Background information about the family.
Dave and Jenny Smith are white, married, in their early twenties and live on a London housing estate. They have two children; Sean aged four years, and Sarah, aged two. Their marriage is very stormy, prone to repeated rows and occasional violence. Jenny accuses Dave of spending the house-keeping money on drinking and gambling. Dave admits that he spends about £40 a week at the bookies, and he goes to the pub about three times a week. Jenny spends money each week on a mail order catalogue.
The family have rent arrears and hire purchase debts. Two weeks ago they received a letter from a loan company threatening to repossess items to the value of the money owed to them. Most of their problems are about money, and each blames the other for Sean’s behaviour, which is described by the nursery staff as wilful and aggressive. They only seem to communicate when rowing. Dave works irregularly on building sites as a labourer. Jenny’s mother lives in another part of London, but Dave’s parents are from the north of England. The couple moved into the estate two years ago and hardly know anyone in the area.
Sean is attending the local day nursery and a mother and toddlers group was offered for Sarah, but the offer was never taken up. Both Dave and Jenny would like help with their financial difficulties. Jenny would also like their relationship to improve. Dave says the only thing wrong with their relationship is their lack of intimacy since Sarah was born. The family was referred by the Health Visitor, who felt the family’s problems were affecting Sarah.
‘..to practice without a theory is to sail an uncharted sea;
theory without practice is not to set sail at all…’
(Hardiker and Baker, 1991)
This paper seeks to examine the above case study. It first explains what social work theories are and their limitation. It then goes on to explain the different types of theory I intend to use and why I chose such theories. Finally, I will analyse the case study using my chosen theories, followed by brief conclusion and any references I used.
Beckett (2006: 33) defines social work theory as a “set of ideas or principles to guide practice”. Howe ( 2009: 2) contends that if we can understand theories, then we are ‘half way towards knowing what to do’. However, one needs to understand that there are different types of theories and they have limitations, for example “informal” theories might not be useful in this case as they tend to incorporate prejudice and assumptions’ and hence do not ‘merit the word theory’ but they need to be taken into account for their existence. (Beckett, 2006: 185) Formal theories however, are more complex, beneficial and express our understandings of social issues and might help us understand and make sense of a complex human world. For example, how family become dysfunctional? Why people become offenders? Or why some children misbehave? And so on.
The difficulty of choosing a particular perspective in Dave and Jenny’s case is that, while some theory can be right for their case; incorrectly applied theories could prove disastrous. For example, a social worker who rely his or her own informal theory for assessment and interventions would be very limited in scope. Having said that, there are number of social work theories that I believe are suitable for this case. Payne, (1997) emphasises that the use of multiple theories are more effective than single theory, and use of single theory can be defective and out of scope. (Payne, 1997: 36) Thus, I intend to use more than one theory for this case study.
And for this reason I intend to use Psychodynamic, Attachment, and system theories Feminist viewpoints, behavioural therapy and Person-centred approach would also be considered. My choices for these theories are based on the idea that Dave and Jenny’s relationship problems might be rooted in their childhood upbringings. The case study shows that their relationship is not healthy, and their argument often lead to violence, and their behaviour is affecting the wellbeing of their children.
The couple have indicated that they are willing to accept help in finding solution for their problems, and most importantly, seeking help should be seen as a sign of responsibility and not failure. The first thing a social worker needs do in this stage is to talk to them, and explain that the only way they can fix their problems is to talk and communicate well and be ready to receive professional advice and support. The social worker should be holistic in approaching their problems, keeping in mind that this is not onetime event but, rather continuing process which would lead to plan of action that is suitable for them. ‘When the problems are identified, the social worker and the family need to agree to prioritise their problems and to identify which ones they want to work on’. (Cree and Myers, 2010: 93).
Anti-oppressive practice requires that social workers need to undertake least interventions (Payne, 2005: 286), working in partnerships with a social worker and finding ways to enable Dave and Jenny to become more aware of their own problems, One element of anti-oppressive practice is to make sure that people’s rights are not violated. (Dalrymple and Burke, 1995: 57) Social worker must put the needs of the children’s first, but also need to respect the family’s human rights, including rights to liberty, private and family life.
In the case study, it’s not clear who is oppressed, one can only assumed that Dave is using his masculine power to his advantage. My aim here is to avoid placing oppression into a hierarchy and prioritising one form of oppression over another, as Jenny might also be the oppressor. Feminist theory in domestic violence emphasizes gender and power inequality in family relationship, it points out the traditional norm that endorses a male’s use of violence and aggression against their female partners (Pence and Paymar, 1993). They also pointed out that the cause of violence against women is that, the society turns blind eye to the violent behaviours perpetrated by men against them. (Pence and Paymar, 1993) In this regard, Dave might be using his physical power to oppress Jenny; however, critics of this theory would also point out that, this is not always the case as issues of power and abuse have also been identified in lesbian relationship. (Lawson, 2003) Therefore it is difficult to pin point who oppressing who.
As professional worker, it is important to note that the main concern here is the family’s ‘problematic situation’, it would be unethical and judgmental to see either of them as problem. (Thompson, 2009) I would encourage the couple to take the lead in solving their problems, ‘given that empowerment is central to social work intervention’ (ibid, p 15). Educational skills such as communication skills might be needed to overcome their problems. Seeking counselling might help ease tension, learning basic budgeting skills might also help reduce their financial problems, and better communication skills might also reduce tension. And lastly they need to learn how to ‘channel their emotion and feelings more responsibly’ (Thompson, 2009: 80-81)
Sigmund Freud’s Psychodynamic theory suggests that “ our behaviours come from movements and interaction in our minds” (Payne, 1997: 72-73) according to this perspective, Dave and Jenny’s repeated rows and aggression is driven by their id, thus a good co-operation between their ego and superego would have resulted a better understanding of Dave and Jenny’s marital problems. Furthermore, Dave’s intimate violence against Jenny might mean that he did not receive adequate nurturing in early years. Therefore understanding his early childhood experiences might be central to understanding their trouble relationship. Talking to Jenny’s mother might be helpful if both parties are willing to accept, with support they would need to develop solution to overcome their problems. They would also need to learn and to focus as a team a meaningful goal to improve their relationship, such as seeking anger management treatment and taking responsibility for their actions (Thompson, 2009)
One of the strength of psychodynamic theory is that it focuses on the causes of one’s aggressiveness and behavioural problems and links this to their early childhood experiences (Trevithick, 2011). Freud’s theory also led to other theorists such as Piaget developing theories on childhood development. It is weaknesses are that, it suggests that behaviour is pre-determined and individuals are “under control of instinct” this contrast to Humanist perspective, which suggest that individuals are able to decide for themselves and have “potential for their own development” (Atkinson and Wells, 2003: 25) Another weakness is that Freud theory is Eurocentric and did not take into account other none European cultures.
