The Social Care Needs of the Client - Essay Example

Practice Study Faculty Table of Contents I. Introduction II. Background Of The Client 2 II.i. General Background II.ii. Medical Background II.iii. Analysis of Background III. Work Environment III.i. External Environment III.i.a Legal Environment: III.i.b Anti-Discriminatory Work Culture: III.i.c Referrals III.ii. Internal Environment: III.ii.a Core Issue III.ii.b Risk and Need Analysis III.ii.c Interagency Liaison III.ii.d Presentation Problem with Client III.ii.e Client Interaction III.ii.f Analysis of Student Intervention III.ii.g Empowerment III.ii.h Behavioural Analysis of Student And Client III.ii.i Anti-Racist and Anti Discriminatory Practice III.ii.j Issues of Power, Race , Gender, Professional Differentials IV. Practice Study IV.i. Familiarity with Mental Health Problem of Client IV.ii. Theories Applied: IV.ii.a Egan (1998) Skilled Helper Model IV.ii.b Rogers Person Centred Approach IV.ii.c Task-Cantered Theory IV.ii.d Empowerment Theory (Payne, 1997) IV.ii.e Schons Reflection-In-Action And Reflection-On-Action To Self Reflect (1987) IV.ii.f Others Studies IV.iii. Statutory Framework IV.iv. Perspective Taken: IV.iv.a Humanistic Perspective IV.iv.b Others IV.v. Challenges of the Work V. Conclusion VI. References I. Introduction This is a dissertation based on the eighty-day placement in local Community Mental Health Team for Older People. It was an assessment study of social care need of the client. This work is based on multi-agency liaison. To understand and support the client it was required to take help of various studies and professional groups like medical, psychology and others along with social work. The client is 73 years old Caribbean man. He had been reported to suffer from mental illness/problems. The practice study aimed at assessing client’s mental and behavioural condition and selecting appropriate ways to help the client within the statutory and social work guidelines. Recently the client was diagnosed with fronto-temporal lobe dementia. Client denies his mental illness condition and allegations. During the study the focus had been in the theories of social work, medical studies, psychology and others to gain knowledge to guide our understanding to understand the reaction pattern of the client and help him. The study also has an objective to understand its contribution to the development of the student of social work. Various theories of social work have been studied. Based on the background and medical history of the client and inputs from various working professionals like supervisor, GP, psychologist and others the appropriate theories have been practiced. II. Background of the Client The client would be referred as BM to preserve the confidentiality under Data Protection Act 1970. The involvement in the case of BM was due to the eighty-day placement requirement of the study. To understand background of the client the first requirement was to study his recorded file. The information from this source can be grouped in: II.i. General Background BM belongs to the senior citizen group. His age is 73 years. He is of the Caribbean origin. BM is originally from Jamaica. He had come to UK in 1956. He lives alone. BM case is a good example of race and ethnicity. He is being treated equally and getting the proper care and support by the professionals irrespective of their age, sex, community or race. With the prior experience in first placement and knowledge expansion the priority was to understand the background and specifications about the client to apply any practice theory. Among these the most important factor here was client’s physical and mental health. Client has a divorced life and has been in touch with his son. Family support for the client was the minimum. He has a lonely life. In December 2004, BM was admitted under Section 3 of the Mental Health Act 1983. The information provided indicated BM was arrested by the police, because he was behaving in a sexual uninhibited way and it was also noted that allegations were made against him for making inappropriate engagements with a 12 year old girl, however it is not clear whether the allegations were true. II.ii. Medical Background BM has a long history of mental illness and has had numerous admissions between 1969 and 1998 both formal and informal. First recorded diagnosis of the client with any mental illness was in 1969 when he was diagnosed with Paranoid Schizophrenia. This is a severe chronic disorder of brain. This not just affects behaviour of an individual but also impacts on his thinking and overall personality and perception about the world1 In 1992 his diagnosis changes to Schizo – Affective disorder. Schizoaffective disorder symptoms look like a mixture of two kinds of major mental illnesses that are usually thought to run in different families, involve different brain mechanisms, develop in different ways, and respond to different treatments: mood (affective) disorders and schizophrenia.2 This disorder also has impact on the behaviour and personality of an individual. The disorders unipolar and bi-polar disorder (manic depressive). People experiencing a manic mood suffer from sleeplessness, distractible, buying spree, compulsive talkative, convinced of their own