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Abstract

This paper looks into the issue of poverty and social justice. The paper shows the contribution of poverty to social injustice. This is done by examining a social organization which fights poverty. This paper examines the City Team Ministry one of the many organizations which is helping to reduce poverty. The beneficiaries of the organization are interviewed to shed light on the issues of poverty. The questions used in guiding the interview are appended.

SECTION I

City Team Ministries was started by Lester and Pauline Meyers in 1957. It began as a feeding program. Four years later it expanded to include women in its feeding program and still later in 1069 merged with another ministry to bring on board homeless and troubled youths. In 1983 it changed its name San Jose Rescue Mission to City Team. In 1987 the churches in Philadelphia invited the City team to start national expansion to the East Coast. This was to serve the greater Delaware valley. The City Team Ministry records that this was the period that the full long term recovery program for men was started. Further the website claims there were continued increase in the number of the children and women who suffered from abuse, addiction, crisis pregnancy, abandonment and homelessness. To bring on board the women and children the city team ministry launched three programs three programs: heritage home and house of grace in San Jose and well baby program Philadelphia. The programs caused a lot of changes in the lives of the women ands children (City Team 2010).

The City Team International was launched in 1997 in an effort to broaden the City Team. In 2007 the name was changed to New Generations International. The New Generations International is specifically concern with training, equipping and coaching national leaders in 38 countries. This division cares people through the provision of compassionate services such food, clean water, education and medical services (City Team, 2010).

The City Team Ministry has a disaster response team which started in 1989. The first beneficiaries of this team were the victims of the Loma earthquake. Afterwards the team has responded to and sheltered the victims of the Hurricane Katrina and the tsunami in 2004. Since 2005 the response team has developed a four phase framework specializing in the long term recovery of communities affected by the major disasters (City Team, 2010).

The mission statement of the ministry is, “In obedience to Christ, passionately transforming individuals, their families and communities throughout the world” (City Team Ministry para. 4). The programs which are offered by the organization are as follows: rescue missions, men’s recovery programs, youth outreach, family programs and church advancement. These programs will be explained in a detailed way in the course of the paper (City Team, 2010).

Section II

I carried out an interview on clients served by the City Team Ministry. The interview was carried out after obtaining permission from the ministry authorities. Six classes of people were interviewed one from each program offered by the City Team Ministry. The fist person interviewed was a beneficiary of the rescue mission. This program is designed to offer a hot meal and a safe night’s sleep. The program offers temporary emergency care to the homeless. A young man who had just been released from prison was one of those beneficiaries of this program who was interviewed. He has an Islamic background and was headed to the streets after being released but bounced into the agents of the ministry who enrolled him in the program. For the sake of this paper he will be called 1A.

The second person to be interviewed (2B) was a black man an addict of drugs. He was a beneficiary of the men recovery program. He was not homeless but had been driven to the streets after being left by his wife who was the bread winner. The man in desperation turned to abuse of drugs. The program agents enrolled him in the program and slowly he was making some progress in recovering from drug use.

The third interview was carried out on a group of street kids. These kids had an arrangement with the City Team Ministry whereby they met every Saturday and Wednesday. In the meetings they hold bible discussions and are groomed to become better citizens. These kids operate under the youth outreach program. Some of the have already being taken off the streets and are attending schools. The kids are of various backgrounds. The fourth interview was carried out on a family which is a beneficiary of the family program. This program offers basic needs like clothes to the families which can not afford the basic needs and view them as luxuries. The last person interviewed was a lady around the age of thirty who had been abused and was pregnant. She was taken in under the women’s programs where she was taken care of through her pregnancy.

Section III

This section presents the results of the interviews carried out above. The interviews were guided by the questions appended in the appendix. The interviews focused on how the clients have experienced social injustice as a result of poverty. Through the interview it was also possible to assess how the macro conditions of the society may have impacted upon the poverty experienced by the clients.

Person 1A: Education

The first interview carried out on person 1A who had just been released from the prison having been charged with mugging. He was a sharp young man aged 27 years who answered the questions succinctly though he was well educated having just attended the elementary level education. He could not continue with studies because he could no longer depend on his family which actually needed his help for sustenance. He therefore pulled out of school to help his family meet the basic needs of life. Education which is a basic had turned out to be a luxury for him. This is one incident which clearly shows how poverty can easily cut short and change basic needs like education into a luxury irrespective of whether one is willing to continue studies or not.

Some macro condition of the society can equally contribute to making the access of these basic services a challenge (Kirst-Ashman, 2008). According to the National Academic Press (2001), “The U.S. system of education finance is characterized by large disparities in funding and opportunities” (National Academic Press para 1). This disparity makes attaining education in some region to be expensive. Expensive education coupled with poverty makes education almost unattainable. The property tax is basically used to sponsor the education at the district level. This means that a poor district will equally be unable to fund its schools leading to disparity in education among the districts. Another macro environment factor which may contribute to insufficiency education and therefore poverty is the attitude of some communities. Education is not taken seriously by some people especially in regions which have large numbers of poor inhabitants (National Academic Press, 2001).

Person 1B: Medical Care

The second person to be interviewed is labeled person 1B. This man was a victim of depression which led him to drug abuse. He had part ways with his wife who used to provide for the family and could not take care of himself therefore resorting to the streets. He looked as a man who was well built before. Before joining the men recovery program with the City Team Ministry he could not afford medical care being unemployed. He was sick on several occasions as he narrated but could not afford medical care. From the interview, the main reason he gave for not getting something casual job to work on was his ailing status. He also made claims that he could not secure a job in his status of health.

The interview with person 1B brings into limelight the issue of the access to health insurance. Health insurance is only accessible by those who are employed. Once one’s job is no more and being not in position to submit the required periodical premiums the coverage is frozen and attaining medical care becomes hard. With the exception of such programs as Medicare and Medicaid it becomes extremely hard for the poor people to access medical care facilities (Cellini, McKernan & Ratcliffe, 2008).

Street Youths:

This was the third interview which carried out. Some street kids who are beneficiaries of the youth outreach program volunteered to give information about their lives and the program they were enrolled in. The program offers a combination of youth activities and mentorship to youth especially those who are affected by the street ways of life such as drugs. From the interview carried out it was found out that the youths mostly lacked a source of direction and mentorship. Most of the youths interviewed under this interview group were willing to work on any casual job. A close cross examination showed that they lacked the presentation skills which would be quite necessary if they were to win the confidence of those they would work for.

Under this interview some macro conditions came into play (Kirst-Ashman, 2008). The first which was quite noticeable was the community. Some employers are likely to avoid employing individuals from some communities because of stereotypes which might be associated with them. For instance not all employers will be willing the street youths work for fears that they may steal from the workplace and cause some kind of conflict. The youths were mentored on presentation skills through the program offered by City Team Ministry.

Family

The fourth interview was carried out on a family which is a beneficiary of the family programs. This program is designed to help poor families have an access to basic necessities. This is done in form of giving the families quality second hand appliances, clothes and furniture. This has gone a long way to raise the standard of living of the families in the family programs. The family which were interviewed were able to live a comfortable life and invest money businesses which they could have spend buying the basic home necessities. Having a comfortable home environment is a basic for a family to concentrate on developing itself. This is quite significant especially for the parents who wish to see their children having a smooth life. From the family interview it was realized that children in a comfortable family set up are less likely to fall sick and have a potential of performing better in the schools.

This interview implicated that comfort at homes is a necessity which is vital in helping families fight poverty in by creating peace of mind. This helps the family members to maximally concentrate in their duties.

Abused Lady

The last interview was on a lady who was an orphan staying with uncle. The uncle sexually abused her for some times after which she decided to run away after learning about the women programs at the City Team Ministry. During the interview the lady appeared tormented by the acts of her uncle. She could not report the uncle to the police because she dependent on him for the payment of her college fee. When she could not bear it any more she run way terminating her studies and later realized that she was pregnant.

The interview brought to surface the social injustice which silently takes place without anybody being aware of them. In this case poverty created a forum which an elderly person advantage of and exploited a young person. Poverty could not allow the lady to report the person for fear that she could lose her college sponsorship.

Section IV

This section will look at the issues of poverty at large. According to Anup Shah (2009) the poverty is caused by both individuals and governments. He examines this in a global perspective. He starts by analyzing the causes at individual levels. Being lazy and making poor decisions are the two reasons he gives which contribute to poverty. This is true but the he fails to talk about the victims of circumstances who find being born in poor families where despite any wise decisions made it takes a lot time to escape poverty. This happens to most of the children born in the ghettos of America. They start life with no basic education and nothing as a heritance. With no education and no money wise decision almost become a vague idea though not in most cases. Street musicians have been known to rise from dust but it should be noted that this may not happen to everybody born in the street (Anup Shah 2009).

Anup Shah (2009) also brings in the issue of the corruption and unwise government policies. Corruption is predominantly responsible for poverty in the third world countries. In the U.S. government decision may make some region poor. For instance the federal government should come in to aid those districts which are in a position to support their own schools (Anup 2009). NCLB Act is one way the federal government is doing that but there should be more efforts to ensure that all the school age going kids are included especially in the poor regions. The government should adapt a friendly way of drug war techniques. Instead of just hundreds of youths to prisons they should find a way keeping these youths busy (Cellini McKernan & Ratcliffe, 2008).

Conclusion

Poverty and social injustice are two issues which seem to go hand in hand. Poverty creates a gate for many social injustices to be committed. This is so because poverty seems to handcuff the power of the people involved from shouting and demanding for their rights. Despite the many non governmental organizations which are fighting poverty across America, t he government has a responsibility in changing some of its policies which seem to foster poverty.

References

Anup, S. (2009). Causes of Poverty. Retrieved on February 4, 2010 from: http://www.globalissues.org/issue/2/causes-of-poverty

Cellini, S, McKernan, S. & Ratcliffe C. (2008). The Dynamics of Poverty in the United States: A review of data, methods, and findings. Journal of Policy Analysis and Management 27(3), 577-605.

City Team. (2010). City Team Ministry. Retrieved on 4th February, 2010 from: http://www.cityteam.org/about/programs/

Kirst-Ashman, K. (2008). Human Behavior, Communities, Organizations & Groups in the Macro Social Environment: An Empowerment Approach (2nd Ed.) Thousand Oaks, CA: Thomson.

Kissane, R. (2008). Teaching and Learning Guide for: Assessing Welfare Reform, Over a Decade Later, Sociology Compass 2(3), 1115-1126.

National Academic Press. (2001). Equity and Adequacy in Education Finance. Retrieved on February 4, 2010 from: http://books.nap.edu/openbook.php?record_id=6166&page=1

Appendix (interview questions)

1st interview (to person 1A)

Do you view education as basic need?
Given a sponsorship can you go back to school?
How do you think would you be if your family had enough money?
What could you have avoided if you had enough money?

2nd interview (to person 2B)

Give us your story?
How has the men recovery program helped you?
What do you think has kept you in poverty

3rd interview (to the street youths)

What are doing to get out of your current situation?
How have you benefitted from the youth outreach program?

4th interview (family)

How is the family program helping you to fight poverty?

5th interview (abused lady)

Why did you give in to be abused?

This essay will discuss what is meant by the term “Poverty”, how it affects individuals and the wider community as well explaining why it is important for Social Workers to have a clear understanding of these issues. By looking at the organisations in place in the UK, in areas such as education and health and social care establishments; this essay will demonstrate how the structures of these organisations both help and hinder Social Workers in their role and how it affects the workings of daily practice.

The UK has the oldest and biggest National Health Services in the world, so this essay will also go on to compare the provision in this country with that in the USA. As a first world country, the USA has an economy and culture not vastly different from that in the UK, which makes for some interesting comparisons of the care they both provide. Both the UK and the USA spend the same proportion of their annual budget on social services and education and have a similar rate of poverty.

Poverty is a common term which many people would define as simply being a lack of financial resources. This is a very constricted view which makes it difficult to determine how many people live in poverty because the definition is vague and subjective. To understand and measure poverty and its impact upon individuals and the community, it is important to define it further.

Instead of one main definition for poverty, sociologists have agreed there are two main types; absolute and relative poverty, as described by Giddens (2009). Absolute poverty is used to describe the inability to provide the basic human needs; food, accommodation and clothing, on a budget of around $1 US dollar per day. The idea of absolute poverty is a global one which can be applied regardless of country or culture and applies equally to people of similar ages and abilities. According to a recent study by UNDP (2010), as many as a third of the world’s population live in absolute poverty.

Due to the modern welfare state and benefit system in place in the UK today, no one is expected to survive on $1 per day. However, figures provided by The Poverty Site (2010) show that approximately 9% of the population in the UK have an income which equates to only 40% of the national median income. This has risen almost 7% in just over 20 years and suggests that poverty is on the increase in the UK. These statistics would also suggest that people living in the UK are affected by relative poverty as opposed to absolute poverty.

Relative poverty compares the income of individuals to the national or local average, and where it falls below 40-60% of that average, the individual is said to be living in relative poverty. There is still some debate about where the percentage rate should fall but many agree it should be 60% of the national median income (Giddens, 2010). This is referred to as the poverty line; those below this line live in relative poverty.

Certain groups of people are more likely to find themselves living in poverty, these include; children, women (particularly single mothers), people with disabilities, ethnic minorities and the elderly. Cunningham & Cunningham (2009), Giddens, (2010) and Llewellyn, et al (2008) all agree the reason these groups are more likely to suffer from poverty than other groups is a direct result of social exclusion.

Social exclusion is a term which grew in popularity in 1997 when New Labour was re-elected into government. Part of the pre-election campaign of New Labour was to tackle the root causes of the issues affecting those who were marginalised by main stream society (The Poverty Site, 2010). People, who for reasons including; age, race, gender and class are often denied access to service and opportunities making it easier to exclude them from society. This was evident when the BBC undertook a survey, and found that when considering job candidates, whose qualifications and experience were almost identical; those with a name traditionally given to people from non-white backgrounds were far less likely to be called to interview, proving that racism is still present in the workplace, (Cunningham & Cunningham 2009).

To tackle some of the inequalities present in mainstream society, New Labour introduced a number of initiatives and policy changes to improve the standard of life, these included;

The introduction of Tax Credits for families and individuals on low incomes,

Every Child Matters – a 5 point framework to improve the quality of life for all children,

Connections – an easily accessible advice point on a range of topics for young adults ages 13 – 19yrs,

SureStart – aimed at giving babies and young infants the best start in life by providing advice, drop in centres and child care for their parents.

People who face social exclusion often live in the same locality; council house estates for example, which tend to have a higher proportion of single parents and high rates of unemployment. These groups of people are frequently given negative labels, which over time can become self-fulfilling. For example, a young child growing up in a single parent family on an council estate as indicated above is more likely to be viewed negatively and given such labels as; ‘trouble’, ‘lazy’, ‘good for nothing’, which over time can have a detrimental effects upon the child who will begin to view themselves as the labels placed upon them (Llewellyn et al, 2008). This negativity can lead to an increase in truancy, which in turn will lead to a poor education and employment prospects, thus setting up a life in poverty (Mail Online, 2007).

According to Bebbington and Miles (1989), children from an impoverished background are 700 times more likely to be involved with social services than children from a wealthy background. This statistic alone shows how vital it is for social workers to have a strong understanding of the impact and experiences living in poverty can have. It is argued by Cunningham and Cunningham (2009) that many professionals in the social work field feel overwhelmed by the structural inequalities faced when tackling poverty, this tends to mean that poverty is dealt with on an individual case basis. Changes in policy, both at national and at local level can have an impact on poverty by the way services are implemented and delivered. As social workers are present at both the point of service and within the organisations where policies are made, it puts them in a prime position to affect change.

Understanding and recognising the factors that cause and keep poverty part of modern society will allow a social worker to understand how they can interrupt the poverty cycle encouraging positive change.

Placing some of the responsibility for poverty on society and within the structural inequalities that exist, can sometimes be viewed as taking responsibility away from the individual and the choices they have made, making them less accountable. A social worker should always maintain a positive and optimistic outlook and believe that despite the inequalities that exist, change is still possible regardless of the situation. It is important to understand how the education system and health and social care organisations are set up in the UK to recognise how this can impact the access to care.