The case study, suggest that Dave is using the housekeeping money on gambling and alcoholic drinks, these tragic problems are not specific to Dave. In fact, studies suggest that gambling is a major problem in the UK and is out of scope of social care agencies (Rogers, 2013: 41-60). People of similar life style and income situations as Dave and Jenny’s are known to spend significant amount of their income on gambling than those on higher income (ibid). Thus, Dave’s gambling problems needs to be addressed as it’s a major source of their conflict. Much of the literature I have come across seems to have said little about gambling problems, and as Roger (2013) suggests, “It remains an inadequately understood entity and an under-theorised area of human behaviour”. (Rogers, 2013: 50) Psychodynamic theory would suggest that Dave’s gambling problem happens at an unconscious level. In sociological theory on understanding compulsive gamblers’ Bernhard (2007, 137) argues that “our habitual process are products of sociological as well as psychological factors”. (Bernhard, 2007: 122-138)
Good relationship between social worker and the family are central to the effectiveness of good anti-oppressive practice. Another social work theory that might be suitable for this case would be Person-centred approach. This perspective seeks to understand the needs of the family, what do they want and how can this be accommodated. The social worker needs to explain what support is available for them and how they can get access to such support. These include counselling, support and budgeting and other support that can best meet their needs (Thompson, Kilbane and Sanderson, 2008). Not all interventions work for all, thus, social worker needs to consult with the family. Using person-centred approach, both should be reminded, that Dave’ tendency to use the housing keeping money for drinking and gambling and Jenny compulsive catalogue spending would have dire effects on their lives. The rent arrears, hire purchase debts as well as the threat of repossession to their personal belongings needs to be addressed too. This theory emphasises self-empowerment, so Dave and Jenny are aware of their situations and are able to take responsibility for their actions, however they may make too lofty of goals that are not achievable.
It is clear in this case study that financial difficulties and unemployment are another major cause for their problems. The main goal of intervention should therefore be, to restore the family’s stability as there are two vulnerable children among them. Thus, the social worker should identify any financial support the family might be entitled to and how to get such support, work with Jenny’s mother and apply the intervention that will be most effective in restoring the family’s stability. The logic behind all these is the social worker to enable the family to help themselves.
The social worker should not jump into conclusion regarding child removal, and remind him or herself that the best interest of parents and the children is to “support children and family to stay together.” (Children Act 1989). it is clear in this case that Dave and Jenny’s rows and repeated disputes has affected their children, Sean’s behavioural problems at the nursery is a good example. The fact that the family has moved into this areas recently suggests that they are experiencing social isolation, contacting and consulting other family members are therefore vital for this case. Even though none of the children is physically abused, Hague and Malos (1998) believe that the kind of behaviour shown by couple constitute child abuse (Hague and Malos, 1998). In this scenario children need emotional support to help them emotionally and to enable to sustain attachment and pleasure’ with their parents (Caroll, 2000: 11-12).
Evidence suggests that, parents who mistreat their children often have drinking problems, and in some cases may be suffering mental health problems. (Davies and Carolyn, 2011: 4) Jenny’ apparent detachment from Sarah and the lack of intimacy with her partner might be sign that she is suffering a depression. In these scenarios attachment theory might help explain Jenny’s lack of attachment and intimacy with Sarah and Dave.
This perspective focuses on the parent and child relationship as well as spousal relationships. It suggests that mother and child attachment is vital for emotional development of the child. Like Psychodynamic approach, attachment theory suggests that children’s earliest bonds with their caregivers shapes the development of their childhood and continues to affect throughout their life. Thus, violence at home affected their children and therefore they may not develop an emotional security. The argument here is that ineffective or lack of attachment in their childhood could have been responsible for the mother child detachment in this case study (Lishman, 1991: 59) so Jenny’s detachment with her daughter and lack of intimacy with her husband may have its roots to her early childhood development. Attachment theory is an ideal for to use in dysfunctional family situations because it seems to correctly explain behavioural and relationship problems as typical to Dave and Jenny’s (Lishman, 1991: 14)
It is paramount importance that the social worker needs to get as much information as possible in advance before he or she first arranges meeting with the family. This ideally involves checking multi agency records to see whether the family is known to the authority, and what information is held about them, particularly the children. The report on the death of Victoria Climbié in 2000 stressed the importance of social workers reading case files, this is to substantiate whether common assessment framework on Sarah already exist, this will allow the social worker to decide whether Sarah is considered to be child in need under section 17 of Children Act 1989 (Laming, 2003). And if this is the case, carry out the necessary steps.
