Care Theory for Adults With Learning Disabilities

Critically discuss care theory in relation to social work with adults with learning disabilities.

Social work has undergone a radical transformation in the last two decades. Today ideas about the multi-layered nature of disabilities and the complexity of needs are commonplace in the public discourse on welfare and social work. People with learning disabilities and their carers and families have formulated their urgent demands upon society while academics and practitioners have supported this re-shaping of the social care agenda and the government has attempted to integrate the various challenges and interests in new and significant policy documentation such as Valuing People (2001). This essay will deal with three interrelated issues that are of particular importance to people with learning disabilities and their quality of life. It will (1) explore the relationship between care theory and the issues of ethical practice when dealing with adults with learning disabilities. It will look at the rules of engagement that have found their way into the various codes of practice for social work practitioners and the ethical problems that they may give rise to. And (3) it will consider the link between anti-discriminatory practice and the rights that service clients have and how these rights may influence the way in which practitioners may discharge their responsibilities throughout the social service sector.

Within the confines of this essay, (1-3) will be examined through the following lens. Given the existing code of practice and policy stipulations, what could self-determination mean for people with learning disabilities? And how do ethical difficulties find their expression in particular practices of social work for adults with learning disabilities, such as person-centred planning and direct payments.

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There have been several attempts to regulate and standardise work practice for employees and employers of social work practitioners in the UK. These attempts have deep historical roots, such as the Hippocratic oath (Loewenberg 1992: 36). Yet the more recent attempt by the Scottish Councils to draw up a conclusive list of responsibilities and duties of social workers and their employers has been triggered by the desire to introduce reliability and transparency into a field of social care which has hitherto featured a plethora of often conflicting norms and standards. The code of practice sets out (for the first time) the expectations, obligations and duties under which social workers and their employers ought to operate. It is supposed to be the initial step in a broader process of standardisation of the social services (Codes 2001: 13). It echoes the definitions of the nature, aims and guiding principles of social work given in the Code of Practice by the British Association of Social Workers (BASW 1986 and Codes 2001). The various values that inform social work are human dignity and worth, social justice, service to humanity and integrity and competence of practitioners (BASW and CoP) In particular, the Code emphasises the right of individuals to control their lives and the obligation of social workers to promote the right to self-fulfilment by clients (Codes 2001: 15 and BASW 1986: 2). This agglomeration of values and norms that ought to inform social care practice however raises some serious questions when it comes to their application in the social work with people with learning disabilities.

First of all, it is generally acknowledged by analysts of the service as well as by practitioners that the particular interpretation of the notion of self-determination is a culturally contingent idea. Loewenberg as well as Watson acknowledge that the ethical principles and rules of social work are derived from societal norms (Loewenberg 1992: 38; Watson 1985: 22). However, modern society encompasses a multitude of often conflicting social norms and it is this plurality of notions of a good life and standards of social agency which creates problems. The code explicitly urges social service professionals to take account of their client’s understanding of self-determination and individual independence. Yet, within a culturally diverse population, different notions of what is acceptable and desirable with respect to the independence of people with learning disabilities prevail. To promote independence of an adult or child with learning disabilities in a community that traditionally places a fundamental emphasis on continuous care within the family can pose a particular dilemma to social workers.

More generally, however, governmental policy and the codes of practice can produce significant problems for social care workers. The government has made inclusion one of the main policy priorities with regard to people with learning difficulties. Mainstreaming employment for individuals with learning disabilities is a pillar of this new approach. However, the competitiveness of the first labour market has traditionally represented a considerable barrier to finding viable employment for people with learning disabilities or emotional behaviour problems. Social care workers are tasked to identify problems that impact on the quality of life and decrease the chances of self-fulfilment for their clients. But often they are neither trained nor have access to resources in order to identify and put in place support programmes that ensure that adults with learning difficulties can find employment in the first labour market. The compartmentalisation of services continues to produce additional barriers that prevent social care workers from discharging their duties with regard to their clients.

Let us consider an example. Let us suppose that a social worker has the responsibility to support some individuals with learning disabilities which live in group homes (Beckett 2005: 138). One of the residents approaches him and tells him that she has got into a muddle with her benefits with the result that she has run out of money and is very distressed about this. The social care worker calms her down and places some phone calls to the local benefits office and sorts it out for his client.

In a way, the social worker

‘has respected [the client’s] wishes and done exactly what she asked of him. Has he therefore supported her right to determine her own life?’ (Beckett 2005: 138)

His commitment to support her desire to self-determine her life here clearly conflicted with her desire to draw on needed support. The real crux of the problem however lies elsewhere. The client has been unable to get sufficient support from the benefits office and therefore felt unable to sort out the issue on her own. In fact, the lack of adequate support on the side of the benefits office, possibly the absence of a trained worker in the office who has the skills and training to deal with people with learning disabilities has made it impossible for her to deal with it independently. Additionally, the social worker may have chosen to limit his support by assisting her in dealing with the benefits office rather than sorting it out himself. In this way, policy and practice may substantially collide when it comes to practical issues for individuals with learning disabilities. The codes of practice fail to give any meaningful guidance in these cases.

