The purpose of this meeting was to carry out an update SAP assessment, under Section 47, NHS and Community Care Act 1990, because Diane’s needs have changed.
Diane is a 69-year-old White British Female who has been living in Critchill Court since her discharge from hospital in Jan 2010. Diane had a Sub Arachnoids’ Haemorrhage, which has caused memory loss, confusion and depression in 2009. Earlier review in Feb 2010 reveals that Diane expressed a wish to return to independent living. Since then, an OT has supported Diane in re-learning independent living skills.
Prior to the meeting, I went to social service to discuss with Diane’s social worker to initiate information sharing and ask advice. We agreed on the need to complete the assessment before Diane’s review in May 2010. I also obtained permission to have this meeting from Diane, and her daughter and their agreement that my placement supervisor would attend the meeting – but only to assess me.
My aim was to identify Diane’s current and future needs with her and her daughter, who specifically stated her wish to be involved during earlier casual conversation. To do this I gained permission from Diane and her daughter during the meeting that I would seek the views of other professions, (OT, key worker, and CPN) to fill in some parts of the assessment. Diane has also given permission for me to share the information that she provided with others on a ‘need to know’ basis.
My role as a student gave me flexible time to commit in more supportive work with Diane. I had been working in partnership with Diane, her daughter, OT and social worker for 3 weeks before the meeting. I have taken Diane out, building her confidence in accessing local resources, and importantly, a relationship based on empathy, trust, and confidence.
Authority/requirement for carrying out this piece of work (Legislative context/ agency policy/ government guidelines)
The NHS and Community Care Act 1990, Section 47, which requires a needs-led assessment when appropriate and services provided accordingly if practicable.
The Mental Health Act, 1983 and the Mental Capacity Act, 2005 apply because Diane has Sub Arachnoids’ Haemorrhage, which has caused memory loss and confusion. Particular attention is required, as these laws require that one must assume a person has capacity to make decisions unless established otherwise, and that one may not treat a person as unable to make a decision unless established otherwise. In my casual interactions with Diane, I have observed considerable ability to take decisions with regard to her life.
The National Occupational Standards for Social Work (2002) and The GSCC Code (Code 1 for social workers) require the social worker to empower the service user by informing them their rights and entitlements and listening to what they have to say to involve them in taking any decision that may affect them. The Code also requires the social worker to recognise the user’s expertise in their own lives and make informed choices about services they receive.
The Disability Discrimination Act 1995/2005 defines discrimination as, treating an individual less favourably than treating another. This legislation is important because it states what the government “expects and requires of local authorities in relation to good practice” (Trevithick, 2005: 17). Macdonald-Wilson et al (2001) defines disability as the condition of being unable to perform, because of physical or mental unfitness; to this extent, this definition follows the medical model. In the case of a person with a disability, a person is being discriminatory if they fail to comply with a duty to make a reasonable adjustment in relation to the disabled person. Higgins (1980: 123) defines stigma as a “deeply discrediting trait, which may also be called a failing, a shortcoming, or a handicap.”
The Equality Act 2006 and the Care Standards Act, 2002 also have bearing on this case as it involves assessment of the care provided against need.
Community Care (Direct Payments) Act 1996 enables local authorities to make direct payments (cash payments) to individuals to enable them to secure provision of care in lieu of social services provision.
The Data Protection Act 1998, which requires the express consent of the individual prior to sharing any personal information obtained on individuals and shared with others. Additionally, all the information gathered should be kept in accordance with the data protection guidelines. Diane and her daughter had given me consent to collect and share information with other agencies if required.
Knowledge (e.g. legal, psychological, sociological, political, socio-political, procedural, social work method) applied
In undertaking this meeting I carefully prepared by brushing up on my knowledge of the relevant laws, guidelines, and different perspectives on empowerment, anti-oppressive, and anti-discriminatory practice. Besides these laws, my reflection on the case before the meeting showed me the values that would help in obtaining a positive outcome of the meeting. Theory and guidelines on ‘best practice’ in social work required that I adopt an approach that would place Diane in a position where she feels empowered to make decisions. This approach requires me to work with the person-centred theory (Rogers, 1959) that requires me to work on the premise that Diane is an expert on her own life, and to focus on her strengths i.e. what she can do rather than on what she cannot (Saleebey, 2006). Using the person centred method enables the creation of a comfortable environment where the caseworker demonstrates genuineness through a non-judgmental and non-directive approach that bases itself on empathy and unconditional positive regard (Rogers, 1957). Therefore, my approach had to demonstrate feelings of warmth, liking, caring, and being drawn to Mary instead of aversion and anger (Barett-Lennard, 1986: 440)
I also reflected on Egan’s recommendations (SOLER) that help display an encouraging and open attitude towards Diane.
In considering the assessment process, I have adopted Milner and O’Byrne’s five state model of assessment (1998). These are preparation, data collection, weighing up the data, analysing the data and utilising the data.