inflated importance, emotionally irresponsible and indiscreet sexual advances and foolish investments. His admission since 1992 has been precipitated by his unconscious sexual behaviour. This can be one of the symptoms of his mental illness. BM has been diagnosed with fronto-temporal lobe dementia. This is caused by the damage of frontal lobe and temporal parts of the brains. These parts are responsible for various important activities and responses Frontal Lobe is associated with reasoning, planning, parts of speech, movement, emotions, and problem solving and temporal Lobe- associated with perception and recognition of auditory stimuli, memory, and speech3. An individual with this disorder faces various behaviour related problems. In most of the cases patient denies their mental illness. Even in this case BM denies there is anything wrong with his mental condition as he is able to recall events. He has his own set of perceptions and belief regarding him. He believes that the incidence of December 2004 was result of mistaken identity and denies any allegations against him. II.iii. Analysis of Background Mental health treatment is an area of medical science where several problems related to diagnosis and treatment has been noticed. This filed still lacked the standardisation of diagnosis method and diagnosis varied therapist to therapist. Patient always denies his mental health condition preventing him to coming forward for any treatment related activities. Poor record keeping is another issue. Even in the case of BM the treatment followed in the after the earlier diagnosis are not clear. Treatment of mental illness is complicated. III. Work Environment III.i. External Environment: The overall working environment has been very supportive. People from various professions worked together for the community. The local Community Mental Health Team for Older People works alongside the Primary Healthcare Trust. The team operates a multi - disciplinary approach. It is made up of Social Workers, Community Psychiatric Nurses (CPN), Consultant Psychiatrist (CP), Doctors, Clinical Psychologists, Occupational Therapists (OT) and Physiotherapists. III.i.a Legal Environment: The unit operates under the legislative framework as set out by the Mental Health Act 1983 and the Human Rights Act 1998. With regard to the models of practice these somewhat differ between the various professions. The Health Service remains hierarchical and health professionals continue to practice according to the medical model of care, whereas social work professionals despite limitations attempt to practice according to the social model. It is a good example of people from different fields working together. III.i.b Anti-Discriminatory Work Culture The ethos is to work in a non-discriminatory way by providing a seamless service when providing information, advice, assessing, and planning and co-coordinating care plan and identifying services to meet the needs of the individual. III.i.c Referrals Referrals made to the Older Persons CMHT are for service users over the age of sixty-five and come primarily from local General Practitioners (GP). In the weekly MDT meetings new referrals are discussed along with feed back from members of the team regarding current service users. III.ii. Internal Environment Under the supervision of team manager allocated cases aimed to meet learning and developmental needs. The supervisor discussed the possibility of working with BM. For a social worker this case is always challenging because it produces challenge of work. All the required information of the client and other resources required for the case were available. For any case the best practice starts with the complete analysis of case before meeting the client. This analysis involves study of the client’s background, specific need areas, concerned professionals and other information pertaining to client specific needs. Most of the background information was recorded on the official file. III.ii.a Core Issue The core message and the reason for the referral was that BM required a social care needs assessment with a view to arranging a package of care to support him in the community on discharge. III.ii.b Risk and Need Analysis The risk involves in the case are more behavioural risks. The client is mentally ill. The most symptoms of the disorders are related to distorted behaviour. This includes lack of emotional empathy with others, behavioural inappropriateness, losing inhibitions and others. The client also faces problems in communication and language. All these things can lead to an uncomfortable situation for both the client and the professionals involve in the case. The client has a history of mental illness. He indeed needs social care and support. At the same time the professionals working with him need to create a comfortable and friendly environment for him. III.ii.c Interagency Liaison The case is handled with support of interagency liaisons. Different professional groups are working together to help the client. It involves social workers, GP III.ii.d Presentation Problem with Client The client is not comfortable talking about the allegations. He denies his mental condition which is one of the common problems with mentally ill patients. III.ii.e Client