The health visitor’s referral did not mention whether Sarah is in danger, social worker needs to take into account about this. In this scenario Social worker must adopt a “position of healthy scepticism” (Laming, 2003) as social worker, I would need to be aware of the concerns raised by the health visitor, but at the same time be ready to independently and fairly assess the situation. In this case ‘Common Assessment will be helpful in clarifying the health visitors’ concerns as well as the needs of Sarah and at the same time identifying the services that the family require’ (Cree and Myers, 2010: 32) while it is right that any social worker might be thinking of child protection issue in this case, the Children’s Act 1998 reminds us that, the best interest of children is to “support children and family to stay together” (Children’s Act 1998)
The family’s traumatic situation might be the reason the couple are struggling to meet the emotional needs of their children and the lack of intimacy between them. Because both couple are anxious about financial difficulties, they become preoccupied with their own problems and neglected their children’s emotional feelings. Referral to relationship counselling would probably help the couple to overcome such difficulties. The nursery describes Sean’s behaviour as “wilful and aggressive” the couple’s problems, particularly Dave’s, violence and behavioural problems from the perspective of attachment theory suggest “insecure infant attachment and intergenerational transmission of violence” (Killeen and McClellan, 2000: 353-360) Thus, Sean’s behaviour at the nursery could be indicative of the caregiver’s deficiency as children’s “patterns of attachment is influenced by what their attachment figures do” (Lishman, 1991: 59) However, contrary to explanations of attachment and psychodynamic theories, not all children who are ‘abused or witness abuse incidents follow the footsteps of their caregivers (Killeen and McClellan, 2000: 353-360)
In conclusion, social work theory is ideas and principles that guide us to understand social issues that affect us on daily bases. While theories may not give us expected outcome, the critical and logical approach they provide ensure that assessment and interventions are consistently made on the best information and with professional judgment. Learning social work theory is crucial in understanding social crises such as Dave and Jenny’s case and how we might best respond to such crises. It is vital that social workers read case files before doing any intervention and reach firm but professional judgment keeping in mind the human rights of service users. And finally I would like to share the following interesting quotation as they sum up the importance of social work theory. “To practice without a theory is to sail an uncharted sea; theory without practice is not to set sail at all” (Hardiker and Baker, 1991) without social work theory the social worker is at the mercy of discouragements” (Marchal 1946, 1; quoted in Lishman, 1991: 41)
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This essay seeks to critically evaluate my role as a child observer. Drawing on two or more theories of child development, I will look at the main theoretical concept and critically evaluate in relation to my observation. First, I begin a brief description of the child I observed and the setting in which the observation took place. Next I attempt to show my understanding of normal child development, and aspects that can disrupt ‘normal’ child development. Throughout the essay, I will critically examine and reflect on the process of undertaking my observation. And finally, issues of ethics and anti- oppressive practises will be discussed.
The child I observed was three and half year’s old girl called Sara (not her real name), of African Caribbean background and English is the only language spoken at home. All three observations took place at the day-centre she attends. The day-care centre gave me permission to observe her, but not to interact and interfere with her educational activities. As this was my first observation, I was a bit anxious about how Sara might react about me watching her, and while her parents consented about the observations, Sara did not know that I am here to observe her; it is this scenario that made me uncomfortable. I was particularly more concerned about the ethical issues of not informing Sara about the observation. One element of anti-oppressive practice is to make sure that people’s rights are not violated. Social workers must put children’s needs first, and to respect their human rights, including rights to liberty, privacy and family life (Dalrymple and Burke, 1995: 57).
In common with anyone who is undertaking child observations, I was quite unsure where to start and how to conduct myself. I was anxious watching Sara in such an intimate way, and thought this could be intrusive to her personal space. For example; early in the observation, Sara was not talking and was mostly sitting quietly and I did not want to upset her. But most importantly, the fact that Sara was the same racial background as mine made my observation a difficult one, because I was not sure whether I would get adequate learning about anti-discriminatory practice. However, because this kind of feeling is common among student child observers, gave me some comfort and internal support. (McMahon, 1994)
During the first 29 minutes of my observations, Sara was not talking at all. I moved closer so that I could see and hear her better. Sara looked up and then smiled at me. I did not know whether Sara talks or not, but to my ignorance I expected three and half years olds to speak at this stage. Up to this point, I was not fully aware what “child development was” I remembered child development lecture we have had at the University, and I recalled the terms “selective mutism” I asked myself whether Sara is in selective mutism mode or whether she is uncomfortable with my intrusion. To my surprise at 10:29 am I heard and saw Sara saying something. When Adult2 said “its playtime” Sara shouted and said something I understood as “playtime” unfortunately, Sara did not say a single word for the rest of the observation for this day. I ask Adult2 about Sara’s ability to speak. “Sara has a delayed speech” She replied. Sara is three and half years old and still is not talking, she says very few words and she seemed to be way behind compared with her peers.
So what is normal child development? Sigmund Freud’s psychosexual theory suggests that children develop through series of stages, he named them as: oral, anal, phallic, latent and genital stages. (see Goswani, 2011) Freud believed normal childhood development is subject to successful completion of these stages. He believed a child becomes ‘fixated’ if any of these stages are not completed. (Parrish, 2010: 59-62).He believed that three parts of personality; id, ego, and superego ‘become integrated during the stages’ (Berk, 2006: 17). This perspective thus suggests that ‘the process of desire and gratification in each stage defines the basis of personality formation’ and paves the way for the type of adult such personality would be later in life. (Avan and Kirkwood, 2010). According to this perspective Sara’s speech delay is caused by unsuccessful completion of one or more of these stages.
While Freud highlights the importance aspects of child development, critics would point out that his tendency to focus on sexual urges to explain his concepts. Another weakness is that the theory seems to be Eurocentric and does not take into account none European cultures. Other theorist such as Erik Erikson’s theory although an extension of Freud’s work ‘placed more emphasis on social influences such as parents and siblings, role models and cultural backgrounds than Freud did, and thus placed less emphasis on sexual urges to explain children’s behaviour’ (Parrish, 2010: 63)
Having said that, understanding developmental expectations of children of similar age would have helped me better understand Sara’s situations. I did not understand why Sara was not able to talk; I was comparing her with my son who was able to talk by the age of two. ‘Slow talking often raises parental and professional concern’. However, knowing what’s “normal” and what’s not is crucial in understanding child development as there are wide variations among the “normal children in the rate of language acquisition” (Sheridan, 1997).
Why do we need to know child development? A good knowledge of child development and understanding theories that underpin such knowledge is essential, because it allows us to understand the concept of child development, hence theories of child development. Similarly, understanding theories of language development can help us identify how children such as Sara develop their own language and communication skills. It is therefore important that Social workers understand the process of human growth and how children such as Sara acquire language acquisition. (Doherty and Hughes, 2009: 5)
There are a number of theories associated with child development; behaviourism and nativists are two of them. Behaviourism focuses on the process of language acquisition, it suggest that children learn through observation and reinforcement. For example, when a parent encourages a child to say ‘Mama’ or ‘Papa’ and the child responds the parent gets excited and encourages the child to so say it again; chances are the child is more likely to try to repeat it. Behaviourist such as Watson (1924) and B. F. Skinner suggested that child development is a ‘continuous process of change shape by the environment and it is one that could be differed according to the individual’. (Doherty and Hughes, 2009: 37) Although reinforcement and imitation can help early language development, this perspective is primarily concerned with visible behaviour, and therefore does not address or ignores important child behaviour such as ‘thoughts, feelings and emotions’. (Berk, 2006: 355).
