Throughout In an report from Scie.org.uk Personalisation for Social

Throughout this assignment I will be exploring the roles and tasks of
social workers in relation to work in adult services, I will also be looking at
the principles of working in partnership with other professionals and with
using services that underpin effective practice.

I will be demonstrating this with examples of social work practice with
the use of a case narrative, linking theoretical perspectives and research in
order to inform effective assessments, planning, intervention, reviewing and
evaluation in adult care.  Furthermore, I
will explain how social worker values can be used to underpin effective
practice in working with adults, their families and carers. 

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This case study focuses on Helen Vaughan (HV) and A Vaughan (AV).  HV has been diagnosed with Sotos Syndrome and
is vulnerable to cold callers and been bullied into buying a number of good and
services which she doesn’t need or can afford. HV has learning disabilities and
other health issues. AV is her mother and carer.

The Department of Health Publication Valuing people (DOH, 2009) defined a
learning disability as; “the presence of significantly reduced ability to
understand new or complex information, to learn new skills (impaired
intelligence) and reduced ability to cope independently (impaired social
functioning).” When describing disabilities there is a danger of focusing on
what a person cannot do. We should remember that people with learning
disabilities are people first; individuals with different skills and talents as
well as needs (People first, 2013).

The Social worker’s role
is to raise HV consciousness of the problems that leads to unjust social
structure (Healey, 2005).  H.V
vulnerability raises concerns about how to ensure she is not further exploited.

To underpin our values in effective social
work practice disability awareness training for Social worker, other
professional and volunteers are aimed at making the professionals aware of the
difficulties that people with disabilities experience and the necessity of the
provision of information and materials in alternate formats: large print is
preferable for shorter pieces. 

“Personalisation and Safeguarding in adult
social care are intrinsically linked”,  (Galpin & Hughes 2011, p. 150-159).  Social work and its values can potentially
shape personalisation; In an report from Scie.org.uk Personalisation for Social
Workers in adults services believed that ‘
listening, empowering individuals, recognising and addressing potential
conflict; safeguarding the needs and capacity of individuals and putting people
in control should be central to the ways social workers and services treat
people from any first or last point of contact ‘ (SCIE, 2010).

The Disability
Discrimination Act (2005) places
‘Disability Equality Duty’ on public bodies to promote equality of opportunity
for disabled people and avoid discrimination (DDA, 2005). The Disability
Equality duty came into force in 2006 and meant that any public body, such as
the NHS or Social services, has to look at ways to ensure that disabled are
treated fairly. This means that services have to be proactive and make
reasonable adjustments to the way they commission or provide services.
Opportunities are not always equal to everyone, many people with learning
disabilities have communication difficulties such as; not being able to read; not
hearing or understanding question asked; or being ignored in the conversation
(Mencap, 2008).   HV who has learning
difficulty may find it difficult to understand how and where to get help for
example: making an appointment at the general practitioners’ surgery or
accessing her community.

Diagnostic shadowing was first used in the 80’s to refer to disabled
people with underlining cognitive deficits that overlooked physical or mental
health problems (NICE, 2017). Reports have expressed how people with learning
disabilities or health problems are overlooked resulting in diagnostic
shadowing (BBC news, 2013). Faced with such barriers, many parties assume that
they do not fit in such surroundings.

The New Equality Act (2010) came
into force, making it easier for people to request ‘reasonable adjustments’
from services providers this contained two new duties that are particularly
relevant to people with learning disabilities. This Act will ensure that HV is
not treated unfavourably because of her learning disability, secondly The first
duty of all organisations is to promote good practice and prevent something
potentially harmful occurring (Safeguarding Adults, 2005). 

Working in partnership is very significant, it should not be assumed
that ‘partnership working is very easy, but there is an important element to
understand; whose role is it to bring together the public, private, voluntary
and community sectors into a single overarching
framework (Sussex, 2008, pg. 217).  Frontline
level collaborative working has been signalled in just every policy.  Pritchard (2008) theorises that no one job
can meet all the profession’s aim and aspiration. However, by working together
through quality standards and procedures of staff, there may be a reduction to any
possibility of abuse or poor practices (ADASS, 2005).  Under the General Code of practice for Social
Care Workers, the client’s best interest should take priority in every
circumstance (GSCC, 2002a, 2015).  HV
social worker and other professionals need to balance their duty of care
against respect for autonomy to make it an effective partnership.

