Intervention
Crisis Intervention - I approached my Initial Visit with a non-judgemental attitude. The family’s breakdown appeared to be imminent due to the parents’ serious ill health. The father looked exhausted, and the mother had remained in bed, although knowing we would be attending that afternoon. The father was requesting that the child be removed into care for the summer holidays. With my background knowledge about other children taken into care, I assessed that there was an urgent need for respite provision. Caplan (1964), quoted in Trevithick (2000), defines crisis as ‘a situation where an individual is thrown for a time into an upset in a steady state and as a result, finds himself unable to benefit from their normal methods of coping with such problems’ (p.184). Crisis intervention to help the parents adjust to a higher level of functioning seemed necessary. We could then review the larger issues facing the family.
The Local Authority has the duty to provide a range of services for Children in Need to safeguard and promote their welfare and. so far as it is consistent with that aim, to promote their upbringing by their families (S17 C.A.1989).
To enable Tommy to remain with his parents, I assessed their need for urgent respite and identified services in the area that would provide daytime activities. To obtain funds for these activities from the Local Authority, I had to complete a form, attaching a report recording reasons why I considered funding appropriate. This went to the Local Authority’s panel for consideration.
This I found frustrating. I assessed the situation as being a crisis. I was aware that, according to psychoanalytic theories (particularly ego psychology), crisis situations occur when the introduction of a new schema challenges when a person’s equilibrium. Tommy’s challenging behaviour was the new schema being introduced. Piaget’s theory discusses ‘Accommodation’, which occurs when existing schemas must be modified to fit new situations. Existing schemas are then expanded, or new ones are created (Crawford & Walker, 2003, p.39). During this period, however, a person is thrown into a state of disequilibrium, or crisis. The situation needed urgent intervention to prevent deterioration, i.e. to prevent it deteriorating (Section 1.23 in the Framework for Assessment, 1999).
The Local Authority eventually decided that funding was appropriate, and Tommy was provided activities, including outreach activities. However, during this two week period, I had to monitor the situation very closely with respect to Child Protection. The Code of Practice for Social Workers indicates that ‘I should respect the rights of Service User whilst seeking to ensure that their behaviour does not harm themselves or other people’ – here, Tommy.
During the next three sessions, Tommy’s parents were invited to vent their feelings. Assistance was given to help them restore their equilibrium. Alternative solutions were offered, including specific achievable goals such as reorganising the kitchen drawers to prevent Tommy reaching any hazardous equipment, such as gas lighters and knives. (Coulshed and Orme, 1998, p.103).
Trevithick (2000) would state that this enabled Tommy’s parents to develop new adaptive ways of coping, so they could function at a higher level; achieving ‘assimilation’ (p.185). This facilitated a move to a ‘Task centred’ social work intervention approach.
Task Centred Approach - Barker (1995) as discussed in Trevithick (2000) refers to this model of social work intervention as short-term. The Social Worker and client identify areas or specific problems and the tasks needed to change these problems. A contract is then developed in which various activities are to occur at specific times. The tasks and goals are chosen because they are achievable, and highlight people’s strengths and builds on the person’s self-esteem, promoting respect for individuals as expected in Social Work values. This theory allows a person-centred approach; which I consider encourages empowerment of the person, which was my main purpose in using this approach (p.184).
Coulshed and Orme (1998) outline five phases in helping clients to achieve their own modest goals
This allows the plan to be formulated to each individuals needs. Thompson (2002) states that:
Problem exploration –Tommy’s parents indicated that because of their own health needs coping with childcare during the summer holidays was a particular need that they viewed as important: they requested that respite activities be sought for Tommy.
Tommy had a sister Jenny, (names have been changed) who presented no problems to the family, but the parents were very aware that Jenny was receiving little or no stimulation from them as they were so busy with Tommy.
Managing Tommy’s behaviour, the parents indicated, was also a high priority.
Tommy’s parents were unable to provide structured activities for Tommy during school term times, due to the financial restraints the family were under. This they felt was impacting on promoting Tommy’s long term welfare.
Agreement – It was agreed that this task would be undertaken in partnership with the parents and the other agencies involved which included; Children’s and Adolescent Mental Health Team, Education and Family Support Resource Services. Social Services had now transferred the case to the Family Support Resource Services as it was felt that the service offered would be more appropriate.
