Throughout use of a case narrative, linking theoretical perspectives

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. 

This case study focuses on HV and 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.  Finally, her
Income support was cut off.  HV has
learning disabilities. AV is her mother and carer. People with learning
disabilities need extra support to access Health Services to live healthy
lives.

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The Department of Health Publication Valuing people (2001) 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)

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).  Social work and its values can potentially
shape personalisation; SCIE 2010 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 ‘.

The Disability
Discrimination Act (2005) places
‘Disability Equality Duty’ on public bodies to promote equality of opportunity
for disabled people and avoid discrimination. 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.

Faced with such barriers, many parties assume that they do not fit in
such surroundings.  Reports have
expressed how people with learning disabilities or health problems are overlooked
resulting in diagnostic shadowing (BBC news, 2013).  Diagnostic shadowing was first used in the
80’s to refer to disabled people with underlining cognitive deficits (, 2008).

In October 2010 most of the New
Equality Act came into force, making it easier for people to request
‘reasonable adjustments’ from services providers. The Equality Act contains 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,

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 that 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
practice in HV situations (ADASS, 2005). 
Under the General Code of practice for Social Care Workers, a ‘Duty of
Care’ acts in the client’s best interest, and 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) have an opportunity to be part of the process assessing 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 Assessment, 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, this should 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 requirements
state, “It should not be a bureaucratic process based on ticking boxes” (2001,
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 Helen; 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 to 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 a task or activity.

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

Individuation
Purposeful
expression of emotion
Controlled
emotional environment
Acceptance
Non-judgmental
attitude
Client
self-Determination
Confidentiality
(Biestek, 1983)

 

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 peoples is the building of ‘close
relationships’ and it 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 bearing in mind that this may make them feel
uncomfortable at times, causing a barrier for communication, but showing that
we understand their situation will promote trust in the social worker.   

Personal Centred practice requires organisational culture which values
and empowers people, valuing them as individuals and promoting their rights,
dignity, choice, aspirations, independence and overall wellbeing. 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, 2009). 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 is 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,.

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 some 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 because even though she was capable of answering
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 and lives independently
in her own home there was still 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, and speaking to people that
she does not know was another risk factor to be considered.

In HV and AV case study
there may have been particularly at times of major change or stress. There are personal
factors that could lead or increase the risk of abuse, 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 and connected with friends and family will decrease the
risk of isolation and being a good problem solving skills.  Building
relationships is a daunting task’ (2005), the external factors could also
reduce the risk of abuse, get them into good community networks with
professionals trained to recognise and respond to abuse, facilitate leisure
activities and opportunities to meet others.  (Quotereference).  Reducing the sense of isolation felt by the person suffering from
a disability, as well as other involved family members Increasing levels of
understanding and enabling family members to lead as fulfilling a 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 used my own
experiences of diversity within skills practice, which helped 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. Systemic
support is 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 support, which caters for the
individuals, needs, in a way they fit into their lives. (An Introduction to
Personalisation, DOH, January 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. This can happen in
various situations, including when someone is hospitalised.

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 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 of the Act. 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. The
CQC has been given stronger enforcements powers. It can decide what action to
take when care falls below the required standards (CQC, 2015). Care and support
provided must promote a person’s wellbeing. This includes supporting the person
to have as much choice and control as possible over the way they live their
life.

The government principles for
safeguarding adults have six key principles that should be applied to all adult
safeguarding work:  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 the care that 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 will be
obliged despite that they are not eligible for LA funded care, to provide
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 (MCA, 2005). The Act
co-ordinates and simplifies the law about the care and treatment of people who
lack capacity. This too included prosecuting providers without having to issue
a warning notice first the Care Act
builds on the principles of the MCA This Act protects AV on her decision
making whether right or wrong.  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 cannot.   AV has
her carer to help in making potentially life-changing decisions. 

The law says that everyone should have the right to make their own decisions
if they are capable of doing
so. This includes people with learning disabilities.

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 adults 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 is 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 discussed within our group to the many theoretical
perspectives, such as AsPIRE,
and when using this (different)
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 so it does not eliminate the service user and
carers giving them the support, choice and rights to an assessment. However it
can be daunting at times, individual suffering from learning disabilities are socially
ignored, and often are subject to prejudicial treatment, partly owing to lack
of awareness and more so, on account of the lack of availability of
opportunities.

Overall disability is changing I hope within my
practice I
will be able to prevent learning disabilities or, at the least, to develop
innovative and successful interventions. To avoid systemic issues families
who have a history of learning disability need appropriate support for them as
well as to assist with early interventions. Hence professionals gaining trust and building
relationship over a period of time are important consideration not only
establishing and maintaining relationships but to avoid any oppression
discrimination or barriers that may arise, I 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.