(AV) as a carer should have an opportunity to be part of the process assessing
both their needs thereby making HV and AV the centre of the process, which fits
into the client centred approach.  Parker
(2007) believed that as a social worker the point and aim (role) of the
assessment model – (AsPIRE) – is Assessing, planning, intervention review and
evaluation.  This supports the social worker
in clarifying the issues and organisational values; ‘It includes the referral
stage at the beginning, recognising that the first request for intervention is
the starting place for intervention,’ (pg. 176). 

The questioning model focuses on the social workers’ expertise in
planning, asking questions, listening and processing the answers.  This reflects on the social workers’
agenda.   The disadvantage to the
questioning model eliminates the impact of race, gender and disability leaving
little room for social work values and may cause conflict. The concept of ethics relates to human
rights, is to provide good quality in care equitable and fair distribution of
resources, benefits and services among the disability people regardless of race
gender and disability (BASW, 2012). The
Department of Health (2001) requirements state, “It should not be a bureaucratic
process based on ticking boxes” (p11). 
The advantage of the procedural model, is that it identifies the
criteria for needs, however it can also be seen as a disadvantage for HV; as it
demands the filling out forms which could cause problem, because it focuses
more or producing data rather than on the person.

Good practice for social
workers and professionals should make reasonable adjustment for those
with learning disabilities including; easy to read letter with photographs, a
longer appointment, travel directions to the clinic, contact details and if
needed, help to get to a destination. HV Social worker and other service
providers need to be able to clearly communicate with her and AV in order for
them to: have a good understanding of the care support plan; feel involved and
informed about choices available to them and learn how to use equipment or
carry out task or activity.

When interviewing and struggling
with my own practice, I reflected on Felix  Biestek’s seven principles of
attributes a social worker needs to be effective in their day-to-day work with
clients in relationship based practice:

Individuation
Purposeful expression of emotion
Controlled emotional environment
Acceptance
Non-judgmental attitude
Client self-Determination
Confidentiality  (Trevithick, 2003)

During the seminar my own values were repeatedly in conflict
with the values of my cohorts. We often debated the theories conveyed.  I needed to be aware of my views and opinions, and be able to
challenge them when working with clients if I am to remain objective. Rustin (2004) identifies
this problem and suggests that recognizing feelings and working with them is
very important in our work. Remaining separate, distinct, whole and intact is
what I continually strive for as a social worker. Stratton (2011)
research proposed that what matters most to people is the building of ‘close
relationships’ its very useful to identify different types of emotions that
start with the choice and judgement at hand, this emotion can usually shape
decision-making (p. 5).    Our responsibility is to make facts based
decisions, being clear about ethics involved, awareness of sensitivity to
feelings and reliability of the information we gather. These skills could be
used with the client and families, but bearing in mind that this may make them
feel uncomfortable at times, causing a barrier for communication, but showing
that we understand their situation should promote trust in the social worker.    

Personal Centred practice requires organisational culture that values
and empowers people, valuing them as individuals and promoting their rights,
dignity, choice, aspirations, independence and overall wellbeing (Koubel, 2008).
While supporting people with learning disabilities we ought to consider the
following for them to stay healthy, making sure that we take a person-centred
approach (SCIE, 2015). On reflection, anti-
oppressive practice need to be instilled in developing social workers so they
learn about the challenges people may encounter in their lives, this I believe
will also enable social workers to give individuals control and empowerment of
themselves.  As social workers we may
have the power of the law, or the power afforded through status, but the
service users such as HV and AV maintains the power to say no in the majority
of circumstances.

Sterman (2000) In Elf, Poutilova and Ohrn Research based care planning
process in Sweden (2006) believed care planning may be difficult, without
carrying out an assessment in order to practice in an anti- oppressive practice
manner.   It could be contended that
careful planning is required before an assessment or review takes placed
(Sterman, 2000).  Anti-oppressive theory
and practice in social work pursue relentlessly to recognise oppression in
society (Clifford, 2009).  Given that HV
has a mild learning disability and the narrative describes HV being exploited
by online users and cold callers. The social workers’ role is to raise HV
consciousness of the problems that lead to unjust social structure (Healey
2005). 

Furthermore, personal centred practice came from two elements of
history.  In the 1950’s the
psychotherapist Carl Rogers used the term ‘Client centred’ to describe his approach,
which contrasted with the medical view of the professional as expert, he saw the
person as expert on their life history and the practitioners as facilitators
(Joseph, 2015). He also believed the (KEY)
term ‘co-operation’ is issued to describe a working relationship where
organisations recognise the knowledge and skills of service users and work
together with them to develop and improve services (Zastrow, 2008).