Responsibility for education in the UK has become a devolved matter for each individual country and overseen by their own government. The Department of Education and The Department for Business, Innovation and Skills predominately oversee the education system in England, with involvement from Local Authorities. Since 2005/2006, Local Authorities are given a grant which is ring fenced for the purpose of education and with consultation from all schools under the Local Authorities control, the finance is distributed, (Department for Education, 2010). There are approximately 20,000 public schools in the UK; a growing number of these are faith schools, almost 7000 at present.

In addition to these state schools, there are a growing number of independent schools, almost 2600; responsible for the education of 7% of the population, (Independent Schools Council, 2010). There schools are funded primarily through tuition fees and in some faith schools, donations from the associated church. A large proportion of these schools are faith schools who do not take children outside the designated faith of the school within their catchment area.

Historically, health and social care has been provided by the private and voluntary sector. Until the introduction of the Poor Law Act 1930, the majority of care for those in need was provided by charities and the work houses. People who lived in poverty had to rely on hand-outs, if they were deemed worthy of charity, or would have to pay at the point of service. Often it was those most in need of the service that were unable to pay forcing them to go without. The Poor Law Act 1930 moved the responsibility of care from these sectors to the Local Authorities, who began to take over the work houses and Poor Law hospitals (Spicker, 2010).

The National Health Service was established in 1948 with the ideology that everyone should be entitled to the same level of health and social services which were free at the point of service. Today’s modern National Health Service is overseen by the Department of Health. The country is split into 10 Strategic Health Authorities who control the care provided by the trusts in its area. Care is split into two main areas, Primary and Secondary care. Primary care services include; GP’s, Opticians, Dentists and NHS Direct. Secondary care is acute health care and normally only accessed in emergency or extreme situations and includes; The Ambulance Trust, Emergency and Urgent Care Units, Mental Health, Care and NHS Trusts. (NHS, 2010).

The National Assistance Act 1948 called for Local Authorities to set up Health and Welfare comities, providing the first form of residential care. In 1970, The Local Authority and Social Services Act of the same year created the first Social Services departments including; children’s, welfare and mental health. (The National Archives, 2010).

The National Health Service remained largely unchanged until 1990 when the first major reforms took place. With the general population living longer, the cost of providing care was increasing and becoming unviable. The organisation of the National Health Service had also become unproductive and unyielding to those it was meant to help. Bureaucracy and red tape became the norm when trying to access any services or treatment.

The National Health Service and Community Care Act 1990 was the first step in the reforms to the health and social services departments. The introduction of the Purchaser/Provider split meant for the first time since the establishment of the National Health Service, government departments were no longer responsible for the provision of all services (Kirkpatrick et al, 1999). The reason for this was threefold; firstly, to lessen the financial responsibility of care provision, secondly, removal of public provision would allow the private and voluntary sectors to grow and expand, making the care market more competitive, and thirdly, to increase choice for service users. This act was also the start for a number of large care homes and institutions being closed and the care provided in the community.

The principles behind these changes were well intentioned; allowing people to be cared for within the community promoting independence and control over personal care. However, in reality what was offered were standard care packages and limited resources which did not deliver the true freedom of choice that was promised, (Llewellyn et al, 2008).

To supplement the care provided for under the new system, many people have turned to charities to help fill the gap left by the lack of financial assistance. Providing people with the finances to pay for their own care, rather than provide the care itself, has meant people are able to choose how and by whom the care is provided. Many people have chosen to pay friends and relatives for the provision of care rather than rely on agencies and strangers. For Social Workers, this gives an opportunity to think outside the box when producing care plans with individuals. In communities, people are now able to form groups and committees to address and tackle problems and difficulties to provide a tailor made solution. This not only gives people control over their own care but also encourages the community to take action and to help itself.

Although the UK has the biggest National Health Service in the world (NHS, 2010), the change in direct care provision and growing reliance on the private and voluntary sectors is more in line with the health and social care services in the United States of America (USA).

The USA has a minimalist National Health Service which provides the most basic of health care; caring for those on very low incomes and or in emergencies. Many people living in poverty will be eligible for “Medicaid” which is a healthcare programme paying for the whole cost of care, but poverty alone is not an automatic eligibility criteria. Many older people, 65yrs and over, are reliant on the “Medicare” system, which only covers 80% of the cost of care, the remaining 20% must be funded by other means. Anyone who is outside the eligibility for these benefits must pay for private health care insurance, unless it is provided for through employment, (US Department of Health & Human Services, 2010).

Another benefit provided by the USA government is food stamps; however this is being phased out and replaced by Temporary Assistance for Needy Families, which is a short term benefit aimed at getting families back on their feet, (US Department of Health & Human Services, 2010).

The health and social care system in the USA is structured much the same as the UK, in that the government provides each state (Local Authority) with a budget to spend on care. In addition to this, states in the USA are allowed to set its own tax rates on things such as Income Tax, Sales Tax and House Tax. The proportion of money put back into care differs between states, some providing a higher level of benefits than others.

The USA has a much higher dependency than the UK on voluntary organisations, namely the church; who provide care and financial assistance to those in their communities.

Comparing the UK and the USA, there seems to be a different attitude towards the provision of care. The UK system is geared up to help prevent poverty and social exclusion, whereas the USA system is designed to help people get out of poverty but placed a bigger reliance on the individual helping themselves. Both systems are becoming more reliant on the community, voluntary organisations and the private sector for the provision of care; lessening the financial burden on the state in the face of an ever aging population. Both countries seem to be unified in the attitude that people should “help themselves out of poverty”.

Although the role of the Social Worker will always be required, there is a strong shift in the role from the provision of direct care to one of care co-ordination. To provide the best possible level of care for both individuals and the community, Social Workers must maintain a high level of knowledge of both statutory and non-statutory providers of care and how best to access them.

This essay has demonstrated that poverty is a global problem which is maintained by the way society works by socially excluding people and keeping them impoverished. It has also shown how two similar countries differ in their approach to care; the UK government provides the majority of care with assistance from charities and the private sector, whereas the USA government provides only the most basic forms of assistance which a strong reliance on the church, charities and the public sector. Both countries are in agreement that with an increasing older population, each government needs to do more to lessen their contribution to the provision of care. During this time of change, Social Workers will need to find a way of providing the best possible care for those in their charge.

Introduction

Malnutrition is the underlying cause of every one out of two deaths in children under 5 years of age.

Bryce J, Boschi-Pinto C, Shibuya K, Black RE, and the WHO Child Health Epidemiology Reference Group. WHO estimates of the causes of death in children. Lancet 2005; 365: 1147-52.

It is a largely preventable cause of over a third-3.5 million- of all child deaths. Four-Fifths of undernourished children live across 4 regions-Africa, Asia, Western Pacific and the Middle East-. These are high priority nations for action. The first of the millennium development goals was “to half between 1990 and 2015 the proportion of people who suffer from hunger.”

U.N.Mellinium Project 2005. Halving hunger:It can be done. London and Sterling, VA:Task force on hunger, 2005.

Nutrition is a neglected aspect of child health which is not justifiable as we know that it is a major risk factor for disease.

Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJL. Global and regional burden of disease and risk factors, 2001:systematic analysis of population health data. Lancet 2006: 367:1747-57.

Inappropriate feeding practices and their consequences are major obstacles to sustainable socioeconomic development and poverty reduction. Governments will be unsuccessful in their efforts to accelerate development in any significant long-term sense until optimal child growth and development, especially through appropriate feeding practices, is ensured.

WHO Global Strategy on Infant & Young Child Feeding Report of the Secretariat 55th World Health Assembly, April 2002(5)

The indicator by which progress is measured is the prevalence of underweight in children under five, specifically, the percentage of children aged 0-59 months who fall below minus two standard deviations from the median weight for age of the standard reference population.

http://www.unicef.org/progressforchildren/2006n4/index_undernutrition.html

World Bank Report on 11th May 2006, there is a dominant focus on food supplementation that detracts from aspects that are more crucial for improving child nutritional outcomes, such as improving mothers’ feeding and caring behavior – For example, only 40 percent of Indian mothers practice exclusive breastfeeding.

Also delivery of services is not sufficiently focused on the youngest children (under three), who could potentially benefit most from ICDS interventions – Growth-faltering starts during pregnancy, and approximately 30 percent of children in India are born with low birth weight, and by the age of two years most lifetime growth retardation has taken place, and is largely irreversible

The flowchart below depicts the interactions between underlying and immediate causes of malnutrition –

The Positive Deviance concept which forms the basis of this study focuses on two direct behavioural causes of malnutrition at the household level, namely inadequate dietary intake and disease prevention.

This study measures childhood malnutrition using the new growth standards that have been recently released by the World Health Organization. The new standards are based on children from Brazil, Ghana, India, Norway, Oman and the US and adopt a fundamentally prescriptive approach designed to describe how all children should grow rather than merely describing how children grew in a single reference population at a specified time.

Garza C, de Onis M. (for the WHO Multicentre Growth Reference Study Group). Rationale for developing a new international growth reference. Food Nutr Bull 2004; 25 (Suppl. 1): S5-14.
Magnitude of Malnutrition

Malnutrition is a widely prevalent problem in India and one of astonishing magnitude. According to the National Family Health Survey 3 (NFHS III, 2005-06), about a third of India’s children are born underweight, about 44 percent of children under five are underweight, 48 percent are stunted, 20 percent are wasted and 70 percent are anaemic. NFHS II (1992-93), more than half (53%) of children below four years of age are under nourished. In 1998, 29.1% children between 1-5 years of age suffered from moderate and 12.3% from severe under nutrition. This shows only a gradual decrease in the prevalence of under nutrition in India over twelve years. Nutritional adequacy is one of the key determinants of the health and well being of the children. Under-nourishment not only retardsphysical developmentbut also hampers the learning and cognitive process, leading to sluggish educational, social and economic development, according to Sanjeev Kumar in his study – Malnutrition in Children of the Backward States of India and the ICDS Programme.

According to the NFHS III data, Tamil Nadu, although considered one of the better performing states, recorded to have nearly 35% of its rural children as undernourished. This value was certainly lower than the national rural average of 49%, but according to the NNMB survey based on the NCHS standards in 2001, there was a rise in the levels of severe malnutrition in both boys and girls in the under 5 age group in Tamil Nadu

Therefore the focus of this study is to investigate how some children living in the same surroundings escape the ill-effects of malnutrition and thrive in spite of poverty and limited resources, and use these practices to eliminate malnutrition among the rest.

The Positive Deviance Approach and its benefits

Positive Deviance is based on the fact that solutions to some community problems already exist within the community and need to be discovered. It is a “strength-based” or “asset-based” approach based on the belief that in every community there are certain individuals (“Positive Deviants”) whose special, or uncommon, practices and behaviours enable them to find better ways to prevent malnutrition than their neighbours who share the same resources and face the same risks.

Through a dynamic process called the Positive Deviance Inquiry (PDI), these practices are discovered to contribute to a better nutritional outcome in under nourished child This intervention is designed to enable families with malnourished children to learn and practice these and other beneficial behaviours. The programme actively involves the mother and child in rehabilitation and learning in a home – like situation and work to enable the families to sustain the child’s enhanced nutritional status at home. The typical session consists of nutritional rehabilitation and education over a twelve-day period followed by home visits.

The development of a community-based nutrition rehabilitation model called PD/Hearth was promoted by USAID and other international organizations such as UNICEF.

The Hearth approach

In the Hearth approach, caregivers of malnourished children practice new cooking, feeding, hygiene and caring behaviours shown to be successful for rehabilitating malnourished children. The selected practices come from both the findings of the Positive Deviance Inquiry and emphasis behaviours highlighted by public health experts. The Hearth session consists of nutritional rehabilitation and education over a twelve-day period followed by home visits.

The Hearth approach promotes behaviour change and empowers caregivers to take responsibility for nutritional rehabilitation of their children using local knowledge and resources. After two weeks of being fed additional high-calorie foods, children become more energetic and their appetites increase. Visible changes in the child, coupled with the “learning by doing” method, results in improved caregiver confidence and skills in feeding, child care, hygiene and

health-seeking practices. Improved practices, regardless of mothers’ education levels, enhance child growth and development. This approach successfully reduces malnutrition in the target community by enabling community members to discover the wisdom of Positive Deviant mothers and to practice this wisdom in the daily Hearth sessions.

Positive Deviance/Hearth is an effective tool in discovering the solutions from within.

Need for the Study

Maternal and child under nutrition is highly prevalent in low and middle income countries like ours, resulting in increased mortality and overall disease burden.

It is well recognised that among the basic and underlying causes of under nutrition include environmental and economic factors with poverty having a central role. Thus for a sustainable solution to this very common problem, there needs to be an ecological and holistic approach rather than the current and commonly used approach of the government giving supplementary feeds to those who are malnourished. The latter approach not only puts a financial strain on the government but also make the community members dependent on this external aid. Therefore this study concentrates on identifying affordable and sustainable solutions within a community which can be used to prevent undernutrition. This approach is also not resource hungry unlike the traditional approaches where the focus is on finding and fixing what is wrong and missing in the community rather than identifying what is already working and build on the strengths of existing healthy practices within the community that is protecting them from undernutrition even though they are faced with same constraints of resources. This approach is known as the Positive Deviance approach.

Knowledge shared through this approach not only changes behaviour but also changes how a community perceives malnutrition and their ability to change the situation. The Positive Deviant approach has been shown in other studies and projects to quickly eliminate malnutrition and through the sustainable new behaviour; the younger siblings have also received these benefits. Positive deviance is a successful approach to decrease malnutrition and has enabled hundreds of communities the world over to reduce and prevent malnutrition. This approach is also culturally acceptable which helps bring about change in our society.

However, there are only a few studies that use this concept to reduce malnutrition in India, whereas the potential here is very high. And , although Tamil Nadu has shown gains in terms of reduction of the problem of malnutrition, it still has a high percentage of malnourished children and therefore this study was undertaken to estimate prevalence in fourteen villages within the rural field practice area of the department of community medicine of PSG Institute of Medical Science and Research and explore the feasibility, sustainability and effectiveness of combating the problem by using the Positive Deviance concept and approach.

Tamil Nadu has a high prevalence of malnutrition. Recently, there has been a paradigm shift in the primary focus from “Management of Malnutrition” to “Prevention of Malnutrition”. Towards achieving this, strategies and activities have been proposed under various components for the year 2006-07 with priority for greater attention on the health and nutritional status, by the Government of Tamil Nadu. One of the guiding principles suggested to help achieve “Malnutrition free Tamil Nadu”, is effective nutrition intervention, and communication to bring about behavioural change. To help achieve this goal, this study was undertaken in fourteen villages under the rural field practice area of the department of community medicine of PSG Institute of Medical Science and Research using the Positive Deviance concept.

Objectives
To estimate the prevalence of under 3yrs undernutrition in 14 villages of Vedapatti.
To identify Positive Deviant practices in the community.
To rehabilitate undernourished children identified in the most affected village.
To reassess families at their homes after 6 months and ensure sustainability of Positive Deviant practices.
Review of literature
Classification of under nutrition

Under nutrition is defined as the outcome of insufficient food intake and repeated infectious diseases. It includes being underweight for one’s age, too short for one’s age (stunted), dangerously thin for one’s height (wasted) and deficient in vitamins and minerals (micronutrient malnutrition) according to UNICEF. Low weight for age is termed as underweight.

Weight for age classifications are widely used in assessing nutritional status of children as it gives a picture of both acute and chronic onset malnutrition. The earlier classifications include Gomez, Indian Association of Paediatrics, and Welcome. These classifications use different reference standards, but the current recommended standards are the WHO references.

This study uses the WHO references to classify underweight. In a study done by Bridget Fenn and Mary E. Penny across three countries, fewer children were classified as underweight according to the WHO classification when compared to the NCHS reference standards.

Another study done by Marc-Andre Prost et al showed contrasting results. The WHO standards gave a prevalence of underweight 3.6 times higher early in infancy,0 – 4 months (6.1% against 1.7%) and half the estimated prevalence of the NCHS reference in the second half of infancy, 11 – 15 months(6.6% against 13.6%)

Implication of New WHO Growth Standards on Identification of Risk Factors and Estimated Prevalence of Malnutrition in Rural Malawian Infants

Marc-Andre? Prost1*, Andreas Jahn1,2, Sian Floyd1, Hazzie Mvula2, Eleneus Mwaiyeghele2, Venance Mwinuka2, Thomas Mhango2, Amelia C. Crampin1,2, Nuala McGrath1,2, Paul E. M. Fine1, Judith R. Glynn1

In a study done by P.R. Deshmukh et al , in Anji, Maharashtra, the prevalence of underweight as assessed by WHO standards was significantly lower when compared with the assessment based on NCHS reference (p<0.01). But, WHO standards gave higher prevalence of severe underweight than NCHS reference though the difference was not statistically significant (p>0.05).

