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Alyna Punjwani

Mentally ill people not only suffers from psychological distress, but “they often experience significant physical, social, and cognitive disability” (Kaur, Masaun, & Bhatia, 2013, p.404). To help patients cope up with these issues, along with psychological treatment, physical activity plays a therapeutic role. According to Moodie (2001), “Physical activity refers to virtually any sustained bodily movement that expends energy” (p.02). It ranges from simple tasks, like activities of daily living, to complex tasks like competitive sports (Doh, 2004 as cited in Creek, 2008). Participating in Physical activity helps an individual to improve physical, psychological as well as emotional health (Mcguirk, 2012).

Sedentary lifestyle among the mentally ill clients is the significant problem among all psychiatric care (Happell, Scott, Platania-Phung & Nankivell, 2012). Consequently, physical activity is the initial step to reduce their dependency on others. It conveys a sense of hope, power, and control towards their lives which encourages them to actively participate in daily living activites. Therefore, when these clients move back to their community, they would not be dependent on others and would be self-sufficient to care for themselves.

During my mental health clinical, I and my group members conducted a morning session for all the patients in Karwan-e-Hayat psychiatric hospital. While interacting with the patients, I felt that they are distressed, and not communicating their feelings and thoughts to the fullest. After 15 minutes of unhealthy communication, the group members thought to start some physical activity. We played music and instructed everyone to participate. Most of the patients participated and it was clearly evident that they are thoroughly enjoying it. Even those patients who were not communicating initially, also joined in for the physical activity. After 10 minutes of this activity, we resumed our communication. I observed that now everyone is expressing their views and thoughts. One of the patient, who was primarily not contributing at all in the communication, shared with us the beautiful poetry in Urdu. This drastic change in the patients urged me to think about the impact of physical activity on client’s wellbeing.

On analyzing the case scenario, CARE framework could be integrated effectively. Engagement is found to be the most appropriate component of this framework, whereby the physical activity could be applied. One of the goal of this component is to offer opportunities to the client in order to move together towards a therapeutic change in the client (Mcallister & Walsh, 2003). As in the case scenario, activities were demonstrated first and the clients were expected to model those acts. Hence, demonstrating, providing support, and providing a motivation that there is a possibility to enact a positive change helps achieve this goal.

Every person with mental disorder is different from the other, but they have one thing in common i.e. low level of physical activity (Dunn & Jwell 2010). Physical activity is useful as it increases cognitive function. According to Ratey and Loehr (2011), exercise causes angiogenesis in temporal lobe, frontal lobe, and parietal cortex leading to increase blood flow towards these parts of the brain which in turn results in escalation of memory, learning, and attention. As highlighted in the case scenario, the client shared an amazing poetry in Urdu which indicates that physical activity had an effect in his cognitive functioning and memory. Moreover, exercise increases the uptake of insulin-like-growth factor (IGF-1), it crosses the blood brain barrier, and increases neurogenesis in a specific part of brain called hippocampus. Hence, further enhancing the cognitive function (Trejo, Carro, & Torres, 2001 as cited in Ratey & Loehr, 2011). In addition, Cohen and Shamas (2009) states that during physical activity, the body releases high amount of nor-adrenaline, dopamine and serotonin which effects the part of brain dealing with arousal and attention. As highlighted in the case that all the clients were more focused, and more involved in communication after the period of physical activity.

In addition, physical activity also serves as a coping mechanism. As schizophrenic patients engage themselves in different activities, it diverts their mind and distracts them from hallucinations (Richardson et al., 2005). Similarly, it can be an adaptive coping strategy for aggressive patients. For example one client verbalized that whenever he gets angry or frustrated, he goes outside and walks for about 5 minutes which gives him a sense of relaxation, and the feeling of anger diminishes eventually. Moreover, Physical activity is also useful in order to boost up self-esteem of the client. The successful completion of particular task may lead to increase self-confidence and self-efficiency (Crone, Smith, & Gough 2006). Hence, it is important to analyze the ability of the client to accomplish a task before involving them in activity. For example, during our exercise session, one patient was having difficulty performing the exercise due to his asthmatic condition. As we used directive approach for the exercise, everyone was doing it but the asthmatic client had to give-up and sit back in order to stabilize his condition. The client verbalized “I cannot do it anymore”. This would have created a doubt within him regarding his abilities and competency to achieve that goal. Apart from that, clients were talking to each other, and learning from others by observing them. Hence, physical activity provides a platform to bring people together, to promote interaction, and to contribute towards community cohesion in culturally diverse group. It creates a sense of belonging among other clients thereby promoting social inclusion (Trimble, 2012).

The socio-cultural barrier I found was that the activity was done with all the male and female clients together, which was an inappropriate intervention in respect to the Pakistani culture. This was one the major hindering factor in promoting the physical activities in psychiatric setting. Hence, this practice has to be avoided in order to encourage the client to participate in these activities

As a nurse, it is very important to assess the patient’s ability to perform physical activities and recommend them accordingly. Societal, cultural and personal factors which hinders their ability to involve in activities must also be identified and addressed. Moreover, those patients who are unable to gather in activity area due to their disease process then separate activities should be planned for them to be performed in their own private space. The environment should be supportive and non-competitive to have a positive impact on client’s wellbeing. 15 to 30 minutes of moderate exercise for at-least 4 days a week is recommended for mentally ill clients (Richardson et al., 2005). It could be further adjusted according to client’s abilities. Intense physical activity at first should be avoided because it creates a sense of frustration and distress, further disrupting the patient’s condition. . It is necessary to reinforce the patients which gives a sense of achievement and boosts up their confidence level

At institutional level, integrating physical activities as part of the treatment therapy would increase adherence towards these activities. Moreover, goals should be planned collaboratively with psychologist, therapist, and other medical health care workers to ensure effective approach towards health promotion. Institution should make sure that physical activities are done on continuous basis because fragmented, inadequate, and unsupported activities are of no worth (Richardson et al., 2005).

At community, awareness sessions could be conducted to teach people about the impacts of physical activity on client’s well-being. This awareness could help mentally-ill patients in community to reduce their dependency

In our everyday lives we are faced with situations that do require us to work extremely hard. Whereas this is a very vital thing in every success of an organization, employees suffer severe health problems. This is because pressure emanating from this tight and demanding work conditions has with it several negative aspects. Amidst believes that pressure is necessary for an organization to achieve its mission it has greatly affected many lives. All organizations should educate themselves to be able to cope with this inevitable challenge and instead use it to make the health of workers less vulnerable. Also, an understanding as to the causes of work-related stress should also be studied.

Introduction

Today, most workers are faced with great challenges due to their work demands. Majority of organizations and companies invest a lot on labor. In this regard, workers play a vital role in the economic prosperity of the company they work. The profits realized are deemed to be equivalent to the amount of efforts put in by the workers. Employers, in most cases lay blame on the employees if in case their business does not perform effectively. In such circumstances employees suffer entrenchment or sucking, strict work conditions, lots of pressure among other worse conditions. This study seeks to demonstrate some of the health hazards posed to workers due to increased pressure at work.

Stress at Work Place

It is true that we all need some amount of pressure in all that we do to be able to appreciate our work and even derive satisfaction from it. This is also a valid reason why one will rush to meet deadlines. If our work environment is devoid of deadlines, workers involved would not have much to do and may even find themselves bored. This is a waste as far as their career is concerned since results and profits depend on how much we are able to deliver within certain time lines. Again, life today is full of struggles and up and downs, frustrations and endless demands. For almost everybody, stress is the order of the day and an inevitable aspect in our lives. As it has been widely believed that stress is harmful, some are of the opinion that it is not always bad. It acts as a catalyst for people to perform more productively, a means to cope with pressuring situations and pulls out the best from them. It becomes worse if the subjects are not able to control it or if the demands outweigh their capacity to handle situations. It is at this point that one’s mind and body pay the price. This becomes the beginning of many other health problems. Everyday, economic activities are changing and almost all employers are struggling to have in place products that can meet consumers’ needs. Due to this, a lot is demanded from the workers so that they can participate fully to meet the challenges and demands of the time. As demand for certain products change with time so do the expertise of the workers change, for example, a company dealing with phones may discover that mobile phones without internet services are no longer in demand. The company will put in double efforts to ensure that they have enough stock ready for the market. This increased changes occasion stress. Work-related stress poses a great danger to health both physically and socially and psychologically. This is because a worker’s efforts involve energy and muscle, emotions and thinking. For example, if an individual strains in manual work like carrying a heavy load he or she may experiences body pains, the same case applies to that individual who spends a lot of time doing mental management leading to psychological imbalances. Therefore, it cannot be assumed that stress at work place only affects the health of the workers physically but also the effects extend to their soul. Stress at work place is indisputable and it has even been argued that stress is useful. It is seen as a way to motivate workers and drive them to been more productive. As mentioned earlier, most organizations are faced with changes in time and environment; hence pressure at work place instills fire in the workers to cope with the modern circumstances. Most governments have taken cognizance of the fact that work places pose a great danger to health. Policies to ensure the safety of the workers have been put in place. The U.S. National Institute for Occupational Safety and Health (NIOSH) developed a summary of levels of interventions and categories of prevention. Intervention in the primary level refers to efforts to protect the health of people who have not yet become sick. Secondary prevention involves early detection and prompt and effective efforts to correct the beginning stages of illness (for example, reversing high blood pressure, building up of plaque in the arteries, or chronic insomnia, before a heart attack occurs). Tertiary prevention consists of measures to reduce or eliminate long-term impairments and disabilities and minimize suffering after illness has occurred (for example, rehabilitation and return-to-work after a heart attack) (Landsbergis, 2009).

Impact of Work Place stress on Health

Rapid growth in economic activities and rise in consumer needs may create a pace unfavorable to the workers. As a result workers may be unable to cope with the situations. It is in such circumstances that pressure evolves among workers. Depressing stress grows and majority of workers may succumb to depression or insomnia. There are also occupational consequences for example, dissatisfactions in one’s job, less dedication to the organization’s vision, decreased performance and failing to report to duty or non attendance. Ellis argues that in the early stages job stress can ‘rev up’ the body and enhance performance in the work place thus the term ‘I perform better while under pressure’. However if this condition is allowed to go unchecked and the body is revved up further, the performance ultimately declines and the person’s health degenerates (Allis, 2005).

There exists a great variation on how people get affected by work-related stress and this also depends on how long they have been subjected to the source of stress and the amount or level of the stress itself. Typical symptoms of job stress can be: Insomnia, loss of mental concentration, anxiety, depression, sexual problems, alcohol and drug use, diabetes, heart disease, migraine, headaches, high blood pressure, digestive problems, skin rushes, sweating, blurred vision, tiredness and sleep problems, muscular tension, stomach problems and back problems. Stress at work place interferes with family life. There are cases where spouses fail to fulfill conjugal rights of their partners. The emotional life of the employees is normally affected and their libido lowers as such. It is from this that there are mood swings, poor appetite and low spirits.

In a random sample of just over 300 medical doctors and consultants throughout Germany, various job-related variables were assessed together with sociodemographic data including time-related parameters work, and specific categories of accidents (moving vehicle and work-related). Occupational stress was related to number of weekly working hours, duration of the lunch-break, as well as age. Moving vehicle accidents were significantly correlated with the incidence of work related accidents during the last year. There was no evidence that medical doctors working longer weekly hours were more likely to be involved in a driving or work-related accident per se, but they did tend to report more accidents during house visits. Moving vehicle accidents were best predicted by the onset of working day as well as the number of dependent children (more children associated with fewer accidents). Furthermore, work-related accidents were significantly more frequent in larger communities and when surgeries were later in finishing (PsycINFO Database Record, 2009). Look around. One of ten people you see at work, at the store, and wherever you go in your daily live is over stressed at any given moment. Scientists agree that stress causes actual chemical changes in the brain, and these changes can influence the state of your health (Cornforth, 2007).

There has been an on-going observation on the impact that stress has on the entire health of a person. Stress is associated with many backaches complaints and cancerous effects and chronic fatigue syndrome. Women may succumb to failure in menstruation or unusual blood loss. Hormonal imbalances as a result of stress may propagate the symptoms of fibroid tumors and endometriosis as well as make pregnancy difficult to realize for married partners with cases of infertility or impotence. Heart problems, high blood pressure, heart attacks and stroke are also stress related cardiovascular conditions. The effects go to the extent of interfering with the sexuality of women and sexual dysfunctions such as decreased desire and vaginal dryness. As outlined earlier, case of emotional problems may also arise such as depression, anxiety and lack of sleep. Gastrointestinal disorders, for example, ulcers and lower abdominal cramps. In most cases, people undergoing work related stress will have more infections in form of colds and other infections due to lowered immune system responses. . As noted earlier, work related stress not only affects our physicality but also extends to our psychological realm. In deed, it has severe psychological coercion. It is in the work place that busy schedules, arguments between colleagues or line managers with their junior staffs, accountants under pressure to settle bills or inconveniences as a result of traffic jam cause a lot of stress. Here, the body undergoes very strong reactions similar to the reactions faced when one is challenged and has to make a choice between life and death. This is never a pleasant situation and a lot of bodily tension occurs. Workers with lots of duties and responsibilities and worries due to deadlines, their response to stress is always on high alert. In fact, there are workers who succumb to such situations in the entire working life. Such long-term exposure to stress may can translate to grave health problems and complications. This is what can be referred to a chronic stress which actually disorganizes almost every system of the body. It is in such instance that one can fall victim of blood pressure, heart attack, impotence and even the person is more vulnerable to grow old prematurely.

It would be of paramount importance to not only look into the effects of work related stress on health but also understand the causes of such stress and how to manage it. In most cases a big percentage of employees globally will confess that their work is the source of stress in their lives. No wonder comments like ‘I had a very busy day’ or ‘had a stressful day with my client’ or ‘my boss does never understand’ and many others. As noted in an article published by Bupa’s health information team… Health and Safety Executive survey, one in six of all working individuals in UK reported that their job is very or extremely stressful. Work-related stress is also one of the biggest causes of sick leave (Bupa, 2008).

Some of the causes associated with stress include vulnerable and miserable working conditions, prolonged working periods, type of relationship with colleagues since team work is entrenched on this fact, diminished job security, means of transport may be unfavorable to some employees hence challenges in trying to commute to and from work, management of the company and low salaries and wages to mention a few. There are employees who feel under worked or overworked or feel that their job designation does not match their qualifications. For example, when one is supposed to serve as an accountant but assigned as the front office manager or a receptionist. These from the word go does not give satisfaction to the employee. In rare cases will one posit a particular cause of work-related stress. All in all it can evolve due to sudden, unexpected pressures and more so due to the combination of stressful factors that develop as time goes. . As mentioned earlier, pressure is an indisputable factor in any work place. In strict sense, no work without pressure, therefore employees need to educate themselves on how to deal with stress successfully. The negative aspects of job stress need to be pruned in a number of ways. For example, every employer should seek to understand how they function at work. This builds their self esteem at all times. Good time management to avoid inconveniences, for example, in the case when one is caught up in a traffic jam and cannot get to work in time. It would be prudent to start moving early. If one is faced with many deadlines and tasks to perform, one can prioritize them in order of importance and urgency. Through team work, one can delegate some of the work to other colleagues. Break and relaxation is also highly recommended. There are employees who want to do many tasks at the same time instead of doing one task and after its completion take on the other. Managers should create a conducive atmosphere for all where each employee feels comfortable and accepted. . Organizations should at least, have a health and safety officer who can ensure that proper mechanisms have been put in place to safeguard the workers from unnecessary causes of work-related stress.

Conclusion

In deed, work-related stress is an omen that will keep on affecting the lives of many organizations. We have seen the symbiotic relationship there is between pressure and any work environment. I strongly agree that much is on how to deal with work related stress. It is clear that we cannot eradicate it in our reality as workers. Any government must put in place measures that address the basic needs of workers or rights of workers and essentially to protect them from risks posed to their health due to job stress. Any employer or organization who deliberately fails to provide a comfortable work environment should be said to commit a crime punishable by law and. In addition, a compensation policy should also be entrenched to reward all workers who suffer unjustly from work related stress.

To what extent do theories relating to risk inform our understanding of an aspect or aspects of contemporary social work? I am going to briefly discuss the meanings of risk. Whilst I am aware that there are many theories of risk, I have identified three main themes and will be exploring these in relation to contemporary social work, the themes of governmentality, cultural theory and risk society.

