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This essay explores how the identity of ‘Looked after children’ (hereafter LAC) contribute to oppression and discrimination in two specific areas of Education and Health. The essay will analyse the role of legislation and policy in combating or promoting discrimination and oppression. The history, societal attitudes, diversity, views of the children and theories underpinning LAC will also be discussed. Finally I will focus on the implications and relevance to social work practice.

Cocker and Allain (2008) identify LAC and young people as children in the care of the local authority, through a Care Order made by a court or voluntary agreement with their parent(s) to accommodate them. They may be looked after in children’s home by foster carers, or other family members. All unaccompanied asylum seeking children are deemed LAC. For the purposes of clarity I will start by defining ‘oppression’, ‘discrimination’ and ‘stigma’. Thompson (1997) identifies oppression as the disregarding of individuals or group of people’s rights resulting in inhuman or abusive treatment with dominance and power by one group over another. For Thompson (2006), discrimination refers to a process of unfair or unequal treatment of individuals or groups resulting in undermining the interests of people from a less powerful category within society. Goffman (1963) highlights that stigma is constructed through social interactions. The individual who is stigmatised is seen as below societal expectations. Similarly, Parker and Aggleton (2003) associate stigma with an instrument that maintains boundaries between those with power and the powerless. This causes social inequalities that formulate into social norms that

promote power structures. Through such power, social inequalities are developed leading to creation of social norms. From the above definitions oppression, discrimination and stigma it can be deduced that the common elements are abuse of power and privilege resulting in inequalities and disadvantage. LAC are one of the less fortunate groups of people in society who experience such treatment because of their identity.

The last three decades have experienced a huge overhaul and introduction of legislation and policies seeking to address the needs of children. The Children’s Act 1989 reformed Law relating to children and in particular set out the framework for the provision of support for children and families and for the protection of children in England and Wales. This was in line with the United Nations on the Rights of the Child (UNCRC 1989) which was the first legally binding International instrument to promote the rights of children throughout the world. (Burke and Parker 2007). The Quality Protects (1998), Children Leaving Care Act (2000), Adoption and Children Act (2002), the Choice Protects policy, the Children’s Act (2004), Every Child Matters (2004), Care Matters (Green and White Papers) and The Children and Young Persons Act (2008) are some of the initiatives and legislation introduced to reinforce safeguarding children, and also as responses to reports of abuse, neglect, harm and safeguarding children in different institutions of residential care in the UK with the most publicised individual cases such as the deaths of Victoria Climbe (2000). It was revealed that Staff working with vulnerable children was not adequately trained, rigorously checked on recruitment, no support and vigilance towards diversity and openness. This led to Laming Report (2003) which revealed significant failings within individuals and organisations which were meant to be looking after children.

The Children’s Act (2004) emerged to implement and address the recommendations. In 2009 Lord Laming was also asked by the government to provide an emergency progress report on issues surrounding safeguarding children following the death of Baby P in 2007. He reinforced his earlier findings on systematic and individual failures as the cause of the death of Baby P (Laming report 2009).

Research has questioned the effectiveness of such initiatives in reducing discrimination of LAC. Examples of such research are : “Children experience of the Children Act (1989),” “Discrimination Against Young People in Care (1998)”: “Remember my message (1993)”, “The Multidimensional Treatment Foster Care in England Project (2006),” “Barriers to change in the Social Care (2000),” “Bursting at the seams (2010)” and the recent Panorama BBC programme on experiences of children leaving Care (5 October 2010).

The UK is a multicultural society with diversity which policy makers and legislators need to acknowledge. Blaine (2007) views diversity as the presence of differences in society in relation to gender, race, ethnicity, religion, social class and sexual orientation. These differences are neither good nor bad; however some of the differences are associated with inequality and disadvantage. Social work practice is concerned with addressing these differences and disadvantages (Burke and Parker 2007).

There is no exact figure for LAC but DfE Statistics (2010) reveal that there were about 64,400 LAC as at 31 March 2010 while the BBC Panorama ( 2010) mentioned around 70, 000 LAC as of 5 October meaning the number is increasing. The main reasons of being in care were abuse or neglect (52 per cent). There were 3,400 Unaccompanied Asylum Seeking Children (UASC) who were looked after at 31 March 2010. This is a decrease of 12 per cent from 2009. There is a decrease in the Unaccompanied Asylum Seeker Children (UASC) (DfES 2010).

Hogg and Vaughan (2002) views identity as associated with the process an individual becomes who they are in the sense of personhood and other’s view of who they are. Furthermore a person has multiple identities which need to be seen as part of the whole individual as disregarding some aspects would be misleading and reductive of the individual’s identity. Graham (2000) highlights that identities have different meanings and are not fixed but change over time as a result of environment, personal circumstances and outside influences. These influences will significantly affect the social experience and the self image of those defined, through, for example the experience of negative discrimination.

All aspects of a child’s identity need to be recognised and acknowledged regardless of gender, race, ethnicity or religion. By developing a positive identity children are motivated and their self esteem is enhanced for them to feel a sense of value, belonging and worth Blaine (2007). However Cocker and Allain (2008) argue that not all environments are positive in fostering this idea. When this occur the child becomes withdrawn and shy to open up and engage. Having a LAC identity endangers a child to be different, socially excluded, marginalised and denied equal opportunities in accessing services.(Assessing Children in Need 2000). As such social workers need to adopt and work with a culturally sensitive approach and apply the balancing act to enhance the resilience concept. (Masten 1994 cited in Daniel et al 2002).

Burke and Parker (2007) highlight that the social work context and the involvement of a social worker in a child’s life apply and identify the child as different. From my experience in social care practice I agree with Burke and Parker when they note that the bureaucratic and comprehensive paperwork, regular review and educational meetings, visits, contact arrangements and procedures and guidelines are associated with the LAC; these are not experienced by most children in normal life settings. However this argument is dismissed by Garret (2003) cited in Burke and Parker (2007) when he affirms that paperwork and bureaucratic procedures are essential tools for a social worker to use in helping them identify and address important developmental needs of the child but should however encourage more one- to -one contact with the child rather than spending time on paperwork.

Because of their identity a ‘LAC’ they are disadvantaged and discriminated against at school and in matters related to Education. They most likely risk being expelled from School due to behaviour (DfE 2010).Statistics show that a third of LAC obtains a GCSE and a further fifth obtain fewer than five GCSEs. Although these figures are lower than a few years ago, they are still much higher than for children as a whole: more than half not obtaining five or more GCSEs compared to less than one in ten children as a whole (DfE 2010)

The Social Exclusion Unit (2003) published a document “A Better Education for Children in Care”, (Thompson and Thompson 2003) which highlighted five reasons for the low attainment levels ranging from instability caused by insecure placements, bullying, lack of support and encouragement at home, time out of school due to expulsion, support and encouragement and emotional, mental or physical health.

Schofield and Beek (2009) suggest that parents and people at home where the child lives need to be supportive and encouraging to the child learning success. School environment should promote learning that develops a child holistically to facilitate the self discovery method and accepting themselves as they interact with other children. They also note that this is not always the case as children are disrupted of continuity in settling and making friends if placement breaks down. Sometimes bullying at school results in low self esteem. Although most local authorities have put in place a number of inter disciplinary services looking at the physical, mental well being of children discrepancies still exist. However in Jackson and McParlin (2006) in their article “The education of children in care” professionals are seen to be making assumptions and jumping into conclusions ending up giving labels and long prescribed long term solutions to short term problems unnecessarily. This is associated with neglect and discrimination. More training and awareness of diversity, anti discriminatory practices and individualised person centred approach should be reinforced (Every Child Matters 2004).

Morgan (2010) argues that the problem of poor school performance in LAC lies in the care and education system not in the children. He argues that the care and education systems do not address pre care experiences of the child’s low attainment and also fail to address the aftermath or the impact of separation when children are removed from their families. The child may be suffering from undiagnosed post traumatic stress which can erupt in any confined environment such as school classrooms. He also contends that teachers have no knowledge of the child’s history. Teacher training does not equip teachers with knowledge of the care system and on addressing behaviour from LAC.

Jackson et al (2005) cited in Morgan (2010) carried out a research with students in Higher education who had a care background over a five-year period. The respondents experienced a high level of trauma, abuse and neglect but were placed in foster homes that were supportive and valued education. The findings revealed that foster families who support education and celebrate the child’s achievements are more likely to compensate to some level of the pre care experiences and promote higher attainment in education. It is important to place children in placements which are supportive to the child’s success in education, foster resilience and offer a safe place to grow and achieve. To support children’s wellbeing the government has put in place the Children and Young Persons Act (2008) with a commitment to promote the wellbeing of children and those who are involved in their care. Children and Young Persons Act (2008).

Dunnett et al (2006) acknowledged the initiatives by Government such as the improvement of health of LAC as important and the proposed Care Planning for LAC and Care Leavers to be implemented April 2011. However according to research a number of health deficits still prevailed such as ill health, poor diagnosis, and dental neglect, neglect of routine immunisation screening, poor diagnosis, limited attention to chronic ill health and limited attention to mental health problems. A study carried out by Loughborough University for the Department of Health (2006) revealed inconsistencies and concerns on consultation and treatment. Also studies revealed that teenagers in care found it difficult to discuss sex education due to fear, lack of privacy and trust. They wanted a significant trustworthy person to confide in. As such most of their health needs are overlooked and not met as they are labelled, stereotyped and marginalised. Axford (2008) in her article exploring social exclusion noted this difficulty as more prevalent among children from Black Ethnic Minority background who face a cultural, language and racism within organisations that are meant to support and look after them especially asylum seekers. In the article LAC experiences of the Children Act (1989) highlighted that there are continuing myths about the Act which are still disadvantaging LAC. The children still feel they are not fully aware of their rights under the Act as they face day to day regulations and successive barriers. Children still feel they do not receive what the law says they should. A typical example was in socialising with restrictions on risk assessments for overnight stays by teenagers in care. This has brought a sense of discrimination and marginalisation as it is for normal teenagers to do overnight stays. Prout (2000) cited in Glenny and Roaf (2008) further picked up another conflict and tension among within government departments and targets when he mentions that control and self realisation are both present in legislation and policy but in tension. On one camp there is the idea of viewing children as individuals with a capacity for self realisation within a safe societal environment while in the other camp there is the idea of viewing children as vulnerable and requiring control, regulation and surveillance. One example is the “Youth Matters Four Challenges” to help teenagers achieve the Every Child Matters outcomes. ( DfES 2005)

Social workers need to listen, engage and work in partnership with looked after children. In a research by Holland (2010) exploring the ‘Ethics of Care’ as being

marginalised, not being implemented and recognised, it was evidenced that lasting relationships are disrupted by placements as children often acknowledged their links to their past and significant people in their lives. This highlights the importance of their individual pathway in promoting their wellbeing and interpersonal relationships and future achievements. Clarke (2010) emphasises the need to sustain and promote lasting care relationships with formal carers and social workers to avoid the consequences of loss, neglect and worthlessness by listening to their story, exploring and putting their needs and choices first. Oliver et al (2006)’s “Briefing Paper Advocacy for LAC” unveiled that research has highlighted that there were some ambivalence within professionals as to what extent children must be involved in decision making to matters concerning their care as well as resource barriers. To overcome these constraints Winter (2009) suggested regular contact, feedback, advocacy and putting the needs of the child first need to be priority as children value being listened to and having their wishes fulfilled by active participation in matters concerning their wellbeing.

In a consultation exercise with young persons leaving care as part of my coursework, they highlighted that sometimes they did not receive any satisfactory feedback from social workers when they need it. Also they mentioned that there was a lot of bureaucracy such as reviews or educational meetings which made them feel treated differently. Social work regular visits at school made them feel stigmatised. The respondents felt they wanted to be treated as normal children not service users. Barriers to Change in the Social Care (2000), a report by the Joseph Rowntree Foundation, supports that there should be a human rights approach in working with LAC.

Glenny and Roaf (2008) suggested early Intervention is essential to support children and families before problems either from within the family or as a result of external factors, which have an impact on both the child and family. Statutory and voluntary organisations have an obligation to work in partnership for the success of early intervention agenda. Teamwork will establish protocols which will help to ensure early indications of being at risk of social exclusion are addressed and receive proper attention.

