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High profile investigations since 2000 highlight failures in child protection (Laming, 2003 and Laming, 2009), causing nationwide concern, media comment and public debate and putting social work under the microscope.
Working Together to Safeguard Children: A Guide to Inter-agency Working to Safeguard and Promote the Welfare of Children (H M Government, 2010) sets out how organisations and individuals should work together to safeguard and promote the welfare of children in accordance with the Children Act, 1989 and the Children Act, 2004. The document sets out statutory guidance from primary legislation and responsibilities for professionals and agencies.
The Children Act, 1989 is designed to help keep children safe and well and, if necessary, help a child to live with their family by providing services appropriate to the child's needs. It places a general duty of every local authority to safeguard and promote the welfare of children in their area who are in need. Section 17 defines a 'child in need' as a child who is "unlikely to achieve or maintain, or to have the opportunity of achieving or maintaining, a reasonable standard of health or development without the provision for him/her of services by a local authority" or "his/her health or development is likely to be significantly impaired, or further impaired without the provision for him/her of such services" or "he/she is disabled" (H M Government, 1989, section 17)
The local authority has a duty to ascertain whether Sean and Laura are in need of an initial assessment addressing whether there are concerns about impairment to the children's health and development (HM Government, 2010). Learner and Rosen (2002) describe that the duty of the referral and assessment team is to ascertain the degree of need of the child and the degree of risk to the child.
The social worker may initiate an initial assessment using the multi agency Framework for the Assessment of Children in Need and their Families (DoH, 1999b) which must be completed within a maximum 10 days from the referral. If there was evidence that the children were suffering or likely to suffer significant harm, the social worker would then investigate this and conduct a core assessment under Section 47 (HM Government, 2010). Broadhurst et al (2010) describe that the level of safeguarding response remains a challenge in social work as decisions are often made in difficult circumstances with limited information. Munro (1996) describe how decisions made by social workers during this initial contact which determine how cases are responded to.
Social workers need good observation and analytical skills to understand the nature of the relationships, the signs of noncompliance, to work alongside families, and to come to safe and evidence based judgements about the best actions (Laming, 2009). Intervention is direct social work input that is based on understanding of the situation or problem presented and can involve providing services or trying to effect change in the social environment in order to improve outcomes (Kadushin 1993). It requires that social workers have clarity in why they are intervening and justification to do so (Doel and Shardlow, 1994). Intervention can be distressing for families so it is paramount that social workers employ a variety of skills, theories and knowledge when making decisions in the process.
The common core of skills and knowledge for the children (DfES, 2005) sets out skills to be used when working with children, aiming to promote equality, respect diversity and challenge stereotypes, helping to improve the life chances of all children and to provide more effective and integrated services. The document acknowledges the rights of children.
Sean and Laura are of dual heritage, their culture and context should be considered. Phillips (2002) suggests that a colour-blind approach, common practice in the 1980s, was actually the process of judging families according to a white and middle class view of normality. This led to an imbalance of power for many service users. The paper Protecting Children (DoH, 1988) challenged this view, recognising that cultural patterns within families will influence parenting styles and the ways children are reared. Practice was required to change as legislation laid definite responsibilities for local authorities to recognise religion, race, culture and language (DoH, 1988).
The Framework for the Assessment of Children in Need and their Families (DoH, 1999b) provides guidelines for white staff who undertake assessments with black children, but all staff should be willing to reflect on their own practice. Race, culture, religion and language are central to children's identity. Assessments should address identity holistically considering these elements (DoH, 1999a)
Sean and Laura lost their mother 3 years ago. Rando (1988) states children who are bereaved at that age may experience reawakened feelings of childishness, may repress feelings, putting them at risk for grief reactions consistent with Erikson's stages of psychosocial development of inferiority versus industry (Erikson, 1970). Longress (2000) and Anderson et al (1999) describe that there would push for a child to become industrious and confident during this stage of development and admitting helpless feelings at this time may be difficult. Worden (2002) states when a death of a parent occurs in childhood , the child may not mourn effectively and this may create problems with depression and inabilities to maintain close relationships with others. The role of the position of the lost parent within the family system would give meaning to systemic loss. According to Bolwby's attachment theory, the loss of a parent means a loss of stability, security, nurturing, and affection (Despelder and Strickland, 2005, Davies, 2004). The child's understanding of the death of a parent can be a shock. Piaget stated that the child can make sense of this process by the formal operating stage of development (Longress, 2000, Berger, 2001). In working with the family, the social worker must understand that the loss of a parent will affect the roles and expectations of those left behind. Gaining better understandings of child an adult reactions to loss and examining it through cultural perspectives will be important.
Trevithick (2005) discusses the importance of non verbal communication, acceptance, empathy, warmth, listening skills, the use of silence and observation in working with children along with asserting that the relationship that is built between practitioner and service user is central to achieving change.
It is noted that parents who voluntarily engage with services make more progress while a more coercive approach can deteriorate into an adversarial relationship which blocks progress. Becoming more intrusive carries both gains and losses and so creates a complex decision (Munro, 2011).
