Social Work Practice and Theory
Professional practice requires you to be clear about the ideas that are guiding your thinking and influencing your practice’ (OKO 2008 p. 17). in the light of the above statement, analyse a piece of work that you have undertaken on placement, critically discuss and evaluate a particular aspect of the theoretical base, the rationale for applying this knowledge base to your practice, and to what extent your practice has benefited from this. Professional practice requires you to be clear about the ideas that are guiding you thinking and influencing your practice.
In the light of the above statement my essay begins by illustrating the plight of disabled people, and the role of social services. What is also demonstrated is the legislation which developed as a result of the Seebohm Report. This is followed by signifying the value of assessment, and thus begins the starting point of my work with client X who had an inability to cope due to the admission of his mother to hospital.
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The significance of the NHS and Community Care Act 1990 s. 7 and the FACS ‘Fair Access to Care Services’ are applied; this determines the eligibility of the client/s.
The essay then goes on to discuss and evaluate personalisation and the theory attached to this and how I applied this to my practice in the work with client X and in what ways this benefited my practice. Lastly the essay addresses the issue of anti-discriminatory practice and concludes by showing how personalisation is a tool of empowerment for individuals who are part of adult services.
Prior to 1970, help for disabled people and their families were only available through the health service (medical social workers) or voluntary organisations. During the 1950’s a few local authorities set up professional social work services which were staffed mainly by medical social workers and in some cases occupational therapists. Previous to the Seebohm Report welfare departments also offered services to disabled people, but the majority did not employ trained social workers, the support which was given was material help and information giving, and provision for residential care.
The current role of social service departments emanate from the Seebohm Report which recommended the expansion of services for disabled people. Based on the Seebohm Report thus came the development of the Local Authority Social Services Act 1970, this was followed by the social services departments and the recommendations on disability were incorporated into the additional Act the Chronically Sick and Disabled Persons Act 1970 (Oliver and Sapey, 2006).
In the mid 1980’s social services departments were under pressure first from disabled people who were dissatisfied with the lack of autonomy they could achieve through the design of personal care services (Shearer, 1984, cited in, Oliver and Sapey, 2006) and its inequitable distribution (Fielder, 1988, cited in, Oliver and Sapey, 2006) and second from the government who were concerned about the spiralling costs of welfare services for adults(Audit Commission, 1986, cited in, Oliver and Sapey, 2006).
This resulted in the Disabled Persons (Services, Consultation and Representation) Act, 1986 this was the attempt to ensure that disabled people had a voice in the assessment of their needs (Oliver and Sapey, 2006). Coulshed and Orme (2006) stress the importance of the process of assessment which they note is core to social work practice.
They further note that the organisation and delivery of social work services change and develop in response to political and economic reforms and that the assessment process is the one part of service delivery that depends on the skills, knowledge and values of those who have been educated and trained as social workers. Assessment is a key factor in the work with adult service users this establishes the nature and breadth of issues to be addressed for the individual.
This will vary, and may include the availability of appropriate accommodation and access to regular health care; this may also include access to money whether through employment or the benefits system, this can be assistance with personal or domestic tasks, attention to the individual’s recreational and social needs and response to particular circumstances for example bereavement counselling or befriending networks (Davies, 2008). For the purpose of this essay I will make reference to client X who is male and 52 years of age, this client is listed as having a physical disability and is registered blind.
A review was required and would include a holistic assessment of the client’s needs there were concerns regarding his ability to cope. Client X is stated on the system as having a physical disability and is registered blind, care is provided daily for personal care and preparation of breakfast. Client X was living with his mother who was his main carer although this was not official. Client X is very attached and dependent on his mother having lived with her all his life this was where the difficulty lay in learning to cope with everyday living as his mother was admitted to hospital due to ill health.
In the article by Bradley and Cafferty ‘ Attachment among older adults: Current issues and directions for future research (2001), it has been found that ‘Individuals who tend to view their close relationships as characterized by ambivalence, dependency, or conflict are likely to experience maladjusted grieving following the loss of an attachment figure’ (p. 215). Client X is noted on file as having a drinking problem and this increased as his mother was admitted to hospital. His sister had called the office on several occasions as she was anxious about his physical well-being and the state of the property that he is living in.
Having called the office the brother of client X also had concerns of the state of the property and that client X was drinking as he had seen empty bottles of spirits when he had helped client X to clear his room, he also stated that client X was not eating properly. The brother’s request was that client X needed extra help to clear the property and also help to prepare regular meals, the brother also wanted to be part of the review.