McLeod (1998) highlighted the need to acknowledge Child development which enable children accept and discover themselves through stages and exposure to promote self awareness, confidence, self esteem and positive attitudes. McLeod highlighted Freud’s psycho-analysis theory (1859-1939), Erickson’s psycho-social development theory (1950) and Bowlby’s attachment theory (1969). This view is shared in the literature review by Hunt (2003) cited in Ritchie (2005) which highlights that although there is no concrete evidence of kinship care over non kin foster care there are indications that chances are the former promotes the child’s wellbeing and welfare than the latter. It is important for social workers to be aware of child developmental needs and how valuable family ties are. Schofield and Beek, (2005) cited in Shaw (2010) affirms that past relationships with family and professionals has an impact on the child’s wellbeing and ability to cope with life on their own. Active parenting focusing on the child’s needs and positive engagement with the child will help and promote skills to deal with difficult situations in life. Social workers need to promote resilience to empower children to face challenges and deal with their past and future (Daniel and Wassell 2002) .

Bates et al (1997) suggests that assessment framework should foster identity and acknowledge diversity in order to promote a child’s perception of themselves and their environment. Social workers need to employ anti-discriminatory practice with opportunities and resources for self discovery through interaction (Assessment for Children in need Practice 2000). The Children and Young Persons Act (2008) also emphasises its commitment to promote a child’s well being and the people involved in the care of the child.

This essay discussed a particular aspect of discrimination and oppression among LAC and extent to which legislation, policy, practice and services relevant to social work exacerbate or assist in overcoming negative experiences of LAC. Although there has been notable initiatives in addressing the needs of LAC for the past ten years a lot still has to be done in terms of societal attitudes, resources and safeguarding. To achieve the every child matters outcomes all the stakeholders need to work together by putting the needs and act in the best interest of the child. By listening and engaging with LAC practitioners will be able to improve Children’s quality of life. Anti discriminatory practice, empowerment, diversity and equal opportunities practices are part of the answer.

Dementia is a general term for a decline in mental ability severe enough to interfere with daily life. Memory loss is an example. Alzheimer’s is the most common type of dementia. Dementia is not a specific disease. It’s an overall term that describes a wide range of symptoms associated with a decline in memory or other thinking skills severe enough to reduce a person’s ability to perform everyday activities.

Symptoms and signs of dementia

While symptoms of dementia can vary greatly, at least two of the following core mental functions must be significantly impaired to be considered dementia:

Memory

Communication and language

Ability to focus and pay attention

Reasoning and judgment

Visual perception

Many dementias are progressive, meaning symptoms start out slowly and gradually get worse. Loss of memory for recent events is a common early sign. Some people at the middle stage become very easily upset, angry or aggressive – perhaps because they are feeling frustrated – or they may lose their confidence and become very clingy. At the last stage, the person may also become increasingly frail. They may start to shuffle or walk unsteadily, eventually becoming confined to bed or a wheelchair.

Impacts

As a carer, we are likely to experience a range of very different, and often quite extreme, feelings. Some feelings commonly experienced by carers of people with dementia include distress, frustration, guilt, grief and loss, exhaustion, annoyance, frustration and anger. Some of the most common feelings families and caregivers experience are guilt, grief and loss, and anger. And for the clients themselves they may suffer the stresses from the society and the people around them

The consequences of the people with dementia in relation to individual:

People living with dementias often have mental health problems — especially depression and anxiety disorders — as well as dementia. Memories they have always relied on become hazy and uncertain. Knowledge and skills cultivated over a lifetime diminish. Relationships change or are lost. People with dementia can become deeply sad, fearful and/or angry. Sometimes their behavior becomes a challenge for people who care for them.

The consequences of the people with dementia in relation to the family

The family of the people with dementia will find it is very hard to care for the patient. And they may feel distress, frustration, guilt, grief and loss, exhaustion, annoyance, frustration and anger. They are facing lots of problems with the patient. They will have the very heavy stress from the caring process and the society or the people around them. So it is important to inform the patient`s family how it is going on when the carers are caring for the patient.

The consequences of the people with dementia in relation to the carers

As a carer, we are likely to experience a range of very different, and often quite extreme, feelings. Some feelings commonly experienced by carers of people with dementia include distress, frustration, guilt, grief and loss, exhaustion, annoyance, frustration and anger. Caregivers face many obstacles as they balance caregiving with other demands, including child rearing, career, and relationships. They are at increased risk for burden, stress, depression, and a variety of other health complications, the effects on caregivers are diverse and complex, and there are many other factors that may exacerbate or ameliorate how caregivers react and feel as a result of their role. Numerous studies report that caring for a person with dementia is more stressful than caring for a person with a physical disability.

The way to reduce the stresses for the individual, family and carers.

For all of those 3 kinds of people, they can get help from relax, they are supposed to have the Quality sleep and rest, Quality relationships. They need to be Feeling safe and secure. And the sense of connection to the family and community should be nice. For the carers themselves, they have to learn how to enjoy themselves and get rid of stress. Individuals and families can be both informed the treating process and the good things. They will be getting better when they get encouragement.

The diverse dynamics of the family:

Each family member may act differently in response to coping with an individual with dementia. Some family members may feel resentful or angry while others cope by seeking support and information. And others may simply fall into a place of denial and avoid the situation.

Caring for a family member or friend with dementia can be both a very rewarding and challenging experience. It can also be very physically, emotionally and financially demanding and affect our lifestyle and life choices

As a dementia progresses, the need for caring and supporting is increasing. It is that carers take the time to look after themselves and to respond to their own needs and emotions

Caring for someone with dementia impacts every aspect of daily life. As a patient loses one`s ability after another, caregivers face tests of stamina, problem-solving, and resiliency. During this long and difficult journey, communication diminishes, rewards decrease, and without strong support, caretakers face challenges to their own well-being. Maintaining emotional and physical fitness is crucial. Preparing and protecting yourself, working to understand your loved one`s experience, and embracing help from others can minimize the hazards and enhance the joys of your caregiving experience.

The code of rights for the people living with dementia:

People with dementia and their carers have the right to be provided with accessible information and the support they require in order to enable them to exercise their right to participate in decisions which affect them.

People with dementia and their carers have the right to live as independently as possible with access to recreational, leisure and cultural life in their community.

People with dementia and their carers have the right to full participation in care needs assessment, planning, deciding and arranging care, support and treatment, including advanced decision making.

People with dementia and their carers have the right to be assisted to participate in the formulation and implementation of policies that affect their well-being and the exercise of their human rights.

People with dementia and their carers have the right to be able to enjoy human rights and fundamental freedoms in every part of their daily lives and wherever they are, including full respect for their dignity, beliefs, individual circumstances and privacy.

Public and private bodies, voluntary organisations and individuals responsible for the care and treatment of persons with dementia should be held accountable for the respect, protection and fulfilment of their human rights and adequate steps should be adopted to ensure this is the case.

People with dementia and their carers have the right to be free from discrimination based on any grounds such as age, disability, gender, race, sexual orientation, religious beliefs, social or other status.

People with dementia have the right to have access to appropriate levels of care providing protection, rehabilitation and encouragement.

People with dementia have the right to help to attain and maintain maximum independence, physical, mental, social and vocational ability, and full inclusion and participation in all aspects of life.

People with dementia and their carers have the right to access to opportunities for community education and lifelong learning.

People with dementia have the right to access to social and legal services to enhance their autonomy, protection and care.

People with dementia have the right to health and social care services provided by professionals and staff who have had appropriate training on dementia and human rights to ensure the highest quality of service.

People with multiple impairments

Multiple disabilities are a disability category under IDEA. Children with multiple disabilities have two or more disabling conditions that affect learning or other important life functions. To qualify for special education services under this category, both of the student’s disorders must be so significant that her educational needs could not be met in programs that are designed to address one of the disabilities alone.

Symptoms and signs of multiple impairments

People with severe or multiple disabilities may exhibit a wide range of characteristics, depending on the combination and severity of disabilities, and the person’s age. There are, however, some traits they may share, including:

Limited speech or communication;

Difficulty in basic physical mobility;

Tendency to forget skills through disuse;

Trouble generalizing skills from one situation to another; and/or

A need for support in major life activities (e.g., domestic, leisure, community use, vocational).

It is a cross-classification of disabilities that involves significant physical, sensory, intellectual, and/or social-interpersonal performance differences. The need for extensive services and supports is evident in all environmental settings.

Impacts

For the clients themselves, they may be suffered the Discrimination from others, they may have the pressure on themselves, so there should be a positive person to care them. And for their family, they are going to have a long-term pressure from the society and they may have some problems with the finance.

The consequences of the People with multiple impairments in relation to individual:

For the clients themselves, they may be suffered the Discrimination from others, there are multiple stresses on this client because they have more than one kind of impairment. There should be a positive person to care them. Support and encourage them to have a good mood in order to let them getting heal. People with multiple impairments can become deeply sad, fearful and/or angry. Sometimes their behavior becomes a challenge for people who care for them.

The consequences of the People with multiple impairments in relation to their family:

The family of the people with multiple impairments will find it is very hard to care for the patient. And they may feel distress, frustration, guilt, grief and loss, exhaustion, annoyance, frustration and anger. They are facing lots of problems with the patient. They will have the very heavy stress from the caring process and the society or the people around them. So it is important to comfort the family while caring the client.

The consequences of the people with multiple impairments in relation to the carers

As a carer, we are likely to experience a range of very different, and often quite extreme, feelings. Some feelings commonly experienced by carers of people with multiple impairments include distress, frustration, guilt, grief and loss, exhaustion, annoyance, frustration and anger. They are at increased risk for burden, stress, depression, and a variety of other health complications, the effects on caregivers are diverse and complex, and there are many other factors that may exacerbate or ameliorate how caregivers react and feel as a result of their role. So the caregivers are supposed to relax and do not take it so hard, they need to find some ways to decompress

The way to reduce the stresses for the individual, family and carers.

For all of those 3 kinds of people, they can get help from relax, they are supposed to have the Quality sleep and rest, Quality relationships. They need to be Feeling safe and secure. And the sense of connection to the family and community should be nice. For the carers themselves, they have to learn how to enjoy themselves and get rid of stress. Individuals and families can be both informed the treating process and the good things. They will be getting better when they get encouragement.

The diverse dynamics of the family:

Different family may act differently in response to coping with an individual with multiple impairments. Some family member may feel resentful or angry while others cope by seeking support and information. And others may simply fall into a place of denial and avoid the situation. Caring for a family member or friend with multiple impairments can be both a very rewarding and challenging experience. It can also be very physically, emotionally and financially demanding and affect our lifestyle and life choices

Caring for someone with multiple impairments impacts every aspect of daily life. As a patient loses one`s ability after another, caregivers face tests of stamina, problem-solving, and resiliency. During this long and difficult journey, communication diminishes, rewards decrease, and without strong support, caretakers face challenges to their own well-being. Maintaining emotional and physical fitness is crucial. Preparing and protecting yourself, working to understand your loved one`s experience, and embracing help from others can minimize the hazards and enhance the joys of your caregiving experience.

The code of rights for the people living with multiple impairments:

The people with multiple impairments should always be treated with respect, including respect for your culture, values, beliefs and personal privacy.

No-one should discriminate against the people with multiple impairments or push you into doing something or making a decision that you are not comfortable with.

The care for the people with multiple impairments and treatment let you live a dignified, independent life.

the people with multiple impairments have the right to be listened to, understood and receive information in whatever way you need. Where possible, an interpreter should be provided if you need one.

It is your decision whether to go ahead with treatments or not and the people with multiple impairments are able to change yourthe mind at any time.

In most situations, the people with multiple impairments can have a support person of the choice with the people with multiple impairments if he/she wish.

Multidisciplinary working is work undertaken jointly by workers and professionals from different disciplines or occupations Pearson Thomas 2010:342 and it has evolved at varying speeds over the past 30 years or so in response to imperatives of central government. Mental health was among the first professions to adopt teams of workers from different professions. The community mental health team is widely regarded as the model for multi-disciplinary working. (Community Care, 2010). Relating this to social work the distinctive quality is demonstrating a holistic approach, by working with a range of situations, people and having an attribute for developing multi-disciplinary and partnerships,(Higham,2006:) c

The crisis centre is run by a Local Council and NHS Trust based in a local community. Which corresponds with the 1975 White Paper ‘Better Services for Mentally Ill’, professions working together to provide a community based service. (Scie, 2010) The crisis centre provides beds for four adults suffering a mental health, social crisis, who have been referred to them by the Crisis Resolution Home Treatment Team, the service users for instance can be referred from in their home or accident and emergency. Next they complete an assessment inline with local authority guidelines and procedures, then produce a care plan and risk assessment. If they decide the service user is in crisis and can’t return home, then they contact the crisis centre for a place with the goal of leaving the centre after the crisis, normally within two weeks. Once the service user is placed, there are numerous methods of contacts from the Crisis Resolution Home Treatment Team and social workers through emails, phone calls and visits.

