My Analytical Skills and Professional Practice - Essay Example

Case Analysis and Reflection Introduction This report seeks to illustrate my analytical skills and also seeks to assess my professional practice by using the different theories, knowledge, and skills which support Social Work. By evaluating a specific case involving a client, it is possible to reflect upon the progress of the counselling in the duration of this placement. The practice will be evaluated comprehensively and will focus on the analysis of the case, demonstrating the practitioner’s ability in assessing evidence on the application of this practise. This paper is divided into four parts with the first part presenting the background of the case and its legal basis or context. The second part will present the different theories applicable to the case. It shall also present the assessment and risk management, planning, intervention, and legislation. It shall also present the different actions taken throughout the case analysis by using questions like: what, when, why, which, and how. The third part will evaluate my practice and the effectiveness of my applied interventions while also pinpointing the main roles that relate to social work practice and the different personal and ethical issues underpinning the issue or case. The final and concluding part shall combine the entire assessment and self-assessment process needed to be effective in one’s practice. All in all, this paper shall evaluate the different aspects of practice and integrate them into a logical and comprehensive whole. Background of the Case Aldrin is a 55 year-old male; he is Irish and has been living at a temporary housing centre for the past 18 months. During the client interview, it is revealed that he has had a history of alcohol abuse spanning almost 20 years. He also has a history of drug dependency, but he says he has been off the drugs for about 10 years now. When he was 12 years old, he, along with his parents and siblings moved to London from Ireland. He married 30 years ago and he lived in London with his wife where they raised their 3 children. After 15 years of marriage however, his wife died and he was left to raise their 3 children. He was a closet alcoholic and when his wife was alive, she prompted him to get help several times, but he denied having a problem. When his children were grown, his drinking habits got worse as he had more free time on his hands. It got to a point when his drinking habit lost him his house and his job and he became homeless. He lost contact with his children throughout the years. He chose to segregate himself from them partly because he felt shame and also because he did not want to burden them with his situation. He tried to gain employment again and to find suitable housing but the work he always seemed to find were short-term. He was dismissed from several of these jobs because he sometimes came in late and hung-over. Since he could not find permanent work, he also had difficulty finding decent housing. Most of the time, he was homeless and nursing his habit in the streets with what little money he could earn. Due to the patient’s drinking problem, he had various health issues. Three years ago, he had a stroke which led to right-sided paralysis. He is currently undergoing physical rehabilitation to regain mobility. Aldrin reports that he feels sad about his current situation and he sometimes reverts to drinking in order to temporarily forget his problems. For over a month now he has been attending AA meetings, but is having slower progress during the sessions. However, he does express a desire to end his habit and make a good start with his life. With the various efforts at expansion, housing accommodations are now being made available for clients in order to give these people a chance to live independent lives. This housing option has been discussed with Aldrin and one is currently being prepared and adjusted to meet his specific needs. This housing opportunity is however only good for 6 months or until Aldrin will be able to live independently. The staff is hoping that he will be able to regain his mobility within the 6 month rehabilitation period and for him to not revert to his alcohol-drinking days. My current relationship with Aldrin will now be geared towards improving his motivation, reducing his depression, and improving his independence in his activities of daily living. Legal Context There are various policies, procedures, and codes of practice which govern work in established agencies. From the very beginning and before meeting with the client, I had to acquaint myself with the different important policies and laws which I might apply to the client. One of the main policies is the Supporting People policy which basically seeks address the issue of homelessness. The Homelessness Act of 2002 emphasizes a duty to “provide accommodation indefinitely for unintentionally homeless people in priority need when there is suitable available housing” (2.5). The Equality and Diversity Policy is also another policy which can be applied to the case. And along with the provisions of the Prevention of Corruption Acts of 1906 and 1916, vulnerable clients like the homeless people are protected. In order to protect the confidentiality of service users, the Data Protection Act of 