and advertised on the internet. Although Angel wants to escape the life she was forced to live, she often finds herself drugged, beaten, and far from home. She has no resources and is not allowed to make calls or befriend anyone. Angel feels trapped. She often contemplates suicide and feels that taking her life is the only way out of her lifestyle.

Although Angel’s family attempted to find her, they had no luck. She was reported missing to the police, but dismissed as a delinquent runaway. Months began to pass and Angel became another statistic. Angel is now a part of the child sex trafficking ring. Daily, she is forced into prostitution and forced into a life she should not have to live. This commercial exploitation is the result of the lack of importance given to human rights around the world, the disregard of children’s needs, and the vast amount of money involved (Herrmann, 1987).

Ethical Issues

There are several ethical issues that may affect practice with this population. Although social workers are mandated to report sexual abuse of children, ethical and legal considerations for treatment of sexually exploited children remains an issue. Before treatment begins with the victim, is it appropriate for a practitioner to directly inquire and/or process information with a victim about an alleged offense in a pending criminal matter? To what degree can such inquiry, recounting, or processing of the events in question alter the child’s recollection of what took place (Branaman & Gottlieb, 2013)? Social workers must consider ethical issues of the effects of questioning, retelling, and suggestion on perceived personal experience. These processes operate in all therapeutic settings, but when they arise in the context of treating a child witness, they may influence, if not dramatically alter, a child’s memory (Branaman & Gottlieb, 2013). Also, social workers should be cautious when considering introducing a new treatment approach to these children. New approaches to the profession usually generate controversy among social workers because many unknown issues may arise. Social workers should attempt to locate empirical literature documenting the effectiveness of new approaches. Most social workers will conclude that using a controversial new treatment approach is too risky, ethically and clinically (Reamer, 2010).

Policy Issues

Often, policy issues may affect practice with this population. Child sex abuse issues are handled by state and local authorities, and not by the federal government. This is because of the relationships between the states which have broad authority within their jurisdictions. Unfortunately, the federal government has constitutional limitations on its authority. Because of this matter, the Department of Justice generally has no authority over child sex abuse issues. However, if a child is sexually abused or sexually exploited on federal land, the offender may be prosecuted under federal law in addition to state law. Another policy issue is the statute of limitations in child sexual abuse cases. Every state has a standard suspension of the statute of limitation for legal actions while a person is a minor. Most states have adopted additional extensions for cases involving sexual abuse of children. In the state of Mississippi, victims must file their claim within 3 years of the sexual abuse and/or within 3 years of the victims release from incarceration.

Assessment and Evidenced-based Practices

Treatment and assessment of child victims of sexual exploitation has several objectives. According to Zastrow & Kisrt-Ashman (2013), the first objective is to provide a safe environment where the survivor feels comfortable enough to talk. The survivor must learn to identity, express, and share feeling, even when they are negative and frightening. A second treatment goal is to have the survivor acknowledge that the abuse was no fault of theirs. The third objective involves teaching the child new ways to express their feelings. A fourth treatment goal is to address and special treatment needs of the child. These needs may include medical treatment or behavioral modification programs. The fifth goal is to enhance family communication, support, and understanding of the abuse.

On a micro-level of intervention, practitioners have been known to use several evidence-based treatment modalities when treating sexually abused children. Often, the psychodynamic theory and treatment is used. Psychodynamic theories emphasize the importance of stages of psychosocial development and the unconscious mental processes of human behavior. According to Walsh (2010), in ego psychology, problems or challenges may result from conflicts within the person or between the person and external world. Also, crisis theory and intervention is used. A crisis is defined as the perception or experience of an event as an intolerable difficulty. Crisis intervention represents a strengths approach because it underscores the possibility of client growth, even in horrible situations. The social worker must build upon clients’ strengths in order to help them adapt to, and grow from, the experience (Walsh, 2010).

On the mezzo-level of assessment and intervention, structural family theory (SFT) and intervention is often used. This theory attempts to bring structure back to the family. The focus of the theory is family structure. Family structure is a concept that refers to the invisible and often unspoken rules that organize how family members interact. In this intervention, the social worker is highly directive and directly leads the family’s process of problem resolution. During the intervention of SFT, role plays and role reversals are often employed by practitioners. The role plays are enactments of possible family situations that aim to adjust family interactions. The goal of role reversal is to sensitize family members to the feelings of other members in the family. Also, the Family Emotional Systems Theory is used. The theory provides a comprehensive conceptual framework for understanding how emotional ties within families of origin influence the lives of individuals in ways they often fail to appreciate and may tend to minimize (Walsh, 2010). The theory offers broad intervention strategies with which the social worker can utilize techniques in accordance with a family’s particular concerns.

On a macro-level of assessment and intervention, the ideal way to treat sexual abuse of children is to prevent the events from happening. Information and education are significant factors of prevention. In the community, parents need both education about how to raise children and knowledge that in the event they are in crisis resources are available to help. Special programs could be readily available in the community to help parents with these issues ((Zastrow & Kirst-Ashman, 2013). These programs would be beneficial to the community on many levels.

Diversity Issues

There are diversity issues that affect this population. Minorities from different backgrounds are at higher risk of child sexual exploitation. Many children from low-educational backgrounds are also at higher risk for exploitation. Most of the children that are misled into sexual exploitation are from impoverished areas of the world. In some cases, racial disparity has become an issue in the matter of child sex trafficking.

Often, cultural difference must be taken into account when working with sexually abused children. In some countries, touching of a child’s genitals is accepting. In the Philippines, it is culturally accepting to touch a child’s private area and not seen as deviant behavior. In the Korean culture, touching a child’s genital area is also an acceptable behavior. This behavior is considered an expression of adoration and pride for a male child who is to carry on the family name and tradition. In the Vietnamese culture, this behavior is thought of as an expression fondness, not a crime.

The cultural differences of the world suggest that some cultures do not view the sexual abuse of a child in the same context as others. Although most societies view these behaviors as deviant and unacceptable, others view these behaviors as normal and accepting. These accepting views can be related to family pride or superstitions. It is of the most importance for practitioners and other health professionals to be aware of the cultural difference in order to provide adequate and effective treatment to children in need. This knowledge will help to ensure that social justice is granted to those who need it the most, sexually abused and exploited children.

References

Branaman, T. & Gottlieb, M. (2013). Ethical and Legal Consideration for Treatment of Alleged Victims: When Does It Become Witness Tampering? Professional Psychology: Research and Practice, 44(5). 299-306.

Herrmann, K. (1987). Children Sexually Exploited for Profit: A Plea for a New Social Work Priority. National Association of Social Workers, Inc., 523-525.

Reamer, Frederic. (2010). Ethical Standards in Social Work: A Review of the NASW Code of Ethics. (2^nd ed.) Baltimore, MD: Port City Press.

Walsh, J. (2010). Theories for direct social work practice. (2^nd ed.) Belmont: Wadsworth Cengage Learning.

Zastrow, C. & Kirst-Ashman, K. (2013). Understanding Human Behavior and the Social Environment. (9^th ed.) Belmont, CA: Brooks/Cole Cengage Learning.

Literature review that critically analyses the sexual abuse of people with learning disabilities in institutions

There are a great many facets to the problem of sexual abuse of people with learning disabilities in institutions. The wide variety of learning disabilities, the wide scope for different types of sexual abuse and indeed the huge variety in the institutions themselves, means that there is not any unified standpoint or all-encompassing view that can be taken on the subject. (Ryan J et al 1987). This review will therefore consider each of these aspects in turn together with the literature associated with them and then attempt to draw conclusions from a critical evaluation of each

The term learning disability is applied to cover a wide range of different clinical entities. Differing impairments due to differing aetiologies are typically “lumped together “ under this one term. In the context of this review, differentiation of the various types of learning disability is largely irrelevant and the only discriminating factor that may be relevant is the degree of disability or impairment. For that reason alone we shall consider all causes of learning disability and the conclusions reached will therefore largely be generalisations in the area.

Approximately 2% of the UK population are currently classified as having a learning disability and this proportion has been slowly rising over time. In their comprehensive review of the subject, Xenitidis suggests that the reasons for this growth are manifold and complex. (Xenitidis K et al 2000). Part of the reasons given are that the definitions and criteria for the diagnosis of a learning disability are progressively changing as our knowledge of the area expands together with the fact that other relevant factors are changing such as the socio-economic conditions together with the fact that pre-term neonates who would previously been expected to die are now helped to survive but with an increased risk of cognitive impairment and learning disability (Aspray TJ et al. 1999).

The McGrother study suggests that over a 35yr period from 1960 the prevalence of learning disability has increased at an average rate of 1.2% per year (McGrother C et al. 2001).

One of the difficulties encountered in the context of sexual abuse is the problems that there are in discovering it. The typical person with a learning disability may have differing perceptions of “right and wrong” and therefore may not be in a position to make a judgement about what is happening. Other factors are that they have a greater difficulty in accessing professional help. (Wilson D et al 1999).Clearly this is less of a problem if we consider the group who are in institutions rather then those who live in the community, but against this is the argument that those in institutions generally tend to be those with the greatest disability and therefore would intuitively be less able to draw attention to a potential problem. (Patja K. 2000)

The literature in this area is not particularly extensive but there are a few high quality papers that stand out. The first is by Sequeira (Sequeira H et al 2003) which was a case controlled study (a rare construction in this particular area) which set out to consider any correlation between sexual abuse, mental health and behavioural problems in people with learning disabilities. The authors suggest that this is the first study to seek such a connection. They matched a surprisingly large entry cohort of 54 adults with learning disability in a residential setting who had suffered from sexual abuse with a similar cohort who had not been abused. The actual study was both carefully constructed and meticulously carried out. In broad terms the findings of the study were that there was a statistically significant correlation between sexual abuse and mental illness and behavioural problems together with symptoms of post-traumatic stress.

Reassuringly, the authors found that the reactions to abuse were essentially the same as in the general population which suggests that when recognised, the symptoms were evident to observers, but equally this implies that a significant amount of abuse is undetected. (Thompson D et al 1997).

With the group with learning disabilities, the authors concluded that in addition, the study group tended to exhibit stereotypical behaviour patterns and that there was a positive correlation between the degree of abuse and the severity of the symptoms reported. We can confidently conclude therefore that there is a positive association between sexual abuse and both psychiatric and behavioural abnormalities in people who have learning disabilities.

How does the design and architecture of institutions foster abuse?

It has to be observed that an extensive literature search reveals no specific studies on the issues of institution structure and opportunities for abuse. There are a number of papers that refer tangentially to the issue however, and we shall assimilate the points raised in them. Brown, (1999) and Manthorpe (et al, 1999), both observe that institutions, both large and small, are not specifically immune from sexual abuse of their residents. They point to working practices that allow professionals a degree of privacy when dealing with residents in vulnerable situations. (Burke K 1999).

It would be unlikely that anyone would disturb a nurse giving a patient a bath or a doctor conducting an interview or examination of a patient. In this respect, it is not the actual architecture of the institution, it is the structuring of the working practice that fosters the possibility of abuse in this area. (Churchill J 1998).

Some institutions have mixed sex dormitories and areas which can be difficult for nursing staff to monitor. Inter-resident abuse can therefore take place in areas which may be less easy to detect than the open plan structure of many wards in general hospitals (Brown H et al 1997)

Who are the perpetrators of abuse against people with learning disabilities?

This is clearly a difficult area in which to be dogmatic, as one can cite evidence from various enquiries which have examined the issue and have implicated virtually every category of professional from medical staff, (COI 1969), through nurses (COI 1971), to care assistants and sub-contracted employees (DOH 2000). Equally, to be balanced, one has to also examine the recent spate of prosecutions form residential care home workers that have been overturned in the appeal court where allegations of abuse have been found to be vindictive or fraudulent. (also COI 1978)

What impact does power imbalance between carer and service user have over occurrence of abuse?

Abuse, almost by definition, implies an abuse of power.(Northway R 1998).There is automatically an imbalance between those with learning disabilities and those in the general population as, by the very nature of their disability, the majority of those with a learning disability are dependent on other carers for their own protection and safety. (Pillemer K et al. 1993).This power imbalance is taken to a greater extreme when those (healthcare professionals) who are employed to care for their patients, and thereby are generally invested with a degree of trust give instructions to those who are more vulnerable. As Rogers points out, (Rogers AC 1997) the moment a nurse puts on a uniform or the doctor a white coat, they are invested with an automatic degree of authority and respect by the general population and possibly all the more so by those with learning disability, who may well have learned to be more deferential or respectful because these healthcare professionals are effectively the gatekeepers to their own security and well-being. (Sines D 1995)

What can be done to reduce abuse in institutions?

It is clearly important to be able to restore confidence in the residential settings for the care of those with learning disabilities. One of the prime mechanisms of reduction is to place professional emphasis on detection of abuse together with implementation of management procedures that will minimise the potential for abuse. The recent Government White Paper “No Secrets” (DOH 2000) has gone a long way into implementing such measures, and this, together with provincial measures in other parts of the UK (NAW 2000), presents guidelines which will help to prevent sexual abuse and also facilitate the investigation of such abuse when it is alleged.

Professional bodies have publicly proclaimed a policy of Zero tolerance in this area and have encouraged the philosophy of “whistle blowing” (NMC 2002 a) it should be noted however, that a study commissioned by the same group, The Nursing and Midwifery council (NMC 2000 b) suggested that despite the guidance and directives given there is clear evidence that nurses, in particular, do not have sufficient knowledge or have received sufficient training in the area of prevention of sexual abuse to effect the recommendations in the Government White Papers.

References

Aspray TJ, Francis RM, Tyrer SP, and Quilliam SJ 1999 Patients with learning disability in the community BMJ, Feb 1999; 318: 476 – 477

Brown H & Stein J 1997. Sexual abuse perpetrated by men with intellectual disabilities: a comparative study. Journal of Intellectual Disability Research 41 (3) 215-224.

Brown H 1999, Abuse of people with learning disabilities. In: N Stanley J Manthorpe &r B Penhale (Eds) Institutional Abuse: Perspectives Across the Life Coarse. London: Routledge. 1999

Burke K 1999, Nurses told to avoid close relationships with their patients. Nursing Standard 13 (49) 4.