Interaction The client interaction process was focused for the assessment of the social care need. The first step was to inform him about the reason of interactions and involvement. The primary responsibility was to support him and it was made clear to him. He had been asked open ended questions giving him flexibility to respond. Emphasis was towards maintaining proper verbal and non verbal communication to make the client comfortable and help him responding in more appropriate ways. The practice and study of various theories have helped in the client interaction process. III.ii.f Analysis of Student Intervention The eighty-day placement with the client has been helpful in understanding the assessment requirements. It helped in gaining knowledge and experience for this particular area. It also helped to practice theories and models for the better results. Effective communication established rapport with self and knowing the boundaries of thoughts, feelings and experiences. This help in developing understanding with client. The best way to understand client situation is considering oneself in his situation. The feeling of being old, without family, from a minority group and other factors help in understanding the Psycho-social factors of the client. The reactions of people in that particular situation are compared with the reaction of the client. Dementia has become a major social problem. Interaction with client helped in understanding of areas of comfort and enthusiasm and of discomfort and anxiety, in contact situations. This gives insights to further develop communication strategy with the client in order to know about the reasons of discomfort or making comfortable condition for him to interact. Contextual factors are other important issues here. The client has spent majority of his life in UK. He has relevant life experiences. Talking about good experiences fill positive feelings in client. Respecting his belief systems; culture, ethnicity, and race again enhances his comfort in conversation. The experience sharing with other members of the organization and supervisor had been very beneficial. Their experienced inputs have helped in better analyzing the interview outputs of the client. III.ii.g Empowerment Communication is the best tool for the clients like him. It helps in developing proper understanding with the client. Once proper understanding is developed after series of repeated communication and client feels comfortable in talking about the issues related to his condition. It is valuable as it is a way of empowering clients and promoting good practice. It requires time, empathy and efforts to reach at this level. III.ii.h Behavioural Analysis of Student and Client In this case client has allegations and his behaviour can not be expected to normal or perfect on the basis of his mental health history. The challenge in front of any social worker is controlling his/her own emotions and behaviours from any assumptions. For a smooth and effective communication process the social worker need to be balanced, using his/her common sense to lead the communication. III.ii.i Anti-racist and Anti discriminatory practice To understand the cultural perspective Schons reflection in action and reflection on action to self reflect have helped. Here placing in BM’s situation and viewing the world from his perspective have helped. The work with BM has been a valuable experience. The anti –racist and anti discriminatory practice was followed. Focus was on the humanistic perspective. The anti-discriminatory and anti-oppressive practices were followed at each level of work. These have supported the client and the work environment for a student of social work. The availability of supervisors and experts to discuss the complex issues and other resources of work and open environment have supported in proper and dedicated study of the case. III.ii.j Issues of power, race , gender, professional differentials According to Adams et al. (1998) the ethics, discrimination and oppressive themes signify my thoughts of constraints, are reflexive of political, cultural, economic and social value base. In recognition of the power differentials, Professional differential in the organization have impact on the way people interact and react. Even professionals share different views about the same individual because of the valuing difference. Every family member and organization differs in the way individuals communicate their values and structural relationships. IV. Practice Study The theories which have been applied were based on the working conditions, inputs from supervisors and faculty and client’s background. Through out the placement duration it was required to have self analysis to check on any irrelevant theory practice. IV.i. Familiarity with Mental Health Problem of Client Before meeting the client it was required to understand his background. This is required for to make decision regarding approaches required to be taken. This was done through studying his background and discussion with professionals and searching various sources for more dept of information. IV.ii. Theories Applied: Cognitive Behavioural Models IV.ii.a Egan (1998) Skilled Helper model This model is based upon the basic questions of the condition, expected