As this would be not only just a review but an observation of my assessment skills I informed the brother that my supervisor would be present he agreed to this and the appointment date was then set. The starting point for any adult wishing to access social care services is the NHS and Community Care Act 1990’ (Gardener 2011 p. 38). s. 47 this provides all local authorities with a duty to offer an assessment to anyone who appears to have a social care need. This part of the process is carried out to make an initial assessment and more recently Fair Access to Care (FACs) (DoH, 2003c) this is used to determine eligibility and is a national eligibility framework for allocating social care resources fairly (Gardener, 2011).
In 2003 the eligibility criteria was introduced this is divided into four categories: critical, substantial, moderate and low. The council in which I am on placement use these four categories and also the twelve domains suggested by the Department of Health, this is endorsed by in Control the twelve domains are: * Physical and mental health and well – being * Eating and drinking: nutritional needs * Keeping yourself safe * Looking after yourself: meeting personal care needs * Day to day/household tasks * Being a part of the community Work and learning *
Making decisions and organising my life * Managing my actions and choices * Relationships and roles: Parent, carer or looking after someone else * The help I can get from family and friends ( taken from the councils intranet) These domains assist me to meet the needs of the client X and any other clients that I will assess. During the process of the review I also ask the client about his mother, the client states that when she became ill he was collecting her prescriptions and doing some of the house-hold tasks.
During supervision I am told by my P. E that with this assessment that my focus needed to be on the client and not the needs of the mother as she had been allocated a social worker to meet her requirements , this was a learning curve for me and something that I will bear in mind for future assessments. In the application of the eligibility criteria the guidance on this stresses the need to ensure that in applying this it prioritises individual need and that local councils are not neglecting the needs of the wider population.
The guidance still allows councils to operate the four categories in addressing eligible needs but also requires the council to consider presenting needs, that may not be as serious and may not meet the criteria but service users may still benefit from some level of support (Gardener 2011). For example the council in which I am on placement do not provide provision for those who have low or moderate needs the client is then signposted to other services that will meet their requirements; this can include prevention services or re-enablement.
Client X has substantial needs and therefore met the criteria for extra services. The services which were provided and commissioned to the client were two extra visits per day of 30 minutes this would provide the client with the help to prepare meals so that he would be eating on a regular basis. The client also still has the service that he received previously which was for personal care and help to prepare breakfast. As illustrated previously for many adult services users in England the provisions of the NHS and Community Care Act 1990 are a major feature.
This Act, together with its connected guidance and directions provided the framework for service provision for adult service users. The Green Paper, Independence, Well Being and Choice (Department of Health, 2005b, cited in, Davies 2008) and the subsequent White Paper, Our Health, Our Care, Our Say, (Department of Health, 2006a cited in, Davies 2008) this was together with the cross department strategy document Improving the Life Chances of Disabled People (Prime Ministers Strategy Unit et al. , 2005, cited in, Davies, 2008) have set out the agenda for adult social care.
This is based on the principle that clients should be able to have greater control over their lives, this is with strategies that deliver personalised rather than uniform services this is referred to as personalisation (Davies, 2008). The origins of personalisation lie in the field of information technology, and are associated with think tank demos and in particular Charles Leadbetter a journalist and writer. Leadbetters writings on personalisation, social work and social care have been extremely influential (Ferguson, 2007).
Leadbetter views ‘personalisation as a way out of the impasse within which professional social work finds itself’ (Ferguson, p. 390). One of the major features of personalisation is direct payments, presently services are purchased by councils, and the costs of services are needed in order to allocate an appropriate level of direct payment if that is what the client requests (Mandelstam, 2005). Direct payments came into force on 1 April 1997 this gave the local authority the power to make payments to disabled people between the ages of 18-65(Gardener, 2011).
A particular aspect of direct payments is that the client needs to have the mental capacity to be able to purchase their own care. Direct payments are made to clients who are eligible; this is for those who are receiving non-residential community care services. The service to be purchased also has to reasonably meet the need of the client, additionally that he or she consents to payment and they are able to manage this without assistance. The main purpose of direct payments is to give service users greater independence and control over their daily lives (Mandelstam, 2005).
The process of personalisation ensures that the service user is placed at the centre of each stage of the process from assessment through to support planning and finally to review. Thus social workers must adopt a person centred approach to their work (Gardener, 2011). With client X, I needed to include him at every stage of the assessment process to meet his present and immediate needs, other needs would met through other services. For example client X was socially isolated, I was advised by my P.
E to connect him with the Reablement Officer who works with the visually impaired my P. E contacted him so that a joint visit would be arranged, I would then be able to observe the type of assessment this would consist of. My support plan for this client also included a referral to an association for the blind who offer support and assistance in the form of household tasks, reading correspondence and the provision of curricular activities; I felt that this would be of great importance to this client in order for him to have greater control and independence.