Clearly, Sara used language to label objects of interest to her. In one occasion, I observed Sara naming shapes. For example, I heard her saying ‘green colour’ ‘yellow colour’ she was also able to name complex shapes such as ‘hexagon’ and ‘octagon. When I enquired how Sara learned these, objects, I was told she uses ipad at home. However, Sara demonstrated difficulty with simple instructions such as ‘put your shoes on’ or ‘take your coat off’ and she found difficult to consistently follow simple instructions, but she was able to repeat phrases such as ‘let’s go’ and ‘ready set go’ she therefore demonstrated the core principle of behaviourism, which is learning through imitation and reinforcement as she was able to repeat what she saw on the ipad and what she heard from others. However, what behaviourism does not tell us are Sara’s thoughts and emotions, and this is the some of the weaknesses of this perspective.
Thus, theoretical knowledge is the key to effective intervention and good assessment when assessing children in need and their families. Critical awareness and self‐reflective has allowed me to re-examine my own values, and biases and as result I have gained basic knowledge of child development. The observation and my ongoing learning of aspect of human growth module allowed me to become aware of positions of power and how such power can impact child development. For example, parents or staff at day-care centres or even a social worker abusing their power when dealing with children.
Berk, (2006) Comments that behaviourist arguments cannot ‘account for language development’. And while early reinforcements may help children learn some phrases, it’s the adults who ‘influence children’s language development through interaction’. (Berk, 2006: 355). Furthermore, while this perspective emphasis on nurturing through reinforcement, in contrast, nativist proponent such as Noam Chomsky would argue that children have their own way of learning language without being reinforced by adults. In other words they have ‘inborn human ability to learn’. Chomsky focuses on grammar and contends that it is, too ‘complex to be directly thought to a child, even if such child is cognitively sophisticated’ (Berk, 2006: 355)
These different views helped me understand more about children growth and their language development. Before the observation, I rarely thought and tried to find out how children develop their language skills. But having read the deference perspectives about children development helped me understand and gave me a basic knowledge about child development. For example behaviourism’s reinforcement concept reminded me how I actually did this to my own children without knowing it.
Another theory that interested me is Jean Piaget’s Cognitive development theory. Like Sigmund Freud’s psychosexual theory, also suggests that children develop through series of stages, namely; sensorimotor, pre-operational, concrete operational and formal operational periods (see (Doherty and Hughes, 2009 for more details). But unlike Freudians, the perspective suggests that all these stages take place inside child’s brain (Doherty and Hughes, 2009) the aim of the theory is to explain the process by which a child, develops into a personality that can reason and think. Paiget believed that children’s development is marked by ‘qualitative differences in their thinking as they grow up (Miller, 2011: 653)’. His theory suggested that children do not necessarily learn from their care givers and peers or experience, instead, they ‘actively construct knowledge and experience through interacting with the world and reflecting on these experiences’. (Miller, 2011: 653). He highlighted the importance of ‘maturation’; he believed that children are natural learners. Although Piaget’s theory has been influential and contributed Western understanding of child development, some of the criticism of his work is that, the stages of development seemed to be Eurocentric and therefore overlooked other cultural backgrounds. Furthermore, Berk (2006), comments that although Piaget’s work contributed to the field of child development, he ‘underestimated the competencies of infants and preschoolers’ (Berk, 2006: 23).
In contrast to Piaget’s view, Lev Vygotsky Socio-cultural theory (1978) (see Goswani, 2011: 673) suggested that children’s social interactions with important figures such as parents can have positive impact on their developing. He argued that children learn by example, they tend to copy the language or behaviour they see or hear being used around them. (Goswani, 2011: 673) Although Vygotsky’s theory relates to Piaget’s cognitive development theory, unlike Piaget he did not see children as solitary learners. But as learning through social interaction that involve observing what others are doing, learning from them and then communicating with them. He further, believed that children’s parents, teachers and peers are crucial to their cognitive understanding (Daniels, 2011: 673).
Like Piaget, Vygotsky saw children as active learners in their own right, but believed that this needs ‘access to rich and stimulating environment’ (Doherty and Hughes, 2009: 269) in light of what I have observed about Sara, I think she needs access to speech and language therapy which would help her support her language development needs. During my third observation, I observed number of factors which I taught were crucial in child development. Sara was playing with her peers away from where I was. This gave me an opportunity to observe her in naturalistic setting. I observed that Sara’s playing skills were far better than her speaking ability. She was able to play alone and with groups and was clearly learning from them. From above simple observation, it is clear Sara’s behaviour resembles those described in Vygotsky’s socio-cultural theory. During my observation, I noticed that while Sara was not able to initiate her own speech, she was able to copy and say what she saw or heard. Furthermore, her social interaction was impressive, she played and interacted well with her peers and did not exhibit any sign of isolation. By observing this child, I have gained insight into the child’s strengths, weaknesses interests and skills. I have noted barriers that might be holding back this child’s development, such as speech delay.
As child observation has become an important tool for understanding child development, issues such ethics, values and anti-oppressive practice needs to be taken into account. Good relationship between social workers and services users are central to the effectiveness of good anti-oppressive practice. Dalrymple and Burke (1995) states that social workers should seek knowledge, understanding and be able to identify their strengths and weaknesses. Understanding how one’s own behaviour and emotions impacts on services users is vital for the profession. Although I did not witness any wrong doing during my observations at the day-care centre, I felt that it is paramount important that one needs to be encouraged to use anti-oppressive practices when working with children and families, in settings such as day-cares and nurseries. ‘One element of anti-oppressive practice is to ensure that children’s rights are not violated’ (Dalrymple and Burke, 1995: 30) Anyone working with children also needs to be aware of and familiar with statutory legislations such as Children Act 1989 and Human Rights Acts 1998 in order to effectively engage good anti-oppressive practice.
In conclusion, in this essay I have stated that how child observation tasks I have undertaken has opened my eyes to the world of children. Because I have learned something I knew, but did not realise that I knew it. Every day I observed my own children but I rarely give a second thought about such observations. I have also talked about how my understanding of child development was very limited and the module contents and the child observations boosted my understanding immensely. In addition, I mentioned the child I observed was the same racial background as mine, and felt that I might not get sufficient learning in terms of anti-oppressive and anti-discriminately practice, and because as a potential social worker, it is vital that I need to be exposed to other cultures.