Present day social work is concerned with matters of vulnerability and risk (Kemshall et al, 1997), (Dalrymple and Burke, 2006), (Parton, 1996), (Titterton, 2005), (Hothersall and Mass-Lowit, 2010). Media coverage of serious case reviews regarding the deaths of children have led to an onslaught of criticism into social work practice.

In looking for definitions to define risk, I found several meanings. Traditionally risk was defined neutrally as a ‘chance’ or likelihood a behaviour or event will occur (Lishman, 2002: 154), (Munro, 2002:64), for example the possibility of a gain as well as a loss. Kemshall (2002) discusses the uses of risk to insurance and a mathematical probability approach to risk. In postmodern society, risk is now attributed to the terms of “danger” or “hazard” (Lupton, 1999 a: 12).

The concept of ‘Governmentality’ was developed by the French philosopher Michel Foucault in the later years of his life between the late 1970’s and his death in 1984. His concept provides an understanding of power, not just in terms of the power of the state from a top-down approach, but in the “more subtle forms of power exercised through a network of institutions, practices, procedures and techniques which act to regulate social conduct” (Joseph 2010:225). Power is noticeable in a positive way through the production of knowledge and discourses that are internalised by individuals, guiding the behaviour of populations and leading to more efficient forms of social control. Parton (1994) cited in Pease (2002) writes how individuals permit government at a distance through being encouraged and supported to exercise freedom and choice. Because power is de-centred individuals play a role in their own self-governance.

Criticisms of Foucault argue that he fails to recognise that power is not equal to all. It can also be argued that he lacks reference to the exercise of power in relation to race, age, gender and class, especially how accessible power is between different social groups. Cooper (1994: 450) argues about the “character” of the technologies of power regarding racist and gendered discourses being used. It was argued that Foucault was not attentive to how people respond to discourses in their daily lives (Lupton: 1999 b: 102). Critics also believed that Foucault lacked awareness in the power institutions had over individuals and that individuals behaviour in society was down to following rules of conventions (Hoy: 1986:151). Feminist critics such as Hartstock (1990:171-172) believe Foucault’s understanding of power diminishes individuals to objects of power than individuals able to resist.

Foucault’s work on defining the relations and mechanisms of power like governmentality can support social workers to think about their position of power within the structures (that maintain the oppression of service users) in their work. Empowerment uses social science to solve social problems and is a social justice discourse in social work. It allows social workers to redistribute power and knowledge in their practice, whilst challenging and combating injustice and oppression. Empowerment develops capacities of individuals, whilst emphasising individual responsibility. Pease (2002:137) argues that there is an assumption that power is something that can be given and empowering someone is to confer. Therefore as Braye and Preston-Shoot (2003:100) discuss, empowerment is about “oppressed people taking the power and demanding to be heard”. Because knowledge is central to understanding power within society, in order to empower service users there must be a reallocation of knowledge, an “insurrection of subjugated knowledge” as indicated by Foucault (1977). Listening to service users and allowing them to have more control over seeking solutions to their problems or identifying their needs within the wider social context, is another example of empowerment. We belong to many social groups, some by choice and some because they are forced upon us. Within these groups, some have more or less power over others. Social workers need to be aware of difference and diversity and develop a greater sense of self awareness about the risks of labelling, stereotyping and holding subjective beliefs.

The term ‘Risk Society’ describes a society that is exposed to harm as a result of human activity. German sociologist Ulrich Beck (1992) first used the term, although British sociologist Anthony Giddens has also written on the same subject matter.

Both authors argue humans have always been subjected to risk, e.g. natural disasters but these are seen as being caused by non-human forces. Modern society is now exposed to risks such as terrorism, chemical pollution and nuclear power. Giddens (1999) defines these as ‘external’ and ‘manufactured risks’, external being risks arising from nature (e.g. flooding) and manufactured risks being the result of human activity, e.g. developments in science and technology. As humans are responsible for manufactured risks, both Beck and Giddens argue that societies can assess the level of risk being produced in a reflexive way that can alter the planned activity itself. People are now more wary of what professionals tell us, which is different to the view of the older generation. We are more critical of professionals and more likely to question them They believe there is an increase in reflexivity (the idea that society can adapt to new risks) as a response to risk and uncertainty in postmodern society, but Beck (1992:21) relates this to more risks and hazards being produced, where Giddens (1999:3) believes in human subjectivity being more sensitive to risk.

Criticisms of risk society question the level of risk in postmodern society. Turner (1994: 180) questions whether life has become more risky in the present day, than how it affected individuals in the past. Ungar, cited in Goode and Ben-Yehuda (2009: 82) argues that the threats of today infuse fear as well as, not instead of the past fears. Culture, race and gender do not feature in both Beck and Giddens writings and it could be argued that it would be difficult for an individual to be reflexive regarding conflicts of this nature. Joffe (1999) argues that there had been a failure to recognise emotion in respect to how people cope with living in a risk society. Delanty (1999:171) draws from the criticisms by Lash, arguing that Beck and Giddens do not recognise the cultural dimension of reflexivity, due to disregarding collective agency such as the community in favour of individualism.

Social work has changed from a concern with need to one of risk (Kemshall, 2002). The media perception of social workers failing in their duty to prevent the deaths of children or protect the public from individuals known to be mentally ill, has led to more “bureaucratic solutions, through legislation, procedures and guidelines” (Ferguson, 2004). Blame is allocated due to the emphasis in risk (Douglas, 1992).

The regulation of risk replaces need as a focal point and reasoning for social work intervention. Lishman (2007: 164) writes how “working with risk will always remain a risky business, but with the assistance of sound methods and defensible decision-making it can be well managed”. Titterton (2005:50) argues “there is no such thing as a risk free option: all options hold potential risks”. Lishman explains further that in the climate of the blame culture, risk assessments need to be of a standard that contain “defensible decisions” that can hold up in cases where there has been a risk failure (2007:157).

There is the danger that in using risk assessments to check availability for a service, there is the potential for the social worker to be distanced from the service user. Involving the service user to do their own risk assessments and explain what they believe are the risks is a form of empowerment, which places them at the centre of the process. Clutton et al (2006: 18) links the involvement of the service user to empowerment, “Risk assessment may be empowering if it allows the service user to take an informed decision on future action”.

Social workers have to be able to asses the predicted outcomes of a potential risk to a service user but this is not always easy. Differing interpretations of a situation due to the cultural and social background of people and groups can make understanding risk and risk management difficult in decision making (Reed et al, 2004:149). Service users have started to make choices in how they interact with social services e.g. self-referral. In order to make plans about their lives, social workers need to interact with families in new ways that recognise their disadvantage and oppression in society. It could be asked if service users really have choice or do they have options within choice? Harris and White (2009:100) consider choice to be a key element of the government’s modernisation agenda and are established in services such as direct payments and choice of hospital.

Labelling of service users in assessments as ‘disturbed’, ‘at risk’, ‘in need’, describes behaviour from a value perspective (Dalrymple and Burke, 2006). Slovic (1999) writes how risk assessments are coloured by subjective judgements of the social worker at every stage of the assessment process. Hall et al (2006:23) argues however that categorisation of service users in reports, meetings and in the court is an expectation of social workers as a practical and professional duty to provide assessments and provide a course of action or services.

The notion of ‘Culture Theory’ developed by Mary Douglas (1966, 1798) and Douglas and Wildavsky (1982) has been influential in looking at perspectives on risk. Cultural theory aims to explain how personality and cultural traits influence risk perceptions and why different people and social groups fear different risks. Douglas argues the relation of risk to politics and its link to accountability responsibility and blame (Lupton, 1999:39). Douglas and Wildavsky (1982) introduced the ‘grid/group’ concept to explain how cultural proportions can compare society. It defines how people can be divided into four types that predict how they react to different types of hazards- Individualist, Egalitarian, Hierarchists and Fatalist. Thompson et al (1990:5) explain group as referring to how much the individual is integrated into enclosed units and grid to how much a person’s life is restricted as a cause of exterior compulsory instructions.

Douglas’s theory is not without criticism. Lupton (1999:7) questions the media’s contributory role to the risk knowledge of their audience. It can be argued that you cannot foresee how anyone will behave in response to a particular circumstance and that cultural theory is opaque, not taking into account the complexities of modern society (Rayner, 1992, Boholm, 1996). Tansey and O’ Riordan (1999) argue the theory is deterministic and takes no account of the free will of individuals. Ostrander (1992) makes a prominent argument, suggesting that cultural theory should apply to social environments in order to distinguish social systems as a whole. It could also be argued that as Douglas does not explain how risk perceptions regarding to individuals and organisations change over time, her theory could be seen as “static” (Bellaby (1990). Gross and Rayner (1985:18) argue that Douglas fails to explain, “what economic inducements or deprivations dispose persons to change their social position”.

Accountability means being answerable to others for the quality and efficiency of one’s efforts. Social workers are accountable to service users, the community, their department and their supervisors. They must be able to explain what it is they do, how it is done and that their work meets professional standards for competence. Mishra (1984), cited in Wilson et al, (2008:39) writes how there is a reduction in professional autonomy and control due to accountability and structural demands being placed on agencies. Social workers, through fear of miscalculating a situation can undertake cautious and defensive practice which falls short of considering the implications, risks and benefits to the service user of the decisions made and measures taken. Bamford (1990) writes how “social workers must develop a system of accountability which does not lose sight of the needs of the clients and their support systems”.

O’ Hanlon, cited in Parton and O’ Byrne (2000: 88), separates blame from accountability in that accountability features responsibility, is empowering and promotes self agency. Blame does not invite co-operation, is alienating and closes down possibilities. An example of the links between risk and blame is the case of baby Peter, who was killed by his mother’s partner and was the subject of a multiple amount of media attention, proportioning blame on the social workers in his care. The description of harm and danger portrayed by the media, the government and organisational responses to complaints and legal action, resulting in a blame culture is a consequence of risk aversion employed by some social workers (Furedi, 2002). This could leave social workers feeling the need to protect themselves and hesitant, leading to passing the blame onto other people. Webb, (2006:70) links blame culture to risk avoidance being the main priority, resulting in tighter measures of accountability and transparency being involved. Kemshall (2002: 94) suggests blame “serves to strengthen accountability, but also subtly to control information flow and usage and to reinforce loyalty and solidarity with particular viewpoints on risk”.

Responsibility of the social worker is linked to accountability. These are sustained in codes of practice, the law and daily verbal exchanges. Hall et al (2006: 16) describes how professionals are mindful of their interactions, should their speech causes their conduct to be accountable. Parton and O’Byrne (2000: 183) discuss the ethics of responsibility in which service users are able to talk freely about themselves, their situation and the best way to solve their problems. Social workers are supporting service users to take responsibility for their own actions, which replaces concepts of “cause and determination” Howe (1986), cited in Parton (1996:88). The responsibility of the social worker is to the well-being of service users, but there are times when they work in situations that are conflicting. Dominelli (2009:11) offers one explanation of this in a “care-control dilemma”, when there is a need to balance the determination of the service user with harm. The social workers responsibility to the wider society and adherence to the law mean that at times the well-being of the service users may not take priority.

In conclusion we have considered the impact of risk in the field of social work. In doing so we have identified three main theories, that of Govermentality, Risk Society and Culture Theory. We have analysed the impact of social work on these theories. Govermentality Theory helps us to understand power and the production of knowledge that enables individuals to govern themselves. Empowerment, as discussed previously enables service users to gain control over decisions that affect their lives. Risk Society Theory helps us to understand how communities are organised in its response to risk. This has been discussed in relation to social work in the media and the bureaucratic defensive practices that have developed as a result of extensive coverage of high profile service failings. Culture Theory seeks to explain how the social context in which we operate affects our responses to risk. As considered earlier, accountability is a means for social workers to explain their actions and the reasoning behind them, blame culture leads to social workers feeling apprehensive and self-preserving of their role. The social worker also has responsibility to the service users, but also to the wider society.

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Drawing on the concepts you have studied in Block1, critically reflect on the ways in which your own life course has affected how you work in, or use, health and social care.

In this essay I will look at the life course perspective, and how it has provided me with an essential tool to offer a more personalised service. I will describe how my own life course and ‘Biographical Disruption (Bury 1982) has changed the person I am beyond the expectations I had of my presumed journey, and how it has impacted on my practice. Where it has proved to be a strength or a weakness, and how it has made me more sensitive to people’s needs and behaviour. I will look at how my personal values have been shaped and influenced by my life course, and discuss possible ethical conflicts. I will start off explaining the concept of life course using the five principles discussed by Bengtson et al. (2005).

Recognising the course that people’s lives take is relatively new to study and research. Until relatively recently the understanding of human development was based on the life cycle approach, one of the oldest accounts of how life’s and families are organised over time (Bengtson, et al 2005, p.9). The approach is based on the idea that people’s lives go through a series of relatively predictable and chronological stages and transitions from birth to death, providing insight in peoples changing roles and identities in relation to landmark occasions such as coming of age, marriage, childbirth and old age. From the 1960’s onwards the life cycle approach began to incorporate psychological elements, which considered the relationship between an individual’s inner world, and the social context in which they live. This idea of considering the whole of a person’s life as offering opportunities for development and change (Crawford and Walker p.2) is referred to in literature as life –span development (Sugarman, L. 1986, p.3) or the life-span perspective (Baltes, P. 1987, p.3).

At the same time these approaches began to merge with the idea that age and ageing is not only related to a chronological stage in human development, but also to subjective experiences between the individuals own construction of their life course, and social constructions such as schools, labour markets and normative pathways. Ageing is a lifelong process, in general common to all of us, but throughout our journey from birth to death, events can be imposed upon us from which we may have to make decisions and choices that change the path of our life course. Timing is often unexpected and change may not happen at a time we would have chosen it to; this not only impacts upon our own life and future but on those we are linked with. understanding my own life course also supports me professionally working in social care, Crawford and Walker (2003, p.2) point out that social work practice involves interactions between people, which are influenced by each person’s life course, their experiences and perceptions about their own life, emphasising the quality of these personal relationships between service users, their families, carers and professionals. In order to understand the impact human development and life events have on individuals I need to have a critical, reflective understanding of how my own life course has shaped me, my behaviour and influenced my beliefs and values. This will enable me to engage with people better, respond more sensitively to people’s experiences and needs and explain why people don’t always act in ways that appear to be in their best interests (K319, Learning Guide 3, 2013). My self-perception and my values and beliefs are very much shaped by my own life courses’ significant events, experiences and transitions, such as growing up in a very large family in the seventies, being a divorced woman with young children and being a main carer for my terminally ill mum.

Bengtson et al (2005) identifies five principles that are essential to the life course perspective.

First there is the principle of linked lives, which emphasizes on the fact that people’s life courses are interdependent with others, especially relevant in the context of families. Having grown up in a very large family my life has been linked to my siblings and parents, so when my dad fell seriously ill, and never recovered enough to ever return to work, and he needed almost constant supervision and support. The impact on all the family was life changing, my siblings that still lived at home had to find jobs to help the household finances, and they all feel this event ended their childhood. I was 10 years old I was taken to live with my eldest brother and his family. This felt very strange and I remember feeling afraid I would not see my parents again. It was thought that I was too young to understand what was happening so I was never told how ill my dad was, I was never allowed to visit him in hospital, and he was there for a full year. I was just told to be good and not make a fuss. I then stayed for short periods of time with my grown up siblings and extended family, this went on for many months , living a very transient existents and not staying in one place long enough to develop friendships with children my own age. Looking back from my adult self, I can now relate to my difficulties in developing long term relationships and poor self-esteem. On the positive side I was able to develop a lifelong close relationship with a maiden aunt which looking back I don’t feel would have happened if I had stayed in the family home over that period.

Secondly there is the principle of historical time and place, “emphasising the importance of social and historical context in shaping individual lives” (Bengston et al, 2005 p11). This is discussed as how events such as wars, trauma, depression or a period of prosperity affects our lives, Impacting on the life courses of all generations living in that particular time and place. My dad’s illness in the seventies meant he could no longer work and provide for his family, so from being a provider he became cared for, which changed the whole dynamic of the family structure. He also had to rely on sickness benefit, which in the seventies welfare system was very difficult to get and the financial support was very low. This impacted on all the family. We were poor prior to his illness but this plunged us further into poverty. This had a negative effect on us all, but for me at a time when I was just about to start secondary school I felt the stigma of being subjectively poor. I spent many difficult days in school feeling marginalised and bullied by my peers, because I didn’t have nice clothes and had to have free school dinners, at that time children on free dinners had to queue in different lines, this compounded the feelings of inferiority. My mum did her best, and managed to get some part time work alongside her being the main carer for dad, and mother to her children. Looking back, I realise my mum must have been a very strong person to cope with the situation she found herself in, she instilled a strong work ethic into her children, believing hard work would bring rewards. She influenced me with her single minded determination, like Enid with her mother (k319, Learning Guide 3 Audio 3.1). With hindsight this period of my life forced me to become more independent as I had to fend for myself a lot, it also provide me with a valuable lesson in managing on very little money. This benefitted me when I was a single parent following a divorce I was able to budget with a small income.

