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A given scenario on Recognising Children at Risk (Child Protection). The essay should be based on a given scenario, which has been divided into three sections with question prompts at the end of each section which should assist the essay’s focus.
Section One

Stephen and Eileen have been together for seven years and have two children aged five and eleven months. Eileen also has a daughter aged ten from a previous relationship. The family seemed to function quite well until Stephen lost his job a year ago. He has been unable to find other employment and has been drinking heavily, this means that the family have financial worries and this impacts on family relationships. Eileen has recently found a part-time job and leaves the baby with Stephen. In light of his drinking problems, his being left in sole charge of a very young child would, in itself, be an area for concern. The neighbour’s concern was justified with regard to children she was used to seeing on a regular basis. Both the teacher and the school nurse have concerns with regard to the children’s wellbeing. The rows and screaming that the woman overheard tend to suggest that there is violence in the home and it is well documented that this has a deleterious effect on children and their behaviour.

The police referred the neighbour’s concerns over the Drake/Harris family and it thus warrants an initial assessment, which should take place within seven days of the original referral. An initial assessment would involve the social worker visiting the family home and seeking permission to speak with staff at the school, the Health Visitor , and the family’s G.P. as well as the family themselves. This might also involve a request for the children to be examined by the family doctor and a report made for Social Services. There would need to be some kind of assessment as to the extent of violence in the family and how that is affecting the family’s wellbeing. It is often a good idea to see how the children respond to questions regarding what has been happening at home recently. At the same time the Social Worker might want to establish that the family are receiving all the benefits they are entitled to while the man is unemployed. I think it would also be appropriate that if the mother is to continue working then alternative arrangements need to be made for the baby’s care while she is at work. Once these initial elements are addressed then a multi-agency case conference needs to be convened in order to assess what might be the best way forward for the whole family. This would usually consist of the Social Worker his/her immediate superior, someone from the child protection scheme, the police (as the referral was made by them) teacher, health visitor and the parents.

Eileen denies that her partner inflicted the bruising noted on her arms and legs and insists that she fell down the stairs. This is a common response by women subjected to domestic violence. The father has a problem with alcohol and is also known to indulge in violent outbursts and this raises serious concerns as to whether he is a suitable person to be left in charge of an eleven month old baby. Clearly the family is in need of further support under the terms of the 1989 Act and a full multi-agency assessment of those needs is required. Stephen sees this as interfering and insists that his only problems are lack of work and money. Eileen is more compliant and agrees to visit the GP with the children.

Although the GP has few concerns with regard to the children’s wellbeing other than the fact that they have lost some weight and the baby is not gaining weight at the rate expected, there are some concerns that Eileen might be suffering from depression. Staff at the school report that there are some concerns over the children’s behaviour which has altered considerably over the past few months. Jack in particular has been displaying behaviour that is normally associated with a two or three year old, doing anything to attract attention. This was also noted at the initial assessment when Jack was jumping all over the place. His reception class teacher also reported that she had noticed a lack of concentration in class. Cathy and Jack were clearly unhappy with the situation at home and with any attempt to question them about what was happening. It might be that they were simply trying to protect their parent’s privacy but Cathy’s reluctance to talk about the bruises she received and what has been going on raises concerns as to whether Stephen’s violence is restricted to their mother or whether it extends to the children. It is also of concern that a previously lively ten year old should now be withdrawn. This kind of withdrawal is a common occurrence among children who witness violence in the home and those who have worked with children witnessing domestic violence (Abbott & Wallace, 1997).

Section Two

A week after the initial visit the Health Visitor has reported that she has some concerns over the baby’s health and is also concerned for Eileen who has just discovered that she is pregnant with a fourth child and has bruising to her face. Eileen has admitted to the Health Visitor that Stephen hit her during a row over money she agrees to again visit the GP with Lucy. The doctor did not examine Eileen but noted that the baby Lucy had some bruising on her arm which her mother said had been caused by her brother Jack throwing a toy. This is new information and actually requires a further assessment of the family’s needs. Agencies, both statutory and non-statutory, have a duty with respect to safeguarding children. This was highlighted in research evidence (1995) and further documented in the Department of Health 1999 Report Working together to safeguard children. Guidance has tended to be clearer and more precised in accordance with Lord Laming’s recommendations over the Victoria Climbie enquiry (Laming, 2003). A whole series of measures have since been put in place to target families such as the Drake/Harris’s. The Joint Chief Inspector’s Report, Safeguarding children (2002) defines safeguarding children and their families in the following way:

All agencies working with children, young people and their families take all reasonable measures to ensure that the risks of harm to children’s welfare are minimized, and
where there are concerns about children and young people’s welfare, all agencies take all appropriate action to address those concerns, working to agreed local policies and procedures in full partnership with other local agencies.

Under section 17 of the 1989 Children’s Act the authority has a duty to treat the Drake/Harris children as children in need. This means that the family will need some service provision in order to ease the immediate strain and to give better prospects for the children’s emotional, physical and social development.

Eileen has admitted to having suffered violence at the hands of her partner and is now concerned because she is pregnant with another child. The Health Visitor suggests a termination but as yet it is not clear whether Eileen is going to take this route. While there is no immediate reason to suspect that Lucy is being ill treated there is some concern that she is left in the care of her father for two afternoons a week while her mother is working. It is recommended that alternative care be found for Lucy. Under Section 18 (1) of the 1989 Act it may be possible to arrange nursery care for those afternoons.^[1]

At the present time there are a number of concerns associated with this family. The concern for Lucy has already been expressed and although it is not clear that either her or the other two children have suffered violence they are certainly affected by the situation. In view of this, and the husband’s resistance to outsider involvement it may be necessary to apply to the Courts for a Child Assessment Order. It seems fairly clear that the family does need some support during this crisis and that without such support the children will be at risk of harm due to a number of factors.The family circumstances i.e. unemployed father and significant financial problems, indicate that the children’s development (even without domestic violence) is liable to suffer. Sidebotham, et al’s (2002) study of parents and children and children on the At Risk Register, found that in homes where there was unemployment and financial deprivation children ran a greater risk of being abused. The researchers found a clear link between social and economic deprivation and the risk of abuse.

The Health Visitor phones the next week and explains that Eileen came into the surgery that morning in a terrible state as she thinks she is pregnant again. The health visitor noticed that baby Lucy appeared unwell again, with a bad cold and problems breathing and that there was bruising on the left side of Eileen’s face and over her right shoulder. When the HV asked her about the bruising, Eileen admitted that Stephen had hit her during a row the night before. She claimed that Stephen had been full of remorse and promised to make amends and did not want the HV to tell anyone else about it. Eileen was still worried about how he would take the news that she is pregnant again. The Health Visitor had advised Eileen about the possibilities of a termination of the pregnancy and suggested that she make an appointment to discuss this with the GP and to check her injuries and Lucy’s chest and breathing, which seemed poor. On checking with the GP after surgery this morning the HV has discovered that he only examined Lucy and gave a prescription for medication for her cold and severe nappy rash. Eileen’s own injuries and her possible pregnancy were not discussed. The Doctor however did also notice bruising on the baby, which the mother told him had been caused by Jack, her brother, throwing a toy. The second assessment was decided over the telephone by several representatives. The family receive another visit and this time the social worker is joined by the Child Protection Officer injuries to Lucy are again questioned. Steven admitted to striking Eileen while she was holding the baby and the team decided that the injuries to Lucy were non-accidental. Concern was also expressed over her significant weight loss.

Section Three

Gardner (2002) in a study undertaken for the NSPCC found that support services could be of significant help under these circumstances and that 58% of children considered to be at risk, and had access to support services, showed significant improvement in their development after these measures were put in place. In 2001 the Government commissioned the Children in Need Census^[2] which attempted to establish why children accessed children in need services, what type of provision they accessed and the costs associated with that provision. The Drake/Harris children are further at risk due to Stephen’s alcohol abuse. Harwin and Forester (2002) found that in cases where the parents misused drugs or alcohol, the children often came to the attention of Social Services as a result of concern for their safety and well being. Over 290 cases across four London Boroughs, showed that a third of those requiring long term intervention had parents with some form of substance misuse. This caused concern in a number of areas, particularly where there were children under the age of six. In the present case two of the children, Jack aged 5 and Lucy aged 11 months should be assessed as potentially being at considerable risk. It would seem that there is sufficient concern that a core assessment might be suggested at the inter-agency case conference as there is some evidence to suggest that a deeper and more comprehensive evaluation of both the family circumstances and their needs should be carried out. It is not clear how Cathy’s injuries were received and perhaps a Child Protection Plan might be considered at the Child Protection conference.

The most immediate threat, the father, has agreed to leave the house for a week. This negates the need for a care order to remove the children to a place of safety. He should receive some advice and support on how to handle his drinking. It might also be appropriate to suggest anger management. However, the father is expected to return and there is therefore a need to place all three children on the child protection register. It would seem appropriate for both Jack and Cathy to be placed on the register under two categories, emotional abuse (due to domestic violence) and physical abuse, although in Jack’s case there is no evidence and in Cathy’s case the evidence as to how she received the injuries is unclear this is still a cause for concern. Lucy is the child that raises the most concern and it would seem appropriate that she be registered under three categories, emotional abuse, physical abuse and neglect. This last is due to her significant weight loss, coupled with nappy rash which should have been seen by a doctor before the referral. Sometimes when domestic violence is an issue children become neglected because the mother is so engrossed with dealing with the violence and her own feelings that she does not always take sufficient notice of what is happening to her children (Dobash and Dobash, 1992). It might also be helpful if the family were assigned a regular family support worker who could keep an eye on the children’s development and lend support with baby until the mother was feeling better. She also needs to be given information regarding refuges and domestic violence issues in case the husband returns and is again violent.

All of the above could be problematic, many families are frightened when they hear about the child protection register and think that children remain on it. The mother would need to be reassured that when a suitable time has elapsed and the team are convinced the children are no longer at risk then they can be de-registered. Whether the father will agree to alcohol counseling and anger management is not known at this moment and if he refuses this could become quite problematic. It is for this reason that it seems appropriate to give the mother advice over what she can do to avoid the same scenario. The parenting support might also be objected but, if necessary, this can be enforced by a court order.

The school would need to be informed as to the progress of the family. The Health Visitor should continue visiting regularly and report any problem areas to the GP and to the social worker. If the father is compliant and either stays out of the family home or obtains the help outlined above then there should be no need for further police involvement or for a care order to be requested. I can see no areas where there might be conflict between the various agencies with regard to this protection plan.

Bibliography

Abbott and Wallace (1997) An Introduction to Sociology, Feminist Perspectives Routledge, London.

Department of Health (1999) Working Together to Safeguard Children: A guide to inter-agency working to safeguard and promote the welfare of children HMSO.

Department of Health (2000) Framework for the Assessment of Children in Need and their Families The Stationary office.

Department of Health (2000) Assessing Children in Need and their Families The Stationary Office

Dobash, R and Dobash, R (1992) Women, Violence & Social Change, Routledge, London & New York

Gardner, R. 2002 Supporting Families: L Child Protection in the Community Chichester Valley

Harwin J. and Forester, D. 2002 Parental Substance Misuse and Child Welfare: A study of social work with families in which parents misuse drugs or alcohol Department of Health

Sidebotham, P. et al “Children at Risk of maltreatment in Children of the Nineties: deprivation, class and social networks in a UK sample” Child Abuse 26 (12) pp 1243-1259

Wilson, K. and James, A. (Eds) (1995) The Child Protection Handbook, Bailliere Tindall.

1

There are a number of recent developments in policies relating to care, however, I am going to focus on just one of these policies which is the National Health Service And Community Care Act 1990. Community care has no single meaning, broadly, it means helping people who need care and support to live with dignity and as much independence as possible ‘in the community’. The ‘community’ is hard to define, it most often means ordinary homes, but for some people, it includes special forms of housing, residential or nursing homes.

Community care involves provision which is largely pensions, benefits, income, transport, housing, the opportunity to work, policies for essential services such as fuel, telephone, recreation, education and leisure. Community care is part of our lives. It is the web of care and support provided for frail, people have sick, dependent people both by their families or others members of the community and by public or other services. This means helping some people remain in their homes or creating homelike places appropriate support.

