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Reflective Diary

CASE STUDY

Introduction

Working with patients with physical disabilities or sensory impairment offers one of the most interesting professions. Working in this kind of field has definitely been a fulfilling job, especially with the fact that I got to work with the families of these patients who are basically from different cultures and backgrounds.

The succeeding work on which I will reflect on shall focus on the point of referral. This reflection shall address questions that inevitably surfaced during the course of identifying the significance of this social work. This reflection shall try to answer what social work research knowledge which includes research work was drawn from this work? Moreover, it shall also reflect the result of the corresponding interventions. Apart from this, learning that involved values and ethical issues that inevitable arose from this work shall also be tackled. Such reflection shall present that realizations as well as the learning that were achieved in the course of the social work. Actions and decisions made shall also discuss in the objective of analyzing their significance to the decisions to be done in the future.

The Subject: Jane

The focus of this case study is an orphan who is to be guised in the name, Jane.

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For confidentiality purposes, her real identity shall be protected. I have been working with Jane since the October of 2008. A lot of issues were raised in the course of this case, and a lot of challenges were also presented before me that tested my ability to incorporate theories, my ability to research, my knowledge on legislation and policies as well as my knowledge in this kind of practice. Aside from the pleasure of exploring the wonders of social work as a profession, this case has also been a good opportunity which allowed me to deal with deaf service users as well as to recognize the anti-discriminatory practice issues related in this service user group.

The objective of this study shall delve on systems and attachment theory which has been utilized for this specific service user. Such theories shall be discussed in the succeeding parts of this discussion. To aid in fulfilling such an objective, the genogram below shall be used to represent the subject’s family situation:

Jane’s Genogram

First child

Second child

Mother

Father

Systems Theory

The Systems theory is an example of the complex interrelationship of ideology, theory and the resulting model of intervention. Hall and Fagen describe this theory as a set of onjects together with relationships between the objects and their attributes (cited in Vass, 1996 p21). The Systems theory offers social workers a perspective which encompasses both the individual and his or her social environment (Pincus and Minahan, 2007). However, it was also argued that this theory also tends to aid or destabilize systems, whether they are families, teams, or organization, so as to function efficiently. Apart from this, the concept of a system can also be problematic, as it may denote a set of organized social relationships that have almost a limitless scope (Vass, 1996).

The Attachment Theory

The Attachment theory deals with a long lasting emotional bond between two individuals, involving or seeking proximity between each other and finding pleasure in each other’s company (Bowlby, 1999). In relation to this theory, Bowlby argues that separation at an early age could become a disruption during the early stages of a person’s development. Over the years, Bowlby’s works together with other experts on this subject matter have been very significant within the field of social work as they bridge the gap between children’s emotional development and behavior, as well as the quality of their relationships with their parents and other significant personas. Consequently, the Attachment theory has been utilized extensively in day care settings, in residential and fostering facilities as part of child protection assessments (DOH, 1998).

Service Users’ Needs and Issues

Jane is a 22-year old Afro-Carribbean woman. She is a deaf service user and was separated from her birth mother at the age of nine months. Although she has a younger sister who is eight years younger than her, nobody could argue that Jane is literally an orphan since he never knew who her father is, since he fled just before she was even born. Jane lived under foster care for 15 years. In this span of time, Jane went to believe that the people who brought her up were her real parents. But at 15, she finally knew she was an adopted child. As what can be expected from a teenager who just discovered she was an orphan, Jane grew very irrational and disruptive from that moment on. She decided to move from her foster family to live in children’s home until the age of 18, when she had to move to a supported housing in Brent.

It was Jane’s key worker at the supported housing who referred her to the duty team. The social worker then obtained Jane’s personal information and updates personal details on the system including all equalities monitoring information. In this light, part of my role is putting details of service users on framework-I computer system. This system has been designed according to DOH regulations and best practice.

The first task of the key worker was to describe the main concerns and needs of Jane. He then stated that Jane has been expressing her unhappiness at the supported housing as she wanted to live independently. It was also said that she was very disruptive and irrational. Through the use of the fair access to care services criteria which determines an individual’s needs in four levels (critical, substantial, moderate and low), Jane’s level of needs and risks was verified during the referral stage. And thus, it was found that Jane is at the substantial level.