The next principle considers “the timing of significant life transitions and whether they fit well with cultural expectations of when things should happen” (K319, Learning Guide 3, Activity 3.1). I came into my career as a result of two biographical disruptions in my life. First I was divorced in my mid-twenties and needed to get work to support my children. Then my mum was diagnosed with terminal cancer and I became her carer. I was able to get part time paid work as a home care assistant through social care, I found I could transfer the skills I had used as a carer and the training I received helped me to support my mum better. I discovered I had very good people skills and enjoyed supporting older people to stay independent. Even later in my life I commenced my social work degree studies in contradiction to society’s view of what is ‘normal’. As with Mike, the case study in Learning Guide 3, Activity 3.5, I had concerns that studying as a mature student would lead to ‘sub-normative’ feelings of being different but on reflection my life skills and experiences have enriched my learning experience.

The fourth principle considers the control most people have over their own lives and “they make choice about what to do and have plans for the future” (K319, Learning Guide 3, Activity 3.1). Although I did not have any influence on my upbringing and not a large amount over my divorce. My experiences have provided me with the power and choice over my future which included a career in social care. I feel my life experience has made me aware of understanding everyone has past life events that impact on their current life. So when I am working with service users and planning for social work interventions, having an understanding of the potential of disruptions such as illness, and other life changes can be major turning point in their lives, and can help people see how they can become an opportunity for them to make changes (agency) in their lives. As in the story of Doireann and Iskender (K319 Learning Guide 3, Audio 3.7), where Iskender’s heart attack became a turning point in both his and Doireann’s life.

Finally the fifth principle that affirms that ageing is relevant to both the young and old, and development is not exclusive to younger people and children. Our lives are fluid as we travel our life course and we continue to change and develop whatever age we are. My life is still developing and changing as I age, in the sense that I am developing my academic skills, and my experience of caring for my mum throughout her terminal illness and the impact this had on my life.

The life cycle assumed that people would have a ‘normative life course’ (K319 Learning guide 3, Activity 3.5).That is to say people will have a life that is expected to be desirable and virtuous by society that is free from problems. Whereas a person with a “non-normative life course” is often considered to be judged and having to justify and explain their lifestyle. As a divorced woman in my mid-twenties, with two young children, which was not the normal status in the social groups I mixed in, this resulted in me feeling ‘different’ and stigmatised. I felt I had to explain my single status and felt I was seen as a threat to my married friends. I felt I had failed both myself and my children and was worried my children would feel as I did as a child, being bullied for not having a normal childhood. These feelings gave me insight into the lives of others with ‘non-normative’ life courses, whether due to their sexuality or life style choices.it has also made me question as a social care provider, does that service user feel as I did, and feel I am judging them therefore they have to explain themselves?. My own experiences of feeling ‘different’ has made me sensitive to the feelings and needs of those who society judges as non-normative, in comparison to people who follow the expected ‘norms’ and pathways we are expected to take.

My own life course was in my early childhood a non- normative course, due to the biographical disruption of my dad falling ill and resulted in me having an unconventional childhood. As I grew into adulthood my life course was comparable to the life cycle in that it had proceeded in a socially accepted pattern within a presumed time span which Giele and Elder (1998) described as “a sequence of socially defined events and roles that the individual enacts over time.” My early adult life followed a life that was considered ‘normative’, I was following the cycle of “completing formal education, working, forming relationships, marrying and having children…”(K319 Learning Guide 3, Activity 3.3).I did not predict that in my mid-twenties my life would suffer more biographical disruption that would have a huge impact on me, my family and lead into a future I would not have predicted.

Bury (2012) describes biographical disruption to be a negative experience but I would disagree with that in relation to my own experience so far as a career in social care is concerned. If I had stayed married and my mum had not got ill, I am sure I would not have followed this path and likely I would have had a very different life now.

However I had not consciously thought about entering into the social work profession, I presumed my entry into social care was the result of events that has steered me in the direction of this profession and opportunities that have presented themselves to me i.e. I was in the right place at the right time. Having read ‘Life experience: A neglected form of knowledge in social work education and practice, by Christie et al 1998,I am inclined to agree that my career choice has not been a coincidence but a choice I have made based on the knowledge I have acquired as a result of my life experiences. I am able to draw on my experiences as a knowledge base for my practice alongside the ever developing knowledge I am gaining from my studies. However, I do not “persist in viewing social work as the profession effective in bringing about social change” (Christie et al 1998). I feel my role is to support others in bringing about their own change, as I have been able to do. However I am mindful that the experiences I draw on in my practice are my personal experiences and are owned by me, and others experiences are exclusive to them. I am aware that my knowledge within in my work is limited to my own personal experiences and my personal feelings could influence my approach to service users and the decisions I make in my assessments of them.

In conclusion the article from Christie and Weeks has in fact made me question my theory that I did not choose social work as a profession purposefully; perhaps my life experiences have directed rather than influenced my choice to be a social worker, ”my own working class background, marriage difficulties, poverty, powerlessness, has influenced me strongly” (Christie el at 1998).This assignment has shown that our life course is an unpredictable path that we follow; it is constantly being reshaped from what we have imagined our life path to follow, by the events that take place around us. But although it presents us with many situations that are out of our control that impact upon us. The understanding of our life course gives us the strength to move forward in our lives, it also presents us with choice and power and positivity to look forward to the future. And as Winston Churchill says “the farther backwards you can look, the farther forward you are likely to see” (Churchill circa 1941)

Word count 2601

References

Baltes, P. (1987) in Crawford, K. and Walker, J. (2003) Social Work and Human Development, Exeter, Learning Matters Ltd.

Bengtson, V. L., et al. (2005) ‘The lifecourse perspective on ageing: linked lives, timing and history’ in Katz, J., Peace, S. and Spurr, S. (ed) Adult Lives; A life course perspective, Bristol, Policy press/Milton Keynes, The Open University.

Bury, M. (1982) ‘Chronic illness as biographical disruption’ in Katz, J. Peace, S. and Spurr’ S(eds)Adult Lives: A life course perspective, Bristol, Policy press/Milton Keynes, The Open University.

Christie, A &Weeks J (1998): Life experience: A neglected form of knowledge in social work education and practice: Social work in Action. http://dx.doi.org/10.1080/09503159808411477 (accessed 25 November 2013)

Crawford, K. and Walker, J. (2003) Social Work and Human Development, Exeter, Learning Matters Ltd.

Hareven, T. K. (1982) in Hutchinson, E. (2011) Dimensions of Human Behaviour ; The Changing Life Course, London, Sage Publications.

Hutchinson, E. (2011) Dimensions of Human Behaviour; The Changing Life Course, London, Sage Publications.

National Churchill Museum: Miscellaneous Wit and Wisdom

http://www.nationalchurchillmuseum.org/wit-wisdom-quotes.html (assessed 25 November 2013)

Phillips, D. (2006) ‘Quality of Life’ in in Katz, J., Peace, S. and Spurr, S. (ed) Adult Lives; A life course perspective, Bristol Policy press/Milton Keynes, The Open University.

Sugarman, L. (1986) in Crawford, K. and Walker, J. (2003) Social Work and Human Development, Exeter, Learning Matters Ltd.

The Open University, (2013), ‘Learning Guide 3.1 The life course perspective’, K319 Block 1 Approaches to adulthood and ageing, [online] available at http://www.learn2.open.ac.uk/mod/oucontent/view.php?id=255389 (Accessed 23 November 2013)

The Open University, (2013), ‘Learning Guide 3.5 ‘unusual life course’, K319 Block 1 Approaches to adulthood and ageing, [online] available at

https://learn2.open.ac.uk/mod/oucontent/view.php?id=255389 (Accessed 23 November 2013)

The Open University (2013) ‘Learning Guide 3: Introduction’, K319 Block 1 [Online]. Available at https://learn2.open.ac.uk/mod/oucontent/view.php?id=255389 (accessed 23 November 2013).

The Open University (2013) ‘I Think I’m still working through it’ [Audio], ‘Learning Guide 3.3: Biographical Disruption’, K319 Block1 [Online]. Available at https://learn2.open.ac.uk/mod/oucontent/view.php?id=255389&section=3 (accessed 26 November 2013).

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Sexual Assault

Abstract

Sexual assault is any sexual activity to which you haven’t freely given your consent. This includes completed or attempted sex acts that are against your will. Sometimes it can involve a victim who is unable to consent. It also includes abusive sexual contact. It can happen to men, women or children. Most people feel that sexual assault occurs when you don’t know the person but that not so, it can be a friend, family member, or a co-worker. “According to the National Center for Injury Prevention and Control. Nearly 1 in 5 (18.3%) women and 1 in 71 men (1.4%) reported experiencing rape at some time in their lives.” “Approximately 1 in 20 women and men (5.6% and 5.3%, respectively) experienced sexual violence other than rape, such as being made to penetrate someone else, sexual coercion, unwanted sexual contact, or non-contact unwanted sexual experiences.”

When it comes to sexual assault, most people don’t want to talk about this because they don’t want to re-live that time in their lives. Most people want to push it in the back of their minds as if it didn’t really happen. Being sexual assault can lead to many different feeling causing a person to become physically, emotionally, and mentally disturbed. Women are more likely to be assault than men because most women don’t want to talk about what happen because they are afraid no-one will believe them. Most women don’t report what has happen to the police because they are afraid nothing will happen so they just keep quiet and keep it bottled up inside. Each year in the United States, between 300,000 and 700,000 adult women are estimated to experience sexual assault, with 40,000 of such victims typically seeking treatment in an emergency department (Kwence, Sherri). When a women is sexual assault an start seeking professional help for what she has went through can be hard just trying to move forward from such pain that she has endure.

It is said that sexual abuse is the most common and threatening behavior calculated to induce fear in all women, it means men have chosen to maintain control over women. Rape is the fastest growing crime in the country. Rape occurs in India every twenty minutes (Behere, P.B). In 2011, more than 24 thousand cases were reported-about 70 a day. New figures released by the Delhi Police reveals that a women is raped every 18 minutes or molested every 14 minutes. There are 80, 000 pending rape cases in India and nearly 1,000 rape cases are pending in Delhi courts (Behere, P. B.). In the United States, 1 in 6 women reported experiencing rape or attempted rape at some time in their lives. Being sexual assault can make a women start feeling anger toward men. When someone you know has been sexual assault they must seek professional help so, they can live a healthy life. As a social worker we must help victims who has been harm in any way possible.

The conflicts in which a social worker may face when working with women or men who has been sexual assault. The value of the social worker is to promote resources to help victim who has been mistreated. When a women has been assault it take a lot from her. Once someone take something as precious as sex from you, can make you feel bad about yourself. When you think about sex, it something that should be shared between two people who care about each other. For someone to come and take that away from you can make a person become very bitter at the world? As a social worker we must promote social justice to make sure our client get the best help possible by setting up counseling. We first has to assess the problem at hand and see what really happen and then we can move forward with the problem.

As a social we must not impose on the client right to do what she feel is right for her, we can only try and led them down the right path. Social worker values can’t get in the way when it comes to helping a client get the best help needed. The client have every right to refuse any help at any time. Social worker have to be the voice for those who are not willing to speak and the ear for those who can’t hear what is been said, and the legs to help the client walk that extra mile needed. Not only do sexual assault happen to women but it also happen to men and children. Most people don’t think that men are sexually assault but it happen, but more common in small children because it’s hard for them to fight back. Most men are victim because they choose to be gay or because they are locked up in jail. As a social worker no, matter who is seeking help it is our job to provide the best care needed. When someone has been assaulted by a family member it hard to tell someone especially when you are a small child because they are scared and don’t want to get anyone is trouble so children suffer for a long time from assault because they are afraid to tell because no one will believe them. Children will grow-up feeling ashamed of what happen to them so it will cause them to sexual assault someone. They why it’s important to get the proper help needed when you have been assault. Everyone deserve to live a happy and success life.

Results of this study showed that 66% of the women were aged 15-24 years old and 75% had met the perpetrator before the sexual assault with nearly 50% reporting that the perpetrator was a current or former boyfriend, family member or someone they considered a friend.

Women with no previous contact or knowledge of their perpetrator were more likely to report to the police and were at a higher risk of sustaining an injury, the research showed.

Looking specifically at alcohol, the study found that over 40% of women had consumed more than 5 units of alcohol. These women were more often sexually assaulted by a stranger or someone they met within 24 hours prior to the assault. Furthermore, a physical injury was found in 53% of cases and 33% of the victims had suffered a previous sexual assault (Wiley). In fact, researchers found that college women who experienced severe sexual victimization were three times more likely than their peers to experience severe sexual victimization the following year. RIA researchers followed nearly 1,000 college women, most age 18 to 21, over a five-year period, studying their drinking habits and experiences of severe physical and sexual assault. Severe physical victimization includes assaults with or without a weapon. Severe sexual victimization includes rape and attempted rape, including incapacitated rape, where a victim is too intoxicated from drugs or alcohol to provide consent (University at Buffalo). We don’t realize just how much sexual assault go unreported while in college. No-one should have to experience this kind of abuse while they are trying to learn. It hard trying to learn when sexual assault is going on at a campus sight because you are afraid to walk around at anytime day or night because you don’t know who to trust or who is watching your every move. You have to be aware of your surrounding at all times.

A student, age 24 came into my office just like any other day set down and she had a strange look upon her face. I spoke and said what, I can help you with today. She replied, I was sexual assault at a party which I had attended on Friday with a couple of my friends. My response to her was are you alright and she replied no. She started telling me in details what had happen so I just sat and listen to what she had to say. It was a surprise party for her best friend so it was a lot of people there as you know the usual crowd family, friend, and co-worker. At this part there were loud music, drugs, and lots of alcohol, so we all were having a good time so it was this guy who I’ve known for a long time was there and we started talking, laughing, and dancing. As the night grew old we went back to his place of course I had been drinking and so had he. While we were alone in his place he started hugging, kissing, and touch me and it was making me feel uncomfortable so I asked him to stop and he said you know you want it and I said no but he didn’t pay me no attention and processed to throw me down and force himself upon me. I started screaming saying stop but he didn’t you continue on until he was finish. After he finished he took me home like nothing never happen I was so scared. When I made it to my house I ran upstairs and started to shower because I was feeling so dirty. So could you please help me I am afraid to tell someone what happen because I shouldn’t went there? She replied, I just feel so helpless all I do is just sit in my room and cry it’s driving me crazy. The scene just keep playing over and over in my head. So, I felt that I needed to talk to someone before I go crazy. I don’t want my friends to know what happen to me Friday night. I don’t need no-one judging me because I had too much to drink. I thought I knew this guy that’s why I agreed to go to his place not knowing he had other things own his mind. It goes to show you, can’t trust anyone these days not even a good friend. So, I found myself walking around in a daze and it led me to your office on Monday. Please help me figure out what to do before I beat myself up about what happen.

As a social worker I assure her it wasn’t her fault and I will do everything to help her gain her self-respect back. She didn’t want to go to the police and tell them what had happen because she felt the police wouldn’t believe her because she went to his house on her own and plus she had been drinking. As we were talking, we talked about the negative and positive things that was going on with her. I had to ask some personal question such as did he use protection, do you know if he had any sexually transmitted diseases, or do you think you might be pregnant. She replied, I don’t know. So I advise her to go and get herself checked out and so she did and everything was just fine. Now that’s something you want have to worry about. After the assessment I set her up with a counselor to help her understand that she wasn’t at fault. While in session with the counselor we talk about how she can regain her self-respect back and not let this get the best of her. First just accept what had happen and talk to your family and friends so you don’t have to go through this alone. No-one will judge you because of what happen, right now you need all the support you can get. The more you talk about what happen to you that night is the only way the healing can begin. Later when you regain your strength you can go to the local authority and report him so it want happen to someone else. Always stay involved with people in the community because your story can help safe someone else someday. Remember to always hold your head up high and don’t let negative talk get you down because you survive. You have to start setting goal in your life to help you get back on the right track. We can’t change the facts about what happen or the feeling you have. The only thing we can do is just help you begin to heal. At the end of the long session she was able to deal with her feeling and regain her self-respect.