Community care means a preference for home life over ‘institutional’ care. It means helping people to be integrated with their local community, rather than being separate from it, in a long stay hospital, where people do live with others in what are called ‘communal settings’ or ‘group homes’. There is a general reference for smaller homes close to where people have always lived.

New arrangements are being introduced for publicly provided social services. These are often referred to as the ‘community care changes’. They were first described in 1989 Government document called ‘Caring for people’, the NHS and Community Care Act 1990 made the necessary legal changes.

Firstly, When looking at the history behind the NHS and community Care Act 1990, In 1948 the new National Health Service (NHS) and local authorities inherited 500 old workhouses that catered for, or ‘warehoused’ a mixture of elderly people, some of whom were incapable of looking after themselves, some of whom needed medical or nursing care, and some of whom simply had nowhere else to go. The NHS, wanted to get rid of its embarrassing institutions, which contained hundreds of people confined to large wards with no privacy and receiving no significant medical treatment (Townsend 1962).

The Nuffield Foundation issued a report from a committee chaired by seebohm Rowntree in 1947 on the circumstances of old people living in these homes, in smaller residential accommodation and at home. It recommended the development of small units, of no more than thirty five people, sited in the community. Central Government issued guidance to local authorities encouraging them to develop such smaller residential homes, though its own expenditure restrictions made this difficult to achieve until the 1960’s when closure of the remaining workhouses became a major policy goal and local authorities began to build up services that supported elderly people in their homes, such as home helps and meals on wheels. In NHS terminology these alternatives to long stay care in the old hospitals and workhouses came to be called community care.

The same approach can be seen in the next social group to be considered for community care, which was the mentally ill. The Royal Commission on the Law relating to mental illness and mental deficiency in 1957 saw a decline in the number of people needing long-term compulsory detention in hospitals. Many were there and their civil liberties denied merely because no alternatives were available. The preparation for the closure of large long stay hospitals for the mentally ill began in the early 1960’s but it progressed very slowly at first. It was the scandals that hit the long stay institutions for the mentally handicapped in the late 1960s and early 1970s that began a large programme of hospital closure for that group too. (Martin 1984).

The term community care came to be applied to those facilities that were developed to replace long-stay hospital care. The expectation was that local authorities would take on the role of proving such alternative care. In the 1980’s, the emphasis changed again. In their very early statement of policy priorities for the elderly, ‘growing older’, the new conservative government emphasised the importance not of care in the community but of care ‘by the community’ (Department of Health and Social Security 1981).

This essentially meant care by the family and support by neighbours and local voluntary groups, not the local authority. Community care has been a concern to shift the responsibility for care from one agency to another, from the NHS to local authorities, from local authorities to families.

The NHS and Community Care Act 1990 was introduced for a number of reasons, it introduced new procedures for arranging and paying for state funded social care. The government stated that they aim to make the best use of public money to make sure that the services which are provided by local and health authorities meet their needs. They encouraged authorities to set priorities to decide how they will spend money if there is not enough to provide for everyone’s needs. They also ensure that local authorities check on the quality of care which is being provided through inspection units, complaints procedures, care management, setting of service specifications and monitoring contracts for care and they aimed to encourage local authorities to use other organisations to provide services, not just to provide themselves.

The Audit Commission 1986 carried out a report called ‘making a Reality of Community Care’, which was a highly cogent and critical document. It discussed the fragmented nature of the so-called spectrum of care that was supposed to be available, from hospital to domiciliary care. It pointed out that many agencies were involved and that many people were either getting the wrong kind of care or not getting care at all. It criticised funding arrangements that gave more central government support to hospital care than to local authorities, which were providing an alternative. What was new was the exposure of what was happening to the social security funding of residential care.

The Audit Commission documented the rise in spending and argued that the government was being wholly inconsistent. It was telling local authorities that it wanted old people to stay at home for as long as possible because that was the most cost-effective and desirable thing to do, but at the same time it was pushing large sums of public money into expensive residential and nursing home care.

Sir Roy Griffiths, Mrs Thatcher’s trusted advisor on the NHS, had already reported to her on the management of the NHS. He was called into service again. He established the Griffiths report in 1984 to review the way in which public funds are used to support community care policy and to advise the secretary of state on options which would improve the use of these funds. (Department of Health and Social Security 1988). His essential job was to sort the money problem. In his report he recommended that public finance for people, who require either residential home care or non-acute nursing home care, whether that is provided by the public sector or by private or voluntary organisations, should be provided in the same way. Public finance should only be provided following separate assessments of the financial means of the applicant and of the need of care. The assessments should be managed through social services authorities.

Local authority social services departments were responsible for the funding of support and organisation in the community, which commenced when the establishment of the NHS and Community Care 1990 was made. The blurring of the boundaries involving health and social care came into effect at the same time as the development of this Act was made. Recent debates are concerned with equality in community care over the allocation of public resources involving various client groups, income groups, localities and generations.

Local authority services departments were in charge of funding and organising care and support in the community, this was carried out by the NHS and Community Care Act 1990 to allow individuals who are affected by disability or ageing to live independently as possible. Both the idea of responsibility and community care and for its organisation has been especially hard to identify. For example, in 1981 a study by the Department of Health and Social Security distinguished the inconsistent understanding of community care by health and social services authorities. For the NHS, community care typically referred to care offered outside the health service, for example, residential care from local authorities. Residential care was referred mainly by social services departments.

The central department of social security was handed the main responsibility for funding from means testing to local service departments. Providing and planning care and assessing people’s needs was the local authority’s responsibility. This included domiciliary care as well as the allowance of money for places in residential and nursing homes.

The Act included key objectives, which were, three different types of services available for people at their homes such as respite, day and domiciliary services which includes occupational therapy, bathing services, home care and home help, various types of daytime care outside a person’s home is associated with day services. Examples of day services are lunch clubs, day hospitals and day centres. Another key objective is respite care enables people who are being cared for and carers to get a break from another. Respite services include day centre attendance, family placement schemes, sitting services and also respite care provided in nursing and residential homes. Another objective from the Act was service for carers, when an individual’s needs assessment is being prepared, carers need to be considered.

Another key objective was that a referral on behalf of a patient to social services can be made by any individual as well as any person who is a member of the primary health care team. Also, anyone who appears to need a community care service must be carried out by the local authorities. A written care plan should be then set out by the local authority which should address who, when and what will be achieved by providing services, to deal with issues with services there should be a contact point and if any circumstances change, there should be information on how the individual can ask for an evaluation of the services.

Another objective is that GP’s are expected to deliver helpful information on health to assist social services in the care assessment. There are a number of adult client groups that benefited from these objectives. The children Act 1989 introduced many changes relevant to provision for children and their protection, adult client groups include elderly people, people with physical disabilities, mental health problems, drug and alcohol problems, people with HIV or AIDS, homeless people and people who are terminally ill.

However, the National Health Service and Community Care Act 1990 have been criticisms. There is a tension between the idea of ‘user-led’ assessment and the ‘targeting’ of resources on people. Some social services departments are worried that the assessment process will raise expectations which cannot be met.

It is possible that some assessments will not reflect people’s ‘actual’ needs, but only the needs they are allowed to express in line with those the authority feels able to meet. Such a system would suppress only understandings of the true level of need, unless the unmet needs are carefully recorded and fed back into the system.

Also the community care reforms are rooted in the idea that people should have choice about how their care needs are met. Assessment should be user-led, but gives the ultimate responsibility for defining need and working out how or if it will be met to the local authority through the assessor or care manager

The Act has been also criticised for using the term ‘vulnerable adults’. They are defined as ‘at risk of abuse’. They are those meeting the criteria of the NHS and Community Care Act 1990, or being in need of community care services by reason of mental or other disability, age or illness and being unable to take care of themselves or to protect themselves against ‘significant harm or exploitation’. The term ‘vulnerability’ is being used in this Act to stress the differences between people in terms of their ability to protect themselves. However, these differences are not fixed and a disability perspective would argue that casting disabled or older people, or people with health problems, as vulnerable is a form of infantilization and further perpetuates their less than full adult status. They can be seen as helpless or dependent and unable to manage the risks of ordinary living. Examples of this are: people with learning disabilities may be over-protected by those who fear they will be exploited, in particular, sexually.

Another criticism of the Act is that Lewis and Glennerster (1996) have suggested that NHS officers regarded the 1990 Act as ‘good grounds for getting rid of their long-term care responsibilities as soon as possible’. Some health authorities stopped providing any continuing care beds at all (Richards 1996). Eventually, these developments forced the department of health publicly to accept that the 1990 Act had led to a reduction in the responsibility of hospitals for long term care, not withstanding its earlier claims to the contrary.

On a 1994 report by the Health Service Commissioner into the case of a seriously brain damaged patient, for whom the local health authority had refused to accept responsibility, The Commissioner found that, in refusing to spend resources on patients of this type, the health authority was failing to fulfil its duties. (Health Service Commissioner 1994).

Another criticism of the NHS and Community Care Act 1990 are that even though the reforms have stressed the significance of carers (primarily other family members), however, some of the individuals that need care do not have families and of the individuals who do have families do not have carers. Also the basic difference in individual’s family situation is not directly addressed by the current policy. The community care reforms, which were preceded by the white paper, found that ‘the government distinguishes that demographic movements will have repercussions for the potential availability of carers. However, it failed to explore what these repercussions might be; the reforms also persist to place the relatives at the middle of the care system. Another criticism is that there also may be no interpreting service to help people whose first language is not English, or who is death, People may not want their financial means to be assessed, disablement benefits have to be put towards services offered, when there is already difficulty making ends meet.

In conclusion the community care involves provision which is largely pensions, benefits, income, transport, housing, the opportunity to work, policies for essential services such as fuel, telephone, recreation, education and leisure. Community care is part of our lives.

The NHS and Community Care Act included key objectives, which were, three different types of services available for people at their homes such as respite, day and domiciliary services which includes occupational therapy. Criticisms of the policy include casting disabled or older people, or people with health problems, as vulnerable is a form of infantilization and further perpetuates their less than full adult status.

(2599 words)

“White Social Workers’ pejorative assessment of black families and the reinforcement of racist stereotypes through their intervention are central to the ‘social working’, i.e. social control, of black families and form the major avenues through which they ‘clientise’ black people.” (Dominelli, 1988)
Introduction

While keeping the above statement in mind this paper will discuss how assessment can be effective in assessing need and managing risk for all users. It will do this by looking at how problems and conflicts are addressed and in what ways this might be effective for users of mental health services.

Assessment

Assessment is a process that all users have to undergo in order to determine what services they might be entitled to and how their needs might best be addressed. Social workers who specialise in the area of mental health are bound by the 1995 Act which defines their responsibilities to people with mental or physical disabilities.

Disability is defined as a physical or mental impairment which has a substantial and long-term adverse effect on ability to carry out normal day-to-day activities (Brayne and Martin, 1999:460).

The Human Rights Act of 1998 is phrased in such a manner that local authorities now have a duty to act in ways that are conversant with the Act. Social workers help people with mental health difficulties to deal with the problems that they face. It is the social worker’s duty to help organise care and support for people with physical disabilities, with learning disabilities, and with mental health problems. This duty begins with an assessment of need for services, it is only once such an assessment has taken place that social workers and local authorities will be able to decide whether they can help with that need.

In the 1980s the Tory Thatcher Government brought market policies into the health service that included what is known as ‘care in the community’ this meant that large numbers of psychiatric hospitals were closed. This resulted in those who were mentally impaired, along with a small number of psychotic patients being discharged into the community. They did not receive proper treatment and a number of incidents created public unrest. Thus, whenever a social worker makes an assessment for someone with mental health difficulties they have a duty to do so with the concept of also assessing any risk that they feel users might face or that they could pose to society. Under the 1990 NHS and Community Care Act (circular LAC (92) 12 any needs assessment that a social worker undertakes needs to take into account the following:

The capacity/incapacity of the person being assessed
Their preferences and aspirations
Their living situation
Any support they might have from relatives and friends
Other sources of help

With regard to people with mental health problems and with other disabilities, just because local authorities have a duty to find out about such people in their area and offer help, does not depend on a client’s request for services rather it requires the social worker to carry out an assessment of anyone in that group who might be eligible for services (Brayne and Martin, 1999). Once an assessment has been carried out and the client’s needs identified then social workers have a duty to help people with mental health problems obtain the benefits that they are entitled to. The social worker also has a duty to ensure that the client is in accommodation that is suitable to their particular needs. The authority may need to provide extra support to enable a person to continue living in their own home or they may need to arrange a move to residential accommodation or long term hospital care. Thus working with this client group is a large and varied field and social workers are faced with a number of different duties in this respect. These duties and responsibilities are further defined under legislation and policy relating to the needs of people with mental and or physical disabilities.