After determining Jane’s needs level, contact assessment was completed and recorded in framework-I within 48 hours of the first contact.

Jane’s situation met the eligibility criteria for assessment and service which was set at the earlier stages of this course. Thus, her case was discussed with duty manager who assigned the case to me for an overview assessment, which has to be completed within 28 days with accordance to the DOH guidelines.

The assessment was carried out under the section 47 of the National Health Service and Community Care Act of 1990. The assessment sought to identify the social care needs of service users, which cannot be met by their own resource systems, and aimed to promote independence as well (Parker & Bradley, 2003).

I coordinated with the staff at the supported housing regarding the booking of a date for the overview assessment. This was also done in order to make sure that the time is convenient with Jane and her foster father. I then booked an interpreter through the interpreting service for a BSL interpretation to enable me to converse and communicate well with Jane.

During the community care assessment, I introduced myself to Jane as a social work student. This part was not that easy for me during that time since I have not yet worked with deaf service users before. I became worried and somewhat scared to communicate with Jane since I have no idea during that time how to deal with deaf clients. Nonetheless, I was able to carry out such assessment through the assessment form. In the context of this case study, I would have to describe Jane’s assessment as a holistic and needs-led model. The following presenting problems were then identified: 1) hearing impairment, 2) weight problem (underweight), and 3) behavior problem (irrational and disruptive due to early age abandonment).

The theories and legislations that will be drawn upon this work shall include systems theory, attachment theory, NHSCCA 1990 and Data Protection Act of 1998.

Intervention

During the assessment, Jane expressed that she was not happy with the staff at the supported housing because it seemed to her that they really could not help her with her behavior problems. John, Jane’s foster father, explained that it has been difficult for Jane to live in the supported housing. Considering this predicament, I decided to utilize the Attachment theory of Bowlby (1999). To recall, the theory describes attachment as the long lasting emotional connection between two individuals which also involves seeking closeness between other as well as finding pleasure with each other’s company. Bowlby also explains that irrational behavior could be a result of a certain disruption in the emotional bond. This theory allowed me to understand that Jane’s behavior could be primarily due to her separation from her biological mother at a very young age.

Together with this theory, I also incorporated the Systems theory in this study so as to solve the dilemmas of Jane and her father regarding Jane’s wanting to live independently. This conflict made the dynamics within the group more apparent as Jane kept on insisting of living alone, while her father was left with holding her back since he was aware that Jane was not in the right emotional and physical state to live alone just yet – apart from the fact that her behavior also appears as a dilemma. As we went on with the interview, I was able to realize that Jane really needed some protection and guidance considering her situation, so I took the decision to let her stay at the supported housing.

NHS and Community Care Act 1990 is another legislation used in this work which deals with local authority carrying out assessment and having regard for assessment and provides care for the people who are eligible (Assessment and Care Management Manual, 2002).

In the assessment, through data gathered, it was deduced that Jane really needs counseling which will aid her in reducing her anxiety and frequent irritable tendencies. The intervention served as a very significant process where in I was able to connect and converse with Jane closely enough to understand her views, which eventually allowed me to forward some evaluation to her GP. I then discussed Jane’s anger management issues to her GP, and the GP agreed for a referral to the counseling services. I coordinated with all the professionals involved in Jane’s situation and we formed a planning meeting wherein we discussed Jane’s future housing. During the overview assessment, we planned to have a one-on-one session at the office with Jane. I then booked a BSL interpreter and a room for the said meeting.

Outcome

During the session, I felt a bit upset as Jane’s expression turned very frustrated due to her difficulty in communicating with me. Jane conveyed that she has been living from one children’s home to another since she left her foster parents. She explained that she wanted to meet her biological mother and that she did not know what she has done to deserve such a cruel fate of being abandoned at such an early age. I empathized with Jane at this point and felt a bit tearful when Jane mentioned what she just said. However, I opted not to show my emotions so as not to make her more upset and disturbed. In this part of working with Jane, I decided to incorporate the Systems theory. The Systems theory describes the understanding of social work based on analysis and activation of the human systems around the client (Pincus & Minahan, 2007). I was able to appreciate this ideal when I incorporated with other professionals such as GPs, psychologists and occupational therapists.