As a social worker we have to get involved with families, groups and organization or communities to help promote social justice when dealing with people. As a social worker we must be equipped with the skills and knowledge to be able to better serve clients. As a social worker we play many roles in people lives for example: negotiate, mediate, advocate, broker, and educator. As a social worker, in the work, that we do go a long way in helping client achieve their goal weather they are short term or long term we have to do whatever it take to make sure our clients are treated with the up-most respect.

When a social worker deal with someone who has been assault they have to deal with outsider also and it can make it hard on the victim. Because the victim have to re-live the whole thing all over again so many time they just sit back and deal with the problem the best way they know how by just leashing out at the world for no reason. Being the victim trying to pick up the piece and move forward can be one of the hardest things to do because they feel as if they have the weight of the world on their shoulder. They just have to be strong and not show anyone what’s really going on inside. According to The Canadian Press (2014), the most common reasons for not reporting were shame and embarrassment, fear of the offender and lack of confidence in the justice system. While 53 per cent of participants stated that they were not confident in the police, two-thirds stated that they were not confident in the court process and in the criminal justice system in general,” the study says. Participants cited ongoing, long-term effects of being attacked, including depression, difficulties with trust and forming relationships, and anxiety, fear and stress. The women described a number of means of coping with effects of the trauma, both positive (such as reading, exercising, and writing in a journal) and negative (drug and alcohol abuse, self-harm, suicide attempts).The women suggested that survivors of sexual violence become informed about the criminal justice system, and know that help is available for victims and that legal proceedings can take a long time. The best way of sharing this information is through school programs and counsellors, they said (Canadian Press).

There are many form of sexual assault it’s all around you just have to sit back and watch and see what is going on in people lives. Looking at the women and men in the military we don’t look at them as being victim but in reality they are victim. They are putting their lives on the line every day for us and look at what is happening to them. In the serves its their policy to not tell what happens in the field but look at how many lives are been ruin because of the way men are treating women or because of the way men or treating men. No-one deserve to be treated that way. The sergeant are up holding the men in their wrong doing telling them it ok what they are doing because no-one will never find out. No-one want to be label as a snitch because they will lose all their right and benefit and no-one will be able to provide care for their families. The men and women just have to live with this until they have a break-down in their lives and break the bond and tell what has happen to them while they were out fighting for their country. No man or women should have to feel in shame for what happen while they were serving their country. Yes there need to be stronger sentence for people who commit these type of crimes. In the U.S. Military academies, 5% of women report surviving rape every year, as do 2.4% of the men,for women abused as children, 92% of perpetrators were men, of those men who enter the Navy, 15% are perpetrators prior to their service, 28% of women in the military experienced rape during their military service. Of those women who men rape in the military, 96% of the perpetrators are U.S. military men (Sadler, Booth, & Doebbeling, 2005). No one should have to lose their right because they chose to speak about the truth. Although the truth may hurt a lot of people because being assault in the service will follow you for a long time. Making it hard to truth anyone in authority.

A young male 22 walk in my office and spoke and said he was gang rape and needed some help. We both sit down and I assess him on the nature of the matter of just what happen. He said, they he was walking home from a party and a group of guys pulled him into the car and drove him down a dark back road and that’s where the assault occurred. It was three guy that he recalled pulled him into the car. He said, he was scared for his life. What made the guys pull you into the car? He replied, I was dress in women clothes and when they got to the place and realize, I wasn’t a women it made them mad. To teach me a lesson the guys place a drink bottle into my rectum and begin to push with all their might. That wasn’t good enough each of the guys took turn and place there penis inside. I never imagine anything like that happening to me. I was afraid for my life they left me there to die. I was screaming but no one could hear me because we were on a dark lonely road. The counselor assured me that it wasn’t my fault and that I had nothing to be ashamed of. The counselor advice the young man to go to the doctor so he can get himself checked out. While at the hospital the police officer pulled up on the scene and gather some background information on what had happen. The guy went into detail and told the officer what happen. The counselor ask the young man would he be interested in seeking professional help and he replied yes. The counselor made come called and got him place in outpatient care. The counselor ask him some personal question. He said, as you know I am a man trapped into a woman body. The counselor asked are you sexually active and he replied no I am not. Did they use any type of protection you use protection he replied, I don’t know. The counselor said make sure you get yourself checked for sexually transmitted disease. The counselor reassured him that it was not his fault that he didn’t do anything wrong. In order for you to heal you will need to get set up in individual counselling and group therapy. You must be willing to talk with family and friends and let them know what you are going through. You must learn to let your feeling out and get involved in positive things and start setting goal in your live to help you get back on the right track. Talk to family and friend because they want judge you because at this point in your life you need all the support you can get. The counselor let him know that this wouldn’t be an easy journey. After all he went through time will heal all wounds. No-one can take the pain away after all the therapy, he did gain his self-respect.

In conclusion I provide insight on sexual assault and how it effect people in many ways. Most people don’t like talking about sexual assault because it makes them feel dirty and ashamed, but they must realize it wasn’t their fault. As a social worker it is our job to help reassure the victims that everything will be alright. If you know of anyone that has been sexual assault my advice is to please get the proper help so you don’t have to live in fear. The healing only start when you are ready to tell your story.

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www.sciencedaily.com/releases/2014/10/141015092243.htm

In order to maintain confidentiality the names used in this piece of work have been anonymised.

The purpose of this assignment is to demonstrate the knowledge and understanding of the impact that policy and specifically Child Protection (CP) policy has made on professional practice. I will identify and analyse an incident associated with child protection in practice which will enable a discussion to debate appropriate local, national and international perspectives. I will also consider the impact of policy on other professionals involved in the event. Furthermore I will use PEST analysis as a framework to explore the impact of policy on practice.

Pest analysis is described by Mindtools, 2009 as a simple, useful and widely-used tool that helps you understand the “big picture” of your Political, Economic, Socio-Cultural and Technological environment’. It is used by business leaders worldwide to build their vision of the future and likewise can be used by practitioners to attain best practice to achieve positive outcomes for individuals.

The practice placement that is the focus of this assignment is a mixed senior school of predominantly working class white students aged 11 – 18. The incident that occurred was discussed between a female pupil – known as Beth Jones aged 12 years and a student social worker (SSW). While in a 1:1 mentoring session Beth disclosed that her mother Elaine Jones had pushed her down the stairs in her home that morning. Beth was traumatised and stated that she was fearful to return to her home that day.

Recently, the views within the UK concerning the status of children have been wide-ranging and this has had some impact on policy and practice. At a socio-cultural level children are now viewed as having the capabilities to engage in building and constructing their own lives and opinions have swayed towards autonomy of women and in particular of children. In today’s society, through the emergence of feminist writers especially on issues such as patriarchy and domestic violence, children are viewed as independents rather than being the property of men. This has been reinforced through changes in the political economy of welfare where society’s perceptions of children have transformed towards children being independent service users whose wishes and preferences have been given greater importance. (Armstrong, et al 1991).

The introduction of the Human Rights Act 1998 also ensures that children now have legal rights. (WHO, 1998). The term ‘Gillick competent’ is used to describe a child under the age of 16 who is judged to be of a ‘sufficient understanding and intelligence to be capable of making up his own mind on the matter requiring decision’ (Smith, 1996 p52) thus enabling young people like Beth to be heard. The practice implication for this is that when taking into consideration the opinions and wishes of the child, it must first be established what those wishes and views are and then whether those wishes and views are to be considered, or acted on, based on whether the child is deemed to have a full enough understanding of the implications of their decisions.

Every child living in this country is entitled to protection from abuse regardless of his or her background. With the help of the Children Act 1989, and the recommendations made by Lord Laming, (Every Child Matters, 2004), child services within the UK have been given the power to act when they feel a child is being abused. Victoria Climbie aged 8 died from 128 injuries at the hands of her carers in February 2000. The investigatory inquiry into her death conducted by Lord Laming discovered many instances where professionals including line managers had failed to fulfil their roles and numerous flaws where professional networks had failed to protect Victoria during the last months of her life. Laming criticised the lack of professionalism and cooperation between agencies (Laming, 2003 S.1.30) – the Laming Enquiry, lay the foundations for the ‘Every Child Matters’ Green Paper published in 2003.

In the U.K. the Children Act 1989 aimed to introduce key changes for practice by focusing on principles such as paramountcy of the child, partnership and parental responsibility as well as child protection and family support and the rights of the family against the rights of the child. This has lead to increasing pressures on social workers who have to prove that they have been empowering, anti oppressive and supportive to those involved in their cases. Within the U.K. these policies afford children considerable rights as individuals and these are considered primarily before those of the parents in child protection cases. This has led to a predominantly rights-based legal approach where social workers hold considerable amounts of power. (Archard el al 2002).

Farnfield (1998, p53) talks about ‘children as consumers’ and the difficulty which many social workers have in balancing the rights of the parents with the rights of the child. Given the drive towards working in partnership with parents in childcare and inclusion of all relevant parties when working within a social care field, it may be difficult, when working with families, to remain focussed on the issue of whom the client is and whose interests are best being served by any particular course of action. Trevithick (2005, p229) discusses a particular case where she was having difficulty in establishing a good relationship with parents in a child protection case. The issue of having the ‘agenda’ of protecting the children was identified as a stumbling block in the establishment of a rapport with the parents. Brayne and Martin (1999) however argue that, from a legal perspective, in child protection cases the primary client must ‘always be the child’. This is borne-out by the policy document ‘Working Together to Safeguard Children’ which states that professionals should: ‘work co-operatively with parents unless this is inconsistent with the need to ensure the child’s safety.’ This is also compatible with the ethos of child centred practice in placing the child first.

Article 19 of the UN convention on the rights of the child states governments should ensure that children are properly cared for and protect them from violence, abuse and neglect by their parents or anyone else who looks after them. The Human Rights Act 1998 is linked to the implementation of no-smacking policies and states that every child has the ‘right not to suffer ill treatment or cruel, unusual punishment.'(Flynn, 2004. p.41). As Beth disclosed to the SSW that she has been physically abused, the SSW refers the disclosure to the Child Protection officer. In line with the Data Protection Act 1998 the information is kept confidential as it is not necessary that any other member of staff need to know about the case at that time. As a result of the deaths of Jessica Chapman and Holly Wells in 2004 the Bichard Report was published and made recommendations about how information is shared and stored.Child protection information on a pupil is filed in a separate area to the school file and can only be accessed by the child protection officer and shared with other professionals in a ‘need to know basis’ a positive impact of policy to protect confidentiality of vulnerable children.

“Undoubtedly the most significant development in childcare policy in Britain over the past twenty-five years has been the preoccupation with child abuse” (Alcock et al 1998). Also it can be suggested that this increase in concern can be seen in all major European countries and constitutes a major key issue in this area of social policy. This concern has not only been emphasised through the formal and legal frameworks of society but also by the general public.

As stated above the rise in concern with child abuse has been evident from the late 60’s and early 70’s. It is from then that child abuse has become identified as a “social problem” (Alcock et al 1998) mainly through high-publicised cases of child abuse victims. The high profile case of Maria Colwell who died in 1973 after serious injuries were inflicted upon her at her home whilst under the supervision of social services demonstrates this point effectively. Even today 30 years on this case is still being analysed and discussed. When identifying the key issues within child protection it is important to consider the concept of ‘balance’. This is a main concern for all countries who find themselves victims of either jumping in too quickly with overzealous assumptions, or on the other hand holding off too long and in the end delaying intervention until in some cases it is too late.

“Any major piece of legislation develops in response to a variety of influences.” (Hill, M. and Aldgate, J. 1996). In the U.K. for example, the Children’s Act 1989 was the result of a number of influential factors. One of the biggest influences, which have already been mentioned, is that of the wave of child abuse tragedies that occurred over the years. The public inquiries and the amount of media attention that arose because of these cases shed light upon the inadequacies of practice and previous policies. Cases such as Jasmine Beckford and Kimberley Carlisle and the Orkney and Cleveland inquiries impacted public perceptions and professional practice and shaped the responses of the U.K.’s policies to the problem of child abuse. The social reaction prompted those in power to reassess their protection schemes and to readdress the issues of evidenced based practice within their policy changes. According to Alcock et al. these high publicised inquiries, “led to the promulgation of extensive procedural guidance at central and local levels to social welfare and other agencies designed to avoid repetition of tragedy and scandal” (Alcock et al 1998).

Back to the scenario with Beth, after discussion with the child protection officer, a decision is made to make a referral to social services. Policy states that any disclosure of physical abuse results in steps that must be taken to protect the child. This may produce an emergency protection order as she is deemed to be at risk of harm if she returns to her mother’s care. A social workers main aim in the U.K. is to guarantee young people like Beth’s right to protection from harm and if necessary will battle with parents and other agencies to fulfil this.

In comparison, Europe and specifically France, children have not been accorded as many individual rights independently of their family. Their position is a result of the ‘traditional’ state and family perspective’. The French policies have adapted to this cultural opinion and have enforced that child protection work should be focused on the family and that children should be considered not as an individual but as part of the family. Traditionally the focus is that the parents are superior to the children giving them the rights of decisions, protection and care. This is the view of French society where their main concern is keeping the birth family together and taking risks is acceptable. It can be suggested that in France a ‘humanistic model’ (Parton ,cited in Armstrong et al 1991) is followed to a certain degree. The country’s view that social factors are very likely to be involved in child abuse cases is evident in their policies, which apply preventative, counselling and therapeutic approaches. Examples of this can include the forcing of families to co-operate at the intervention stage, which is unheard of in Britain. One of the main concerns of this system is the fact that in most cases the Children’s Judge does not hear the child’s wishes and views, and if they are heard they are poorly represented. In the U.K. as stated the protective attitude of society is reflected in their policies that recognise the state as having direct responsibility for protecting children when the parents have failed. If Beth were in France she would not be given an independent voice and a right to immediate protection without a full family investigation.

The protective U.K. system appears to have disadvantages, Cooper proves this point by highlighting that in France there has never been any highly publicised cases of abuse as in Britain; therefore there has never been a lack of confidence in social work. The positive aspect of French child protection policy is a constructive public perception which eases tensions within the social worker and family relationship and also encourages co-operation of the family. It was also found that French social workers have a, “consistent, trusting professional relationship at the centre of their professional aims” whereas in the U.K. social workers are mainly concerned with “whether parents are guilty or innocent and with the task of collecting evidence” this impacts on UK social workers as they are on the receiving end of accusations and abuse and stereotypical blame. (Cooper, A. 1994 p59-67).

Effective communication is essential for organisations to be successful. It is the process by which information is exchanged between one group or person and another, by computer, telephone, letter, meetings, text, fax or face to face. The deaths of Holly Wells and Jessica Chapman in August 2002 sparked the Bichard enquiry into child protection procedures in the Humberside Police and Cambridgeshire Constabulary in the light of the trial and conviction of Ian Huntley for the murder of the two young girls. He had previously been suspected of committing sexual assaults on at least eight occasions and at the age of 21 Ian Huntley had sexual relationships with at least three 15-year-old girls for whom social services were aware but failed to communicate this information to the police. If the police had been aware of this information, this may have shown up when vetting checks were being carried out on Huntley and may have stopped him from getting a job at the school that the girls had attended. In December 2003 the Humberside Police said ‘the main reason for this was because of the Data Protection Act’. Information about dealings with Ian Huntley had not been available to them during vetting checks. This inquiry also stated that the problem was due to the police not having been told about this legislation regarding information about the person being vetted. A report stated that police officers were nervous about breaching the legislation, partly at least because too little was done to educate and reassure them about its impact. Michael Bichard labelled it an inelegant and cumbersome piece of legislation and the judiciary stated that better guidance is needed on the collection, retention, deletion, use and sharing of information, so that police officers, social workers and other professionals can feel more confident in using information properly. This simply indicates the importance of effective communication. The information system may have been used to its full potential if the officers had been aware of the limits of the Data Protection Act. Ian Huntley’s date of birth had been entered into the system incorrectly. If this information had been entered correctly then they would have been aware of his past behaviour. This would effectively stop him working in the school and the girls trusting him as a safe adult. The PNC (Police National Computer) only checked against the name Ian Nixon (an alias)

and not Ian Huntley. An Information system can fail completely without accurate information from the end user, highlighting the systems reliance on good communication with its users. (Bichard Inquiry, 2004).