During this observation multidisciplinary working was witnessed between the crisis centre staff and the Crisis Resolution Home Treatment Team about a service user already in the centre through a phone call. The crisis resolution home treatment team seemed to be following the National Occupational Standards key roles section three, by supporting the individual, representing their needs, views and circumstances by acting as an advocate (Higham 2006: 98) as they were informing the crisis centre of what was happening. The crisis centre staff were asking questions in a way that was treating the service user as an individual by listening to their individual case, respecting and maintaining dignity by only asking questions relevant to the crisis centres needs and criteria. They also spoke clearly and discussed the dynamics of other service users (respecting confidentiality) already in the centre declaring any conflict or positive interactions that had arisen since their last visit (GSCC,2010).These skills are fundamental to social work practice as they are valuing the individual and having a holistic approach.

Furthermore, in the 1990’s new labour recognised that problems cannot be addresses by people and organisations working in isolation. So the Department of Health 1998 introduced the white paper Modernising Social Services, which had multi-disciplinary working as a key objective. (Wilson, et, al, 2008:388). In 2000 No secrets actively promoted that multidisciplinary teams, empower and promote well-being of vulnerable adults, through the services they provide and the need to act in a way, which supports the rights of the individual to lead to independence. (Department of Health 2000)

This was observed, by the service user, crisis centre and Crisis Resolution Home Treatment Team via staff communicating frequently throughout the day and providing an environment where service users can come and go freely, yet still have support, during their crisis, they were also encouraged to cook and clean for themselves .This was seen during the observation also in Tony Ryan’s (2010) evaluation of crisis centre and Crisis Resolution Home Treatment Team, asked service users what they valued best about their stay, their responses “I was on the lowest rung of the ladder in terms of depression and self esteem. Now I can cook and iron. It has restored my ‘get up and go’.” and “It is given me a sense of life back and helped me to find myself. I couldn’t have gone on any longer. Staff have taught me to cope better and manage my panic attacks.” This demonstrates partnership working with the service user and multidisciplinary working. The White Paper Our health, our care, our say also emphasises the importance of people having more control over their lives and access to responsive, preventative services by working together in multidisciplinary teams. (Department of Health 2006). The crisis centre fulfils this.

Throughout the day through discussions and observation it appeared that the crisis centre staff and Crisis Resolution Home Treatment Team encouraged emancipatory practice by involving the service user in their support which shows good practice also staff were not routinized as each day was different, they discussed how each individual was unique with a unique situation. If social workers become oppressed by working in routines this does not always benefit the service user, it is not good practice and is not fundamental to social work values. An example of this was observed when a member of the Crisis Resolution Home Treatment Team came to the crisis centre and completed a visit with a service user. During her visit to the crisis centre she was constantly contacted from her office through phone calls, one of which was a new service user needing to be assessed urgently, she had already one visit booked in after the crisis centre, but had to re -evaluate her cases as the new referral was seen to be more of a priority. She did this by speaking to her manager on the phone and re -arranging for another colleague to see her service user and then asked the office to let the service user know about this change.

The above paragraph demonstrates multidisciplinary working and partnership working with the service users are fundamental and collaboration is needed for social work and the interpretation from the staff involved demonstrates good practice. To show the importance of partnership working with service users in the crisis centre Tony Ryan (2010) completed a service evaluation of the crisis centre and Crisis Resolution Home Treatment Team, they asked service users how they felt about staff. Service user’s responses “Any questions or anything you are upset over, you can go and ask the staff” and “Staff are very supportive and help sort problems out.” As social work is about working with people to help them to sort their problems out. Also each individual brings unique skills and experience into the working professional relationship. (Thompson. N. Thompson, S. 2008:24)

So far this essay has demonstrated positive multidisciplinary working through observation at the crisis centre. However, in reality multidisciplinary working can be negative and can be totally dysfunctional. As when a group of diverse people with varied skills come together into a team, things don’t always go smoothly. (Community Care, 2010) Cree, 2003:163 believes that multidisciplinary working can be positive but also frustrating, isolating and difficult. (Dalrymple Burke 2006:139) Wilson et al (2008) also agrees multi disciplinary working does not always work effectively and such failures have been documented in such finding of Victoria Climbie enquiry and baby Peter, lastly Thompson (2005) believes that multidisciplinary can do more harm than good and can make situations worse.

During the course of the day it was bought to attention through a staff handover that one of the service users in the crisis centre had at first experienced a positive interaction of multidisciplinary practice, but sadly it turned into a negative experience. Conquesenlty, this seemed due to the breakdown of communication between multidisciplinary teams such as his social worker, Crisis Resolution Home Treatment Team, crisis centre staff and medical staff. According to Thompson (2009) without effective communication the notion of multidisciplinary becomes unobtainable. Staff at the crisis centre believed it was due to lack of budgets and lack of communication. During this handover reflective practice was witnessed, as, as a team they spoke about what, why and how things had gone wrong for the service user and how they could approach the situation to get the best outcome for the service user.

The staff at the crisis centre spoke about how they valued supervision meetings as it gave them the chance to voice any concerns they had and also gave the manger chance to deal with any systematic practice that was leading the staff to become unfocused. (Thompson. N. Thompson, S. 2008). As supervision meetings demonstrate good practice and in social work codes of practice, developing ones self through development opportunities to strengthen skills and knowledge.

This essay has demonstrated through observation that it is important to work with other professionals as one person cannot solve another person’s problems and dilemmas alone (Thompson. N. Thompson, S. 2008:19) and that multidisciplinary working is a fact of live for social workers and many other professionals also, this essay showed a balance outlook on multidisciplinary working as it has positive and negative points.

Health, Wellness and Nutrition
Introduction

In this assignment, I will discuss various aspects of nutrition in a Residential Care setting. I will look at the opportunities and challenges a social care worker has in addressing the holistic and nutritional needs of the clients and staff. I will look at some of special dietary considerations and the social factors that are involved in a residential care setting.

Residential Care

Residential Care is an alternative care for young people whose family are unable to care for them. These centres are managed by the Family Support Agency, now Tulsia, or by a voluntary or private Company. There are usually between two and six young people living in each house. In 2013, there were 321 children in residential centres. (www.dcya.gov.ie)

The children who live in residential care deserve the very best care that social care workers can provide. To achieve this, their nutritional needs have to be met to ensure that each person can reach their full potential. Social care workers have a duty to look after and provide good wholesome food at the centre. Food is an important part of everyone’s life therefore social care workers need to support children in residential care to make healthy choices and give them practical skills and knowledge to enable them to make the right choices for their health and wellbeing.( Caroline walker Trust) The food pyramid is the recommended guide that is use in Ireland. Foods are divided into different parts in the pyramid to show the recommended intake of each food group. It states that you should eat

Plenty of bread, rice pasta and other starchy foods preferably wholegrain varieties with six or more servings for all ages. Although men and boys may eat up to twelve servings depending on how active they are.
Plenty of fruit and vegetables, at least six or more portions
Three servings of milk, cheese or yoghurt. Children and teenagers will need more.
Some meat, fish, eggs beans, pulses, and other non-sources of protein. Two servings is sufficient.
Very small amounts of fats and oil.
A very small amount or none of foods or drinks that is high in sugar.( Safe food.)

A report published in England by Save the Children in 1998, Look Ahead: Young people in Residential Care and Food stated that, many young people who had left residential care were unequipped to live independently. For example, they did not have the skills to shop and cook and this led to unhealthy lives. Young people who had left the service said that they did not learn enough food skills. Less than half of the young people said they had never helped to prepare a meal most of the actives they had taken part in involved setting the tables, washing up or peeling the vegetables. Less than a third said they had a role in the menu planning. The study also showed that a major barrier in residential care was the Health and Safety regulations that excluded young people from the kitchen. (eatingwellchildren2001pdf)

Special Dietary Considerations

Children and young people need the right balance of food and nutrients to enjoy a healthy life. The key is to get the balance right, to provide essentianal vitamins, minerals, protein and fibre into the diet. If there are insufficient nutrients in the diet, this can lead to diseases and bad health. Childhood obesity has increased over the past few years. Obesity affects children in a number of ways including physical mental and emotional wellbeing. If it continues into adult life, it can have serious affects on health such as diabetes, heart disease stroke and some types of cancers. section 3 nutrition guidance scotish download.

Putting into practise a healthy eating plan in a residential care setting, needs to be approached in a sensitive way. It may take time for young people, to adopt a healthier eating plan and to feel comfortable eating in a group. Some young people may choose eat a vegetarian diet. The staff must ensure that this type of diet is varied as much as possible to make sure that good sources of iron, zinc, protein and calcium are included in their diet.

Some children in residential care may have a food intolerance or food allergy, which is a reaction to a food or ingredient. Some foods can cause a severe allergic reaction (anaphylactic shock) to such food as peanuts, shellfish or eggs. This should be highlighted in the child’s care plan. Anaphylaxis is the most serious type of allergic reaction and you could die without the proper medical intervention. Although food is the most common allergic reaction insect stings and sometimes exercise can cause anaphylactic shock. The symptoms usually occur within minutes but it can also take a few hours after exposure. As social care workers, it is crucial to be aware of the signs and symptoms as it can happen to anyone at any time. ( www.anaphylaxis.ca)

Unlike this serious life threatening allergy are those who suffer from celiac disease. This disease causes the person to react to gluten which is the protein found in wheat. People with celiac disease have an intolerance to wheat products such as bread, cakes, and biscuits. It causes damage to the lining of the small intestine and thus prevents the absorption of nutrients. The only way to manage celiac disease is to avoid all foods that contain gluten to prevent further damage. (Celiac society of Ireland)

Diabetes like celiac disease is also an autoimmune condition that results in the body unable to burn up sugar (glucose) properly. This happens when the pancreas does not produce sufficient insulin a natural hormone that regulates blood sugar level. Insulin helps the sugar in the blood enter the cells of thee organs in the body. Without this process to much sugar would build up in the blood. As a result, this can cause faintness weakness and coma. There are two types of Diabetes;

Type 1 Diabetes occurs mostly in children and young people. It requires the person to take insulin injections as well as a healthy nutritious diet and exercise. In the residential centre, the staff would have to monitor the person’s diet to make sure that the amount of insulin is carefully balanced against the food that supplies the sugar and the amount of excise that is burning off the sugar.

Type 2 Diabetes is on the rise and it is generally seen in older adults. It can be kept under control with a good healthy diet usually there is no need for insulin but some people need to take tablets. (Kirkpatrick, 2004)

Social factors

Mealtimes are an important part of our culture. It is where children learn about behaviour and develop new skills. It also offers a sense of belonging. Children in residential care may never have experienced this with their own family. Mealtimes should be an enjoyable experience where staff and children can share stories. When planning a meal it is important to take every person likes and dislikes into consideration. Children who have special diets or those who are vegetarian need a variety of suitable nutritious food. Child care (Placement of Children in Residential Care) Regulations, 1995, Part 111, Article 11. www.dcya.gov.ie xxxxxxxxxxput in

It is important to build good relationships between staff and children. The care workers ought to look for the views of the children around food and food-related issues. This should be a fundamental part of day-to-day activities at the centre. Social care workers at residential centres have an opportunity to improve children’s experience and health and wellbeing in areas of food practise. It is important for staff to adopt a healthy eating plan, as this will serve as a good example to the children. Children need to develop practical skills around budgeting, buying, preparing and cooking of food as this will prepare them for when the leave the centre. www.Scotland. Gov.uk.

Food can work as powerful symbolic medium where thoughts, feelings, and relationships are played out and it can be a useful tool for children who have experienced neglect. Through food, children can experience consistency and nurture and develop autonomy with a sense of control. It can demonstrate trust and care. Food is a simple way for a social care worker to monitor the ethos and the culture of the centre. By reflecting on the food practices and attitudes towards food, you can see how your centre is doing in many ways.

Reflection

I have found this module both interesting and challenging. I did not realise how complex and intense it would be. I have really enjoyed learning about nutrition and I have integrated this new knowledge into my family life. It has changed the way I look at food. I would also like to do a course on nutrition, as it is such an important aspect of overall health and wellbeing. I have a good understanding now on infections and diseases, which is so important to social care practise and in my own personal life. The subject that has had the most impact on was the subject of child abuse. I found it very informative and very challenging. This subject has really opened my eyes to the realness of the work that is involved in social care practise.

I feel this module is central to social care practise and it has prepared me for social work. I have gained practical every day skills that I will require, to work as a social care worker.