A social worker whose clients are in one of the aforementioned groups may find themselves visiting clients in a number of different settings. It may be the client’s home, hospital, residential accommodation, or sometimes at the social worker’s place of employment. Generally the social worker will act as part of a team dealing with a number of different cases and in each one will need to be aware of the general legislative framework as it applies to that particular client group. Social workers are required to write reports on every case that he/she is engaged with. This will then be seen by their supervisor and by the care management team. This helps in addressing client needs and determining a care package. It is also a way of determining whether the social worker has done their job in the best way possible i.e. a way that empowers the service user and gives them some say in the decision making process. This is especially relevant where mental health is concerned as there has been some speculation as to whether social workers and other mental health professionals deal with service users in ways that are non-prejudicial.

Some research tends to suggest that over the last fifteen years those who use mental health services have been treated in a prejudicial way. This is because (and Government debates are also at fault here) this group of users have tended to be defined in terms of the risk they constitute to themselves and the wider society. This is despite all the evidence supporting the view that those with mental health problems are not generally a risk to society. Langow and Lindow (2004) argue that such a concentration on risk means that an individual so defined runs the risk of having decisions concerning their lives taken out of their hands. This is certainly borne out by government policy proposals regarding people who are considered to be a risk to themselves or others. Langow and Lindow (ibid) maintain that this concentration on risk means that social workers and other mental health workers often find it hard to distinguish the reasons why someone may behave in an aggressive manner. Is it due to psychotic behaviour, or is it just that they feel disempowered or feel themselves as having been subject to racial abuse? The danger here is simply to err in favour of the psychosis rather than believing they have to take the risk that someone would not pose a threat to the rest of society. Service users are often not aware that they are being assessed in this way. The fact that staff might consider users to be a risk to others however, could have serious implications for that person’s future.

Dilemmas and Conflicts

It is not always easy working with people with mental health problems. A social worker may undertake an assessment and then find that the client does not want the help that is on offer. This really can be problematic as the legislation implies that local authorities must make an assessment of needs once mental health problems or disability have been identified. This further implies that they will produce a care package to address those needs. If a client refuses to allow a social worker entry then they are not able to do their job and undertake an assessment or provide services as required by the legal framework. If an assessment is made then the social worker has to try and identify areas where family and friends can help the person. When such arrangements break down and there are no alternatives in place then problems may arise. Thus a person who may previously have been assessed as being able to remain in their own home may later have a need for either supported living (particularly in the case of people with mental health problems or learning disability) or for residential care. If a person is deemed unfit to live alone or is a problem to others then the social worker has a duty to call in the medical officer of health who then has to obtain an order from the magistrates court. Removal to residential accommodation then involves the social worker in another set of rules as to how the accommodation is financed. This is also pertinent to regular inspection of such accommodation and other welfare services that the client is entitled to.

Clearly there are a growing number of legal and policy requirements that a social worker must adhere to when dealing with specific client groups. Mental health is an increasingly problematic area because new regulations are coming up all the time and the wording is not always clear or precise. This means that the social worker’s job can be a minefield as they try to adhere to the needs and wishes of the client and yet remain within the legislative framework.

Factors that Promote and Limit Service User Involvement in Decision Making

Current debates on the needs and rights of services users show that although there has been a move to ensure individual’s rights to equality of service, some service users still face discrimination. Under these circumstances it is vital that power imbalances between service users and professionals be acknowledged and the contributing factors addressed. Once they come to such an acknowledgement the parties can then work together to minimalise any factors that contribute to the marginalisation and exclusion of some service users (Carr, 2004). Some of these issues might include the fact that there is still a tendency for some professionals to ignore service users’ views or to at least misinterpret them. This means that instead of being enabled through greater user participation, service users may end up feeling further disempowered. Institutional barriers have to be overcome, and the continuing use of professional jargon can also serve to exclude service users from the decision making process. Carr (2004) found that service users often saw such gaps as a disempowering and exclusionary factor, but, once aware of this fact, most professionals were more than happy to try to modify their language in order to encourage greater service user participation.

It is sometimes very difficult for people with mental health problems to communicate their needs in a way that is fully understood by the professionals trying to assess them. 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 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. 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. People with mental health problems 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 (Moore, 2002).

Conclusion

Ethical and effective social work should involve a thorough assessment of the needs of users with mental health problems and a care package that takes their problems and wishes into account. This should be tailored to suit an individual’s 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.

Effective social work is client centred and this is achieved through the social worker’s own reflective practice. If criticisms and accusations of prejudicial attitudes are to be avoided then it might be argued that advocacy, coupled with reflexive and effective social work practice should bring an end to service user disempowerment and become one that assesses need and manages risk in a way that is beneficial for both users and professionals.

Bibliography

Brayne and Martin 6^th ed. 1999 Law for Social Workers London, Blackstone Press

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

Langow and Lindow. 2004. “Mental health service users and their involvement in risk assessment and management” Findings, Joseph Rowntree Foundation

Leason, K. 2005 “Fear and freedom” Community Care April 14^th 2005 p. 32-34

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

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

Disability Discrimination Act 1995 http://www.drc-gb.org/thelaw/thedda.asp

http://www.after16.org.uk/pages/law5.html

Koster (2003) stated that “supervision leads to a mental and emotional education that can guide practical work, frees fixed patterns of experience and behaviour and promotes the willingness as well as the ability to act suitably, carefully and courageously”(p1). This essay will explore Koster’s quotation about best practice in supervision, in relation to supervision in the area of counselling. This essay will also identify the benefits and difficulties of supervision, in regards to counselling, that can arise in supervision. Examples from a personal perspective will be presented on how supervision throughout work experience enabled difficult situations to be handled. Furthermore, an analysis of how effectively supervision was conducted throughout work experience, as well as personal suggestions on improvements of supervision in that work setting.

Koster’s quote does speak truth as supervision can lead to all sorts of positive and negative developments (Pelling, Bowers & Armstrong, 2007). In particular he claims that it can lead to mental and emotional education that guides practical work, frees from fixed patterns of experience and behaviours. Supervision in counselling is very vital as it aims to increase self-awareness and enhances professional competence which will guide the supervisee throughout their work in a confident manner (Pelling, Bowers & Armstrong, 2007), which is similar to what Koster is trying to state.

The goal of supervision is primarily about the supervisee’s developmental growth and professional awareness (Pelling, Bowers & Armstrong, 2007). Which again leads back to Koster’s quote about how supervision leads to development; and that development of experience will guide the supervisee throughout their work in counselling. Thorough supervision, the supervisee will grow, reflect and develop in their professional and personal skills. It is through these developments that will alter their behaviour that will eventually guide them through their work to act in a suitable, careful and courageously; throughout their career in counselling. Which in return, is vital for a counsellor as his or her mental and emotional education needs to continually develop, and this can be accelerated through supervision.

It can be said that a number of individuals and organisations can benefit from quality clinical supervision. Quality supervision is about making sure the client is not being harmed and is being assisted to accomplish established goals in competently appropriate ways, the receiver of counselling services is the first to benefit (Page & Wosket, 1994). The majority of the conversation in supervisory sessions centres on interventions being used for the client and advance to how the supervisee is stressed with various parts of the case.

While the supervisor is interacting, clarifying, explaining, educating, supporting and coming up with helpful professional interventions, another person is benefiting from this while interacting back to their supervisor – the supervisee.

As Pelling, Bowers, and Armstrong (2007) suggests:

This is where the supervisee’s scope of practice, expertise and insight is being intentionally and incrementally expanded. Engaging supervisors in the struggle for understanding is valuable for deep learning to occur. In this sense it is the clinical material that is the teacher, not just the supervisor themselves. Supervision can insulate the supervisee from work-related stress, variously referred as burn-out. (p. 126)

In addition, if the supervisee is an apprentice from an educational establishment, the organisation itself benefits with the development of a more proficient and safe practitioner (Pelling, Bowers & Armstrong, 2007). This gives the organisation an excellent reputation for supporting and appropriately training the people in their charge in a professional manner, hence supervision being provided by the organisation benefits the organisation with a good positive professional reputation.

Last of all, the clinical supervisor gains a great deal from offering supervision. While they support the supervisees, their understanding of clinical work, knowledge, experience, the world and themselves develops a great deal and the sense of fulfilment of being additive to so many is indeed rewarding and satisfying (Pelling, Bowers & Armstrong, 2007).

Supervision can be a valuable constructive learning tool, but at times difficulties in supervision can make it a negative experience. Moskowitz and Rupert (1983) found in their research, within USA, that supervisees reported that 38% of those surveyed claimed that there had been difficulties and conflict in their supervision that interfered with their learning. Their research further found that there are three major areas of difficulties and conflict that arise in supervision: theoretical orientation, style of supervision and personality issues (Moskowitz & Rupert, 1983).

Differences in theoretical orientation may lead to difficulties and conflict in supervision (Carroll & Gilbert, 2006). In various organisations, supervisees may not have a choice of a supervisor and may perhaps end up getting supervised by somebody who has a different theoretical to their own. For example, a supervisor may be convinced of the ‘rightness’ of their orientation and is not ready to accept interference that arise from a different school of psychology. These differences in theoretical orientation are a common problem in supervision and it may lead to rifts between the supervisor and supervisee, therefore failing to negotiate differences of this kind (Holloway, 1995).

Secondly, difficulties and conflicts may arise in supervision when it comes to the style of supervision. Some supervisors have a formal style whilst others have an informal style of approach (Carroll & Gilbert, 2006). There are four unsatisfactory styles of supervision that cause conflicts and difficulties: constrictive supervision; amorphous supervision; unsupportive supervision; and ‘therapeutic’ supervision’ (Abott, 1984).

In the constructive type, there is limited autonomy. In the amorphous type, there is very little supervisory contribution and the supervisor may have a somewhat laissez faire outlook to the entire process, where ‘whatever happens goes’. Unsupportive supervisors are unfriendly and distant and supervisees would not willingly approach them with their difficulties. Therapeutic supervision transforms the supervisee into a ‘patient’ while the supervisor takes on the position of the ‘therapist’ often in a persistent and pushy manner that infantilizes the supervisee (Carroll & Gilbert, 2006).

The last style of supervision that causes conflict and difficulties is known as personality issues. This is when there is a ‘personality clash’ between the supervisor and supervisee which can result to a rupture in the supervisory alliance (Carroll & Gilbert, 2006). These ruptures are often caused by confusion in communication, for example the supervisor may misinterpret something the supervisee has said in a negative way. Furthermore, the rapture may be simply be caused by the supervisees own defensiveness. An example would be that the supervisee may act defensively when the supervisor gives feedback, therefore causing a strain in the supervision relationship.

Supervision is a valuable tool for a supervisee when they are having difficulty dealing with their client in an effective professional manner. Whatever the problem is, in regards to the well-being of the client, the supervisee can discuss these issues throughout supervision in order to uncover helpful interventions in dealing with the matter (Wosket, 1999).

An example from work experience in which supervision enabled to deal effectively with a difficult situation, is when there was a client who brought up an issue that was difficult to handle. The reason the issue was difficult to handle is because there was limited knowledge in that area and there was no confidence in dealing with the matter. So in order to deal with this dilemma, it was brought up to the attention to the supervisor throughout the supervision session.

Throughout the supervision session the supervisor, listened to the dilemma and asked explorative questions, made encouraging statements and shared self- disclosure. She also in return, working the supervisee, came up with interventions to put together in order for the supervisee to handle the struggling case. The supervisor clarified the problem to the supervisee and explored potential explanations and interventions for the supervisee to consider. The supervisee filled in the gaps of the knowledge and asked the supervisee to reflect and explore options on how he will put the explored interventions in to action. The supervisor also used modelling and role-plays to show the supervisee on how they might be able to assist their client. So through supervision, the supervisor’s challenges and confrontations facilitated the supervisee’s critical reflection and learning, hence this gave confidence to the supervisee to handle and deal with their difficult situation.