Churchill J 1998, It doesn’t happen here! In: T Thompson & P Mathias (Eds) London: Sage/Open University Press. 1998

COI 1969, Committee of Inquiry (1969) Report of the Committee of Inquiry into Allegations of Ill-treatment of Patients and Other Irregularities at the Ely Hospital, Cardiff. Cmd 3975. London: HMSO.

COI 1971, Committee of Inquiry into Farleigh Hospital (1971) Report of the Committee of Inquiry into Farleigh Hospital. London: HMSO. 1971,

COI 1978, Committee of Inquiry into Normansfield Hospital (1978) Report of the Committee of Inquiry into Normansfield Hospital. Cmd 7357. London: HMSO.1978

DOH 2000, Department of Health (2000), No Secrets: Guidance on Developing and Implementing Mula-agency Policies and Procedures to Protect Vulnerable Adults from Abuse. London: The Stationery Office. 2000

Manthorpe J & Stanley N 1999, Shifting the focus: from ‘bad apples’ to users’ rights. In: N Stanley J Manthorpe &r B Penhale (Eds) Institutional Abuse: Perspectives Across the Life Course. London: Routledge 1999

McGrother C, Thorp C, Taub N, Machado O. 2001, Prevalence, disability and need in adults with severe learning disability. Tiz Learn Dis Rev 2001;6: 4-13

NAW 2000, National Assembly for Wales (2000) In Safe Hands: Protection of Vulnerable Adults in Wales. Cardiff: Social Services Inspectorate for Wales.

NMC (2002 a), Code of Professional Conduct. London: Nursing and Midwifery Council.

NMC (2002 b), Practitioner-Client Relationships and the Prevention of Abuse. London: Nursing and Midwifery Council.

Northway R 1998, Oppression in the Lives of People with Learning Difficulties: A Participatory Study. PhD Thesis. Bristol: University of Bristol.

Patja K. 2000, Life expectancy of people with intellectual disability: a 35-year follow-up study. J Intellect Disabil Res 2000;44: 590-9.

Pillemer K & Hudson B 1993, A model abuse prevention programme for nursing assistants. Gerentologist 33 (1) 128-131.

Rogers AC 1997, Vulnerability health and healthcare. Journal of Advanced Nursing 26 65-72.

Ryan J & Thomas F 1987, The Politics of Mental Handicap. London: Free Association Books.

Sequeira H, Howlin P, Hollins S 2003, Psychological disturbance associated with sexual abuse in people with learning disabilities, The British Journal of Psychiatry (2003) 183: 451-456

Sines D 1995, Impaired autonomy: the challenge of caring. Journal of Clinical Nursing 4 (2) 109-115.

Thompson D, Clare I & Brown H 1997, Not such an ordinary relationship: the role of women support staff in relation to men with learning disabilities who have difficult sexual behaviour. Disability and Society 12 (4) 573-592.

Wilson D, Haire A. 1999, Health care screening for people with mental handicap living in the community., BMJ 1999;301: 1379-81

Xenitidis K. Thornicroft G. Leese M. Slade M. Fotiadou M. Philp H. Sayer J. Harris E. McGee D. Murphy DG. 2000, Reliability and validity of the CANDID-a needs assessment instrument for adults with learning disabilities and mental health problems. British Journal of Psychiatry. 176:473-8, 2000 May

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Promotion of sexual health, and all Adolescence, the second decade of life, is increasingly recognized as a critical phase in the life course, especially from the health and social perspectives. The most challenging aspect of adolescence is sexual and reproductive health, as it is aspect of adolescence is sexual and reproductive health, the area that poses the greatest difficulty in maintaining adolescents’ health and implementing appropriate and effective interventions. For a start, there is a paucity of information and, if there is information, it is often uncoordinated and fragmented and not very useful for policy-making and programme interventions (WHO, 2005)

Understanding human sexuality is a prerequisite to the promotion of sexual health, and all over the world sexuality remains one of the most problematic and dangerous aspects of person-hood (Wilson and Mcandrew, S, 2000). Professor Catherine Ingram of the school of Nursing at the University of North Carolina at Chapel Hill has defined sexuality perhaps more succinctly than most authors in this field. She describes sexuality as ‘an important dimension of the human personality’ and sees it as being ‘inextricably woven into the fabric of human existence (Catherine Ingram, 1990)

The belief prevalent in the early part of the twentieth century, that sexual education of the intelligent adolescent was best served by one short, sharp talk- in the fifth if the school was enlightened, in the sixth if it was felt to be an unpleasant but unavoidable duty-was perhaps typical of attitudes to education in many other disciplines. Facts were enough, and sex was put over in a way similar to that used when dealing with the maps of the coalfields. The only difference was the special atmosphere which surrounded the short, sharp talk. It must often convey to its victim that these matters were unspeakable and no well-bred pupil would either need or investigate them further. This method had at least one advantage- it did not attract unfavourable critic from parents or education committees large because all concerned were much too embarrassed to mention it.

After the first World- war, pragmatic objectives in sex education become more apparent and by early 1930’s several of our national agencies with the prevention the prevention of illegitimacy, the spread of knowledge about contraceptives and marriages guidance had begun. There was a small but interesting upsurge of intellectuals who nobly hid their embarrassments they discussed sexual matters with their children and solemnly left the bathroom door unlocked so that nudity could be rationally displayed. There were, however, even in those days, teachers in schools effectively relieving adolescent anxiety and ignorance about sex often under the name of human biology, wit equivocally worded syllabuses, and without a word to the head. Such strategies are still in use today.

The ironic evidence from research on the effects of fear-arousing information in connection with types of preventive health behaviour is that people tend to reject the information rather than change their behaviour (Radelfinger, 1965; Young, 1967)

In 1936, Wilhelm Reich commented that sex education of his time was a work of deception, focusing on biology while concealing excitement arousal, which is what a pubescent individual, is mostly interested in. Reich added that this emphasis obscures what he believed to be a basic psychological principle: that all worries and difficulties originate from unsatisfied sexual impulse (Reich W, 1936)

The existence of Acquired Immunodeficiency Syndrome (AIDS) has given a new sense of urgency to the topic of sex education. In many African nations, where AIDS is at epidemic level, sex education is seen by most scientists as a vital public health strategy. Some international organizations such as Planned Parenthood consider that broad sex education has global benefits, such as controlling the risk of overpopulation and the advancement of women’s rights.

According to the Sexuality Information and Education Council of the United States (SIECUS), 93% of adults they surveyed support sexuality education in high school and 845 support it in junior high school (SIECUS,1984). In fact, 885 of parents of junior high school students and 80% of parents of high students believe that sex education in school makes it easier for them to talk to their adolescents about sex. Also, 92% of adolescents report that they want both to talk to their parents about sex and to have comprehensive in-school examination.

When sex education is contentiously debated, the chief controversial points are whether covering child sexuality is valuable or detrimental: the use of birth control such as condoms and hormonal contraception: and the impact of such use on pregnancy outside marriage, teenage pregnancy and the transmission of sexually transmitted diseases (STIs.) Increasing support for abstinence-only sex education by conservative groups has been one of the primary causes of this controversy. Countries with conservative attitudes towards sex education (including the United Kingdom and the United states ) have a higher incidence of STIs and teenage pregnancy (Monbiot, 2004)

The proportion of women aged 20-24, who had a child before age 20 is a useful summary indicator that reflects the differences in teenage birth rates by country. This proportion is lowest in Sweden (4%), slightly higher in France (6%), much greater in Canada and Great Britain (11% and 15%, respectively) and highest in the United States (22%). Differences in the proportion giving birth by age 15 and by age 18 are also much higher in the United States than in the other four countries (Jacqueline et al, 2001)

Teenage pregnancy is times is a factor of early sexual exposure. Immaturity, inexperience or risky sexual experience often results in the unplanned pregnancy. In the study carried, between 1980 and 1998, among men and women to determine the age of first sexual experience, women were found to be exposed earlier than men (figure 1).

Figure 1. Proportion of participants younger than 16 years at first intercourse, by year of first intercourse.

Teenage pregnancy in Europe :

The incidence of teenage pregnancy across Europe varies considerably. The United Kingdom has the highest rate in Western Europe and is lower only than Bulgaria , Russia , and Ukraine in Europe as a whole. Throughout most of Western Europe, teenage birth rates fell during the 1970s, ’80s, and ’90s, but in the United Kingdom , rates have remained high-at or above the level of the early ’80s.

http://www.bmj.com/content/330/7491/590.full

Figure 2: showing teenage pregnancy in 6 European countries over a 25 year period.

The graph shows the trend over a twenty-five year period (1973-1995)

There is a sharp decline in the United Kingdom figures and then a near steady value in the late 70s and early 80s, before gradually reaching a crescendo in 1991 and then a sharp drop towards the end of the survey. The Netherland has the least and was fairly constant throughout the study period. Germany , France , Ireland ad Italy had fluctuating values, but generally, there was a decline towards the end of the study.

UNITED KINGDOM: In England and Wales , sex education is not compulsory in schools as parents can refuse their children take parting the lessons. The curriculum focuses on the reproductive system, foetal development and the physical and emotional changes of adolescence, while information about contraception and safe sex is discretionary and discussion about relationships is often neglected. Britain has one of the highest teenage pregnancy rate s in Europe and sex education is a heated issues I government and media reports. In 2000 study by the University of Brighton , many 14 to 15 year olds reported disappointment with the content of sex education lessons and felt that confidentiality prevents teenagers from asking teachers about contraception. In a 2008 study conducted by YouGov for channel 4 it was revealed that almost three in ten teenagers said they need more sex and relationships education.

In Scotland , the main sex education programme is Healthy respect, which focuses not only on the biological aspects of reproduction but also on relationships and emotions. Education about contraception and sexually transmitted diseases are included in the programme as a way of encouraging good sexual health. In response to a refusal bythe catholic school to commit to the programme, however, a separate sex education programme has been developed for use in those schools. Funded by the Scottish Government, the programme ‘Called to Love’ focuses on encourage children to delay sex until marriage and does not cover contraception and as such is a form of Abstinence-only sex education.

It is important to recognise that for some young women, particularly from certain ethnic or social groups, teenage pregnancy can be a positive life choice. Rates of teenage pregnancy within marriage are high, for example, in some South Asian ethnic groups in the United Kingdom . However, for many other young women, the costs of teenage pregnancy can be very high, particularly when linked with poverty. These risks include poorer outcomes for the children of teenage mothers as well as for the mothers themselves.

http://www.bmj.com/content/330/7491/590.full

Figure 3: showing the rate of teenage pregnancy in 17 European countries.

A sex survey by the World Health Organization concerning the habits of European teenagers in 2006 revealed that the birth rate among 15-19-year-olds in the UK was 27.8 births per 1,000 populations. The graph shows, the United States with the highest rate of teenage pregnancy and Switzerland with the least. The United Kingdom has the highest rate in Europe, which is clearly above the average value in Europe

FRANCE: In France , sex education has been part of school curricula since 1973. Schools are expected to provide 30 to 40 hours of sexual education and pass out condoms to students in grades eight and nine. In January,2000, the French government launched an information campaign on contraception with television and radio spots and the distribution of five million leaflets on contraception to high school students

GERMANY: In Germany , sex education has been part of school curricula since 1970. Since 1992 sex education is by law a government duty. It normally covers all subjects concerning the growing-up process, body change during puberty, emotions the biological process of reproduction, sexual activity, partnership, homosexuality, unwanted pregnancies and complications of abortion, the dangers of sexual violence, child abuse and sex-transmitted diseases, but sometimes also things like sex positions. Most schools offer courses on the correct usage of contraception.

A survey by the World Health Organization concerning the habits of European teenagers in 2006 revealed German teenagers about contraception. The birth rate among under 15- to 19-year-olds was very low- only 11.7 per 1000 population, compared to the UK’s 27.8 births per 1,000 population and – in first place -Bulgaria’s 39.0 per 1,000.

FINLAND: Sexual education is usually incorporated into various obligatory courses, mainly as part of biology lessons (in lower grades) and later in a course related to general health issues. The Population and Family Welfare Federation provide all 15-year-olds on introductory sexual package that includes an information brochure, a condom and to be most effective when a multifaceted approach is used, as the problem is multiple determined and multidimensional. The interventions

cartoon love story should not only focus on sexual factors and related on sequences, rather Interventions that are designed to reduce teen pregnancy appears they should include non sexual factors such as skills training, and personal development as well. Further, stakeholders including pregnant teens, parents, health sector, schools and churches should work together to devise programs that are practical, evidence based, culturally appropriated and acceptable to the target population.

Boostma writing on Sex Education: Preparing Instead of Prevention, surmise that the teenage pregnancy rates has been (one of) the Netherlands for years now. Asking the question if Netherlands are hardly sexual active or if the Dutch promote abstinence from sexual intercourse? He asserts that in the Netherlands , there is not one specific governmental programme for teenage sex education or contraception. There is however, a lot of information about sexuality and contraception that is coming from all directions.

Boostma believes that the Dutch approach attitude towards sexuality is one of tolerance, open mindedness and pragmatism and that studies from many countries that giving the message to young people ‘not to have sex’ are having the opposite effects. The same account for countries where the subject sex is more or less a taboo to talk about. The Dutch concluded that many young people will have sex anyway, so they should be prepared for sexuality than to be prevented from it. This preparing attitude is coming from different levels of the society:

The government through the National Health insurance pay for the contraception. Parents talk about sexuality and its consequence.

The Mass-media (Television, newspaper, magazines, radio) addresses sexuality and sexual health. Schools give sexuality talk/sex education. There many accessible services for sexuality and contraception. These and other factors result in a tolerant and pragmatic attitude towards sex make information and contraception accessible and explains the low rate teenage abortion or pregnancy.