I have also commented that the ethical dilemmas I have faced whilst observing. For example the child was not told that I will be observing her. I looked at the various perspectives in relation to child development, what do they have in common and where they differ, their strengths and weaknesses. I have also talked about how anti-oppressive practice is vital when dealing with vulnerable service users, and those intend to work with children need to be made aware the statuary legislations that underpin child protection and Human rights. And finally, I have stated how this observation boosted my understanding of child development and that not all children speak and grow up at the same rate and how the adverse effects such as speech delay can impact on ‘normal’ child development.
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Background Information about the case study
Mandy Robertson, a 48 year-old, white, UK, woman, lives with her two youngest children, Jo (19) and Lucy (16), who are of mixed parentage, in a three–bedroom, ground floor flat. Mandy’s previous partners and the fathers of the children were physically violent to Mandy and as a result these relationships ended. Neither Mandy nor her children have contact with either of these men. Jake her son, lives nearby with his partner Ryan and visits his mother and half-sisters several times a week.
Mandy was diagnosed with Bi-polar Affective Disorder in her early 20s and 4 years ago, whilst an inpatient in the local psychiatric hospital, she met her current partner, Jim O’Neil. Mandy’s mother, Jean, lives nearby. Mandy and Jean have a difficult relationship, often clashing over Jean’s racist and homophobic attitudes. Mandy’s father died 25 years ago and her brother Derek, died 4 years ago aged 32 from a heart condition associated with his Down’s syndrome. Mandy is close to her grandmother Pru and until recently they lived together before Pru’s Dementia meant Mandy could no longer look after her and Pru was admitted to a residential nursing home a five-mile train journey away.
This paper seeks to examine the above case study. It first identifies the services users (Mandy and Pru) and the specific day-to-day difficulties each of them faces, and explores the impact these difficulties have on their lives. Finally, I will try to explain the kind of support each service users require and provide critical evaluation and give reasons why they need such support followed by brief conclusion and any references I used.
The case study raises the importance of understanding challenges and difficulties face by Mandy and providing support to her because of her mental and emotional problems, and also the need to understand the emotional vulnerability of Dementia patients such as Pru. The case study suggests that Mandy was diagnosed with Bi-polar Affective Disorder. This condition, also known as ‘manic-depressive illness’ is serious long-term condition “That affects one’s moods, which can swing from one extreme to another” (NHS, 2012). I can therefore understand how this condition can have a dramatic effect on Mandy and her two children. Studies suggest that social factors such as loss and grief are major causes of depression. Studies further suggest that ‘biological and genetic elements’ are also factors for the more severe form of mental illness such as Bi-polar Affective Disorder. (Jenkins et al., 2014: 43) Therefore, it can be difficult for her two children to distinguish between the illness and their mother’s behaviour. It is therefore, important that they are armed with information and support to help understand this condition and help their mother manage her illness. Thus, social workers need to provide Lucy and Jo with age appropriate information and support. They also need to know that Mandy’s mental health disorder is not fixed condition. Her problems can fluctuate over time, in response to a variety of stresses such as the emotional pain and bereavement she is going through.
The other server user I have chosen for my case study is Pru. Pru suffers Dementia, which is an illness that affects how human brain functions, such as memory and speech. There are different types of Dementia and therefore symptoms vary, and as the case study does not mention the type of Dementia Pru has, I cannot talked about specifics of her condition but can only generalise it. Therefore, what Pru can or cannot do depend on the type of Dementia she has. Nevertheless, Pru’s condition can not only be very distressing to her, but it can be very painful for both Mandy and her two children, whom she developed, closed relationship. Therefore, like Mandy, Pru could also develop other mental problems such as depression.
Mandy, difficulties and disadvantages
As person with Bi-polar Affective Disorder condition, Mandy can face many challenges, difficulties and disadvantages from the members of the public, their immediate family members or even social workers. This is because of the lack of knowledge and understanding of her mental illness. For example, the case studies suggested that Mandy was diagnosed with mental illness in her early 20s and previously admitted in psychiatric hospital; therefore having a mental illness could make her feel alone and isolated. And as a mother of two teenagers, she may be anxious about losing her children because of her illness, and the sense of feeling guilty for not being able to carry out her parental responsibilities can make things even harder for her. Furthermore, Bi-polar Affective Disorder condition can have serious impact on her, and she can have a difficult time caring and providing her children’s needs. Daily routines such as shopping and cooking can seem impossible. Mandy seems to ‘feel trapped in her situation. She needs an advocate to assist her in gaining access to children’s services and help her understand the mental health system’ (Glover-Wright, 2003)
Therefore, Mandy should take the lead and seek written information about the nature of her illness and should have the opportunity to make an informed decision about her well-being and the care of her children. According to the case study, Mandy’s mental illness may have been precipitated by an adjustment reaction to her relationship breakdown and the fact that her previous partners and the fathers of her children were physically violent to her. Grief is a natural response to loss and distress, thus, it is the emotional pain one feels when something or someone they love is taken away either by death for separation that needs to be addressed. Therefore, ‘the meaning of loss or change to an individual is critical in determining the nature of any grief response’ (Quinn, 2005: 2, Parker 1993)