Going back to Jane’s sentiments, I was able to discover that Jane wanted to have her mother’s records so that she could contact her. However, I told her that that might not be possible since such information is being protected by the Data Protection Act of 1998. She discussed with me the possibility of meeting her half sister, and I explained to her that as much as I can I will try and contact her aunt to facilitate the meeting. Jane also revealed that she actually knows she has an anger management problem which she has to address. However she also expressed her difficulty in dealing with it. I then explained to her that it is normal for everybody to get angry; however it is important to understand that managing it is the key. I hoped to somehow alleviate her situation by suggesting that whenever she feels irritated, she could reduce her anger by writing her sentiments down. In incorporated such task to the task-centered approach by Payne (2005), which says that the task-centered approach is a social work approach which places strong emphasis on solving problems that clients consider as by the completion of a series of small tasks.

Jane continued to convey that her minicom has been broken and that I have to refer her to the Safe and Sound Department; however, the work was returned because she then lives in Brent, thus, the minicom needs to be provided by Brent social services since she pays her council tax  in Brent since she has lived there for three years already.

After the session, a review meeting was set up. During the review meeting, Jane stated that she is unhappy at the supported housing, and that she wants to move on and live independently where she could live freely, following the life that she wants. The staff grew worried of Jane’s behavior, for even outside the housing facility she still appears to be at risk of discrimination because of her impairment. The outcome of this interview was to advice to Jane to sign a consent form for her file to be transferred to Brent, as Haringey social services are not ready to provide her with adequate support since she lives in Brent. Jane agreed for me to refer her to a housing facility in Brent. I then wrote a supported letter to Brent and assisted Jane to fill out a housing application. I then coordinated with her GP and requested him to carry out a mental capacity assessment just to ensure that Jane will be able to live independently in the community.

Values and Ethical Issues

Jane appeared neat and tidy, yet very thin during the first day of my visit. It was not easy to communicate with her as I had to make use of a BSL interpreter. However, I was able to manage to communicate with her in a sensitive manner, bearing in mind that we share some similarity as to gender and ethnicity (Banks, 2006). I was aware of my knowledge base and power imbalance during the assessment and service. I made a provision for a BSL interpreter so as not to make Jane’s impairment a hindrance to communication. And consequently, the conversations turned out just fine. This just shows how significant anti-discriminatory practices are especially when dealing troubled and impaired clients. I was also able to work closely with other professionals involved in the care provision to Jane. Furthermore, I was able to promote the use of assistive technology in reducing the risk and enhance independence.  An example of this would be that particular situation when Jane complained about her minicom.  I responded immediately by referring her to the safe and sound department in order to provide her with another minicom.  I was also able to work in an anti-discriminatory practice by not threating Jane differently from others just because of her disability.

The major ethical issue that arose from this work is involved with her longing for a sense of belonging which made me empathize with her. However, the issue comes in with the fact that I cannot just give her the details and information regarding her biological parents since this will go against the Data Protection Act of 1998. I tried to contact he aunt, who appeared very difficult to deal with at first since she did not seem to be that interested in helping me to set up a meeting for Jane and her half sister. However in the end, I succeeded in organizing this meeting. During the anticipated, Jane expressed that her irrational behavior must have came as a result of her abandonment from her mother, since it was hard for her to grow up in a foster home. Her aunt explained to her that her mother was unwell at the time she was born that was why she could not look after her. Thus it was revealed that sending Jane to a foster home was not indeed her mother’s deliberate decision. With this, I used the systems theory by Pincus and Minahan (2007) which says explains that Jane’s disruptive and irrational behavior might have been brought by inadequate support and guidance. In was able to appreciate this theory well since I was able to know how to work and experience family dynamics. After the meeting, I closed Jane’s file as she will no longer be my service user anymore as her file has already been transferred to Brent.