Sexual heath in the Netherlands means preparation instead of prevention. This preparation means that young people are stimulated to become sexually autonomous and can make their own sensible discussions. Up till now, ‘the Dutch method’ has proven its effectiveness over and over again. Ian Sutherland, who was director in the Health department of Britain in the early 80’s co-authored a book, Health Education, perspective and Choices which dwells on the several choices available to people and the choices they make based on the information they have. The book analyses the different areas where choice is inevitable and the ideological basis for which certain choices should be made. Various authors contributed various topics on the theme Health education. The book first published in 1979 is invaluable as it coincide with the transition period of balancing health needs in Britain . The increased rate in teenage pregnancies and the consequence rise in abortion rates. It was also a period Britain was trying to establish formal curriculum on sex education. In an effort to include as much as possible, the authors referred extensively to a literature which begins with Plato. The authors tried to draw the readers’ attention to as many authorities as possible, and so made attempt at bringing together in one book the extensive libraries of ‘health’, ‘education’, and health education.

Crosby et al (2008) in a study titled, The Protective Value of Parental Sex Education: A clinical-based exploratory study of adolescent females compared the impact of sex education provided by parents to female adolescents against the same education provided by formal settings to female adolescent.

They sampled females aged 16-24 years, attending an adolescent medical clinic in urban area of the south were recruited prior to examination. Each patient completed an anonymous self administered questionnaire. Data from 110 respondents were analysed to compare those who indicating they had learned about each of 4 topics from parents to those not indicating learning about all 4 topics from a parent. The same process was repeated relative to learning about all 4 topics in a formal education setting.

The result showed that in controlled, multivariate analyses, adolescent not communicating with parent on all 4 topics were nearly 5 times more likely to report having sex partners in the past 3 months. Further, adolescents were 3.5 times more likely to have low self efficacy for condom use, 2.7 times more likely to ever using alcohol or drugs or sex and about 70% less likely to have ever talked about HIV prevention with a partner before engaging in sex. Differences relative to learning about all 4 topics in formal settings were not found out.

Looking at works done recently in the United Kingdom, (SHARE: Sexual Health And Relationships; Safe, Happy and Responsible) included 8400 pupils aged 13-15years in 25 secondary schools in east of Scotland (Wight et al,2002) Questionnaires was completed at base line and follow up done 2 years later. The intervention was a new 5-day teacher training programme plus a 20-session pack: 10sessions were delivered in the third year (at 13-14 years) of secondary school and 10 in the fourth year (at 14-15years). The primary outcome for the study was use of condoms at first intercourse. Similar proportions of both intervention and control groups used condom at first intercourse with less than 105 of pupils reporting first intercourse without condom. For all other behavioural outcomes (condom use after first intercourse, oral contraceptive use and unplanned pregnancy) there were no differences with the groups. However, as with Martiniuk’s study in Belize, published in this issue of the international journal of epidemiology, pupils in the intervention group were more knowledgeable than those in the control group.(Martiniuk,2003).

The Belize study was well designed in allowing for the clustered nature of samples both when calculating and the sample size and analyzing the data. Publishing the intra-cluster correlation will be good for planning future research.

However, there are a number of weaknesses with the randomized procedures discussed by the authors in their paper. The imbalance between groups in the number of classrooms could have been overcome by a block method rather than the simple coin toss employed here. (Schulz and Grimmes, 2002) There were considerable differences between groups at baseline in terms of gender and sexual experience. These data were not available to the researchers prior to the study starting. It may have been appropriate to allocate classes to intervention and control groups when the results from pre-test questionnaires were available. At this time an alternative randomization procedure such as stratification or minimization may have reduced the chances of imbalance between groups in the study (Pocock, 1984)

Anna Graham noted that the factor with the strongest influence preventing teenage pregnancy is educational opportunity. It is well-educated women who tend to delay childbearing. For women aged 20-24 years the longer a woman remains in school the less likely she is to have a child before the age of 20. Adolescents with little schooling are often twice as likely as those with more education to have baby before their 20th birthday. For example, 46% of young Columbian women with less than 7 years schooling have their first child by the age of 20, compared with 19% of those with more education. The contrast is even greater in Egyptian, where 51% of less educated women have their first birth before the age of 20 compared with 9% of better educated women. She noted that the link between lack of education and early childbearing is also strong among adolescents in the US . Some 58% of young American women who receive less than a high school education give birth by their 20th birthday, compared with 13% of young women who complete at least 12 years of schooling. The report from the Alan Guttmacher Institute, from which these data came, suggested that low level of education is not necessary a direct cause of early child bearing, however, the two characteristic of living in impoverished and rural environments. She further argued that when school is the main source of information about sexual matters, like the cross-sectional surveys in the UK , early and unprotected sexual intercourse is less likely, compared with when other sources such as friends and the media dominate.

She surmised that, the greatest impact to be made in reducing unwanted pregnancies and sexually transmitted infections is to increase the time spent in education by young women worldwide. She believes this form of intervention is likely to change the role of women in society empowering them to avoid the adverse consequences of sexual activity.

The author in her work tried to justify the need for a comprehensive education over and above the micro aspect of education-sex education. Believing that with increased time spent acquiring education, a women is more likely to avoid the bad aspect of sexual activity. She had looked into certain aspects of form of sex education and did not really weigh each on its own merit. She probably relied on her experience to draw a far reaching conclusion.

Boostma writing on Sex Education: Preparing Instead of Prevention, surmise that the teenage pregnancy rates has been (one of) the Netherlands for years now. Asking the question if Netherlands are hardly sexual active or if the Dutch promote abstinence from sexual intercourse? He asserts that in the Netherlands , there is not one specific governmental programme for teenage sex education or contraception. There is however, a lot of information about sexuality and contraception that is coming from all directions.

He believes that the Dutch approach attitude towards sexuality is one of tolerance, open mindedness and pragmatism and that studies from many countries that giving the message to young people ‘not to have sex’ are having the opposite effects. The same account for countries where the subject sex is more or less a taboo to talk about. The Dutch concluded that many young people will have sex anyway, so they should be prepared for sexuality than to be prevented from it. This preparing attitude is coming from different levels of the society. He noted that the government through the National Health insurance pay for the contraception. Also parents talk about sexuality and its consequence. The Mass-media (Television, newspaper, magazines, radio) addresses sexuality and sexual health. Schools give sexuality talk/sex education.There many accessible services for sexuality and contraception. These and other factors result in a tolerant and pragmatic attitude towards sex make information and contraception accessible and explain the low rate teenage abortion or pregnancy.

Sexual heath in the Netherlands means preparation instead of prevention. This preparation means that young people are stimulated to become sexually autonomous and can make their own sensible discussions. Up till now, ‘the Dutch method’ has proven its effectiveness over and over again. Perspective and choices which dwells on the several choices available to people and the choices they make based on the information they have is important in tackling the issue of teenage pregnancy. The different areas where choice is inevitable and the ideological basis for which certain choices should be made should essentially be based on informed choices.

Health authorities have proposed several methods of addressing Health education. This was very significant, particularly during the transition period of balancing health needs in Britain . The increased rate in teenage pregnancies and the consequence rise in abortion rates is significant, particularly going back to the period Britain was trying to establish formal curriculum on sex education.

Abortion seems to be on the increase in the United Kingdom , according to the office of national statistics in the United Kingdom , the proportion of conceptions terminated by abortion among under 20-year-olds increased slightly from 36 per cent in 1990 to 39 per cent in 2000. Over half (51 per cent) of all conceptions among under 16-year-olds resulted in a termination in 1990 and this increased slightly to 54 per cent in 2000. Legal abortion rates were highest in London and the West Midlands in 2000 and 2001?. Similarly, the data collected by the agency noted a corresponding decrease in conception rate, it noted that, “In 2000, the conception rate among females under 20 years was 63 per 1,000 females aged 15 to 19 years. This marks a decrease in conception rates over the last decade that mirrors a general decrease among females of all ages. The exception however has been among females aged 13 to 15 years. Rates of conceptions in this group have remained consistent at between 8 to 10 per 1,000 females from 1990 to 2000”. A likely consequence of abortion is decreased fertility and sexual infections, the agency equally noted a rise in sexual related infection within this time period, “Genital infection with chlamydia trachomatis if untreated, is associated with pelvic inflammatory disease (PID) in women and infertility. The diagnostic rate of genital chlamydia infection in females aged under 20 years old has increased since the mid-1990s. In 2001, the highest rates of diagnosed chlamydia seen in GUM clinics, were among 16- to 19-year-olds (1,035 per 100,000 females). Genital warts are the most commonly diagnosed viral STI. In 2001, 29 per cent of females diagnosed with genital warts were under 20 years of age, compared with only 10 per cent of males in the same age group. Rates of diagnosis among females aged 16 to 19 years increased by more than 15 per cent during the last decade and reached 680 per 100,000 females in 2001”.

Intervention in teenage pregnancy, need to among other things focus on improving contraceptive use, and initiate attitudinal changes and life style likely to prevent pregnancy and sexual transmission infection transmission. This should involve long-term services and interventions, which are tailored to addressing the major causes of teenage pregnancy. This should be spelt in information, which are clear and unambiguous and may involve ideas which the youths relate with. It should also be home grown, in that it should relate with the culture or practices inherent in the society.

This will start with identifying the risk group. There are certain categories among this age, which appear to be vulnerable. Vulnerability may be by choice or imposed due to social economic reasons or accessibility to health care, such as contraception use. Interpersonal skills development is vital in achieving this objective. Programmes and other educational facilities, which allow interpersonal development, should be explored, this will allow productive engagement. Clinic service for education and information, will also serve a vital role in checkmating the trend. As teenage will not only benefit, but the society will be better for it as well. Information dissemination is vital and there is the possibility of teenagers accessing this on their own, if encouraged to talk to health personnel or attend clinics for advice and education. Education in this sense should be all encompassing and structured to the need at hand. Constructive engagement and participation of all and sundry are vital.

Periodic review of methods is important in our ever changing world. Therefore, interventions should not just be in theory, but clear goals which are practicable should be outlined to follow the strategies mapped out. Outcomes envisaged, need to be weighed in relation to the input.

The delicate age, adolescence confers on teenage, makes it imperative, to address peer pressure and to make leaders of peer groups participatory in addressing the problems identified. All this need be done in an atmosphere of trust and confidentiality. It is often difficult to identify sexually active individuals, therefore, the scope of the intervention need be broad-based to cater for all and sundry. This can be achieved by recruiting experts or people trained in working with youths, who have enough experience to deal with the challenges teenage present.

Catherine et al 2003, working on reviews which looked at teenage pregnancy and interventional means of check in the scourge, surmised the intervention on socio-demographics, which addressed the various health, education and psycho-social needs of teenagers and their environment in tackling the problem.

They found out that, there is mixed evidence for the effectiveness of school-based and/or teacher-delivered sex education. They are of the opinion that, the best chance of interventions being successful in this setting is when they are multifactor and address a broad range of issues, including self esteem, vocational development, and access to services.

In the area of Clinic/primary care as an interventional means, they equally believe that, there is mixed evidence for the effectiveness of interventions that take place in a clinic/primary care setting alone, and that it will be beat, based on the literature search, that they are linked widely to other community and school services, and evaluated as part of a broader programme. They are of the view that, confidentiality is of utmost importance considering the age group. They also surmised that in the UK context, particularly on UK-specific services and settings, such as doctors who may be the first to see these individuals.

On Education and information dissemination, there is mixed evidence for the effectiveness of educational approaches. It was found out that, the more positive outcomes, have been found for education based approaches which link directly to services offered. This also includes a broad range of skills to help improve confidence and relationships among teenagers Vocational development may also be useful. It is said that, programmes should be long term, sustained across school years, and be in place before teenagers become sexually active.

It is also suggested that, there is the need to support young parents to continue their education to enhance educational and employment opportunity for parents, mother/child interaction, and social outcomes for children. Early educational interventions for disadvantaged children can improve long-term. The family is foremost in checking the trend and this is dependent on teenagers getting support from parents and families. Neglect has always been attributed as a cause of teenage pregnancy. This could be deliberate or due to pressure from social responsibilities from parents to support the family, often leading to children not getting enough or desired attention from their parents.

They further found out that, ‘community interventions should be developed with regard to local needs and existing services. There is some evidence that multi-factor interventions involving a degree of community activity or service may be effective at improving contraceptive use.’

On school-based clinics., it is noted that, although, more research is needed on these as the evidence covered by reviews here was methodologically weak, They may be effective as part of multi-factor programmes, but clinic-based healthcare programmes for teenage mothers and their children can improve their health outcomes, if taken as a priority at all stages. The media and the Internet are often seen as social agents which are often not properly utilised, either as a child educator and form of entertainment, but also as a means of redeeming the problem. The study noted that much work has not been done in the United Kingdom , but again, further work is needed here for the UK . Skills, meant to give self-esteem are vital. There is encouraging result for approaches that focus on these factors, particularly when they are part of a broad-ranging intervention. Peer education, is also important in addressing the core issues right from the onset.

Abstinence, as an interventional means has actually, not been fully found to be effective, as there are little or no evidence for the e

Introduction

This paper will consider some aspects of user and carer participation in theory and practice in relation to the case of a seventy two year old man named Harold.

Different Levels of Service User Participation

Service user participation is an integral part of social work practice and stems from the concept of the empowerment of service users.^[1] This ranges from consultation on an individual level…to user control and management of services (Carr, 2005, p.14). Service user participation is a principle that is quite often difficult to put into practice, although new initiatives such as Direct Payments which allow service users to choose and pay for the services they want go some way to alleviating this, in the case of a person such as Harold, who has complex needs, this is not always straightforward. There are power implications in the relationship between service users and social work professionals, and this makes it hard for service users to know whether their concerns are being taken seriously.^[2] This is even more problematic in situations where the person concerned does not appear to have any interest in what happens to them and this is discussed without reference to the service user as appears to be happening with Harold.

Harold has told his sons that he can’t be bothered to get washed or cook a meal… The sons have recently spoken with the day centre manager about their concerns regarding their father… he is spending most of his time in bed, and he is not eating regularly… he sometimes seems to be slightly confused and distant.