Newly Developed WHO Growth Standards : Implications for Demographic Surveys and Child Health Programs P.R. Deshmukh, A.R. Dongre, S.S. Gupta and B.S. Garg

Prevalence of under nutrition

The World Bank estimates that India is ranked 2nd with 47% after Bangladesh for the most number of children who suffer with malnutrition (in 1998). The prevalence of underweight children in India is among the highest in the world, and is nearly double that of Sub-Saharan Africa with dire consequences for mobility, mortality, productivity and economic growth.

According to the National family health survey -3 the percentage of under 3 children who were underweight in Tamilnadu were 33.2 % (31.3% in the urban areas and 34.8% in rural areas)

The National Nutrition Monitoring Bureau observed that in about 40% of the households, the intake of dietary energy by preschool children was inadequate. About 55% of the preschool age children were underweight, 52% were stunted and 15% were wasted.

In a study done by Bhanderi D et al, the prevalence of under weight (wt. for age below 2SD) was 43.67%.

“An epidemiological study of health and nutritional status of under five children in semi-urban community of Gujarat.”

Bhanderi D, Choudhary SK.

A study done to find the prevalence of malnutrition in Uttar Pradesh showed that the maximum over all prevalence of malnutrition was in the age group of 13-24 months. The maximum number of grade IV malnutrition was found in the age group 25-36 months.

Harishankar, Shraddha Dwivedi, S.B. Dadral, D.K. Walia, “Nutritional status of children under 6 years of age” Indian Journal of Preventive and Social Medicine. Vol. 35 No.3 & 4 2004
Methods of assessing nutritional status

Nutritional assessments can be done by both direct and indirect methods. The method used can result in a wide variation in the prevalence of malnutrition.

P. Mohanan et al in their study evaluated the efficacy of Body Mass Index, Mid-Arm Circumference and Weight-for-age in detecting Malnutrition in terms of sensitivity, specificity and predictive value and concluded that weight-for-age is the best indicator.

P.Mohanan, A.Kamath, B.Motha, M.Philip. Evaluation of Anthropometric Indices of Malnutrition in under-five children. Indian Journal of Public Health 1994 July-September;28 (3); 91-94.

A Comparison of Anthropometric Methods for Assessing Nutritional Status of Preschool Children in the Philippines was done to identify the most reliable anthropometricmeasurements that reflect nutritional status and the Dugdale’s nutritional index, weight/height, was a reliable measurement for malnutrition. This is exceptionally useful when the age of the child is not know.

A Comparison of Anthropometric Methods for Assessing Nutritional Status of Preschool Children: The Philippines Study Marilyn D. Johnson, MS,William K. Yamanaka, PhDandCandelaria S. Formacion, MS
Factors associated with malnutrition
Gender
A case-controlled study conducted in a rural area in Tamil Nadu, India, on 97,000 children showed that female gender was a significant risk factor for malnutrition.

YALE JOURNAL OF BIOLOGY AND MEDICINE 70 (1997), pp. 149-160. Copyright C 1997. All rights reserved. A Case-Control Study of Maternal Knowledge of Malnutrition and Health-Care-Seeking Attitudes in Rural South India Kaori Saito, Joshua R. Korzenika, James F. Jekel and Sara Bhattacharji

Also another study in Tamilnadu on a total of 2954 children attending the TamilNadu Integrated Nutrition Project (TINP), showed that there was an association between female sex and malnutrition. In this study the malnourished children were referred to as negative deviants.

Use of Positive-Negative Deviant Analyses to Improve Programme Targeting and Services: Example from the TamilNadu Integrated Nutrition Project

MEERA SHEKAR, JEAN-PIERRE HABICHT AND MICHAEL C LATHAM

Girls showed only a slightly higher level of prevalence of malnutrition in the study done by The Research and Special Studies Division of the Department of Census and Statistics, Sri Lanka
A study done in the slums of Chandigarh on 1286 preschool children found no significant gender difference. This study shows similar reports as our study in Vedapatti.

H.M. Swami, J.S.Thakur, S.P.S.Bhatia, Vikas Bhatia. Nutriotional status of preschool children in an ICDS block of Chandigarh. Journal og Indial Medical Association; 99(10): 554-556

The sex of the child was found to be significantly high in association to malnutrition. The percentage of female children that were malnurished was higher in school going children.

“Epidemiology of malnutrition in a rural field practice are of Navi Mumbai” By Sumedha Joshi and Santosh S. Walgankar… Indian Journal of Preventive and Social Medicine Vol 35, 1 and 2, 2004

Mother’s Literacy
The Research and Special Studies Division of the Department of Census and Statistics, Sri Lanka, undertook a methodological study to investigate the prevalence of malnutrition in children under five years of age, and the factors contributing to such a situation. The study found that 25% of pre-school children that were undernourished had mother’s who had not gone beyond the primary level of school education. The effected proportion dropped to 11% when the mother has had at least secondary education.
Mother literacy was found in this study to have a positive effect on bringing down the incidence of malnutrition in socio-economically backward villages around Agra.

“Positive Deviance determinants in Young Infants in rural Uttar Pradesh” by Vani Sethi1, Sushma Kashyap1, Veenu Seth1 and Siddharth Agarwal, Department of Foods and Nutrition, Lady Irwin College, New Delhi, India. Indian Journal of Pediatrics Volume 74, June 2007.

Sandip Kumar et al in a study among 600 under 5 children in West Bengal showed that illiteracy of both parents was a significant risk factor for malnutrition.

Sandip Kumar Ray, Anima Halder, Biswajit Biswas, Raghunath Mishra, Satish Kumar. Epidemiology of Under Nutrition. Indian Journal of Pediatrics 2001 November: 68:1025-1030.

Socio-economic status

This study in 2003 on 4187 children showed contrasting results in Nigeria. The southeast and southwest regions had large inequalities between the poor and the rich whereas northeast and northwest regions had a considerably small gap between the rich and the poor on malnutrition.

Using extended concentration and achievement indices to study socioeconomic inequality in chronic childhood malnutrition: the case of Nigeria

Olalekan A Uthmancorresponding author1,2

A study done in 1000 under 5 children in Rajasthan showed that 82% of the malnourished children belonged to the socio economic classes 4 and 5.

“Nutritional disorders in rural Rajasthan” A.L.Soni1, R.N.Singh1and B.D.Gupta. Indian Journal of Peadiatrics, May, 1980,Vol 47: 199-202.

A case-control study of maternal knowledge of malnutrition and health-care-seeking attitudes in rural Tamilnadu, showed that socio-economic status was a stronger risk factor for malnutrition than health-care availability and health-care-seeking attitudes.

A case-control study of maternal knowledge of malnutrition and health-care-seeking attitudes in rural South India, Saito K,Korzenik JR,Jekel JF,Bhattacharji S.

Birth order

The study done by Vani Sethi et al also evaluated other factors that contribute to malnutrition in the society and found that third or earlier born infants escaped malnutrition

“Positive Deviance determinants in Young Infants in rural Uttar Pradesh” by Vani Sethi1, Sushma Kashyap1, Veenu Seth1 and Siddharth Agarwal21Department of Foods and Nutrition, Lady Irwin College, New Delhi, India. Indian Journal of Pediatrics Volume 74, June 2007

Another study in Uttar Pradesh observed that grade III malnutrition was absent in the children whose birth order was one and two. A significant rise in Malnutrition was found in the children of birth order IV and above.

Health and Population – Perspectives & Issues 4(2):106-112, 1981

A community based, cross-sectional study was conducted in the Mollasimla village of Hooghly district of West Bengal, showed a significantly higher proportion of malnutrition was found to be present among female children of higher birth order and those belonging to families with lower per capita income compared to the males.

Gender inequality in nutritional status among under five children in a village in Hooghly district, West Bengal. Dey I,Chaudhuri RN.

PROTEIN ENERGY MALNUTRITION IN CHILDREN – A CASEFOR THE NEED OF A PLANNED FAMILY Deoki Nandan*, J. V. Singh** and B. C Srivastava

A study done by Harishankar et al showed that the highest percentage of malnourished children was seen in the first born children (47.2%) and the least in children with birth order 3 and above (17.8%)

Harishankar, Shraddha Dwivedi, S.B. Dadral, D.K. Walia,”Nutritional status of children under 6 years of age” Indian Journal of Preventive and Social Medicine. Vol. 35 No.3 & 4 2004

Spacing

The same study in Uttar Pradesh, by Deoki Nandan et al also studied the relationship to spacing and malnutrition showed that there was a direct association between Protein energy Malnutrition and less spacing between sibilings.

Health and Population – Perspectives & Issues 4(2):106-112, 1981. Protein Energy Malnutrition In Children – A Case For The Need Of A Planned Family Deoki Nandan*, J. V. Singh** and B. C Srivastava

Studies using Positive Deviance concepts

The successful application of the PD approach has been documented in more than 41 countries in nutrition and a variety of other sectors from public health to education to business.

Positive deviance is not specific to nutrition practices, but can be used for many other behaviours.

Ref:http://www.positivedeviance.org/PD_Evaluation_Report_for_DEPKES_FINAL.pdf

Positive Deviance was used in two Colombian hospitals to combat the spread of MRSA Infection. All hospital staff up to the security guard involved themselves by reminding the visitors to practice good hand hygiene. As a result the infection rates have dropped down my more than 75% from 1.1 infections per 1000 patient days to less than 0.2 infections per 1000 patient days.

Ref: http://www.positivedeviance.org/projects/healthcare.html?id=49

In West Bengal, India, ICDS has undertaken pilots projects in the use of the PD approach in Nutrition and Child Care Program (NCCP) in 4 districts to improve the nutritional status of children under three years of age. The projects substantially decreased the number of malnourished children by promoting good care practices. The PD informed project enabled families to break the dependence on donated food, by identifying cheap locally available and bringing it daily to the NCC session to prepare and feed their malnourished children. Every month the malnourished child is weighed and in most cases, mothers find their children gaining weight between 100 and 600 gm.

Ref:http://www.positivedeviance.org/projects/nutrition.html?id=77

Ref:http://www.unicef.org/india/nutrition_1557.htm

In 1990 Save the Children initiated a PD program in Viet Nam to enable poor villages to address the pervasive problem of childhood malnutrition. At that time 60% of children under the age of 5 suffered from malnutrition in Viet Nam. The initial pilot project was in the first 4 villages. In each of the villages, six of the poorest families with well nourished kids were chosen and caretakers were questioned and observed. In every instance where a poor family had a well-nourished child, the mother or father was collecting tiny shrimps or crabs or snails (the size of one joint of one finger) from the rice paddies and adding these to the child’s diet along with the greens from sweet potato tops. Although readily available and free for the taking, the conventional wisdom held these foods to be inappropriate, or even dangerous, for young children. Along with these food and atypically strict hand hygiene in 5 of the 6 PD households, other positive deviant behaviors emerged, involving frequency and method of feeding and quality of care and health-seeking behaviors. Through the PD inquiries, community members had discovered for themselves what it took for a very poor family to have a well-nourished child. Rehabilitation started as for two weeks every month, mothers or other caretakers would bring their malnourished children to a neighbor’s house for a few hours every day. Together with the health volunteer, they would prepare and feed an extra nutritious meal to their children. This showed great success by reducing malnutrition by as much as 80%. The project was then applied in large scale reaching more than 2 million people and in 250 communities and sustainabily rehabiliteted 50,000 malnourished children under the age of 5. This is probably the best known and best documented large scale application of PD.

Ref: http://www.positivedeviance.org/projects/nutrition.html?id=105

In Nepal a PD project to cover more than 8000 children under 3 years of age from 15 very disadvantaged communities was started with an aim of reducing child malnutrition in a sustainable manner. Positive practices regarding child feeding, caring, health seeking and maternity care are identified from the poor families having well nourished children through the PDI and then are made accessible to the families with malnourished children through a “learning by doing” process.

Ref: http://www.positivedeviance.org/projects/countries.html?id=82

In the year 2000 a Positive Deviance Inquiry to identify specific behaviors and strategies that contribute to healthy pregnancy outcomes amongst poor women was conducted. The inquiry determined that mothers-in-law played a central role in assisting women in obtaining medical care. Low-income women with weight gain greater than 1.5 kg per month in the second trimester of

pregnancy reported multiple antenatal care contacts, increased rest during pregnancy, and more consumption of meat and vegetables. These results were incorporated into a program for 200 women that resulted in a decrease in the prevalence of low birth weight.

Ref: http://www.positivedeviance.org/projects/public_health.html?id=117

The following is illustrative of the impact of Positive Deviance over the last 15 years:

Sustained 65 to 80% reduction in childhood malnutrition in Vietnamese communities, reaching a population of 2.2 million people. Significant reduction in childhood malnutrition in communities in 41 countries around the world. Reduction in neo-natal mortality & morbidity in Pashtun communities in Pakistan and minority communities in Vietnam with near universal adoption of protective behaviors and social change. Estimated 50% increase in primary school student retention in 10 participating schools in Missiones, Argentina.

Community intervention methods to combat under nutrition

Traditional nutrition interventions include growth monitoring, counselling and the provision of supplemental foods and micronutrients But over decades the weighing of children undertaken by several National health ministries has brought little or no change to the nutritional status. In fact, in a study done by Sridhar Seetharaman, in Uttar Pradesh and Rajasthan, it was found that the Mid Day Meal did not make any appreciable and significant impact on improving the nutritional status of the children.

Impact Of Mid Day Meal On The Nutritional Status Of School Going Children, Sridhar Seetharaman, NIRD, Hyderabad

Zulfiqar A Bhutta et al used a cohort model to study the interventions that affect maternal and child undernutrition and nutrition-related outcomes. The interventions included promotion of breastfeeding; strategies to promote complementary feeding, with or without provision of food supplements; micronutrient interventions; general supportive strategies to improve family and community nutrition. They found that these interventions could reduce stunting at 36 months by 36%; mortality between birth and 36 months by about 25%; and disability-adjusted life-years associated with stunting, severe wasting, intrauterine growth restriction, and micronutrient deficiencies by about 25%.

Prof Zulfiqar A Bhutta PhDa, Tahmeed Ahmed PhDb, Prof Robert E Black MDc, Prof Simon Cousens PhDd, Prof Kathryn Dewey PhDe, Elsa Giuglianif, Batool A Haider MDa, Prof Betty Kirkwood PhDd, Saul S Morris PhDd, Prof HPS Sachdevg, Meera Shekar PhDhand for the Maternal and Child Undernutrition Study Group, Lancet Volume 371, 8 February 2008, Pages 417-440

Reasons for age selection

Care is an important determinant of nutritional status. It determines the delivery of food and health care resources to the child by optimizing the existing resources to promote good health and nutrition in children.

Ramakrishnan U. UNICEF-Cornell colloquium on care and nutrition of the young child-planning. F Nutr Bull 1995; 16: 286-92.

The first two years of life are the “window of opportunity” to prevent early childhood undernutrition that causes largely irreversible damage. This is proved by the following studies across the world.

Study shows more benefit from reaching all at-risk children

One could suggest, to have a full understanding of the concept of child care polices within Ireland, we must first look at childcare and its practice from a historical perspective. According to Kelleher, Kelleher & Corbett, (2000) modern social care in Ireland evolved in part from the insufficiency in the running of children’s institutions, schools and other care facilities; with a litany of abuse and atrocities now documented, social policy reformation has been a key component in integrating safe and secure work practice and care. This assignment will seek to define two macro policies in relation to child care within the social care sector, while emphasis will be given on application within Children’s residential units, other care providers for example after school programmes and youth programmes will also be given consideration.

According to Curry (1998) social policy in relation to child care services has been slow to emerge. The developments and new recommendations for policy have been the combination of many forces; public outcry coupled with state intervention resulted in high profile reports being commissioned and published; namely ‘The Kennedy Report’ and the ‘The report of the task for on Child Care Services’. The Kennedy report called for an introduction of a revised and complete children’s act, the subsequent introduction of The Child Care Act 1991 has been described as a ‘watershed in child care policy in Ireland’ (Curry, 1998:171). Among the many provisions within the act, the main emphasis was on the safety and security of the care of children, with particular emphasis placed on children who had been abused, neglected or who were deemed at risk.