The True Spirit of Healing in Medicine: Norman Bethune

Introduction

Henry Norman Bethune was a Canadian doctor who became famous for his selfless service of people in the Second Sino-Japanese War. His service endeared him to Mao Zedong, who hailed him as a communist and supporter of the Chinese people’s efforts for liberation. Even today, Bethune’s popularity in China stands undisputed with his statues present all over the country. There is no doubt that Bethune had in him the true spirit of healing, a unique spirit, because doctors often perceive their professions as scientific pursuits or even money making endeavors. This is illustrated in the manner in which pharmaceutical companies and doctors work hand in hand to achieve profits and market prominence by selling medicines. Bethune’s dedication to his profession was illustrated in the manner in which he served in the World War I and the Spanish Civil War before his stint in the Sino-Japanese War, in spite of his open contention that wars were meant to make profits (Shepherd and Levesque 147). He was known repeatedly state that “the private economic profit” (Clarkson 40; Stewart and Stewart 317; Wilson 75) should have no place in medicine. In addition, he was also a proficient inventor, who designed and altered several surgical instruments, such as the portable blood transfusion system he developed in the Spanish Civil War (Stewart and Stewart 92, 95). Moreover, many of his inventions continue to be in use today (Stewart and Stewart 92, 95). It is also notable that while Bethune passionately and dedicatedly adhered to his professional ideals, he also had clear political ideologies. In the Spanish Civil War, he sided with the democratic republic and during the Second Sino-Japanese War, he sided with the rural population in China and accepted communism as opposed to Imperialism. However, today he is heralded in China for his communist ethoses, which were very different from the communism that was practiced in China under Mao Zedong. This paper contends that Bethune was not simply a doctor by profession but also a healer at heart who formed political ideals according to the welfare of humanity, and thus, his image as a communist leader in and outside China might be somewhat misconstrued.

Discussion

Bethune’s ideology behind traveling all the way to China in 1938 and to serve the people in the Sino-Japanese War was to aid the suffering and poor people there. This was in line with his endeavors in his life thus far, that is, in World War I and the Spanish Civil War. He also carried out crisis surgical procedures on the casualties in the war as well as instituted training for medical personnel for the same (Stewart and Stewart 32). He also refused to treat the casualties by considering their race, culture, political side, or even the side in the war (Stewart and Stewart 32). Clearly, he was dedicated to the cause of serving his patients, irrespective of the social conditions. As a doctor, he treated the people who were suffering and sick. He was also believed in the communist ideologies, that is, those that had been propounded by Marx and was a member of the Canadian Communist Party (Stewart and Stewart 124). This was in spite of the fact that in those days, it was illegal to be a part of the communist party in Canada (Stewart and Stewart 124). However, this was naturally because of the conflicts between what would become the allied and axis powers in the World War II. In fact, most people in Canada associated communism with Stalinist and Nazi policies of control (Stewart and Stewart 371). Moreover, the United States’ staunch anti-communist policies must have also influenced the Canadian policies. However, in Bethune’s philosophy, the poor, proletariats, who were subjugated under capitalism or were the casualties in war, should be side he supports. Consequently, he became a part of the communist party in Canada, because he believed in Marxist philosophies, which communists promised to practice. Clearly, his political ideology was founded in his dedication to his professional and moral ideal of serving the suffering and the weak.

When Mao Zedong welcomed Bethune as a communist comrade, he was impressed with Bethune’s dedication to the communist ideals. Bethune illustrated his ideals with his dedication to his profession and by serving in the frontlines in the war. As mentioned before, this was not different from the manner in which he served in World War I and the Spanish Civil War. However, Mao interpreted Bethune’s work and ideologies as his dedication to the communist cause and the cause of the people. It must be remembered that under Mao’s rule, there was no growth of the proletariats and the Chinese economy collapsed as all the contributing members to the economy, such as, doctors, owners of industries, and lawyers were banished from their jobs to serve in the rural areas. In such conditions, the overall suffering, illness, and pain experienced by the Chinese people were probably worse if not as bad as in Imperial China. Although Bethune died in China of blood poisoning, while serving in the Second Sino-Japanese War, he was, nevertheless, unaware of the true ethos of the brand of communism that would be practiced by Mao. Considering his ideals, he would have probably never wanted to be a part of this kind of communism. Ultimately, Bethune was a man who wanted to serve the people and not simply have a political ideal, where personal and profit goals were in focus. Today, it can be said that communism and democracy have both failed in the ability to separate the profit making processes from the social serving ones. Given these facts, Bethune would have probably sought to be a part of a more humanitarian political ideology.

Notably, Bethune’s legacy rests on the fact that Mao published an essay on him—In the Memory of Norman Bethune in 1939—for unselfishly serving in the Second Sino-Japanese War. This essay was considered essential reading in Chinese schools then and even today, students are required to be familiar with this essay. Indeed, the philosophy of the essay is in tune with Bethune’s philosophies. Consider the following excerpt from the essay:

We Chinese Communists must also follow this line in our practice. We must unite with the proletariat of all the capitalist countries, with the proletariat of Japan, Britain, the United States, Germany, Italy and all other capitalist countries, for this is the only way to overthrow imperialism, to liberate our nation and people and to liberate the other nations and peoples of the world (Tse-tung)

Clearly, Bethune would have been glad to be associated with such ideologies. He expressed his views on his profession by stating that, “medicine, as we are practising it, is a luxury trade” (Allan and Gordon 130). He further abhorred the use of monetary ends in practicing medicine and believed individualism, which is always associated with democracy and never with communism, as the reason for such a state of affairs (Allan and Gordon 130). However, Bethune died well before the Chinese Cultural Revolution of the 1960s started. This was a time when millions of Chinese died because communism had turned to totalitarianism (Yan and Gao 2). The death toll in the Chinese Cultural Revolution has not been released by the Chinese government until date (Yan and Gao 2). However, this was a time when people were ruthlessly massacred by governmental encouragement of mobs and by authorized attacks on civilian populations by military personnel (Yan and Gao 2). Moreover, the anti-democracy stand Bethune held would have probably been shaken if he had lived to experience the shock the world felt when the truth that Hitler carried out genocides in Germany was publicly known and acknowledged after World War II. However, since he never lived to experience such events, and thoroughly believed communism to be anti-exploitation, he stood by it while practicing his medical ideologies.

It can also be recalled that Bethune was virtually unknown in Canada well after he died. Canadians and the rest of the Western world did not know about him until 1952, when Ted Allan and Sydney Gordon published their book, The Scalpel, the Sword: The Story of Doctor Norman Bethune (a new version is mentioned in the works cited section of this paper). However, unfortunately, they hailed him as a communist hero in this book. However, the timing could not have been worse, because in this Cold War era, anti-communist feelings thrived in Canada (Stewart and Stewart 327). Thus, Bethune’s contributions to science and his altruism were well forgotten until much later. Only in the past few decades, especially since China has cautiously opened its doors to the western world for trade has Bethune’s abilities and work been acknowledged. Today it is known that Bethune was among the original advocates of socialized medicine, which is in high demand in Canada and in the rest of western world—the Obamacare policies next door are perhaps the best examples of this. Bethune also formed the Montreal Group for the Security of People’s Health (Stewart and Stewart 371), which established the need for socialized medicine. Bethune has also visited the Soviet Union to understand and learn about socialized medicine (Stewart and Stewart 122). Such endeavors eased his way into the political ideology that was communism and thus, he became a part of the Communist Party of Canada. In the most unbeknownst manner, he became a part of a political thought that defied the altruism fundamental to his ideologies.

Conclusion

This paper illustrated the manner in which Bethune contributed toward the development of medicine and struggled to treat the injured and the sick as a doctor. Undeniably, he endeavoured to achieve his professional idealism through his research and treatment as in shown by his inventions. Similarly, as became aware of the social and economic characteristics of disease, he adopted a political thought that he believed cared for the proletariats and the suffering as he did. However, he was not well informed about the nature of such communism or even to of democracy. As time showed, both were capable of exploitation, and in fact, communism enabled totalitarianism—a concept that Bethune would have definitely abhorred considering his ideologies. It can be thus concluded from the facts presented in this paper that Bethune was indeed a dedicated doctor, who truly adhered by the Hippocratic Oath as well as formed political ideals keeping the welfare of humanity in mind. However, his image as a communist leader in and outside China has been misconstrued over the years, since he died well before the harms of communism were experienced by the world.

Work Cited

Allan, Ted and Sydney Gordon. The Story of Doctor Norman Bethune. Dundurn Press: Dundurn. 2009. Print.

Clarkson, Adrienne. Extraordinary Canadians: Norman Bethune. Toronto: Penguin Canada. 2009. Print.

Stewart, Roderick and Stewart, Sharon. Phoenix: The Life of Norman Bethune. Toronto: McGill-Queen’s Press .

Shephard, David A. E, and AndreI?e LeI?vesque. Norman Bethune: His Times and His Legacy. Ottawa, Ontario: Published by the Canadian Public Health Association, 1982. Print.

Tse-tung, Mao. In Memory of Norman Bethune. 1939. Web. Accessed on April 15, 2015 from https://www.marxists.org/reference/archive/mao/selected-works/volume-2/mswv2_25.htm.

Wilson, John. Norman Bethune. Dundurn: Dundurn Press. 1999. Print.

Yan, Jiaqi, and Gao Gao. Turbulent Decade: A History of the Cultural Revolution. Honolulu: Univ. of Hawai’i Press, 1996. Print.

Introduction

Ever since the report of Sir William Beveridge ‘The Social Insurance and Allied Services’ report was published at the end of 1942 has been seen as the cornerstone of the Welfare State as it indentified that national insurance contributions would insure that the state would provided social security so that the population would be protected from the ‘cradle to the grave’. This was the ideological aim by Beveridge to improve productivity our standing in the global market at a time when the world had be financially damaged by the conflict that occurred during World War 2.

This report was the basis of welfare support by the state and the end of the ‘poor law’

This essay will be looking at the Welfare Reform act introduced by the coalition government and the implied changes of the reform in which the transition of the population being protected by the state from ‘cradle to grave’ towards a change the under the statement on the DWP website to make the benefits and tax credit systems fairer and simpler by:

Creating the right incentives to get more people into work

Protecting the most vulnerable in our society

Delivering fairness to those claiming benefit and to the taxpayer.

This essay will examine as to whether or not these changes to the welfare act has signalled a change in the direction for anti-poverty policies or whether these changes have already been coming and if the reform has highlighted and presented a change of direction in anti poverty polices in a more public light.

It can be said that the impact of the global credit crunch and subsequent recession has played a contributory part in the changes that are taking place and has possibly garnered more public support in light of the squeeze that the recession has caused on the purses of working households.

Seventy years ago, with Britain locked in battle against the armies of Nazi Germany, one of the most brilliant public servants of his generation was hard at work on a report that would change our national life for ever.

Invited by Churchill’s government to consider the issue of welfare once victory was won, Sir William Beveridge set out to slay the ‘five giants’ of Want, Disease, Ignorance, Squalor and Idleness.

When his report was published at the end of 1942, it became the cornerstone of a welfare state that supported its citizens from cradle to grave, banishing the poverty and starvation of the Depression, and laying the foundations for the great post-war boom.

For years the welfare state was one of the glories of Britain’s democratic landscape, a monument to the generosity and decency of human nature, offering a hand up to those unlucky enough to be born at the bottom.