Learning

Doing this work has allowed me to learn a lot of things. Firstly, I have learned to understand a client group, how to communicate with them as well as how to engage them in conversations. In the case of Jane, it was difficult for me to work with her initially. But I have learned to use the interpreter all the time, and this made me realize that indeed, communication will never be impossible. I have also learned that advocating on behalf of service users actually goes a long way by enabling and empowering them to live more independently in the community. I have also learned how to incorporate theories, legislations, policies as well as social work knowledge in this kind of practice. I realized the significance of working with other professionals when it comes to foster care. I realized how important it is to work closely with families when it comes to this kind of cases. I also learned that in this kind of work the principles underpinning the assessment framework of being client centered. I was also able to treat my client with respect and dignity by not being judgmental about her behavior as well as he physical disability.

If there is something I would have done differently, it is probably to see her more often than I did so as to get to know her more. However, due to the inconsistent availability of a BSL interpreter, this was not that easy to accomplish.

Conclusion

Doing this kind of work has given me a lot of realizations and learning relating to referral processes and care management. This has also given me a lot of information about how social workers go about their job. I was able to understand that working with deaf service users needs utmost focus and effort when it comes to communication since it appears to be the greatest challenge in these cases. I have learned the value of treating people equally regardless of their color, race, gender, religion and even their disability. A lot of issues arose, but through the help of theories and legislations, I was able to successfully manage such dilemmas. And aside from the fulfillment brought by helping another person, a deeper sense of fulfillment comes with the fact that I was able to at least make a person happier than what she was before.

References

Assessment and Care Management Manual (2002) Step by Step guide to assessment and care planning. Haringey Social Services.

Banks, S. (2006) Ethics and Values in social work, 3rd edition. BASW, Palgrave Macmillan.

Bowlby, J. (1999) Attachment, 2nd edition. Attachment and Loss. Vol.1, New York, Basic Books.

Coulshed, V & Orme, J. (2006) Social Work Practice, 4th edition. BASW, Palgrave Macmillan.

Data Protection Act (1998).

Department of Health (1988) Quality Protects Circular: Transforming Children’s Services. London, The Stationery Office.

National Health Service and Community Care Act (1990).

Parker, J & Bradley, G. (2003) Social work practice: assessment, planning, intervention and review. Great Britain, Learning Matters Ltd.

Payne, M. (2005) Modern Social Work Theory, 3rd edition. Great Britain, Palgrave Macmillan.

Pincus, A & Minahan, A. (2007) Women, the family and social work. Routledge Publisher.

Vass, A. (1996) Social Work Competencies: core knowledge, values and skills. London, Sage Publications Ltd.

REFLECTIVE DIARY

As part of my final year in social work training, I was placed in the Physical Disabilities/sensory impairment team. Part of my duties is to work with individuals, families, carers and groups of people with diverse background. Having been placed in a different setting from this, from my first placement, I saw this statutory placement as an opportunity of approaching my work differently. At the university, I became more knowledgeable about using social work theories such as systems theory, attachment theory, and interventions such as crisis intervention and Task-centred approach.

Systems theory is an example of interrelationship of ideology, theory and the resulting model of intervention. It offers the social worker a perspective which encompasses both individuals and their social environment (Pincus and Minahan 1973 cited in Vass, 1996 pg 21). I thought this theory was appropriate because it helped me in the case of JC in stabilising her emotional and physical well-being in order to function effectively and smoothly (Vass 1996).

My interventions focus on systems theory (Pincus and Minahan 2007) that proved useful in providing accounts of JC’s support, which in JC’s case revealed that she was a victim of prejudice attitude towards her substance. The reason I had for using this theory to inform my practice was because of JC’s family situation. She does not have any social contact and I felt that systems theory will be useful as it will give her the opportunity of working with other professionals which will form a social support in meeting her needs.