A concise breakdown will currently be offered on how efficiently supervision was carried right through work experience. Supervision was conducted effectively because the supervisor followed a significant process in order for supervision to function at its best. The initial supervision session is when the supervisor clarified what the supervisee has done in the past in regards to practice and supervision, and asks where they would like assistance.

When it came to the daily supervision sessions, it was noted at times that the supervisor would follow a process right from beginning to end. When the supervisee had an issue, it would be looked thoroughly. Issues discussed in supervision included: intervention strategies and future plans; counsellor professional development; supervisee – client alliance and boundaries; client issues and goal setting; supervisor – supervisee relationship; ethical and legal issues; and so on.

Once the issue were discussed, the supervisor would ask a series of structured questions in order to gain clarification, as well as allowing the supervisee to reflect and offload. Such helpful questions included: What are you feeling and views about the issue?; Where do you feel most confused?; what kind of help would you like?; and what are the key details I need to know about the case?.

Furthermore, during supervision the supervisor and supervisee took notes during sessions to have an ongoing record of plans, themes, struggles, clients discussed, learning and progress. Once the issue was discussed and the supervisor asked her questions, the supervisor would then encourage the supervisee to: understand the problem; find links among the information; develop a treatment plan to put into practice; and create a working proposition (Carroll & Gilbert, 2006).

Towards the end of every supervision session, the supervisor would give feed back as well as ask for verbal feedback back from the supervisee. The supervisor would ask something as simple as ‘How was our session for you today?’ or ‘Was this session valuable or unbeneficial to you today?’

Summing up, supervision was conducted effectively because the supervisor followed a valuable process throughout the sessions. Apart from following an effective process, the supervisor herself was encouraging, respectful, genuine, empathetic, and self-disclosed, which as a result added further to the effectiveness of supervision.

From personal experience, the supervision that took place during work placement cannot be faulted. However, there is lack of knowledge of how the other supervisors function in their role, as during placement only one supervisor was given to work closely with. Focusing purely on the supervisor provided with, her name being Amy, she was nothing but professional, educated and friendly. One could suggest that Amy is the ideal supervisor as throughout work placement she always showed respect, genuineness, empathy and was always encouraging. She was also concrete and showed a great deal self-disclosure throughout supervision. As stated, Amy would be the ideal supervisor as her supervision qualities match what Carifo and Hess found in their research in what makes an ideal supervisor. Carifo and Hess (1987) found that “the ideal supervisor is a person who shows respect, empathy, genuineness, concreteness and self-disclosure in his or her dealings with supervisees” (p.247).

So as one can see, supervision cannot be faulted as it was nothing other but a positive learning experience, with the help of a true professional supervisor who knew how to function in her role. Therefore, it is too complex to come up with suggestions for improvements for supervision in the work setting because it just worked to well in order to suggest any changes.

Supervision may have its benefits and difficulties, but it is those experiences a supervisee needs to experience in order to develop their mental and emotional experience. It is these developments and experiences that allow the individual to be able to learn and handle future challenges in their area of counselling. With the right supervisor, as well as having regular supervision sessions that are conducted effectively, it will consequently transform the supervisee into a stronger counsellor who is willing to learn, act suitably, carefully and courageously; throughout their counselling career.

Loneliness is a geriatric giant leading to impaired quality of life, greater need for institutional care and increased mortality. Routasalo, Pitkala, 2003

The phenomenon of loneliness occurs in people of all ages it may be a particular problem in the elderly according to a study carried out at Edinburg University in the nursing science department. It is acknowledged that loneliness is not necessary accompaniment to ageing and that ageing is not solely responsible for the development of loneliness in the elderly people; however there is a relationship between ageing and loneliness.

There is a need to understand the casual relationship between life-events and loneliness, how to predict it and whether negative consequences maybe alleviated.(Routasalo, Pitkala, 2003).

This study is about loneliness among the elderly people. I was interested in this topic because the fact that many old people are still experiencing loneliness at different levels cannot be overlooked. ‘Loneliness’ and social isolation have often been used to characterise the social world of older people and as an indicator of their quality of life (Victor, scamber and Bond, 2009) but loneliness among the elderly has been under addressed.Like many other social science concepts,loneliness is often a taken-for-granted idea from every day life.Loneliness is a common problem among the elderly that lead to widespread unhappiness and social exclusion.

The purpose of this study is therefore to portray loneliness among the elderly ,the main influencing factors and strategies to address it.

This study is entirely based on Qualitative Research methodology by probing into different academic disciplines so as to gather a deeper understanding of this particular topic.

WHAT IS LONELINESS?

Loneliness is a situation experienced by the individual as one where there is unpleasant or inadmissible lack of (quality of) certain relationships. This includes situations in which a number of existing relationships is smaller than is considered desirable or admissible as well as situations where the intimacy one wishes for has not been realised. (De jong gierveld, 1987, p.120 quoted in vangelisti and pelman 2006, p. 585-500)

(Peplau, 1981 quoted in vangelisti and pelman 2006, p. 585-500) defines loneliness as ‘the unpleasant experience that occurs when a person’s network of social relations is deficient in some important way either qualitatively (Quality related) or quantatively (size related).

Loneliness categories

(Weiss, 1973 in vangelisti and pelman 2006, p. 585-500) categorise loneliness as:

Emotional loneliness

This is as a result of absence of an intimate figure or a close emotional attachment (a partner, best friend) e.g. in divorce or widowhood.

We can further subgroup it as:

Developmental

Experienced when there is a need for intimacy balanced by a pursuit for personal happiness and independence (goals).

Internal

Often includes feelings of low-esteem and vulnerability.

Social loneliness

This kind of loneliness arises with the absence of a broader group of contacts or an engaging social network like friends, collegues and people in the neighbourhood.

It can also be termed as Situational/Circumstantial which can be explained by situations like loosing a relationship or moving to a new city.

Measurements of loneliness among the elderly

Loneliness is subjective(It is based on somebody’s opinions or feelings rather than on facts or evidence) and is measured using questions that seek perceptions of relationships,social activity and feelings about social activity(British Columbia ministry of health ,2004)

Loneliness is very cultural and temporally specific(jylha 2004).It is and has been difficult to compare levels of loneliness accross cuntries because the meaning of ‘loneliness’ is highly cultural(and possibly temporary)specific. Variations in measures used to measure loneliness by researchers in different countries has made it difficult to make a comparison across different countries.

Findings of the study
Main factors influencing loneliness among the elderly
Health resources

Chronic poor physical or mental health, Sensory impairments, Falls and

Self-rated health and Health expectations

(Tijhuis et al 1999) found that increase in loneliness was attributed to poorer subjective health but not on activity limitation or cognative function.Lonely and isolated peoples health may deteriorate because”they lack the environmental support,social ties and assistance by others that become critical factors in the maintainance of their independence later in life.(Bosworth and schaie 1997 p.197)

Mental health issues such as depression can impact self-rated score in an indirect way as those who are depressed may evaluate their social relationships negatively and therefore create apparent associations with other risk factors when infact it is depression that is the issue.(Russel et al,1997)

Social resources

E.g. Availability of family, friends and Social contacts

Recognition of the importance of the importance of the relationship between social engagements and ‘quality of life’ is not new (Victor, scamber and Bond, 2009). Social relationships and social engagements are a very important part of quality of life in old age according to (Victor, camber and Bond 2009).Rowe and Kahn (1997) suggest that a high level of social engagement is a key factor in achieving the goal of ‘successful ageing’. This same observation has been made in ideas of ‘healthy’ ageing and ‘active’ ageing.

Demographic factors

E.g. Age, gender, household composition, neigbourhood and

Marital status

Age and gender

Being widowed and living alone are more common among women because of their tendancy to outlive male partners.

Neigbourhood

Favorable neighborhood is associated with feeling safe and secure. Immediate neighborhood is of particular importance to the well-being and quality of life of older people(bowling 2006,Victor,Scamber and Bond 2009)Whilst there has been much focus on the importance of maintaining older people at ‘home’ this has been often interpreted as the narrow confines of the built dwelling or house rather than the wider environment of neighborhood or locality. Yet place is clearly important in providing the spatial context within old age (Berkman et al., 2000; berkman and Glass, 2000, Victor, Scamber and Bond 2009)

Household composition

Most people who live alone are lonely but not all people who live alone are lonely.Living alone also interacts with many other variables to create varying pictures of loneliness.Living together with someone and living in one’s own apartment(as opposed to an institition) showed a positive influence on feelings of loneliness for this population(Holmen et al 2000 as cited in gierveld,Tilburg and Dykstra in Vangelisti and perlmans 2006)

Material resources

E.g. Home ownership, access to car and education Qualifications

Economic status and self-esteem have been found to have a relationship with loneliness. Loneliness was expressed by those older persons with less adequate self-rated economic conditions and those living in actual poverty.(Mullins,Elston and Gutkoiski,1996) agrees that the less financially adequate individuals perceive their situation to be the more lonely they were.

Access to Transport/car

Driving status and transportation have an effect on the loneliness and social isolation of the elderly because of their role in facilitating access to the social network.(Kivett 1979) categorized older rural adults with transportation problems as a high risk of loneliness. Many seniors are restricted to pre-arranged van trips with community or volunteers drivers. Dependence on others for transportation related socializing may change the nature of social interaction for those people (Hall Havens,1999). Programs for seniors will be ineffective if they cannot access them.

Life Events

E.g. Bereavement ,widowhood and onset of illness

Death of a spouse and living alone is a major additive risk factor for loneliness and isolation.

Events like widowhood emphasize that bereaved persons are especially vulnerable for emotional isolation(loneliness)rather than social isolation (Van baarsen et al,1999)

Discussions of findings

Given the potential harmful effects of social isolation and loneliness in seniors,it is important to persue this issue in order to reduce emotional damage to seniors and inappropriate health and social service usage.However,caution should be observed when again interventions without knowing the target population and assessing the possible negative consequences of the planned intervention.( British Columbia Ministry of

Health.March 2004)

Strategies to address loneliness and isolation for older people.

A survey done in campaign launced by leeds metropolitan university on behalf of the british gas to combat isolation and lonelness developed recommendations with the

older people to address the issue of isolation and loneliness.Through interviewing older people and trying to identify what they want,the following suggestions were arrived at.

Involving older people in planning,developing and deliverly of activities that target social isolation and loneliness.

Practical,flexible and low level assistance that could help older people to remain indipendent,gain confidence to identifytheir own solutions and support them in retaining their own social networks.

Individually tairoled solutions to meet specific needs,within a variety of activities available within their local neighborhood and within the reasonable travelling distance.

Transport that takes the mobility of the elderly into account.

Availability of Services that cater for specific groups such as carers,ethnic minorities,older men and those with hearing impairments or mobility problems and those who have been isolated for a long time.

Support and encouragement for the elderly to learn new skills as well as the opportunity to share their skills with other older people.

The purpose of this meeting was to carry out an update SAP assessment, under Section 47, NHS and Community Care Act 1990, because Diane’s needs have changed.

Diane is a 69-year-old White British Female who has been living in Critchill Court since her discharge from hospital in Jan 2010. Diane had a Sub Arachnoids’ Haemorrhage, which has caused memory loss, confusion and depression in 2009. Earlier review in Feb 2010 reveals that Diane expressed a wish to return to independent living. Since then, an OT has supported Diane in re-learning independent living skills.

Prior to the meeting, I went to social service to discuss with Diane’s social worker to initiate information sharing and ask advice. We agreed on the need to complete the assessment before Diane’s review in May 2010. I also obtained permission to have this meeting from Diane, and her daughter and their agreement that my placement supervisor would attend the meeting – but only to assess me.

My aim was to identify Diane’s current and future needs with her and her daughter, who specifically stated her wish to be involved during earlier casual conversation. To do this I gained permission from Diane and her daughter during the meeting that I would seek the views of other professions, (OT, key worker, and CPN) to fill in some parts of the assessment. Diane has also given permission for me to share the information that she provided with others on a ‘need to know’ basis.

My role as a student gave me flexible time to commit in more supportive work with Diane. I had been working in partnership with Diane, her daughter, OT and social worker for 3 weeks before the meeting. I have taken Diane out, building her confidence in accessing local resources, and importantly, a relationship based on empathy, trust, and confidence.

Authority/requirement for carrying out this piece of work (Legislative context/ agency policy/ government guidelines)

The NHS and Community Care Act 1990, Section 47, which requires a needs-led assessment when appropriate and services provided accordingly if practicable.