The Social Worker explained that, as she has to work with a high proportion of Children on the Child Protection Register, if the case was left with her then Tommy and his family would receive a lower priority service from Social Services. The service we were offering would ensure that weekly visits would be maintained.
Dominelli (2002) states:
Standard one of the GSCC Code of Practice also stipulates that each person should be treated as an individual, should promote the individual’s wishes and support the service users’ rights to control their lives and make informed choices about the services they receive. Bearing this in mind I informed the parents about activities/services that were available in the area for Jenny. The parents were able to action this resource without intervention from myself, as it was a local summer play scheme organised by the City Council. This was a free provision. This allowed a first opportunity to empower the parents. I was aware at this stage that I could have easily taken over and implemented this procedure.
Tommy parents were requested to make enquires into ‘out of school’ activities that Tommy could attend in the area. This was a rural area with very few resources. The parents were then to present me with the details which would enable me to put forth a further request for funding.
Dominelli (2002) inferred that there is a growing weight of evidence to reveal the growth in poverty and marginalisation of those who survive at the edge of society impacts on people’s capacities to develop and interact with their world. This has dominated their struggle for basic survival and that they have to work harder to get those who are better off to listen to them and prioritise their concerns. (p.3)
Fran Ansley (1972), a feminist Marxist believes that the capitalist system creates oppression through the economic system. As practitioners we should be careful to practice in an anti-oppressive manner, (to avoid identification with the bourgeoisie) which would include mobilising communities to look after each other and make the most of the resources that are contained within them, and to raise the issue of a more equitable distribution of resources in society in general. (www.goldenessays.com)
Tommy’s parents were invited to take part in a Parenting Course which would help them put strategies in place to address Tommy’s behaviour. I used information from different Parenting programmes i.e. NCH, NSPCC, and the Positive Parenting Course. I noticed from this material that the information seemed very bland and uninteresting.
Tommy’s parents struggled with reading and writing. Cognisant of Social Work Values I took the ideas from these courses and developed my own outline and pictorial handouts to enable me to facilitate the information so that it would communicate the information to them in a way that was more easily understood. My goal was to empower Tommy’s parents. I tried to remember that according to Milner & O’Byrne (2002) social workers are not in a position to give power but their aim should be to reduce powerlessness.(p.29)
The final task would be to liaise with the different agencies to ensure that Tommy’s referral to the Children and Adolescent Mental Health team was followed up, and that an assessment could take place to establish if Tommy was suffering from ADHD, and how we could work with Tommy in that arena.
Formulating an objective- It was agreed that this plan would be monitored every six weeks. I would take on the position as Key Worker between the agencies to ensure that we were all fulfilling the six purposes for multi-professional work, put forward by Payne (2000), which are ‘bringing together skills, sharing information, achieving continuity of care, apportioning and ensuring responsibility and accountability, co-ordination in planning resources and co-ordination in delivering resources for professional to apply for the benefit of service users’ (p.41). Sessions with the parents would take place on a weekly basis at their own home whereby evaluation on the set tasks would take place and new goals and objectives would be identified.
Achieving the tasks – The task revolved very much on Tommy’s parents working in partnership with the service. However Tommy’s mother was found to be in bed during many of the sessions. The father explained that his wife was sleeping throughout the day as Tommy was keeping them up at night. I explained to Dad that I understood mum was exhausted but that it would be more appropriate for her to be present on the next visit. I ascertained Dad’s permission to ring around the various agencies to gather more information on Tommy, and to ascertain the stage of the referral to the Childs, Adolescent Mental Health Team.
On the subsequent visit mum was out of bed but appeared very wary of myself. I explained that I was working under Section 17 CA 1989 which encourages the local authority to provide a range of services for Children in Need and that as far as it is consistent with that aim promote their upbringing by their families. Mum seemed relieved with this and voiced her concerns that the children may be removed as with her previous children, and that she had felt we were intervening with the goal of removing Tommy and Jenny from her care.
This I felt was an example of Carl Roger’s client-centred therapy which has the central belief that as stated in Trevithick (2000) that:
The role of the practitioner is to create the conditions necessary for people to find their way to a new self-concept and self-regard. Tommy’s mother had obviously been having negative feelings about working with Social Services due to the previous history but by being informed of the legal framework in which we were working this put her into a new position whereby she was working with the agency on a voluntary basis, not under the Child Protection umbrella.