JC is a 41 year old British woman who has just been recently diagnosed with HIV. She is going through depression as a result of the illness. JC has no social contact as she is worried about issues of confidentiality (Parker & Bradley 2003). I was full of anxiety to work with JC as she had a history of substance misuse and she was depressed at that moment in time. When I got in there on the day of the assessment her flat was very messy and untidy. I felt a bit uncomfortable at that point but I had to re-adjust myself so as not to show my feelings to JC, since my first priority was to protect the rights and interests of my service user (Banks 2006). I knew from the day of the assessment that JC would like to live independently, therefore my focus was to do everything possible that will give her that privilege. I was able to work with JC in an anti-discriminatory manner by not treating her different from people who have no physical disability (Banks, 2006). Bearing in mind that JC had no social contact, I made referrals to other professionals on behalf of JC due to my knowledge of systems theory. As she did not meet the criteria for service provision for personal care since she was able to carry out her personal care, I referred her for an OT assessment to enable her in carrying out her personal care without difficulty. I showed her to places such as the drop-in centre where she can meet with other HIV positive people. This intervention was quite useful as she can hear from someone who has been living with HIV for 10 years or more, and that gave her hope. I liaised with her GP with her consent in order to disclose her medical record. I sent a referral to psychology service for counselling, as well as a referral to a supporting team to help her with benefit maximisation and other financial matters (Dominelli 2004).

Reflecting on my learning for the experience of applying theory to practice has made me understand that without theory it will be difficult to actually practice one’s learning. Systems theory has made it easier to work with JC as she is a newly diagnosed person with HIV (Surface, D 2007). I was able to help her cope with HIV in a wide variety of settings including referrals to hospitals, infectious disease clinics and HIV service organisations. I was able to build relationship of rapport and trust with JC, which is one of our strengths as social workers (Trevithick, 2000). The comment from the peer assessment feedback was also useful in this piece of work as it seems to be reflective of the work I have done, which was actually positive. I was able to change the theory I used in the peer assessment process as it was not one of the theories used in this module; but the systems theory has been quite appropriate with my work with JC as it focuses on problem solving.

My critical analysis of applying systems theory to practice is that the diverse range of skills, knowledge and approaches of social work are all relevant and needed in work with adults. Adults are amongst the poorest and most poorly housed members of society. This means that workers must have a good knowledge of the welfare and housing rights and legislation, or of where to find this information (Vass 1996 pg 122). This was the intervention I incorporated in my work with JC after the assessment.

I was able to recognize the confidentiality issues with JC as she does not have a social contact with family and friends due to the stigma attached to people who are HIV positive (Goffman, 1990) – and I am very much aware of these issues in working with JC. I treated JC with dignity and respect, even though I was a bit frightened at the initial stage of the assessment due to disposition, coupled with the fear of the unknown; but I was able to adjust myself not to show all such feelings.

Conclusion

This reflection has shown a contemplative view of work practise and the corresponding theory involved. This area of work also required great sensitivity and tact due to the serious implications of HIV. Having the time for reflection has shown how much skill and knowledge social workers must acquire to work effectively in this fragmented and sensitive field. Background reading and research have been very important in relating theory to practice. In addition to the skill at viewing the varied complexities of the clients’ lives, social workers dealing with HIV patients can benefit by becoming aware of the deeper cultural resonance of the clients’ condition. Sometimes, I think social workers have to struggle to learn about what AIDS really is (Cox cited in Surface 2007). It is indeed not just the medical facts. There is a bigger picture, a whole meaning system that is highly individualistic. It was a really stirring and inspiring experience to deal with because of the fact that there is still so much stigma attached to HIV worldwide.

References

Banks, S. (2006) Ethics and Values in social work, 3rd edition. BASW, Palgrave Macmillan.

Dominelli, L. (2004) Social Work; theory and practice for a changing profession. Oxford, Polity Press.

Goffman, E. (1990) Stigma. Penguin Books.

Parker, J & Bradley, G. (2003) Social Work Practice: assessment, planning, intervention and review. Great Britain, Learning Matters Ltd.

Pincus, A & Minahan, A. (2007) Women, the family and social work. Routledge Publisher.

Surface, D. (2007) Social Work Today: HIV/AIDS medication compliance, how social support works. Accessed @http://www.socialworktoday.com/archive/septoct2007p20.shtml. On 22nd of February, 2009.

Trevithick, P.. (2000) Social Work Skills; a practice handbook. Great Britain, Open University Press.

Vass, A. (1996) Social Work Competencies: core knowledge, values and skills. London, Sage Publications Ltd.

 

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