Egan's SOLER model (Egan, 2002) employs a counselling skills approach to communication and would be of benefit. Engaging in meaningful and reciprocal dialogue allows for collaborative meaning-making and joint-knowledge construction where the social worker is no longer the expert but rather a partner and an equal contributor (White, 2007).
A social worker may utilise systems theory, considering how the family, community, economic and political factors affect the children (Hoffman and Salle, 1994). It allows the social worker to consider possibilities for change in the whole system, i.e. James having sleeping problems has an effect for the family. Systems theory acknowledges strengths i.e. the children have good family links, are involved in the community and a church group and they have had bereavement counselling. System's theory acknowledges that a change of one part of the system can change another part. The limitations of systems theory is that it is descriptive, not explanatory, can disempower individuals as it does not allow for individual responsibility (Kemp et al, 1997).
A strengths perspective, which focuses on a belief that however bad things seem, people can discover strengths within themselves, may also be used (Mullaly, 1993). The perspective is seen through a role of enhancing personal strengths and resources, helping service users solve both interpersonal and environmental problems, and helping clients mobilise for change (Saleebey, 2003).
Consideration of oppression and discrimination of children would be appropriate. MacDonald and Winkley (2000) discuss the vulnerability of young people and state that each child has the right to "expect that professionals intervening in their lives will do so on the basis of the best available knowledge" (MacDonald and Winkley, 2000, page 1). The social worker would need to remain sensitive to power differences and the difficulties that some young people experience in relating to adults. In terms of the specific interventions chosen, initially these focused on building up trust, as well as attempting to identify risk factors.
Social workers have an obligation to conduct themselves ethically, engaging in ethical decisionâ€making, including partnership with service users. The Code of Ethics for Social Work (BASW, 2011), provides a moral code and a regulator of behaviour and moves uneasily between the two. There are moral imperatives that could place social workers in conflict with their employers or government policies i.e. social workers need to "challenge ways in which the policies or activities of government, organisations or society create or contribute to structural disadvantage " (BASW, 2011, p. 3). In practice, social workers may meet pressures from managers to keep children within the family unit, sometimes resources may mean it is not possibly to challenge service provision, and service provision is met with barriers in eligibility (Dalrymple and Burke, 2006).
If social workers are to practice anti-oppressively, they must first understand their roles as oppressors in order to create a space for deeper empathy and understanding. Bishop (2002) argues that ignorance to oppression simply compounds the issue.
Section 53 of the Children Act, 2004 gives due consideration to the wishes and feelings of the child as far as is reasonable before determining what services to provide or action to take (H M Government, 2004) Article 3 of the United Nations Convention on the Rights of the Child (UNCRC, 1989) places children as a top priority for services, being child focused.
James has been suffering from insomnia and suffering from grief from the loss of his wife. A referral for a mental health assessment may be appropriate for support such as counselling
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ADULT CARE CASE STUDY
The NHS and Community Care Act 1990, imposes a duty on local authorities to carry out an assessment of need for community care services with people who appear to them to need such services and then decide whether those needs call for the provision of services (H M Government, 1990). This makes the task of assessment a key activity as it establishes a person's needs but also if a person meets the criteria or threshold for support (Crisp et al, 2003). Fair Access to Care Services provides councils with an eligibility framework for adult social care to identify whether or not the duty to provide services under the following legislation is triggered (DoH, 2003)
Preparation for assessment involves reading all relevant information. A lack of knowledge of older people's social history may lead to presenting behaviours being misinterpreted and emotional needs ignored (Feil 1992).
Tact, sensitivity and empathy must be employed in communicating with Mr and Mrs Smyth as the situation may be very distressing for them. Employing Egan's model of SOLER (Egan, 2002) would be useful. The National Framework Service for Older People (DoH, 2001) requires that we recognise and respect the individuality of older people, that we listen to them and encourage their choice about care options. Effective communication is essential to fulfil these requirements (Milne and O'Byrne, 2002).. Parker and Bradley (2007) state that feelings of powerlessness and humiliation can be provocative for vulnerable people. Social workers should attempt to empower people by communicating openly and by providing as much information as possible (Parker and Bradley, 2007)
All people have a desire to be understood, to be accepted and for our lives to have meaning (Howe, 1995). Service users want to be listened to and respected as individuals and have choice and control of their support. Crawford and Walker (2008) state older people share traditional social work values, such as a concern for relationships, and appreciate social work skills, for example, in carrying out comprehensive assessments and regular reviews. Bauld et al (2000) state that people place importance on relationships with professionals and that these relationships impact on their wellbeing. Effective social work with older people draws on distinctive aspects of the social work role, sensitive communication, moving at the individual's pace, starting where the service user is, supporting through crisis, challenging poor practice, engaging with the individual's biography and promoting strengths and resilience (Crawford and Walker, 2008).
