“ Routine service led assessments are the antithesis of an empowering
approach to assessment and care management”
(Smale et al. 1994:68)
Section 47 of The NHS and Community care Act 1990 states all local authorities have a legal duty to assess needs for community care services. It points out that if a person is in need of services then an assessment of those needs will be carried out, and with regards to the result of the assessment will decide whether the needs call for provision of any services. This contributes to my understanding g of Mrs P due to her health and severity of needs. Mrs P's daughter may also be liable for assessment under the Carers Recognition and Services Act 1995.
Due to the severity of Mrs P’s needs it is obvious that she requires a lot of care, time and support. I feel the family’s decision to keep her at home rather then residential care is the best option, despite the daughter having difficulty in coping. I feel day-care during the day will be of a great benefit to Mrs P and will also give the daughter respite from her caring role. I feel day-care is a better option than residential care as I feel Mrs P should be in her own environment with her family at home. This is also apparent in the1989 White Paper Caring For People. Where the objectives are to promote the use and development of day and respite services and to enable people to live in their own homes.
The DOH defines a vulnerable person as…
“Someone who is or may be in need of community care services by
reason of mental or other disability, age or illness and who is or may
be unable to take care of him or herself against significant harm or
or exploitation.”
(Dept. of Health 1999)
With regards to the above definition I feel Mrs P is very vulnerable and is entitled to community services. I feel her eligibility for fair access to services is critical because significant health problems have been developed and may be impaired further e.g. her poor mobility, depression, communication and isolation She is also at risk of harm to herself as she is unable to carryout domestic tasks such as dressing and toileting without assistance and she is also fed through peg therefore she is not allowed to pass anything by mouth which she tries to do at times without realising.
According to The General household Survey 1994 there is clear evidence of a greater incidence of both chronic and acute sickness amongst older people than in any other group. This contributes to my understanding of Mrs P as she is on various medications. Other health issues include how sight declines with age and there is an increase in the prevalence of eye diseases. Mrs P is registered blind and has also previously had an eye operation. Hearing also declines with age as in evident in Mrs P.
Surveys have also shown that the main cause of loss of mobility is rheumatic, arthritic conditions followed by cardiac conditions. Mrs P has previously suffered from two strokes, which has seriously affected her mobility. She now also requires use of a wheelchair.
As Khaw 1996 pointed out that the health of individuals is clearly affected by what they eat. He went on to say that those who are at ‘high risk’ of poor nutrition included those who cannot swallow. Mrs p cannot swallow and is fed through a peg. Consequently this is a contributing factor to her ill health.
Other ageist theories, which contribute to my understanding of Mrs P’s needs, include Depression. Mrs P is severely depressed and this is cited in research that depression is more likely amongst older people. The main reason behind this is that they are physically, emotionally and mentally less resilient than they used to be, which means there failing health affects them because they are not as strong as they used to be and cannot carry out and perform tasks and activities like they used to. They are more dependent.
Families under stress theory are also evident within the family. The daughter is having clear difficulty in coping with five children and providing care for Mrs P. Therefore she is under great deal of stress and if this is accumulated it can lead to a family crisis e.g., children being neglected, illnesses and domestic violence. Family stress also leads to depression, which is evident in Mrs P and her daughter.
Unfortunately we live in a democratic society where power, manipulation, discrimination and oppression are present especially in older people. There is little doubt that in a society that seems geared to youth and beauty there is great emphasis on remaining young. Therefore older people are widely oppressed and discriminated against. Comfort 1997 argues that ageism discrimination against old people on the grounds of there being old.
Assumptions about older people include older people are poor. Lonely, are ill, no longer contributing to the economy and seen as a burden. When working with older people it is important not to make these stereotypical assumptions and to generalise. Not all the elderly have the same characteristics e.g. a 60yr old may have the same characteristics of a 30 year old, and why should people in there sixties and nineties be classed as one group. We must acknowledge that each individual will be at a different stage in his or her life and needs and circumstances will vary, including with different ethnic minority groups. Therefore throughout my work with the family I did not make ageist assumptions and avoided all stereotypes and stigmas. To work effectively with older people we must develop anti ageist practice.
Midwinter 1990 says that old age is like having returned to a second childhood where others will make decisions for you. When working with the family I made sure that Mrs P wishes needs and circumstances were the focus of my assessment and intervention and that she was involved in decisions about herself.
When working with service users we need to be aware of power issues. In reality other professionals and service users see social workers function as agents of social control who are paid by the state to do so. Therefore power imbalances need to be separated out and a partnership approach should be implemented.
When working in partnership with the family I took account of Trevthick’s (2001) fifteen points to effective partnership working. These included explaining to the family my role and power to intervene. I feel a clear mandate is the basis of a partnership-based intervention. Sensitivity was given to power imbalances and the family were not just consulted but had full participation in decision-making and problem solving (Bray 2001). Sensitivity was also given to the language being used. I avoided jargon and took into account cultural language barriers. When working with the daughter in law I spoke in Urdu because her first language was not English. The assessment was carried out with an English speaker but I strongly felt that the daughter should be acknowledged of what is being said and if she had any issues, therefore I interpreted in Urdu throughout the process. I was also aware of my own feelings, values and prejudices. During the assessment process I also ensured that the services users strengths were recognized. Taking all these points into consideration ensured that I worked in an anti oppressive manner.