This criticism is not new. Academic observers have repeatedly noted that the codes of practice are too abstract and cease to have any meaning unless sufficient resources are made available to enable service professionals to act in a positive way towards service clients (Watson 1985: 31). More worryingly, Watson writes:

‘the abstraction of the code of practice renders principles not simply incapable of application, but capable of application in a number of ways – only some of which are consistent with the conception of professional social work.’ (Watson 1985: 31)

Again, this gives rise to some serious problems with regard to care for people with learning disabilities. Let us consider another example. The conception of self-determination as enshrined in the Codes of Practice draws on culturally contingent notions of autonomy. On the other hand they also pay respect to the need to recognise other culture’s diverse social commitments. The code however fails to recognise that these two principles conflict. For some families and carers who belong to ethnic minorities, service support may be seen as contradicting cultural norms and standards and the family may be the preferred vehicle for support. Societal inclusion and integration in the wider community may therefore be barred as an option. Social workers are in a dilemma here. It is their obligation to promote the self-determination of their clients, this however may contravene the cultural and religious norms prevalent in some families. This demonstrates that the Codes of Practice are based on an understanding of social life that is predominantly Western in character. Different stipulations of the Code are therefore inconsistent with each other. As Beckett writes, the notion of individual autonomy may be differently stressed in the various cultures (Beckett 2005: 132), Often the rights of individuals with learning disabilities may run counter to the interests of the rights of particular groups or communities (Beckett 2005: 132).

The second way of framing the idea of social care and its conflict with particular practices is utilitarian in nature. Social workers and their management may be led by calculations of expediency in determining the right way of dealing with problems of people with learning disabilities. Resource allocation and budget constraints are the primary factors in these considerations. This approach is however often detrimental to the interests of adults with learning disabilities. Their interests are defined through the limitations and budgetary restrictions that are placed on the service. The individual with learning disability is not placed at the centre of planning and support packages.

One particular practice has tried to square the constraints placed on the service with the ethical demands under which social workers operate. Direct payments have been actively promoted by central government and are often seen as a way to empower clients with learning disabilities. They are considered as an appropriate means to re-focus the delivery of social services on the needs of the individual with learning disabilities as well as represent a viable answer to the resource allocation problem. Clients are granted a particular budget and exercise total control over its spending. Adults with learning disabilities become buyers in a market of social and care services, or so the theory goes. At a first glance this will alleviate several acute problems. It enhances the (chances for) independence of clients and motivates them to make their own choices about important life decisions. It increases their participation in the decision making process and improves quality of life. It also effects a significant shift away from total care packages which are expensive to the tax payer and facilitates the involvement of clients in more task-centred care packages which are less expensive (Mansell 2005: 20). It therefore adequately and neatly addresses resource constraints while mirroring the move to individualised care and support plans (Mansell 2005: 20). This way it mirrors the stipulation of the Code of Practice which places the duty on social workers to maximise participation of clients in the decision making process (BASW 1986: 5; Codes 2001: 16).

However, it works with a very lop-sided notion of independence. While participation in the labour market may still be prevented to clients with learning disabilities, acting as a buyer in an economic relationship is seen as a form of empowerment. The conception of social agency is severely restricted to co-operative schemes that are economic in character. The enhancement of social involvement may benefit little from this. This demonstrates that ethical issues in social work are often critically influenced by practices that are understood to reflect universal cultural attitudes but, more appropriately, may only resonate with erroneous and impoverished notions of social agency.

Bibliography

Beckett, Chris and Andrew Maynard (2005), Values and Ethics in Social Work. An Introduction. London e.a.: Sage

British Association of Social Workers [1986], A Code of Ethics for Social Work, Birmingham: BASW

Codes of Practice for Social Service Workers and Employees (2001), Scottish Social Services Council, Dundee 2005

Loewenberg, Frank M. and Ralph Dolgoff (1992), Ethical Decisions for Social Work Practice, Itasca: F.E. Peacock

Mansell, Jim and Julie Beadle-Brown (2005), Person Centred Planning and Person-Centred Action. A Critical Perspective, in Person Centred Planning and Care Management with People with Learning Disabilities, London and Philadelphia: Jessica Kingsley, pp.19-33

Watson, David (1985), What’s the point of A Code of Ethics for Social Work? In A Code of Ethics for Social Work. The Second Step, edited by David Watson, London e.a.: Routledge and Kegan Paul, pp.20-39

Valuing People (2001). A New Strategy for Learning Disability for the twenty-first century, London: The Stationary Office