Rogers explained that:
Rogers approach to help individuals to overcome these constraints demanded that I create a particular kind of relationship which would involve using congruence, unconditional positive regard and empathy. This would be used in order to understand Tommy’s mother’s subjective experience, get alongside her world and see the situation from her perception. This was achieved by asking permission for any activities that were to be undertaken, requesting feedback and allowing criticisms and positive comments to be made about the session undertaken. This gave mum a feeling of being in control or empowered.
Thompson (2000) would call this ‘emancipatory practice’ where he outlines that:
By informing Tommy’s mother, and including her in the plans and reflection on the sessions, counteracted the negative influences that she had felt towards the service.
Individual work I undertook with Tommy included self-esteem work – this was taken from a set workbook. This identified that Tommy had very low self-esteem. I changed the parenting skill course to the Positive Parenting course (NCH), which focuses on looking for and rewarding the positives. Within two weeks of commencing this course Tommy self-esteem had significantly increased.
It became apparent that Tommy was extremely impulsive and hyperactive during outreach sessions that I undertook with him. I liaised with the School on a regular basis and they confirmed that this was typical behaviour for Tommy. The collaborative Support system encourages direct, pro-active communication between practitioners (Beresford & Trevillion, 1995, p.23). Therefore, I contacted the Children’s and Adolescents Mental Health Team who informed me that Tommy had an appointment the following week. Tommy attended and was diagnosed with ADHD. He was prescribed Ritalin. It was recommended that Tommy should attend a six week in-patient assessment at the Children’s and Adolescent Mental Health Unit to enable a full assessment of his needs to take place.
Tommy’s parents had established that there was a Boy Scouts club at the local village hall and had made enquiries as to whether Tommy could attend. However being a rural village there appeared to a lot of value judgements from the local residents. Tommy’s parents were informed that Tommy could not attend the club as they would be unable to manage his behaviour. Tommy’s parents indicated that they felt the local residents were using this as an excuse. There had been incidents involving the council whereby the local residents had complained of unsociable behaviour by the family. These incidents included the children riding their bikes, mum calling/shouting them in for tea, and the children playing too loudly.
Melvin M. Tumin(1995) when discussing social division stated that:
This is what Tommy’s parents perceived; they felt excluded from their rural neighbourhood.
However, they were able to access the local school’s After School club as this came under the Education Codes of Practice which dictates that ‘all children with special educational needs have the greatest possible access to a broad and balanced education’; which would include having access to educational resources. (Code of Practice on the Identification and Assessment of Special Educational Needs, 1994)
Review
Termination - It is important that practice is reviewed periodically so adjustments can be made in the social work intervention plan. Situations change over time therefore our assessments need to change too. The Initial Assessment is not always correct and may contain inaccuracies. It may be necessary in some cases to abandon the plan altogether (Thompson, 2000, p.61).
Tommy’s case was reviewed at six weekly interviews. These were arranged by myself in conjunction with the parents and the other agencies involved. The review took place at the school. A small report for the review gave a clear account of the services provided, work undertaken, achievements and current concerns, plus an action plan for further intervention if this were to be needed.
Discussion around this report formed the basis of the meeting. Ford & Stepney (2000) highlights areas to consider when reviewing - ‘…the client’s impression of any changes that are happening as a result of the work, or other factors’ (p.57). Also ‘If it is agreed that enough has been achieved, and there are no other problems pressing, then work may be concluded.’ (Ford & Stepney, 2000, p58)
I attempted to demonstrate a partnership approach with the parents. I referred to the parents in the first person and deferred to them for further comment at each stage. This reflected the level of respect that I had for Tommy’s parents as individuals throughout a process whereby there could have been an imbalance of power. This also offered the family a level of dignity – they were being listened to and were interacting with their own plan of intervention. They had received a copy of my report prior to the meeting, which I had endeavoured to communicate to them in an open, accurate and understandable way. This enabled the parents to have the opportunity to think about the contributions they wished to make. This thus enabled them to take a full and positive part in the discussion. The Working Together to Safeguard Children policy published by the Department of Health (1999) made this statement about the importance of working in partnership with Families:
I empathised with the parents who were finding it very hard to cope with Tommy’s hyperactive behaviour e.g. the father had expressed the difficulties he had experienced with his son over the previous weekend. I reinforced his achievements by implementing new behaviour management strategies and reassured him that it is very difficult to “get things right” all the time.