Nine characteristics of Policy Making

FORWARD LOOKING

The policy-making process clearly defines outcomes that the policy is designed to achieve and, where appropriate, takes a long-term view based on statistical trends and informed predictions of social, political, economic and cultural trends, for at least five years into the future of the likely effect and impact of the policy. The following points demonstrate a forward looking approach:

aˆ? A statement of intended outcomes is prepared at an early stage

aˆ? Contingency or scenario planning

aˆ? Taking into account the Government’s long term strategy

aˆ? Use of DTI’s Foresight programme and/or other forecasting work

OUTWARD LOOKING

The policy-making process takes account of influencing factors in the national, European and international situation; draws on experience in other countries; considers how policy will be communicated with the public. The following points demonstrate an outward looking approach:

aˆ? Makes use of OECD, EU mechanisms etc

aˆ? Looks at how other countries dealt with the issue

aˆ? Recognises regional variation within England

aˆ? Communications/presentation strategy prepared and implemented

INNOVATIVE, FLEXIBLE AND CREATIVE

The policy-making process is flexible and innovative, questioning established ways of dealing with things, encouraging new and creative ideas; and where appropriate, making established ways work better. Wherever possible, the process is open to comments and suggestions of others. Risks are identified and actively managed. The following points demonstrate an innovative, flexible and creative approach:

aˆ? Uses alternatives to the usual ways of working (brainstorming sessions etc)

aˆ? Defines success in terms of outcomes already identified

aˆ? Consciously assesses and manages risk

aˆ? Takes steps to create management structures which promote new ideas and effective team working

aˆ? Brings in people from outside into policy team

EVIDENCE-BASED

The advice and decisions of policy makers are based upon the best available evidence from a wide range of sources; all key stakeholders are involved at an early stage and throughout the policy’s development. All relevant evidence, including that from specialists, is available in an accessible and meaningful form to policy makers. Key points of an evidence based approach to policy-making include:

aˆ? Reviews existing research

aˆ? Commissions new research

aˆ? Consults relevant experts and/or used internal and external consultants

aˆ? Considers a range of properly costed and appraised options

INCLUSIVE

The policy-making process takes account of the impact on and/or meets the needs of all people directly or indirectly affected by the policy; and involves key stakeholders directly. An inclusive approach may include the following aspects:

aˆ? Consults those responsible for service delivery/implementation

aˆ? Consults those at the receiving end or otherwise affected by the policy

aˆ? Carries out an impact assessment

aˆ? Seeks feedback on policy from recipients and front line deliverers

JOINED UP

The process takes a holistic view; looking beyond institutional boundaries to the government’s strategic objectives and seeks to establish the ethical, moral and legal base for policy. There is consideration of the appropriate management and organisational structures needed to deliver cross-cutting objectives. The following points demonstrate a joined-up approach to policy-making:

aˆ? Cross cutting objectives clearly defined at the outset

aˆ? Joint working arrangements with other departments clearly defined and well understood

aˆ? Barriers to effective joined up clearly identified with a strategy to overcome them

aˆ? Implementation considered part of the policy making process

REVIEW

Existing/established policy is constantly reviewed to ensure it is really dealing with problems it was designed to solve, taking account of associated effects elsewhere. Aspects of a reviewing approach to policy-making include:

aˆ? Ongoing review programme in place with a range of meaningful performance measures

aˆ? Mechanisms to allow service deliverers /customers to provide feedback direct to policy makers set up

aˆ? Redundant or failing policies scrapped

EVALUATION

Systematic evaluation of the effectiveness of policy is built into the policy making process. Approaches to policy making that demonstrate a commitment to evaluation include:

aˆ? Clearly defined purpose for the evaluation set at outset

aˆ? Success criteria defined

aˆ? Means of evaluation built into the policy making process from the outset

aˆ? Use of pilots to influence final outcomes

LEARNS LESSONS

Learns from experience of what works and what does not. A learning approach to policy development includes the following aspects:

aˆ? Information on lessons learned and good practice disseminated

aˆ? Account available of what was done by policy-makers as a result of lessons learned

aˆ? Clear distinction drawn between failure of the policy to impact on the problem it was intended to resolve and managerial/operational failures of implementation.

Conservative – Thatcher Era

It can be said that characteristics of the Labour and Conservative party remain constant, wherein there is a greater focus for Conservative government to reduce State dependency and a culture in the view of Thatcherism ‘I think we have gone through a period when too many children and people have been given to understand “I have a problem, it is the Government’s job to cope with it!” or “I have a problem, I will go and get a grant to cope with it!” “I am homeless, the Government must house me!” and so they are casting their problems on society and who is society? There is no such thing! There are individual men and women and there are families and no government can do anything except through people and people look to themselves first. It is our duty to look after ourselves and then also to help look after our neighbour and life is a reciprocal business and people have got the entitlements too much in mind without the obligations.’ (^ “Interview for Woman’s Own (“no such thing as society”) with journalist Douglas Keay”. Margaret Thatcher Foundation. 23 September 1987. Retrieved 10 April 2007.)

This ideology is represented with policy changes such as the introduction of poll tax in which everyone was expected to contribute the same amount of tax regardless of income or wealth and is seen as a poverty creating policy. It could be said that the era of Tory power between 1979 and 1997 was a period when actions were being implemented to deal with the ‘crisis’ of welfare within the UK. It had been suggested that between 1951 and 1979, levels of controversy over anti-poverty policies were, arguably, not particularly high. Conservative ideologists however had much to say about the case for bringing market conditions more effectively to bear on distribution of social services, but only in the housing field had Conservative governments taken steps that represented major responses to this viewpoint. Labour disappointed many of its supporters, who closely identified the party with the advancement of the Welfare State. A succession of economic crises limited the money available for new anti-poverty polices. Yet both parties, even before the Thatcher government came into power had considerably advanced public expenditure particularly on social policies, to the point where some economists argued that this kind of expenditure had become inflationary force, limiting the scope for new wealth creating private investment. This is a view politicians began to take seriously by the 1970s, with the most staggering growth in seen in public employment and social security transfer payments.

Although it is tempting to attribute the change in climate for social policy in the UK to the Conservative led government of 1979, the changes had been gradually emerging before that date, and those changes were rooted as much in economics as in ideology. Keynesian economic management techniques involving manipulation of levels of government expenditure and taxation were employed to try to retain full employment without inflation. This however was not possible with monetarists’ school of thought being that the government must control the money supply and let economic forces bring the system under control (Friedman, 1962, 1977). The government at the time when Thatcher took office were undoubtedly hostile to state social policy. This hostility was rooted in a commitment to privatization, the curbing of public services and attacking trade unions. The government was untroubled by the evidence that such an approach was generating increased poverty. Despite the aims to control social policy expenditure, it nevertheless grew as a whole, with spending on the National Health Services and Welfare continually increasing. See Glennerster and Hills (1998) for a detailed analysis of those trends.

It was during that era that they changed supplementary benefit which was a means-tested benefit in the United Kingdom, paid to people on low incomes, whether or not they were classed as unemployed such as pensioners, the sick and single-parents. Introduced in November 1966, it replaced the earlier system of discretionary National Assistance payments and was intended to ‘top-up’ other benefits, hence its name. It was paid weekly by the DHSS, through giro cheques and order books, or fortnightly by the Unemployment Benefit Office by giro and cashed at local post offices. This was subsequently abolished and replaced by income support and housing benefit by the Thatcher government and also signalled the change for the provision of sickness absence for the first 28 weeks from National Insurance to a Statutory Sick Pay scheme run by employers.

The 1986 Social Security Act extended the scope for contracting out from the SERP (State Earnings Related Pension Scheme) which is now the basic state pension allowing the growth of private pension plans. The family income supplement was replaced by family credit which went onto evolve into tax credits under the New Labour government. Under the Thatcher government was a total restructure of the benefits system, which included, along the ones mentioned previously that change of unemployment benefit to job seekers allowance to emphasise the behaviour required and make allowance tested means after the first six months.

Other changes made by the government at that time included the transformation of the invalidity benefit to incapacity benefit, aiming to force all but severely handicapped, below pension age, to become job seekers. One of the most complex pieces of legislation was the state support for single parent families, which was designed to secure increased contributions from ‘absent’ parents (normally fathers) through the Child Support Act of 1991.

Labour

The Blair government when it came to Welfare declared themselves as the government for Welfare Reform with a commitment to a stable public expenditure programme, but the tendency of social security costs to rise regardless of policy change which is a problem also faced by the Thatcher government, which in turn limited New labour’s room to manoeuvre. Labour saw the solution to this dilemma by increasing employment; the stimulation of labour-market participation by single parents and the disabled as well as the unemployed is central to their social security policy strategy This is seen trough the introduction of working tax credit and their ‘welfare to work’ programmes for young people under 25.

The most significant aim of New Labour was to eradicate child poverty and this was done with schemes such as child tax credit, but possibly the biggest change introduced to tackle poverty was the National Minimum wage, which was transcending and ensured that everyone was entitled to a basic pay regardless of job role and prevented employers from exploiting employees, there has now however been greater argument for the introduction of a living wage, which is something that the present labour party actively support, with current opposition leader Ed Milliband and former Mayor of London Ken Livingstone supporters of a national living wage.

It is worth remembering that when Tony Blair came to power in 1997, he claimed that we had ‘reached the limits of the public’s willingness simply to fund an unreformed welfare system through ever higher taxes and spending.’ Urgent welfare reforms, he said, would ‘cut the bills of social failure’, releasing money for schools and hospitals.

Welfare Reform 2012 – The Policy Agenda

The main elements of the welfare reform act are

The introduction of Universal Credit to provide a single streamlined payment that will improve work incentives

A stronger approach to reducing fraud and error with tougher penalties for the most serious offences

A new claimant commitment showing clearly what is expected of claimants while giving protection to those with the greatest needs

Reforms to Disability Living Allowance, through the introduction of the Personal Independence Payment to meet the needs of disabled people today

Creating a fairer approach to Housing Benefit to bring stability to the market and improve incentives to work

Driving out abuse of the Social Fund system by giving greater power to local authorities

Reforming Employment and Support Allowance to make the benefit fairer and to ensure that help goes to those with the greatest need

Changes to support a new system of child support which puts the interest of the child first.

This changes signal possibly the hugest shake up to the welfare act in one fell swoop, it can be argued however that New Labour were already implementing changes to reduce the welfare bill, but not in a way as direct as the coalition government, with one of the main focus being to reduce poverty and eradicate child poverty – which is something that this essay will touch on further on in the essay.

Britain now spends 7.2 per cent of GDP on it’s welfare system, and the costs of supporting the, supposedly, needy continue to rise. As the Whitehall empire grows, drowning the noble intentions of welfare in red tape, so too do the number who chose to abuse the system.

the turn against welfare is unprecedented. In previous times of austerity, public attitudes have always remained remarkably generous. Even in the straitened late Seventies, for example, seven out of ten people told pollsters they would like to see higher taxes to pay for higher social spending. The truth is that we have reached a watershed.

To look after the weak is the first duty of any decent government; to abandon them would be unconscionable.

Embarrassingly, Britain now has the highest proportion of working-age people on disability benefit in the developed world. And while just 3aˆ‰aˆ‰per cent of Japanese people and 5aˆ‰aˆ‰per cent of Americans live in households

where no one works, the figure in Britain is 13aˆ‰aˆ‰per cent.

The people who really lose from this, incidentally, are those who are genuinely disabled. They deserve boundless public sympathy; instead, thanks to the abuse of the system, they are too often treated with scepticism.

But behind all this lies a deeper issue. Beveridge designed the welfare state for a tightly knit, deeply patriotic and overwhelmingly working-class society, dominated by the nuclear family.

Though millions of people had grown up in intense poverty, they were steeped in a culture of working-class respectability and driven by an almost Victorian work ethic. In the world of the narrow terrace back streets, deliberate idleness would have been virtually unthinkable.

It could be said that the welfare reform might not necessarily be a change in direction for anti-poverty policies, but a policy implemented to change the mind set of a nation that has transformed from one where people thought about what they could contribute towards their own nation especially at a time of war, to a nation where certain individuals, bearing in mind a small minority of people believe they deserve more from the state without having to earn it.

The key factors of welfare reform is universal credit which will be an all encompassing payment that incorporates vast majority of out-of-work and housing benefits that households can receive.

Poverty – Relative and Absolute

Child poverty – Prominent reduction target. Major tax benefit reforms benefiting low-income families with children.

Working-age poverty – Policy focus on worklessness, not poverty in itself. Policies aimed at employment and income at work.

Employment – Clearest initial priority. Action through New Deals and ‘active’ policy towards unemployed.

Political participation – Some aspects of constitutional reform and parts of Social Exclusion Unit (SEU) agenda for neighbourhood renewal. Participation requirements embedded in nearly all policy areas. Targets for volunteering and confidence in institutions.

Poor neighbourhoods – Major focus of SEU, with ambitious overall target. Policies both area-based and for mainstream services.

Children and early years – Has moved up the agenda with reviews in 1998 and 2004. Large increase in resources.

Older people – services and long-term incomes – Royal Commission on Long Term Care – but divided report and responses in England and Scotland. State Second Pension and Pension Credit reforms.

The making of Anti-Poverty Policies

Anti poverty policies –

Tax credits (Child and working tax credits),

Child benefit,

housing benefit,

council tax benefit,

income based JSA and ESA (Job seekers allowance and Employment Support Allowance),

Income Support,

Universal Credit

Anti-poverty policy making – Joseph Rowntree Foundation

Prior to the Welfare Reform act the focus of policies was that the state help its citizens from the cradle to the grave with welfare support – polices introduced throughout which coincided with the introduction of the national health service has been the mainstay and direction of a lot of anti-poverty polices that have been introduced in which the state takes care of those unable to take care of themselves. Countless policies have been introduced in that time that have provided assistance to the elderly, disabled, women, children, unemployed and those with long-term sickness are some of the groups that polices introduce since Beveridge’s report in 1942 have focused on assisting and helping. Although it’s not a surprise that ever since the coalition came into government, bearing in mind that the party is dominated by the Tories as the majority party, there manifesto ever since 1979 and the era of Thatcherism has always been to reduce the role of the state and give individuals greater power and responsibility over their own lives.