While Curry notes the provisions within the Act were slow to be implemented, several high profile abuse cases, The x Case 1992, ‘Kilkenny incest case 1993 and the Kelly Fitzgerald case 1994 prompted the government to respond thereafter with urgency; however it was 1996 before all the provisions within the act would be fully realised. Curry (2003) also notes that following a documentary aired by RTE ‘States of Fear’, which highlighted the systematic abuse imposed on children within Residential and Reformatory schools, in turn forced the Taoiseach Bertie Ahern on the 9th May 1999, to address the nation to apologise on behalf of the state, to its citizens who had been abused in state institutions as children.

Macro Policy

Children First – National Guidelines for the protection and welfare of children (Department of Health & Children, 1999) & Our Duty to Care (Department of Health and Children, 2002)

Curry (1998) notes, as a result of the high profile cases noted above, The Children first guidelines were introduced in 1999, they were intended to support & inform the professional, teacher, community worker or any person who would have regular contact with children through sporting or community organisations, in best practice on reporting and identification of child abuse. These set of guidelines set out ways in which professional practice in both statutory and voluntary agencies and organisations, which offer services for children and families can be improved upon and adhered to, the specific objectives of the guidelines are;

“Improve and focus on identification, reporting, assessment, treatment and management of child abuse and to clarify the responsibilities of various professionals and individuals within organisations” (Children First Summary, 1999:5)

The main ethos of the guidelines is the ‘welfare of the child is paramount, among its aims are to achieve a consolidated and specific identification and reporting functions for all persons concerned in child welfare. As indicated within the guidelines each organisation must have a designated person who is wholly responsible for overseeing the procedures and policies are adapted in house. Special emphasis is given to a holistic approach to welfare of the child, the child, the guidelines state must be considered in the family setting and parent and carers should be respected and consulted as ongoing concerns are addressed. The child ultimately has the right to be heard and must also understand the procedures; so it would be an important function within residential setting for example to have a child friendly policy which the child can understand (dohc: Children First Guidelines, 2010).

According to the Children first summary (1999), any investigations should not cause the child undue distress and investigations should be respectful of the family unit; however the child’s safety is of upmost importance. The criminal aspect of any investigation into child abuse should not and cannot be ignored and where necessary the Garda should be informed as appropriate by the health boards. The guidelines also indicate a compulsory training for personnel or staff, this would seem extremely important and relevant that all prospective and current social care staff should be fully updated and trained in the National Guidelines. Training one could suggest should also incorporate specific ways in which to identify abuse as defined with the guidelines and subsequent avenues for reporting same. It would also be extremely important that a statement, knowledge and understanding of best practise, as indicated in the guidelines should be the expected standard within any residential or child care setting.

Further to the Children’s first guidelines a document entitled Our Duty to Care was produced by the department of Health and Children (2002), this document sets out to detail ways to improve upon child welfare and the development of safe practices when working with children. It is specifically aimed at community and voluntary organisations regardless of size so would be of particular relevance to social care sector. Our Duty to care lists specific principles, which if adopted across the organisation, will create a safe environment where children’s rights, safety and protection are at the forefront; the guidelines are representative of the recommendations within the Children’s first guidelines as noted above.

These guidelines also advices the recruitment of staff and volunteers within the organisation should fall under clearly defined guidelines and be consistent with best practice; for example Garda Vetting forms for prospective staff members working within children. Ongoing and updated training should be provided for all workers within the organisation. The recommendations also advise developing a policy of openness with parents, consulting and advising parents/caregivers at every possible opportunity (dohc: Our Duty to Care, 2010). One could suggest communication in this respect would be extremely important; sitting with parents on a one to one basis if necessary and having clear guidelines or an explanation of what is happening in a format which can be easily understood.

Macro Policy
National Standards for Children’s Residential Units – Department of Health & Children

According to the National Standards for Children’s residential Units (2010), the guidelines were produced in conjunction with various agencies and the Social Services Inspectorate. These particular guidelines set out standards which any residential facility both statutory and non-statutory must adhere too.

According to information available through Social Services Inspectorate (2010) over 4,870 Children are within the care system. This also incorporates foster care, with 172 residential centres, 102 in the statutory sector with 74 in the non-statutory sectors. The Social Services Inspectorate is responsible for inspecting said premises under the provisions within the 1991 Child Care Act. Within the National guidelines every health board has responsibility to notify the SSI of new premises being established as residential care facilities. There must be a written statement within each centre/facility which details and describes what the centre does. In effect the ethos and mission statement could incorporate this information. This must be kept up to date and contain relevant information which is clearly visible to all visiting persons. The centre must be effectively managed with suitably qualified staff. Each staff member prior to job placement must be properly vetted by An Garda Siochana. There must also be adequate levels of staff to care and supervise young person’s residing in the facility. Each new staff member must receive an induction into the centre, supervision and support, coupled with training and further development in line with position should also be provided.

Any files pertaining to the child or young person in care should be kept in a safe and secure environment and administrative files should be co-ordinated in line with the Freedom of information Act 1997 (dohc, 2010). The facility/centre is required to have an authorised person to ensure that compliance with all the standards within the National Guidelines are adhered to. This person should not be part of the current management. They should facilitate meetings with the young person’s to enquire about general happiness or care within the centre and ensure young person has an outlet to voice concerns. Any reported incidents should be recorded and the appropriate authorities informed accordingly.

According to the guidelines (2010) a Statutory Care plan is required for each and every child/young person within care centre. This care plan should be facilitated by the assigned social worker, the staff and management within the care centre should be informed of necessary information prior to or shortly after the young person has joined the centre. This differs from the placement plan within care, which is referred to as a ‘placement plan’; this plan may detail day to day specific activities or future goals within the centre.

The guidelines (2010) make reference to the importance of the young person having a voice, the young person should be provided with every opportunity to discuss their care. They along with the family should be informed of any decisions which will affect their future. Parents/guardians should be informed of all decisions and where appropriate be part of the future care plan. If emotional or specialist support is required it is the responsibility of the centre to ensure the child has an adequate inter disciplinary team or available service to alleviate issues.

The guidelines are very clear on the role and involvement of the family while the young person is in residential care. Family visits must be accommodated and indeed encouraged; these should also be facilitated in a private area. Staffs are required to support the visits and contact unless directed otherwise by the courts which will also be indicated within the statutory care plan, this one could suggest firmly establishes the important role of social care worker, facilitating the voice of the young person and encouraging family involvement where appropriate (dohc: National Standards Children’s Residential Centres, 2010).

In this essay, the social problems I have chosen to write about is Homelessness. I will also be exploring different perspective of Homelessness and the policy responses and the impact it have on the society. The groups I will focus my discussion on are young people and rough sleepers as the evidence indicates that young homeless people experience rough sleeping before securing temporary accommodation.

There are wide ranges of definition Homelessness and it varies from country to country or among different institutions in the same country. According to |Liddiard, M (2001:119) the immediate sense of the term as regularly employed by the mass media and politicians, simplistically equates homelessness with rooflessness or literally sleeping rough on the street. This is can be a straightforward and easy to understand definition but this does not reflect the true scope of the problem so a broader definition of homeless peoples include those lacking permanent residence and living in a range of unsatisfactory housing conditions. They can include those living in temporary hostels, bed and breakfast, night shelters and squatters. However, the legal definition of someone homeless is if they do not have a legal right to occupy accommodation or if their accommodation is unsuitable to live in. They also include families and peoples who do not sleep rough and some are accommodated by friends and family on temporary basis. So from the above definition the social construction of homelessness are not the small amounts of individual that sleep on the street, looking dirty and smells of alcohol and drugs but comprises of all individual who do not have a permanent decent place of accommodation or without a regular dwelling and are on a waiting list or takes housing benefit and in temporary accommodations. (Giddens 2007)

The cause of homelessness varies as many are of the view that homelessness is a result of personal failings and consider if the economy is going on well, there is no excuse to be homeless. Shelter (2007) is of the view that homelessness is cause by a complex interplay between a personaˆ™s individual circumstances and adverse structural factors outside their direct control. Among the individual factors include social exclusion, thus when a person lack of qualification because they did not have access to good education and decent job. Ones misuse of drugs and alcohol which result in lack of personal control, lack of social support and debts especially mortgage or rent arrears. Having mental health problems and getting involved in crime at an early age also contribute to homelessness. Family breakdown and unresolved disputes are a major factor of homelessness as a result of divorce and separation and a greater number of men and women are affected. People from institutional background like having been in care, the armed forces are likely to be affected. Ex-offenders who come out of prison and lose their friend and families can become homeless and the majority from ethnic minority or ex-asylum seekers who have the right to stay but have no accommodation. Structural causes of homelessness are mostly social and economical in nature often outside the control of individual or family concerned. These may include poverty, lack of affordable housing, unemployment and the structure and administration of housing benefit.

According to the shelter (2007) the number of households found to be homeless by local authorities increased 31percent between 1997/98 and 2003/2004. Historically, homelessness had low publicity until the 1966 when the BBC screened Ken Loachaˆ™s film about homelessness Cathy Come Home. This was watch by 12million people and the film alerted the public, the media and the government to the scale of the housing crises and then Shelter was formed. Another policy response was the 1977 Housing (Homeless Persons) Acts was the first measure to place responsibilities on local authorities to rehouse homeless families and individuals permanently. (Liddiard, M .2001) The 1977 legislation had Priority Need which included women with children or pregnant, vulnerable due to age, mental illness, disability, and loss of home by natural disasters. This did not cater for everyone who was homeless and the criteria by which local authorities accepted someone as homeless was complex and restricted. Hence the 1996 section 177 amended to include domestic violence as a priority need but strict eligibility remains (Hill, M: 2000).

Young people were not covered under the existing legislation and the number of young homeless increased. Existing data on youth homelessness has significant limitation; in particular it is only possible to count young people who are in contact with services. According to ONS (2007) it can be estimated that at least 75,000 young people experienced homelessness in the UK in 2006-07. This included 43,075 aged 16-24 of which 8,337 were 16 -17 year old who were accepted as statutorily homeless in the UK and at least 31,000 non-statutorily homeless young people using supporting people services during 2006-2007. The Homelessness Act (2002) changes significantly the way in which homeless in England and Wales is tackled. The priority need categories was extended to includes 16/17 years rather those who social services are responsible for accommodating, care- leavers under the age of 21 who were looked after by social services when they were 16/17 and ex- prisoners, former soldiers and young people leaving care. This act also introduces greater flexibility with regards to social housing allocation giving more people the right to be considered for a council or housing home.

The local authorities had a statutory duty to care for all the homeless people but no extra resources were added. This had a great impact on the number of homeless people who were able to relocate permanently at a given time and especially those under priority need.

Young people experiencing disruption or trauma during childhood who may be from socio-economic background are at increased risk of homelessness. The main trigger for youth homelessness is relationship breakdown usually parents or step-parent. Among the impact of homeless on young people is poor health as they cannot take care of their health being. They lack basic food and shelter to help them grow to become healthy adults and they may suffer from depression. Homelessness can lead to increased levels of non- participation in formal education, training or employment. At times leaving school early without a qualification and a decent job may lead some young people into the misuse of drugs and some have mental health problems.

Another homeless group of concern is the rough sleepers who were in temporary accommodation but some choose to roam the streets, sleeping rough free from the constraints of property and possessions. But a large majority has no such wish at all but they have been pushed over the edge into homelessness by factors beyond their control. Once they find themselves without a permanent dwelling, their lives sometimes deteriorate into a spiral of hardship and deprivation. ( Giddens 2009:503)

The Homelessness Act 2002 extended the definition of the priority need to include new groups of vulnerable people, and requirement that all homeless people receive advice and assistance. In addition, Local Authorities are requires to periodically develop homeless strategies, including an assessment of levels of homelessness and conduct an audit of those sleeping rough. In 1998 there were around 1,850 people sleeping rough on the street of England on any one night. This follows on from the government drive to reduce rough sleeping by two-thirds in 2002. The Rough Sleeper Unit was set up in April 1999 to take the lead on delivering this challenging new target and help thousands of people to escape fro good from the humiliation and misery of life under a blanket in a shop doorway. One of the key principal of the strategy was to understand the cause of rough sleeping, why people end up on the street and what could be done to stop this from happing in the future. The strategy also place the emphasis on encouraging rough sleepers to become active members of the community, to build self esteem and bring on talent as well as helping the individual to become prepared for the life away from the street. Positive result soon follows as reductions in rough sleeping were achieves around the country in December 2001 the target set by the government was met ahead of time.

The target was met amid the controversy about how rough sleepers were counted and concern about the emphasis on street homelessness, which campaigners claimed was only tip of the homelessness iceberg. According to BBC New Magazine, housing minister Grant Shapps believes that the government figures on the count of rough sleeper is low and the system of counting is flawed. He argues that, under previous governmentaˆ™s system, councils with fewer than 10 rough sleepers were not obliged to count them, and that vagrants sitting up in sleeping bags were not counted as homeless. After Mr. Shapps insisted that councils provide estimates, the England wide figure rose to 1,247, this comprised 440 from 70 authorities that count and 807 from 256 authorities that provided estimates. Despite government investment in hostels to accommodate rough sleepers many are on waiting list as resources and financing is limited. Overcrowding, lack of bed space and sharing rooms or limited facilities with others are also identified as a problem especially if you have a partner or a dog, your choices narrow considerably. Although the quality of hostels has improved considerably, hostels are often considered unsafe. Over 57 percent of those who stayed in hostels mentioned problems with other residents, including drug and alcohol use, violence, theft, bulling, noise and arguments. And some are of the view that it is not a place to go if you want to stay clean of drugs. People are under the same legislation and the local authorities are unable to permanently house all in priority need.

In addition to the above, there are certain groups who are excluded from hostels, such as people from the EU and asylum seekers from non-EU countries who are homeless and destitute in the street of the UK. Their entitlement to benefits is restricted until they have lived and worked and paid into the UK system through national Insurance and tax for one year continuously. Such laws bring about social exclusion as street homeless people have reduced access to health care and dental services. They face discrimination and general rejection from other people and may have increased risk to suffering from violence and abuse. The impact of rough sleeping is limited access to education, not being seen as suitable for employment and loss of usual relationship with the mainstream. Most of all, living on the streets is dangerous as rough sleepers die young with the average life expectancy at 42.

Inequalities among the population still remain one factor of homelessness. Privatisation and residualisation of the council housing meant that fewer houses are available for council tenant. This imposes greater long term risks on the former council tenants while also generating considerable costs for the taxpayer. The process also excludes the many tenants who either reject transfer or are not given the choice and therefore exacerbates inequalities. There are 1.4 million unfit home in England as the majority of homeowners are in the private sector. The increase of housing association rents and increases in house prices means most people cannot afford a decent accommodation. Low income families are the most affected as 4 million people receiving housing benefit. ( Quilgars D. et al 2008)

In conclusion, the problem of homelessness has been tackled by the governments over the years through policies and legislation. However, the problem require long term policy solutions such as changes in the benefit system, the building of more affordable homes and ensuring that a wider cross- section of society benefits from the fruits of economic growth. For many people, there is no single event that results in sudden homelessness; instead homelessness is due to a number of unresolved problems outlined above building up over time. The achievement of one government policy on rough sleepers indicates much could be done to reduce the impact of homelessness as the number still rises. Ministers are now focusing on the prevention of rough sleeper and youth homelessness through a new government homelessness strategy.

According to Ewles and Simnett and Edelman Mandle , values and principles mean powerful drivers of how we think and behave. These are often a significant element of culture, where they form a part of the shared rule set of a group. Every people’s personal values and principles influence their work contribution significantly in health and social care management. There are different types of values like instrumental values, personal values, political values, social values, economic values, religious values etc.

Vilkka (1997) and Edelman Mandle (2005) have stated that instrumental values mean being honest, courage, polite, gentle, well-behaved etc. In addition, these values mean to have a good moral. It has a great impact of work contribution. For example, in a care home employees may need to keep the service users’ belongings which are valuable. In this case, they have to be honest. Otherwise, dishonest people may take those materials and flee away. So instrumental values influence work contribution.

Posner (n.d.) has cited that personal value means dignity, creativity, courage, attitude of care, independence, friendliness etc. It can influence work contribution. For example, a person with good creativity skills can serve the service users in a better way. In addition, if they become friendly and positive in caring, then the service users or the clients will be happier.