1998 has been passed. It seeks to “regulate the processing of information relating to individuals, including the obtaining, holding, use of disclosure of such information”. Because of the sensitive nature of support being administered, under the standards of service, the information which is released by the client must be revealed if it places him (client) and others at risk or in instances when the law requires disclosure. The Lone Working Policy is also applicable to Aldrin. There would be many times when I would be alone with him; therefore based on the NHS provisions, I need to make a proper assessment of the situation, to reduce risk and avoid untoward incidents. The policy obligates me to ensure that clients are kept safe and away from harm, even if they would contribute to harm or danger to themselves. Through the Mental Capacity Act, the different provisions covering a person’s right to choose and determine his care are discussed. The first section of the Act sets forth that capacity is assumed to be present, unless otherwise proven. Therefore, a person who seemingly lacks the capacity to make a decision must be treated as having the capacity until steps have been taken in order to prove otherwise (Mental Capacity Act, 2005). During my time and my sessions with Aldrin, it would be very tempting for me to assume that he lacks the capacity to make sound decisions for himself. It is therefore important for me to remember that the very goal of the Supporting People policy is to eventually assist them in being more independent in their daily activities. While assessing the needs of Aldrin, an important ethical concern also came up, and this involves the Human Rights Act of 1998. It is a person’s right to live his life without interference. The nature of my relationship with Aldrin basically revolves around getting him to make adjustments on his life and the way he lives his life. This actually violates the Human Rights Act of 1998. It is important to note however that this interference in Aldrin’s life is with his knowledge and his consent. These provisions affected the way I dealt with Aldrin in the sense that I was more conscious of his rights and of the standards of practice that should be applied to him. I learned that these policies can be used to both my and the client’s advantage and they ensure that I am not violating the legal provisions and the standards of practice. These provisions also made me more aware of the options available for my client in the hope of improving his current circumstances. Assessment My self-assessment revealed that I did not have sufficient expertise and knowledge on alcohol addiction. I also discovered that I had a preconceived notion about alcoholics which would not serve me well as a social worker. I also discovered that I needed to gather as much information as I could about alcoholism and about alcoholics in order to arm me with sufficient knowledge on the subject matter. I realized that by improving my knowledge on alcoholism, I would be able to serve my client well. I also gathered personal information about the client from the previous social worker and from the support worker assigned to Aldrin. Through the information I gathered, I was able to understand my client’s addiction and triggers to his addiction. I was also able to make an evaluation of his physical limitations – what he can and cannot do for himself and what he would allow other people to do for him. In order to prepare for my contact with the alcoholic client, I used several theories in order to allow for a thorough assessment of the client. I first used the System Theory in understanding the client and the client’s situation. The Systems Theory is an important theory which can be used to understand a client’s family and social environment. “This theory perceives each of us holding membership of a series of overlapping and related social systems” (Grant & Gwinner, 1979, p. 133). Simply put, an alcoholic may have his life compartmentalized into different categories like his family, his work mates and work life, and his friends with who he has a drinking relationship with. Moreover, the alcoholic will have separate and different responsibilities in each compartment (Grant & Gwinner, 1979). I used this theory to understand the different “compartments” in Aldrin’s life and how each “compartment” and each role he plays affects his drinking habit. On first reviewing with the support worker the routine and the different activities Aldrin was involved in before his stroke, I was able to determine that Aldrin was holding a part-time job at a courier company, 4 days a week, 5 hours a day, making door-to-door deliveries. He chose not to have any contact with his family, so he lived alone. He had friends with whom he mostly hangs out with at the local pub on weekends, on days off, and after work. During my initial meeting with Aldrin, he expressed and admitted that he felt depressed and miserable with his home life. He hated going home to an empty apartment. This mostly drove him to the pubs where he could forget about being alone and be among other people. He also expressed that he wants to reconcile with his children. He is however afraid of how they would receive and welcome him after almost a 25 year absence in their lives. He was afraid of being rejected. In