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Based on the information provided, what needs, risks and strengths can you identify in relation to the individual or family in the case study? How would you plan the assessment, including consideration of theneed for a multi disciplinary approach?
Case study E:
James Downing is 16 years old, white andlives at home with his mother, Sarah, her same sexpartner, Teresa, and his younger sister Joanne, who is 13 years. Jameshas no contact with his birth father, who left Sarah when she was pregnant withJoanne, but he does have a close relationship with his paternal grandparents,who live nearby. James has been in trouble with the police since he was 13years old, and has numerous convictions for care theft, possession of cannabisand ecstasy and for house burglaries.
Sarah has asked a social worker to visither, since she feels that she can no longer cope with the situation and feelsthat the whole family is in danger of `fallingapart'. Joanne is beginning to stay out at friends all the time and clearlydoes not want to be at home, where there are frequent arguments. Teresa worksin a very demanding job, involving a lot of travelling, and Sarah feels she isspending less and less time at home because of James's behaviour.
Research published in Child Protection:Messages from Research (Department of Health, 1995 cited in Horwath, 2001)states that families often feel they lack control and autonomy when dealingwith social services departments. This becomes particularly problematic whenassessments focus on family weaknesses and disadvantages. Hence a holisticapproach utilising strengths and identifying need is required. This approachforms the crux of the Framework for the Assessment of Children in Need andtheir Families.
Sarah has identified the family difficultiesand has requested support - this is encouraging, suggesting commitment to thewell being of the family, and to change. It is important to highlight thisstrength to the family and emphasise that together we will work to build uponthis. James has a close relationship with hispaternal grandparents, adding to the family resilience and acting as animportant resource during periods of difficultly. Hence grandparents should beengaged with the planning of the assessment.
The family's economic status is not clear;however there is at least one family member in employment. Traditionally thisis interpreted as a familial resilience factor. Awareness of differingperspectives is essential - the nature of Teresa's work and the effect of theemployment on the family as a whole is currently unknown and hence couldequally be viewed as a risk factor by the family.
James has established offending behaviourand has been involved with illegal drugs in some capacity. Family andprofessionals will generally view this as risky behaviour; however it must beconsidered that criminal activity could be viewed as a strength within somesocial groups, hence it is essential to ascertain all points of view, withoutprejudgement and then consider ways forward together.
There maybe risk linked to the lessening orloss of James' attachment to Teresa as she is spending less and less time athome. Equally, there could be risk attached to the potential loss ofattachment between Joanne and James, as Joanne is stay(ing) out withfriends.and clearly does not want to be at home. The family is under a greatdeal of strain, and it seems Joanne and Teresa are coping with this by shiftingaway from the household. This gives some insight as to how the family functionsunder stress; this will need to be explored further with Sarah and Teresa toidentify the processes that will ensure the family achieve theirdesired outcomes when faced with difficulties.
James has no contact with his father,raising concerns around paternal attachment and possible negative lifeevents/experiences due to separation. The assessment will need to explore howJames and his family view this separation; again each may hold conflictingviews and this must be sensitively addressed.
One must consider that the immediate familyunit, the extended family and professionals may all have differing perceptionsof families with same-sex caregivers; some view this as strength whereas otherswill see membership of a minority group as a risk. Family members themselvesmay negatively discriminate on the basis of sexuality. Prior awareness of thepossibility of conflicting opinions will enable the worker to reactthoughtfully and mediate effectively. The social worker should criticallyevaluate their own practice continuously, checking for assumptions,stereotyping and cultural bias.
Preparation for the assessment should beginwith ensuring an appropriate social worker is allocated. The team managershould consider the field workers knowledge and understanding of the issuespertaining to this particular family (for example youth offending,discrimination/oppression based on sexuality/gender, attachment issues etc), aswell as ensuring the worker is an appropriate match in terms of race and gender.
Once a suitable worker is allocated thecase, he/she will need to refer to all information gathered previously. Thiswill prevent the family repeating sensitive information again, and will enablethe social worker to identify gaps in information that need to be filled duringthe assessment.