The Mental Health Act, 1983 and the Mental Capacity Act, 2005 apply because Diane has Sub Arachnoids’ Haemorrhage, which has caused memory loss and confusion. Particular attention is required, as these laws require that one must assume a person has capacity to make decisions unless established otherwise, and that one may not treat a person as unable to make a decision unless established otherwise. In my casual interactions with Diane, I have observed considerable ability to take decisions with regard to her life.

The National Occupational Standards for Social Work (2002) and The GSCC Code (Code 1 for social workers) require the social worker to empower the service user by informing them their rights and entitlements and listening to what they have to say to involve them in taking any decision that may affect them. The Code also requires the social worker to recognise the user’s expertise in their own lives and make informed choices about services they receive.

The Disability Discrimination Act 1995/2005 defines discrimination as, treating an individual less favourably than treating another. This legislation is important because it states what the government “expects and requires of local authorities in relation to good practice” (Trevithick, 2005: 17). Macdonald-Wilson et al (2001) defines disability as the condition of being unable to perform, because of physical or mental unfitness; to this extent, this definition follows the medical model. In the case of a person with a disability, a person is being discriminatory if they fail to comply with a duty to make a reasonable adjustment in relation to the disabled person. Higgins (1980: 123) defines stigma as a “deeply discrediting trait, which may also be called a failing, a shortcoming, or a handicap.”

The Equality Act 2006 and the Care Standards Act, 2002 also have bearing on this case as it involves assessment of the care provided against need.

Community Care (Direct Payments) Act 1996 enables local authorities to make direct payments (cash payments) to individuals to enable them to secure provision of care in lieu of social services provision.

The Data Protection Act 1998, which requires the express consent of the individual prior to sharing any personal information obtained on individuals and shared with others. Additionally, all the information gathered should be kept in accordance with the data protection guidelines. Diane and her daughter had given me consent to collect and share information with other agencies if required.

Knowledge (e.g. legal, psychological, sociological, political, socio-political, procedural, social work method) applied

In undertaking this meeting I carefully prepared by brushing up on my knowledge of the relevant laws, guidelines, and different perspectives on empowerment, anti-oppressive, and anti-discriminatory practice. Besides these laws, my reflection on the case before the meeting showed me the values that would help in obtaining a positive outcome of the meeting. Theory and guidelines on ‘best practice’ in social work required that I adopt an approach that would place Diane in a position where she feels empowered to make decisions. This approach requires me to work with the person-centred theory (Rogers, 1959) that requires me to work on the premise that Diane is an expert on her own life, and to focus on her strengths i.e. what she can do rather than on what she cannot (Saleebey, 2006). Using the person centred method enables the creation of a comfortable environment where the caseworker demonstrates genuineness through a non-judgmental and non-directive approach that bases itself on empathy and unconditional positive regard (Rogers, 1957). Therefore, my approach had to demonstrate feelings of warmth, liking, caring, and being drawn to Mary instead of aversion and anger (Barett-Lennard, 1986: 440)

I also reflected on Egan’s recommendations (SOLER) that help display an encouraging and open attitude towards Diane.

In considering the assessment process, I have adopted Milner and O’Byrne’s five state model of assessment (1998). These are preparation, data collection, weighing up the data, analysing the data and utilising the data.

I used Systems Theory in the assessment process, for example, in preparation stage I sought information not only from the service user but also from family members, other professionals, etc. In data collection stage, I used brief solution focused techniques, which allowed me to use supportive questions aimed at enabling Diane to recognise her own strengths and abilities. I particularly chose to use scaled response questions, asking Diane to score the present, when she was came to Critchill and what she hope to achieve on a scale of 1 to 10. By using this technique, I was able to support Diane to identify the successful strategise she has used in the past and this gave her confidence to apply her own strategies to improve her situation now and for the future.

The brief solution focused therapy has been useful when I addressed one of the problems in the running records about the use of language to others. Diane has acknowledged this issue and was able to identify an occasion when all the triggers were present that could have caused the problem but she was able to deal with it herself and prevent the problem occurring.

Erik Erikson (1950) says that when the person is aged about 60 years old or more, “The person has time for reflection and as they look back on their life, they may have a sense of satisfaction; this will lead to a feeling of integrity. If the person’s reflection results in them feeling they missed key opportunities, then there is an increased risk of experiencing despair”

In his article, Rogers (1957) quotes a study by Kinner that found that “the client who sees his problem as involving his relationships, and who feels that he contributes to this problem and wants to change it, is likely to be successful. The client, who externalizes his problem, feeling little self-responsibility, is much more likely to be a failure.” This highlighted the need for me to help Mary see that change in her life situation is more likely if she feels responsibility for at least a part of the problem and make her want to change.

A complaint that Diane has voiced is that people (particularly her social worker) treat her like a child. Thompson (2006) says that this happens when a younger person sees an older person not able to make her own decisions and takes decisions on the older person’s behalf thinking this is natural and normal without realising the discrimination and oppression this causes.

It is often the case that the social worker or the carers see the older person as disabled to take decisions, particularly if the person suffers from some disability. The medical model of disability focuses on physical deficits and individual health needs, and it is a challenge for the worker not to fall into “disablest [sic] perceptions” by accepting this model (Parker & Bradley, 2005: 76). The individual may experience loss and bereavement (Kubler-Ross, 1976), feel they have suffered a personal tragedy, and therefore label themselves as disabled as has happened in Diane’s case. It was therefore essential that I approach the assessment with this knowledge and ensure non-discriminatory practice, not attaching any stigma to Diane’s needs and disability caused by her medical condition.

The social model of disability switches focus away from any physical limitations the impairment to physical and social environmental limitations, thus requiring promotion and empowerment of disabled people (Oliver & Sapey, 2006). Additionally, the social worker’s own attitudes and values affect how he/she applies theoretical models of disability (Crawford & Walker, 2004). The social model of disability is inclined to focus on cultural or structural aspects of disability (Priestley, 2003) and is the predominant model of disability used in social care. This is because social work approach does not look at mending something that is broken, but relies on overcoming societal barriers, which enables the treatment of a person with a disability just as others are (DDA, 1995/2005; Davies, 2002). While it is easy to comprehend the difficulties faced by an individual with a visible disability (e.g. using a wheelchair), it is also easy to ignore the wider cultural and structural factors that affect a person with a disability (Thompson, 2001). Herein lies the problem of seeing the disability as a problem with the person themselves (ibid).

What Skills did you use for this piece of work? (please distinguish between those you have and those you need to develop)

I used Planning and preparation, research, information gathering skill before the meeting and this has helped me to carry out the meeting well

In terms of working anti-oppressively I think I have made Diane feel less oppressive by reducing the power imbalance. I have involved her daughter whose presence has been a great comfort to Diane as she sometimes looks at her for answers due to her short-term memory. I have successfully conveyed my respect and understanding of her strengths and limitations by adopting Egan’s empathy skills, active listening, summarising. I used Roger’s person centred to focus my attention on Diane and this in term helping me to forget that I was assessed by my placement supervisor. I used unconditional positive regard to make Diane feel a sense of acceptance of herself when addressing an issue.

I need to develop assessment skills as I feel I don’t feel comfortable with the forms which have so many questions. Also some of the questions are very sensitive to ask for example the section of “assessment of physical health” there are questions like bladder control, bowel control, etc

Also I need to develop liaising skill, sharing information with other agencies. As evident prior to the meeting, there were some miscommunication between different agencies.

Which aspects of anti-oppressive practice were relevant to this piece of work?

In terms of working anti-oppressively, I was aware my role as a student social worker this may have lead Diane to feel oppressive and not valued because she may think that she was not good enough to have a qualify social worker. To reduce this potential oppression, I have involved Diane’s daughter and have been open and honest to tell them that I was inexperienced and has never carry out a SAP assessment before. I also offered them opportunities to decline or cancel the meeting.

My ethnic origin as a non-white British may have attributed discrimination or oppression to myself from Diane or her daughter. However, this has never been an issue in the meeting or prior to my engagement with Diane and her daughter.

“the black perspective has made clear that racism is based on white European/ white north American ideological beliefs about the claimed superiority of white people over non-white people” (Maclean and Harrison 2008:58).

Considering my gender, which is different from Diane may present a difficulty for both of us. From the feminist perspectives – if I had not recognise the extensive inequalities in society based on gender with men consistently being dominant, I may act oppressively unaware. Women is socially constructed to be a better carer as a wife, mother and daughter and the fact that the majority of social worker are female. As a male student social worker, my role may present oppressive to Diane.

“the feminist perspective has noticeably failed to adequately address structural inequalities within social care and social work organisations. In employment terms some 75% of the workforce in social care organisations are women. The proportion of men in senior management has remained stubbornly high and has only recently dropped below 75% of all senior managers” (Maclean and Harrison 2008:56)

“there has been a recognition that societal developments and social policy initiatives affect men and women differently (because of their gender). The role of women as unpaid carers of family members with personal care needs is one example” (Machean and Harrison 2008:55)

If I have not used Social vs medical model to see Diane’s depression, I may have not recognised the negative stigma associated with the labels applied to people and may have act in an oppressive way, overseeing the facts that her depression may be attributed by her despair for her current environment and loss of her abilities, eg, health and memoey,etc

In what ways would the service user and or carer have preferred your practice to be different

After the meeting, I apologised to Diane and her daughter that the outcome of this meeting may not have been as productive as they had expected and I told them that I would like to have another meeting again with them in the near future to discuss a plan to support Diane. (as I feel I have failed to conduct the meeting well, because my placement supervisor joined our discussion in the midway, and this i think should not be happen because she was there to assess me, unless she think she I needed help.)

However, Diane, her daughter said they were happy with the outcome and she especially appreciated what I have done for her mother. My placement supervisor said to me. What do you mean this meeting is not productive” she said I did very well.

The only thing that Diane’s daughter asked me was to inform her of anything I do for her mother. As there was an incident the week before that I took Diane out but forgot to ask her to check her daily. Diane’s son and daughter in law came to visit when we went out and as a result they have not spent much time together that day. I asked Diane’s daughter how she would like to be contacted and she gave me her email address as she may not be convenient to answer her mobile in her workplace.

My placement supervisor also told me that I need to share the information with her about what I do or who I have contacted for Diane.

Which key Roles, units and Values/Ethics do you think were demonstrated in this piece of work and how? (these must refer to practice discussed within the direct observation)

In making a thorough preparation for the meeting with Diane, where my placement supervisor would observe me, I demonstrated delivery of all the units of Key Role 1. I had reviewed the case notes, spoken with the staff at the Home, her social worker, and daughter to carefully evaluate my involvement.

My efforts to build a trusting relationship with Diane during my placement, and discussions with her about her preference for those elements of her care plan she likes to be included, show that I achieved important aspects of Key Role 2 (Unit 5 and 6).

In my thorough research on best practices, legal and practice guidelines, and reflection on the best way to achieve my aim showed that I have responded well to the requirements of Key Role 6 (Unit 18 and 19).

With regard to the values and ethics, I demonstrated awareness of my own values, ethics, dilemmas, and conflicts of interest (VEa). I have shown respect for and promotion of the wellbeing of Diane (VEb). I have also responded with oral and non-verbal communication skills in a way not to make Diane feel oppressed (VEc). Finally by showing my ability to build and maintain a relation of trust with Diane I have met the need identified by (VEe).

What evidence did you use to evaluate your practice?(e.g. supervision notes, user feedback etc)

In evaluating my practice, I have used two resources. The first is a feedback from Diane, whom I asked to judge how I had done. This feedback, in the form of a written response to a questionnaire I prepared for this specific purpose. However, the feedback given by my placement supervisor after the meeting has been valuable for me in terms of understanding my performance and identifying ways to improve in future practice.

Give your evaluation of this piece of work – (e.g. what went well, what did not go well, what if anything would you do differently next time?)

I have learnt from my previous mistake in my first direct observation. I have used a mixture of open and close questions. Also I have used paraphrasing, clarifying techniques appropriately. In terms of choosing a place for the meeting, I have considered the noise and disruption and asked Diane’s opinion where she would like the meeting to be. The location of the meeting in her room turned out to be a good choice.

I feel I have reduce the potential of oppression by involving Diane’s daughter whose presence has been great comfort to Diane as Diane has short-term memory and she feel more confident as she could get answer or help from her daughter. Also, I feel that working together we have achieved more than I had expected, as I have made the meeting like informal discussion rather than a job interview or assessment.