using the Systems Theory to assess this case, it is easy enough to make parallels between a miserable home life and alcoholism. His role in his family is basically absent because he ceased being a father. But this absence in his life has driven him to seek solace in the hands of his drinking buddies. With the current health crisis in his life, he feels like he was given a second chance at life. However, he does not favour reuniting with his family as an invalid. He is very much willing to undergo the rehabilitative process in order to regain mobility and regain independence in his daily activities. The Systems Theory points out that by assessing or evaluating what is wrong with any of the different systems of a person’s life, it is possible to pinpoint the trigger or the cause of alcoholism and consequently address such cause. My goal now is focused on making the transitions and adjustments for him less stressful and less unnerving. In my analysis of this case, I also used the 1982 Cycle of Change theory by James Prochaska and Carlo DiClemente. This theory unifies the ideas of 3 theorists (Freud, Jung, Rogers) on why people change. Through this theory, we can easily understand what stage clients are in the cycle of change and how to work with them based on such stage (Prochaska & DiClemente, 1982). By knowing the stage where the client is in, it would arm us with the necessary tools in helping our client change. Cycle of Change The Cycle of Change Theory prepared me for the fact that the process of changing one’s life would likely take a long time. There may also be various and numerous instances when the client may relapse. I should expect relapses and encourage the client to keep trying after each relapse because it would eventually bring him closer to recovery (Prochaska & DiClemente, 1982). The stages of change include: pre-contemplation, contemplation, decision, action, dependency free, maintenance, and relapse which brings a person back to pre-contemplation. In applying this theory with the client, I was able to determine that the client is in the decision stage of quitting his drinking habit. In my interview with the client, he has revealed that he has thought about quitting drinking many times in the past several years, but he never actually went through with it. Now, the stroke triggered him to make a tough and decisive action for change in his life. He wants to meet his family and turn his life around before he loses the opportunity for good. The next stage of change would be the action stage and my role during this stage would be to assist him in making changes in his life – in kicking his drinking habit and in managing to live his life independent of other people’s assistance. It is also important for me to note that throughout the years, Aldrin has been consuming alcohol which is considered a depressant (Aje, 2010). Since alcohol is a depressant, it has also been decreasing his motivation to care for himself. And since he lacked encouragement from family members, his depression and his self-neglect was exacerbated. By understanding the effects of alcohol on a person, I was able to understand Aldrin’s physical appearance and to note that such appearance may improve when he would stop drinking and get the alcohol off of his system. Another theory that was applied in this case is the Motivational Interviewing theory by Miller and Rollnick (as cited by Clark, 2006). This theory basically offers a way of talking with people about change. This approach is useful because it helps social workers initiate or get back into the business of behaviour change (Clark, 2006). It also keeps the addiction from getting worse. It is an approach which also prepares clients for change (Clark, 2006). Together with the Cycle of Change theory, Motivational Learning gives the client the necessary push towards change. It helps dispel his reluctance to change by dealing with his doubts and his personal issues. Motivational Learning works by giving the client the ‘motive’ to change and to actualize such motive to change. It is very much related to Maslow’s self actualization stage because Maslow explains that by improving a person’s motivation, he is actually brought closer to the realization and actualization of his goals (as cited by Heylighen, 1992). Aldrin’s alcohol use can be explained by using the Behavioural Theory. This theory basically refers to learned behaviour, and that alcoholism is a learned behaviour (Naik, 1998). The Behaviourists discuss Classical Conditioning as a crucial aspect of the theory. Behaviourists point out that, based on Pavlovian principles, addiction occurs because of the pleasures that the addiction and the substance itself can bring to a person (Naik, 1998). The substance brings about a pleasurable taste in a person and it is already a conditioned response every time a person may catch a whiff or a taste of the addictive substance. In applying this theory, I took the time to evaluate the conditioned behaviour that Aldrin was accustomed to. He found pleasure and release from drinking alcohol. Eliminating triggers and instances when he may revert to his drinking is crucial in this case in order to prevent a relapse and consequently improve his independence. I began my intervention process with Aldrin by focusing on his emotional