Assessments and subsequent care plans aremore effective if the child and family feel empowered and involved throughoutthe process (Department for Education and Skills, 2001). Indeed this is a dutyof any professional working with children as outlined in Article 12 of theUnited Nations Convention on the Rights of the Child:
the child who iscapable of forming his or her own views (has) the right to express those viewsfreely in all matters affecting the child, the views of the child being givendue weight in accordance with the age and maturity of the child
The social worker must engage with Jamesand his family at the outset, establishing how and where theassessment will be carried out, exactly what help is requested andidentifying desired outcomes.
As outlined in the Framework for theAssessment of Children in Need and their Families, the social worker andfamily should identify the relevant agencies to be involved in the assessmentand ensure it is clear to all professionals and the family the precise role andpurpose of each professional. Advice and information will be sought byidentifying all key informants, recording their details and organising aschedule to collect information from these people or organisations. Thefollowing would be a minimum essential list of informants:
FamilyGP and other relevant health professionals
Prior to any interviews taking place, a listof essential questions should be drawn up to give structure and purpose to themeetings. Following these initial discussions, further interviews may beneeded with Connexions, local police, wider family, or other community groups,in order to build a comprehensive picture of the family.
In planning any assessment, there should bea clear statement of intent, outlining the purpose, limitations and timescalesof the assessment. This must be shared with the child and their family. Forall assessments this will include the main principles of the Children Act 1989. The particularfocus for this assessment should only be decided upon after furtherconsultation with the James and his family.
In what ways doesthe information provided in the case study raiseissues of power, disadvantage andoppression? You are asked to carry out an assessment of need? How would youattempt to work in an anti-oppressive way?
Case study C:
Razia Akhtar is a 26-year-old single woman,of South Asian Muslim origin, (although born is Britain)who is currently in hospital, following a rapid deterioration in her physicalhealth. She has now been given a diagnosis of Multiple Sclerosis. Razia livesalone in a small terraced house, and is very keen to return home as soon as possible.Her older brother and his wife, Mohammed Khan and Shanaz Begum, who live on thenext street, have suggested that she moves in with them, but she is veryreluctant to do so. The hospital staff feel that Razia is being very unrealisticabout her future, and that she needs to come to terms with the fact that she willbe dependent on others for the rest of her life. Her presentcondition is such that she will need quite a high level of personalassistance,with someone to get her up in the morning and help her to bed at night.
The hospital basedsocial worker is asked to carry out an assessment to determine Razia'needs once she is discharged from hospital.
Power describes thecapacity to influence or control people, events, processes or resources (Thompson,2003, pg 152). If utilized in a negative fashion, power can be a significantbarrier to equality and lead to oppression and disadvantage. Imbalances ofpower can manifest in a variety of social work situations; in this case studythere are potentially a multitude of disparities of power, which requirecritically reflective practice to ensure equality and empowerment arepromoted.
When debating issues of oppression anddisadvantage, we must consider the process leading to it - negative discrimination.Negative discrimination is defined by the identification of negative attributeswith regard to a person or group of people (Thompson 2003). Generally negativediscrimination relates to social and biological constructs and can be basedupon sexual orientation, gender, class, race, disability, age and so on.Negative discrimination creates the circumstances that give rise to oppression,which is defined by Thompson (2001) as:
inhuman ordegrading treatment of individuals or groups; hardship and injustice broughtabout by one group or another; the negative and demeaning exercise of power(pg 34)
In relation to MissAkhtar, we should consider the power that is implied through hospital staffhaving superior medical knowledge, skills and expertise in relation to MissAkhtar. From the case notes provided, it appears that current thought relatingto Miss Akhtar's long-term care is based upon the medical model; the impairmentis seen as the problem and her dependence is emphasized (Adams et al, 2002). Thompson(2001) says social work should take a demedicalised stance and look past thepathology, utilizing the social model of disability as described by Adams et al (2002). The social model suggests Miss Akhtar'sneeds should be considered in a much wider context, ensuring her social andmental health are given equal consideration to her medical needs. Viewingsocietal constraints as the problem and not the individual creates the frame ofmind to consider how to remove barriers to mainstream social, political andeconomic life. The social worker should liaise with Miss Akhtar and looktowards an solution-focused (not impairment-focused) care plan whereby withinthe assessment, barriers are identified and solutions sought collaboratively,utilizing Miss Akhtar's strengths.