condition and finding our solution to achieve the expected results. It has been described as: ‘…a 3-stage model or framework offered by Egan as useful in helping people solve problems and develop opportunities. The goals of using the model are to help people to manage their problems in living more effectively and develop unused opportunities more fully, and to help people become better at helping themselves in their everyday lives. (Egan G., The Skilled Helper, 1998, p7-8) 4 STAGE 1: What is going on? The first stage focuses on the analysis of the situation. This was done by talking to the patient, providing him an active listening booth, reflecting a positive attitude and supporting behaviour, using open ended questions and summarizing or paraphrasing the conversation with the client. The skill required at this stage by the social worker varies with the answers of the client. Social worker should be ready to take the challenge. S/he should be aware to notice the non verbal signs and things which have not been told. The client showed his discomfort in talking about the allegations against him by mainly non verbal signs. STAGE 2: What do I want instead? The focus at this stage should be on the desired outcome. The assessment of the social care need is the primary area. This has been made clear to the client in the initial talk. First few conversations were aimed to establish an understanding with the client than the focus was towards the assessment. The next few conversations were to prompt the client to talk more about the situations, circumstances and his illness. STAGE 3: How might I get to what I want? The third stage focused on more appropriate strategies. The comfort level was achieved and the client was comfortable in conversation. The formal action plan could have been designed and implemented. At this stage the placement duration was over. Implementing the theory to understand clients need and develop focused strategy had been useful in developing relationship, overcoming communication barriers, cultural and other complexity from both the sides. IV.ii.b Rogers Person Centred approach The second behavioural approach followed was Rogers Person Centred Approach. This is based on the conditions in which client-social worker work. As explained; The person-centred approach maintains that three core conditions provide a climate conducive to growth and therapeutic change. They contrast starkly with those conditions believed to be responsible for psychological disturbance. The core conditions are:5 Unconditional positive regard Empathic understanding Congruence The positive regards help the client to be more comfortable and open. The sense of being important comes through this. In old age people the sense of positive regard works very well. The empathic understanding provides an environment where the client does not feel himself very different from the social care provider and develops an understanding with him/her. The client when is able to see similarity of culture and respect for his background he become more comfortable. The person centred theory has helped in providing comfortable environment to the client at individual level. This theory is based on simple principle of empathy and respect. As a person each of us have a respect and association with our background, culture, race or the way we have spend our lives. Respecting these aspects of life offers friendliness to other person. IV.ii.c Task-cantered theory6 This is considered to be the best way to retain clear understanding of what it means to undertake task centred work. The various agencies can work together with this clear understanding to solve particular need requirement of the client. Focusing on Task Centred model there are five phases to be considered. Entry This is a phase of developing understanding of the case and purpose of working on that. This is the stage where social worker analyses the background, resources available and decides approach or the extent of relationship with the client. Exploring problems This stage almost overlaps with the first step. During the entry phase the problems are usually recognised. It is further explored in this phase. This is the stage where social worker applies his/her past experiences and knowledge to understand the specific problems and decides the goals. In the case the goals were to assess clients social care needs. Agreeing goals This is the stage where written agreements are prepared following specific format. This is done with the view of agreed goals, overcoming the problem areas, focusing on time and resources available. Planning and implementing tasks As decided in the previous phase on the agreed goals the planning is done. The five stage planning and implementation sequence of Tolson et al (1994) was based on task development and its implementation to achieve goals. Exit The complexities are involved here to decide upon the length of work. It is truly judgemental for the social worker. Socialist Collectivist Model IV.ii.d Empowerment theory (Payne, 1997) The best way to help a client is to empower the client. There are various factors impacting client in the interaction process. These are of psycho-social and interactive factors, contextual and organizational and other factors. Empowerment