The question has to whether the welfare reform act 2012 has signalled a change in direction for anti-poverty policies is not a straight forward question, with a straight forward answer, it can be suggested that it is important to look at the changes that have been taking place, with the welfare bill spiralling out of control, which was something noticed by New Labour when they came into power.

Conclusion

The welfare reform act can be seen as change in direction from the description of a ‘nanny state’ into state that ‘helps those who want to help themselves’

Divorce is the worst situation that a child experiences in the growth and development life which they have to cope up with. The effects divorce has on children depend on age of the child when divorce occurs. Other factors that determines the effects the divorce impacts on children depends on child’s personality and the gender, the support offered by other family members and relatives besides the frequency of conflicts and disagreements between parents determines the magnitude of the effect. In consideration of age, young children who are below two years of age are less affected by divorce although this might not be the case when there is a close relationship between the children and the parent (s). These infants do not get to understand the nature of the conflict but nevertheless they react to the changes that accompany divorce. When such a situation is prone to happen, the concerned parents should make special and prior arrangements on childcare and parenting to reduce the negative influence their separation would impact on children (Alison and Cornelia 34).

Children who are yet to join school (preschool children) usually takes the blame incase divorce and separation occurs. This is facilitated by their fear of been abandoned and left alone by parents’ separation. However if separation through divorce occur, preschoolers responds by turning to be uncooperative, angry and depressed. Their personality is also greatly affected and they change completely from their initial socialization when they become aggressive and disobedient towards any adult near them while living a life of denial that nothing happened (DeBord 12).

Divorce has the greatest and long lasting effect on school aged children than the young ones. Their personality and emotional attachment to their parent is so strong that they find it extremely difficult to cope up and adjust with the new situation of loneliness of either parent. The difficult situation experienced by elementary children who are school age results from their maturity to understand every bit of situation that is happening with their parents. This age is mature and old enough to comprehend and feel the pain associated with separation from divorce of their parents. The unfortunate part that school age children undergo is the inability they have to control the internal pain caused by divorce (Mary 1).

The manifestations associated with effects of divorce on this age group of children are resentment, grief, intensive anger, embarrassment, resentment and divided loyalty. They also tend to be isolated from other children and may develop total withdraw from other children’s activities like creative playing and games. These children live with a hope that their parents will still return together; in case of otherwise, these children feel rejected by the parent who left. Apart from personality and emotional effects, divorce at this age may affect the health of children who may frequently complain of stomachaches and headaches (Eileen and Josephine 23).

When divorce occurs during adolescent stage of children, its effects are more severe than any other stage in child’s development. Some teenagers feel abandoned, guilt and a sense fear. Their emotional set up is severely disrupted by divorce; they experience loneliness, depression and anger towards other people and mostly their parents especially the one who has left. During this age, the children are mature enough to handle some family responsibilities. However they feel punished and burdened especially when they are responsible for the childcare of their younger siblings. Their response is always swift and they try to fill the gap by assuming adult responsibilities due to high levels of stress and low energy levels with their parents. Some teenagers struggle with sexual desires since they have no one to confine to and experience low self esteem of handling marriage and getting married. Since teenagers understood well the causes and situations surrounding their parents separation and subsequent divorce, their stability in education greatly declines due to lack of concentration and stability, in addition, they are not in a position to deal with future changes occurring in their family life. Children in this age bracket gets themselves in a confused state of mind since they are unable to decide which parent to accept over the other (Hughes 12).

The pressure they experience on deciding who to blame for the cause of divorce stress them up affecting negatively their academic life declining in performance since they spend much of their school time evaluating and thinking about the situation back at home. They are also occupied with many thoughts especially if they have assumed responsibilities to take care of their younger siblings. Their emotional status is greatly affected since they experienced whatever happened with their parents; they lose confidence with marriage institutions and do no longer have ability and confidence to handle their family life (Mary 1).

Based on gender, children who are raised by parent of the opposite sex are greatly affected by divorce more than boys raised by fathers and girls raised by mothers after divorce. Children raised by opposite sex tend to develop aggressive behaviors and resentment. Emotional disorders are common to children brought up by opposite sex parent while those raised by same sex tends to be responsible and respond to their environments more quickly. Although age, gender and other factors have been identified as influencers of the extent to how children respond or/ and affected by divorce, the most determining factor is the parent to children relationship (Alison and Cornelia 43).

However, children should be assisted to adjust to divorce situations in their life. The parent in custody of children should consistently maintain communication and discussion of divorce regardless of how painful it is to the children to help them overcome it. This process will also assure their confidence and adequately prepare them for the future especially the adolescent group who requires understanding in a more detailed manner than younger ones. To recover quickly and reduce the effects of divorce, conflicts and aggressiveness of parents after divorce should be minimized and avoided if possible. Finally disruptions of children should be kept at low levels always and parents should have proper plans of how to deal with after divorce events.

Work Cited
Alison Clarke and Cornelia Brentano, “Divorce: causes and consequences,” Yale: Yale University Press, 2006
DeBord Kennedy, “Focus on Kids: The effects of divorce on children,” North Carolina, Cangage Learning, 1997
Eileen Hetherington and Josephine Arasteh,” Impact of divorce, single parenting and step parenting on children, New York: Routledge, 2001
Hughes Recker, “Parenting on your own:” Illinois, Routledge, 1999
Mary Temke, “The effects of Divorce on Children: Family and Consumer Resources,” Retrieved on April 5th 2010 from: http://74.125.153.132/search?q=cache%3AQPgXCQMt0pcJ%3Aextension.unh.edu%2FFamily%2FDocuments%2FDivorce.pdf+The+negative+effects+of+divorce+on+children&hl=en&gl=ke

Understanding the specific needs in Health & Social Care

Table of Content

Acknowledgement

Table of Content

Introduction

1.1 Roles of the health care agencies

1.2 Epidemiology of non infectious disease

Epidemiology of infectious disease

1.3 Effectiveness of different strategies and approaches

2.1 Regulate healthcare methods

2.2 Relationship of health and social care service provision

2.3 Current lifestyle choices lead to future health and social services

3.1 Health and wellbeing priorities

3.2 Encouraging behavioral changes

3.3 Changes needed for improving Health and wellbeing

Conclusion

Recommendations

References

Introduction

Without any doubt, health is the most important factor for a living being. A person’s life is depended on the well-being of health, not to mention all the regular activities are centered towards this. But with the increasing difficulties in regular living is making this very health deteriorating each day. It is very important for mass people to understand the basic of health dynamics. With the changes in the natural spectrum, huge changes have also taken place in human needs regarding needs of health and social care services. Not only the pattern has changed overtime, but also the perception towards these is transformed drastically.

1.1 The core concept- health & changes in perception regarding health and social care services

The fundamental pattern of health and social care is changed due to revolution in the need regarding this. There are various macro factors contributing to this, alongside the micro ones. In various countries, there are mammoth changes in the demographic pattern and the health literacy which has changed the whole landscape of health and social care services. To understand the perception of changing health and social care services it is very important to understand the underlying concepts like normality, disability, illness etc.

Normality:

Normality which is also known as normalcy depicts the behavior which is consistent with an individual’s most common behavior in terms of health factors. It is very vast term to describe and it in many cases it changes with the context. When it comes down to the definition of health, this normality is a very significant concept. A healthy state generally stands for normal and sound process of all the functions that drives a human being. Clinically normality represents the consistency between the bodily and psychological functions. The reverse is generally known as abnormality.

Disability:

Disability means partial or total forfeiture of a person’s bodily function which could be motor functionality, walking etc. As mentioned earlier this loss could be partial or complete and this could even be from birth. A person might have one disability or he could have multiple disabilities which could be ostensible for instance loss of a limb or it could also be in hidden form for example epilepsy or post-polio syndrome. Some types of disabilities are multiple-sclerosis, spina bifida etc.

There was time when there was a norm in the society which permitted the stigma and discrimination. People tend to avoid and stigmatize the person with illness, disabilities and it kept going on for a long period of time. The ultimate result of this was that it made the whole situation way more difficult for the affected person and consequentially, it becomes really hard for them to recover from the illness. The problem of mental illness is a common phenomenon for example at some point of life out of every four people generally experiences mental health problem. Still approximately one in every ten children faces various mental health problems. With the changes in the condition health and social care services have changed drastically. On the positive side, the stigmatization and discrimination have been reduced significantly due to continuous awareness in mass level.

1.2 impact of social policy, legislation and culture on availability of services

In the sector of health and social care, social policy along with legislation and culture play a great role when it comes to availability of necessary service for each a group of individuals having specific needs. If the social policy does not support the support the specific needs and patronize it in favorable way then it will become impossible to lead life in a favorable way. The legislation, in this case, is very important both on individual and mass level. For example, right now it is secretary of state’s responsibility to promote comprehensive health service all over UK which will lead to significant improvement in physical as well as mental health of the individual; in addition to this, the service will aid in not only the prevention but also the diagnosis of mental and physical issues. The outcome of the health and social care services will be measured based on the effective, quality and the experience of the concerned persons.

In this regard, only legislation and policy will not suffice in the long run. To make this kind of practice sustainable and craft the system in such flexible way so that the changes can be made whenever it is necessary. To attain this objective, the services required for the individuals with specific needs have to turned into a culture which people will adhere to follow, not for just the sake of legislation that has to be followed in formal manner.

2.1 the mechanism of supporting individual with specific needs

To attain this objective, the services required for the individuals with specific needs have to turned into a culture which people will adhere to follow, not for just the sake of legislation that has to be followed in formal manner. There are been number of cases of where health and social care do not work in harmony when it is about the meeting the specific needs of the individuals. Every year total number of people in UK requiring both health and social care is on an increasing trend. Just for example, total percentage of individuals crossing eighty five will double in the next twenty years which will arouse the complex need

https://www.gov.uk/government/policies/making-sure-health-and-social-care-services-work-together

of health care as well as social care. By complex need of health care we refer to multiple health problem at the same time which need to be backed up by the social care services. So far the most glaring issue is that, these two are not collaborating as per expected level. And this is turning into a big problem for the service takers. For example, a person after staying a while in hospital requiring final treatment is trying to know how many days he might have stay after treatment. Over the period of time, being in hospital became a gruesome experience for him; but this mental issue is mostly overlooked. This is just a representation of common scenario taking place most often. In many cases, one important parts either health care or social care is missing. When health and service care is joined up and given properly to the people, that has the highest probability of meeting individual need. This concept should be put into model and later on, it will work as a guiding principal for the health care and social care service providers.

2.2 evaluaiton of currently available system & services

Generally it is perceived that, when two services- health care and social care are collaborated it must be very beneficial for the people who are taking this service as well as for the service providers. But yet this notion is to be supported by number of facts.

http://www.ncbi.nlm.nih.gov/pubmed/14629210

there is an study done by Brown L, Tucker C by to evaluate the efficacy of the currently available system of health care and social care to meet the specific needs of the individuals. This study more of less represents the current scenario of available systems. The study was conducted among a group of aged persons who were given both health care and social care. In the initial stage the result was very much aspiring. The health care and social care needs were assessed successfully and in a timely manner. This was like a one stop approach for two big aspects catering the individual needs. The whole process of communication of the issue, understanding the aspect and the exchange of required information was drastically improved but it comes down to implementation this seemed not to work properly. Even though the individual need assessed properly, the problem started in the implementation level. The implementation of the service was not satisfactory because of the duly implementation as well as the follow up process. Innovation in the phase of implementation can play a great role as well as the change in implementation process also. Even though two entities giving health and social care services have the same goal they have different organizational structure, ideology and working process. During the implementation phase, it becomes very difficult to accommodate both services in subsequent point of time. So far in nationwide analysis, the same problem is been observed. Even though the general perception is that, the outcome has to be good naturally the fact is quite the opposite. In many cases the efficacy of current model is questioned thoroughly. To make these two services more appropriate and effective for the individual needs it is very important to do the organizational and legal fixes rather than just focusing first hand coordination portion.

3.1 understanding approaches & intervention strategies supporting individual specific needs

There can be a number of ways to support the individual need with health care and social care, but it is very important to come up with the best strategy and blend it effectively. Here the challenge is, each individual aspect for example health care can be appropriate in its own stance but when it comes to collaboration the approach will be different. Let us consider a common scenario- Autism where it is very important to use the perfect strategy to meet the individual specific need.