The ethnicity of people, tradition, regional ties, linguistic ties, national ties etc. are included in cultural values. For example, if anyone is from white ethnic background, then they will be more punctual where Asian ethnic people are less sincere. Another thing can be, people who are from the Middle East are very honest.

Social values may include equality, justice, liberty, freedom and national pride. These are the values that put the rights of wider groups of people first. As it promotes equality, justice, freedom and liberty then it can impact on work contributions significantly. For example, in a care home there may have employee and service users from different ethnic and national background. Their culture can be different from each other. So, following equality law, justice, national pride etc. improve workplace contribution.

According to Connor et al (2006), work values mean autonomy, dedication, teamwork, competitiveness, trustworthiness, reliability, professionalism, ethics etc. Autonomy means feeling relaxed and confident. It is universal truth that if anyone fell relaxed, ambition, and confident then she or he can play a very good role in work. Another thing is teamwork. It is always better than single work. Dedication has a positive impact as well. Doing favor to someone is called dedication. Health and social care is mainly related to co-operation and co-ordination between the employees and clients. For instant, an employee may not able to handle heavy things. So, in that case if anyone helps him to accomplish his task that is called dedication. It improves work outcome as well.

Trustworthiness and reliability are the two main sources of work effectiveness (Holloway Wheeler, 2002). If the employees trust one another, they can work with free from tension. Because they know whatever the co-workers are doing are correct. Also, they should be reliable so that staff can get help from them whenever it is required.

According to Allison (2001) and Posner (n.d.), professionalism has a significant effect in work contribution in health and social care. If professionals forget about their role and start making close relationship with clients, then it brings very negative outcome for the staff. They may be penalized for breaking organizational law. Sometimes, they chat with their co-workers ignoring the service users. But those follow the professionalism rules, can never do such kinds of things. As a result, clients will be happy and work outcome will be increased significantly. Thus, proffesioanlism influences contribution to work.

Litman (2009) has stated that economic values may include ownership of property, contributing to common good etc. This value means the value around money. According to some people, this is the most important value for work contribution because if the employees are paid soundly, then they must try to give their best. In reverse, if their expectations are not fulfilled, they must not give their best.

Religious values are the other important values. According to Cooper Palmer (1998), these are spiritual values, which means how we should behave, including caring of one another and in worship. Religion views have one of the most significant effects to work contribution. For example, according to Muslim laws, if you do not try to give your best to your employer, then you will be penalised by your god. So, those people who have respect on their religion, they will always try to do better in work. Thus religion values can influence work contributions.

According to McPartland (1991), principles are the policy, objectives, rules, fundamental norms, or value that state what are the role of an individual, or an organization, or a community. It also makes a distinction between fairness and unfairness. So, it can influence work contribution as well. Some people may have principles which may be directly opposite to organizational principles. For instant, if a conservative Buddhist is told to serve a non-Buddhist client, he/she may not give positive response and it will affect work contribution negatively. On the other hand, if an open minded Christian is told to something that is work related, they will do with 100% positive attitude. Thus, principles influence workplace contribution in health and social care.

1.2 Analyse how your own cultural values and beliefs influence your work in support and care of service users in your work place.

According to Kitayama Cohen (2007) and O’Donnell (2001), different cultural values and beliefs impact support and care of service users in workplace differently. Values and principles include equal rights, diversity, confidentiality, protection from abuse and harm. In addition, personal values are beliefs and preferences, culture, political perspectives, interests and priorities, change over lifespan to date etc.

I have my own culture and beliefs which also influence the care of the service users. For instance, I am not either vegetarian or non-vegetarian. I take all types of dishes which are halal because I am a muslim. So, I may not be interested to serve those people who will eat much haram dishes. But, in the same time I may provide a better service than a Buddhist. The reason of that is most of the Buddhists are non-vegetarian and they are not willing to serve the people who deserve meats. My culture and value has taught me to treat every person equally. It has also taught me to give adult people their freedom. So, I will not discriminate any people. People from any background are same to me. So, I can provide them a good service.

1.3 Explain how development of new priorities targets and legislation impact upon your role as a care worker.

There are a few new developments in legislations, priorities, research, policies, principles and values that can impact upon my role as a care worker. For example, Sex Discrimination Act 1975, The Carers (Recognition and Services) Act 1995, The Carers and Disabled Children Act 2000, The Carers (Equal Opportunities) Act 2004, Disabled Persons Act 1986, Human Rights Act 19980, The Work and Families Act 2006, The Children and Young Persons Act 2008, Care and Support Green Paper, are the legislations and priorities that impact upon my role. Sex Discrimination Act 1975 states that it is unlawful for an employee to discriminate anyone because of their sex. The Carers (Recognition and Services) Act 1995 has given a legal status and some rights to carers. Carers are requested to assess their ability of work under this act. So, as a carer now I do self-assessment and inform it to local council and they take necessary steps. The Carers (Equal Opportunities) Act 2004 is very necessary for all the carers as it ensures their rights. According to this act, authorised people have to assess their needs, give priority to their wishes, and provide training whenever they need. It also facilitated co-operation between care workers and authorities in relation to the services. The government has recently prepared green paper where care and support system will be mentioned. Also, the government has given carers to express their opinion. In addition, they have engaged all the carers, stakeholders, service users, shareholders and members of the public to give their views to improve care plans. So, now I can share everything related to job with authorized persons and work with free of hassle. Thus these priorities and legislations impact upon my role as a care worker.

1.4 Discuss how the changes in personal values have contributed to your personal development

Pavlina (2008) has cited that the changes in personal values and principles have contributed a lot in personal development. For example, if I change my beliefs and preferences then it affects the service users. I used to think that serving the lesbian or gay or people who are not from my background are not good. But when I can come to know the legislations and change my beliefs then I can serve them as well and that is a part of my personal development. As an Asian my culture is different from European culture. So, while serving clients I may have to face difficulty as I don’t know their culture very good. But when I will be aware of their culture and views then I can deliver a better service because my cultural value will be changed that time. Thus the changes in personal values have contributed to my personal development.

Produce, monitor, revise and evaluate plans for personal progress in developing the skills and abilities required of a care worker

2.1 Assess your own preferred learning style and abilities

As a care worker personal progress is very important as it is related to the skills and abilities. According to Jonassen Grabowsk (1993), preferred learning style and abilities vary from person to person. Kolb’s (1984) states that, learning style can be concrete experience (feeling), diverging (feeling and watch), accommodating (feeling and doing), active experimentation (doing), reflective observation (watching), assimilating (thinking and watching), and abstract conceptualization (thinking). Learning from experience from outside world can be categorized as assimilating learning style. But usually people can learn four ways and those are watching, listening, writing, and reading. This is called linguistic learning method. Basically I prefer to learn in all ways but it depends what am I learning? For example, if I want to learn how to provide a better service to the service users then I prefer to learn it by linguistic mode and then by assimilating and accommodating because by this way I can read, watch, feel and think that I am doing. Then I have to do that practically. I can take notes as well if I want. The reason of that is there are certain things of learning where practical learning is more important than theoretical learning. After that I like to learn by writing and reading. There are a few things where it seems that easy after reading. But after some time I may forget that because only reading can not stimulate the memory cells most effectively. So to stimulate the memory cells effectively, I need to learn by writing as it stimulates my memory cells better than reading. I miss much information while learning by listening. A diagram of my learning style is given below:

Reading-Writing-Diverging -Accommodating- assimilating

2.2 Produce and justify a personal development plan with short-medium-and long term aims and Outcome

Gallen and Buckle (2001) has noted that acquiring new skills, updating practice, learning, career development etc are the main parts of personal development.

According to them, personal Development Plan (PDP) is important for all types of people whatever they are employee or employer or student. As a care worker or a as student of Health and Social care management personal development plan is vital for me. It can be short term, long term, short-medium-and long term aims. My personal development plan with short-medium and long term aims can be learning IT skills, being well-disciplined, improving presentation skills, negotiation policy, learning human resource management, learning people psychology, different types of acts and legislations related to health and social care, making effective decision, acquiring knowledge about medicine, improving leadership skills and developing communication skills.

IT skill: At this era information technology is the most important thing to learn as it has an effective impact in Health and Social care management. Without learning IT skills none can reach in a good level of their career. In addition, this branch is vast as well. So I have to spend a long time to be efficient of this branch. Now-a-days all information are saved and managed by computers. In addition, in some cases, computers can be used to diagnose the problem of the service users. I need to learn about programming, Microsoft word, Microsoft excel, power point, drawing good diagrams, presenting power point slides etc.

Negotiation policy: this is the area where I must need to improve. For example, when my manager will tell me you are going to be paid this amount of money for your job then I have negotiate with him if I am not satisfied. I have to show him/her the reasons as well why I should be paid more. This is important as money has an influence of employee’s mentality and employee with good mentality can provide good service.

Presentation skills: as a social worker I should have good presentation skill what I don’t have at all. If I can not present anything clearly to the service users then many misunderstanding will take place. So, I have to avoid this. It is not possible to improve presentation skills by day night. So, I will do a long term plan to improve my presentation skills.

My personal development plan and its outcomes are shown below in the table:

Development area

Mode

Duration

Outcome

Information technology

Long term

5 year

Be able to keep records correctly, create necessary soft wares if necessary.

Presentation skills

Long term

1 year

Make clients understand what services they are going to get

Negotiation policy

Short term

3 month

Ensured self betterment

Human resource management

Short-medium term

3 month

Managing human resource

Law, legislation and acts

Long term

5 years

Be able to deal with complaints and play by rules.

Leadership skills

Short medium

3 months

Leading effectively.

Decision making

Medium term

1 year

Be able to take right decision.

2.3 Discuss the arrangements to monitor the progress of your personal development plan.

The progress of my personal development program can be monitored by the outcome and job performances. For example, if I take IT and leadership skill as my personal development plan then it can be monitored by my record keeping skills, saving patients data, handling electronic devices etc. leadership skills can be monitored by the way I am managing people. For example, if hundred employees work under me I have to manage all of them efficiently where ever they are from or who ever they are. In addition, my progress can be monitored by performance appraisal.

2.4 Evaluate your personal development plan in context with your duties as a care worker

Bild Pountney (2007) have shown the necessity of personal development plan of a care worker. So, as a care worker my personal development plan is very important. IT skills and decision making were included in my personal development plan. As a care worker knowledge about IT helped me to keep all medical records digitally. I could find out information from computer or any electronic devices quickly. Decision making was another important thing. For example, if any frail client tells me he can not move and breathe properly. Also, he does not know what happened to him last night. But so far, he knows he did not take any food last night. In that situation, I am to take quick decision otherwise something can happen seriously. So, in context with my duties as a care worker these are essential to include as my personal development plan (PDP).

Analyse the application of principles of professional engagement with service users in a specific setting

3.1 Analyse the nature of different professional relationships in health and social care context

According to Fritz Omdahl (2006), professional relationship is a process by which staffs make relationship with individuals, service users’ family and friends, workers with other agencies, colleagues or any authorized persons related to health and social care. Usually, it is focused on some specific principles of an organization. The natures of professional relationships are described below:

Relationship with service users:

All the service users’ should be respected as individual and service users’ with no mental problem can choose any services those are required.

Service providers are entitled to provide appropriate care to clients without any hassle. In addition, healthcare professionals are not allowed to discriminate anyone while providing service.

Carers, doctors, social workers or any healthcare professionals must ensure service users confidentiality. They are not allowed to disclose any information to anyone unless it harms to their clients.

Every health care specialists, carers or service users will ensure the full autonomy of their clients.

Engagement with co-workers:

A good understanding and work relationship among the staff must be established so that they can work as a team. Martin et al (2009) have stated that, teamwork always ensures good outcome of work.

Health care staff, social workers, carers will share their views and knowledge with everyone which are related to job to provide better service.

Every staff will respect other cultures and may accept the good knowledge from them.

Employers and service providers will work together to keep a workplace with no discrimination, harassment, bully etc.

Everyone will work together to keep a safe workplace.

They will make a work relationship among them but not more than that like emotional relationship. this can harm engagement among the employees.

3.2 Analyse effectiveness of different models of care/support in health and social care settings

According to Heller et al (1999), health care services can be provided by various models e.g. bio-medical model/conventional medical model, bio-psycosocial model, traditional social care model, NHS social care model etc. But in the UK health care services are traditionally delivered by bio-medical model. Every model has particular effectiveness for providing health care which are described below:

According to Srivastava (2007), effectveness of conventional medical model:

Supports are available in terms of healthcare as conventional medical model is formed by the basis of NHS and western health care systems.

Protecting illness and disability becomes easier as health services are mainly geared towards treating the sick and disabled people.

A high value can be ensured in terms of specialist medical services especially in institutional setting or clinics.

This model gives a chance to conduct medical research effectively.

Effectiveness of bio-psychological model:

In 1986 Kleinman and Good have stated that bio-psychological model focuses on the psychological, emotional, social and mental problem. As a result, experts can identify service users’ mental needs effectively.

It recognizes that disease or illness can be neither studied nor treated in isolation from social and cultural environment.

It considers the links between socioeconomic deprivation and adverse health e g improving access to health care and reducing health inequalities.

Effectiveness of tradtional social care model (according to Leira, 2002):

It always priorotse the vulnearable groups so that they can get help from the service providers without any hassle at any time.

Service users and their organisations are fully involved in the development and even delivery of services. It also empower the people.

Effectiveness of the NHS social care model:

Glasby Littlechild (2004) has shown that NHS social care model always prioritizes the improvement of care for people with long term conditions.

This model will help to ensure health and social care organisations take an overall structured and systematic approach to improving the care of those long term conditions

The immediate focus should be the introduction of case management for the most vulnerable people with complex long term conditions so that long term hospital admissions can be reduced.

It aims to achieve early detection, good control to minimise effects of disease and reduce complications, improve effective medicine management. It also promotes independence, empowers patients and allows them to take control of their lives. Overally, it improves patients’ quality of life.

3.3 Critically analyse own role in promoting individual’s choice, ability and right to care for and protect themselves

According to Bradley et al (2009), own role is very important in health and social care workplaces to promote individual’s choice, ability, right and to protect the service users. The lists of my plans are given below to implement these things:

As a social care worker I will must protect the rights and promote the interest of service users. This means I will Treat every person as an individual, Respect their privacy and promote the individual views and wishes of both service users and carers. In addition, I will promote equal opportunities, Respect diversity and different cultures and values for service users and carers.

I must strive to establish and maintain trust and confidence of service users and carers. It includes to be honest, trustworthy, Communicating in an appropriate, open, accurate and straightforward way with the colleagues and clients. In addition, I will be relieable and dependant, honoring to service users and carers. Also, I will be adhering to policies and procedures about accepting gifts and money from service users and carers.

I will promote the independence of service users while protecting them from dangers. It means Using established processes to challenge and report dangerous, abusive and discriminatory or exploitative behavior and practice.

I will ask them to give their opinions because people usually feel important if anyone asks about their choice or wish. I may identify their emotional needs as well by this way.

I will talk to the service users cordially about their concerns and interests so that they can express what they want. So, I can be aware of them and can protect them.

(CD lesson 3, page 7, little bit)

3.4 Analyze the dilemmas that may arise in professional relationships and how you would deal with them

In 2005, Tribe Morrissey have noted that, lots of dilemmas can arise in professional relationship e.g. abuse, ethics, challenging behavior, risk, conflicts between values and principles, confidentiality vs. disclosure, values of others etc.

For example, ethical dilemmas can arise frequently in professional relationship. it means people can not understand actually what to do. Though sometimes they are able to take a decision, many questions arise like is it correct that is done? Usually, there are two types of ethical dilemma and one is the Right to Accept or refuse treatment and other one is the Patient Bill of Right. A patient with no mental problem can take his medical decision. They have right to choose whther they will accept death or life. But as a medical professional his/her duty is to ensure client’s well-being or save life. So, this is an ethical dilemma. But most of the cases, it is suggested to give priority of the client’s wish.

Another dilemma can arise in terms of ensuring client’s confidentiality and disclosure of any information. For instant, if a care service user tell his/her carer like this, “I want to tell you something if do not disclose it.” After that the carer can come to know that his/her clint is being abused by another carer. By that case, he/she should infrom it to an authorized person to protect the client from abuse but she/he is already told not to disclose it. So, dilemma can arise between confidentiality and disclosure by this way. In this case, the carer should tell it to an authorized person to protect the client from abuse and to ensure safe-guarding and well-being.