helps people to regain their own power. It helped in changing the idea of self of an individual. IV.ii.e Schons reflection-in-action and reflection-on-action to self reflect7(1987) At any point of work for social care services the social worker need to do self assessment. This helps in maintaining or increasing motivation for work and gives better self reflection. The knowledge of self and level of motivation would be reflected in the work Questions contributing to reflection on action include How did I engage with that person or in that situation? What previous experiences influenced me? What did I do? Why did I do it? On reflection how might I have responded differently, if at all? Reflect in Practice: What am I feeling/ How am I presenting? Do I need to change my approach or focus? Why do I feel uncomfortable? Looking at the answers of these questions during the placement has helped in utilising the learning of previous experience and knowledge. The reason of association kept the motivation level high to help BM. Each time after meeting with BM the reflection on action analysis study helped in understanding the reaction pattern of self in the particular scenario. This gave an idea about how to react next time in similar situation or how to handle any particular kind of situation with the client. This helped in self improvement for the services. IV.ii.f Others Studies: The mental condition of the client and diagnosis can not be ignored. Even for a social worker it is important to have positive attitude and practical ways to resolve the difficult situation faced by him/her as mentioned by Coulshed and Orme, 1998. Gather information and the development of an action plan (Thompson. 2001) have helped in systematic study of the client. It also helped in gaining knowledge to understand various medical and social concepts. The Smale’s et al. (1993) exchange model is specifically used in Person centred model. Within this model as the individual or social worker facilitates and negotiates the exchange with the parties involve in it. IV.iii. Statutory Framework The case has been handled within the perspective of various theories, under the guidelines and framework of social and legal environment General Social Care Council (GSCC) National Health Service (NHS) and Community Care Act 1990 The Mental Health Act 1983, The Human Rights Act, Race Relation Act and the agencys Equality and Diversity Policy IV.iv. Perspective Taken: IV.iv.a Humanistic perspective BM belongs to minority, senior citizen and is mentally ill. If anyone keeps oneself in that situation s/he might be requiring the similar care and support. All the practitioner involved need to have humanistic perspective to help the individual to live with dignity and respectfully. IV.iv.b Every social care service work along with various agencies. The success rate will be high if there is a positive Inter professional working (Weinstein et al., 2004) environment. IV.v. Challenges of the Work There is various kind challenges involved in the work. Starting from the individual, client, statutory and time specific challenges are faced. At the individual level feelings and values of social worker has impact on the working. Social workers work in complex working conditions. Each case and each individual client for them are different. The social conditions are different. There are cultural, racial and ethical concerns between the client and the social workers. The challenges start from the individual social worker who needs to control his/her own feelings, maintain positive attitude and provide a comfortable environment to the client for his assessment needs. In hindsight there are things in the case would had been done differently, was ability to not acknowledge that the Consultant Psychiatrist who had known BM for longer. The CP was expert in her field and her insights would have helped to explore with BM the need to accept the support with medication to maintain his mental health. V. Conclusion For any social worker this case would have been challenging. This case provides an opportunity to understand the mental health problem of an old person. This case has element of ethnicity and race. This case requires an interagency liaison. It offers all the relevant issues in the area of study of any social worker. BM needs care. His need and risk assessment is required to help him. The importance of non verbal behaviour in his case can not be ignored due to his age and illness. Effective communication requires empathy and use of common sense of social worker. Client needs to feel comfortable and friendly with the social worker so that effective communication can be established. At the same time social worker is required to work with professionals in mental healthcare field to make the assessment effective. Client is denying his illness and allegations against him. He had been diagnosed with mental illness in the past and even today. Apart from educational skills, behavioural skills are very important part of this overall assignment. The work with BM was a valuable experience which allowed analysing and evaluating past experiences and skills. It helped in acquiring added knowledge about mental health issues. VI. 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