Furthermore, Bereavement and loss are not isolated events; ‘they emerge from and interact with other life experiences’ (ibid). For example, Mandy’s father died 25 years ago and her brother Derek, died four years ago aged 32 from a heart condition associated with his Down’s syndrome. Therefore, the loss of Mandy’s loved ones may have a profound impact on her. Similarly, Mandy’s mental illness can negatively affect on her children, for example, they may not understand their mother’s behaviour, and they may even blame themselves and may take it personally and might feel very frustrated and angry about her behaviour. According to social care institute of excellence ‘an estimated one-third to two-thirds of children whose parents have mental health problems will experience difficulties themselves’ (SCIE, 2011: p,8) Young children are more ‘dependent on their parents’ reaction to grief and loss than older peers, so if Mandy shows resilience and cops well with her illness with support, Lucy and Jo may not develop serious or long lasting grief. (Cohen, Mannarino and Deblinger, 2006: 4)
Pilgrim and Rogers (1999) argue that, stereotyping service users with mental health condition are common in health and social care settings because people tend to have devaluating attitudes towards mental health service users because they are seen as ‘objects of the clinical gaze of mental health professionals’. (Pligrim and Rogers, 1999) Therefore, as psychiatric patient, Mandy would value none stigmatising support and a fair access to mental health services and an appropriate person centred support from social workers, as the core values of social work practice requires that service users are seen as an individual and not an object (Basw, 2012) Thus, Social workers need to encourage Mandy to get involved in planning and delivering her mental health needs. ‘The ability to make choices about services and taking control of their lives has been highlighted by service users as being critical to their recovery’ (Barr, 2007: 319)
Another support that Mandy would most value would be, enrolling or taking part in self-help or peer support group. Mandy needs to be exposed to an environment where she feels respected and valued, and seen as an individual and not a person with mental health disorder. Research has shown joining bipolar support group’s yields ‘improvement in psychiatric symptoms and works towards the individual’s well-being and recovery’. (Barr, 2007: 319) There are benefits for joining self-help groups ‘one of the key benefits of support groups is the greater perceived empathy and respect that support groups are seen to have for the individuals they support’. (mentalhealth.org.uk, 2013)
Furthermore, if Mandy’s mental disorder is not addressed and given the support she needs, it could have negative impact on her two young children. Mandy needs support and recognition of her responsibility as a parent. Her two children’s needs must also be addressed. Researchers have highlighted the extent of the mental health problems on families. Cree (2003) suggested that children who have been ‘caring for a parent with mental disorder, might be at risk of developing mental problems themselves’ (Cree, 2003: 301-309) Adrian Falkov’s family model might be a useful when it comes to planning care package for Mandy and her children. This model is a ‘developmental and system perspective’ which is design to help in assessing parents like Mandy who are bereaved by the death of love ones and subsequently developed emotional and mental health disorders. (as quoted in Mainstone, 2014: 20) Falkov’s model examines how relations between adult mental health problems, the children and parenting issues affect each other. For example, Mandy’s mental health illness can negatively affect the development and the safety of her children. Similarly, the model shows that Mandy’s condition can also affect her parenting and her relationship with her children (Mainstone, 2014: 20,Goodman, 1999: 458-490) therefore, Mandy would value a package of care that is design to consider her, and her children as a whole when assessing their needs, as Social work practice ‘places ideas about crisis, loss, grief and bereavement within an appreciation of people’s diverse and unequal social circumstances’ (Napier, 2003: 154)
Pru, difficulties and disadvantages
In my opinion, Pru is the only service user in the case study that faces the biggest difficulties and disadvantages for the following reasons. First, like people with this condition, Pru faces widespread discrimination because of the misconception and stigma attached to Dementia. Anthea Innes (2009) comments that ‘Negative perception based on misunderstanding and stigma can lead to negative experiences, but a network of understanding and empathetic people can ease the experience of Dementia’ (Innes, 2009: 75) One of the most important disadvantages face by Pru is the pivotal role that stigma plays in defining the experience of her condition. The World Health Organization, for instance, recognize that, ‘‘stigma against older people with dementia . . . is widespread and its consequences far-reaching’’ It further, points out that stigma and misunderstanding of dementia exacerbates the pain and the grief experienced by Dementia patients (Graham et al., 2003)
Second, the role of stigma plays is only minor compared to the other more challenging problems Pru is facing or could face in the future as her conditions deteriorates. Because Pru is an elderly service user, she is more at risk with age discrimination. Alison Milne (2010) agrees and argues that, ‘Dementia is a major issue amongst older people like Pru and constitutes one of the most serious challenges facing the older population’ (Milne, 2010: 227–233). The attitudes towards ageism are perpetuated in a number of ways, for example, Pru may labelled as “dirty old woman” unproductive, or demented because of her inability to communicate or inability to do demanding tasks. These labels place too much emphasis on negative side of ageing, and tend to ignore the impact of stereotyping on people like Pru who happened to be a dementia sufferer often through no fault of their own.
Pru could also face problems in health settings such as hospital and hospices, as stereotyping are often reinforced (Walsh et al., 2011) Social workers, nurses and other staff members usually decide what service user can or cannot do. For example, hospital staff determines when a patient can have food, go to bed have a bath and so on. Robert Butler (1969), the man who coined the term ageism described ageism as having three ‘distinguishable but interconnected aspects’ one of them is how institutional practices contribute to the perpetuation of stereotypes of ageism (Department of Health, 2009: 10) Crichton (1999) noted that ageism disempower the elderly and makes them vulnerable to abuse ( as cited in Walsh et al., 2011). In addistion to ageism, Pru could also face physical, psychological, and emotional abuses. But most importantly, Pru is more at risk facing human rights infringements.
Human Rights Act 1998 protects Pru against human rights violations, although obligations under the Human Rights Act 1998 are imposed mainly on public bodies. The case does not say whether the nursing home is private or public setting.