well-being and his physical limitations. During my sessions with him, I asked him to talk about his children. There were times when he chose not to talk about them so I shifted to other topics like those relating to his work and his friends. I had to be sensitive to his moods and respect his need for space because they often affected the effectiveness of my interventions for him. At one point, I dared to ask him about his deceased wife. I was surprised to note that he was still very much affected by the loss of his wife. He was still grieving and mourning his loss. It was safe for me to conclude that he was also grieving the ‘loss’ of his children. Based on the different stages of grieving (denial, anger, bargaining, depression, and acceptance) I assess him to be in the depression stage of grieving. It is important for me to ease him into the acceptance stage because it may also improve his chances of licking his habit and of literally standing up and taking control of his life once again. Most likely, getting over his drinking habit needs also to go through various stages – from denial to acceptance. Planning The initial concerns that I took note of were his mobility and his ability to conduct his individual activities independently. He was undergoing physical therapy daily with a community assigned physical therapist. He was also attending weekly AA meetings and seeing a psychiatrist once a week. He still felt apprehensive about his sessions with the psychiatrist because he was not comfortable about sharing his feelings. He also felt frustrated about being unable to groom himself and move around comfortably. His frustrations made him easily depressed and made him angry with himself and even with me. In my discussion with Aldrin, he expressed that he was aware that he was going to have a difficult time getting through the initial process of gaining his mobility and getting rid of his drinking habit. He said that the difficult process depressed him. I discussed options with him in order to deal with his depression but he said he did not like the effect the anti-depressants had on him. He said it made his mouth dry. When I discussed this with my superiors, they said that anti-depressants were prescribed to Aldrin, but since the patient was trying to manage his depression on his own, they left the choice up to Aldrin. My superiors expressed that another medication may be given to Aldrin to counteract the side-effects of the anti-depressant. The social cognitive theory discounts the value of stable personality (Pallone, 2003). Aldrin has an unstable personality which makes him vulnerable to frustrations and to the effects of his frustrations. When he experienced the difficulties of rehabilitation (both as a recovering stroke patient and as an alcoholic) he easily reverted to depressive thoughts which made him vulnerable to a slower rehabilitative process and to alcoholism. When the primary interventions were carried out, subsequent plans to move him into the housing centre were initiated. I applied the theories on motivational interviewing and an evidence-based practice in order to ensure that Aldrin would feel at ease with me as his social worker. During the first session, I discussed with him the possible adjustments that he needed to make his living quarters safer and more comfortable. I also discussed my current role in his life and I conferred with him about his own goals and how we could combine our goals to ensure that he would be able to manage independently. I used Egan’s skilled helper model, as supported and expanded by Val Wosket in order to client-responsive approach with Aldrin (Wosket, n.d). Questions which focused on Aldrin’s feelings, his goals, and how he would reach those goals were asked during my session with him. Although the question and answer sessions covered some personal details about his life, he was open about these and he was also blunt about parts of his life he did not want to share. I did not press him on these areas. For the moment, it was important for me to allow him to lead, to determine the trend of our sessions, and to eventually express his personal goals. Intervention As was previously mentioned, I let Aldrin lead our conversation. My role was to listen and to allow him to be comfortable with me. He was eager to make a change in his life and based on the Cycle of Change, he already made the decision to change. I was also ready to eager to ease him into the action stage of the cycle. Intervention was already started when I was assessing Aldrin. During this stage, he was eager to participate in planning the possible actions for change. Once again, during the assessment and planning stages, the client-centred approach was used in order to ensure that Aldrin’s needs would be taken into consideration and the plan of action would be based on his needs. The daily meetings with Aldrin slowly allowed Aldrin to take control of his life and the activities he needed to do. I encouraged him daily to perform and master one task each day without any assistance. Each day, we monitored his progress. I applied the task-centred approach in order to slowly achieve his goals because it is structured, focused, and time-limited in its intervention (Healy, 2005). I wanted to help him gain contact with his children however, I could not do it as