Personal and Social Context of Agnes Price - Case Study Example

Discussion of Need in Relation to the Personal and Social Context of Agnes Price Submitted November 25, 2005 ID Abstract This paper will include an assessment of a 64 year old woman who lives with family and is suffering from depression. The assessment will be made based on Bowen’s System Theory with consideration for the fact that Agnes is in the latter part of her life span and has a number of stressful conditions to deal with. This case is being opened as a result of concerns raised during a family health visitor’s regular visits to the home where Agnes resides with her daughter and the young woman’s family. In addition to creating a case plan for Ms. Price this document includes a discussion of the rationale, theory and ethical concerns related to this case. Assessment and Case Plan (Data, Assessment, Plan (DAP) Client: Agnes Price Age: 64 Years DATA: During this writer’s regular visits to the Davies family home it has become apparent that Mrs. Price is very devoted to her daughter and the children. Agnes, who is 64 years old apparently cares a great deal about the lives of all of the family members and she states that she “doesn’t mind” caring for the children when her daughter goes out. Kylie, Agnes’s 25 year old daughter goes out frequently and appears to be allowing her mother to bear more responsibilities than this writer believes are appropriate. Agnes is in charge of the children and the house far more often than her daughter due to Kylie’s busy social life (she has a number of friends she chats with on the phone with when she is at home and she frequents the local pub at least once and sometimes twice in a day). Agnes said she often picks up after the children, tries to amuse them by reading stories and is usually responsible for making and serving meals to the kids and Kylie’s husband Jim who is disabled and unemployed. Agnes told this writer that Jim is usually “quite nasty” when he comes out of his room, which isn’t often so she prefers to mind the children rather than have them be exposed to his “surly manners.” Agnes told this writer that the children are often “quite rowdy” and she is concerned about the baby, Karl who has very little interest in learning to talk or walk. Agnes said she feels the baby is aware that his older brother David is jealous of him and she sees that the baby often crawls off in another direction when David comes in. Agnes believes it might be better for David to be sent to live with his father, which, she said is “what the lad wants to do.” The boy does not like his mother’s new husband or his baby brother and perhaps would be happier if he could be with his dad according to Agnes. Agnes is currently taking anti depressants prescribed by her GP. Agnes continues to work on grief issues resulting from her husband’s recent death from cancer and she has problems communicating with people who do not speak her first language, which is Welsh. Kylie’s children and husband do not speak or understand Welsh and Kylie herself makes fun of her mother’s accent and “stubborn streak” because she refuses to learn to communicate in English. Assessment Based On Bowen’s Family Systems Theory Agnes may have grief issues she needs to work on. These, along with the stress of living in a family that requires more support than she is able to give and no support whatever for her own emotional and psycho social needs could be largely responsible for the depression she is experiencing. While this writer is not suggesting that the GP’s prescription for anti depressants should be ignored it is possible that his diagnosis could be different if our agency were to develop a solid case plan based on assisting Agnes to build in the supports she needs to become more healthy on an emotional level. Plan This writer recommends that Agnes be assigned a support worker to help her facilitate outings on her own and to help her begin taking steps to develop a social support system outside the home. It appears that the woman’s depression may be increasing due to the stressful living conditions and lack of communication with anyone outside of the family. There are strong indications of possible Elder Abuse in this family situation and the writer recommends ongoing observations by all workers connected with the case in order to make a valid assessment regarding this possibility. It is also recommended that Agnes be given weekly appointments to see a therapist and attend the grief support group at the community clinic. Subsequent to Agnes accessing services as outlined here it is possible that there will be opportunities for the workers she is seeing to begin developing plans for her to interact with the family in a more positive way. Bryannann (2004, Chapter 4) provides some excellent suggestions for exercises to improve the quality of family relationships and once the tension between family members is reduced it is possible Agnes could begin to initiate some of these and other socially stimulating ideas. RATIONALE Bowen’s Family Systems Theory seems to be the logical choice for working with Agnes Price. “Bowen family systems theory is a theory of human behavior that views the family as an emotional unit and uses systems thinking to describe the complex interactions in the unit. It is the nature of a family that its members are intensely connected emotionally. Often people feel distant or disconnected from their families, but this is more feeling than fact. Family members so profoundly affect each others thoughts, feelings, and actions that it often seems as if people are living under the same "emotional skin." People solicit each others attention, approval, and support and react to each others needs, expectations, and distress. The connectedness and reactivity make the functioning of family members interdependent. A change in one persons functioning is predictably followed by reciprocal changes in the functioning of others. Families differ somewhat in the degree of interdependence, but it is always present to some degree.” (2000, p.2) From the information provided, the Davies family and Agnes Price are in a great state of flux that easily fits the patterns of systems theory. While the emotional interdependence may have evolved to promote the “cohesiveness and