It is difficult to assess how far user participation might apply to Harold under these circumstances he no longer wants to attend the day centre and is not looking after himself so it is difficult to know whether he would be able to be involved at any real level in an assessment of his needs. This case does provide a dilemma for social workers on the one hand they have a duty of care, and also in terms of ethical practice, to take into account what the service user actually wants for him/herself. Service user participation often takes place in groups so that the service user does not feel overwhelmed by professional involvement, but this does not seem to be an option in Harold’s case. He sometimes gets confused and he also prefers to be on his own. If, on the other hand, the day centre manager and the other professionals (social worker, a Physiotherapist, Occupational Therapist, and a Community Psychiatric Nurse) involved with Harold take too much notice of the sons then they could be addressing their needs rather than Harold’s and it is difficult to see what level of service user participation would be applicable in Harold’s case.

An Approach to Service User Empowerment

Harold does not object to people coming to the house and perhaps user participation for Harold might best be achieved through the services of an advocate who could present Harold’s views in the best light. As a group older people can be disadvantaged and it is often forgotten that they are people who are as entitled to be treated with respect and consideration as are other groups. Since the 1960s there has been a growing movement in Britain which has come to be known as advocacy. Advocacy involves speaking on behalf of someone, it is an attempt to enable and empower people who might otherwise be disadvantaged. An advocate is there to promote the interests and views of the person they are speaking for. Dunning (2005) maintains that there are a number of stages in people’s lives (particularly those of older people) when advocacy should be a requirement, and especially if there is:

..a decline in physical and mental health, sensory impairment and the need for health and social services (Dunning, 2005, p.10).

This is a clear description of how things are in Harold’s case, he loses his way around the local shops and his GP has recently diagnosed that Harold has Parkinson’s Disease. Harold is becoming increasingly divorced from reality he acts as though his dead wife is still in the house with him and is unaware of the professional concern and considered involvement in his case. Under these circumstances it would seem clear that Harold is in need of someone who will act in his best interests and speak on his behalf if he is to have any control over his own future. An advocate would, hopefully, be able to establish what Harold should be asking for and what he might be entitled to in terms of services and support. Whether Harold would be empowered by knowing what is on offer is difficult to assess because of his tendency to become confused, but an advocate could make a case for the fact that Harold wants to stay in his own home and this would alleviate any fears he has of residential care. Quinn (2003) is of the opinion that information and advocacy are themselves services and can be the building blocks of …enabling older people to receive the services they require (Quinn, 2003, p.3). The team mentioned above have all received referrals for Harold, an advocate would try to elicit what Harold really wanted and convey this to the team so that his wishes are made known, and as far as possible, catered for. In this way an advocate would give Harold a voice and thereby empower him.

Factors that Promote and Limit Service User Involvement in Decision Making

Ongoing debate on the needs and rights of older people highlight the fact that while there has been a move to ensure individual’s rights to equality of service, older people may still face discrimination. Under these circumstances it is vital that factors relating to power imbalances between service users and professionals be acknowledged. It is only with this acknowledgement that the parties can then work together to at least lessen those factors that contribute to the marginalisation and exclusion of some service users (Carr, 2004). These factors might include a tendency of some professionals to ignore service users views or to at least misinterpret them so that rather than being enabled service user participation can result in service users feeling further disempowered. Institutional barriers need to be overcome, as does a continuing use of professional jargon which can also serve to exclude service users from the decision making process. Carr’s (2004) research found that service users often cited language gaps as a disempowering and exclusionary factor, however, once this was brought to light most professionals were more than happy to try to modify their language in order to encourage greater service user participation. Research tends to suggest, and Harold’s situation is a case in point, that greater and more effective service user participation cannot be achieved in a unitary way. There is a need for different models and levels of participation depending on the service user’s circumstances. Some service users will be so empowered by participation that they will go on to be involved in how services are delivered, still others are not able to be truly involved at any recognisable level without the intervention of a third person. Thus advocacy is an important element of lower levels of service user participation. An advocate can help to empower people in Harold’s situation because service users will then have someone who is impartial, who can inform them as to what is available in terms of services and support and who will promote their best interests among other professionals and make sure that their wishes are made known.

Harold, for example wishes to remain in his own home, he does not want to attend a day centre, neither does he want to go into residential care. Carr (2004) notes that the service user movement has been instrumental in promoting the rights of people’s entitlement to as ordinary way of life as is possible.

Working with Service Users and Carers in an Ethical and Anti-Oppressive Manner

Society often views old people as of little use because they no longer contribute to society in the same way as when they were younger and at the same time they are greater consumers of health and welfare services (Moore, 2002). Clearly it is not always easy working with older people because they may have multiple and complex needs, nevertheless under the 1998 Human Rights Act, they are entitled to be treated with dignity and local authorities have a duty to abide by the requirements of this Act. Any move to force a person like Harold to attend a day centre when he clearly does not want to is arguably not good practice. In order to deal with a person like Harold in an ethical and anti-oppressive manner it is vital that he is listened to. If his confusion makes this difficult then again, this is where the services of an advocate could play a vital role. An advocate would be able to see that Harold’s voice was heard they would also be able to express the concerns of his family. Harold may not be aware how concerned his sons are, he needs to be informed of their concerns but this does not mean that their concern for him should take precedence over his own desire not to attend day centres or to go into residential care. The professionals involved with Harold should not be persuaded by the arguments of his family because this could result in oppressive practice. Anti-oppressive and ethical practice has to consider the rights and needs of the service user as prior to the concerns of those close to him. Ethical and effective social work should involve a thorough assessment of Harold’s needs and a care package that takes his health and his wishes into account. It should be tailored to suit his individual needs and there should be room for changes and adjustments if the care package is not to become an imposition (Kerr et al, 2005). Where a person is not fully cognisant of what is happening then anti-oppressive practice should involve the use of an entirely independent advocate. This would be advisable in Harold’s case where there could be a conflict of interests between what his family wants for him and what he wants for himself, or what the care team may consider is best for him. An independent advocate would be the best way of ensuring that the team were consistently mindful of the need to engage in ethical and anti-oppressive practice. This is often achieved by those involved being reflective in their dealings with service users.

How Reflective Practice Informs Social Work Practice

In the contemporary climate social workers are often faced with a conflict of interests between bureaucratic requirements and targets and the needs of their clients. This is unfortunate because it negates the claim that effective social work is client centred, Schonn (1991) has argued that:

Professionals claim to contribute to social well-being, put their clients’ needs ahead of their own, and hold themselves accountable to standards of competence and morality. But both popular and scholarly critics accuse the professions of serving themselves at the expense of their clients, ignoring their obligation to public service, and failing to police themselves effectively (Schon, 1991:11-12).

When people reflect on what they are doing then they are more inclined to recognise people’s individual worth and therefore to act in an ethical manner, one that works towards the best interests of the client. Ruch (2002) maintains that reflexive practice results in a deeper understanding of a person’s self and the role it has in professional practice it makes them more open to new and different ways of working and thus it is now becoming an integral part of social work practice. In Harold’s case a reflexive practitioner may find it easier to balance the conflict of interests between Harold and his sons and with the help of an advocate empower Harold in his role as service user.

Bibliography

Carr, S. 2004 Has Service User Participation Made a Difference to Social Care Services? London, SCIE

Department of Health (2002b) Information Strategy for Older People (ISOP) in England. London: Department of Health

Dunning, A. 2005 Information, Advice and Advocacy for Older People York, Joseph Rowntree Foundation

http://www.assoc-optometrists.org/uploaded_files/nsf-olderpersons.pdf

Jordan, B (2000) Tough Love—Implementing New Labour’s Programme: social work and the third way (London: Sage).

Kerr, Gordon, Macdonald and Stalker 2005 Effective Social Work with Older People

Moore, S. 2002 3^rd Edition Social Welfare Alive Cheltenham, Nelson Thornes

Quinn, A., Snowling, A. and Denicolo, P. (2003) Older People’s Perspectives: Devising Information, Advice and Advocacy Services. York: Joseph Rowntree Foundation

Ruch, G. 2000 “Self and social work: Towards an integrated model of learning” Journal of Social Work Practice Volume 14, no. 2 November 1^st 2000

Schon, D. 1991 The Reflective Practitioner: How Professionals think in Action Ashgate Publishing, Avebury

www.scie.org.uk/publications/leadingpractice/files/scie_9%2520service%2520user.ppt+SERVICE+USER+PARTICIPATION& accessed 27/4/06

http://www.scie.org.uk/publications/positionpapers/pp03.asp Has Service User Participation Made a Difference to Social Care Services accessed 27/4/06

1

Identify, using examples, how a professional social worker should work in such a way as to ensure user and carer participation.
Consider the practice issues for working anti-oppressively with users or carer’s who are either a frail elderly person and their carer.

A professional social worker must approach the elderly person as an individual and ensure that individual as opposed to generic needs are assessed. In practical terms this means that the approach taken is built upon a mix of professional pragmatism and textbook rules. This manner of approach also ensures that the social worker can approach the practice issues identified in an anti-oppressive and professional manner which promotes both user and carer participation. Certainly in terms of personal reflection, and from the writer’s perspective; as a white, middle class person, integrating the theory of how one is required to engage oneself anti-oppressively, in the capacity of social worker with the pragmatics of good social skills and an ability to put a user, such as a frail elderly person and their carer at ease is all the more important where there are differences between the practitioner and the service user in terms of age, race, religion and sex to name just a few examples. Therefore promoting user and carer participation and working anti oppressively with frail elderly users is by no means an easy task. Such a task requires an understanding of models of oppression. Models of oppression mainly relate to the ‘isms’ within society such as ageism, sexism, classism, racism and many others (Williams, (2002) 1), and in the context of this question perhaps ageism and its avoidance within a user/practitioner setting is the most relevant. The professional social worker must be aware that models of oppression must be understood and applied within carer/user settings in order to promote an ethical, participatory relationship between the two (Cambridgeshire and Peterborough Mental Health Partnership NHS Trust (2006) 14). This is because as Beckett and Maynard ((2005) 46) observe, the social worker often deals with those groups within society who are the ‘least powerful’.

One classic example of this for the social worker in a practice situation could be at a juncture where a frail elderly person reaches a stage where their needs cannot be accommodated at home, and supported accommodation options for the elderly person may need to be discussed. In this instance ‘alone time’ spent between carer and the social worker and the user and the social worker can allow both to discuss the issues at hand frankly, and decide what the best way forward might be. This ensures that there is holistic user participation, as it is important that the needs of a frail elderly person are not entirely overshadowed by the input of the carer. This by no means implies that the carer should be ignored during a home visit, or should be excluded in any manner, but there will be times when it is appropriate for the frail elderly person (provided they are compos mentis) to express their viewpoint independently of those close to them (for example if they express a wish to have arrangements made for a will). This will also give the social worker an opportunity to have some time alone with the carer, which gives the carer an opportunity to raise concerns or to discuss issues which they would perhaps not feel comfortable raising in the presence of the person who they take care of. Of course, the user participation will be important once these discussions have taken place, because a frail elderly person cannot be placed into supported accommodation without their co-operation and consent. However, it is often beneficial, where a sensitive issue should as a move between home and supported accommodation is to be broached, that a carer and a professional social worker have an opportunity to discuss the needs of the ‘user’ of the services in a setting where these issues can be spoken of frankly. This does not mean that issues should be concealed from a user or from a carer, but often in terms of facilitating anti-oppressive practice issues it is appropriate to relate to both user and carer in different ways, and therefore it may be necessary to communicate with one or another (user and carer) separately.

In this context the issue of power within society and how it relates to social inequalities must be understood. The social worker is in quite a powerful position compared to an elderly and frail service user, and therefore a professional social worker is required to appreciate how their language must be employed as a strategy to engage the service user, and carer anti oppressively, and at the same time promoting participation.

To take stock of another example to illustrate this point, let us look at a scenario whereby an elderly person who is frail is hostile to interventions from a social worker. Here, the requirements for anti-oppressive techniques of care become all the more important. Difficult questions become apparent in this context. Some examples are as follows: What should one do whereby a frail elderly person has a carer who looks after their needs on a part time basis, and the social worker feels that there are issues of self neglect during episodes where the carer is not present? To take this example a little further, a scenario could arise where a frail elderly person, whose carer is not present, is being visited by a social worker. Let us imagine that the social worker wishes to gain entry to the house of the elderly frail person in order to assess their needs and the elderly person is suspicious and does not wish to allow the person in. How can language be employed in this setting to promote an ethical relationship based on anti-oppressive techniques in this scenario? A simple answer would be for the social worker firstly to explain who they are and why they wish to pay a visit to the elderly person, and secondly another strategy which could be employed would be to say to the service user (the elderly frail person); Can I come in for a Chat/some Tea?, rather then an overly formal explanation of why they are there for example ‘I have to speak to you to assess whether you are capable of looking after yourself’. This approach also empowers the service user, since they may feel more in control of the interaction, and they might also be more inclined to perceive the social worker on friendly terms.

To pose another critically important question here: how should a social worker in this above outlined scenario handle a conflict which arises between an elderly user and the state where an elderly person, who lacks capacity to make decisions for themselves is self-neglecting and will not co-operate with a social worker who encourages them to move into supported accommodation? Two models of intervention may be employed here by the social worker, to deal with the conflict. One is the state intervention model, which may involve sectioning the frail elderly person and removing them into the care of an institution, and alternatively the social worker can choose to employ more moderate interventions which involve living support from voluntary sector groups (Scottish Executive (2006) Section 1.3). Which one is best always depends upon the individual circumstances of the frail elderly person, and the judgement of the individual social worker^[1].

In this context, and to continue the reference to the particular example where a social worker wishes to gain entry to the house of a frail, elderly person for the purposes of assessing their needs, it is also important to remember that the social worker owes the frail elderly person some legal responsibilities. All social work practitioners, for example are required to adhere to the various codes of ethics which have been issued through the General Social Care Council, which was set up in 2001. Amongst other duties, each of the 84000 social workers and social worker students on the Social Care Register must submit to inspection by the Commission for Social Care Inspection, and are required to have their own copies of their codes of conduct; and also as of 2003, the Social Care Register requires that only registered social workers may describe themselves as social workers (to label oneself a social worker, and at the same time intending to deceive others in this respect is now a criminal offence) (www.gscc.org.uk). Another legal responsibility which the professional service user owes to the user and to the carer is the duty not to discriminate unnecessarily against a person on the grounds of their race, ethnicity, disability, and age to give just a few examples of areas which are protected by law by anti-discrimination legalisation. Research into what practice issues are important for services users including carers and the elderly which was carried out by the Cambridgeshire and Peterborough Mental Health Partnership NHS Trust suggests that the combating of discrimination and how it can lead to an oppressive relationship between service user and social worker is very important in social work practice (Cambridgeshire and Peterborough Mental Health Partnership NHS Trust (2006) 14).