I have achieved the aim I set for myself and completed parts of the assessment, by working in partnership with Diane and her daughter. However, I have achieved more by building a open and trusting relationship with them, this would in term enable me to devote my supportive work with Diane in the future.

I did not complete the SAP assessment in the meeting as I have not planned or anticipated. I will continue to work on this assignment with Diane, her daughter and other professionals.

I have however, failed to share the information about what I do with Diane with my placement supervisor. This has resulted in miscommunication between different agencies. I need to develop skill in liaising and sharing information with other professionals in the future.

What additional learning, in relation to knowledge, skills or anti-oppressive practice and values and ethics, would enhance your performance in the future?

In terms of working professionally I need to work in accountability way within agency, sharing information with others. System theory will help to improve my practice in the future.

I also need to use my supervision session to discuss theories, values, dilemmas and anti-oppressive practice

I have improved considerably about the use of interview techniques but with more practice I will be able to communicate in more confidence.

Signed

Placement Supervisor_________________ Date _____________

Student ____________________ Date _____________

Dementia is a chronic, heterogeneous neurodegenerative disorder which develops as a function of age, typically from 65 years old, with symptoms ranging from personality changes and losses of memory/intellect to severe reductions in mobility. Alzheimer’s disease is the most prevalent form of dementia (Cooper & Greene, 2005). The diverse and deteriorating nature of the dementia process is uncontrollable and dramatically reduces suffers ability to care for themselves independently, resulting in the need to be cared for, predominantly by informal carers, constituting family members; particularly Spouses or children of the dementia sufferer. Consequently, the majority of dementia sufferer’s remain living at home (Rabins, Mace & Lucas, 1982). Undoubtedly the role of caring for a person living with dementia has negative psychological (Dura, Kiecolt-Glaser & Stukenberg, 1990) and social effects (Rabins et al.) on carers. However, amount of social support carers receive (Haley, Levine, Brown & Bartolucci, 1987), stage of the dementia process (Quinn, Clare, Pearce & Dijkhuizen, 2008; Haley & Pardo, 1989) and symptoms expressed (Kinney & Stephens, 1989) mediate negative psychosocial effects on carers. Psychosocial effects can be also be positive (Andren & Elmstahl, 2005), with gender mediation (Fitting, Rabins, Lucas & Eastham, 1986). Indirect causes of psychosocial effects on carers are financial strain (O’Shea, 2003) whilst effects of dementia on society also exist (Wimo, Ljunggren & Winblad, 1997).

Firstly, in relation to psychological effects on carers of persons living with dementia, research proposes behavioural symptoms expressed by dementia sufferers are the predominant cause of negative effects carer’s experience. Behavioural symptoms range from embarrassing public behaviour to self-harm, causing carers to be persistently aware of the dementia sufferer’s actions which subsequently induces psychological effects of stress, anxiety, emotional upset and fatigue on carers (Dura et al., 1990). The dementia sufferers’ argumentative temperament, violence towards carers and rejecting carers help also augments psychological stress and upset, with exhaustion as dementia sufferers often wake carers at night, augmenting further fatigue and thus stress (Rabins et al., 1982). In consequentially, following extensive periods of care (approximately 74months), psychological well-being of carers reduces dramatically with 30% expressing symptoms of depression, not existent prior to commencement of caring (Dura et al.). Implying, induction of negative psychological effects on carers are a direct consequence of caring for the person with dementia.

Secondly, caring for a person with dementia induces negative social effects on carers with an average 30 of 55 carers reporting feeling social-isolated as a consequence of fulltime care, due to restricted time available for social activities/friendships, to insufficient support from family members and also due to leaving fulltime employment, as the work place is a major basis for social-interaction. Considering, carers undergo these major life changes to care for the dementia sufferer it is not surprising they feel socially-isolated, especially when dementia sufferer’s communication abilities deteriorate (Rabins et al., 1982) and feel ultimately trapped (Gaugler, Anderson, Zarit & Pearlin, 2004). Furthermore, social effects on carers elucidate the relationship between caring for dementia sufferers and depression, as social isolation amplifies the probability of carers experiencing depressive symptomology. This is vilified by carers who receive social support, remain in contact with social networks and partake in social activities and consequently report absence of depression, reduced stress and augmented satisfaction (Haley et al., 1987). Thus, effects on carers of persons living with dementia can be psychological and social; psychosocial but appear mediated by carer’s social situation. The stage of dementia is also primary (Quinn et al., 2008)

Thirdly, severity of psychosocial effects on carers of persons living with dementia, appear determined by the stage of dementia. As Quinn et al. (2008) proposed negative psychosocial effects on carers are at their peak of severity during early dementia stages due to drastic changes taking place in carer’s lives, primarily, adapting to prevalent changes in the dementia sufferer and accepting changes in the relationship with the dementia sufferer with augment carers stress (Burns & Rabins, 2000). Conversely, Haley and Pardo (1989) proposed negative psychosocial effects peak during later dementia stages, specifically augmented stress levels and social isolation as carers role becomes increasingly demanding. Particularly, care of daily needs, such as feeding and clothing due to dementia sufferers declining immobility due to the deteriorating progression of dementia. Also anxiety augments with fear of the dementia sufferers looming death (Rabins et al., 1982). Moreover, it is comprehensible both early and latter dementia stages induce negative psychosocial effects on carers, although which stage carers perceive to account for the majority of negative effects relies on individual differences. Especially as some carers conversely report later dementia stages to reduce negative psychosocial effects as behavioural symptoms become less adverse which may, be easier for some carers to cope with. Furthermore, some carers even report satisfaction from aiding daily-needs of immobile dementia sufferers (Kinney & Stephens, 1989). However, older carers seemingly experience augmented psychological stress than do younger carers (Kiecolt-Glaser, Dura, Speicher, Trask & Glaser, 1991) whereas younger carers experience augmented social-isolation and rage, with all effects appearing worse for women (Fittings et al., 1986).

In view of these individual differences, two hypotheses are proposed to account for variability in psychosocial effects experienced by carers. The first;Wear and Tear hypothesis predicts; as symptoms of dementia sufferers worsen, so do carers stress and depression levels, subsequently affecting carer’s social life, inducing negative psychosocial effects which supports Haley and Pardo (1989) findings as suggestive of later dementia stages inducing greatest negative psychosocial effects on carers. Whereas the second;Adaptation-hypothesis predicts carers adapt to caregiving requirements and subsequently experience reduced stress and increased satisfaction over time, thus reduced negative and increased positive psychosocial effects on carers (Townsend, Noelker, Deimling & Bass, 1989). Accordingly, Townsend et al. indeed revealed the majority of adult-child carers; 52% (averaging 47 years old), actually adapted overtime to their caregiving role, supporting earlier dementia stages as inductive of the most negative psychosocial effects, which accounted for both centralized and non-centralized caregivers. Although relationship between carer-dementia parent prior to caregiving mediated whether adaptation or declination occurred. Nevertheless, deciphering which carers require support during early or later stages of dementia may aid alleviation of negative psychosocial effects on carers of persons living with dementia (Townsend et al.). Although positive, psychosocial effects on carers are also reported (Andren & Elmstahl, 2005).

Andren and Elmstahl (2005) report carers experience positive psychosocial effects, specifically, portrayals of positive behaviour and interaction with dementia sufferer is gratifying for carers. Particularly because interaction is gratifying for the dementia sufferer which positively enhances carer mood; decreasing negative psychosocial effects.. Although carers experiencing positive psychosocial effects appear to be those who perceive their caring ability positively and have established coping mechanisms such as talking to others about their feelings; emotion-focused coping and learning more about what dementia is; problem-focused coping/information seeking, particularly decreasing feelings of social isolation (Haley et al., 1987). However the carers Andren and Elmstahl assessed, received help from care nurses and only cared for the dementia sufferer around every two months, thus due to their limited involvement and supplementary support, it is not surprising carers reported augmented positive as compared to negative psychosocial effects. Further suggesting time involvement as mediating negative psychosocial effects on carers, especially as O’Shea (2003) reported two-thirds of carers working approximately 80 hours per week caring for the person with dementia; double the average working week, experienced caring to be highly stressful and felt substantial social isolation due to extensive time devoted to caring. Carers reported they would exhibit greater satisfaction by receiving supplementary support allowing reduced working hours, which therefore supports Andren and Elmstahl’s findings. Although, O’ Shea reported 73% of carers do receive support from formal carers, suggesting lack of support from family members causes negative psychosocial effects or formal carers being strangers may augment carer’s stress (Burns & Rabins, 2000). Even so, other variables require investigation, particularly financial cost (O’ Shea, 2003).

The cost of caring for a person living with dementia can be up to a‚¬630 per week and considering majority of carers leave employment or work fewer hours to care for the dementia sufferer; carers are reported to averagely lose a‚¬200 per week. Consequently, two-thirds of carers report financial difficulties especially as only 30% of carers receive carer’s allowance (O’Shea, 2003), thus inducing psychological stress due to financial strain. Furthermore, caring for a dementia sufferer at home saves society ?6billion per year which stresses the high cost of dementia care being absorbed by carers which undoubtedly increases carer’s psychological stress. On-the-other-hand carers may merely desire recognition in the form of payment from society for their challenging role as a carer, as it seems stress is induced on carers due to feeling ignored by society (O’ Shea). Considering many carers stated that they would receive satisfaction from just a‚¬2.40 an hour, suggests recognition of carer’s duties with a small financial payment may convert negative psychosocial effects on carers to positive. Without this payment, society potentially face problems by inheriting the bulk cost of dementia care if carers struggle to cope and resort to early institutionalization of the dementia sufferer, which is reported to cost $166 per day in America (Wimo et al., 1997). On-the-other-hand, institutionalizations may reduce negative psychosocial effects on carers (Gaugler, Pot and Zarit, 2007).

Gaugler et al. (2007) reported alleviation of carers psychological stresses associated with daily aiding of dementia sufferers and social effects associated with social isolation due to constant care when dementia sufferers are placed in nursing homes. However these effects are reduced only temporarily as carers consequentially report psychological effects of guilt of institutionalizing the dementia sufferer, which suggests, even after their central role as a carer ends, psychological effects still remain. Although compared to nursing homes, group-living homes are designed to resemble the typical home and Colvez, Joel, Ponton-Sanchez and Royer (2002) found carers to experience less psychological stress associated with guilt when placing the dementia sufferer into group-living homes. Possibly because they are more sociable, granting dementia sufferer’s a better quality of life which feeds-back positively to carers. However this does not seem consistent for all carers (Boekhorst et al., 2008). Nevertheless, group-living homes may be an intervention to reduce negative psychosocial effects on carers. Interventions are also essential, particularly as co-existence of negative psychosocial effects on carers appear to enhance probability of physiological effects on carers such as ill health (Kiecolt-Glaser et al., 1991). Moreover, carers may benefit from training in how to effectively care for a dementia sufferer and knowledge of the nature of the dementia deterioration may make caregiving less stressful by increasing carers awareness and predictability of the dementia process (O’Shea, 2003). Personally, assigning a mentor to carers may teach effective ways of caring whilst simultaneously providing them with support, attacking both psychological and social effects on carers of persons living with dementia. Although individual carer assessments may be needed to ensure interventions are targeted at reducing the psychosocial effects particular carers experience (Rabins et al., 1982).

Overall, it is prominent that caring for persons living with dementia is a demanding role with various, predominantly negative psychological (stress and depression) and social effects (social isolation) on carers. Although there is no unified theory accountable for all carers which can predict definite psychosocial effects that will be experienced by all carers, as no single individual or situation is identical. Multiple variables have emerged which appear to mediate psychosocial effects on carers, particularly carers received level of social support (Haley et al., 1987), the stage of dementia (Quinn et al., 2008; Haley & Pardo, 1989) and the symptoms expressed (Kinney & Stephens, 1989). Although individuals adopting coping mechanisms appear more likely to experience positive psychological effects (satisfaction) and positive social effects (interaction with the patient) of caring for a person living with dementia. Although Indirect mediators; not directly related to the dementia suffer per se; financial cost of caregiving, induce stress due to financial strain. Future research needs to decipher carers at risk of experiencing negative psychosocial effects and subsequently address interventions aimed at reducing negative psychosocial effects to reduce probability of carers developing not only mental deterioration (depression) but also physiological deterioration (Kiecolt-Glaser et al., 1991).