Since there is hardly any permanent cure for autism, the professional bodies use a number of approaches that aid the concern in different ways. The most challenging aspect in this case is, there are never two individuals with exact same case of autism where a approach might perfect work one person, whereas the same approach will fail with slightly different case.

http://www.autism.org.uk/living-with-autism/strategies-and-approaches.aspx

before coming up with the exact approach it is highly important to gather all the relevant data pertaining to the autism for that specific individual. In addition to this, dealing with this is a long term approach, so while choosing the method one must be very careful and plan down the line what might take place. One standard startup intervention procedure is health and service based intervention. Apart from the health and service based intervention The starting intervention could be like behavioral and developmental intervention, motor and sensory intervention, counseling etc.

Health and service based intervention takes places in multiple phases and it needs to be planned beforehand. Standard Health and service based intervention is planned based on the focus to constantly uphold the well being of the individual with autism which will require a vast range of treatment and therapies as well as well a number of sociological approach. The common scenario is to use variety of approaches and methods which generally include professional therapists, speech, langue therapist along with psychological therapists. This panel of therapists will be working together to ensure the proper development of the concern. This combination of different therapies is used with behavioral, motor sensory, augmentative in addition to alternative intervention method. Among these, the standard procedure of health care includes standard operational procedures like medication, psychotherapy, physiotherapy, speech pathology aiming at the development of speech and language. On the other hand, service based interventions generally include aiding people in education, development of social skills, day to day basis development on social skills, accessing the needs and change in those and respond accordingly. This is just the beginning. The challenge with autism is the lack of awareness and when people do not admit to have the autism. It is a common barrier for autism. The autism is most cases is invisible because it just possess few signs; so it becomes really difficult what exact health and social care needs are required for he particular individual and how it can be tailored to maximize the benefits. Starting from the daily rituals to particular special activities, everything needs to be chalked out and it needs to done on a daily basis. This is one approach dealing with the individual with autism. Another approach could be, after assessing all the possibilities, figuring out two or three most potential route to deal with the scenario and start trying those out in a controlled setting for smaller time being. After getting the results, the best method will be carried forward. The disadvantage with this approach is that the change could have negative impact on the concern. That it is very important to access the health and social care needs thoroughly at first and then act on this. The social care support might be very extensive here, starting from the education it could end up in finding appropriate works. The employment service are designed in such a way that it suits individual abilities and needs and to make the approach successful the team of health and social care need to work closely with the family members, at least at the very first stage they need to collaborate with the concerned family to understand the early stage development scope and devise the plan accordingly.

3.2 need for development and support for individual with specific need

Specific development methods need to be applied for the individual with specific needs, more specifically showing different characteristics. Other than the social needs, the health and wellbeing need to be checked on a regular basis because at the end of the day, if he does not have the functioning body he won’t be able to do anything else. For this purpose, the health needs have to identified thoroughly and plan the acts based on that. There could be a number of activities which the person has to undergo and for convenience, these should be turned into a ritual format so that it becomes easier. Apart from these, health improvement needs to be monitored on a regular basis. Other than this it will not be possible to track the whether the approach is right or wrong. There should scope for adaptions and improvisations to make the process much better and updated.

4.1 Strategies for coping up with challenges, potential impact of challenges and strategies to cope up

While working in health and social care there are a number of scenarios posing specific challenges. Below are two of them-

With the increasing access to information, people are right now more knowledgeable in various subjects, even it could be to small extent but with the blessing of technology information is on the fingertips. But analyzing this information is totally different issue. In most cases being a part of health and social care I have seen that, the parents or relatives of the person taking services are intruding into the operational procedure without having sufficient knowledge on the subject. It is very much possible that it happens because of their extra cautiousness towards the wellbeing of their closed ones. Since we have deal with concern usually on a long term basis it becomes very difficult to experience this kind of intrusion. Another challenge is to tailor the service with the given agenda and financial constrain. In many cases, it becomes very difficult to meet specific need by tailoring it as per the agenda given. This is mainly because of the continuously changing demand and increasing public expectation. Since there are multiple entities involved in this procedure, it is very difficult to accommodate minor changes if that are done on a continuous basis.

The potential impact of the challenging behavior on the health and social acre is that the health and social care givers have to be pretty much through regarding their understanding of the all the necessities and act accordingly. Starting from the planning, collaboration and execution phase they have to be very much cautious and the same time flexible regarding the plan. All the works need to be functionally assessed all the time and regular evaluation has become mandatory for the efficacy of the work.

The core strategy to keep up with challenge is support from all the entities, be it the party taking the service or the one giving this. While dealing with the challenges clear target need to be set regarding the timeline, deliverables and all other specific activities. For working the with the challenging behaviors regarding specific needs it is very important to clearly communicate with the involved member, share the course of actions along with other specifications clearly. The rewards and sanctions will be set in such a way that it best suits and eases the operational procedure.

Introduction

Work life balance has become the hot issue around the world. In the United Kingdom, a high level of support has been given to work life balance. Employers think people can only give best performance when they can strike a balance of work and life. In the United States, more importance has been given to work life balance, it has accounted for more than two-thirds of work characteristics that has been rated by surveyed companies which they think to be “absolutely essential” to attract and retain the talent. (Michaels, Handfield- Jones & Axelrod, 2001)

In Hong Kong, a survey is conducted on work life balance has indicated that more than 80% of employees being interviewed and they have considered work life balance as important to them and only less then 50% of them said that they were able to achieve it.

Literature Review

Over the past decades, balance between work and other factors of life has been made much difficult which happened due to changes in technology, demographic workforce and business environment. It is now become a challenge for modern employees to achieve work life balance without jeopardizing their well being and satisfaction with other aspect of the lives and overall quality of life. Technological advancements, like mobile phones, internet, have enabled people to conduct work anywhere and at anytime, whether they are on holidays or flying on planes. Furthermore the use of computers has changed their lives as people are taking their work to home. Long working hours now becomes a norm in many countries worldwide. Which have indirectly increased the workload, long hour’s culture and job insecurity?

Over the past decades, the employment of women has increased substantially. In some developed economies, women are occupied half or more of workforce (International Labor Office 2007). In 2005, about 88 million women whose ages lie between 20 to 64 were employed in the United States, which was the 50.8% of the total workforce (US Census Bureau, 2005) and 70.9% of the women were participated in labor force in 2005.

Work Life Balance

Work life balance was first used in the late 1970 that actually describes that the individual has a personal life too. Work and life balance is important and it should be manage in way that increases satisfaction. Individual’s personal life in which family, friends, love, play etc comes.

Work life balance is about people manage the difference between work and life. How they manage work and life. Work life balance is important only in the framework of what company does for the individual worker.

The work life balance however is a two pronged approach, it is achievement with enjoyment. If the employee is giving his best input to the organization but not really enjoying the same then happiness then satisfaction can not be achieved.

Work life balance does not mean only balancing the profession and family, it means balancing the mental and status quo and balancing the emotional intelligence. Organizations facilitate their employees via implementing work life balance and training.

There is a life at home and at work and life having space for leisure time. If the employee work life is imbalance then it effect comes on productivity means productivity is declining and efficiency level is also decreasing, the imbalance work life has a negative impact in professional and personal life. Imbalance work life results in absenteeism, turnover, less committed to organization.

Employee retention is seriously important for organizations. Now organizations are focusing on grooming their employees and treating them as human capital of the organization.

That’s why companies most of the companies are implementing work life balance by facilitating part time work, work at home, attend meeting via video conferencing, can do job sharing.

Work life and personal life are two sides of the same coin. According to various work life balance surveys, more then 60% respondents said they are not able to find the balance between them. They have to make difficult decision between work and personal life. But now it is close to equilibrium. Traditionally managing a balance between life and work was considered to be a woman’s issue but increasing work pressure, technological changes and globalization have made this issue for male and female, all professionals working across all countries. Achieving a balance work life is not simple as it seen.

Personal life and work life both are inter-connected and interdependent and doing long hours job, dealing with clients, deadlines in jobs can interfere and affect the personal life of an individual and sometimes it becomes difficult to maintain the relationship. On the other side, personal life can also be demanding such as kids, wife, parents and relatives, giving them time is very important. If not managing then it leads to absenteeism form work, stress level increases and concentration on work diminishes.

The work life balance conflict occurs when burden, obligations and responsibilities and family roles becomes incompatible.

Need and Benefits of Work Life Balance

Today the deadlines of work are getting tighter and it’s really much difficult for an individual to achieve it. Due to these deadlines it becomes difficult to maintain a family life. It is difficult to have engagement of min with the engagement of body. In every individual’s life there are four stakeholders- his or her personality, family, job and the society.

It is very important for an individual person to give equal importance to all stakeholders (personality, family, job and society) and then an individual can term as successful person. When a life is imbalance then happiness, peace and harmony of life vanishes and it has a negative impact on work life too. So it is very important to avoid imbalance of life. The transition of work life imbalance and work life balance has negative and positive impact on organization’s success.

On an individual level work life balance bring phenomenal changes in his life and also have impact on society. A balance work life results in good health, stress level decline due to health levels and can derive more value form work and life and which leads to satisfaction and self actualization.

At the organizational level, balance work life enables productivity and efficiency and employees becomes more creative and derive more satisfaction. Employee better communicate and do better teamwork in a working environment. Work life balance leads to fully enjoying the work and which increases passion for it, which results in employees commitment level increases and thus develops a strong value system.

Advantages of Work Life Balance

Many organizations such as IBM, Merrill Lynch, Pfizer and Accenture have introduced work life programme within their companies to help their employees to achieve effective balance between the work and personal life because they believe that it makes good business sense to provide such programmes to their employees due to financial and non-financial benefits that can be reaped.

Policies and practices of work life balance are good for business; there are many benefits for the business who have implemented it.

The one of the most important advantage of work life balance is that employee feel satisfaction because of managing the work and life.

Organizations implement work life balance in order to attract or retain talented employees.

This work life balance was implemented by organizations to decrease the labor turnover in the organizations.

It increases the productivity in the organizations because of the work life balance.

When people are satisfied with their life as well as work means they have kept the balance between work and personal life, which results in less absenteeism in the organization.

It increases the overall profit in the organization because of balance between work and personal life.

Organizations implemented work life balance then it increases overall profit in any organization as employees are working hard to increase productivity.

Employees are loyal where organizations have implemented work life balance.

An overall more enjoyable workplace as all employees are achieving and enjoying.

Employees give best input to organization as they are happy with their life and work balance.

Work life balance initiates an individual to give his best input to organization and work hard to achieve organizational goals and provides innovative ideas and thus organization rapidly grow in the direction of success.

When an individual has work life balance then he or she can better know how to spend the time.

Employees less miss the time as they have well manage the work and personal life.

Depression is a condition of mental disturbance and when employee’s work life is balance and he or she can perfectly manages everything.

Individual have other things to do in life then work which is as playing, giving time to family means spending time with the family, meeting with friends etc. So work life balance is very important in individual’s life.

There are many responsibilities of an individual such responsibility parents, wife, children and as well as of society so work life balance is very important in respect to managing these multiple responsibilities at a time.

Companies who have implemented work life balance programme, they have reduces the health cost as employee have to work less and that’s the reason they have good health.

According to the Corporate Executive Board’s Research, effective work life balance encourages workers to work harder and discourage them for leaving the job.

The worker can easily meet the need of family, personal obligations and the life responsibility.

Employees are more committed to organizations who have implemented it.

Employer can recruit outstanding or talented employees in the company.

Implementation, Effect and Results of work life balance in Pakistan

Implementation, Effect and Results of work life balance in Pakistan
The Unilever Pakistan Limited

The Unilever Pakistan Limited, formerly Lever Brothers Pakistan Limited was established in 1948. Unilever Pakistan is one of the largest fast moving consumer goods (FMCG) company in the Pakistan and has a multinational operational network.

The Unilever Pakistan Limited has implemented work life balance to facilitate their employees to enjoy and improve productivity in the organization.

Unilever, Pakistan has given employees the chance to work flexibly through different schemes which is as part time job, work at home and job sharing.

They have change the way they work in past. But now they avoid travelling to meetings which cost money and it also impacts the environment and takes the people far away from home. That’s why they have introduced effective ways to communicate through new generation video conferencing, virtual meetings, videophones and online collaboration environments.

In the result of work life balance implementation in Unilever, Pakistan; employees are more committed, highly satisfied and loyal to the company and have less turnover.

Procter & Gamble, Pakistan

Procter & Gamble, Pakistan was established in 1991 and is global consumer goods company which is locally operating in a Pakistan that provides premium quality product for their consumers.