Rogers client centred approach, as mentioned earlier, states that:
The school felt that progress had been made. Tommy was arriving at school on time and was now able to concentrate on his lesson in the mornings due to the medication he was now taking, and the parents were commended for their active involvement with services.
The parents had arranged for Tommy to attend an after school club, and funding had been agreed for the school year. This was going well. The school had arranged for a private school counsellor to see Tommy whilst he was waiting for his assessment at the mental health unit took place. However, the counsellor made no comment in the meeting.
The parents clearly felt that the intervention in their family life had been useful, and the evidence was that they had worked very hard to make use of the advice that was offered. They stated their satisfaction and were very complimentary in the meeting.
The following day the counsellor based at the school rang the service to inform me that she had a serious concern about both Tommy and Jenny of a sexual nature. It was claimed that the children had disclosed that they were sleeping over night, in the same bed as a middle aged man. I was surprised that this had not been brought up at the meeting.
Section 47 (CA1989) states that when a local authority is informed that they have:
This enquire should be commenced as soon as practicable and, in any event, within 48 hours of the authority receiving information. (Working Together (1999) p.42).
I was requested by my manager to visit the family to attempt to ascertain an explanation of the children’s remark. The family were surprised at my visit as they stated that this had been handled a year before my involvement. I rang the previous Social Worker who confirmed this, and the parents reassured me that the children had not been allowed to stay with this person since that time, in fact this person had now moved away. I was satisfied that this was the case and reflected upon the fact that if this had been brought up at the review meeting in a open and honest way it could have been resolved at that time.
Collaboration involves sharing power and negotiating issues connected with different perceptions, values and interests so as to promote the collective ability to work together (Beresford &Trevillion, 1995, p.14). I rang the counsellor and informed her of the outcome of my investigation. I asked if she would like me to send out the policies that the agencies have in respects to multi-agency working – she was pleased to accept these.
This would outline the Working Together policy’s ideal, outlined in point 5.6, of seeking agreement with the parents before referring to Social Services, unless it would increase the risk of a child suffering significant harm. (p.40)
The aim of the service was to prevent deterioration, i.e. to stop situations from getting worse, as well as to improve the child’s health and development. It was felt that this had been achieved by the systematic approach that Thompson (2000) outlined (p.23).
The parents had recognised that the situation had deteriorated, just prior to the summer holidays. This they attributed to their inability to cope with childcare during this period because of the impact their own health had on their capacity to care for the children. The parents had learnt new behaviour management techniques, Tommy was now being administered with Ritalin to treat his ADHD and he was attending after school activities, along with his sister.
The parents had already begun to put in place activities for the following school holidays. The parents were now empowered through an understanding of Tommy’s condition and recognising that they would need extra support for the times they were caring for him more fully i.e. School holidays.
The termination of the process of Task Centred work was as outlined by Coulshed and Orme (1998) ‘built in from the beginning’ (p.118). In the interim sessions I had reminded the family of the time remaining. However this was not rigid. Ford & Stepney (2000) state:
Tommy’s parents expressed the need that I remain in touch with them. I asked two very pointed questions to ascertain what they were feeling. Firstly, I asked “What was the problem like at the onset?” This helped Tommy’s parents evaluate what the situation was like before the intervention. Secondly, I inquired “What changes have since occurred?” Reflecting on the progress that Tommy’s parents had made gave them the confidence to realise that my role was no longer needed. However we decided that I would visit once every three weeks for the next two months and this would be in a supporting capacity rather than intervention.
After the extended period the case was closed. I undertook a final visit. The family were not at home for the prearranged visit. I reflected back to Dominelli (2002) where she indicated that ‘the practitioner would become disempowered’ (p.183), I realised that this had happened.
At the onset of the intervention the parents needed the services input, and at least one of Tommy’s parents had been available for all of the sessions, but now had forgotten that I was coming. This at this stage I felt was good. I left a letter explaining that this was my last visit and that I hoped that they would continue with the good progress they had already made. This I intended to be the end of my involvement. However through reading Coulshed and Orme (1998), who discussed Task Centred Practice and encouraged the practitioner to say ‘goodbye sensitively’ (p.127), I rang the parents and arranged a further visit to enable this to take place. The parents appreciated this and closure seemed more appropriate.