Psychosocial Critical Evaluation: Case Study of Rory

Introduction

Psychosocial theory originates from psychoanalytic and psychodynamic casework, which has had a profound and lasting impact on social work (Kenny and Kenny, 2000). This assignment will use the case study of Rory, a fifteen year old boy living in a family home with his brother, mother and stepmother. Throughout the assignment Rory’s social environment and his relationships within this environment will be analysed in order to understand how these factors have shaped his development. Following on from this an evaluation of group work as an intervention method to support and empower Rory shall be explored. Group work will be taken as evidence for practice, where social work practice is carried out in groups (Doel, 2000, p.148). Psychosocial theories will be explored into how they influence group work and group dynamics, and the way group work can be used to change and adjust dysfunctional social environments. In doing so, the model of psychosocial theory and its relevance to social work will be explored, and how useful it is in understanding clients and promoting their best interests.

In order to critique the model of psychosocial theory, and explore how it influences our perception of the human condition, we must have a clear idea of what we mean by the term. Modern social work theorists have stressed the importance of applying the correct competency to the individual person, with regard to their social environment (Hutchinson, 2008). It sees people as ‘products of the interaction among their biogenetic endowment, the effects of significant relationships, the impact of life experiences, and their participation in societal, cultural and current events’ (Turner, 1978, p.2). The social work profession, can see the individual person as interdependent with their environment, which they are able to influence and change (Kondrat, 2002). By seeing individuals as being uniquely shaped by their environment, it helps social workers avoid the issues of social identity theory. Rather than categorising or stereotyping people, social workers are able to empathise and see all service users as individuals (Tajfel and Turner, 1979, cited in Gaine, 2010). The main ideas of psychosocial theory are reflected in other social work theories and methods, such as systems and attachment theory. Both theories developed from the need to build upon the traditional psychoanalytic model of individual therapy (Walker, 2012), and the idea that individual experiences with families were continually being shaped and influenced by the evolving interaction patterns of communication.

For group work to be beneficial there must be a mindfulness of the social context or sociology of the individual and group. Understanding individuals who compromise the group requires knowledge of ‘psychosocial functioning and development through the life cycle’ but also the impact of the group’s structure and process on the members’ behaviour. A group cannot be understood without knowledge of members in their individual social context (Northern and Kurland, 2001, p.35). This promotes and encourages diversity within the group, as practitioners are mindful of differences within the group, and how they can be addressed to promote social skills such as empathy and respect. If a client’s environment and social context has been dysfunctional, as in Rory’s case, the group work can provide a model of a healthy culture through the group values, communication patterns, and the way it addresses interpersonal conflict (Northern and Kurland, 2001).

Having explored the connection between group work and psychosocial theory, two theories of social work shall be applied and explored next. Attachment theory focuses on the quality of the attachments in the significant relationships in a client’s past (Bowlby, 1979, 1988). Bowlby’s theory of attachment stresses the importance of past relationships by determining which will develop emotionally and socially, and form relationships in the future. Bowlby was particularly concerned with the interactions and attachments that individuals had with their parents or carers. The ability of a child to attach to a parent or carer, the level of consistency of the parent or carer to meet the emotional needs of a child and the ability of the child to feel safe and secure, predicted how the child would develop emotionally. This theory has particular relevance and importance for this case study. The relationship between Rory and his mother can be recognised as a disorganised attachment. His mother’s bi-polar disorder means her behaviour is inconsistent at times, due to her having stable periods but when her mood is very bleak she neglects the needs of Rory and his brother. From this behaviour Rory receives mixed messages, leaving him feeling anxious and unable to explain and possibly understand his own feelings (Bowlby, 1988). His father appears to display as insecure or ambivalent attachment, this is due to him demonstrating an inconsistency in his attitude to Rory, neglecting contact for several weeks at a time. His unpredictable behaviour and failure to display attention in a consistent way leads to anxiety and distress for Rory.

Attachment theory is helpful to social workers in planning intervention, as they have insight into how past experiences of the service user can impact on their behaviour, and their ability to form relationships. For example, at the Youth Club Rory is seen as increasingly withdrawn and erratic by the youth workers. This may be due to his disorganised attachments impacting upon his ability to behave in social situations. Preston-Shoot and Agass (1990) explains that the development and quality of relationships can be influenced by considering the impact of the client’s feelings on behaviours.

Group work can be a powerful tool when based on attachment theory issues. Egeland and Erikson (1993) and Eriskon et al., (1992) described a group in which young, high-risk mothers were brought together for weekly group sessions from the time their children were born until they were one year old. Group work was effective here for two reasons. Firstly, through the therapeutic relationship itself, or the relationship with the group facilitator, in which ‘the facilitator maintains a healthy, supportive alliance with the parent, proving such relationships are possible’ (Erikson et al., 1992, p.501). When using any intervention, it is important to create a working alliance, in which the patient has confidence that the practitioner can help (Holmes, 2001). Due to Rory having all his immediate adult relationships in his life being inconsistent and causing him anxiety, having another which proves to be consistent in his life, one that is dependable, may improve his self-esteem and address problems he is exhibiting in social situations, such as at the Youth Club. The reason he may be attending the Youth Club could be due to him searching for that consistency and dependable person he needs, as the Youth Club is a weekly activity which is always there. The ‘therapeutic’ relationship gives Rory a ‘secure base’ (Holmes, 2001, p.17) where the task can challenge assumptions and relationship patterns.

Group work would also introduce Rory to a plethora of perspectives and individuals. Through this, Rory may become conscious of thoughts and attitudes that were previously unconscious (Holmes, 2001). In listening to and working with others Rory may build up his self-esteem. As he begins to form relationships with members of the group, he has models of healthy and functional relationships that are different from his own attachments with family members. This could increase his confidence, addressing problems of withdrawn and erratic behaviour that have been raised by Youth Workers at Youth Club. A number of studies have shown group work can improve social skills (Reid and Hammond, 2001; Fargan and Jones, 2002). Group work also promotes diversity as those it helps do not feel isolated or alienated by their problems: through sharing experiences in a respectful and tolerant environment they gain insight into the sufferings and challenges of others, and methods to overcome this. Groupwork as a form of learning extends beyond this, as groups offer members feedback that is often more effective coming from peers than from a social worker (Northern and Kurland, 2001). When done sensitively and constructively, such feedback helps clients such as Rory with their social skills and their ability to build relationships outside of the group.

A weakness of this theory, however, may that does it is not sufficiently encompassing of all the social forces that act on the individual. Psychosocial theory holds that we should acknowledge the role in human development of temperament, racism, poverty, social class, and other environmental conditions (criticism outlined in Coady and Lehman, 2007). Group dynamics and interactions cannot be understood through individual’s relationships with their parents alone. Psychosocial theory assists social workers in understanding and analysing the situations and behaviours of their client. This provides practitioners with insight into what has occurred in the past or what may occur in the future. However, some argue that attachment theory does not paint a picture of the client whole: by attributing all of Rory’s behaviours and concerns to his parents, the practitioner may neglect the wider social context that is acting on him.

Systems theory may offer a more encompassing picture of Rory’s social context. This theory holds that individuals and their environments are separate systems that are interconnected and interdependent (Teater, 2010). By thinking of families as living systems, systems theories are able to think about how dynamics are constantly altering as each family member deals with life inside and outside the family. Rory’s withdrawn behaviour, and self-destructive thoughts can be attributed to the frequency with which his family dynamics change. This change is at times dramatic – for example the breakdown of his parent’s relationship, or his sister leaving the family home- but also in the inconsistencies due to his stepfather’s temper and mother’s mental illness. Systems theory also promotes tolerance and diversity, as it recognises that there is no one model for a healthy, functioning family (Walker, 2012).

A change or movement in one of these systems results in change or movement in the others. In Rory’s case, social systems theory is useful as it allows social workers to identify which system requires an intervention (Teater, 2010). The key question is ‘does this structure work for this family’ and does it allow for the healthy development and growth of family members? As such, the Munro Report confirms that a systems perspective offers the most holistic tool for undertaking informed assessment work that takes into full account the wide environmental factors combined with the inter-personal relationship patterns that influence family experiences (cited in Walker, 2012). Furthermore, a family’s structure and organisation allows social workers to determine, to some extent what is possible within a particular family. Thinking of families systematically also ensures no family member is marginalised (Walker, 2012). One-to-one intervention with Rory will have an impact on the whole family system; his mother, brother and stepfather will be affected, and also the family dynamic as a whole.

As such, group work is an effective method of intervention according to social systems theory. This is because it avoids the risk that the family’s problems and their solutions are individualised. By placing Rory in a different group dynamic, one that has been constructed by a facilitator or practitioner, social workers may be able to assess which elements of the family’s structure need intervention, and where Rory and the family need extra support. By assessing Rory’s patterns of communication and interaction outside his family dynamic, practitioners may gain greater insight into his specific needs and methods that can be used to support and empower him.

Groupwork for families links closely to the family therapy movement (pioneered by figures such as Murray Bowen, Jay Haley, and Virginia Satir). The family therapy movement advocates systemic features as a means by which to assess the way groups of relatives organise themselves over time, creating stable patterns, that are inclined to return to familiar states. As such, one of the beliefs is that systems tend to be self-correcting, based on positive or negative feedback (Coady and Lehmen, 2007). By using groupwork intervention with Rory, he may feel empowered and supported to address and correct the patterns and familiar states of his family, rather than simply removing himself from situations. Furthermore, the counsellor or practitioner can address the dysfunctional and destructive subsystems that exist within Rory’s family.

A concern surrounding this theory of social work, however, is the emphasis social systems theory places on adaptation. The purpose of the group work intervention is to explore how systems can be adjusted and change to create a healthy and supportive structure. As such, some fear that practitioners are encouraging clients to accommodate to oppressive circumstances (Coady and Lehmen, 2007). From this perspective, Rory may be being taught to accept and adapt to the hostile and threatening behaviour of his stepfather, or the neglect he sometimes faces from his mother. This can be addressed by being mindful of social work’s traditional concern with social justice- an integration of values such as social justice and social systems based thinking is possible. To do this, practitioners must be self-reflective and question their own values and assumptions, particularly in terms of prejudice and diversity, in order to ensure that the client’s best interests are at the heart of group work intervention.

An awareness of social circumstance is also important in tackling diversity with regard to mental health. Parental mental health, and the disruption to parenting capacity has been found to have profound and persistent implications for children and their parents (Smith, 2004). As such, it has been advocated that social workers have improved access to training that assists with psychosocial interventions, such as group work (National Institute for Mental Health in England, 2005). This helps us to understand the quality of attachment between Rory and his mother. Rory himself is displaying behaviours that may point to mental health, particularly disclosing suicidal thoughts. Research shows that social work plays a significant role of social work in promoting the involvement of people using services and developing systemic approaches to practice with families (Gilbert, 2007). Diversity is important here- social workers must address societal stigmas regarding mental health. Effective intervention can also promote diversity by helping those with mental health to function and become involved in society.

A psychosocial approach helps us to understand Rory’s patterns of communication and behaviour, as it gives us insight into the formative relationships, experiences and environments that have categorised his life thus far. This puts troubling behaviours, such as self-destructive and suicidal thoughts, within a social context that can be used as the basis for assessment and intervention. Our chosen intervention method, group work, is also revealing about how Rory can be supported and empowered. By modelling healthy and secure relationships, and developing Rory’s social skills, Rory’s future relationships do not have to be influenced solely by dysfunctional attachments with his parents and stepfather. By understanding his family as a system, and observing Rory but within that system and in other groups, insight is gained into how Rory’s social context can be adapted in order to promote the healthy growth of all its members.

The birth of a child is usually anticipated with so much expectations and excitement of a very happy and successful future not only for the child but also for the family at large. However, this excited might be muted by the birth of an infant with any kind of disability. It does not matter whether the handicap is retardation, blindness or physical abnormality. Families with members with disabilities cannot live a similar style of life like that enjoyed by other families that have got normal individuals. In most cases these parents are more sensitive to the needs of the disabled individuals. According to Gillam (1999) caring for people with disabilities is not always an easy job because these are normally considered to be delicate people who need extra care. For this reason disability could have various physical and psychological impacts on the family. This paper provided a discussion of various psychological effects of disability on families. Some background information will first be provided to give an overview of what disability is all about.