The person centred approach explores fundamental skills for effective communication, building on listening skills, congruence, empathy and unconditional positive regard (Rogers, 1957). However, social work involves the use of authority and this opposes unconditional positive regard. It is not always possible for social workers, who have a responsibility to protect not only the service user but also other people, to be non-directive, empathetic, unconditionally accepting and congruent (Dalrymple and Burke, 2006)
Mrs Smyth has cried when talking to the community nurse. It may be that Mrs Smyth is experiencing depression. The white paper, Our Health, Our Care, Our Say (DoH, 2006) acknowledges older people with depression and states that many other supports (i.e. transport, social contacts) must be considered alongside health and social care if practitioners are to make a reality of independence, well-being and choice all of which are often seen as potentially helping to addressing depression and its prevention. Mrs Smyth has new physical problems with which depression also tends to be associated (Copeland et al, 1999) Factors that contribute to depression include loss (e.g. of a relative or of mobility) and social circumstances, such as isolation (O'Neill, 1999).
The Mental Health Foundation (1999) suggests about 15% of older people experience depression. Literature also suggests that older people are less likely than younger people to take up mental health services (Ashton and Keady, 1999). There is a tendency for professionals and older people treat late life depression as an inevitable consequence of aging (O'Neill, 1999). However, there is evidence of the effectiveness of a range of interventions, including environmental changes, psychotherapies and cognitive behavioural therapies, and anti depressant medication (Snowdon, 1998).
Maintaining good social relationships is a key to quality of life for older people (Percival, 2010, Bowers, 2009). Yet isolation and loneliness are problems shared by many older people with support needs (Manthorpe and Moriarty, 2010, Cattan and Giuntoli, 2010). Those with mobility, cognitive or sensory impairments are at particular risk of being excluded from social life (Callaghan et al, 2009). Mr Smyth has experienced confusion and Mrs Smyth's mobility has decreased.
Thompson (2001) describes anti ageism as a dimension of social justice which increases active and independent lives for older people and that assessment should consider the impact of ageism on people's lives, including low self esteem and feelings of being a nuisance. Dominelli (2004) states that portraying older people as dependent and in need of care is an ageist construction. Care must be taken to ensure that ageist assumptions are not influencing assessment. As with racism and sexism, if we are not actively "swimming against the tide of cultural and institutional ageism we shall be carried along with it, such is the strength of ageist ideology" (Thompson, 2001, page 12).
Mr and Mrs Smyth are experiencing loss of health. Phillipson (2002) suggests that social work with older people is inseparable from managing loss.
The life course involves transitions, including the developmental stages associated with the work of Erikson (1977). Thompson (2002) suggests that an understanding of each transition should be understood, seeing older people in the context of life history stressing the importance of individual life stories and include activities such as reminiscence and storytelling. This approach also takes account of people's environment and the impact of wider social issues including gender, class and race (Crawford and Walker 2004).
Danny is concerned about violence from his father to his mother. The risk of abuse of older people is not a new phenomenon but it has only recently been addressed (Penhale, 2003). Pritchard's (2001) study of older abused women highlight the importance they attach to being able to talk to somebody about their experiences. It is important that social workers are trained not only to identify abuse but also to understand and be equipped to work with survivors to address longer term as well as short term practical needs. Danny states that there have been "many years" of violence. Research conducted to determine older women's understandings of elder abuse has emphasised the importance of looking at the quality of care giving relationships, rather than simply analysing action or behaviour when assessing risk and vulnerability (Morbey, 2002).
Social work is complex in these potential risk situations, raising difficult questions about how to balance empowerment with protection. Preston-Shoot (2001) argues that the value of self determination is highly influential in social work practice but should not absolve practitioners from finding ways to protect vulnerable users. The literature on elder abuse emphasises the importance of social workers: using communication skills e.g. building trust and support assessing, especially the vulnerability of the service user and circumstances of the abuse, providing information about services and consideration of different options protection planning, monitoring and review understanding the law relating to welfare provision, incapacity, common law and criminal justice (Preston-Shoot, 2001). The Social Care Institute of Excellence stated that "Improving dignity, respect and human rights should be a priority in all policy development for older people. But to implement these principles social care needs to identify good practice and produce guidance for everyone who works in the sector " (SCIE, 2006).
Danny and Mr Smyth are providing care to Mrs Smyth. Under the Carers Recognition Act, 1995, they may be entitled to an assessment of their ability to provide care (H M Government, 1995) . We also know that there is a significant group of older people providing care (typically for partners) who may themselves fit the definition of having 'high support needs' (Blood, 2010). Service users and carers are not easily distinguished.
The dog needs to be considered. Cusack (1988) states that older people can be deeply affected by the loss of a pet who can be important attachment figures in people's lives, bringing their owners physical, psychological and social benefits. Garrity et al (1989) discuss how strong pet attachments are linked with decreased depression rates. Danny currently walks the dig every day but Mrs Smyth may be struggling with looking after it. Sensitivity will be needed in addressing this.
Direct payments were extended to older people in 2000 and are empowering for service users as they have more control over their care provision.
They live in a rural community.
Viewed from a social model of disability, Mr and Mrs Smyth could have low support needs as they live in accessible housing with enabling technology, within a supportive community