In terms of both user and carer participation, the issue of confidentiality is of the utmost importance. This builds trust between user and the social work practitioner and also may lead to a feeling of empowerment by the service user, who is in the context of this question a frail elderly person. To refer back to the first example used in this essay (where the issue of perhaps assessing the needs and views of both carer and an elderly frail person separately has been raised); where there are issues which are quite sensitive between a carer, and a frail elderly person, it is important that the confidence of both parties are respected by the social worker. It is also important to speak to each person on their terms. One classic example of this in the context of a frail elderly person, addressing the user firstly by using their formal title ‘Miss Jones’ for example or ‘Mrs Smith’, as opposed to the use of first names is potentially an important strategy to employ. It is often the case that there will be a large generational gap between the frail elderly person and the social worker, and this makes to concept of anti-oppressive techniques and participation techniques all the more important. Such a generational gap may make a frail elderly person perceive the social worker as more of a threat to them, and may perhaps convey to them the impression that the social worker has little understanding of their needs and view of the world. In this sense, also good case management and record keeping (often a legal requirement for social workers) will also facilitate user and carer participation, as well as anti-oppressive practices.

In conclusion therefore there are a plethora of practice issues which are pivotal in a scenario where a social worker is required to interact in a professional capacity with a frail elderly person and their carer. All of these issues are intersecting, related, and sometimes contingent upon each other. The requirements for user and carer participation and for an understanding of anti-oppressive techniques are therefore complex concepts which require a pragmatic approach, integrated with a theoretical approach on the part of the contemporary professional social worker. These arguments have been supported throughout the essay through a focus upon reflective and theoretical reasoning.

Bibliography
Books

Beckett, C. and Maynard, A. (2005) Values and Ethics in Social Work. Publisher: Sage Publications. Place of Publication: UK.

Articles

Cambridgeshire and Peterborough Mental Health Partnership NHS Trust (2006) Strategy for Social Work and Social Care. Publisher: Cambridgeshire and Peterborough Mental Health Partnership NHS Trust. Place of Publication: UK.

Scottish Executive (2006) The Need for Social Work Intervention. Publisher: Scottish Executive. Place of Publication: UK.

Williams, C. (2002) A Rationale for an Anti-Racist Entry Point to Anti-Oppressive Social Work in Mental Health Services Critical Social Work, 2002 Vol. 3, 1.

Website

<< http://www.gscc.org.uk/News+and+events/Media+releases/Put+social+care+centre+stage+in+social+exclusion+drive.htm >>.

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This review will consist of an introduction, aims of the review, and methods of data collection, findings on a series of questions and answers on the extent of service user involvement in the discharge process, conclusions, and possible recommendations for change. It will conclude with a reflection piece.

The following review will discuss the issue of service user involvement in the discharge/transfer procedure. The review was compiled by the author within a nineteen bedded Forensic Mental Health unit. The ward was at full capacity at the time of writing this review.

The service users’ all had different levels of mental illness, each with a different history, level of cognitive awareness, degree of institutionalisation and willingness to adapt and change. This review will assess to what extent service users are involved with the discharge planning process in the ward, if any, and give possible recommendations on how this process may be improved.

Aims of the Review

During this placement the author decided on a subject to review, this subject was service user involvement in discharge planning. While collating information for the review some questions arose these questions were:

Does the service user feel included in decision making?

How does the staff involve the service user in the decision making if at all?

Has discharge been discussed with the service user?

These questions lead to the author constructing some key questions to carry out in the review these will be discussed further in the findings.

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Methods used to construct review

The data for the review was collected over a ten week period within the ward. The author consulted service users’ notes, attended multidisciplinary team meetings and conducted a series of semi-structured, one to one interviews with service users and staff, including a consultant, doctors, ward manager, nurses, nursing assistants and occupational therapists.

A literature search was also carried out using accredited databases including CINAHL and the British Nursing Index. Relevant journal articles were found on these databases using keywords such as service user, involvement and mental health services. Nursing research books were also used to gather information along with web sites underlining national policies and models for mental health nursing.

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Findings

How are decisions made within the placement area regarding discharge planning?

A Forensic Mental Health Unit is not part of the prison services it is a service that specialises in the assessment and treatment of people who have a Mental Disorder. According to the Mental Health Care and Treatment Act 2003 a mental disorder is an illness such a personality disorder or learning disability defined by the act, whereby the mental disorder has been a contributing factor to the person offending.

Throughout the weeks on this placement research was carried out by the author on policies and procedures for discharge planning. The one in particular that was found to be relevant was the Care Programme Approach (CPA). CPA is about early identification of needs, assignment of individuals or organisations to meet those needs in an agreed and co-ordinated way and regular reviews of progress with the service user and care providers. CPA is also about involving family or carers at the earliest point. The Care Programme Approach requires that service users should be provided with copies of their care plans and it has been increasingly common for service users who have been the responsibility of forensic psychiatrists to have copies of documents relating to their care. (DOH 2008).

Systems were in place for comprehensive care planning. There was evidence to show that the service users’ social, educational and occupational needs were taken into account in the care planning process and other specialist interventions were available.

In addition to this, in some cases, discharge/transfer planning was evident from an early stage (not long after admission), although in other cases a few months had elapsed before any document noted those discussions. Discharge planning is enhanced by the Care Programme Approach (CPA) a multi-disciplinary care planning systematic approach that involves service users and their carers’. Care Programme Approach is the framework for care co-ordination and resource allocation in mental health services. Decisions for discharge are made through the multi-disciplinary team which consists of consultants, ward manager, nursing staff, occupational therapy and social workers. discharge guidance 4. This will go forward to a tribunal where the service user will be invited to take part, here all the evidence will be put forward and a decision will be made. If the service user is restricted then the decision will be made by the First Minister. When a service user is restricted it means an order has been applied to them as they are seen by the act to be a more serious offender, this then means that the Home Office is responsible for granting discharge and a representative will be invited to the Tribunal (MHCT Act 2003 SECTION 37/41).

Most service users have long term mental health problems and complex social needs and have been in contact with mental health services for more than twenty years so never think about discharge. Being in hospital for so long has become part of their lives so service users see it as pointless being discharged, “what would I do”. 488

SECTION 117 AFTER-CARE

Prior to 1983, no statutory provision was made for the after-care of patients discharged from hospital. Section 117 introduced and defined formal after-care. In particular it stated:

“It shall be the ditty of the health authority and the local authority to provide in conjunction with voluntary agencies after-care services for any person to whom this Section applies, until such time that the health authority and local authority are satisfied that the person concerned is no longer in need of such services “.

Section 117 of the 1983 Mental Health Act applies to patients who have been detained under Section 3,37, 37/41, 47/49, 48/49.

Before a decision is taken to discharge or grant leave to a patient, it is the responsibility of the RMO to ensure, in consultation with other members of the multi-disciplinary team, that the patient’s needs for health and social care have been fully assessed, and that the care plan addresses them.

The Section 117 meeting

The aim of the meeting is to draw up an after-care plan, based on the most recent multi-disciplinary assessment of the patient’s needs.

During the meeting the following areas should be covered as appropriate:

Housing Finances Relationships/family Employment Social needs

Psychology/mental health difficulties Relapse predictors Known risk factors

When the care plan is agreed the team should ensure that a key worker is identified to monitor the care plan. The Care Co-Ordinator can come from either of the statutory agencies, and should not be appointed unless they are present at the meeting, or unless they have given their prior agreement.. The process for Sec 117 can be found in Trust Policy and Procedure and applies to all patients accepted by psychiatric services.

What decisions/involvement does the service user have in this process?

Within this placement the care and treatment plans are reviewed on a regular basis. Service users are expected to meet with their key worker and other team members on a regular basis, care plans are reviewed at these meetings and a mutual agreement will be decided, on the best way forward, once the care plan has been agreed by all the service user has to adhere to the care plan.(discharge guidance)no.16

Rights, Relationships and Recovery (2006): The Report of the National Review of Mental Health Nursing in Scotland

Service users’ are encouraged to be fully involved in all aspects of their care as far as they are able to. Service users past and present wishes should be taken into account, their views and opinions with regards to their treatment plan must also be recorded, as stated in the Mental Health (Care and Treatment) Act Scotland 2003. These wishes and aspects will be turned into a care plan that is individual to the service user. The principles of the act underpin any decision made relating to a detained service user in Scotland. The Milan Committee devoted a chapter in the act that referred to high risk patients it stated that service users should have the right of appeal to be transferred from a high or medium secure facility to that of a facility with lower security conditions. (Mental Health Care and Treatment Scotland Act 2003). This however seemed to be the problem across the board, lack of medium/low secure facilities to discharge /transfer appropriate service users to.

Service users have the opportunity for regular one-to-ones with their key workers (weekly basis) or more regularly if they require. Service users have the opportunity to put forward their thoughts on discharge and any other aspect of their care at the review, such as their rights, beliefs and their right to a tribunal. The author attended these independant tribunals while on this placement and at these tribunals people had stated that their human rights had been violated (The Human Rights Act 1998). They felt they were still being discriminated against for offences they had committed 20-30 years ago and feel they were being held under “excessive security” hence the reason for the tribunal to appeal against this level of security. this would mean they would be granted grounds access on a trial period which may be supervised, then become unsupervised for a trial period to see how the service user would cope, this in turn will lead to a further tribunal taking place in a set time agreed for example 4 or 6 months away, where the service user may be granted discharge/transfer to a lower secure unit depending that all provisions that had been put in place had been adhered to, for example, risk assessment reviewed, treatment regime being followed, attend all social/therapy/strategy groups that were agreed.

The review takes place every four months, again this is a multi-disciplinary meeting and service users are invited to attend with the support of advocacy or someone of their choice. The Human Rights Act 1998 gives legal effect in the UK to certain fundamental rights and freedoms contained in the European Convention on Human Rights (ECHR). These rights not only affect matters of life and death like freedom from torture and killing, but also affect your rights in everyday life: what you can say and do, your beliefs, your right to a fair trial and many other similar basic entitlements.

During the time spent on this placement it was noted that service users and key workers met at the beginning of the week to discuss how they felt things had been for them, the service user has the opportunity to discuss what changes they would like to happen, this is then recorded in the service users’ notes and taken forward to the clinical team that week where it would be discussed if any changes in care and treatment would take place, the service user is then informed of any changes and decisions made which they have the right to appeal against (The Human Rights Act 1998). The opportunity arose for the author to take part in these weekly reviews, during this one-to-one time most service users were able to express their thoughts and feelings about issues they had encountered that week and describe what therapeutic strategies they used to get through it.

The service user will be provided with a copy of the Treatment Plan Objectives, or informed in detail of the contents of the treatment plan, in the event that any learning or specific reading or language difficulty information should be provided in a way that is most likely to be understood.

Arnstein (1969) constructed a “ladder of participation” which described eight stages of user participation in services, including mental health. These stages ranged from no participation to user controlled services. The above service users would be placed on the sixth rung of the ladder in the partnership range as they agree to share planning and decision-making responsibilities.

Partnership

Partnership, like community, is a much abused term. I think it is useful when a number of different interests willingly come together formally or informally to achieve some common purpose. The partners don’t have to be equal in skills, funds or even confidence, but they do have to trust each other and share some commitment. In participation processes – as in our personal and social lives – building trust and commitment takes time. discharge guidance 16.6 908

Does this placement area reflect its practice on local or national policies regarding service user involvement in discharge planning?

(Mental Health Care and Treatment Scotland Act 2003).
(The Human Rights Act 1998).

When asked their views on the subject the Ward manager and senior nursing staff presented documentation which reaffirmed current practice within the ward. The Ten Essential Shared Capabilities (ESC’s) DOH (2004) he explained was the model now being followed on the ward, has just been implemented into this area of placement within the last two years, which the ward staff have adopted well by providing a person-centred approach as much as possible. This new person-centred model embraced the ethos of the above, and senior staff stressed that good practice dictated that service users have the opportunity to appropriately influence delivery of care and support. A review of policies and procedures as well as discussions with staff provided evidence that the policies were actually in place.

Throughout the placement, the author noticed that efforts were being made all the time to nurse according to the new model. Included were regular one to one sessions between nurses and service users to hear their views and thoughts, these already took place before the ESC’s were introduced. Moreover some staff do find it difficult to adopt the ESC’s and the mental health act due to the restraints of the environment (secure ward); however they are prepared to embrace the opportunity for further education and support. 211

Identify barriers and constraints.

Before a decision is taken to discharge or grant leave to a patient, it is the responsibility of the RMO to ensure, in consultation with other members of the multi-disciplinary team, that the patient’s needs for health and social care have been fully assessed, and that the care plan addresses them.

Section 117 of the 1983 Mental Health Act applies to patients who have been detained under Section 3,37, 37/41, 47/49, 48/49.

While on placement and conducting this review the author noted that one of the barriers to effective involvement came from some of the service users, due to the complex nature of the area the service users had become institutionalised and found it difficult to be thinking about discharge at this stage in their lives, so they just accept the way things are and do not get too much involved as far as care plans are involved and just say what they think the staff want to hear.

In secure settings engagement of service users in assessment and treatment can be difficult, as there is a potential risk of perceived coercion. Moreover with the lack of medium secure facilities around this can hinder service users from moving on within the specified time limit agreed, as there are no provisions.

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Recommendations for Development
SMART

Most service users were more concerned about their futures and life post discharge. They wanted their time between now and then to be concerned with preparing them for discharge. It was frustrating for many service users that they felt that little in the way of such preparation was taking place. Continue to provide service users with support and skills needed appropriate to their function and skills already held, for example cookery groups, IT groups.

Provide groups that enhance social skills such as coping strategy groups, anger management, alcohol/drug treatment/groups.

