Strategies for Discrimination in Adult Community Care
Identify and reflect on potential strategies for addressing oppression and unfair discrimination encountered in community care for adults. Examine the implications of this process for a social worker value base.
The Audit Commission report of 1986 and the Griffiths report 1988 emphasised the need for care to become consumer-led; traditionally state run services were quickly contracted out to private and voluntary sector providers. Value-for-money became key, and community care became the favoured option over and above residential care (Blakemore, 2003). Some argued that social work values became secondary to resource-led decision-making (Banks, 1995).
Negative discrimination can be defined as the attribution of negative traits or features with regard to an individual, or a group of people (Thompson 2003). Generally negative discrimination relates to social and biological constructs and can be based upon a multitude of characteristics, such as gender, race, sexual orientation, disability, class, age and so on. Negative discrimination creates situations that can lead to oppressive practices, which is defined by Thompson (2001) as:
“Inhuman or degrading treatment of individuals or groups; hardship and injustice brought about by one group or another; the negative and demeaning exercise of power” (pg 34)
The core principle of the NHS & Community Care Act 1990 was to give people the choice, where possible, being cared for in their own home (Blackmore, 2003), and the social care field was opened to market forces; services users became consumers. However, the purchasing power of service users is disparate, dependant upon social, economic and individual variables. Adults partaking in community care are particularly vulnerable to oppression where there is an imbalance in the distribution of financial or other material resources; economic status can create real disparities in the standard of care received. Service users will often find their financial resources are controlled by their carers, placing the carer in a powerful position and disempowering the service user. This can be countered by being very open with the service user and avoiding “closed” decision-making and mystery (Topps, 2001). The service user should be involved at all levels of decision-making regarding resources. The Community Care (Direct Payments) Act 1996 is encouraging as it allows local authorities to make direct payments to service users, enabling them to arrange and pay for their own care package. This is a positive step forward in empowering community care service users.
It is also important for practitioners and carers to consider their use of language and its potential effects. Dehumanizing and medicalised language can result in a loss of esteem and a sense of disempowerment for the any service user, particularly those with intellectual impairments who maybe less able to understand medical terms. This can be prevented by avoiding jargon and providing lots of opportunities for questions and open discussion. Carers and social services staff should continually check themselves for use of infantilising language and ensure they engage in mature, adult discourse with service users. An example of dehumanizing language that is still used regularly in care setting is the term “manual handling”. Many physically impaired service users have reported this term as degrading (Elder-Woodward, 2001), as the implication is that the person is an object to be handled. The term “moving and assisting” is more widely accepted now.
We should also consider the power that is implied through the assumption that “professionals” have superior medical knowledge, skills and expertise in relation to the community care service user. Often, care plans are based upon the medical model; the impairment is seen as the problem and the service users dependence is emphasized (Adams et al, 2002). Thompson (2001) says social work should take a “demedicalised” stance and look past the pathology, utilizing the social model of disability as described by Adams et al (2002). The social model suggests the service users needs should be considered in a much wider context, ensuring their social and mental health are given equal consideration to their medical needs. Viewing societal constraints as the problem, and not the individual, creates the frame of mind to consider how to remove barriers to mainstream social, political and economic life. Social workers should liase with service users and look towards a solution-focused (not impairment-focused) care plan whereby barriers are identified and solutions sought collaboratively, utilizing strengths.
Social workers are trained to critically reflect on their practice to ensure they continually monitoring their reactions to, and engagement with, service users. Critically reflective practice is crucial in anti-oppressive and anti-discriminatory work. Until recently, community carers were not trained in such practice and therefore were more likely to repeat oppressive practices over and over as they maybe not be aware of the implicit discriminatory messages of some behaviours. The issue is tackled by new regulations, which require all paid carers to hold an NVQ qualification. The NVQ requires carers to consider issues of discrimination and oppression, and look at significant elements of their own identity. It is important this training is followed up by regular supervision and support (Thompson 2003). Care can be stressful, and it is crucial that steps are taken to minimise pressure, where possible, and for managers/social workers to take the opportunity to debrief with carers as necessary.
The ability to identify and promote non-discriminatory and anti-oppressive practice and procedure is a focal point of the social work value base (Training Organisation for Personal Social Services, 1989). Social workers must maintain awareness of the value base by using a variety of strategies to ensure service users are not discriminated against. The aforementioned strategies mean the social work value base is referred to, and reflected upon on a regular basis; it makes it a working, “live” document. All of the aforementioned strategies are referred to within the value base as issued raised by service users.
Anti-discriminatory and anti-oppressive practices are once again key focus areas for social workers and carers alike. It is encouraging that all workers are required to consider such issues within their training and as part of their value base, and steps are being taken to empower service users by facilitating the co-ordination and funding of their own care package. It remains the case that many care-receivers live with friends/family, who ultimately are in a position of considerable power over the service user, which can lead to oppression and discrimination.
References
Adams, Robert et al (eds) 2002 Critical Practice in Social Work. Basingstoke, Palgrave.
Banks, S (1995) Ethics and Values in Social Work. Macmillan Press LTD, London
Blackmore, k (2003) Social Policy: An Introduction. 2nd Ed. Buckingham, Open University Press
Elder-Woodward, J (2001) Making Sense of Community Care – Recent Initiatives: A service user’s perspective; or, Farewell to Welfare – The perspective of an ungrateful bastard. Retrieved 16th August 2005 from: http://www.leeds.ac.uk/disability-studies/archiveuk/elderwood/CCPS paper3 (Times12).pdf
Thompson, Neil (2001) Anti-discriminatory Practice 3rd Ed. Basingstoke, Palgrave.
Thompson, Neil (2003) Promoting Equality: Challenging Discrimination and Oppression 2nd Ed. New York, Palgrave
Training Organisation for Personal Social Services (2001) National Occupational Standards for Social Work. Topps, Leeds