Tom Kitwood used Carl Rogers approach to improve care for people with dementia.
He challenged the medical model of care because it ignored fundamental needs:
Comfort – The need for closeness and security, Inclusion – being part of a
valued group, Occupation – Being involved in activities, Attachment – Forming
specific bonds and attachments, Identity – Having a sense of who one is.  Kitwood demonstrated the positive impact of
good communication and respectful relationships, and the fundamental importance
of building a full understanding of people being cared for. Much of the work
completed by social worker is client centred, based on the principles of
empowerment, partnership and participation. 
It would be expected that HV and her mother
would be a recipient of this type of care.

Current government policy is clear about the need to ensure that, when
decisions are made about someone’s health and wellbeing, the person is central
to the process. This approach is referred to as ‘no decision about me without me’;
Central to personalisation is the way we plan with people Valuing people (2011)
advocates a person centred approach to planning.

Sometimes HV found it difficult to provide the information requested and
at times was prompted by her carer (MOTHER), this demonstrates the importance
of carers as seen in HV’s case, even though she was capable of answering some questions
she still relied on her carer (AV).    The group discussed the risk in
relation to HV feeling isolated, even though she
had some form of activities during the week she lives independently in her own
home it was felt there was a potential risk and vulnerability to abuse.  HV’S health was also a risk as she may
sometimes be reluctant to attend hospital and doctor appointments.  HV going online, speaking to people  she does not know was considered another risk
factor.

In HV and AV case study
there may have been particularly times of major change or stress. We discussed
personal factors that could lead or increase the risk, Relationship issues linked to
difficulties in adjusting to major life changes such as: bereavement communication and intimacy difficulties, lack of understanding impacting on
relationships with the family and professionals for example: history of abuse,
low self-esteem, substance abuse by the adult at risk, inability to stand up to
abuse, minority status and possible discrimination, unemployment separation or
family breakdown, closed culture in the care environment leading to abuse not
being reported and poor standards of care (Trevithick, 2003). Reducing the personal factors Social
workers and other professional worker with the family should get each
individuals to participation in activities which increase awareness,
independence and personal safety, getting them involved in active in the
community, connecting friends and family will decrease the risk of isolation
although for some building relationships can be a daunting task. Reducing the sense of isolation felt by the
person suffering from a disability, as well as other involved family members
Increasing levels of understanding may enabling them to lead a fulfilling life
as possible.

 

Schön (1983) reminds us that flexibility and creativity are key part of
reflective practice.  It was interesting
how our group looked at personal centred approach and the concept of diversity
when looking at HV’s case.  I thought my
own experiences of diversity within skills practice, would enable me start the
feasible needs of client needing support because of diversity issues. 

 During the seminar the group
experienced difficulties in showing empathy due to the issues of diversity.
Having not experienced some of the difficulties experienced by the service user
I noted that rather than empathy I was feeling sympathetic.  While my colleagues had a desire for better
understanding, the time constraint meant that we were limited in our ability to
gather information and thus it limited the depth to which we could empathise.  PCS model by Thompson is a good example when focusing on diversity and
identifying how discrimination is reinforced at different levels. This model
helps us to understand how power relationships are extracted from groups and
individuals and the under layered effect of oppression (Thompson, 2006).  I agree with Thompson’s PCS Model as it
reveals how each level of society interacts with the other, that power relationships
do not exist separate from one another but are actually unified.  Systemic support is also the idea that family
relationships form a key part of the emotional health of each member within
that family.  As such the professionals
working with HV and AV need to explore strengths and resources so as to
determine their behaviour in the context of relationship. It explores the
dynamics of the relationship.

 

Enablement has also been
considered a strong personal-centred approach involving a person identifying day-to-day
activities that are important for them to do in order to feel a sense of
control and independence. The enablement approach supports the Government’s
‘Personalisation’ agenda; providing care and support, which caters for the
individuals needs, in a way they fit into their lives. An Introduction to
Personalisation (DOH, 2008) which helps Social workers and other practitioners
with good practice. Since the report by the independent inquiry in 2008 and by
the Health ombudsman have also highlighted failures to meet the health needs of
people with learning disabilities. It is widely acknowledged that HV with some learning
disabilities may have been at risk of abuse and exploitation.

Priory to the care Act 2014 it was the local authority’s responsibility
to provide services to the residents needing it.  The Chronically Sick and Disability person
act built on the National Assistance Act. 
The care Act became law in May 2014, building a new, coherent approach
to adult social care in England.  As such
the old system would be difficult for HV and AV to navigate. 