High secure units should ensure that at the point of discharge patients have a copy of their discharge care plan in a suitable format which includes appropriate information about the circumstances that might result in their return to a secure mental health provision such as??????

However a recommendation that high secure units should ensure that factors to be weighed in assessing relapse are part of the risk assessment included in the discharge plan of all service users.

The National Service Framework for Mental Health states that ‘Service users and carers should be involved in planning, providing and evaluating training for all health care professionals’ (Department of Health, 1999). This is the case in most health care provisions but for more education, training and information to be more readily available.

Strengthening the user perspective and user involvement in mental health services has been a key part of policymaking in many countries, and also has been encouraged by World Health Organization (WHO) in order to establish services that are better tailored to people’s needs and used more appropriately.

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Reflection

In this review, I need to reflect on the situation that took place during my clinical placement to develop and utilise my interpersonal skills in order to maintain the therapeutic relationships with service users. In this reflection, I am going to use Gibbs Reflective Cycle Gibbs (1988). This model is a recognised framework for my reflection. Gibbs (1988) consists of six stages to complete one cycle which is able to improve my nursing practice continuously and learning from the experience for better practice in the future.

During the first week of placement I was encouraged to work closely with my mentor. This gave me the opportunity to orientate myself to the ward and get an overview of the needs and requirements of the service users. This also provided me with the chance to observe how the nursing team worked on the ward. During this time I had learned that if the concept of inter-professional working is to succeed in practice, professionals need excellent team working and communication skills. Good communication, as we have staged in our group work theory, (skills for practice 3) is crucial in the effective delivery of patient care and poor communication can result in increased risk to the service users. I have learned the valuable skills required for good communication and will transfer these into practice by adapting to the local communication procedures (expand). The NMC advices that at the point of registration students should have the necessary skills to communicate effectively with colleagues and other departments to improve patients care (NMC, 2004).

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Life is a learning process and this involves a lot of interactions and interpretations to evaluate one and evolve as a better person. The observations made by the superiors, colleagues and self have enabled me to identify my strengths, weaknesses, opportunities and threats. Below is a brief discussion on the same.

(S)trengths

Strengths just do not mean the obvious job skills one has. It means the resources a person has, to tackle a situation. These could be things like knowledge gained through a hobby, ideas absorbed from sports, family background, and sense of humor and much more. Developing a list of a person’s strengths is a time killing process as inherent skills may not be recognized as strengths until specific situation brings them on action. Similarly, strengths in dealing with a situation may not be so when a person faces other issues.

My strengths are best derived while at work. I could identify my strengths, whenever a task was assigned to me. My immediate response would be to step forward and ask the requester for his / her objective behind this task and his / her expectations out of this particular task. This has always helped me enhance my ability to focus on structuring my tasks and giving optimized output.

This reminds me of a past instance at my work place where, there was difference of opinion emerging within the team, under the supervision of a colleague of mine who was nominated as the Acting Team Lead (ATL) of the month. ATL was a concept brought in to enable the team with team leading experience. The differences emerging had led the team into a cold war. This is a situation that no supervisor or any superior would desire his/her team to be in which might cripple the performance and relationship of the team. When this started to be visible, I was asked by my General Manger to handle the team until the issues were resolved.

This task was critical for me, as this responsibility was given to me by my GM. He set his expectation and told why he chose me and I had to live up to his expectations.

Since I had been with the team for more than two years, I was confident that I would be able to crack the puzzle. I had to be cautious in approaching the team. A wrong move or decision could turn things around for the worst. Hence, I decided to break ice by meeting every individual of the team to get a better perspective of the issue. This way, I was able to analysis the core issue and come up with a resolution to resolve the particular issue. I initiated a “fish on table” activity for the team, where everyone from the team was allowed to speak their mind out and discuss their issues. This activity helped them understand each other and sort their differences. Post this activity, the bonding of the team was further strengthened. There was a visible change amongst the members of the teams approach toward tackling any issue. They wouldn’t wait for a third person to come and resolve their issues; rather they started walking up to each other and sort the issues themselves.

With this particular incident, I was able to identify my strengths. When my GM looked up to me to handle the situation, it showed his faith and confidence in my problem solving techniques. A one to one session with my GM made me realize that I possessed a greater level of patience. I realized some of my strengths through this particular incident, which were my approachability, decision making, ability to negotiate and solve problem.

(W)eaknesses

A It may be very easy to identify a person’s weakness, but it takes far more objectivity. For example, showing sympathy on a person’s problem is a very good human characteristic, but if it exceeds, it may cause problems in leading a team. As in the case of STRENGTHS, it is important to be aware of all your weaknesses while dealing with an issue and also to know which weaknesses could be related to a particular situation.

Some of my weaknesses that I would like to work towards is to improve my area of expertise i.e. my knowledge on MS office applications. This was necessary for me to understand and put to ease the complexities involved in my work. I also would like to bring about improvement in attaining best possible control over my emotions, to incorporate the skills attained to improve my social networking and to put to best possible use, my creativity.

The main culprit to be blamed for this absolutely is the lack of time. Due to which, I am most of the time unable enhance my knowledge as mentioned above.

Once, I planned to dig to the roots of my weakness, and approached my supervisor to give me a feedback. That’s when I realized that I couldn’t say ‘No’ when I had to say it.

Let me quote an incident which is fresh in memory. One fact that was brought to my notice during a feedback session was, I had the habit of going out of my way to help others even when I was piled up with so much of work for the day. I would land up myself doing the extra work not oblivious of the fact that if I took even a smallest of extra work, I would miss my deadlines. This began to affect my regular deliverables. Knowing the fact that an adjoin on work would affect my regular deliverables, neither did I say “No” nor did I seek help. Though I had an opportunity to say no or to get the time lines extended, I did not do so. Instead I ended up extending my shift. After this feedback from my superior, I knew I had to change myself by working towards this issue to overcome this particular weakness of mine.

(O)pportunities

It is important to examine a problem in its entirety and also to identify the opportunities that may exist in it. A simple example is that of a production manager who has to lay off workers in order to reduce the production due to a fall in demand for the product of the company which he works. This is a problem. However, if he is updated of the happenings of his industry and the economy, he can use this problem as an opportunity to optimize the operations and prepare for product enhancements for the future which the market will require at that point of time.

Similarly, I believe that my strengths could be my gateway for opportunities. I consider every challenge that I come across as an opportunity to learn. This would enable me to tackle different situations, undauntedly. I always try to learn from my own mistakes, as well as from others mistakes too. This has helped me narrow down my mistakes and even to correct the mistakes which I have already done.

To me, approaching people to understand their requirements and providing them with the desired output is one of the strengths. According to me, this is a quality which can be put to use for the advantage of the others as well me. This trend not only creates a great visibility but also enables me to understand things better and look at things from a wider perspective and from different angles.

This reminds me of an instance where in all the managers from different departments were asked by the SDL (Service Delivery Lead) to work on analyzing the attrition trend for their respective spans. The SDL also informed the managers that they could approach me for any kind of help with regard to data or for any details required for the analysis. At this moment I realized that I was noticed by my SDL and my capability to work efficiently was made transparent, by him to others. I also realized my way of working turned my strength into an opportunity of getting to know more people from the hierarchy, to widen my network and provide me the opportunity to work with all LOBs (Line of Business).

(T)hreats

A Every circumstance has its own threats. The one who faces it has to recognize it and gather his strengths to tackle those. Similarly, threats are easy to identify. But differentiating the “impossible” and the “unlikely” among them may be a difficult task. The “unlikely” is the one that often turns around to make you mad. It is the unexpected threats which could be the greatest danger than the obvious ones. Knowing the fact that the unexpected may suddenly occur and a pre-existing knowledge of one’s strengths allow for most effective response to these situations.

According to me, everything is a threat – My strengths, weaknesses and opportunities

My way of approaching people to understand their requirements creates visibility, which my competitors could find threatening and try to persuade others to go against me. This is a potential threat that I experience.

I recall an instance when I was recognized for my hard work and dedication in many occasions. I was rewarded point and vouchers as gift as an appreciation for my hard work. My competitors started envying me for getting recognized. They started stretching their shifts and began to work on weekends as well to gain attention. For which they succeeded to some extent. When I noticed their behavior and actions, I realized that I had become a threat to them and that was a threat for me.

In another instance, I had to take calls of our clients. Since I had no experience in taking calls, I found it difficult to understand their accent. This was a threat as the other were either well trained or had prior experience in taking call before they joined. Knowing the client and understanding them was the most important part of our job. Since I lacked such an understanding with the client, I was given the least importance when it came to attending client calls.

Emotions are one of the weaknesses that can be exposing me to a threat of being misused. As I very easily get carried away emotionally, people could take advantage of me and get me to do things for their selfish motives.

STAGE 2
Improvement Plan

It is important for one to identify his/her strengths and opportunities, and work towards enhancing them at the same time; it becomes equally important to work towards improving the same to overcome threats and weakness.

One of the strengths if feel is important and would add value or become an added advantage is to gain my supervisor’s reliability / confidence in me. As an individual, I was successful enough in gain my supervisors and co-worker’s confidence on any kind of work given to me. However at a supervisor level it was still verified. This could be due to the importance of the report or data or else it could be that I couldn’t gain his/her complete confidence. I had to work on this and had to overcome by improvising an improvement plan or a strategy and reach the point of confidence where my supervisor would give me complete authority to send report without he / she cross checking.

I intend to approach my supervisor and talk to him about the same. ask him to observe my work for a week and only once he is confident in me would send the reports directly to the concern departments or people. To achieve this I plan to adopt a strategic way of doing my work. This can be achieved by looking into each and every details of the given task, identifying the areas of modifications or areas which have some scope of improvement or areas of interest of the requestor and the purpose of the report. This way I would be working towards perfecting my skills, understanding the requestor’s requirements, improving on visualizing the minute details and gaining confidence of my supervisor to be confident in me.

I also had work towards improving my knowledge on MS Excel. Due to my limitation on MS Excel knowledge, most of the time, I depend on the experts for complex formulas which had become one of the core areas of improvement. Improving the knowledge on Excel would widen my areas or expertise, help me improve or modify complex formulas and enable me to create new templates to ease the work for everyone.

If I excelled on this, it would enable me to perform critical and complex tasks. Hence I intend to overcome this weakness of mine by attending some classroom trainings or online trainings on MS Excel and by reaching out the experts. I also intend to seek for help from my supervisor to help me understand complex formulas.

The second weakness I thing I would like to improve is to say “No” when required. As I feel, I might offend a person by saying No or might give an impression that I am not willing or I do not possess the ability to perform that particular task. One way to do so is by gathering courage to say No, by sympathizing myself and not allowing others to take advantage. A sincere effort would help me overcome this challenge. Probably by saying ‘No’ in different way rather than being curt. Probably addressing the same to my supervisor or by delegating / sharing the work with my colleagues would help me solve this problem.

As mentioned above, my threats, my hard work and recognitions for the same could become a threat. This could lead to a bad relationship or unhealthy competition within the team. I would try to overcome the same by changing my approach to such situations. By getting others from the team involved in all my activities and cross training everyone on each other’s work can ease the pressure off. This approach wouldn’t be a strategy to overtake others but a step or opportunity to work together as a team for good. This way both parties would get an opportunity to improve their skill and thoughts; and plan better for the best results.

The lack of experience in taking calls as mentioned earlier was one of the most important drawbacks in my career. As this could set me back or leave me behind when it come to my assessments or performance review and would become a road block in my career growth. Hence I decided to approach my superiors and colleagues to help me over come on the same. At the same time I decided to side barge with my colleagues to learn how to take client calls and speed up my learning curve. This way would be back on track for the race and wouldn’t allow this weakness to affect my performance or growth.

STAGE 3
Summary of progress

When I implemented the plan to improve my SWOT, I began to realize that my quality of work had improved. I was more confident in terms of structuring my daily activities related to work. I knew exactly how I had to achieve my goals.

When I joined the team I lacked confidence in attending client calls. I did not want this deficiency to set me back or leave me behind in the race. As planned I addressed this issue to my supervisor. He then advised me to enroll myself for a voice and accent training. As I enrolled myself to the advised training I realized that it would take longer time than expected to learn. Hence I decided to attend the training every day and post that came to the work place and side barged with my colleagues to understand and learn quickly. This strategic move helped me finish my voice and accent training in two weeks which normally takes six to seven weeks. Post this training I was back on track to compete at power with the other team members.

Post my training on voice and accent I start with my plan to gain confidence of my supervisor, I realized that this actually was working out. I approached my supervisor to seek for his help in observing my work, he was happy to do so. He in fact began giving me feedbacks regularly and gave me tips on how to overcome certain issues. And soon I got an opportunity to prove myself this was when my supervisor had to take his personal time off. This was an opportunity that helped supervisor gain confidence on me. I also received rewards from my GM for taking care of my supervisors work in his absence. This particular incident helped me to take more responsibilities and relieved my supervisor of his regular jobs allowing him to take new jobs from his supervisor. Because of this action plan it helped my supervisor and me to move ahead take up additional roles and responsibilities.

During my improvisation of improvement plan, I had enrolled myself for class room trainings and online trainings on MS Excel. This was one of the tips by my supervisor to me. Since my supervisor was also good at MS Excel, I approached him for help when ever required. He helped me to read and understand complex formulas and worked with me in creating few. This way I began to gain confidence in myself and was able develop my own templates to make our jobs easier. As I began to improve on my MS Excel knowledge, I was being observed by everyone around me and was ask to help them in creating templates for their reports. Looking at my knowledge on Excel my supervisor appointed me to set test papers on MS Excel for interviews and was asked to train the team as well on the same. This was one of the important milestones I had achieved.

As started to improve and began to receive rewards for my hard work, I was getting piled up with work. It so happened that the expectations were rising and I couldn’t do anything about it to stop it. I had reached a point where I was only accepting more and more work, and could not put a stop to it. My health began to deteriorate, as I began to stretch my shift, pushed myself to complete the assigned tasks. My co-works realized this and advised me not to accept anything and everything. When I approached my supervisor to address him of the issue, he said that he knew about the pressure I was in but could not do much about as the profile demanded for it. He then told that he would look into the issue and look for an alternative. He then decided to appoint an additional person to help me. But it was a lengthy procedure to appoint a person to assist me, as it would take at least a month to appoint one. Hence I decided to delegate some of my work to my colleagues who were well equipped with the tools I used. As I began to get my work done by colleagues, my supervisor observed this and appointed one of my colleagues to help me. A process of appointing that took at least a month now was reduced to two weeks.