The Children Act 2004 empowered the Secretary of State for Education to create a database (or databases) of everyone in England who is aged under 18. In July 2007, the regulations that will bring this first national database of children into being were passed by Parliament. The government has announced that the database will be called ContactPoint. It was originally known as the Information-Sharing Index, but re-branded in February 2007 because of negative publicity about information sharing. ContactPoint is effectively a file-front that serves the whole range of agencies that may be involved with a child. It is intended to provide a complete directory of all children from birth, together with a list of the agencies with which s/he is in contact. It will not hold any case records, but will enable practitioners to indicate their involvement with a family and contact each other in order to share information. It will also show whether an eCAF (an in-depth personal profile under the Common Assessment Framework) has been carried out and is available for sharing. A response from teachers in local schools have indicated that agencies are finding the procedure confusing with long waiting times for an initial reply for services. Another negative criticism of this policy as stated by Searing, 2007 ‘the danger is that once social work has become more closely aligned with an inter-agency system of surveillance and monitoring of families most people will be less open and trusting towards social workers and this will make their job more difficult’ thus further negative impact on the social worker role.

The Governments response to the Laming Enquiry was almost immediate with the production of the Green Paper ‘Every Child Matters’ 2004. In conjunction with Every Child Matters (ECM) is The Children Act 2004, which is in addition to the original Act 1989. The Act encompasses several components based on recommendations from the Laming Report and is responsible for promoting a partnership between agencies working with children including health, education and social care in a more cohesive manner (Allen, 2008). According to Smith the Children Act 1989 (CA, 1989) simplified all pre-existing legislation in relation to children and families. It imposed new duties on local authorities relating to the identification and assessment of ‘children in need’, and gave all Local Authorities new responsibilities for looked after children. The introduction of the Act also provided the Court with Emergency Protection Orders to protect children at risk of harm which replaced the Place of Safety Orders. Smith (2001) argues that the Children Act was particularly relevant because for the first time it placed more emphasis upon the importance of inter-agency collaborative working as a means of responding to the needs of both children and their families. This policy provided immediate protection to Beth, initiated within the school environment and in collaboration with social services, a good example of interagency working. If Beth had not been listened to or taken seriously she would be at risk of further abuse and may not disclose further abuse due to lack of support.

It is important that professionals and agencies co-operate and work together in child protection cases so that all the relevant and correct information is available, and accurate in order to help and support the child. In recent cases, specifically that of Victoria Climbie, this was not done and therefore Victoria was put at further harm, and subsequently died when she could have been saved if the agencies had worked effectively and shared information. This is why the Every Child Matters legislation came about, to try and prevent this in the future. Children at risk need coordinated help from health, education, social services and other agencies, including youth justice services. These professionals are required to work together in order to protect the children and keep them safe, and to help bring to justice the perpetrators of crimes against children. As a result of Every Child Matters, now children known to more than one agency will have a single named professional to lead their case. This has proved to be an effective tool in Beth’s scenario as guidance enables the professionals within the school to take action immediately to protect her as she was placed on an emergency protection order. Even though the policy is over five years old, when applied effectively stops a child falling through the net. Policy has shaped the care for this service user and had a significant impact on her outcome.

References
Allen, N. (2008) Making Sense of the Children Act 1989, 4th ed. West Sussex: John Wiley & Sons.
Alcock, P. Erskine, A. and May, M. (1998) The Students Companion to Social Policy Blackwell Publishers
Armstrong, H. and Hollows, A. (1991) in Hill, M. (Ed) Social Work and the European Community: the Social Policy and Practice Contexts. London: Jessica Kingsley Publishers, 142-161
Brayne, H. Martin, G (1999) Law for Social Workers (6ed). London: Blackstone
Bichard, M. Sir. (2004 April 21), The Bichard Inquiry – An Independent Inquiry arising from the Soham murders, (The Bichard Inquiry), Available: http://www.bichardinquiry.org.uk/, (Accessed: May 2009).
Children Act 1989- Section 47.
Children Act 1989 (c.41). www.hmso.gov.uk/acts/acts1989/Ukpga w19 March 2009.
Cooper, A. (1994) In Care or En Famille? Child Protection, the Family and the state in France and England. Social Work in Europe. Volume1No.1.
Davies, M. (2002 p107) Companion to Social Work. (2nd). London: Blackwell. (Data Protection Act 1984 and 1998).
DfES (2006) What to do if you’re worried a child is being abused. Summary. Crown Copyright. Department of Health, Home Office, Department for Education and Employment, 1999
Every Child Matters (2003) Every Child Matters (2005) Background to Every Child Matters (http://www.everychildmatters.co.uk/aims/background [Accessed online: 17/01/2009]
Farnfield, S (1998) The rights and wrongs of social work with children and young people in Cheetham, J. and Kazi, M.A.F (eds.) The Working of Social Work. London: Jessica Kingsley
Flynn, H. (2004) Protecting Children. Heinemann.
Hill, M and Aldgate, J (1996) The Children Act 1989 and Recent Developments in Research in England and Wales, in Hill, M. and Aldgate, J. (Eds.) Child Welfare Services: Developments in Law, Policy, Practice and Research, London: Jessica Kingsley Publishers
Lord Laming.2003. The Victoria Climbie inquiry. Crown London
http://www.mindtools.com/pages/article/newTMC_09.htm
Searing, H (2008). The Crisis in Social Work: The Radical Solution. Available at http://www.radical.org.uk/barefoot/crisis.htm (Accessed May 2009)
Smith P (1999) Support for Children and Families:
Trevithick, P. (2005) Social Work Skills.2nd ed. Berkshire: Open University Press.
World Health Organisation (WHO)
Bibliography
Burton S., (1997) When There’s a Will There’s a Way: Refocusing Child Care Practice – A Guide for Team Managers London: National Children’s Bureau
London Borough of Greenwich and Greenwich Health Authority (1987) The Kimberley Carlile Report
Cleveland Report (1988) Report of the Inquiry into child abuse in Cleveland 1987 London: HMSO
General Assembly of the United Nations (1989) The Convention on the Rights of the Child. Adopted by the General Assembly of the United Nations on 20 November 1989. (UN Convention) http://www.unicef.org/crc/text.htm
Parton, N. (1996) ‘Social Work, Risk and “the Blaming System”‘ in N. Parton (ed.) Social Theory, Social Change and Social Work, London: Routledge & Kegan Paul.
Trotter, C. (2004) Helping Abused Children And Their Families, London.

1

Contents

BACKGROUND

LITERATURE ON THE TOPIC

STATEMENT OF THE PROBLEM

OBJECTIVES

SIGNIFICANCE OF THE STUDY

RESEARCH METHODOLOGY

Research design

Population of the study

Sampling Design

Tools for data collection

Nature of tools

Sources of data

Data analysis

LIMITATION OF THE STUDY

WORK PLAN

LIKELY OUTCOME

Reference

INTRODUCTION

The high fertility rate leading to the rapid growth of country’s population is a major hindrance towards the development of a nation. Keeping this in mind, India was the first country to launch a well-defined family planning (FP) programme in 1951 with the major objective to balance the population with resources available. India’s current demographic phase is characterized by high fertility and moderate mortality rates. As a result, the country’s population is growing rapidly with about 18 million people being added to it annually, to give a 2.1 per cent increase per annum. Despite a 40-year old Family Planning Programme, India’s 1991 census has shown a population increase of 160 million during the 1981- 91 decade. The gap between expressed favorable attitude towards the small family norm and knowledge and practice of family planning amongst Indian couples is intriguing. Family Planning basically, refers to the practices that help individuals or couples to avoid unwanted births, bring about wanted births, regulate the intervals between pregnancies, control the time at which births occurs in relation to the age of parents and determines the number of children in the family. Under the programme, various training programs have been conducted to train health care providers. Several health workers, both male and female became multipurpose workers responsible for providing a set of basic family planning, maternal and child health (MCH), and public health services. A community oriented service-network was developed to expand family planning and MCH services. In 1977 conscious shift was made in the policy to include voluntary family planning along with the other health care services under the umbrella of ‘Family Welfare’ and various centers have been set up in rural (primary health centers, community health centers etc.) as well as in urban areas (postpartum centers, urban family welfare centers, dispensaries and hospitals). Services administered through the programme have been broadened to include immunization, pregnancy, delivery and postpartum care, and preventive and curative health care.

The range of contraceptive products delivered through the programme also widened. The various contraceptive methods are categorized as barrier, chemical, natural or surgical (Weeks 2002). Surgical method includes sterilization (vasectomy and tubectomy) which is a permanent and irreversible method of birth control. Induced abortion is the post–conception method of family planning and is performed if there is a need to terminate an unwanted pregnancy because of failed contraception. Despite of many temporary methods, the emphasis was put on sterilization of male or female. Although sterilization is a safe and most effective technique it cannot serve the needs of all couples in the different stages of the reproductive life-cycle. Thus, a large proportion of couples remained unserved because of non-availability of proper contraceptive technology. So, the new approach emphasized the target-free promotion of contraceptive use among eligible couples, providing the couples a choice of contraceptive methods and encouraged them towards adequate spacing of births (at least three years birth interval). The National Population Policy (2000) has set the task of addressing unmet need for contraception as its immediate objective. Attitudes towards fertility regulation, knowledge of birth-control methods, access to the means of fertility regulation and communication between husband and wife about desired family size are essential for effective family planning (Dabral and Malik 2004). Various factors governs the acceptance of contraception e.g., religion (NFHS 1998-99, 2002), number of sons in family (Bhasin and Nag 2002), and education of husband and wife (Bhasin and Nag 2002), etc. Besides, spousal communication also increases the likelihood of contraceptive use (Kamal 1999; Ghosh 2001). Sterilization is usually accepted when the couple is sure that they have completed their family size and gender preference (Bhasin and Nag 2002).

Although the family welfare programme has made an important contribution towards improving the health of mothers and children, there are some major impediments. Even though a huge infrastructure has been established through out the country to deliver an integrated package of health and family welfare services, the quality and outreach services need improvement. According to Santhya (2003), the contraceptive prevalence rate in Meghalya is just 4.7 (2.8 for sterilization and 1.9 for other temporary methods), which is lowest in the whole India. This drew the attention towards the need to carry out a study in Meghalaya. So, the present study was conducted with an objective to study the extent of awareness of women with regard to family planning, i.e. birth control measures and awareness level regarding the Government schemes on family planning among the Khasi women of East Khasi Hills, Meghalya.

BACKGROUND

Family Planning is a program or practice to regulate the number and spacing of children in a family through the practice of contraception or other methods of birth control. Since the world and also India is facing with the problem of overpopulation. Government as well as non government agencies is taking major step to overcome this problem. In India the use of contraceptive methods increased from 13 per cent in 1971 to 56 per cent in 2005/06, and fertility declined from about 6 births per woman in the 1960s and 1970s to about 2.7 births in 2004. This decline of more than 3 births per woman represents about 85 per cent of the decline required to reach replacement fertility: 2.1 births per woman. As per the latest official data, the total number of family planning acceptors in India decreased by 5.1 % between 2011-12 and 2012-13. The data revealed that condom is the most preferred method of family planning while sterilizations the least adopted means. The number of couples adopting various methods for family planning, including spacing methods was found to be 30.2 million, with 13.9 million preferring condoms to any other means. The total Family Planning Acceptors in India have increased over the years but in recent years especially after 2007-08 the number of accepters has shown a gradual decreasing trend. The contraceptive prevalence rate for currently married women is the lowest at 24 percent in Meghalaya among all the states in India. The national average is 56 percent. The rise in contraceptive use and the pace of fertility decline, however, has not been uniform throughout the country. There are disparities in contraceptive use and fertility between the poor and the rich, and between the educated and the uneducated. While the country has also made tremendous progress in terms of economic growth, these disparities in contraceptive use and fertility have important implications for the future of the country. The purpose of this study is to review the current status of the family planning programme in East Khasi Hills District, Meghalaya, to assess the factors responsible for these inequalities.

STATEMENT OF THE PROBLEM

Over population is widely regarded as a major social and economic global problem since it is directly connected with the economic growth of the country and therefore welfare of the person and her/his family. Over population is an enormous issue and is important indicator of lack of human welfare in developing countries like India. Over population refers to the condition where the population growth of a country has overcome the economic growth of a country .It is also an indicator of poverty especially in the rural as well as urban area (i.e., more mouth to feed in). This trend has grave consequences for countries like India and many other developing countries, where population growth has been quite high and where employment generation falls far short of the rate of the population growth. It also engenders the issue of inequality and social justice. Due to this reason the government through the department of Family Welfare is implementing the National Family Welfare Programme by encouraging the production and utilization of contraceptives all over the country.

In the North East State of India including Meghalaya, women enjoy greater visibility and mobility than women of other communities in the country. This is often cited to portray a picture of equity between men and women in the region. Education has been the main catalyst in bringing about far-reaching changes in the status of women and to a great extent education of women in the region has been fairly non-discriminatory. Despite the fact still many people has a large and big family and are not aware of the various method of family planning or even if they are aware of it they are not access to it. This may be due to any social stigma or cultural factors, against their faith or maybe against their husband wish to practice it.

The literature review shows that there is large difference between the knowledge and practice of family planning and that it differs from one society to the other. The decision taken is mainly of a male dominated whereby the husband or a man takes a decision and there is less communication between the spouses regarding this matter.

But there was no study to compare and analyze the practice of family planning only among young adult who are in the most productive age of reproduction. Therefore the main aim is to study the various factors on the usage of family planning methods and the usage of different family planning methods by the targeted study population.

OBJECTIVES
To learn about the respondents’ knowledge about Family Planning method
To study the perception of married young adults towards Family Planning
To know about the utilization of family planning services among married young adults.
To learn about the misconception that the respondent has about family planning.
To know about the reasons for not practicing family planning among the respondents.
SIGNIFICANCE OF THE STUDY

With Meghalaya having recorded one of the highest decadal growth and fertility rates in the country as per the latest census, the state government has emphasized on the urgent need to reduce the population in the state to ensure sustainable economic growth and development.”The government is making efforts to stabilize the population of the country at a level consistent with the national economy,” said the Health Minister of the Government of Meghalaya. As per details from Census 2011, Meghalaya has a population of 29.67 Lakhs, an increase from figure of 23.19 Lakhs in 2001 census. Total population of Meghalaya as per 2011 census is 2,966,889 of which male and female are 1,491,832 and 1,475,057 respectively. In 2001, total population was 2,318,822 in which males were 1,176,087 while females were 1,142,735.The total population growth in this decade was 27.95 percent while in previous decade it was 29.94 percent. The population of Meghalaya forms 0.25 percent of India in 2011. In 2001, the figure was 0.23 percent. In spite of the low density and population of Meghalaya, it is worth noticing that, the state has a rapid population growth rate, and has the third fastest growing population in India, according to the Meghalaya Census 2011.

Therefore, based on this idea, the purpose of this study is to know about the life situation of married young adults their knowledge, attitude and practice also their access and utilization of various methods of family planning. Furthermore, such type of research has never been conducted before in this particular area. Therefore, it is thought to be useful to conduct this study in this area where like everywhere else, over population seemed to be a major problem that affect both the mother and the infant.

RESEARCH METHODOLOGY
Research design

The design to be adopted in this particular research is a mixture of explanatory, descriptive and research as the researcher will describe as accurately as possible the characteristics of married young adults and perception towards family planning and also to explain the causes and effect relationship between various factors that leads to the non utilization of family planning.

Population of the study

Any married young couples who come to Ganesh Das Hospital for maternal care at the period of data collection.

Sampling Design

The research will be carried out through a purposive random sampling as the sample will be selected based on judgement as to who can provide the best information to achieve the objective of the study.

Tools for data collection

Data collection will be conducted through structured interview method. This method will provide uniform information, which assures the comparability of data. Structured interviewing requires fewer interviewing skills than does unstructured interviewing

Nature of tools

Structured interview will be the tools used for data collection to ensure that all respondents are asked exactly the same set of questions in the same sequence and it is better for quantitative analysis.

Sources of data

Sources of data will be primary as well as secondary data as the researcher can obtain data through interview and also use census data to obtain information on the utilization of family planning in Meghalaya.

Data analysis

Data will be analyzed using Statistical test as per the requirement.This process will include editing, coding, classification and tabulation of collected data.

LIMITATION OF THE STUDY
Some sample may not respond to the researcher due to some ethical issues.
Over population due to high birth rate may not likely seen as a problem to everyone.

Since family planning is a wide concept, the researcher may not be able to cover all its respective area.