Norman Lamb explained that the old system was unable to respond to the
difficulties faced by care and support’.

The Care Act 2017 guidance consolidates
previous Health and Social legislations and guidance with the aim of providing
a consistent approach to Adult Social Care to help both the wellbeing of both
the person needing support and their carer. It focuses on the provision of
Person-centred care, Preventative support and integrated services. The Act
provides a statutory framework for safeguarding adults in England
(Safeguarding, 2011).  The CQC has been
given stronger enforcements powers. It can decide what action to take and when to
care.

 The six principles key for safeguarding
is:  empowerment,
prevention, proportionality, protection, partnership and accountability (Doh, 2013). Social workers and
local authority have a duty under the new safeguarding duties adopting the
national minimum threshold for eligibility for care and support and promoting
the physical and mental wellbeing of those needing care and support and their
carers (DOH, & Lamb Norman, 2014). 
This act would clarify and empower HV and her carer as to the care they
should expect from the system.  This
system would mean that HV and her carer would get help before it reached crisis
point.  Their social worker would be
obliged despite they may not be eligible for LA funded care, to provide a support
plan, personal budget and direct payments.

Centred on Assessment a
person with mental capacity should be assessed in relation to making a
particular decision at a particular time (MCA,
2005).  While HV may have the capacity to
make a decision about a day-to-day issue such as what to eat or wear, she may
be reliant on AV to make a major decision, such as whether or not to have
surgery.  Mental capacity should be
assessed at the time a particular decision needs to be made because capacity
may fluctuate; for example, as the symptoms of a mental illness gets worse or
better (MCA, 2005).

The Mental Capacity
Act
(2007) Aims to protect people who may lack the capacity to make some decisions
for themselves; for example, because of mental illness, a disability, stroke or
dementia (The Department for
Constitutional Affairs, 2007). This Act should protect AV on her decision-making. It
also provides a clear legal framework to ensure that fraud and abuse does not
take place. (Department for Constitutional Affair, 2007).   It suggests that AV should be able to make
her own decision unless it is clearly shown that she is unable to.

Information sharing: Guidance for practitioners and mangers, published
in 2008, now covers safeguarding adults in addition to safeguarding children. Section 1.4 OF THE GUIDANCE STATES Information
must be shared on a need to know basis when it is in the best interest of adult
at risk.

The SAFGUARDING ADULTS RETURNS (STATISTICS)

REFERRALS OPENED BY ADULT SAFEGURADING TEAM IN England and between April
1st 2013 and March 31st 2014

49% of allegations related to someone
know to the adults, but in a social care capacity
26% of allegations related to Social
care employees
15% of allegations related to someone
unknown to the adult

The most common
types of abuse alleged were:

Neglect and acts of omission (30%)
Physical abuse (27%)

The above statistics describes ‘abuse as a violation of an individual’s
human and civil rights by any other person or persons’ (DOH, March 2000). The
main forms of adult abuse are: Physical, Sexual, Psychological, Financial or
material abuse, Neglect and acts of omission, Discriminatory abuse, Domestic
abuse and Hate Crime are now also widely regarded as abuse. However, they have
clear processes and principles for sharing information; No one should assume
that someone else would pass on information. 
If there are any concern that a person is suffering, or is likely to
suffer; abuse or neglect, this should be shared with the Local Authority.

Throughout this assignment I have addressed and
explored the roles and tasks of social workers and the many challenges and
complexities in relation to working with adults in particular those with
learning disability.  I have been able to
link the narrative of a case study discussed within our group to the many
theoretical perspectives, and explained when using this Practice framework how
to utilise the exchange model, questioning model, values and ethics when
working with the family, other professionals, and service users. The Care Act
has been introduced as our guideline when working with the
vulnerable, which help us to give them support, provide choices and rights to
an assessment. Individual suffering from learning disabilities can be socially
ignored, and often are subject to prejudicial treatment, partly owing to lack
of awareness and more so, because the lack of availability of opportunities.

Overall disability awareness is changing.  I hope within my practice I will be able to develop
innovative and successful interventions. To avoid systemic issues,
families who have a history of learning disability need appropriate support for
them including early interventions. Hence it will be important for me as a
professional to gain trust and build relationship over time.  These are important consideration not only for
establishing and maintaining relationships but to avoid any oppression,
discrimination or barriers that may arise. 
I will endeavour to continue to develop on my own practice and my
reflective skills to ensure that I critically assess my practice throughout my
time with service users at present and in the future. 

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