This approach in fact led to more opportunity within the team and helped everyone get cross trained so as to work as a team to ease the pressure off.

This way I was getting everyone in the team involved in different activities and shared my work. This approach was eliminating possibilities of threat in the team. The team no more felt threatened by anyone, as everybody was receiving an opportunity to learn, explore and expand their area of knowledge. I was a no more a war but a healthy competition, a race to learn more and not to pull down one another. There were rewards and recognitions delegated for the most helpful person of the team, knowledge priest award, most improved person award and the best performer award. The objective of these award titles was to create more opportunities, enhance skills, direct most of the people in the team towards a healthy competition and most importantly to work as a team to achieve organizational goals.

STAGE 4
Future plan

After the completion of my SWOT analysis, I was able to identify my SWOT in the initial stage of assessment, planned to improve by setting some milestones in the second stage and implemented the action plan to see the outcome of the same in the third stage. Post the successful implementation it is time for me to work on future plans to further improve my SWOTs.

My future plans are to:

Organize a forum where the best practices can be shared and implemented and look for new opportunities or scope for developing new strategies. I look forward to implement this in all the places where I would work.

This would help the people around and me to work together towards creating a better place to learn and work. This forum can also be termed as “Focus Group”. As mentioned above, this group would concentrate on people development. Further it would focus on improvising corrective action plans, new idea generation in terms of reducing cost and time for a cost effective high performance and fun activities for stress busting in the work place.

Organize an observation forum to identify the successful and potential areas of improvement. The forum would allow every individual to share their experiences. If a strategy they implement is successful, then, the forum would discuss how it can be utilized by others and how it can be improved and if the strategy fails, then this forum would look at what went wrong and how can it be corrected. We would then be able to list down all the do’s and don’ts. Also look for new and innovative ideas to enhance our skills and work. The observation forums will observe all the implementations and give out a general feedback or individual feedback on the implementation methods. This forum would help to avoid or correct mistakes committed.

Social work practice can be seen as a very complex process as it seeks to promote social change, social justice, equality, anti-discriminatory and anti-oppressive practices and also social inclusion. It is therefore significant that as social workers, we reflect and evaluate our practice in order that the values we stand for are promoted and adhered to. Reflective practice is therefore a way of making social work professionals more accountable through an ongoing scrutiny of the principles upon which the profession is based (Fook, 2002). However, Ixer (1999) criticizes that reflective practice has simply become uncritical and orthodox mainly because it can be applied in many ways and across many professions. None the less, Donald Schon (1983) a key theorist of reflective practice, saw reflective practice as a way forward for professionals to bridge the gap between the theoretical and practical aspect of their work by unearthing the actual theory which is embedded in what they do, rather than what they say they do. He made it clear that by being reflect practitioner, one is aware of the theories or assumptions underlining your practice and what actions to take in improving your practice or providing better services for the service user. To me reflective practice is therefore like a ‘looking glass’ or mirror where you as a practitioner have the opportunity to correct or redirect your course of action. For the purpose of this assignment, I am going to use a case study from my previous practice placement to illustrate my reflection and evaluation of my own practice, how the use of self, my beliefs and values might have influenced my actions, how I have developed new meaning and understanding through peer supervision/feedback and the unit lectures and how theories underpinning reflective practice may help in improving my practice as a social worker.

Case study

I e-mailed the learning mentor at N. Middle School concerning a boy named J (for confidentiality purposes). A 12-year old, of ‘White’- British background, who was referred to my previous placement agency for having behavioural problems (such as fighting with his peers, being disruptive during lessons, disrespecting his teacher and general misconduct) at school. J from an early age of about 6 had witnessed Domestic Violence in his family. My concern was that J had revealed very confidential information to me regarding his mum and her ex-boyfriend (his mum’s ex-boyfriend was violent toward his mum and he witness it as well). J was worried that this might happen again since his mum’s ex-boyfriend was back into his mum’s life and sleeps over sometimes at the family home. I informed the school about this revelation since it was a school referral and also because J had mentioned that any time his mum’s ex sleeps over it affects him and his behaviour at school becomes disruptive due to the worries he has. When I passed this information to the school authorities, the school also informed J’s mum about it which I felt was not appropriate due to the fact that J’s mum had been very wary as to what information or issues J would reveal to professionals. In my email I also pointed out the fact that the trust and confidence J had towards me could be undermined since his mum got informed about this although it was suppose to be confidential among professionals.

Reflection and Evaluation of my practice

In this case study, I felt that the school authorities should have acted more professionally. They should have contacted me first before informing J’s mum but this was not the case. I only got to know that they had informed J’s mum when she asked me questions or tried to clarify the issues that J had revealed to me. Although, this situation didn’t mar my professional relationship with the school authorities at the time, it has made me wary of how much information I can share with other professionals and how that particular information should be treated (if very confidential).

I felt that I had eroded the trust and confidence between J and I because his mum got to know about what J had revealed to me although he did not want her knowing. Order to maintain the trust and confidence we had, I should have sought J’s consent first. Also the school should have contacted me first before informing J’s mum so that my trust and confidence in the school could be maintained as well. I also felt that this broken trust and confidence might extend to other professions who might be working with J in future. This experience could therefore distance J from other professionals (including myself). He might view all professionals as untrustworthy and as enemies rather helpers. This therefore meant that I did uphold public trust and confidence in social care services as enshrined in the code of practice for social workers (TOPPS, 2004)

I felt that J was very opened and honest to me. He had trust and confidence in me as well. I listened to him as a friend in a professional capacity which I feel he needed. However, I felt I let him down in this situation because he was not made aware that his mum would be informed (issue of consent).

This issue of confidentiality posed as a big ethical dilemma for me, in that I questioned myself whether it was right for the school to have informed J’s mum about his revelation? Have I broken J’s trust and confidence by informing the school about this? And am I right to question the school authorities why they shared the information with J’s mum even though the referral was made by the school. These were ethical dilemmas I was faced with before emailing the Learning mentor. I was therefore aware of these ethical dilemmas and conflict of interest and the implication to my practice (social work value A). However, not sharing the information could also mean that I would be held responsible for my actions if something went wrong.

Furthermore, I felt this could have been an issue of potential discrimination, in that the school had overlooked the effect on J, and also the relationship between mother and son, this could have potentially estranged J’s relationship with his mum, the school and even me. If this happened, he would be reluctant in dealing with professionals and this may pose as a barrier to him accessing the needed support he may require.

Theories used in case study

In this case study, the gathering and use of information was the main focus. Establishing service user confidentiality is as important as providing the need/service for him/her. However, though the issue of confidentiality is usually negotiated and established during the agreement meeting with the service user, there are lots of ethical dilemmas surrounding this (as to whom you can share the information with and how much of that information can be shared. Seden (2005) mentioned clearly that in working with Children services it is particularly difficult to have total confidentiality because a child may reveal something or an issue in confidence which may be a child protection issue. And as a professional you would have to share this information with others so that prompt action can be taken. It highlights the fact that in child protection issues, safeguarding and promoting the child’s welfare is paramount (Children Act 1989) rather than confidentiality.

Yet the Data protection Act 1998 and my previous placement agency’s policy on confidentiality also informed me of my practice. In accordance with the Data Protection Act 1998, it entreats all agencies that have access to people’s personal information to keep it safe and must only use the information solely for the purpose for which the information was sought. It also means that if personal information about people fall into the wrong hands it can be used maliciously and our right to private and family life (Human Rights Act 1998) could be contravened. Personal data can further be use to enforce discriminatory and oppressive practice by using it to categorise people in terms of service delivery.

Another important theory in this case study was multi-disciplinary and multi-agency working. The ‘Working together’ document (DOH, 2006) highlights the importance of multidisciplinary and inter agency working in children work force. This document was put together by Department Of Health, Department for Education and Employment and the Home Office. It serves as a guide to inter-agency working to safeguard and promote the welfare of children as well. In my first placement setting, it was good practice to liaise with the lead professional/organisation that carried out the assessment and referred the case to my agency. All relevant information and process of the intervention were shared with the other agencies involved. In this way I was working according to my agency policy of liaising with other agencies, following the legal requirement of the ‘working together’ document and meeting unit 17 of the National Occupational Standards (TOPPS 2004). In doing so I was able to communicate effectively with other professionals and this also facilitated information sharing between professionals.

Theories of Reflection

Using the case study as a reference point, I realised that most of the reflection I did took place after the event. This is what Schon (1998) referred to as ‘reflection-on-action’. According to Schon (1998), reflection-on-action therefore means that as a professional, I only sit back after I have undertaken the intervention to think about what I did, how I did and whether there were any ethical considerations I took for granted. In doing so I am able to analyse and critical evaluate my actions and practice and improve on my shortcoming. For example, in the case study scenario, I realised that the trust and confidence J had in me was eroded once his mum was informed about his revelation to me. Had I reflected before the event or during my meeting with J (reflection-in-action), I would have made him aware that his mum would hear about it and hence J and I could have come to an amicable agreement as to how to inform his mum. This might have provided a more positive outcome rather than the presented outcome in the case study.

This same model of reflection-on-action can be related to Gibbs model of reflection. In Gibbs (1988) model, he identified six key stages of reflection; Stage 1: Description of the event – A detailed description of the event you are reflecting on.

Stage 2: Feelings and Thoughts (Self awareness) – Recalling and exploring those things that were going on inside your head.

Stage 3: Evaluation- making a judgment about what has happened. Consider what was good about the experience and what was bad about the experience or what did or didn’t go so well

Stage 4: Analysis- Breaking the event down into its component parts so they can be explored separately.

Stage 5: Conclusion (Synthesis) -Here you have explored the issue from different angles and have a lot of information to base your judgement. It is here that you are likely to develop insight into you own and other people’s behaviour in terms of how they contributed to the outcome of the event. The purpose of reflection at this stage is to learn from the experience.

Stage 6: Action Plan-During this stage you should think forward into encountering the event again and to plan what you would do – would you act differently or would you likely to do the same?

These six stages of Gibbs model serve as aiding tools to help professionals critically reflect on their experiences. For instance, through detail description in my case study I am able reflect on my feelings and thoughts towards the school authorities and how my actions may have affected the welfare of J. I have also been able to identify that I did not promote the social work code of practice (upholding public trust and confidence in social services). When faced with a similar situation like this in future or in practice, I believe I would think critically and reflect critically before passing information to other professionals with the view that the information will be used solely for the intended purpose.

However, another reflective model is that developed by David Kolb (1984) on experiential learning. Kolb (1984) created his famous model out of four elements: concrete experience, observation and reflection, the formation of abstract concepts and testing in new situations. These entire four elements are connected in a circular way. Kolb (1984) argued that the experiential learning cycle can begin at any one of the four points and that it should really be consider as a continuous and unending process. Meaning, the learning process often begins with a person carrying out a particular action and then seeing the effect of the action in the given event or intervention. Following this, the second stage is reached in which the professional/learner understands these effects in the event or intervention so that if the same action was taken in the same circumstances it would be possible to anticipate what would follow from the action. With this understanding, the third stage is to understand the general principle under which the particular instance happens.

Generalising may involve actions over a range of situations/events for the professional or learner to gain experience beyond the particular instance and suggest the general principle. Understanding the general principle does not imply, in this sequence, an ability to express the principle in a symbolic medium but rather implies only the ability to see a connection between the actions and effects over a range of circumstances.

When the general principle is understood, the last stage is the application through action in a new circumstance within the range of generalisations. Thus the action is taking place in a different set of circumstances and the learner is now able to anticipate the possible effects of the action. Two aspects can be seen as especially noteworthy: the use of concrete, ‘here-and-now’ experience to test ideas; and use of feedback to change practices and theories (Kolb 1984: 21-22).

Relating Kolb model to my case study, I felt that by emailing my concerns to the school mentor about how the information was treated seemed a more professional way of dealing with the issue. As the school authorities later apologised to me about their actions. I do believe that if I am faced with a similar situation with other professionals I would elegantly challenge their actions in a similar manner as I have done before and if it works I might generalise that this approach works well. This would therefore give me new meaning and a new perspective as to how to work with other professional collaborative in achieving the desired outcomes for service users.

Feedback from my peers.

During the learning sets meetings, I presented his case study to my peers and one the learning points from them was that I had assumed that the school authorities would not inform J’s mum about the revelation and because of that I hadn’t insisted on them keeping the information as confidential as possible until such a time when consent had been sought from J. I in my view this is what Brookfield (1988) called assumption analysis in critical reflection. To him, Assumption analysis describes the activity adults engage in to bring to awareness beliefs, values, cultural practices, and social structures regulating behaviour and to assess their impact on our dad to day activities. Assumptions may therefore be paradigmatic, prescriptive, or causal (Brookfield 1995). He stresses that assumptions structure our way of seeing reality, govern our behavior, and describe how relationships should be ordered. Assumption analysis as a first step in the critical reflection process makes explicit our takenaˆ‘foraˆ‘granted notions of reality. Members of the learning set also raised my awareness to the fact that the underlying assumption I had about the case could possibly being derived from my own beliefs, value base, cultural and social background, agency policies, my gender and race. Brookfield (1995) highlighted this by noting that a contextual awareness is achieved when adult learners come to realise that their assumptions are socially and personally created in a specific historical and cultural context. I should therefore have been self aware of the influences my personal, cultural and social (Thompson, 2006) may have had in the given case study.