Procter and Gamble has implemented work life balance. According to their view, they believe that work life balance is as important as the performance. They have fitness clubs, days-off to work from home programmes. They are giving special consideration to working mothers. In results of implementing the work life in Procter Gamble employees are more productive which translates to success.

Telenor Pakistan
Telenor Pakistan is owned by the Telenor Group and is an international provider of voice, data, and content and mobile communication service.
Telenor has implemented work life balance which they believe is critical to their business success. They have provided in-office facilities to their employees such as gyms, game rooms and cafes to get relax at work and enjoy these facilities.
The other organizations who have implemented work life balance in Pakistan are;
BankIslami Pakistan, Pakistan State Oil, Netsol – Pakistan, National Bank of Pakistan, Pfizer Pakistan, Nestle Pakistan, State Bank of Pakistan, Daewoo Pakistan, Pakistan National Shipping Corporation, Standard Chartered Bank Pakistan, Pakistan Steel Mills, Dubai Islamic Bank Pakistan, Pakistan, Pakistan, Gourmet Foods (Pakistan), State Life Insurance Corporation Of Pakistan, PEPCO Pakistan, Qubee (Augere Pakistan), Citibank Pakistan, United Energy Pakistan Limited, OCS Pakistan, Tetra Pak Pakistan, Mobilink Pakistan, PepsiCo, Chartis Insurance Company, Pakistan Water and Power Supply Authority, Roche Pakistan Limited, Publicis Pakistan, Engro Foods, The Coca-Cola Company, World call Telecom, Nokia, Xavor
Conclusion
Work life balance remains an important issue that requires considerable attention from organizations. Nowadays many organizations operates 24/7 schedule and technological advancement has made it easy to connect all the time. Employers have found out that burnt-out employees are nearly useless while satisfied employees are the key to organization’s success in future. To this ends, many organization has implemented work life balance programs to facilitate employees in handling conflicts that may arise between work and life. The work life balance programs incorporated at organizations providing the flexibility and support that help employees manage the complexities of modern life.
Outcomes of imperfect Work life balance

Stress

The number of employees suffering from many ailments including hypertension, heart attack, diabetes has grown in recent years, which worst effected by long working hours and stressful working hours.

Relational Problems

If the employees spend more time in the workplace rather then spending time with the parents, spouses, children and family, can disturb the relationship as there is no longer time to give for these relations.

Unethical Practices

To handle the stress in the organizations as well as in the home, employees tend to adopt unethical practices such as smoking, drugs, improper relations etc.

Community care essentially aims to provide individuals in need with social, medical and health support in their own homes, as far as possible, rather than in residential establishments or in long-stay institutions. The enactment of the NHS and Community Care Act in 1990 marked a watershed in the evolution of community care practice in the UK (Means, et al, 2002, p 71). Implemented after years of discussion on the social and financial viability of maintaining people in institutions and homes, the NHS and Community Care Act, initiated by Margaret Thatcher, showcased her desire to radically change the practice and delivery of social and health care in the UK (Means, et al, 2002, p 71).

The years following the passing of the Act have witnessed significant developments in the practice and delivery of social work in the country. This short essay attempts to investigate the basic reasons for the enactment of the NHS and the Community Care Act, its basic ideology and thrust, and its impact on the social work sector of the country. The essay also studies the developments in social care that have occurred in the years following the act, with particular focus on direct payments for people with learning disabilities, social care provisions for carers and the contemporary emphasis on personalisation.

NHS and Community Care Act 1990

Whilst the initiation of the policy of community care in the UK is by and large attributed to Margaret Thatcher’s conservative government, the concept of community care, even at that time, was not exactly new (Borzaga & Defourny, 2001, p 43). The need for community care existed from the beginning of the 1950s. It aimed to provide a better and more cost effective way to help individuals with mental health concerns and physical disabilities by removing them from impersonal, old, and often harsh institutional environments, and taking care of them in their home environments (Borzaga & Defourny, 2001, p 43). Although various governments, since the 1950s, supported the need to introduce community care and tried to bring in appropriate changes, lack of concrete action on the issue resulted in constant increase of the number of people in residential establishments and large institutions during the 1960s, 70s and 80s (Borzaga & Defourny, 2001, p 43).

With numerous negative stories coming out in the media on the difficult conditions in such establishments, Sir Roy Griffiths was invited by Margaret Thatcher to investigate the issue of community care for the residents of such establishments and make appropriate recommendations (Harris, 2002, p 11). The Griffiths, (1988), Report named “Community Care: Agenda for Action”, followed by the publication of a White Paper “Caring for People: Community Care in the Next Decade and Beyond” in 1989 led to the enactment of the NHS and Community Care Act 1990 (Cass, 2007, p 241).

Apart from being a strong attempt to improve the lives of people in long term institutions and residential establishments, the law was also an outcome of the conservative government’s desire to bring market reforms into the public sector and stimulate the private sector to enter the social services, as well as its conviction that competitive markets would be better able to provide more economic services than a bureaucratised public sector (Harris, 2009, p 3). With social services being among the highest revenue spending departments at the local authority level and domiciliary and residential services for older people consuming the bulk of social service funds, community care for older people presented an obvious area for introduction and implementation of market principles (Harris, 2009, p 3).

The act split the role of local and health authorities by altering their internal structures, so that local authority departments were required to ascertain the needs of individuals and thereafter purchase required services from providers (Lewis, et al, 1994, p 28). Health organisations, in order to become providers of such services, became NHS trusts that competed with each other. The act also required local social service and health authorities to jointly agree to community care plans for the local implementation of individual care plans for long term and vulnerable psychiatric patients (Lewis, et al, 1994, p 28).

The act has however come in for varying degrees of criticism from service users, observers and experts, with some observers claiming the altered care conditions to be unresponsive, inefficient and offering little choice or equity (Malin, et al, 2002, p 17). Other experts, who were not so pessimistic, stated that whilst the system was based upon an excellent idea, it was little better in practice than the previous systems of bureaucratic resource allocation and received little commitment from social services; the lead community care agency (Malin, et al, 2002, p 17). The commitment of local authorities was diluted by the service legacies of the past and vested professional interest, even as social services and health services workers were unable to work well together (Malin, et al, 2002, p 17). Little collaboration took place between social and health services and the impact of the reforms was undermined by chronic government underfunding. The voluntary sector became the main beneficiary of this thrust for the development of a mixed economy of care (Malin, et al, 2002, p 17).

Developments after the Enactment of the NHS and Community Care Act

The assumption of government by the labour party in 1997 resulted in the progressive adoption of numerous forward looking policies in various areas of social care. The publication of a white paper in 1998 reinforced the government’s commitment to promotion of community based care and people’s independence (Means, et al, 2002, p 79). The paper focused on assisting people to achieve and maintain independence through prevention and rehabilitation strategies, with specific grants being introduced to facilitate their implementation. The Health Act of 1999 removed obstacles to the joint working of health and social services departments through provisions for pooling of budgets and merging of services (Means, et al, 2002, p 79). The formulation of the NHS plan aimed to improve partnership between health and social care, the development of intermediate care and the construction of capacity for care through “cash for change” grants for development of capacity across social and health care systems (Means, et al, 2002, p 79).

Direct Payments for Individuals with Learning Disabilities

The Community Care (Direct Payments) Act 1996, which came into operation in April 1997, marked a radical change in the provision of community care for people with disabilities, including those with learning difficulties (Tucker, et al, 2008, p 210). It was illegal, prior to the implementation of the act, for local authorities to support people with disabilities by making cash payments in lieu of providing community care services. Policymakers however realised that many local authorities were successfully supporting independent living schemes, centres for independent living and personal assistance schemes (Tucker, et al, 2008, p 210). Such schemes handled community care payments for disabled people and provided them with help to organise assistance or support. The Community Care (Direct Payments) Act built on this situation, allowing direct payments to be made to replace care services, which otherwise would be given by social service departments (Tucker, et al, 2008, p 210).

Direct payments provide flexibility in the way services are provided to eligible people. The giving of money, in lieu of social care services, helps people to achieve greater control and choice over their lives and enables them to decide on the time and mode of delivery of services (Tucker, et al, 2008, p 210). Direct payments can not only be used for services to satisfy the needs of children or their families but also enables carers to purchase the services they need to sustain them in their roles. Research conducted in 1997 in the utilisation of direct payments by people with learning difficulties revealed that whilst utilisation of direct payments by people with learning disabilities was increasing, such utilisation was low among women and individuals from minority or black ethnic groups (Tucker, et al, 2008, p 210). Research also revealed the presence of wide differences in the interpretation of the capacity of persons for consenting to direct payments by local authorities. Whilst some local authorities felt that direct payments could be sanctioned to all persons with learning difficulties who were able, with assistance, to successfully control and use direct payments, other authorities did not heed the fact that such people could indeed be assisted to communicate decisions and consequently assumed their inability to consent to direct payments. Such interpretations, it was felt, could debar many people in need from obtaining the facility for direct payments (Tucker, et al, 2008, p 211).

Assistance for Carers

Recent years have seen a number of social care initiatives for easing the condition of carers. Carers are people who provide assistance and support, without payment, to family members or friends, who are unable to manage without such assistance, on account of illness, frailty or disability (Government Equalities Office, 2010, p 1). Carers can include adults who care for other adults, parents who care for disabled or ill children, or young people who care for other family members. The government’s social care policies for carers include supporting people with caring responsibilities for (a) identifying themselves at early stages, (b) recognising the worth of their contribution, and (c) involving them from the beginning in designing and planning individual care (Government Equalities Office, 2010, p 1).

Such policies aim to enable carers to (a) satisfy their educational needs and employment potential, and (b) provide personalised support, both for carers and the people they support, to enjoy family and community life and remain physically and mentally well. Whilst the NHS and community care Act 1990 looked at carers as valued resources because of their ability to provide support, it did not refer to their rights; relying instead on rhetoric to deliver the message of their value to society (Government Equalities Office, 2010, p 2). Succeeding years have however witnessed greater focus on the needs of carers and to progressive introduction of suitable laws and appropriate policies. The passing of the Carers (Recognition and Services) Act 1995 drew attention to the needs of carers. This was followed by the passing of the Carers and Disabled Children Act 2000 and the Carers (Equal Opportunities) Act 2004 (Government Equalities Office, 2010, p 2). These acts entitle carers for (a) assessment of their needs, (b) services in their own right and support in accessing education training, employment and leisure opportunities. The proposed equality bill introduces four new opportunities for carers. It (a) requires public authorities to give due consideration to socio-economic disadvantages, whilst exercising strategic planning functions, (b) takes account of associative discrimination with regard to disabled people, (c) provides for prevention of indirect discrimination, and (d) calls upon public bodies to ensure that their policies are designed to eliminate harassment and discrimination and further equality of opportunity (Government Equalities Office, 2010, p 2).

Personalisation

The concept of personalisation in social care, whilst discussed for some years, was formally inducted into social care practice in the UK with the publication of Putting People First in 2007.

The concordat outlined the concept of a personalised adult social care system, where individuals will have extensive control and choice over the services received by them. The government committed that social services would progressively be tailored to meet the preferences of citizens, with person centred planning along with self directed support becoming mainstream activities, assisted by personal budgets for maximising control and choice (Aldred, 2008, p 31). Whilst personal budgets and direct payments form an important aspect of personalisation, the idea concerns fitting services to the needs of people, focusing on outcomes, and recognising the worth of the opinions of service users assessing their own needs, planning their service, and producing their outcomes (Aldred, 2008, p 31).

Conclusions and the Way Forward

This essay investigates the reasons behind the enactment of the NHS and the Community Care Act and studies the developments in social care that have occurred in the years following the act, especially in areas of direct payments for people with learning disabilities, social care for carers and personalisation. It is obvious from the results of the study that social care in the UK has experienced significant change and metamorphosis since the enactment of the 1990 act.

Whilst significant progress has been made a consensus s growing that the British social care system is facing a crisis because of drivers like increasing demographic pressures, alterations in family and social structures, rising public expectations, increasing desire for greater choice and control, and eligibility for services (Glasby, et al, 2010, p 11). The need to move people out of local accommodation because of rising rents exemplifies the challenges faced by the social care system.

With the financial system becoming more challenging, the social care system will have to find ways of improving efficiencies without diluting the quality of care (Glasby, et al, 2010, p 11). The next round of social reforms, whilst attempting to achieve better delivery efficiencies will have to renew its commitment to satisfying social expectations and basic human rights, reducing costs, preventing future needs, helping people to regain independence, freeing individuals to contribute, and supporting carers to care and contribute to society (Glasby, et al, 2010, p 11).