cooperation families require to protect, shelter, and feed their members. Heightened tension…can intensify these processes that promote unity and teamwork, and this can lead to problems.” (2000, p. 2) According to Family Systems Theory when some “family members get anxious, the anxiety can escalate by spreading infectiously among them. As anxiety goes up, the emotional connectedness of family members becomes more stressful than comforting. Eventually, one or more members feel overwhelmed, isolated, or out of control.” It is this writer’s opinion that Agnes is experiencing all of these symptoms as are most other members of this family system. Since Agnes is the client we are working on a case plan was developed to help her cope with the life problems she currently faces. According to Bowen “These are the people who accommodate the most to reduce tension in others. It is a reciprocal interaction. For example, a person takes too much responsibility for the distress of others in relationship to their unrealistic expectations of him. The one accommodating the most literally "absorbs" anxiety and thus is the family member most vulnerable to problems such as depression, alcoholism, affairs, or physical illness.” Agnes has taken on a great deal and her caring and concern for other members of the family along with the grief issues she is experiencing put her in a ‘high risk’ situation that warrants immediate attention. POSSIBILITY OF ELDER ABUSE: When making an assessment for further work with Agnes Price one must not overlook the need for further observation and assessment of possible abuse. In Britain Elder Abuse is seen as “a problem for welfare….It has been argued….that placing elder abuse within a welfarist framework recognizes the ambiguity arising in situations of dependency and family expectation, the stresses involved with the caring role and the need to see abuse within the context of long-term relationships (2004, p, 76) Agnes is in a situation where she is literally ‘at the mercy’ of her daughter and the rest of the family members. According to the literature this is not unusual in the UK and the reason for situations like hers arising can be attributed to a message of familial responsibility regarding care of the elderly that was issued as part of Britain’s ‘Back to Basics’ campaign initiated in 1993-94. The outcome of that initiative was, “in terms of the risk of elder abuse…relatives or others who were unsuited or unwilling to care would be obliged to maintain a fantasy of coping.” (1997, pp. 82-83) Agnes’ family is not in a position to care for an aging woman suffering from grief, depression and isolation. In fact, this family seems to fit all the criteria that health professionals must look for when making assessments about Elder Abuse. Decalmer and Glendenning (1997, p. 242) suggest the following as “Danger Signals” for Elder Abuse: “Social isolation…Physical dependence…Multi Generational Family Structure…Poor communication…Challenging behaviors…Stigma…Carers own health and resentment of the caring role.” In view of the data given about the Davies family one must not discount the need to look into the possibility that Agnes is a victim of Elder Abuse. While the crime of Elder Abuse is not a punishable offence because it is considered to be a ‘welfare concern’ the family would not be charged or punished but good case planning could be implemented with positive outcomes for Agnes and, hopefully, other family members as well. Application of Code of Practice, Consideration of Ethical Issues and Anti-Oppressive Practice “The social work profession promotes social change, problem solving in human relationships and the empowerment and liberation of people to enhance well-being. Utilising theories of human behaviour and social systems, social work intervenes at the points where people interact with their environments. Principles of human rights and social justice are fundamental to social work (2001). Social workers attempt to relieve and prevent hardship and suffering. They have a responsibility to help individuals, families, groups and communities through the provision and operation of appropriate services and by contributing to social planning. They work with, on behalf of or in the interests of people to enable them to deal with personal and social difficulties and obtain essential resources and services. Their work may include, but is not limited to, interpersonal practice, groupwork, community work, social development, social action, policy development, research, social work education and supervisory and managerial functions in these fields.” (Bolton, 2003) Bolton points out that Social Work is committed to the following five basic values: · Human dignity and worth · Social justice · Service to humanity · Integrity · Competence This writer postulates that all aspects of sound social work practice as outlined in the Code of Ethics and the description given by Bolton are evident in this assessment and plan. Every effort was made by the ‘Community Health Worker’ to exhibit her “ respect for human dignity and pursuit of social justice through service to humanity, integrity and competence” (Bolton, 2003) while working with Agnes Price. In summary the dilemmas faced by Agnes Price are indeed very serious and could lead to serious consequences if not dealt with by caring professionals. This writer believes the case plan described in this paper will be an excellent format for ongoing work to help Agnes find the highest possible quality of life. References Bolton, Jon, Code of Ethics for Social Work, April 25, 2003; Article: British Association of Social Workers Web Site. Retrieved November 25, 2005 from: http://www.basw.co.uk/articles.php?articleId=2 Bowen (Family System Theory; Copyright 2000-20004; Bowen Center for the Study of the Family; Bowen Theory Website; Retrieved November 25, 2005 from: http://www.georgetownfamilycenter.org/pages/theory.html Bryannann, Laura; Dancing in the Shadows; Chapter 16; World Wide Web; Retrieved November 25, 2005 from: http://www.homestar.org/bryannan/family.html Crawford, K & Walker, J.; (2003) Social Work and Human Development; Decalmer, Peter and Glendenning, Frank; The Mistreatment of Elderly People, Second Edition, 1997; SAGE Publications; London, Thousand Oaks, New Delphi Read More