Needles to say, ‘abuse is a violation of an individual’s human and civil rights’ (SCIE, 2011: 16) and Social work ethics and values emphasise the importance of respecting the rights and needs of vulnerable service users such as Pru, it also points out the importance of good anti-oppressive practice ‘One element of anti-oppressive practice is to make sure that people’s rights are not violated. (Dalrymple and Burke, 1995: 57) The Human Rights Act 1989 is very clear regarding upholding Pru Human rights. ‘No one shall be treated in an inhuman or degrading way’ (legislation.gov.uk, 2014)
There are a number of support and services that Pru would most value. First, it is vital that Pru is respected as a human being and not to be seen as a demented person. The case study suggests that Pru was admitted to residential nursing home and is in the care of social care setting. Person centred planning and direct payments and giving more choice to control of her life would have been better option for Pru. But, in the absence of these, palliative care would be the best care for her because there is lack of support available at home as Mandy could no longer looked after her. The aim of palliative care is to relieve the suffering of patients such has Pru and support them through difficult times. The World Health Organisation (2008) has defined palliative care as ‘an Approach that improve the quality of life of patients and their families facing the problems associated with life-threatening illness’ (WHO, 2014)
‘Older people, especially those living in care homes, are vulnerable to being de-humanised. (Bowes et al., 2009) As Pru is in institutional care, it is important that Pru is treated with respect and her dignity and well-being is promoted, and her views, wishes and feeling are taken into account. Similarly involving in her care is vital as she is the expert in her condition. People with dementia ‘know their condition better than anyone else’ thus, Pru’s views and experience must inform the health care services that she is using (alzheimers.org.uk, 2013) thus, facilitating such involvement would contribute to the safeguarding of her dignity and self-respect. Furthermore, Research has suggested the support that older people with dementia would value most is having ‘meaningful personal relationships’ (Bowes et al., 2009). In Pru’s case, this may be having continued contact with Mandy and most importantly with her grand children. Because of broken contact with her loved ones, Pru will have experienced loss and grief; therefore, having good contact with her family members is vital for her social well-being. (Sherman, Dacher and J, 2005) And finally assuming that a proper care plan is in place for Pru, one last thing she would value would be the right to liberty. The nursing home should care for Pru in a way that does not infringe her human rights and does not deprive her liberty. Should Pru decide to go back home even if this is seen as unwise decision, such decision must be respected and Pru should be assumed to have capacity unless otherwise proved by Approved Mental Health Practitioners. (Mental Capacity Act , 2005) The Mental Capacity Act stipulates that a person’s liberty can only be deprived in certain circumstances; for example if it is the best interest of Pru, or if such depreciation has been authorised by law. (ibid)
In conclusion, in this case study, I have selected two adults from the list given and I described the kind of disability or illness that they suffer or likely to suffer for example I have identified the mental disorder that Mandy faces and the impact this could have on herself and her two children. Similarly, I have also identified Pru’s complex problems. I have then discussed in detailed the daily disadvantages and difficulties each of them faces and the types of support they would most value, and given my reasons why they would need such support.
Word count: 2579
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A poor assessment of vulnerable children and their families has attracted considerable attention now and then. For effective intervention to be achieved, a comprehensive assessment has to be carried out when dealing with children in need and their families, keeping in mind that any decisions made will change the lives of the children and their families respectively. Past serious case reviews such as Victoria Climbie and Baby Peter, as well as this case has shown that assessment can be complex and challenging. This essay considers the assessment of the needs of child B and D and their family. It also seeks to critically examine the barriers that prevented meeting their needs. And, finally this paper seeks to consider how effective social work interventions could have been applied so that their tragic outcome could have been prevented.
The Children and their family’s problems and difficulties could have been improved very dramatically with early intervention and appropriate assessment. London Child protection procedure states that ‘early assessment and intervention is vital because incidents of neglect and abuse within families are on a continuum and situations where abuse is developing can at times be resolved by preventative services outside the child protection procedures’ (London child protection procedure, 2010, p.262) complying this guidelines would have reduced the difficulties faced by the children and their parents. The case review suggests that there had been ‘substantial contact’ between the parents and different agencies in Bromley, and these various agencies were aware and concerned about the plight of the family and about neglect of the children in particular for more than five years’. (Children D & B SCR, 2011, p.3) Yet, the family and children in particular were not assessed by the local authority. The duties and powers of the local authority to assess children in need and families are laid down in Part III of the Children Act 1989. The Act states that ‘It shall be the general duty of every local authority to safeguard and promote the welfare of children within their area who are in need…. (Children Act, 1989).
Furthermore, according the case review, the children were seen as in need, and not children in need of protection and no assessment or investigation took place (Children D & B SCR, 2011). The Local authority should have carried out their statutory duties and should have considered making enquiries to find out what is happening to the children, and whether further actions should be taken to protect them. London Child protection procedures guidelines requires that local authorities ‘to assess, plan and provide support to children in need, including those suffering or likely to suffer significant harm’ (London child protection procedure, 2010, pp.p,37) despite these clear guidelines it is clear as stated in the case review that agencies particularly Bromley children’s services failed to carry out their duties and had not ‘responded adequately’ to the needs of the family (ibid) Working together states that ‘initial assessment should be carried by local the authority children’s services and is to be discussed with the family’ (Working together, 2013, p.146). However, this was not done as the children’s services underestimated the situations and decided not to have any contact with the family (Children D & B SCR, 2011, p.8 para 5.1.2). During our role-play regarding this case review we talked about how we are going to tackle this case and after numerous discussions come to the conclusion that there is a child protection issue here, and that we should inform the parents that our concerns and the steps we need to take to promote the wel-lbeing of the children and the subsequent feedback given seemed to be consistent with our conclusions.
The parent’s lack of cooperation with the agencies and the fact that Ms. Q colluded with her partner to distract and divert professionals from investigation concerns about the children should have been challenged, this is not only a barrier to meeting the needs of the family and children in particular, but a professional dangerousness. Because some professionals allowed themselves to believe that ‘all is well for the family and the children, even when neglect and abuse were clear’ (Davies, 2014) It was clear that the lack of cooperation and secrecy that characterised the family had significant consequences for the children. However, professionals should have challenged this and insisted to see the children and to look around the condition of their accommodation. There were concerns about the children as early as 2006, when they ‘displayed signs of faltering growth’ and a number of ‘professionals identified developmental delays’ yet agencies misjudged the situations and chose not to carry out immediate steps to safeguard the children (Children D & B SCR, 2011, p.7 para 4.7)
Ironically, the case review finding also shows that some of the greatest barriers to intervention were presented by the parents themselves, because they made it very difficult for agencies to gain access to the children. These barriers might be linked to stigma and labelling fears that surrounds Mr G’s epilepsy condition as well as the condition of the house becoming visible to professionals such as social workers. (Children D & B SCR, 2011, p.11 para 5.5.3) Another barrier would be the family might have thought that their behaviour would be seen as harmful to the children, and therefore they devised plans for covering up any problems in the care of the children. ‘This may be mirrored by professionals avoiding contact with the family’. (Davies, 2014)