Coming from an Asian heritage background myself I feel I can understand and empathise with people from my own culture. However I realise as Henley (1986) discusses that each group even within the Asian culture is separate and distinct from the others. I am aware that placing people together and seeing them as a single culturally homogeneous group is misleading and unacceptable. Throughout the intervention I treated Mrs P and the family as individuals with different needs and circumstances. I carried out relevant background information to assist me and gave particular attention to the cultural aspects of the family. I felt I worked in an ethically sensitive way and valued cultural diversity.
A strengths based approach will also be applied when working with the Family. This approach focuses on positives with the intension of increasing capacity, motivation and potential for making choices. The service user is classed as the expert on there own problems. This approach also demands change and reduces the power imbalance between service users and practitioners. Working with service users strengths ensures an anti oppressive focus is maintained.
Systematic practice will also be adapted. This enables me to keep a clear focus of what I am doing and why, which is to safeguard and protect Mrs P.
Due to Mrs P’s circumstances she was unable to communicate her needs and take part in decision making, therefore the assessment and care plan were undertaken with the family. Mrs P has a very supportive family who have cooperated with the organisation and myself greatly. They also implemented the assessment and care plan.
The main method of intervention from our part was providing appropriate day care services for Mrs P. From this we revised a care plan, which we can work towards to create positive change and maintain present standards.
Mrs P has now been attending day care for 4months. According to the family members there has been a great positive impact on the family. Mrs P’s daughter his now balancing her time between her children and Mrs P. It has been a great relief for her and is no longer under stress. She now also has time for herself during the day, which she did not have before and it has given her a break from her caring role.
Mrs P is content in attending the daycentre. She feels more secure in an environment with people her own age range and with similar problems. One of Mrs P's main concerns were her depression and isolation however she is slowly overcoming this by attending day care, meeting people and joining I activities. Mrs P's granddaughter previously mentioned that Mrs P had a tendency to cry at home due to loneliness. Fortunately day care has stopped this.
I feel Mrs P is maintaining her present level of needs and has shown no signs of detereation, which is very promising. She is also making relevant progress in achieving the goals identified in the care plan.
Mrs P is in a secure environment and is monitored regularly to ensure safety. At home Mrs P had tendency to put things in her mouth, which she is not allowed to do. At day care we have not yet encountered this problem and this is also improving at home. Mrs P has been allocated a key worker who monitors her regularly and completes a daily diary about her. A home care package has also been put in place where a carer goes into the family home twice a day to help Mrs P with personal domestic tasks.
Overall I feel Mrs P and her family are greatly benefiting from community services. Present needs are being maintained as well as positive improvements. Mrs P is also living at home in her own family environment, which is one of the main objectives of the1989 White Paper Caring For People.
Social work evaluation aims to assess the effectiveness of the intervention.
“The demand for social workers and their managers to identify the
effectiveness of their work is now very great.
(Cheetham et al, 1992:3)
Considering this was my first assessment and intervention project I felt I was very competent and effective in my role. Fortunately this was because prior to the assessment I had undertaken previous background reading on assessments, planning and intervention. This assisted me greatly in my work as well as enhancing my knowledge on the subject.
Throughout the process I felt I was aware of anti oppressive and anti discriminatory strategies, I felt I worked in an ethically sensitive way, taken into consideration family diversity, cultural and religious factors. I felt this was important in understanding the needs and circumstances of Mrs P. and also acknowledging that every individual’s circumstances and needs are different and will be influenced by cultural factors.
I was also aware of power issues and power imbalances. I predominantly worked in partnership with Mrs P and her family. I encouraged them to participate in decision-making and problem solving. The family were not merely consulted but were given full participation. As Bray (2001) points out consultation is not power sharing, full participation is required from both parties. With this approach I felt the power issues were balanced and we all shared an effective power sharing relationship.
My communication and interpersonal skills have also been improved vastly and I am now more confident with my language inn both English and Urdu. The assessment was mainly carried out in English, but as a form of anti oppressive practice I translated and interrupted the conversation in Urdu to Mrs P’s daughter in order for her to have an understanding of the conversation and also be involved. I felt I translated effectively and aided communication. I personally feel communicating in two languages and constantly switching from one to another is a great skill to have. Also when communicating I gave particular attention to the language being used, making sure it was jargon free, understandable and sensitive. I felt I had a balance of professionalism and being myself.
Throughout the intervention I maintained a positive relationship with the family as well as demonstrating the following skills as articulated by Rogers (1951). Empathy, I felt I had the ability to experience Mrs P’s world and circumstances and adjust my understanding accordingly. I feel I showed warmth and accepted the family’s circumstances and showed respect and created a trusting environment. I was also genuine in my approach. I was open and clear about my role and power to intervene. I feel a clear mandate is the basis of a partnership-based intervention. When working with the family I also realised there were other people involved who were in need such as Mrs P's daughter, however I did not lose focus of my main priority which was Mrs P. Towards the end of the intervention I gradually reduced contact with the family, and explained that I was only a student on placement and that I had enjoyed working with them.
Mrs P was unable to participate in any form due to her inability to communicate. However I am aware that in my future work I would like to see the service user as the expert on their circumstances and to participate in decision them selves. If there is a communication barrier then sign language can be implemented and also written methods of communication, to enable service user participation.
A second area for improvement is the implementation of the care plan. The care plan was discussed, produced and reviewed over the phone with a family member. In future I hope to work in person, with the individual rather than over the telephone. This will enable clearer communication and will also cause less confusion. By taking all these learning needs into consideration it will enable me to practice in a more efficient way in my future practice.