Miss Akhtar has an autoimmune degenerativedisease and again, it is well documented that individuals with physicaldisabilities are more likely to be subjected to oppressive practices. Dehumanizingand medicalised language can result in a loss of esteem and a sense ofdisempowerment for the physically impaired service user. This can be preventedby avoiding jargon and providing lots of opportunities for questions and opendiscussion when working through the assessment with Miss Akhtar. Professionalsshould continually check themselves for use of infantilizing language andensure they engage in mature, adult discourse with Miss Akhtar.
Miss Akhtar's religious and cultural needsshould be explored and understood as central part of the assessment. Theseneeds must be identified as quickly as possible, to ensure the worker can besensitive to Miss Akhtar's Islamic or other customs, without making culturalassumptions. Karmi (1996) examines the Islamic emphasis on modesty; hence theworker should consider with Miss Akhtar the extent to which her modesty shouldbe preserved throughout the assessment. It should be explored if Miss Akhtarwould prefer female medical staff and social care professionals only to beinvolved in the assessment and clear guidelines should be established aroundpreservation of modesty and the practice of physical examinations.
It is accepted in manyMuslim communities that the most senior male of the family will take responsibilityfor a female relative's care. Hence it is possible there may be an imbalanceof power between Miss Akhtar and Mr. Begum, dependent on their personal beliefsand how far these correlate with each other's religious and cultural ideals.If there is a difference in these ideals, the social worker should strive toempower Miss Akhtar by discussing choices and involving a culturally matchedadvocate if Miss Akhtar desires, in order to mediate within the family. Thismust be managed sensitively, as Miss Akhtar, Mr. Begum and the social workermay all hold very different views regarding patriarchal hierarchies. Thediversity of these views should be acknowledged and respected within theassessment. It is important to be aware of ethnocentrism, as described byThompson (2003), whereby situations are viewed from the norms of a majorityculture and those values projected onto the minority. This can be countered bycritically reflective practice, which will promote consciousness ofpower and oppression, leading to a decreased likelihood of the worker makinginaccurate ideological inferences.
Discrimination and oppression can arisethrough an imbalance in the distribution of financial or other materialresources. This is a concern in this case study as Miss Akhtar's economicstatus prior to her illness is not clear. Miss Akhtar may experience barriersin accessing the same level of financial resources as previously. Hence thesocial worker and potentially Mr. Begum could be in positions of power as theyare likely to have control over the allocation of resources. This should becountered by being very open with Miss Akhtar and avoiding closeddecision-making and mystery. Again, this promotes equality as it avoidswelfarism, whereby it is assumed the Miss Akhtar requires welfare services dueto her disability (Thompson, 2003).
Due thought must be given to use oflanguage and culturally biased humour throughout the assessment. Miss Akhtaris an ethnic minority in the UK; as such Thompson (2003) states discriminationcan occur at personal and cultural levels. It is the role of the social workerto critically reflect on their personal prejudices, which could lead todiscriminatory stereotyping. Personal discrimination is enveloped by inequity ata cultural level, whereby ethnic minorities, and hence Miss Akhtar, maybesubjected to a general felling of not belonging and polarization, by the use ofculturally-specific language and humour.
A central theme throughout these casestudies is the need to put the service user at the heart of all planning,decision-making and reviews. Care packages imposed upon users will beineffective; users must be enabled to help themselves, whilst the social workertakes every opportunity to stand in the users shoes and see life from thetheir perspective.
Adams, Robert et al (eds) 2002 CriticalPractice in Social Work. Basingstoke, Palgrave.
Great Britain (1989) Children Act 1989(C41). London, Stationery Office
Department for Education and Skills (2001) Learningto Listen: Core principles for involvement of Children and Young People. Availablefrom: www.dfee.gov.uk/cypu
Department of Health (2000) Frameworkfor the assessment of children in need and their families London, TheStationary Office.
Horwath, Jan (eds) 2001 The Child'sWorld: Assessing Children in Need. London, Jessica Kingsley Publishers.
Karmi, Ghada (1996) The EthicalHandbook: A Factfile for Health Care Professionals. Oxford, BlackwellScience LTD
Thompson, Neil (2001) Anti-discriminatoryPractice 3rd Ed. Basingstoke, Palgrave.
Thompson, Neil (2003) PromotingEquality: Challenging Discrimination and Oppression 2nd Ed. NewYork, Palgrave
United Nations (1991) United NationsConvention on the Rights of the Child (online). Available from:http://www.unicef.org/crc/fulltext.htm