I used Systems Theory in the assessment process, for example, in preparation stage I sought information not only from the service user but also from family members, other professionals, etc. In data collection stage, I used brief solution focused techniques, which allowed me to use supportive questions aimed at enabling Diane to recognise her own strengths and abilities. I particularly chose to use scaled response questions, asking Diane to score the present, when she was came to Critchill and what she hope to achieve on a scale of 1 to 10. By using this technique, I was able to support Diane to identify the successful strategise she has used in the past and this gave her confidence to apply her own strategies to improve her situation now and for the future.
The brief solution focused therapy has been useful when I addressed one of the problems in the running records about the use of language to others. Diane has acknowledged this issue and was able to identify an occasion when all the triggers were present that could have caused the problem but she was able to deal with it herself and prevent the problem occurring.
Erik Erikson (1950) says that when the person is aged about 60 years old or more, “The person has time for reflection and as they look back on their life, they may have a sense of satisfaction; this will lead to a feeling of integrity. If the person’s reflection results in them feeling they missed key opportunities, then there is an increased risk of experiencing despair”
In his article, Rogers (1957) quotes a study by Kinner that found that “the client who sees his problem as involving his relationships, and who feels that he contributes to this problem and wants to change it, is likely to be successful. The client, who externalizes his problem, feeling little self-responsibility, is much more likely to be a failure.” This highlighted the need for me to help Mary see that change in her life situation is more likely if she feels responsibility for at least a part of the problem and make her want to change.
A complaint that Diane has voiced is that people (particularly her social worker) treat her like a child. Thompson (2006) says that this happens when a younger person sees an older person not able to make her own decisions and takes decisions on the older person’s behalf thinking this is natural and normal without realising the discrimination and oppression this causes.
It is often the case that the social worker or the carers see the older person as disabled to take decisions, particularly if the person suffers from some disability. The medical model of disability focuses on physical deficits and individual health needs, and it is a challenge for the worker not to fall into “disablest [sic] perceptions” by accepting this model (Parker & Bradley, 2005: 76). The individual may experience loss and bereavement (Kubler-Ross, 1976), feel they have suffered a personal tragedy, and therefore label themselves as disabled as has happened in Diane’s case. It was therefore essential that I approach the assessment with this knowledge and ensure non-discriminatory practice, not attaching any stigma to Diane’s needs and disability caused by her medical condition.
The social model of disability switches focus away from any physical limitations the impairment to physical and social environmental limitations, thus requiring promotion and empowerment of disabled people (Oliver & Sapey, 2006). Additionally, the social worker’s own attitudes and values affect how he/she applies theoretical models of disability (Crawford & Walker, 2004). The social model of disability is inclined to focus on cultural or structural aspects of disability (Priestley, 2003) and is the predominant model of disability used in social care. This is because social work approach does not look at mending something that is broken, but relies on overcoming societal barriers, which enables the treatment of a person with a disability just as others are (DDA, 1995/2005; Davies, 2002). While it is easy to comprehend the difficulties faced by an individual with a visible disability (e.g. using a wheelchair), it is also easy to ignore the wider cultural and structural factors that affect a person with a disability (Thompson, 2001). Herein lies the problem of seeing the disability as a problem with the person themselves (ibid).
What Skills did you use for this piece of work? (please distinguish between those you have and those you need to develop)
I used Planning and preparation, research, information gathering skill before the meeting and this has helped me to carry out the meeting well
In terms of working anti-oppressively I think I have made Diane feel less oppressive by reducing the power imbalance. I have involved her daughter whose presence has been a great comfort to Diane as she sometimes looks at her for answers due to her short-term memory. I have successfully conveyed my respect and understanding of her strengths and limitations by adopting Egan’s empathy skills, active listening, summarising. I used Roger’s person centred to focus my attention on Diane and this in term helping me to forget that I was assessed by my placement supervisor. I used unconditional positive regard to make Diane feel a sense of acceptance of herself when addressing an issue.
I need to develop assessment skills as I feel I don’t feel comfortable with the forms which have so many questions. Also some of the questions are very sensitive to ask for example the section of “assessment of physical health” there are questions like bladder control, bowel control, etc
Also I need to develop liaising skill, sharing information with other agencies. As evident prior to the meeting, there were some miscommunication between different agencies.
Which aspects of anti-oppressive practice were relevant to this piece of work?
In terms of working anti-oppressively, I was aware my role as a student social worker this may have lead Diane to feel oppressive and not valued because she may think that she was not good enough to have a qualify social worker. To reduce this potential oppression, I have involved Diane’s daughter and have been open and honest to tell them that I was inexperienced and has never carry out a SAP assessment before. I also offered them opportunities to decline or cancel the meeting.
My ethnic origin as a non-white British may have attributed discrimination or oppression to myself from Diane or her daughter. However, this has never been an issue in the meeting or prior to my engagement with Diane and her daughter.
“the black perspective has made clear that racism is based on white European/ white north American ideological beliefs about the claimed superiority of white people over non-white people” (Maclean and Harrison 2008:58).
Considering my gender, which is different from Diane may present a difficulty for both of us. From the feminist perspectives – if I had not recognise the extensive inequalities in society based on gender with men consistently being dominant, I may act oppressively unaware. Women is socially constructed to be a better carer as a wife, mother and daughter and the fact that the majority of social worker are female. As a male student social worker, my role may present oppressive to Diane.