WORK PLAN

Sl No

Activity

Scheduled

Remark

1

Choosing of topic

April

Completed

2

Review of literature

August 2013

Completed

3

Synopsis

November 2013

4

Data Collection

December2013-January 2014

5

Analysis, interpretation and report writing

February-March 2014

6

Submission and defense

March 2014

LIKELY OUTCOME

This study is expected to describe the family planning knowledge, to identify the attitude towards family planning, highlight the factors and causes that hinder married young adult to practice family planning and to know about the rate of family planning utilization. Moreover, the study will also tell the strategies adopted by the married young adult in handling family size. Finally, the study would serve as a reference for the other like-minded individuals who would like to conduct a similar study in the future or who are interested in this field.

.

One has constructed this essay in a manner in which the reader will be able to appreciate the motives of discrimination and inequality and when they could take place; as well as the meaning and the impact they have, not only on the LGBT community but on the society as a whole. Throughout this essay one will attempt to identify the manifestation of inequality in the modern society, which in spite of everything is still occurring even after the Equality Act 2010 has come into practice and it introduced the Public Sector Equality Duty (PSED). This essay will focus on and around the inequality experienced by the LGBT community only, while keeping in mind of the fact that many other communities are suffering due to the injustice caused by being discriminated against.

Supposedly, due to a recent period of advancement in law-making, the people identifying themselves as lesbian, gay, bisexual and transgender (LGBT) are benefiting from extraordinary privileges and safeguarding which were initiated in the light of the appalling experiences they had, as well as promoting diversity; these rights are protected by the legal system in the UK, but are they mere theories/ideologies whose application still remains of question? Many people have overlooked any existing inequalities post enforcement of the aforementioned laws, thinking that if the law exist it means that it will happen. This essay will critically appraise the actual application of these laws within public and private organizations as well as at an individual level.

The writer contemplates on commencing this essay with investigating the definitions of inequality and discrimination, for the reason that it will provide a solid foundation for the further understanding of the aforementioned terminology often described as a concern within the society; as well as providing reassurance that the reader is in agreement with the writer as far as the meaning of the words.

According to Collins’ dictionary, inequality is the disparity in social class, assets, health, and prospect between human beings or social classes. The inequalities may be experienced by everybody, especially those people who are part of minority groups. Inequality is often stemmed from the society’s discriminatory behaviour practiced by institutions, governmental chambers and individuals in the United Kingdom of Great Britain, Wales and Northern Ireland (UK) towards the people identifying themselves as lesbian, gay, bisexual or transgender (LGBT).

Subsequently, one would like to define the term discrimination, similar words that relate are bigotry, bias, injustice, favouritism, unfairness, inequity, prejudice, and intolerance. In essence, it refers to certain individuals or groups of people behaving unfairly (discriminating), toward a person or a group of people they perceive to be different from themselves or the group of people they associate with.

Discrimination often stems from people’s evolutionary fear of the unknown, promoted by the lack of education and obliviousness towards phenomena that are regarded as out of the ordinary. Lorde, A talks about her opinion on the social division present in our society “It is not our differences that divide us. It is our inability to recognize, accept, and celebrate those differences.” Lorde, A. (1995)

The society became indoctrinated overtime and the discriminatory practices have come to be accepted as culturally/societally and furthermore unswervingly tolerable. This of course, should have been subject to change in the modern society of the twenty first century. Regrettably, the society has learned nothing from history, and an abundant amount of discrimination is still present and it leads to societies morals being questioned. This is mainly due to argumentum ad populum[1] which leads people to have unthinkable preoccupations just to belong and feel accepted. The reader may be familiar with the concept of “othering” also known as “otherness”. Classified as a psychological approach, it is fundamental to sociological studies and it illustrates the imbalance within political power between the majority and the minority groups. It appears that from a sociological perspective the majority versus minority power balance leans towards the majority. Othering is a manner of obtaining one’s own definite individuality as a result of the defaming of an “other”. Bauman, Z claims that the notion of otherness is based on the fact that the human individualities are established as irreconcilable difference and he approves of the idea of otherness as an acceptable social concept. One would argue that this theory is defending the need for social classification based on the higher number of people which belong to a certain set of criteria which are more commonly found; furthermore making this theory very short sighted. One must aim for equality as a social norm, Goldwater, B explains that” Equality, rightly understood as our founding fathers understood it, leads to liberty and to the emancipation of creative differences; wrongly understood, as it has been so tragically in our time, it leads first to conformity and then to despotism. “Goldwater, B (1964)

LGBT communities often live with “The sword of Damocles”[2] hanging above their heads meaning that they live under constant real and perceive threat during their lives, having an impact on their relationships with friends and family, health status, mental health (there are higher risks of depression, suicide, anxiety and mental distress in the LGBT population), and financial deficits. These people feel the need to “come out” in front of their friends and family, and want to be accepted without the fear of rejection and guilt. Then again, why the notion of “coming out of the closet”? The society is building closets to hide what they want to avoid, i.e. skeletons in the closet. Do heterosexual people have to make their sexual orientation public and fear of disapproval, rejection, and discrimination? One of the reasons for all this unwanted attention towards people’s sexual orientation may be because focusing on the LGBT community and spending energy and time on discriminating (please see otherness) is a red herring[3] used to distract the society’s attention from more important problems such as poverty and recession. The aforementioned theory is a mere extrapolation, such trying to find reason in madness or a as Nietzsche portrays it “….there is also always some reason in madness” Nietzsche (1914) although some people do prefer to accept it as oppose to admitting that people can be so venal. Wilkinson et al believes that “although sexual orientation is only one component of an individual’s sexual identity there is a common misconception that the components of a person’s sexual identity operate in parallel. For example, when people are described as possessing cross-gender sex roles, they are more likely to be perceived as being gay or lesbian.” Wilkinson, Wayne and Roy, Andrew (2005)

One cannot avoid drawing attention to the standing of the Christian Church and its philosophies, and their impact on people’s way of life (at least from a historical perspective). Therefore, one of the reasons behind the inequality and discrimination people within the LGBT community are experiencing, it is due to the intransigent position of the Abrahamic religions[4] as far as sexual orientation. The Church is (was) profoundly engrossed within the social and cultural background, especially in the very religious population but not limited to; this has engendered fallacies emerged from pious puritanical dogmas regarding the individuals with non-heterosexual orientation. Therefore these individuals exposed to the aforesaid ideologies have grown up to think that it is unnatural and dehumanizing to have a non-heterosexual orientation. This may affect the individual as far as their own sexual orientation thus often causing them to deny who they are, keep it hidden and even practice suicidal behaviour (please see closet); or practice homophobic behaviour with a view in being accepted in their communities. On the other hand, many Christian denominations adopt newer and more open ideas about homosexuality, which allows more people to keep following their faith while being themselves. Many people/health professionals/social worker fail to understand that homosexuality is only a small aspect of a person’s individuality.

The reader may inquire about the impact of the inequality towards the LGBT community on today’s society and vice versa. It is causing a social problem, for the reason that the society ends up persecuting prolific members of the society who would be able to elicit much beneficial changes for the posterity. Unfortunately the lack of opportunities, the mental distress and disapproval they experience leads to them not being able to achieve their full potential and thus impedes the social growth and progress. On the other hand, the constant discrimination and harassment experienced by these individuals could evoke strengths of character in certain people, who would eventually become leaders of the resistance against inequality and discriminatory practices. They may devise strategies to further educate the masses by becoming transparent and open themselves up to sharing their private experiences with others. Ultimately, fighting for the rights to be heard and accepted as parents, as spouses, as teachers, as friends, colleagues, leaders, care providers and furthermore human beings as well as form closely knit groups which provide emotional support to one another. One of these people is Lorde, A, a well-known civil rights, feminist movements activist and writer emerged from the LGBT community as an advocate by voicing her view on the importance of community support; “The outsider, both strength and weakness. Yet without community there is certainly no liberation, no future, only the most vulnerable and temporary armistice between me and my oppression.” Audre Lorde (1996)

One could argue that there are many people within the society who are celebrating the differences in people and that in the ideal world people would accept the variety of sexual orientation as a norm and utilizing the knowledge regarding the aforementioned only when offering personalized support. One’s outlook about the necessary awareness of individual’s sexual orientation by the private and governmental institutions is further explained by Trevor Phillips, Chair of Equality and Human Rights in his speech as it follows “Commission Data matters– because injustice that goes unseen goes uncorrected. How can we expect care homes to be sensitive to the needs of older LGB residents, or schools to the needs of the children being brought up by same-sex couples, if they don’t even acknowledge they’re there?”

Sadly, the society teaches their children that discrimination is a tolerable practice thus leading towards an impasse and further narrowing of the acceptance. The homophobic views of the parents get transferred onto their children, people may be able to see children from an early age i.e. in the kindergarten using terminology such as “gay” or “lesie” as insults among themselves and others, leading to a negative view of homosexuality from an early age. Should a modern society accept this sort of behaviour from the future generations?

The reader may think that the aforementioned statements could not be accurate, taking in consideration the Human Rights Act of 1989 as well as the Equality Act of 2010 and other laws and policies which support the equality of the individual at large. Well, in the light of such thoughts one feels the need to go even further and illustrate with examples these inequalities. Ellison et al explains that “Nearly four in ten lesbians and gay men reported that they had been bullied, felt frightened and had suffered from low self-esteem.” Ellison and Gunstone, 2009

Social workers will without a doubt come in contact with service users which identify themselves as LGBT. Therefore they must be able to communicate by using acceptable terms, be respectful and take in consideration the person as a whole, pertaining to their physical, emotional and financial needs. Disregarding a person’s sexual orientation, would be like ignoring somebody’s arm, it is part of them, a piece of the puzzle. One must carefully identify areas of inequality and discrimination, which the service users may be experiencing and make use of this information to further one’s understanding and awareness of the support needed. Spirituality, togetherness, health needs, age and other factors must be taken in consideration when evaluating a service user’s needs. The sad truth is that there is a tendency in the social and health professionals to assume heterosexuality in the elderly. This is inadvertently discriminative practice. On the other hand, the social worker must be able to reflect honestly on their own feelings and beliefs regarding other people’s various sexual orientation; being aware of any prejudices one may have would help to provide anti discriminative support to the service users.

To be able to explain the seriousness of the issues discussed within this essay, one must quote Ellison et al for a second time, they claim that “55 per cent of gay men, 51 per cent of lesbians and 21 per cent of bisexual women and men said they would not live in certain places in Britain because of their sexual orientation.” Ellison and Gunstone, (2009). This is unacceptable by the moral and ethical standards expected from today’s society, therefore the social worker must be aware of the people who do live in those areas and empower and safeguard them as necessary. On the other hand Ellison et al also explains that “Seven in 10 lesbians (69 per cent) and gay men (70 per cent) felt they could be open about their sexual orientation in the workplace without fear of discrimination or prejudice. This contrasts sharply with only around two in 10 (23 per cent) bisexual men and three in 10 (30 per cent) bisexual women who felt the same.

83 per cent of respondents would be happy or felt neutral about having an openly LGB manager at work” Ellison and Gunstone, (2009). This provides proof that the society has grown to be more accepting of the LGBT community and that the laws and policies are being enforced within private and governmental organisations. It appears that education seems to make a big difference as far as being open and accepting of diversity.

There is evidence of bullying due to sexual orientation at school levels, were people get physically and emotionally abused. ‘People call me “gay” everyday, sometimes people kick me or push me, they shut me out of games during school gym and they steal my belongings.’ James, 17, secondary school (South West). Hunt and Jensen, (2007)

The social worker, needs to be able to act as an advocate for these people, they must be empowered and supported so they learn to accept themselves.

In summary, the society inclines to be critical of the people in the LGBT community due to different factors; these are religious, cultural, fuelled by fear of unknown, lack of education, upbringing, and avoidance behaviour(i.e. questioning own sexuality). Unfortunately, this translates into discrimination and inequality, which leads to many unwanted effects.

Due to the fact that this paper is a mere literature review, one could not offer more specific examples of actual cases, therefore this article talks more generally about inequality and where it may be present, it’s impact on the society and the individuals as well as the impact of the law on the changes that have taken place towards acceptance of the LGBT community.

As a future social worker, one finds that the knowledge acquired through the present paper will be of great aid to further one’s knowledge in understanding not only the lesbian, gay, bisexual and transgender population, but also other minority groups that more often than many people would expect suffer in silence.

After much research, one must admit that there is very little literature present about the ageing and LGBT population. As the population is getting older, many people in the aforementioned community are interested in their future, especially if their partners pass away. Many transgender population live in fear that if they lose their capacity, will they still be able to get their hormonal treatment to maintain their identity. Therefore, one would suggest further research in that area, in form of an empirical study.

Dementia and Incontinence
An exploration of the impact that these conditions have on quality of life and a discussion of strategies that may be employed to manage the problem and/or enable the sufferer and carers to cope.

Based on the 2001 census, it is estimated that the total number of people living with dementia in the United Kingdom (UK) is 775,200 and that this figure will rise to 870,000 by the year 2010 and to 1.8 million by 2050 (Alzheimer’s Society 2004). Dementia affects about one person in 20 over the age of 65 years. This figure rises to one person in three for people over the age of 90 years (Gow and Gilhooly 2003). Studies have estimated that 18,000 people with dementia are under the age of 65, and that the number of people in the UK with dementia in minority ethnic communities could be as high as 14,000 (Alzheimer’s Society 2004).

Dementia is described as “a syndrome due to disease of the brain, usually of a chronic or progressive nature” (World Health Organization 2001). Dementia is associated with a range of symptoms including impaired memory, disorientation, poor concentration and difficulty in naming and use of language. Patients with dementia have an impaired ability to learn or recall learned information, difficulty in using motor skills and co-ordination, difficulty thinking in a clear and coherent way and in understanding or following a sequence (Jacques and Jackson 1999). The significant disabilities associated with

dementia can be accompanied by personality and mood changes, and changes in judgement. The term “dementia” is an umbrella term used to describe a number of conditions in which these symptoms occur, and where a differential diagnosis has been undertaken to rule out other causes for these symptoms (Cheston and Bender 1999). These include Alzheimer’s disease, vascular dementia and Lewy body dementia.

It is proposed that dementia commonly leads to incontinence of urine, faeces, or both. Urinary incontinence us up to four times more common in individuals with dementia than in people without dementia. Loss of continence may be more prevalent in Alzheimer’s disease than in vascular dementia, and becomes more common with increasing dementia severity (Skelly and Flint 1995). Men are more at risk than women, possibly because of associated prostatic problems. Faecal incontinence is less common than urinary incontinence, however both urinary and faecal incontinence are strongly associated with caregiver stress and possible premature entry to nursing and residential homes (Armstrong 1999). In fact, the rates of incontinence are particularly high among patients in hospitals, nursing homes and residential homes, where it is debated that approximately half might be affected (Irwin 2001).

This essay will briefly discuss the pathophysiology of the different types of dementia and incontinence with a view to investigating how these linked conditions affect quality of life. There will also be a discussion about various strategies that may be employed to manage the problem and/or enable the sufferer and carers to cope.

It is proposed that approximately 55 percent of patients diagnosed with dementia have Alzheimer’s disease, also known as Alzheimer’s dementia (Killeen 2000). It is a degenerative disease affecting the brain. This is a result of changes in the structure and function of two proteins, beta-amyloid and tau that cause the formation of plaques and neurofibrillary tangle form in areas of brain tissue, which destroy them (Burns et al 1997). The cause of this process is not yet fully understood. The temporal and parietal lobes of the brain are generally affected in Alzheimer’s disease, which can result in significant memory loss and an inability to recognise people and places. This can be extremely distressing, particularly if the person no longer recognises his or her image or that of friends and family (Kitwood 1997). As the condition progresses, basic skills and capabilities can be lost. Visual-spatial skills can become impaired, resulting in the patient becoming unable to put sequences of an activity or movement together (Jenkins 1998). The frontal lobe can also be affected and this can result in difficulties in communication and judgement resulting in disinhibited behaviour (Jacques and Jackson 1999). In Alzheimer’s disease the symptoms progress gradually but persistently over time (Burns et al 1997).

Vascular dementia, also referred to as multi-infarct dementia, is another common type of dementia. It is caused by problems in the circulation of blood to the brain, which results in multiple strokes to brain tissue resulting in significant cognitive impairment (Sander 2002). These strokes can cause damage to areas of the brain responsible for speech or language and can produce generalised symptoms of dementia. As a result, vascular dementia may appear similar to Alzheimer’s disease. Vascular dementia can progress in an irregular manner with episodes of sudden loss. It can also take the pattern of gradual change, as in Alzheimer’s disease. The rate of memory loss and impairment of insight appear to progress at a slower rate than in Alzheimer’s dementia. Vascular dementia has been identified as a distinct condition in up to 20 percent of people with dementia (Miller and Morris 1993); however, as with all types of dementia it can co-exist with other forms of the condition. Vascular dementia is considered the second most common form of dementia in the western world (Nor et al 2005).