Client X also needed assistance with housing as there is a possibility that his mother will not be returning home due to her ill health. This created a dilemma for me as the client professed the wish to stay in the family home and the brother felt that he should have some type of supported accommodation as he feels that client X has some mental health issues, and would be unable to cope. My solution to this was to still apply for housing for the client and to advise him of his rights as well as making the brother aware of the rights of the client to stay in the family home.
The above requires that you adopt a person centred planning approach and seek to use what is important to the individual as the focus for developing support and change (Gardener, 2011). Person centred planning was developed initially among service users with physical disabilities and represents a move against the notion of counselling which is associated with medical and tragedy models of disability (Coulshed and Orme 2006). This model of practice is a key method for delivering the personalisation objectives in the Putting People First Programme for social care (DoH, 2008b, cited in, Gardener, 2011).
Putting People First recognises that person-centred planning and self directed support are central to delivering personalisation and maximising choice and control. Person-centred planning is a way of discovering what people want the support they need and how they can get it. It is based on evidence based practice that assists people in leading an independent and inclusive life. Person-centred planning is both an empowering philosophy and a set of tools for change, at an individual, a team and an organisational level.
It shifts power from professionals to people who use services (DoH, 2007) A statement affirming the role of social work for the delivery of Putting People First in England has been issued by ADASS, the Department of Health, Skills for Care, BASW and the Social Care Association (in conjunction with the Joint University Council Social Work Education Committee, SCIE and the GSCC) It clarifies the vital contribution of social work to personalisation, acknowledging it as an international, value-based profession.
The statement sets out the purpose of social work and its distinct contributions, particularly those relating to better outcomes and increased control and independence for people who use services, their carers, families and the wider community (Carr, 2010). Although the term personalisation is relatively recent, it has grown from a number of different ideas and influences. Personalisation originates at least in part as previously noted from social work values.
Good social work practice has always involved putting the individual first; values such as respect for the individual- and self determination have long been at the heart of social work In this sense the underlying philosophy of personalisation is familiar (Carr 2010). Respect for the individual can also be evaluated in terms of the kantian philosophy which focuses on the content of morality, explicitly stating how we should treat other people (Banks 2006).
Self determination this is regarded as an important principle in social work and can be viewed from the deontological position in that self determination is a right and part of what it means to be human. In the context of social work this is also a utilitarian argument as it adopts a form of practice that promotes the service users belief in their ability to manage their own lives. This approach also enables the service user to cope with more of their own problems and will be a satisfactory outcome for him or /her.
For example with the client X with the employment of the values and method of practice used ‘utilitarian’ this helped the client to see that he was a valued individual and that he had the ability to cope with the changes that were happening in his life. On reflection I now acknowledge that client X became more self sufficient and confident in his abilities. The Utilitarian approach is also seen as a much more efficient use of resources than an approach which requires the service user to come to the social worker for assistance over a long period of time (Beckett and Maynard, 2008).
Social work and its values can potentially shape the responses to personalisation of the entire health and social care workforce. The values are listed as listening, empowering individuals, recognizing and addressing potential conflict, safeguarding needs and the capacity of individuals, being sensitive to diversity and putting people in control should be central to the way staff and services treat people from the first point of contact (Carr, 2010).
Thompson (2001) asserts that social work with disabled people has never achieved priority status and has been marginalised as a minority special interest, often receiving minimal attention on professional qualifying courses. Furthermore it has often been subsumed within medical discourse and distanced from mainstream social work but parallel with health related social work. It has thus been given low status, low levels of funding and little attention in terms of research and professional development.
This Thompson (2001) states is discriminatory and symptomatic of the marginalisation and negatively valued position of disabled people and the issues that are related to their well-being . This has become known as disablism a form of systematic discrimination and prejudice against people with disabilities, this produces a milieu of oppression and degradation. It is the social model of disability which underpins the concept of disablism; this is alongside sexism, racism, and ageism.
Disablism as well as the above can be seen as a form of discrimination against disabled people based on the stereotypical view that such people are dependent. The provision of care provided to this group is seen as disabling rather than enabling as there is the misguided emphasis on helping people to become more independent through the provision of care (Thompson, 2001). This view is seen as placing power in the hands of professionals, however as illustrated in this essay the utilitarian approach challenges this perception as it gives the individual the belief of their ability to manage their own lives.
To conclude personalisation for adult social services is not just about the provision of services but practising in a person centred way. This means working in a way that people who use the services have as much control over their lives as other people. As confirmed in this essay this could be with the use of a person centred plan, usage of direct payments or a personal budget to provide their own support and care and employ their own staff. Additional aspects of personalisation include prevention and early intervention, workers supporting people early enough so that they do not require complex and intensive services.
Types of provision may include support and modern equipment to stay at home, services provided in their community such as the support provided for client X, services which shorten their stay in hospital and support provided to keep people well and safe. Lastly and more importantly the support of community networks means that people can be independent from services.