1000 words

4.1 Evaluate own contribution to your work team

Bradley et al (2009) and Leathard (2003) have mentioned that in health and social care every individual’s performance is very important. My own contributions as a social care worker are evaluated below:

In my workplace I always inform my colleagues about my activities to an appropriate level of detail.

I always behave in such a way so that it supports the team to be more effective. It means my actions, speech, language, body language, gestures, written and verbal communications are always polite.

I am efficient in computer skills. So, I can handle all the electrical data.

I share my views, ideas and information relevant to job with team members. I also accept other’s ideas and information to make team work smoother.

I always offer assistant in a friendly and helpful way whenever it is required.

I suggest clearly if I have any better idea to improve team work at an appropriate time.

4.2 Discuss how your contribution influence the effectiveness of the teams of which you are a member.

According to West (2004) and Snee (n.d.), contribution of every individual has an influence of the effectiveness in a team. My contribution also influences the effectiveness of team work in various ways. For example, I know about the Legislations, Policies and Good Practices which are relevant to health and social care. So, I can provide a very good service to the clients. Moreover, my colleagues often are benefitted by me. As a result, teamwork becomes developed. in addition, I can communicate in a effective way with my fellows. So that, lots of misunderstanding, ambiguity, conflict, backstabbing, and mistrust can be avoided which influence the effectiveness of team work.

I have a clear idea about the role of individual. So, I can specify their roles and they can perfrom according to that and it increases team outcome significantly. In addition, I am aware of different cultures and values and I act in a way what they want. According toaˆ¦aˆ¦. it inspires teammates which are another root of effective teamwork.

I have very good leadership skills and it helps to lead my colleagues. Time management is one of the most crucial skills that I have. So, I do my job in time and I suggest other people to follow me. They also follow me which influences team effectiveness.

Thus my contributions influence the effectiveness of the team.

4.3 Describe the limits of your work role and how these impact on your work with others

According to Heron (1998), every employee has limitations of their roles and responsibility and these are influenced by others. As a care management trainee I have some limitations as well. For example, I am not allowed give any new medication to a service user at any condition. In addition, as I work in management position, I should not involve in care work. I am not allowed to gather any personal information both of colleagues and clients. I should not handle their documents which are supposed to handle by their lawyers. Failing to do any of these has very negative outcome of individual role. Colleagues may not trust and respect. Also, employees may not listen to me and I can be frustrated. As a result, work outcome can be reduced sharply.

4.4 Analyse the barriers for effective team working and how you would contribute minimizing such barrier.

West (2004) and Snee (n.d.) notes that effective teamwork is very important in every sphere of work and there are lots of barriers of effective team work. For instant, poor leadership, interpersonal interactions, poor communication, professional codes, poor team dynamics, high expectations, different priorities, lack of trust, silo thinking, pressure of high accountability can be the barriers of effective teamwork. In the same time, there are many ways as well by which social workers can minimize these barriers.

As a social care worker I am required to work with my colleagues as well as various professionals and it is a daily occurrence for me. These professionals could be doctors, nurses, physiotherapists, occupational therapists laboratory technicians and pharmacists and many other professions. My colleagues and they may be from different cultures and they have different values. So, at the starting level of job all people need to share their views and knowledge and it wastes lots of time.

Leadership has a great impact of team working because almost everything flows from here. It is leader’s fault if a team can not perform in proper way. The reasons can be not enough communication among the employees or lack of proper guidance. Sometimes, leaders fail to specify of individual’s agenda. So, team members are not aware of their roles and can not perform well which reduce the productivity of team work.

Poor communication and high expectations are the other barriers of effective team work. These cause lots of misunderstanding, ambiguity, conflict, backstabbing, and mistrust among the employees. Employees have to work under stress as well if they have to fulfil higher expectation.

Study from Anon (n.d.) has shown that, poor team dynamics can cause breakdown of team dynamics and team can fail to achieve their goals. Also, absenteeism of employees reduces team dynamics and cut performance of a team.

Ways to minimize barriers of team work:

Trust in all colleagues.

Being respectful to seniors and team leaders.

Communicate effectively with the employees.

Let the employees work according to their ability.

Focus on team as well as individual performance.

Constructive criticism should be improved.

Reducing the absentee rate etc.

Overall, any organization can minimize the barriers by following these things and does excellent team work.

4.5 Discuss how you can contribute personally to the effectiveness of your team

According to Snee (n.d.) and West (2004), every individual can influence team effectiveness significantly by playing their professional roles. My own contribution can influence team effectiveness as well and some of the ways are given below:

Share own views, ideas with co-workers.

Offer help to service users and colleagues whenever it is necessary.

Provide suggestion for the betterment of work.

Respect everyone in the team especially the seniors.

Explaining team roles and goals to eve

The underlying principles for this assignment are to critically evaluate my professional development in a practice placement setting and record reflections for future learning. Within this essay, I will include my reflections on the social work process of assessment, planning, intervention and review, and will critically analyse what I feel was successful and unsuccessful in each process, with efforts to identify what could be changed to enhance future practice. I will also include my knowledge, skills and values incorporated into my practice with two service users and my group work, while explaining my efforts to promote anti-oppressive practice. Throughout my assignment I will endeavour to portray my learning journey from the beginning to the end of my placement and conclude with future learning needs, to enhance my practice as a social worker.

Introduction:

The practice placement I acquired was a Court Children’s Officer (CCO), based at the Belfast Family Proceedings Court. It forms part of the Belfast Health and Social Care Trust. My role as a CCO, formerly known as a Child Welfare Officer, was to use my training and experience to ascertain the wishes and feelings of children and their families in private law matters. The role falls within family and child care services and determines that the child’s interests remain paramount in court proceedings. As a CCO my role was to deal with cases where assistance was needed to help parties focus on the needs of their children, as opposed to continuing the incriminations as to who was responsible for the breakdown of their relationship. As a CCO I was then asked to present the information to court in oral or written report format. The CCO is used if other efforts to get the parties to reach a decision in the interests of their children have failed. This is to prevent the court process itself contributing to a lengthy breach in contact before it reaches a decision. As a CCO I was also responsible to act as liaison officer between the court and HSS Trusts, or other agencies (e.g. NSPCC etc) in respect of the court’s decisions. Although employed by the Trust, I was responsible to the court.

Before commencement of this placement I had limited understanding of the court process, and the legislation involved in private law cases. I was excited about the prospect of the experience I would gain having undertaken law and court modules, and attended court for certain flexible learning days, but I was also anxious about identifying the social work role within such a specific placement. “I feel nervous and uncomfortable. I’m finding the role intimidating being surrounded by legal professionals and legislation (being just a student). I’m worried about having to provide oral and written evidence to the court, and perhaps having to disagree with the legal representatives views in court. I feel deskilled and anxious” (PPDW: 21/01/10). After this initial anxious stage I began researching private law and knowledge, and used my practice teacher and on site supervisor to ask questions.

Having completed a practice placement last year I already knew of the benefits of using reflection as a crucial aspect of my practice and learning. Thompson (2005) explains that it is important that practitioners use not only established theories, but use their own knowledge and experience to meet the needs of service users. He claims that “reflective practice should help us to acknowledge the important links between theory and practice and to appreciate the dangers of treating the two elements as if they were separate domains” (Thompson, 2005: 147).

I was anxious to identify the social work process within my placement, as it was not evident on commencement. I was already familiar with the process of assessing, planning, intervention and review having had a previous placement with adults with learning disabilities. Within a court, however, this was very different, as a direction of the court determined my involvement with service users. Schon (1987) identifies that more than ‘a process’ is needed with service users – practitioners need to incorporate experience, skills and intuition for outcomes to be successful. The knowledge and skills that I identified, within my Individual learning plan, were skills in working with children, assertiveness skills, report writing and presenting skills, organisational skills, and group facilitation skills. I also wanted to enhance my value base as my previous placement helped me challenge issues around learning disabilities and the current placement is a very different setting. I wanted to develop my values around children’s feelings about parental separation, and also working in partnership with children to ascertain their wishes and feelings about contact issues.

I have outlined below the three cases I intend to use that will help identify my professional development within my placement setting. I will use these to provide an analysis of how my knowledge, skills and values have been developed through the social work process.

Family C: Polish origin

Child C (Age 7) currently resides with her father. The parental relationship lasted for seven years. Mother (Ms C) moved out of the family home to gain alternative accommodation when the relationship broke down. Ms C and the child’s contact have been very sporadic since. Contact has not taken place since December 2009. Mr C is concerned with Ms C’s new accommodation being unsuitable for the child’s safety staying overnight – claiming alcohol misuse and the child coming home “smelling of smoke”. Ms C requires an interpreter and is seeking a Contact Order.

As directed by the court I carried out an assessment of Ms C’s home, and also used mediation and counselling when meeting with the parties to focus on the child’s best interests. The child’s wishes and feelings were also ascertained.

Family E:

Child E (14) currently resides with his father (Mr E). Mother (Ms E) is seeking a Residence Order. Father currently resides with the child in a family hostel provided by the Belfast Housing Executive, which Ms E is concerned about. Court direction stipulated me to ascertain the child’s wishes and feelings about residence with his father and contact with his mother. In addition to this I used mediation as an intervention to try to help the parties reach agreement about the child. I concluded my work with the family using a Person Centred Review with Child E to determine if the plans implemented earlier in my practice were working, and what he would like to change when his case was due for review in court.

Group Work:

My group work consisted of working with teenage girls at a high school in North Belfast; they were aged 14/15. I worked alongside the Health for Youth through Peer Education (HYPE) team who regularly visit schools to promote sexual health awareness. I co-facilitated this group and worked to educate the group about sexual health and relationships. This was to promote the need for the provision of accurate information to prevent teenage pregnancies and STI’s, which have been highlighted as statistically higher in this area of Northern Ireland.

Preparation of placement

As indicated above, to prepare for this placement, I began by developing my knowledge base around the court setting and private law, so that I could be accountable to the court and the Trust for my actions. Trevithick (2000:162) claims to be accountable denotes ‘professionalism’ – by using knowledge, skills and qualifications, and adhering to values and ethics when serving a client. I began to tune in to the placement setting using knowledge, skills and values, with legislation such as The Children (NI) Order 1995, The Family Law Act (NI) 2001 and The Human Rights Act 1998.

I tuned into the court setting and the rights of the service users who used it. Article 3 of the Children (NI) Order 1995 claims that the court should act in the best interests of the child, and I was interested in seeing if this occurred or if parental interests were considered higher. I tuned into the effects that divorce and separation have on children, and focused on gaining knowledge on how to minimize the negative impact this may have on children. The issue of contact in private law proceedings is a complex subject which raises questions of rights, responsibilities and ‘ownership’ of children (Kroll, 2000: 217). I was initially interested in researching if children knowing both parents were in their best interests, and why.

Having had a placement with adults and learning disabilities last year I had reflected on the medical model versus the social model of disability, this placement was very different in that it would be the a legal context versus the social work role. I found this initially difficult as the legal obligations of the court over-shadowed the social work process. Court directions dictated the aspects of work to be done, which I found difficult as service user needs were not necessarily established and met.

Assessment:

Ms C’s assessment required me to meet with her, discuss issues regarding contact with her child, and investigate her living environment to determine if it was suitable for the child to have contact in. Prior to Ms C’s assessment it was necessary for me to tune in to contact disputes between parents. I recognised that there is significant animosity with both parties, but that having contact with both parents is in the child’s best interests to promote for attachment, identity and positive relationships. To initiate Ms C’s assessment I had received court directions, a referral and met with her legal advisor. I was at this time I was informed that Ms C was Polish and required an interpreter. The Human Rights Act 1998 and the Race Relations Amendment Act 2000 both stipulate that an interpreter should be provided for health services to promote anti-discriminative practice and equal opportunities.

I was then required to make a referral to the Trust interpreting service, and they informed me that they would make initial contact with Ms C. I found this unnerving, as the interpreter would be making first contact with the service user, and I would have liked the opportunity to explain my role. Having carried out previous assessments, I knew that communication was essential for the assessment and central to the process of gathering information and empowering service users (Watson and West, 2006), therefore to not be able to make initial contact with a service user I found to be restrictive and stressful.

On initial contact with Ms C (and the interpreter) communication was difficult to establish. I found that by communicating through an interpreter I was limited in gathering information. I found it difficult to concentrate on Ms C, especially observing body language and tone of voice; instead I focused on the interpreter and actively listening to her. Ms C came across as frustrated and disengaged, showing signs of closed body language. I felt empathetic to Ms C because of the court process she was involved in, and the fact that she had to go to court to gain contact with her child. I felt the initial meeting with Ms C was not as successful as I had hoped, I was not able to discuss the issues affecting her, and unable to establish an effective working relationship due to the barrier on an interpreter. I left the meeting feeling deskilled and questioning my practice. On reflection, I should have provided more time to Ms C due to the language obstacle and gathered more information on her issues. I should have focused on Ms C and not the interpreter, and used the interpreter more effectively to establish a relationship. For future learning I will endeavour to use these reflections.

The next part of Ms C’s assessment was her home assessment. I was initially reluctant to carry out a home assessment, as I had no previous experience, and did not know what was classed as an “unsafe” environment for children. I began tuning in and identified that a home assessment required strong observational skills for child protection concerns. I also discussed the home assessment with my practice teacher and on site supervisor for aspects I should be concerned about within the home. It was indicated that a safe environment for a child did not have to be overly clean, just safe considering where the child sleeps, fire hazards, is there evidence of drug or alcohol use, or smelling of smoke (as Mr C alleges).

On entering Ms C’s home, as the interpreter had not arrived yet, I was reluctant to try and converse with Ms C. Ms C spoke limited English, and I did not want to confuse or alarm her by trying to discuss the case issues. However, I did try to use body language and facial expressions to reach for feelings and try to build a rapport by asking general questions about weather and work etc. I feel this helped our relationship, and helped me empathise about how difficult it must be to not be able to communicate effectively. By the time the interpreter had arrived I felt more at ease with Ms C, and addressed her (as opposed to the interpreter) with non-verbal cues such as nodding and body language. I felt more comfortable talking with Ms C, I felt more able to understand her frustrations at the court process, her ex-partner and his allegations.

Prior to the assessment of the home I had gained stereotypical perceptions about Ms C’s home. I thought that the house, as it was in a working class area, would be unclean and neglected. However, the assessment of the home, using observational skills, indicated no child protection concerns, a clean environment for a child, and Mr C’s allegations unfounded. On reflection of my perceptions I feel I was oppressive to Ms C having been so judgemental, and I felt guilty about my opinions having been class discriminatory.

Throughout the assessment with Ms C I found that by using an interpreter Ms C was able to stay informed and in control over her situation (Watson and West, 2006). I feel that by working with Ms C has helped my challenge my future practice with individuals who are non-English speakers. It will help me consider the needs of the service user, before judging them solely on language or their country of origin to provide equal opportunities. I now feel interpreters are required for a balance of power between the worker and service user, and promote anti-discriminatory practice.

Planning:

According to Parker and Bradley (2008: 72) Planning as part of the social work process is a method of continually reviewing and assessing the needs of all individual service users. It is based upon the assessment and identifies what needs to be done and what the outcome may be if it is completed.

Prior to the beginning of placement I had limited experience of planning, or group work. It was important for me understand the facilitation and communication skills needed for successful group work, and help to develop my understanding of group dynamics, group control, and peer pressure for this age group.

The key purpose of planning the group was to enable the young people to develop their knowledge and skills to be able to make informed decisions and choices about personal relationships and sexual health. I began preparing for the planning stage of the social work process by meeting with the HYPE team and researching their work. I was interested in the sexual health training for young people at school, as my own experience at school showed that the information was often limited, and I was interesting in finding out if it had been challenged.

I then began by tuning in to how I wanted to proceed through the planning process, and researching the topics of the different sessions as I considered I had limited knowledge on sexual health awareness. As I had to plan every week separately it was important to tune in to each and use knowledge, such as group work skills to inform my practice.

During initial sessions I noted how group members were quiet and withdrawn, this was important to note as the subject of sexual relationships may have been embarrassing for them to discuss. I too felt uncomfortable discussing the material, as I had limited understanding of sexual health, but it was important for the group to overcome these anxieties and work through them together. I identified that ‘ice breaking’ techniques were required to facilitate trust and partnership.