Reflecting on a role-play based on this case which I have participated led me to question whether some professionals felt helpless to take action due to legislative constraints and to avoid not to be seen as oppressors. For example, Article 8 of the European Convention on Human Rights (the Right to Respect for Private and Family Life) might seem to hold back or restrict non voluntary involvement with this family. But, then I realised that this is not a valid reason when it comes to safeguarding a child. As the Article 8 rights is not absolute and it is allowed if it is to: safeguard a child and protect his/her health, ‘morals, rights and freedoms’. (Human Rights Act, Articel 8, 1989). Furthermore, there was non-compliance with statutory procedures, for example London child protection procedure states that if there is a ‘reasonable cause to believe that a child is suffering or is likely to suffer, significant harm’, including neglect and emotional abuse, then there must be an ‘immediate provision of child in need to promote his or her well-being’. The guidance also states that strategy meeting must be instigated to discuss whether a child protection enquiry should be carried out. If these procedures were followed, then the children would have been safe. Liz Davies (2014) states that Inquiries commonly report that legislation, policy and practice are sound, but professionals fail to comply with their implementation’ this is exactly what happened in this case. (Davies, 2014)
Article 3(1) of the UN Convention on the Rights of the Child (to which the UK is a party) is also relevant to this case. The convention states that ‘in all actions concerning children, whether undertaken by public or private social welfare institutions, …… or legislative bodies, the best interests’ of the child shall be their primary consideration’ (OHCHR.ORG, 1990). In complex cases such as this one, where various agencies involved, attention can be diverted from the children to other issues which the family may be facing for example the family used Mr G’s Epilepsy condition to ward off closer scrutiny of their condition. This seems to me a deliberate attempt by the family to shut out professional intervention (Children D & B SCR, 2011). During our role-play, we discussed the best way to find out what is happening with the children and came to the conclusion that since the parents are shutting themselves off from professionals; a social worker should see the children at the school where the children attend. However, we later learned that parental permission is required and the only time we can do this, is if a child is at risk of significant harm. I was dissatisfied with this feedback as I felt the children needed an urgent protection and neglect and emotional abuse are categories of significant harm. NSPCC has found that “Neglect often co-exists with other forms of child maltreatment and boundaries between abuse and neglect can become blurred’ (NSPCC, 2012)
Continuity of social work support is vital for this complex family and prevention and early interventions are key to preventing tragic cases like this happening again. ‘Preventative services can do more to reduce abuse and neglect than reactive services’. (Munro, 2011, p.74) Agencies and professionals should have addressed the needs of the children and their parent and this should have involved both children and adult services. According to the case review Mr. G ‘had reported that his health was causing increasing problems for him’ similarly Ms. Q was also said to have some psychosocial condition and learning difficulties. It should have been important to assessed their needs and provide support for both parents and Ms. Q in particular as early as possible. Professionals should have been particularly concerned about the mother as she was suffering mental disorder and had learning disability. Parents with learning disabilities are no more likely to harm or neglect their children than any other parent, ‘but it is essential to always assess the implications for the children’ (London child protection procedure, 2010, p.216 para 5.33.1) There should have been initial assessment when the family was referred by Bromley charity to determine the nature of any services required by the family and whether more detailed Core assessment should be carried out. Section 47 enquiries should also have been considered as there were grounds to suspect that the children were suffering impairment of health and development as stated on section 120 of the Adoption and Children Act 2002 (Children D & B SCR, 2011, p.74 para 4.7) London child protection procedures states that assessment must be initiated when a professional has concerns that a child’s development and well-being are at risk, and the findings of such assessment should have rung the alarm bells.
‘Fundamental to establishing whether a child is in need and how those needs should be best met, is that any approach must be child centred’ the case review suggests that this was not the case. Although many agencies and professionals were involved with the family, their involvement lacked a holistic child centred perspective. Similarly a good relationship between professionals and service users are central to the success of an effective intervention. Social workers empower services users to find a solution that work for them based on their circumstances and to have control of their lives, thus, a person-centred approach should have been considered for this family. This perspective seeks to understand the needs of the service users, what do they need and how can this be accommodated. The perspective requires that Professionals to explain what support is available for them and how they can get access to such support. These include counselling, information giving, and financial support, advocacy budgeting and other support that can best meet their needs. In addition, professionals need to develop good relationship with the services users (in this case the family) based on empathy and none oppressive. One element of anti-oppressive practice is to make sure that the people’s rights are not violated. (Dalrymple & Burke, 1995, p.57)
However, the implementation of person-centred planning ‘relies heavily on a shift in thinking among professionals’, Bromely’s children and family services in particular about the way in which support should have been delivered to this family (Woodrow, 1998). Unfortunately, they decided that they have nothing to do with the family as the level of concern was not sufficiently serious. (Children D & B SCR, 2011, p.9 para 5.1.2) During our discussion in this issue, I felt the children’s services decision not to have contact with the family was an oppressive. Professionals needed to indentify oppressive practices when working with this family; instead I felt they were judged as trouble family, I have also felt the family’s chaotic life style was accepted as normal and ‘chronic neglect is often ignored because of this attitude’ (Davies, 2014). Dalrymple and Burke (1995) state that social workers should acquire knowledge and understanding of their own selves and challenge oppressive practices (Dalrymple & Burke, 1995, p.57)
Early intervention should have made real difference to this family and this would have in turn safeguarded the children. However, without the family’s cooperation good outcome would be difficult to achieve and as clear in this review the parent did not respond positively to attempts to help them and this itself was a challenge and a barrier that hindered any effective intervention and support for the family. Furthermore, as mentioned in the case review, very little was known about the background of the mother, thus, there should have been a multi-agency strategy meeting to discuss what is known about her past and to examine her parenting capacity. Similarly a child protection conference to bring together all professionals and the family including their extending family members should have taken place, and plans to keep the children safe from harm should have been drafted. In addition, using wide-ranging assessment processes that place the children, and parents at the centre from the outset would have encouraged the active involvement of parents and their extended family members in identifying solutions to address the problems the family was facing .By carrying out a comprehensive assessment of the family’s’ needs would have allowed the professionals to have a good understanding of the issues the family was facing and how best to support them, sadly as clearly shown in the case review none of these steps was considered.
In conclusion, the role-play and the module content allowed me to more aware of positions of power and how such power can impact child protection. For example, parents, social services or even social workers abusing their power when dealing with children and families. This essay argues that, the children and their families’ problems and difficulties could have been improved very dramatically by early intervention and appropriate assessment. And complying the statutory guidelines such working together and London child protecting procedures would have safeguarded the difficulties faced by the children and their parents. The paper also suggests that the children’s social services failure to have contact with the family was oppressive. The essay acknowledges the lack of cooperation by the parents was a barrier, but suggests that the professionals should have challenged this as they have duties to protect the children. And finally, the essay suggests that if strategy meeting and child protection conference had been held, this tragic event could have been avoided.
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