Person centred reviews in adult services

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

Introduction:

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

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

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

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

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

Family C: Polish origin

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

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

Family E:

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

Group Work:

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

Preparation of placement

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

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

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

Assessment:

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

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

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

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

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

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

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

Planning:

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

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

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

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

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

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

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

Intervention:

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

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

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

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

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

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

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

Review:

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

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

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

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

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

Conclusion:

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

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

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

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

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

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

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