As the sessions progressed, one of the main challenges found was that peer influence was a major issue, with some of the participants controlling other quieter members. I felt it was necessary to include all members and encouraged participation using games. However, it was important not to push individuals when they became uncomfortable, as this could cause them to withdraw and disengage, disempowering them. Another challenge was that despite time management of the sessions, inevitably there had to be flexibility. Some of the group monopolised more time than others and it was necessary to be able to alter the plans according to time restraints.

I also needed to be aware of my own values when planning sexual health awareness training, as it is still regarded as a controversial issue, especially in Catholic schools with teenagers (www.famyouth.org.uk). I considered sexual health awareness to be a great benefit in schools, but obviously due to religious considerations many Catholic schools continue simply to teach abstinence as the only form of contraception. This was important to consider as the group was facilitated in a Catholic school and many of the members or their teachers could have had religious views and opinions on the sessions, creating tension or animosity. Reflecting on this parental consent had been provided for the group, but the group itself were required to take part during a free period. I consider this to be an ethical dilemma as the children’s views weren’t regarded as highly as their parents. If undertaking this group in future, I feel it would be necessary to ask the group if they wish to take part, and give the opportunity to withdraw – promoting anti-oppressive practice.

Intervention:

Prior to this practice placement I had limited experience using intervention methods. My previous placement focused on task centred work with service users, but in the court children’s service this could not be facilitated due to the time restrictions of the court. I had also previously used Rogerian person centred counselling which I found I could use some of the theory and apply it to this setting.

After gathering a range of information from the court referral, C1 and other professionals, I began to tune in to E’s case. I had been directed by the court to ascertain his wishes and feelings in regards to residence and contact arrangements, and mediate between his parents to find agreement about the child’s residence. As Child E is fourteen, I felt it was necessary to research levels of development for this age group and understand, according to psychologists, what level Child E would be at emotionally, physically and psychologically. I found that Child E should be at a level of becoming more independent, having his own values, and being able to make informed choices.

One of the most important issues, through mediation, was challenging my own values and becoming aware of my own stereotypical views on adults who have separated, and the effects on their children. I had to challenge the idea that Child E just wanted to reside with his father as he was the less disciplined parent, or that Child E would most likely be playing his parents off against each other to get his own way. However, by challenging these views, and working with the parties through mediation, I came to realise that E had strong views about living with his father and had a stronger attachment to him. By reflecting on my values I realised that it was oppressive to consider the child as manipulating and could have affected my work with him.

I found that having to be a neutral ‘third’ party in mediation was difficult, I found myself having a role as a witness, a referee and a peacekeeper trying to find common ground. Despite this I feel a ‘third side’ was necessary to help the parties work through issues. I found the most difficult aspect of this role to be impartiality as I found myself empathizing more with the mother (as the child refused to live with her). However, I also understood the child’s reasons behind his decision.

During mediation, and in court, I also challenged my judgements on gender and the notion that the mother is the ‘nurturer’ or ‘primary care giver’ in the home (Posada and Jacobs, 2001). The child clearly stated that he wanted to reside with his father, and when using questioning skills to probe about this, he claimed he had a stronger bond with his father, and that his mother was continually ridiculing him. I found myself having to alter my views about attachment and mother being the primary care giver and focus on what the child wants.

As the intervention progressed I used family mediation session to work through issues. I found that effective communication was principal in ascertaining Child E’s wishes and feelings, and helping the parties consider his views, as opposed to their own relationship incriminations. This not only empowered E by promoting partnership, but also gave him the knowledge that the court would be considering the information he provided. Within the meeting I felt I could have paced the meeting better and made better use of silences with E, as I dominated the conversation.

I consider mediation to be successful as it helped the parties focus on the needs of the child, and helped them realise that they had a child’s feelings to consider instead of the adversarial relationship built from court.

Review:

Prior to the review process I had experience of carrying out person centred reviews (PCR) through my previous practice placement. I had previous training on PCR’s and found them to be more effective than traditional reviews, due to the service user involvement. A PCR is an example of a person centred approach and the information from a review can be the foundation of a person centred plan (Bailey et al., 2009).

Within the family proceedings court the purpose of reviews are to reassess interim plans, and either change them, or confirm they are working for the child(ren). In Child E’s case a review was necessary to indicate if living with his father was working, and to discuss if he wanted to change anything about his interim plans, which were introduced three months earlier. Within the court children’s team a review is fundamental to consider what is in the child’s best interests, assess what is working and what is not working, and how to progress (considering the child’s wishes and feelings).

Child centred preparatory work with Child E was fundamental to the review success as it established what was important to him (Smull and Sanderson, 2005). Reflecting on my person centred work last year; I recognised that it was important to have preparatory work with Child E as it promoted choice and options to explore. I had also recognised that the information gathered from the preparatory work could be the foundations of the review itself, especially if Child E felt embarrassed or shy speaking out in front of his family on the day of the review (Smull and Sanderson, 2005)

I conducted the review with Child E and his parents present, but reflecting on this it could also have been useful including his school teacher or other friends to have a holistic approach. Throughout the review I feel I was able to engage the participants successfully using goals to focus on, and we were able to create a person centred plan for Child E. During the preparation for the review Child E had expressed that he felt he was having too much contact with his mother, and would like to limit this, he also expressed that this was an awkward subject to discuss with his mother present. I identified this in the review as child E did not wish to. I used skills such as facilitation and communication to show that Child E felt strongly about this issue, and both parents claimed they understood his view point. The review was also useful in presenting the information in court, as the child could not be present and I could advocate on his behalf.

On reflection of Child E’s review I feel it was a successful measure to determine what was working and not working since plans were implemented from the last court date. I had confidence in facilitating the review, but I did feel I perhaps dominated the conversation as both parents were hostile towards each other, and Child E was shy and unassertive about expressing his feelings. During future reviews I will endeavour to promote communication between parties, while empowering of the child. I will use better use of silences and encourage active involvement.

Conclusion:

“No matter how skilled, experienced or effective we are, there are, of course, always lessons to be learned, improvements to be made and benefits to be gained from reflecting on our practice” (Thompson, 2005: 146)

I feel this PLO has provided me with learning opportunities and identified my learning needs. It has encouraged me to reflect on my knowledge, skills and values and ensured that I used my reflections to learn from my practice.

At the beginning of placement I was concerned I would oppress the service users by having limited understanding of the court process, and unable to work effectively as a result. However, through training, help from my practice teacher and knowledge, I soon realised that the placement was about providing support, not being an expert. I feel I was able to establish a balance of the legal requirements of court and social work role, which has contributed to my learning experience and future knowledge.

As my placement progressed I used tuning in and evaluations to analyse my practice, and use them to learn from. My placement has enabled me to improve my court report writing skills, presentations skills and legislation knowledge, which I consider to be invaluable for the future.

In terms of future professional development, I will endeavour to challenge my stereotypical assumptions about service users, I will seek advice and guidance from more experienced members of staff, and I will use knowledge and theory to inform my practice prior to meeting service users.

Future learning requires me to continue to develop skills in working with children, to use silence as a skill, as listen actively to what the service user wants. Having an opportunity to work within the court system has been invaluable, but I would also like the opportunity to have more experience working with children to enhance my knowledge, skills and values further.

References:
Bailey, G., Sanderson, H., Sweeney, C. and Heaney, B. (2008) Person Centred Reviews in Adult Services. Valuing People Support Team.
Kroll, B. (2000) Milk Bottle, Messenger, Monitor, Spy: Children’s Experiences of Contact. Child Care in Practice: 6: 3
Parker, J., and Bradley, G. (2003) Social Work Practice: Assessment, Planning, Intervention and Review. Learning Matters Ltd.
Posada, G and Jacobs, A. (2001) Child-mother attachment relationships and culture. American Psychologist. 56(10), 821-822.
Schon, D. (1987) Educating the Reflective Practitioner. San Francisco: Jossey-Bass.
Smull, M and Sanderson, H. (2005) Essential Lifestyle Planning for Everyone. The USA: Learning Community
Thompson, N. (2005) Understanding Social Work: Preparing for Practice. Basingstoke: Palgrave Macmillan
Trevithick, P. (2005) Social Work Skills: A Practice Handbook (2nd Ed). Buckingham: Open University Press.
Watson, D and West, J (2006) Social Work Process and Practice: Approaches, Knowledge and Skills. Basingstoke; Palgrave Macmillan
Williams, P (2006) Social Work with People with Learning Disabilities. Learning Matters Ltd
Webpages:
http://www.famyouth.org.uk/pdfs/CondomControversy.pdf – accessed 24/4/10

SOCIAL THEORIES FOR PROFESSIONAL PRACTICE
A REFLECTIVE REPORT ON GROUP POSTER

The main purpose of the report is to demonstrate an understanding social work theory for practice person-centred approach in relation to adults with depression; the target audience is social work students. According to Teater (2010:1) theory “helps to predict, explain and assess situations and behaviours, and provide a rationale for how the social worker should react and intervene.” Therefore social work theory for practice is defined “as a set of ideas used to guide practice and which are sufficiently coherent that they could if necessary, be made explicit in form which is open them to challenge.” Payne (1997:150) held the view that for a social work theory to be successful in achieving its result it required three elements, perspective, an explaining theory and a model. Teater (2010:4) emphasised that social workers may combine learning theory with social learning theory to work with a service user, as theory informs practice. Payne (2002:270) stated that “a theory cannot be evaluated only in relation to its ideas and effectiveness, because the ideas have a historical and social context and effectiveness is judged according to particular institutional requirements.”

When my group met each group member gave suggestions of what theory they thought would be a good idea we decided to create a poster on Person-centred approach. The title of the poster was “A person-centred approach in relation to adults with depression: a guide for social work students. The purpose of developing this poster was to inform and educate social work students about Person-centred approach in a relation to adults dealing with depression. To have an understanding of my role and contribution to the group it is essential to review the process of how the team formed. The group formed not as a result of choice but as a result of random selection but with consideration of where we lived as this would make it easier to come together. The formation of the group made me realise that I did not have a choice in deciding who I would work with but despite that I was happy with my group and we worked well to complete the task at hand. The group was small and consisted of 4 people 3 females and 1 male and with different experience and educational background. A group can be defined in a many different ways which relate to function, membership for instance why people join and whether membership is voluntary and its goals and eventual purpose. Cartwright and Zander (1968) describes the group “as an aggregate of individuals standing in relations to each other, the relations exemplified will depend on or determine the kind of group, whether it is a family, an audience, a committee, union, or crowd”.

Hogg et al (2005) defined a team as “a group of people organised to work interdependently or cooperatively to complete a specific or accomplish a purpose or goal”. On reflection it is essential to note that my group was a task centred one because it was purely set up in order to complete the task at hand. Basically the group had collectivism this relates to “a world view based on the idea that the group needs and goals are more important than any individual”. We worked to complete the task and went through Bruce Tuckman groups develop through five basic stages: Forming – apprehension, Storming – conflict, Norming – status and role attainment, performing – goal striving and accomplishment, Adjourning – disbanding or re-organizing (Thompson 2010: 92).

No one had been nominated as leader but there were two definite leaders who took on the role of deciding what task each of us should do. This occurred as a result of the two feeling that they were going to take on more, we let them take the lead due to their willingness to undertake the greater part of the task. Despite this I managed to take charge when it came to the title and how information was displayed. Due to the lack of clear leadership this meant that we did not always meet up and there was no time to rehearse before presenting to the class. Each team member was given a task to complete but due to lack of clear roles and responsibilities and we got on to complete the task at hand. According to Thompson (2009:160) “good practice is based on partnership, team work and good communication amongst all members”. It was essential to create positive group dynamics as this would aid the relationship between the team members, as such the relationship had to be constructive as well as productive (Lafasto & Larson 2001).

Belbin (1996:64) stated “that an approach to human relationships in work groups, in which each individual has a defined role”. In this case there were two people that were the leaders and they were dominant in making decisions without consulting the rest of the team. In relation to team roles I took on the role of resource investigator Belbin (1981: 84) describes this as a person that is very optimistic. I endeavoured to relay my opinion in order to contribute and make corrections as expected by the group but to my work was disregarded in my absence. There are a number of issues that can affect a good group dynamic and for our team it was poor communication, different information would be passed on yet after meeting the other teams had done something differently. This factor I believe affected my performance and others as well. For instance we emailed each other what our ideas but the two leaders were negative towards my suggestions and the responded in a way that demonstrated decisions had been made already.

Furthermore not all members received updates due to not being linked in so there was missed information, at the time of presenting suggestions on how it should be done were ignored this was annoying and evoked some strong emotions. Unfortunately it was late to resolve this issue I felt strongly that decisions were made without critical analysis and this was a direct result of lack of leadership.

When we started to develop the poster we recognised that we had limited time, space and therefore we decided to develop a poster that was precise, concise and easy for the social work students and service users to understand. The purpose was to inform and provide an understanding of about the social theory for practice and also how well it works with service users. It was also essential for the design and colour scheme of the poster to be practical. According Fook et al (2007:54) states that “depending on visual workshops students or people are more likely to remember colourful presentations and are drawn to them”.

The poster was good it described the social work theory for practice and was

clear and precise on the subject matter, but despite this I felt that the poster should have been more about the social work theory for practice than the subject depression. The arrangement of information was sufficient considering the information that had to be gathered but it would have been better to have less information on the poster. The poster illustrated clearly that the service user was the expert of their own recovery and this in turn empowered them in making good choices, this evidently highlights the advantages and disadvantages of the person-centred therapy. Trevithick (2012: 91) emphasised that social workers should work with service users holistically in order to get a better understanding of their life. Service users and carers express that the most essential quality they would appreciate from social workers is understanding and patience.

This I believe was as a result of the fact that social work theories and service policies vary in their assumptions on the nature of service users, their problems, society and role of social workers. Whittington et al (1995:27) states that “when a social worker makes sense of a problem or issue he or she also makes certain assumptions”. This is subjectivist philosophy and works with free will. It deals with insider’s view, self determining ways and human nature for instance dealing with the relationship that the client has with the social world around them (Stepney et al 2000). The poster did not illustrate the advantages of the usage on the therapist this was due to limited space and only focusing on the service user. For instance a therapist may not feel weighed down while working with a service user who is aware and more positive this will empower the therapist as well as the service user. Rowe and Llic (2009) stated that “posters are brilliant way of transferring knowledge and suitable form of educational publication”. He further emphasised that people are more likely to be drawn to visual elements of a poster than the subject or content and it was essential for the author to include their name in order to effectively convey the educational subject matter.

As a student social worker I have to critically analyse and appraise the social work theories there are six critical criteria’s namely; Subjectivist- objectivist = philosophical position, Theories of society= provides an explanation, Research and research evidence= provides evidence and credibility to theories, Ethics and theories of social justice =provides understanding against the BASW codes of ethics and values, Service user and carers perspective=an insider perspective and Model of practice= theories are in context. There are six theories in social work practice namely psychodynamic theory, Social learning theory, Theory of moral reasoning, systems theory, conflict theory and theories of cognition.

The person-Centred approach was adopted work of the psychologist Dr Carl Rogers (1902-1987),the approach was psychotherapy and counselling. He believed that “the basic nature of the human being, when functioning freely, is constructive and trustworthy”(Rogers 1961:94). The Person-centred approach (PCA) “is an emotional and psychological approach to the person a ‘way of being’, from which perception of self, reality and behaviour may be reorganized. Its underlying principles are “the primacy of the actualizing tendency, the assertion of the necessity and sufficiency of the therapeutic conditions and the realization on the part of the therapist – of a non-directive attitude” (Rogers 1947).

According to Thorne (1991:36) “one of the limitations of person-centred approach resides not in the approach itself, but in the limitations of particular therapists and their ability or lack of it to offer their service users the required environment for transformation and development”. Thorne on the other hand unreservedly accepted that in his own experience, there are particular kinds of service users who are unlikely to be much helped by the approach.

Furthermore Christopher (1996:22) concurred that “there are sincere attempts to understand our own motivations, theories, service users are best achieved through considered and critical dialogue and reflection.” Nevertheless person-centered approach is very relevant in social work practice and this approach as “a psychosocial approach takes into account that people have both inner worlds and outer realities but the way we perceive the world sometimes differs from the way others see it” (Coulshed & Orme, 2012:108).

Trevithick (2012:124) stated that “person-centred approach was a well researched psychological approach that is based psychoanalysis-Freud (1856-1939), behaviourism based on theories of Pavlov (1927), Watson(1970),Skinner (1974)etc and humanistic psychology Carl Rogers(1902-1987) and Maslow (1973).”