a social worker. My job only entails assisting him to gain independence in his daily activities. However, I was able to get him to share his thoughts and feelings regarding his children. Risk Assessment and management I was aware that Aldrin had a history of alcoholism and that he got thrown out of some of his homes because of his inability to pay rent. He was not however a violent or angry drunk. Nevertheless, I was careful not to put my guard down in case he would resort to violent or threatening behaviour. In order to keep both myself and my client safe and comfortable, the first sessions I had with Aldrin were with his support worker or his previous social worker. The anti-depressant medication that Aldrin was prescribed with produced undesirable effects which prompted him to discontinue intake. He often felt drowsy and unable to finish his task due to drowsiness. He also did not like the dry mouth feeling that the anti-depressant caused. The anti-depressants were also not recommended with alcohol as the combination can potentially endanger his life. However, it was obvious that he needed the antidepressants in order to improve his disposition and improve his ability to cope with frustrations. He was cautioned that he should not take alcohol while he was on anti-depressants because it could endanger his life. However, with recovering alcoholics, the risk of relapse is always there. When he was released from the hospital after his stroke, he was using a cane. The housing unit was made slip free in order to prevent slips and falls. Slip mats were placed on the floor and corners of carpets were properly nailed down and tucked. Cords and wires were put under tables and chairs to prevent him from tripping over them. Handrails were also fastened strategically in order to assist him in moving around the house. He was also taught techniques on how to bathe and groom himself while using only his left hand. He was encouraged and supervised in his independent daily activities. Assessment of effectiveness During the first few days of implementing the plan, the work with my client did not go well. He was having a hard time coping with his limited mobility. The goals that we set for each day was hardly met and we had to make adjustments in our schedule for each activity in order to decrease the pressure on him. I felt his pain and his frustration during the sessions. It was unavoidable that we revise our plan of action because they were too overwhelming for him. I also tried my best to encourage him with each task. When he was having difficulty with some of the tasks, I allowed him to rest and set his own pace for each activity. When I assessed the initial plans we made, I noticed that we were both focused on him learning each task, and we did not make adjustments for his disabilities. We simply assumed that he will be able to meet the goals for each task. However, we were forced to re-evaluate our assumptions when he was struggling so much with each task. Our re-evaluation prompted us to come up with a simpler and more client-centred activity, one which was not focused on the end goal, but on the process of learning and adjusting. Through the re-evaluation, I was able to convince him to take his time with each task and to focus more on learning and easing himself into each activity. I was very much aware of the fact that by pressuring him to do and to be too much too soon, his frustration level would continue to rise and his motivation for accomplishing the tasks would decrease. When he was frustrated, he became depressed, and when he became depressed he can potentially revert to alcoholism. By re-evaluating our goals and activities, we both were able to bring our focus back to him, and not to the task. In the sessions that followed, Aldrin was able to show a more engaged attitude with each activity. When we did not meet our goals for each task, we made the necessary adjustments. We focused on what he was able to accomplish, not on what he had yet to accomplish and in the process I was able to gradually re-enforce his positive thoughts and energy. He constantly needed to be encouraged and to be told that when he did not meet his goals, he could try again the following day and keep trying until he succeeded. Aldrin was aware of his goals and of the long process needed in order to reach these goals. He knew that we may not be able to meet all of the goals within the time we set out. I noticed that this was a cause of concern for him and was an unavoidable source of frustration for him. And during these times, he would often take out his frustration on me. However, he never got violent during these times. I believe that with patience, Aldrin can eventually gain mobility and live independently. With proper motivation, he may also be able to set aside his drinking habit. His eagerness to meet with his children is a crucial motivator for him. It is therefore important for the agency to look in on the possibility of locating his children. A longer time with the client may indeed be forthcoming. I felt that we both have made remarkable progress in meeting the client’s goals. The client has also become more comfortable with me. However, I did notice that Aldrin was slowly and surely making progress towards accomplishing his goals. And I know that when my time with him