Evaluation
Assessment & Planning – I felt that I had understood the purpose, aims and goals of the Family Support Resource Services. I also had knowledge of the legal framework in which I was working; namely S17 (CA1989). This enhanced my practice, knowing that my objection was to promote Tommy’s welfare and to promote his upbringing by his family.
Considering future intervention, within a different practice setting, it would be good to ascertain fully the legal framework that should enhance practice.
I had also read the policies ‘Working together to Safeguard Children’ (1999) & ‘Framework for Assessment of Children in need and their Families’ (2000) under which I was working.
This enhanced multi-agency working. I will have to be aware of my own judgemental attitudes to ensure that I do not become an Isolated Expert who is described as:
I am not a professional in health; therefore I need to listen to what is said by other professionals.
Intervention – I employed the use of crisis intervention which did enable the family to function on a higher level. This was costly due to the lack of resources in the rural area, and although was successful on this occasion, if this had been a family that had no previous involvement with Social Services it would have been highly unlikely that resources would have been funded. This type of intervention does not enhance the notion of empowerment as it involves the practitioner being highly intrusive in the service user’s life.
Task Centred practice allowed the opportunity for me to build on Tommy’s parents’ self esteem; it allowed them to have a feeling of being in charge. Task Centred practice enhances multi-agency collaboration. However, this approach cannot be easily used when working with reluctant service users. Tommy’s mother had problems engaging with the service initially.
On reflection it would have been more appropriate to pre-empt this non-engagement by ensuring that I had fully explained to the service user the legal framework the service was working under. This I will endeavour to undertake when working in practice on future occasions.
I am mindful that whilst working in a Task Centred way, that this deflected from direct work with Tommy. The sessions undertaken with Tommy’s parents prevented the situation deteriorating, but the referral had highlighted minor child protection concerns at the onset. Theses could have been monitored more closely by undertaking direct work with Tommy, alongside sessions with his parents.
I feel by sharing the review report with the service user and explaining this in clear understandable terms enables them to be involved fully in the review system. I believe that this encourages working in partnership with the parents and other agencies. This is a transferable skill that could be used in all the different practice settings.
Closure should be sensitive with all the parties being involved being informed. Tommy’s parents rightly needed closure as this would enable them to achieve self-actualization, as discussed in Maslow’s hierarchy of needs; cited in Trevithick (2000):
Trevithick (2000) went onto explain that this has important implication for our work because by providing the right kind of support we could ‘release the momentum and motivation towards self- sufficiency and independence’ which she called ‘self-actualization’ (p.33). This skill can be further enhanced whilst working with other service users.
The Family Resource Service was set up as a universal service across Lancashire County Council, which covers a vast area including areas of deprivation such as East Lancashire. These areas have large and pro-active Sure Start programs operating in and around the area. However, I personally feel that not enough consideration has gone into the Morecambe Bay Area. The Sure Start program operates only in the Skerton ward – which is very small in comparison to the Morecambe Bay area. Ideally I would have liked to introduce Tommy and his family to some Network in the local community; in reality there was no agency to refer them to. The rural areas seemed to be very much neglected in this regard and it poses the question “are there no children in need living in rural areas?” As a practitioner I feel that there should be an awareness of these dilemmas whilst working in a rural community and ensure that the system does not oppress those with whom we work.
Word Count 5373 (excluding references)
Bibliography
Beresford, P. & Trevillion, S (1995) Developing Skills for Community Care – A collaborative approach. UK Arena
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Dominelli, L. (2002) Anti-Oppressive Social Work Theory and Practice, Basingstoke, Palgrave
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Milner, J. & O’Byrne, P. (2002) Assessment in Social Work, Second Edition, Basingstoke, Palgrave
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Payne, M.(1997) Modern Social Work Theory, Second Edition, Basingstoke, MacMillan Press Ltd
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Thompson, N. (2000) Understanding Social Work, Preparing for Practice, Basingstoke, Palgrave.
Trevithick, P. (2000) Social Work Skills a practice handbook, Buckinghamshire, Open Press.
Bibliography (cont)
Policy’s
Assessing Children in Need and their Families: Practice Guidance (2000), London, The Stationary Office Ltd
Department for Education and Employment (1994), The code of practice on the Identification and Assessment of Special Educational Needs, HMSO, London
Every Child Matters (2003) Department Of Health, London, The Stationary Office Ltd
Framework for the Assessment of Children in Need and their Families (1999) Department Of Health, London, The Stationary Office Ltd
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Internet