An internet search on PsycINFO revealed 612 educational journals on person-centred therapy of these 411where peer reviewed journals the data was gathered from a range of groups, ages and genders. The bulk of the studies demonstrated that person-centred approach is essentially effective in getting results with service users to transform their lives. There is research evidence on the use of person-centred approach or therapy in mental health settings with adults, children and older people. It is essential to note that despite the fact that it has been used in cognitive behaviour therapy has also shown that it is a successful implement. There are a number of other approaches for instance pharmacological, psychodynamic and psychoanalytical evidence has shown that as a course of action it is short term but it is better to have intervention than non at all. The observed research, analysis as well as other types of research are vital in appraising the social work theory for practice. Orme et al (2010:159) stated that “when one finds research or peer reviewed journals there are questions to be asked for instance who owns the research and what their objective is”.

In conclusion the making of the poster was a new experience for me but helped provide clarity on group dynamics, theory of practice related to the poster and social work practice.“The social work profession promotes social change, problem solving in human relationships and the empowerment and liberation of people to enhance well-being. Utilising theories of human behaviour and social systems, social work intervenes at the points where people interact with their environments. Principles of human rights and social justice are fundamental to social work.”(BASW 2012)

APPENDIX 1

REFERENCES

BASW 2012 Code of ethics

Belbin, R, M. (1993) Team Roles at Work, Oxford; Heinemann

Christopher, J.C. (1996) Counselors’ inescapable Moral visions Journal of Counseling and Development, 75, 17-24.

Coulshed, V and Orme, J. (2006) Social work Practice, 4^th Edition, and Palgrave Macmillan.

Fook J and Gardner F (2007) Practising critical Reflection, A Resource Handbook, Open University Press.

Healy, K. (2012) Social work methods and skills, the essential foundations of practice Palgrave Macmillan.

Hogg, Micheal A, Vaughan, Graham, M. (2005) Social Psychology 4^th Edition Pearson, Prentice Hall.

Howe, D. (2009) A brief introduction to social work Theory.Basingstoke; Palgrave Macmillan.

Orme J and Shemmings D (2010) Developing research based social work practice, Palgrave Macmillan.

Payne, M. (1997) Modern social Work Theory, 2^nd Edition, Basingstoke Macmillan

Payne, M. (2005) Modern social Work Theory, 3rd Edition, Basingstoke Macmillan

Rogers, C. R and Russell, D.E (2002) Carl Rogers: The Quiet Revolutionary – An Oral History. Roseville, CA: Penmarin Books

Stepney P and Ford D (2000) Social Work Models, Methods and Theories, A framework for practice, Russell House Publishing.

Stogdon C and Kiteley R (2010) Study skills for social workers, SAGE publications.

Thompson N (2009) Understanding Social Work, 3^rd edition, Palgrave Macmillan.

Trevithick P (2012) Social Work Skills and Knowledge, a practice handbook, 3^rd edition, Open University Press.

Wilson K, Ruch G, Lymbery, M and Cooper A (2008) Social Work, An introduction to contemporary Practice, Ashford Colour Press Ltd.

For this assignment I will explain personal values, prejudices, ethical dilemmas and the impact they have had on social work practice by reflecting on one of my beliefs and how I had to challenge myself to overcome it.

Using Marxists and Feminists views of oppression I aim to identify, recognise, respect and value diverse individuals for which I will give an example of which happened to me and how I had to challenge discrimination towards others.

I will also discuss theoretical frameworks to tackling oppression and discrimination by using the PCS model and how people can become empowered through groups, advocacy or legislation.

Personal values, Prejudices, Ethical Dilemmas, Conflict of Interest and their impact on Social Work Practice

A value is something that concerns someone or a belief they hold, this determines how a person behaves, values do not determine if something is said whether it is right or wrong in today’s society. However, a person’s belief’s can affect how they behave towards others.

“Prejudice is a term which has rather negative connotations and is normally taken to mean a hostile attitude towards a person or group”

(Billingham et al. 2008. Pg. 196)

One of my values and a prejudice of mine is that any job I am employed in will eventually go to people working in a foreign country, especially India. This all stems from when I worked for a third party credit card processor, after giving them nine years of service I was going to be made redundant and my job would be actioned from people in India. For the next two months I would have to train people from there all the applications I was currently or had worked on. This gave me a dilemma do tell them all the information I knew or just some of it? I had to be professional, so I gave them as much information on the applications for which I knew about, I even created user guides to aid with the training and they could use when I had left the company.

When talking to the people I found that we had things in common with each other and they were saddened that a person would lose their job. It wasn’t their fault I was being made redundant but the companies in which we worked for. I had successfully challenged the new belief that had risen from a sad situation.

“Values are only as good as the actions they prompt”

(Preston-Shoot, 1996. Pg 31)

When working with people from other countries I will need to put my own values and prejudices aside, as everyone deserves help and advice in their lives no matter where they come from in the world. If I fail to put my values and prejudices aside whilst working with them it will affect the help they will receive from me, I need to be open minded to all cultures. Thompson (2005) explains that there is a need for genuineness (congruence) to be achieved in social work, that a positive working relationship between service user and social worker is needed based on trust and respect for each other to develop.

Identify, Recognise, Respect and Value Diverse Individuals

Thompson (2006) describes discrimination as “to identify a difference and is not necessarily a negative term”. But when used in terms of legal, moral or in a political sense it is referred to as being unfair e.g. being unfairly treated for your sexuality or ethnic origin. If this occurs it can lead to a person being oppressed.

When looking at oppression from a Marxists view D’Amato claims that people are oppressed because of the class in which they live in, that women, homosexuals or people of non-white skin are subordinate to the Bourgeoisie and Capitalism is needed in society as it shapes and depends on oppression for its survival. Marxists argue that if racism, sexism or homophobia was to be embraced it will mean that a capitalist government would need to be overthrown and that oppression is essential to the struggle of socialism.

From a Radical Feminists view Zeiber (2008) argues that women are oppressed within the patriarchal system, that marriage and the family are a result of capitalism. Holmstrom (2003) speaks about Socialist Feminism, agreeing that women are oppressed by the dominance of men and of the economic inequality because of the positions of power males have within society.

I work on a farm where we often have Polish as well as British people working there. One year a colleague was making cruel jokes towards the Polish people, as others were making fun at their culture, and their Catholic beliefs were wrong. I could see that something was wrong, so I spoke to them; they told me they felt they were being discriminated against and started to feel very oppressed because they were not British.

Then I spoke to my manager about the situation which was happening and he left me to “deal” with. I had to think about how I was going to approach it so both parties would be happy with the outcome.

So I asked the perpetrator to come outside and talk with me. I told him that the Polish people were unhappy the way in which he was treating them. He was shocked as he thought they were all “having a laugh” with each other. It was hard for me to confront the perpetrator as it was my father, a man I looked up to.

Reflecting on what had happened I knew I had said the correct things to my father as they continued to work with each in harmony, not wanting to offend each other, enabling a good working environment for all.

Discrimination can be found in institutions like the church, prison or by a person in a position of power. It can be covertly actioned by using disguises like the Klu Klux Klan in USA wear masks concealing their identity or overtly actioned like apartheid in South Africa or the BNP in Britain.

Theoretical Frameworks for Understanding Discrimination and Oppression

Thompson (1997) shows how oppression can be analysed using the PCS model and there are three levels:

Personal (P) – an individual’s views e.g. prejudice against a group of people.

Cultural (C) – shared values between others, what is wrong or right, this in turn forms a consensus.

Structural (S) – how oppression of society is formed through institution who support cultural norms & personal beliefs e.g. religion, media or government.

Here is an example of the PCS model in action:

P: Young man in the club you work at makes offensive and derogatory comments about a gay man who attends also. He says that ‘gay people are not natural’ or ‘normal’.

C: Gay people largely repulse the community around him, and many of the community members are involved with the local church, holding firm views about ‘sexual morals’.

S: Popular tabloid media berates the ‘abnormal’ activities of gay people. Religious leaders of all faiths support the instatement of laws to stop equal rights for gay people. Legislation is passed by parliament that compromises the rights of gay, lesbian and bisexual people. There is an overwhelming ‘consensus’ of power used in all forms of structural life.

(Wood, J. 2001)

By using the PCS model it can help a person build an idea as to why others act the way they do e.g. the stereotype of a teenager wearing a hood, you believe they are trouble makers because of what the media have reported, but not every teenager is out for trouble.

Another theoretical framework to tackling oppression and discrimination is through empowerment.

By empowering someone means to enable a person to gain control over and taking responsibility for own their actions. The Humanistic approach by Carl Rogers (1959) encourages people to become empowered.

As student social workers we are taught about empowering the service user, to focus on their strengths and to work together as equals, we also need to safeguard vulnerable people, to take into account a person’s economic, political and cultural background at the same time.

Groups also work to empower people as they offer support and if they act as one they can become powerful. An example of this is from the Times Online dated June 13th 2007 ‘How football made us’ (see attachment 1), by forming a football team for mentally ill patients they each became empowered able to do things on their own without having help from others.

Make use of Strategies to Challenge Discrimination, Inequality and Injustice

There are strategies in place to help educate people about inequality, discrimination and injustice such as advocacy and legislation. As social workers we need to support and speak up for individuals that face being oppressed or discriminated against.

By using advocacy to represent those who are unable to speak up for themselves. E.g. have learning or communication difficulties. Walker (2008) advises that advocacy has it strengths but also has its weaknesses.

Strength from using advocacy are: People who have been socially excluded from mainstream society gain a voice, when a service user has a social worker who listens can be given confidence to speak for themselves, thus growing in self confidence and social workers can learn and understand more on how it feels to be disempowered when listening to a service user.

But the weaknesses are: there is a danger that the social worker can put their own views forward and not those views of the service user, the advocate can take over, thus the service user can become disempowered and the social worker may find that by using advocacy it can put them in conflict with the organisation in which the work for, their loyalties can become split.

The legislation in place is to help and protect people against inequality and discrimination, for example:

Equal Pay Acts 1970 & 1983 – prohibits discrimination on the grounds of sex relating to pay and terms of contract.

Race Relations Act 1976 – prohibits discrimination on the basis of race, colour, nationality or ethnic origin.

Later amended in 2000 to include a duty on public authorities in carrying out their duties to have due regard to eliminate unlawful discrimination and to promote equality.

(Brayne et al, 2010. Pg. 89-90)

The British Association of Social Work (BASW) has a code of ethics relating to how social workers must become more cultural aware. Paragraph 4.1.6 (pg. 49) states that as a social worker you will:

Recognise diversity among cultures and then recognise what the impact of their own cultural & ethnic identity can have on others.

Gain working knowledge and understanding of service users ethnic and cultural affiliations and the values, beliefs and customs associated with them, even though the service users may be different.

Communicate effectively in a language in which both parties will understand, if needs be then by using an independent interpreter.

By using the tools I have learnt through the course I will be able to challenge discrimination, inequality and oppression, I will be more open minded to people that need help from social services and no matter what their cultural background is I will be able to use this knowledge successfully.

Words used 1622

The 10 Essential Shared Capabilities are to set out the minimum requirements that all mental health services staff should possess as best practice. They are about relationships, behaviours, expectations and attitudes. They also allow service users and carers to be aware of what to expect from staff and services (NES 2006).

The 10 ESC’s are, working in partnership, respecting diversity, practising ethically, challenging inequality, promoting recovery, identifying people’s needs and strengths, providing service user-centred care, making a difference, promoting safety and positive risk taking and personal development and learning.

I will now give an overview of each of the above capabilities.

Working in Partnership involves working with service users their families and carers in a positive way to develop and maintain supportive relationships. Working this way helps people to make decisions and choices. (Edwards 2000). Whilst on placement when involved with service users who were starting treatment for Hepatitis C treatment it was very important to make them aware of how a good support network helps as this treatment can have an impact on everyday life causing flu-like symptoms, emotional issues, sleeping problems and loss of appetite. (Roche 2009).

Respecting Diversity is about providing care that makes a positive difference taking into account, age, race, culture, disability, gender, spirituality and sexuality. (The Scottish Government 2006). On placement within the Addiction Services it was very important not to discriminate any service user. There were many different people who attended the addiction team and it was imperative to treat them equally. According to NHS Quality Improvement Scotland (2009), we as nurses must try to eliminate discrimination and promote equality of opportunity for everyone.

Practising Ethically is about identifying the hopes and rights of patients and their families. It is important to work within the law and treat all service users as individuals. (NMC 2008). Whilst on placement the NMC Code of Conduct must be adhered to and The Code (2010) states that “you must support people in caring for themselves to improve and maintain their health”.

Challenging Inequality involves addressing the consequences of stigma. Patients with mental health problems must be treated with the same rights as everyone else suffering from other health needs. (See Me 2010). On placement the service users I cared for all had substance misuse concerns. This group of people are often stigmatised. I found that most of the service users had many contributing factors to their addictions and could sympathise with them more.

Promoting Recovery is all about working together with patients and professionals to provide care which helps service users overcome mental health problems. It gives service users hope and optimism in working towards a valued life. (Tidal Model 2000). The recovery process on placement was about helping the service users try and overcome their addiction or help them to manage it better.

Identifying people’s needs and strengths involves gathering information about service users’ health and social care needs. Assessments can be carried out to help focus on the service users strengths. (De Jong and Miller 1995). On placement I spoke with a service user who had remained drug free for 3 months. This service user had had her children taken from her and put into care. She was being assessed by the GP and nursing staff to see if they felt she was ready to have her children returned to her.

Providing service user-centred care involves working alongside service users and their families to help them negotiate achievable goals for the individual and identifying all resources that are available to help these goals be achieved. (Shepherd, Boardman and Slade 2008). On placement I worked alongside my mentor in helping a young pregnant girl with a benzodiazepine addiction. Her goal was to slowly detoxify herself from the drug as it can cause cardiac problems and facial clefts in unborn babies (Be My Parent 2010). The GP decreased her prescription by 2mg each week.

Making a difference involves ensuring that services are of a high quality and are suited to each individual. (The Sainsbury Centre for Mental Health 2003). Most of the service users found it very helpful if they were provided with leaflets to make them aware of the effects that the illegal substances had on their lives.

Promoting Safety and Positive Risk Taking involves working with service users to decide the level of risk they are prepared to take with their health and safety. All care must be planned to maximise the benefits for the patient ensuring safety is maintained. (Morgan 2000). It was important on placement to make service users aware of the damage they were doing to both their physical and mental health. Again leaflets being available seemed to help.

Finally, Personal development and learning involves keeping up to date with any changes in the way services are provided. It is a lifelong learning process and is important to reflect on the practice you provide. The Nursing and Midwifery Council 2008, state it is important to keep your knowledge and skills up to date throughout your working life.

The 10 ESCs relate to and support the delivery of mental health policy and legislation in mental health practice in Scotland by linking up with the Mental Health (Care and Treatment) (Scotland) Act 2003. The principles of this act should influence our practice accordingly. Some of the principles include non discrimination, equality, respect for diversity, respect for carers and participation all of these principles relate to the 10 ESCs. The Nursing and Midwifery Council Code of Conduct framework exists to give nurses the foundation of good nursing and midwifery practice, and is a key tool in safeguarding the health and wellbeing of the people in our care.

During this placement I have found working through the 10 ESCs very beneficial as they have helped me improve my experience of mental health nursing and how to better my care for service users. I am also aware of the importance of keeping up to date with any changes and how the learning experience will continue throughout my nursing career.

Work Based Learning 1 – Module 3

This part of the assignment will describe the links between service users and carers involvement and the 10 ESCs. It will also discuss different levels of involvement that service users and carers have. Also what local approaches are available to help increase service users involvement in their care.

NHS Education for Scotland (2010) states that involving service users and their carers is about encouraging them to have responsibility in their own care and treatment and to be involved in the development of services. By using the 10 ESCs there are things that can be done to overcome any of the following barriers, losing hope, negative experiences of mental health services and stigma. ESC 3 – Practising Ethically helps service users to build up a relationship with their nurse and shows the nurse how to recognize the services users rights and hopes

There are three levels of involvement which are, individual, organisational and strategic levels I will now discuss the service user and carers involvement at each of these levels.

Involvement at an individual level includes individuals being given choices and having involvement in all stages of their care process. Service users and carers should have easy access to any information or advice available to them and