“the feminist perspective has noticeably failed to adequately address structural inequalities within social care and social work organisations. In employment terms some 75% of the workforce in social care organisations are women. The proportion of men in senior management has remained stubbornly high and has only recently dropped below 75% of all senior managers” (Maclean and Harrison 2008:56)
“there has been a recognition that societal developments and social policy initiatives affect men and women differently (because of their gender). The role of women as unpaid carers of family members with personal care needs is one example” (Machean and Harrison 2008:55)
If I have not used Social vs medical model to see Diane’s depression, I may have not recognised the negative stigma associated with the labels applied to people and may have act in an oppressive way, overseeing the facts that her depression may be attributed by her despair for her current environment and loss of her abilities, eg, health and memoey,etc
In what ways would the service user and or carer have preferred your practice to be different
After the meeting, I apologised to Diane and her daughter that the outcome of this meeting may not have been as productive as they had expected and I told them that I would like to have another meeting again with them in the near future to discuss a plan to support Diane. (as I feel I have failed to conduct the meeting well, because my placement supervisor joined our discussion in the midway, and this i think should not be happen because she was there to assess me, unless she think she I needed help.)
However, Diane, her daughter said they were happy with the outcome and she especially appreciated what I have done for her mother. My placement supervisor said to me. What do you mean this meeting is not productive” she said I did very well.
The only thing that Diane’s daughter asked me was to inform her of anything I do for her mother. As there was an incident the week before that I took Diane out but forgot to ask her to check her daily. Diane’s son and daughter in law came to visit when we went out and as a result they have not spent much time together that day. I asked Diane’s daughter how she would like to be contacted and she gave me her email address as she may not be convenient to answer her mobile in her workplace.
My placement supervisor also told me that I need to share the information with her about what I do or who I have contacted for Diane.
Which key Roles, units and Values/Ethics do you think were demonstrated in this piece of work and how? (these must refer to practice discussed within the direct observation)
In making a thorough preparation for the meeting with Diane, where my placement supervisor would observe me, I demonstrated delivery of all the units of Key Role 1. I had reviewed the case notes, spoken with the staff at the Home, her social worker, and daughter to carefully evaluate my involvement.
My efforts to build a trusting relationship with Diane during my placement, and discussions with her about her preference for those elements of her care plan she likes to be included, show that I achieved important aspects of Key Role 2 (Unit 5 and 6).
In my thorough research on best practices, legal and practice guidelines, and reflection on the best way to achieve my aim showed that I have responded well to the requirements of Key Role 6 (Unit 18 and 19).
With regard to the values and ethics, I demonstrated awareness of my own values, ethics, dilemmas, and conflicts of interest (VEa). I have shown respect for and promotion of the wellbeing of Diane (VEb). I have also responded with oral and non-verbal communication skills in a way not to make Diane feel oppressed (VEc). Finally by showing my ability to build and maintain a relation of trust with Diane I have met the need identified by (VEe).
What evidence did you use to evaluate your practice?(e.g. supervision notes, user feedback etc)
In evaluating my practice, I have used two resources. The first is a feedback from Diane, whom I asked to judge how I had done. This feedback, in the form of a written response to a questionnaire I prepared for this specific purpose. However, the feedback given by my placement supervisor after the meeting has been valuable for me in terms of understanding my performance and identifying ways to improve in future practice.
Give your evaluation of this piece of work – (e.g. what went well, what did not go well, what if anything would you do differently next time?)
I have learnt from my previous mistake in my first direct observation. I have used a mixture of open and close questions. Also I have used paraphrasing, clarifying techniques appropriately. In terms of choosing a place for the meeting, I have considered the noise and disruption and asked Diane’s opinion where she would like the meeting to be. The location of the meeting in her room turned out to be a good choice.
I feel I have reduce the potential of oppression by involving Diane’s daughter whose presence has been great comfort to Diane as Diane has short-term memory and she feel more confident as she could get answer or help from her daughter. Also, I feel that working together we have achieved more than I had expected, as I have made the meeting like informal discussion rather than a job interview or assessment.
I have achieved the aim I set for myself and completed parts of the assessment, by working in partnership with Diane and her daughter. However, I have achieved more by building a open and trusting relationship with them, this would in term enable me to devote my supportive work with Diane in the future.
I did not complete the SAP assessment in the meeting as I have not planned or anticipated. I will continue to work on this assignment with Diane, her daughter and other professionals.
I have however, failed to share the information about what I do with Diane with my placement supervisor. This has resulted in miscommunication between different agencies. I need to develop skill in liaising and sharing information with other professionals in the future.
What additional learning, in relation to knowledge, skills or anti-oppressive practice and values and ethics, would enhance your performance in the future?
In terms of working professionally I need to work in accountability way within agency, sharing information with others. System theory will help to improve my practice in the future.
I also need to use my supervision session to discuss theories, values, dilemmas and anti-oppressive practice
I have improved considerably about the use of interview techniques but with more practice I will be able to communicate in more confidence.
Placement Supervisor_________________ Date _____________