Also, the learning sets helped me to unearthing or understand more about the power imbalances that exist between service users and professionals. One of my group members made it clear that possibly the school authorities acted the way they did because they had the power to do so and as a way of proving to his mum that the boy’s problem was generated from home rather at school because the mum blames the school authorities constantly for her son’s behaviour. According to Mandell (2008), power affects the experience and behaviour of both the practitioner and service user and so the practitioner needs to ask, or be asked, where does power lie in his/her relationship, how does it operate and who is defining the character and direction of what’s taking place. Therefore, to be a critical reflective practitioner I need to acknowledge the power imbalances in my practice before making decisions or embarking on a course of action. It’s also important for me to consider ‘all the angles’ and checks ‘out all the details before taking the plunge’ (Payne, 2002, p124) so that a more opened, honest, fair, just, anti-discriminatory and anti-oppressive practice can be achieved in my service delivery.

The case study analysis with my peers provided me yet with another very important learning point. Thus, in sharing the information with the school authorities, I was focusing more on the theory (the ‘Every Child Matters’ and ‘working together’ agenda) for ‘off the peg’ solution (Thompson, 2005, p146) or what Schon (1998) calls ‘technical rationality’, the belief that well developed theory can provide solutions for professionals. Rather, I should have used both my theoretical background and past experiences to help inform me of my practice. This would have had a more balancing effect or less impact on J. With this now, I am confident that my decisions and actions in future placements would be drawn from my theoretical or formal knowledge and that of my past experiences or informal knowledge.

Conclusion

Summing up, I feel that this unit has provided me with greater insight about how my actions or decisions are influenced by my belief system, culture, values, gender, religion, assumptions, political and social orientation. It have also learnt that drawing from the views of others, I would be able to see the issue or problem from a different perspective and this might help me develop a new meaning of the event. Mezirow (2000) called the process of developing this new meaning of the event as perspective transformation. I now also understand that as a social worker, t would have draw on knowledge from all sources (theoretical and non-theoretical) in order to address the ‘messy’ complexities of real-life situations and to consider each individual situation or event unique (Yelloly & Henkel, 1995).

Therefore, the way forward for me as a social worker is to critical reflect on the use of self, the awareness of power imbalances (deconstruction) and the development of new meaning/ perspective( re-construction) illustrated by Howe (2008).

Title: Selfie: A new unconscious illness

1.0 Introduction

People have been taking selfie as a trend that is ongoing. The word ‘selfie’ is officially named by the Oxford Dictionaries World of the Year in 2013. ‘Selfie’ is define as a photograph that one has taken of oneself, typically one taken with a smartphone or webcam and uploaded to a social media website (Oxford University Press, 2014).Moreover, selfie is often associated with social networks like Facebook, Instagram or Twitter. People take selfie wherever they are and whatever they are doing.

These days, people snap pictures of themselves wherever they are. For example, selfies taken at funerals, presidential selfies, and even a selfie from space (The Daily Hit, 2013). The popularity of selfies has dramatically increased and had become a social media phenomenon. So, should this be seen as an issues? According to Doctor Pamela Rutledge (2013), selfies can be damaging to a person’s mental health and that indulging in them is indicative of narcissism, low self-esteem, attention seeking behaviour and self-indulgence. Even Thailand’s Department of Mental Health come to a conclusion that the ‘selfie culture’ bring a potential negative impact and claiming that young people are suffering from emotional problem when their selfies is not underappreciated by others. The public does not concern about this issue [L1]because they are not conscious of the illness that selfie can bring.

2.0 Sickness of selfie

2.1 Narcissism

The meaning of narcissism is excessive self-love (Acocella Joan, 2005). Due to the improvement of the technology, taking selfie now is much more convenient. Camera are now being placed on our phones with high mega pixel, we get to edit the picture that we just snap with a touch and we can share it to everyone with a click. The more shots that are taken, the danger you are. You might feel each of the photos of you are so pretty due to the effect that make your skin smooth, fair and make you look younger. This thought may be the platform of the sickness – Narcissism. Narcissism can be also defined as a personality disorder that cause by behaviour like exploiting others, envy, lack of empathy and an insatiable hunger for attention (Acocella Joan, 2005). It is a pretty judgmental label to string up on someone who might be happy with him or herself. According to Doctor Pamela Rutledge (2013), the growing selfie trend is today being connected to a lot of psychological disorders that can be damaging to the overall psyche of the users. Psychologists and psychiatrists are reporting rising numbers of patients who are suffering from narcissism, body dysmorphic and dramatically low self-esteem, all thanks to selfie-nation. According to Doctor David Verle (2014) “Two out of three of all the patients who arrive to examine him with Body Dysmorphic Disorder since the cost increase of camera phones have a compulsion to repeatedly read and post selfies on the social media sites.” This indicates that too much selfie can actually lead to Narcissism.

2.2 Addiction

Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry (ASAM, 2011). Selfie can be an addiction to everyone, not only youngsters, elderly may also addicted to the selfie phenomenon. It seems that some people can’t stop turning the camera their way for that perfect shot, and now psychologists say taking selfie can turn an addiction for people already affected by certain psychological disorders. Research found that UK’s first selfie addict is the teen and has had therapy to treat his technology addiction (Fiona Keating, 2014). They believe that the addiction toward selfie is because “Selfies frequently trigger perceptions of self-indulgence or attention-seeking social dependence that raises narcissism or low self-esteem,” (Pamela Rutledge, 2013). Someone that who are addicted to selfie can snap more than 200 times selfie per day. The first case is of Danny Bowman who is 19, a British teen diagnosed with selfie addiction. He reportedly spent 10 hours daily with 200 photos of himself, but the numerous shots cannot still satisfy his desires. He eventually tried to commit suicide to break free from addiction (Aldridge Gemma; Harden Kerry, 2014). Due to the addiction of selfie, he quit school to have more time for selfie, shutting himself in the house for six month, lost 13 kg just to get a better feature from the camera and become aggressive with his parents when they tried to stop him from selfie. Danny says that he constantly search for the perfect selfie and when he realise the he couldn’t he wanted to suicide. Because of the addiction of selfie, he lost his friends, disappoint his family, giving up his education, health and almost scarifies his own life. The addiction of selfie is most likely to the addiction of drugs, alcohol or gambling which require a lot of efforts to be recover.

3.0 Dealing with selfie

3.1 How parents can help to reduce this issues

Most of us do practice selfie, but how to deal with it, how to prevent from getting any illness but still enjoying selfie. First, parent’s education is most important. Knowing what is your children going through and having a better example of selfie phenomena. Some of the children go through rebellious period, they tend to do the opposite thing when their parents say not to (Rutledge Pamela, 2013). So due to this, parent should know their kids well and have a good communication between them to solve this issue. Next, parents should keep the habits of taking selfie when their children is not around because the behaviour of a parent’s influence their children because children tends to modify what their parents doing. Furthermore, parents should also educate their children on what negative effect can selfie bring. Parents play an important role in a child’s life and what they have made changes what they think.

3.2 Time limitations on phone

Other than having the parents educate, time limitation on the phone also helps in dealing with selfie. The lesser the time you spend on your mobile phone, the lesser your addiction towards selfie. Most of us search for photo perfection for example Danny Bowman. After selfie, we spend most of the time on choosing the perfect picture and spend time on editing. Due to the advance technology, there are now thousands of applications for you to edit your picture. From the case of Danny Bowman, there is a cure toward the addiction of selfie – which is to limit his time on his mobile phones. Danny claimed that the doctor confiscate his phone from him for ten minutes, then half an hour, then an hour (Aldridge Gemma; Harden Kerry, 2014). It was tough for him at first, but the idea of living keeps him motivated. According to Doctor Veal, the usual treatment for selfie is where a patient gradually learns to work for a longer period of time without satisfying the urge to submit pictures. There is not much worried because there is a cure for addiction and narcissism.

4.0 Conclusion

Selfie addiction is so new there are, as yet, no statistics on it (Aldridge Gemma; Harden Kerry, 2014) so it causes people to be unconscious about it. How can the society help to improve the selfie phenomena is to spread the word and inform about what illness can bring when they having too much of selfie. Other than that, self-conscious is also important as we. Always control yourself on the number of selfie and the time spent on selfie, make sure you are not addicted to it. If you were addicted, find someone to talk to, get some opinion or seek for a further medical check-up if you can’t manage to get out from the illness that you are having. Lastly, we can make the selfie phenomena a better world by reminding each other not to take too much shots to avoid all the illness and educate them on how to deal with selfie.

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Growing up in a strong Christian household, my parents always emphasized the importance of helping others. My father was a Methodist Minister at three local churches and encouraged my family to take part in the community. He was very active in the Urban Missions Christian Care Center located in Watertown N.Y, participated in Bridge meetings (an alternative to incarceration program), and was also the founder of the Watertown N.Y based Wheels to Work Program. I remember as a young child having my dad come home with the look of pure joy on his face when he gave his first car away to a single mom. I was so amazed how he could literally transform the lives of individuals through his ministry and participation in the community. One of my fondest memories as a child was going to the Urban Mission with my dad on the weekends and just following him around. The Urban Mission offers many great services to individuals in need such as a food pantry, thrift store, critical needs assistance, housing assistance, and the Christian Care Center, which provides a place of caring and acceptance. It was always wonderful seeing the joy on the recipients’ faces after receiving such services. My dad definitely set the foundation for my interest in the social work profession.

Up until my dad died in 2005, I would often volunteer my time at picnics that my dad hosted for families in need, primarily those with little or no income who were regular visitors at the Christian Care Center. I enjoyed preparing food for the picnics because I knew how much these individuals looked forward to a cooked meal. During the picnic, I loved socializing with teens my age. At first I was uncomfortable because I did not know what to expect from someone whose lifestyle differed so much from mine. But soon I determined that these individuals were not that different from myself. Yes, they were less fortunate than I, some were even homeless, but these girls still had the same aspirations and goals as I did, still enjoyed the same activities, and still needed someone they could relate with. I realized how much of a difference I was making just by looking past our differences and embracing our similarities. From that point I recognized the true importance of treating others with dignity, regardless of their lifestyle. Eventually, I realized that I, like my dad, had developed a genuine passion for helping others.

Upon entering 12th grade, I knew that I wanted to enter the human services profession. I originally wanted to become a Licensed Mental Health Counselor, so I did my undergraduate work in psychology. But I soon realized that the MSW degree was a more effective degree for my career choice. My ultimate goal is to become a Licensed Clinical Social Worker with a concentration in Mental Health, and open a private practice. Currently, treatment by LMHCs is not covered by insurance. Therefore, becoming a LCSW is the better option for me because in regards to treatment, I will be able to bill insurance, which will make my services more affordable. In addition, opening a private practice will allow me to be financially flexible with those who do not have insurance. It is extremely important to me to help those with low income and give them the option to take advantage of such services.

Inadequate resources is a huge social problem faced by many, primarily those with low income. I feel as though everyone has the potential to improve their overall well-being if the proper resources are available. However, all too often, certain resources such as counseling are not available financially to those with low income. Without these resources, many individuals may not have the chance to reach their highest potential and become productive members of society. That is why I have a passion to enter the Social Work field, and provide beneficial services to those even in the low income population.

Another major social problem is that there is a strong stigma attached to mental illness. Many believe that having a mental disorder such as depression is attached to personal weakness. As a result, those suffering from mental illness are sometimes reluctant to seek out treatment. I strongly affirm that it is important for society not to label individuals with mental illness. I personally encourage others not to define people as their illness but to see their illness as just a part of who they are.

Thankfully, religious institutions have a role in society in promoting social and economic justice, by providing behavioral guidelines and offering moral support. The Methodist churches that I have been a part of growing up were non-judgmental and worked to provide social equality. As a teen, I was able to experience the diverse community of the congregation at my church. The organist of the church was gay but the congregation did not discriminate against him. Not all churches accept homosexuality, but my dad lived by the rule that you should treat others how you want to be treated. He emphasized the fact that you do not have to support their lifestyle, but you still need to treat them with dignity and respect. He was very accepting, and encouraged our family to be the same way. He always enforced living by the Ten Commandments, which gave our family a solid Judeo-Christian foundation. My dad definitely had an extraordinary influence on how I live my life today. Religion was and still is an important aspect of my family, and these values have continued with me throughout my adult life.

I strongly believe that my solid family and religious foundation has enabled me to acquire characteristics, which will help me succeed in the Social Work field. One characteristic I am blessed with is empathy. I am able to understand others’ emotions and feelings and convey my understanding of how they are feeling. My parents always said when I was younger, aˆ?How would you feel if you were in his/her shoes?aˆ? I often think of that statement, and I do put myself in others’ shoes and I am able to understand what others are feeling. In regards to counseling, I believe empathy is an important characteristic because it allows the client to feel heard and understood. Empathy will help me as a counselor to connect with my clients. I also believe that I have exceptional communication skills. One strong component of communication that I often demonstrate is active listening. I believe this will be beneficial in a counseling setting because it will allow me to interpret what the client is saying and as a result will enable me to deliver a beneficial response. Most importantly, active listening is important in the counseling setting because it will enable the client to develop trust and respect for me as their counselor.

Aside from my strengths, I also have areas in which I need to grow and change. One weakness of mine is that I often find it difficult to establish boundaries. I believe that being able to set up boundaries in the Social Work profession, especially counseling is critical. My main problem is not being able to say no to individuals. I feel as though if I say no to people, they will be disappointed and I therefore, will experience a strong sense of guilt. However, with the direct practice offered at Roberts Wesleyan College, I believe I can transform my weaknesses and learn effective ways of setting up boundaries. I believe that the ability to set boundaries relies on self-confidence. At Roberts Wesleyan College, I know I will be able to develop a stronger sense of self-confidence through the compassionate and supportive environment. Based on the Christian context offered at Roberts, I trust that my weaknesses will be accepted and my strengths will be recognized which will ultimately lead to my growth and development.

Overall, I’m convinced that the MSW program offered at Roberts Wesleyan College is the best program for me. I believe aside from my determination, my current GPA reflects my ability to succeed. My grades have placed me on the President’s list for the last two semesters here at Potsdam. I know that graduate level work will be challenging, but with my motivation and determination I have faith that I can succeed. I am determined to get accepted into the best MSW program, which I believe is offered at Roberts Wesleyan College. Education and religion have always been important to my family and I. I know that my dad would truly be proud to have a daughter attending Roberts Wesleyan College, which offers a solid education foundation along with a Christian context. I know this is the best college for me and will ultimately allow me to achieve to my fullest potential and improve my overall well-being.