Background Information

According to Marinelli & Orto (1999) the rate of disabilities in families has relatively reduced compared to the situation 50 years ago. The introduction of immunizations and improved medical care has also helped a great deal. However, statistics has it that in regions such as the UK, a child is diagnosed with some kind of disability every 25 minutes. Over 95% of those diagnosed with disabilities either live with their family members of their children. Another country that faces the same problem is Australia.

A person’s body is a very important part of their identity and self perception and even extends to the identity of the family. In most of the time, a family with a disabled individual will always receive similar perceptions from the society like the ones given to the disabled person. The disability is therefore normally considered in terms of the larger family. Although some people could be borne normal but later become disabled either through sickness or accidents, most of the disabilities are normally realized at birth. Family members of disabled individuals normally have an extra burden of not only taking care of their individual needs but also for the needs of the disabled in the family (Gillam, 1999). Most people in such situation would tell you that it is not as easy as most people might think. It requires sacrifice and determination.

Discussion

Giving birth to a handicapped child and taking care of him to grow into adulthood is one of the most stressful things a family could endure. The first reaction by parents on realization that their child is disabled tells it all. According to Strnadova (2006) most parents are normally in shock and wish that they could reverse the whole process. It also creates a confused situation of guilt, anger, sadness, depression all in one that some parents begin lamenting to God what wrong they might have done. Depending on the conditions of the parents, they handle these issues differently and could stay in different stages of depression longer than others.

Some parents feel like the handicapped children are their extension and may feel ashamed, ridicule, embarrassment or social rejection. The reactions by parents might be affected by economic status, marital stability and personality traits. Generally, the initial reaction of any parent would therefore be of psychological or emotional disintegration (Marinelli & Orto, 1999).

In instances where an individual was living normally and later becomes disabled, denial is normally the first psychological impact in the family. Some members refuse to accept that things have changed and their loved one is now disabled. This is very difficult especially when the person is the first one in the family to suffer from such a disability or when he is the sole bread winner and the family cannot comprehend how it will survive the next day. In situations where the family does not know much about the illness, they could also become very pessimistic about the future and act like the illness has control of their entire destiny. Although no one really checks on the parents to find out whether they get enough sleep or spent most of their time at night checking on their disabled children, research has it that families with disabled members also suffer from exhaustion and anguish.

After denial there is usually a gradual acceptance of the fact that the family member is truly disabled. The family then tries to come up with better ways of dealing with the issue because there is nothing else they could do. The acceptance stage could taking varying durations does not necessarily lead to the acceptance of the disability. Marinelli & Orto (1999) explains that sometimes members could just decide to minimize the psychological balance to an achievable degree and deal with the person. In cases where parents completely fail to accept this fact, they could even abandon the individual or give them for adoption. This is the reason why there have been cases of parents throwing their children in pits or abandoning them on the road side as demonstrated in some developing countries. There is the realization stage is where parents or family members fully accept the disability of their loved ones regardless of its consequences. However, not every family reaches this stage.

Strnadova (2006) argues that many families consider taking care of an individual with disability in terms of the cost they will have to incur throughout the existence of the disabled individual. This process could sometimes be costly that if a family is not well prepared it could lead to debts and loans. For instance, if a family member suffers from down-syndrome or Cerebral Palsy, he will definitely require some medication, counseling, therapy, physiotherapy or rehabilitation. All these services need money which is not always easy to come around. This could therefore lead to the family making use of every single cent they have just to see their own survive. Some could even end up borrowing from family members or asking for loans from their banks but there is always a limit to where you can source money from. If a family faces the dilemma of not knowing where next to turn to and ask for money, it’s normally very frustrating and hurting to know that you could make life more comfortable to a family member if only you had the money but the reality is that you have none.

Having gone through many dead ends to find assistance for their loved ones, family members often become worn out and might be discouraged to look for a different approach for assistance because they might be scared of facing yet another failure (Strnadova, 2006). This might create a feeling of hopelessness in the family in that they feel like they can no longer take care of their loved one and could even abandon him or offer him for adoption.

Stress in families with disabled individuals normally starts way back even before the disability is diagnosed. In most occasions, parents would suspect that there might be something wrong with the life of their child or family member. This normally appears in cases where the family members become disabled later in life after leading a normal life. For this reason members would request for examination from a psychologist to fully understand what might be wrong. Sometimes families with disabled members are isolated from the society like and this makes them feel like they are less equal. This could also make some of parents to feel like it is their fault that they gave birth to disabled children. What parents also fear most is the likelihood of the heredity of the disability to their future siblings. According to Power & Orto (2004) some might even get scared and feel like they do not want to have other children in future. They may also fear that they might have grand children with similar disabilities. They are also worried of what the future holds for their child with disability. The feeling of helplessness due to the fact that there is very little they can do to change the child’s disability makes them hate themselves.

The anxiety in family members stems from an attempt to strike a balance between their own life and that of the disabled individuals. A number of parents have talked of pain and anguish in their lives and their desire and hope to improve the lives of their loved ones even though sometimes it never possible. Single and unmarried mothers face more psychological problems than others. Considering that individuals with disabilities need extra care, it becomes cumbersome for one individual to keep watch of him and do his/her own duties. Disabled individuals could also be a huge burden to their own siblings especially because of the fact they require extra care (Power & Orto, 2004). This means that their siblings will have to forgo some activities and duties in order to take care of them. Unlike other children who might go playing up and down, they will be forced to offer extra care to their disabled brother or sister.

One thing most people don’t understand is that it’s nobody’s fault that they have disabled individuals in their families. However, most family members might not know how to react around such individuals and might decide to stay away. Sometimes the families might be reluctant to discuss with others about their members disability because they do really know how others would react. Fear of stigmatization from the society could make some families to hide these conditions for a long time (Warner, 2006). However, this is not always the best option because it implies that one is ashamed of a family member. A result of stigma is that the family ends up being withdrawn from the society because they are afraid of being hurt by comments or reaction from other people.

Shaw (2009) laments that sad as it might be, most people with disability are still socially unacceptable. It’s common to here whispers from all corners about families with disabled members as well as judgments being made behind closed door about how a disabled member might be behaving. Some even make comments that insinuate that the family is unable to take of their own blood and flesh. Some of these comments even come from close friends. Considering that every person might have his own opinion on how a family deals with the disability, it’s never an easy thing for a family that is trying so hard to remains brave and accept their member with his disability. When on outings, families with disabled individuals normally have to deal with stares, unpleasant gapes from both adults and kids. These annoying stares can inhibit the ability of family members especially the kids to freely interact disabled family members.

Sometimes family members especially parents have to deal with feeling of jealously from other siblings. For instance, you here of a child wishing that he was sick like his sister so that he could also receive preferential treatment from the parents. This feeling also disturbs parents psychologically and makes them feel like they are discriminating their children. Of course as you would expect there is always a good side of disability where one is treated differently and carefully more than others (Shaw, 2009). If not carefully done, it could also lead to misunderstandings in the family that could add to psychological problems.

Warner (2006) explains that some families with disabled children face so many difficulties that they even end up separating. In such a situation, kids are either split each of their parents or their custody could be awarded to one parent. Sometimes one parent in most cases the dad could run from the vicinity and disappear completely leaving the child in the hands of the other parent.

Recommendations

Families with disabled members need love and support from close friends and relatives. It is never their wish to give birth to disabled individuals. Its God will that everyone is the way he is and we should accept that and live with it. As the saying goes, disability is not inability. There are families whose brain winners are people with disabilities. As Gillam (1999) puts it these people could still be very useful to the family and the society at large unlike what people might expect. It is therefore important that families with disabilities are accepted as any other family so as to give them the moral to take care of their disabled members rather than isolating them.

It is also advisable that families with healthy and normal kids should teach their children on how to deal with other members of the society that might be living with disabilities. This will make everyone grow up with a good attitude and caring feeling for unfortunate members of the society. With increase in technology and innovation, disabled members could still survive and lead a normal life like others. Children should therefore not abandon their loved ones just because of their disability. We should all be thankful to God to whatever child he gives unto us because there are so many parents would wish to have a child but they can’t.

Independent living is about disabled people having the same level of choice, control and freedom in their daily lives as any other person. Everyone will need assistance or equipment of some kind, although many people with learning disabilities, physical and/or sensory impairments, mental health support needs, long-term health conditions or who experienced frailty associated with old age, will have additional needs for assistance. Although these additional needs for assistance and equipment may be met, it is not always giving people choice and control over the matter, others will decide on behalf of them which can lead to segregation and social exclusion. It is necessary for everyone, whatever their impairment, to express preferences and therefore express choices about their needs and how they should be met.

What evidence is there that it is an issue?

With reference to Christensen, K. (2010), ‘The late 20th century rhetoric about empowering people by providing them with more independence in their lives has recently emerged within developed welfare states and led to the introduction of cash for care systems in many European countries. These systems allow local authorities to pay people cash instead of providing care if they are assessed as eligible for community care services and are willing and able to manage the payments alone or with assistance’.

What evidence is there that different policy options will affect the issue?

The Prime Ministers Strategy Unit produced their final report on, ‘Improving life chances of disabled people’, in January 2005. Within this report it sets out an ambitious programme of action that will bring disabled people fully within the scope of the “opportunity society”. By supporting disabled people to help themselves, a step change can be achieved in the participation and inclusion of disabled people. This report sets out a strong vision for improving the life chances of disabled people, which is needed to help disabled people face fewer disadvantages. It is never going to happen straight away so they give themselves a 20-year vision:

‘By 2025, disabled people in Britain should have full opportunities and choices to improve

their quality of life, and will be respected and included as equal members of society’.

This report plans to have big changes as a result of this strategy, to make these changes the strategy will ’empower and involve disabled people, personalise the support they receive and remove the barriers to inclusion and participation’. Reference!! The centrepiece of this strategy is the promotion of independent living. Independent living is more than about being able to live in their own home, it’s about providing disabled people with; choice, empowerment and freedom.

For the government to give disabled people more choice and control over their care ‘The Community Care (Direct Payments) Act was introduced in 1996. With reference to the Directgov website, ‘Direct Payments are local council payments got people who have been assessed as needing help from social services, it gives the individual the chance to arrange and pay for their own care and support services instead of receiving them directly from the local council’.

Direct payments and individualised budgets are central to the UK government’s independent living strategy for disabled people ‘to live autonomous lives, and have the same choice, freedom, dignity and control over their lives as non-disabled people’ (ODI, 2008:27).

While Direct Payments have delivered important choice and control for some people, they are not suitable for everyone. Furthermore, the fragmentation of people’s needs across different budgets means that Direct Payments are not always sufficient to deliver a personalised and holistic response to individuals’ needs. The report, ‘Improving life chances of disabled people’, therefore suggests proposes that ‘different sources of funding should be brought together in the form of individual budgets – while giving individuals the choice whether to take these budgets as cash or as services. The overall aim would be to enable existing resources to be allocated and services delivered in ways that personalise responses to need, and give disabled people choice over how their needs are met’.

The Independent living strategy was published in 2008 and its aim was to ‘ensure that all disabled people, including those with significant learning disabilities or other forms of cognitive impairment (including dementia), are enabled to have choice and control over how their support needs are met, and also to have greater access to housing, education, employment, leisure and transport opportunities and the participation in family and community life’. REFERENCE!! Of paper. Within this strategy it includes; ‘Putting People First, a shared vision and commitment to the transformation of adult social care, introducing personal budgets and help gaining information, advice and support, ‘Lifetime Homes, Lifetime Neighbours, a national housing strategy for an ageing population’, the development of a national employment strategy to enable individuals to remain in employment when they become disabled or when an existing condition gets worse. Therefore the strategy covers all aspects of a disabled individual’s life.

Why is this an important issue?
What should we do about the issue?

Disabled people themselves, employers, health professionals,

educators, local communities, and providers of goods and services all have a key role in improving the life chances of disabled people. Disabled people’s experience of government support and services needs to change. Too often disabled people feel that they are fighting a system which is fragmented, complex and bureaucratic, and

which does not put the needs of disabled people at the heart of service provision. Public service reform and investment has not yet benefited disabled people to the extent it should. REWORD paper improving life chances of disabled people.

http://www.direct.gov.uk/en/DisabledPeople/financialsupport/DG_10016128