would be finished, that he would be able to eventually accomplish his bigger goals. During my previous sessions with Aldrin, he was showing more determination in his daily tasks and his routine was also becoming easier for him to maintain Reflection on NOS Key Roles and Units During my time with Aldrin, I was able to appreciate what my key role was. I was able to move out of the theories I read in books and to translate these to actions. My key role in the client’s life was crucial because through these key roles, I was able to align the client’s goals. Through this process, I was able to realize the importance of collaboration, and how this collaboration can accomplish goals that can encompass my goals as well as the client’s. This case challenged me in so many ways because it forced me to re-evaluate what I was accomplishing – was it for me or for the client? I was also able to challenge myself into applying skills which were crucial to the accomplishment of the client’s goals. Reflections on values requirements I had preconceived notions about alcoholism before I was assigned the case. I did not think of these people with a history which brought them to this unfortunate point in their life. I always thought that they became alcoholics by choice and that they had no way of recovering from their habits. I changed my views when I learned of Aldrin’s history and his life in general. I also found out that with proper motivation, alcoholics can turn their lives around. I had to address and cope with my prejudice against alcoholics. And with proper reflection, I was able to eventually change my frame of mind about alcoholics. In considering the different values and legal considerations which apply to this case, I was able to find out that it is possible to use these legal standards to protect both the client and the social worker. During my work with this case, I realized that the client-centred approach is the best approach which can be used in order to make possible full client recovery. In the planning process, such approach must also be the very basis of the plans. In the end, it is not really about the social worker, or the goals, or the tasks to be accomplished, it is actually all about the client. And when goals revolve around the client, the task of getting to these goals will eventually be easier to accomplish. Works Cited Aje, F. (2010) Alcohol Depression: The bottle May Be Increasing The Depression. Health Guidance. Retrieved 15 February 2010 from http://www.healthguidance.org/entry/2518/1/Alcohol-Depression-The-bottle-May-Be-Increasing-The-Depression.html Clark, M. (2006) Motivational Interviewing for Social Work: Motivation, Change Talk & Positive Outcomes. Strength Based Strategies. Retrieved 15 February 2010 from http://www.strengthbasedstrategies.com/PAPERS/05%20MClark%27sarticle.pdf Community Overview & Scrutiny (10 December 2002) Rochford District Council. Retrieved 15 February 2010 from http://cmis.rochford.gov.uk/CMISWebPublic/Binary.ashx?Document=8651 Customised training about drugs and alcohol associated with the Competence Group (n.d) Alcohol-Drugs. Retrieved 15 February 2010 from http://www.alcohol-drugs.co.uk/themes/Cycle%20of%20Change.htm Data Protection Act 1998 (1998) Office of the Public Sector Information. Retrieved 15 February 2010 from http://www.opsi.gov.uk/acts/acts1998/ukpga_19980029_en_1#Legislation-Preamble Grant, M. & Gwinner, P. (1979) Alcoholism in perspective. St. John Paul’s Road: Taylor and Francis Healy, K (2005), Social Work Theories in Context: Creating Frameworks for Practice, Palgrave Macmillan, Houndsmill Heylighen, F. (1992) A Cognitive-systemic reconstruction of Maslow’s Theory of Self- Actualization. Behavioral Science. Principia Cybernetica. Retrieved 15 February 2010 from http://pespmc1.vub.ac.be/Papers/Maslow.pdf Human Rights Act 1998 (c. 42) (1998) Office of the Public Sector Information. Retrieved 15 February 2010 from http://www.opsi.gov.uk/acts/acts1998/ukpga_19980042_en_3 Lone Working Policy (17 October 2007) NHS Direct. Retrieved 15 February 2010 from www.nhsdirect.nhs.uk/media.aspx?id=1335 Mental Capacity Act 2005 (c. 9) (2005) Office of the Public Sector Information. Retrieved 15 February 2010 from http://www.opsi.gov.uk/acts/acts2005/ukpga_20050009_en_2#pt1-pb1-l1g1 Naik, P. (August 1998) Behaviorism as a Theory of Personality: A Critical Look. Personality Research. Retrieved 15 February 2010 from http://www.personalityresearch.org/papers/naik.html Prochaska, J.O. and DiClemente, C.C. (1982) Transtheoretical theory: towards a more integrative model of change. Psychotherapy: Theory, Research and Practice Topic 6: Applying Theory to Practice: Task Centred Approach (n.d) Online Education Support. Retrieved 15 February 2010 from http://www.unisanet.unisa.edu.au/Resources/13141/Course%20website%20for%20Magill%20students/Lectures/Week%208.doc Williams, L (n.d) NRCFCPP Concurrent Permanency Planning Curriculum: Module 3: Stages of Change Understanding the Change Process/Cycle of Change. Hunter College. Retrieved 15 February 2010 from http://www.hunter.cuny.edu/socwork/nrcfcpp/downloads/cpp/module3-stages_of_change.pdf Wosket, V. (n.d) Egan’s Skilled Helper Model. Routledge Mental Health. Retrieved 15 February 2010 from http://www.routledgementalhealth.com/egans-skilled-helper-model-9781583912034 Read More