Another common form of dementia is Lewy body dementia. Lewy body dementia is characterised by fluctuations of cognitive impairment, which are defined by episodic confusion and lucid intervals. These fluctuations in cognition can occur over minutes, hours or days. They can occur in as many as 50-70 percent of patients and are associated with shifting levels of attention and alertness (Archibald 2003). Patients with Lewy body dementia can experience visual and auditory hallucinations, secondary delusions and falls. These symptoms can result in the person presenting with behaviours that are challenging. Lewy bodies are tiny spots containing deposits of a protein called alpha-synuclein. These are found in the hippocampus, temporal lobe and neocortex in addition to the classic sites in the substantia nigra and other subcortical regions (Del Ser et al 2000). Lewy body dementia is ranked as the third major type of dementia. It is estimated that around 20 per cent of people with dementia will have the Lewy body form of the disease (McKeith et al 1995). However, this figure could be much higher, and it is estimated that up to 36 percent of people with dementia could have this type (Del Ser et al 2000).

It is posited that continence is a basic function that should be maintained in healthy elderly people, regardless of age. Loss of continence can be interpreted as a dysfunction of either the lower urinary tract or bowel, or of some other system that participates in the maintenance of continence, in particular the nervous system (Crome et al 2001). Loss of continence in the patient with dementia is related most commonly to alteration in basic factors necessary for its maintenance or to use of medication (Ouslander 2000). People with dementia are also more prone to suffer delirium which is associated often with incontinence. Immobility can soon lead to loss of continence and the frequency, and severity of incontinence is strongly associated with dementia severity and incapacity to walk or make transfers (Skelly and Flint 1995). Resnick (1995) analysed the relationship between incontinence and a series of factors outside the lower urinary tract. He found that if patients maintained independence to make transfers and to dress, even though their dementia was severe, they could maintain continence. The influence of sedative drugs, physical restrictions and other environmental or social factors must not be forgotten. Furthermore, the attitude of professionals, with over-use of absorbent or palliative products for incontinence, can itself lead to loss of continence.

Since the aetiology of incontinence in the older person with dementia may be multifactorial, it is suggested that a multidimensional assessment is required to identify the pathogenic mechanisms involved. The diagnostic assessment should be individualised, depending on the characteristics of each patient (clinical, functional, life expectancy) as well as the impact of incontinence (Khoury 2001). Generally, it is accepted that the basic assessment should include several components such as a medical history, clinical type of incontinence, the severity of incontinence, and the timing of leakages. A functional assessment focusing on mobility (transfers, walking, and skill grade) and mental function should be undertaken and a formal assessment should be made of the severity and nature of the cognitive impairment and of any depression or behavioural disorders that could influence presentation, as well as management of incontinence. Finally, an environmental assessment would prove useful to detect the existence of barriers that could limit access to the lavatory (Alzheimer’s Society 2004).

It is posited that incontinence has an adverse effect on the quality of life. Quality of life can be defined as the awareness of the capacity to meet personal, psychological and social needs on a daily basis. It is proposed that incontinence is very distressing and it can affect an individual’s sense of dignity and self-esteem especially if the person needs personal help from a carer or relative as a result of incontinence (DuBeau et al 2006).

Treatment of urinary incontinence is based on various approaches, which should be used in a complementary way to obtain the best results. It is fundamental to establish realistic therapeutic objectives. However, it is argued that it will not be easy to obtain positive results in all patients, because of immobility and lack of co-operation. Trying to reduce the severity of incontinence and maintenance of patient well-being, good perineal hygiene and “social continence” may be a more realistic goal. Thus, an individual approach is essential, adapted to the characteristics and situation of each patient (Irwin 2001).

It is proposed that treatment measures should include the identification and treatment of concurrent medical conditions, active management of constipation, hygienic-dietary recommendations (reduction of stimulant substances e.g. caffeinated drinks, modification of timing of fluid intake). An improvement in mobility, a review of usual treatment and change of drugs that are potentially involved in incontinence recommendations should be included in treatment measures. The type of clothes worn such as clothes with simple opening and closing systems can help with toileting and incontinence. Utilising environmental interventions such as; enhanced visibility by painting toilet doors bright colours, signposting and good lighting, ensuring easy access to toilets, providing grab-rails and raised toilet seats, and ready availability of mobility aids, commodes and urinals, preferably with nonspill adapters, will be of immense help. Debatably, these measures might assist the dementia patient with any possible confusion as to where the toilet is (Alzheimer’s Society, 2004).

Other strategies for the management of incontinence in the dementia sufferer could include behavioural techniques. These techniques attempt to promote a change in the patient’s (or caregiver’s) behaviour, trying to re-establish a normal pattern of bladder-emptying or to prevent the patient from being wet. Simple, non-invasive, behavioural techniques are relevant for almost all types of patients and incontinence, and can be used jointly with other therapeutic options, especially drug treatment (Khoury 2001). Two groups of techniques are differentiated: those performed by the patient (pelvic floor exercises, bladder-retraining, biofeedback) and those by the caregiver (micturitiontraining, scheduled voiding, prompted voiding). It is argued however, that the patient-dependent techniques require previous instruction as well as understanding and collaboration by the patient, so they may be impracticable for people with advanced dementia.

The most used behavioural techniques are prompted voiding, micturition training and scheduled voiding. Prompted voiding has the greatest scientific support. The objective of this technique is to stimulate the patient to be continent through periodic assessments by the caregivers and positive reward systems. Several studies demonstrate the effectiveness of behavioural techniques in institutionalised elderly subjects with dementia, especially in reduction of incontinence episodes. However, most data report its effectiveness only in the short term (Eustice et al 2002, Durrant and Snape 2003).

Dementia is a distressing long-term condition that affects both sufferers and their carer’s quality of life. Coupled with that incontinence can be humiliating for the individual with dementia and upsetting for their significant others around them. It is important to assess the person’s individual needs as incontinence in dementia is multifactorial. There are various strategies and treatments that can be put into place that will assist both the sufferer and their carer. Behavioural techniques such as prompted voiding, micturition training and scheduled voiding have been found useful as a treatment alongside environmental and current review of medical history. It is important to note that incontinence should always be viewed as associated with, rather than caused by dementia and therefore potentially treatable.

References

Alzheimer’s Society (2004) Policy Positions: Demography, www.alzheimers.org.uk/News_and_Campaigns/Policy_Watch/demography.htm, (Last accessed: August 2006)

Archibald C (2003) People with Dementia in Acute Hospital Settings: A Practice Guide for Registered Nurses, Stirling, The Dementia Services Development Centre

Armstrong M (1999) Factors affecting the decision to place a relative with dementia into residential care, Nursing Standard, 14, 16, 33-37

Burns A, Howard R, Pettit W (1997) Alzheimer’s disease: A Medical Companion, Oxford, Blackwell Science

Cheston R, Bender M (1999) Understanding Dementia: The Man with the Worried Eyes, London, Jessica Kingsley

Crome P, Smith AE, Withnell A (2001) Urinary and faecal incontinence: prevalence and health status, Reviews in Clinical Gerontology, 11, 109-113

Del Ser T, McKeith I, Anand R, Cicin-Sain A, Ferrara R, Spiegel R (2000) Dementia with Lewy bodies: findings from an international multicentre study, International Journal of Geriatric Psychiatry, 15, 11, 1034-1045

Durrant J, Snape J (2003) Urinary incontinence in nursing home for older people, Age Ageing, 32, 12-18

Eustice S, Roe B, Paterson J (2002) Prompted voiding for the management of urinary incontinence in adults, Cochrane Database Systemic Review

Gow J, Gilhooly M (2003) Risk Factors for Dementia and Cognitive Failure in Old Age, NHS Health Scotland, Glasgow

Irwin B (2001) Management of urinary incontinence in a UK trust, Nursing Standard, 16, 13, 15, 33-37

Jacques A, Jackson G (1999) Understanding Dementia, (3e) Churchill Livingstone, Edinburgh

Jenkins DAL (1998) Bathing People with Dementia: The Bathroom and Beyond, Stirling, The Dementia Services Development Centre

Khoury JM (2001) Urinary incontinence: No need to be wet and upset, North Carolina Medical Journal, 62, 74-77

Killeen J (2000) Planning Signposts for Dementia Care Services, Edinburgh, Alzheimer Scotland

Kitwood T (1997) Dementia Reconsidered: The Person Comes First, Milton Keynes, Open University Press

McKeith IG, Galasko D, Wilcock GK, Byrne EJ (1995) Lewy body dementia: diagnosis and treatment, British Journal of Psychiatry, 167, 6, 709-717

Miller E, Morris R (1993) The Psychology of Dementia, Chichester, John Wiley and Sons

Nor K, McIntosh IB, Jackson GA (2005) Vascular Dementia: Series for Clinicians, Stirling, The Dementia Services Development Centre

Ouslander J (2000) Intractable incontinence in the elderly, British Journal of Urology International, 85, 3, 72-78

Resnick NM (1995) Urinary incontinence, Lancet, 346, 94-100

Sander R (2002) Standing and moving: helping people with vascular dementia, Nursing Older People, 14, 1, 20-26

Skelly J, Flint AJ (1995) Urinary incontinence associated with dementia, Journal of the American Geriatrics Society, 43, 286-94

World Health Organization (2001) Alzheimer’s disease: The Brain Killer, Geneva, WHO

policies of past and present, explain how the quality of life for the service users have improved over time:

P1.1: Identify key historical landmarks in social welfare, focusing on the period up to 1945:

The Key historical landmarks in social welfare focusing 1945 period were: In 19th century it was the role of religion, the voluntary sector in welfare. And in early 20th century Liberalism and the foundations of British welfare, votes for women.Let us analyse the historical landmarks of Social welfare policies for a period of upto 1945.

1901 Seebohm Rowntree’s first study of poverty in York, Poverty: a study of town life

1903 Charles Booth’s study of poverty in London, Life and Labour of the People of London

(1906 – 1912) THE NEW LIBERALISM: To make people liberal in their living.It is said by Lloyd George that ‘We will draw a line below which we will not allow people to live and labour’

1906 School Meals Act

1908 Old Age Pensions Act: means-tested pensions from age 70

1909 The People’s Budget: super tax introduced, child tax allowances introduced

1911 National Insurance Act: sickness insurance and limited provisions for unemployment

(1913 -1941) CHANGE AND DEVELOPMENT: It mainly focuses on dealing with problems individually.Beveridge Report goes this way: ‘In all this change and development, each problem has been dealt with separately, with little or no reference to allied problems’.

1920 Unemployment Insurance Act: non-manual workers included.

1925 Widows’, Orphans’, and Old Age Contributory Pensions Act: first national scheme of contributory pensions

1936 J.M. Keynes’ General Theory of Employment, Interest and Money

1940 Old Age and Widows’ Pensions Act: pension age for women reduced from 65 to 60

(1942 – 1945) TOWARDS A ‘BEVERIDGE’ WELFARE STATE: Contributing for the welfare of the people.Beveridge Report goes this way:’It is, first and foremost, a plan of insurance – of giving in return for contributions benefits up to subsistence level, as of right and without means test, so that individuals may build freely upon it’.

1942 Sir William Beveridge’s Report on Social Insurance and Allied Services

1943 Juliet Rhys Williams’ work-tested Citizen’s Income

‘The Beveridge Plan,will have the effect of undermining the will to work of the lower-paid workers to a probably serious and possibly dangerous degree. The prevention of want must be regarded as being the duty of the State to all its citizens, and not merely to a favoured few’

Family Allowances Act: ?0.25 a week for each child after the first.

P1.2 Outline evolution of health and social care policies following World War II until 1979:

This is the time during the war when the government got committed to full employment through the Keynesian Policies, free universal secondary education, and the introduction of secondary allowance.

1946 National Insurance Act:Has flat-rate NI benefits.Provided a comprehensive system of unemployment, sickness, maternity and pension benefits funded the by employers and employees, together with the government .

1948 National Assistance Act: Poor Law got abolished

1955 Richard Titmuss’ Eleanor Rathbone Lecture on the Social Division of Welfare: ‘The tax saving that accrues to the individual through income tax allowances is, in effect, a transfer payment’

1959 National Insurance Act: graduated pensions got introduced

1962 Milton Friedman’s Capitalism and Freedom includes negative income tax proposals

1965 Poverty ‘rediscovered’: The Poor and the Poorest, Brian Abel-Smith and Peter Townsend

1966 Supplementary Benefit replaces National Assistance.Rate rebates got introduced.

1971 National insurance invalidity benefit got introduced.Family Income Supplement (FIS) introduced (and with it the poverty trap)

1972 Heath Government’s Proposals for a tax-credit scheme.Tax credits become Conservative policy. First national scheme of rent rebates (and higher rents)

1975 Social Security Pensions Act: State Earnings-Related Pensions (SERPS). Earnings-related national insurance contributions introduced at 5.75%

1976 One-parent benefit got introduced

1978 ‘Meade Report’ on The Structure and Reform of Direct Taxation includes a chapter on Social Dividend. SERPS gets implemented.

1977-79 Tax-free child benefit phased in, replacing taxable family allowance and child tax allowances.

P1.3 Outline health and social care policies from 1979 to the present day:

(1979 – 90) TOWARDS A RESIDUAL WELFARE STATE: It was said by Margaret Thatcher that ‘We offered a complete change in direction’.

1980 Social Security Acts 1 and 2: Instead of earnings pension upratings got linked to prices. Education Act: Local Education Authorities allowed to choose whether to provide school meals: fixed prices and national nutritional guidelines got abolished.

1982 National insurance contribution increased to 8.75%. Earnings-related supplements with national insurance unemployment and sickness benefit cease to operate.

1983 First official reference to Basic Income in the report of the Meacher sub-committee of the House of Commons Treasury Select Committee.National insurance contribution increased to 9%. National insurance sickness benefit replaced by statutory sick pay. Rent/rate rebates got replaced by housing benefit.

1984 Basic Income Research Group formed.Child dependency additions with national insurance unemployment benefit cease to operate.

1985 Norman Fowler’s Social Security Review. Billed as ‘the most fundamental since World War II’, but did not examine integrated systems.

1986 Social Security Act: Three major Bills in one (Got effective from April 1988)

1987 National insurance maternity grant replaced by statutory maternity pay. Payment of half and three-quarter rate national insurance unemployment benefit ceases.

1988 Tax cuts and benefit cuts.Top rate of income tax down from 60% to 40%. Standard rate of income tax down from 27% to 25%.The withdrawal of income support from most 16-17 year olds.Cuts in housing benefits, SERPS and national insurance widows’ pensions. Maximum rate rebate limited to 80% of liability.Child benefit frozen.Income-tested Family Income Supplement replaced by means-tested Family Credit. Free school meals restricted to families on Income Support.

1989 Child benefit frozen.Abolition of pensioner earnings rule.Social Security Act introduces actively seeking work test.

1990 Liberal Democrats’ Conference votes for Citizen’s Income.Independent taxation of husbands and wives introduced, but with married couples’ allowance for husbands

Child benefit still frozen.

(1991 – 1996) CUTS AND TINKERING: Peter Lilley said,’The changes I have announced today will help shift the balance back to a benefit system that does not discriminate against married couples, and which aims to reduce benefit dependency by helping people into work’.

1991 Child Support Act introduced.Benefits Agency established. Child benefit unfrozen.

1992 Disability living allowance replaces mobility allowance and attendance allowance for the under-65s. Disability working allowance introduced.Additional minor reforms of disability benefits.

1993 Peter Lilley launches sector by sector review of social security.

1994 Budget introduces ‘welfare to work’ measures to ease transition into paid work and encourage full-time work.Introduction of child care allowance for certain parents claiming family credit and related benefits.

1995 Incapacity Benefit replaces Sickness Benefit and Invalidity Benefit.Phasing out of additional assistance for lone parents.Cuts in housing benefit for young people

Pensions Act reforms occupational pensions, reduces value of SERPS, extends scope of personal pensions, and equalises pension age for women born after 5th April 1955 (with phasing in from 60 to 65 for those born after 5th April 1950).

Cuts in housing benefit and in help with mortgage interest for income support claimants.

1996 Jobseeker’s allowance replaces unemployment benefit and income support for the unemployed.Contributory benefit is paid for 6 months instead of 12 and the level is reduced for 18-24 year olds.The Asylum and Immigration Act 1996, introduces restrictions on benefits, housing and employment for asylum applicants.

(1997 – 2008) NEW LABOUR: Tony Blair said ‘In future, welfare will be a hand-up not a hand-out’

1997 Tony Blair becomes Prime Minister. First Labour government for 18 years.

1999 Family Credit replaced by Working Families Tax Credit (WFTC) and Disabled Persons Tax Credit (DPTC).Winter fuel payments of ?100 per year for those aged 60 or over introduced. Payments are not means-tested.

2000 Benefit entitlement for new asylum seekers ends.

2001 Children’s Tax Credit introduced – a tax allowance for those with children.

Bereavement benefits reformed so that widowers as well as widows entitled to benefits when their spouses die.

2002 State Second Pension replaces SERPS. Carers and those with children under 6 become entitled to credits in accruing pension rights.

2003 Child Tax Credit (CTC) and Working Tax Credit (WTC) replace WFTC, DPTC and Children’s Tax Credit. Payment depends on a claimant’s annual income and is assessed annually unless there are certain changes of circumstances during the tax year.WTC includes payments for childcare but only up to 70% (later 80%) of the childcare costs and a maximum limit.9 out of 10 families with children qualify.Pension Credit introduced, replacing income support for people aged 60 or over.Guarantees a minimum income for pensioners and often paid to top up state retirement pension.Work-focused interviews for benefit claimants introduced. Claimants for certain benefits are required to participate in an interview with a personal adviser in order to meet entitlement conditions.

2005 Civil partnerships introduced for same-sex couples. Cohabiting same-sex couples treated in the same way as heterosexual couples for benefit purposes rather than as two individuals.

2006 The Government’s White Paper Security in Retirement proposes an increasing retirement age, personal savings accounts, and a basic state pension uprated in line with earnings from 2012.Winter fuel payments increased to ?200 (?300 for a person aged 80 or over).

2007 The House of Commons Work and Pensions Committee’s report on Benefits Simplification recommends a Single Working Age Benefits and publishes a costed Citizen’s Income Scheme in its evidence.

2008 Welfare Reform Act 2007 comes into force. As well as making minor changes to benefit legislation, it introduces a Local Housing Allowance to simplify Housing Benefit for privately rented tenants. The Employment and Support Allowance (ESA) replaces Incapacity Benefit and Income Support paid for new claimants on the basis of incapacity for work. Claimants face tougher tests before being granted ESA which also makes the benefit system even more complicated.

M1.1: Analyse and express your views.

Welfare services comprises of social security, which makes different provisions against disruption of earnings due to sickness, injury, old age or even unemployment. They take the forms of unemployment and sickness benefits, family allowances as well as income supplements that is being provided and financed through the insurance schemes of the government.

During 1945,the government was committed to full employment through the Keynesian Policies, and introduced free universal secondary education, and the introduction of secondary allowance.Family allowances, a national health service and full employment were the main considerations during that time.Many policies provided a comprehensive system of unemployment, sickness, maternity and pension benefits funded the by employers and employees, together with the government.

Another important aspect that needs to be considered for the social and health welfare in the UK is the social citizenship model.The issues regarding the social citizenship model was not a challenge in the anticipation of the emergence of the Conservative Party leader in 1975 and the Prime Minister in 1979. After 1975 the government actually promised low taxes, less state intervention, as well as lower levels of public spending. In the theory it involved, vital cuts in the welfare spending.

But at present,policies reduce benefit dependency by helping people into work. New Labour and social inclusion, important legislation and health and social care initiatives begin to take over the society with which we live in.

D1.1: Critically compare and explain the facts:
Upto 1945
Till 1975
At Present

It deals with role of religion, the voluntary sector in welfare. Also dealt with free universal secondary education. Sickness was a primary cause of pauperism, and the Poor Law authorities began to develop ‘infirmaries’ for sick people.

It deals with policies regarding welfare state. Beveridge report is based on three assumptions:family allowances,health service,full employment.Other than this it was during this period the Insurance,Pensions,Tax credits,Family Income supplement etc was introduced as benefits to the common man.

It deals with New Labour and social inclusion, important legislation and health and social care initiatives,New Rights and Thatcherism.Also the changes done by Peter Lilley announced that today will help shift the balance back to a benefit system which aims to reduce benefit dependency by helping people into work

Task 2.1: Explain and analyse the process of key acts coming through

the parliament to become the policy of the government. Explain in terms of Health and Social policy. Analyse the influential factors which shapes the key themes and concepts in a parliamentary act. Evaluate the impact on service users once an act becomes the policy/law.

P2.1: Identify and analyse the processes involved in development of a key Act of Parliament:

An Act of Parliament creates a new law or changes an existing law.Also Acts are Acts of Parliament which have been given Royal Assent. All Acts of Parliament start life as a Bill which must pass through Parliament. These must be distinguished from Private Members’ Bills which are Public Bills proposed by backbench MPs. Public Bills originate from a number of different sources.It may arise from government, civil service, government agencies, political parties, committees, enquiries, legislative process, green/white papers, debate.The Government decides whether or not to agree to these proposals and put them before Parliament. Once a department has decided that it wishes to ask Parliament to pass legislation on a certain topic, it will undergo a consultation process with interested parties. The extent of this process will differ depending on the complexity, importance and urgency of the matter. It may take many months or a few days. The first stage is often a consultation document called a Green Paper which sets out in general terms what the Government is seeking to do and asks for views. Once these are received and taken account of (or not) the Government will produce a White Paper, which sets out the proposals decided upon and the reasons for the legislation. These two stages may be contracted into one.These stages are not fixed by formal rules and are subject to change. For example, it is increasingly common for draft Bills to be drawn up and circulated for consultation before being formally laid before Parliament, an example being the Mental Health Bill 2002. Occasionally Bills are scrutinised by the Parliament.In terms of Health & Social department ,health policy is a set course of action (or inaction) undertaken by governments or health care organizations to obtain a desired health outcome.The overall health care system, including the public and private sectors, and the political forces that affect that system are shaped by the health care, policy-making process. Public health-related policies come from local, state, or federal legislation, regulations, and/or court rulings which govern the provision of health care services. Nurses are very familiar with institutional policies including those developed and implemented by the Joint Commission on Accreditation of Healthcare Organizations. Policy making takes place in a wide variety of settings ranging from fairly open and public systems. The location of decision making in the public or the private sector, the scope of the issue, and the nature of the policy all have an impact on the characteristics of a policy. Since a basic understanding of the policy process is the first step in strategizing how to activate potential power and influence meaningful changes in the health care system, We will discuss the three phases of policy making. Basically there are three phases of policy making: the formulation phase, the implementation phase, and the evaluation phase. During the formulation phase there is input of information, ideas, and research from key people, organizations, and interest groups. At this point the issue is framed; the purpose and desired outcomes are clearly identified & strategies most appropriate to the desired outcome are selected; and needed resources are identified and planned. The implementation phase involves disseminating information about the adopted policy and putting the policy into action. In this phase, the proposed policy is transformed into a plan of action. The policy process also includes an evaluation and modification phase when existing policies are revisited and may be amended or rewritten to adjust to changing circumstances.

P2.2: Analyse the factors that influenced the key themes and concepts in the Act:

Health depends on a number of factors, including biological factors, environmental factors, nutrition, and the standard of living.The main factors currently affecting people’s health in the United Kingdom include smoking, bad diets, alcohol, and lack of exercise. While the British government has worked to reduce the influence of these factors, only the people themselves can put an end to them by changing their attitudes toward health.Apart from these many other factors act as influential factors which shapes

the key themes and concepts in a parliamentary act.

Evaluation and evidence are not the only factors that influence policy making and service

delivery.The experience, expertise and judgement of policy makers, and those people who have responsibility for planning and delivering policies and public services, are important factors in the policy making process. So too are the finite resources that are available for policies, programmes and projects.The values and value system within which contemporary politics take place are also contributory factors to the policy making process.This includes beliefs, ideologies, and party manifesto commitments. Policy making also involves habitual and traditional ways of doing things that may sometimes defy rational explanation yet nonetheless exist and often define what can and cannot be done in making and implementing policy. The influence of lobbyists and pressure groups on policy making also paves an important way to reach the target. The policy making process can be strongly affected by unforeseen circumstances and contingencies, the response to which can sometimes be opportunistic rather than well thought through, soundly evaluated, and evidence based.

P2.3: Evaluate the impact of the Act on service users:

Generally, as the function of health and social care, it can be concluded as a body which provide services that relates to ‘care services’ but the two bodies are separated in term of governing, policies, act, and so on. The UK government are concerned with the separation of social and health care. Because of the separation, it cause a major problem such as service fragmentation, higher cost of treatment and problem in continuing care after discharge from the hospital.Reflecting to this problem, the UK government has put a priority in integrating these two entities.The Govt organization can ensure better benefits to service users by having benefits to:

Strategies for health promotion

Health and safety

Manual handling

Data protection

Food handling

Care practice

Mental health

Children Disability

Task 2.2: M2.1: Critically analyse and explain how political leaders leading the country through economic hardships and recession in the aftermath of World War 2 and leading to the World War 2, made key improvements through parliament acts for their people.

Also political leaders leading the country through economic hardships and recession in the aftermath of World War 2 and leading to the World War 2, made key improvements through parliament acts for their people.Political leaders introducing few other acts to make key improvements in parliamentary acts.They were:

Health Act 2009: It proposed measures to improve the quality of NHS care, the performance of NHS services, and to improve public health.

Health and Social Care Act 2008: It contains significant measures to modernise and integrate health and social care.

The Local Government and Public Involvement in Health Act 2007: It is an Act to make provision, with respect to local government and the functions and procedures of local authorities and certain other authorities; with respect to persons with functions of inspection and audit in relation to local government; to establish the Valuation Tribunal for England; in connection with local involvement networks; to abolish Patients’ Forums and the Commission for Patient and Public Involvement in Health; with respect to local consultation in connection with health services.

Health Act 2006: It is an Act to make provision for the prohibition of smoking in certain premises, places and vehicles and for amending the minimum age of persons to whom tobacco may be sold; to make provision in relation to the prevention and control of health care infections; to make provision in relation to the management and use of controlled drugs; to make provision in relation to the supervision of certain dealings with medicinal products and the running of pharmacy premises, and about orders under the Medicines Act 1968 and orders amending that Act under the Health Act 1999; to make further provision about the National Health Service in England and Wales and about the recovery of National Health Service costs.

Task 2.3 D2.1
Critically explain and analyse how person centred care could
be improved for the service users with the on-going policy changes from the government. Why is it important for the political sector of the country need to evaluate and understand the final impact towards the service users before processing those social acts through parliament?

Most major public policies are subject to modifications in a incremental fashion. Making smaller changes in existing policies are usually less controversial than making major changes as they require less understanding of comprehensive relationships and less effort to achieve. An example of incrementalism in health policy can be seen in the many changes that the Medicare Program has undergone since its enactment in 1965. A change to the program of importance to advanced practice registered nurses came in 1998, when the U.S. Congress added nurse practitioners and clinical nurse specialists as providers who can bill for Part B services they provide to Medicare beneficiaries. Since then, Congress has tweaked Medicare program many times and added a number of preventive services to the Medicare program. Most recently Medicare Part D, an optional prescription drug program available for Medicare beneficiaries, has been added.

If we think about why is it important for the political sector of the country need to evaluate and understand the final impact towards the service users before processing those social acts through parliament,the Govt is actually responsible for.That needs to be understood first. As any health care issue moves through the phases of the policy process, from a proposal to an actual program that can be enacted, implemented, and evaluated, the policy process is impacted by the preferences and influences of elected officials, other individuals, organizations, and special interest groups. These different factions do not necessarily view the issue through the same lens and often have diverse and competing interests. Added into the mix are the partisan agendas of the two political parties, the Democrats and the Republicans.The political party holding the majority usually has the political advantage.Decision makers rely mainly on the political process as a way to find a course of action that is acceptable to the various individuals with conflicting proposals, demands, and values.As a general rule, any policy involving major change, significant costs, or controversy will be relatively more time consuming and difficult to achieve and will require the use of more political skills and influence than will policies involving less complex changes. Throughout our daily lives, politics determines who gets what, when, and how. Political interactions take place when people get involved in the process of making decisions, making compromises, and taking actions that determine who gets what in the health care system. Special interest groups and individuals with a stake in the fate of a health care policy use all kinds of influencing, communication, negotiation, conflict management, critical thinking, and problem solving skills in the political arena to obtain their desired outcome.

Task 3.1. Explain the current policy initiatives in Health and Social Care and evaluate the impact on service users. Analyse the differences in formation and adaption of social policy initiatives from other national perspectives.
P3.1: Identify current policy initiatives in all health and social care.

The Department of Health & social care works to define policy and guidance for delivering a social care system that provides care equally for all, whilst enabling people to retain their independence, control and dignity.Government strategies and policies aimed at providing a broad range of health care services and facilities.Other current initiatives include complementary health settings, or public health arenas,with children, older people or those with disabilities.Apart from these initiatives there are also few that act as policy initiatives in all health & Social care facilities.They are disability,gender, ethnic issues, community care,poverty and social security, crime and criminal justice, health and health services. For promoting health the initiatives that need to be taken are labelling regulations to inform consumers of nutritional content of foods,Educational campaigns to promote healthy diets and special programmes targeted to children,Promotion of consumption of fruits and vegetables for the general population,Fruit and Vegetable distribution programmes for school children.Also there is a chance where there will be multi-agency partnerships that creates many job opportunities in line with government initiatives to address health improvement, health inequalities and social exclusion, the health of children, young people and families, care and wellbeing of older people, those suffering from mental health problems and community development.This inturn gave rise to increased employment opportunities in these Health & Social care.Child social care, like many public services is under pressure to make financial savings, greater use of resources and effective working practices are essential if the sector is to continue delivering high quality care.Other Initiatives may be

Employee related initiatives: Increasing skills & employability of unemployed people,working Family tax credit,National Minimum wage

Area Focused initiatives: Health focused zones

Initiatives to tackle social exclusion:National Strategy for Neighbourhood renewal (Hunter, 2003,58)

P3.2: Evaluate the impact of these policy initiatives on service users

The United Kingdom Government uses a wide range of evaluation methods to ensure that policies, programmes and public services are planned and delivered as effectively and efficiently as possible to the service users.A major driving force for high quality policy evaluation in U.K. is the Government’s commitment to evidence-based policy making. This requires policy makers, and those who implement policies, to utilise the best available evidence from national statistics, academic research, economic theory, pilots, evaluations of past policies,commissioned research and systematic consultation with delivery agents.The Government’s strategy for public spending and taxation also provides the context within which policy evaluation takes place in the U.K. The UK Government has undertaken, and is currently undertaking, a number of randomised

controlled trials of policy initiatives. In the field of labour market and welfare policy, the

Restart evaluation (1990) randomly allocated unemployed people to a compulsory major

interview at 6 months unemployment to see if this had the effect of successfully reintroducing them to the labour market. This is one of the largest and best-known randomised controlled trials in U.K and it established a clear and positive impact on exits from unemployment with lasting effects still.

P3.3: Analyse the differences in formation and adaption of social policy
initiatives from other national perspectives

The social & healthcare policy initiatives emerged as a distint area in the UK in the early 20th century.To make a civilized society by provision of welfare benefits to the citizens ,irrespective of their ability to pay for them and aim for universal health service,pensions & state education.

In USA health care is been controlled by private & occupational insurance schemes with the state playing no part.It is the same with Japan.

In Western Europe there are health care systems that are run by both private & state run insurance schemes.

In wales it maintains the patient centered focus and answerable to all citizens of the state.Also it involves the communities in the development of the policies for healthcare.

So many health problems are prevented before they start of.

In Scotland the plan is an contract between the government & the individual citizen.

The English policy is straightforward.It ensures commitment to improve the health service rather than the policy itself.It is a contract between govt,service & the customer.

In Welsh document it is based on the notions of community enhancement & community capacity building.But it is absent in English & Scotland documents(Adams, Robinson, 2002:63-65).

Task 3.2 (M3.1):
Critically analyse the contemporary policy developments in
Health and Social Care. How would you expect these policies could
improve quality of life of your service users under your care at a facility?

The policies can improve the life of the service users by participating in the interest groups,such as patient organizations.And it paves the way for influencing healthcare as a representative in parliamentary system.Participating in public hearing processes,participating as members in publicly appointed boards & councils.

Task 3.3 (D3.1):<